Health News Roundup

I'm still making this up as I go along. Today's focus is on finding some of the gems about healthcare and health policy that you can subscribe to via email. These are typically daily reports with excerpts and kinks to primary health and policy resources. They are deeply referenced, cited transparently, and they have a high degree of reliability and validity.

Feedback makes me all warm and fuzzy - and it makes the quality and focus better for you, dear reader. Please let me know what you think, what you would like to read, and what stories and issues you're interested in reading about. Here's your cup to sip from the health fire hose. *g*

Health References About Public Health And Pandemic Influenza

The Flu Wiki

The purpose of the Flu Wiki is to help local communities prepare for and perhaps cope with a possible influenza pandemic. This is a task previously ceded to local, state and national governmental public health agencies. Our goal is to be:

* a reliable source of information, as neutral as possible, about important facts useful for a public health approach to pandemic influenza
* a venue for anticipating the vast range of problems that may arise if a pandemic does occur
* a venue for thinking about implementable solutions to foreseeable problems

No one, in any health department or government agency, knows all the things needed to cope with an influenza pandemic. But it is likely someone knows something about some aspect of each of them and if we can pool and share our knowledge we can advance preparation for and the ability to cope with events. This is not meant to be a substitute for planning, preparation and implementation by civil authorities, but a parallel effort that complements, supports and extends those efforts.

While we will continue to administer and maintain the Wiki, we are turning the wheel over to the community, to take it where the road leads us.

Influenza Pandemic Preparation and Response: A Citizen’s Guide v.1.3 (PDF)

Use Doctrine
This manual is meant to be a guide for many citizens in its present form, but we
encourage individuals, communities, and organizations to revise and adapt it to their
individual needs and cultures and to translate it into other languages. We ask that
such revisions reference the original document and remain in the public domain.
Revisions should be posted on fluwikie.com so that those derivates will be widely
available. To check for current updates to this manual, please visit
http://www.fluwikie.com/pmwiki.php?n=Consequences.VersionHistory
Corrections and Additional Acknowledgments
If you wish to correct an error in this manual or if you find material for which the
original author or source is not properly acknowledged (an increasingly common
and unavoidable problem in the age of multiple postings and of extracts that do not
retain identification of the original source) please document your concern and email
it to PandemicPrepAndResponse@gmail.com.

Reuters Humanitarian Crisis Alerts

Want to know about flu in Fiji or cholera in Colombia? Easy and fast search functions to find crisis, locations, severity and statistics.

AHRQ Public Health and Pandemic Flu Information, News and Guides

The Agency for Healthcare Research and Quality's research in public health emergency preparedness is an outgrowth of its mission to develop evidence-based information to improve the quality of the U.S. health care system. This is critical to the U.S. Department of Health and Human Services developing programs to combat bioterrorism and other public health emergencies such as pandemic flu.

To help communities prepare for a flu pandemic and other emergencies, AHRQ offers these tools from its Bioterrorism and Emergency Preparedness Program.

Health Policy Subscriptions

Kaiser Daily Health Policy Report

Add Daily Reports via RSS

Kaisernetwork.org provides four daily online reports -- summaries of news stories with links to the original articles and a fully searchable archive. The Kaiser Daily Health Policy Report, the Kaiser Daily HIV/AIDS Report, the Kaiser Daily Women's Health Policy Report and the Kaiser Health Disparities Report keep you in touch with legislative, political, legal, scientific, and business developments in each area. Issues include Medicare reform, Medicaid, patients' rights, access, the uninsured, minority health, children's health and health care advertising.

Kaiser First Edition, available each weekday morning at 8:30, provides headlines and links to the day's top stories and events.

You may also be interested in GlobalHealthReporting.org's Weekly TB/Malaria Report, which provides summaries of malaria and tuberculosis news stories, containing links to original articles and related resources.

Email DailyReports@kaisernetwork.org with story submissions and press releases.

Enhanced Search: Based on user feedback, we have improved the Daily Reports Search so you can more effectively search by date, sort by date or relevance, narrow your search results and more.

This is my favorite. The reportage is fast, timely, heavily referenced and fairly comprehensive.

Fierce Healthcare is a proprietary daily newsletter that is also referenced well, has a fairly comprehensive approach to issues coverage, and leans heavily toward promoting healthcare IT issues, in which it has a business interest.

