Rabies: 9 years and things are not getting better

For about nine years now, I have been traveling to Baltimore on a semi-annual basis. I go to the Johns Hopkins Bloomberg School of Public Health and deliver, more or less, the same talk, year after year, about rabies.

9 years, and more deaths.

It’s part of the vector-borne section of the course. While not a vector-borne disease (unless we wish to think of dogs as a vector between us and bats–a bit of a stretch, if you ask me), rabies is considered one of the Neglected Tropical Diseases (NTDs), and because it’s a preventable cause of horrific and needless suffering it needs to be somewhere.

Opening Salvo

I always preface my talk with two informal survey questions:

Does anyone know what the OIE is?
Does anyone know what One Health is?

Answers:

OIE stands for Office International des Epizooties, or World Organisation for Animal Health (yes, they use the British spelling of “organization, which I think is a political statement, but that’s another post). It’s kind of like the WHO for animals, and it is based in Paris.
One Health is a concept advanced by the American Veterinary Medical Association, the CDC, and other organizations. The CDC states “One Health recognizes that the health of people is connected to the health of animals and the environment. The goal of One Health is to encourage the collaborative efforts of multiple disciplines-working locally, nationally, and globally-to achieve the best health for people, animals, and our environment.”

I think that over the years, I’ve had maybe three ‘yes’ answers to these questions, combined. The conclusions are obvious:

The OIE is failing in its mission to educate the other health professions, as well as the general public, on the importance of animal health, both as it relates to animals alone and to human health as well.
The One Health concept is a failed attempt by the veterinary profession to assert its presence into discussions of public health. It represents the profession’s inability to move itself from the general world of agriculture (where it is also clearly important) and place itself among the disciplines of other health sciences.

(As a veterinarian, we are used to being the red headed stepchild of the medical professions, so this doesn’t really surprise or irk me. Sometimes, we even create brilliant concepts, like One Health, so we can pretend that it’s really a thing for those outside of our bubble.)

So, what’s the problem here, specifically regarding rabies?

Let me preface this by saying that , I don’t really trust rabies statistics. The latest updates I’m reading estimate the annual number of rabies deaths at 59,000. Given that most of these deaths come from rural areas in Africa and Asia with poor access to treatment and prevention, I’m not sure how they come up with that number. (On my to-do list: contact a rabies epidemiologist.) What I do know is that when I first started giving the talk, the number was 25,000 – 50,000. The range itself, varying by 100% of the low number, inspires doubt in and of itself.

That noted, the trend over the past nine years is at best level, and at worst shows an increase of 18%. Rabies does not get a lot of attention. Most diseases of the poor—Chagas’ disease, cysticercosis, leishmaniasis, hydatid disease, and others—get little attention. AIDS/HIV, tuberculosis, and malaria are the exceptions, but two of those are not restricted to poor areas overseas. Rabies kills “only” 59,000 people a year, a number that pales in comparison to the other diseases listed here. But working on one disease does not preclude working on another. Rabies is low hanging fruit. The numbers of rabies deaths are skewed towards children. Rabies is not a medical mystery. The bottom line is that no one should die the horrible death that comes with rabies infection.

July 27, 2017 0

Haiti Veterinary Mission

Please go to this site and give a hand. Or a few bucks.

There are NO veterinary schools in Haiti. The Christian Veterinary Mission is teaching young Haitians to be veterinary agents, helping them take care of the livestock that is so important to their livelihood.

https://www.gofundme.com/haitivet

February 13, 2017 0

Back From Haiti

haiti — American Aid Worker Kate Bartow addresses a crowd following the recent unrest.

Was I safe?

The week before I arrived, Guy Philippe, a leader in the 2004 coup to overthrow the government of Jean-Bertrand Aristide, was arrested on drug trafficking charges and extradited to the United States. Seen by some as an affront to the nation’s sovereignty, there were protests in Haiti, and several groups felt it necessary to evacuate their missionaries or aid workers, or else had them seek shelter among United Nations forces. The arrest was also seen as a last-chance effort to apprehend Philippe, as he was days away from being sworn in as a Senator, which would have rendered him immune to prosecution (senators in Haiti have passed a law which places them above the law.)

I was blissfully unaware of all of this before I left. My family was even more unaware. If they had read this account from the NY Times they would have been driving me crazy with phone calls and warning me not to go. My cousin Nettie would have said, “Are you CRAZY?” and my older sister would have been yelling at me on the phone. The article wasn’t published until the day after I left ( a week after the event), highlighting its relative lack of importance in the American mind, especially in the run-up to the Disastrous Inauguration. The arrest was reported a week earlier by the BBC and the Miami Herald.

