The Washington Independent - U.S. news and politics - washingtonindependent.com: Stories by Arthur Allen

A Bird from Ashes?

Arthur Allen — Mon, 31 Dec 2007 17:23:41 GMT

This is beginning to sound like a meeting of Media Dinosaurs Anonymous.

Hello, my name is Arthur Allen and I, too, am an old media critter. For 13 years I worked as an Associated Press reporter and editor, covering the war in El Salvador and the post-unification struggles of Germany, among other things. In 1995 I dumped the wire service and returned to my college fascination with the biomedical sciences. As a freelancer I’ve focused on the ways that medical innovation affects politics and culture and vice versa, writing for publications such as the Washington Post Magazine, Mother Jones, The New York Times Magazine, The New Republic, Linguafranca (R.I.P.), Redbook, Slateand Salon. Last January I published Vaccine: the Controversial Story of Medicine’s Greatest Lifesaver.

As one friend after another, weighted down by mortgages and college tuition, sloughs off of a dying newspaper and goes into public relations, I’m thrilled to have the chance to contribute to a new kind of outlet that’s founded on some old-school journalistic values. (Dang, we should have called it The Washington Phoenix). For the Independent, I will contribute reporting in a column called “Political Science,” examining the politics of scientific issues du jour. In particular, I will look at the politicization of the federal scientific bureaucracy under the Bush Administration. Our scientists and science policymakers have been under a lot of stress the past seven years. Whether it’s White House officials suppressing reports on greenhouse gases, anti-vaccine activists threatening CDC officers, or Bush appointees firing Texas education officials for upholding the theory of evolution, this administration and its cronies have sought to control or tinker with scientific decisions to an unprecedented degree. At the same time, I do believe that we live in an age of wonders. While casting a jaundiced eye on the corruption of science, I’ll be highlighting some of the exciting news coming out of labs and research institutions.

Vaccines Don't Cause Autism

Arthur Allen — Thu, 17 Jan 2008 18:56:31 GMT

The ongoing vaccines-cause-autism debate has taken a new turn recently. There’s really little left to be debated, since the scientific evidence has overwhelmingly disproven a link (check out this report to start), but the controversy is being kept alive by money issues.

Under a 1986 law, parents can bring children thought to be injured by vaccines into a special program of the federal Court of Claims. It can be extremely costly to get autistic children the medical, psychiatric and educational services they need, and many parents are seeking help through lawsuits. About 5,000 parents of autism spectrum children have sued in federal court to get compensation for damage they say was caused by vaccines. The first rulings on those hearings aren’t expected until this spring.

But a few dozen of these cases have slipped into the U.S. District Courts, and the first major decision, which surfaced recently, indicates that judges aren’t buying the testimony of scientists who believe in a link.

Meanwhile, an important new study from California has driven another nail into this undying corpse. The study showed that while thimerosal—the mercury-containing preservative many parents blame for causing autism—has been nearly eliminated from pediatric vaccines in California, the numbers of kids diagnosed with the disease keep rising.

Cultural Baggage Stymies AIDS Prevention in Africa

Arthur Allen — Fri, 18 Jan 2008 15:11:21 GMT

Photo credit: Chris Gander, stock.xchng

When two African trials last year showed that circumcised men were 60 percent less likely to become infected with HIV than those with foreskins, the World Health Organization and otherfunders began recommending the procedure as a routine preventive measure. This was front-page news, but part of the story wasn’t told.

For a decade, a handful of HIV prevention professionals had been shouting about the evidence that circumcision could help stop AIDS, but few listened. Their saga offers a painful example of how cultural baggage in the public health world can lead to bad policy—and sometimes, to unnecessary deaths.

Whether it’s abstinence-only education or the refusal, by some African leaders, to acknowledge that HIV causes AIDS, wishful thinking often obscures and hampers public health. In the case of circumcision, 20 years of data have shown that the African countries with high circumcision rates have far lower rates of HIV. Basic research has helped explain this phenomenon by demonstrating that the foreskin contains cells rich with HIV receptors, and that other foreskin infections can provide a bridge for the virus to enter the body. But many of the world’s AIDS authorities put their fingers in their ears when confronted with this evidence.

“The tragedy of the endorsement of male circumcision is that we could have done it five or ten years ago,” said Malcolm Potts (an embryologist and professor of public health at the University of California). “You can’t push the light switch and do a million circumcisions immediately. It takes time. And people are dying as a result.”

To get a feel for the surreal world of AIDS bureaucracies, consider this tale from a friend of mine, an officer of the U.S. HIV prevention program in Southern African when Randall Tobias, director of the President’s Emergency Plan for AIDS Relief or Pepfar, visited his base in Swaziland a few years ago.

In the weeks before Tobias’ visit, my friend’s bosses issued repeated warnings. “Whatever you do,” they said, “do not even mention the subject of male circumcision.”Pepfar has provided lifesaving drugs for about 2 million people with HIV, but also pushed a partisan line of abstinence-based education, sometimes refusing to fund services like those that teach prostitutes to use condoms. Male circumcision was not on its agenda. Tobias, a formerATT and Eli Lilly chief executive, toed the line, urging the “abstain, be faithful, or use a condom” approach. Then he quit the government when he was linked to a D.C. prostitution ring.

As it happens, my friend in Swaziland, Daniel Halperin, a medical anthropologist, was among a small group of researchers who had been frustrated for years by the unwillingness of big AIDS organizations to recognize the more low-tech methods for fighting HIV.

Hundreds of millions of dollars had been sunk into HIV vaccines as well as microbicides designed to protect women from the disease. Hundreds of millions more were paying for condoms. Yet AIDS kept growing. Now, 25 million Africans have the disease, and nearly 2 million died of it last year.

All this time, Halperin was virtually laughed out of HIV prevention conferences for insisting that male circumcision could effectively serve as a first-generation vaccine against AIDS. It was not a perfect prevention, to be sure, but then, none of the scientists working on AIDS vaccines expected to be able to provide a perfect vaccine, either—if they ever succeeded in producing any vaccine, that is.

At a luncheon for Tobias, several Swazi clergyman told him that the biggest cause of HIV’s spread was something no one wanted to talk about: the long-term affairs that married men and women had on the side (see Helen Epstein’s brilliant book for a convincing explanation of how this works). At this point, Tobias happily whipped out a copy of his business memoir, "Put the Moose on the Table," which preaches the gospel that large organizations fail by ignoring their biggest problems—the elephant in the room, the moose on the table, you get the idea. As a loyal political appointee, Tobias was only too happy to hear these African men fess up to the immoral origins of their tragedy.

My friend is not easily dissuaded, and all the talk of moose made it hard to keep his tongue stapled, especially when so much was at stake. “Ambassador,” he said in a private moment after lunch, “there’s another moose on the table.” Circumcision, he said, could save millions of lives, but no one wanted to talk about it. A week later,Pepfar issued its first news release saying that it was “studying” the issue.

Unfortunately, studying wasn’t enough. It wasn’t until last March, when the National Institutes of Health stopped the African circumcision trials—it was no longer ethical to continue them, because circumcision was clearly beneficial—that the World Health Organization and other agencies did an about-face.

Even then, the cautious consensus statement issued by UNAIDS reflected how leery many specialists remain about the practice.

