Christmas Prison Break: Six Inmates Escape Through the Toilet

Early Christmas morning, six inmates at a Tennessee jail made a run for it and escaped through a broken toilet. Police captured five of them pretty quickly, but one is still on the loose. David Wayne Frazier is considered the most dangerous escapee and was imprisoned for aggravated robbery and possession of a weapon.

The unusual escape was made possible by a water leak behind a toilet that had damaged the surrounding concrete wall and bolts. The men were able to simply remove the toilet and crawl out through the hole in the wall, according to the Cocke County Sheriff’s office. At least the men got a little bit of freedom on Christmas.

They were able to unscrew and remove the toilet’s bolts, exposing a hole big enough for them to wiggle through https://t.co/oiK4LzvgoA

— New York Post (@nypost) December 26, 2016

Emma Von Zeipel

Emma Von Zeipel is a staff writer at Law Street Media. She is originally from one of the islands of Stockholm, Sweden. After working for Democratic Voice of Burma in Thailand, she ended up in New York City. She has a BA in journalism from Stockholm University and is passionate about human rights, good books, horses, and European chocolate. Contact Emma at EVonZeipel@LawStreetMedia.com.

The post RantCrush Top 5: December 27, 2016 appeared first on Law Street.

Treating people when they’re already sick is like beating back invaders who have already breached your defenses. In either scenario, prevention through good defense saves money, time, and lives. But when it comes to boosting our nation’s wellness defenses through public health spending, America falls short.

When it comes to health, concerns abound that we’re wasting money, time, and lives by spending too much on treatment and recovery and not enough on prevention. Public health interventions like smoking cessation programs and disaster preparedness initiatives save lives. The more we learn about the power of these interventions, the more experts call to keep them afloat with better funding. Spending a few dollars to get a person to quit smoking makes more sense than spending thousands of dollars to try to treat their lung cancer several years down the road. Preparing for a natural disaster beforehand is preferable to picking up the pieces afterwards.

So what is public health? It’s something that aims to keep you alive as long as possible. From preventing diseases to preparing for disasters, public health programs keep a wary eye out for threats and then help populations avoid or mitigate them. For example, if data shows a high diabetes risk for a certain population, public health programs will target that population with preventative messages about diet and exercise. Public health departments might also help local school systems prepare for potential natural disasters, like Florida does with its Children’s Disaster Preparedness Program.

Read on to learn about public health spending in the United States, and where we might need to invest some more time and money.

Where’s the money?

In April, the Trust for America’s Health (TFAH) released its report Investing in America’s Health: A State-by-State Look at Public Health Funding and Key Health Facts. The report highlights many ways America falls short on public health spending. They say America’s public health system “has been chronically underfunded for decades.” In Why We Don’t Spend Enough on Public Health, author David Hemenway says this is because the benefits of public health spending today aren’t seen until potentially far in the future. Governments and politicians want to see the benefits of their investments in the present day, so they favor spending on medical treatment and other immediately fulfilling initiatives.

Here are some of the key findings:

Public Health Spending is Actually Shrinking

According to TFAH, when you adjust for inflation, public health spending in 2013 has sunk 10 percent from 2009. Many simply don’t see the benefits of spending on public health programs that yield intangible, future benefits when money could be spent on initiatives that produce immediate results like transportation or construction projects.

All States are Not Created Equal

States vary widely in what they spend on public health as funding is determined by the set-up of each state’s unique public health department. Indiana came in at a low of $15.14 per person, while Alaska spends $50.09 per person. This could be why health levels also vary widely from state to state.

Communities Aren’t Prepared for Public Health Emergencies

Public Health Emergency Preparedness (PHEP) Cooperative Agreement Funding helps communities respond to natural disasters, epidemics, and outbreaks. It was backed by $919 million in 2005. In 2013, it was supported by just $643 million.

Hospitals Aren’t Prepared for Public Health Emergencies

The Hospital Preparedness Program (HPP) gives healthcare facilities funding to beef up their preparedness measures. Funding for this program has been slashed by almost half, dropping from $515 million in 2004 to $255 million in 2015.

It’s estimated that 2/3 of all deaths in the United States result from chronic diseases typically linked to behaviors like diet or substance abuse. These diseases could be prevented by well funded intervention programs to decrease the behaviors that eventually lead to chronic diseases. Public health spending could save Americans millions in treatments for preventable diseases. Likewise public health under-spending could be costing us more than we’re saving.

In this video, the American Public Health Association outlines financial returns on every dollar of public health spending for different activities:

The above video states that every dollar spent on fluoride in our water supply could save $40 in dental care costs and that a dollar spent on nutrition education could save $10 in health care costs. The main point? Public health programs make for a smart investment.

The Consequences of Meagre Public Health Budgets

So, America spends too much money on treatment and not enough on prevention. The results aren’t pretty. In Integrating Public Health and Personal Care in a Reformed US Health Care System, authors Chernichovsky and Leibowitz write,

Compared with other developed countries, the United States has an inefficient and expensive health care system with poor outcomes and many citizens who are denied access.

The State of U.S. Health, 1990-2010 report put the U.S. up against other members of the Organization for Economic Cooperation and Development (O.E.C.D.), a program that advocates to improve economic and social outcomes. Since 1990, the U.S. has fallen in rankings for both life expectancy and healthy life expectancy. In 1990, the U.S. stood at the number 20 spot for life expectancy.  By 2010, it was down to number 27.  In 1990, the U.S. also enjoyed the number 14 spot for healthy life expectancy. The year 2010 found us in the 26th spot.

Under-spending in public health doesn’t just lead to generally poor health, it also impedes our ability to respond to emergencies. Assistant professor at the Harvard Business School, Gautam Mukunda, referred to Ebola as a “wake-up call” for the state of U.S. health preparedness. In Ebola as a Wake-Up Call he wrote,

Ebola may serve as a badly needed wake-up call about something the public health and biosecurity community has been banging the drum about for years: the U.S. has massively underinvested in public health.

Mukunda says the Ebola situation highlighted the measly number of extreme disease cases our U.S. hospitals can handle. Hospitals have decreased their capacity for extreme cases to increase their efficiency, only to lose the ability to treat patients when rare diseases strike. Although the need for extreme treatments arises only occasionally, hospitals should always be prepared for them. But with limited funding, it’s hard to be prepared for the unlikely “worst case scenarios.”

