Archives for category: politics

 

If it is not advantageous, do not move. If objectives cannot be attained, do not employ the army. The ruler cannot mobilize the army out of personal anger … When it is advantageous, move. When not advantageous, stop. Anger can revert to happiness, annoyance can revert to joy, but a vanquished state cannot be revived, the dead cannot be brought back to life.

Sun-tzu[1]

 [Dear Fred. I’m up at the mountain cabin this weekend, doing an inventory of freeze-dried food packets and potassium iodide tablets, so I haven’t had time to concentrate on the latest news about North Korea, China and the Russians. I know the rhetoric has heated up, and our media are beginning to scare the snowflakes, but I’m not impressed. You and I have seen this before; we’re older than a lot of folks, and remember the Bay of Pigs, and the October, 1962 nuclear showdown between us and the Russians [aka the old Soviet Union]. They installed intermediate range nuclear missiles in Cuba and aimed them at us.[2] We took exception but it was a knotty problem because we had done essentially the same thing when we installed similar weapons in Italy and Turkey. Our missiles were right at the Soviets’ doorstep and, of course, were aimed at them.

I was in college at the time, and in the ROTC, so I had a basic understanding of the forces in play. World War II had ended not 20 years earlier, so I knew for sure that global wars were possible. I also knew, because this was a big topic when I grew up, that the next big one could be fought with far deadlier weapons. That is, with bombs and missiles of the nuclear persuasion. Our Government thought so too. See Boom, Watch the Fallout!, a blog we did last May on bomb shelters and war planning.[3] Frankly I was appalled at the prospect of a first ever, widespread nuclear war. It was like science fiction gone bad.

Why didn’t we have a nuclear slugfest in 1962? Well, perhaps somebody on our side, and the Russian one as well, had read Sun-tzu. A war at that time and place simply made no sense:

  • We and the Soviet Union were evenly matched, more or less, in that each of us could severely, if not permanently damage the other in any nuclear war;
  • Elements in our respective Governments realized this basic truth; and
  • There was nothing at stake to warrant extreme measures and possible mutual destruction.

Both sides had long range bombers that could reach the other’s homeland, so strategically it wasn’t really necessary for either of us to have intermediate range missiles on the other’s doorstep. Such missiles were useful, perhaps, but not absolutely essential.  Also, each side continued to develop and deploy long range ballistic missiles and warheads for them; these were easier to secure, because they could be stationed far from an enemy, yet could strike an opponent’s homeland within minutes of launch.[4]

With such weapons coming into inventory, why would any strategist recommend going to war to protect shorter range capabilities? Even the winner of such a war, if there were one, wouldn’t gain much, and would lose a lot. So war was not advantageous to either side, and that made negotiations possible. Eventually the Soviet Union moved its intermediate range missiles out of Cuba and we removed some that we had put in Italy and Turkey. The details of our negotiations didn’t come out for years, but that was the deal and that was what happened.[5]

Anyway, please take a look at our current situation with North Korea and tell me your thoughts. Is it at all like the Cuban Missile Crisis and, if so, what are the prospects for a peaceful resolution? Good, I hope, but tell the truth. And go ahead and publish your thoughts when you’re ready. You don’t need my input for this kind of thing and, anyway, I won’t be back in town for a while. G. Sallust.]

Then and Now

OK, Mr. G. Sallust, I understand. This is Fred, by the way. Normally G. Sallust would write this piece, but he’s doing inventory so I’m to fill in. The question he’s posed is, is the current unpleasantness with North Korea similar to the situation we had with Cuba and the Soviet Union 50+ years ago?