AHRQ Patient Safety Network

AHRQ Patient Safety Network (PSNet) is a new national web-based resource featuring the latest news and essential resources on patient safety. The site offers weekly updates of patient safety literature, news, tools, and meetings ("What’s New"), and a vast set of carefully annotated links to important research and other information on patient safety ("The Collection"). Supported by a robust patient safety taxonomy and web architecture, AHRQ PSNet provides powerful searching and browsing capability, as well as the ability for diverse users to customize the site around their interests (My PSNet). It also is tightly coupled with AHRQ WebM&M, the popular monthly journal that features user-submitted cases of medical errors, expert commentaries, and perspectives on patient safety. AHRQ PSNet and AHRQ WebM&M are both funded by the Agency for Healthcare Research and Quality and edited by a team at the University of California, San Francisco, with the technical support of Silverchair.

Subscribe here.


Today's Health News

Health Insurance Gaps Keep Would-Be Retirees Working

The number of Americans between 65 and 74 who are still working has jumped sharply, from 19.6% in 2000 to 23.2% last year, the Census Bureau said today. This morning’s Washington Post suggests several reasons for the jump, but one caught the Health Blog’s eye: Cuts in retiree health benefits have pushed employees to work longer to save on health care costs.

“People are simply hanging on to their job as a way to hang on to their income and to their health insurance so they can supplement their Medicare coverage,” Christian Weller, a University of Massachusetts professor and a senior fellow at the liberal Center for American Progress, told the paper.

Health Savings Accounts Aren't Catching On

A closely watched survey of employer-sponsored health insurance released today is getting attention for finding a 6% rise in premiums this year.

That headline number is climbing faster than inflation, though still below the double-digit increases of a few years back.

But the Health Blog was interested in a nugget buried inside the results. High-deductible insurance plans tied to special savings accounts continue to lag behind expectations, despite being praised high and low as a tool to slow the rise in health-care costs.

The Wall Street Journal is always looking for the free market, employer-focused angle.

Here's the New York Times' take on the same report:

Cost of Health Insurance Rises Again, but at a Slightly Slower Rate

The cost of employer-sponsored health insurance premiums has increased 6.1 percent this year, well ahead of wage trends and consumer price inflation, but below the 7.7 percent increase in 2006, the Kaiser Family Foundation reported yesterday.

Because doctor and hospital costs continue to rise at an even faster rate, the modest slowdown in insurance inflation mainly reflects cutbacks in coverage by many health plans, which have found ways to make employees pay more for their care. Industry experts said that without those measures, premium costs would have risen by 9 percent or more.

The total average annual cost for family coverage premiums rose this year to $12,106.

“For that kind of money, you could buy a compact car every year,” said Drew Altman, president of the Kaiser Foundation, a nonprofit group that produces the widely watched annual survey. He noted that health costs had increased 78 percent since 2001, more than four times the pace of prices and wages.

The 2007 increase was the smallest annual rise since 1999, when health premiums jumped 5.3 percent.

When the cupboard is bare, there isn't anything left over to put into HSAs (healthcare savings accounts).

That's a wrap for today. Your doses of flu references, email health news subscriptions and individuals' healthcare insurance costs will keep you wise to the latest in prevention and self-preservation.

Where The Surge Is Working

There is a real effective surge in Iraq. It just isn't with the combat forces.

Cholera is surging through the country.

A cholera epidemic in northern Iraq has infected approximately 7,000 people and could reach Baghdad within weeks as the disease spreads through the country’s decrepit and unsanitary water system, Iraqi health officials said Tuesday.

The World Health Organization reported that the epidemic is concentrated in the northern regions of Kirkuk and Sulaimaniya and that 10 people are known to have died. But Dr. Said Hakki, president of the Iraqi Red Crescent Society, a relief organization that has responded to the epidemic, said that new cases had turned up in the neighboring provinces, Erbil and Nineveh, indicating that the disease had spread.

What is cholera?

