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October 20, 2005


Note: I just changed this. In the original, I said that the person in charge of the federal response to avian flu was an idiot. I changed it because I don't know that; what I do know is that he has no obvious qualifications for his job. (I plead sleepiness.) The New Republic:

"According to his official biography, Stewart Simonson is the Health and Human Services Department's point man "on matters related to bioterrorism and other public health emergencies." Hopefully, he has taken crash courses on smallpox and avian flu, because, prior to joining HHS in 2001, Simonson's background was not in public health, but ... public transit. He'd previously been a top official at the delay-plagued, money-hemorrhaging passenger rail company Amtrak. Before that, he was an adviser to Wisconsin Governor Tommy Thompson, specializing in crime and prison policy. When Thompson became HHS secretary in 2001, he hired Simonson as a legal adviser and promoted him to his current post shortly before leaving the Department last year. Simonson's biography boasts that he "supervised policy development for Project BioShield," a program designed to speed the manufacture of crucial vaccines and antidotes. "That effort, however, has by most accounts bogged down and shown few results," The Washington Post reported last month."

He'd previously been a top official at the delay-plagued, money-hemorrhaging passenger rail company Amtrak

I dunno, Hilzoy - he has experience with plague and hemorrhage, so perhaps he's better qualified than you think.

"...or why the former is normally regarded as tough Republican spending and the latter as squishy liberal spending."

Perhaps liberals view gov't as essentially an insurance, spreading the costs of risk among its citizens. The amount necessary should be able to protect the least able and affluent and the most vulnerable.

Conservatives think the amount necessary should be only what is necessary to protect Bill Gates when his personal resources are not sufficient, e.g., national defense.

Investing in 'public health' inevitably means that sooner or later you're going to give some poor people things they couldn't afford to buy on their own, even if it's just vaccine or a simple HIV test.

This is sensible medicine, but incompatible with current Republican ideology. The proverbial pound of cure seems to be the preference, particularly if it can be purchased via a no-bid contract.

I have little doubt that the plan has actually been finished, but expecting to see "The plan is we keep the Tamiflu for ourselves and you guys are on your own." is probably unrealistic.

Neil Boortz didn't have anything to do with this plan, did he?

Tangentially relevant, which is close enough for me, but Brad Delong has a post up savaging George Will regarding the absence of some sort of taxypayer-funded universal health care in America, the Delphi/General Moters debacle, and the utterly, willfully, ignorant, purely innocent and destructive idea among the powers that be that real people who signed contracts should be screwed because the elegant concept of "comparative advantage" says so.

Except that comparative advantage for Honda, Toyota, and Mercedes includes basic, government-provided and decent healthcare in their home-countries.

Yeah, I know, they open factories here, because costs are lower. Nice that we bring out the best in people.

Side note to the side note: Here in Colorado, the folks (non-human Douglas Bruce, the Gingrich-Delay spawn John Andrews, Independence Institute funny boy/mass murderer Jon Caldera, all backed by Norquistian and Dickarmy national money) who are campaigning against Amendments C and D, which loosen the strictures of the draconian anti-tax Tabor amendment, passed without my permission in the early 1990s,
are quoted in yesterday's Rocky Mountain News
backing the idea that the poor, none of them, the sods, should receive government-backed healthcare (not even vouchers).

The election is close. A defining moment.

We (not me, Kemosabe) are very close to choosing death for the poor.

It will be a national model, Bush hopes.

FWIW - If avian flu hits, you may not be able to get your "Tamiflu," but cheer up! Tamiflu may not even work!! I quote a press release from the University of Wisconsin:

