From NPR SciFri
Transcript
Thursday, September 23, 2010
Tuesday, January 26, 2010
Haiti: Obama's Katrina
Many post-quake deaths could have been prevented.
By SOUMITRA R. EACHEMPATI, DEAN LORICH AND DAVID HELFET
Four years ago the initial medical response to Hurricane Katrina was ill equipped, understaffed, poorly coordinated and delayed. Criticism of the paltry federal efforts was immediate and fierce.
Unfortunately, the response to the latest international disaster in Haiti has been no better, compounding the catastrophe.
On Tuesday, Jan. 12, a major earthquake overwhelmed a country one hour south of Miami whose inhabitants include American citizens and their relatives. Thanks to the Internet, pictures of the death and destruction were familiar to the world within hours, and the need for a massive influx of relief and specialized medical care was instantaneously apparent. While particular fatalities such as head injuries or massive blood loss are rarely treatable in mass casualty situations, delayed deaths from infection may be preventable.
On Wednesday, the day after the quake, we organized a relief team in cooperation with the U.S. State Department and Partners in Health (a Boston-based humanitarian organization) to provide emergency orthopedic and surgical care. We wanted to reach the local hospitals in Haiti immediately—but were only allowed by the U.S. military controlling the local airport to land in Port-au-Prince Saturday night. We were among the first groups there.
This delay proved tragic. Upon our arrival at the Haiti Community Hospital we found scores of patients with pus dripping out of open fractures and crush injuries. Some wounds were already infested with maggots. Approximately one-third of the victims were children. Most of the patients already had life-threatening infections, and all were dehydrated. Many had been waiting in the hospital compound for days without water, antibiotics or even pain medicine. The hospital smelled of infected, rotting limbs.
Our team spent the next 60 plus hours performing a variety of operations including orthopedic repairs to broken limbs and amputations. Sadly, a limb amputation in an underdeveloped country may be a death sentence.
We tallied over 100 operations between four surgeons and three orthopedic fellows (medical doctors getting additional specialty training), and evaluated perhaps 100 more patients for surgery. In contrast, a busy night in a New York City hospital might include four or five surgeries. Hindering the effort was an absence of ventilators, anesthetic machines, and oxygen tanks. There was no blood bank or laboratory, and a dearth of surgical instruments. Due to the lack of resources, we know many patients may still succumb to infection and other postoperative complications.
The U.S. response to the earthquake should be considered an embarrassment. Our operation received virtually no support from any branch of the U.S. government, including the State Department. As we ran out of various supplies we had no means to acquire more. There was no way to transfer patients we were poorly equipped to manage (such as a critically ill newborn with respiratory distress) to a facility where they would get better care. We were heartbroken having to tell patients suffering incredible pain we could not perform their surgery for at least a day.
Even after hearing gunshots outside the hospital, we had no protection for ourselves or our belongings—though we observed that a Jamaican medical team came with armed guards.
All these problems stemmed from ours being an isolated operation, a feature that may work in a humanitarian medical mission but not in a disaster situation. Later, as we were leaving Haiti, we were appalled to see warehouse-size quantities of unused medicines, food and other supplies at the airport, surrounded by hundreds of U.S. and international soldiers standing around aimlessly.
With an organized central command dedicated to medical relief, we could have done much better. A reconnaissance team, managed by government or U.N. officials in conjunction with medical and logistic specialists, could have immediately come to Haiti to evaluate local facilities. Preapproved groups of experienced civilian and military medical teams could have been consolidated in the U.S. from the Pensacola, Fla., military base or other locations, to avoid the airplane traffic clutter and delays that plagued landing of people and supplies into Port-au-Prince. Targeted teams with military support could then go to adequate facilities where they could be most effective.
After the disaster, certain roads should have been secured to allow the transfer of patients or supplies. A base hospital could have been established for patients requiring specialized services (such as a neonatal ICU and neurosurgery). A specialized, postoperative care center should have been established. In our case, however, we lacked the resources to ensure that patients were receiving basic wound care, antibiotics, nutrition or hydration.
The death toll from Katrina was under 2,000 people. Deaths in Haiti as of yesterday are at least 150,000. Untold numbers are dying of untreated, preventable infections. For all the outcry about Katrina, our nation has fared no better in this latest disaster.