It has been argued, with some justice, that it would have been irresponsible for AIDS groups to promote male circumcision until the randomized controlled trials, the gold standard of good science, had been conducted.

Among us Semites—Jews and Muslims—circumcision is a tradition with practical origins: it prevents the irritation of sand under the foreskin, and some African tribes ritually circumcise adolescents in coming-of-age rituals. Initially, some scientists speculated that lower HIV rates in Muslim African countries were due to different sexual practices. But this wasn’t the case. In Kenya for example, Muslims have lower HIV infection rates despite cultural practices no different from Christians.

Halperin and other proponents of circumcision have long argued that it would have been prudent, given the horrible advance of AIDS and the potent, if incomplete, evidence for circumcision, to at least discuss it, especially because few other alternatives were available to people trying to survive the epidemic.

It will take precious time to “roll out” a male circumcision policy in Africa, to make sure it is culturally sensitive and that the procedure is done in properly hygienic settings. Sex before the circumcision has healed might cause, rather than prevent HIV infection. It’s time that many Africans don’t have.

“We could have learned what the complication rates are," said Potts, "who should perform the circumcisions, how many can be done in a day. We could have had that data from the year 2000 or before.”

Potts is a convert to the circumcision cause. As the head of Family Health International, a leading family planning organization, from 1978-1990, he promoted HIV testing and counseling and blanketing the continent with condoms. Later he became an enthusiast of microbicides, medicines that women would insert in the vagina before sex to kill HIV. Neither approach has worked. Potts, unlike many of the leaders of HIV prevention, has the guts to admit he was wrong.

“I spent 10 years working on HIV prevention in Africa," he said. "I have to say we didn’t make any difference in slowing the epidemic.”

Groups like the UN World Health Organization have been reluctant to deal with circumcision until recently. There are a number of explanations for this. Taken together, they constitute a shocking display of how cultural blinders can cause death.

The first explanation may be that male Europeans, who are powerful in the WHO and other agencies working on AIDS, are, for the most part, not circumcised. From the sexually liberated perspective of European baby boomers, they tend to see circumcision as “unnatural”—an interference with sexual pleasure and a form of sexual repressiveness that the West should not be foisting on Africans.

One academic I spoke with described meeting a World Bank official in Malawi last summer. When she asked her what the bank was doing about circumcision, the woman replied, “We will never do anything about circumcision. Can you imagine the reaction when they hear we want to cut the penises of black men?” The World Bank has gotten a lot of grief for its programs over the decades, she added, and “we don’t want Africans saying, ‘You robbed us of our land and culture, and now you want our foreskins?’ ”

But in fact, surveys of Africans detect little anxiety about circumcision. When Halperin and his HIV prevention colleagues helped introduce the idea in the largely Christian Swaziland a few years ago, it caught on so quickly that men rioted Mbabane, the capital, because of the long waiting lines.

But scientists and charitable organizations have difficulty giving up on cherished notions. When money started flowing into AIDS, the people with infrastructure and staff were family planning groups, which knew how to move condoms and set up counseling, but shied from procedures that seemed culturally sticky.Microbicides were hot because they seemed to “empower” African women.

Male circumcision, neither politically correct nor technologically advanced, had no commercial, scientific or political champions. “It had no advocates except DanielHalperin,” said Ann Swidler , a Berkeley sociologist who is studying the response to the AIDS epidemic in Africa. “Gradually these groups are trying to form, but they still have trouble getting funding. Donors don’t find it sexy.”

In addition, a small but bitterly vocal minority of academics and activists feel that male circumcision, like the female variety, is genital mutilation, and that is causes lifelong psychological trauma and robs men of pleasure (the data doesn’t back them up).

Finally, though, some resources are being generated to promote circumcision. Visit a bris some time if you want to see how innocuous a procedure it can be.
And it may be the kindest cut of all.

Merck Aids Vaccine Study Failed

Arthur Allen — Fri, 18 Jan 2008 15:14:41 GMT

SIDEBAR

Efforts to make an HIV vaccine were dealt a severe blow in September when a 3,000-person trial of a Merck vaccine failed. An analysis later showed that that not only did the vaccine fail to protect against HIV, it may have made some trial participants more susceptible to the virus. One theory, currently under investigation, is that a cold virus used in the vaccine to help stimulate the immune system may have somehow stimulated HIV replication, rather than provoking a defense against HIV. An examination of the theory is to be presented at a conference in February.

Meanwhile, other vaccine trials using the cold virus “vector” have been slowed down. Most other potential HIV vaccines in the pipeline are in more rudimentary stages of development. Seth Berkley, director of the International AIDS Vaccine Initiative, said that during vaccine trials, researchers now recommend that all male participants get circumcised as part of the preventive effort. “It ought to be done, but you can’t cram it down peoples’ throats,” he said.

Congress Slashes High-Tech Physics Budget

Arthur Allen — Fri, 18 Jan 2008 15:25:16 GMT

American physicists awoke from the New Year’s holidays to find that Congress had filched their stockings. Under pressure from Bush to make cross-the-board budget cuts, Congress sliced $400 million out of the $4 billion science budget at the Department of Energy. The Stanford Linear Accelerator Center (SLAC), one of the premier U.S. physics research centers, expected $120 million in high-particle physics money from DOE. Instead it got $95 million, forcing it to lay off 125 people and curtail the activities of Babar, its major high-energy physics experiment. “This is going to be bloody,” one scientist said. “And you’re cutting into the lab’s core competencies.” There were also cuts and layoffs expected at Lawrence Livermore National Laboratory and the Fermi National Accelerator Lab in Chicago. Most of these projects are international, and scientists at the U.S. labs were humiliated at having the rug cut out from under them and their European partners—especially since $120 million in earmarks, for things like community college buildings in North Dakota—remained in the budget.

There’s no science more basic than particle physics, which explores things like the origin of mass and what dark matter is; the World Wide Web page you’re reading came about as a result of particle physics. This makes it rather curious that the White House and Congress, which are always pontificating about U.S. scientific competitiveness allowed this to happen. “If you’re concerned about U.S. leadership in science, this is not the way to do it,” says Aaron Roodman, an associate professor in the departments of particle physics and astrophysics at SLAC. “If this continues, it guarantees we’ll be second-rate.”

Conspiracy Theorist Candy

Arthur Allen — Wed, 23 Jan 2008 18:45:41 GMT

I’m blogging today from Rock Creek Stables, where my daughter is taking a riding lesson, which brings me to the latest manure from the medical conspiracy world. A new ABC TV legal drama, “Eli Stone,” depicts an heroic lawyer, remorseful for all his years spent defending the evil pharmaceutical industry, doing a turn for the good guys by representing a woman who believes her son became autistic because of the mercury-containing preservative thimerosal (they call it “mercuritol”) in his vaccines. It is clearly impossible to drive a stake through the heart of this theory, which is mind candy to conspiracy lovers everywhere. Although science has buried it and the real-life courts don’t seem to be buying either, the idea of an evil government-drug company plot to poison a generation of kids is just too strong for celebrities to resist. Participant Productions has optioned David Kirby’s lurid 2006 book Evidence of Harm, which foisted the theory on thousands of parents of autistic kids to begin with. Robert F. Kennedy Jr., Don and Deirdre Imus, Donald Trump and neuroscientist (just kidding) Jennifer McCarthy are among the celebs who buy into the bad vaccines theory. Tracking the vaccine zeitgeist has grown tiresome; no matter how much good science is out there (here’s a recent example), this is the Pamela Anderson of conspiracy theories. It may be a bimbo, but it’s just too sexy to ignore.

