The Forgotten Side of Medicine ~ How Corruption Dictates the Practice of Medicine

Steve Kirsch recently wrote an excellent article highlighting three “scientists” whose guideline recommendations were ultimately responsible for the deaths of nearly a million Americans. 

To summarize: It shows that there are dozens of treatments for COVID-19 that have numerous peer reviewed studies demonstrating their efficacy.  Despite those existing therapeutics and countless petitions for their usage, the committee responsible for developing the guidelines on what is an appropriate treatment for COVID-19 has only approved remdesivir, which is a toxic drug with no therapeutic value for treating COVID-19.  As a result, a dangerous drug has been mandated, while many drugs that would save lives are prohibited in most medical systems.

Evidence based medicine is commonly thought to mean “the best evidence” dictates the standard of care. In reality, it typically means financial interests dictate the standard of care and “evidence” is just used as a smokescreen to justify profiteering. This table that I initially discovered from Kirsch’s article provides clear and unambiguous proof of that contention. See if you can figure out what the circled drugs (those which received an EUA) all have in common!

Because I expected the conflicts of interests of the committee that determined the COVID-19 treatment guidelines to follow the typical pattern, I did some digging and discovered a lovely web of corruption that entangled many of its members.  The purpose of this article is to explain the typical pattern and illustrate how it was followed in this case.  I am doing this because I believe the first step to moving beyond that pattern is to recognize its existence. For those of you who do not need the context, please skip ahead to the COVID-19 Treatment Guidelines section.

Introduction

There are two ways you can observe most organizational systems:

•As someone trapped inside the system observing their surroundings.

•As an outside observer who sees the entire system as a whole.

Since we typically do not explore or examine systems that are outside our everyday lives, we will typically experience the first type of observation. This occurs after life circumstances force us to become stuck in a system, which happened to many of us who were swept into the maelstrom of COVID-19.

Two of my central principles for understanding the architecture of modern society have been the relentless creation of hierarchal systems and the monopolization of resources that are essential for life. 

In regard to the first principle, no matter where you look, a typical pattern is always followed: a hierarchy is established, significant investment is created to establish the importance of the hierarchy, and the top of the hierarchal pyramid is bought out (often through bribes) so that a small investment at the top can be leveraged to control an entire population. 

In regard to the second, those with obscene fortunes seem to always find ways to monopolize resources essential for life and transform them from something each person can independently produce to something they must continually work to obtain. For example, it is extremely common after communist revolutions that the independent farmers in the nation will either be prohibited from farming or executed, allowing agriculture to be transitioned to a state-run enterprise.  Once this happens, everyone is forced to work for the state or starve, which leads them to becoming obedient subjects that can be easily exploited for their labor.

In most cases when the monopolization of a life essential resource occurs, the new approach is hailed as a technological miracle and this is used to encourage people to let go of their traditional and self-sufficient approach. The new “miraculous” approach is initially deemed “superior” but before long turns out to be worse than the now abandoned initial approach.

The Green revolution is an excellent example of this (more and more fertilizers herbicides and pesticides are needed to produce the same agricultural input). For example, Bill Gates, under the guise of “charity,” has frequently made people in Africa abandon their traditional self-sufficient forms of agriculture and switch to modern chemical-intensive industrial agriculture. Before long, this spikes their price of food and farming supplies (which must be purchased from a multinational corporation like Monsanto). As we are now hitting an unprecedented global wave of fertilizer and food inflation, it is likely that millions who were coaxed into abandoning their traditional forms of agriculture will starve to death.

I have similar reservations about our current transition to green energy technologies. I know of numerous proven effective technologies that could lessen the environmental impact of our energy consumption. However, none of the technologies currently being evaluated meet this fundamental criteria. Instead, each one further centralizes control over this life essential resource, and in the future will likely be used to significantly limit unauthorized consumption of energy or transportation once our existing fossil fuel infrastructure is displaced. For example in light of recent political developments, concerns have begun to be raised over the switches existing in electric cars that can turn them off remotely.

Medical Inflation

Those two principles (rigid hierarchal organization and monopolization of a life essential resource) also happened with the medical industry and really kicked into gear when the Rockefellers (and to some extent Carnegie) bought the AMA and invested a great deal of money into standard medicine (often called “allopathic” or “biomedical” medicine).  A variety of competing schools of medicine were removed from the United States, and the practice of medicine was monopolized (those curious to learn more can find more details in this freely available classic).

This proved to be an excellent investment and the effect of this monopolization is striking:

Numerous changes in society emerged to support this medical paradigm. Some of the most important were as follows:

•Society was conditioned to believe that they needed a doctor to be healthy, rather than health being viewed as something each individuals was empowered to seek for themselves. This effectively created an unlimited demand for medical services, and as the above graphs show, an ever-growing need for medical spending. Medical Nemesis by Ivan Illich was the earliest work I was able to locate detailing this change and its consequences.

•Things that genuinely improve public health (and thereby reduce medical expenses) are typically not allowed to emerge, while pointless initiatives that do not improve public health (water fluoridation or annual flu shots) are continually promoted. Likewise, basic health education is not taught to most people, and instead health behaviors developed by corporate interests constitute the majority of “health education” (industry funded nutrition textbooks for example are very common in college courses). In short, there are dozens of simple and obvious policy changes that many have independently identified which could rapidly improve public health and save a lot of money, but despite decades of campaigning to enact them, most have never been adopted.

•Hundreds (or possibly thousands) of highly effective medical treatments for common diseases have been kept off the market to preserve the market for expensive but ineffective treatments that often require lifelong purchasing. For example, prior to the legislative battle to legalize acupuncture, I remember cases where Chinese immigrants were raided at gunpoint for practicing acupuncture in their own community without a license. For those interested, I’ve spent decades tracking those “forgotten cures” down, and while I have found many that for one reason or another were oversold and didn’t really work, I also found many others that were highly effective.

•Every medical service or product is designed to encouraged the consumption of more medical services or products.

•A rigid hierarchy was created to support this monopoly.

Medical Hierarchies

The first hierarchy relates to the right to practice medicine. A large debate exists over whether or not a license should be required to practice medicine. The trade-off is that if no license is required, unqualified practitioners who might harm the public are allowed to practice, while if a license is required, the practice of medicine is monopolized (making medicine much more expensive) and medical practitioners are unable to provide life saving medicines they believe in.

I will now examine a few levels of this hierarchy:

•Medical boards have the power to pull the licenses (and hence careers) of any physician who does something “bad.” Unfortunately, since medical board members are directly appointed by governors, they often end up with crooked and corrupt members (one colleague who served on a midwestern medical board attested to this). Some of the reasons why medical boards exercise their authority are definitely valid, but many others are done to target physicians who step outside the line of what prevailing interests want done. This has happened for a long time. Here are a few examples:

1. After SB 276 was signed in 2019, writing vaccine exemptions was for all practical purposes outlawed in California and I heard of numerous cases where doctors wrote a single justified exemption and then had their license terminated. For this reason, doctors in California will not even write exemptions for patients who nearly died from their first COVID-19 vaccine (ie. from anaphylaxis or a heart attack).

2. The federation of state medical boards put out a statement that publicly promoting any type of COVID “misinformation” (ie. mask efficacy, early treatment options, vaccine safety concerns) could be used to take away a physician’s license.

3. Physicians have had their license suspended for using early treatment options that have FDA approval for other conditions.

The experiences of Robert Malone’s colleague Meryl J. Nass MD is a well known example of the above, but there are many others as well.

As you might imagine, it is quite easy for corporate interests to influence the composition of medical boards (as they are composed of individuals appointed by the governor). In the late 1990s the opioid manufacturers concocted the idea of having present levels of pain be the 5th vital sign and hence measured at every visit.

Since their opioids had “no addictive potential” once this epidemic of “unrecognized” pain emerged (since everyone was encouraged to say they were in pain) the manufacturers managed to lobby the medical boards into taking the position that failing to treat pain with an opioid as malpractice. Once that happened, to protect their licenses, any physicians who had hesitations providing opioids to patients started giving out opioids like candy and this created the current opioid epidemic which has been beyond devastating for many poorer regions of the USA. The problem is massive; hundreds of thousands of people have died from drug overdoses since COVID (which is a figure comparable to the death count from COVID).

•It is very difficult for physicians to work privately in independent practice (a variety of factors have been put in place to force this change over the last 10-20 years). Instead they are required to work at corporate, federal or state jobs where they are largely at the mercy of the institution they work for to follow its policies.

It is for this reason that as soon I was able to, I stopped working for an institution that controlled my practice of medicine.

During the pandemic, many physicians who had serious concerns about the existing approach towards COVID-19 attempted to do things differently, and were frequently shut down by their institution. This led to physicians being fired for not telling their patients the vaccine was “safe and effective” and others such as Paul Marik MD having to sue their hospital in order to be permitted to prescribe a treatment they felt could save the lives of their patients (where no effective treatment was currently available and the patients were frequently expected to die otherwise). Trump’s “Right to Try” law was meant to address this issue, but corporate management has largely superseded it.

•Everyone in medicine is taught to defer to the judgement of a doctor. Hence if you want to do some type of medical treatment and the doctor does not “approve” it, you can’t. In nursing textbooks, it is repeatedly hammered in to always defer to a doctor’s judgement. Nurses typically spend significantly more time with patients where they can see and in their hearts question the human cost of an enforced medical regimen. In contrast, physicians (the ones with authority over the patient), due to their time constraints, typically spend very little time with their patients and are much more detached and isolated from them. This results in bypassing the human connection that should be necessary in medical decision making being bypassed. This type of organizational structure has been used in numerous inhumane systems in the past.

Similarly, many individuals who have found their loved ones in the hospital have been told that unless the supervising doctor approves it, they cannot have any other type of therapy administered. Since many hospitals would not change their policy, numerous lawsuits have been filed to permit patients expected to die to receive ivermectin for example. To my knowledge, in each case where the lawsuit ordered ivermectin to be administered, the drug then saved the patient’s life.

To further illustrate this hierarchy, I know a few physicians with active medical licenses who were hospitalized for COVID-19. Each told me during their hospital stay their that care was continually mismanaged, they had to constantly be on the alert for a fatal medical error, and many of their reasonable requests were not approved by the doctor supervising their hospital care.

•Medical schools to a large extent select for individuals who do not challenge the system, and once in medical school, they rigidly target anyone who is not compliant and obedient to the existing hierarchy to ensure that they will not graduate.

The medical education process is extremely difficult (you have to work brutal hours which break a certain number of medical students and resident physicians each year, and suicide is quite common) and many aspects of the education could be equated to a form of hazing. These types of experiences are known to produce subservience to a system and have been utilized in many fields besides medicine throughout history.

Finally, there is a massive financial cost to become a doctor (most physicians now graduate with between $200,000 to $400,000 of debt at ~7% interest) which leaves many doctors who want to do things differently being completely unable to challenge this system.

The second hierarchy is “medical evidence.” When evidence based medicine was initially introduced, it was a very good and needed paradigm. Many horrific and harmful practices were in wide usage that evidence based medicine had relegated to the dustbins of history. However, medical evidence also follows a hierarchy which rejects foreign or competing ideas, and the upper levels of this hierarchy is bought out by pharmaceutical interests. Here are some examples:

•In order for a study to “matter,” it has to be published in a prestigious journal. The problem is that with the occasional exception of the British Medical Journal, none of the prestigious journals will ever publish studies which go against the existing narrative. “Controversial” studies that merit publication are continually rejected, while bad studies that support mainstream views are regularly published.

One of the better-known recent examples involved The Lancet publishing a study showing hydroxychloroquine was unsafe and ineffective, which was used to end trials of HCQ globally. This study used blatantly fake data and was eventually retracted after readers complained.

The Journal of the American Medical Association appears to be the most biased publication in this regard, and in most cases you can predict what an entire article will say on a topic before you even read it (ie. does the COVID vaccine have any possible harm associated with it…no). The one interesting exception I have seen to this was a recently published study debunking the use of ivermectin. Here the conclusion of the article argued against the use of ivermectin, while the actual data argued for it, raising the possibility the authors phrased the conclusion to say the opposite of their results so that JAMA would publish the study (it is very common for conclusions in journal articles to not be representative of their results).

•In order for a study to be published in most journals, it has to pass “peer review.” In most cases, peer review will hold ideas challenging the existing narrative to either a high standard or an impossible-to-meet standard. Conversely, if an idea agrees with existing narratives, it is held to a very low standard in order to be published. This is an extremely common issue and why much of the most useful research I come across is not published in peer reviewed journals.

•In order for a study to be conducted, it frequently needs approval from the FDA (or an equivalent) and in most settings needs approval from an Institutional Review Board (IRB). In general, it is very difficult to get approval from the FDA to conduct any type of study unless a lot of money is behind the endeavor (for example I was familiar with multiple teams who had safe and effective treatments for COVID with supporting data that nonetheless could not receive FDA approval to begin their human trials). Similarly, despite the fact that extremely unethical human experiments are often conducted under an IRB, IRBs typically will not approve “controversial” research, leading to it not being done.

As a result, I frequently hear of fascinating therapeutic discoveries made outside the normal research process through trial and error that greatly benefit those who receive them, but in most cases these approaches can never be published because no IRB is willing to evaluate them. An excellent 2016 article published by the Association of American Physicians and Surgeons (a group that has also continually advocated for COVID patients) summarizes how many actually useful medical discoveries are made in independent clinical practice, but the recent hierarchal shifts in medicine have made it so this process is becoming continually rarer and rarer.

The accepted practice of medicine is also a hierarchy largely dictated by “medical evidence.” The existing hierarchal structure here makes it so that contrary research that does end up being published nonetheless is prevented from challenging the status quo. I will review some key examples:

•Medical practice is largely determined by “guidelines” that each physician is expected to follow. In most cases if you follow existing guidelines (ie. don’t treat someone with COVID until they have respiratory failure, then put them on a ventilator and give them remdesivir), you get paid and cannot get in trouble. If you do not follow guidelines, it becomes possible for you to be sued for medical malpractice, health care systems will fire you, and medical boards may take your license.

To illustrate physician attachment to guidelines: Throughout the pandemic I have participated in an online forum that approximately 100,000 US healthcare workers use. As you would imagine, the general mentality there is very conventional. One of the more interesting things I noticed in the early days of the pandemic was health care providers desperately asking for and enthusiastically sharing COVID-19 treatment guidelines from various academic institutions, while at the same time aggressively shooting down independent suggestions or ideas raised by individual physicians.

Guidelines are supposed to be made by impartial committees of experts tasked with reviewing the existing evidence in order to determine the most appropriate guidelines. In reality, as pointed out in Steve Kirsch’s article, these committees are extremely biased, and selectively choose evidence supporting the prevailing narrative.

In most cases, the decision of these unelected guideline committees goes unchallenged and even though they should not be (as discussed later), they are in effect the law.

The only exception I know of occurred when the Lyme community sued the Infectious Disease Society of America (which has also published widely cited COVID treatment guidelines I and others strongly disagree with). The lawsuit challenged IDSA’s guidelines that argued against the use of antibiotics for chronic Lyme disease, which was frequently being used by insurers to deny payment for those treatments and as a basis for authorities to crack down on those treatments being administered in private practice.

•Many people can only afford medical care covered by their insurance. In most cases, insurance will only pay for treatments supported by guideline committees and forces providers to spend most of their time fulfilling requirements of the insurance companies rather than treating patients. As you would imagine, significant financial entanglements exist between hospital systems, pharmaceutical companies and insurance companies (for example they often share interlocking board members), which further incentivizes specific therapeutic approaches.

