Timeline/Stages for Collapse of our Way of Life

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Recent victory against NDAA is an unending struggle...

AMY GOODMAN: Bruce Afran, talk about the significance of the extent to which she struck down this statute.

BRUCE AFRAN: Well, it’s quite incredible, in a sense, because it’s rare that statutes are struck down completely. Judge Forrest struck down the entire provision of the NDAA governing indefinite detention of civilians and U.S. citizens. She said this provision is overbroad. She said it clearly embraces speech, even if it doesn’t intend to. And she criticized the government severely, because it refused to acknowledge in court that First Amendment activities would not bring someone into a state of indefinite detention. And five times, Judge Forrest asked the U.S. attorney, "Will you agree that First Amendment activities will not bring someone under the scope of this law?" And the government five times said, "We can’t answer that question."

...

AMY GOODMAN: Now, President Obama signed it, but he was opposed by key members of his administration—for example, Defense Secretary Leon Panetta—

CHRIS HEDGES: Right.

AMY GOODMAN: —FBI Director Robert Mueller, Director of National Intelligence James Clapper.

CHRIS HEDGES: That’s what’s so interesting. None of the Pentagon, the FBI, as you—Mueller and everyone else, as you pointed out—none of them supported the bill, even to the extent where Mueller and others were testifying before Congress that it would make their work more difficult. And yet it passes anyway. And it is a kind of—I think it’s a kind of mystery to the rest of us as to what are the forces that—when you have the security establishment publicly opposing it, what are the forces that are putting it in place? And I can only suppose that what they’re doing is setting up a kind of legal mechanism to criminalize any kind of dissent. And Bruce can speak to this a little more. But in the course of the trial, with Alexa O’Brien, US Day of Rage, that WikiLeaks dump of five million emails of the public security firm Stratfor, we saw in those email correspondence an attempt to link US Day of Rage with al-Qaeda. Once they link you with a terrorist group, then these draconian forms of control can be used against legitimate forms of protest, and particularly the Occupy movement.

...

- Link

Chris Hedges' intellectual gift has been marvelously applied to providing us an insightful and comprehensive overview of our current socio/economic environment. Listen to this interview.

"The elite within the Corporate State understand, far better perhaps than we do, the political turmoil and dislocation that we are about to enter with the collapse of globalization and the reconfiguration of not only American society but the global society into a form of neofeudalism with a rapacious, tiny, totally empowered oligarchic elite ruling over a vast underclass.... and they [the elite] have put into place the security and surveillance state to essentially permit these corporate forces to continue to disembowel the nation.

... They anticipate turmoil and unrest. The kind of lifestyle, the kind of consumption that we have carried out is just not sustainable and they now it. So how far will they go [with authoritarianism]? There are two ways that they do it. They control us through fear. As Randolph Bourne said, "War is the health of the State." This era of perpetual war justifies the kind of intrusiveness from the State that we have seen recently...

Harbingers of what's to come...

The purpose of bread and circuses is... to distract, to divert emotional energy towards the absurd and the trivial and the spectacle while you are ruthlessly stripped of power.

I used to wonder, is Huxley right or is Orwell right? It turns out they’re both right. First you get the new world state and endless diversions and hedonism and the cult of the self as you are disempowered. And then, as we are watching, credit dries up, the cheap manufactured goods of the consumer society are no longer cheap. Then you get the iron fist of Oceania, of Orwell’s 1984. That’s precisely the process that’s happened. We have been very effectively pacified by the pernicious ideology of a consumer society, which is centered around the cult of the self, kind of undiluted hedonism and narcissism. That became a very effective way to divert our attention while the country was reconfigured into a kind of neofeudalism, with a rapacious oligarchic elite and an anemic government that no longer was able to intercede on behalf of citizens but now cravenly serves the interests of the oligarchy itself.

...

