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March 5, 2014 By Brian Stoffel Motley Fool
Genetically modified organisms (GMOs) have the ability to cause “an irreversible termination of life at some scale, which could be the planet.”
This warning, as emotional and overstated as it sounds, isn’t coming from some anti-science zealot or conspiracy theorist.
It is, instead, coming from Nassim Taleb, distinguished professor of risk engineering at New York University, author of best-sellers The Black Swan and Fooled by Randomness, and shrewd investor who made a fortune when “black swans” like September 11 and the Great Recession occurred.
Recently, he’s been making his feelings on GMOs crystal clear: they’re dangerous to the overall health of our planet. In a paper that’s available to the public, yet still in draft form, Taleb — along with two colleagues — lay out their case.
GMOs are historically different from their naturally occurring peers in that their genetic make-up has been altered in a laboratory before being planted in fields.
Often, these types of seeds are favored because of their ability to yield larger harvests and avoid certain pests or weeds that usually eat up some of their productivity.
Taleb’s primary concern isn’t that ingesting GMOs is necessarily bad for us; he’s instead focused on the monumental threat such technology has on our worldwide ecosystem. While Taleb agrees that the relative risk of any one transgenic seed ruining the ecosystem is incredibly small, people are still underestimating the risks involved.
That’s because, as humans, we are ill equipped to understand the mathematics behind such risks. Let’s say each GM seed that’s produced holds a 0.1% chance of — somehow, in the intricately interdependent web of nature — leading to a catastrophic breakdown of the ecosystem that we rely on for life. All by itself, it doesn’t seem too harmful, but with each new seed that’s developed, the risk gets greater and greater.
The chart below demonstrates how, over time, even a 0.1% chance of ecocide can be dangerous.
I cannot stress enough that the probabilities I am using are for illustrative purposes only. Neither I, nor Taleb, claim to know what the chances are of any one type of seed causing such destruction.
The focus, instead, should be on the fact that the “total ecocide barrier” is bound to be hit, over a long enough time, with even incredibly small odds. Taleb includes a similar graph in his work, but no breakdown of the actual variables at play.
As Taleb says, “Over time, something bound to hit the [ecocide] barrier is about guaranteed to hit it.”
Why be so worried if the level of threat isn’t known?
The crux of this argument hinges on the fact that GMOs represent a systemic, and not localized, risk. Because the wind will blow where it wants to, insects will go — and carry with them — what they please, and GM goods will surely be exported to countries throughout the world, the concept of being able to control GM traits in nature is impossible to guarantee.
As Taleb says, “There are mathematical limitations to predictability in a complex system, ‘in the wild,’ which is why focusing on the difference between local (or isolated) and systemic threats is a central aspect of our warnings.”
Answering the critics
Unsurprisingly, Taleb has run into a fair share of criticism for his views.
But Taleb also addresses those concerns in his paper. Here’s how he responds to the most common critiques:
Humans have been modifying plants for years via selective breeding and tinkering with crops.
While this may be true, Taleb claims there’s a fundamental difference between this and GMOs. “There is no comparison between the [bottom-up] tinkering of selective breeding and the top-down engineering of taking a gene from an organism and putting it into another.”
Furthermore, Taleb claims that nature has never allowed such a systemic risk to evolve. “The planet took about close to zero risks of ecocide in trillions of variations over 3 billion years, otherwise we would not have been here.”
How about the risk of famine without GMOs?
This is “a deceitful strategy, no different from urging people to play Russian roulette in order to get out of poverty.” That’s because, as his probability shows, we’ll all end up dying in the end when we hit the ecocide barrier.
New technologies could solve these problems if they arise
The whole point is that these threats could lay dormant for years before they finally surface. When they do, they would be difficult to control, and could act fast.
Risk is inherent in everything. We can’t just be paralyzed by fear and not progress.
The risk of “generalized human extinction” is not inherent in everything. That’s because most consequences are localized, not systemic. And progress can be made using bottom-up techniques that have worked for eons.
There is no evidence that this type of ecocide could really happen
The precautionary principle — which is what Taleb calls his warning — is all about managing risk, not about waiting for it to surface. The fact that GMOs are a systemic entity is undeniable. Taleb is equally skeptical of all entities that carry systemic risk — like too-big-to-fail banks.
New organisms have been introduced into new ecosystems before and this hasn’t caused total collapse
Many of these new organisms — people often refer to potatoes or tomatoes being introduced into the Old World from the New World — were naturally occurring in nature, or the result of bottom-up tinkering.
Also, the fact that there’s no evidence showing that GMOs have so far caused system damage doesn’t mean it won’t eventually surface. We don’t, as Taleb says, argue that a game of Russian roulette is safer with each empty barrel we find. It is, in fact, more dangerous.
By no means am I as smart as Taleb when it comes to risk, and I don’t have a degree in agricultural sciences. I do find Taleb’s assertions to be a little alarmist.
At the same time, as someone who spends a quarter of every year working on a coffee farm in Costa Rica that transitioned from conventional farming methods to permaculture ones — and having seen the vast improvements in the overall ecosystem on the farm, I think it’s wise to, at the very least, give some credence to the concerns Taleb raises.
After all, it’s not that scientists are dumber than Mother Nature; it’s simply that Mother Nature has been around for about 300,000 times longer than us humans, and what she’s picked to stay around have obviously passed the test of time.
Click PLAY to hear Let’s Roundup Monsanto by The Refusers
Read the article
Definition of Iatrogenic: Induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures.
JAMA, July 26, 2000—Vol 284, No. 4
Highlights: The health care system also may contribute to poor health through its adverse effects. For example, US estimates of the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error include:
• 12,000 deaths/year from unnecessary surgery
• 7,000 deaths/year from medication errors in hospitals
• 20,000 deaths/year from other errors in hospitals
• 80,000 deaths/year from nosocomial infections in hospitals
• 106,000 deaths/year from nonerror, adverse effects of medications
These total to 225,000 deaths per year from iatrogenic causes … these estimates are for deaths only and do not include adverse effects that are associated with disability or discomfort. Third, the estimates of death due to error are lower than those in the IOM report. If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer.
Click PLAY to hear Refusers song FIrst Do No Harm
Is US Health Really the Best in the World? Barbara Starfield, MD, MPH JAMA, July 26, 2000
Information concerning the deficiencies of US medical care has been accumulating. The fact that more than 40 million people have no health insurance is well known. The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as many as 20% to 30% of patients receive contraindicated care.
In addition, with the release of the Institute of Medicine (IOM) report “To Err Is Human,” millions of Americans learned, for the first time, that an estimated 44,000 to 98,000 among them die each year as a result of medical errors. The fact is that the US population does not have anywhere near the best health in the world. Of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available health indicators. Countries in order of their average ranking on the health indicators (with the first being the best) are Japan, Sweden, Canada, France, Australia, Spain, Finland, the Netherlands, the United Kingdom, Denmark, Belgium, the United States, and Germany. Rankings of the United States on the separate indicators are:
• 13th (last) for low-birth-weight percentages
• 13th for neonatal mortality and infant mortality overall
• 11th for postneonatal mortality
• 13th for years of potential life lost (excluding external causes)
• 11th for life expectancy at 1 year for females, 12th for males
• 10th for life expectancy at 15 years for females, 12th for males
• 10th for life expectancy at 40 years for females, 9th for males
• 7th for life expectancy at 65 years for females, 7th for males
• 3rd for life expectancy at 80 years for females, 3rd for males
• 10th for age-adjusted mortality
The poor performance of the United States was recently confirmed by the World Health Organization, which used different indicators. Using data on disability-adjusted life expectancy, child survival to age 5 years, experiences with the health care system, disparities across social groups in experiences with the health care system, and equality of family out-of-pocket expenditures for health care (regardless of need for services), this report ranked the United States as 15th among 25 industrialized countries.
Thus, the figures regarding the poor position of the United States in health worldwide are robust and not dependent on the particular measures used. Common explanations for this poor performance fail to implicate the health system. The perception is that the American public “behaves badly” by smoking, drinking, and perpetrating violence. The data show otherwise, at least relatively. The proportion of females who smoke ranges from 14% in Japan to 41% in Denmark; in the United States, it is 24% (fifth best). For males, the range is from 26% in Sweden to 61% in Japan; it is 28% in the United States (third best). The data for alcoholic beverage consumption are similar: the United States ranks fifth best. Thus, although tobacco use and alcohol use in excess are clearly harmful to health, they do not account for the relatively poor position of the United States on these health indicators. The data on years of potential life lost exclude external causes associated with deaths due to motor vehicle collisions and violence, and it is still the worst among the 13 countries.
Dietary differences have been demonstrated to be related to differences in mortality across countries, but the United States has relatively low consumption of animal fats (fifth lowest in men aged 55-64 years in 20 industrialized countries) and the third lowest mean cholesterol concentrations among men aged 50 to 70 years among 13 industrialized countries.
The real explanation for relatively poor health in the United States is undoubtedly complex and multifactorial. From a health system viewpoint, it is possible that the historic failure to build a strong primary care infrastructure could play some role. A wealth of evidence documents the benefits of characteristics associated with primary care performance.
