Pacific Eclipse – A tabletop exercise on smallpox pandemic response

BackgroundIn December 2019, we ran Pacific Eclipse, a pandemic tabletop exercise using smallpox originating in Fiji as a case study. Pacific Eclipse brought together international stakeholders from health, defence, law enforcement, emergency management and a range of other organisations.AimTo review potential gaps in preparedness and identify modifiable factors which could prevent a pandemic or mitigate the impact of a pandemic.MethodsPacific Eclipse was held on December 9–10 in Washington DC, Phoenix and Honolulu simultaneously. The scenario began in Fiji and becomes a pandemic. Mathematical modelling of smallpox transmission was used to simulate the epidemic under different conditions and to test the effect of interventions. Live polling, using Poll Everywhere software that participants downloaded onto their smart phones, was used to gather participant decisions as the scenario unfolded. Stakeholders from state and federal government and non-government organisations from The United States, The United Kingdom, Australia, New Zealand, Canada, as well as industry and non-government organisations attended.ResultsThe scenario progressed in three phases and participants were able to make decisions during each phase using live polling. The polling showed very diverse and sometimes conflicting decision making. Factors influential to pandemic severity were identified and categorised as modifiable or unmodifiable. A series of recommendations were made on the modifiable determinants of pandemic severity and how these can be incorporated into pandemic planning. These included preventing an attack through intelligence, law enforcement and legislation, improved speed of diagnosis, speed and completeness of case finding and case isolation, speed and security of vaccination response (including stockpiling), speed and completeness of contact tracing, protecting critical infrastructure and business continuity, non-pharmaceutical interventions (social distancing, PPE, border control) and protecting first responders.DiscussionPacific Eclipse illustrated the impact of a pandemic of smallpox under different response scenarios, which were validated to some extent by the COVID-19 pandemic. The framework developed from the scenario draws out modifiable determinants of pandemic severity which can inform pandemic planning for the ongoing COVID-19 pandemic and for future pandemics.     

Surgeon General’s Report on Addiction: What Does It Mean?

A new Congress and a new President-elect mean changes are in store for 2017. But one topic that remains bipartisan is addiction. The Surgeon General’s first-ever report on substance misuse and related disorders, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health, reminds us of the inequities in treatment of addictions and opens new opportunities for change.     

Richard Dean: The Value of Humanity in Kant’s Moral Theory

Medicine, Health Care and Philosophy - This is critical review of Richard Dean’ book, The Value of Humanity in Kant’s Moral Theory. Dean’s book was evaluated, and some of his...     

Governments Need Better Guidance to Maximise Value for Money: The Case of Australia’s Pharmaceutical Benefits Advisory Committee

In Australia, the Pharmaceutical Benefits Advisory Committee (PBAC) makes recommendations to the Minister for Health on which pharmaceuticals should be subsidised. Given the implications of PBAC recommendations for government finances and population health, PBAC is required to provide advice primarily on the basis of value for money. The aim of this article is twofold: to describe some major limitations of the current PBAC decision-making process in relation to its implicit aim of maximising value for money; and to suggest what might be done toward overcoming these limitations. This should also offer lessons for the many decision-making bodies around the world that are similar to PBAC. The current PBAC decision-making process is limited in two important respects. First, it features the use of an implicit incremental cost-effectiveness ratio (ICER) threshold that may not reflect the opportunity cost of funding a new technology, with unknown and possibly negative consequences for population health. Second, the process does not feature a means of systematically assessing how a technology may be of greater or lesser value in light of factors that are not captured by standard measures of cost effectiveness, but which are nonetheless important, particularly to the Australian community. Overcoming these limitations would mean that PBAC could be more confident of maximising value for money when making funding decisions.     

Children’s Exposure to Metals: A Community-Initiated Study

In 2007, it was shown that the shipping of lead (Pb) through Esperance Port in Western Australia resulted in contamination and increased Pb concentrations in children. A clean-up strategy was implemented; however, little attention was given to other metals. In consultation with the community, a cross-sectional exposure study was designed. Thirty-nine children aged 1 to 12 years provided samples of hair, urine, drinking water, residential soil and dust. Concentrations of nickel (Ni) and Pb were low in biological and environmental samples. Hair aluminium (Al) (lower than the detection limit [DL] to 251 μg/g) and copper (Cu) (7 to 415 μg/g), as well as urinary Al (<DL to 210 μg/L), manganese (Mn) (<DL to 550 μg/L), and Cu (<DL to 87 μg/L), were increased for a small number of participants. Concentrations of nickel (Ni) in urine, soil, and dust decreased with increasing distance from the port, as did soil Pb concentrations. The results suggest exposure to Ni and Pb was limited in children at the time of sampling in 2009. Further investigation is required to determine the source(s) and significance of other increased metals concentrations.     