Similarities and Differences

  1. Originally I thought there’s no similarity between the two situations. Back then it was us against the old Soviet Union, two giants each of whom had weapons that might destroy the world. This time it’s us against North Korea, a very, very minor power with, at the moment, a modest nuclear capability. So what we have today, I thought, is definitely not the Cuban Missile Crisis.
  2. But actually the similarities are greater than the differences. We tried to “covertly” invade Cuba in 1961, did a very bad job of it with “volunteers” at the Bay of Pigs, and failed.[6] Naturally Cuba worried that we might make a second attempt, so Fidel Castro [yes, the Castro who just died] invited the Soviets into Cuba to station troops and missiles there. We found out and demanded that the Soviets remove them. The result was a major confrontation.
  3. From 1950 to 1953 we and the U.N. fought a “police action” in Korea to prevent the North from invading the South. The battle was fought to a stalemate, a line was drawn between the two Koreas, a “demilitarized zone” was established, and the areas around it were heavily fortified. Since then we’ve maintained a substantial force of ground troops, etc. in the South to help with its defense.[7]
  4. By all accounts, no foreign power has stationed nuclear weapons in North Korea. Instead the Government there has developed its own over a period of many years. No doubt it had substantial foreign assistance in this effort. But the net effect is that North Korea, not some foreign power, controls the North’s nuclear forces. At least that’s the way it seems. It’s North Korea that has been making direct threats to attack the U.S. The threats are credible, in that apparently North Korea has some capability to do so. On the other hand, North Korea is not a military equal of the U.S.
  5. But it also has potential allies: Russia and China. To date Russia has shown little interest in intervening on behalf of North Korea in its dispute with us. Russia says that it is “deeply worried” about the “bellicose rhetoric” between us and the North, [8] but hasn’t offered military or other assistance to any party. At least not officially, that we know of. To date Chinese state media say that “it would remain neutral if North Korea attacks the United States, but warned it would defend its Asian neighbor if the U.S. strikes first and tries to overthrow [the North Korean] regime …”[9] I think that means the Chinese intend to intervene if we do more than shoot down North Korean missiles.
  6. But, of course, these are only words, and they can change overnight, with circumstances.

Nuclear Weapons

Currently North Korea is threatening to fire missiles at Guam, the site of several U.S. military installations. What if Kim Jong Un, North Korea’s leader, does that, hits something and blows it up? What if he uses a nuclear weapon? Then I suppose we will retaliate in force, and it would be up to Russia and China to decide whether they will get involved. What might they win by intervening and what might they lose?

  1. Some people already think we’re headed to some kind of war with Russia.[10] Others don’t believe it’s inevitable, but think it’s risky to blunder from a cold to a hot one because of small or nonexistent provocations[11]. I agree with both views, by the way.
  2. And war always brings up the question of nuclear weapons. Today we and NATO maintain the right to strike first with those things, if we’re properly threatened[12]; and the Russians will use them if Russia or its allies are attacked with weapons of mass destruction, or Russia is losing badly in a conventional war.[13]
  3. And the first one of us who decides that the other side intends to go nuclear will, of course, do it first, to minimize its losses and maximize the enemy’s. And if you want to know more about what happens after that, go read Herman Kahn’s book, On Thermonuclear War. [14]

Conclusion

I have no conclusions. North Korea’s threats are ridiculous, may lead to catastrophe, and it should be muzzled. Apparently China, the only country with influence, doesn’t want to do that. Why not? I wonder. What game are the Chinese playing?

This all very depressing! If there really is a large war faction in Washington, DC, they must be rejoicing! What does that crazy guy say on YouTube? Oh yes, it’s all Satanic!

Sun-tzu, anyone?

[1] That’s from Sun-tzu, The Art of War (Sawyer translation) (Barnes & Noble, 1994), at Incendiary Attacks, p. 227 – 228. Sun-tzu is a famous Chinese military strategist of the 5th Century B.C. For more about him, see the Wikipedia entry at https://en.wikipedia.org/wiki/Sun_Tzu . Henceforth we’ll cite this edition of the book as Sun-tzu at ___.

[2] For an explanation take a look at the Wikipedia entry on the Cuban Missile Crisis at https://en.wikipedia.org/wiki/Black_Saturday_(Cuban_Missile_Crisis) .

[3] See our blog of May 11, 2017, Boom, Watch the Fallout, available at https://opsrus.wordpress.com/2017/05/11/boom-watch-the-fallout/

[4] For information on ICBMs, see Wikipedia at https://en.wikipedia.org/wiki/Intercontinental_ballistic_missile .

[5] For more information, see the Wikipedia entry at https://en.wikipedia.org/wiki/Cuban_Missile_Crisis . It’s quite thorough.

[6] Id.