Of the 7 countries in the top of the average health ranking, 5 have strong primary care infrastructures. Although better access to care, including universal health insurance, is widely considered to be the solution, there is evidence that the major benefit of access accrues only when it facilitates receipt of primary care.
The health care system also may contribute to poor health through its adverse effects. For example, US estimates of the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error include:
• 12,000 deaths/year from unnecessary surgery
• 7,000 deaths/year from medication errors in hospitals
• 20,000 deaths/year from other errors in hospitals
• 80,000 deaths/year from nosocomial infections in hospitals
• 106,000 deaths/year from nonerror, adverse effects of medications
These total to 225,000 deaths per year from iatrogenic causes. Three caveats should be noted. First, most of the data are derived from studies in hospitalized patients. Second, these estimates are for deaths only and do not include adverse effects that are associated with disability or discomfort. Third, the estimates of death due to error are lower than those in the IOM report.
If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000 to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer. Even if these figures are overestimated, there is a wide margin between these numbers of deaths and the next leading cause of death (cerebrovascular disease). One analysis overcomes some of these limitations by estimating adverse effects in outpatient care and including adverse effects other than death.
It concluded that between 4% and 18% of consecutive patients experience adverse effects in outpatient settings, with 116 million extra physician visits, 77 million extra prescriptions, 17 million emergency department visits, 8 million hospitalizations, 3 million long-term admissions, 199,000 additional deaths, and $77 billion in extra costs (equivalent to the aggregate cost of care of patients with diabetes).
Another possible contributor to the poor performance of the United States on health indicators is the high degree of income inequality in this country. An extensive literature documents the enduring adverse effects of low socioeconomic position on health; a newer and accumulating literature suggests the adverse effects not only of low social position but, especially, low relative social position in industrialized countries.
Among the 13 countries included in the international comparison mentioned above, the US position on income inequality is 11th (third worst). Sweden ranks the best on income equality (when income is calculated after taxes and including social transfers), matching its high position for health indicators. There is an imperfect relationship between rankings on income inequality and health, although the United States is the only country in a poor position on both (B.S., unpublished data, 2000).
An intriguing aspect of the data is the differences in ranking for the different age groups. US children are particularly disadvantaged, whereas elderly persons are much less so. Judging from the data on life expectancy at different ages, the US population becomes less disadvantaged as it ages, but even the relatively advantaged position of elderly persons in the United States is slipping. The US relative position for life expectancy in the oldest age group was better in the 1980s than in the 1990s.
The long-existing poor ranking of the United States with regard to infant mortality has been a cause for concern; it is not a result of the high percentages of low birth weight and infant mortality among the black population, because the international ranking hardly changes when data for the white population only are used.
Whereas definitive explanations for the relatively poor position of the United States continue to be elusive, there are sufficient hints as to their nature to provide the basis for consideration of neglected factors: The nature and operation of the health care system. In the United States, in contrast to many other countries, the extent to which receipt of services from primary care physicians vs specialists affects overall health and survival has not been considered. While available data indicate that specialty care is associated with better quality of care for specific conditions in the purview of the specialist, the data on general medical care suggest otherwise.
National surveys almost all fail to obtain data on the extent to which the care received fulfills the criteria for primary care, so it is not possible to examine the relationships between individual and community health characteristics and the type of care received.
The relationship between iatrogenic effects (including both error and nonerror adverse events) and type of care received. The results of international surveys document the high availability of technology in the United States. Among 29 countries, the United States is second only to Japan in the availability of magnetic resonance imaging units and computed tomography scanners per million population.
Japan, however, ranks highest on health, whereas the United States ranks among the lowest. It is possible that the high use of technology in Japan is limited to diagnostic technology not matched by high rates of treatment, whereas in the United States, high use of diagnostic technology may be linked to the “cascade effect” and to more treatment. Supporting this possibility are data showing that the number of employees per bed (full-time equivalents) in the United States is highest among the countries ranked, whereas they are very low in Japan – far lower than can be accounted for by the common practice of having family members rather than hospital staff provide the amenities of hospital care.
How cause of death and outpatient diagnoses are coded does not facilitate an understanding of the extent to which iatrogenic causes of ill health are operative. Consistent use of “E” codes (external causes of injury and poisoning) would improve the likelihood of their recognition because these ICD (International Classification of Diseases) codes permit attribution of cause of effect to “Drugs, Medicinal, and Biological Substances Causing Adverse Effects in Therapeutic Use.” More consistent use of codes for “Complications of Surgical and Medical Care” (ICD codes 960-979 and 996-999) might improve the recognition of the magnitude of their effect; currently, most deaths resulting from these underlying causes are likely to be coded according to the immediate cause of death (such as organ failure). The suggestions of the IOM document on mandatory reporting of adverse effects might improve reporting in hospital set tings, but it is unlikely to affect underreporting of adverse events in noninstitutional settings. Only better record keeping, with documentation of all interventions and resulting health status (including symptoms and signs), is likely to improve the current ability to understand both the adverse and positive effects of health care.
The relationships among income inequality, social disadvantage, and characteristics of health systems, including the relative contributions of primary care and specialty care. Recent studies using physician-to-population ratios (as a proxy for unavailable data on actual receipt of health services according to their type) have shown that the higher the primary care physician–to–population ratio in a state, the better most health outcomes are. The influence of specialty physician–to–population ratios and of specialist–to–primary care physician ratios has not been adequately studied, but preliminary and relatively superficial analyses suggest that the converse may be the case. Inclusion of income inequality variables in the analysis does not eliminate the positive effect of primary care. Furthermore, states that have more equitable distributions of income also are more likely to have better primary care resource availability, thus raising questions about the relationships among a host of social and health policy characteristics that determine what and how resources are available.
Recognition of the harmful effects of health care interventions, and the likely possibility that they account for a substantial proportion of the excess deaths in the United States compared with other comparably industrialized nations, sheds new light on imperatives for research and health policy. Alternative explanations for these realities deserve intensive exploration.
Click PLAY to hear Refusers song Unavoidably Unsafe
An Exclusive Interview With Dr. Barbara Starfield: Medically Caused Death In America By Jon Rappoport
On December 6-7, 2009, I interviewed Dr. Starfield by email.
What has been the level and tenor of the response to your findings, since 2000?
My papers on the benefits of primary care have been widely used, including in Congressional testimony and reports. However, the findings on the relatively poor health in the US have received almost no attention. The American public appears to have been hoodwinked into believing that more interventions lead to better health, and most people that I meet are completely unaware that the US does not have the ‘best health in the world’.
In the medical research community, have your medically-caused mortality statistics been debated, or have these figures been accepted, albeit with some degree of shame?
The findings have been accepted by those who study them. There has been only one detractor, a former medical school dean, who has received a lot of attention for claiming that the US health system is the best there is and we need more of it. He has a vested interest in medical schools and teaching hospitals (they are his constituency). They, of course, would like an even greater share of the pie than they now have, for training more specialists. (Of course, the problem is that we train specialists—at great public cost—who then do not practice up to their training—they spend half of their time doing work that should be done in primary care and don’t do it as well.)
Have health agencies of the federal government consulted with you on ways to mitigate the effects of the US medical system?
Since the FDA approves every medical drug given to the American people, and certifies it as safe and effective, how can that agency remain calm about the fact that these medicines are causing 106,000 deaths per year?
Even though there will always be adverse events that cannot be anticipated, the fact is that more and more unsafe drugs are being approved for use. Many people attribute that to the fact that the pharmaceutical industry is (for the past ten years or so) required to pay the FDA for reviews—which puts the FDA into a untenable position of working for the industry it is regulating. There is a large literature on this.
Aren’t your 2000 findings a severe indictment of the FDA and its standard practices?
They are an indictment of the US health care industry: insurance companies, specialty and disease-oriented medical academia, the pharmaceutical and device manufacturing industries, all of which contribute heavily to re-election campaigns of members of Congress. The problem is that we do not have a government that is free of influence of vested interests. Alas, [it] is a general problem of our society—which clearly unbalances democracy.
Can you offer an opinion about how the FDA can be so mortally wrong about so many drugs?
Yes, it cannot divest itself from vested interests. (Again, [there is] a large literature about this, mostly unrecognized by the people because the industry-supported media give it no attention.
Would it be correct to say that, when your JAMA study was published in 2000, it caused a momentary stir and was thereafter ignored by the medical community and by pharmaceutical companies?
Are you sure it was a momentary stir? I still get at least one email a day asking for a reprint—ten years later! The problem is that its message is obscured by those that do not want any change in the US health care system.
Do medical schools in the US, and intern/residency programs in hospitals, offer significant “primary care” physician training and education?
NO. Some of the most prestigious medical teaching institutions do not even have family physician training programs [or] family medicine departments. The federal support for teaching institutions greatly favors specialist residencies, because it is calculated on the basis of hospital beds. [Dr. Starfield has done extensive research showing that family doctors, who deliver primary care—as opposed to armies of specialists—produce better outcomes for patients.]