Black US college women’s strategies of sexual self-protection

While previous scholarship on the sexual practices of college students in the USA has explored how the co-constitution of whiteness, economic privilege and gender inequality are central to ‘hooking up’, less attention has been paid to how the sexual culture of predominantly white universities shape Black college women’s sexual practices. In this article, we use an intersectional theoretical framework informed by Black feminism to analyse interviews with Black, cisgender, heterosexual women, aged 18–22, attending a university in the south-eastern USA. We explore how they interpret the university’s sexual culture and in turn how that informs their sexual decision-making. We find that the intersection of racism and sexism limits Black college women’s sexual partner options and leads them to pursue sexual relationships outside the university setting. While most do not engage in committed romantic relationships with off-campus partners, they do engage in a range of strategies to protect their social, emotional and sexual well-being. The study findings expand the scholarship on hook-up culture by centring the narratives of a group often excluded from the literature.     

Public Health’s Falling Share of US Health Spending

We examined trends in US public health expenditures by analyzing historical and projected National Health Expenditure Accounts data. Per-capita public health spending (inflation-adjusted) rose from $39 in 1960 to $281 in 2008, and has fallen by 9.3% since then. Public health’s share of total health expenditures rose from 1.36% in 1960 to 3.18% in 2002, then fell to 2.65% in 2014; it is projected to fall to 2.40% in 2023. Public health spending has declined, potentially undermining prevention and weakening responses to health inequalities and new health threats.Despite widespread rhetorical endorsement of prevention, public health programs have received less attention and far less funding than personal medical services.1 The 2010 Affordable Care Act (Pub L No. 111–148) mandated insurance coverage of clinical preventive services such as colon cancer screening and contraception. In addition, it earmarked funding for a new Prevention and Public Health Fund, buoying hopes for an expansion of public health spending.In this brief report, we analyze trends in public health spending over the past 53 years, as well as projected trends in the coming decade.     

Men’s Mate Value Correlates with a Less Restricted Sociosexual Orientation: A Meta-Analysis

Men, relative to women, can benefit their total reproductive success by engaging in short-term pluralistic mating. Yet not all men enact such a mating strategy. It has previously been hypothesized that high mate value men should be most likely to adopt a short-term mating strategy, with this prediction being firmly grounded in some important mid-level evolutionary psychological theories. Yet evidence to support such a link has been mixed. This paper presents a comprehensive meta-analysis of 33 published and unpublished studies (N?=?5928) in which we find that that self-reported mate value accounts for roughly 6% of variance in men’s sociosexual orientation. The meta-analysis provides evidence that men’s self-perceived mate value positively predicts their tendency to engage in short-term mating, but that the total effect size is small.

     

A critique of the US Surgeon General’s conclusions regarding e-cigarette use among youth and young adults in the United States of America

Background

In December 2016, the Surgeon General published a report that concluded e-cigarette use among youth and young adults is becoming a major public health concern in the United States of America.

Methods

Re-analysis of key data sources on nicotine toxicity and prevalence of youth use of e-cigarettes cited in the Surgeon General report as the basis for its conclusions.

Results

Multiple years of nationally representative surveys indicate the majority of e-cigarette use among US youth is either infrequent or experimental, and negligible among never-smoking youth. The majority of the very small proportion of US youth who use e-cigarettes on a regular basis, consume nicotine-free products. The sharpest declines in US youth smoking rates have occurred as e-cigarettes have become increasingly available. Most of the evidence presented in the Surgeon General’s discussion of nicotine harm is not applicable to e-cigarette use, because it relies almost exclusively on exposure to nicotine in the cigarette smoke and not to nicotine present in e-cigarette aerosol emissions. Moreover, the referenced literature describes effects in adults, not youth, and in animal models that have little relevance to real-world e-cigarette use by youth. The Surgeon General’s report is an excellent reference document for the adverse outcomes due to nicotine in combination with several other toxicants present in tobacco smoke, but fails to address the risks of nicotine decoupled from tobacco smoke constituents. The report exaggerates the toxicity of propylene glycol (PG) and vegetable glycerin (VG) by focusing on experimental conditions that do not reflect use in the real-world and provides little discussion of emerging evidence that e-cigarettes may significantly reduce harm to smokers who have completely switched.