How does the future look?

The good news: The Senate finally passed a joint budget resolution after a five year absence of agreement.

The bad news:  Their budget slahes non-defense government spending by about $500 billion over the next 10 years.

The budget cuts spell trouble for discretionary educational public health programs. From disease prevention to health care worker training, programs to promote good health may suffer across the board.

In an APHA press release opposing the measure, Georges Benjamin, executive director of APHA, says,

Simply put, our federal, state and local public health agencies will not be able to do their jobs to protect the health of the American people if these drastic cuts are enacted.

The budget would also annihilate the Affordable Care Act, including the Prevention and Public Health Fund, a program that focused on moving America towards a preventative health model by funding prevention communications, research, surveillance, immunizations, tobacco cessation programs, health-care training, and more.

The resolution isn’t yet a binding law, but indicates a set of collective and alarming priorities that steer America farther from the path of an integrated, preventative public health system. The Appropriations Committee still has to draft the spending bills, so there’s room for opposition. President Obama for one said he’ll veto bills following the restrictive budget.

Evidence to Inform the Future

According to the article, Evidence Links Increases In Public Health Spending To Declines In Preventable Deaths, published in Health Affairs, mortality rates fall anywhere from 1.1 – 6.9 percent for every 10 percent uptick in public health spend. The researchers made observations over thirteen years and found that the localities with the highest upsurges in public health spending had the most significant reductions in preventable deaths. The relationship held true in multiple causes of death and across different demographics. While the study is only a correlation, the linkage presents compelling evidence for the death-decreasing value of public health spending. The researchers believe a lack of substantial evidence for the ROI of public health campaigns may have hindered spending in the past, and their report takes one step towards getting that evidence.

The Trust for America’s Health (TFAH) advocates for an America with increased core public health spending. They also recommend ways to spend the money correctly. They call for a solid public health foundation for all populations in all states so everyone can be healthy no matter where they live. After that’s established, they advise investing in strong, evidence-backed public health programs and efforts to fortify emergency preparedness. Finally, they believe public health expenditures should be completely transparent and accessible to the American public.

Experts at a recent forum of National Public Health Week looked past mere spending to consider the future of public health and consider novel ways of approaching health to make America a healthier nation. The speakers want to stretch health thinking beyond the doctor’s office to focus on environmental and lifestyle factors that promote well-being like employment, housing, education, and even racism.

These experts dream of an improved, 360 degree view of public health. But sadly, their dreams need funding to become reality. If we continue on this path, it will be very hard to become a more healthful nation.

Resources

Primary 

U.S. Department of Health and Human Services: Prevention and Public Health Fund

Additional

American Journal of Public Health: Integrating Public Health and Personal Care in a Reformed US Health Care System

The New Yorker: Why America is Losing the Health Race

Harvard Business School: Ebola as a Wake Up Call

Public Health Newswire: NPHW Forum: Creating Healthiest Nation Requires Addressing Social Determinants of Health

The Trust for America’s Health: Investing in America’s Health

The Washington Post: Senate Passes Budget Even as Impasse on Spending Continues

Public Health Newswire: House Adopts ‘Devastating’ Budget Agreement

Public Health Newswire: Senate Passes Budget that Batters Public Health

American Public Health Association: APHA Calls Budget Agreement Devastating

The Trust for America’s Health: Investing in America’s Health: A State-by-State Look at Public Health Funding & Key Health Facts

Health Affairs: Evidence Links Increases in Public Health Spending to Declines in Preventable Deaths

The National Priorities Project: Military Spending in the United States

New England Journal of Medicine: Why We Don’t Spend Enough on Public Health

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Are We Spending Enough on Public Health? appeared first on Law Street.

Is whether or not you survive Ebola all about your genetics? A new study on mice indicates that it might be. Scientists found that certain genetic factors determine if the disease manifests as mild or devastating.

To reach this conclusion, scientists injected mice with the same strain of Ebola that caused the 2014 West Africa Outbreak. The expressed severity of the disease among the mice was scattered although they were all injected with the same unaltered and unmutated strain. Why did some resist the disease while others surrendered?

One correlation posits a provocative answer. Scientists noticed a strong correlation between symptom expression and the genetic lines of the mice. Dr. Michael Katze, a researcher on the project, declared that their data suggest disease outcomes are largely dependent on genetic factors.

It seems that the genes of the mice determined their immune response. In some mice, the genes that promote blood vessel inflammation and cell death became agitated and ultimately these mice succumbed to the disease. In other mice, the white blood cells were more lively and the genes that promote blood vessel repair were activated. These mice were able to fight back. As they observed the mice over multiple generations, they found that the ability to survive was tied to genetic lines. The continuous correlation of immunity in genetic lines presents a puzzle. Did the mice pass specific immunity on to their offspring?

Immune responses to specific pathogens, like Ebola, only develop after exposure. Specific immunity is an acquired trait, and so far, science has told us that acquired traits cannot be passed on through DNA. Traits we acquire in our lifetimes are not written into DNA and therefore not built into genes. Acquired traits result from environmental influences, like memories or even tans. If you’re a bronze goddess while pregnant, you won’t have a baby with a gorgeous tan.

So it is intriguing to think that mice who were exposed to Ebola had somehow passed on their specific, acquired, immunity to offspring through their genes. Below we’ll explore the possibility of inheriting acquired immunity.

Your Two-Sided Immune System

We’re all born with an innate immune system. It’s responsible for the classic immune response that recognizes and eliminates foreign invaders with the help of killer cells and cytokines. Skin, mucus, cells, and molecules all present at birth innately protect your body from foreign pathogens. Think of any computer you buy. It comes with a built in operating system. But that doesn’t mean you can’t upgrade, right?

Environmental factors prompt us to make little upgrades to our basic innate immune system like we do to our computer’s operating system. This is called adaptive or acquired immunity. Adaptive immunity activates in response to a specific problem that the innate immune system isn’t able to overcome. As it works, it also forms memories, so it can remember how to fight a specific pathogen if it ever returns for vengeance. A classic example is the Chickenpox. It doesn’t take much for most people to catch it the first time, but after that, many are resistant for life.