Cholera is an acute diarrhoeal infection caused by ingestion of the bacterium Vibrio cholerae. Transmission occurs through direct faecal-oral contamination or through ingestion of contaminated water and food. The disease is characterized in its most severe form by a sudden onset of acute watery diarrhoea that can lead to death by severe dehydration and kidney failure. The extremely short incubation period - two hours to five days - enhances the potentially explosive pattern of outbreaks, as the number of cases can rise very quickly. About 75% of people infected with cholera do not develop any symptoms. However, the pathogens stay in their faeces for 7 to 14 days and are shed back into the environment, potentially infecting other individuals. Cholera is an extremely virulent disease that affects both children and adults. Unlike other diarrhoeal diseases, it can kill healthy adults within hours. Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera.

Isn't that a disease from the Middle Ages?

During the 19th century, cholera spread repeatedly from its original reservoir or source in the Ganges delta in India to the rest of the world, before receding to South Asia. Six pandemics were recorded that killed millions of people across Europe, Africa and the Americas. The seventh pandemic, which is still ongoing, started in 1961 in South Asia, reached Africa in 1971 and the Americas in 1991. The disease is now considered to be endemic in many countries and the pathogen causing cholera cannot currently be eliminated from the environment.

Two serogroups of V. cholerae - O1 and O139 - can cause outbreaks. The main reservoirs are human beings and aquatic sources such as brackish water and estuaries, often associated with algal blooms (plankton). Recent studies indicate that global warming might create a favourable environment for V. cholerae and increase the incidence of the disease in vulnerable areas.

Who is at risk? How do they get it? Global warming - is Al Gore behind this?

Cholera is mainly transmitted through contaminated water and food and is closely linked to inadequate environmental management. The absence or shortage of safe water and sufficient sanitation combined with a generally poor environmental status are the main causes of spread of the disease. Typical at-risk areas include peri-urban slums, where basic infrastructure is not available, as well as camps for internally displaced people or refugees, where minimum requirements of clean water and sanitation are not met. However, it is important to stress that the belief that cholera epidemics are caused by dead bodies after disasters, whether natural or man-made, is false. Nonetheless, rumours and panic are often rife in the aftermath of a disaster. On the other hand, the consequences of a disaster -- such as disruption of water and sanitation systems or massive displacement of population to inadequate and overcrowded camps -- can increase the risk of transmission, should the pathogen be present or introduced.

Since 2005, the re-emergence of cholera has been noted in parallel with the ever-increasing size of vulnerable populations living in unsanitary conditions. Cholera remains a global threat to public health and one of the key indicators of social development. While the disease is no longer an issue in countries where minimum hygiene standards are met, it remains a threat in almost every developing country. The number of cholera cases reported to WHO during 2006 rose dramatically, reaching the level of the late 1990s. A total of 236 896 cases were notified from 52 countries, including 6311 deaths, an overall increase of 79% compared with the number of cases reported in 2005.

Was it a surprise? Um - NO!

AMMAN, March 22 (Reuters) - United Nations agencies working in Iraq warned on Thursday a chronic shortage of safe drinking water risks causing more child deaths and an outbreak of waterborne disease such as cholera during the summer.

Four years after the U.S.-led invasion of Iraq in 2003, millions of Iraqi children still find that safe water is no easier to access, said a statement issued by leading U.N. aid agencies operating in Iraq.

Does General Petraeus have a slide for this?

The major human displacement caused by the Iraq conflict — people being driven from their homes or simply choosing to leave — is likely to be driving the epidemic, officials say.

Who is helping?

Between 23 August and 6 September 2007, the cumulative number of cases of acute watery diarrhoea reported from five out of eleven districts of Sulaymaniyah Governate stands at 3,182 including 9 deaths (case fatality rate, CFR: 0.3%). Of these reported cases, Vibrio cholerae has been laboratory confirmed in 283 stool specimens.

During the period from 29 July to 2 September 2007, the health authority of Kirkuk Governate reported a total of 3,728 cases of acute diarrhoeal disease including 1 death (CFR: 0.03%). The first index case of cholera, confirmed by laboratory test, was reported from Kirkuk Governate on 14 August 2007. Most recently, six laboratory-confirmed cases of cholera were reported from Erbil Governate.

