Such Lazy Blogging (with Rabies!)

I continually have fleeting visions of actually writing something substantive about public health in this blog, but even those visions are subject to my highly-restricted attention span. However, I have found some public-health worthy news to share with you today. It does not, however, really approach the criteria for substantive.

I subscribe to a ludicrous number of public health-related emails, among them the CDC's MMWR Weekly Report, DHS' Daily Infectious Disease Report, NIH press releases, Kaiser Health News, the Robert Wood Johnson Foundation's Public Health News Digest, and of course, Pro-Med. Most mornings I wake up to all of them in my email inbox, and promptly delete them in my pre-shower haze that is comprised of 65% lethargy and 30% contempt for anything producing noise, and 5% ill-will towards my dog for being so happy that I'm awake. I used to read, or at least quickly browse, almost all of these publications. I suppose without John Swartzberg's prodding to share current events in my Principles of Infectious Disease course, they take a backseat to more pressing matters, like making coffee, walking my dog, and whatever came from Netflix that week. Sometimes I even study.

But I digress... I had the opportunity to check one of my Pro-Med emails during a particularly dry lecture today and found this noteworthy headline, "RABIES - CHINA: (GUANGXI) COUNTERFEIT HUMAN VACCINE". Apparently, 8 people have been arrested in China's Guangxi Zhuang region for selling over 1,200 fake rabies shots, which caused the death of one child, and were administered to over 1,000 others. No other harmful effects have been reported by those who received the shots. Pro-Med linked to this article for reference.

China has a notoriously high rate of rabies infections, second only to India. Rabies vaccine is typically adminstered as post-exposure prophylaxis (PEP), which means it's given after a suspected infection. Why doesn't everyone get it beforehand? Well, because you have to get 4 shots, and they hurt something fierce. It's the sort of thing you really only want to experience if absolutely have to. China will likely do the vaccine counterfeiters one better and simply execute them, since that's their preferred approach dealing with any crimes remotely serious.



If, like me, you're from the east coast, you generally think of raccoons a primary reservoir for rabies. Stumbling about in the daytime, refusing to not tear through your trash, and even refusing to yield when you throw logs at them when you're camping. Well, on the west coast, the primary reservoir are bats. What's even better is that many people get infected without knowing it because a bite from a bat can be so minuscule that you don't even notice it. The incubation period for rabies can be well over a month, depending how long it takes for the infection to travel to your central nervous system. However, once it arrives there and severe symptoms occur, you're about 99% likely to die, after progressing through fever, malaise, depression, violent movements, hydrophobia, hallucinations, and eventually coma. I think hydrophobia would be the worst part, I really love swimming.

So, those vaccine swindlers in China are likely to die, or least fester in a prison camp in a remote sector of the Tibetan Plateau for quite some time. But I still have unanswered questions: (1) what on earth was in the fake vaccine? (2) What sort of cold-hearted bastard picks rabies as the vaccine to counterfeit? Why not go for something a little less 'life-or-death', like a flu shot? Or maybe some fake Viagra? (3) And finally, and perhaps most importantly, this story makes no sense! People only get rabies vaccines if they have a suspected exposure to it, usually an animal bite, likely a dog in the case of China. If over 1,000 people got this FAKE vaccine, and still didn't die of rabies, and 99% of untreated cases die... then what gives?

I have a few of plausible hypotheses:

1. People in China are getting bit by dogs all the time, but none of them actually have rabies.
   
2. This fake vaccine wasn't as fake people think it is.
   
3. The folks in China are just a hardy bunch, apparently they've got the anti-rabies gene.
   
4. China doles out pre-exposure rabies vaccine for some reason.
   

If I find out, I'll report back....

The People's Republic of California

Since moving here last year I've been trying to get a handle on the circus that is California politics. Even for someone such as myself, well-versed in the political arena thanks to my mediocre undergraduate public education, trying to get a handle on all the issues is akin to trying to grapple a greased pig on a trampoline. Here is a brief rundown on the latest trainwreck that's occurring between the executive and judicial branch...

