Here's an interview with Don Hopkins, the point person for the Carter Center's Guinea worm eradication efforts (the job he took up after helping lead worldwide smallpox eradication):
It is believed that those snakes you see in the logo for medical services (caduceus) are actually Guinea worms as physicians used to advertise their services that way. See for example
You've posted an article that conflates the two symbols, but the caduceus means different things than the Rod of Asclepius and has different origins despite the similar appearance.
the wikipedia article on the Rod of Asclepius tells the story of the parasitic worms, so while the GP perhaps should not have mentioned Caduceus, he's referring to an actual story associated with the medical symbol.
And in the age of Covid, perhaps the Caduceus "ancient and consistent associations with trade, liars, thieves, eloquence, negotiation, alchemy, and wisdom" is just perfect for the state of medical science and public health and laboratory gain of function experiments, horse dewormers, and mRNA vaccines which turn out to be no so much like the vaccines we're used to.
~330 million people live in the United States. 7.6 billion live outside of it. Be honest to yourself: which of your vs. op’s take is probably the more valid one?
> The Caduceus became a symbol of alchemy and pharmacy in medieval Europe. Its first appearance as a medical symbol can be traced back to 1st−4th century CE in Oculists’ stamps that were found mostly in Celtic areas, such as Gaul, Germany and Britain, which had an engraving of the name of the physician, the name of the special medicine or medical formula and the disease for which the medicine was to be used [1]
“.. older representations from Syria and India of sticks and animals looking like serpents or worms are interpreted by some as a direct representation of traditional treatment of dracunculiasis, the Guinea worm disease.“
In Persian, old times, snake was a symbol of health! Even today “sick” in Persian translates to “Snake-less”!
I was also believed that snakes eat the animals that can carry dangerous sicknesses (small mammals) and their existence is a sign of healthy environment.
I am not sure if it’s related to the said logo but thought it might be interesting.
tldr: if you're bitten by a bronzelook at a copper snake wrapped around a pole and you'll live
> 6 Then the Lord sent venomous snakes among them; they bit the people and many Israelites died. 7 The people came to Moses and said, “We sinned when we spoke against the Lord and against you. Pray that the Lord will take the snakes away from us.” So Moses prayed for the people.
8 The Lord said to Moses, “Make a snake and put it up on a pole; anyone who is bitten can look at it and live.” 9 So Moses made a bronze snake and put it up on a pole. Then when anyone was bitten by a snake and looked at the bronze snake, they lived.
First is not necessarily best. But Washington deserves credit for setting the precedent of becoming an ex-president voluntarily. That was a big deal at the time.
It's worth noting that Washington simply didn't want to be president any more. Leaving politics was also relief of his personal burden, rather than solely a noble sacrifice for republican values. He was exhausted after years of public service, his health was growing worse, and he was deeply frustrated by the mismanagement of his farm. In short: he was burnt out and wanted well-earned rest.
That isn't to say he was blind to the dangerous precedent that would be set by remaining president until death. After all, he was president of the Society of the Cincinnati. (Named after Lucius Cincinnatus, a Roman who was given emergency dictatorial powers (two times?), which he relinquished when they were no longer necessary.) But he didn't want to remain president anyway, so the decision was not a fraught one.
Source: half-remembered details from Ron Chernow's "Washington: A Life"
Carter no doubt has marketing behind the name and stellar executive teams at his various associated programs.
But as far as I can tell, he's the only recent ex-President who's kept up a similar pace of work and results since: everyone else finishes and retires.
I think Carter is a decent human being, served his country, a devout Christian, and has done a lot of good in his post-presidency. But he was a terrible president. My father, a lifetime straight-ticket D voter, could not bring himself to vote for him a second time. The economy of the late 70s was a nightmare. High inflation, double-digit interest rates, low growth. Energy crisis (I remember sitting in school with most of the lights off and wearing winter coats because the heat was set so low). Iranian hostage crisis, and rescue debacle. It was not a good time.
Absolutely. We often judge Presidents as though the state of the country today was defined by their decisions yesterday. Or even by their predecessors a few months or years ago.
And they shouldn't avoid blame! They are in the most powerful seat in the US government.