Imperial power is a disease, because the techniques of imperial power, which is all about not only control through force but the looting of natural resources, not about democracy, the techniques that imperium uses abroad it soon uses at home. That’s what Thucydides wrote, that the tyranny that ancient Athens or the Athenian empire imposed on others, it finally imposed on itself. That's what destroyed Athenian democracy; it was destroyed from within. That’s precisely what’s happening. What is Homeland Security? It’s the most intrusive government institution in the history of America. And yet we accept it. We accept it because we’re made afraid of terrorism.

...

So I think we’d better grow up. You strive towards a dream. You live within an illusion. We are the most illusioned society on the planet. We have to become adults. And it’s hard, it’s painful. I struggle with despair all the time. But I’m not going to let it win. I don’t have any false illusion that I’m going to build some great populist movement or be part of some great populist movement that’s going to overthrow the corporate state and impose light and goodness. Yet, I think it is incumbent upon all of us that at the same time we recognize how dark the future is, we also recognize the absolute imperative of resistance in every form possible.

--- Chris Hedges in interview "Empire abroad, tyranny at home"

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Oblivious to Oblivion...

            

It's been a while since I posted something from DOTE.

The environment will continue to go down the tube because the economy is all that matters. And what is the economy?... CAPITALISM. Capital and the accumulation of it are all that we strive for. This means anything and everything will be commercialized, commodified, and harvested until the fields are barren, the forests are denuded, and the oceans trawled empty. Our ethos is based on this never-ending exploitation, not the health of the environment. We don't appreciate and respect the fact that the very foundation of life is based on having a healthy ecosystem, rather we base it on the growth of profit and a healthy balance sheet. $$$ is our God and from it all else springs.

A while back I made the comparison that species extinction and mankind's indifference to the 6th Mass Extinction was analogous to the residents of a 100 story building randomly removing the bricks from the 1st floor without knowing what effect each removed brick may have on the stability and integrity of the entire structure. Here is a new study which answers some questions in regards to that analogy:

05/18/2012

Extinction As A Driver Of Ecosystem Change

The journal Nature recently published a paper with the unwieldy title A Global Synthesis Reveals Biodiversity Loss As A Driver Of Ecosystem Change (pdf). Here's the story

Loss of biodiversity appears to impact ecosystems as much as climate change, pollution and other major forms of environmental stress, according to a new study from an international research team...

“Loss of biological diversity due to species extinctions is going to have major impacts on our planet, and we better prepare ourselves to deal with them,” says University of Michigan ecologist Bradley Cardinale, one of the authors. The study was published online May 2 in the journal Nature.

Prepare ourselves? I'll have more to say about this at the end.

“These extinctions may well rank as one of the top five drivers of global change,” says Cardinale, assistant professor of natural resources at the [University of Michigan] School of Natural Resoures and Environment, and assistant professor of ecology and evolutionary biology, LSA.

Studies over the last two decades have demonstrated that more biologically diverse ecosystems are more productive. As a result, there has been growing concern that the very high rates of modern extinctions — due to habitat loss, overharvesting and other human-caused environmental changes — could reduce nature’s ability to provide goods and services like food, clean water and a stable climate.

But until now, it’s been unclear how biodiversity losses stack up against other human-caused environmental changes that affect ecosystem health and productivity.

“Some people have assumed that biodiversity effects are relatively minor compared to other environmental stressors,” says biologist David Hooper of Western Washington University, the lead author of the Nature paper. “Our new results show that future loss of species has the potential to reduce plant production just as much as global warming and pollution.”

And the abstract.

Evidence is mounting that extinctions are altering key processes important to the productivity and sustainability of Earth’s ecosystems. Further species loss will accelerate change in ecosystem processes, but it is unclear how these effects compare to the direct effects of other forms of environmental change that are both driving diversity loss and altering ecosystem function. Here we use a suite of meta-analyses of published data to show that the effects of species loss on productivity and decomposition—two processes important in all ecosystems—are of comparable magnitude to the effects of many other global environmental changes.