Acquired immunity, like other acquired traits, is not inherited. Even though you might have had the chickenpox, your kid will probably still get it, just like they can’t inherit your amazing tan or stellar vocabulary. With that said, we return again to the mice in the study above. Is it possible that they passed on their acquired immunity to their offspring?

“Lamarck-y” malarkey! Or maybe not….

If you’re intrigued by the study above, one historical figure would be absolutely riveted. Jean Baptiste Lamarck had this idea a long time ago — in 1801 to be specific. He theorized that evolution takes place when species develop traits to adapt to their environment and then transmit those adaptations to their offspring. Per his theory, giraffes developed long necks to feed from the tallest trees and then passed the “long neck” trait to their offspring.

Somebody else thought that evolution occurred in a different way. Charles Darwin proposed that evolution occurs through random mutations that bestow a competitive advantage for survival over a long time. Per his theory, the giraffes didn’t develop long necks to feed. It was just that the giraffes that happened to have slightly longer necks were able to survive to make more offspring. Eventually, the long neck became a dominant feature of all giraffes.

Darwin’s theory eclipsed Lamarck’s as the favorite theory of evolution. But were there some nuggets of truth in Lamarck’s musings? A growing body of evidence is creating a whisper of renewed interest in Lamarckian evolution. Collectively, it’s a young field called epigenetics.

For example, observations of starving Dutch mothers during the famine of World War II revealed that they had offspring and grandchildren more susceptible to obesity. Experiments on rats have found that obesity in mice might be caused by the high fat diets of their fathers. And there’s more where that came from.

The proof is in…the roundworm?

Dr. Oliver Hobert was curious to find out if Lamarck might have been right about the heritability of acquired traits. He suspected that ribonucleic acid, or RNA, and its role in genetic expression might shed some light on the subject.

Hobert was specifically interested in RNA interference (RNAi). Cells use RNAi to turn down or suppress certain genes. Watch the video below to see how it works.

Hobert and his team of Columbia University Medical Center (CUMC) researchers turned to roundworms to study RNAi’s influence on immunity. Roundworms have a unique capacity to battle viruses using RNAi that made them ideal for the study. The team found that a RNA molecule memory of instructions on fighting off certain viruses could be passed on from one generation of roundworms to the next.

Here is a quote from Dr. Oded Rechavi, lead author of the study, courtesy of the CUMC newsroom:

In our study, roundworms that developed resistance to a virus were able to pass along that immunity to their progeny for many consecutive generations.The immunity was transferred in the form of small viral-silencing agents called viRNAs, working independently of the organism’s genome.

More Pieces in the Puzzle

Studies like this one give scientists pause on long standing notions about the heritability of acquired traits and what we know about our genes. While many more studies are needed to completely vindicate Lamarck and his ideas, some puzzling clues are coming together. Here are some highlights from other studies that tackle similar ideas:

SardiNIA Study of Aging: Researchers at the National Research Council’s Institute of Genetic and Biomedical Research in Italy found that genetics play a key role in our ability to fight off disease. According to the study, the immune system has evolved to reject certain pathogens and cancers. The basis of the study is that several adaptive immune cells are regulated by genetics. They found 89 gene variants with significant ties to the production of specific immune system cells.

Chief of NIA’s Laboratory of Genetics, David Schlessinger, Ph.D., sums it up nicely:

If your mother is rarely sick, for example, does that mean you don’t have to worry about the bug that’s going around? Is immunity in the genes? According to our findings, the answer is yes, at least in part.

Natural Environment Research Council UK: This study demonstrates that genetic variations in cytokines are a crucial component of individual variation in pathogen resistance and immune function. During both adaptive and innate immune responses, cytokines carry messages. They directly determine how an immune system will respond to a given challenger. So variations in the genes that control these cytokines, therefore, ultimately affect the immune system.

Analysis of Genetic Variation in Animals: A study of hemophiliac individuals infected with HCV showed that genetic factors determine the outcome of the disease. The researches studied siblings and found correlative rates of disease recovery among siblings was much higher than the pairs of randomly paired individuals, concluding that people who share genes might also share higher resistance to certain diseases.

Innate Immune Activity: Another study looked at the genome sequence that regulates expression of genes involved in the immune system. The study found that sometimes genes of interest reveal themselves when certain cells involved in fighting an infection are stimulated.

Back to the E-word…

Ebola usually depletes a person’s immune cells. Some immune systems stand up against the initial attack and their bodies are able to maintain some immune cells. These people are more likely to survive. We learned from the study on mice that it could be genetic factors that determine the disease outcome. What about people?

One study found that people with certain variations of the human leukocyte antigen-B  gene survived Ebola while those with another variation did not. Another finding deals with a mutation in the NPC1 gene. Cells taken from people with this gene are resistant to Ebola. The mutation is relatively common in certain populations in Europe and Nova Scotia.

More research is needed, but studying these genetic variances might reveal more secrets of why some survive Ebola and others do not.

Immuno Synergy

These findings do more than just play with our ideas of how traits can be inherited. If doctors were able to browse through your genetic catalog of specific pathogen resistance, they could administer therapies that create synergies among treatments. We might be able to predict what ailments you’re more susceptible to and take appropriate preventive actions. We might be able to study the genetic factors that make some people resistant to illnesses like Ebola, and synthesize them to construct even more effective treatments.

Is this science fiction? We don’t know yet, but no theories should be completely forgotten. As we’ve learned from Lamarck, even formerly discarded ideas can make a splash centuries after their inception.

 Resources

Primary

PLOS Genetics: Genetic Diversity in Cytokines Associated with Immune Variation and Resistance to Multiple Pathogens in a Natural Rodent Population

The Royal Society: Variation in Immune Defence as a Question of Evolutionary Ecology

NIH: Genetic Variability of Hosts

University of Western Australia: Genetic Variation of Host Immune  Response Genes and Their Effect on  Hepatitis C Infection and Treatment Outcome

Additional

Science Daily: Genetic Factors Behind Surviving or Dying From Ebola Shown in Mouse Study

Broad Institute: Scientists Make Connection Between Genetic Variation and Immune System in Risk for Neurodegenerative and Other Diseases

Wellcome Trust Centre for Human Genetics: Study Tracks Effects of Immune Activity Across the Genome

MNT: Immune Response Determined by Our Genes, Study Shows

History of Vaccines: Viruses and Evolution

LiveScience: How Do People Survive Ebola?