Are you aware of any systematic efforts, since your 2000 JAMA study was published, to remedy the main categories of medically caused deaths in the US?
No systematic efforts; however, there have been a lot of studies. Most of them indicate higher rates [of death] than I calculated.
What was your personal reaction when you reached the conclusion that the US medical system was the third leading cause of death in the US?
I had previously done studies on international comparisons and knew that there were serious deficits in the US health care system, most notably in lack of universal coverage and a very poor primary care infrastructure. So I wasn’t surprised.
Has anyone from the FDA, since 2000, contacted you about the statistical findings in your JAMA paper?
NO. Please remember that the problem is not only that some drugs are dangerous but that many drugs are overused or inappropriately used. The US public does not seem to recognize that inappropriate care is dangerous—more does not mean better. The problem is NOT mainly with the FDA but with population expectations.
… Some drugs are downright dangerous; they may be prescribed according to regulations but they are dangerous.
Concerning the national health plan before Congress—if the bill is passed, and it is business as usual after that, and medical care continues to be delivered in the same fashion, isn’t it logical to assume that the 225,000 deaths per year will rise?
Probably—but the balance is not clear. Certainly, those who are not insured now and will get help with financing will probably be marginally better off overall.
Did your 2000 JAMA study sail through peer review, or was there some opposition to publishing it?
It was rejected by the first journal that I sent it to, on the grounds that ‘it would not be interesting to readers’!
Do the 106,000 deaths from medical drugs only involve drugs prescribed to patients in hospitals, or does this statistic also cover people prescribed drugs who are not in-patients in hospitals?
I tried to include everything in my estimates. Since the commentary was written, many more dangerous drugs have been added to the marketplace.
106,000 people die as a result of CORRECTLY prescribed medicines. I believe that was your point in your 2000 study. Overuse of a drug or inappropriate use of a drug would not fall under the category of “correctly prescribed.” Therefore, people who die after “overuse” or “inappropriate use” would be IN ADDITION TO the 106,000 and would fall into another or other categories.
‘Appropriate’ means that it is not counter to regulations. That does not mean that the drugs do not have adverse effects.
24 Feb 2014 The Intercept
Among the core self-identified purposes of JTRIG are two tactics: (1) to inject all sorts of false material onto the internet in order to destroy the reputation of its targets; and (2) to use social sciences and other techniques to manipulate online discourse and activism to generate outcomes it considers desirable. To see how extremist these programs are, just consider the tactics they boast of using to achieve those ends: “false flag operations” (posting material to the internet and falsely attributing it to someone else), fake victim blog posts (pretending to be a victim of the individual whose reputation they want to destroy), and posting “negative information” on various forums …
Government plans to monitor and influence internet communications, and covertly infiltrate online communities in order to sow dissension and disseminate false information, have long been the source of speculation. Harvard Law Professor Cass Sunstein, a close Obama adviser and the White House’s former head of the Office of Information and Regulatory Affairs, wrote a controversial paper in 2008 proposing that the US government employ teams of covert agents and pseudo-”independent” advocates to “cognitively infiltrate” online groups and websites, as well as other activist groups …
Then there is the use of psychology and other social sciences to not only understand, but shape and control, how online activism and discourse unfolds. Today’s newly published document touts the work of GCHQ’s “Human Science Operations Cell,” devoted to “online human intelligence” and “strategic influence and disruption” …
Under the title “Online Covert Action”, the document details a variety of means to engage in “influence and info ops” as well as “disruption and computer net attack,” while dissecting how human beings can be manipulated using “leaders,” “trust,” “obedience” and “compliance” …
Claims that government agencies are infiltrating online communities and engaging in “false flag operations” to discredit targets are often dismissed as conspiracy theories, but these documents leave no doubt they are doing precisely that.
One of the many pressing stories that remains to be told from the Snowden archive is how western intelligence agencies are attempting to manipulate and control online discourse with extreme tactics of deception and reputation-destruction. It’s time to tell a chunk of that story, complete with the relevant documents.
Over the last several weeks, I worked with NBC News to publish a series of articles about “dirty trick” tactics used by GCHQ’s previously secret unit, JTRIG (Joint Threat Research Intelligence Group). These were based on four classified GCHQ documents presented to the NSA and the other three partners in the English-speaking “Five Eyes” alliance. Today, we at the Intercept are publishing another new JTRIG document, in full, entitled “The Art of Deception: Training for Online Covert Operations.”
By publishing these stories one by one, our NBC reporting highlighted some of the key, discrete revelations: the monitoring of YouTube and Blogger, the targeting of Anonymous with the very same DDoS attacks they accuse “hacktivists” of using, the use of “honey traps” (luring people into compromising situations using sex) and destructive viruses. But, here, I want to focus and elaborate on the overarching point revealed by all of these documents: namely, that these agencies are attempting to control, infiltrate, manipulate, and warp online discourse, and in doing so, are compromising the integrity of the internet itself.
Among the core self-identified purposes of JTRIG are two tactics: (1) to inject all sorts of false material onto the internet in order to destroy the reputation of its targets; and (2) to use social sciences and other techniques to manipulate online discourse and activism to generate outcomes it considers desirable. To see how extremist these programs are, just consider the tactics they boast of using to achieve those ends: “false flag operations” (posting material to the internet and falsely attributing it to someone else), fake victim blog posts (pretending to be a victim of the individual whose reputation they want to destroy), and posting “negative information” on various forums. Here is one illustrative list of tactics from the latest GCHQ document we’re publishing today:
Other tactics aimed at individuals are listed here, under the revealing title “discredit a target”:
Then there are the tactics used to destroy companies the agency targets:
GCHQ describes the purpose of JTRIG in starkly clear terms: “using online techniques to make something happen in the real or cyber world,” including “information ops (influence or disruption).”
Critically, the “targets” for this deceit and reputation-destruction extend far beyond the customary roster of normal spycraft: hostile nations and their leaders, military agencies, and intelligence services. In fact, the discussion of many of these techniques occurs in the context of using them in lieu of “traditional law enforcement” against people suspected (but not charged or convicted) of ordinary crimes or, more broadly still, “hacktivism”, meaning those who use online protest activity for political ends.
The title page of one of these documents reflects the agency’s own awareness that it is “pushing the boundaries” by using “cyber offensive” techniques against people who have nothing to do with terrorism or national security threats, and indeed, centrally involves law enforcement agents who investigate ordinary crimes:
No matter your views on Anonymous, “hacktivists” or garden-variety criminals, it is not difficult to see how dangerous it is to have secret government agencies being able to target any individuals they want – who have never been charged with, let alone convicted of, any crimes – with these sorts of online, deception-based tactics of reputation destruction and disruption. There is a strong argument to make, as Jay Leiderman demonstrated in the Guardian in the context of the Paypal 14 hacktivist persecution, that the “denial of service” tactics used by hacktivists result in (at most) trivial damage (far less than the cyber-warfare tactics favored by the US and UK) and are far more akin to the type of political protest protected by the First Amendment.
The broader point is that, far beyond hacktivists, these surveillance agencies have vested themselves with the power to deliberately ruin people’s reputations and disrupt their online political activity even though they’ve been charged with no crimes, and even though their actions have no conceivable connection to terrorism or even national security threats. As Anonymous expert Gabriella Coleman of McGill University told me, “targeting Anonymous and hacktivists amounts to targeting citizens for expressing their political beliefs, resulting in the stifling of legitimate dissent.” Pointing to this study she published, Professor Coleman vehemently contested the assertion that “there is anything terrorist/violent in their actions.”
Government plans to monitor and influence internet communications, and covertly infiltrate online communities in order to sow dissension and disseminate false information, have long been the source of speculation. Harvard Law Professor Cass Sunstein, a close Obama adviser and the White House’s former head of the Office of Information and Regulatory Affairs, wrote a controversial paper in 2008 proposing that the US government employ teams of covert agents and pseudo-”independent” advocates to “cognitively infiltrate” online groups and websites, as well as other activist groups.
Sunstein also proposed sending covert agents into “chat rooms, online social networks, or even real-space groups” which spread what he views as false and damaging “conspiracy theories” about the government. Ironically, the very same Sunstein was recently named by Obama to serve as a member of the NSA review panel created by the White House, one that – while disputing key NSA claims – proceeded to propose many cosmetic reforms to the agency’s powers (most of which were ignored by the President who appointed them).
But these GCHQ documents are the first to prove that a major western government is using some of the most controversial techniques to disseminate deception online and harm the reputations of targets. Under the tactics they use, the state is deliberately spreading lies on the internet about whichever individuals it targets, including the use of what GCHQ itself calls “false flag operations” and emails to people’s families and friends. Who would possibly trust a government to exercise these powers at all, let alone do so in secret, with virtually no oversight, and outside of any cognizable legal framework?