Conclusions

The U.S. Surgeon General’s claim that e-cigarette use among U.S. youth and young adults is an emerging public health concern does not appear to be supported by the best available evidence on the health risks of nicotine use and population survey data on prevalence of frequent e-cigarette use. Nonetheless, patterns of e-cigarettes use in youth must be constantly monitored for early detection of significant changes. The next US Surgeon General should consider the possibility that future generations of young Americans will be less likely to start smoking tobacco because of, not in spite of, the availability of e-cigarettes.

     

Relation between active mediation,exposure to Daniel Tiger’s Neighborhood,and US preschoolers’ social and emotional development

This study explored the relationship between active mediation, exposure to Daniel Tiger’s Neighborhood, and key indicators of preschoolers’ social and emotional development. One hundred and twenty-seven children aged 2–6 either watched or did not watch 10 episodes of Daniel Tiger’s Neighborhood over a two-week period. Results revealed that preschoolers who watched the program exhibited higher levels of empathy, self-efficacy, and emotion recognition when their regular TV-watching experiences are frequently accompanied by active mediation. This was especially true for younger preschoolers and preschoolers from low-income families. Implications for policy-makers, parents, producers of prosocial programming, and educators are discussed.     

“The Big WHY”: Philip Morris’s Failed Search for Corporate Social Value

Objectives. We examined Philip Morris USA’s exploration of corporate social responsibility practices and principles and its outcome.Methods. We analyzed archival internal tobacco industry documents, generated in 2000 to 2002, related to discussions of corporate social responsibility among a Corporate Responsibility Taskforce and senior management at Philip Morris.Results. In exploring corporate social responsibility, Philip Morris executives sought to identify the company’s social value—its positive contribution to society. Struggling to find an answer, they considered dramatically changing the way the company marketed its products, apologizing for past actions, and committing the company to providing benefits for future generations. These ideas were eventually abandoned. Despite an initial call to distinguish between social and economic value, Philip Morris ultimately equated social value with providing shareholder returns.Conclusions. When even tobacco executives struggle to define their company’s social value, it signals an opening to advocate for endgame scenarios that would encourage supply-side changes appropriate to the scale of the tobacco disease epidemic and consistent with authentic social value.Corporate legitimacy, the public’s general perception that a company’s actions are consistent with shared norms of appropriate behavior, enables corporations to maintain their operating licenses and status as publicly sanctioned institutions.1,2 When public approval is threatened, reduced, or withdrawn, however, a legitimacy crisis occurs: a corporation’s practices become something to be addressed and perhaps modified significantly in response.2 As delegitimation of the tobacco industry and denormalization of tobacco use reconfigure the social meaning of tobacco, the tobacco industry faces legitimacy crises beyond those experienced intermittently by most other corporate entities.2–7 In light of the deadly, addictive nature of its products and the tobacco industry’s now well-documented history of deceit, legitimacy crises may be particularly difficult for tobacco companies.7We examined executive deliberations at Philip Morris USA in 2000 to 2002 as the company’s leadership sought to restore legitimacy through a formal corporate social responsibility commitment. Struggling to reconcile responsibility principles with Philip Morris’s history and its products’ deadliness, these executives questioned the purpose and value of Philip Morris itself. Although previous studies have explored Philip Morris’s evolving interest in corporate social responsibility,8–12 none have examined the internal processes by which a tobacco company tries to explicitly address its raison d’être. The evolution of this process at executive levels of the largest US tobacco company suggests that tobacco companies face not only ongoing external public relations concerns, but also internalized legitimacy struggles that may create openings for policy innovation to address the tobacco epidemic more effectively on the supply side.     

Parental mediation of US youths’ exposure to televised relational aggression

Exposure to televised relational aggression can negatively influence youths’ well-being. Research shows that parent–child interactions about media – parental mediation – can alter children’s responses to media exposure. Therefore, this study explored the relation between US parents’ perceptions of relational aggression in the media, parental mediation, and the responses of their pre-adolescent and adolescent children to relational aggression exposure. Results revealed that parents’ attitudes toward and perceptions of the amount of relational aggression on television were associated with parental mediation efforts. Parental mediation was positively associated with relational aggression among girls. Findings suggest that parental mediation may be related to an increase in relational aggression among pre-teen and teenage girls.