Hope is not a plan

Viruses, in general, are highly adaptive. One of the big concerns in active antiviral therapy (where a drug is given to an already-infected patient to stem the tide of a viral infection, as opposed to preventing it in the first place with a vaccine) is that the virus will very, very quickly outmaneuver the antiviral medication, resulting in a more resistant virus. This tendency of viruses to evolve their way around treatments is why HIV is treated with a combination of multiple antivirals with differing targets (you can read more about Highly Active Anti-Retroviral Therapy, or HAART, here).

In a study titled Antiviral Oseltamivir Is not Removed or Degraded in Normal Sewage Water Treatment: Implications for Development of Resistance by Influenza A Virus, Fick et al test the effects of conventional sewage treatments on Oseltamivir -- a drug you might know better by its trade name of Tamiflu. Tamiflu is, as manufacturer Roche reminds us on the product site, "the number 1 doctor-prescribed flu medicine," used for both prevention and treatment of flu.

...and recently, patients have been showing up with Oseltamivir-resistant strains of flu. Critically, those patients have not been treated with Tamiflu. So where does the resistance come from? As Fick and colleagues report, it looks like Tamiflu makes it through normal sewage treatment processes intact. This is significant, since each seasonal burst of Tamiflu use (preventative and in treatment) will lead to a concomitant burst of Tamiflu into our sewers. If the antiviral then passes through sewage treatment intact and en masse, then influenza strains running around in natural reservoirs stand a decent chance of being exposed to Tamiflu. This, in turn, means a head start on development of resistance.

The punchline is that Tamiflu may start "wearing out" sooner than we expect, leaving us back where we started with flu vaccines and "drink plenty of fluids and get some rest."

Following the model of HAART and other successful antiviral regimes, the hope would be to develop and deploy additional anti-flu medications with completely orthogonal targets, to slow down the rise of resistant strains. Failing that, we can hope that abundant vaccines this year (and going into the future) will keep flu levels low enough to limit exposure of the virus to waste antiviral meds.

As described here, George Bush is trying to push through his attorney general nominee (Michael Mukasey) by disingenuously tying it to the war:

"Judge Mukasey is not being treated fairly," the president said, after taking the extraordinary step of inviting a group of reporters into the Oval Office to vent his feelings. Sitting behind his desk and leaning back in his chair, Mr. Bush said he was concerned that some people may have "lost sight of the fact that we're at war."

I think some people have. Some people like to cut taxes, despite the historical record that we win wars by raising taxes. Some people like to commit pocket treason by blowing our own spies' cover to advance domestic political goals, again hurting our war effort.

I completely agree with George Bush. He clearly lost sight of the fact that we're at war long ago. If he hadn't, he might be supporting our troops in Afghanistan, where the true war on terror began.

In this article, the BBC summarizes a 60 Minutes expose' on "Curveball," the sole source behind Colin Powell's false claims of mobile bioweapons factories in his pre-invasion speech to the United Nations.

As it happens, rather than being a top-notch chemical engineer, Rafid Ahmed Alwan was just a chem E student with bad grades and a natural desire to win asylum anywhere other than Iraq. Mindful of this exact possibility, German intelligence passed on Alwan's claims with an advisory letter warning that they had no way of verifying what he said. Failure medal winner George Tenet claims he never saw that letter. Maybe so, but surely he had some inkling that sole-source word-of-mouth intelligence with no material evidence backing it up is not enough.

For more exciting action without evidence, you may want to go look George up at his current job as a non-executive director at defense contractor QinetiQ. Perhaps a non-executive director is one who directs without actually taking action? That seems safest, given his track record.

One might, at the end of the day, be inclined to ask exactly how "conservative" it is go to war based on the unsupported statements of one random student bucking for his green card.

...I believe it.

Americans are now in Yongbyon and have begun the process of disabling the reactor there. Although this still leaves open the possibility of nuclear facilities elsewhere, it removes any fuzziness about activity at Yongbyon.

That, at least, is comforting.

BBC article

Items produced in China are once again turning out to contain problematic bonus ingredients. A batch of Bindeez beads -- little beads meant to be arranged artistically and then sprayed with water to fix them in place -- was found to be coated with gamma-hydroxy butyrate, the anesthetic and date-rape drug. Apparently, the manufacturers of this batch went "off formula" and decided to mix some GHB into the surface fixative on the Bindeez, a fact that was discovered when several children were hospitalized after swallowing Bindeez beads (note that a bunch of little swallowable beads is already probably not the best kids' toy).