The insurance dynamic creates the unfortunate situation where many people who need help for a condition must depend on word of mouth to identify a physician outside the insurance system who they have to pay for out of pocket. Provided they find the right physician and can afford their care (each of which is often not the case), these individuals often are able to recover from their illness.

•Reciprocally, insurance companies will often pressure health care providers to perform certain services for each patient that “improve quality of care.” If you follow those suggestions (which frequently results in most of the visit being taken up to do so), you are paid more by the insurance companies. Since everyone in health care is tight on money, those incentives result in significant pressure being put on physicians from their administrators to follow those suggestions.

The problem is that many of these suggestions encourage doing things I do not believe help patients and often harm them. For example, one of the reasons doctors aggressively push vaccines to their patients is because insurance companies pay them significantly more for all visits if most of their patients (especially children) are vaccinated. Similarly, one of the reasons why hospitals have been so aggressive in forcing ventilation and remdesivir (to the point they will fight expensive lawsuits to continue doing so), is because Medicare, in accordance with the COVID treatment guidelines, pays them a lot more to manage (and then kill) their patients in this way.

•Federal, state and municipal law enforcement authorities will frequently target those who promote treatments that violate guidelines. In my own experience (and for many others), IV vitamin C has been extremely helpful in certain (but not all) COVID cases. There is also research showing a benefit in COVID from this therapy Nonetheless, the guidelines recommend against it and individuals who publicly promoted IV vitamin C (at a time when no treatment for COVID-19 was available) had their clinics raided and were criminally charged.

•The media will attack any controversial treatment by claiming there is no evidence for it, and simultaneously refuse to report any evidence that emerges in favor of it. Likewise, Big Tech aggressively censors anything that goes against the existing medical narrative. For example, early in the pandemic, a video was posted by a leading researcher who had conducted clinical trials on using IV vitamin C for COVID-19 presenting his data to the NIH. This video was removed by Youtube shortly afterwards for violating their COVID misinformation policy.

How the Hierarchy is Bought Out

As you might imagine, the hierarchy outlined before is immensely susceptible to bribery. As so much money is in health care, this is what always happens.

•When the Affordable Healthcare Act was passed in 2010, its goal was to make health care more affordable. In 2009, total USA healthcare costs were 2.6 trillion dollars. In 2020 it was 4.3 trillion dollars (compared to wages going from $40,711.61 to $55,628.60 per the SSA). As this data shows, Obamacare failed its stated objective. I believe the central problem with Obamacare was that the medical industry is the largest lobbyist in Congress. Because of this, they were able to craft Obamacare to benefit their industry and thereby remove each provision that would have achieved the stated goal of the Affordable Health Care Act, leaving us instead with a variety of highly problematic federal regulations.

•The pharmaceutical industry is the largest sponsor of the mainstream media. For this reason, they prevent stories critical of pharmaceutical products from being discussed and regularly air stories promoting pharmaceuticals. Likewise, they will relentlessly attack anything that opposes mainstream pharmaceutical positions (frequently “cancelling” it and labelling it unscientific and without evidence). During COVID-19 this trend has accelerated following the Biden administration dispensing 1 billion dollars to news outlets across the political spectrum in return for positive coverage of the vaccine. I do not know of any past precedent for this.

Many journalists have complained about their inability to criticize dangerous pharmaceutical products, and to my knowledge, Tucker Carlson is the only individual with a mainstream platform who has (occasionally) spoken out against the industry. In recent times Big Tech and Big Pharma (who during Obama’s presidency became the core sponsors of the Democrat Party) have financially merged with each other, and like the media Big Tech now has a similar commercial interest in protecting Big Pharma’s monopoly.

•Most medical journals are primarily funded by pharmaceutical companies. Because of this, there is a strong bias to publish questionable industry sponsored trials. Conversely, there is also a strong bias to not publish data supporting alternative therapies that challenge their sponsors (an early example of this this is explicitly detailed and can be found within the 2001 book Heart Frauds but I am sure many earlier ones exist). As many of you have noticed, this publication bias has gone into overdrive throughout COVID-19.

•”Large randomized double-blind studies” are typically considered to be the best form of evidence, and many individuals will reflexively dismiss a study unless it fulfills that criteria. The problem is that these types of studies are immensely expensive to conduct, and in most cases can only be done if a pharmaceutical company sponsors them.

As you might expect, numerous studies have shown that when pharmaceutical studies are compared to noncommercial studies, industry studies tend to greatly overestimate the benefits of a drug and understate its harms. This is due to them having a large number of (fraudulent) tricks to create the “scientific” outcome they want. One of the best known recent examples concerned an article in the BMJ discussing a whistleblower who provided proof widespread fraud occurred during Pfizer’s vaccine trials.

While a small benefit can be attributed to the placebo effect (hence suggesting the need for a “placebo controlled trial), in most cases, the bias that emerges from the inherent conflict of interest in a pharmaceutically sponsored trial greatly exceeds the placebo effect. This is extremely important to understand, but rarely understood.

Even in non-blinded studies where a large magnitude of benefit is found (which greatly exceeds any possible placebo effect) those results are typically ignored or dismissed in favor of corporate sponsored research. A sad reality with many scientific publications is that if you read the author conflict of interest disclosures (which intentionally omit key details) and see who sponsored the study of the study, you can typically predict most of what will be written within the publication.

•Most researchers and academic institutions are extremely short on money. Because of this, they are forced to accept pharmaceutical money for any type of research they want to do, and in most cases not ask questions that will upset their sponsors (and even when honest researchers exist, administrators directly concerned with institutional finances will keep them in line). To a lesser extent, they can also function through public grants, but as detailed in “The Real Anthony Fauci” the grant system has been compromised so only researchers who support the mainstream narratives (and have not opposed Anthony Fauci) can get grants. Many respected scientists I have learned a great deal from, believe the corruption of the grant system, which Fauci is largely responsible for, has prevented American science from developing innovative scientific discoveries that were frequently developed in the past.

•In many cases, guideline committees are composed of individuals who have a direct financial conflict of interest over the guidelines they are promoting. The Lyme disease lawsuit for instance was filed on this basis. Malcom Kendrick an English physician who has done an excellent job illustrating many of the scams conducted by the pharmaceutical industry provided one of the best examples for this concept in his book Doctoring Data.

Many physicians are of the opinion statins (which lower cholesterol) have minimal benefit in preventing heart disease and expose patients to frequent and significant adverse effects, but since statins were put on the market, guideline committees have continually lowered the acceptable blood levels of cholesterol, thereby significantly increasing the pool of people who could take statins (leading to the situation that on almost any medical board examination, the correct answer is almost always “give the patient a statin”).

Kendrick’s specific example was that on the guideline committee responsible for determining who needed to receive statins in the United States, every single person who was on the committee (except the chair who was legally barred from it) had a financial conflict of interest with statin manufacturers. As you might guess, one of the quality metrics that administrators have held meetings on and which I was forced to attend regarded not enough “eligible” patients at the clinic being prescribed statin therapy.

•One of Fauci’s major achievements was turning the NIH and NIAID into pharmaceutical production pipelines. This was largely accomplished by allowing federal officials who were involved with the discovery or development of a pharmaceutical that went to market receive royalties for the drug once it was approved that often vastly exceed their salary.

As a result, there is an inherent conflict of interest to push unsafe or ineffective pharmaceuticals through the regulatory process. This frequently happens, whereas non-commercial enterprises focused on public good can almost never receive approval for a medication. Many outside observers believed based on the existing data, remdesivir should not under any circumstances have received an FDA approval, yet it did, largely due to the FDA electing to waive all the required safeguards (such as needing to consult an outside advisory panel) put in place to prevent something like this from occurring.

One of the most interesting aspects of this scheme (detailed in the Real Anthony Fauci) was that Fauci developed a large network of principal investigators (PI’s are needed to run clinical trials) who hold significant sway in getting IRBs around the country to approve ethically questionable trials needed to get unsafe drugs to market. The Real Anthony Fauci also discusses the retaliation faced by honest regulators who raise objections to problems with those trials.

In short, pharmaceutical companies have always bribed regulators, but Fauci had the unique accomplishment of transforming this into being an integral part of the HSS where the regulators would often take it upon themselves to solicit those bribes.

•Lastly, physicians in everyday practice are remarkably susceptible to being bribed, and a cornerstone of the pharmaceutical industry is sending sales reps to convince physicians to prescribe their medications. A small number of physicians refuse to see reps under any circumstances as they feel it is immoral for their own financial self interest to influence their treatment of patients. Typically however, pharmaceutical reps are remarkably effective at accomplishing their goal of selling their chosen medication and many academic physicians who widely promote pharmaceutical products receive immense payouts for doing so.

Revisiting HIV

In my initial post on this substack, I stated I was able to predict much of what has happened with COVID three months before the pandemic started. This was because I have found whenever a formula is discovered which “works” it is typically reused over and over.

The story of HIV, for those interested was originally detailed in Peter Duesberg’s book Inventing the AIDS Virus, and then subsequently further discussed in The Real Anthony Fauci. Fauci’s conduct during this period appeared to have laid the blueprint for what was done with COVID.

At the start of the HIV, there was no cure and many members of the gay community suffered severe disease or died. As time moved forward, independent physicians working in the community discovered a variety of effective treatments for the AIDS patients, some of which were alternative therapies, but most of which utilized repurposed FDA approved drugs. Like the stories shared in those books, a few of my own friends worked in HIV hot spots during this time, and each found they were able to save the lives of their patients if they abandoned government recommendations and tried their own protocols.

Despite endless requests to study these approaches, Anthony Fauci blocked every single one from being studied or adopted into standard of care. In parallel, he pushed along research on a highly toxic drug, AZT. AZT had originally been intended to be used for chemotherapy, but was abandoned as it proved to be too toxic.

While AZT should have never been approved, Fauci was eventually able to manipulate one (terrible) study enough that alongside sufficient pressure being applied to the FDA, earn AZT an FDA approval. Once AZT entered the market, as was obvious from the existing clinical trial data, it significantly worsened the prognosis for AIDS patients, something both reported in each of those books and also reported to me by a few colleagues who observed it enter the market. Despite being responsible for killing many members of the gay community (who at the time protested against Fauci for being a mass murderer), Fauci was hailed a hero, became one of the most influential members of the US government, and made a lot of money in the process.

COVID-19 Treatment Guidelines

At the start of COVID-19, the WHO made the curious announcement that Remdesivir would be the standard of care for COVID-19, despite almost no evidence existing to support this decision. After finding out the drug was a nonspecific viral RNA polymerase inhibitor, I became worried it would likely be somewhat toxic to cells, as broad spectrum antivirals tend to overlap with chemotherapy drugs (AZT being one example).

My initial suspicion was that Remdesivir would also affect cellular RNA polymerases (the classic example you learn in medical school are poisonous wild mushrooms triggering organ failure through this mechanism). As I began hearing of reports of organ failure near the start of the pandemic from physicians in China, I prayed we would not see a repeat of AZT. Since that time, significant evidence against Remdesivir has been uncovered suggesting it should have never been brought to market and to some extent, like AZT, it appears Remdesivir has caused significant harm.

As I observed the trajectory COVID-19 was headed in, I formed the hypothesis that a new lucrative drug needed to be put onto the market which could be theoretically argued to treat COVID-19 (“remdesivir must work since it is a non-specific viral RNA polymerase inhibitor”) but in reality would not be effective and instead would worsen and prolong the pandemic. I suspected this strategy would be adopted since the profit from selling the drug could be channeled into keeping effective therapies off the market long enough for vaccines to enter the market. This sadly appears to be what exactly happened once the COVID-19 Treatment Guidelines Panel of the NIH made remdesivir the standard of care for COVID-19.

Reference Link : A Midwestern Doctor / Substack

Election 2020 Presidential Election Voter Fraud Findings from Various Sources

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Shining Light on “Dark Winter”

Oxford Academia Cinical Infectious Diseases

Clinical Infectious Diseases, Volume 34, Issue 7, 1 April 2002, Pages 972–983, https://doi.org/10.1086/339909

Shining Light on “Dark Winter”

Abstract

On 22–23 June 2001, the Johns Hopkins Center for Civilian Biodefense Strategies, in collaboration with the Center for Strategic and International Studies, the Analytic Services Institute for Homeland Security, and the Oklahoma National Memorial Institute for the Prevention of Terrorism, held a senior-level exercise entitled “Dark Winter” that simulated a covert smallpox attack on the United States. The first such exercise of its kind, Dark Winter was constructed to examine the challenges that senior-level policy makers would face if confronted with a bioterrorist attack that initiated outbreaks of highly contagious disease. The exercise was intended to increase awareness of the scope and character of the threat posed by biological weapons among senior national security experts and to bring about actions that would improve prevention and response strategies.

On 22–23 June 2001, the Johns Hopkins Center for Civilian Biodefense Strategies [1], in collaboration with the Center for Strategic and International Studies (CSIS) [2], the Analytic Services (ANSER) Institute for Homeland Security [3], and the Oklahoma National Memorial Institute for the Prevention of Terrorism [4], held a senior-level exercise entitled “Dark Winter,” which simulated a covert smallpox attack on the United States. Tara O’Toole and Thomas Inglesby of the Johns Hopkins Center for Civilian Biodefense Strategies and Randy Larsen and Mark DeMier of ANSER were the principal designers, authors, and controllers of the Dark Winter exercise. John Hamre of CSIS initiated and conceived of an exercise in which senior former officials would respond to a national security crisis caused by use of a biological weapon. Sue Reingold of CSIS managed administrative and logistical arrangements for the exercise. General Dennis Reimer of the Memorial Institute for the Prevention of Terrorism provided substantial funding for exercise.

The first such exercise of its kind, Dark Winter was undertaken to examine the challenges that senior-level policy makers would face if confronted with a bioterrorist attack that initiated outbreaks of highly contagious disease. The exercise was intended to increase awareness of the scope and character of the threat posed by biological weapons among senior national security experts and to catalyze actions that would improve prevention and response strategies.

Of all potential biological weapons, smallpox is historically the most ominous and feared [5–7]. It is a disfiguring, communicable disease with a case-fatality rate of 30% [8, 9]. There is no effective medical treatment [9]. The World Health Assembly officially declared smallpox eradicated worldwide in 1980 [10]. Since its eradication, smallpox vaccination programs and vaccine production have ceased around the world [6]. The United States stopped its mandatory vaccination program in 1972. Thus, residents of the United States—and indeed, the global population—are now highly susceptible to an inadvertent or deliberate release of smallpox.

It has been argued that the smallpox virus is the organism least accessible to potential bioterrorists. Since its eradication, the only officially existing stocks of the smallpox virus have been stored in 2 World Health Organization reference laboratories located in the United States and Russia [11]. Many experts believe, however, that the smallpox virus is not confined to these 2 official repositories and may be in the possession of states or subnational groups pursuing active biological weapons programs [12]. Of particular importance and concern is the legacy of the former Soviet Union’s biological weapons program. It is widely known that the former Soviet Union maintained a stockpile of 20 tons of smallpox virus in its biological weapons arsenal throughout the 1970s, and that, by 1990, they had a plant capable of producing 80–100 tons of smallpox per year [13].

Exercise Participants

The 12 participants in Dark Winter portrayed members of the National Security Council (NSC). Each is an accomplished individual who serves or has served in high-level government or military positions. Among these, the Honorable Sam Nunn, former US Senator from Georgia, played the President of the United States, and the Honorable Frank Keating, the governor of Oklahoma, portrayed himself. Five senior journalists who currently work for major networks or news organizations observed the deliberations of the simulated NSC and participated in a mock press conference during the exercise (table 1). In addition, ∼50 people with current or former policy or operational responsibilities related to biological weapons preparedness observed the exercise.

