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By: Nick ShapiroBuy clomid c.o.d., Just a quick note on what is below and what is to come: this post briefly introduces some (re)emergent techniques of zoonotic disease preparedness and surveillance accompanied by a few theoretical implications that, well, seem to overheat quite quickly.
The second post will take a more empirical turn, ordering clomid no rx, Cheap clomid online cheap, and will flesh out some of the issues at hand by way of an interview.
Early on in her latest manuscript Donna Haraway proclaims:
Species interdependence is the name of the worlding [ie alternative globalizing] game on earth, where to buy clomid, Buy clomid from canada, and that game must be one of response and respect. That is the play of companion species learning to pay attention.
This declaration is a slightly modulated echo of the plea of ‘One Medicine’ or ‘One Health, clomid over the counter, φτηνές φαρμακείο clomid, ’ a discontinuous cadre of MDs, DVMs, Louisiana LA , Alabama AL Ala. , and public health experts that are calling for a renewed focus on interspecies medical entanglements. Although the movement does include many non-infectious disease elements such as trans-species oncology, shared pet and owner obesity, cheap generic clomid, Washington WA Wash. , and perhaps even the ultra-mundane pet-as-tripping hazard, the main thrust of the One Health agenda revolves around the threat posed by zoonoses, price of clomid, North Dakota ND , or diseases that can hop between animals and humans.
Of particular interest to this blog is the past and proposed further use of animals as biosensors for zoonotic disease (for both ‘natural’ and intentional epidemics), order clomid c.o.d.. These calls for ‘animals as sentinels’ of disease draw upon the epidemiological triad of animals oft increased exposure to pathogens, reactions at lower doses, and shorter incubation periods in comparison to humans, to sound an early outbreak alarm. Resonating with the Haraway quotation above, many One Health advocates are requesting more MD respect for and faster response to animals’ sickness as an early indication of human exposures, and for the security community to learn to pay attention to the signs of sentinel species, buy clomid c.o.d.. Buy clomid online legally, As some members of the medical community chisel away at the great medico-ontological divide between humans and animals it seems fitting to also tinker with some of cultural theory’s anthropocentrism, a task which Haraway (among others) has already initiated, buy clomid. New Mexico NM N.Mex. , With ‘animals as sentinels’ many of the resolute bio-ontological boundaries of biopower are unmoored, and contemporary discussions of the politics of “bare life, clomid ordine on-line, Cheap clomid online, †“life itself†and “biological citizenship†can no longer delimit ‘life’ and ‘biology’ to the confines of the human body. As the coal mine canary model is redeployed to assist in the discovery of clandestine bioterrorist attacks, clomid pharmacy, Connecticut CT Conn. , and also animal-borne disease outbreaks more broadly, there is a national-scale unification of non-human and human animals under common rubrics of disease risk and susceptibility, order clomid. Clomid,
While many philosophies could stand to be reworked in light of even a proposed (re?)harmonization of veterinary and human medicine, some of the theories put forth by this collaboratory are being reinforced. Interspecies relations are increasingly being read through the prism of distributed preparedness. Vulnerability is seen in the cultural architecture of interspecies relations, Virginia VA Va. . Cheap clomid, The “Western†dogma of human exceptionalism locates Homo sapiens at the enclosed epicenter of its taxonomic kingdom (see above illustrations that accompanied articles on One Health), a strategically dangerous position to inhabit under the contemporary US security doctrine of distributed preparedness, acheter clomid bon marché, or as Peter Galison refers to it, “the war against the center.†One Health advocates are increasingly viewing humans as structurally susceptible to infection due to our positioning of ourselves at the point of convergence of a centralized and hierarchical ontological system. Thus, leveling human-animal medical divides by distributing the responsibilities of epidemic detection across species is seen as a way of mitigating the structural pathogen exposure risks of our kingdom.
In order to get a better understanding of the viscera of One Health and its biosecurity engagements a couple weeks ago I sat down with Dr. Laura Kahn, who holds the unique position of being an outspoken advocate for One Health, a biosecurity columnist for the Bulletin of the Atomic Scientists and the sole MD in Princeton’s Science and Global Security program, buy clomid c.o.d.. A truncated transcript will appear soon as the second half of this discussion.
In the meantime… further reading.