Arkansas Teachers Avoided Evolution Under Huckabee

Arthur Allen — Wed, 23 Jan 2008 19:21:19 GMT

Photo credit: Lauren Burke, WDCPix

Science educators in certain U.S. states operate a bit like dissidents in the old Soviet bloc. They have to pick their battles as they walk the fine line between telling the truth and keeping their jobs. This was nowhere truer than in Arkansas under Gov. Mike Huckabee, a professed Young Earth Creationist who disdained Darwinism and the theory of evolution.

As governor, Huckabee funded a creationist museum and loudly endorsed the teaching of “creation science.” While his political allies in the state legislature twice introduced bills to ban the teaching of evolution, Huckabee presided over a school system that earned a “D” in science education and an “F” in teaching evolution. Only about a fifth of the science teachers in Arkansas taught evolution, though it was part of the school science education guidelines.

Yet Huckabee didn’t intervene publicly in the Department of Education, and even critics cannot uncover a paper trail of active resistance to teaching evolution. In fact, toward the end of Huckabee’s 10-year reign, the state science curriculum was updated to include use of the word “evolution” for the first time. “He’s slippery,” says Jason R. Wiles, an Arkansas-raised science educator who teaches biology at Syracuse University and manages McGill University’s Evolution Education Research Center.

But Huckabee’s obvious sympathies, and the intransigence of Fundamentalist school board officials, led Arkansas science educators to self-censor. Administrators cautioned science educators against using the “e-word” in their encounters with schools and students. At the Arkansas Museum of Discovery, the traditional state science museum, for example, museum officials removed an evolution exhibit amid a whispering campaign about the ire of conservative powers.

Did students really have to learn about evidence that the earth is 4.5 billion years ago? Nah. Why alienate the fundamentalists who controlled some of the science museum’s funding?
Yet some science educators in the state showed real courage.

“They would have thrown me to the wolves if the chance came along but they didn’t,” says Bill Fulton, who headed the committee that rewrote Arkansas’ science curriculum at the state Department of Education in 2005. “I was never directed to go in and throw this out or anything of that nature. I’ve always lived in fear that might happen, but it didn’t.”

As he put together the curriculum committee, Fulton was warned by his boss, who “lived in fear of certain ministers,” not to put too many science teachers on it. To get around that, Fulton made sure to include several teachers who were “very religious but believed in sticking to science in science class.” Fulton’s boss wanted to strike all references to evolution, instead calling it “change over time,” but Fulton finessed this by pointing out that anti-science people would see through the euphemistic language, he said.

“I did things that I shouldn’t have in so far as wanting to keep my job,” says Fulton, who retired last year after 39 years as an educator. “But I did them because I thought they were important. I’m 64, what the hell. What’s the worst thing they can do, fire me?”

Chris Comer, who held the same position in the Texas schools, was not so lucky. The Texas Department of Education forced out Comer in November after she forwarded an email to colleagues about an upcoming speech by a pro-evolution philosopher. Her boss, Lizette Reynolds, whom George W. Bush had hired while governor of Texas, called her on the carpet and removed her. “I’ll never get hired in Texas education again,” she said.

Science educators in Arkansas face a dilemma, Fulton says. They want Arkansas children to get as much science as possible in order to compete in education and jobs. But if they refuse to back down to evolution opponents, they fear losing funding for entire science programs. At the same time, “they don’t’ want to seem like country bumpkins who don’t realize that evolution is important,” he adds.

About a fifth of Arkansas teachers teach straight evolution, while another 30 percent teach “something along those lines,” according to a survey by state education officials. The other 50 percent don’t teach it, either because of their own weaknesses or community opposition. About 10 percent teach straight creationism.

Fulton is concerned about what the absence of evolutionary thinking means to the training of Arkansas kids as professionals. “I’m worried about doctors who don’t understand evolution, because the evolution of germs is certainly a real thing. But most folks accept that. The thing that gets them is that we descend from primates.”

The removal of Comer was deeply preoccupying to Fulton and other biology teachers, both because was a manifestly unjust, stupid act, and because Texas science textbooks are used by Arkansas and other states. “All Chris did was forward an email, which is exactly what my boss wouldn’t have wanted me to do and exactly what I would have done,” Fulton said. “It could have been me.”

Plenty of Arkansas politicians endorse creationism. In 2001, conservative state Rep. Jim Holt introduced a bill that banned the imparting of “fraudulent or false information”—specifically, the age of the earth or the origins of life—in Arkansas schools, museums or other state-funded programs. It died in committee, but a few years later, Mark Martin introduced another bill, which was squashed for procedural reasons. Huckabee isn’t on record about either bill. Nor did he comment on the ruckus over the anti-evolution stickers that the Beebe, Arkansas School Board removed from its science textbook in 2005 under threat of a lawsuit from the American Civil Liberties Union.

“He doesn’t want to come off as the yokel who supported these things,” said Wiles. “He likes to be able to get the conservative and evangelical vote by supporting creationism as an issue of fairness, but doesn’t want to appear too zealous.”

Corn Will Keep Us Competitive

Arthur Allen — Wed, 23 Jan 2008 19:38:07 GMT

Silicon Valley is apparently none too pleased about the big cuts in the federal Department of Energy’s physics research budget I mentioned last week.

Craig R. Barrett, chairman of Intel, wrote to Nancy Pelosi that the cuts to physics experiments, as well as science and math education, send a message that his industry isn’t keen on hearing.

"At a time when Congress can pass a $250 billion Farm Bill to support the industries of the 19 th century, isn’t it about time that we pull our political leadership together to start supporting the industries of the 21st century?" he writes in the Dec. 19 letter, which was made available to Washington Independent. "If this is really the message that Washington wants to send… I fear we have a major problem. Industry is listening carefully to your deliberations. If there is no government support to these areas that will dictate our competitiveness for the next century that we might as well just accept that and make our investments elsewhere. "

Update: Conspiracy Mind Candy

Arthur Allen — Wed, 23 Jan 2008 23:13:07 GMT

A reliable source tells me that the plot for this show originally had "Eli Stone" representing the mom because her insurer wouldn’t pay for her autistic son’s risperidone, an anti-psychotic drug that previously wasn’t FDA-approved to treat autism. But the FDA recently signed off on risperidone to treat some symptoms associated with autism. Did that real-life change have anything to do with the script alteration? I preferred the old script. If Hollywood has to drag someone’s name through the mud, health insurers are a better candidate than the vaccine establishment.

Breakthroughitis

Arthur Allen — Thu, 24 Jan 2008 15:40:35 GMT

Here’s a good post by science writer Merrill Goozner on a new, possibly unworthy early screening test for prostate cancer. In taking down a celebratory front-page article last week in The NY Times by Gina Kolata, Goozner notes that there are already problems with the existing biomarker screen, the PSA, or prostate specific antigen—which Kolata herself noted in 2004. He asks whether our healthcare system really needs a new expensive diagnostic with questionable efficacy for a disease that affects many old men but isn’t always the main factor in their death. Kolata is notoriously trigger-happy with Big Medical News. You can’t help but admire her tenaciousness and energy, and she is usually right, but Kolata has a tendency to oversell stories of medical breakthroughs. She’s not alone, of course. Breakthroughitis is a chronic ailment of us medical writers. It’s hard to write breaking medical news because the latest publication, even in high-status journals like the Journal of the American Medical Association, The New England Journal of Medicine, and the Lancet, are rarely conclusive. Most studies about drugs and diseases provide only a piece of the evidence. Convincing statements on the cause and treatment of disease are usually the result of decades of research and consensus.