Table 1

Roles of key participants in the Dark Winter exercise.

Roles of key participants in the Dark Winter exercise.

Exercise Design

Dark Winter was a “tabletop” exercise. Decision makers were presented with a fictional scenario and asked to react to the facts and context of the scenario, establish strategies, and make policy decisions. To the extent possible, the decisions made were incorporated into the evolving exercise, so that key decisions affected the evolution and outcomes of the scenario.

Dark Winter was divided into 3 segments and simulated a time span of ∼2 weeks. Each segment portrayed an NSC meeting, which were set several days apart in the story: on 9, 15, and 22 December 2002. The participants began segments 2 and 3 with a review of all events that had taken place in the intervening period since the last meeting. In an effort to mirror the process of NSC meetings, exercise participants received information through a variety of sources. Exercise controllers played the roles of deputies or special assistants, providing briefings of facts and policy options to participants throughout the meetings as needed. Participants were also presented with newspaper summaries and video clips of television news coverage of the epidemic. In addition, specific individuals were given memoranda during the exercise on issues or events that would normally fall within the purview of that individual’s position or agency. Thus, for example, the Director of Central Intelligence was given memos that provided updated intelligence data during the course of the meetings.

Exercise Planning Assumptions

In designing Dark Winter, the authors of the exercise analyzed plausible delivery methods for bioterrorist attacks as well as available scientific and historical data from smallpox outbreaks in the past [14–18]. Numerous factors influence whether a pathogen will successfully invade a host community and how that pathogen will spread once established in that community [19, 20]. Two key assumptions were made that had a direct effect on the scope of the epidemic portrayed in the exercise: the number of people infected in the initial attack and the transmission rate (i.e., the number of people subsequently infected by each person with a case of smallpox). These assumptions were not intended to be definitive mathematical predictors or models and should not be interpreted as such. However, these assumptions were derived from available data and the current understanding of the smallpox virus and, therefore, serve as a foundation for the Dark Winter scenario. These assumptions are further articulated below.

The quantity of available smallpox vaccine also significantly affected the options and outcome of the exercise. The authors posited that the quantity of undiluted vaccine available during the exercise equaled the amount in the US Centers for Disease Control and Prevention (CDC) stockpile at that time: ∼15.4 million doses of vaccine.

Number of persons infected by the initial attack. In the Dark Winter scenario, 3000 people were infected with the smallpox virus during 3 simultaneous attacks in 3 separate shopping malls in Oklahoma City, Philadelphia, and Atlanta. It has been estimated that only a few virions are required to cause human smallpox infection, and thus the total quantity of virus necessary to cause 3000 infections in humans is small [9]. For example, William Patrick, a senior scientist in the US offensive biological weapons program before its termination in 1969, has stated that 1 g of weaponized smallpox would be sufficient to infect 100 people via an aerosol attack [21]. Accordingly, as little as 30 g of smallpox could cause 3000 infections, the number of infections resulting from the initial attack in this exercise. Given the small infectious dose required to cause disease, and considering that the former Soviet Union was able to produce smallpox by the ton, an attack resulting in 3000 infections is scientifically plausible.

Smallpox transmission rate. The transmission rate for smallpox is not a static characteristic of the smallpox virus that can be readily determined, but a complex, dynamic, fluctuating phenomenon contingent on multiple biological (both host and microbial), social, demographic, political, and economic factors [17, 19]. As such, the smallpox transmission rate within any given population is highly context dependent. Therefore, any effort to estimate how smallpox might spread through contemporary societies must account for contextual differences, to the extent possible.

Dark Winter was designed to investigate the challenges following a covert attack with the smallpox virus. As described in the scenario above, the first recognition of a covert attack with smallpox virus will likely occur when people infected in the initial attack begin showing signs of infection and start appearing in emergency departments and doctors’ offices [16]. At this point, those people will have become capable of transmitting smallpox to others. Thus, by the time a covert attack is discovered, the disease will already be spreading to the next generation of cases, known as “second-generation” cases. Given that very few doctors currently practicing medicine have ever seen a case of smallpox, and given that there is currently no widely available, rapid diagnostic test for smallpox, it is likely that the diagnosis of initial smallpox cases will be delayed, further promoting spread of disease. These factors are crucial in estimating the transmission rate in this exercise.

Another important factor in such estimations is the level of national and global susceptibility to smallpox virus infection. Human beings are considered universally susceptible to smallpox virus, unless they have been vaccinated or have been infected previously with an orthopox virus [17]. Given the absence of endemic smallpox in the world and the absence of vaccination programs since the 1970s, the global susceptibility to smallpox virus is higher than it has ever been in modern history [6]. Data from the 2000 US Census indicate that ∼42% of the US population is aged <30 years and, therefore, has never been vaccinated against smallpox [22]. For those who have been vaccinated, the susceptibility to smallpox infection is uncertain, because acquired immunity is known to wane over time. Exactly how long and to what extent smallpox immunity endures is unknown. Epidemiologic data offer some information and insights into the expected duration of immunity and the benefits of past revaccination: “an increased level of protection against smallpox persists for ⩽5 years after primary vaccination and substantial but waning immunity can persist for ⩾10 years….antibody levels after revaccination can remain high longer, conferring a greater period of immunity than occurs after primary vaccination alone” ([23], pp. 3–4).

These findings suggest that those who were vaccinated in the United States before vaccination programs ceased 30 years ago would have waning immunity, although those who were vaccinated ⩾2 times may have maintained higher levels of immunity. A rough estimate of the level of total population herd immunity to smallpox in the United States is 20% (D. A. Henderson, personal communication), a number that will continue to decrease over time. A recent analogous estimate for the United Kingdom is 18% [24]. Thus, an estimated 228 million US citizens would be expected to be highly susceptible to smallpox infection. Some experts have recently argued that immunologic memory in response to vaccination against smallpox may last considerably longer than hypothesized [25] and, consequently, that the level of herd immunity may be higher. However, for now, that remains a matter of conjecture.

The authors of the exercise used a 1 : 10 ratio for the transmission rate of smallpox in Dark Winter, which was based on an analysis of 34 instances of smallpox importation into Europe between 1958 and 1973 [14, 17]. These smallpox importations were instances in which a person contracted smallpox in a country where the disease still occurred naturally and then unknowingly brought the virus back to a country that no longer had endemic smallpox. Ten of those importations occurred in the months June–November, when the smallpox transmission rate is at its seasonal low. These importations were not included in further analysis, because the smallpox attack simulated in Dark Winter took place in December, when the smallpox transmission rate is at its seasonal high. Of the remaining 24 imported cases that occurred during the seasonal high for smallpox transmission (December–May), most were quickly diagnosed and contained [14, 17].

The authors of this exercise determined that 6 of these 24 importations most closely paralleled the conditions and context of the Dark Winter exercise, as well as what should be anticipated and planned for in the event of a smallpox attack on the modern United States. In those 6 importations, health care practitioners were slow to diagnose initial smallpox cases, and infected people had considerable interaction with other people before appropriate infection-control measures were initiated [14]. The number of second-generation cases in those 6 outbreaks ranged from 10 to 19 cases, with an average of 13.3 secondary cases per initial case (95% CI, 9.3–17.3). Gani and Leach [24] have recently analyzed these smallpox importations and have estimated that the transmissibility of smallpox in those outbreaks was 10–12 new infections per infectious person. This estimate may be toward the low error bound, because it does not account for seasonal differences in transmission rates (D. A. Henderson, personal communication).

Of the smallpox importations analyzed, the importation into Yugoslavia in 1972 is particularly instructive because that outbreak encompassed many of the attributes that would be expected if a smallpox outbreak occurred today (e.g., a large number of susceptible people, delayed diagnosis, both hospital and community transmission, wide geographic dispersion of cases, difficulty in contact tracing) [17]. In that outbreak, a man on a religious pilgrimage to Mecca and Medina became infected with smallpox virus while in Iraq and subsequently brought the disease back to Yugoslavia. His infection with smallpox virus went undiagnosed, and he unknowingly infected 11 others, whose infections also went undiagnosed. The smallpox outbreak was not recognized and control measures were not initiated until the advent of the second generation of cases, which comprised 140 new cases (transmission ratio, 1 : 13). Ultimately, a single index case caused 175 cases of smallpox and 35 deaths before the outbreak was brought to an end. Gani and Leach [24] estimated the transmissibility of smallpox in the 1972 Yugoslavia outbreak to be 10.8 new infections per infectious person.

Given the low level of herd immunity to smallpox and the high likelihood of delayed diagnosis and public health intervention, the authors of this exercise used a 1 : 10 transmission rate for Dark Winter and judged that an exercise that used a lower rate of transmission would be unreasonably optimistic, might result in false planning assumptions, and, therefore, would be irresponsible. The authors of this exercise believe that a 1 : 10 transmission rate for a smallpox outbreak prior to public-health intervention may, in fact, be a conservative estimate, given that factors that continue to precipitate the emergence and reemergence of naturally occurring infectious diseases (e.g., the globalization of travel and trade, urban crowding, and deteriorating public health infrastructure) [26, 27] can be expected to exacerbate the transmission rate for smallpox in a bioterrorism event.

Meltzer et al. [28] have reviewed data from a selected series of past smallpox outbreaks and determined that “the average rate of transmission is <2 persons infected per infectious person” ([29], p. v). However, they also conclude that “data suggest that one person can infect many others,” that a “large percentage of the population in the United States is now susceptible” to smallpox, and that “the average transmission rate following a deliberate release of smallpox might be µ2 [persons infected per infectious person]” ([29], p. v). The authors of this article believe that the average past transmission rate calculated by Meltzer et al. [28, 29] does not have significant application to planning for a smallpox attack on the contemporary United States. Their analysis does not adequately account for confounding factors, such as poor herd immunity [24], seasonality, and likelihood of delayed or inadequate vaccination or other public health interventions and, therefore, significantly underestimates the transmission rate that should be anticipated if a smallpox attack occurred today. Gani and Leach [24], on the other hand, incorporated a number of these confounding factors in their mathematical analysis and predicted that the rate of transmission of smallpox in contemporary industrialized societies is 4–6 new infections per infected person, and possibly as high as 10–12 new infections per infected person in the absence of appropriate hospital infection-control procedures.

During Dark Winter, participants were told that the rate of transmission beyond the first-generation to second-generation cases (i.e., to third and fourth generations of cases) would be highly dependent on additional variables (e.g., vaccination and isolation). The Dark Winter exercise ended in the middle of the second generation of cases. However, exercise participants repeatedly requested worst-case scenario predictions for the spread of disease beyond the second generation of cases to guide their key policy decisions. Accordingly, participants were given estimates of the projected number of smallpox cases and deaths, on the assumption that no additional vaccine would become available and no systematic, coordinated isolation procedures could be broadly and effectively enacted—in other words, the worst-case scenario. In these worst-case scenario conditions, it was determined that the transmission rate would continue to be 1 : 10, on average. Therefore, it was estimated that the third generation of cases would comprise 300,000 cases of smallpox and lead to 100,000 deaths, and that the fourth generation of cases could encompass as many as 3,000,000 cases of smallpox and result in as many as 1,000,000 deaths. It was emphasized to participants that these numbers were worst-case projections and could be substantially diminished by institution of large-scale and successful vaccination programs and disease-containment procedures.

Available doses of smallpox vaccine. The United States, through the CDC, maintains a stockpile of 15.4 million doses of smallpox vaccine [30]. Exercise participants were asked to assume that only 12 million doses of vaccine would be available. This estimation was based on practical experience obtained during the smallpox eradication program in the 1960s and 1970s. During the World Health Organization’s smallpox eradication campaign, it was common to lose ∼20% of the available doses of vaccine from any given vial because of unavoidable inefficiencies and waste (D. A. Henderson, personal communication).

Exercise Scenario

The year is 2002 [31]. The Unites States economy is strong. Tensions between Taiwan and the People’s Republic of China are high. A suspected lieutenant of Osama bin Laden has recently been arrested in Russia in a sting operation while attempting to purchase 50 kg of plutonium and biological pathogens that had been weaponized by the former Soviet Union. The United Nation’s sanctions against Iraq are no longer in effect, and Iraq is suspected of reconstituting its biological weapons program. In the past 48 h, Iraqi forces have moved into offensive positions along the Kuwaiti border. In response, the United States is moving an additional aircraft carrier battle group to the Persian Gulf.

NSC Meeting 1

Information presented to NSC members, 9 December 2002. The 12 members of the NSC gather for what initially was to be a meeting to address the developing situation in southwest Asia but are given the news that a smallpox outbreak is occurring in the United States. In Oklahoma, 20 cases have been confirmed by the CDC, with 14 more suspected. There are also reports of suspect cases in Georgia and Pennsylvania. These cases are not yet confirmed. The initial exposure is presumed to have occurred on or about 1 December, given the 9–17-day incubation period for smallpox (figure 1).

Figure 1

Map showing cumulative reported smallpox cases (n = 50) reported to the National Security Council at meeting 1 (9 December 2002) as part of the Dark Winter simulation exercise.

Map showing cumulative reported smallpox cases (n = 50) reported to the National Security Council at meeting 1 (9 December 2002) as part of the Dark Winter simulation exercise.

The governor of Oklahoma, who is in Washington, D.C., to deliver a speech, agrees to participate in the NSC meeting to clearly articulate the priorities and needs of his state before rushing home to manage the growing crisis. NSC members are briefed on the status of the outbreak and on smallpox. It is explained that smallpox produces no symptoms at the time of exposure and that fever, malaise, and rash will develop 9–17 days after exposure; that, although vaccination before exposure or up to ∼4–5 days after exposure may prevent or ameliorate disease manifestations, there is no effective treatment once the disease has developed; that the case-fatality rate for smallpox is ∼30%; that smallpox virus is communicable from person to person and is spread at close range by respiratory droplets or, in some instances, at longer range by aerosols (i.e., droplet nuclei) [18]; that although the transmission rate for smallpox virus is a complex dynamic that is dependent on multiple factors, epidemiologic evidence indicates that a single infected person in a highly susceptible population can be expected to infect 10–19 others; and that the US stockpile of smallpox vaccine is 15.4 million doses, but it is estimated that this amount translates to ∼12 million usable doses [8, 9].

The Deputies Committee advises the NSC members on possible disease-containment strategies, including isolation of patients, identification and vaccination of patient contacts, and minimization of public gatherings (e.g., closing schools in affected states). In addition, the Deputies Committee provides the NSC members with 3 vaccine distribution policy options. Policy option 1 is a ring vaccination policy, in which enough vaccine would be distributed to each of the 3 affected states to vaccinate patient contacts and essential personnel, and 2.5 million doses would be set aside for the Department of Defense (DoD). Policy option 2 is a combination ring/mass vaccination policy, in which enough vaccine would be distributed to each of the 3 affected states so that all residents of affected cities could be vaccinated, as well as patient contacts and essential personnel, and 2.5 million doses would be set aside for the DoD. Policy option 3 is a combination ring/mass distribution policy, in which enough vaccine would be distributed to each of the 3 affected states so that all residents of affected cities could be vaccinated, and 2.5 million doses would be set aside for the DoD, and the remaining 47 unaffected states would immediately receive 125,000 doses of vaccine each, to use as they see fit.