Dr. Eachempati is a trauma surgeon and incoming president of the New York State Chapter of the American College of Surgeons. Drs. Lorich and Helfet are orthopedic surgeons. All practice at the Weill Cornell Medical Center in New York City
By SOUMITRA R. EACHEMPATI, DEAN LORICH AND DAVID HELFET
Four years ago the initial medical response to Hurricane Katrina was ill equipped, understaffed, poorly coordinated and delayed. Criticism of the paltry federal efforts was immediate and fierce.
Unfortunately, the response to the latest international disaster in Haiti has been no better, compounding the catastrophe.
On Tuesday, Jan. 12, a major earthquake overwhelmed a country one hour south of Miami whose inhabitants include American citizens and their relatives. Thanks to the Internet, pictures of the death and destruction were familiar to the world within hours, and the need for a massive influx of relief and specialized medical care was instantaneously apparent. While particular fatalities such as head injuries or massive blood loss are rarely treatable in mass casualty situations, delayed deaths from infection may be preventable.
On Wednesday, the day after the quake, we organized a relief team in cooperation with the U.S. State Department and Partners in Health (a Boston-based humanitarian organization) to provide emergency orthopedic and surgical care. We wanted to reach the local hospitals in Haiti immediately—but were only allowed by the U.S. military controlling the local airport to land in Port-au-Prince Saturday night. We were among the first groups there.
This delay proved tragic. Upon our arrival at the Haiti Community Hospital we found scores of patients with pus dripping out of open fractures and crush injuries. Some wounds were already infested with maggots. Approximately one-third of the victims were children. Most of the patients already had life-threatening infections, and all were dehydrated. Many had been waiting in the hospital compound for days without water, antibiotics or even pain medicine. The hospital smelled of infected, rotting limbs.
Our team spent the next 60 plus hours performing a variety of operations including orthopedic repairs to broken limbs and amputations. Sadly, a limb amputation in an underdeveloped country may be a death sentence.
We tallied over 100 operations between four surgeons and three orthopedic fellows (medical doctors getting additional specialty training), and evaluated perhaps 100 more patients for surgery. In contrast, a busy night in a New York City hospital might include four or five surgeries. Hindering the effort was an absence of ventilators, anesthetic machines, and oxygen tanks. There was no blood bank or laboratory, and a dearth of surgical instruments. Due to the lack of resources, we know many patients may still succumb to infection and other postoperative complications.
The U.S. response to the earthquake should be considered an embarrassment. Our operation received virtually no support from any branch of the U.S. government, including the State Department. As we ran out of various supplies we had no means to acquire more. There was no way to transfer patients we were poorly equipped to manage (such as a critically ill newborn with respiratory distress) to a facility where they would get better care. We were heartbroken having to tell patients suffering incredible pain we could not perform their surgery for at least a day.
Even after hearing gunshots outside the hospital, we had no protection for ourselves or our belongings—though we observed that a Jamaican medical team came with armed guards.
All these problems stemmed from ours being an isolated operation, a feature that may work in a humanitarian medical mission but not in a disaster situation. Later, as we were leaving Haiti, we were appalled to see warehouse-size quantities of unused medicines, food and other supplies at the airport, surrounded by hundreds of U.S. and international soldiers standing around aimlessly.
With an organized central command dedicated to medical relief, we could have done much better. A reconnaissance team, managed by government or U.N. officials in conjunction with medical and logistic specialists, could have immediately come to Haiti to evaluate local facilities. Preapproved groups of experienced civilian and military medical teams could have been consolidated in the U.S. from the Pensacola, Fla., military base or other locations, to avoid the airplane traffic clutter and delays that plagued landing of people and supplies into Port-au-Prince. Targeted teams with military support could then go to adequate facilities where they could be most effective.
After the disaster, certain roads should have been secured to allow the transfer of patients or supplies. A base hospital could have been established for patients requiring specialized services (such as a neonatal ICU and neurosurgery). A specialized, postoperative care center should have been established. In our case, however, we lacked the resources to ensure that patients were receiving basic wound care, antibiotics, nutrition or hydration.
The death toll from Katrina was under 2,000 people. Deaths in Haiti as of yesterday are at least 150,000. Untold numbers are dying of untreated, preventable infections. For all the outcry about Katrina, our nation has fared no better in this latest disaster.