White House Skirts Regulating Greenhouse Gases

Arthur Allen — Mon, 28 Jan 2008 05:15:45 GMT

Photo Credit: stock.xchng

Illustration by: Matt Mahurin

For six years, the Bush administration denied or ignored the impact of climate change. But last May, after the Supreme Court ruled that the Environmental Protection Agency could no longer avoid it, President George W. Bush ordered the EPA to regulate greenhouse gases. He promised to release new rules by the end of the year.

Eight months later, the rules to limit tailpipe emissions of carbon dioxide and other greenhouse gases are locked up in a White House vault somewhere, a doleful example of this administration’s unsubtle political maneuvering around inconvenient scientific truths, and a slap in the face to government scientists who try to confront them.

The administration’s evasions have created an embarrassing spectacle. The EPA’s administrator, Stephen Johnson, denied California the right to issue its own greenhouse gas regulations, despite warnings from his staff that EPA would be sued over this—and would lose. Then, when Congress demanded to see internal documents where this advice was given, Johnson handed them over—but they were almost entirely whited out with tape. He claimed attorney-client privileges because EPA had been, as his staff warned, sued. Congressional staffers tore the tape off the documents and gave them to reporters anyway.

Dramatic changes are riding on the policy struggle that inspired these shenanigans. Big industry groups have pressed the Bush administration to forbid the EPA to regulate greenhouse gases from cars and trucks. They fear, correctly, that an agency ruling on vehicles will open the way to strict controls on coal plants, factories and other industries. They paint the regulations as a looming threat to the economy as it hovers near recession.

Environmental groups say that industry has been dragged kicking and screaming through Clean Air Act rulings in the past, without bringing the economy to its knees. Cleaner and safer cars, soot-free smokestacks and acid rain-free forests came about through EPA rules, not the beneficence of industry, they point out. If global climate change, they add, is as serious a problem as scientists say, we need to act now.

"Over the last 35 years of the Clean Air Act," said Vickie Patton, a former EPA official who is now at the Environmental Defense Fund, "we have consistently demonstrated that America can meet big challenges in addressing the impacts of airborne contaminants. But you have to have standards to unleash American innovation and ingenuity on these critical challenges. And there’s no bigger challenge today than the imperative to address global warming. ’’

Industry lobbyists, who view global warming as theoretical or unstoppable, and efforts to slow it as futile and destructive, have worked hard to keep the EPA from fulfilling the high court’s order. Their key target is an "endangerment finding" that EPA scientists have been working on as the first step toward regulating carbon dioxide and other greenhouse gases. Before the EPA regulates a pollutant, it makes a finding to establish the threat to "public health and welfare." Once the threat is established, regulation becomes mandatory, which explains why the administration has been leery of a finding on carbon dioxide.

Indeed, the White House tactic of centralized control has been at work in other agencies that produced evidence in favor of EPA regulations. In October, the Centers for Disease Control Director Julie L. Gerberding prepared testimony for a Senate committee in which she called climate change a "serious public health concern." Her remarks were vetted by White House Office of Management and Budget officials, who removed (pdf) "serious public health concern" as well as seven of the text’s 15 pages that described health effects, like the spread of infectious diseases and the impact of storms and drought.

This White House has routinely used OMB review to tinker with science that supports regulations it dislikes. Science editor Donald Kennedy, whose journal is considered the most prestigious in the scientific world, described this action as an egregious example of the Bush administration’s instinct to secrecy and suppression.

Much is at stake. In a Dec. 7 letter to the Senate, the U.S. Chamber of Commerce and six major industry groups warned that if the EPA started regulating tailpipe greenhouse gases, it would tie up more than 300,000 businesses in red tape, "causing significant harm to the economy." Following a Dec. 17 meeting with White House officials, conservative groups warned that regulations would lead to "mind-boggling construction delays, economic uncertainty, paperwork burdens and engineering expenses … for no measurable environmental benefit."

Industry’s panic led the White House and Congress to work together on an energy bill that the administration clearly hopes will supplant regulations. The bill, which Bush signed into law Dec. 18, for the first time in 33 years increased the fuel economy standards of cars and trucks. It requires automakers to have a fleetwide average of 35 miles per gallon by 2020.

That law did not free the EPA from its obligation to regulate, however. So the administration took other steps. Four years ago, California created its own greenhouse gas regulations, which would take effect with model year 2009 vehicles. California’s proposal, which 19 other states have adopted or shown interest in, requires cars to average 44 mpg by 2020 and would cut greenhouse emissions from vehicles, over the next 13 years, by roughly twice as much as the new energy bill. Such changes seem to be feasible. Indeed, Paul Argyropolous, an EPA official, was quoted in November as saying that the EPA’s rules would probably follow those of California.

But the day after Bush signed the energy bill, the EPA reversed course, in a move that looked like it came out of the White House playbook. Johnson, the EPA administrator, denied California’s right to implement its own regulations, and signaled that the agency was going to let the energy bill replace its own efforts. "The Bush administration is moving forward with a clear national solution," Johnson said, "not a confusing patchwork of state rules, to reduce America’s climate footprint from vehicles. When fully implemented, our federal fuel-economy standard will achieve significant benefits by applying to all 50 states."

In snubbing California, Johnson also stiffed his own staff, who had warned that EPA would be sued (several states sued on Jan. 2) and lose. Jerry Brown, California’s attorney general, said Johnson "must have gotten his advice from a Ouija board."

EPA has been silent about its own, 250-page set of regulations, that were completed in mid-December and sent to the White House. An EPA spokesman, Jonathan Shradar, said the agency was reviewing the energy bill to "determine how it may affect our regulatory options." Those options include not regulating at all, he said.

When Johnson was called before the Senate Environment and Public Works Committee last Thursday, he was met by bipartisan exasperation at the EPA’s inaction. James Inhofe, the Republican climate change denier from Oklahoma, was the only sympathetic senator. Barbara Boxer (D-Cal.) called Johnson’s refusal to acknowledge that climate change was damaging to health "at best embarrassing, at worst dangerous."

California has particularly strong reasons to care about climate change. Erratic precipitation patterns, which match up nicely with climate change models, threaten more floods and fires and could threaten farming in the nation’s breadbasket—as well as critical environmental habitats and city water supplies. A study in the journal Geophysical Research Letters says that carbon dioxide-induced warming disproportionately affects Californians, causing 300 additional deaths a year.

To be sure, climate change is not as easy to get one’s arms around as some of the substances EPA has targeted in the past. Sulfur dioxide, which EPA regulated by forcing coal plants to use scrubbers, clearly caused acid rain that harmed forests. Similarly, plenty of data shows that diesel particulates exacerbate asthma. Climate change is both a far bigger problem and a harder one to tackle. "You don’t inhale climate change," as the EPA’s George Sugiyama said at a November advisory meeting.