But at the same time, economic timescales are lengthy, and often more than 4 or 8 years.
I get why: because the people pushing that framing are doing so as political PR (positive or negative). But we shouldn't confuse the inaccurate framing with the underlying truth.
I think it’s reasonable to judge presidents for ~4-6 months after they take office to six months after the next guy takes office. Plenty of presidents left just before or after things when to shit, but you only get 4 years, including a lame duck period, which means moving quickly.
Sure they don’t control the legislature but they do have quite a bit of leverage to make real compromises.
Why is the president responsible for how the economy goes? To me it seems like one of those things that's easy to mess up but hard to improve. It's also the result of a lot of interactions, so blaming or crediting the president seems unfounded.
The president heads the executive and at the and of the day is responsible for setting industrial policy, economic policy and foreign relations. Of course he is responsible (but we all know that in truth the country is run by appointed civil servants, all of who are under 40 years old).
I actually don't know the details for East Timor, but, presumably Carter didn't personally sponsor this, like as a hobby after he was President or something - instead it was US government policy and it remained US government policy to turn a blind eye to what was happening in East Timor and presumably as the US President receives high quality global intelligence briefings Carter will have had a pretty good idea what it was turning a blind eye to.
It seems an unfortunate truth that moral purity is impossible for the leaders of the largest countries. Every decision is made with complex trade-offs and regrettable consequences even for the “right” choice.
It’s hard for me to understand how holding people to account for sponsoring genocides means holding them to an impossible standard of moral purity. This strikes me as a straw man.
If you don't know the details why are you speaking on it? Jimmy Carter increased US military aid to Indonesia as we knew they were committing genocide and selling donated Red Cross supplies. 90% of the weapons Suharto used in the invasion of East Timor were supplied by the United States. And we were responsible for the coup that put Suharto in power.
You can spin it however you want to try and defend poor Jimmy Carter, but I know Americans would not make the same effort for, say, Xi Xinping.
I can't speak for Americans, but I'm sure to some extent Xi Jinping (that's who you meant right?) is railroaded by the existing situation of the PRC. That of course doesn't magically make him not responsible for things done by China under his control - for say, Hong Kong's "National Security Law", or the attempted expansion of Chinese control in the South China Sea not to mention the Uighurs, but it's also not as though he seized power one afternoon and China's policies changed overnight to reflect his personal preferences. We are a product of our society.
For example China can't just wake up on a Tuesday morning and become a thriving modern industrialised democracy. Even if Xi Jinping desperately wanted that (and I've no reason to think he does) it can't be done, so there's a huge gap between what you might wish and what these leaders can actually do with their power. Do you think that East Timor would have been stopped if Gerald Ford had won the 1976 election instead of Carter? Would he have picked up the phone and said "Sorry, changed my mind, if you don't pack up and leave East Timor I will bomb you into the stone age"? No?
Lots of countries tacitly supported Indonesia. Australia basically wanted to split the loot, which is in some sense morally worse than selling them arms; the UK sold guns and military aircraft to Indonesia during the fighting; India argued that such invasions are legitimate (and like the US it closed its eyes to the torture, rape and murder) because of its own history of such de-colonial activities. Lots of blame to go around so far as I can see. Carter deserves some share of that blame.
.. I put that at about a five decade period? "Hipster" wasn't really a thing until about the Obama era, and the "party of the deep south" ended round about the Civil Rights Act?
Carter lost due to (a) oil crisis inflation driven by OPEC and (b) the botched military operation in Iran, neither of which outcomes were really within his control.
(The emphasis on Benghazi used against Hilary Clinton was clearly driven by this strategy having worked previously)
The fact sheet has an apt comment: "Eradication can be certified only when surveillance can be carried out in all areas to show transmission has been interrupted in humans and animals. Parts of some affected countries are inaccessible to the program because of internal armed conflict. Resolution of these conflicts is key to eradication."
Is this true eradication or elimination? A reduction to zero cases is amazing and awesome, but is there ever a chance of the disease being truly eliminated?
True eradication was the original goal, but since 2016 there's a zoonotic reservoir in dogs which complicates that. If not for that it would've been eradicated a few years ago and it's currently unknown if that can be brought under control.