In experiments, intermediate levels of species loss (21–40%) reduced plant production by 5–10%, comparable to previously documented effects of ultraviolet radiation and climate warming.

[My note: Ozone depletion causes increased levels of ultraviolet radiation. Below, nutrient pollution (eutrophication) comes from excessive nutrients in the environment e.g. nitrogen-driven algal blooms in the oceans.]

Higher levels of extinction (41–60%) had effects rivalling those of ozone, acidification, elevated CO2 and nutrient pollution. At intermediate levels, species loss generally had equal or greater effects on decomposition than did elevated CO2 and nitrogen addition.

The identity of species lost also had a large effect on changes in productivity and decomposition, generating a wide range of plausible outcomes for extinction. Despite the need for more studies on interactive effects of diversity loss and environmental changes, our analyses clearly show that the ecosystem consequences of local species loss are as quantitatively significant as the direct effects of several global change stressors that have mobilized major international concern and remediation efforts.

Extinction_productivity
Figure 1 — "Changes in primary production as a function of per cent local species loss. Effects of species loss on primary production from 62 studies (379 observations). Thick red line, lower productivity as species richness decreases; grey bands and black error bars, 95% confidence intervals. The thin red line shows the inverse of the thick red line to allow comparison of effect magnitudes with environmental changes with positive effects." Note that the effects on productivity of some ecosystem changes are actually positive (light blue text).

It comes as no surprise that extinctions will directly affect productivity (e.g. photosynthesis in plants) and decomposition (rot, decay) in ecosystems, which also directly affects the Earth's carbon cycle. Everybody knows that ecosystems must be regarded holistically, and when they become impoverished relative to their "original" state, they are not nearly as robust as they were formerly. This text from the study provides some necessary context.

A variety of global changes are driving rates of species extinction that greatly outpace background rates in the fossil record10,11. If these trends continue, projections suggest that within 240 years Earth may face the sixth mass extinction. Such projections have prompted hundreds of experiments examining how different components of biodiversity affect ecosystem processes that sustain the provisioning of goods and services to society.

[My note: Saying we will enter the 6th mass extinction 240 years from now seems a tad optimistic, but I don't want to get into that today.]

Syntheses of these experiments have made it clear that plant biodiversity loss will reduce plant production and alter decomposition. However, it is uncertain how the sizes of these effects compare with the direct effects of other types of environmental change, such as changing atmospheric composition, climate warming and nutrient pollution, that also threaten ecosystem functioning. This uncertainty has generated wide-ranging speculation about how strongly biodiversity loss might affect humanity.

Perhaps it would be better to ask the plants & animals about their uncertainty regarding how human activities are affecting them instead of trying to resolve the wide-ranging opinions humans hold about just how badly it will affect them if they continue fucking up the Earth's natural systems. Unfortunately, the plants & animals are merely victims here and have no strong opinion on the matter Smiley_glasses 

Thus the main result of this paper has been to reduce uncertainty regarding the effects of biodiversity loss on ecosystems. The effects rival those of ozone depletion and anthropogenic climate change.

What can we say about this less than felicitous finding? This revealing text is from the University of Michigan press release quoted above.

“Within the range of expected species losses, we saw average declines in plant growth that were as large as changes seen in experiments simulating several other major environmental changes caused by humans,” Hooper says. “I think several of us working on this study were surprised by the comparative strength of those effects.”

The strength of the observed biodiversity effects suggests that policymakers searching for solutions to other pressing environmental problems should be aware of potential adverse effects on biodiversity, as well, the researchers say.

I love shit like this. Why is it important that policymakers be thus aware? Should policymakers be aware of the potential adverse effects on ecosystems brought about by species extinctions because they will be willing and able to do something about the problem if they know about it? Is that the point here?

Suppose this study didn't exist and nobody carries out a similar study in the future. It's not as if policymakers will wake up in 50 years, notice that species extinctions are having adverse effects on productivity and decomposition, and then ask why didn't somebody tell us about this? We might have done something about it if we had known!