[7] For more information, see the Wikipedia entry at https://en.wikipedia.org/wiki/South_Korea . For the most up-to-date information, check out the CIA World Fact Book at https://www.cia.gov/library/publications/the-world-factbook/ .

[8] See MSN, Russia says that bellicose rhetoric on North Korea is over the top, at http://www.msn.com/en-us/video/peopleandplaces/russia-says-bellicose-rhetoric-on-north-korea-is-over-the-top/vp-AApTlYB

[9] See Fox News, Lukas Mikelionis, China pledges neutrality – unless US strikes North Korea first (August 11, 2017), available at http://www.foxnews.com/world/2017/08/11/china-pledges-neutrality-unless-us-strikes-north-korea-first.html

[10] See, e.g., Institute for Political Economy, Roberts, Will the November US Presidential Election Bring the End of the World?  ( May 24, 2016) sometimes available at http://www.paulcraigroberts.org/2016/05/24/will-the-november-us-presidential-election-bring-the-end-of-the-world-paul-craig-robert s/

[11] See, e.g., Rand Corporation, Libicki, Crisis and Escalation in Cyberspace (2012), especially pp. 97-99, available at http://www.rand.org/pubs/monographs/MG1215.html

[12] Actually, it’s worse than that. NATO maintains the right. See the Wikipedia entry on “no first use” at https://en.wikipedia.org/wiki/No_first_use

[13] Id. Russia will use nukes if others use them [or weapons of mass destruction] against it or its allies; or use even conventional weapons “when the very existence of the state is threatened.” I don’t know the Chinese position on this, but I think it’s probably similar to the Russian.

[14] See Kahn, On Thermonuclear War (Princeton, 1960, Transaction reprint, 2010), at p. 136. We’ve written a lot about that book. See, e.g., our blog of 12/28/2015, Bomb Them into the Stone Age, available at https://opsrus.wordpress.com/2015/12/28/bomb-them-into-the-stone-age/ .

 

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.

National Institute on Drug Abuse[1]

 [This is Fred and I’m here with more bad news about heroin and the other opioids now destroying us, plus some cheerful speculation. Note the paragraph quoted above. Apparently in the 1990s we didn’t understand that opium and its relatives are highly addictive, even though it was obvious 200 years earlier. See our recent blog[2] on Thomas de Quincey’s Confessions of an English Opium Eater.[3] So I guess our great planners didn’t expect patients to start abusing opioids once those drugs became plentiful by prescription. And once more people became addicted certainly no one expected the criminal class to fill the increased demand with their own, informal products. Who would ever dream such a thing?

Also, we still don’t know if opioids actually treat pain when they are used in the long term. According to one recent study: “Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. Evidence supports a dose dependent risk for serious harms.”[4] Translation?  The long term benefits are unclear, but the dangers are obvious.

Not to worry, the National Institutes of Health [NIH], and their parent, the Department of Health and Human Services [HHS] have swung into action. Today society has a problem with opioid addiction and they will solve it by:

  1. Improving access to treatment and recovery services;
  2. Promoting use of overdose-reversing drugs;
  3. Strengthening our understanding of the epidemic through better public health surveillance;
  4. Providing support for cutting-edge research on pain and addiction; [and]
  5. Advancing better practices for pain management.[5]

So what could go wrong? Well, think about it. If we’re going to improve access to “treatment and recovery” services [Point 1], what does that mean? Do we have some magic cure that will wipe away addiction? I don’t think so. It’s very difficult to ween an addict from his [or her] opioid of choice. It was that way for Thomas de Quincey, and the situation hasn’t changed.  And if the weening process takes a long time, that sounds expensive. Taxpayers beware!

OK, but surely it would be a good thing to promote “overdose-reversing drugs.” [Point 2] Yes it would, because those drugs prevent death by overdose and it’s always good to do that. But overdose drugs don’t cure addiction, so we still have the problem of treating the survivors.

All right, then what about Point 3? NIH wants to know more about the size of the problem, how many addicts there are, and so forth. Again, who can quarrel with that? “Knowledge is power,” we’re told;[6] and why rent a rowboat for addicts if we really need a passenger liner? So yes, by all means study the problem, but not at the expense of making progress elsewhere. And by the way, the early returns are in. See Crappy News, the next section.

