Rabies: 9 years and things are not getting better


 rabid dog
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:
  1. Does anyone know what the OIE is?
  2. Does anyone know what One Health is?
Answers:
  1. 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.
  2. 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:
  1. 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.
  2. 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.

 

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Parasite Attack! Flesh-eating Worms in the United States!


 

A Meta-Bug News Roundup

Screwworms in Florida

The New World screwworm, Cochliomyia homnivorax, isn’t probably something you think about. Fortunately, you don’t have to. The screwworm, a larval form of a fly, has been eradicated in the United States since 1982.

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Unlike maggots, which eat only dead flesh, the screwworm eats live tissue. When I was in Haiti recently, I saw what they are capable of. Any wound, any abrasion, any cut is an invitation for the flies to show up. Then the larvae come out, and work their way not just into the necrotic parts, but the actual live tissue.

Screwworms obviously present a serious danger to livestock. I can even find you a gross story where they went into a woman’s ear. But since the ’50s, researchers began experimenting with the release of sterile male flies, first on the relatively controlled setting of an island, and then on the mainland. By 1982, there were no more screwworms in the US.

Naturally, flies don’t recognize international borders, so in partnership with Mexico and the nations of Central America, the screwworm has been restricted to south of the isthmus of Panama, a bottleneck that is relatively easy to defend. The breeding of sterile males is ongoing in Panama.

Recently, 40 endangered Key Deer had to be euthanized in Florida when it was discovered that they were infested with screwworms. Sterile males were introduced, the Florida Department of Agriculture set up inspection stations in Key Largo for animals leaving the keys, and the outbreak was contained.

 

Robert Pirsig, author of Zen and the Art of Motorcycle Maintenance, has died.

“When one person suffers from a delusion, it is called insanity. When many people suffer from a delusion it is called a Religion.”

pirsig

Here’s a passage  from Zen  that I always found interesting.

Things are getting worse.

Twittler has proposed huge tax cuts, and naturally they benefit him and those in high income brackets the most. They propose eliminating the inheritance tax, which is probably the best tax we have: WE’RE TAXING DEAD RICH PEOPLE! They’re decomposing, they can’t complain, and if their whiny little offspring think it’s just horrible that they have to be just a tiny bit like the rest of us (which they won’t, they’ll still be stinking rich), well, they can commiserate in their gated communities and in their country clubs, just like they always have. The Great Unwashed will be able to perhaps feed and educate their children a little better. It’s understandable how those at the top don’t really want a level playing field, but keeping the “Paris Hilton” tax–or maybe we should call it the Trump Kids Tax–is a good thing. Just ask Teddy Roosevelt. Whatever you name it, don’t let anyone get away with calling it a “death tax.” It’s not.  It’s a tax on plutocracy and oligarchy.

I can’t write anymore today. A buffoon is fucking up or determined to fuck up so many things at once–relations with Canada and Mexico, military policy, health care, foreign trade– that it’s overwhelming. As I’ve written before, there’s a good chance that the American Experiment has failed, and the wise will at least be keeping an eye open on an exit strategy. While I’m here, I will work to make this a better and safer place, but I do not believe that this is the best place for my children to plan their future in.

In the Aftermath of 9/11


While going through all the detritus that I’ve dragged from house to house (I didn’t have time to sort, but that’s a divorce story), I found a few pages from this Boston Globe from December 28, 2001.

Rudy Giuliani makes an ass of himself (again).

The Mayor Who Spent His Life Preparing His Rictus Grin uses his farewell address to slam Boston, reminding us that although he may have been able to fake leadership for a few short months, he’s still a delusional deviant at heart. mayor gross

 

The ‘Shoe Bomber’ had recently put himself in the news.

Yup, Richard Reid, the man who failed to blow up a plane yet has still managed to inconvenience billions of travelers–and continues to do so–first appeared around this time. Has 16 years of removing shoes at airport security flown by so fast?

 

There was this incisive cartoon regarding the Taliban and St. Reagan.

The truth actually a bit more complicated. There is a photo of Reagan with mujahideen in the White House, and it often accompanied by the claim that those men are Taliban. Snopes says this is false, that the Taliban did not exist at the time. While they weren’t Taliban at the time, Afghans who would later fight the US were indeed armed by Reagan. Reagan had no problems giving arms to groups with sketchy histories and could hardly be considered reliable allies. For more on how we often embrace reprobates, you can readIMG_0454

this editorial from the the late, great Molly Ivins with the haunting title How We Could Still Lose in Afghanistan.IMG_0452

 And a page full of ads for knickers. . .from Filene’s! (now located in the Mall of Heaven, right next to Marshall Field’s). IMG_0453

Shavuah Tov. Impeach Drumpf.


Can you fall asleep like this? Were you ever able to?

Asleep on a Roadtrip
Asleep on a Roadtrip, Boston to Columbus.
From “In The Loop” (2009):
Lt. Gen. George Miller: Twelve thousand troops. But that’s not enough. That’s the amount that are going to die. And at the end of a war you need some soldiers left, really, or else it looks like you’ve lost.

 

From “Duck Soup” (1933):
Another Cabinet Member: Gentlemen, gentlemen. Enough of this. How about taking up the tax?
Firefly: How about taking up the carpet?
Member: I still insist we take up the tax!
Firefly: [to his secretary] He’s right—you’ve got to take up the tacks before you take up the carpet.
Member: I give all my time and energy to my duties, and what do I get?
Firefly: You get awfully tiresome after a while.
Member: Sir, you try my patience.
Firefly: I don’t mind if I do. You must come over and try mine some time.
Member: That’s the last straw: I resign. I wash my hands of the whole business.
Firefly: Good idea. You can wash your neck too.

(Social) Media Shabbat


Friday night dinner,  scattered and smothered. See ya tomorrow night with a whole new set of complaints.  On second thought, they’ll probably just be new iterations of old ones . IMG_0274

What I Threw Out Today: The Hotel Brochure from My Trip to Phuket, and what it says about aging


WAS I ALREADY TOO OLD to call it a voyage of my misspent youth? Maybe–we extend youth so long these days, heaven forfend that we get older, IMG_1879because as you age, you disappear. When you age you get to that point where, when contemplating the future, you no longer see the things that once inspired you, but rather the indignities and the infirmities that lie ahead. That is, unless you adopt a healthy attitude towards aging, and I haven’t. I’m in the midlife crisis I’ve been in since I was 25.

What does it say, in any case? It says to me that I went to Thailand with some woman. It says that people drift apart and experiences are the remembrance of emotion, not of images or place. The trip to Thailand was fun, and it wasn’t fun. It was one of those relationships that had just a bit too much competition and a bit too much held inIMG_1883 reserve. It’s all part of the past now, and whatever was good (or bad) about it I will hold in my memory. IMG_1886However, I’m at the point in my life where I’d like to–if I’m able–choose the time and place of my remembering things. I don’t like bad memories slipping in at inconvenient moments. It just muddies my mental waters. If I were a brightsider, I’d say at least I can still remember.

I know it’s only one piece of paper that I am throwing out. But they add up. If I kept it, my children would find it one day (maybe) after I died, and say, oh, so he went to Thailand once. It would not even be a footnote in their memories of me.

On the lighter side, the translations from the Thai are hilarious.
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