Haiti is a small country, only slightly larger than Vermont. However, distances are much greater than they would be in the US due to the conditions of the roads. The problems that occurred were far from where I spent my time. My presence in Haiti was relatively cloistered, and if I hadn’t been told about these events I would not have learned of them otherwise in the course of my visit.

Haiti disbanded its military in 1995, partially in response to military coups, partially out of financial necessity. There is a national police force, and the United Nations peacekeeping forces have been in the country for over a decade for police and stability operations. The UN forces are viewed by some as occupiers, and they are responsible as well for the current cholera epidemic. UN soldiers reintroduced cholera to Haiti following the 2010 earthquake, and though on the decline, the disease continues to cause morbidity and mortality.

The term “basket case” arose during WWI as a rather cruel way to refer to a quadruple amputee. It now refers to something or someone that is such a mess that it is unable to help itself, most often a person who is suffering from a mental or emotional problem that renders him or her less than functional.

January 25, 2017 0

With Your Help, I’m Going to Haiti

Haiti is the poorest country in the Western Hemisphere. It got a lot of attention in 2010 when a devastating earthquake hit the country. Since then, it has kind of fallen off of the map. In a way, that’s understandable–there is no shortage of need everywhere, we’ve had a crazy political environment, and the whims of news cycles are ephemeral.

So if you click on this picture, you can throw a little lucre in the hat, and I’ll make it there. We are already 25% on our way to the goal.

January 3, 2017 0

TUESDAY TANTRUM: Influenza. Loneliness. Bad business. Vaccinations.

I just got a chilling thought.

If I get influenza this winter,

I am fucked. Really fucked. Why? Because I have no friends here. None. If I missed work, someone would call and wonder where I am, but other than that, no one would check up on me. I would have to go to the store and spread my germs, because I wouldn’t have any other way to get food. In addition to the pain of illness would be the added pain of isolation and fear. My 11 year-old daughter would be worried and try to make sure I was OK, but she’s just an 11 year-old who would be in the custody of her mother , Fräulein Schadenfreude, who really hates me and might even take some cruel pleasure in the fact I was alone in my misery. Not that she’s bitter or anything.

I’ve had the flu before. It was debilitating. I was febrile and in pain for a full week. Yeah, sometimes it’s “just the flu”, but at other times it’s the disease that kills around 36,000 Americans per year ( a lot more Americans than Ebola, West Nile Virus, Eastern Equine Encephalitis will). Fortunately it’s rare, but other times flut has been the epidemic that has knocked off 3-5% of the world’s population. It’s not the flu—it’s the ‘flu, dumbspeak for influenza.

All in all,I was well cared for. I was at my girlfriend’s mother’s house. We had driven down to Atlanta for Christmas(see what happens when you date a shiksa!) , and it was my first time meeting the family. I think I made a good first impression.

People with strong connections heal better and are in better general and mental health. Living in isolation is toxic—it can literally shorten your life. What is the worst punishment we can give (short of the death penalty)? Solitary confinement. Lock ‘em up, and let ‘em go nuts.

So winter’s coming up. Whaddaya gonna do?

First of all, don’t be a moron, and go get your flu shot.

Your immune system is not a muscle. Don’t think that by “stressing” it with exposure to a virus is going to make it stronger. The flu shot cannot give you the flu, nor will it cause autism, cause narcolepsy, or make you vote for Rick Perry. Unless you are allergic to eggs or religiously opposed( a weak reason, in my humble opinion), there is no reason not to get it. If you are under 50, get the intranasal—it shows better efficacy.

What population needs vaccination the most? School-age children. They run off to the viral exchange facility 5 days out of 7, and they are the super spreaders of the disease. If you want to protect infants and the elderly, it’s better to vaccinate school -age children than vaccinating those groups. I’m not going to argue science with whackos who think that vaccines are poison distributed widely. They can join my raw milk friends and throw a party. Go get your children vaccinated, or you are a parasite worse than Echinococcus multilocularis.

Secondly, don’t go to work sick.

I worked at a horrible corporate veterinary practice where the manager (where do they find these people? They went through 5 managers in a little over a year. The Company bought into the ridiculous Business School Conceit that if you know how to manage a convenience store you also know how to manage a machine shop or a veterinary practice—the falsity of this claim was demonstrated on a hourly basi, oh how we loved the days when she was off! ) Anyway, as I was saying the manager announced at an office meeting one day that “if anyone is sick and can’t come in to work, you still have to come in unless you find a replacement.” My response was, “As soon as I hear of anyone coming in with a fever, I’m leaving, and I will recommend that anyone else leave.” I don’t see why the employees should have to do the manager’s job of finding a replacement (other than the manager’s desire to shift the blame off of herself, in addition to cruelly burdening a sick person with a bad task). And it is sheer lunacy to have sick people come into work. Massachusetts is contemplating a paid sick leave law. Only slavemasters and fools (aka “job creators”) would oppose such a law.