How about “cutting edge research” [Point 4]; is that a good idea? Practically always, say I. If our scientists research pain, perhaps they’ll develop new ways to treat sufferers without dosing them with addictive substances. That’s got to be a “better practice” [Point 5] than what we’ve been doing.

Then what about “cutting edge research” on addiction itself? Should we work on that as well? Yes, and we’ll discuss that later, under Vaccines.]

The Crappy News, or Why One Should Avoid the Drudge Report Early in the Morning

So the other day I was minding my own business, checking the Drudge Report, when I happened on a piece from Reuters that said: “More than third of [all] U.S. adults [were] prescribed opioids in 2015.[7] [Drudge is my substitute for a morning tabloid; feel free to pick a different service if you want; but definitely we all need something to read at breakfast.]

Ugh? Looking further I found the original data, or at least an abstract of it.[8] Officially the study is called the 2015 National Survey on Drug Use and Health [NSDUH]. So let’s sketch the findings. What else can you do with an Abstract?

  • In 2015 72,600 eligible civilian, noninstitutionalized adults were selected to participate in the study, and 51,200 completed the survey interview.
  • Based on these inputs, NSDUH estimated that, in 2015, 91.8 million (37.8%) of U.S. civilian, noninstitutionalized adults used prescription opioids.
  • 11.5 million people (4.7% of all adults) misused opioids; and 1.9 million (0.8%) had an opioid use disorder.
  • Among adults with a prescription, 12.5% reported they misused it; and of these, 16.7% reported a “prescription opioid use disorder.”
  • Most commonly people who misused opioids did so to relieve physical pain (63.4%). Does that sound familiar? Check out Thomas de Quincy’s story, referenced above.
  • Misuse and use disorders were most common with adults who were uninsured, unemployed, had low income, or had behavioral health problems.
  • Among adults who misused opioids, 59.9% reported using them without a prescription, and 40.8% obtained prescription opioids – for their most recent episode – for free from friends or relatives.[9]

So there you have it. Lots of doctors prescribe opioids; more than one-thired of U.S. adults had prescriptions in 2015; and some of those also used opioids without a prescription. Thank you, NSDUH, for that insight.

And some patients get violent if their doctors refuse to write prescriptions.[10] The states are upset; they argue over-prescription and the resulting addictions are impacting state resources;[11] and they’re beginning to sue the drug companies [and others] they think are responsible. Congress is alert, and will hold hearings on the matter.[12] Mexico is producing more and more opium to satisfy the demand growing in the U.S.[13] [Frankly, I didn’t know Mexico produced any opium; I thought most of the world’s supply came from our dependency, Afghanistan.] And, of course, our medical establishment is studying the problem that, one could argue[14], it created.

Vaccines

None of this is good, but is there sunlight behind the clouds? A month or so ago a friend[15] sent us an article about medicines that fight opioids and other addictive substances.[16] Apparently this has been researched since the 1970s, although without much recent success. Right now therapists have only three medications – methadone, buprenorphine, and naltrexone – to use to help the opioid addicted “get clean” and stay drug free. They work, but “not perfectly.”[17]

Current research is directed toward finding vaccines to directly counter opioid addiction. Most foreign substances are blocked from entering the brain by something called the blood-brain barrier. Opioids are an exception to that. They are very tiny molecules; can penetrate the barrier and enter the brain; and then do their damage unopposed. Opioids may lose their advantage – of small size – if they are attacked by antibodies “that bind to the drug molecules, creating complexes that are too large to cross into the brain.”[18] If the brain isn’t accessed, “there’s no high.”[19] And, one might add, there’s no corresponding brain damage to reinforce later addictive behaviors.

So the research is directed at triggering the human immune system to directly attack opioids. To (i) convert opioids to larger things that will not pass into the brain, or (ii) flush them out of the body before they reach the brain, or (iii) to do both. The Scripps Research Institute in La Jolla, CA, and the Walter Reed Army Institute of Research in Silver Spring, MD, have promising lines of study, and may have vaccines ready to begin human trials in the not too distant future. There are other candidates out there as well.

Conclusion

The situation with opioids is grim and looks worse every day, but perhaps there really is sunlight behind the clouds. The important thing for Congress to remember is that, when they’re throwing oodles of money at law enforcement to chase bad guys with drugs, they shouldn’t forget the scientists who, with funding and a bit of luck, may solve this problem for everybody.