Dr. Eachempati is a trauma surgeon and incoming president of the New York State Chapter of the American College of Surgeons. Drs. Lorich and Helfet are orthopedic surgeons. All practice at the Weill Cornell Medical Center in New York City
Tuesday, December 15, 2009
Thursday, December 3, 2009
Climategate: Science Is Dying Science is on the credibility bubble.
Climategate: Science Is Dying
Science is on the credibility bubble.
By DANIEL HENNINGER
Surely there must have been serious men and women in the hard sciences who at some point worried that their colleagues in the global warming movement were putting at risk the credibility of everyone in science. The nature of that risk has been twofold: First, that the claims of the climate scientists might buckle beneath the weight of their breathtaking complexity. Second, that the crudeness of modern politics, once in motion, would trample the traditions and culture of science to achieve its own policy goals. With the scandal at the East Anglia Climate Research Unit, both have happened at once.
I don't think most scientists appreciate what has hit them. This isn't only about the credibility of global warming. For years, global warming and its advocates have been the public face of hard science. Most people could not name three other subjects they would associate with the work of serious scientists. This was it. The public was told repeatedly that something called "the scientific community" had affirmed the science beneath this inquiry. A Nobel Prize was bestowed (on a politician).
Global warming enlisted the collective reputation of science. Because "science" said so, all the world was about to undertake a vast reordering of human behavior at almost unimaginable financial cost. Not every day does the work of scientists lead to galactic events simply called Kyoto or Copenhagen. At least not since the Manhattan Project.
What is happening at East Anglia is an epochal event. As the hard sciences—physics, biology, chemistry, electrical engineering—came to dominate intellectual life in the last century, some academics in the humanities devised the theory of postmodernism, which liberated them from their colleagues in the sciences. Postmodernism, a self-consciously "unprovable" theory, replaced formal structures with subjectivity. With the revelations of East Anglia, this slippery and variable intellectual world has crossed into the hard sciences.
The Climate Emails
This has harsh implications for the credibility of science generally. Hard science, alongside medicine, was one of the few things left accorded automatic stature and respect by most untrained lay persons. But the average person reading accounts of the East Anglia emails will conclude that hard science has become just another faction, as politicized and "messy" as, say, gender studies. The New England Journal of Medicine has turned into a weird weekly amalgam of straight medical-research and propaganda for the Obama redesign of U.S. medicine.
The East Anglians' mistreatment of scientists who challenged global warming's claims—plotting to shut them up and shut down their ability to publish—evokes the attempt to silence Galileo. The exchanges between Penn State's Michael Mann and East Anglia CRU director Phil Jones sound like Father Firenzuola, the Commissary-General of the Inquisition.
For three centuries Galileo has symbolized dissent in science. In our time, most scientists outside this circle have kept silent as their climatologist fellows, helped by the cardinals of the press, mocked and ostracized scientists who questioned this grand theory of global doom. Even a doubter as eminent as Princeton's Freeman Dyson was dismissed as an aging crank.
Beneath this dispute is a relatively new, very postmodern environmental idea known as "the precautionary principle." As defined by one official version: "When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." The global-warming establishment says we know "enough" to impose new rules on the world's use of carbon fuels. The dissenters say this demotes science's traditional standards of evidence.
What would Galileo do?
The Environmental Protection Agency's dramatic Endangerment Finding in April that greenhouse gas emissions qualify as an air pollutant—with implications for a vast new regulatory regime—used what the agency called a precautionary approach. The EPA admitted "varying degrees of uncertainty across many of these scientific issues." Again, this puts hard science in the new position of saying, close enough is good enough. One hopes civil engineers never build bridges under this theory.
The Obama administration's new head of policy at EPA, Lisa Heinzerling, is an advocate of turning precaution into standard policy. In a law-review article titled "Law and Economics for a Warming World," Ms. Heinzerling wrote, "Policy formation based on prediction and calculation of expected harm is no longer relevant; the only coherent response to a situation of chaotically worsening outcomes is a precautionary policy. . . ."
If the new ethos is that "close-enough" science is now sufficient to achieve political goals, serious scientists should be under no illusion that politicians will press-gang them into service for future agendas. Everyone working in science, no matter their politics, has an stake in cleaning up the mess revealed by the East Anglia emails. Science is on the credibility bubble. If it pops, centuries of what we understand to be the role of science go with it.
Write to henninger@wsj.com
Science is on the credibility bubble.