My understanding (not an expert - just saw the articles in 2016-2017) is that it might have been pre-existing but no one was looking because human-human transmission was overwhelmingly dominant.
But I had he date wrong - apparently it was first observed in 2012, but only became a significant vector in 2016 (presumably as humans stopped being such accessible hosts).
It’s not a deadly disease it’s a parasite. Though I do believe humans are the primary hosts. Filtering water, using deep Wells or anti-parasitic drugs are what’s driving down the number of cases.
It's a disease (a set of symptoms) and a parasite (the cause of the symptoms / disease). It is not bacterial or viral. If we're looking for accurate words.
Ah, I didn't even notice the contention over the word 'disease'. I just found it notable that there are no anti-parasitic drugs for it, according to the WP article.
In all likelihood, 100 years from now mere knowledge of the entire genetic code will suffice to recreate the animal from scratch. You won't even have to store specimens.
Perhaps much sooner than that, at least with worms. This is a simple organism, it does not need 9 months in a womb like we do.
"In all likelihood, 100 years from now mere knowledge of the entire genetic code will suffice to recreate the animal from scratch."
For some animals, maybe. I'm not so sure of those that require a womb.
A living organism born from a womb is not just the result of its genetics, but also of its interaction with its parent while in the womb.
If an animal is extinct, then you won't have an animal of its species to gestate in, so you'd be forced to either use a different animal or an "artificial womb" (if that ever becomes possible). In either case the environment it gestates in will be different from gestation in the real animal of its own species.
It's an open question whether the result of that will really be the same as the extinct animal, even if the genes are the same.
Yes, that is definitely an important questions. We are probably not that far from fuctional artificial wombs (the research into them seems to be slowed down by ethical concerns rather than by outright impossibility), at least for some animals, but they won't be the same as natural wombs, and the effects down the line are ... unclear to say the least.
Having the genetic code without being able to recreate epigenetic conditions is like having source code but no compiler or reference system architecture.
Some types of the poliovirus are already eradicated! The polio case is exceedingly frustrating as it's been hindered by the Taliban, Boko Haram, and the likes with their stupid "this is a tool for massacre Muslims!!11" and similar rhetoric. It's not inconceivable Polio would already have need eradicated if it wasn't for that, and COVID didn't help either due to shifting priorities and such.
The good news is that the Taliban did a u-turn on this after taking over last year, and now vaccination efforts in Afghanistan are underway again. Small silver lining from the Taliban takeover I guess :-/
At any rate, current hopes for polio eradication seem to be for 2026[1], whereas Guinea worm is 2030.
The real vaccination campaign with alternate motives. Nobody who got a shot there wasn't vaccinated. That they also carried out surveillance was regrettable, because it did create a negative narrative, but the vaccines weren't fake.
“Fake” go with “campaign”, not “vaccine”. The vaccine was real, the campaign was fake: they run a surveillance campaign and incidentally vaccinate a few people, hence “fake vaccination campaign”
I guess the torture program was regrettable, too. Not regrettable enough to prosecute anyone, though. Or even to allow the UN to prosecute, or to allow anyone indicted (e.g. in Spain) to be extradited.
Allowing CIA to corrupt vaccination efforts is better described as a disastrous debacle.
No, that's not the biggest problem. The biggest problem is cVDPV2 (i.e. vaccine derived type 2 Polio). Type 2 Polio is extinct in the wild, but the vaccine derived version refuses to stop.
The trouble is the only way to stop cVDPV2 is to immunize for it - but that same immunization is what creates cVDPV2 in the first place.
Until a better vaccine arrives, it doesn't look like we'll ever eradicate it, Taliban etc aren't changing that. However there might be good news:
"March 2021 saw the first use of the modified nOPV2 vaccine in selected countries. This was engineered to allow vaccination against strain 2 poliovirus without the frequent spawning of cVDPV2 seen with the original OPV2. Full rollout was not expected until 2023."
I was under the impression that vaccine derived polio would eventually fizzle out after the entire population becomes vaccinated (i.e. "herd immunity")?
