Health Care
-

Abstract: Recent advances in synthetic biology are transforming our capacities to make things with biology. This bio-based manufacturing technology has the potential to be most disruptive around products for which existing material supply chains result in limited access. For example, broad access to medicines and the development of new medicines has been difficult to achieve, largely due to the coupling between material supply chains and these therapeutic compounds. We are developing a biotechnology platform that will allow us to replace current supply chains for already approved medicines with stable, secure, scalable, distributed, and economical microbial fermentation. Our initial target is the opioids, an essential class of medicines for pain management and palliative care, which are currently sourced through opium poppy cultivation. In addition, we will leverage this technology to access novel compound structural space that will open up tremendous opportunity for transforming the discovery and development of new drugs over a longer-time frame.

About the Speaker: Christina D. Smolke is an Associate Professor, Associate Chair of Education, and W.M. Keck Foundation Faculty Scholar in the Department of Bioengineering and, by courtesy, Chemical Engineering at Stanford University. Christina’s research program develops foundational tools that drive transformative advances in our ability to engineering biology. For example, her group has led the development of a novel class of biological I/O devices, fundamentally changing how we interact with and program biology. Her group uses these tools to drive transformative advances in diverse areas such as cellular therapies and natural product biosynthesis and drug discovery. Christina is an inventor on over 15 patents and her research program has been honored with numerous awards, including the NIH Director’s Pioneer Award, WTN Award in Biotechnology, and TR35 Award.

Encina Hall (2nd floor)

Christina Smolke Associate Chair for Education, Associate Professor, Bioengineering Speaker Stanford University
Seminars
-

More information TBA. 

 

Speaker bio:

David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and chief of infectious diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also co-director of the Center for International Security and Cooperation and senior fellow at the Freeman Spogli Institute for International Studies at Stanford University.

Dr. Relman’s primary research focus is the human indigenous microbiota (microbiome), and in particular, the nature and mechanisms of variation in patterns of microbial diversity and function within the human body, and the basis of microbial community resilience. His work was some of the first to employ modern molecular methods in the study of the microbiome, and provided the first in-depth sequence-based analyses of microbial community structure in humans. During the past few decades, his research has included pathogen discovery and the development of new strategies for identifying previously-unrecognized microbial agents of disease. A resulting publication was cited by the American Society for Microbiology as one of the 50 most important papers in microbiology of the twentieth century. He has also served as an advisor to a number of agencies and departments within the U.S. Government on matters pertaining to host-microbe interactions, emerging infectious diseases, and biosecurity. He co-chaired a widely-cited 2006 study by the National Academies of Sciences (NAS) on “Globalization, Biosecurity, and the Future of the Life Sciences”, and served as vice-chair of a 2011 National Academies study of the science underlying the FBI investigation of the 2001 anthrax mailings. He currently serves as a member of the National Science Advisory Board for Biosecurity (2005-), a member of the Committee on Science, Technology, and Law at the National Academy of Science (2012-15), a member of the Science, Technology & Engineering Advisory Panel for Lawrence Livermore National Laboratory (2012-), as Chair of the Forum on Microbial Threats at the Institute of Medicine (NAS) (2007-), and as President of the Infectious Diseases Society of America (2012-2013).

Dr. Relman received an S.B. (Biology) from MIT (1977), M.D. (magna cum laude) from Harvard Medical School (1982), completed his clinical training in internal medicine and infectious diseases at Massachusetts General Hospital, served as a postdoctoral fellow in microbiology at Stanford University, and joined the faculty at Stanford in 1994. He received an NIH Director’s Pioneer Award in 2006, was elected a Fellow of the American Academy of Microbiology in 2003 and the American Association for Advancement of Science in 2010, and was elected a Member of the Institute of Medicine in 2011.

 

 

Reuben W. Hills Conference Room

CISAC
Stanford University
Encina Hall, E209
Stanford, CA 94305-6165

0
Senior Fellow at the Freeman Spogli Institute for International Studies
Thomas C. and Joan M. Merigan Professor
Professor of Medicine
Professor of Microbiology and Immunology
1-RSD13_085_0052a-001.jpg MD

David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford, and served as science co-director at the Center for International Security and Cooperation at Stanford from 2013-2017. He is currently director of a new Biosecurity Initiative at FSI.