Then, too, the droughts, floods and epidemics resulting from climate change are most likely to hit the countries that produce the fewest greenhouse gases. This is partly due to the vicissitudes of weather patterns, partly to the shabby infrastructure of the Third World.

Take, for example, dengue fever, a sometimes fatal, mosquito-born illness that has overwhelmed parts of Asia and Latin America in recent decades. The disease has found a home in south Texas over the past 10 years, as two dengue-carrying mosquito species have moved north. Yet the U.S. effects aren’t as severe, at least so far.

A recent survey found that 23 percent of the residents of Laredo, Tex., have antibodies—meaning they’ve been exposed to dengue. Across the Rio Grande, in Nuevo Laredo, 48 percent have antibodies. The more deadly, hemorrhagic form of the disease—which can result from repeated infections—strikes hundreds of people each year in Mexico, but is so far rare in the U.S. This is probably because the Mexicans have fewer air conditioners and more standing water—exposing them to more insect bites—and a less reliable health care system.

Because it’s hard to put numbers on the health effects of climate change, particularly in the U.S., the EPA was leaning in early December toward an endangerment finding that greenhouse gases caused "welfare" effects, without quantifiable "public health" impact. This would have allowed more lenient emission limits. Scientists who track the spread of infectious diseases can’t easily link climate change to specific health effects, but most of them are appalled by the idea of ducking regulation.

But the administration is keeping its head in the sand. It will be interesting to see whether this position will enable it to weather the storm of Congressional outrage.

Show About Discredited Science Airs Tonight

Arthur Allen — Thu, 31 Jan 2008 18:53:21 GMT

Despite protest from the American Academy of Pediatrics, ABC has decided to air the controversial first episode of its daffy new show "Eli Stone" tonight. It's about a money-grubbing drug company-representing lawyer who has a saintly conversion and helps a winsome momma win $5 million by convincing a jury that the mercury-containing preservative in a flu vaccine--thimerosal--gave her kid autism.

The AAP wanted ABC to cancel the show because the narrative gives credence to a theory long-since discredited by science. In doing so it may lead parents--especially the dopey ones who get their medical advice from fantastic TV dramas--to avoid vaccinating their kids. AAP's effort elicited howls from David Kirby that it was trying to "crush artistic freedom." Kirby's tendentious 2006 book Evidence of Harm is largely responsible for the vaccines-cause-autism zeitgeist. In the face of growing evidence against his thesis, he's been getting more and more shrill on Huffpo. (Yo, David. The AAP is a prestigious group, but it certainly doesn't have the power to "crush artistic freedom" even if it wanted to).

The vaccines-cause-autism meme is particularly strong among Hollywood celebrities, fictional and otherwise. In the movie "Knocked Up," for example, Katherine Hegl's sister doesn't vaccinate her kids. Anne Sweeney, president of ABC-Disney TV Group, sent her autistic child to a therapy center where most parents are obsessed with vaccines, according to a parent whose child was there. ABC will run a "this is just fiction" disclaimer on the show. What the hell, it's all good publicity, right? But pediatricians--that's kid doctors, for those of you who don't know any--are worried. When vaccination rates in communities fall below certain levels, diseases like whooping cough and mumps can make comebacks. To get a share of the news cycle, the AAP yesterday released early a study from an upcoming issue of its journal, Pediatrics that adds more evidence thimerosal is quickly flushed out of the bodies of babies. This is not a major study, however, and it won't convince any diehards. Besides, as I predicted in my book Vaccine (pp 421-3), the slow death of the thimerosal theory is only leading vaccine opponents like Barbara Loe Fisher to blame vaccines in general for autism.

Times Gets Slippery on Sushi

Arthur Allen — Thu, 31 Jan 2008 20:22:20 GMT

More on the mercury beat: The National Fisheries Institute is angry about a front-page New York Times, and a related piece yesterday, claiming that restaurant sushi contains dangerous amounts of mercury. No surprise there. The Institute represents fisherpersons, who make a living off the large fish that are sliced into tiny bits and sold to raw fish lovers at a huge markup. But I think they have a point. In her Jan. 23, above-the-fold lede, food columnist Marian Burros wrote that people eating six pieces of sushi a week on a regular basis "would exceed the levels considered acceptable by the Environmental Protection Agency." Further down, Burros wrote that six pieces of sushi from most of the restaurants and stores the Times investigated would contain more than 49 micrograms of mercury, which she described as the amount the EPA "deems acceptable for weekly consumption over a period of several months." But this isn't really true.

The limits Burros referred to come from the EPA's "reference dose," which the EPA defines as exposures that are "likely to be without an appreciable risk of deleterious effects during a lifetime." [italics mine] There is no weekly reference dose. Nor is it "dangerous" to exceed the daily "reference dose" on a weekly or even a monthly basis. For one thing, there has never been a clinical case of mercury poisoning from eating fish in the United States. To be sure, scientists know that methyl mercury is a neurotoxin, if the dose is large enough. They know that large fish and sea mammals contain disproportionately large amounts of methyl mercury. These animals are high on the seafood chain--which mercury enters through industrial pollution and volcanic eruptions. To determine what amount of mercury-containing seafood was safe to eat, the EPA had access to two major, decades-long studies of seafood consumption. One came from the Seychelles--islands in the Indian Ocean. The mothers in that study who ate lots and lots of mercury-containing fish had kids who were smart and healthy. But in another study, in the Faeroes Islands, children whose mothers ate seafood including lots of pilot whale meat had more subtle neurological problems, on average, than those that didn't. Some have theorized that the healthy ingredients in the Seychelles fish counteracted the mercury, while the pilot whale flesh may have contained other substances, like PCBs, that made it more dangerous. To be on the safe side, the EPA used the Faeroes Islands data to establish its "reference dose." To be even safer, it set the dose at ten times lower than the lowest amount of mercury consumption that had caused harm to children in the Faeroes. Oh yeah--Did I mention that these reference doses come from studies of harm to fetuses of pregnant women, a particularly vulnerable group? And that recent studies have shown that the kids of fish-eating moms are healthier than those whose mothers avoid fish during pregnancy?

To be sure, there are some scientists who feel that mercury is not well-studied enough to be sure that even the "reference dose" is safe. But if you gathered together a room of people who are knowledgeable about mercury toxicity, most of them would conclude that the Times piece was alarmist.

Warming Is Increasing Hurricane Activity

Arthur Allen — Fri, 01 Feb 2008 17:33:12 GMT

Illustration by: Matt Mahurin

A paper published yesterday in Nature for the first time measures the contribution of rising sea surface temperatures to changes in hurricane frequency and intensity. The authors found that about 40 percent of the increase in Atlantic hurricanes between 1996 and 2005 --in comparison to the average over the 1950-2000 period--is due to the heat of the sea surface--about 0.5 degrees centigrade on average. In the past, it's been argued that changes in near-surface trade wind speed were the cause of increased hurricane activity. The British authors of the study, Mark Saunders and Adam Lea, do not claim that their analysis can establish whether global warming is responsible for the increase in sea temperatures. But it seems likely that it is, at least partly. The only other explanation is something called the Atlantic Multidecadal Oscillation. The latter is a hypothetical natural cyclic shift in the ocean's temperatures.