That was the idea - but it failed. Type 2 does not exist in the wild, it's all from vaccine derived. It got so bad they stopping giving type 2 vaccine, but then people have no immunity to the vaccine derived version - but if you give the vaccine, then the vaccine causes more cases (of type 2) than it's stopping.
There's no solution here - either option makes things worse.
So I hope the new version of the vaccine works, because otherwise this will fail.
Type 3 appears basically extinct - both in the wild, and vaccine derived. Only type 1 still exists in the wild, and vaccine derived type 2.
> if you give the vaccine, then the vaccine causes more cases (of type 2) than it's stopping.
> There's no solution here - either option makes things worse.
That's false and misleading. The OPV2 vaccine will stop both vaccine-derived cvdpv2 virus from spreading and the wild type 2, which has been eradicated. Since OPV2 is a live attenuated virus, it will also continue to multiply and confer protection to any person drinking contaminated water, the vaccine "spreads". It is thus highly effective at stopping polio and in no way it can be said that it "causes more cases than it's stopping".
The problem with OPV2 is that it has a relatively higher chance of reverting to an variant that causes polio. This is not a problem if the population has a high level of vaccination, since the live attenuated virus cannot propagate and mutate. It's only problematic in low coverage areas where it can multiply extensively in many hosts.
Thus, the cvdpv2 epidemic is an expression of low vaccination rates, similar in every way to a wild poliovirus resurgence. The novel OPV2 vaccine will improve the genetic stability of the attenuated virus, allowing further "viral vaccinations" in low coverage areas - but we could eradicate cvdpv2 today with the existing OPV2 vaccine, if only we could get good vaccinations rates everywhere, as it has happened in most of the world.
You are completely misinformed about this. I spent quite a long time reading about this.
What you write is what they hoped would happen. However it did NOT happen. The reason is that the more you try to vaccinate the entire population, the more cases of cvdpv2 you cause. Until you hit that magic 100% you cause more harm than you prevent.
And in the real world 100% is impossible. So yes opv2 "causes more cases than it's stopping" - there are zero cases of wild type 2, so it's stopping nothing except itself.
And in fact that people running this campaign noticed this and stopped vaccinating with opv2! (Which perhaps you did not know.)
The new version of it will hopefully help, and we can eradicate this.
But right now Polio eradication is failing, not because of Taliban, but because of cvdpv2.
I have high hopes for the new version, but it'll be years before we know.
> The reason is that the more you try to vaccinate the entire population, the more cases of cvdpv2 you cause. Until you hit that magic 100% you cause more harm than you prevent.
This makes little sense if you understand that both wpv2 and cvdpv2 were eliminated in the poorest regions of the world using OPV2. If what you claim is true, elimination would have been impossible, you would simply replace wpv2 with cvdpv2, since any attempt at eradication would seed new cvdpv2 cases.
Inactivated injectable vaccine, which does not boost herd immunity, is inefective in these countries with limited health systems.
> And in fact that people running this campaign noticed this and stopped vaccinating with opv2! (Which perhaps you did not know.)
Perhaps you refer to the global coordinated action to move from trivalent vaccine to bivalent (wpv1+ wpv3) in 2016 after the wild type 2 virus was certified as eradicated. But monovalent OPV2 was still being used recently to target specific areas where cvdpv2 is endemic. It makes little sense to use it elsewhere and seed cvdpv2.
And 8 years later the vast majority of Polio in the world is cvdpv2. (There is more cvdpv2 then wild type 1 and 3 combined.)
You are correct in your details, but are completely missing the bigger picture.
If you look at stats there is zero evidence that cvdpv2 is going away, it just shifts countries, goes up, goes down, but has no signs of ending.
If not for the new vaccine (and I hope it works), cvdpv2 indicates the failure to eradicate Polio. The new vaccine may change the picture, we shall see in about 2 years.
Right now the Taliban is not the biggest obstacle to Polio eradication, cvdpv2 is. And if you check my comments this has been my claim from the start, so I'm not sure what you are arguing against.
Just because vaccines are great, doesn't mean they are perfect, it's not necessary to reflexively defend them.
There have been dozens of cVDPV outbreaks that have been successfully contained in countries around the world. We know how to do it even with our existing vaccines. These outbreaks don’t just come and go at random, they happen in places with inadequate vaccination and are eliminated using a proven playbook.