The manufacturers insist that this is a batch-specific issue.

Naturally, there's a lot more vigilance about products imported from China in the last year, but this brings up an interesting question about the hit rate in successfully identifying items that are, one way or another, "off formula." If pet food causes kidney failure and toys knock kids out, the adulteration is apparent. But how long will it take to discover that a product simply lacks a necessary active ingredient. If toothpaste contains poison, that's clear. If it lacks fluoride, then that's an incremental increase in cavities over a large population, and that is not amenable to product-linked surveillance.

It's hard to say if there's a ready solution to this issue, or not.

BBC article

In a report titled Drug Testing: Undercover Tests Reveal Significant Vulnerabilities in DOT's Drug Testing Program, GAO evaluates the drug testing protocols and centers responsible for carrying out regular drug testing of motor carrier employees (e.g. long-haul truck drivers).

GAO approached this evaluation by creating a couple fake motor carrier companies and then sending "employees" to be tested. Most critically, they found that their test employees were able to take drug tests at all 24 official Department of Transportation testing facilities using fake identification, meaning that a would-be test taker could send anyone they wanted in their place using fake ID. Keeping that fundamental flaw in mind, they also found that many test centers could be spoofed in a number of other ways:

In testing the sites, the GAO also found that many of the adulterants or spoofing agents that can be purchased online actually do work (this surprised me).

In another report, GAO noted that drug use among motor carrier employees is not one of the biggest contributors to motor vehicle accidents caused by cargo vehicles, but this report is great for highlighting just how weak many of our favorite controls are. Fundamentally, this process is broken from the start because it relies on photo identification -- much like watch lists at airports, which assume that diabolical terrorists are going to try and board planes under their actual name and using their own identification. This is especially problematic when innocent people who happen to share a name are repeatedly staked up trying to go through airport security (and when you can't convince TSA to provide an exception for you).

There are straightforward ways around some of these problems -- for example, biometrics on file, compared with biometrics on site. In the meantime, many security measures will provide the sense of security while being so weak that any highly motivated teenager can get past them.

The State of California today filed suit against the U.S. Federal government to push the EPA to approve a two-year-old California law mandating a 30% reduction in vehicle emissions (in new vehicles) by 2016. American auto manufacturers have been fighting this law, saying that it will hurt their ability to compete and other random nonsense -- nonsense, because the California law will apply equally to vehicles from foreign and domestic manufacturers. Were they honest, auto industry representatives would just out and out admit that they know California is a bellwether for nation-wide legislation impacting human health and safety, and they'd like to keep us off laws like this as long as possible. They've been very successful nationally, although that was with the backing of a Republican legislature that happily let automotive emissions standards stagnate for well over a decade.

Since the California law is stricter than current Federal standards, the state needs a waiver from EPA before it can go ahead and enforce the law. The official word from EPA is that they'll have a "decision" by the end of the year. It is not terribly surprising that the current EPA, hamstrung by manipulation from industry carpetbaggers associated with the Bush administration, had not even reached a decision about when it was going to decide whether or not to allow California to police our own air -- not until we sued.

Pathetic, but expected. The last word here goes to our governor:

Speaking at a news conference, Mr Schwarzenegger accused the federal government of "ignoring the will of tens of millions of people" by failing to approve the legislation.

"There's no legal basis for Washington to stand in our way."

BBC article

Among recent NIH program announcements was RFA-CE-08-006, "Feasibility of Acute Concussion Management in the Emergency Department."

As part of the "Healthy People 2010" program's injury and violence prevention component, NIH is putting funding into empirically evaluating the worth of different approaches and treatments to traumatic brain injury (TBI), with an emphasis on mild traumatic brain injury (MTBI) -- that is, getting a concussion.

Few studies have investigated the impact of interventions during the acute recovery phase on outcomes of mild TBI. However, one study in children (Ponsford et l., 2001) and a similar study of adults (Ponsford et al, 2002) conducted with patients recruited from emergency departments during the acute recovery phase reported that one-time provision of an information booklet outlining symptoms associated with mild TBI and suggesting coping strategies reduced anxiety and lowered the incidence of ongoing problems compared with a control group of patients who received standard care. Although to our knowledge, no published studies have investigated the impact of serial follow-up of MTBI patients, preliminary results from an ongoing CDC-funded study suggest that receiving multiple episodes of telephone counseling may decrease the negative impact of MTBI-related symptoms (Kathleen Bell, personal communication, July 2007).

