PSoTD

Every once in a while I'll post one of these. Just in case it might be useful someday...

From Legacy: History of Nursing Education at the University of British Columbia, 1919-1994

Book by Ethel Warbinek, Glennis Zilm; University of British Columbia Press, 1994

All these factors contributed to the demands in B.C. for a university-based nursing education program. As well, the activities of nurses in World War I and in the care of the Spanish flu victims in the world-wide epidemic of 1918- 1919 imparted a glorification of nurses; this was among influences that led to the opening of the Department of Nursing at UBC. Nurses had served magnificently in field hospitals, often near the front lines, and had become icons to be emulated by women. Even women's fashions were influenced by the shorter, more practical length of the skirts of nurses' uniforms. The influenza epidemic killed more than 50 million people world-wide and 50,000 in Canada and brought home to the public the need for better health care generally. During the height of the epidemic in B.C., the university was closed for five weeks and the auditorium and classrooms turned into wards for flu patients. President Wesbrook and several students died from this virulent flu. Victims generally progressed rapidly to a toxic pneumonia with severe nosebleeds that required packing. Treatment was symptomatic and good nursing care was essential: tepid sponges for high fevers, mustard plasters for chest congestion, and fluids for dehydration. The dedication of the nurses from the nearby Vancouver General Hospital was duly noted and authorities also awakened to the need for better health education generally, which could be done by public health nurses.

As promised, the second half of Q&A with Revere of Effect Measure. Again, Revere's responses are in the blockquotes.:

3) About public health systems: If the public were to pressure government and the health industry to greatly improve one component of how the public health system works, what should the public focus on? Where could the public get their greatest bang for their political buck in terms of improving the quality of health?

You ask what appears to be a sensible question, to which I have a hard time giving a definite answer. In my view this is because the problems with public health in this country are deep and systemic and not easily addressable with a single solution.

In answer to your previous question I spoke of public health being leaderless, dispirited and demoralized. There are cycles in public health and we have just been through 35 years on the "up" side. The full analysis is too long for this format, but suffice to say the profession as a whole has been marginalized and forced under the rubric of public safety (EMS, police, fire) and is being progressively militarized (hierarchical organization different from its horizontal one). One of the reasons for this is the ideological assault on the core ethic of public health, the notion of public service.

With so many crimes to lay at the feet of our political leaders over the last several decades it is hard to know which to place at the top of the list and I won't even try. Starting at least as early as the Reagan Administration, politicians of both parties have developed whole platforms based on the very notion of denigrating public service. This is what is behind the "big government is bad" theme (which is not to say that big government can't be bad, but that the theme has a different origin). The ideology here is "self-reliance" and the evil of helping those who cannot help themselves. Lakoff and many others have explored the ideological roots of this attitude (and I have explored his views extensively on the blog) so I won't go further here. But a major result has been to stigmatize public servants, take their tools away from them, and demoralize them. This, of course, includes public health professionals.

So the general (and not very satisfying) answer to your short and seemingly restricted question is a political effort (non-partisan) to restore the honor, dignity and social value of public service in general. This requires a conscious and explicit effort on the part of progressives, something we haven't seen so far. This is consistent with the theme for public health strategies I noted in my last response. The best way to approach the daunting public health challenges we face is via cooperation: neighbors helping neighbors, facilitated by resources provided by the public health system. This is an ideological approach as much as a scientific one (one we believe on rigorous analysis of costs and outcomes would be superior, although if it were not, we would still advocate it).

4) Now for a left field question: In terms of a whole earth, all species view: could a pandemic actually be a good thing for the future of the world and humankind? And if so, what's the likelihood of that?

and no, I'm not a fatalist, just philosophical in questions...

I'm a public health guy so I don't believe in "cleansing" the race. But here's my response, such as it is:

If the human species doesn't suffer a major population crash after becoming overcrowded and having fouled its own nest, it would be unlike virtually every other natural population we know about. On the other hand, humans have additional protections most other species don't have: well-developed culture and technology which have allowed it to become the geographically most widely distributed species on the globe. Those abilities have often been used in a destructive way but there is no Law of Nature (known to me, anyway; the theologically inclined may think what they wish) that forbids it from being used constructively. And I hope it will be with respect to a pandemic. It is hard to see how a pandemic could be a boon to humankind. It more likely will be a catastrophe which will cause a great deal of suffering and set us back as a species, although probably not for very long.

However, on the more cheerful side, a scourge that did wipe out the human species would be a great gift to many other species. The same technology and culture that has been so beneficial to us has had disastrous consequences for other living beings. Just think how different the living world would be if humans had never domesticated agriculture. The world, is a relatively closed system (except for solar radiation coming in and our own electromagnetic radiation going out), and eventually comes back into balance. The only question for us is whether we will still be here as a species when it does.

5) What are your hopes and plans for your blog in the future? Is your blog a short-term or long-term commitment?

Our blog is signed Revere, to recognize one of the first civilian members of any local Board of Health in America. But Paul Revere no longer exists. Neither does the Revere who signs the blog. Revere is just a label for a set of opinions and a particular voice.