Critical debate issues and decisions. The NSC confronts an array of important questions and decisions. With only 12 million doses of vaccine available, what is the best strategy to contain the outbreak? Should there be a national or a state vaccination policy? Is ring vaccination or mass immunization the best policy? How much vaccine, if any, should be held for the DoD? Should health care workers, public safety officials, and elected officials be given priority for vaccination? What about their families? Should vaccine be distributed to all of the states now, or as new cases emerge? What should the size be of the aliquots of vaccine given to each state? Should there be a mandatory or voluntary immunization policy? What is the federal role in emergency response? What are the state roles in emergency response? How are the 2 responses coordinated? Should the National Guard be activated? How best can the Guard be used (under state or under federal control)? What should be done about the developing situation in southwest Asia? What should the public be told? What should our allies be told? Was this a deliberate attack on the United States? If so, who is responsible? Is the nation at war?

The NSC members agree that the public should be fully informed as quickly as possible to maximize public confidence and adherence to disease-containment measures and to minimize the possibility that disease-containment measures would need to be forcibly imposed. NSC members decide to use vaccine distribution policy option 1, which is the ring vaccination policy intended to focus and limit vaccination efforts to those at highest risk of contracting smallpox (e.g., patient contacts and health care and public safety personnel in Oklahoma, Georgia, and Pennsylvania) while preserving as much vaccine as possible for use as the epidemic unfolds. NSC members decide that the same directed vaccination strategy will be followed if additional new cases emerge in other cities or states. In addition, NSC members decide to set aside sufficient doses of vaccine for the DoD to meet its immediate needs, with the expectation that this will be ∼1 million doses and with direction to the DoD to determine those needs. NSC members decide to proceed with the deployment of the additional aircraft carrier battle group to the Persian Gulf but defer other decisions regarding deployments, pending further developments. NSC officials hope that the people of the United States will view these policy decisions as rational and equitable. The meeting closes as the NSC prepares a presidential statement for the press, detailing their decisions and actions.

NSC Meeting 2

Information presented to NSC members, 15 December 2002 (6 days into the epidemic). A total of 2000 smallpox cases have been reported in 15 states, with 300 deaths (figures 2 and 3). The epidemic is now international, with isolated cases in Canada, Mexico, and the United Kingdom. Both Canada and Mexico request that the United States provide them with vaccine. All of the cases appear to be related to the 3 initial outbreaks in Oklahoma, Georgia, and Pennsylvania. The public health investigation points to 3 shopping malls as the initial sites of exposure. Only 1.25 million doses of vaccine remain, and public unrest grows as the vaccine supply dwindles. Vaccine distribution efforts vary from state to state, are often chaotic, and lead to violence in some areas. In affected states, the epidemic has overwhelmed the health care systems, and care suffers. The DoD expresses concern about diverting its critical supplies and personnel to the civilian health care system, given the evolving crisis in the Persian Gulf.

Figure 2

Map showing cumulative reported smallpox cases (n = 2000) reported to the National Security Council at meeting 2 (15 December 2002) as part of the Dark Winter simulation exercise.

Map showing cumulative reported smallpox cases (n = 2000) reported to the National Security Council at meeting 2 (15 December 2002) as part of the Dark Winter simulation exercise.

Figure 3

Smallpox cases reported to the National Security Council at meeting 2 (15 December 2002) as part of the Dark Winter simulation exercise.

Smallpox cases reported to the National Security Council at meeting 2 (15 December 2002) as part of the Dark Winter simulation exercise.

Several international borders are closed to US trade and travelers. Food shortages emerge in affected states as a result of travel problems and store closings. Sporadic violence has been reported against minorities who appear to be of Arab descent. There are no solid leads regarding who may have perpetrated this attack. The government response to the epidemic has been criticized. The media continues its 24-h news coverage of the crisis. Misinformation regarding the smallpox outbreak begins to appear on the Internet and in the media, including false reports of cures for smallpox. Schools are closed nationwide. Public gatherings are limited in affected states. Some states limit travel and nonessential gatherings. The Department of Health and Human Services establishes a National Information Center. Three US drug companies agree to produce new vaccine at the rate of 6 million doses per month, with first deliveries in 5 weeks. Russia offers to provide 4 million doses of vaccine.

Critical debate issues and decisions. NSC officials confront a growing set of challenges and decisions. Given the shortage of vaccine, how can the spread of smallpox be halted? Should patients with smallpox be confined to facilities dedicated to care for them? Should contacts of patients be forced to remain at home or in dedicated facilities until they are proven to be free of smallpox? Should national travel restrictions be imposed? How can disease containment best be balanced against economic disruption and the protection of civil liberties? To what extent can and should the government infringe upon civil liberties? Under what conditions can those powers be exercised? What federal actions can and should be taken to care for the sick? Should the National Guard be federalized (i.e., put under federal control)? What additional assistance can the federal government provide to the states? Should troops continue to deploy overseas to southwest Asia? What should the President tell the people of the United States? Who orchestrated this attack and why? Is the nation at war?

NSC members make a series of important policy decisions. Members decide to leave control of the National Guard as well as decisions on quarantine and isolation in the hands of state officials. Members decide to pursue a crash production program for new smallpox vaccine, despite unresolved liability issues. They also decide to accept smallpox vaccine offered by Russia, provided it passes safety evaluations. In addition, a statement is produced for the President to deliver in a press conference. In the press conference, the President provides an assessment of the gravity of the situation and discusses the government’s response. He appeals to the people of the United States to work together to confront the crisis and to follow the guidance of their elected officials and their public health professionals regarding necessary disease-containment measures.

NSC Meeting 3

Information presented to NSC members, 22 December 2002 (13 days into the epidemic). A total of 16,000 smallpox cases have been reported in 25 states (14,000 within the past 24 h) (figures 4 and 5). One thousand people have died. Ten other countries report cases of smallpox believed to have been caused by international travelers from the United States. It is uncertain whether new smallpox cases have been transmitted by unidentified contacts of initial victims, by contacts who were not vaccinated in time, or by people who received ineffective vaccine, or are due to new smallpox attacks, or some combination of these. Vaccine supplies are depleted, and new vaccine will not be ready for at least 4 weeks. States have restricted nonessential travel. Food shortages are growing in some places, and the national economy is suffering. Residents have fled and are fleeing cities where new cases emerge. Canada and Mexico have closed their borders to the United States. The public demands mandatory isolation of smallpox victims and their contacts, but identifying contacts has become logistically impossible.

Figure 4

Map showing cumulative reported smallpox cases (n = 16,000) reported to the National Security Council at meeting 3 (22 December 2002) as part of the Dark Winter simulation exercise.

Map showing cumulative reported smallpox cases (n = 16,000) reported to the National Security Council at meeting 3 (22 December 2002) as part of the Dark Winter simulation exercise.

Figure 5

Smallpox cases reported to the National Security Council at meeting 3 (22 December 2002) as part of the Dark Winter simulation exercise.

Smallpox cases reported to the National Security Council at meeting 3 (22 December 2002) as part of the Dark Winter simulation exercise.

Although speculative, the predictions are extremely grim: an additional 17,000 cases of smallpox are expected to emerge during the next 12 days, bringing the total number of second-generation cases to 30,000. Of these infected persons, approximately one-third, or 10,000, are expected to die. NSC members are advised that administration of new vaccine combined with isolation measures are likely to stem the expansion of the epidemic. NSC members ask for worst-case projections. They are advised that in worst-case conditions, the third generation of cases could comprise 300,000 new cases of smallpox and lead to 100,000 deaths, and that the fourth generation of cases could conceivably comprise as many as 3,000,000 cases of smallpox and lead to as many as 1,000,000 deaths. It is again emphasized to participants that these numbers are worst-case projections and can be substantially diminished by large-scale and successful vaccination programs and disease-containment procedures (figure 6).

Figure 6

Smallpox epidemic projections, worst-case scenario (in the absence of disease-containment measures or new vaccine delivery), reported to the National Security Council meeting 3 (22 December 2002) as part of the Dark Winter simulation exercise. Gen, generation of cases; K, thousand.

Smallpox epidemic projections, worst-case scenario (in the absence of disease-containment measures or new vaccine delivery), reported to the National Security Council meeting 3 (22 December 2002) as part of the Dark Winter simulation exercise. Gen, generation of cases; K, thousand.

No solid leads as to who masterminded the attack have emerged. A prominent Iraqi defector claims that Iraq is behind the biological attack. Although the defector cannot offer proof beyond a reasonable doubt, the intelligence community deems his information highly credible. Polls of US citizens show overwhelming support for retribution when the attacker is identified.

The scenario ends when it is announced that the New York Times, the Washington Post, and USA Today have each received an anonymous letter demanding the removal of all US forces from Saudi Arabia and all warships from the Persian Gulf within 1 week. The letters threaten that failure to comply with the demands will result in new smallpox attacks on the US homeland as well as other attacks with anthrax and plague. To prove the veracity of these claims and the seriousness of their threats, each letter contains a genetic fingerprint that matches the fingerprint of the smallpox strain causing the current epidemic, demonstrating that the author of these letters has access to the smallpox strain.

Critical debate issues. With no vaccine remaining and new vaccine not expected for at least 4 weeks, how can the rapidly expanding epidemic be contained? What measures should the federal and state governments take to stop the epidemic, given the scope of the crisis, the lack of remaining vaccine, and rising stakes? Should the United States pull its forces out of the Gulf in response to the anonymous letters? With no conclusive evidence as to who orchestrated the attack, how and should the United States respond? If the United States discovers who is behind the attack, what is the proper response? Would the American people call for response with nuclear weapons?

Lessons of Dark Winter

The authors of this article have drawn a series of lessons from the Dark Winter exercise. These lessons are based on an analysis of comments and decisions made by exercise participants during the exercise, subsequent Congressional testimony by exercise participants, and public interviews given by participants in the months after the exercise [32]. The lessons learned reflect the analysis and conclusions of the authors from the Johns Hopkins Center for Civilian Biodefense Strategies and do not necessarily reflect the views of the exercise participants or collaborating organizations.

In this section, these lessons are listed, each accompanied by a short explanatory note and quotations from participants in the exercise to illustrate it. The Dark Winter event did not permit attribution of comments without permission from individual participants. Where comments are ascribed to a particular person, permission has been obtained.

Leaders are unfamiliar with the character of bioterrorist attacks, available policy options, and their consequences. The senior decision makers in Dark Winter were largely unfamiliar with the sequence of events that would follow a bioterrorist attack. Important decisions and their implications were dependent on public health strategies and possible mechanisms to care for large numbers of sick people—issues that the national security and defense communities have not typically analyzed in the past.

“We are used to thinking about health problems as naturally occurring problems outside the framework of a malicious actor….If you’re going against someone who is using a tool that you’re not used to having him use—disease—and using it toward—quite rationally and craftily—…an entirely unreasonable and god-awful end—we are in a world we haven’t ever really been in before” (James Woolsey).

“This was very revealing to me—that there is something out there that can cause havoc in my state that I know nothing about—and, for that matter, the federal family doesn’t know a whole lot [about] either” (Frank Keating).

“My feeling here was the biggest deficiency was, how do I think about this? This is not a standard problem that I’m presented in the national security arena. I know how to think about that, I’ve been trained to think about that…a certain amount of what I think went [on] around this table was, ‘I don’t get it. I’m not in gear in terms of how to think about this problem as a decision-maker.’ So then I get very tentative in terms of what to do” (John White).

“This was unique…[you know] that you’re in for a long term problem, and it’s going to get worse and worse and worse and worse and worse” (Sam Nunn).

After a bioterrorist attack, leaders’ decisions would depend on data and expertise from the medical and public health sectors. In Dark Winter, even after the smallpox attack was recognized, decision makers were confronted with many uncertainties and wanted information that was not immediately available. (In fact, they were given more information on locations and numbers of infected people than would likely be available in reality.)

For example, it was difficult to quickly identify the locations of the original attacks; to immediately predict the likely size of the epidemic on the basis of initial cases; to know how many people were exposed; to find out how many were hospitalized and where; or to keep track of how many had been vaccinated. This lack of information, critical for leaders’ situational awareness in Dark Winter, reflects the fact that few systems exist that can provide a rapid flow of the medical and public health information needed in a public health emergency.

“What’s the worst case? To make decisions on how much risk to take…whether to use vaccines, whether to isolate people, whether to quarantine people….I’ve got to know what the worst case is” (Sam Nunn).

“You can’t respond and make decisions unless you have the crispest, most current, and the best information. And that’s what strikes me as a civil leader…that is…clearly missing” (Frank Keating).

The lack of sufficient vaccine or drugs to prevent the spread of disease severely limited management options. In Dark Winter, smallpox vaccine shortages significantly affected the response available to contain the epidemic, as well as the ability of political leaders to offer reassurance to the American people. The increasing scarcity of smallpox vaccine led to great public anxiety and flight by people desperate to get vaccinated, and it had a significant effect on the decisions taken by political leaders.

“We can’t ration….Who do you choose and who do you not choose to get vaccinated?…People are going to go where the vaccine is. And if they know that you’re going to provide the vaccine to my people, they’ll stay to get vaccinated. I think they’ll run if they think the vaccine is somewhere else” (Frank Keating).

“If we had had adequate vaccine supplies…we would have had more strategies to help deal with this thing and help control the epidemic” (Margaret Hamburg).

The US health care system lacks the surge capacity to deal with mass casualties. In Dark Winter, hospital systems across the country were flooded with demands for patient care. The demand was highest in the cities and states directly attacked, but by the time many victims became symptomatic, they were geographically dispersed, with some having traveled far from the original site of attack. The numbers of people flooding into hospitals across the country included people with common illnesses who feared they had smallpox and people who were well but worried. The challenges of distinguishing the sick from the well and rationing scarce resources, combined with shortages of health care staff, who were themselves worried about becoming infected or bringing infection home to their families, imposed a huge burden on the health care system.

“We think an enemy of the United States could attack us with smallpox or with anthrax—whatever—and we really don’t prepare for it, we have no vaccines for it—that’s astonishing. That’s like, for me, in Oklahoma, where we do have tornadoes, to be assiduously studying hurricanes, or not studying tornadoes” (Frank Keating).

“It isn’t just [a matter of] buying more vaccine. It’s a question of how we integrate these [public health and national security communities] in ways that allow us to deal with various facets of the problem” (James Woolsey).

To end a disease outbreak after a bioterrorist attack, decision makers will require ongoing expert advice from senior public health and medical leaders. The leaders in Dark Winter were confronted with rapidly diminishing supply of smallpox vaccine and an expanding smallpox epidemic. Some members advised the imposition of geographic quarantines around affected areas, but the implications of these measures (e.g., interruption of the normal flow of medicines, food and energy supplies, and other critical needs) were not clearly understood at first. In the end, it is not clear whether such draconian measures would have led to a more effective interruption of disease spread.

“A complete quarantine would isolate people so that they would not be able to be fed, and they would not have medical [care]….So we can’t have a complete quarantine. We are, in effect, asking the governors to restrict travel from their states that would be nonessential. We can’t slam down the entire society” (Sam Nunn).

Federal and state priorities may be unclear, differ, or conflict; authorities may be uncertain; and constitutional issues may arise. In Dark Winter, tensions rapidly developed between state and federal authorities in several contexts. State leaders wanted control of decisions regarding the imposition of disease-containment measures (e.g., mandatory vs. voluntary isolation and vaccination), the closure of state borders to all traffic and transportation, and when or whether to close airports. Federal officials argued that such issues were best decided on a national basis to ensure consistency and to give the President maximum control of military and public-safety assets. Leaders in states most affected by smallpox wanted immediate access to smallpox vaccine for all citizens of their states, but the federal government had to balance these requests against military and other national priorities. State leaders were opposed to federalizing the National Guard, which they were relying on to support logistical and public supply needs. A number of federal leaders argued that the National Guard should be federalized.