Research Gate: What is the Scientific Position on the Inheritance of Acquired Characteristics (Lamarckism)?

Ashley Bell

Ashley Bell communicates about health and wellness every day as a non-profit Program Manager. She has a Bachelor’s degree in Business and Economics from the College of William and Mary, and loves to investigate what changes in healthy policy and research might mean for the future. Contact Ashley at staff@LawStreetMedia.com.

The post Is the Key to Surviving Ebola in Your Genes? appeared first on Law Street.

The Ebola outbreak, which at first seemed like a distant fear, has become a reality in the United States, especially for the family of Thomas Eric Duncan. Duncan was the first individual to have died from Ebola on American soil. In the aftermath of his death, there has been speculation as to whether Duncan’s family will pursue a liability lawsuit against the hospital that treated Duncan. However, under Texas Law, it would be very difficult for Duncan’s family to succeed with any claims against the Hospital.

The Facts

On September 25, 2014 Thomas Eric Duncan went to Texas Health Presbyterian Hospital where he was treated for a fever, abdominal pains, and vomiting–all symptoms of Ebola. Duncan was not tested for Ebola, and in fact, he was sent home with pain relievers and antibiotics. He was diagnosed with Ebola after returning to the hospital when his symptoms worsened. On October 8, 2014, Duncan died.

The Law

In 2003, Texas passed a tort reform that gave an extra layer of protection against civil liability lawsuits for Emergency Room doctors and nurses. Under this reform, plaintiffs must demonstrate “willful and wonton” conduct in order to prove negligence. This is one of the highest legal burdens to prove in the country.

This standard requires that the individual’s conduct creates “an extreme risk of danger” and that the individual has “actual, subjective awareness of the risk involved and chooses to proceed in conscious indifference to the rights, safety, or welfare of others.” Relating to this situation, to successfully prove negligence, Duncan’s family must show that the ER doctors not only created an extreme risk of danger, but that they actually knew about the danger, and continued to act in a manner that demonstrated their indifference toward Duncan. An important aspect of this question would be to determine what exactly the doctors and nurses knew about Duncan’s condition during his first visit.

Even if liability were proven, the tort reform established a $250,000 cap for non-economic damages in a healthcare lawsuit. So even if Duncan’s family were able to prove willful and wonton negligence, they would most likely be limited to $250,000 in damages.

The Reality

The harsh reality is that Duncan’s family probably has a slim chance at succeeding in a lawsuit against the hospital. On one hand, the 2003 tort reform has been a major success. It has caused medical malpractice claims to decrease by nearly two thirds between 2003 and 2011. On the other hand it begs the question, “at what cost?”

Melissa Klafter

Melissa Klafter has a JD from St. John’s University School of Law and plans to pursue a career in Personal Injury Law. You can find her binge-watching her favorite TV shows, rooting for the Wisconsin Badgers, and playing with her kitty, Phoebe. Contact Melissa at staff@LawStreetMedia.com.

The post Slim Chance of Legal Recourse for Family of First American Ebola Death appeared first on Law Street.

Mankind’s greatest enemy is not war or hunger but infectious disease. Throughout history it has cost countless deaths, and even in the twenty-first century our defenses against it remain limited. Above all, it is the threat of outbreak that unsettles us so; it is not just suffering and death, but fear. Whether it’s the Black Plague, Cholera, Spanish Influenza, H1N1, or Ebola, disease is a dark cloud looming over our lives.

Most of the microscopic killers with which we contend have been transmitted to us through animals. In the early ages of settled agriculture, close contact with domesticated chickens, pigs, cows, and others exposed humans to pathogens to which their immune systems had no previous exposure and consequently minimal means by which to combat them. There are two primary behavioral patterns of diseases. Some ascribe to the category of “chronic.” In this case, as geographer and ornithologist Jared Diamond explains, “…the disease may take a very long time to kill its victim; the victim remains alive as a reservoir of microbes to infect other[s]…” The other category is “epidemic.” In this case, Diamond continues, there might be no cases for a while, followed by a large number in an affected area, and then none for a while more. Such behavior is a consequence of the intensity of the disease’s manifestation; it strikes with such force that it basically burns itself out because the potential hosts all either die or become immune.

“Epidemic” is a widely feared term. Rather than consider the fact that they can and have been occurring on very small scales throughout human history, many people associate epidemic with things like the Black Plague in Europe, Smallpox in the New World, or a global zombie apocalypse. Since people naturally fear most what they do not understand, insufficient knowledge of disease vectors and behavior results in widespread fear and panic.

Ebola is a relatively late arrival on the scene. Originally suspected to be yellow fever, it was discovered in 1976 near the Ebola River in what is now the Democratic Republic of the Congo. Samples extracted from an ill nun who had been working in the region came to doctors and scientists in an Antwerp, Belgium laboratory. They eventually discerned that the infection behaved differently from what would be expected of the original diagnosis. After sending samples to the Center for Disease Control in Atlanta, their conclusions were confirmed and a new disease had been discovered. Shortly thereafter, another outbreak occurred relatively far away in Sudan. While knowledge of the initial source and starting location of the disease is still vague, it was determined that it had spread via unsterilized syringes and contact with bodies during funerals. Therefore a lack of knowledge of the nature of the disease lent itself to its spread.

Ebola in large dropped off the radar screen until the recent epidemic began in West Africa. Going hand in hand with lack of knowledge of the disease are incomprehensive and underdeveloped means of addressing it. On a recent edition of Global Public Square, the insightful international news show hosted by CNN’s Fareed Zakaria, international relations PhD Chelsea Clinton declared that the disease is spreading exponentially, necessitating exponential containment measures. This is very difficult to achieve, due to the poor technological and economic infrastructures of the region. As Dr. Paul Farmer — another guest on Zakaria’s show — expanded, the Liberian healthcare system is also very weak. Liberian Foreign Minister Augustine Ngafuan detailed how Liberians have deeply ingrained burial practices that involve close contact with bodies; this is an important aspect of cultural values in the region and not easily relinquished in the face of something that foreign experts, much less locals, barely understand.

A Liberian village, courtesy of jbdodane via Flickr.

