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There was a great hubub back in 2003 after Pres. Bush announced the creation of BioWatch, part of the Federal response to the anthrax attacks of Oct. 2001 and the threat of bioterrorism. The objective of BioWatch is to deploy thousands of sensors across the country - mostly in cities - sensors that can pick up biological, chemical, or nuclear traces. Basically, the sensors are part of an early-warning system primed to detect pathogens like anthrax, smallpox, tularemia and influenza. They are assumedly agnostic as to the origin of a trigger - they can't detect intent or whether the release is from a bioterrorist or a Indonesian chicken that snuck over to Queens. (BioWatch is not to be confused with BioSense, a syndromic surveillance network that gathers intake information from hospitals, over-the-counter sales from pharmacies, lab tests, and other info into an ad-hoc information network. Nor to be confused with BioShield, the ambious effort to provide an end-of-market demand for the vaccines and pharmaceuticals that might be used to treat a biological attack.)

One of the big consequences of the germ theory and the move towards a more scientific medicine was the consequent move away from the way medicine had been practiced. That sounds obvious, but here's what I mean: Scientific medicine (which is pretty much how we're all treated now) was the systematic and systemic use of rigor and experiment in medicine, so that some universal facts could emerge and patients could be treated for widespread, rather than individual, conditions. Meaning disease could be treated broadly, for many people at once, rather than piecemeal, each person to their own symptoms. This was distilled into the aphorism: Treat the disease, not the patient. The old way of treatment was called - and I love this term - idiosyncrasy (note the wikipedia link!), and it held that every patient's illness was idiosyncratic, and thus must be treated distinctly. Needless to say, this was very inefficient. But with a greater understanding of the broader causes of disease (especially infectious disease, via pathogens) and a greater opportunity to see disease before it manifests as symptoms (via X-rays or microscope), scientific medicine let the medical industry treat people in far greater numbers, with far better results. Which brings us the age of medicine and public health we have today.

So I got slashdotted. First, welcome to all of you, and thanks for reading. I knew opining on Wikipedia would create some attention, but I didn't quite gauge the scale of things. Anyway, some quick reactions:

Wikipedia is, by all measures, one of the great accomplishments of the Internet Age. I'm willing to say it stands alongside Google, eBay, GoogleMaps, IMDB and Wired.com as among the greatest resources on the Web (ok, that last one is self-serving).

One of the most striking correlations in all of public health is the strong association between education and health status. The more education people have, the better health they seem to have. For a striking graphical look at the phenomenon, the CDC's MMWR this week has a great chart on self-reported health status and educational status. "Association does not mean causation" is a mantra of epidemiology, though - meaning that just because there's a link that doesn't mean more education causes improved health. It could be any number of confounders. Basically it's a chicken/egg thing: Are the better educated likely to have better health because they're in school - or are the more healthy simply more likely to get an education? For health economists, this is an endless source of chatter and speculation. They can look at all sorts of side effects: Are the better educated more likely to learn about sound health practices (ie, don't smoke)? Are the better educated more likely to earn more, and therefore be able to buy better health?

One of the challenges of tracking the future of healthcare is the signal-to-noise problem: seemingly every day there's a new report from a lab that claims to have isolated a gene X for condition Y. These reports (usually press releases from a university PR dept) carry the requisite "so what?" paragraph that goes something like: "It is expected that in the future, this work can be extrapolated into clinical tests for condition Y, helping physicians diagnose earlier and helping patients get treatment sooner." Keith Robison's Omics! Omics! blog has a much greater tolerance and acumen for this stuff than I'll ever have, so you won't see me try to keep pace with it all. But read them for months on end, and these "in the future..." paragraphs start to seem like a shellac layered on by said university PR department, in order to give their research a relevance that they really don't yet have. After all, these genes are being isolated in labs, in vitro, and are usually one-offs - a long way from replicable results.

A side-effect of vaccines has always been that, in some people, the treatment actually induces illness rather than immunity. After all, the idea behind vaccines, ever since Edward Jenner, is that exposure to a teeny bit of a pathogen is enough to kick in the body's antibodies and develop resistance, but not enough to actually foster disease. There's always been some imprecision in this, though, given that vaccines are deployed across huge populations - some number of which will always have lowered immunity or other risks that will mean even a small exposure is enough to germinate disease. That's all backstory to this week's MMWR report from the CDC, which includes a case of a woman who developed a strange infection after having sex with a Army soldier who'd recently had a smallpox vaccine. The genital infection wasn't herpes or any other common sexually transmitted disease. This was a second-hand infection, meaning she developed a disease even though she hadn't herself gotten vaccinated (thus making for a particularly tricky outbreak investigation).

The American Cancer Society recently announced it needed some volunteers for an upcoming prospective study on cancer. How many volunteers does it need? 500,000.

That's a big study. The idea is to find Americans between 30 and 65, with no cancer, and track them for the next 20 years through blood tests and questionnaires. This Reuters story says it matches some similarly sized trials in Europe and Asia. But it makes me wonder: What's the largest cohort ever assembled for a forward looking study? (It's easier to do retrospective studies with big numbers because there's no tracking to do; it's all done through records). Here's a prospective study in India that claims 14 million participants, but it looks like it's all done through vital statistics records. In the UK, Biobank and the EPIC study both claim half a million participants and make claims of "most participants" status.

Lots of excitement this week on GINA, the Genetic Information Non-discrimination Act. On the whole, I think this is a good step, and a good thing to get out ahead of what I believe will be a wholesale shift in our approach to health. But I don't want to repeat what's been said elsewhere, so I'll link to the good and thorough GINA Primer over at The Genetic Geneologist.

I've put off linking to Whoissick.org because it got pickup on Boingboing and elsewhere. But I thought again after I realized that no one I'd read had applied a little Epidemiology 101 to the site. So it's a cool idea: using a Google Maps mashup, let the hoi polloi post when they're feeling ill, checking off a few symptoms and other info, and plot it by location. Get enough contributors, and you have an interesting surveillance map of possible infectious outbreaks. Add a little more Web 2.0 magic - tagging, analytics - and you've got perfect blog fodder. The idea is basically a self-reported version of what's called 'syndromic surveillance,' which is basically the effort to systematically track disease outbreaks on a geospatial level, by pulling from a host of data inputs - hospital admissions, drug store purchases, school illnesses, and so forth. It's been used for infectious disease for years, but it's gotten attention more recently because of it's utility in possible terrorist or bioterrorist events. That, plus the fear of avian flu, make it quite a trendy concept.