In January, 1986, 73 seconds after lift-off, the
space shuttle Challenger exploded,
killing all 7 astronauts on board, including one of the first civilians to go
up, New Hampshire teacher Christa McAuliffe. It was a disaster; indeed the
words are now paired so that we always say “Challenger
disaster”. The cause was a flaw in the design of the solid rocket boosters
(“SRB”s) and in the now famous “O-rings”, flexible rubber seals, like max
versions of the ones we see on a lot of home tools. It was perhaps the worst
domestic disaster of its time, nine years before the 1995 domestic-terrorist
white-power bombing in Oklahoma City, almost 16 years before the attack on
9/11. It was a disaster in two ways; the obvious one, the explosion, and in
that it could have been prevented; NASA and the company that produced the SRBs,
Morton Thiokol, knew about the problem.
Morton Thiokol engineers, and particularly one named Roger Boisjoly, had
been worried about the problem for years; Boisjoly had expressed his particular
concerns in 1985. Morton Thiokol managers considered telling NASA to scrap the
launch, and then decided not to. After the disaster, Boisjoly testified before
a commission about the problem, and about the warnings that he had sent to his
bosses. In 1988 he was awarded the Award for Scientific Freedom and
Responsibility by the American Association for the Advancement of Science. He
was shunned and at Morton Thiokol, and resigned. He was right; Morton Thiokol
and NASA were wrong, and it led to a disaster. And he was out of a job.
In 2014, Michigan Governor Rick Snyder appointed an
emergency manager named Darnell
Earley, for the bankrupt city of Flint. One of his cost-cutting measures
was to stop buying treated Lake Huron water from the Detroit system and instead
supply water from the Flint River. The river was full of corrosives, from
decades of industrial discharge, and one effect was to degrade the old lead
pipes in many Flint homes, dramatically increasing the lead levels in the
water. And in the bodies of Flint’s children. The politics of the decision are
continuing to play out, with calls for Snyder’s resignation, and it would have
been corrupt and evil even if the problem had been identified and remedied earlier.
It wasn’t, and thus became a disaster. Good
piece on it in Rolling Stone.
Again, we have a hero, a Flint pediatrician named Mona Hanna-Attisha.
Dr. Hanna-Attisha had heard that a team from Virginia Tech had found high lead
levels in Flint’s water, and noted that she was seeing a rise in the number of
children with high lead levels. She led a team doing “the easiest research
project I have ever done”; because Medicaid requires children to be tested for
lead at 1 and 2 years of age, she was able to compare the prevalence of high
levels from 2013 to 2015. The percentage
of children with elevated lead levels “doubled
in the whole city, and in some neighborhoods, it tripled. And it directly
correlated with where the water lead levels were the highest” she noted in
an interview
on “Democracy Now”. She announced it at a press conference, and was
immediately attacked by the powers-that-be (I call them the “PTB”); in this
case both the political leaders of the state and the state health department.
Well,
that evening, we were attacked. So I was called an "unfortunate
researcher," that I was causing near hysteria, that I was splicing and
dicing numbers, and that the state data was not consistent with my data. And as
a scientist, as a researcher, as a professional, you double-check and you
triple-check, and the numbers didn’t lie. And we knew that. But when the state,
with a team of like 50 epidemiologists, tells you you’re wrong, you
second-guess yourself. But that lasted just a short period, and we regrouped
and told them why, "No, you were wrong." And after about a week and a
half or two weeks, after some good conversations, they relooked at their
numbers and finally said that the state’s findings were consistent with my
findings.
There is a long and distinguished tradition of doctors
making breakthrough discoveries that helped cure or prevent disease in
thousands or millions of people. Some of the most storied are Edward Jenner, the 18th
century physician who invented the vaccine to prevent smallpox, 19th
century physicians John
Snow, who discovered that the contaminated water from a particular pump in
London was the cause of a cholera outbreak, Ignaz Semmelweis, who
showed that doctors washing their hands could prevent deaths in post-partum
women, Rudolf Virchow,
the “father of social medicine”, who showed an outbreak of typhus among miners was
the result of the social conditions they lived in, Louis Pasteur, Robert Koch, and Joseph
Lister who proved that germs caused those diseases, and 20th
century doctor Jonas Salk, who found the vaccine against polio. Does Mona
Hanna-Attisha’s work rise to this standard?
Well, it may not in terms of the total lives saved, although
it is worth noting that, like the work noted above, it is about public health,
about populations, not individual interventions, and thus has a great impact on
so many (despite the fact that in the US at least 95% of all “health spending”
is on individual medical care, not public health). But she is heroic in that
she stood for the truth and for the health of the children in defiance of the powerful
who were trying to minimize or cover up the problem, and who tried for a while
the “best defense is a good offense” strategy of attacking her, shamefully. Indeed,
this is what it takes to be a hero, to not only do something important that has
an impact on many, but even more to do it when you have to stand against the
establishment, the PTB, the powers-that-be. This takes a great deal of courage,
as well as commitment.
In Kansas, the legislature legalized concealed-carry of guns
a couple of years ago, but exempted schools and hospitals until July 2017. As
that date approaches in 18 months, there is little indication that the
exemption will be extended, and there is great concern. A recent survey found
that 70%
of faculty and staff at the 6 state Regents universities oppose the law. Faculty
are worried about telling students that they are failing them while they sit in
their offices armed; doctors worry that if a crazy person pulls a gun in
clinic, several others will draw down and make it more dangerous, police worry
that they won’t even know who created the original threat. The data shows that
there is a real risk of more homicide with more access and carriage of guns; “natural
studies” of homicides showed a marked increase after Missouri eliminated its permit
laws in 2007 and decrease after Connecticut tightened its laws after Sandy
Hook.[1] [2] Moreover,
60% of gun deaths are suicides, and these are also dramatically decreased by
making guns less easily accessible.[3] Doctors and researchers need to speak out
about the public health implications of easier access to guns. Luckily, many
are; others are worried that perhaps the notoriously-vindictive Kansas
legislature may respond by cutting funding for the university. These people
will not become heroes, but they may keep their jobs and their funding.
Being a whistleblower is not easy. It is not a way to have a
calm, peaceful life. Some folks have made a lot of money and retired far from
those they blew the whistle on, but many more I know of are, like Roger
Boisjoly, are shunned, forced out of their jobs, threatened, and may even
suffer PTSD. It is not easy to take on the PTB. Better to work in their
interests; for his great work as emergency manager in Flint, Darrell Earley has just
been named emergency head of the Detroit Public Schools!
The full impact of the Flint lead-poisoning disaster is not
yet known, because the full impact of these elevated lead levels on the brains
and bones of Flint’s largely poor and African-American children will take years
to take their toll. Even then, and even if, because they are treated the damage
is limited, we will never know what kid who grew up seemingly ok and normal
might otherwise have been brilliant.
She might have become a doctor, maybe even a heroic one like Dr.
Hanna-Attisha.
[1] Rudolph, KE et al., Association Between Connecticut’s
Permit-to-Purchase Handgun Law and Homicides Am J Public Health. 2015;105:e49–e54.
doi:10.2105/AJPH.2015.302703
[2]
Webster D, et al., Effects of the Repeal of Missouri’s Handgun Purchaser
Licensing Law on Homicides, Journal of Urban Health: Bulletin of the New York
Academy of Medicine, Vol. 91, No. 2, doi:10.1007/s11524-014-9865-8
[3] Crifasi CK et al., Effects of changes in
permit-to-purchase handgun laws in Connecticut
and Missouri on suicide rates, Preventive Medicine 79
(2015) 43–49
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