So it doesn't matter whether policymakers know about this extinction disaster or don't know about it. This study, like every other similar study in this and other research areas, will be ignored by policymakers. Yes, it will be cited by researchers doing future studies along these lines, which will also be ignored by policymakers.

This science is serious stuff, and that's why I'm reporting it, but I'm sorry—when people start talking about making policymakers aware of the problem in the expectation that something will actually be done about it, I can't take that seriously at all.

Have a nice weekend.

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Future Shock

      

American Empire and the Future

5-18-2012

...

The real issue facing the so-called “advanced” nations and now China, India and the Asian tigers is that cheap oil is running out. Extracting oil will become ever more difficult and expensive and at some future point will be so costly that it will cause essentially a collapse of globalism with real depression here in the US. The fact that oil commerce is denominated in dollars while the value of the dollar steadily declines also presages a future in which the dollar may be toppled as the world currency, thus leading to widespread inflation and certain critical shortages of basics.

Widespread suffering will be endemic, unless an alternative source of energy is found able to sustain our way of life. But that is extremely unlikely. Coal and natural gas can compensate to some degree but since our luxurious and wasteful way of life is based on oil and since we see our many profligate luxuries as necessities, the industries that support them will fail, and that will lead to mass unemployment, cold winters indoors and the absence of air-conditioning in summer, not to mention starvation in what we like to think of as the “backward” nations, and hunger here since our supermarket cornucopia requires hydrocarbon for fertilizers and pesticides. Miracle cures like bio-fuels and hydrogen are wishful thinking. Nuclear power could maintain the electrical grid but the recent meltdown in Japan may make that hope insurmountable despite Obama’s continuing support for a nuclear renaissance. Green technologies are unlikely to fill the void on time to avert the falling economic and political dominoes, if ever.

The US government’s real energy policy up to now has been to support energy corporations to exploit oil as usual and gain control over such reservoirs still existing. Congress is the creature of oil and other hydrocarbon corporations and their financiers…largely to protect their profit margins, and there is no plan for the day when the Age of Oil ends with a crash. Again natural gas and coal can maintain some of the richer nations at a much lower standard of living but this will result in widespread social upheaval leading to more international tension…not to mention an intensification of global warming.

American foreign policy is premised today on garnering as much control over shrinking energy resources as possible…and to protect this access strategically. The various military commands are deployed primarily for this reason. Note that a new military command with responsibility for Africa has been created. The opportunity to create new military bases for AFRICOM is one of the prime reasons the U.S. is now in Libya. Note the recent incursion of American “advisors’ into Uganda and Sudan. Nigeria now provides a third of American needs, and Angola and other smaller nations have reservoirs that are targets for U.S. control. Obviously our attempt to gain control of the lion’s share of Middle East oil and especially of oil and natural gas in the Caspian and Central Asian regions will bring us into serious conflict with those nations that see these as their back yard – namely China and Russia and India and Pakistan. Imagine our response if China were to inject 150,000 troops into Mexico, the number two supplier of our domestic needs, or Venezuela, with the clear intention of siphoning these reserves to themselves?

<break>

Mexico crude production peaked in 2004 at 3.7 million barrels a day, and is now down to 2.5 million, and falling fast. Their super giant Cantarell has been declining by 30 percent per annum. Mexico used to be our second largest supplier, but is now no.5, supplying only 8 percent of imports. Mexico will soon be a net oil importer bidding against us for declining net exports.

continued...