Relman was an early pioneer in the modern study of the human indigenous microbiota. Most recently, his work has focused on human microbial community assembly, and community stability and resilience in the face of disturbance. Ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. Previous work included the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. One of his papers was selected as “one of the 50 most important publications of the past century” by the American Society for Microbiology.

Dr. Relman received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. He served as vice-chair of the NAS Committee that reviewed the science performed as part of the FBI investigation of the 2001 Anthrax Letters, as a member of the National Science Advisory Board on Biosecurity, and as President of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Science, Technology and the Law, both at the National Academies of Science. He has received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011.

Stanford Health Policy Affiliate
CV
David Relman Thomas C. and Joan M. Merigan Professor, Departments of Medicine and of Microbiology and Immunology, Stanford School of Medicine; CISAC Co-Director; FSI Senior Fellow; Stanford Health Policy Affiliate Speaker
Seminars
-

Peter will discuss work at SRI and the University of Cambridge under two projects currently funded by DARPA, relating to clean-slate architectures for hardware, software, networking, and clouds, aimed at higher-assurance security, resilience, evolvability, and other critical requirements.

Two papers provide some early views of the ongoing work:

http://www.csl.sri.com/neumann/law10.pdf 
http://www.csl.sri.com/neumann/2012resolve-cheri.pdf


Peter G. Neumann (Neumann@CSL.sri.com) has doctorates from Harvard and Darmstadt. After 10 years at Bell Labs in Murray Hill, New Jersey, in the 1960s, during which he was heavily involved in the Multics development jointly with MIT and Honeywell, he has been in SRI's Computer Science Lab since September 1971. He is concerned with computer systems and networks, trustworthiness/dependability, high assurance, security, reliability, survivability, safety, and many risks-related issues such as election-system integrity, crypto applications and policies, health care, social implications, and human needs -- especially those including privacy. He is currently PI on two DARPA projects: clean-slate trustworthy hosts for the CRASH program with new hardware and new software, and clean-slate networking for the Mission-oriented Resilient Clouds program. He moderates the ACM Risks Forum, has been responsible for CACM's Inside Risks columns monthly from 1990 to 2007, tri-annually since then, chairs the ACM Committee on Computers and Public Policy, and chairs the National Committee for Voting Integrity (http://www.votingintegrity.org). He created ACM SIGSOFT's Software Engineering Notes in 1976, was its editor for 19 years, and still contributes the RISKS section. He is on the editorial board of IEEE Security and Privacy. He has participated in four studies for the National Academies of Science: Multilevel Data Management Security (1982), Computers at Risk (1991), Cryptography's Role in Securing the Information Society (1996), and Improving Cybersecurity for the 21st Century: Rationalizing the Agenda (2007). His 1995 book, Computer-Related Risks, is still timely. He is a Fellow of the ACM, IEEE, and AAAS, and is also an SRI Fellow. He received the National Computer System Security Award in 2002 and the ACM SIGSAC Outstanding Contributions Award in 2005. He is a member of the U.S. Government Accountability Office Executive Council on Information Management and Technology, and the California Office of Privacy Protection advisory council. In 2012, he was elected to the newly created National Cybersecurity Hall of Fame as one of the first set of inductees. He co-founded People For Internet Responsibility. He has taught courses at Darmstadt, Stanford, U.C. Berkeley, and the University of Maryland. See his website (http://www.csl.sri.com/neumann) for testimonies for the U.S. Senate and House and California state Senate and Legislature, papers, bibliography, further background, etc.

CISAC Conference Room

Peter Neumann Principal Scientist, SRI International Computer Science Lab Speaker
Seminars
-

The tools of molecular biology have augmented forensic biological analyses and contributed to solving crimes, developing investigative leads, and exonerating the innocent. The methods are exquisitely sensitive and highly resolving. Success stories abound and are reported almost daily in the media. Indeed, forensic DNA typing is the gold standard of the forensic science disciplines. Although the methods and interpretations generally are reliable, there are some limitations that scientists, stakeholders, decision makers, and the public may not appreciate. This presentation will provide insight into the applications extolling their value and discussing the problems that need to be overcome or avoided.


About the speaker: Bruce Budowle, PhD, director of the UNT Health Science Center's Institute of Investigative Genetics and vice chair of the Department of Forensic and Investigative Genetics, has been named a Health Care Hero by Dallas Business Journal. He joined the Health Science Center in 2009, bringing renowned expertise in the areas of counterterrorism, primarily in identification of victims from mass disasters and microbial forensics.

Prior to joining the Health Science Center, Budowle spent 40 years as a senior scientist for the Federal Bureau of Investigation (FBI) in Washington, D.C. He was a principal advisor in efforts to identify victims from the World Trade Center attack in 2001 and helped establish a mitochondrial DNA sequencing program to enable high-throughput sequencing of human remains.

Budowle's commitment to helping families resolve missing persons cases led him to Fort Worth after a lifetime in the Virginia/Washington, D.C., area in order to collaborate with Health Science Center researchers and advance the knowledge and use of forensics and DNA to improve health and safety of the world's population. Budowle has also been instrumental in establishing the DNA-ProKids initiative to identify missing children on an international scale.

Reuben W. Hills Conference Room

Bruce Budowle Director Speaker University of North Texas Health Science Center Institute of Investigative Genetics
Seminars
-

The life sciences have many examples of where research results and technologies can be used for good, but also for bad purposes. Because such scenarios are so common, it is critical to identify that research which is particularly bad and would be classified as dual use research of concern (DURC). Attributes that might result in a DURC designation include how immediate a threat it represents, the magnitude of the threat, the availability of safeguards to defend against its nefarious use and its relative risk to benefits ratio. Several policy forums have studied this problem and the National Science Advisory Board for Biosecurity (NSABB) is currently the official U.S. government advisory group for DURC policy. Recently, NSABB was asked to review two manuscripts that reported adaptation of the high-path avian influenza virus H5N1 to transmission in a mammalian model. This virus rarely infects humans but when it does, it has catastrophic consequences with ~60% mortality. The board weighed the risks and the benefits of the work and recommended that the papers not be published as written, but only in a highly redacted form that would prevent the rapid and direct replication of the work. NSABB also argued for a communication pause so that the consequences of these papers and this research focus be evaluated by a broad cross section of science, public health and society. The US government accepted these recommendations and the two journals (Science and Nature) have thus far not published the papers. Multiple additional forums are planned to discuss the issues and recommendations. The future for policy development in the area of pathogen research and DURC will be shaped by these recommendations and subsequent activities.

About the speakers:

Dr. Paul Keim holds the E. Raymond and Ruth Cowden Endowed Chair in Microbiology at Northern Arizona University (NAU), where he is also a Regents Professor of Biology. In addition, he directs the Pathogen Genomics Division at The Translational Genomics Research Institute (TGen). Both institutions are based in Flagstaff, Arizona. His biological interests span many types of organisms and microbes, but revolve around genetic diversity and its organization in populations and species. This necessarily has involved systematic and phylogenetic analyses to understand how observable genetic diversity is based upon past evolutionary processes. Biodefense programs have capitalized upon his approach of using genomic analysis to understand bacterial pathogen populations for microbial forensics and molecular epidemiological analyses. His laboratory was heavily involved in analysis of evidentiary material from the 2001 anthrax-letter attacks. He has published extensively on the evolution and population genetics of Bacillus anthracis, Yersinia pestis, Francisella tularensis, Burkholderia pseudomallei, Burkholderia mallei, Brucella spp., and Coxiella burnetii. Recently, these same principles have been applied to other public health-related and clinically important pathogens such as S. aureus and E. coli. In all, he has published over 230 scientific or policy papers. Dr. Keim received his B.S. in Biology and Chemistry from Northern Arizona University in 1977 and his Ph.D. in Botany in 1981 from the University of Kansas. Dr. Keim has previously served on the editorial boards of Crop Science and Molecular Breeding; he currently serves on the editorial boards of Infection Genetics and Evolution, Investigative Genetics, and Biotechniques.

Dr. David Relman is a professor of medicine – infectious diseases, and of microbiology and immunology at Stanford. He joined CISAC as an affiliated faculty member in November 2011. He is also chief, Infectious Diseases Section, at the VA Palo Alto Health Care System. Among his other activities, Dr. Relman currently serves as Vice-President of the Infectious Diseases Society of America, Chair of the U.S. National Academies of Science Institute of Medicine's Forum on Microbial Threats, and member of the National Science Advisory Board for Biosecurity. He received a S.B. in biology from the Massachusetts Institute of Technology (1977) and an M.D. from Harvard Medical School Medicine (1982).

CISAC Conference Room

Paul Keim Acting Chair, National Science Advisory Board for Biosecurity, The Cowden Endowed Chair of Microbiology, Northern Arizona University and Director, Pathogen Genomics Division, Translational Genomics Research Institute Speaker

CISAC
Stanford University
Encina Hall, E209
Stanford, CA 94305-6165

0
Senior Fellow at the Freeman Spogli Institute for International Studies
Thomas C. and Joan M. Merigan Professor
Professor of Medicine
Professor of Microbiology and Immunology
1-RSD13_085_0052a-001.jpg MD

David A. Relman, M.D., is the Thomas C. and Joan M. Merigan Professor in the Departments of Medicine, and of Microbiology and Immunology at Stanford University, and Chief of Infectious Diseases at the Veterans Affairs Palo Alto Health Care System in Palo Alto, California. He is also Senior Fellow at the Freeman Spogli Institute for International Studies (FSI) at Stanford, and served as science co-director at the Center for International Security and Cooperation at Stanford from 2013-2017. He is currently director of a new Biosecurity Initiative at FSI.

Relman was an early pioneer in the modern study of the human indigenous microbiota. Most recently, his work has focused on human microbial community assembly, and community stability and resilience in the face of disturbance. Ecological theory and predictions are tested in clinical studies with multiple approaches for characterizing the human microbiome. Previous work included the development of molecular methods for identifying novel microbial pathogens, and the subsequent identification of several historically important microbial disease agents. One of his papers was selected as “one of the 50 most important publications of the past century” by the American Society for Microbiology.

Dr. Relman received an S.B. (Biology) from MIT, M.D. from Harvard Medical School, and joined the faculty at Stanford in 1994. He served as vice-chair of the NAS Committee that reviewed the science performed as part of the FBI investigation of the 2001 Anthrax Letters, as a member of the National Science Advisory Board on Biosecurity, and as President of the Infectious Diseases Society of America. He is currently a member of the Intelligence Community Studies Board and the Committee on Science, Technology and the Law, both at the National Academies of Science. He has received an NIH Pioneer Award, an NIH Transformative Research Award, and was elected a member of the National Academy of Medicine in 2011.

Stanford Health Policy Affiliate
CV
David Relman Professor of Medicine-infectious diseases, Stanford Medical School and CISAC Affiliated Faculty Member Commentator
Seminars
Paragraphs

Russia watchers in the West cannot be surprised that Vladimir Putin is on his way back to the Russian presidency. Dmitri Medvedev was always his protégé, and there was no doubt that major decisions could not be made without his approval. This includes signing the New START arms control treaty, cooperating with NATO in Afghanistan and supporting U.N. sanctions on Iran — all of which should provide reassurance that Putin’s return won’t undo the most important accomplishments of the U.S.-Russia “reset.”

Yet the relationship with the West will inevitably change. For one thing, Putin can have nothing like the rapport his protégé developed with President Obama, which was built upon the two leaders’ shared backgrounds as lawyers, their easy adoption of new technologies, and their fundamentally modern worldviews.

The Bilateral Presidential Commission which Obama and Medvedev created and charged with advancing U.S.-Russia cooperation on everything from counterterrorism to health care may suffer. The relationship as a whole is not adequately institutionalized, and depends on the personal attention of Russian officials who will likely avoid taking action without clear direction from Putin, or who may be removed altogether during the transition.

Putin’s return to the presidency will also provide fodder for Western critics bent on portraying Obama and the reset as a failure, or dismissing Putin’s Russia as merely a retread of the Soviet Union.

These critics are wrong — today’s Russia bears little resemblance to what Ronald Reagan dubbed an “evil empire” — but Putin has been far more tolerant of Soviet nostalgia than his junior partner, and his next term will surely bring a new litany of quotations about Soviet accomplishments and Russia’s glorious destiny that will turn stomachs in the West.

Although he has spent his entire career within the apparatus of state power, including two decades in the state security services, Putin is at heart a C.E.O., with a businessman’s appreciation for the bottom line. Western companies already doing business in Russia can expect continuity in their dealings with the state, and it will remain in Russia’s interest to open doors to new business with Europe and the United States. The next key milestone for expanding commercial ties will be Russia’s planned accession to the World Trade Organization, which could come as soon as December.

At home, Putin faces a looming budget crisis. As the population ages and oil and gas output plateaus the government will be unable to continue paying pensions, meeting the growing demand for medical care, or investing in dilapidated infrastructure throughout the country’s increasingly depopulated regions.

This means that while Putin will seek to preserve Russia’s current economic model, which is based on resource extraction and export, he will be forced to assimilate many of his protégé’s ideas for modernizing Russia’s research and manufacturing sectors. Medvedev’s signature initiative, the Skolkovo “city of innovation,” will likely receive continuing support from the Kremlin, although it will have little long-term impact without a thorough nationwide crackdown on corruption and red tape.

Putin’s restored power will be strongly felt in Russia’s immediate neighborhood, which he has called Moscow’s “sphere of privileged interests.” Even though Kiev has renewed Russia’s lease on the Black Sea Fleet’s Sevastopol base through 2042 and reversed nearly all of the previous government’s anti-Russian language and culture policies, Ukraine is unlikely to win a reprieve from high Russian gas prices. Putin will also continue to press Ukraine to join the Russia-dominated customs union in which Kazakhstan and Belarus already participate. He may also take advantage of Belarus’s deepening economic isolation and unrest to oust President Aleksandr Lukashenko in favor of a more reliable Kremlin ally.

Putin and Medvedev have been equally uncompromising toward Georgia. Both are openly contemptuous of Georgian President Mikheil Saakashvili, and it is unlikely that any progress on relations can occur until Georgia’s presidential transition in 2013.

Putin has good reason to continue backing NATO operations in Afghanistan to help stem the flow of drugs, weapons and Islamism into Tajikistan, Uzbekistan and Russia itself. Moreover, as China extends its economic hegemony into Central Asia, he may find America to be a welcome ally.

Putin appreciates the advantages of pragmatic partnerships and will seek to preserve the influence of traditional groupings like the U.N. Security Council and the G-8 while at the same time promoting alternatives like the Shanghai Cooperation Organization and the Brics.

The succession from Putin to Medvedev and back again was decided behind closed doors, and the formal transition of power is likely to take place with similar discipline. This should offer the West and the wider world some reassurance. Putin’s return to the presidency is far from the democratic ideal, but it is not the end of “reset.” Many ordinary Russians support him because he represents stability and continuity of the status quo and, for now, that is mostly good for Russia’s relations with the West.

All Publications button
1
Publication Type
Commentary
Publication Date
Journal Publisher
The New York Times
Authors
Authors
News Type
Commentary
Date
Paragraphs
In this op-ed, CISAC's Richard Rhodes argues that public health, a discipline that organizes science-based systems of surveillance and prevention, has been primarily responsible for controlling the effects of infectious disease. A similar campaign around public safety could help end the existential threat posed by nuclear weapons. Such a push would help create unity in common security and a fundamental transformation in relationships between nations, Rhodes argues.

Today, at the other end of the long trek down the glacier of the Cold War, the nuclear threat has seemingly calved off and fallen into the sea. In 2007, the Pew Research Center's Global Attitudes Project found that 12 countries rated the growing gap between rich and poor as the greatest danger to the world. HIV/AIDS led the list (or tied) in 16 countries, religious and ethnic hatred in another 12. Pollution was identified as the greatest menace in 19 countries, while substantial majorities in 25 countries thought global warming was a "very serious" problem. Only nine countries considered the spread of nuclear weapons to be the greatest danger to the world.

The response was very different among nuclear and national security experts when Indiana Republican Sen. Richard Lugar surveyed PDF them in 2005. This group of 85 experts judged that the possibility of a WMD attack against a city or other target somewhere in the world is real and increasing over time. The median estimate of the risk of a nuclear attack somewhere in the world by 2010 was 10 percent. The risk of an attack by 2015 doubled to 20 percent median. There was strong, though not universal, agreement that a nuclear attack is more likely to be carried out by a terrorist organization than by a government. The group was split 45 to 55 percent on whether terrorists were more likely to obtain an intact working nuclear weapon or manufacture one after obtaining weapon-grade nuclear material.

"The proliferation of weapons of mass destruction is not just a security problem," Lugar wrote in the report's introduction. "It is the economic dilemma and the moral challenge of the current age. On September 11, 2001, the world witnessed the destructive potential of international terrorism. But the September 11 attacks do not come close to approximating the destruction that would be unleashed by a nuclear weapon. Weapons of mass destruction have made it possible for a small nation, or even a sub-national group, to kill as many innocent people in a day as national armies killed in months of fighting during World War II.

"The bottom line is this," Lugar concluded: "For the foreseeable future, the United States and other nations will face an existential threat from the intersection of terrorism and weapons of mass destruction."

It's paradoxical that a diminished threat of a superpower nuclear exchange should somehow have resulted in a world where the danger of at least a single nuclear explosion in a major city has increased (and that city is as likely, or likelier, to be Moscow as it is to be Washington or New York). We tend to think that a terrorist nuclear attack would lead us to drive for the elimination of nuclear weapons. I think the opposite case is at least equally likely: A terrorist nuclear attack would almost certainly be followed by a retaliatory nuclear strike on whatever country we believed to be sheltering the perpetrators. That response would surely initiate a new round of nuclear armament and rearmament in the name of deterrence, however illogical. Think of how much 9/11 frightened us; think of how desperate our leaders were to prevent any further such attacks; think of the fact that we invaded and occupied a country, Iraq, that had nothing to do with those attacks in the name of sending a message.

Richard Butler, the former chairman of the Canberra Commission on the Elimination of Nuclear Weapons and the last chairman of UNSCOM, often makes the point that the problem with nuclear weapons is nuclear weapons. People don't always understand what he means. He means that it is the weapons themselves that are the problem, not the values of the entities that control them. U.S. nuclear weapons are just as potentially dangerous to the world as, say, North Korean nuclear weapons. More, I would say, since we have greater numbers of them and have not hesitated to brandish them--even to use them--when we thought it in our interest to do so.

That the problem with nuclear weapons is nuclear weapons may seem counterintuitive, but two centuries ago governments began to think that way about disease, with untold benefits to humanity as a result. Epidemic disease had been conceived in normative terms, as an act of God for which states bore no responsibility. The change that came when disease began to be conceived as a phenomenon of nature without a metaphysical superstructure, a public health problem, a problem for government and a measure of government's success, was revolutionary. More lives were saved, and spared, with public health measures in the twentieth century in the United States alone than were lost throughout the world in all of the twentieth century's wars.

As my Scottish friend Gil Elliot wrote in his seminal book Twentieth Century Book of the Dead, "[These lives] are not saved by accident or goodwill. Human life is daily deliberately protected from nature by accepted practices of hygiene and medical care, by the control of living conditions and the guidance of human relationships. Mortality statistics are constantly examined to see if the causes of death reveal any areas needing special attention. Because of the success of these practices, the area of public death has, in advanced societies, been taken over by man-made death--once an insignificant or 'merged' part of the spectrum, now almost the whole.

"When politicians, in tones of grave wonder, characterize our age as one of vast effort in saving human life, and enormous vigor in destroying it, they seem to feel they are indicating some mysterious paradox of the human spirit. There is no paradox and no mystery. The difference is that one area of public death has been tackled and secured by the forces of reason; the other has not. The pioneers of public health did not change nature, or men, but adjusted the active relationship of men to certain aspects of nature so that the relationship became one of watchful and healthy respect. In doing so they had to contend with and struggle against the suspicious opposition of those who believed that to interfere with nature was sinful, and even that disease and plague were the result of something sinful in the nature of man himself."

Elliot goes on to compare what he calls "public death," meaning biological death, death from disease, to man-made death: "[I do not wish] to claim mystical authority for the comparison I have made between two kinds of public death--that which results from disease and that which we call man-made. The irreducible virtue of the analogy is that the problem of man-made death, like that of disease, can be tackled only by reason. It contains the same elements as the problem of disease--the need to locate the sources of the pest, to devise preventive measures, and to maintain systematic vigilance in their execution. But it is a much wider problem, and for obvious reasons cannot be dealt with by scientific methods to the same extent as can disease."

To advance the cause of public health it was necessary to depoliticize disease, to remove it from the realm of value and install it in the realm of fact. Today we have advanced to the point where international cooperation toward the prevention, control, and even elimination of disease is possible among nations that hardly cooperate with each other in any other way. No one any longer considers disease a political issue, except to the extent that its control measures a nation's quality of life, and only modern primitives consider it a judgment of God.

In 1999, for the first time in human history, infectious diseases no longer ranked first among causes of death worldwide. Public health, a discipline which organizes science-based systems of surveillance and prevention, was primarily responsible for that millennial change in human mortality. One-half of all the increases in life expectancy in recorded history occurred within the twentieth century. Most of the worldwide increase was accomplished in the first half of the century, and it was almost entirely the result of public health measures directed to primary prevention. Better nutrition, sewage treatment, water purification, the pasteurization of milk, and the immunization of children extended human life--not surgeons cutting or doctors dispensing pills.

Public health is medicine's greatest success story and a powerful model for a parallel discipline, which I propose to call public safety.

Where nuclear weapons--the largest-scale instruments of man-made death--are concerned, the elements of that discipline of public safety have already begun to assemble themselves: materials control and accounting, cooperative threat reduction, security guarantees, agreements and treaties, surveillance and inspection, sanctions, forceful disarming if all else fails.

Reducing and finally eliminating the world's increasingly vestigial nuclear arsenals may be delayed by extremists of the right or the left, as progress was stalled during the George W. Bush administration by rigid Manichaean ideologues who imagined that there might be good nuclear powers and evil nuclear powers and sought to disarm only those they considered evil. Nuclear weapons operate beyond good and evil. They destroy without discrimination or mercy: Whether one lives or dies in their operation is entirely a question of distance from ground zero. In Elliot's eloquent words, they create nations of the dead, and collectively have the capacity to create a world of the dead. But as Niels Bohr, the great Danish physicist and philosopher, was the first to realize, the complement of that utter destructiveness must then be unity in common security, just as it was with smallpox, a fundamental transformation in relationships between nations, nondiscrimination in unity not on the dark side but by the light of day.

Violence originates in vulnerability brutalized: It is vulnerability's corruption, but also its revenge. "Perhaps everything terrible," the poet Rainer Maria Rilke once wrote, "is in its deepest being something helpless that wants help from us." As we extend our commitment to common security, as we work to master man-made death, we will need to recognize that terrible helplessness and relieve it--in others, but also in ourselves.

All News button
1
Authors
News Type
News
Date
Paragraphs
At an April 11 symposium in Washington, D.C., Homeland Security Secretary Michael Chertoff said while the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster. CISAC members Lynn Eden, Martha Crenshaw, and Mariano-Florentino Cuéllar participated in "Germ Warfare, Contagious Disease and the Constitution," a daylong event co-hosted by Stanford Law School. CISAC affiliate Laura K. Donohue conceived and developed the project, which aimed to bring together senior policy-makers and legal experts to discuss how issues of constitutional law inform responses to natural pandemics or bioterrorism attacks.

Secretary Michael Chertoff of the Department of Homeland Security delivered the keynote address April 11 at the panel titled “Germ Warfare, Contagious Disease and the Constitution” in Washington, D.C.

Although the best-laid plans are likely to change if a pandemic or bioterrorism attack hits the United States, having no plans in place is a sure guarantee for disaster, Homeland Security Secretary Michael Chertoff told policy-makers, government officials, constitutional law experts and law students at a symposium April 11 in Washington, D.C.

"Preparation won't eliminate the problems and the stress, and it is often said that no battle plan has ever survived first contact with the enemy," Chertoff told the roughly 200 people attending the event, "Germ Warfare, Contagious Disease and the Constitution," hosted by Stanford Law School and the Constitution Project, a nonprofit organization.

"But I can tell you this," Chertoff continued. "If you don't have a plan, you are definitely going to have the worst-case outcome. A plan at least gives you a running start."

During the symposium, experts discussed the need to reform the complex web of federal and state laws to enable agencies to respond effectively to deadly natural or manmade epidemics—from pandemic flu to smallpox and aerosolized anthrax—while protecting individual rights.

Earlier that day, about 60 people from the current and two previous presidential administrations, public health officials, Stanford academics and law students participated in a closed-door, fictitious scenario that explored the federal government's response to an unfolding deadly epidemic as it crossed state lines. Lynn Eden, associate director for research at Stanford's Center for International Security and Cooperation (CISAC) at the Freeman Spogli Institute for International Studies, moderated the session, which was developed in cooperation with experts from the Department of Homeland Security.

"I think it's the first time detailed issues of constitutional law have been brought to bear in a natural pandemic or bioterrorism exercise," Eden said afterward. "It's very hard to plan for a catastrophe. This approach brought another facet to bear on disaster planning."

Margaret Hamburg, a former assistant secretary in the Department of Health and Human Services, opened the symposium, which was broadcast live on C-SPAN from the Dirksen Senate Office Building. Kathleen Sullivan, director of the Stanford Constitutional Law Center, moderated a panel featuring Stanford law Professors Pamela Karlan and Robert Weisberg; Christopher Chyba, director of the Program on Science and Global Security at Princeton and a former CISAC co-director; Jeff Runge, assistant secretary in the Department of Homeland Security; Michael Greenberger, director of the Center for Health and Human Security at the University of Maryland; and Martin Cetron, director of the Division of Global Migration and Quarantine at the U.S. Centers for Disease Control and Prevention.

Sullivan opened the panel by reflecting on how recent health crises have informed ongoing legal and policy debates: "West Nile virus. Anthrax mailings. Avian flu—responses to these infectious disease issues and concern about bioterrorism are running about our minds as we think about the response to 9/11 and Hurricane Katrina, and the complex web of local, state and federal authority to deal with such emergencies. What does the Constitution have to say about our ability to deal with infectious disease, whether it's naturally occurring or composed as a weapon of violence?"

In the 21st century, Cetron explained, health officials still rely on a "14th-century toolbox of isolation and quarantine" to control an outbreak. That is "part of our modern reality," he said. "The biggest area is not lack of specific authority, but the fact that jurisdictions are highly complex when it comes to international ports of entry [and] interstate movement. There are often overlapping jurisdictions and overlapping authorities. If there's a gap in some of this, the risk is that neither the state nor the feds would want to step up to that responsibility."

Greenberger said state officials are often ignorant about what they can do in an emergency. "The powers given to governors are extraordinary," he said. Three statutes exist in Maryland to authorize declarations of emergency and allow the governor to enforce isolation and quarantine of infected people, order citizens to take treatment against their will, force doctors to serve in dangerous situations and seize hospitals. "What's extraordinary is that most governors don't even know they have this power," Greenberger said. "The extent of legal illiteracy in this area is shocking."

Despite such challenges, Chertoff praised the participants for tackling the issue. "I think for the first time we've begun to think very seriously and in a disciplined fashion about how to plan for dealing with a major natural pandemic or a major biological attack," he said. "I wish I could tell you these things are unthinkable. But the one thing I've learned in the last seven years is there's pretty much nothing that's unthinkable."

Stanford in Washington

Laura K. Donohue, a CISAC affiliate and a 2007 Stanford Law School graduate who is the inaugural fellow at the Stanford Constitutional Law Center, conceived the daylong event to bring together policy-makers and constitutional experts to discuss response to natural pandemics and bioterrorism. "It was a chance to bring together the policy world, both operational and strategic, and give them the opportunity to talk to legal experts," she said. "This helped policy-makers think through the issues and think outside the box, and it did so in a non-threatening manner."

Donohue said she was prompted to create the symposium after directing a CISAC-supported terrorism-response exercise in 2003 that involved more than 25 agencies at the national, state and local levels. "In these exercises involving first responders, legal issues always got pushed off the table," Donohue said. "I was struck by this. In an emergency, the law goes out the window. Then, when I got to law school, I saw the broader legal and constitutional context for this discussion."

With support from the directors at CISAC and Stanford Law School, and funding from donor Peter Bing and the Stanford Constitutional Law Center, Donohue brought the two groups together in a high-profile setting.

"This was Stanford in Washington," she said. "It was an opportunity for Stanford to be visible at the U.S. Senate with participation from leading people on these issues. There is no doubt we got an audience we wouldn't otherwise have attracted."

This article first appeared in Stanford Report, 4/16/2008.

All News button
1
Subscribe to Health Care