Thirdly, make sure you’ve got some strong connections.

If you’re sick, you’re going to need friends. If you’re not, they are going to make your life better. Remember: it’s a long winter.

October 8, 2014 2

Burn Your Lawn Mower!

As soon as the weather gets nice, finally, sometime in the middle of May, I think of getting back outside. Not necessarily to do anything, but to just get outside without the burden and discomfort of cold and extra clothing and let the sun irradiate my skin. O let the sweat drip from my forehead, let my clothes stick to me, I do not care. I do not have to shovel. I do not have to clear the car off. I can open the windows and turn off the heated seats.

But then they start. The incessant whine, the buzzing around your ear like that damn mosquito that won’t go away while you try and sleep. Cursed things! Could somebody tell me why on G-d’s green earth an able-bodied person needs a riding mower for a 1/4 acre plot? Or even a motorized mower? Get some exercise! Use a reel mower! Let’s ignore the fuel that it takes to run the mowers of this country–just imagine all the fossil fuel used in creating and transporting the mowers. Is any device more suited than the mower in showing us how inconsiderate our neighbors are, out there at 7 am on weekend mornings, conveniently ignoring the fact that some of us may be sleeping (typical New Englander)? Is this a good use of technology? To be sure, there’s hardly an hour when someone isn’t mowing somewhere within earshot–can’t we have a few hours to listen to the wind and the birds and parents screaming at their children?

The pride people take in their lawns! Folks–It’s just grass. And I, for one, refuse to pour perfectly good drinking water on the ground on purpose. What’s the worst that could happen? That my lawn turns beige? and I don’t have to mow it at all. Chemicals? Why? To get rid of the dandelions, which are a) pretty, b) native, and c) edible? There are various species of things growing out there, and they are no less green that bluegrass or fescue.

The gas mowers will remain in reserve for those occasions when the grass has grown too high, or when the neighborhood is suffering from too much quiet. Actually, I may need to buy a house, so maybe I’ll let the whole thing go to hell and lower the property values until they reach an affordable level.

Even fancy neighborhoods can have nice beige lawns.

May 12, 2014 4

CAN’T WE FIND BETTER THINGS TO WORRY ABOUT?

THE TRAGEDY (?) OF DAVID GUMPERT, PART THE SECOND

Mr. Gumpert had cancer of the prostate. All things considered, I don’t rate this as tragic. Unfortunate, yes, but certainly not down in the depths as was the case with Frank Zappa, whose prostrate cancer struck at the age of 53 and was fatal.

With Zappa’s death, the world was deprived of an unusually sharp wit coupled with a virtuosic musical talent and an incredible knack for humor and originality. (I am in no way saying that Zappa’s life was worth more or less than any other human being’s. But I feel free to compare their works.) Mr. Gumpert, on the other hand, is a sort of reverse Carrie Nation, wielding his hatchet so that we can drink something instead of having it prohibited. Like Ms. Nation, Mr. Gumpert will probably not achieve any long-term success. I believe that raw milk will continue to be a highly regulated substance, consumed only by a small part of the population. Most Americans, I imagine, are to be content to drink inexpensive, safe milk.

IF YOU’RE GOING TO OBSESS ABOUT ONE THING, YOU’D BETTER PICK A GOOD ONE.

But while raw milk is a bagatelle, prostate cancer is a serious problem. It is also an extremely complicated problem. there are a lot of unanswered questions that come up after the doctor’s glove comes off:

Should all men get PSA tests?How often? Is it different for those with a family history of prostate cancer? How do we know when a biopsy is called for? What is the best way to biopsy? What are the consequences of false positive tests? How can a patient find the best surgeon? How can we be sure that the media is conveying this information accurately? How do we get the correct information to the men at risk? How do we deal with the fact that men tend to be such poor patients? Can we change the behaviors of men to make them act more in their interest as patients?

So here is a very real public health problem, suffered by someone who is actually a real journalist. He has an audience. He knows how to meet a deadline and get his material out. He has connections with trusted publications with large circulations. He is in a real position with the help a lot of men parse out the difficulties of a very difficult disease, one that even if it doesn’t kill, strikes at the very core of what it means to be a man. And yet, he chooses to be the bandleader for a small group of fanatics, many of whom have an economic interest in the outcome of this bizarre fight. The Complete Patient (which is neither complete nor about patients) doesn’t even say if Mr. Gumpert is so interested in raw milk because he believes that it cured his prostate cancer.

I don’t think most of his current readers are interested in real and pressing public health and health policy problems. If so, it seems to follow that he would’ve been writing about them more regularly. There are, however, plenty of worried people out there with plenty of questions about problems other than the single imaginary one dealt with in his blog. With all the monomaniacal energy expended on something that really isn’t a problem, one can’t help but wonder if he couldn’t use all this energy to perhaps give the next Zappa a few more years.