Al Qaeda does not constitute an “existential threat” to the US and most real terrorist threats can be dealt with by police methods as the last decade has shown. It is well known in Washington but not among the public that the Taliban told al Qaeda not to attack the US from Afghanistan before 9-11. The fact that al Qaeda did so created a break between the two groups. The Afghan Taliban itself cannot threaten the US, and has never declared any intention to do so. But when Americans kill Muslims in Muslim lands we do far more to create terrorists than anything al Qaeda could do on its own. Meanwhile, attacks on Pakistan have promoted a separate Pakistani Taliban, and that faction has vowed to wreak vengeance on America, though its capacity to do so remains limited. The Pakistani Taliban, coupled with American air assaults, could destabilize Pakistan, and perhaps foster a takeover by Islamic fundamentalist junior officers. Recall that Pakistan possesses nuclear weapons.

Meanwhile, the public is frightened and off balance and paying through the nose for endless deployments. None of this four trillion dollar war (as Nobel economist Joseph Stiglitz, and Harvard professor Linda Bilmes now estimate) has been paid. Our children, and grandchildren, if they are lucky to have a future worthy of the name, will spend their working lives paying off these debts at jobs that won’t reflect degrees in higher education. Meanwhile, the various elements of the secret team are currently reaping the benefits of deficit spending and the national debt and they feel sure that eventually the real price will be paid by those who sacrifice their lives and by taxpayers forced ever more into bankruptcy, foreclosure and unemployment.

The current wars will fail to achieve their goals. Premised as they are on lies they are in fact crimes against the peoples of the region, crimes intended to take advantage of their weaknesses and reward American energy and financial corporations and secondarily we citizens of the empire who insist on maintaining a failing way of life. It is the same ancient game of beggar our neighbors to advantage ourselves. In neither Iraq nor Afghanistan will the US achieve control of shrinking energy reserves for essentially the same reason it could not control Vietnam, the very war waged upon their peoples ostensibly to “liberate” them recruits more opponents. Moreover, the attempt to do so will result ever more tensions with the Muslim world and the other nations that need energy too.

In other words, the global climate is heating up in more ways than one. The conditions for another global war are present, and let us not ignore the fact that the last one was waged with toys compared to the present.

President Obama has said that he wants to see a “nuclear free Middle East. That would require the nuclear disarmament of Israel. Yet Obama goes along with the pretense of all his predecessors and refuses to acknowledge that Israel has these Weapons of Mass Destruction. If, indeed Iran is building nuclear weapons why wouldn’t it given the fear of Israel’s, or of America’s in the Persian Gulf, of Russia’s to the north, of Pakistan’s to the east? A world in which some nations declare their entitlement to such horrific weapons is a world in which many others tremble and come to reason that their only protection lies in possessing such themselves. As international tensions rise over shrinking resources, and the ravages of climate change, the more likely a hair trigger mentality will arise. Hiroshima was the handwriting on the wall. As these demonic weapons increase sooner or later they will be used.

That is, unless the American people force our policies toward sanity, and come to focus on what our rhetoric has claimed we stand for all along.

Congressman Barney Frank has stated that the current economic crisis could be resolved by simply reducing the size and mission of the military. To be sure, the U.S. could defend itself against any existential threat with a tenth of our current military budget,. But the real threats perceived by elites are to their control of resources and markets. Such a redirection of resources could ameliorate economic crisis significantly but only for a time. The issue still remains the energy future, especially depletion and the effects of discharging hydrocarbon effluents into the atmosphere in the first place, and the growing likelihood of spreading violence. By all measures the American government and the public appear intent to hang on to our way of life no matter the consequences. That way of life is inherently profligate and unsustainable. We have altered the climate to the extent that ravaging events like the recent floods in Pakistan, vast forest fires in Russia, Hurricane Katrina, water shortages, and desertification are mere warnings. The worse all such conditions become the more social and political instability with severe danger of armed violence.