Until the next one comes along, of course. Humans are weak, and our criminals are very ingenious. Didn’t you know?

 

[1] This is from the website of the National Institute on Drug Abuse, an organization within NIH. You can find it at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis . It was last updated in June of this year.

[2] That’s the blog of 07/16/2017, Opium Portrayed, at  https://opsrus.wordpress.com/2017/07/16/opium-portrayed/

[3] That’s Confessions of an English Opium Eater, Being an Extract from the Life of a Scholar. It’s currently in print from the Oxford University Press.  It was first published in 1821 in London Magazine, and was picked up in 1886 by George Routledge and Son. You can find the hard copy on Amazon. However, in keeping with blog policy, we found an alternate, free source for the text, this time in an eBook from Project Gutenberg.  Go to http://www.gutenberg.org/files/2040/2040-h/2040-h.htm .

[4] See Annals of Internal Medicine, The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop (February 17, 2015) at Abstract, available at http://annals.org/aim/article/2089370/effectiveness-risks-long-term-opioid-therapy-chronic-pain-systematic-review .

[5] See n. 1.

[6] See Knowles, Oxford Dictionary of Quotations (6th Ed., 2004) at Proverbs, p. 624, n. 45.

[7] It’s at Reuters Health News, Seaman, More than a third of U.S. adults prescribed opioids in 2015 (July 31, 2017), available at http://www.reuters.com/article/us-health-opioids-prescriptions-idUSKBN1AG2K6 .

[8] The Abstract appears as Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health (August 1, 2017). You have to pay for a copy if you want to read the underlying article. I don’t know why that’s the case, since the study apparently was funded by our government. Anyway, the abstract is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782928/pdf/nihms753305.pdf .

[9] These findings are paraphrased or directly quoted from the Abstract.

[10] See, e.g., Fox 5, Hundreds mourn doctor slain after denying opioids to patient (August 2, 2017)), available at http://www.fox5ny.com/news/271464646-story .

[11] See Reuters, Raymond, State attorneys general probe opioid drug companies (June 15, 2017) available at http://www.reuters.com/article/us-usa-opioids-idUSKBN1962JJ

[12] See Clair McCaskill speaking to the DNC on July 28, 2016, available at https://www.bing.com/search?q=hthtps%3A%2F%2Fwww.yahoo.com%2Fnews%2Fu-senator-launches-probe-five-top-opioid-drugmakers-165514279 finance.html&form=EDGEAR&qs=PF&cvid=59500fa1e8204d0a8a8906e8292f9679&cc=US&setlang=en-US&elv=AXXfrEiqqD9r3GuelwApuloTP6wVwkOjONBqpuAMtOReD2p9Vv8km70BwEANJJDGrbYQZQruLL%21jduPgTqpAT%212GMOjDF0L2w7LKJr4QVFIa

[13] See RT, US offers to help fund Mexico’s heroin eradication efforts – report (22 April 2017) available at https://www.rt.com/usa/385656-mexico-fund-heroin-reuters/

[14] In fact, there doesn’t really seem to be an argument about this. See n. 1 and the quote that accompanies it.

[15] That’s Dave Feagles. Many thanks, Dave!

[16] See Science News, Gaidos, Vaccines could counter addictive opioids, Vol. 190, No. 1, p. 22 et seq. (July 9, 2016), While we have this article in our library, we don’t have a web  address for it, so we’re citing to the hard copy magazine.

[17] Id. We’re citing to the print version of the article, but don’t have the printed pages before us. We estimate that this information appears around p. 23.

[18] Id. at around p. 24.

[19] Id.

 

Viral haemorrhagic fever is a general term for a severe illness, sometimes associated with bleeding, that may be caused by a number of viruses. The term is usually applied to disease caused by Arenaviridae (Lassa fever, Junin and Machupo); Bunyaviridae (Crimean-Congo haemorrhagic fever, Rift Valley Fever, [and] Hantaan haemorrhagic fever); Filoviridae (Ebola and Marburg); and Flaviviridae (yellow fever, dengue, Omsk haemorrhagic fever, [and] Kyasanur forest disease).

