A Nightmare Waiting to Happen

Five vials of smallpox were found in a storage room at the National Institutes of Health, apparently misplaced for decades. This finding is ironic in that  earlier this year there was intense discussion concerning whether the last “known” samples of smallpox ostensibly located under heavy guard elsewhere in the US and  in Russia should be destroyed. I’m not sure what was decided then, but surely this discovery should add new color to these discussions.

As this discovery, the nuclear accident in Japan, or the historical mishaps with respect to nuclear weapons show, there is no 100 percent safety. Even if we currently have tip-top procedures, past mistakes can undermine that security.  While we may believe that we have dangerous chemical and biological agents under control, a  random misplacement could cause catastrophe. Imagine, for example, if the vials had been broken and they had not been properly labeled. We could have had a small epidemic on our hands that almost certainly would have killed thousands of people. This is even more likely as most doctors trained today, as we are learning with respect to measles, are unfamiliar with many of the diseases supposedly eradicated in the 20th century. 

More troubling, of course, is considering if these vials were discovered by someone with  more nefarious intentions. Since they are completely off the grid, there are no structures in place to ensure that such an individual could have walked off with it.

Such scenarios are plausible anywhere and much more likely in places where security is not nearly as tight as the US and could facilitate an attack that our security state, with its focus on electronic surveillance and conventional weapons detection, may not be entirely able to handle. I’m reminded of the backstory in the movie 12 Monkeys starring Bruce Willis. In this film, the virus, taken from the lab by a research scientist, was actually released during an airport security check and transported worldwide via the airline networks. 

Hopefully this episode places our security officials on notice to avoid these nightmare scenarios.

Update: The CDC has admitted its laxity with respect to security and practice at its labs. The nightmare is probably more likely than I believed.

 

 

Reducing our physician shortage

I read a New York Times article that discusses several new medicals that are opening over the next few years. Given our shortage of physicians, increasing their supply is definitely a public health imperative.

It states:

The Commonwealth is one of nearly two dozen medical schools that have recently opened or might open across the country, the most at any time since the 1960s and ’70s.

These new schools are seeking to address an imbalance in American medicine that has been growing for a quarter century. Many bright students were fleeing to offshore medical schools, or giving up hope entirely, when they could not get into domestic schools. Meanwhile, Americanhospitals were using foreign-trained and foreign-born physicians to fill medical residencies. During the 1980s and ’90s only one new medical school was established

The low supply of doctors, particularly in primary care, relative to  the number of patients has long been suggested as one of the primary impediments to health care access. This shortage is also used to promote increased numbers of visas for high skilled workers.

The lack of new medical schools in recent decades clearly stems from monetary concerns. It is expensive to run a medical school and there is fear that increased numbers of doctors will depress wages. By contrast, a new law school is proposed and opened every couple of years as they are veritable cash cows for universities. They require little equipment and the necessity for quality control is much lower.

Standard economics, of course, suggests that an  increased supply of workers will result in lower wages. However, in  medicine, this does not seem to be the case:

“When you add more physicians to an area, they just add more services, and their salaries don’t go down anywhere near in proportion to the increased supply,” said Dr. David Goodman, professor of pediatrics at the Dartmouth Institute for Health Policy and Clinical Practice and a practicing physician who has studied work force issues for 20 years. “More care may not be better, but it certainly is paid for,” Dr. Goodman said.

These new medical schools will specialize in filling the needs of society:

Many of the developing medical schools are well aware of such arguments, and are billing themselves as different from traditional medical schools, more focused on serving primary care needs in immigrant and disadvantaged communities. Administrators say that they expect that approach to be buttressed by a shift in state and federal reimbursements from specialists to primary care doctors.

I believe this is a good development