The fatal weakness of blogging is that there are essentially no start-up or maintenance costs but there are substantial costs in time, emotional energy and commitment. If a blog isn't updated with some frequency it shortly loses readers. While our goal is not vast readership, neither is it no readership. We are not an online diary, but a forum for progressive public health thinking. It is our hope that it will become a place where the public health community and its many allies can begin to work out some of the daunting theoretical problems the discipline and the profession face at this point in history. But there is a delicate balance between accommodating to readers' interests and pushing the envelope. We have persistently expressed the opinion that organized religion and war are both properly seen as public health problems mindful of that tension.

How long will we do this? Hard to say. There have been multiple posts on the blog everyday, seven days a week, since Thanksgiving 2004. That is a difficult schedule when when we have extremely busy "day jobs" and professional lives that are not only separate from the blog but employ vastly different conventions in the way we must express ourselves. In some instances we are severely criticizing institutions of which we are part and parcel. At the lowest level, you can say we posted on the blog today because we posted yesterday, a fairly prosaic but perhaps accurate description of the process. But over the last nine months we have also accrued a reasonable daily readership that ,on most weekdays, averages six to seven hundred, often considerably more. If we knew we could go to a lecture room everyday and be guaranteed of an audience of six or seven hundred people specifically interested in public health that showed up voluntarily to hear our latest opinions or take on the news, we would be delighted. So we persist.

Is this long-term? Probably not, for the simple reason that things change rapidly. With new technology and new formats, blogs will have seen their day and some other way of communicating will take their place. Whether we will be moving on with that change is hard to say. If I could tell the future, I'd be rich. And I'm not.

Revere of Effect Measure agreed to be both subject and part of my learning curve to present e-mail blog interviews - bloggerviews. I asked a question each day and have posted the responses in their entirety.

Originally I intended to post the whole bloggerview in one post, but it turned out pretty long. So I'll post the first half today, and the second tomorrow. Let me know if you have any suggestions for the process that you think might be worth implementing.

Revere's responses are in the blockquotes.

1) What blogs do you primarily rely on for news or information or just value? How did/do you find them?

Not sure you'll like the answer. It's hard to put the URLs for the referenced blogs on dial-up and email, but all are pretty easy to get to stick in. But it's a beta test, right?

I'm not sure I can reconstruct this completely. I remember getting to Majikthise (perhaps my favorite blog) through James Wolcott, but how I got to James Wolcott is lost to my now porous memory. Those two blogs have some of the most stylish writing going. I collected a bunch of blogs off blog rolls during the 2004 election campaign, when I became a serious blog reader, and I would accrue and discard them relatively quickly. Since starting my own blog 9 months ago, I picked some up by seeing who was reading mine.

However since much of my blogging relates to current news I spend an inordinate amount of time surfing news sites now, much more so than blogs. There are a couple of other public health blogs out there (Confined Space is outstanding and is the main source of news about occupational health and safety for the progressive wing of the profession) and Stayin' Alive is also great reading. So is Pharyngula, the best biology/political blog out there by a long way.

I confess I have much less interest these days in the partisan political blogs like Atrios, DailyKos and MyDD because they are preoccupied with electoral politics, while I am mainly interested in public health issues. The Democratic party also makes me retch. It is unbelievably cowardly and has been whipped by the right wing to the point it can't even muster a reasonable response to unreasonable events like the Plame outing. Why should I bother about the latest rearrangements of the deck chairs on the Titanic? In Australia the opposition party has made in issue out of the failure of John Howard's right wing government to prepare adequately for a bird flu pandemic. In this country the head of the DNC is a doctor and all we get is silence. Jeez.

2) You post a lot about Avian flu. Who would you ask (or force) to guest post on your blog about the subject, assuming they would do it? And what specific points would you want those guest posts to cover?

This interesting question has a double answer: no one; and just about anyone that has something useful to say.

No one:

The bird flu theme on our blog is somewhat misleading. Ours is not a bird flu site, although for many months it was one of the few that mentioned it at all and during that time mentioned it very often: there have been around 150 posts on the subject. But the main topic remains what it was at the outset, public health, especially public health in the US. American public health professionals are having a difficult time. We have no effective leadership and the profession and discipline have become increasingly marginalized, dispirited and demoralized. Bird flu emerged as a theme initially because it seemed the perfect metaphor for this lack of attention by our political (and through them) our public health "leaders," and because it seemed it was a genuine emerging threat of major proportions that was not being attended to. Today, of course, we find frequent mention, both in the MSM and in the blogosphere, but for a long time we were among the few to discuss it and the only ones to discuss it in relation to the failure in leadership. Thus we have no specific need for anyone else to come along and add their expertise.