The Government of Iraq has mobilised a multi-sectoral response to the outbreak. A high-level National Committee on Cholera Preparedness and Outbreak Response has been established. The provincial health authorities of Sulaymaniyah, Kirkuk and Erbil Governates have initiated a number of public health control measures to contain the outbreak, including risk assessment, improving water safety and sanitation, strengthening the surveillance system for diarrhoeal disease, improving coordination and information flow, standardising clinical case management, mobilising medical and other essential supplies, and implementing social mobilisation and health education campaigns. All public water supply systems in the affected districts have been chlorinated by the provincial authorities. In addition, water samples from the public water supply sources are being collected and tested routinely to ensure they meet potable water safety standards.

WHO, UNICEF, UNDP, International Committee of the Red Cross (ICRC), a number of non-governmental organisations including the International Medical Corps (IMC), and Médecins Sans Frontières (MSF - France) are supporting the Ministry of Health and local health authorities in ongoing response operations.

The Numbers

Up until the Iraq epidemic, in 2005 WORLDWIDE, there were 236,896 total number of cases with 6311 deaths.
In Iraq alone now, there are 3182 cases with 9 deaths, and the number is exploding. For comparison, in 2004, the WHO reported 35 cases of cholera in Iraq with zero deaths.

Imagine for just a moment. You have explosive, debilitating diarrhea. It's over 100 degrees. You have no refrigeration, no bottled water, no cans of broth, soup and jello, no rehydration fluids, no toilet paper, no air conditioner or fans, no ice, no flushing toilets, no clean potable water of any kind, no medication, no clinic or hospital. How do you feel now?

Not a single US agency in the mix of health and relief agencies tackling this national nightmare. The US breaks a country, causes a 100% preventable epidemic, causes untold suffering, and leaves the mess for the international relief community to address.

And Americans have already learned that every single governmental agency is headed up with partisan political appointees who will report distorted and false information at the mandate of the Bush White House. So there is no trust in anything that the CDC or the HHS has to say about a cholera epidemic.

In Iraq with military supply lines becoming increasingly imperiled, it's only a matter of time before the beleaguered and exhausted troops also succumb to cholera. They are tired, they may not have timely and adequate deliveries of bottle or treated water, and just as they had to host bake sales to raise funds to purchase their own body armor, they have no guarantee that the White House won't fail them again, since the budget always funds political donors, regardless of what the troops need.

Love in the time of cholera. Not just a book title anymore.

Hearts and minds, baby.

Health News Roundup

{Crossposted at DocuDharma. Permission to use noncommercially with attribution.}

I thought I'd create a little links fest for those who would like to sip from the firehose that is health and healthcare. 

This post is for novice readers and features some core and must-have reference links.

Since I'm a two a day essayist, and I already used one of my daily offerings, I'll add the links for the major highlights of today at the bottom.  If you like what you read, or if you would enjoy something different, please let me know in the comments, and I'll adjust accordingly.

Health Policy Links

Kaiser Network Health08.org

Excellent website with RSS feeds, links and stories about politics intersecting with healthcare.  All of the presidential candidates' stances on healthcare are included in table format.

The Commonwealth Fund

The Commonwealth Fund is a private foundation that aims to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-income people, the uninsured, minority Americans, young children, and elderly adults.

The Fund carries out this mandate by supporting independent research on health care issues and making grants to improve health care practice and policy. An international program in health policy is designed to stimulate innovative policies and practices in the United States and other industrialized countries.

Health Affairs Blog

After twenty-five years as a non-profit, bimonthly print journal and six years in online publishing, Health Affairs has entered the blogosphere as a new means of engaging readers in the health policy debate. The journal is all about an ongoing dialogue on health policy issues of concern to a diverse audience of interested readers. Read more from Health Affairs' founding editor John Iglehart on why the journal has started a blog.

What will the blog include?

Health Affairs plans to experiment with the blog. Some posts (short, invited commentary) will be clustered around a hot topic. Some will be one-time postings on news items of interest. Linking and interactivity will be key. Our goal is to offer a range of views, not to push a particular agenda.

The main elements will include:

  * invited posts from leading policy analysts;
  * responses from a variety of health care stakeholders;
  * comments welcome from all readers;
  * links to timely information both within Health Affairs and from other sources;
  * staff-written posts on policy briefings, new reports, hot policy topics

Institute of Medicine

The nation turns to the Institute of Medicine (IOM) of the National Academies for science-based advice on matters of biomedical science, medicine, and health. A nonprofit organization specifically created for this purpose as well as an honorific membership organization, the IOM was chartered in 1970 as a component of the National Academy of Sciences.