Intro and History
“'One medicine—one pathology': are veterinary and human pathology prepared?â€
Robert D Cardiff, Jerrold M Ward, and Stephen W Barthold
Laboratory Investigation (2008) 88, 18–26; published online 26 November 2007.
Animal Sentinels:
Animals: The world's best (and cheapest) biosensors
Laura Kahn
The Bulletin of the Atomic Scientists; 13 March 2007.
Animals as Sentinels of Bioterrorism Agents Buy clomid c.o.d., Peter Rabinowitz et al.
Emerging Infectious Diseases, Vol. 12, No. 4; April 2006.
Bird Watchers as Sentinels, first few paragraphs:
Profit, plague and poultry:The intra-active worlds of highly pathogenic avian flu
Radical Philosophy, Commentaries; September/October 2006.
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April 16th, 2009 at 12:40 am
Thanks Nick for this interesting post and welcome to the blog! I am curious to learn more about your project!
It is quite interesting that the concept of One Health once refered primarily to an initiative to provide (one kind of) health to the poor.
http://www.oneworldhealth.org/
So here we have a shift towards another problematic and a different concept of the population under the same sign. Again the question is what kind of health is being envisioned here. And how does this form of One Health displace or articulate with that
other form of One Health?
My other point is simply that I have never been convinced that early detection really constitutes the crucial problem. It is indeed hard to miss an event like SARS. In this case, early detection was certainly not the issue. Nonetheless there is a tremendous investment into the idea of early detection while the crucial problem seems to be rather how to intervene. I wonder if you have any thoughts on this peculiar obsession with early detection and the kind of diagnosis on which it is based. What are the exemplary cases, what are the rationalities, what are the technologies, who are the actors, and where does the funding come from?
April 16th, 2009 at 9:08 am
… just a sidenote, particular species of fish have been used for a very long time as a living means to surveil the quality of water.
April 16th, 2009 at 12:29 pm
Thanks, Nick, for the introduction to your project, and Carlo for the important question of why everyone agrees that “early detection” is the problem.
Let me take a beginning stab at some of the history of this – in the hopes of hearing from Nick, Carlo, Lyle and others to fill this out.
It seems like a key part of the history here the idea that the emergence of AIDS should be understood in terms of zoonosis (specifically, the “bushmeat” theory). AIDS was arguably the central exemplar for the “emerging infections” discourse of the late 1980s and early 1990s.
In this discourse – taking, for example, the 1992 IOM Report – there are two premises with respect to the need for early detection: (1) if there had been a global early detection system in place when AIDS first emerged, it would have been possible to stamp it out before it became a pandemic; and (2) there are going to be new and equally dangerous viruses coming down the pike; while in the past, these might have remained confined within their setting of emergence, there is now global “viral traffic” that will quickly spread it to other parts of the world unless it is detected and responded to immediately. In terms of the experts involved: there is an interesting intersection between disease ecology (which is Joshua Lederberg’s epistemic framework) and “epidemic intelligence” (Langmuir to Henderson).
In any case: the diagnosis of the 1992 IOM Report was that what was needed, in order to avert such future outbreaks, was a global system for monitoring “emergence.” CDC picked this up in the mid-1990s when it developed its International Emerging Infections Program, which involved creating satellite CDC offices for tracking disease emergence in places like Kenya, Thailand, Guatemala, etc. Nick King has described this history.
The next part, I think, needs more investigation. WHO imported the CDC model in the late 1990s – one hypothesis is that graduates of the CDC epidemic intelligence service like David Heymann were the carriers of the model to WHO. In any case, before SARS hit the model was in place at WHO (in the “Programme on Emerging and other Communicable Diseases”) and there were outbreak investigators at the ready to act as first responders, as well as efforts to track reports of outbreaks through non-state sources, eg. GPHIN.
Re – zoonosis. The centrality of AIDS to this story helps explain why people like Nathan Wolfe (“viral forecaster”) are getting a lot of attention and resources to do things like test bushmeat in Cameroon.
April 16th, 2009 at 1:53 pm
Thanks, Andy, I completely agree with you. I would only add a couple of things. First the Luhmann point: Experts are constantly looking for problems to which they can offer technical solutions. In the aftermath of the genome mapping projects, scores of experts were prospecting for new problems. Early detection already prominently figured in the discussions of the 1990s, but it really took off only after 2000, for a variety of reasons.