“My fellow governors are not going to permit you to make our states leper colonies. We’ll determine the nature and extent of the isolation of our citizens….You’re going to say that people can’t gather. That’s not your [the federal government’s] function. That’s the function, if it’s the function of anybody, of state and local officials” (Frank Keating).

“Mr. President, this question got settled at Appomattox. You need to federalize the National Guard” (George Terwilliger).

“We’re going to have absolute chaos if we start having war between the federal government and the state government” (Sam Nunn).

The individual actions of US citizens will be critical to ending the spread of contagious disease; leaders must gain the trust and sustained cooperation of the American people. Dark Winter participants worried that it would not be possible to forcibly impose vaccination or travel restrictions on large groups of the population without their general cooperation. To gain that cooperation, the President and other leaders in Dark Winter recognized the importance of persuading their constituents that there was fairness in the distribution of vaccine and other scarce resources, that the disease-containment measures were for the general good of society, that all possible measures were being taken to prevent the further spread of the disease, and that the government remained firmly in control despite the expanding epidemic.

“The federal government has to have the cooperation from the American people. There is no federal force out there that can require 300,000,000 people to take steps they don’t want to take” (Sam Nunn).

Conclusion

In conducting the Dark Winter exercise, the intention was to inform the debate on the threat posed by biological weapons and to provoke a deeper understanding of the numerous challenges that a covert act of bioterrorism with a contagious agent would present to senior level policy makers and elected officials. Since the Dark Winter exercise, the country has endured the horrific events of 11 September, as well as anthrax attacks through the US postal system. Bioterrorism is no longer just the subject of war games and the source of “futuristic and disturbing topics for…[Congressional] committee meetings” ([33], p. 2454). Many of the challenges and difficulties faced by the Dark Winter participants, unfortunately, have been paralleled in the response to the recent anthrax attacks. The Dark Winter exercise offers instructive insights and lessons for those with responsibility for bioterrorism preparedness in the medical, public health, policy, and national security communities and, accordingly, helps shine light on possible paths forward.

References: https://thetrailblazingpatriot.wordpress.com/2022/05/04/shining-light-on-dark-winter/

CURRENT EVENTS AND NEWS 📰 HEADLINES FOR 4/30/22

CURRENT EVENTS AND NEWS 📰 HEADLINES FOR 4/30/22

Elon Musk Sells Billions of Dollars in Tesla Stock.

Weather, Severe Storms, Midwest, Texas, Oklahoma.

Ukraine fights to hold off Russian advances in south, east https://apnews.com/article/russia-ukraine-kyiv-business-evacuations-moscow-f1d99718192f44056b839595996ac72e

DeSantis vows Florida will allow people to carry firearms without permits ‘before I am done as governor’ | CNN Politics https://www.cnn.com/2022/04/29/politics/desantis-concealed-firearms/index.html

Wall Street closes sharply lower on Amazon slump, inflation worries https://www.reuters.com/business/futures-fall-amazon-apple-results-disappoint-2022-04-29/

Doctors may not get abortion training if Supreme Court overturns Roe v. Wade https://thehill.com/changing-america/enrichment/education/3471732-doctors-may-not-get-abortion-training-if-supreme-court-overturns-roe-v-wade/

Is Russia Using Dolphins To Guard Key Naval Base? Photos Suggest So, Analyst Says. https://www.huffpost.com/entry/russia-dolphins-naval-base_n_626a2e4ce4b0bc48f5774806

Jack Dorsey says he’s against permanent Twitter bans – TechCrunch https://social.techcrunch.com/2022/04/29/jack-dorsey-against-permanent-twitter-bans-with-an-asterisk/

Biden seeks to lure Russia’s top scientists to the U.S. https://www.nytimes.com/2022/04/29/world/europe/biden-russia-scientists.html

Egg-laying facility in Iowa kills 5.3 million chickens, fires 200-plus workers https://www.cbsnews.com/news/rembrandt-farms-iowa-avian-flu-kills-5-million-chickens-fires-workers/

Former Vice President Dick Cheney told friends that Trump is ‘a maniac’ and said he admired his daughter’s impeachment vote: book https://www.businessinsider.com/dick-cheney-trump-maniac-daughter-liz-impeachment-vote-gop-book-2022-4

Evidence of Trump officials’ meddling puts trust spotlight on CDC https://www.politico.com/news/2022/04/29/evidence-of-trump-officials-meddling-puts-spotlight-on-trust-in-cdc-00029058

‘What Are We Supposed to Cut Back?’ Britons at Risk as Fuel Bills Skyrocket. https://www.nytimes.com/2022/04/30/business/cost-of-living-uk-prices.html

U.S. FAA extends environmental review of SpaceX program in Texas https://www.reuters.com/business/aerospace-defense/us-faa-extends-environmental-review-spacex-program-texas-2022-04-29/

At least five Russian businessmen have died by apparent suicide in just three months | CNN https://www.cnn.com/2022/04/29/europe/russian-oligarchs-suicides-intl/index.html

Franklin Graham Praises the World’s Richest Man for Pro-Free Speech Stance https://www.charismanews.com/culture/89021-franklin-graham-praises-the-world-s-richest-man-for-pro-free-speech-stance

How to watch the April 2022 solar eclipse online https://nypost.com/2022/04/30/first-solar-eclipse-of-2022-to-occur-on-saturday/

Russia expects trade with China to reach $200 billion by 2024, Ifax reports https://www.reuters.com/business/russia-expects-trade-with-china-reach-200-bln-by-2024-ifax-2022-04-30/

SpaceX posts stunning footage of Dragon capsule traveling to the ISS.

Cases are rising in nearly every corner of the United States. https://www.nytimes.com/2022/04/29/world/coronavirus-cases-us.html

Special grand jury considering Trump election interference in Georgia convenes Monday https://www.cbsnews.com/news/trump-georgia-election-interference-grand-jury/

Dow Jones Dives; Tesla Stock Falls As Elon Musk Reveals This; Amazon Plunges Despite Bullish Calls https://www.investors.com/market-trend/stock-market-today/dow-jones-dives-tesla-stock-rallies-as-elon-musk-reveals-this-amazon-stock-plunges-despite-bullish-calls/

Here’s what we know about the deaths of 3 children at Camp Lejeune https://www.militarytimes.com/pay-benefits/2022/04/29/heres-what-we-know-about-the-deaths-of-3-children-at-camp-lejeune/

Deutsche Bank Issues Warning About the Economy as the Fed Reins in Inflation https://townhall.com/tipsheet/leahbarkoukis/2022/04/29/deutsche-bank-warns-a-major-recession-is-coming-n2606472

First on CNN: A record 35 million-plus Americans have Affordable Care Act coverage — but the gains may not last long | CNN Politics. https://www.cnn.com/2022/04/29/politics/aca-obamacare-coverage-record/index.html

You Need to Update iOS, Android, and Chrome Right Now. https://www.wired.com/story/ios-android-chrome-updates-april-2022/

Twitter Hastily Enacts New Rule, Desperate Measure to Stop Elon Musk Will Only Activate Once He Crosses Threshold

The left is scheming hard to prevent free speech advocate Elon Musk from being able to mount an effort to set social media giant Twitter back on the road to freedom and liberty.

Musk delivered his offer Thursday to buy Twitter out so he can move in and begin restoring free speech there:

On Friday, the social media giant issued a news release stating that the company’s board of directors unanimously adopted a limited duration shareholder rights plan as a direct response to Musk’s offer to buy the tech giant.

“The Rights Plan is similar to other plans adopted by publicly held companies in comparable circumstances,” Twitter insisted in its PR wire.

“Under the Rights Plan, the rights will become exercisable if an entity, person or group acquires beneficial ownership of 15% or more of Twitter’s outstanding common stock in a transaction not approved by the Board,” the message reads. “In the event that the rights become exercisable due to the triggering ownership threshold being crossed, each right will entitle its holder (other than the person, entity or group triggering the Rights Plan, whose rights will become void and will not be exercisable) to purchase, at the then-current exercise price, additional shares of common stock having a then-current market value of twice the exercise price of the right.”

The new rule allows Twitter shareholders to buy up cheap shares which would dilute the commanding stake a buyer such as Musk might hold.

The news released was a long-winded way of saying that Twitter added a “poison pill” to its operating rules to prevent Musk from gaining control of the company.

“The Rights Plan will reduce the likelihood that any entity, person or group gains control of Twitter through open market accumulation without paying all shareholders an appropriate control premium or without providing the Board sufficient time to make informed judgments and take actions that are in the best interests of shareholders,” the company claimed.

The board was scared when the Tesla and SpaceX CEO offered to buy additional shares of the company for $54.20 per share, which would value the company at $41.4 billion. His offer was an 18 percent premium over the closing price of the stock on April 13.

Despite the offer, analysts have questioned how Musk would come up with the cash necessary to make the buy. Despite being one of the richest men in the world, $42 billion in cash is a big ask.

But Musk seems prepared to go the distance. He has related a specific vision for what Twitter should be, and it’s one he thinks the social media giant’s current leadership is not fulfilling.

“I invested in Twitter as I believe in its potential to be the platform for free speech around the globe, and I believe free speech is a societal imperative for a functioning democracy,” Musk said in a letter to Twitter board chair Bret Taylor. “However, since making my investment I now realize the company will neither thrive nor serve this societal imperative in its current form. Twitter needs to be transformed as a private company.

“As a result, I am offering to buy 100% of Twitter for $54.20 per share in cash, a 54% premium over the day before I began investing in Twitter and a 38% premium over the day before my investment was publicly announced. My offer is my best and final offer and if it is not accepted, I would need to reconsider my position as a shareholder.

“Twitter has extraordinary potential,” Musk declared. “I will unlock it.”

Still, he signaled that he has also planned an out if he needs one.

“If the deal doesn’t work, given that I don’t have confidence in management nor do I believe I can drive the necessary change in the public market, I would need to reconsider my position as a stakeholder,” he wrote.

Regardless, in light of the blocking maneuver that Twitter just made, it seems the ball is now in Musk’s court. While he did hint that he has a “plan B” for this Game of Thrones drama, we’ll soon see just how serious he is about righting Twitter’s anti-free speech ship.

If nothing else, this episode of corporate theater has certainly shown just how hard these leftist, Big Tech giants will fight to quash free speech, continue to prevent conservatives from having the freedom to express themselves online, and control the political narrative to keep left-wing Democrats in power.

The gate keepers of the left have been squalling for Musk’s head ever since he announced his interests in preserving free speech. Clinton operative Robert Reich, for instance, was infuriated by Musk’s efforts, calling Musk’s aims “dangerous nonsense.”

Further showing what he thinks of our constitutional right to free speech, Reich added that Musk’s ideas about a free and open Internet is “the dream of every dictator, strongman, and demagogue.”

Then there was wild-eyed never Trumper and neoconservative Max Boot who revealed his inner fascist by quixotically claiming that to save freedom and democracy, we need to curtail free speech.

On Thursday, Boot whined that he is “frightened” by Musk’s free speech advocacy and added, “For democracy to survive, we need more content moderation, not less.”

Finally, Twitter’s own extremist, left-wing employees also went apoplectic over the idea that conservatives and Trump supporters would be allowed to speak freely on Twitter. According to reports, many of Twitter’s employees jumped to their own Twitter accounts to lament Musk’s intentions.

Whatever Musk does with this Twitter drama, he has fully proven that Democrats, Big Tech, and the left are intent on taking 100 percent control of the media and the Internet to screen out any ideas that might lead to the loss of their political power.

And to heck with the U.S. Constitution.

This article appeared originally on The Western Journal.

States look for solutions as U.S. fentanyl deaths keep rising

NATIONAL

States look for solutions as U.S. fentanyl deaths keep rising

by: GEOFF MULVIHILL, Associated Press

Posted: Apr 5, 2022 / 12:34 AM CDT

Updated: Apr 5, 2022 / 12:50 AM CDT

Source

https://www.borderreport.com/news/national/states-look-for-solutions-as-u-s-fentanyl-deaths-keep-rising/

As the addiction and overdose crisis that has gripped the U.S. for two decades turns even deadlier, state governments are scrambling for ways to stem the destruction wrought by fentanyl and other synthetic opioids.

In statehouses across the country, lawmakers have been considering and adopting laws on two fronts: reducing the risk to users and increasing the penalties for dealing fentanyl or mixing it with other drugs. Meanwhile, Republican state attorneys general are calling for more federal action, while some GOP governors are deploying National Guard units with a mission that includes stopping the flow of fentanyl from Mexico.

“It’s a fine line to help people and try to get people clean, and at the same time incarcerate and get the drug dealers off the streets,” said Nathan Manning, a Republican state senator in Ohio who is sponsoring legislation to make it clear that materials used to test drugs for fentanyl are legal.

The urgency is heightened because of the deepening impact of the drugs. Last year, the U.S. Centers for Disease Control and Prevention reported the nation had hit a grim milestone. For the first time, more than 100,000 Americans had diedof drug overdoses over a 12-month period. About two-thirds of the deaths were linked to fentanyl and other synthetic drugs, which can be 50 to 100 times more potent than morphine, heroin or prescription opioids. Texas lawmakers failed to legalize fentanyl testing strips last year, but there’s still a push for access

The recent case of five West Point cadets who overdosed on fentanyl-laced cocaine during spring break in Florida put the dangers and pervasiveness of the fentanyl crisis back in the spotlight.

The chemical precursors to the drugs are being shipped largely from China to Mexico, where much of the illicit fentanyl supply is produced in labs before being smuggled into the U.S.

While users sometimes seek out fentanyl specifically, it and other synthetics with similar properties are often mixed with other drugs or formed into counterfeit pills so users often don’t know they’re taking it.

Advocates say test strips can help prevent accidental overdoses of drugs laced with fentanyl. The strips are given out at needle exchanges and sometimes at concerts or other events where drugs are expected to be sold or used.

Thomas Stuber, chief legislative officer at The LCADA Way, a drug treatment organization in Ohio that serves Lorain County and nearby areas, has been pushing for the test strip legislation. It also would ease access to naloxone, a drug that can be used to revive people when they’re having opioid overdoses.

“This is a harm-reduction approach that has received a lot of acceptance,” he said. “We cannot treat somebody if they’re dead.”

Since last year, at least a half-dozen states have enacted similar laws and at least a dozen others have considered them, according to research by the National Conference of State Legislatures.

In West Virginia, the state hardest hit by opioids per capita, lawmakers passed a bill this month to legalize the testing strips. It now heads to the governor.

The measure was sponsored by Republican lawmakers. But state Delegate Mike Pushkin, a Democrat whose district includes central Charleston, has also been pushing for more access to fentanyl strips. He said the situation got worse last year when a state law tightened regulations on needle exchanges, causing some of them to close.

Pushkin, who also is in long-term addiction recovery, is pleased with the passage of the testing strip bill but upset with another measure passed this month that would increase the penalties for trafficking fentanyl. That bill also would create a new crime of adding fentanyl to another drug.

“Their initial reaction is, ‘We have to do something,’” he said. “It’s not just about doing something, it’s about doing the right thing that actually has results.”

But for many lawmakers, making sure that tough criminal penalties apply to fentanyl is a priority.

California Assemblywoman Janet Nguyen, a Republican, introduced a measure that would make penalties for dealing fentanyl just as harsh as those for selling cocaine or heroin. The Republican represents Orange County, where there were more than 600 reported fentanyl-related deaths last year.

“This is sending messages to those who aren’t afraid of selling these drugs that there’s a longer, bigger penalty than you might think,” said Nguyen, whose bill failed to advance from her chamber’s public safety committee in a 5-2 vote last week. She said after the bill failed that she was considering trying again. 