Globalization and increased interconnectedness between individuals, societies, and locations has exacerbated the rate at which diseases spread. Many Americans cried out when infected aid workers were brought home to be treated. Appropriate measures were taken in this instance, with sanitary transportation vehicles bringing the patients to the Emory hospital in Georgia. Due to its affiliation with the CDC, this is one of the few facilities truly equipped to accommodate infectious diseases of this nature. Both those patients recovered, though they would likely have died if they were forced to remain in Africa. The situation was handled intelligently and effectively, without resounding negative consequences. Yet the outcry and fear demonstrates people’s lack of knowledge and tolerance of the unknown and perceived dangers. This was in fact the first occasion in which Ebola was present on American soil.

The situation changed with the death of Thomas Duncan. Having arrived from Liberia in late September, Duncan provided a new first by being the first patient diagnosed with Ebola in the United States. His illness was unknown during his transit, and so new fears arose as to the likelihood of Ebola crossing the ocean with traveler hosts. Now in a complete state of fear, Americans want more and more action taken in defense of the nation’s health, yet do not know what those measures ought to be because we do not know enough about the disease. Many airports have begun taking travelers’ temperatures. The CDC initially cited 101.4 degrees as the point at which one must be quarantined, but lowered it after some supposedly ill people were cleared. This demonstrates the uncertainty of the disease’s nature; in what ways does Ebola affect a person’s body temperature? At what point in their illness are they contagious? Is a body temperature an effective indicator of this? These questions have yet to be answered for the disease of whose existence we have known for less than 40 years.

Specialists clean up a Hazmat area, courtesy of sandcastlematt via Flickr.

The second set of problems that are causing fear are the alleged breaches of protocol that have enabled several other people to catch the disease in the United States. The Dallas hospital in which Duncan died was not equipped to handle this disease and consequently could not treat him effectively. Furthermore, the staff did not have the proper training insofar as interacting with Ebola, and this has been cited as the reason why nurse Nina Pham, who was treating him, became ill as well. A recent video surfaced wherein a patient is being transferred from one vehicle to another by four workers in “hazmat,” or hazardous material, uniforms. A fifth person, dubbed “clipboard man,” stands with them completely unprotected. Finally, CDC Director Dr. Tom Frieden has come under fire for making statements and then retracting them. Pennsylvania Republican Congressman Tom Marino has even called for him to step down. We have quickly forgotten, though, that in the early 1990s Frieden was instrumental in developing awareness and programs to combat a rising Tuberculosis epidemic in New York City. In addition to other stellar career highlights, Frieden is a highly capable leader experienced in engaging these concerns.

We are too wrapped up in fear of the unknown to do anything but demand immediate results. Ebola is a newcomer on the scene and will take some time to understand effectively. As we continue to discern our relationships with our surrounding environments, we do know that ebola is not nearly as contagious as other diseases. It requires direct contact with bodily fluids of infected patients. As we continue to learn how it works, and how our actions, societies, and cultures interact with it, we will become more effective at addressing it. In the meantime, we annually face airborne foes which are far more dangerous and contagious; do not forget to get your flu shot in the coming weeks.

Franklin R. Halprin

Franklin R. Halprin holds an MA in History & Environmental Politics from Rutgers University where he studied human-environmental relationships and settlement patterns in the nineteenth century Southwest. His research focuses on the influences of social and cultural factors on the development of environmental policy. Contact Frank at staff@LawStreetMedia.com.

The post Ebola and America’s Fears appeared first on Law Street.

From Ebola to killer relationships to resume tips, the top posts on Law Street really ran the gamut last week. Writer Anneliese Mahoney brought in the number one most read post of the week with her warnings against overreacting to Ebola in the United States; Marisa Mostek shed light on a few recent cases of incredibly disturbing murders that developed out of relationships gone very, very wrong in the second most read piece; and Natasha Paulmeno wrote post number three encouraging Millennials to highlight the history of temporary work experience that many of us have as positives instead of negatives. ICYMI, here are Law Street’s top three articles from last week.

#1 Keep Calm and Carry On: You Don’t Have Ebola

It seems like all anyone can talk about anymore is Ebola. Especially now that the first case of Ebola has been found in the United States, in Dallas, and the first case transmitted outside Africa reported in Madrid, people seem to be freaking out. One big concern has been that Ebola is going to become an issue in the U.S., which I just want to start by saying is unfounded and unrealistic. The public health infrastructure in the U.S., as well as our ability to isolate the disease make it incredibly unlikely that it becomes an epidemic. You’re still significantly more likely to die of the flu, or a car accident than even go near someone who has Ebola. (Read full article here)

#2 Be Careful Who You Love

People tend to do some pretty clinically insane things to get back at their exes. Disgruntled men dumped by the girls of their dreams have posted naked pictures of them online, dated their best friends, and other concerning but far-from-deadly actions. However, the men starring in recent headlines have taken revenge to a whole new and disturbing level. Recently, a dude was so peeved when his girlfriend left him that he concluded that feeding her dog to her was the best means of revenge. What ever happened to the saying “living well is the best revenge”? Not anymore, apparently. (Read full article here)

#3 Resume Booster: Maximize Your Temporary Work Experience

A history of consistent temporary work may be comparable with full time experience in the eyes of senior hiring managers. So why aren’t more millennials taking advantage of their temporary work history as resume boosters and learning experiences? Temp jobs teach young professionals a wide variety of skills they wouldn’t have otherwise acquired. These temporary work opportunities expose young business pros to many new industries and work environments. The flexibility temp workers develop under these conditions offers desirable traits to prospective employers. (Read full article here)

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Chelsey Goff (@cddg) is Chief People Officer at Law Street. She is a Granite State native who holds a Master of Public Policy in Urban Policy from the George Washington University in DC. She’s passionate about social justice issues, politics — especially those in First in the Nation New Hampshire — and all things Bravo. Contact Chelsey at cgoff@LawStreetMedia.com.

Chelsey D. Goff

Chelsey D. Goff was formerly Chief People Officer at Law Street. She is a Granite State Native who holds a Master of Public Policy in Urban Policy from the George Washington University. She’s passionate about social justice issues, politics — especially those in First in the Nation New Hampshire — and all things Bravo. Contact Chelsey at staff@LawStreetMedia.com.

