Effect Measure is a forum for progressive public health discussion and argument as well as a source of public health information from around the web that interests the Editor(s)
The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.
The lights are out at Effect Measure. It is closed and locked. No one is there any more. So consider this a note tacked on the door. I had always intended to leave it as a way to connect you with The Pump Handle and that's still its purpose. But now I feel compelled to add a thank you note as well.
Shortly after publishing the final post I went off to my university's commencement. Of all the duties of a university faculty member, this is one of the nicest and happiest, the moment where we send our intellectual offspring into the world to do good on their own. The students who receive their PhDs (an achievement that takes years of arduous and often frustrating effort) have their academic hoods placed on them by their thesis advisor. It is a wonderful moment for both parties. This year one of them was a young woman whose thesis advisor herself had a thesis advisor for whose thesis I was the advisor. She was, in essence, my intellectual great grandchild. The world keeps spinning. When I got home, I was stunned by the nice things and good wishes people wrote in the comment thread to our Farewell post. I literally blushed. I have a multitude of defects and one is that I don't handle praise easily. My first impulse is to think of all the reasons why it isn't true. But the fact is I am also a fairly normal person and it would be both a lie and ungenerous not to admit I was gratified. Who wouldn't be? So thank you. It meant much, even if I can't quite fathom it.
Now to my original plan, a note about The Pump Handle. If you aren't familiar with it, it is a public health catchphrase for disease prevention. Its origin is a famous episode that occurred during a cholera outbreak in London's Soho district in 1854. You can read a detailed account in Steven Johnson's book, The Ghost Map, or hear Johnson talk about it at a TED talk which we posted a while back here. A London surgeon, Dr. John Snow, traced the source of the cholera to a well in Golden Square and convinced the local selectmen to "take the handle off the pump," thereby stopping the outbreak. John Snow is now considered the Father of Epidemiology (there is a more complicated historical background here, including a bit of mythology, but I'm not blogging any more so you'll have to ferret it out on your own). When some of my friends and colleagues decided to start another public health blog a few years ago I suggested the name The Pump Handle and so it is.
The Pump Handle blog has, as of today, moved to Scienceblogs.com and will hold down the public health blog position that Effect Measure occupied. There are other blogs at Scienceblogs that also do public health, notably Tara Smith's fine Aetiology, and many of the other medical and biological sites discuss public health issues regularly. Now TPH will be here as well and make public health its sole subject. Public health blogs aren't very common. There are many medical blogs and blogs devoted to microbiology but not too many devoted to public health in general. So the very existence of TPH is important.
But beyond just the blog's existence, the contributors there are public health heavy hitters. The bloggers at TPH have a wealth of knowledge and experience in environmental and occupational health and that will no doubt continue to be a major topic. But I hope to blog there on occasion on other matters (my business is the same as theirs I prefer not to blog about what I do professionally) and they plan to attract other contributors to broaden the scope. Make no mistake, though. These folks are real experts in their subject area. Jordan Barab's Confined Space blog got folded into TPH when he gave up his site and he is now Deputy Director of OSHA. The blog master at TPH is Liz Borkowski who blogged originally at unbossed and works in policy at Georgetown. Celeste Monforton also blogs at TPH. She is a PhD in policy who has advised the Governor of WV on both the Sago Mine Disaster and now Upper Big Branch. A former contributor to TPH was David Michaels, who now is Obama's OSHA Director and another TPH contributor is Susan Wood, a professor of health policy and environmental and occupational health at Georgetown and the Executive Director of the Jacobs Institute of Women's Health there. The folks are recognized authorities in the world of public health and readers will learn from them -- and as I have good cause to know, they will learn from you. I hope they develop the kind of loyal, critical, feisty, knowledgeable and influential readership we were privileged to have at Effect Measure. They couldn't do better than that.
So that's the note. We don't live here any more. Further inquiries at The Pump Handle.
It's been a long time coming but the time has come. Effect Measure is closing up shop, after 5 and a half years, 3 million visits and 5.1 million page views of some 3500. You commented on them some 37,000 times. It's been a grand ride but to all things there is a season. It's time to simplify my life and while my family has had me all along, at times science got short shrift. Now my time is getting short and I want to turn my attention to my research, the other polar star of my life. "Revere" will continue to post occasionally on Effect Measure's successor site, The Pump Handle (TPH), which will hold down the public health anchor position after EM is gone. We'll provide more details later this week when we officially hand off this spot to our friends and colleagues at TPH. Our archive will be folded into theirs, with details to follow when they are firmed up.