Already important for youth athletes and people in general, MTBI treatment -- including treatment of recurring MTBI -- is obviously and particularly relevant for members of our armed forces who may be hit repeatedly with IEDs while in theater in Iraq, and who will then return home to VA or civilian medical care.

If you're a physician, the CDC provides Heads Up: Brain Injury in Your Practice, a free toolkit of materials to help in assessing and treating brain injuries.

Rocket and mortar attacks in Iraq are reported to have fallen to their lowest levels for nearly two years.

Mortar and rocket attacks in Baghdad showed a similar pattern, falling to 53 in October from more than 200 in June.

This runs in parallel with the reported decrease in civilians deaths over the last few months (not a monotonic decrease -- October saw more reported deaths than September). The civilian death numbers, however, must be taken with several grains of salt.

We'll see what the end of November brings. Regardless, it will be very hard to properly attribute the reason for a decline in violence. Candidates include the temporary re-increase in American troops levels, our change in policy to work with certain militia groups, the separation of Sunni, Shia, and Kurdish groups via forced demographic shift, and presumably many others that aren't obvious from the outside.

BBC article

The United Nations is a common and safe target of criticism for American politicians. Although we helped create it and make use of it, it's still "other" and thus strikes all the chords of fearing and disliking the outside world. A member of Congress is unlikely to antagonize a significant portion of their voter base by taking the time out to suggest that the United Nations is corrupt, or inefficient, or a waste of money or effort. It's much safer to point to the outside world and cry foul than to point to a fellow member of Congress and ask them to explain their earmarks, or their inefficiencies, or their ethical lapses.

In their report United Nations: Progress on Management Reform Efforts Has Varied, the GAO gives a progress report on efforts to clean up certain components of the UN, both in terms of ethics and efficiency.

The report leads with the ethics issue. As an organization formed from many nations, the UN naturally can have no expectation that everyone comes in with the same ethical norms. With that in mind, the UN ethics office has the potentially big job of getting everyone on the same page. As with many other elements described in this report, progress in ethics management is "okay":

As of October 2007, the UN ethics office had made some progress in developing and circulating ethics standards and guidance and had begun to develop a systemwide code of ethics. The office reported that it had received 287 requests for services from staff at different levels of the Secretariat between August 2006 and July 2007, including ethics advice on issues such as potential and actual conflicts of interest, protection against retaliation for reporting misconduct, and training.

The ethics office has increased ethics training within the organization, including half-day ethics training workshops for over 3,000 staff members at all levels of the Secretariat and consultations on the acceptance and disposal of gifts received by staff in their official capacity. The office has also developed new ethics standards, such as postemployment restrictions standards.

That last bit is interesting, since within the US we need stronger postemployment restrictions standards for many high-level appointed jobs. The current easy transition between lobbyist for an industry, government regulator of that industry, and back again has of late put a number of the most vulnerable Americans in danger.

The UN has similarly made progress with its whistle-blower policy, with the possibly major caveat that the current rules may only apply to direct employees of the Secretary General. Given recent problems with improper acts by UN peacekeepers, an effective whistle-blower policy is especially important.

GAO seems rather more optimistic about UN oversight efforts. The UN Office of Internal Oversight Services (OIOS) is basically the mirror image of the GAO within the UN. In the past year, OIOS has expanded its audit capacity by adding new locations and additional staff members, as well as handing off non-oversight work that was distracting the office from its primary role. There is still one major hiccup, though, in funding:

However, OIOS faces two conflicts that have been impeding its independence: (1) OIOS’s budget is subject to the review of the Department of Management, for which OIOS has oversight responsibility, and (2) OIOS must negotiate funding for nearly two-thirds of its budget with the entities it is chartered to audit. Without operational independence, OIOS is constrained in its ability to prevent or mitigate risks to the UN’s resources and personnel.

OIOS sees this as a problem as well, and fundamentally agrees with GAO's assessment of things.