Our policies in the future must center on a crash program of conservation of energy, even if this means draconian limits imposed by law such as smaller more fuel efficient vehicles, and heating devices, and restrictions on air-conditioning and banning plastic containers etc. Both the nuclear power and coal industries are ramping up pressure since they know that natural gas, which at present provides most electricity, is also depleting and we need to educate people to be aware of what will happen without secure electricity. Simultaneously we need a Manhattan Project “cubed” and focused on alternative energy. Above all the crying need is for international cooperation in conservation, for cooperation into research into alternative energy sources, and mutual disarmament treaties and agreements to avoid conflict over shrinking resources. The alternative is the worsening probability of a third global war. Yet at present we have only Plan A: Armed intervention.

Alternatives can occur ONLY if the public awakens to the coming storm. We cannot depend on the corporate media to educate us; they are allied with their major clients, not the public, and they are deliberately withholding bad news for fear of stampeding the stock markets into panic. We must get the word out ourselves and make it clear that we will not accept or cooperate with business as usual from Congress or the presidency. That will have to mean more militancy throughout this nation than seen since the 1960s, or really even the 1930s. Unfortunately I fear this will require even deeper crisis before we begin to awaken to the danger ahead.

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Disease Tracking Systems

Mike, from the article in post #1677,  Drones, missiles and gunships 4th paragraph...3 words:

disease tracking systems

Drones, missiles and gunships

5-16-2012 First published at TheNation.org

 

Criminals are not the only ones whose rights can be taken by force of justice...a mentally ill or a contagious person may also have rights taken by force...in the name of healing and health...

 

more on this in the basement...see: http://www.peakprosperity.com/forum/brainwashing-manual/43602


Oh, I found this assessment on disease tracking systems (I include all summary headings for context...please consider the excerpts in the scope of the full assessment summary available to the public...

link http://www.ncbi.nlm.nih.gov/books/NBK52862/ Bookshelf ID: NBK52862)...

note: bold emphasis added to excerpts:

 

Summary and Assessment

GLOBAL INFECTIOUS DISEASE SURVEILLANCE AND DETECTION: ASSESSING THE

CHALLENGES—FINDING SOLUTIONS

...

Surveillance, defined as “the continual scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control” (IOM, 2003; Last, 1995; WHO, 2000), involves the “systematic collection, analysis, interpretation, and dissemination of health data” (WHO, 2000). Disease detection and diagnosis is the act of discovering a novel, emerging, or reemerging disease or disease event and identifying its cause. Diagnosis is “the cornerstone of effective disease control and prevention efforts, including surveillance” (IOM, 2003).

...

Organization of Workshop Summary

This workshop summary was prepared for the Forum membership in the name of the rapporteurs and includes a collection of individually authored papers and commentary.1 Sections of the workshop summary not specifically attributed to an individual reflect the views of the rapporteurs and not those of the Forum on Microbial Threats, its sponsors, or the IOM. The contents of the unattributed sections are based on the presentations and discussions at the workshop.

The workshop summary is organized into chapters as a topic-by-topic description of the presentations and discussions that took place at the workshop. Its purpose is to present lessons from relevant experience, to delineate a range of pivotal issues and their respective problems, and to offer potential responses as described by workshop participants.

Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and presents their beliefs about which areas may merit further attention. The reader should be aware, however, that the material presented here expresses the views and opinions of the individuals participating in the workshop and not the deliberations and conclusions of a formally constituted IOM study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation.

Surveillance Strategies

The practice of infectious disease surveillance is no longer restricted to its original role in recognizing outbreaks of feared human diseases. Workshop presentations reflected diverse goals, approaches, and methodologies for disease surveillance in humans, animals, and plants. To place these presentations and ensuing discussions in context, we begin by briefly describing the multiple purposes served by public health surveillance, as well as current disease surveillance practices in animals and plants.