The Institute provides a vital service by working outside the framework of government to ensure scientifically informed analysis and independent guidance. The IOM's mission is to serve as adviser to the nation to improve health. The Institute provides unbiased, evidence-based, and authoritative information and advice concerning health and science policy to policy-makers, professionals, leaders in every sector of society, and the public at large.

Health News Links

Highlight Health blog

Highlight HEALTH serves as an information medium to provide knowledge and understanding of dietary supplements, nutrition and health news. We evaluate scientific information, disseminate research results and educate readers who are seeking better health to promote an enhanced quality of life.

PhysOrg.com

This is a don't miss site which lists breaking stories from the science, health and tech fields.  Best to subscribe from a reader as the content flows fast and furious, and almost always ahead of everyone else.

PogoWasRight.org blog

Privacy news, discussions, and resources.

The Pump Handle blog

The Pump Handle is a place for people interested in public health and the environment to discuss the issues that interest us, particularly when they're not getting the treatment we think they deserve in the mainstream media.

The story of the pump handle is familiar to any first-semester public health student: During the London cholera epidemic of 1854, John Snow examined maps of cholera cases and traced the disease to water from a local pump. At the time, the prevailing theory held that cholera spread through the air, rather than water, so Snow faced criticism from others in the science community - not to mention resistance from the water companies. He finally convinced community leaders to remove the pump's handle to prevent further exposure.

More than a century later, thousands of people still die from cholera each year, and providing clean drinking water to the world's entire population is a far-off goal. The Pump Handle symbolizes both a public health victory and the challenges facing the public health and environmental fields today.

Most of this blog's founding members are epidemiologists from the US, and we'd like to bring in writers from other disciplines and places.

Today's Health News Links

Compensation for 9/11 Rescue, Recovery, and Cleanup Workers

It is time for Congress to enlist the nation's science and policy experts to help develop a federal workers' compensation program for 9/11 rescue, recovery, and cleanup workers. The inadequacy of state worker programs led Congress to legislate special compensation programs for uranium miners, and civilian workers in nuclear weapons facilities. We did not require the families of those killed in the terrorist attacks to rely on state workers' compensation programs. The September 11th Victim Compensation Fund (pdf) provided more than $7 billion to families of the victims. 

Wall Street Journal Health Blog Renewed Calls for Better Care for 9/11 Responders

"To think we're indebted to their efforts but we're really not doing enough to deal with their health concerns and their health impacts, it's really a sad commentary," New Jersey Democrat Frank Pallone said yesterday, the Associated Press reported.

The ailments common among those close to the site after the attack include post-traumatic stress, gastrointestinal illnesses and a range of respiratory conditions, such as asthma.

Pallone is part of a bipartisan group on Capitol Hill that recently wrote to administration officials asking for more information about plans to continue funding health care for responders and others. He'll chair a hearing on the subject next week.

And a few days ago, three New York congressmen (Democrats Carolyn Maloney and Jerrold Nadler, and Republican Vito Fossella) said they will introduce a bill that would establish a federal program that among other things would guarantee monitoring and care for residents, area workers and school children, in addition to those who worked and volunteered at ground zero.

Last, but in the theme of the last shall be first, please pay attention to this.  The HHS has been using progressives most recently by hosting a phony blog about pandemic flu planning.  Its chief shill, Dr. John Agwunobi, went from blogging false information about flu pandemic planning to jumping ship and going directly to Wal-Mart as its director of health and wellness.  A true Orwellian use of the term.. The AMA should be looking very sharply at a physician who is shilling for Republicans and spouting misinformation. There's a word for that - malpractice.

Hard Time on the HIPAA Front

It's been a week of bad news for lazy or sloppy health care organizations. An employee fired after a security breach of protected health information filed a wrongful termination suit against his former employer, and it may have merit because of poor policies. A community health care provider hacked by a disgruntled employee may be dragged into a compliance quagmire because it's not clear that the organization took basic steps to revoke his access. And to top it off, the U.S. Department of Health and Human Services (HHS) is starting to swing the enforcement rule -- a dowdy part of the Health Insurance Portability and Accountability Act (HIPAA) that few people read -- like a scythe in a field of weedy policies and overgrown practices.