OK, I’m done writing about raw milk weirdness.

zappa — Prostate Cancer Victim, but most definitely not a monomaniac

July 27, 2011 1

Lactic Wackiness and the Fightin’ Foodies–Some things are beyond parody

Historical note: August 2010 was the biggest month ever for the Assassin Bug, when for some unknown reason , searches for Brigitte Bardot (its matron saint) shot up like the price of Halliburton shares during an unnecessary war. The Assassin Bug was the unintended beneficiary.We are hoping that this August we will top last August’s number of visitors, when over 6,000 gawkers drooled over pictures of France’s most famous hate-speech criminal. Please check in daily to The Assassin Bug, or the Meta-Bug if you must, as often as possible between now and Labor Day. Every time you visit, another mosquito is squished.

hoffs — Wrong blog, buddy. If you want Bardot (or Ekberg or Loren), look somewhere else.

August Sweeps Month is coming up for the Assassin Bug, and the foaming-at-the-mouth believers in raw milk can always be counted upon to drive up a site’s number of hits whenever their sacred cow (ha!) is looked at askance. But I won’t write about this on my public health blog, because as a matter of public health, this is settled (at least as far as the science is concerned).

So I’m not going to write about raw milk. I’m going to write about the Tragedy of David Gumpert. It’s a minor league tragedy in comparison with real tragedies, like the dismembered child in New York, or that woman whose drowned body wasn’t discovered for two days in Massachusetts, or that there are people still not able to find adequate medical care. It’s hardly poignant like great fictional tragedy, like Othello or the book version of The Natural (Roy Hobbs does not hit a homer off of the lights, but strikes out–How could Hollywood change that?) But it is tragic nonetheless in the low level why-do-the-Cubs-keep-losing- and-won’t-I-ever-see-a-pennant-in-my-lifetime kind of way.

Gumpert has become the Glenn Beck of the “food rights” movement. (No, this is not the right of foods to vote, marry each other, or not be eaten–it is the supposed right of any citizen to put into commerce whatever he or she deems is edible, though I daresay that that has as much sense. )The movement would have us believe that there exists in the Constitution something that they call food rights.

Historical aside: Some noted historians claim that Food Rights are found in the famous “Lost Amendments Scrolls,” purportedly written by Jefferson while in France (Jefferson was serving as Ambassador to France while the Constitutional Convention was meeting), and lost in transit on their way to the United States. Some scholars go on to say that someone paid to have these parchments hijacked and taken to the Barbary Coast by the hired pirates. On the beaches of North Africa one can occasionally find a pink-skinned American wearing something that looks like a medical detector, but is actually a parchment detector in the hands of a history buff. I know one guy, Apoteoso Arco-Balena’s father of all people, who regularly goes there on his vacation to look for such lost parchments. He never found any of interest in terms of American History, but he did find communications between Hannibal and his generals. Alas, Roman history didn’t interest him, and he sold them for a song–literally–and they eventually ended up in the National Museum in Iraq where they were lost during the pillaging of that institution during the recent sacking of Baghdad. Apparently, Apoteoso’s father, Heinrich, was convinced that Arabic covers of Connie Francis songs were to be the next big thing. He heard a band playing that very stuff at a night club in Oujda, and traded a band member the manuscripts for some low-quality cassette recordings and the international rights to their music. The band’s oud player, it turns out, was an out-of-work archaeologist who specialized in the Roman Conquest of North Africa. Having received a rather healthy sum for the parchments, he now lives in villa on the Costa Smeralda. Much to the dismay of his mother, he hasn’t touched his oud in years.

The Fightin’ Foodies usually fail to distinguish between the right to consume something and the right to enter something into commerce. No matter. In the mind of the zealot such distinctions are useless. The playbook is familiar: Take no quarter! Admit nothing negative! Attack on any level! Play victim! Reading the comments on Gumpert’s blog seem to bring to mind the worst groupthink tendencies of the our current political hostage takers. It seems that fanaticism in our country ranges from tax policy to what goes into your cereal bowl.

But, yesssssss, Gumpert’s Blog, a kind of Cosmic Convergence point of hokey-anna. A milky white hole, if such a thing existed, where misfit minds are sucked in and nothing with any sense escapes. First of all, it’s got a great title: The Complete Patient. Secondly, it’s a complete misnomer. It’s not about being a patient, and it’s far from complete. It’s a busted old harmonica that plays but one note, the one that the Gummint and Big Dairy are engaged in an not-so-secret evil plot to deprive the public of nature’s most miraculous food: milk that has not been pasteurized.

Steger_mosquito1 — See? Wasn't that easy? (Scanning electron micrograph courtesy of stegerphoto.com)

To be continued. . .

July 17, 2011 1

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