According to the 2007 Fourth Assessment Report of the Intergovernmental Panel on Climate Change, it is “more likely than not” that manmade climate change has contributed to hurricane intensification since the 1970s. The IPCC also predicted that as the earth and seas continue to grow warmer, hurricane winds and rainfall will continue to grow more intense.

Worldwide, the number of strong hurricanes and cyclones has increased by 75 percent since 1970.

San Jose State Bans Red Cross Over FDA Rule

Arthur Allen — Wed, 06 Feb 2008 06:27:08 GMT

Last week, San Jose State University became the first college in the nation to kick the Red Cross off its campus. The university stopped all blood drives until the Food and Drug Administration revises rules that prohibit gay men from donating blood unless they’ve been abstinent since 1977. The school’s president, Don Kassing, said that the FDA policy, in singling out gay men, violated campus anti-discrimination policies.

The 1,000 or so pints of blood collected at San Jose State each year represent only about 1 percent of the blood collected in San Francisco and the peninsula below it. But the blood banks worry that this decision could set a dangerous precedent for other universities where blood drives have been targeted by gay activists. “We feel that this was a terribly misguided decision,” said Lisa Bloch, spokeswoman for the Blood Center of the Pacific.

That said, the blood bankers are equally unhappy with the FDA for refusing to budge on a blood donation policy that many see as overly cautious, and some as politically motivated. While the administration maintains that science supports screening out gay men’s blood, some feel that the administration may be kowtowing to religious conservatives who find the idea distasteful. “Until January 2009, this isn’t going to change,” a major blood banking officer told me. “There is a segment of the public that is scared. They don’t understand what the risks are, and how they can be managed.”

Drives at these schools get people into the habit of donating blood, sometimes for a lifetime The FDA says it is willing to change the policy "if we were convinced by scientific data that such a change would not compromise blood safety," said spokeswoman Karen Riley. She urged other institutions not to follow San Jose State's lead. Universities and high schools are important sources of blood donors. Drives at these schools "get people into the habit of donating blood, sometimes for a lifetime," Bloch added.

San Jose State made its decision after about nine months of consultations that followed an employee’s complaint to the campus Equal Economic Opportunity Commission office. “We could have sat back and said ‘the FDA is using outdated science but we can’t do anything about it’” said Larry Carr, the campus spokesman. “But instead, we decided to take action.”

Doctors who do transfusions excoriated the university’s decision. The San Francisco Bay, like most major metropolitan areas, is chronically short of blood. During a severe shortage last January, the University of California-San Francisco hospital had to postpone non-elective surgeries. “Their [San Jose State] cause is a just one, but the action is inappropriate,” said Dr. Celso Bianco, executive vice president of America’s Blood Centers, an umbrella group for companies that collect and distribute about half the nation’s blood supplies.

Others went further. “For a university president, of all people, to allege discrimination over a scientific disagreement and regulatory imperative is very disappointing,” said Dr. Louis M. Katz, executive vice president of the Mississippi Valley Regional Blood Center in Davenport, Iowa, and a member of the FDA’s Blood Products Advisory Committee. Katz, who was previously in HIV medicine, said, “I must have transfused hundreds of AIDS patients. The irony is that a compromised blood supply caused by these kinds of boycotts has the potential to injure those whom the president of San Jose State University is trying to protect.”

Students have also weighed in. “Keeping blood away from dying people,” wrote Kyle Hansen, in the San Jose State campus newspaper, “is not a humane way to protest federal policy.”

San Jose State’s Carr said the university is “not trying to start a movement. We would be upset if a lot of other universities followed our lead.” If the Red Cross pulled a van up across the street from campus and started drawing blood, he added, they'd be welcome to do it.

On a few other campuses, student activists have forced the suspension of blood drives in the past. At McGill, in Montreal, the student government suspended blood drives in November 2006 after a raucous demonstration led by a group called Second Cumming. (Canada also uses the FDA regulations). Campuses in Oregon, Maine and Vermont have come close to banning the Red Cross over the alleged discrimination.

Katz and Bianco, like most blood bank executives, support a relaxing of the deferral on blood donation by gays to make it more similar to other FDA guidelines for donation. For example, women are forbidden from donating blood for a year after having sex with junkies, men from sub-Saharan Africa, or men who have had sex with other men. People are also told to wait for a year after getting tattoos, which have been linked to transmission of hepatitis B and C.

Of course, the broadness of all these rules begs the question of who is really at risk. For example, recent studies have shown that black women are nearly 20 times more likely than white women to be carriers of HIV. Yet no one would demand that black women stop donating blood.

“There are plenty of heterosexuals who put themselves at just as much risk as gay-identified men,” said Dr. Jason Schneider, an assistant professor at the Emory University School of Medicine and president of the Gay and Lesbian Medical Association. “I’m hesitant to support shutting down blood drives, because donated blood is a precious commodity for the public health system. That said, I agree with the principle that’s driving this [San Jose State] decision. The right to donate should be based on individual risk, not the group to which you belong. To say that anyone who’s had sex since 1977 is risky is to equate a person who has had a longterm relationship for ten years with someone who has dozens of partners.”

Gay men, in general, are far more likely than heterosexuals to be HIV-positive. But with major refinement of blood screening techniques over the past decade, the overall risk that would result from allowing them back into the donor pool is disputed.
At present, only about 1 in 2 million blood transfusions results in the transmission of HIV. Still, HIV-tainted blood can pass undetected if it is drawn from someone infected two or three days before the draw.

Katz and Bianco would like gay men to be able to donate blood a year after having gay sex. Bianco said that according to the models he uses, this could add approximately one lot of tainted blood to the nation’s supply every 32 years. The FDA estimate, which is based on studies from the 1990s, when many hospitals didn’t use computers to track their blood supplies, estimates that a few contaminated lots would escape detection each year.

Choke the Whistleblower

Arthur Allen — Thu, 07 Feb 2008 17:09:30 GMT

Leading House science committee members on Thursday issued a scathing attack on the administration for apparently retaliating against a senior scientist who drew attention to the cancer threat of a substance in the 40,000 trailers in which Hurricane Katrina and Rita survivors are living. Committee Chairman Bart Gordon (D-Tenn) and subcommittee chairs Brad Miller (D-NC) and Nick Lampson (D-Texas) demanded that Centers for Disease Control director Julie Gerberding take steps to protect Dr. Christopher De Rosa, who was demoted in October from his job at the Agency for Toxic Substances and Disease Registry (ATSDR). The Atlanta-based agency is under CDC's wing.

The demotion of De Rosa as head of ATSDR's Division of Toxicology and Environmental Medicine follows a pattern of Bush administration retaliation against whistleblowers, including those who report suppression of science at federal agencies to Congress. De Rosa last February was cut out of the loop of a consultation with the Federal Emergency Management Agency after reporting that formaldehyde in the trailers was a likely carcinogen. FEMA removed that warning from its report, which came in response to health complaints from some of thousands of hurricane refugees, many of whom still live in the trailers. Tiny amounts of formaldehyde, the nasty-smelling, volatile liquid used in treating wood products, can cause nausea, headaches and runny eyes. At higher exposures it is thought to be potentially carcinogenic.