There has been a lot of discussion around the possibility of stamping out an influenza pandemic. Given the fact that the success in controlling regular seasonal flu has been modest at best, I would be very sceptical about these knowledge claims.
As to the question of diagnosis, I agree that AIDS has always been the exemplary case. Yet how good an example is it really? AIDS has primarily been a disastrous political failure. So to argue that the virus did spread so rapidly primarily because of a lack of early detection is also to depoliticize a catastrophic epidemic.
April 16th, 2009 at 3:10 pm
Thanks Nick for an interesting and very resonant post. A quick response to Carlo’s last point: Nick King I recall making a similar argument about “emerging infections” science in general–that it was an attempt to rewrite the political failure of AIDS as a technical problem to work on. I completely agree, but its also probably not the only thing going on. Another aspect is what Carlo already mentioned: the development of certain technical capacities and the search for objects on which to apply them. This is certainly the case with syndromic surveillance: the introduction of new data analysis techniques (from outside the public health field) and an attempt to discover ways this could be useful in public health. This has led to the strange history of its shifting ‘ends’: from a means to ‘early warning’; to ‘situational awareness’ in the case of an already detected event; to a kind of background monitoring to verify the scale of a detected event.
Also in my research on syndromic surveillance, I came across a couple of U.S. based systems that attempted to “integrate” [their keyword] data from veterinary, meteorological, and human health sources into a single surveillance system. This would produce what they called a “common biological operating picture”. My provocation was to ask what constituted a significant event in a data set integrating these different types of data. While public health experts can say a single case of smallpox in humans is a highly significant event, or a certain increased number of cases of influenza may indicate a significant [epidemic] event, what number of cases of west nile virus in migratory birds is significant? I think one interesting thing to follow in your research, Nick, would be how these kinds of standards and norms are developed for the ‘One Health’ world.
April 17th, 2009 at 2:19 am
Thanks Carlo, Andy & Lyle for your interest and remarks.
Carlo: I am not so sure about the interplay of the two initiatives that share the signifier ‘One Health’. Perhaps both the One Health that I wrote of and that of your link are riding a holism wave, and maybe both the type of social medicine advocated by your link and the animalia One Health have some historical roots in the ideas of Virchow (and therefore share an underlying ethos), but other than that I am not sure if they are in much of a conversation or competition—but this is something I will think further about.
But your question of ‘what kind of health is envisioned here?’ is exactly the one that I was hoping to elicit with the Dr. Kahn interview. I guess the short answer is these ideas are mostly short of being operationalized and it is difficult to say. I think the first step they see, in the big picture, is establishing communication links between practitioners (MD and VMD) and between educational institutions (there is often also an urban/rural divide between medical and veterinary college campuses). And joint animal/human clinical arrangements for companion species are a distant option. While the composition of the greater One Health isn’t readily apparent to me at this stage, the zoononotic surveillance aspect, a large aspect no less, is better outlined and was in practice for a few years. As stated in the interview there are multiple layers of monitoring: Zoo (had short-lived funding), wildlife (already some), pets (some but rare), livestock (unlikely to get US farmer buy-in). And this zoonotic surveillance would function in NNDSS style and would not be integrated with the hi-tech backpack telemetry data of avian migration or the like, so not functioning very much like mass data sorting syndromic surveillance. In the interview my question about syndromic surveillance was largely reduced to a focus on the lack of applicability of the term ‘symptom’ to animals. But there are notable syndromic type projects in the US and the UK: The National Companion Animal Surveillance Program, several smaller scale US projects, and a pilot project on cattle heath up north in Yorkshire. But I am not aware of much communication between these systems and human systems, and I think that is the frustration, that MDs won’t listen to VMDs.
Lyle, I would be interested in finding out from where “integrated†syndromic systems are getting their veterinary data. On the US federal level my understanding was that only the USGS and the USDA (under APHIS) were collecting veterinary data, although quite a few more are collecting environmental data.