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It seems like all anyone can talk about anymore is Ebola. Especially now that the first case of Ebola has been found in the United States, in Dallas, and the first case transmitted outside Africa reported in Madrid, people seem to be freaking out. One big concern has been that Ebola is going to become an issue in the U.S., which I just want to start by saying is unfounded and unrealistic. The public health infrastructure in the U.S., as well as our ability to isolate the disease make it incredibly unlikely that it becomes an epidemic. You’re still significantly more likely to die of the flu, or a car accident than even go near someone who has Ebola. As of press time, Thomas Eric Duncan — the man in Dallas who had contracted Ebola — has passed away of the disease, and while our thoughts and sympathy are with his family, this development does not change the risk factors in the U.S.

People are losing their minds over it. Seriously, check out #EbolaQandA on Twitter. It makes me terrified — not of Ebola, but at the extent to which our American education system appears to have failed people when it comes to very, very basic concepts of health and geography. Now Ebola is an incredibly important world issue right now, and combating it absolutely deserves our attention, vigilance, and support. That being said, we all need to take a deep breath over here in the U.S., and stop listening to misinformation and conspiracy theories, because this is getting silly. Here’s a helpful flowchart for anyone who’s concerned about the spread of Ebola in America.

Worried about Ebola? Here's a flowchart just for you! #diseases #outbreak #EbolaOutbreak #notenoughwine pic.twitter.com/U6uvQd8MKf

— Melody Butler (@MelodyButler) August 2, 2014

There have been many proposals to try to keep the United States from having Ebola-infected people cross over our borders. One of the most extreme is a “travel ban” aimed at West African countries with high infection rates.

This sounds like a good idea in theory, it really does. But in reality, it’s not something the U.S. will do, or should do. First of all, the best way to make sure that the United States does not experience problems with Ebola is to stop the epidemic. And if we restrict our access and communication with the affected region, it’s just going to get worse. When there’s not a huge risk of Ebola reaching any sort of epidemic levels in the United States, it doesn’t make sense to impede our relief efforts with a ban. A travel ban could mean that relief workers have a harder time going in, or refuse to go at all because they worry that they might not be able to get back.

Also, instituting a travel ban could make it more likely that someone with a case of Ebola makes it into the U.S. If we have a ban in place for countries heavily infected like Sierra Leone, Guinea, and Liberia, people are going to find a way around it. They could go to Senegal, or any other nearby nation where travel is not restricted. Because of the ban they may be incentivized to lie about whether or not they’ve been in contact with an infected person in hopes of not being prevented from getting on a plane. Right now we’re able to track people and examine them at the airport and upon arrival, and we’re going to strengthen our tools for that. We shouldn’t incentivize anything that makes it harder for us to do that.

I’m not an expert in public health; I don’t know what will happen with this epidemic. But what I do know is that panicking is going to do nothing. Educate yourself. Donate to the relief effort. Don’t feed the frenzy. This crisis needs a pragmatic approach, not a reactionary one.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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For the first time in the United States during the current outbreak, a patient was diagnosed with the Ebola virus–the Centers for Disease control confirmed the case on Tuesday. As if Thomas Duncan, the infected Liberian man who came to the United States, doesn’t have enough to worry about, he’s also facing legal trouble. The Liberian government will prosecute Duncan when he returns to Liberia for allegedly lying on an airport questionnaire, the Associated Press reported.

Duncan left Liberia on September 19th to visit his family and wasn’t showing any symptoms at the time. Days before, he helped take a 19-year-old infected pregnant woman to a hospital and helped bring her back home when she was turned away for lack of space, the New York Times reported. The woman, Marthalene Williams, died the next day. Williams’ parents said that Duncan helped carry her back from the taxi to her house. Her brother, who accompanied her, her father, and Duncan on the taxi ride home, also started showing symptoms of Ebola and died less than a week later.

When Duncan was at the airport on his way out of Liberia, he received a questionnaire given to anyone intending to depart Liberia, Guinea, and Sierra Leone – the three West African countries countries most severely facing the Ebola epidemic – asking him about his recent contact history in the country. Duncan answered “no” when when asked whether he had been in contact with anyone who may have been infected.

Duncan passed the screening at the airport without showing any sign of symptoms and boarded his plane. The idea that Liberian officials would threaten to prosecute him might suggest double standards, since people are still able to move between countries in West Africa. But Liberia may have chosen to do this to make an example out of Duncan. It’s likely that Liberia wants to set a precedent that its screenings are serious business and wants countries to where Liberians travel to be reassured about that, Cornell University Law professor Jens Ohlin told the Atlantic.

The sudden decision to prosecute an infected person might also be an attempt not to upset U.S. officials, though Ohlin doesn’t seem to think so. This hasn’t happened in other major countries, so it is tough to say whether Liberia is singling out the United States.

Duncan is arguably very lucky that he happened to be in America when he started to show symptoms of Ebola. The average death rate has been up to 90 percent in previous outbreaks, according to the World Health Organization. But in August, two American aid workers who were working in West Africa were cured of the disease after being treated in Atlanta.

Currently being treated in a Dallas hospital, Duncan started showing symptoms on Sept. 24 and went in for treatment two days later. His family members in Dallas have also been quarantined in their apartment. While the situation is dire in West Africa, CDC Director guaranteed that it wouldn’t be a problem in the United States. “The United States has a strong health care system and public health professionals who will make sure this case does not threaten our communities,” he said in a press release on Tuesday.

—

Zaid Shoorbajee (@ZBajee)

Featured image courtesy of [Phil Moyer via Flickr]

Zaid Shoorbajee

Zaid Shoorbajee is a an undergraduate student at The George Washington University majoring in journalism and economics. He is from the Washington, D.C. area and likes reading and writing about international affairs, politics, business and technology (especially when they intersect). Contact Zaid at staff@LawStreetMedia.com.

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For the first time in decades, the United Nations has declared four of the world’s humanitarian crises a “Level 3 Emergency,” the highest possible rating the organization can assign. The four on the list are Syria, South Sudan, Central African Republic, and Iraq; Iraq was just added to the list on August 14th. From the Islamic State beheading journalists, to the thousands dying from the Ebola virus in Western Africa, from the thousands of civilians fleeing towns in Iraq, to the million malnourished and displaced in South Sudan, as a world, we are collectively in crisis.