Surveillance Purposes and Practices

Public Health Surveillance

In the United States, public health surveillance for infectious disease is conducted through a variety of state and federal programs (GAO, 2004). Health-care providers and others report cases of “notifiable” infectious disease (as defined by local and state health codes) to health departments; health department officials verify disease reports, monitor disease incidence, identify possible outbreaks, and forward their findings to the Centers for Disease Control and Prevention (CDC). CDC and other federal agencies, including the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), and the Department of Defense (DoD), independently gather and analyze information for disease surveillance. In addition, these agencies fund domestic and international networks of disease surveillance laboratories that develop diagnostic tests and conduct disease diagnostic research. Although the CDC has provided guidelines for surveillance systems funded by the federal government, evaluation is generally lacking. Furthermore, as noted by Forum member Edward McSweegan, little evidence has been provided on the cost-effectiveness of massive federal public health surveillance investments (see also Eban, 2007).

Early Warning

Situational Awareness

Animals

Plants

Public Health Surveillance: A Local Perspective

Syndromic Surveillance

Keynote speaker Patrick Kelley, director of the Institute of Medicine’s Board on Global Health, and presenter Michael Stoto, of the Georgetown University’s School of Nursing and Health Studies, reviewed the theoretical underpinnings and historical development of syndromic surveillance (see Kelley, Stoto in Chapter 1). When people first develop symptoms, following an exposure or first contact with a novel or rapidly emerging infectious disease, they may be much more likely to attempt to treat themselves and stay home from work or school rather than seeking care from a health-care provider to obtain a clinical or laboratory diagnosis (Stoto, 2005). Syndromic surveillance systems monitor existing descriptive data of these behaviors (e.g., school and work absenteeism, sales of over-the-counter medications, illness-related 911 calls, emergency room admissions for symptoms indicative of infectious disease) for patterns or clusters of behaviors suggestive of an illness outbreak. The concept of syndromic surveillance is doubly attractive because in addition to its potential to increase the speed and effectiveness of the public health response to natural or deliberate disease outbreaks, it costs far less to implement than traditional, labor-intensive approaches to disease surveillance (Stoto, 2005). However, the ability of syndromic surveillance to reduce disease-related morbidity and mortality remains to be demonstrated, as does its cost-effectiveness (Bravata et al., 2004; Reingold, 2003; RAND Corporation, 2004; Stoto, 2005; Sosin, 2003). Although rigorous evaluations of syndromic surveillance in general may be impossible, individual systems can be assessed under a variety of circumstances (Reingold, 2003). Moreover, because syndromic surveillance systems are warning devices, it will be critical to determine their utility within the context of health systems that respond to both “true” and “false” alarms (Pavlin, 2003; RAND Corporation, 2004).

Global Syndromic Surveillance

In parts of the world where clinicians are in short supply, syndromic surveillance offers a promising model for disease detection, Kelley observed (see Chapter 1). Infectious disease is a major cause of morbidity and mortality in low-resource populations, and such environments frequently provide amplifying conditions for emerging pathogens. Recognition of this threat has spurred the World Health Organization (WHO) to revise the International Health Regulations (IHRs)—the legal framework for international cooperation on infectious disease surveillance. Once limited to a trio of internationally notifiable diseases (plague, cholera, and yellow fever), as of June 15, 2007, the revised IHRs became the “world’s first legally binding agreement in the fight against public health emergencies of international concern” (WHO, 2007). Reporting of new and reemerging diseases with epidemic or pandemic potential, as well as diseases associated with acute chemical or radionuclear events, will be mandatory regardless of their origin or source (WHO, 2007).

“The mandate for general global public health surveillance is moving beyond named diseases to encompass a global responsibility to detect and report in a timely manner internationally important disease events, whether they are individual cases or clusters, whether they are well-defined diseases or ill-defined diseases,” Kelley explained. Syndrome detection is central to this new paradigm, and should be viewed as one of a collection of approaches to global surveillance for infectious diseases, he said. However, he also noted considerable challenges in moving syndromic surveillance from theory to practice.

Syndromic Surveillance by Design

From Syndromic Surveillance to “Situational Awareness”

...This point is illustrated by a recent model of outbreak detection for inhalational anthrax by Buckeridge and colleagues (2006), who concluded that “when syndromic surveillance was sufficiently sensitive to detect a substantial proportion of outbreaks before clinical case finding, it generated frequent false alarms” (Buckeridge et al., 2006).