World Health Organization[1]

The Good Samaritan gave Money to the Host where he had lodg’d his Patient, and said, TAKE CARE OF HIM, and what thou spendest more, I will repay thee.

Benjamin Franklin[2]

[If you’ve read this blog for very long, you know we paid a lot of attention to the Ebola outbreak of 2014 – 2015. Ebola – the version that broke out in 2014 – was and is an ugly customer, but actually it’s only one of a family of medical horrors. WHO[3] names them at the beginning of this piece, and there’s none I want in my home town [or yours, either]. Ebola’s relatives are worse even than the heroin epidemic that’s sweeping our benighted land. A user gets involved with heroin and its friends by an act of will; he [or she] takes a first dose and gets addicted. Hemorrhagic fevers [note the American spelling] jump out at us from friends and family, etc., and may infect even those who run away.

Of course we’ve made a lot of progress treating Ebola, or at least the version that scared us in 2014. In spite of early missteps, that epidemic is over, at least for now. As one commentator put it: “A stuttering, uncoordinated early response, which exposed the overwhelmed public health capacity of the region and claimed the lives of thousands, was followed by one of the most successful global partnerships between foreign and local governments and multinational aid [organizations] to stem an international health crisis.”[4]  Also, as we noted last time, there’s at least one vaccine in our future. Too bad we can’t fix the heroin problem the same way.

But this blog is about Ebola, and what remains to be done. Why dwell on that? Well, because Ebola may evolve and return; and its ugly relatives are still out there. Is it possible our recent success also set a pattern for defeating them the next time they appear? If so, are we learning from our success, or simply ignoring the hemorrhagic fevers on the theory that we’ll deal with them later?]

Dangers of Ebola

Let’s talk for a bit about how dangerous Ebola was in 2014. It was very bad for humans. WHO described it as “highly infectious, rapidly fatal, with a high mortality rate ….” It “spread through direct contact with body fluids (blood, stool, vomit, saliva, urine, sperm, etc.) of an infected person,” or by contact with surfaces or equipment, including linens, contaminated by body fluids from someone who was infected.[5] WHO also said that health workers were “between 21 and 32 times more likely to be infected with Ebola than people in the general adult population.”[6] Nurses and nurses’ aides were particularly vulnerable.

A lot of people died from Ebola, but even the lucky survivors may have problems today. These include mental health issues for “survivors and other family and community members,” and, possibly related, an “increasing recognition that Ebola virus may persist in selected body compartments of survivors.” If the virus persists can a survivor reintroduce it to an area “where transmission [was] previously … eliminated?”[7] Is it any wonder that the neighbors might worry?

Recent Trends

I don’t know about you, but in 2014 I saw the world intervene massively in West Africa to treat Ebola patients and contain an epidemic. It turned out that extraordinary measures weren’t needed because the more traditional methods of treating and isolating the disease broke the epidemic first. Fair enough, I thought; but at least the facilities we built and the people we trained will improve medical care in the area. But apparently that wasn’t the case. Why? Some of the projects were completed on time, but most weren’t completed at all, in large part because they were no longer needed to fight Ebola. The disease was already in retreat. [8]

So our extraordinary efforts didn’t strengthen the medical infrastructure of the infected areas? Apparently that’s the case. A recent study in Guinea,[9] for example, shows that today mothers and children have less access to health care than they had prior to the Ebola crisis. The situation has deteriorated, not improved, at least with respect to them.

  • Child births in hospitals and subsequent visits increased markedly prior to the Ebola outbreak; then reversed during the epidemic; then reversed again when the epidemic was over, but ultimately the trends stagnated;
  • The same happened with childhood vaccinations. They trended upward prior to the epidemic, then reversed during the epidemic[10] and, in some cases, continued to decrease in the post-epidemic period[11];
  • “Most maternal and child health indicators significantly declined during the Ebola virus disease outbreak in 2014. Despite a reduction in this negative trend in the post-outbreak period, the use of essential maternal and child health services have not recovered to their pre-outbreak levels, nor are they all on a course that suggests that they will recover without targeted interventions.”[12]

So why did this happen?  Is it because the women and children of Guinea are afraid of or simply don’t trust their health care providers?  Or have the providers died or left the area because of Ebola virus disease? Or is the local health infrastructure too damaged by the epidemic to function properly? Or are more than one of these factors in play?[13]

Whatever the answer, the experts seem to agree that a lot of work needs to be done to improve health services in West Africa.  “Targeting the root causes, preventing future epidemics, and improving access to health services for the millions affected by weak public health infrastructure will require the international health community … to show unwavering commitment to the long, slow, collaborative work required for meaningful capacity building.”[14] And why should the “international community” be concerned about health and epidemics in remote places? Well, because these days epidemics are tourists; they may start in one place, but like humans they can travel just about anywhere.