I pondered long and hard about whether to mention names of the many wonderful friends, adversaries, readers, commenters, offline email correspondents, fellow bloggers, forum leaders and sources that made EM what it was. It's a dangerous thing to do because you inevitably leave out people whom you cherish, respect and, despite differences, have managed to develop a great affection for. So we're not going to do that. I hope you know who you are or at least realize now you fit that description even without recording your name. Having said that, we are going to make three exceptions, both for historical and personal reasons.
The first is Jordan Barab, whose occupational health and safety blog, Confined Space, was a model for what can be done with the blogging form in public health. When we started EM, Jordan and I met for coffee at a local coffee house and he couldn't have been more helpful and encouraging. He was a pioneer in public health blogging and a master at it. When he became a senior congressional staffer he gave up the blog, but many of its functions were folded into The Pump Handle, so history is repeating itself. Jordan is now Deputy Director of OSHA. Imagine that.
The other two names are the late Melanie Mattson and Greg Dworkin, known far and wide under his blog name, DemFromCT. When we started blogging about avian influenza at EM back in late 2004 it was a topic barely discussed in the blogosphere. Melanie and Greg, separately, were two exceptions and we began to correspond via email and link to one another. When one of my commenters suggested my ever more numerous flu posts could be collected in a wiki format, I suggested it to Greg and Melanie and Flu Wiki was born. I was there at the founding, it is true, but like a delinquent parent I soon had left it to Greg and Melanie to raise the infant site without much help from me. And they did, in grand fashion. Melanie was a very sharp, deeply concerned and committed person who worried tremendously, perhaps excessively, for her fellow humans. She had a difficult and troubled life, and died too early. She was a blog pioneer and is remembered with deep affection by many of her fellow bloggers. As for Greg, if I didn't know him personally I would suspect he was not a person at all but a group of people. A front-pager at Daily Kos, perhaps the world's biggest blog, and one of the main anchors of Flu Wiki, Greg is a practicing pediatric pulmonologist who sees flu at the bedside but also has a public health perspective. When he blogs on health topics as DemFromCT at Daily Kos he does so with the eye of a consummate expert. His politics are progressive as befitting someone on the front lines of the battle to make this a better world. He is also a friend. My hat's off to you, Dem. You're still at it. I don't know how you do it -- but I'm glad you do.
So that's it, folks. We'll follow up soon with information about The Pump Handle, where you might occasionally catch a glimpse of us. But we can no longer blog day in and day out and sporadic blogs lose their audience quickly. EM is now passing into blog history, a good approximation of oblivion.
So it's time to bid you a farewell and we are doing it in the most literal sense: a wish that wherever you fare, you fare well and safely and in peace. It's what we wish for everyone and what this blog was all about.
I shall die, but
that is all that I shall do for Death.
I hear him leading his horse out of the stall;
I hear the clatter on the barn-floor.
He is in haste; he has business in Cuba,
business in the Balkans, many calls to make this morning.
But I will not hold the bridle
while he clinches the girth.
And he may mount by himself:
I will not give him a leg up.
Though he flick my shoulders with his whip,
I will not tell him which way the fox ran.
With his hoof on my breast, I will not tell him where
the black boy hides in the swamp.
I shall die, but that is all that I shall do for Death;
I am not on his pay-roll.
I will not tell him the whereabout of my friends
nor of my enemies either.
Though he promise me much,
I will not map him the route to any man's door.
Am I a spy in the land of the living,
that I should deliver men to Death?
Brother, the password and the plans of our city
are safe with me; never through me Shall you be overcome.
The person who taps the keys here over the signature "revere" (or sometimes "Revere"; it's at most one at a time) is not Paul Revere. The real Paul Revere died in 1818. If you want to know the name or names of any of the key tappers here I'm going to disappoint you right away. This post doesn't reveal how many people do the tapping or who they are. If you are a regular reader you already know quite a bit about us -- in fact much more than about many people whose names you know (or think you know; if you read a news by-line do you really know who wrote the article?). While sometimes there is a bit of misdirection, we have never been untruthful about anything we've said about ourselves or one or another Mrs. R. or the revere daughter or grandchildren. You know what we think, how we react, a lot about our life histories, how old some of us are, what we do for a living, our political and religious views, our areas of expertise, numerous opinions about a large variety of things, what makes us mad, what motivates us, etc., etc. How many people do you know all those things about? Knowing our names wouldn't tell you much more and might even be misleading. Our self-description in the masthead is exactly correct. No embellishment or false information.