De Rosa also had complained that his boss, ATSDR chief Howard Frumkin, withheld a finished report on environmental contamination and health risks in the Great Lakes Basin. The study, which De Rosa directed and was peer-reviewed, showed elevated infant mortality and premature births, as well as higher rates of death from breast, colon and lung cancers in several polluted counties in eight Great Lakes states. The report, requested by a U.S.-Canada commission on the Great Lakes, was supposed to have been released last July. The Congressmen said that ATSDR was reportedly editing the report, in the process redacting much of the health data.

Fidelity Is No Solution

Arthur Allen — Thu, 07 Feb 2008 18:51:39 GMT

Illustration by: Matt Mahurin

A new study in the Journal of Infectious Diseases shows that fidelity is no protection when it comes to the virus that causes cervical cancer. As Merck & Co. was releasing its human papilloma virus vaccine in 2006, some warned against giving it to adolescent girls, saying it sent a message of tolerance of immoral sex. Although some conservative religious groups like the Family Research Council have moderated their positions since then, their guidance on the vaccine still stresses that "abstaining from sexual activity is the surest way to prevent infection." And they are right. Abstain from genital contact with anyone for your whole life, and you have virtually no chance of contracting HPV, the sexually transmitted virus that causes cervical cancer.

But having one partner, it turns out, is not nearly as good protection as some on the Christian right would like to believe. The authors of the Journal of Infectious Diseases study found that virgins entering a sexual relationship had a 28.5 percent chance of contracting a human papilloma virus infection after a year of monogamous sexual contact. Three years into the relationship, the risk was increased to 50 percent. The rates are lower, of course, when both partners are virgins entering the relationship, and remain faithful. The data indicates how often this occurs in the real world.

About one quarter of all HPV infections are caused by two cancer-causing strains, HPV 16 and 18. The Merck vaccine, Gardasil, guards against these and two other strains that cause genital warts. Cervical cancer each year kills about 3,500 American women and hundreds of thousands in poor countries where there are no regular gynecological examinations.

Merck in 2006 touted Gardasil aggressively, pushing states to quickly mandate the vaccine for 6th graders. This misguided policy led to a backlash, in which arguments about the immorality of vaccination were mixed in with more logical concerns about vaccinating millions of kids with a relatively untried vaccine. The vaccine has been on the market a while, now, though, and there are so far no indications that it's unsafe. Except, apparently, to some world views.

The Last Vaccine

Arthur Allen — Mon, 11 Feb 2008 21:58:08 GMT

In 1798, a British country doctor announced a new way to prevent smallpox, the scourge of European cities. Edward Jenner scraped a patient's arm with a bit of pus from the sore on a cow infected with cowpox, a disease that was similar to smallpox. This potion--the first vaccine--gave the patient a mild illness, which provided immunity against the more serious disease smallpox. In Jenner's honor, the great French scientist Louis Pasteur adopted the word vaccine--from vacca, Latin for cow--to refer to all such substances.

Last week, the U.S. military quietly ended the era of the cow-grown vaccine. It announced that the last lots of calfskin-cultured vaccine would expire on February 29. From now on, recruits will be vaccinated with a new smallpox vaccine that's grown in laboratory cell cultures. More than 1.2 million troops and contractors were vaccinated with the old vaccine, which is known scientifically as vaccinia.

Acambis, a biotech company, makes the new smallpox vaccine. The Feds paid Acambis several hundred million dollars to develop it, part of the massive infusion of federal cash into bioterrorism preparedness after 911 and the anthrax mailings to Congress. Acambis says it has shipped 192.5 million doses of its new vaccine to the Department of Health and Human Services for stockpiling.

Making the old smallpox vaccine was a grubby process. The calf was strapped to a table, its underbelly shaved, smeared with vaccinia virus and scarred with knives to produce a good place for the virus to grow. It was produced on "vaccine farms." In Paris, 19th century doctors traveled from neighborhood to neighborhood with a calf in a cart. At each stop, an assistant scraped the vaccine material off the calf's belly and handed the lancet to the sawbones, who would rub it into a wound on the patient's arm. Eventually, scientists developed a way to administer the vaccine by lightly pricking the arm with a tiny fork that had a drop of the vaccine solution suspended between its tines.

It was a tremendously effective preventive -- the only vaccine ever to exterminate a disease. The last case of natural smallpox infection occurred in Somalia 30 years ago. The Bush Administration tried to stir up new fears of smallpox in 2002 as it was getting ready to invade Iraq. Vice President Cheney essentially ordered the Centers for Disease Control to create a smallpox preparedness plan by vaccinating 10 million Americans. The idea was that somehow terrorists or Saddam Hussein might get hold of the stuff, although there was never any evidence they had.

The last U.S. smallpox vaccine manufacturer, Wyeth, stopped making it 1975, but had a few million doses in storage in 2002. The military started vaccinating its forces against smallpox, but efforts to vaccinate large numbers of civilians failed. Only about 35,000 healthcare and emergency response workers responded to the CDC's call to get vaccinated. This was partly because the old smallpox vaccine was somewhat dangerous. People with eczema suffered terrible reactions to the vaccine; about one in 300,000 people got a brain infection or systemic skin rashes. During the recent vaccination campaigns, about 1 in 175 new vaccines suffered myocarditis. Why risk it when everyone suspected that Iraqi smallpox was a fairy tale?

The new vaccine is apparently no safer than the old one. It doesn't stay viable on the shelf as long, and requires more jabs with the vaccine fork to be effective. But it's made in cell culture, which means it's easier to assure uniform quality.
Au revoir, Bessie. You served us well.

Why Do Frenchwomen Find Boy Babies Depressing?

Arthur Allen — Thu, 14 Feb 2008 18:45:05 GMT

Frenchwomen are more likely to suffer post-partum depression if their babies are male, according to a surprising new study released today.

French psychology researchers interviewed 181 women one to two months after birth, and found that 9.4 percent of them were suffering severe postnatal depression; 22 percent were mildly depressed. Of the 17 deeply depressed women, 13 had given birth to boys. In the mildly depressed group (the ratings were based on answers to questions designed to test physical function, pain, mental health, emotions and social vitality), there were 24 girls and 16 boys. But in both the mildly and severely depressed groups, the mothers of boys were doing worse.

These results are the opposite of those arising in surveys conducted in China, South Asia and the Muslim world. In those countries, a high value is put on male babies, who carry the family name and sometimes win the family a dowry when married. In countries like India, women are sometimes beaten for giving birth to girls. No surprise, then, that contemplation of life with a girl baby can be more depressing.

The authors have a few notions about why female babies might be more desired in Western cultures. Using psychoanalytic language of "oedipal" and "narcissistic" personality constructs, they hypothesize that it's easier for modern women to construct a relationship with a baby of the same sex. One woman interviewed during the study said she felt sad when she saw her son on an ultrasound because she would not be able to "educate him in a satisfactory way." The authors also theorize that women having trouble with their relationships might see male babies as more difficult.

Another possibility is this one: the study might be a fluke. More research is obviously needed.

In the meantime, Happy Valentine's Day, fellahs!

U.S. Hospitals Fight Super-Bugs, Finally

Arthur Allen — Thu, 14 Feb 2008 20:04:54 GMT

Illustration by: Matt Mahurin

In 2005, the year that a drug-resistant bacteria known as MRSA killed an estimated 19,000 Americans, Dr. Lance Peterson began an experiment in three hospitals near Chicago. Peterson, infection control officer for Evanston Northwestern Healthcare, tested everyone who entered the hospitals for MRSA, and disinfected those who were carriers of the germ. Within a year, the hospitals’ rates of MRSA infections had fallen by half. Peterson estimated that nine lives were saved.