Conclusion

So I think old Ben Franklin had it right. The developed world, like the Good Samaritan, should work to strengthen the health infrastructure in places like West Africa. Otherwise epidemics may pop up where folks are most unprepared to fight them, and we’ll all lose valuable time and possibly lives as a result. Help the people there now and most likely we’ll help ourselves later

At least that’s what I think. And who am I? Why Phil, the blog philosopher.

[1] The quote is from the World Health Organization [WHO]. See World Health Organization, Health Topics, Haemorrhagic Fevers, Viral, at http://www.who.int/topics/haemorrhagic_fevers_viral/en/ We’ve added some semicolons, hopefully for clarity, but have not changed the spelling of “haemorrhagic.” In the U.S., of course, we would drop the “a,” to spell it “hemorrhagic.”

[2] See Franklin, Silence Dogood, the Busy Body, and Early Writings (LOA, 1987, 2002) at p. 170, Compassion and Regard for the Sick (March 25, 1731)

[3] WHO’s official web site has lots of information on diseases worldwide. It doesn’t focus, only on Ebola. See World Health Organization, at  http://www.who.int/en/

[4] See The Lancet, Comment, Siedner & Kraemer, The end of the Ebola virus disease epidemic: has the work just begun? (February 22, 2017 (online)), available at http://thelancet.com/journals/langlo/article/PIIS2214-109X(17)30079-7/fulltext?elsca1=etoc

[5] See World Health Organization, Interim Infection Prevention and Control Guidance for Care of Patients with Suspected or Confirmed Filovirus Haemorrhagic Fever in Health-Care Settings, with Focus on Ebola (December 2015), at p. 6, available at: http://apps.who.int/iris/bitstream/10665/130596/1/WHO_HIS_SDS_2014.4_eng.pdf?ua=1&ua=1&ua=1

[6] See World Health Organization, Preliminary Report, Health Worker Ebola infections  in Guinea, Liberia and Sierra Leone (21 May 2015), available at http://apps.who.int/iris/bitstream/10665/171823/1/WHO_EVD_SDS_REPORT_2015.1_eng.pdf?ua=1

[7] See World Health Organization, Interim Guidance, Clinical care for survivors of Ebola virus disease  (April 2016 ), at p. 5, available at http://apps.who.int/iris/bitstream/10665/204235/1/WHO_EVD_OHE_PED_16.1_eng.pdf

[8] See, e.g., The Washington Post, Sieff, U.S.-built Ebola treatment centers in Liberia are nearly empty as outbreak fades (January 18, 2015), available at https://www.washingtonpost.com/world/africa/us-built-ebola-treatment-centers-in-liberia-are-nearly-empty-as-disease-fades/2015/01/18/9acc3e2c-9b52-11e4-86a3-1b56f64925f6_story.html

[9] See The Lancet, Article, Delamou et al., Effect of Ebola virus disease on maternal and child health services in Guinea: a retrospective observational cohort study (April 2017), available at http://thelancet.com/pdfs/journals/langlo/PIIS2214-109X(17)30079-7.pdf

[10] Id. “Similarly, the increasing trend in child vaccination completion during the pre-epidemic period was followed by significant immediate and trend reductions across most vaccine types”

[11] Id.  Especially vaccinations for polio, measles and yellow fever.

[12] Id.

[13] See The Lancet, Comment, Siedner & Kraemer, The end of the Ebola virus disease epidemic: has the work just begun? (February 22, 2017 (online)), available at http://thelancet.com/journals/langlo/article/PIIS2214-109X(17)30079-7/fulltext?elsca1=etoc

[14] Id.