GAO Report Reveals Serious Shortcomings in National Strategy to Counter Pandemic Influenza

Chairman Waxman, along with Rep. Tom Davis, Rep. Bennie Thompson, and Sen. Judd Gregg, release a new GAO report revealing serious shortcomings in the nation's pandemic preparedness.

The report urges a clearer definition of the federal government's role, promotes interagency cooperation, and advises the development of a coherent national strategy to deal with pandemic influenza. The lawmakers call on the Administration to address the problems identified in the GAO analysis.

That's the link patrol for today.  Too much?  Not enough?  Just right?

Take the temperature and let me know the diagnosis.

Liberal and Conservative Hard-wired

PhysOrg is just rich with interesting bits today. The latest to come across the site is that I-Told-You-So study which demonstrates that there appear to be hard-wired traits that are distinguishable between people who self-describe as liberal as opposed to conservative.

Aristotle may have been more on the mark than he realised when he said that man is by nature a political animal.

Dozens of previous studies have established a strong link between political persuasion and certain personality traits.

Conservatives tend to crave order and structure in their lives, and are more consistent in the way they make decisions. Liberals, by contrast, show a higher tolerance for ambiguity and complexity, and adapt more easily to unexpected circumstances.

The affinity between political views and "cognitive style" has also been shown to be heritable, handed down from parents to children, said the study, published in the British journal Nature Neuroscience.

Intrigued by these correlations, New York University political scientist David Amodio and colleagues decided to find out if the brains of liberals and conservatives reacted differently to the same stimuli.

A group of 43 right-handed subjects were asked to perform a series of computer tests designed to evaluate their unrehearsed response to cues urging them to break a well-established routine.

{snip}

The match-up was unmistakable: respondents who had described themselves as liberals showed "significantly greater conflict-related neural activity" when the hypothetical situation called for an unscheduled break in routine.

Conservatives, however, were less flexible, refusing to deviate from old habits "despite signals that this ... should be changed."

Interesting that many doctoral programs insist upon entering students signing a commitment to tolerate and to embrace ambiguity and uncertainty.

Final Exam

What should the U.S. do vis-a-vis Iraq?

Well, let's start at the beginning:

What is the mandate via the Constitution for use of the military in foreign lands?

Under what stated mission is the military acting in Iraq? Afghanistan? (Really - provide the mission statement or the link to the same.)

What criteria are stated by which to measure the progress and/or completion of the stated mission(s). Again - provide the written criteria, the author(s) and the links or citations.

Provide the reports by independent and neutral third parties which states the methods used to identify how closely the military has met the mission.

WHAT? You can't answer any items past the Constitutional parameters for the use of the military in foreign lands?????

Now you get it!

Out. Of. Iraq. Now.

Chips and Cancer: Who Knew?

The AP published a story by Todd Lewan which is full of descriptions all sorts of problems with public safety, science and ethics in the US. Underlying it all is the active resistance to both governmental and private organizations and individuals to do the right thing. Over and over and over, known problems are hidden from view, and appointed government officials jump from their positions where they have oversight and regulatory authority to the very organizations for which they were charged to oversee on behalf of the public interest and safety.

When the U.S. Food and Drug Administration approved implanting microchips in humans, the manufacturer said it would save lives, letting doctors scan the tiny transponders to access patients' medical records almost instantly. The FDA found "reasonable assurance" the device was safe, and a sub-agency even called it one of 2005's top "innovative technologies."

This story chronicles the problems with the implanted RFID chips commonly found used in pet identification, but which have also passed FDA approval for use as medical identifiers in humans.

But neither the company nor the regulators publicly mentioned this: A series of veterinary and toxicology studies, dating to the mid-1990s, stated that chip implants had "induced" malignant tumors in some lab mice and rats.

"The transponders were the cause of the tumors," said Keith Johnson, a retired toxicologic pathologist, explaining in a phone interview the findings of a 1996 study he led at the Dow Chemical Co. in Midland, Mich.

Leading cancer specialists reviewed the research for The Associated Press and, while cautioning that animal test results do not necessarily apply to humans, said the findings troubled them. Some said they would not allow family members to receive implants, and all urged further research before the glass-encased transponders are widely implanted in people.