GAO sees less progress overall in procurement:

Some progress has been made in strengthening the procedures for its procurement staff and suppliers, developing a comprehensive training program for procurement staff, and developing a risk management framework. However, the UN has made little or no progress in establishing an independent bid protest system and creating a lead agency concept for procurements, whereby specific UN organizations would procure certain goods and services in order to enhance division of labor, reduce duplication, and reduce costs.

Here, we would do well to pocket our stones and return to our own glass house, as we've seen over and over again in recent years that American procurement is rife with bad planning, massive inefficiency, laziness, and out-and-out corruption. Given that the unstated subtext of many criticisms of the UN boils down to "corrupt and inefficient," it ought to sober the ready critics up a little to look at our own recent record.

GAO rounds out the tracking portion of its report by citing management inefficiencies and the lack of review on certain UN programs and activities.

So what keeps reforms moving slower than they might? It mostly comes down to the committee nature of the United Nations. Member states frequently disagree on priorities, and given the consensus-driven nature of the UN, it's not surprising that there is no strong, successful, executive push for reform. It's one of the ironies of the tired and cheap criticisms of the UN from within our country that were the UN to be more efficient, more organized, and more directed, it would be much more like the one world government that so many of our lawmakers pretend to fear.

The hopeful message of this report is that the UN continues to trend in the right direction. It simply does so in the pace and time of a worldwide committee, which is no more than we might expect.

A recent BBC article takes a look at the ongoing problem of an aging, decreasing population in Japan. If the current trend continues -- and there's no particular reason to imagine it won't -- the Japanese population will be overwhelmingly top-heavy by mid-century, with nearly 40% of the populace at age 65 or older. This naturally leads one to imagine all sorts of problematic consequences as the demographics of Japan progress farther away from what current social structures effectively support.

Japan is just one of several countries facing population contraction at the moment. Consider the trio of Japan, Russia, and South Africa.

Japan, with a population of about 127 million, has a median age of 43.5 years and a population growth rate of -0.088%. This contraction comes down entirely to birth rate issues, as Japan sees 8.1 births/1,000 people per year, and 8.98 deaths/1,000 people per year. With no real immigration into Japan and a lifetime tally of 1.23 children born per woman, Japan appears to be slowly easing itself out of existence by way of a long, comfortable retirement.

Russia, coming in at 141 million people, has a median age of 38.2 years and a population growth rate of -0.484% (notice how much stronger a contraction Russia is suffering in comparison with Japan). Here, the collapse runs on the heals of mortality rather than a reluctance to have kids, with 10.92 births/1,000 people per year being drastically outpaced by 16.04 deaths/1,000 people per year. Russia's lifetime tally is 1.39 children per woman, but mortality is high across the board from infants through adults. Unlike Japan, Russia does see some immigrants, coming in at 0.28 migrants/1,000 people per year, but this does little more than round out the difference between "new people" and deaths to about 5 per year in favor of deaths.

South Africa is a case study in population collapse at the hands of a lone pandemic. Its 44 million people have a median age of only 24.3 years, with a population growth rate of -0.46%. Once again, mortality is to blame. Even though the birth rate is much higher than Russia's, at 17.94 births/1,000 people per year, the death rate is astonishingly high, at 22.45 deaths/1,000 people per year. The infant mortality rate in South Africa is also egregious, at 59.44 deaths/1,000 live births.

One thing that rolls out of this comparison is the perhaps astonishing realization that the populations of Russia and South Africa are collapsing at about the same rate (in fact, Russia's rate is slightly higher). South Africa is in the grip of a pandemic, with perhaps a quarter of its population infected with HIV. What, then, is going on in Russia?

(Figures taken from the CIA World Factbook)

During the 2006 election cycle, would-be Representative Tan Nguyen tried to lie his way to victory with a letter telling immigrants they had no right to vote, and threatening them with unspecified "danger" if they tried.

Now, some bright bulbs in Australia's Liberal party have been caught distributing pamphlets under the Labor party logo that include ginned-up laudatory statements from fake Islamist extremists supporting the Labor party. Like so:

In the leaflet, which carries the Labor Party logo, a fake organisation - the Islamic Australia Federation - applauds Labor for supporting Islamic extremists.

Labor supported the building of new mosques, the leaflet added, thanking the party for backing the entry of controversial cleric Sheikh Taj el-Din al-Hilali - who likened scantily-clad women to uncovered meat.