She said committee members stressed compassion for drug users, something she said she agrees with.

“The less available these pills are out there, the better it is,” Nguyen said. “And that is going after the drug dealer.”DEA: We save lives in Middle America by stopping fentanyl at the border

The same day her measure failed to advance, a Democratic lawmaker in California announced a different bill to increase fentanyl-dealing penalties.

The National Conference of State Legislatures found 12 states with fentanyl-specific drug trafficking or possession laws as of last year. Similar measures have been introduced or considered since the start of 2021 in at least 19 states, the Associated Press found in an analysis of bills compiled by LegiScan. That does not include measures to add more synthetic opioids to controlled substance lists to mirror federal law; those have been adopted in many states, with bipartisan support.

Fentanyl has been in the spotlight in Colorado since February, when five people were found dead in a suburban Denver apartment from overdoses of fentanyl mixed with cocaine.

Under state law, possession with intent to distribute less than 14 grams of fentanyl is an offense normally punishable by two to four years in prison. But fentanyl is so potent that 14 grams can represent up to 700 lethal doses, under a calculation used by the U.S. Drug Enforcement Agency.

“It’s making it impossible to hold the dealer accountable for the deadliness of the drugs they’re peddling,” Colorado House Speaker Alec Garnett, a Democrat, said in an interview.In El Paso, fentanyl, an OD, and unknown reasons for Downtown jail deaths

He and a bipartisan group of lawmakers last week unveiled a bill also backed by Democratic Gov. Jared Polis that would increase penalties for dealers with smaller amounts of fentanyl and in cases where the drug leads to a death. The legislation also would increase the accessibility of naloxone and test strips while steering people who possess fentanyl into education and treatment programs.

Maritza Perez, director of national affairs at the Drug Policy Alliance, a group that advocates for harm-reduction measures, is skeptical of the legislation that would increase criminal penalties.

“We have the largest incarceration rate in the entire world and we’re also setting records in terms of overdose deaths,” she said.

Democratic governors are focusing primarily on harm reduction methods. Among them is Illinois Gov. Jay Pritzker, who released a broad overdose action plan last month.

Several Republican governors and attorneys general have responded to the rising death toll with administrative enforcement efforts and by pushing for more federal intervention.

Last year, Texas Gov. Greg Abbott and Arizona Gov. Doug Ducey called for states to help secure the border with Mexico. Along with trying to keep people from entering the U.S., stopping the flow of fentanyl was cited as a reason. Several other Republican governors have sent contingents of state troopers or National Guard units. 

The Texas Military Department said that from March 2021 through earlier this month, its troops near the border confiscated more than 1,200 pounds (540 kilograms) of fentanyl. By comparison, federal authorities reported confiscating about 11,000 pounds (4,990 kilograms) in 2021 — still a fraction of what entered the country.Gov. Greg Abbott brags about his border initiative. The evidence doesn’t back him up.

Last year, the U.S. Department of Justice filed about 2,700 cases involving crimes related to the distribution of fentanyl and similar synthetic drugs, up nearly tenfold from 2017. Even so, Republican state officials are critical of federal efforts to stop fentanyl from entering the country.

In January, 16 GOP state attorneys general sent a letter to U.S. Secretary of State Antony Blinken calling on him to exert more pressure on China and Mexico to stop the flow of fentanyl. Those are steps that Dr. Rahul Gupta, the director of National Drug Control Policy, said are already being taken.

In March, West Virginia Attorney General Patrick Morrisey called on U.S. Attorney General Merrick Garland for more enforcement on fentanyl trafficking and harsher penalties. 

“Fentanyl is killing Americans of all walks of life in unprecedented numbers,” Morrisey said in a statement emailed to the AP, “and the federal government must respond with full force, across the board, using every tool available to stem the tide of death.”

Copyright 2022 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Over 700 people have been arrested in connection with the events of Jan. 6, 2021. This website provides current information about each one, including relevant news articles, an arrest map, and list of those currently incarcerated. We also provide ways for you to contact those in prison, and to help cover their legal and living expenses. If you would like to provide corrections, updates, or requests, please please contact us.

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Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence

Unhealthy Landscapes: Policy Recommendations on Land Use Change and Infectious Disease Emergence

The could possibly be the rabbit hole from Hell… Some of it seems like it could make sense but that’s how the work. I wonder what one would find if they dug deep – real deep and followed the money Trail on this subject???

Anthropogenic land use changes drive a range of infectious disease outbreaks and emergence events and modify the transmission of endemic infections. These drivers include agricultural encroachment, deforestation, road construction, dam building, irrigation, wetland modification, mining, the concentration or expansion of urban environments, coastal zone degradation, and other activities. These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, disease introduction, pollution, poverty, and human migration. The Working Group on Land Use Change and Disease Emergence grew out of a special colloquium that convened international experts in infectious diseases, ecology, and environmental health to assess the current state of knowledge and to develop recommendations for addressing these environmental health challenges.

The group established a systems model approach and priority lists of infectious diseases affected by ecologic degradation. Policy-relevant levels of the model include:

specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels.

The group recommended creating Centers of Excellence in Ecology and Health Research and Training, based at regional universities and/or research institutes with close links to the surrounding communities.

The centers’ objectives would be 3-fold:

a) to provide information to local communities about the links between environmental change and public health;

b) to facilitate fully interdisciplinary research from a variety of natural, social, and health sciences and train professionals who can conduct interdisciplinary research; and

c) to engage in science-based communication and assessment for policy making toward sustainable health and ecosystems.

Human-induced land use changes are the primary drivers of a range of infectious disease outbreaks and emergence events and also modifiers of the transmission of endemic infections (Patz et al. 2000).

These land use changes include:

  • deforestation
  • road construction
  • agricultural encroachment
  • dam building
  • irrigation
  • coastal zone degradation
  • wetland modification
  • mining
  • the concentration or expansion of urban environments
  • and other activities.

These changes in turn cause a cascade of factors that exacerbate infectious disease emergence, such as forest fragmentation, pathogen introduction, pollution, poverty, and human migration. These are important and complex issues that are understood only for a few diseases. For example, recent research has shown that forest fragmentation, urban sprawl, and biodiversity loss are linked to increased risk for Lyme disease in the northeastern United States (Schmidt and Ostfeld 2001). Expansion and changes in agricultural practices are intimately associated with the emergence of Nipah virus in Malaysia (Chua et al. 1999; Lam and Chua 2002), cryptosporidiosis in Europe and North America, and a range of food-borne illnesses globally (Rose et al. 2001). Road building is linked to the expansion of bushmeat consumption that may have played a key role in the early emergence of human immunodeficiency virus types 1 and 2 (Wolfe et al. 2000), and simian foamy virus has been found in bushmeat hunters (Wolfe et al. 2004).

In recognition of the complexity of land use change and the risks and benefits to human health that it entails, a special colloquium titled “Unhealthy Landscapes: How Land Use Change Affects Health” was convened at the 2002 biennial meeting of the International Society for Ecosystem Health (6–11 June 2002, Washington, DC) to address this issue. The invited experts worked to establish consensus on the current state of science and identify key knowledge gaps underlying this issue. This article condenses the working group’s report and presents a new research and policy agenda for understanding land use change and its effects on human health. Specifically, we discuss land-use drivers or human activities that exacerbate infectious diseases; the land–water interface, common to many infectious disease life cycles; and conclusions and recommendations for research and training from the working group.

Land-Use Drivers of Infectious Disease Emergence

The emerging infectious diseases (EIDs) resulting from land use change can be entirely new to a specific location or host species. This may occur either from “spillover” or cross-species transmission or simply by extension of geographic range into new or changed habitats. More than 75% of human diseases are zoonotic and have a link to wildlife and domestic animals (Taylor et al. 2001).

The working group developed an extensive list of processes by which land use affects human health (specifically, infectious disease occurrence) and of other factors that contribute to this relationship: agricultural development, urbanization, deforestation, population movement, increasing population, introduction of novel species/pathogens, water and air pollution, biodiversity loss, habit fragmentation, road building, macro and micro climate changes, hydrological alteration, decline in public health infrastructure, animal-intensive systems, eutrophication, military conflict, monocropping, and erosion (ranked from highest to lowest public health impact by meeting participants). The four mechanisms that were felt to have the greatest impact on public health were changes to the physical environment; movement of populations, pathogens, and trade; agriculture; and urbanization. War and civil unrest were also mentioned as a potentially acute and cross-cutting driver. Infectious disease agents with the strongest documented or suspected links to land use change are listed in Table 1.

Changes to the biophysical environment.

Deforestation.

Rates of deforestation have grown exponentially since the beginning of the 20th century. Driven by rapidly increasing human population numbers, large swaths of species-rich tropical and temperate forests, as well as prairies, grasslands, and wetlands, have been converted to species-poor agricultural and ranching areas. The global rate of tropical deforestation continues at staggering levels, with nearly 2–3% of forests lost globally each year. Parallel with this habitat destruction is an exponential growth in human–wildlife interaction and conflict. This has resulted in exposure to new pathogens for humans, livestock, and wildlife (Wolfe et al. 2000). Deforestation and the processes that lead to it have many consequences for ecosystems. Deforestation decreases the overall habitat available for wildlife species. It also modifies the structure of environments, for example, by fragmenting habitats into smaller patches separated by agricultural activities or human populations. Increased “edge effect” (from a patchwork of varied land uses) can further promote interaction among pathogens, vectors, and hosts. This edge effect has been well documented for Lyme disease (Glass et al. 1995). Similarly, increased activity in forest habitats (through behavior or occupation) appears to be a major risk factor for leishmaniasis (Weigle et al. 1993). Evidence is mounting that deforestation and ecosystem changes have implications for the distribution of many other microorganisms and the health of human, domestic animal, and wildlife populations.

One example of the effects of land use on human health is particularly noteworthy. Deforestation, with subsequent changes in land use and human settlement patterns, has coincided with an upsurge of malaria and/or its vectors in Africa (Coluzzi 1984, 1994; Coluzzi et al. 1979), in Asia (Bunnag et al. 1979), and in Latin America (Tadei et al. 1998). When tropical forests are cleared for human activities, they are typically converted into agricultural or grazing lands. This process is usually exacerbated by construction of roads, causing erosion and allowing previously inaccessible areas to become colonized by people (Kalliola and Flores Paitán 1998). Cleared lands and culverts that collect rainwater are in some areas far more suitable for larvae of malaria-transmitting anopheline mosquitoes than are intact forests (Charlwood and Alecrim 1989; Jones 1951; Marques 1987).

Another example of the effects of land use on human health involves deforestation and noninfectious disease: the contamination of rivers with mercury. Soil erosion after deforestation adds significant mercury loads, which are found naturally in rainforest soils, to rivers. This has led to fish in the Amazon becoming hazardous to eat (Fostier et al. 2000; Veiga et al. 1994).

Habitat fragmentation.

This alters the composition of host species in an environment and can change the fundamental ecology of microorganisms. Because of the nature of food webs within ecosystems, organisms at higher trophic levels exist at a lower population density and are often quite sensitive to changes in food availability. The smaller patches left after fragmentation often do not have sufficient prey for top predators, resulting in local extinction of predator species and a subsequent increase in the density of their prey species. Logging and road building in Latin America have increased the incidence of cutaneous and visceral leishmaniasis (Desjeux 2001), which in some areas has resulted from an increase in the number of fox reservoirs and sandfly vectors that have adapted to the peridomestic environment (Patz et al. 2000). Foxes, however, are not very important reservoirs for leishmaniasis in Latin America (Courtenay et al. 2002), and a more important factor in the transmission cycle includes domestic dogs.

Ostfeld and Keesing (2000) have demonstrated that smaller fragments in North American forests have fewer small mammal predators. Results suggest that the probability that a tick will become infected depends on not only the density of white-footed mice but also the density of mice relative to that of other hosts in the community. Under this scenario, the density effect of white-footed mice, which are efficient reservoirs for Lyme disease, can be “diluted” by an increasing density of alternative hosts, which are less efficient at transmitting Lyme disease. These results suggest that increasing host diversity (species richness) may decrease the risk of disease through a “dilution effect” (Schmidt and Ostfeld 2001).

Extractive industries.

Gold mining is an extractive industry that damages local and regional environments and has adverse human health effects, because mercury is used to extract gold from riverbeds in the tropical forests. Not only does mercury accumulate in local fish populations, making them toxic to eat (Lebel et al. 1996, 1998), but mercury also suppresses the human immune system. Also, in gold-mining areas, more mosquito-breeding sites and increased malaria risk result from digging gem pits in the forest and from craters resulting from logging; broader disease spread occurs as populations disperse throughout the region (Silbergeld et al. 2002).

Movement of populations, pathogens, and trade.

The movement of humans, domestic animals, wildlife populations, and agricultural products through travel, trade, and translocations is a driver of infectious disease emergence globally. These sometimes inadvertent, sometimes deliberate movements of infectious disease and vectors (e.g., the introduction of smallpox and measles to the Americas by Spanish conquistadors) will continue to rise via continually expanding global travel and by development of Third World populations. Human introduction of pathogens, hosts, or materials into new areas has been termed “pathogen pollution” (Daszak et al. 2000).

Land use changes drive some of these introductions and migrations and also increase the vulnerability of habitats and populations to these introductions. Human migrations also drive land use changes that in turn drive infectious disease emergence. For example, in China’s Yunnan Province, an increase in livestock populations and migration has led to an increase in the incidence of schistosomiasis (Jiang et al. 1997). In Malaysia, a combination of deforestation, drought, and wildfires has led to alterations in the population movements and densities of flying foxes, large fruit bats known to be the reservoir for the newly emergent zoonosis Nipah virus (Chua et al. 1999). It is believed that the increased opportunity for contact between infected bats and pigs produced the outbreak of the disease in pigs, which then was transmitted to people in contact with infected pigs (Aziz et al. 2002).

Another example of human-induced animal movement on a much larger scale is the international pet trade. This movement of animals involves many countries and allows for the introduction of novel pathogens, such as monkeypox, with the potential to damage ecosystems and threaten human and animal health. Monkeypox was originally associated with bushmeat hunting of red colobus monkeys (Procolobus badius); after a localized epidemic emerged in humans, monkeypox persisted for four generations via human-to-human contact (Jezek et al. 1986).

Human movement also has significant implications for public health. Not only are travelers (tourists, businesspeople, and other workers) at risk of contracting communicable diseases when visiting tropical countries, but they also can act as vectors for delivering infectious diseases to another region or, in the case of severe acute respiratory syndrome (SARS), potentially around the world. Refugees account for a significant number of human migrants, carrying diseases such as hepatitis B and tuberculosis and various parasites (Loutan et al. 1997). Because of their status, refugees become impoverished and are more exposed to a wide range of health risks. This is caused by the disruption of basic health services, inadequate food and medical care, and lack of clean water and sanitation (Toole and Waldman 1997). People who cross international boundaries, such as travelers, immigrants, and refugees, may be at increased risk of contracting infectious diseases, especially those who have no immunity because the disease agents are uncommon in their native countries. Immigrants may come from nations where diseases such as tuberculosis and malaria are endemic, and refugees may come from situations where crowding and malnutrition create ideal conditions for the spread of diseases such as cholera, shigellosis, malaria, and measles [Centers for Disease Control and Prevention (CDC) 1998].

Zoonoses.