Then there is the use of psychology and other social sciences to not only understand, but shape and control, how online activism and discourse unfolds. Today’s newly published document touts the work of GCHQ’s “Human Science Operations Cell,” devoted to “online human intelligence” and “strategic influence and disruption”:
Under the title “Online Covert Action”, the document details a variety of means to engage in “influence and info ops” as well as “disruption and computer net attack,” while dissecting how human beings can be manipulated using “leaders,” “trust,” “obedience” and “compliance”:
The documents lay out theories of how humans interact with one another, particularly online, and then attempt to identify ways to influence the outcomes – or “game” it:
We submitted numerous questions to GCHQ, including: (1) Does GCHQ in fact engage in “false flag operations” where material is posted to the Internet and falsely attributed to someone else?; (2) Does GCHQ engage in efforts to influence or manipulate political discourse online?; and (3) Does GCHQ’s mandate include targeting common criminals (such as boiler room operators), or only foreign threats?
As usual, they ignored those questions and opted instead to send their vague and nonresponsive boilerplate: “It is a longstanding policy that we do not comment on intelligence matters. Furthermore, all of GCHQ’s work is carried out in accordance with a strict legal and policy framework which ensures that our activities are authorised, necessary and proportionate, and that there is rigorous oversight, including from the Secretary of State, the Interception and Intelligence Services Commissioners and the Parliamentary Intelligence and Security Committee. All our operational processes rigorously support this position.”
These agencies’ refusal to “comment on intelligence matters” – meaning: talk at all about anything and everything they do – is precisely why whistleblowing is so urgent, the journalism that supports it so clearly in the public interest, and the increasingly unhinged attacks by these agencies so easy to understand. Claims that government agencies are infiltrating online communities and engaging in “false flag operations” to discredit targets are often dismissed as conspiracy theories, but these documents leave no doubt they are doing precisely that.
Whatever else is true, no government should be able to engage in these tactics: what justification is there for having government agencies target people – who have been charged with no crime – for reputation-destruction, infiltrate online political communities, and develop techniques for manipulating online discourse? But to allow those actions with no public knowledge or accountability is particularly unjustifiable.
By Bob Livingston Feb 22, 2014 Easy Health Options
Shingles is caused by a reactivation of dormant varicella zoster (chicken pox) virus. It is most common in older adults and people with immune systems weakened by stress, injury, medications or other reasons.
The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends the shingles vaccine “to reduce the risk of shingles and its associated pain in people 60 years old or older.” According to David Brownstein, M.D., the question of whether to have the shingles vaccine is one of the most asked by his patients.
Since the vaccine is recommended by the CDC, there should be some evidence that it is effective. Brownstein’s analysis of the evidence provided in a research paper titled “Prevention of Herpes Zoster in Older Adults” indicates it’s not nearly as effective as the CDC would have you believe.
Under the section heading Practice Pointers, Brownstein found these gems:
“[T]he author states that, over a median surveillance period of 3.12 years, with over 52,000 participants, there was a 51% relative risk reduction in confirmed cases of herpes zoster in those that received the vaccine. Furthermore, the author stated that among those aged 60-69, the number needed to treat to prevent one case of shingles was 50. Among those 70 years and older, the number needed to treat was 100.
“These numbers show that, in those aged 60-69, the shingles vaccine was ineffective for 98% (forty-nine out of fifty) of those studied. For those aged 70 and older, the vaccine was 99% ineffective, since 99 out of 100 received no benefit.”
So according to the data, the shingles vaccine was a 98 percent to 99 percent failure. Also, the number needed to harm from the vaccine was 2.8. That means that for every 2.8 vaccines administered, one patient was harmed. And for every 100 vaccinated, one patient suffered a severe adverse reaction like a rash, fever or hospitalization.
Brownstein then presented this evidence in the form of a letter to the editor of the American Family Physician Journal. The letter was rejected without explanation.
So should you have the shingles vaccine? The evidence indicates the answer is “no.” It further indicates the medical establishment doesn’t want you to know this.
The best product that we have found to ease the pain and blistering is L-Lysine, an essential amino acid, found at any pharmacy or health food store. It is available as an oral supplement and as a topical ointment. It is also excellent for the relief of cold sores, which are caused by the herpes simplex virus.
By Dave Mihalovic Feb 23, 2014
PhD Scientist and Biochemist Reveals Hidden CDC Documents Showing Thimerosal In Vaccines Increase Neurologic Disorders
The CDC has been shunning the correlations between thimerosal and neurological disorders for a very long time. Although the FDA gave a two year deadline to remove the mercury based preservative from vaccines after the neurotoxin was banned in 1999, it still remains to this day in 60 percent of flu vaccines. A vaccine industry watchdog has now obtained CDC documents that show statistically significant risks of autism associated with the vaccine preservative, something the CDC denies even when confronted with their own data.
For nearly ten years, Brian Hooker has been requesting documents that are kept under tight wraps by the Centers for Disease Control and Prevention (CDC). His more than 100 Freedom of Information Act (FOIA) requests have resulted in copious evidence that the vaccine preservative Thimerosal, which is still used in the flu shot that is administered to pregnant women and infants, can cause autism and other neurodevelopmental disorders.
Dr. Hooker, a PhD scientist, worked with two members of Congress to craft the letter to the CDC that recently resulted in his obtaining long-awaited data from the CDC, the significance of which is historic. According to Hooker, the data on over 400,000 infants born between 1991 and 1997, which was analyzed by CDC epidemiologist Thomas Verstraeten, MD, “proves unequivocally that in 2000, CDC officials were informed internally of the very high risk of autism, non-organic sleep disorder and speech disorder associated with Thimerosal exposure.”
Factually, thimerosal is a mercury-containing compound that is a known human carcinogen, mutagen, teratogen and immune-system disruptor at levels below 1 part-per-million, and a compound to which some humans can have an anaphylactic shock reaction. It is also a recognized reproductive and fetal toxin with no established toxicologically safe level of exposure for humans.
In November, 1997, the U.S. Congress passed the Food and Drug Administration Modernization Act, requiring the study of mercury content in FDA-approved products. The review disclosed the hitherto-unrecognized levels of ethylmercury in vaccines.
In July 1999, public-health officials announced that thimerosal would be phased out of vaccines. The CDC, American Academy of Pediatrics, and FDA insisted that the measure was purely precautionary. They requested of all vaccine manufacturers to eliminate mercury from vaccines.
The requests were denied by vaccine manufacturers and continued every year thereafter.
The FDA does not require ingredients that comprise less than 1 percent of a product to be divulged on the label, so a lot more products may have thimerosal and consumers will never know.
Elevated Risk of Autism
When the results of the Verstraeten study were first reported outside the CDC in 2005, there was no evidence that anyone but Dr. Verstraeten within the CDC had known of the very high 7.6-fold elevated relative risk of autism from exposure to Thimerosal during infancy. But now, clear evidence exists. A newly-acquired abstract from 1999 titled, “Increased risk of developmental neurologic impairment after high exposure to Thimerosal containing vaccine in first month of life” required the approval of top CDC officials prior to its presentation at the Epidemic Intelligence Service (EIS) conference. Thimerosal, which is 50% mercury by weight, was used in most childhood vaccines and in the RhoGAM shot for pregnant women prior to the early 2000s.
The CDC maintains there is “no relationship between Thimerosal-containing vaccines and autism rates in children,” even though the data from the CDC’s own Vaccine Safety Datalink (VSD) database shows a very high risk. There are a number of public records to back this up, including this Congressional Record from May 1, 2003. The CDC’s refusal to acknowledge thimerosal’s risks is exemplified by a leaked statement from Dr. Marie McCormick, chair of the CDC/NIH-sponsored Immunization Safety Review at IOM. Regarding vaccination, she said in 2001, “…we are not ever going to come down that it [autism] is a true side effect…” Also of note, the former director of the CDC, which purchases $4 billion worth of vaccines annually, is now president of Merck’s vaccine division.
Toxic Effects of Thimerosal No Longer Disputed by Scientific Study
Thimerosal-Derived Ethylmercury in vaccines is now well established as a mitochondrial toxin in human brain cells.
There are dozens of scientific inquiries and studies on the adverse effects of thimerosal, including gastrointestinal abnormalities and immune system irregularities.
Thimerosal, is metabolized (converted) into the toxic and “harmful” methylmercury. And then in turn, the harmful methylmercury is metabolized (converted) into the most harmful, long-term-toxic, “inorganic” mercury that is retained in bodily tissue.
“Inorganic” mercury is the end product of mercury metabolism. Methylmercury subject groups confirm that the metabolic pathway for mercury in the human and animal body consists in the reduction/conversion of the harmful methylmercury into a more harmful “inorganic” mercury which is tissue-bound, and long-term-toxic. Hence, both the originating substance (methylmercury) and its conversion/reduction, inorganic mercury are found.
Based on published findings by Dr. Paul King, the metabolic pathway for organic mercury involves the conversion of Ethylmercury (Thimerosal) into “methylmercury” and then the further reduction of “methylmercury” into inorganic mercury.