Almost anyone who has something useful to contribute:

However that doesn't mean we know all the answers. In fact it is clear we know hardly any of them. In our view a pandemic cannot be stopped by any conceivable policy options at this stage. What we require now is to prepare to manage the consequences if a pandemic of avian influenza should occur at some point. In that regard, there is a great deal of expertise but it is scattered among people who often don't know they have it. For example, in small but essential businesses, who are the key personnel and what are the choke points that would be affected if there were an illness with a 30% absenteeism rate? How would they work around it? If someone were the sole (material) support of an aged relative (did their grocery shopping, went to the drugstore and got their prescriptions), what would happen if that younger provider were sick for three or four weeks? If overroad trucking were disrupted by widespread illness among truckers, who would deliver the drugs to pharmacies or supermarkets who have "just in time" inventories? This kind of expertise exists, but it isn't in the public health community and isn't being harvested and marshaled for the purpose by planners. Our blog isn't the place to do this, but a "wiki" is. So along with two other bloggers (DemFromCt at The Next Hurrah and Melanie Mattson of Just a Bump in the Beltway) we started (with the amazing technical expertise of pogge of the pogge.ca blog in Canada) the Flu Wiki (http://www.fluwikie.com). It is an open site where any and all can contribute, edit and correct current entries, and take away much current information on planning for pandemic flu. It has been an amazing success and grows daily. We will need sources like this if we are to prepare to help each other in a crisis, rather than turn our backs on each other, retreat to a cabin in the woods, and guard our families with guns to avoid infected outsiders or those also seeking the staples of life. Cooperation is our strategy, not survivalist preparation and the Flu Wiki is one way to promote it. In a sense, everyone who participates there will be our "guest bloggers on bird flu."

Part II on Sunday.

Flu pandemic?
Plan for the Worst
Preparation
The Economics of a Flu Pandemic: II
Another Angle I Hadn't Considered

How long until the term "avian flu" shows up in the top 10 of Technorati searches...

Guess who is expected to be the lead agency in case of pandemic in the United States?

God help us.

One of the biggest problems with letting a marketplace manage itself?

Hoarding.

North American sales of the drug oseltamivir have more than tripled in recent months, a trend public health experts see as evidence individuals are stockpiling the once little-used antiviral as a hedge against a possible flu pandemic.

With similar reports emerging in other countries as well, a leading advocate for pandemic preparedness is concerned public demand could soon outstrip the limited global supply.

And what happens when supply can't meet demand in that marketplace?

"We are on a collision course to panic," warns Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

"I think that what's going to happen is . . . that this drug - which has yet to really be demonstrated to have any clinical impact on H5N1 infection - is now going to become the 'I can't get product, therefore I must have it right away product.'

"The reality is going to come through that there is only so much available."

Where is the American news media on the subject of avian influenza, and what America is doing to prepare for it?

Most people in America are ignorant of the risk currently being watched by scientists. Bloggers are posting about it, considerably posting in some places... but there's nothing in the broadcast or cable news, really, other than some very very general tidbits.

There's no hard hitting investigations or questions... or anger.

Why isn't there at least one major news media person who nightly is screaming WHAT DOES THE BUSH ADMINISTRATION HAVE TO SAY AND DO ABOUT AVIAN INFLUENZA, AND WHAT SHOULD AVERAGE PEOPLE BE DOING ABOUT IT?

Where the fuck are you on this issue, Wolf Blitzer? What the hell are you doing, Joe Scarborough? Lou Dobbs, can you drop your daily anxiety construction about immigration and cover this topic hard every day instead? Are you all waiting until you've completed building your stockpiles of oseltamivir and surgical masks? What are you waiting for? When will this story get anywhere near the coverage of Natalee Holloway before it's too late? Don't you have a responsibility to prepare Americans so that they can prepare themselves?

Because it may be too late now. And you're hurting America by your lack of coverage of the story.

Good catch by Cosmic Iguana.

From Asia Times:

In the same grim spirit, the British media revealed that officials were scouring the country for suitable sites for mass mortuaries, based on official fears that avian flu could kill as many as 700,000 Britons. The Blair government is already conducting emergency simulations of a pandemic outbreak ("Operation Arctic Sea") and is reported to have readied "Cobra" - a cabinet-level working group that coordinates government responses to national emergencies, like the recent London bombings, from a secret war room in Whitehall - to deal with an avian flu crisis.

Little of this Churchillian resolve is apparent in Washington. Although a sense of extreme urgency is evident in the National Institutes of Health, where the czar for pandemic planning, Dr Anthony Fauci, warns of "the mother of all emerging infections", the White House has seemed even less perturbed by migrating plagues than by wanton carnage in Iraq.

As the president was packing for his long holiday in Texas, the Trust for America's Health was warning that domestic preparations for a pandemic lagged far behind the energetic measures being undertaken in Britain and Canada, and that the administration had failed "to establish a cohesive, rapid and transparent US pandemic strategy".

That increasingly independent operator, Senate majority leader Bill Frist, had already criticized the administration in an extraordinary (and under-reported) speech at Harvard at the beginning of June. Referring to Washington's failure to stockpile an adequate supply of the crucial antiviral oseltamivir (or Tamiflu), Frist sarcastically noted that "to acquire more anti-viral agent, we would need to get in line behind Britain and France and Canada and others who have tens of millions of doses on order".