In November 2008 Californians narrowly approved (51%) a ballot measure to ban gay marriage in the state, thanks in large part to the insidious influence and financial backing of the Mormon church and other conservative religious groups. Prop 8 effectively overturned a California Supreme Court ruling that said same-sex couples have a constitutional right to marry.

On August 4th 2010 Judge Vaughn Walker overturned Proposition 8 after concluding that the law lacked any rational justification and denied equal rights to same-sex couples. Protect Marriage, a conservative religious coalition that defended Prop 8 before Judge Walker has appealed to the 9th US Circuit Court of Appeals. This is where things get interesting...

Walker has questioned whether Protect Marriage has the legal standing to appeal the ruling, citing that usually only elected officials have the authority to defend state laws in court. This may result in Prop 8's supporters being barred from appealing Walker's ruling to the 9th Circuit. Both California's Attorney General, Jerry Brown, and Governor Terminator have repeatedly stated that they will decline to defend Proposition 8 in court.

That's karma, bitches.

But conservatives are a persistent bunch, and accordingly the Pacific Justice Institute filed suit on behalf of a Los Angeles-based minister seeking to compel the State to defend Prop 8 in court. The Third District Court of Appeals in Sacramento dismissed the suit without comment on Monday. PJI said they would file an immediate appeal the state Supreme Court in hopes of obtaining a reversal on the ruling before the September 11th deadline for action on the Proposition 8 case.

Did you get all that? A constitutional provision that overturned a state Supreme Court ruling, was itself overturned by a District Court; appealing that decision may prove impossible due to supporters being barred from appealing, and the state refusing to do, but the state may yet be forced to defend Prop 8 if an appeal to force them to do so is successful, after initially being dismissed by a Court of Appeals. I've created a diagram to help you understand...

Asking the Question is Half the Right Answer

If you start talking to me about the future, you'll quickly realize that John Connor, despite being fictitious, is one of my personal heroes. Of course, anyone who saves humanity from an offending outside force, be it machine, alien, demon, or zombie, should be universally well-respected. As human beings, we're happy to destroy one another, but theoretically take great offense to some other form of being trying to fill that role. We really are one big family.

Why John Connor? Well, as much as I appreciate all the other fictional heroes out there that have saved humanity, I'm quite certain that the Terminator doomsday scenario comes closest to reality, and may in fact be far too prophetically accurate for comfort. Thus, we can learn more from John Connor and repeated viewings of the Terminator franchise than from just about any other medium that portrays humanity's struggle for survival. Update your Netflix queue accordingly.

My trepidations about the coalescence of developing artificial intelligence and the ubiquity of the internet aside (i.e. a technological singularity), as a global society we have been hurtling into the future with technology developing at a truly exponential rate, as Ray Kurzwell demonstrates aptly in a recent TED presentation. One of the more glaring results of the ongoing technological progress in which we find ourselves immersed is the overabundance of information that anyone with an internet connection should be well aware of. With a few strokes of a keypad we're able to find the answer to almost any routine question we could conjure. It sure beats going to the library to pour through the Encyclopedia Brittanica.

This information overload has spawned the new field of data visualization. Faced with enormous amounts of data that cannot realistically be read and understood in the traditional sense, there has been an increasing effort to convert this data into charts, graphs, interactive displays, and supergraphics that will allow users to comprehend the significance of the information being synthesized, compressed, and displayed. As we continue to amass more and more information, the manner in which we convey this data will continually evolve in such a way that considers technological capability, human psychology, and artistic appeal.

The implications for our society's growing data obsession are innumerable and unpredictable. It may one day bring world peace or may instead convert humanity into an enslaved race of human-machine hybrids, much like the Borg, who's to know? Nevertheless, it is obvious that this trend has and will continue to shape how we think. The traditional process of discovery where one asks a question and then must engage in the work of finding the answer has been turned on its head.