Congress Must Act
Dr. Hooker’s fervent hope for the future: “We must ensure that this and other evidence of CDC malfeasance are presented to Congress and the public as quickly as possible. Time is of the essence. Children’s futures are at stake.” A divide within the autism community has led to some activists demanding that compensation to those with vaccine-injury claims be the top priority before Congress. Dr. Hooker maintains that prevention, “protecting our most precious resource — children’s minds,” must come first. “Our elected officials must be informed about government corruption that keeps doctors and patients in the dark about vaccine risks.”
Referring to an organization that has seen its share of controversy this past year, Dr. Hooker remarked, “It is unfortunate that SafeMinds issued a press release on my information, is accepting credit for my work and has not supported a worldwide ban on Thimerosal.”
Brian Hooker, PhD, PE, has 15 years experience in the field of bioengineering and is an associate professor at Simpson University where he specializes in biology and chemistry. His over 50 science and engineering papers have been published in internationally recognized, peer-reviewed journals. Dr. Hooker has a son, aged 16, who developed normally but then regressed into autism after receiving Thimerosal-containing vaccines.
Dave Mihalovic is a Naturopathic Doctor who specializes in vaccine research, cancer prevention and a natural approach to treatment.
by Daisy Luther February 17, 2014
Let’s talk about the meaning of a “god-complex”. Wikipedia defines a “god complex” as
“an unshakable belief characterized by consistently inflated feelings of personal ability, privilege, or infallibility. A person with a god complex may refuse to admit the possibility of their error or failure, even in the face of complex or intractable problems or difficult or impossible tasks, or may regard their personal opinions as unquestionably correct.”
Many parents can find a living, breathing example of a person suffering from a “god complex” as close as the family pediatrician’s office.
One such example is the anonymous pediatrician who wrote this essay, which was published by The Daily Beast.
I always ask if the children are vaccinated, or if the parents intend to vaccinate once the child is born. If the answer is no, I politely and respectfully tell them we won’t be the right fit. We don’t accept patients whose parents won’t vaccinate them.
When I read the essay, I had to check to see if it was satire. Unfortunately, it’s legitimate. That a doctor that you are paying to care for your child feels so omnipotent is simply mindblowing. That a person who swore an oath to do no harm would feel so strongly about imposing his will on parents speaks volumes about his high opinion of himself, even though he says that isn’t the case:
The physician-patient relationship, like so many other human relationships, requires an element of trust. I certainly neither want nor expect a return to the paternalistic “doctor knows best” mindset of bygone years, but I do need to know that patient’s parents respect my training and expertise. Refusing an intervention I desperately want all children to receive makes that respect untenably dubious.
All over the country, doctors are now refusing to treat children who are unvaccinated. This, in my opinion, is just another bullying tactic to try to force a parent’s hand. It pushes them to worry about well-child visits, about what you’ll do if your child becomes ill and needs surgery, about how you would acquire needed antibiotics for a routine ear infection. And with Obamacare, you can be assured the push for standardization of care and for vaccines is going to become even more aggressive.
The pediatrician who wrote this, who is apparently sheepish enough about his views that he used a pseudonym for his essay, pushes the mainstream propaganda with this paragraph (links to his sources are embedded):
There are few questions I can think of that have been asked and answered more thoroughly than the one about the safety and effectiveness of vaccines.
The measles-mumps-rubella vaccine does not cause autism.
The HPV vaccine is safe.
In response to this, I supply my own links:
- The courts have made numerous payouts to families, deciding that the MMR vaccine does, in fact, cause autism.
- The HPV vaccine is a deadly scam.
- Thimerosal, aka mercury, is toxic.
Finally, he wraps it up, and I have to say, I’d be thrilled to be kicked out of his office because I do think he is misguided. I sincerely think he believes what he is pushing, but I also think he has been brainwashed, not educated.
I often wonder why a parent who believes vaccines are harmful would want to bring their children to a medical doctor at all. After all, for immunizations to be as malign as their detractors claim, my colleagues and I would have to be staggeringly incompetent, negligent or malicious to keep administering them.If vaccines caused the harms Jenny McCarthy and her ilk claim they do, then my persistence in giving them must say something horrifying about me. Why would you then want to bring your children to me when you’re worried about their illnesses? As a parent myself, I wouldn’t trust my children’s care to someone I secretly thought was a fool or a monster.
It’s not merely that I don’t want to have to worry that the two-week-old infant in my waiting room is getting exposed to a potentially-fatal case of pertussis if these parents bring their children in with a bad cough. It’s not just that I don’t want their kid to be the first case of epiglottitis I’ve ever seen in my career. Those are reasons enough, to be sure. But they’re not all.
What breaks the deal is that I would never truly believe that these parents trust me. Giving kids vaccines is the absolute, unambiguous standard of care, as easy an answer as I will ever be able to offer.
If they don’t trust me about that, how can I hope they would if the questions ever got harder?
I have personally had tense conversations during doctor’s visits when refusing vaccines or certain medications for my children. I have been quizzed about vaccines in the emergency room when I brought my daughter in for a broken wrist, which is clearly totally unrelated to her vaccination history. I’ve never had a doctor absolutely refuse to treat my child, but there have been some less-than-positive encounters.
It is my right as a parent to make the best choices possible for my children – choices that are based on my personal beliefs, my religious beliefs, and the research that I have diligently searched out. Medicine should not be a dictatorship, where you go in and submit your child to the doctor’s decisions. I want a doctor with whom I can partner in my child’s care, not an arrogant, all-knowing, inflexible authoritarian in a lab coat.
If you have a pediatrician who treats you condescendingly, who refuses to abide by your wishes for treatment for your children, or who refuses to consider your concerns as valid, maybe if that doctor refuses to treat your child, it is the best thing that could happen.
Dr. Joseph Mercola, a leading wellness expert, an osteopathic physician and a board-certified family medical doctor, sums it up:
It goes without saying that when you choose a physician, that physician is working for you. It is an oxymoron that a pediatrician is able to “fire” a patient; more accurately, you have a choice as to whom you trust to provide health care for you and your children.
So you can always FIRE your doctor. It is YOUR right and YOUR choice to take control of your health and your family’s health and you should NEVER allow any doctor to interfere with that right. That said, there are reports of pediatricians ostracizing patients that disagree with the U.S. Centers for Disease Control and Prevention’s (CDC) one-size-fits-all vaccination schedule. Some pediatricians will even resist answering your vaccination questions or concerns.
I find it interesting, though, that one of the most salient points raised in the Time magazine article came not from the author but from her 4-year-old daughter, who asked after receiving five vaccines:
“Why I got to get shots to make me healthy?”
And therein lies a very powerful question … (source)
Learn more about vaccines from these resources:
Daisy Luther is a freelance writer and editor. Her website, The Organic Prepper, offers information on healthy prepping, including premium nutritional choices, general wellness and non-tech solutions. You can follow Daisy on Facebook and Twitter, and you can email her at email@example.com
You can’t make this stuff up. An exhaustive 13-year study found an elevated risk of flu-like illness in the two weeks following well child visits.
Having no insurance showed the lowest risk of illness, because of no doctor visits. In other words, being insured and going to a pediatrician increases your child’s risk of getting sick.
The study focuses on disease transmission in doctors’ waiting rooms. They offer no statistical evidence to support this hypothesis, you are just supposed to believe that germs are the only cause of illness.
Of course there is an element of truth in that theory, sitting there packed like sardines in a stuffy doctor’s waiting room being sneezed and coughed on by sick tykes is certainly not the most healthy environment.
However, one HUGE cause of flu-like disease is VACCINATION. Most doctors are ignorant about vaccine-associated enhanced respiratory disease (VAERD), which is the exact disease described in this new well-child-visit-makes-you-sick study.
According to the Center for Infectious Disease Research and Policy (CIDRAP), piglets who received seasonal flu vaccine ‘got sick with severe pneumonia and had severe lung damage after they were infected with the 2009 H1N1 virus, suggesting that cross-reactive antibodies triggered by the flu vaccine made symptoms worse after infection with a different flu strain.’
Science Translational Medicine Journal calls this form of medical malpractice Vaccine-induced disease enhancement.
Furthermore, the package insert for the FLUARIX flu shot prominently lists upper respiratory tract infection, nasopharyngitis, nasal congestion, diarrhea, influenza-like illness and vomiting as adverse events of the flu shot. In other words, the FLU SHOT gives you flu-like symptoms. The same symptoms this study reports kids develop after well-child visits, which are simply undisguised excuses to pump kids full of vaccines.
Doctors make you sick. Want a healthy child? Avoid pediatricians, well-child visits and vaccines. Find a doctor who serves your interests, not those of pharmaceutical companies and the CDC. Get your nutritional house in order so your child has a healthy immune system that fights off disease challenges and develops superior natural immunity. As vaccine Godfather Paul Offit puts it ‘It is true that natural infection almost always causes better immunity than vaccines.’
These medical appointments shouldn’t be called well child visits. They should be called get-your-well-child-sick-by-going-to-the-doctor visits.