To date, about 2,000 of the so-called radio frequency identification, or RFID, devices have been implanted in humans worldwide, according to VeriChip Corp. The company, which sees a target market of 45 million Americans for its medical monitoring chips, insists the devices are safe, as does its parent company, Applied Digital Solutions, of Delray Beach, Fla.

Once again, a Republican appointee acted in a way that is a clear conflict of interest with his role as the head of the FDA and his jump to an agency that he should have had no dealings with in any capacity. HHS continues to exhibit this unethical pattern with Dr. John Agwunobi's leap from his Assistant Secretary of the HHS position to that of Wal-Mart's Director of Health and Wellness position.

In the latter case, the AMA and the state medical board where Agwunobi is licensed should take a hard look at this disturbing breach of the public trust. Public health officials deal with patients as communities, and this is surely a breach of the physician patient relationship. Who can trust Agwunobi when his alliance is clearly to an organization paying his salary instead of as a professional advocate - as his profession stipulates - to his patients?

The FDA also stands by its approval of the technology.

Did the agency know of the tumor findings before approving the chip implants? The FDA declined repeated AP requests to specify what studies it reviewed.

The FDA is overseen by the Department of Health and Human Services, which, at the time of VeriChip's approval, was headed by Tommy Thompson. Two weeks after the device's approval took effect on Jan. 10, 2005, Thompson left his Cabinet post, and within five months was a board member of VeriChip Corp. and Applied Digital Solutions. He was compensated in cash and stock options.

Thompson, until recently a candidate for the 2008 Republican presidential nomination, says he had no personal relationship with the company as the VeriChip was being evaluated, nor did he play any role in FDA's approval process of the RFID tag.

"I didn't even know VeriChip before I stepped down from the Department of Health and Human Services," he said in a telephone interview.

Also making no mention of the findings on animal tumors was a June report by the ethics committee of the American Medical Association, which touted the benefits of implantable RFID devices.

Had committee members reviewed the literature on cancer in chipped animals?

No, said Dr. Steven Stack, an AMA board member with knowledge of the committee's review.

Was the AMA aware of the studies?

No, he said.

So much for protecting the public. The HHS, the FDA, the AMA - all of the agencies charged with assuring the public's safety and holding the public's trust - have not only failed to do that, but they actively undermine efforts to do what they are charged to do.

Where does that leave Americans?

Former US Surgeons General have testified that science is being distorted and suppressed. They have testified that the public's safety has been subjugated by political partisanship.

The first thing Americans must do is to mandate full Congressional oversight into the HHS, FDA, CDC, and all governmental agencies that are charged with protecting the public's safety.

Henry Waxman has introduced legislation to promote and to demand independence of the US Surgeon General position, and this is a good start.

The public must demand that the AMA, American Nurses Association, and the American Public Health Association put into place tough ethical conditions of membership, and that they publicly disclose members who are expelled or applications that are rejected for breaches of patient trust.

Congress must enact tough legislation that clearly prohibits any elected or appointed official from having any relationship with entities for which they have oversight or regulatory authority and responsibility. No more revolving door from comfy governmental position to private sector conflict of interest lobbying and advocacy. None. The policy must clearly and transparently be, if it appears to be a conflict of interest, it is, and therefore, it is not tolerated, nor is it acceptable.

The private sector is concerned with maximizing profits for its investors. Period.

Government is charged with protecting the public's welfare and safety.

Let the two remain separate and distinct entities.

And let the chips fall where they may. In Veri-Chip's case, may that be in a red bottom line for its egregiousness.

Reflections on Madeleine

Because you're not what I would have you be, I blind myself to who, in truth, you are.

Madeleine L'Engle died this past Thursday. The New York Times and The Washington Post published moving obituaries, and others' memoriams are beginning to make appearances on the internet.

I met Madeleine once at an author's reading, but we had passed each other many times on the streets of the Morningside Heights neighborhood where I had worked, and she had lived and worked.

Almost everyone's introduction to her books was with A Wrinkle In Time. She had said at the author's reading that it was frequently banned.

Banned?? Some souls with warped minds had conflated tessering with having sex. Found pornography in ananda. So sad, and yet, how well I have also been at the pointed end of slashing swords that slash only for the thrill of bloodlust.