As far as early detection being an inflated concern, I think Lyle showed in some of his early work on the NNDSS that the birth of disease warning systems was germinated by fears of intentional and clandestine epidemics in the 50s. The potential extreme abruptness and scale of well orchestrated and furtive attacks beckoned (Langmuir) for new warming systems in a way that even the relatively abrupt 1918 flu didn’t (or was biowar just a selling point? I was never quite sure.). Carlo, you mention the ability to see a cascading ‘natural’ epidemics (SARS) coming without early warning systems and I agree. But (excluding the low intensity stomach bug outbreaks) I see the major thrust, and obviously the funding, behind early warning to be tied to the anxieties of bio-war-cum-terrorism (with spillover into ‘natural’ epidemics) and the difficulties of quickly starting up a halting municipal intervention plan. The ambiguities for me don’t seem to linger around city plans for bioterror response, I think that many of the intervention plans are quite intricately laid out, well, depending on the disease agent.
It also has to do with a certain arithmetic of the population at hand—there is a fetishization of patient flow rates. In Chicago for instance, if there was a large aerosolized anthrax release the city public health department wants to get antibiotics in the entire urban population within 48 hours of the discharge. The population is divided by the Points of (antibiotic) Distribution and then a flow rate per POD is deduced to fit the 48-hour period. For Chicago it is 1200 per POD per hour, and that is based off of an early detection (or an obvious release). Early warning is sometimes a baseline assumption in some of these equations and becomes necessitated within the systems engineering of population flow.
But Carlo that is a great question and I can only begin to scratch (perhaps all to obvious regions of) the surface.
Well that is street level (BioWatch/Syndromic/Zoo) early warning.
Andy also wrote of the moment-of-human-contact mode of surveillance. HIV and the bushmeat narrative have been invoked in supporting One Health and animal surveillance. Nathan Wolfe’s article in the April edition of Scientific American was recommended to me by Dr Kahn as a focal point of zoonotic disease transmission and human-animal relations. Dangerously, in Wolfe’s article, it is modes of human-animal relations that become pathologized, and rubrics of what counts as ‘synergistic’ co-existence become othering. This is often the moralizing origin narrative of zoonoses, Gwen D’Arcangelis touches on this in Tactical Biopolitics. Yet this is not the scale of role-out that the One Health initiative is advocating for, at the moment it seems largely US + UK focused. Echoing Carlo and Lyle, the way Wolfe talks about zoonotic surveillance is a means of finding fault in the bifocal’s of medicine and not in its systematic abdication of certain populations. And while the origins of HIV plays a role there are other notable filaments to the problematic. West Nile was Dr. Kahn’s ‘bellwether event’ for her personal interest in animal early warning systems and it is also zoo surveillance’s most lauded early outbreak sighting. The history of the slow rise of One Health into biosecurity doesn’t appear to be one of strategic rethinking or for that matter one that has moved far beyond the resolutions of medical profession associations.
Also Andy you were spot-on in reading Lederberg hues in the One Health campaign, he was a supporter before his death last year.
April 24th, 2009 at 10:03 pm
Hi y’all, just wanted to clear up one little thing before I disappear back into the Internet– my interest in the politics of zoonoses is not actually part of a larger project, it is merely something that I stumbled upon during my undergraduate research (but perhaps I will return to it someday) and thought it would be worth adding to the VSS puzzle. So, sorry I couldn’t dig deeper into its lineage or if I was over assertive in my response above.
also, I wanted to thank Stephen for facilitating this guest post (thanks!).
(not fishing for replies here just tippin’ my hat as i head home/log out)
July 28th, 2009 at 9:22 am
Nick, can you give me a citation for that world image? I am looking for a one-health type figure for a paper i am writing…
One health is important but so far it’s been a lot of talk and not much action…unless medical and vet schools are linked at the educational level it will be a long time since we as vets tend to approach things from a different direction (populations, interactions, nutrition, behaviour, in the context of a specific environment- all are taken into account) when even working clinically with a single patient – when the patient cannot talk you want as much info as possible! On the wildlife side the Consortium for Conservation medicine sometimes seems to be more about Conversation medicine, lot’s of talk, little action, we need concrete projects to involve all players before things will move forward….
July 28th, 2009 at 9:28 am
as for Dr. Wolfe, I won’t say he pathologizes behavior, his work is one of the few to take an anthropologic view in dealing with rural villagers and bush meat hunting… but there has been a tendency for him to upsell the importance of his “surveillance” networks in setting up his foundation. Having worked with some of those hunters I saw a better approach to working with understanding driving forces more so than blaming behaviors…