EurekAlert CHICAGO (February 12, 2014) – New research shows that well-child doctor appointments for annual exams and vaccinations are associated with an increased risk of flu-like illnesses in children and family members within two weeks of the visit. This risk translates to more than 700,000 potentially avoidable illnesses each year, costing more than $490 million annually. The study was published in the March issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
“Well child visits are critically important. However, our results demonstrate that healthcare professionals should devote more attention to reducing the risk of spreading infections in waiting rooms and clinics. Infection control guidelines currently exist. To increase patient safety in outpatient settings, more attention should be paid to these guidelines by healthcare professionals, patients, and their families,” said Phil Polgreen, MD, MPH, lead author of the study.
Researchers from the University of Iowa used data from the Agency for Healthcare Research and Quality’s (AHRQ) Medical Expenditure Panel Survey to examine the healthcare trends of 84,595 families collected from 1996-2008. Included in the analysis were demographic, office-based, emergency room, and outpatient cases records. After controlling for factors, such as the presence of other children, insurance, and demographics, the authors found that well-child visits for children younger than six years old increased the probability of a flu-like illness in these children or their families during the subsequent two weeks by 3.2 percentage points.
This incremental risk could amount to more than 700,000 avoidable cases of flu-like illness each year and $492 million in direct and indirect costs, based on established estimates for outpatient influenza.
In a commentary accompanying the study, Lisa Saiman, MD, notes, “The true cost of flu-like illnesses are much higher since only a fraction result in ambulatory visits and many more cases are likely to result in missed work or school days. Furthermore, these flu-like illness visits are associated with inappropriate antimicrobial use.”
The authors stress the importance of infection prevention and control in ambulatory settings, suggesting pediatric clinics follow recommended guidelines that include improving environmental cleaning, cough etiquette, and hand hygiene compliance.
“Even with interventions, such as the restricted use of communal toys or separate sick and well-child waiting areas, if hand-hygiene compliance is poor, and potentially infectious patients are not wearing masks, preventable infections will continue to occur,” said Polgreen.
Jacob E. Simmering, Linnea A. Polgreen, Joseph E. Cavanaugh, Philip M. Polgreen. “Are Well-child Visits a Risk Factor for Subsequent Influenza-Like-Illness Visits?” Infection Control and Hospital Epidemiology 35:3 (March 2014).
Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 13 out of 158 journals in its discipline in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.
Are Well-Child Visits a Risk Factor for Subsequent Influenza-Like Illness Visits?
1. Department of Pharmacy Practice and Science, University of Iowa, Iowa City, Iowa
2. Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa
3. Departments of Internal Medicine and Epidemiology, University of Iowa, Iowa City, Iowa
Address correspondence to Philip M. Polgreen, MD, MPH, Division of Infectious Diseases, Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, IA 52242 (firstname.lastname@example.org).
(See the commentary by Saiman, on pages 257–258.)
Objective. To determine whether well-child visits are a risk factor for subsequent influenza-like illness (ILI) visits within a child’s family.
Design. Retrospective cohort.
Methods. Using data from the Medical Expenditure Panel Survey from the years 1996–2008, we identified 84,595 families. For each family, we determined those weeks in which a well-child visit or an ILI visit occurred. We identified 23,776 well-child-visit weeks and 97,250 ILI-visit weeks. We fitted a logistic regression model, where the binary dependent variable indicated an ILI clinic visit in a particular week. Independent variables included binary indicators to denote a well-child visit in the concurrent week or one of the previous 2 weeks, the occurrence of the ILI visit during the influenza season, and the presence of children in the family in each of the age groups 0–3, 4–7, and 8–17 years. Socioeconomic variables were also included. We also estimated the overall cost of well-child-exam-related ILI using data from 2008.
Results. We found that an ILI office visit by a family member was positively associated with a well-child visit in the same or one of the previous 2 weeks (odds ratio, 1.54). This additional risk translates to potentially 778,974 excess cases of ILI per year in the United States, with a cost of $500 million annually.
Conclusions. Our results should encourage ambulatory clinics to strictly enforce infection control recommendations. In addition, clinics could consider time-shifting of well-child visits so as not to coincide with the peak of the influenza season.
Received June 7, 2013; accepted November 14, 2013; electronically published January 29, 2014
The majority of preventive health care for children is administered during routine well-child visits. During these visits, vaccinations are administered, screenings are performed, and developmental milestones are assessed.1 Well-child visits occur annually in children after age 3 years and more frequently before.1 These visits often occur in the same clinics as acute care visits. Among younger children, respiratory infections generate a substantial number of acute care visits.2 Unfortunately, these infections may spread in waiting and exam rooms. Routes of transmission include droplets, the hands of healthcare workers, and environmental contamination.3-5
To prevent the spread of infections to patients during well-child visits, several approaches are used. In addition to stressing the importance of hand hygiene and environmental cleanliness, some clinics have attempted to restrict the use of communal toys and opened segregated well-child waiting areas.4 However, even with these interventions exam rooms are usually not segregated. In addition, hand hygiene compliance and environmental cleaning are routinely not optimal.6 Overcrowding during the respiratory virus season may further increase the risk of transmission.
Knowing the level and timing of elevated risk during ambulatory care may allow rearranging or rescheduling of well-child visits so they do not occur during the peak of the influenza season. However, little information about the scale of the problem in pediatric offices exists. The purpose of this article is to determine whether well-child visits are a risk factor for subsequent influenza-like illness (ILI) visits within the child’s family. We also estimate the cost of these subsequent infections on a national level.
The Agency for Healthcare Research and Quality’s Medical Expenditure Panel Survey (MEPS) is a longitudinal, nationally representative sample of the US population. Primary focus areas are healthcare utilization, expenditures, and health-related attitudes.7 For our analysis, we used the demographic, office-based, emergency department, and outpatient event files from the years 1996–2008. This reflects the entirety of the noninpatient medical care for each subject.
We extracted ILI visits using International Classification of Diseases, Ninth Revision (ICD-9) codes from the pooled outpatient, office-based, and emergency department visit records. Visits were labeled as ILI if they included at least one of the 16 ICD-9 codes listed in Marsden-Haug et al,8 shown here in Table 1. Next, we extracted well-child visits on the basis of 2 criteria: if the records included ICD-9 codes previously used for well-child visit studies9 or if the primary reason for the visit was “immunizations or shots” or “well-child exam.” We focused on well-child visits occurring in patients under the age of 6 years to focus on child health prior to enrollment in elementary school.
We used the MEPS data to create family units. MEPS provides a dwelling unit ID and subclassifies the dwelling unit into families. Combining the unique dwelling unit ID and the family ID generates a unique key for each family. Within these families we created an indicator variable for each week that a well-child visit occurred for a child under the age of 6 years. We also created an indicator variable for each week that an ILI occurred for any family member. Because MEPS panels run for 2 years, each family had up to 104 weeks of observation. Given the 84,595 families under observation, this translates to 8,053,344 overall records.
To determine whether well-child visits are a risk factor for subsequent ILI visits, we used survey-weighted logistic regression. For most of our analyses, the unit of analysis was the family. In our model, an ILI visit in a particular week was the dependent variable. Independent variables included an indicator for the well-child visit risk window, defined as 1 if there was a well-child visit in same or one of the previous 2 weeks. The consideration of the prior 2 weeks accounts for the delay in presentation of ILI. To control for sociodemographic factors, we included the race and education for the MEPS reference person, where the reference person is the person who rents or owns the dwelling unit for the family. To account for access to care, we included whether the reference person had private, public, or no insurance. Family income was converted to percentage of the poverty level and coded as one of 5 levels: poor (income less than 100% of poverty line), near poor (100%–124%), low income (125%–199%), middle income (200%–399%), and high income (more than or equal to 400%). To control for the effect of other children in the family unit, we also included a series of indicator variables to represent the presence of children aged 0–3, 4–7, and 8–17 years. We defined these cutoffs empirically. Finally, we included a dummy variable representing whether the ILI visit occurred during the influenza season. We defined the influenza season as the months of December, January, and February. Analysis was done using the Survey package and R (ver. 3.02).
As a further check of association, we explored the existence of an interaction between the influenza season and the well-child visits. If infections are acquired during well-child care, we would expect the effect of well-child visits on subsequent ILI visits to be elevated during the influenza season. Additionally, as a sensitivity analysis, we assessed the effect of the chosen risk window for the well-child visit by shortening it by a week to include only the same or the previous week as the well-child visit. We also modified the definition of well-child visit to be only those visits in children aged 3 years and under.
To evaluate the cost of well-child-related ILI, we used the MEPS data for 2008 to obtain an estimate that is adjusted by the MPES survey-sampling weights. Using the model without interactions, we calculated the difference in risk of an ILI visit for every family with a well-child visit compared with the counterfactual of no well-child visit. We estimated the total increase in risk during the well-child visit risk window with all covariates except for the well-child indicator held constant. Using the MEPS covariates allowed us to make more accurate estimates of the total increase in risk than, for example, considering the effect of a well-child visit with the other covariates set at their mean/modal values. The resulting estimate is more reflective of the total national burden. We estimated the average increased risk using a survey weight-adjusted mean of the computed increased risk for each family. Using the total annual number of cases and economic burden of outpatient influenza reported by Molinari et al,10 we estimated the mean cost of a case of outpatient influenza as $642.06. This estimate reflects direct medical costs and indirect costs, such as lost work.