The importance of zoonotic diseases should be emphasized. Zoonotic pathogens are the most significant cause of EIDs affecting humans, both in the proportion of EIDs that they cause and in the impact that they have. Some 1,415 species of infectious organisms are known to be pathogenic to people, with 61% of them being zoonotic. Of the emerging pathogens, 75% are zoonotic, and zoonotic pathogens are twice as likely to be associated with emerging diseases than are nonzoonotic pathogens (Taylor et al. 2001). More important, zoonotic pathogens cause a series of EIDs with high case fatality rates and no reliable cure, vaccine, or therapy (e.g., Ebola virus disease, Nipah virus disease, and hantavirus pulmonary syndrome). Zoonotic pathogens also cause diseases that have some of the highest incidence rates globally [e.g., acquired immunodeficiency syndrome (AIDS)]. AIDS is a special case, because it is caused by a pathogen that jumped host from nonhuman primates and then evolved into a new virus. Thus, it is in origin a zoonotic organism (Hahn et al. 2000).

Because of the important role of zoonoses in current public health threats, wildlife and domestic animals play a key role in the process by providing a “zoonotic pool” from which previously unknown pathogens may emerge (Daszak et al. 2001). The influenza virus is an example, causing pandemics in humans after periodic exchange of genes among the viruses of wild and domestic birds, pigs, and humans. Fruit bats are involved in a high-profile group of EIDs that includes rabies and other lyssaviruses, Hendra virus and Menangle virus (Australia), and Nipah virus (Malaysia and Singapore), which has implications for further zoonotic disease emergence. A number of species are endemic to both remote oceanic islands and more populous suburban and rural human settlements; these may harbor enzootic and potentially zoonotic pathogens with an unknown potential for spillover (Daszak et al. 2000).

Thus, some of the current major infectious threats to human health are EIDs and reemerging infectious diseases, with a particular emphasis on zoonotic pathogens transferring hosts from wildlife and domestic animals. A common, defining theme for most EIDs (of humans, wildlife, domestic animals, and plants) is that they are driven to emerge by anthropogenic changes to the environment. Because threats to wildlife habitat are so extensive and pervading, many of the currently important human EIDs (e.g., AIDS, Nipah virus disease) are driven partly by human-induced changes to wildlife habitat such as encroachment and deforestation. This is essentially a process of natural selection in which anthropogenic environmental changes perturb the host–parasite dynamic equilibrium, leading to the expansion of those strains suited to the new environmental conditions and facilitating expansion of others into new host species (Daszak et al. 2001).

Agriculture.

Crop irrigation and breeding sites.

Agriculture occupies about half of the world’s land and uses more than two-thirds of the world’s fresh water (Horrigan et al. 2002). Agricultural development in many parts of the world has increased the need for crop irrigation, which reduces water availability for other uses and increases breeding sites for disease vectors. An increase in soil moisture associated with irrigation development in the southern Nile Delta after the construction of the Aswan High Dam has caused a rapid rise in the mosquito Culex pipiens and consequential increase in the arthropod-borne disease Bancroftian filariasis (Harb et al. 1993; Thompson et al. 1996). Onchocerciasis and trypanosomiasis are further examples of vector-borne parasitic diseases that may be triggered by changing land-use and water management patterns. In addition, large-scale use of pesticides has had deleterious effects on farm workers, including hormone disruption and immune suppression (Straube et al. 1999).

Food-borne diseases.

Once agricultural development has expanded and produced food sufficient to meet local need, the food products are exported to other nations, where they can pose a risk to human health. The increase in imported foods has resulted in a rise in food-borne illness in the United States. Strawberries from Mexico, raspberries from Guatemala, carrots from Peru, and coconut milk from Thailand have caused recent outbreaks. Food safety is an important factor in human health, because food-borne disease accounts for an estimated 76 million illnesses, 325,000 hospitalizations, and 5,200 deaths in the United States each year (CDC 2003). Other dangers include antibiotic-resistant organisms, such as Cyclospora, Escherichia coli O157:H7, and other pathogenic E. coli strains associated with hemolytic uremic syndrome in children (Dols et al. 2001).

Secondary effects.

Agricultural secondary effects need to be minimized, such as the emerging microbial resistance from antibiotics in animal waste that is included in farm runoff and the introduction of microdams for irrigation in Ethiopia that resulted in a 7-fold increase in malaria (Ghebreyesus et al. 1999).

Urbanization.

On a global basis, the proportion of people living in urban centers will increase to an unprecedented 65% by the year 2030 (Population Reference Bureau 1998). The 2000 census shows that 80% of the U.S. population now lives in metropolitan areas, with 30% living in cities of 5 million or more. The environmental issues posed by such large population centers have profound impacts on public health beyond the city limits (Knowlton 2001).

Alterations of ecosystems and natural resources contribute to the emergence and spread of infectious disease agents. Human encroachment of wildlife habitat has broadened the interface between wildlife and humans, increasing opportunities for both the emergence of novel infectious diseases in wildlife and their transmission to people. Rabies is an example of a zoonotic disease carried by animals that has become habituated to urban environments. Bats colonize buildings, skunks and raccoons scavenge human refuse, and in many countries feral dogs in the streets are common and the major source of human infection (Singh et al. 2001).

Infectious diseases can also pass from people to wildlife. Nonhuman primates have acquired measles from ecotourists (Wallis and Lee 1999). Also, drug resistance in gram-negative enteric bacteria of wild baboons living with limited human contact is significantly less common than in baboons living with human contact near urban or semiurban human settlements (Rolland et al. 1985).

The Land–Water Interface

Another major driver of infectious disease emergence results from the land–water interface. Land use changes often involve water projects or coastal marine systems in which nutrients from agricultural runoff can cause algal blooms.

Currently the seventh Cholera pandemic is spreading across Asia, Africa, and South America. In 1992, a new serogroup (Vibrio cholerae O139) appeared and has been responsible for epidemics in Asia (Colwell 1996). The seasonality of cholera epidemics may be linked to the seasonality of plankton (algal blooms) and the marine food chain. Studies using remote-sensing data of chlorophyll-containing phytoplankton have shown a correlation between cholera cases and sea surface temperatures in the Bay of Bengal. Interannual variability in cholera incidence in Bangladesh is also linked to the El Niño southern oscillation and regional temperature anomalies (Lobitz et al. 2000), and cholera prevalence has been associated with progressively stronger El Niño events spanning a 70-year period (Rodo et al. 2002). This observation on cholera incidence may represent an early health indicator of global climate change (Patz 2002).

Infectious diseases in marine mammals and sea turtles could serve as sentinels for human disease risk. Sea turtles worldwide are affected by fibropapillomatosis, a disease probably caused by one or several viruses and characterized by multiple epithelial tumors. Field studies support the observation that prevalence of this disease is associated with heavily polluted coastal areas, areas of high human density, agricultural runoff, and/or biotoxin-producing algae (Aguirre and Lutz, in press). This represents the breakdown of the land–water interface, to the point that several pathogens typical of terrestrial ecosystems have become established in the oceans. Toxoplasmosis in the endangered sea otter (Enhydra lutris) represents an example of pathogen pollution. Massive mortalities in pinnipeds and cetaceans reaching epidemics of tens of thousands are caused by four morbilliviruses evolving from the canine distemper virus (Aguirre et al. 2002). Additionally, overfishing has myriad ramifications for marine ecosystems and sustainable protein food sources for human populations.

Cryptosporidium, a protozoan that completes its life cycle within the intestine of mammals, sheds high numbers of infectious oocysts that are dispersed in feces. A recent study found that 13% of finished treated water still contained Cryptosporidium oocysts, indicating some passage of microorganisms from source to treated drinking water (LeChevallier and Norton 1995). The protozoan is highly prevalent in ruminants and is readily transmitted to humans. Thus, management of livestock contamination of watersheds is an important public health issue.

One example of how overexploitation of a natural water resource led to infectious disease is that of Lake Malawi in Africa. Overfishing in the lake reduced the population of snail-eating fish to such a level that snail populations erupted. Subsequently, schistosomiasis incidence and prevalence markedly rose after this ecologic imbalance (Madsen et al. 2001).

Recommendations from the Working Group

Conceptual model: bringing land use into public health policy.

The recommendations stemming from the international colloquium are highly relevant to the Millennium Ecosystem Assessment (MEA), a broad multiagency/foundation-sponsored scientific assessment of degraded ecosystem effects on human well-being. A conceptual framework of the MEA already provides an approach to optimize the contribution of ecosystems to human health (MEA 2003). This framework offers a mechanism to a) identify options that can better achieve human development and sustainable goals, b) better understand the trade-offs involved in environment-related decisions, and c) align response options at all scales, from the local to the global, where they can be most effective. This conceptual framework focuses on human well-being while also recognizing associated intrinsic values. Similar to the MEA, focus is particularly on the linkages between ecosystem services and human health. Workshop participants developed a conceptual model (Figure 1). Like the MEA, it assumes a dynamic interaction between humans and ecosystems that warrants a multiscale assessment (spatial and temporal).

By using this framework, policy makers may approach development and health at various levels. These levels include specific health risk factors, landscape or habitat change, and institutional (economic and behavioral) levels. For sound health policy, we must shift away from dealing primarily with specific risk factors and look “upstream” to underlying land-use determinants of infectious disease and ultimately the human behavior and established institutions that are detrimental to sustainable population health. The World Health Organization (WHO) has developed a similar DPSEEA (driving forces, pressures, state, exposure, effect, actions) model that in a similar way describes the interlinkage between human health and different driving forces and environmental change (WHO 1997).

As such understanding increases, it will become more feasible to plan how to prevent new infectious disease emergence. Yet, because these are rare events, accurate predictions will remain daunting. It is already evident that inserting humans into complex ecosystems can lead to a variety of EIDs, but health outcomes depend on the economic circumstances of the human population. In poor and tropical communities, land use change can lead to major shifts in infectious disease patterns. For these situations, many conventional public health interventions can prevent several infectious diseases at relatively low cost. In rich and temperate-climate communities, the infectious disease shifts tend to be more disease specific, for example, in the case of Lyme disease and habitat fragmentation.

Research on deforestation and infectious disease.

Considering the deforestation that usually accompanies agricultural development, new conservation-oriented agriculture should be pursued. As discussed above, water project development and modern livestock management present major health disease risks. However, often the secondary unintended consequences can also wreak havoc; for example, a leaking dam may present greater risks than the reservoir itself. A distressingly large number of development projects not only have adverse effects on human health but also fail to attain their primary economic purposes in a sustainable manner.

Habitat fragmentation, whether caused by forest destruction, desertification, or land-use conversion, affects human and wildlife health and ecosystem processes. There is already much research undertaken by landscape ecologists on the consequences of habitat fragmentation for wildlife, especially larger animals. It would be important to study the effects of landscape fragmentation on public health hazards. Such research could entail three components. The first component consists of gathering baseline data, including using historical data where possible and beginning monitoring programs where necessary. Key data include identifying and quantifying the relevant pathogen load of wildlife, livestock, and human communities in fragmented landscapes. The goals of this data collection are, first, to identify key infectious diseases, both chronic and emergent or reemergent and, second, to document the consequences of fragmentation on relative abundance of wildlife and subsequent pathogen load. For example, the loss of large predators in fragmented habitats in the northeastern United States has led to a superabundance of rodent vectors for Lyme disease.

The second component of the research program would involve health impact modeling, primarily in three areas: a) estimating changes in the relative abundance of organisms, including infectious disease vectors, pathogens, and hosts; b) projecting potential vector or transmission shifts (e.g., should the Nipah virus shift to pulmonary as well as neurologic expression in humans as in swine); and c) projecting the impact of infectious diseases in a region on different geographic scales.

The results of these analyses, if successful, could support the third component of research: development of decision-support tools. Improved decisions on land-use policy could be made from a better understanding of costs and benefits to health and environmental decision makers. In all probability, however, they will be very location specific. For example, to construct an irrigation scheme in India would likely invite a malaria epidemic, whereas the same activity in sub-Saharan Africa may have little effect on malaria transmission. It is worth mentioning that costs and benefits could depend on the time course over which they are assessed. For example, some land-use changes can lead to short-term increases in transmission followed by longer-term decreases (e.g., irrigation and malaria in Sri Lanka) or vice versa (e.g., deforestation and cutaneous leishmaniasis in Latin America).

Policies to reduce microbial traffic/pathogen pollution.

In today’s interconnected world, it becomes very important to invest in the worldwide control of infectious diseases in developing countries, for example. It is also necessary to control transport to stem the flow from one place to the next.

Improved monitoring of trade is warranted in order to target infectious disease introductions. In the attempt to prevent the invasion of a pathogen (and drug-resistant organisms) into the vulnerable areas subject to land use changes, we need to pay greater attention to controls at the sources. We need to document and map these trades and investigate the vectors, the infectious diseases they harbor, and the populations they threaten. Risk assessment should guide surveillance and the development of test kits, targeting point-of-origin intervention to preempt these processes. Assessments must further include nonmarket costs (usually to the detriment of the environment and long-term sustainable health). We should communicate to both the exporters and consumers the need to make their trades clean, economically viable, and certified “clean and green” by an independent scientific agency at the source and/or destination. Additionally, strategies for screening travelers for pathogens that may be introduced to a region should be improved.

Centers of Excellence in Ecology and Health Research and Training.

One approach to developing the issues to which this article draws attention is the creation of a system of regional- or subregional-based interdisciplinary Centers of Excellence in Ecology and Health Research and Training. Based at regional universities and/or research institutes but with very close links to the surrounding communities, these centers would have the following objectives:

  • Providing information based on good science to local communities about the links between environmental change and public health, including the factors that contribute to specific infectious disease outbreaks. The new research agenda must gather information on household and community perspectives about proposals for the use of their land. These perspectives are key to assessing the cost/benefit of a proposed project. Training local professionals in environmental, agricultural, and health science issues, with a particular focus on granting degrees in a new “trans”-discipline linking health and the environment, would be emphasized.
  • Acting as centers of integrated analysis of infectious disease emergence, incorporating perspectives and expertise from a variety of natural, social, and health sciences. Research activities would range from taxonomy of pathogens and vectors to identifying best practices for influencing changes in human behavior to reduce ecosystem and health risks.
  • Incorporating a “health impact assessment” as an important cross-sectorial decision-making tool in overall development planning (parallel to an environmental impact assessment), along with the need for doing more research.
  • Equipping professionals with the ability to recommend policy toward maintaining ecosystem function and promoting sustainable public health for future generations. For example, the link between forest fragmentation and Lyme disease risk could lead to preserving more intact tracts of forest habitat by planning “cluster” housing schemes.
Implementing research and policy programs.

In selecting areas for research and the placement of centers of excellence, it is important to choose geographically representative, highly diverse areas around the world. In addition, research projects should take place in regions or landscapes that have both well characterized and less characterized patterns of infectious disease emergence or transmission for comparison purposes. Local health and environment professionals, who are in the best position to understand local priorities, should make the choices within each region for initial research areas and sites.

Addressing trade-offs among environment, health, and development.

There are some inherent trade-offs when considering land-use change and health. They are ethical values, environmental versus health choices, and disparities in knowledge and economic class. Trade-offs are between short-term benefit and long-term damage. For example, draining swamps may reduce vector-borne disease hazards but also destroy the wetland ecosystem and its inherent services (e.g., water storage, water filtration, biologic productivity, and habitats for fish and wildlife). Research can help decision making by identifying and assessing trade-offs in different land-use-change scenarios. Balancing the diverse needs of people, livestock, wildlife, and the ecosystem will always be a prominent feature.