According to Nickolay Mladenov, special representative of the United Nations Secretary General, the “Level 3”  emergency designation facilitates “mobilization of additional resources in goods, funds and assets to ensure a more effective response to the humanitarian needs of populations affected by forced displacement.”

The Inter-Agency Standing Committee, a team of UN and other NGO humanitarians, is responsible for determining the level of crisis. Level 3 is given to countries experiencing civil unrest that causes the displacement or removal of thousands of people. Unlike natural disasters, conflicts put humanitarian workers in the crossfire, making relief efforts that much more difficult.

Iraq became a particular concern after the situation on Sinjar Mountain escalated and thousands of Yazidi families–a particular religious community in Iraq–were trapped on the mountain without water, nourishment or any form of sanitation as ISIS fighters surrounded them. Despite numerous Department of Defense airdrops over a week long period in August, 1.5 million Iraqis are in need of humanitarian help, according to USAID.

USAID estimates that 10.8 million people are in need of humanitarian assistance in Syria; 2.5 million in the Central African Republic, with 900,000 more displaced; and 1.1 million displaced in South Sudan. USAID Administrator Rajiv Shah said:

This is the first time in our agency’s history that we have been called on to manage four large-scale humanitarian responses at once— in addition to reaching other vulnerable populations worldwide and preparing communities ahead of natural disasters.

UNICEF, WFP, UNFPA, UNHCR, CARE USA, World Vision USA, Save the Children, Oxfam America and many other NGOs are currently operating in these four countries. Their contributions have saved thousands from death, and millions of individuals have been helped to get back on their feet. The U.S. government alone has sent more than $2.8 billion in assistance to these four countries; but the battle is nowhere close to being done.

To the 5,000 people who are suffering from the Ebola virus, I feel for you. To my sisters in India, who have no choice but to give contaminated water to their children, I feel for you. To the 5.5 million children affected by the crisis in Syria, I feel for you. To the families in Gaza whose houses have been destroyed, I feel for you. I know my empathy won’t bring your loved ones back, give you a new home, or calm the fear that you have to live with everyday. But I hope my words can reach and inspire my colleagues here in America. I hope my words will make people realize how mundane their issues are compared to those I’ve outlined above. I hope my words can bring us together collectively, so we can finally realize that it isn’t “us and them,” but simply “us.” We are Iraq. We are Syria. We are South Sudan. We are Central African Republic. If they are experiencing a crisis, we are experiencing a crisis. With countries like Gaza, Yemen and the Democratic Republic of Congo on the horizon of reaching a level 3 designation, humanitarian aid is needed now more than ever. We are collectively in crisis, but it doesn’t have to be that way.

Mic Drop

Trevor Smith

Trevor Smith is a homegrown DMVer studying Journalism and Graphic Design at American University. Upon graduating he has hopes to work for the US State Department so that he can travel, learn, and make money at the same time. Contact Trevor at staff@LawStreetMedia.com.

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The recent Ebola outbreak is plaguing thousands across West Africa with illness and even death. In the modern age of science, it seems incomprehensible that there is not yet a vaccine for Ebola. Though the virus is an urgent health concern, pharmaceutical companies have few incentives to develop drugs to combat the disease. Read on to learn what happens when economic incentives do not align with public health needs, and what better solutions may exist for drug development.

What is the status of the Ebola outbreak and vaccine?

Ebola virus disease is characterized by fever, intense weakness, and muscle pain, leading to more severe symptoms. Ebola was initially transmitted by animals and is now spreading between humans through contact with bodily fluids. The outbreak was first detected in Guinea, by which time it had already spread to Liberia, Sierra Leone, Senegal, and Nigeria. A separate outbreak occurred in the Democratic Republic of Congo, which is believed to be unrelated to the outbreak in West Africa. The virus has primarily infected villages where there is extreme poverty and insufficient medical care to combat the spread of the virus.

Statistics

Mortality rates for the Ebola virus are well over 50 percent. Since March, Ebola has killed more than 1,500 people, making it the deadliest outbreak of the virus in human history. The World Health Organization estimates that the Ebola outbreak could affect 20,000 within the next nine months, and that roughly half a billion dollars is needed to stop the spread. Watch the video below for more information on the outbreak:

Vaccines

Ebola first appeared in 1976, yet nearly 40 years later no approved vaccination exists. In part this is due to the nature of the virus. Since incidents of Ebola are rare and occur in remote villages, it is difficult for scientists to effectively obtain samples and study the disease. Scientists cannot predict when an Ebola outbreak will occur, and even during a typical outbreak there are rarely enough people for a vaccine trial.

Since the outbreak, scientists are furiously working on an Ebola vaccine, and requests for approval are being fast-tracked. In the United States, the National Institutes of Health partnered with GlaxoSmithKline to develop a vaccine. The potential vaccine tested very well on primates, but the trial on humans only began on September 1. Initial data from the trial will not be available until late 2014. A number of other prototype vaccines are being worked on across the world.

Other Treatments

ZMapp was the experimental drug given to two Americans who contracted Ebola this year. While vaccines are designed to prevent future infections, ZMapp was designed to treat an existing Ebola infection. Both Americans who took the drug recovered, but the company that manufactured ZMapp has exhausted its supply.

What is the drug development process like?

Developing a new drug or vaccine is an extremely long process due to stringent regulation. Candidates for a new drug to treat a disease range anywhere from 5,000 to 10,000 chemical compounds. Of these compounds, roughly 250 will show promise enough to warrant further tests on mice or other animals. On average, ten of these will then qualify for tests on humans. Since certain outbreaks, such as Ebola, do not lend themselves to have vaccines ethically tested on humans, the United States does provide a way for the drugs to be approved on animal tests alone.

Pre-clinical and clinical development for a new drug takes between 12 to 15 years, though the Ebola vaccine should come much sooner. Pre-clinical development includes testing the various chemical entities and meeting all regulations for use. Three sets of clinical trials are then conducted on humans. Clinical phases include trials on healthy humans to test for the safety of the drug. Testing then moves to those who are ill to see if the treatment is successful. If successful, the drug is submitted for further approval by the Food and Drug Administration. Other countries have similar regulatory bodies to the FDA. Internationally, the World Health Organization oversees which drugs can be used to combat a crisis like Ebola. Learn more details about the development process by watching the video below:

The problem is not that scientists lack the capability to create an Ebola vaccine, but rather that the economics of drug development do not entice companies to develop such a vaccine. Pharmaceutical companies estimate the cost of the entire process of developing a new drug to range from hundreds of millions to billions of dollars. Many times the drugs are not successful, in which case the companies have spent a huge amount of money and have no profit-making product. A Forbes analysis estimates that 95 percent of experimental drugs tested ultimately fail. Only one in five that reach the clinical trial phase are approved.