During our study period of 13 years, we followed 84,595 families. We found 23,776 family-weeks with a well-child visit in children under age 6 years. We also detected 97,520 family-weeks with an ILI visit among family members of any age.
The results from our model exploring the risk factors for ILI visits at a family level are shown in Table 2. We found that a lack of insurance was associated with reduced odds of having ILI office visits. Families receiving public insurance were more likely to have an ILI office visit than their privately insured peers. In terms of race, we found that whites were the most likely group to have an ILI visit. Higher income and higher education levels were also positively associated with ILI visits. Families with young children were more likely to have an ILI visit. As expected, the influenza season was associated with increased risk for ILI.
Finally, we found that even when controlling for all of the preceding factors, the occurrence of an ILI office visit by a family member was strongly associated with a well-child visit in the same or either of the 2 previous weeks. In fact, the odds of an ILI visit for a family with a well-child visit in the same or either of the prior 2 weeks were 1.54 (P < .0001) times that for a family without a well-child visit during this time period.
The inclusion of the interaction term between the influenza season and the well-child visit indicator slightly attenuated the main effect of the well-child visit (odds ratio [OR], 1.46; P < .0001; Table 3). This is because the estimate in the additive model reflects the average burden over the year. If a well-child visit was additively more risky during the influenza season, that relationship would be captured by the influenza season variable. If a well-child office visit elevates the log odds of an ILI visit to a greater extent during the influenza season, we would expect the interaction term to be positive. This could be the case if the influenza season created greater ILI volume in the clinic, thereby increasing exposure during a well-child office visit. The interaction between the well-child and influenza season indicator variables was significant and positive (OR, 1.18; P = .0114). This suggests that the effect of a well-child visit on increasing the risk for subsequent ILI is more pronounced during the influenza season.
Neither of our 2 sensitivity analyses alter our results. If we shorten the risk window by 1 week, the OR remains practically constant at 1.56 (P < .0001). Likewise, if we restrict the analysis to only the 26,786 well-child visits in patients aged 3 years or younger, we arrive at an OR of 1.50 (P < .0001). In comparison, defining well-child office patients to be 5 years or younger and including the same and prior 2 weeks in the risk window yields an OR of 1.54 (P < .0001).
Using the family characteristics and sampling design in MEPS for 2008 and without considering the interaction between influenza season and well-child office visits, we arrive at an average 3.17 (interquartile range [IQR], 2.44–3.91) percentage point increase in the probability of an ILI office visit in the week of or 2 weeks following a well-child visit. When the sample weights are applied, this reflects a potential excess of 778,974 ILI office visits. Using $642.06 as the estimated economic burden of outpatient influenza, we arrive at an annual cost of $500,147,992. Repeating this computation using the model with an interaction term yields a comparable increase in the probability of an ILI office visit (3.12 percentage points; IQR, 2.13–3.72). Using the estimate with the interaction and the sampling weights as before, we estimate 766,151 additional ILI office visits and $491,914,592 annual costs.
Our results demonstrate that well-child visits are associated with ILI visits during the week of and 2 weeks following a well-child visit. Specifically, we find a 3.17 percentage point increase in the probability of an ILI visit based on a well-child visit in the concurrent week or either of the previous 2 weeks. Although this risk is relatively small, the number of well-child visits on a national level is not. We estimate 778,974 potentially avoidable ILI visits for a total economic burden of more than half a billion dollars in 2008. Given that actual provider-based visits measure only a fraction of ILI episodes, this may substantially underestimate the potential risk of well-child visits.
Children and their family members attending well-child visits are certainly at risk for acquiring infections. However, it has been much harder to document the risk factors for infections from ambulatory exposures than hospital-associated infections. Exposures to some diseases in ambulatory clinics are easier to diagnose on the basis of ease of transmission, clinical presentation, and how common the infections are in general. For example, during some outbreaks in the United States, a substantial percentage of measles cases were linked to exposures in ambulatory care environments.11,12 Transmission of tuberculosis has also been linked to exposures in pediatric clinics.13,14 However, exposures and transmission of infections that occur commonly in the community are not reported, and this may be due to the difficulty of attributing exposure to office visits.5 One study of 127 children was designed to determine the risk of acquiring an infection in the week following a pediatric office visit. This study did not detect an increased risk following the visit.15 Another study of 304 children, 137 of whom had an emergency department visit, did not find an increased risk of infection.16 A similar larger study of emergency department visits among elderly residents of long-term care facilities (1,269 participants, 424 of whom visited the emergency department) found that a visit was associated with a 3-fold increase in the risk of a subsequent acute infection.17
The unique design of MEPS enabled us to conduct a much larger investigation than has been done previously. We were able to capture important variables that may explain access to care, the timing of visits, and, most importantly, the potential for capturing possible ILI visits among family members, not just patients attending the well-child visits. In addition, we were able to capture visits that occur in multiple settings across healthcare and payer systems.
Our results stress the importance of infection control in ambulatory settings. Infection prevention and control guidelines for pediatric clinics exist, and these highlight a number of interventions that may be undertaken. Many policies focus on reducing the transmission of respiratory infections. These include improving environmental cleaning, respiratory hygiene and cough etiquette, and hand hygiene compliance.3-5 The last 2 interventions can be practiced by both patients and their family members as well as healthcare workers to reduce risk. In fact, the most effective approach to infection control in ambulatory settings involves the sharing and coordination of information at an early stage. The American Academy of Pediatrics Committee on Infectious Diseases states that “infection prevention and control should start at the time an ambulatory visit is scheduled and is important in every patient encounter.”3(p650) We would argue that this approach should be taken even further so that infection control starts before the well-child visit is scheduled.
Currently, the timing of well-child visits does not exploit information that could decrease the risk of respiratory viruses. Well-child visits are often based on patients’ birthdays as a convenient way to ensure complete and timely vaccinations. It may be possible that changing scheduling by a few weeks on the basis of local influenza patterns may decrease exposures and secondary illnesses for both children attending well-child visits and their family members. An alternative would be to decrease the number of well-child visits scheduled during the peak “influenza season.” This approach may make staffing clinics easier: the upswing in activity due to the respiratory virus season often provides greater demand for acute care services. However, any potential benefits from shifting well-child visits to avoid the peak of influenza season need to be weighed against possible disruptions in routine vaccination scheduling. Thus, we think that before any changes to well-child scheduling are even considered, reinforcing and implementing currently recommended clinic-based infection control guidelines should be most vigorously pursued. The well-child visits are not generating additional ILI cases, it is the possible exposures that occur—many of which could be mitigated via better infection control practices—that are generating the additional ILI cases.
There are several limitations to our study. First, we captured ILI visits using the administrative codes provided by MEPS. These diagnoses were not based on microbiological data (eg, cultures, chart reviews). In addition, because the MEPS data include only the first 3 digits of the ICD-9 codes, it is possible that we are misclassifying some events. However, the first 3 digits provide clinically meaningful categories that are likely specific enough for this study.
Second, we do not know which family members were exposed at a visit or the extent of the exposure. However, we did observe an increase in risk for ILI visits following well-child visits for the patient. This lends support to the estimates obtained considering the entire family.
Third, the analysis did not consider influenza vaccination habits among the family. However, vaccination for all children 6 months to 4 years old was recommended for the 2007–2008 influenza season and for all children with the 2008–2009 season. Children presenting at well-child visits are potentially likely to be vaccinated or offered vaccination against the influenza. This would tend to bias our findings toward the null of no association.
Fourth, it is possible that the relationship we found between well-child visits and ILI is caused by a common temporal relationship with an omitted variable, such as the school year. However, this is not likely: ILI visits are highly seasonal, but well-child visits are not. We also considered multiple alternative definitions of the influenza season, but these alternative definitions yielded essentially the same results (data not shown).
Finally, our findings may be based on some omitted variables not captured by MEPS that are associated with both well-child visits and ILI visits, such as care-seeking behavior. However, we included the variables that were available in MEPS that could be associated with care seeking (eg, parents’ education, insurance status). Note that many of these variables were statistically significant, but the estimated ORs for many of these variables were relatively small compared with that of the well-child visit variable, the focus of our study (see Table 2). In addition, when we repeated the analysis but replaced the ILI office visit with an outpatient office visit for a sprain or strain, we found no significant increase in risk based on a well-child visit in the same week or either of the previous 2 weeks (OR, 1.18; 95% confidence interval, 0.94–1.45). We found no causal relationship between well-child care and these injuries except for differences in care-seeking preferences between families with and without well-child visits. The lack of a significant increase in risk of a sprain or strain in the weeks following well-child visits, in addition to the relatively small ORs for the other included variables, suggests that our finding is unlikely to be the result of care-seeking behavior by families who schedule and attend well-child visits.