Conclusions

When considering issues of land use and infectious disease emergence, the public needs to be attentive to entire ecosystems rather than simply their local environs. Although we may not live within a certain environment, its health may indirectly affect our own. For example, intact forests support complex ecosystems and provide essential habitats for species that are specialized to those flora and that may be relevant to our health. If these complex relationships are disrupted, there may be unforeseen impacts on human health, as the above examples clearly demonstrate.

Encouraging initiatives.

Three new initiatives are rising to the challenges presented above. The first initiative, the Consortium for Conservation Medicine (CCM), was formed recently to address these health challenges at the interface of ecology, wildlife health, and public health (Figure 2). At its core, conservation medicine champions the integration of techniques and partnering of scientists from diverse disciplines, particularly veterinary medicine, conservation biology, and public health. Through the consortium, therefore, these experts work with educators, policy makers, and conservation program managers to devise approaches that improve the health of both species and humans simultaneously [more information is available from the CCM website (CCM 2004)].

The second initiative, the new international journal EcoHealth, focuses on the integration of knowledge at the intersection of ecologic and health sciences. The journal provides a gathering place for research and reviews that integrate the diverse knowledge of ecology, health, and sustainability, whether scientific, medical, local, or traditional. The journal will encourage development and innovation in methods and practice that link ecology and health, and it will ensure clear and concise presentation to facilitate practical and policy application [more information is available from the EcoHealth website (EcoHealth 2004)].

The third initiative, the MEA, is an international work program designed to meet the needs of decision makers and the public for scientific information concerning the consequences of ecosystem change for human health and well-being and for options in responding to those changes. This assessment was launched by United Nations Secretary-General Kofi Annan in June 2001 and will help to meet the assessment needs of international environmental forums, such as the Convention on Biological Diversity, the Convention to Combat Desertification, the Ramsar Convention on Wetlands, and the Convention on Migratory Species, as well as the needs of other users in the private sector and civil society [more information is available from the Millennium Assessment Working Groups website (Millennium Assessment Working Groups 2004)].

Challenges ahead.

As this working group of researchers continues to work on these topics, we face three challenges. First, strong trans-disciplinary research partnerships need to be forged to approach the research with the degree of creative thinking and comprehensiveness required by the nature of the problems. Second, if the work is to influence policy, the choice of questions and the research must be undertaken collaboratively with the local community and also through discussion with decision makers in government, industry, civil society, and other sectors. Third, investigators must consider how they can integrate their findings into the social, economic, and political dialogue on both the environment and health, globally and locally. As links between land use and health are elucidated, an informed public will more readily use such discoveries to better generate political will for effective change.

Figures and Tables

Figure 1 A systems model of land use change that affects public health. This model shows relationships between drivers of land use change and subsequent levels of environmental change and health consequences. Various levels of investigation and intervention are evident and range from specific risks factors and determinants of population vulnerability to larger institutional and economic activity.
Figure 2 The main elements converging under the Consortium for Conservation Medicine. Conservation medicine combines conservation biology, wildlife veterinary medicine, and public health. Adapted from Tabor (2002).

Table 1

SOURCE :

https://ehp.niehs.nih.gov/doi/full/10.1289/ehp.6877

Philadelphia Child Shot, National Media Silent For Specific Reason

Philadelphia Child Shot, National Media Silent For Specific Reason

THE NATIONAL MEDIA WAS SILENT

A 12-year-old boy was shot and killed by Philadelphia police nearly two weeks ago.

Did this make your nightly news? Did basketball teams boycott their games? Was there performative outrage across the country accompanied by violent riots?

Local reports explain Thomas Siderio Jr. was fleeing police when he was shot in the back. It is undetermined whether Siderio was armed.

Siderio is white, like most Americans shot by police, by the way, so he will not be revered like other victims of police shootings.

Folks like Siderio are killed by police at nearly double the rate each year as black people.

Dead Caucasians, however, do not score political points for perpetually angry left-wing bigots. The activists and media usually ignore their deaths because facts interrupt the outrage machine’s Big Lie that police are “systemically racist.”

Walter Wallace, for example, was a black Philadelphian killed by police 17 months ago after attacking them with a weapon. Following a domestic dispute call, Wallace rushed toward the police officers arriving at the scene. Backing away, the cops demanded he drop his weapon, yet he refused. Since police eventually killed Wallace, the incident made national news and led to hooligans rioting and looting in large cities.

For young Siderio, there was no outrage.

As for further particulars, police say he fired a gun at them while they sat in a car, injuring one officer. Police returned fire as Siderio, and a friend ran away. Like the Wallace case, police only used their guns because they felt threatened. Police officers — at least those I know — want to protect us.

Big Tech, as usual, is also culpable via its bigotry and biases.

Internet searches for the Wallace incident show his race in almost every news story; whereas, a search for Siderio rarely lists his race in headlines. Race is clearly only mentioned to vilify police or augment “systemic racism” claims for the New York Times and CNN’s ratings. This is why people enormously overestimate how many blacks are killed annually by U.S. police officers.

“This happened less than a mile from where I live, and I did not know about it until you emailed me,” a Philadelphia resident told me on Tuesday morning. “Thankfully, there was no looting, I guess. It seems more accurate information could destroy the Black Lives Matter and associated movements, which are mostly kept alive by ensuring we the people remain ignorant of truths.”

A.J. Kaufman is a columnist for Alpha News and here at The Lid.

the national media was silent

Ballot Bombshells: 20 episodes exposing fraud, illegalities and irregularities in 2020 election

Ballot Bombshells: 20 episodes exposing fraud, illegalities and irregularities in 2020 election

Illegal rule changes, ballot harvesting, Iranian voter hack are among the many now-confirmed serious irregularities, putting the lie to the “perfect election” narrative.

After the 2020 election ended with Joe Biden declared the winner, the federal cybersecurity agency declared it was a perfectly secure vote. Months later, federal prosecutors admitted two Iranian nationals hacked into a state’s database and stole the identities of 100,000 voters in an effort to influence the election.

Likewise, Wisconsin Gov. Tony Evers declared it was “outrageous” to think his state’s 2020 election needed to be investigated. Now, two separate courts have concluded that state election regulators illegally changed rules, allowing tens of thousands to cast ballots in an unlawful manner.

And that probe Evers so stubbornly resisted just provided evidence of fraudulent vote-collecting operations that exploited vulnerable residents in nursing homes.

Georgia’s elections chief similarly expresses confidence to this day in his state’s declaration that Joe Biden won in 2020, but he now admits the state’s largest county ran a vote counting operation so dysfunctional that the state may take over the county. He also has launched a probe into potential illegal harvesting of ballots that he says may result in prosecutions.

And Arizona, one of the first states to move to no-excuse mail-in voting years ago, has now begun an urgent effort to return to traditional in-person voting with paper ballots after investigations called into question more than 50,000 ballots cast in November 2020 and tens of thousands more verification signatures.

For more than a year, Democrats and their allies in the corporate media have decried what they call the “Big Lie” that America’s 2020 election was flawed or stolen. But almost weekly now, revelations are emerging that the election was, in fact, marred by illegalities, irregularities and mismanagement like former President Donald Trump has argued, leaving a nation increasingly doubting the reliability of its election system.

recent poll found that 40% of Americans no longer believe in the legitimacy of the winner of either of the last two presidential elections, a stunning number for a country globally held as the gold standard for constitutional republics built on democracy.

“We have a lot of work to do,” former Ohio Secretary of State Ken Blackwell told Just the News on Wednesday. “And so I never sugarcoat this, because there’s substantial voter dissatisfaction with the the lack of security of our ballots. And they are very concerned that folks who are voting are folks who are not eligible to vote. And so you can’t have a system where illegal ballots negate the casting of legal ballots.”

The 2020 election results almost certainly won’t be reversed, no matter how widespread the calls for decertification grow. But the opportunity to take the many failures of the last election seriously to improve Americans’ confidence in voting in the 2022 and 2024 elections looms large, experts told Just the News.

“We need to make sure our voting rolls are clean,” Wisconsin State Rep. Janel Brandtjen told Just the News. She oversees the Assembly committee on election integrity and blasted Democratic Gov. Tony Evers for vetoing legislation designed to fix many problems identified in the Dairy State.

“At this point, there is no downside to cheating in Wisconsin, when you have a governor that’s shutting down a lot of the things that we’ve thought in the past as Republicans and Democrats that would make a fair and transparent election,” she added.

Here are 20 of the most important revelations uncovered by Just the News over the last 15 months of reporting, complete with substantiating evidence and links”

  1. A Foreign Intrusion. Federal authorities have confirmed that two Iranian nationals successfully hacked into a state computer election system, stole 100,000 voter registrations and used the data to carry out a cyber-intimidation campaign that targeted GOP members of Congress, Trump campaign officials and Democratic voters in the November 2020 election in one of the largest foreign intrusions in U.S. election history. The defendants “were part of a coordinated conspiracy in which Iranian hackers sought to undermine faith and confidence in the U.S. presidential election,” U.S. Attorney Damian Williams declared in an indictment.
  2. Alleged Bribery. The former state Supreme Court justice appointed by the Wisconsin Legislature to investigate the 2020 election concluded that millions of dollars in donations to election administrators in five Democrat-heavy municipalities from the Mark Zuckerberg-funded Center for Tech and Civic Life violated state anti-bribery laws and corrupted election practices by turning public election authorities into liberal get-out-the-vote activists. “The Zuckerberg-funded CTCL/ Zuckerberg 5 scheme would prove to be an effective way to accomplish the partisan effort to ‘turnout’ their desired voters and it was done with the active support of the very people and the governmental institution (WEC) that were supposed to be guarding the Wisconsin elections administrative process from the partisan activities they facilitated,” Justice Michael Gableman wrote.
  3. Illegal ballot harvesting in Wisconsin. Gableman also exposed an extensive vote collection operation, known as ballot harvesting, in nursing homes in which third-party activists illegally collected the ballots of vulnerable residents, some of whom lacked the mental or physical capacity to vote or were forbidden from voting by guardianship agreements. State election regulators “unlawfully directed the municipal clerks not to send out the legally required special voting deputies to nursing homes, resulting in many nursing homes’ registered residents voting at 100% rates and many ineligible residents voting, despite a guardianship order or incapacity,” Gableman wrote in his explosive report.
  4. Ballot harvesting probe in the Peach State. Georgia Secretary of State Brad Raffensperger has announced he has opened a criminal investigation into allegations that liberal activists engaged in illegal ballot harvesting, collecting ballots from voters and delivering them in violation of state law. Raffensperger said he is planning to issue subpoenas to identify a whistleblower who admitted he engaged in the operation, and there could be prosecutions. The True the Vote election integrity group says in a formal state complaint that the man, identified as John Doe, admitted his role and identified nonprofits who funded it at $10 per ballot delivered. The watchdog group also claims it has assembled cell phone location records pinpointing the alleged harvesting by as many as 240 activists.  
  5. Bad voter signatures? A review of Maricopa County’s mail-in ballots in Arizona’s 2020 presidential election estimated that more than 200,000 ballots with signatures that did not match voter files were counted without being reviewed, more than eight times the number the county acknowledged.
  6. 50,000 Arizona ballots called into question. An extensive audit by Arizona’s Senate officially called into question more than 50,000 ballots cast in the 2020 election, including voters who cast ballots from residences they had left. The tally in question is nearly five times the margin of Joe Biden’s victory in the state.
  7. Illegal ballot drop boxes. A Wisconsin judge has ruled the widespread use of ballot drop boxes in 2020 was unlawful, and the state Supreme Court let that ruling stand. That means drop boxes can’t be used in future elections starting in April. It also means that tens of thousands of ballots in the 2020 election were cast unlawfully.
  8. Foreign voters found on Texas rolls. An audit of Texas voter rollsidentified nearly 12,000 noncitizens suspected of illegally registering to vote and nearly 600 cases in which ballots may have been cast in the name of a dead resident or by a voter who may also have voted in another state. Officials are now in the process of removing the foreign voters and deciding whether prosecutions are warranted.
  9. Foreign voters found on Georgia  rolls. An audit by Georgia’s Secretary of State has identified more than 2,000 suspected foreigners who tried to register to vote in the state, though none reached the point of casting ballots. Raffensperger says prosecutions may be forthcoming.
  10. Unconstitutional mail-in voting. The Pennsylvania Commonwealth Court has concluded the state law that opened the door to no-excuse mail-in voting in 2020 was unconstitutional and that mail-in voting can only be enacted by a constitutional amendment. “A constitutional amendment must be presented to the people and adopted into our fundamental law before legislation authorizing no-excuse mail-in voting can be placed upon our statute books,” the court ruled. About 2.5 million voted by mail in Pennsylvania in 2020, votes now called into question by the ruling.
  11. More noncitizen voters. The Gableman investigation in Wisconsin also found noncitizens had made it onto the state voters rolls in violation of state law. The Wisconsin Election Commission failed “to record non-citizens in the WisVote voter database, thereby permitting non-citizens to vote, even though Wisconsin law requires citizenship to vote — all in violation of the Help America Vote Act,” the investigator wrote.
  12. Ballot chain of custody issues. The Georgia Secretary of State’s office has opened an investigation into the handling of drop box ballots last November in one of the state’s Democratic strongholds following a media report that there were problems with chain of custody documentation in DeKalb County.
  13. Fulton County irregularities. Georgia’s handpicked election monitor for Fulton County, the state’s largest voting district, documented two dozen pages of mismanagement and irregularities during vote counting in Atlanta in November 2020, including double-scanning of ballots, insecure transport of ballots and violations of voter privacy. The revelations prompted the state to take steps to possibly put Fulton County in receivership, empowering state officials to run the elections. Most of Fulton County’s election officials have left their jobs.
  14. Errant vote counting. Georgia Gov. Brian Kemp referred the audited November 2020 election results in Fulton County to the State Election Board after multiple reviews found three dozen significant problems with absentee ballot counting, including duplicate tallies, math errors and transposed data. Kemp’s referral calls into question hundreds of ballots in the official count.
  15. Dirty voter rolls. Michigan’s official state auditor has found that Secretary of State Jocelyn Benson failed to adhere to state election law by properly updating and reconciling Michigan’s qualified voter roll. This oversight, according to the audit, increased the risk of ineligible voters casting ballots.
  16. Illegal exemptions from voter ID. The Wisconsin Supreme Courtruled as many as 200,000 voters were allowed to illegally skip voter ID for absentee ballots by claiming they were indefinitely confined by COVID when there was no such legal authority to do so. Biden beat Trump by about 20,000 votes in the state.
  17. Uneven enforcement of election laws. The Wisconsin Legislative Audit Bureau identified more than 30 problems with the administration of elections in 2020, including unlawful orders and uneven enforcement of the law and urged  lawmakers to make sweeping improvements.
  18. More illegal harvesting. In Arizona, a half dozen people have already been indicted on charges of illegal harvesting in a probe by Attorney General Mark Brnovich that shows signs of expanding. It comes after the U.S. Supreme Court rejected Democrats’ arguments and concluded Arizona’s ban on harvesting was constitutional.
  19. Voter fraud in MichiganMichigan charged three women in connection with voter fraud schemes, including efforts to cast ballots on behalf of non-consenting nursing home residents.
  20. Still more nursing home fraud. In Wisconsin, Racine County Sheriff  Christopher Schmaling announced his investigators have secured evidence that eight out of 42 residents at a local nursing home had been recorded as casting absentee ballots that their families said was not possible because the residents didn’t possess the cognitive ability to vote.

Here is a required reading list for anyone interested in the above issues:

The Gableman Report

Iranian Hackers Indictment

Pennsylvania court ruling striking down mail-in voter law

Georgia state memo on irregularities in Fulton County vote counting

Kemp referral on erroneous vote counting

Georgia Ballot Harvesting Complaint