Collectively, we have the data to answer an overwhelming amount of questions, and while our methods of harvesting this data are in their infancy, they will no doubt progress at the typical exponential pace of technology. Where we are sorely lacking is in our ability to ask the right questions.

Without asking the right questions we cannot put our plethora of information to work. Information for the sake of information is not only useless, its obnoxious. In the context of public health, something I think about from time to time, disease rates, lab results, and health outcomes are meaningless until that data is put to use improving population health. Questions provide the framework for making information work for us. Without asking the right questions we might as well be building a brick house on quicksand.

So the question remains: is "what are the right questions?" the right question to ask?

The Broad Street Pump: Now Serving Beer!

Yes, that's right, the Broad Street Pump is back in action for the first time since 1854... only this time rather than serving up cholera-tainted water, it will be spewing forth amateur brew concocted in west Berkeley. With the help of my esteemed colleagues, brewmasters Rob and Paul, I am formally announcing the informal creation of not one, but two, lines of homebrew - straight from our over-sized storage closet.... Red Star Brewing and Constitution Beer Works



Why create two different brands of beer simultaneously? Because we're clever businessmen, that's why. With the political climate in this country being what it is, there's no better to way to make a profit than by blatantly marketing to the ardent supporters of the liberal left and the conservative right. No self-respecting tea-partier wants to be caught dead drinking the same brew as some deadbeat, Muslim-sympathizing socialist; and why should the educated elite have to suffer the same swill as those creationist simpletons?

No, if this country is going to be properly divided the lines must be drawn. The time for common ground and putting our differences aside is over. We can no longer share the same simple pleasures; they must be branded and marketed in a diametrically opposed fashion. We here at Red Star Brewing and Constitution Beer Works are happy to provide this long-overdue service to a nation of individuals that have too often been forced to commiserate with their polar opposites over the same delicious adult beverage. Enough is enough.

So tape off your half of the room you share with that yokel freshman, show your neighbor how easily his Prius can be destroyed by an F-350, and crack open a fresh beer far, far away from anyone who disagrees with you about anything.

Found: One Slightly-Used Blog

We all lose things. I lose pens and lighters like its my job. I'm used to losing things, searching frantically for them for about 3 minutes, giving up, and having them return to me weeks later. I recently found a lost item while putting on a rarely-worn pair of shoes and noticing that it was, in fact, preventing my toes from reaching their destination. Moral of the story: check your shoes.

Despite being a pro at losing and recovery process, I was worried for most of this summer. For the first time I actually lost an intangible item, though I suppose if you want to count thoughts, ideas, and focus in that category then I lose intangibles all the time. I happened to misplace by blog back in June, shortly after my most recent (and utterly lame) post. My blogging had declined as last semester wore on and I'm fairly certain that my blog had simply set out to find greener pastures. At first I was hurt; I thought I had been a good provider for my blog... feeding it text, adding pictures, and providing it with ample visitors (albeit, all from my IP address). Apparently I was wrong.

I have, however, been given a second chance. My blog has come back to me and we're ready to give it another shot. I have an entire summer (and even some of last spring) to make up for.

At the moment The Woolsey Street Digest has been in a bit of an identity crisis: I no longer live on Woolsey Street. Should I have seen this coming? Probably. So what to do? Change the name but keep the same URL? Get a new blog altogether? Not change a thing? These are the life-altering decisions that I've been contemplating. I've chosen to take the incremental approach: New name, same address. I wouldn't want to confuse my readership that now numbers in the 0.005's... a migration might be in store later on.

So what's with the new name? The Broad Street Pump refers to the cholera outbreak that occurred in London in 1854. The outbreak was eventually controlled when John Snow removed the handle of the Broad Street water pump, which he had identified as the source of outbreak via its contaminated water. Along with the significant fact that Snow was the first to link cholera with contaminated water, the case study is also one of the more seminal pieces of epidemiologic investigation, and an inspiration to public health nerds such as myself.