Despite these limitations, we provide some of the first evidence for what many have suspected: ambulatory exposures are a potential risk factor for respiratory infections. We believe that attendance at well-child visits is critically important for preventing infections through vaccination and that the benefits far outweigh the risks. Nonetheless, our results stress the importance of improving compliance with current infection control guidelines for ambulatory settings—not just for well-child visits, but for all office visits.
Financial support. This work was supported in part by a grant from the National Institutes of Health (K01 AI75089 to P.M.P.) and a KL2 award from the University of Iowa Institute for Clinical and Translational Science (to L.A.P.).
Potential conflicts of interest. All authors report no conflicts of interest relevant to this article. All authors submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and the conflicts that the editors consider relevant to this article are disclosed here.
- 1. Bright Futures/American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care (Periodicity Schedule). http://www.aap.org/en-us/professional-resources/practice-support/financing-and-payment/Documents/Recommendations_Preventive_Pediatric_Health_Care.pdf. Accessed April 9, 2012.
- 2. Schappert SM, Burt CW. Ambulatory care visits to physician offices, hospital outpatient departments, and emergency departments: United States, 2001–02. Vital Health Stat 2006;13:1–66.
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- 5. Canadian Paediatric Society. Infection control in paediatric office settings. Position paper 2008-03. Paediatr Child Health 2008;13:408–435.
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By Martha Rosenberg AlterNet
Big pharma uses celebrities and other sneaky ways to sell diseases that may not exist.
Most of us have our guard up when it comes to direct-to-consumer drug advertising. We know the butterflies, sunsets and puppies in the TV ads are designed to distract us from terms like “blood clot,” “heart attack,” “stroke,” “seizure,” “life-threatening allergic reaction” and “death.” We are aware that more than half the ads tell us why we don’t actually want to ask our doctor about the new wonder drug.
Unbranded advertising, however, is much more insidious. Instead of selling a drug, it sells the disease driving the drug sales and sometimes doesn’t mention the drug at all.
Unbranded advertising often appears to be from the CDC and can even run free as a public service announcement thanks to its apparently altruistic message. The hallmark of unbranded advertising is it calls the disease it’s hawking (whether depression, bipolar disorder or restless legs) “under-diagnosed,” and “underreported” and cites “barriers” and “stigmas to treatment” which of course means sales. Sometimes it calls the disease a “silent killer” to scare people who think they’re fine. (Before drug advertising it was the opposite: the medical establishment said you were probably fine despite how you felt.)
Do You Have Undiagnosed Hypothyroidism?
From Joan Lunden and Mike Piazza selling Claritin, to Dorothy Hamill and Bruce Jenner selling Vioxx, celebrity drug advertising is often phenomenally successful. No wonder the drug company AbbVie has selected actress Sofia Vergara to lead its hypothyroidism campaign.
“Emmy-nominated actress Sofia Vergara is helping to raise awareness about the importance of diagnosing and treating hypothyroidism,” read a press release last spring, “a thyroid condition that affects millions of Americans.” Her campaign, called “Follow the Script,” funded by AbbVie, “aims to educate individuals with hypothyroidism about the importance of being consistent with the treatment their doctor prescribes, and provides a ‘script’ to ensure they consistently receive the medication prescribed by their doctor when they visit the pharmacy.” Ka-ching.
While hypothyroidism certainly exists (as do other kinds of thyroid disorders) Vergara’s campaign capitalizes on the gray areas in its diagnosis and the well-documented human tendency to self-diagnosis, by planting fear and doubt. For example, the AbbVie press release says, “Thyroid conditions affect an estimated 30 million individuals in the U.S.” and “one in every eight women will develop a thyroid condition in her lifetime.” Yet Harvard Health Publications at Harvard Medical School places the figure at 12 million.
Commensurate with unbranded advertising—aka “disease mongering”—Vergara’s “Follow the Script” campaign websitefeatures “interactive polls, symptom and treatment information,” “stories and videos from other individuals with hypothyroidism,” and a chance for visitors to “share their own experiences.” In classic unbranded pill marketing, the site also provides “helpful ‘scripts’ for speaking with your doctor and pharmacist” — so patients don’t go all the way to the doctor and fail to ring the cash register.
AbbVie was formed in early 2013 when Abbott, located near Chicago, split into two companies, with AbbVie to concentrate on the blockbuster Humira, which made it $2 billion in one quarter of 2013. But Synthroid, the thyroid supplement drug behind Vergara’s campaign, enjoyed almost 25 percent growth last year and accounted for $153 million during the same quarter. Synthroid is the nation’s leading thyroid supplement drug despite going off patent decade ago, because it is widely perceived as more stable than competitor and generic versions of the drug.
Lest no potential customers miss the fact that hypothyroidism is an under-diagnosed, underreported major health problem with barriers and stigmas to treatment,a ”National Academy of Hypothyroidism” has been set up.
The first thing visitors to the site will see is a slide of an overweight woman on a scale with the brazen headline “Is Your Thyroid Making You Fat?” Visitors will also learn that hypothyroidism could be causing their stress, depression and chronic pain just as lack of hormones or antidepressants caused them problems 10 years ago. There is even a perk for sufferers of hypothyroidism. The Academy tells them how to apply for disability benefits for their hypothyroidism. Just trying to help!
Do You Have Non-24 Hour Sleep Wake Disorder?
“You can’t see me because of radio… and I can’t see you because I’m totally blind.”
So begins a high-saturation radio campaign that launched late last year to boost “awareness” of an obscure circadian rhythm disorder called Non-24 Hour Sleep Wake Disorder in typical unbranded drug marketing fashion. How obscure is Non-24? There are only 146 citations for the disorder in the entire U.S. National Library of Medicine. By comparison, there are 8,463 citations for the plague.
The narrator says his blindness doesn’t “hold me back” but he often “struggles to keep up” because he is not “sleeping through the night.” He then says, “Sound familiar? You’re not alone!” The ads are from the Washington, DC-based drug company Vanda whose drug candidate for people who are blind and have Non-24, Hetlioz, received an FDA Advisory Committeerecommendation for approval in January which means the FDA will likely approve it. Hetlioz is said to be chemically related to the sleeping pill marketed as Rozerem (Ramelteon).
Developing “orphan drugs” that treat such a small part of the population (like the blind) they are not commercially viable is laudable. But orphan drugs are not usually accompanied by multi-million-dollar ad campaigns and slick websites. (Nor are important messages for the blind usually on the Web.) Is there something disingenuous going on? Under “Could You Have Non-24?” on the site, it says “The key symptoms of Non-24 are the inability to sleep or stay asleep and a powerful urge to sleep during the day” with no mention of blindness. A longer list on the site mentions waking up “groggy,” being “less productive than usual at work or at school,” relationships that “are strained,” “sluggishness and forgetfulness,” mood that is “affected” and frustration “because no one seems to understand what you’re going through,” and also doesn’t mention blindness.
You don’t have to be a cynic to wonder if the new disease — and the drug that will treat it if approved — is actually being marketed to the hundreds of millions of adults with sleep problems. When I called the phone number and asked the “health educator” if I could have Non-24 even though I am not blind, I was told “you don’t have to be blind to have Non-24″ though it is more common in blind people. When I asked if there was a pill I could take if I had symptoms, my educator said he was unable to answer that because, “I am not a doctor,” and promised to send me more information.
Getting a pill approved by the FDA so it can be legally sold and then widening its apparent uses through ad campaigns is called off-label marketing and it is strictly illegal. Since the lab tests and clinical trials that would establish safety for a new condition haven’t been done, patients are guinea pigs. Almost all recent major settlements with drug companies revolve around off-label marketing of drugs including Johnson & Johnson’s Risperdal, Bristol-Myers Squibb’s Abilify, Eli Lilly’s Zyprexa, GlaxoSmithKline’s Paxil, Pfizer’s Neurontin, Bextra, Geodon and Lyrica, AstraZeneca’s Seroquel, Ortho-McNeil-Janssen’s Topamax, Forest Laboratories’ Celexa and Lexapro and Abbott’s Depakote.
“15,000 elderly people in nursing homes [are] dying each year from the off-label use of antipsychotic medications,” testiﬁed FDA drug reviewer David Graham, during congressional hearings, adding that Pharma is “laughing all the way to the bank.”
Selling the “disease” of Non-24 is reminiscent of the campaign to sell Shift Work Sleep Disorder two years ago. “Do you work a nontraditional work schedule?” asked the ads for Cephalon’s stimulant Nuvigil. “Do you struggle to stay awake?” You may be suffering from Shift Work Sleep Disorder! Soon there was a unbranded website called the Wake-Up Squad to sell the disease without ever mentioning the drug. The Wake-Up Squad is “on a mission to lead the fight against Shift Work Disorder,” it announced, offering facts and myths about the disease and a big red headline asking, “Are You At Risk?”
Both the hypothyroidism and Non-24 unbranded ad campaigns are so general, they apply to almost everyone. They bring us closer to what comedian Chris Rock predicted drug advertising would become, in a TV special: “Do you fall asleep at night and wake up in the morning? You may be suffering from ….”