By DANIEL HENNINGER
Surely there must have been serious men and women in the hard sciences who at some point worried that their colleagues in the global warming movement were putting at risk the credibility of everyone in science. The nature of that risk has been twofold: First, that the claims of the climate scientists might buckle beneath the weight of their breathtaking complexity. Second, that the crudeness of modern politics, once in motion, would trample the traditions and culture of science to achieve its own policy goals. With the scandal at the East Anglia Climate Research Unit, both have happened at once.
I don't think most scientists appreciate what has hit them. This isn't only about the credibility of global warming. For years, global warming and its advocates have been the public face of hard science. Most people could not name three other subjects they would associate with the work of serious scientists. This was it. The public was told repeatedly that something called "the scientific community" had affirmed the science beneath this inquiry. A Nobel Prize was bestowed (on a politician).
Global warming enlisted the collective reputation of science. Because "science" said so, all the world was about to undertake a vast reordering of human behavior at almost unimaginable financial cost. Not every day does the work of scientists lead to galactic events simply called Kyoto or Copenhagen. At least not since the Manhattan Project.
What is happening at East Anglia is an epochal event. As the hard sciences—physics, biology, chemistry, electrical engineering—came to dominate intellectual life in the last century, some academics in the humanities devised the theory of postmodernism, which liberated them from their colleagues in the sciences. Postmodernism, a self-consciously "unprovable" theory, replaced formal structures with subjectivity. With the revelations of East Anglia, this slippery and variable intellectual world has crossed into the hard sciences.
The Climate Emails
This has harsh implications for the credibility of science generally. Hard science, alongside medicine, was one of the few things left accorded automatic stature and respect by most untrained lay persons. But the average person reading accounts of the East Anglia emails will conclude that hard science has become just another faction, as politicized and "messy" as, say, gender studies. The New England Journal of Medicine has turned into a weird weekly amalgam of straight medical-research and propaganda for the Obama redesign of U.S. medicine.
The East Anglians' mistreatment of scientists who challenged global warming's claims—plotting to shut them up and shut down their ability to publish—evokes the attempt to silence Galileo. The exchanges between Penn State's Michael Mann and East Anglia CRU director Phil Jones sound like Father Firenzuola, the Commissary-General of the Inquisition.
For three centuries Galileo has symbolized dissent in science. In our time, most scientists outside this circle have kept silent as their climatologist fellows, helped by the cardinals of the press, mocked and ostracized scientists who questioned this grand theory of global doom. Even a doubter as eminent as Princeton's Freeman Dyson was dismissed as an aging crank.
Beneath this dispute is a relatively new, very postmodern environmental idea known as "the precautionary principle." As defined by one official version: "When an activity raises threats of harm to the environment or human health, precautionary measures should be taken even if some cause and effect relationships are not fully established scientifically." The global-warming establishment says we know "enough" to impose new rules on the world's use of carbon fuels. The dissenters say this demotes science's traditional standards of evidence.
What would Galileo do?
The Environmental Protection Agency's dramatic Endangerment Finding in April that greenhouse gas emissions qualify as an air pollutant—with implications for a vast new regulatory regime—used what the agency called a precautionary approach. The EPA admitted "varying degrees of uncertainty across many of these scientific issues." Again, this puts hard science in the new position of saying, close enough is good enough. One hopes civil engineers never build bridges under this theory.
The Obama administration's new head of policy at EPA, Lisa Heinzerling, is an advocate of turning precaution into standard policy. In a law-review article titled "Law and Economics for a Warming World," Ms. Heinzerling wrote, "Policy formation based on prediction and calculation of expected harm is no longer relevant; the only coherent response to a situation of chaotically worsening outcomes is a precautionary policy. . . ."
If the new ethos is that "close-enough" science is now sufficient to achieve political goals, serious scientists should be under no illusion that politicians will press-gang them into service for future agendas. Everyone working in science, no matter their politics, has an stake in cleaning up the mess revealed by the East Anglia emails. Science is on the credibility bubble. If it pops, centuries of what we understand to be the role of science go with it.
Write to henninger@wsj.com
Tuesday, December 1, 2009
Putting the important tasks first!
http://www.thesimpledollar.com/2009/11/30/putting-the-important-but-not-urgent-tasks-above-the-urgent-but-not-important-tasks/
Good short article about looking at projects in the big picture.
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