Given the low rate of success for potential drugs and the huge amounts of money that can be spent on research and development of drugs, cost plays a huge factor. In the United States, basic discovery research is funded primarily by government and philanthropic organizations. Development in later stages is funded mostly by pharmaceutical companies or venture capitalists.

Why do some see funding as a problem?

Funding for areas that support public health is a tricky issue. Since pharmaceutical companies are looking to make a profit, they have an incentive to make drugs that a large number of people will take and be on for a long time. Most research and development for these companies target diseases that affect wealthy people in primarily Western countries.

Targeting wealthier clients leads to a severe underinvestment in certain kinds of drugs. Diseases of poverty cannot compete for investment from financial companies looking for big return. Ebola infects relatively few and primarily affects the poor. Ebola is similar to diseases like malaria and tuberculosis, which kill two million people each year but still receive little attention from pharmaceutical companies. Watch the video below for more on the economics of drug development:

Neglected Tropical Diseases, a set of 17 diseases including Dengue Fever and Chagas Disease, affect more than one billion people each year and kill half a million. Most of these diseases could be completely eradicated, but the drugs are not widely available. One study found that of the more than 1,500 drugs that came to market between 1975 and 2004, only ten were aimed at these diseases.

Even though developing countries may experience an outbreak of a disease, the demand for new drugs is limited. In rural villages in Africa, many reject clinical drugs for diseases such as Malaria and Tuberculosis. Instead, they favor spiritual healers and herbal remedies.

What is being done to promote drug research of neglected diseases?

The Office of Orphan Products Development (OOPD) in the FDA was designed to advance development of products that could be used to diagnose or treat rare diseases affecting fewer than 200,000 people. Orphan diseases do not traditionally receive much attention from pharmaceutical companies. The program provides a tax credit of up to 50 percent for research and development of drugs for rare diseases. When these drugs do become available, however, there is still no guarantee that patients will be able to afford them.

Since 1983 the OOPD program successfully enabled the development and marketing of more than 400 drugs and products. In the ten years prior, only ten of these products came to the market. Learn more about the OOPD with the video below:

Additionally, in 2007 the FDA created a voucher program to encourage research for neglected diseases. If a company receives approval for a drug for neglected diseases, it will receive a priority review voucher to speed up the review time for another application. Only four of these vouchers have been awarded so far.

Are there better ways to fund drug research?

Some argue that researching very rare diseases is not worth the time, and that instead research should be focused on more prevalent diseases. Companies will naturally invest in research for the most pressing concerns that offer the greatest opportunity for profit. Drug development for rare diseases should not be encouraged since the diseases occur so infrequently. Others argue research for rare diseases is essential to public health. The case of Ebola shows that even rare diseases can have a disastrous world impact.

Bioterrorism

Beyond public health, knowledge about the workings of any serious virus or disease is important to combat threats of bioterrorism. Concerns of bioterrorism are what led to Ebola research in the past. Serious threats of bioterrorism force the government to partner with research institutions to learn more about rare diseases. In March, the University of Texas and three other organizations received $26 million from the National Institutes of Health to find a cure for Ebola and the Marburg virus in case they were ever used for a bioterrorist attack. Other groups partnered with the Department of Defense to find an injectable drug treatment for Ebola.

Prizes

Prizes and grants are seen as ways to incentivize companies to develop drugs for diseases they might otherwise ignore. Financial incentives would encourage speedy development for an Ebola vaccine. The World Health Organization has looked into building a prize fund, where a centralized fund would reward drug manufacturers for reaching certain research goals. These tactics are more cost effective for the government, since they only have to pay if the product actually works. By creating grants for specific drugs, the government can pull research into neglected areas. Most prizes and grants, however, are not offered until a severe outbreak occurs, by which time many people are already in need of drugs.

Partnerships

Others point to room for greater partnerships between various entities for drug development. The greatest area for partnerships is between development groups and pharmaceutical companies. For instance, if a company pays to research and develop a product, the government could pay the company for the right to the product and could then promote the product itself without worrying about profit. In another case, GlaxoSmithKline and Save the Children arranged for someone from the charity to be on GSK’s research and development board, so the groups can share expertise and resources.

The Ebola outbreak indicates areas in which our current drug development model is lacking. People are dying because no Ebola vaccine exists. When pharmaceutical companies search only for profits, drugs for rare diseases go neglected. By expanding partnerships and offering greater prizes and financial incentives, the government can encourage drug research for these otherwise neglected diseases.

Resources

Primary

WHO: Ebola Virus Disease

FDA: Developing Products for Rare Diseases

CDC: Experimental Treatments and Vaccines for Ebola

Additional 

CNN: Ebola Outbreak: Is it Time to Test Experimental Vaccines?

Vector: De-risking Drug Development

Guardian: Funding Drug Development for Diseases of Poverty

Reuters: Scant Funds, Rare Outbreaks Leave Ebola Drug Pipeline Slim

Explorable: Research Grant Funding

Vox: We Have the Science to Build an Ebola Vaccine

American Society for Microbiology: Ebola Virus Pathogenesis

NBC: No Market: Scientists Struggle to Make Ebola Vaccines

Wall Street Journal: Two Start-Ups Aim to Change Economics of Vaccine Production

NPR: Would a Prize Help Speed Up Development of Ebola Treatments?

Harvard Global Health Review: Funding Orphan Drugs

LA Times: U.S. Speeds Up Human Clinical Trials

Washington Post: Why the Drug Industry Hasn’t Come Up with an Ebola Cure

New Yorker: Ebolanomics

Alexandra Stembaugh

Alexandra Stembaugh graduated from the University of Notre Dame studying Economics and English. She plans to go on to law school in the future. Her interests include economic policy, criminal justice, and political dramas. Contact Alexandra at staff@LawStreetMedia.com.

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