I aspire to no such greatness with this blog. It will remain a cesspit filled with my scattered thoughts, half-hearted ambitions, and occasional ill-informed rants. Some things will never change.

Dear Eduardo: The Food Entry

Dear Eduardo,

I bet you'd just about given up hope of me writing to you again, huh? I'm sorry to have ignored you and the blog which you so meticulously maintain for so long; I've been busy to say the least. There are so many new developments and I don't have time to discuss them all now (I'm busy after all!), but rest assured I'll find some time over this coming weekend to regal you tales of West Coast happenings such as Bay to Breakers Freedom Day, Celtics in the NBA finals, three new roommates, field epidemiology training, kickball in the park, The National at the Fox Theater, and of course my trip home to Rhode Island (I guess that's more of an East Coast happening).

Anyways... this entry will be short and delicious, since its devoted to food. Why food? Two reasons:

1. Now that school is done for the summer, I suddenly find myself with time on my hands. I've been filling this 4th-dimensional gap by cooking more often. I've really missed it.
   
2. I saw this story on NPR's website today and was filled with feelings of nostalgia, homesick-ness and hunger. http://www.npr.org/templates/story/story.php?storyId=127481915

Providing that link to the NPR story was half the reason for this post. The other half is to inform you that I recently made some pulled pork that I was particularly proud of. I used a North Carolina-style vinegar sauce for the first time and think it came out pretty well. Of course, anytime you have the patience for something to cook in the oven for six hours, it better be tasty. I'd provide you with the recipe, but I forget what it was. Plus its nothing special. I also shredded a head of red cabbage and mixed in a bit of cider vinegar to go with it. Yum.

So I've spent the past few days doing my best to consume five pounds of pulled pork without getting sick of it or because of it. Some of my solutions: pulled pork sandwiches with cabbage (duh), pulled pork omelette with cheddar and red onion, pulled pork and cabbage on polenta patties, and finally tonight pulled pork soft tacos with shredded NY extra-sharp cheddar, peach mango salsa, chopped bacon bits and of course, shredded red cabbage. Stick that with a limited-release Lagunitas 'Undercover Investigator Shut-Down Ale' that weighs in at 9.75% ABV and you've got yourself a solid Friday night dinner. Here is a picture of said meal before I conquered it in less than 10 minutes...

Until next time...

This Guy is a Rock Star

I saw Tallest Man on Earth play this past Sunday night at The Independent in San Francisco. Hands down the best $12 I've spent in a long, long time (and I buy a lot of really good beer). I'm not critical enough, nor do I have a good enough ear for the more technical aspects of music to write any sort of real review... but I found one from the show I saw here that might suffice. Maybe.

What I will say is that if you ever have a chance to see this guy perform you'd better grab that opportunity by the proverbial balls and not let go. Not only does he know the guitar better than the vast majority of performers I've seen, in addition to his effortless voice, but the man has stage presence too; a perfect blend of humility and confidence that lends itself perfectly to his music.

How he produces such full sound from a single guitar is beyond me. At one point Robbie commented that he simply had to have another track playing in the background (I forget which particular song). Almost immediately, as if to say "oh dear boy, do not underestimate me" he threw in an abrupt pause before continuing the song, just enough to show that yes indeed, it was all him and his guitar.

You can check tour dates and sample a few tracks on his myspace page. I'd recommend making use of GrooveShark to listen to both his albums (Shallow Grave and The Wild Hunt) until you realize he's good enough to deserve you actually dropping a few dollars on his albums.

Postscript: I'll actually finish my post on Coachella in next couple of days and maybe even make a few more. Deadlines for my research and infectious disease finals have been haunting my life for the past few weeks.

And if you're going to be homeless, do it here.