When I was young (high school, college) I had a variety of jobs, including golf caddy (cured me of golf for the rest of my life; there were no carts, just an 11 year old lugging two bags with 16 clubs over 18 holes) and paper boy (4 am on Sundays hauling 80 huge Sunday papers in a wagon; took about 2 hours. Weekdays were smaller papers but the same wagon, and after school. I know, I know. Soon you'll expect me to talk about how I had to walk 5 miles to school, barefoot in the winter, but it wouldn't be true. It was only 4 miles). Then I started working in hospitals and basically I've been working in hospitals or medical centers ever since. My first job was as a summer job as a "houseman." About all I did was sweep stairwells and corridors and wipe handrails with disinfectant. All day, from morning until the end of the workday (shift change was about 3 pm). It was a lousy job and I was glad to switch over to transport of patients to and from the x-ray department, a summer job I did until almost entering medical school. Much more interesting. I read the charts, chatted with the patients and watched them read x-rays. But I thought about the houseman job yesterday when reading CDC's Morbidity and Mortality Weekly Reports (MMWR), where there was a report, "Acute Antimicrobial Pesticide-Related Illnesses Among Workers in Health-Care Facilities --- California, Louisiana, Michigan, and Texas, 2002--2007." I found the use of the term "pesticide" here somewhat unusual, since the "pests" aren't insects or rodents but bacteria and viruses and the worker exposure was in doing just the kind of job (and some others) I did as a houseman:
BP has this great reputation for being an environmentally friendly and responsible company. I know it because their incessant television ads tell me it's true. The ones that flank the national news stories about their horrendous safety record of explosions and worker deaths or their catastrophic oil spills. Those ads. When something happens they start the noise machine and appear to be the innocent party let down by their lessee.
In the sixties one of the suggested exist strategies for the War in Vietnam was "to declare victory and get out." Alas, it was the road not taken, increasing the length and depth of the tragedy for all concerned. For the War on Drugs, there is an even simpler solution: stop calling it a war. According to Obama's drug chief, that's the attitude of his administration and it's about time:
Salmonella is an enteric pathogen that causes quite a lot of foodborne illness. I learned there were several species of Salmonella bacteria of which the cause of typhoid fever was called Salmonella typi. Spread via food and water it used to kill a lot of people in the 19th and early 20th centuries. Nowadays all Salmonella bacteria are considered to be different subspecies (serovars) of just one species, Salmonella enterica. There are more than 2500 of them, of which several routinely infect humans. Salmonella enteritidis is the most common form of foodborne bacterial infection (NB: many foodborne infections are of unknown agent and many are probably viral). Since the 19th century we've cleaned up the water supplies with disinfection and filtration and improved the food supplies. We can even treat typhoid and some of the other salmonella infections with antibiotics. Typhoid fever responds well but is only a tiny fraction of salmonellosis these days. For non-typhoid salmonella gastroenteritis whether to treat with antibiotics is a matter of clinical judgment. Randomized trials don't show a clear-cut benefit and even suggest antibiotic treatment may prolong bacterial shedding in the stools, but for serious illness or infants less than 2 months, people with significant co-morbidities like sickle cell disease or immune deficiencies, antibiotics are still used. The main types are fluoroquinolones (e.g., Cipro) or the new generation of cephalosporins (ceftrioxone). Unfortunately both classes of antibiotics are also used in industrial livestock production to increase growth of animals and that has caused worries that these huge operations are incubators for drug resistant organisms. A paper just being published in Foodborne Pathogens and Disease asked whether retail supermarket chickens might be a place where one could contract drug resistant salmonellosis. The answer seems to be, "maybe." From the abstract:
As the flu pandemic ramped up with no vaccine in sight, attention turned to more prosaic things people might do to avoid infection. At the top of most lists was hand washing. I think hand washing is a good thing to do, although the evidence it does much against influenza specifically is weak or non-existent. Hand washing has been shown effective in some studies involving other respiratory viruses and intestinal pathogens, so even it doesn't work for flu you gain something. And now it appears there are other effects of hand washing. Long a metaphor for having done with something, new research suggests it may be more than a metaphor:
