[Peace-discuss] Fwd: Health Data Monitored for Bioterror Warning

[Margaret E. Kosal]

Peace-list folk -

Here's a tertiary source piece that presents some of the complexities (but 
not unfathomable by every citizen) related to epidemiology & electronic 
networks - looking at individual symptoms to try to suggest cause and 
data-mining in our electronically-connected age.

Some of my cursory observations -
Anything with John Poindexter's name connected, immediately puts up red flags.

Private defense contractors (civilians) are not necessarily a better 
alternative than military because they are subject to even fewer 
regulations and monitoring that the military is. For a horrifying example, 
look to the infamous history of US company Dynergy in Kosovo. Not to be 
interpreted in any way, shape or form as advocacy for military.

DARPA funds frightening things; DARPA also funded DARPA-net, which is the 
direct forerunner of the Internet that allows peace list to exist. DARPA 
has a huge amount of money - i advocate co-opting those funds for proposals 
that do benefit humans & other living creatures. This requires more 
creativity and a risk of personal co-option. It's not easy ... but what 
that is worth generally is?

Namaste,
Margaret

"If you want to make peace with your enemy,
  you have to work with your enemy.
  Then he becomes your partner."
   -- Nelson Mandela

http://www.nytimes.com/2003/01/27/national/27DISE.html?pagewanted=print&position=bottom

January 27, 2003

Health Data Monitored for Bioterror Warning

By WILLIAM J. BROAD and JUDITH MILLER

To secure early warning of a bioterror attack, the government is building a 
computerized network that will collect and analyze health data of people in 
eight major cities, administration officials say.

The Centers for Disease Control and Prevention is to lead the 
multimillion-dollar surveillance effort, which officials expect to become 
the cornerstone of a national network to spot disease outbreaks by tracking 
data like doctor reports, emergency room visits and sales of flu medicine. 
"Our goal is to have a model that any city could pick up and apply," a 
senior administration official said of the plan.

Officials would not disclose the program's cost or which cities will be 
involved. But experts say Washington is likely to be one of the eight.

Such surveillance is now possible because of an explosion in commercial 
medical databases that health authorities, with permission and under strict 
legal agreements, are starting to mine. In ambition and potential 
usefulness, the health network goes far beyond an environmental 
surveillance system, disclosed by the administration last week, that will 
sniff the air for dangerous germs.

The emerging health monitoring network, officials and experts say, will 
provide information that could save lives if terrorists strike with deadly 
germs like smallpox or anthrax. In detecting attacks, a head start of even 
a day or two can greatly lower death rates by letting doctors treat rapidly 
and prevent an isolated outbreak from becoming an epidemic. A senior 
official said President Bush was expected to refer to these new 
bioterrorism defenses in his State of the Union address.

The disease centers' initiative represents a sharp swing to civilian 
leadership in a field the military pioneered and once dominated. But even 
in civilian hands, the emerging network has raised concerns that such 
surveillance may violate individual medical privacy rights.

Officials said concerns were initially heightened because of the Pentagon's 
central role in the genesis of many systems, and especially because Vice 
Adm. John M. Poindexter, architect of the much-criticized Pentagon computer 
surveillance effort known as Total Information Awareness, is in charge of 
the Defense Department agency that finances some of the government's 
disease monitoring research.

In November, as the Bush administration came under fire for Admiral 
Poindexter's project, White House officials ordered the military to drop 
plans to link four cities into a $420 million health monitoring network and 
shifted responsibility for such work to the new domestic security agency. 
The transfer was not motivated by privacy concerns, administration 
officials say, but by a judgment that the military was ill suited to 
exploit monitoring for public health.

"We all agreed that doing this surveillance in the civilian sector was not 
the military's job," Dr. Anna Johnson-Winegar, a Pentagon biodefense 
official, said in an interview.

Experts say the prospect of war with Iraq, and the chance that Baghdad 
might retaliate with germ weapons, are accelerating the effort to expand 
and integrate scores of rudimentary disease surveillance systems being 
developed by cities, states and the federal government. But public health 
experts argue that even if the United States never suffers another 
bioterror attack like the anthrax strikes of late 2001, the emerging 
network can still help doctors better track, treat and prevent natural 
disease outbreaks.

"We want as much protection as we can afford," said Dr. Daniel M. Sosin, 
director of public health surveillance at the Centers for Disease Control 
and Prevention in Atlanta. Dr. Sosin is helping to expand the nation's 
health surveillance to incorporate the new systems.

Supporters of the emerging surveillance network insist it raises few 
privacy issues, saying that the data are laundered of names and 
identifiers. People are not tracked as individuals, they say, but their 
symptoms are, and often their age, sex and ZIP code as well. But computer 
surveillance itself has drawn criticism from the American Civil Liberties 
Union, members of Congress and others.

The system is needed, proponents say, because few cheap, reliable sensors 
exist for detecting deadly germs in such likely target areas as subways and 
shopping malls. Sensors are also prone to false positives, or incorrect 
germ identifications.

Dr. Thomas R. Frieden, the health commissioner of New York City, which has 
one of the nation's most highly developed rapid surveillance systems, said 
the emerging network could help authorities gauge the dimensions of germ 
attacks and reassure the public.

He pointed to a case in November in which a New Mexico man visiting New 
York was found to have bubonic plague, a deadly contagious disease. "We 
were concerned this was bioterrorism," Dr. Frieden said. "But we didn't see 
any signals. We didn't see any alarms. That added to our confidence to rule 
out bioterrorism."

Experts say most of the new systems, military and civilian, are still 
experimental. A critical challenge is finding needles in the haystacks of 
data about common ailments like respiratory infections, which can rise and 
fall with great suddenness in winter.

Dr. Marcelle Layton, New York City's assistant health commissioner for 
communicable diseases, said another challenge was ensuring that there are 
enough public health officials to respond to alarms that the new 
environmental and medical surveillance systems might sound.

"The best system will be useless if it's only a fire alarm with no 
firefighters to put out the flames," Dr. Layton said.

Nonetheless, expectations run high.

"We think this will be important," said Dr. Alan P. Zelicoff, a physician 
at the Sandia National Laboratories who helped develop a widely used 
surveillance method, the Rapid Syndrome Validation Project, which is now 
used in California, New Mexico, Texas, Singapore and Australia. "We need to 
get disease reporting from the 19th to the 21st century."

For decades, disease surveillance has valued accuracy over speed. Nurses, 
doctors and public health officers gather raw data, often using paper forms 
sent by mail. In the background, federal, state and private laboratories 
use advanced technologies to determine the causes of disease and confirm 
diagnoses. But the process tends to take days or even weeks.

Moreover, the system is narrow, revealing little about the nation's overall 
health. While the federal disease control agency has more than 100 
surveillance systems, most are designed to track a single organism or 
condition, like heart disease or flu virus. In addition, most are 
independent of one another.

The system has serious gaps. While laboratories usually comply with federal 
rules to report certain illnesses to health authorities, physicians often 
do not.

The military and the national weapons laboratories, increasingly worried 
about germ attacks, tried a new approach in the late 1990's. To learn of 
impending trouble quickly, they decided to scrutinize populations for clues 
of diseases before they were officially diagnosed. Experts zeroed in on how 
clusters of such symptoms as fever, cough, headache, vomiting, rash and 
diarrhea could suggest but not prove the presence of particular diseases, 
some of them lethal. The method was called syndromic surveillance.

An early military system was the Electronic Surveillance System for Early 
Notification of Community-Based Epidemics, or Essence. It drew medical data 
from some 400,000 members of the military and their dependents who lived in 
the Washington area a major potential terrorist target, but hard for 
civilians to scan medically because of "the numerous city, county and state 
jurisdictions," according to a Defense Department statement.

After the 2001 terrorist attacks, the Pentagon's Defense Advanced Research 
Projects Agency put $12 million into an experimental program, Essence 2, 
which tracked millions of civilians in the Washington area for signs of 
bioterrorism. The program now reports to Admiral Poindexter, whose Total 
Information Awareness program was dealt a setback by the Senate late last 
week, its future now in doubt. Joe Lombardo, a civilian who runs Essence 2, 
which is based at the Johns Hopkins Applied Physics Laboratory in Maryland, 
said that although Admiral Poindexter's office finances the system, Essence 
2 shares no data with his computer surveillance project. Essence 2, he 
said, gathers electronic records from drugstore chains, hospitals and 
physician groups. Mr. Lombardo said about a dozen people were developing 
the technology and collecting and analyzing the data.

"We're not Big Brother," he said. "Our objective is to support public 
health. The information we receive has been sanitized by the provider to 
ensure that it is impossible to identify individuals."

Privacy, though a goal, is apparently not yet guaranteed. A Pentagon 
planning document on the surveillance effort for fiscal 2002 and 2003 said 
the Defense Department was working to develop "enhanced automated privacy 
protection methods" that will "assure the anonymity of records accessed by 
the data monitoring software."

Experts say that privacy can, in theory, be violated when connections are 
made between disparate databases for instance, between those of physician 
payment and disease diagnosis, or health and law enforcement. They also say 
the potential for personal identification increases as the surveillance 
becomes a two-way street in which not only are problems detected but 
physicians are notified about potential problems involving individual patients.

This fall, the military sought to incorporate the Essence 2 program into an 
expanded program, the Biodefense Initiative. Costing a projected $420 
million, it was to deploy environmental sensors and wire four major cities, 
including Washington, into a disease-surveillance network.

But after Admiral Poindexter's Total Information Awareness program came 
under criticism by privacy advocates, White House officials moved the 
Biodefense Initiative out of military hands. That step, said Dr. William 
Winkenwerder Jr., the assistant secretary of defense for health affairs, 
"just seemed to make sense." Dr. Winkenwerder added that the military has 
often pioneered technologies, like the Internet, that move into the 
civilian sector.

Privately, some military officials grumble that transferring the Pentagon's 
effort to civilians will be wasteful. "It could be reinventing the wheel," 
a senior officer said.

Administration officials say the new eight-city disease control network 
will deal with the privacy issue directly. "We have to satisfy the legal 
constraints, and also people's concerns," a senior official said.

Other civilian surveillance systems are emerging quickly. In Boston, the 
Harvard Medical School faculty and the Massachusetts Department of Public 
Health are working closely with Harvard Pilgrim Health Care, a health 
maintenance organization. For more than a year, the team has studied data 
from 175,000 people in eastern Massachusetts, and it will soon cover as 
many as 20 million people coast to coast.

In October, the disease control centers awarded the Harvard team $1.2 
million to expand its pilot network nationally. The expansion will not 
monitor cities, but will concentrate on patients calling an after-hours 
medical advisory service.

Health officials say civilian emphasis in the developing surveillance field 
will help ensure privacy and enhance routine disease monitoring.

"It's the practical stuff that's most promising," Dr. Sosin of the disease 
control centers said. "Whether this is going to detect terrorism is 
unclear. But as a safety net and for tracking an event once it's going on, 
it's very promising."