...

Case-Finding by Syndrome

Instead of bypassing health-care providers, Stoto said that syndromic surveillance technology could be used to “arm astute physicians and health departments with modern approaches to finding small numbers of cases” and allow health professionals to identify them before they are formally diagnosed.

...

Situational Awareness

Real-Time and Batched Reporting

Animal Disease Surveillance

Ebola Virus Surveillance in Central Africa

Global Surveillance for Avian Influenza

Plant Disease Surveillance and Detection

National Plant Diagnostic Network

National Center for Plant Biosecurity

Surveillance Networks

ProMED-Mail

Global Outbreak Alert and Response Network

The Global Public Health Intelligence Network (GPHIN)

HealthMap

The Voxiva Model for Resource-Constrained Environments

Considerations for Surveillance Networks

Detection and Diagnostics

The Diagnostic Landscape

Developing Countries

On the Battlefield

Animal Diseases

The Road Ahead: Diagnostics in Development

Inspired in part by the image of the original Star Trek’s character “Bones”® diagnosing a patient with a wave of his medical tricorder (Figure SA-7), Wolcott and fellow DoD researchers are attempting to construct an “integrated diagnostic system” for field use that can detect viruses, bacteria, toxins, “and anything else that could possibly be thrown at us in the biological detection arena,” he said. The current prototype relies on automated real-time PCR, but DoD researchers are testing a wide range of diagnostic technologies (e.g., microarrays, handheld immunoassays, electrochemiluminescence) and targets (e.g., microbial toxins, as well as nucleic acids), according to Wolcott. “We have to have multiple platforms to give us the assurance that what we are reporting up the chain of command is actually there,” he said. The ultimate goal is to combine multiple platforms into a single, universal system for field diagnosis. While the time constraints and primitive conditions of battle present significant barriers to the use of microarrays, Wolcott speculated that chip technology eventually would be adapted to provide point-of-care diagnosis for soldiers in action.

...

The Far Horizon: Presymptomatic Diagnosis

In addition to offering the best chance of treatment for known, emerging, or bioengineered pathogens, detecting infectious disease at the earliest possible moment would permit diagnosis-based triage and increase the effectiveness of quarantine or other social distancing measures, Johnston predicted. He anticipated that presymptomatic diagnosis will have an even greater impact on everyday medical care. “We have a healthcare system that can’t be sustained in terms of physical economy,” he said, adding that care for ill patients accounts for nearly 90 percent of health-care spending. “Why does it cost so much? Because we are diagnosing sick people, taking care of sick people; we even develop our drugs for sick people.” Therefore, he insisted, our society has no choice but to move from postsymptomatic to presymptomatic diagnosis.

Considerations for Detection and Diagnosis

The Challenge of Coordination 

Shifting the Public Health Paradigm

Optimal Surveillance for Risk Management

Needs and Opportunities

Critical Issues in Infectious Disease Surveillance and Detection

System Design and Development

System Evaluation

Integration of Information

Information Transparency, Control, and Access

Reporting

Recognizing that the reporting of unusual findings by health practitioners (and subsequently by governments) is essential to infectious disease surveillance and detection, workshop participants considered a range of incentives to promote the affirmative reporting of human, animal, and plant health status at all levels, including the following:

  • Develop and broadly implement standards for infectious disease reporting and sample submission to public health laboratories.

  • Pay clinicians, especially those in developing countries, to report findings to national public health authorities.

  • Ensure the confidentiality of health practitioners who report infectious disease, while recognizing their contribution to public health. In the case of agricultural diseases, provide financial support for farmers who report disease and guard intellectual property rights of seed companies who assist in identifying vulnerable germplasm.

    ...

    From Alarm to Action

    REFERENCES

    Footnotes

    Copyright © 2007, National Academy of Sciences

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