Date: Fri, 14 Oct 2005 22:13:12 -0600
>From: Kevin and Tammy Naze
>Subject: [wisb] Off topic: Avian influenza virus
>UW-Madison release today:
>An avian influenza virus isolated from an infected Vietnamese girl has
>been determined to be resistant to the drug oseltamivir, the compound
>better known by its trade name Tamiflu, and the drug officials hope will
>serve as the front line of defense for a feared influenza pandemic.
>Scientists from the University of Wisconsin-Madison, working with
>colleagues in Vietnam and Japan, report in a brief communication in next
>week's edition (Oct. 20, 2005) of the journal Nature that a young girl,
>provided with a prophylactic dose of the drug after experiencing mild
>influenza symptoms, developed a strain of the virus that was highly
>resistant to the drug.
>The finding suggests that health officials - now stockpiling millions of
>doses of the drug to forestall a global outbreak of influenza and buy time
>to develop and mass produce a vaccine - should also consider other
>options, according to Yoshihiro Kawaoka, an international authority on
>influenza and the senior author of the Nature paper.
>Recent reports indicate the federal government may spend billions of
>dollars to stockpile as much as 81 million courses of Tamiflu to forestall
>a possible influenza pandemic. The government has already stockpiled an
>estimated 12 to 13 million courses.
>"This is the first line of defense," says Kawaoka, a professor in the
>UW-Madison School of Veterinary Medicine who holds a joint appointment at
>the University of Tokyo. "It is the drug many countries are stockpiling,
>and the plan is to rely heavily on it."
>The drug would be used to slow the spread of influenza until a vaccine is
>developed, which may take up to six months.
>Tamiflu is delivered orally and works to impede the spread of the virus by
>binding to and inhibiting one of the surface enzymes the virus uses to
>exit infected cells of a host. Once inside a host cell, the virus
>commandeers the cell's reproductive machinery to make new infectious
>particles that go on to take over other cells. When the drug is at work,
>Kawaoka explains, "the virus is still able to replicate inside a cell, but
>is unable to get out and infect other cells."
>Oseltamivir, which Kawaoka describes as an "amazing drug," is one of three
>compounds proven to be effective against influenza. One class, derivatives
>of the compound adamantine, would be less effective, as some flu viruses
>have already evolved resistance to it. The other drug, zanamivir, which
>was developed prior to oseltamivir, is effective, but is formulated as a
>powder and requires that a clinician provide instructions for use. Thus,
>it is more cumbersome to administer than the orally delivered Tamiflu.
>These flu-fighting drugs, says Kawaoka, are by no means a replacement or
>alternative to a vaccine. Effective vaccines can confer immunity,
>preventing the virus from gaining a toehold in the body. But it is
>unlikely sufficient quantities of a vaccine can be produced and stockpiled
>prior to the emergence of a new virus in human populations.
>If avian influenza does emerge and becomes infectious from human to human
>- and nearly all experts agree that will happen at some point in the
>future - an outbreak similar to the 1918 influenza pandemic could occur.
>That pandemic killed as many as 50 million people, more than died on all
>the battlefields of World War I. Scientists and vaccine manufacturers
>would be in a race against time to produce enough doses to forestall
>disaster. Drugs like Tamiflu, used in combination with quarantine, would
>be intended to slow the spread of the disease until a vaccine is produced.
>Kawaoka says there may not be enough Tamiflu to go around even though
>countries are stockpiling it. The Wisconsin scientist says that will
>create a risk of patients sharing the drug and using smaller doses, which
>could accelerate the emergence of virus resistant to the drug and hamper
>efforts to contain the spread of the disease.
>He says health officials should consider stockpiling zanamivir and
>recommending that only the therapeutic dosages of Tamiflu be administered
>to patients.
>"We've been watching for this change (in the virus)," Kawaoka says. "This
>is the first, but we will see others. There's no question about it."

Well, you say "We (not me, Kemosabe) are very close to choosing death for the poor."

Alas, their choice is akin to being ecstatic because the idiot we're competing with at the other end of lifeboat just drilled a hole though the bottom of the boat on HIS end!

Perhaps the history will be written to show how the virus came, and took hold among the 45 million without health insurance, in a winter in which they couldn't even afford to heat their apartments any more, and, like Katrina, developed a huge momentum, like a spark falling on gasoline-soaked rags in the basement. In 45 million guts it evolved and perfected itself, a new generation every 20 minutes, 3 an hour, 72 generations a day to try to find the winning combination, times 45 million poor, times 10 trillion cells per person.

As Mike Osterholm quotes at the start of his book "Living Terrors", quoting the IRA - "You have to be lucky all the time - we have to be lucky just once."

And then, in full fury of an F1 epidemic turned into an F6 pandemic by that social choice we all made or stood by and watched being made, it leapt every silly barrier the very wealthy thought they had to keep it at bay. As if the virus would care who was rich and who was poor, who had Tamiflu and who didn't.

If there is one thing we can be sure of, is that it might start with the poor, but it won't stop there.

No, come to think of it, there's a second thing we can be sure of - it's that the mental model behind that social policy simply, totally, cannot conceive of the idea that poor and rich are genetically identical, in every way that matters to a virus.

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