New vaccines will make the process smoother and faster, but we’re certainly not at a dead end without them.
I feel like you keep missing the point. Why are there still outbreaks 6 years later? (Answer: Because we keep causing the outbreaks.)
Is the plan to just keep vaccinating forever? Doesn't that mean that eradication failed? Wild type 2 is extinct, so why are we still fighting it? (Answer: Because we are fighting our own actions.)
> We know how to do it even with our existing vaccines.
You sure? Because it sure doesn't look like success from here.
> they happen in places with inadequate vaccination
If that were true why the switch to bivalent? How can you have "adequate" vaccination when we are not even vaccinating in the first place?
> and are eliminated using a proven playbook.
That's exactly the problem - they do not get eliminated. All we are doing is keeping outbreaks from getting huge, by creating small outbreaks.
This new vaccine is a complete game changer, not the incremental step you think it is.
Where did you get these outlandish expectations of how much progress would have been made by now? The plan, above all else, was and is to eliminate wild polio virus. Even in the best case scenario, we’re still 5-10 years away from being able to declare it extinct, so you should expect the OPV is still going to be in use until then, and the risks of vaccine-derived polio will still have to be managed for a long time to come. Unfortunately not every country have done a perfect job of that, but it certainly is possible, as demonstrated by the majority of the world having zero cases.
I think 'ars' is leading you into a rhetorical trap. The objective was never eliminating the wild virus, the objective was curing polio. The OPV vaccine is a bit like fighting fire with fire: you burn down the forest (immunize susceptible hosts) in a controlled fashion, so that the forest fire cannot reach homes (paralyze children). But when your house burns down, it's irrelevant if it was the "wild" fire or a fire set by the firefighters, i.e a attenuated virus that mutated.
What 'ars' seems to be missing is that this particular "forest" is very rapidly growing back, in some countries you have in excess of 5% of the population as infants each year. Those are new hosts that were never vaccinated, and due to the extreme contagiousness of the disease a few years of lack of coverage can reignite the fire. What happened after OPV2 withdrawal was that a whole new generation inoculated with only bivalent (type 1+3) vaccine became susceptible to cvdpv2 that was still circulating in small pockets.
Essentially, the campaign failed the end-game strategy, they proved they can reduce the infection to arbitrarily low levels using trivalent OPV, but once you take OPV away, as they attempted for a single strain, the epidemic reignites. It's irrelevant if it's a wpv or cvdpv strain. The end-game was always considered a challenge by experts, but a variety of reasons, Covid, political issues etc. conspired to make it very difficult.
This whole thread leaves me very pessimistic about the prospects of eradication. If a relatively inteligent and educated internet-person that has proper sanitation cannot understand these epidemiological dynamics and claims that "OPV causes more infections than it cures", what's the chance you can explain it to rural farmers, especially after the global rise of the antivax movement after Covid?
OPV2 (specifically 2) cures zero infections because type 2 is extinct in the wild. If causes some infections.
So explain how my sentence isn't true?
A decade ago when type 2 was in the wild, OPV2 was very valuable. Today though it's the greatest obstacle to eradication (and not because people are doing something bad, it's just unfortunate circumstance).
> OPV2 (specifically 2) cures zero infections because type 2 is extinct in the wild. So explain how my sentence isn't true?
OPV2 prevents cvdpv2 infections. This is a virus similar in all respects to wpv2, except its lower rate of paralysis onset. It's effectively the same disease, just like in my forest fire analogy.
Before the advent of nOPV2, OPV2 was much more effective at this than any other option. So you could not simply cease OPV2 production, post 2016 it was targeted to cvdpv2 hotspots only.
The thing is that we really, really want to be able to stop giving the OPV vaccine because - aside from the fact that it requires a bunch of resources and there's always the risk of disruptions to vaccination from civil wars, other pandemics, etc - the original unmutated vaccine itself paralyzes and even kills a small fraction of the people it's given to, and at low levels of disease those cases can easily become more common than actual polio-related paralysis. That's why it's not used in the developed world anymore.