Peterson’s study is one of more than 150 showing that when hospitals actively hunt for carriers of MRSA and beef up precautions to prevent its spread, they can dramatically reduce serious infections and deaths. But despite 30 years of research showing that these “search and destroy” tactics can stop MRSA, until recently few U.S. hospitals used the procedures. Instead, they seemingly held up their hands and shrugged at an epidemic that now kills more people each year than AIDS, murder or Parkinson’s disease.

But a grassroots public accountability campaign has been mounting, with 19 state laws now requiring hospitals to tighten infection control. Finally, hospitals are starting to get tough. By late 2006, 29 percent had started so-called “active surveillance” of MRSA, according to a survey by the Association of Professionals in Infection Control. Today, close to half of our 6,000 hospitals are doing it, and most others are in the planning stages. “We’ve reached the tipping point,” says William Jarvis, an infections expert. “The public was tired of waiting.”

MRSA--methicillin-resistant Staphylococcus aureus--is the most notorious member of a group of antibiotic-resistant bacteria that have steadily colonized American hospitals over the past four decades. About a third of adults carry staph germs in our noses – usually without getting sick. But the chronically ill and elderly are particularly susceptible to staph infections, especially after surgery. And an infection involving staph resistant to many antibiotics is particularly difficult to fight.

Year after year, the percentage of drug-resistant staph infections has steadily grown, to as much as 70 percent in many hospitals. Under the infection control guidelines issued by the Centers for Disease Control in the 1980s, hospitals were instructed to isolate patients only after they were found to be infected with MRSA. Healthcare workers were supposed to wear gowns, masks and gloves around these patients, and afterwards carefully wash their hands. But those measures didn’t prevent the spread of MRSA.

Apparently, many people entering hospitals are already colonized with MRSA, but show no symptoms of infection. The best way to control hospital MRSA infections, based on decades of research that began in Denmark, is to test all high-risk patients—that is, those who’ve been in hospitals or nursing homes recently, or have diabetes or kidney problems—when they enter the hospital. In infection control jargon, this is called “active surveillance.” The CDC has been reluctant to order the procedure.

“Active surveillance” can be difficult and cumbersome. Until recently, it was necessary to isolate the patients during the 3-6 days it took for the germs collected in nasal swabs to be cultured and tested for drug resistance. Most hospital administrators were leery of a process that could lengthen hospital stays and seemed inhumane.

Recently, a high-tech tool has made active surveillance easier. For $25 each (compared to the $4 cost of preparing a traditional culture), hospitals can buy rapid-identification kits to test for MRSA. These kits, which use molecular fingerprinting technology, detect MRSA in as little as two hours.

Because they work so fast, hospitals don’t have to isolate suspected MRSA carriers. Once carriage of MRSA is determined, the patient gets nasal antibiotic ointments and is carefully washed for a few days, which is normally enough to disinfect him or her. “It’s arduous to isolate patients preemptively, and most hospitals don’t want to do it,” said Andy Guhl, vice president for hospital-associated infections at Becton-Dickinson, the biggest vendor of the tests. “With a two-hour lab test result we’re allowing the hospitals to think about infection and control a lot differently than before.”

Normally, changes in American health procedures this big take place in coordinated fashion under the leadership of the CDC. But in the case of hospital infections, the CDC didn’t lead for so long that it took a popular insurrection to make change.

The legislative remedies, pushed by groups like Consumers Union have changed the legal risk/benefit equation for hospitals. People with hospital infections usually lose lawsuits because of the lack of evidence that a hospital did something wrong. Under some of the new laws, hospitals could be liable if they don’t chart preventive measures, like nasal swabs and hand washing.

The insurrection against infections has many foot soldiers, most of them shocked and angry relatives of people who died in the hospital. Michael Bennett, a Baltimore contractor, started the Coalition for Patients’ Rights after his dad, a retired actor, died in 2004 following multiple infections and amputations after getting a hip replacement.

"The change that is taking place in hospitals on this issue has been driven by average Joes,” said Bennett. “This dysfunctional culture has killed a staggering number of patients unnecessarily, but it’s better late than never.”

Hospitals and infectious disease doctors bridle at some of the laws, which don’t provide the extra resources needed to improve surveillance of the superbugs. But it’s undeniable that outrage and legislation, rather than science, kicked reluctant hospitals into action. (So has the evidence that avoiding superbug infections can save money. See for example, this study ).

Last May, the Veterans Administration became the first major hospital administrator to introduce mandatory screening of high-risk patients at its 154 hospitals. In October, it began screening all incoming patients for MRSA. (Because of the spread of MRSA in prisons, gymnasiums and schoolyards, Peterson said, it’s getting difficult to pin down who is a high-risk patient. These so-called “community-acquired MRSA” infections are often quite virulent—even worse than the staph bacteria that frequent hospitals.)

Volunteer Hospitals of America, a network of 1,200 institutions, and the Hospital Corporation of America, which owns 250, began active surveillance last year as well. “Basically, everyone is doing it now,” says Jarvis. Later this year, Medicare will refuse to reimburse hospitals for infections that occur after certain types of surgery.

As a stand-alone cause of death, MRSA is currently ranked 14th in America. If you include all hospital infections, the number is closer to 100,000--number six on the mortality list, ahead of diabetes, Alzheimer’s and pneumonia. To be sure, many of these patients had underlying conditions that weakened them before the infections took hold.

Not all these infections, or deaths, can be prevented. But the tragedy of the MRSA epidemic is that it could have been stopped or at least slowed significantly, according to many infectious disease specialists who are fighting for better hospital infection control measures. And many point fingers at the CDC.

“The CDC has tracked the rapid rise, they’ve understated the problem, they’ve done too little to remedy it,” says Betsy McCaughey, a former New York lieutenant governor who has campaigned to stop hospital infections.

“There’s no doubt that the CDC is to blame for the delay,” agrees Jarvis, who spent 23 years in hospital infection at the CDC. He left the agency in 2003 after Julie Gerberding became director. Ironically, Gerberding was a hospital infection specialist at San Francisco’s General Hospital before she came to the CDC, where her first job was director of the hospital infection program.

In 2002, the Society for Healthcare Epidemiology of America, the professional group for infection control, issued guidelines that strongly recommended active surveillance and control of MRSA. But the CDC committee on hospital infections was led by Gerberding-appointed doctors who were reluctant to adopt the requirement. Some prominent infectious disease specialists were not convinced that isolation techniques worked to slow MRSA. The committee haggled for years until issuing guidelines in 2007 that mention isolation, but without stressing it as an immediate step.

“If the CDC issues a priority recommendation, it happens overnight,” said Jarvis. “The infection control officer can throw that on his administrator’s desk, and he’ll respond. But if there’s no CDC recommendation, they’ll say, ‘Oh, it’s too much work, I don’t want to do it.’”

The CDC did not respond to two calls requesting comment. In a future story, I’ll examine some of the political problems at CDC that may have contributed to its foot-dragging on the issue.

Update: Dr. Lance Peterson held his MRSA study at Evanston Northwestern Healthcare. An earlier version of this story called the facility Evanston Northwest Healthcare. We regret the error.