Brilliant.

Much as the Orange Country Republican party quickly kicked Tan Nguyen to the curb, PM John Howard's Liberal party has already distanced itself from this bit of ridiculous fearmongering. The Liberal party should take note, however, of the consequences of the Orange County tumult -- the party distanced itself not only from the effort, but from Tan Nguyen, giving the election up as lost. This seems like an unsatisfactory result for the Liberal party and for Howard in particular.

The take-home lesson may be "hire fewer idiots."

As a follow-up on Tan Nguyen, it's interesting to note that he ran first as a Democrat and then as a Republican in back-to-back election cycles, and despite a very forgiving investigation that basically let the letter off as a "mistranslation," continues to deny knowing anything about it...even though that same forgiving investigation concluded that he did.

When winning is the overriding goal, you can be confident the shell is hollow.

BBC article

As part of the most recent wave of promotions to that position, Benedict has raised Chaldean Patriarch Emmanuel III Delly, a Baghdad resident, to the role of Cardinal. Per this al Jazeera report, Delly represents a much-diminished population of Iraqi Christians, participants in one of the oldest of the surviving Christian rites, the Chaldean. From a Hussein-era total of 700,000, the Christian population of Iraq is believed to have fallen by half to the ballpark of 350,000 since we invaded. Whether this will see a turnaround that matches the reported movement of refugees back into the country won't be clear for a while yet. As the Mandaeans can attest, Iraq has been a surpassingly hostile place for religious and ethnic minorities -- a problem they "solved" by retreating en mass into Kurdish territory.

Will the elevation make a difference? Unfortunately, although I have trouble seeing room for a positive effect, it does seem that it might paint an even larger target on the Patriarch's head. I hope his security team is both thorough and attentive.

In case you missed it, this Voice of America article reports on the recent decision and too-late-to-matter reversal by the Chinese Foreign Ministry refusing to allow the U.S.S. Kitty Hawk and associated ships to dock in Hong Kong for the Thanksgiving holiday. This event, planned long in advance with official Chinese permission, would have let American sailors spend their holiday in port. Many of them planned on meeting up with family members who flew all the way to Hong Kong just to spend a couple days with their loved ones.

As the Kitty Hawk carrier group sailed to Hong Kong, the Chinese Foreign Ministry suddenly and without explanation denied them docking rights. This decision was reversed on Thursday (that would be Thanksgiving day) with the following bit of puerile doublespeak from spokesman Liu Jianchao:

"We have already decided to allow the USS Kitty Hawk aircraft carrier group to stay in Hong Kong for rest and reorganization during Thanksgiving. It is based completely on humanitarianism. China has already informed the U.S. of this decision," he said.

Naturally, this weak-sauce reversal was far too late, and the carrier group was already well on its way to another port, away from the sailors' families. Whether it's because we gave the Dalai Lama an award or some other sad little reason, this is a huge act of disrespect, especially in the face of friendly fleet visits from the Chinese navy to American ports in the last year.

It is a sad and little display, of a type best retained for use within China, and not without.

Zimbabwe, previously reeling under an over 2,000% inflation rate is now stuck reeling under an undetermined inflation rate instead. As we're told by the unfortunate Moffat Nyoni of Zimbabwe's Central Statistical Office, there simply aren't enough basic staples such as bread, sugar, and meat on store shelves in Zimbabwe to even calculate inflation.

Maize meal, bread, meat, cooking oil, sugar and other basic goods used to measure inflation largely disappeared from shops after Robert Mugabe's government ordered prices to be slashed.

Manufacturers have said they cannot afford to sell goods at below the cost of producing them.

The last measured rate, from September, was an abysmal 8,000%, but current unofficial estimates that look to the black market for evidence suggest inflation may hit a staggering 100,000% by the end of the year. Even the proposed Sunrise 2 revaluing of Zimbabwe's currency won't be nearly enough to deal with that degree of inflation. With basic goods unavailable, the tourist trade fleeing the country's borders, and a wrecked farming system, it's unclear if Zimbabwe will ever recover as long as Mugabe is in charge.

There's been no word, yet, on whether they'll be going ahead with Mugabe's million-dollar birthday party early next year or not. Of course, with no actual food or fuel on which to spend their money, the people of Zimbabwe are now especially free to contribute to support the event.

BBC article