I have enjoyed exploring her writing through the warp and weft of the Austins series, the Time series, and her exploration of questions, of universal language, of kairos, and of the Important Questions. I have loved her for her anger at God, of her unafraid questioning, and of her bold and brave and unabashed love of the singing of the spheres.

No matter how many times I read her work, I always was deeply moved during the reading and immersion in it. There's not a day that goes by that her influence isn't upon me and my life.

Madeleine, thank you for a life well-lived, generously shared and joyfully sung. The stars are making their joyful, universal and eternal music with you. We miss you here, and we're delighted that you are forever singing, harmonizing and deepening. Namaste.

From the About.com website, here are some quotes from Madeleine. Enjoy, remember, and discover:

Selected Madeleine L'Engle Quotations

• Our truest responsibility to the irrationality of the world is to paint or sing or write, for only in such response do we find the truth.

• You have to write the book that wants to be written. And if the book will be too difficult for grown-ups, then you write it for children.

• Inspiration usually comes during work, rather than before it.

• We can't take any credit for our talents. It's how we use them that counts.

• Artistic temperament sometimes seems a battleground, a dark angel of destruction and a bright angel of creativity wrestling.

• A book comes and says, "Write me." My job is to try to serve it to the best of my ability, which is never good enough, but all I can do is listen to it, do what it tells me and collaborate.

• That's the way things come clear. All of a sudden. And then you realize how obvious they've been all along.

• We tend to think things are new because we've just discovered them.

• We tend to defend vigorously things that in our deepest hearts we are not quite certain about. If we are certain of something we know, it doesn't need defending.

• I share Einstein's affirmation that anyone who is not lost on the rapturous awe at the power and glory of the mind behind the universe "is as good as a burnt out candle."

• Infinity is present in each part. A loving smile contains all art. The motes of starlight spark and dart. A grain of sand holds power and might.

• The world of science lives fairly comfortably with paradox. We know that light is a wave, and also that light is a particle. The discoveries made in the infinitely small world of particle physics indicate randomness and chance, and I do not find it any more difficult to live with the paradox of a universe of randomness and chance and a universe of pattern and purpose than I do with light as a wave and light as a particle. Living with contradiction is nothing new to the human being.

• Truth is eternal. Knowledge is changeable. It is disastrous to confuse them.

• Conversion for me was not a Damascus Road experience. I slowly moved into an intellectual acceptance of what my intuition had always known.

• I do not think that I will ever reach a stage when I will say, "This is what I believe. Finished." What I believe is alive ... and open to growth.

• If it can be verified, we don't need faith.... Faith is for that which lies on the other side of reason. Faith is what makes life bearable, with all its tragedies and ambiguities and sudden, startling joys.

• What I believe is so magnificent, so glorious, that it is beyond finite comprehension. To believe that the universe was created by a purposeful, benign Creator is one thing. To believe that this Creator took on human vesture, accepted death and mortality, was tempted, betrayed, broken, and all for love of us, defies reason. It is so wild that it terrifies some Christians who try to dogmatize their fear by lashing out at other Christians, because tidy Christianity with all answers given is easier than one which reaches out to the wild wonder of God's love, a love we don't even have to earn.

• We have much to be judged on when he comes, slums and battlefields and insane asylums, but these are the symptoms of our illness and the result of our failures in love.

• In the evening of life we shall be judged on love, and not one of us is going to come off very well, and were it not for my absolute faith in the loving forgiveness of my Lord I could not call on him to come.

• Those who believe they believe in God but without passion in the heart, without anguish of mind, without uncertainty, without doubt, and even at times without despair, believe only in the idea of God, and not in God himself.

• Deepest communion with God is beyond words, on the other side of silence.

• I will have nothing to do with a God who cares only occasionally. I need a God who is with us always, everywhere, in the deepest depths as well as the highest heights. It is when things go wrong, when good things do not happen, when our prayers seem to have been lost, that God is most present. We do not need the sheltering wings when things go smoothly. We are closest to God in the darkness, stumbling along blindly.

• So I go to church, not because of any legalistic or moralistic reasons, but because I am a hungry sheep who needs to be fed; and for the same reason that I wear a wedding ring: a public witness of a private commitment.