IIUC the idea is to mix the oral vaccine with attenuated virus with only the types 1 and 3, and the injectable vaccine with inactive virus with the types 1, 2 and 3. https://en.wikipedia.org/wiki/Polio_vaccine#Schedule So you have coverage for the three types.
(It's more complicated. For example country without recent cases and good vaccine coverage only use the injectable vaccine.)
The problem is that although the inactivated vaccine provides good protection against severe polio it doesn't seem to work too well at stopping people from spreading the virus, which is not ideal for an elimination program. Presumably this was less of an issue in the developed world because polio spreads mostly through the oral-fecal route and there were already a lot of hygene and infrastructure improvements in developed countries aimed at stopping diseases from spreading that way.
There has been significant progress over that time period. There were approximately 10,000 cases in 2007. There were 14 cases in 2021. It may take a few more years to get to zero, but that means no one will ever have to deal with this parasite ever again.
There are those who feel sympathy for any living creature. There are those who espouse a non-human-centric philosophy of existence, some of whom view the elimination of other classes of organisms either neutrally or negatively. There are those who are hostile in varying degrees to the population afflicted by the guinea worm and who, disconnected from their suffering, are ambivalent about the cessation of that suffering.
Any individual in those groups might change their perspective if the guinea worm's menace were made more tangible to them — if they or those close to them were infected, or perhaps if they were to witness the suffering of the afflicted up close. But the range of human emotion and ideology is vast.
I for one do not wish to have any such worm in my body, but eradication of whole species(in other words - genocide) raises some moral questions and also some other issues that have to be dealth in near future.
Apparently, in this case humans already are giving advantages to baboons and if they multiply too many - humans again will need to intervene to kill them to maintain their "normal" numbers.
The solution to the worm and other parasites is very simple - boil your water before using it. Swim only in pools that have been threated against parasites.
Instead the offered solution is to sterilize all water in nature - in jungle environment, that is infested with life, that by nature is hostile to humans and others.
I suppose, that the thinking of eradication of these worms comes from how they are dealing with malaria.
> Instead the offered solution is to sterilize all water in nature
This is not the treatment approach and is not remotely feasible.
The guinea worm life cycle is largely human driven as well. It's like objecting to reducing heavy metals leaching into drinking water out of some notion of keeping it unchanged from its current state, when it's largely put there by human behavior in the first place.
>>This is not the treatment approach and is not remotely feasible.
This is from article:
"They then prevent people from drinking the contaminated water and use pesticides to disinfect it."
Basically they contaminate water with pesticides, which locals are drinking afterwards... there are no imminent effects from pesticides - that is for sure.
from wiki:
D. medinensis larvae reside within small aquatic crustaceans called copepods.
>>The guinea worm life cycle is largely human driven as well.
Not true. It affects mammals, including humans. Infected mammals becomes easier catch for predators. It is part of cycle of life, which humans are disrupting.
The main issue here is that hygiene of people in Africa is still on the same level that Europeans had couple of centuries ago, when they used water from the same water sources where they had dead cats and fecal matter, only European sources of waters are getting "sterilized" by cold weather, unlike in Africa where those water inhabitants thrive all year. USSR had very similar issues with infections from drinking water, until it educated population that only boiled water is safe to drink. Judging from the article - that is still the main issue and part of what they are doing.
> Basically they contaminate water with pesticides, which locals are drinking afterwards... there are no imminent effects from pesticides - that is for sure.
You said:
> Instead the offered solution is to sterilize all water in nature
This article says in fourteen cases they've treated water, and pesticides that target water larvae aren't sterilizing.
>> The guinea worm life cycle is largely human driven as well.
> Not true. It affects mammals, including humans.
Until eradication efforts largely achieved their current success, absolutely this was true. And again, your original claim:
> Apparently, in this case humans already are giving advantages to baboons and if they multiply too many - humans again will need to intervene to kill them to maintain their "normal" numbers.
There have been 23 known baboon infections since the first one was found in 2013. Eliminating the guinea worm will have no effect on baboon populations.
> The main issue here is that hygiene of people in Africa...
I also remember seeing that website years ago, and I feel like this isn't it (or at least that it's been redesigned). I seem to remember the classic unstyled text of the early web.
https://www.hsph.harvard.edu/news/multimedia-article/were-be...