Which is which?

updated photo selection: okay if you are the one person who actually look at this often (Hi, mom), you'll be able to tell, since only one changed - I got a much better photo from Japan (thank you, Der Spiegel).


Tell me which one is Fukushima (Tokyo) and which is Chernobyl (Prypyat)?

Photograph #1


















Photograph #2
















A Ukrainian Liquidator, one of the first on site at Chrnobyl & surprisingly still alive, compliments the Japanese. "We wore normal clothes and a face respirator. As we went in to the reactor we were given an iodine preparation which was normally the first emergency aid..."

Today, 50 are remaining to control 3 reactors, hoping to keep them cooled. Or more, depending on which source. The Ministry of Health increased the acceptable exposure limit to "to 250 millisieverts from 100 millisieverts, five times the maximum exposure permitted for American nuclear plant workers."

Despite the demands of occupational safety experts here to protect workers, I can't imagine the Dept. of Labor (i.e., OSHA) actually being capable of moving overnight to change an exposure limit. The cynic in me thinks this is, in part, because after-the-fact the safety professions would turn around and demand to have all of the other 30-year old limits changed, too.

I'm surprised the Green Party in the US isn't going more ballistic, given its absolutist platform on nuclear power. The party chair for Die Grüne [the German Green Party] was making this point in a rather restrained manner Sunday, anticipating the impending state elections in Baden-Württemburg. Given the party's platform on feminism, I suppose referring to her as the chairman would be gauche.

Interestingly in the German news, the Greens are confronted with 'warming their hearts' [ihre Seele wärmen] over the opportunity to renew one of their core beliefs coming to conflict with their desire to create a Black-Green coalition government, i.e. CDU/Green, which to the American bipolar condition sounds strange with the conservatives & tree-huggers. Admittedly, the German Conservatives are still in touch with reality, unlike ours.


#1 = Chernobyl
#2 = Fukushima

Commencement @ Rodent U.

Pictures from Minnesota & graduation weekend. Yes, I attended Commencement. No, I'm not "really" done. I'll bet that quite a few students aren't either. As long as you'll be done before December - you're really sure you'll be really done - you can go through the motions now. Or wait. Why wait? I was the only current industrial hygiene student.

My brother Sean & his son Ciaran attended, as did Grandma & Grandpa. So, starting with the most important:




Pete my research adviser & me.

I simply couldn't imagine him spiffed up in the academic regalia; normally he dresses like me. Unfortunately the other two IH profs weren't there. I was/am curious what they would have worn.

Mortar boards are sooooo dorky. The "hoods" are pretty, though hood is no doubt some archaic term that no longer reflects the design of the item, which does not and cannot go over one's head. The front/over color reflects the person's degree.
Blue = not smart enough to stop (Ph.D., regardless of field of study)
Pink = public health (either MPH or Dr.PH).

The faculty was pretty colorful taken en mass, due to the vast array of fields of study & granting universities. Unfortunately, the only picture I have is much too underexposed.

The part of the hood hanging in the back is lined with colors of the school granting the degree. If for some reason I ever need to wear this sort of get up again, I'll need to find another pink/gold-maroon one; they are rented, like a tux. I think it was a $100-ish fee for losing it. Don't lie to me - it's pink. You can call it 'salmon' if it makes you feel more elegant. Public Health is a recently recognized profession. Let's face it, we got hind teat after medicine, law, or theology.



Now ... when I actually finish writing my thesis sounds so impressive, as if I've actually started and have my oral exams sounds so dental ... now then there will be serious celebratory events at the Gopher household, albeit with just the 4 of us.




Greg, one of the first people I met at Rodent U., and one of the few of us in EnHS who did the mental-health 3-year tour of duty to the MPH.







The procession went from Coffmann Union over Washington Ave. to Northrup Auditorium. Picture is from over Washington Ave. The quadrangle here is the original campus. They all date to 1911-1914. It's a beautiful area. Northrup is behind the trees.



Jr.Gohper#2 getting into practice.




The boys' younger cousin came out for graduation weekend. They got a long fantastically.




Couldn't have the family visit without stopping at May Day Cafe, my favorite hangout.






Before


















After
I'll let you know how much I get for selling my hair.














Boys & their toys




Hey, Mom, will this apple juice make Apfelschorle?

Drugs vs. Reading good books

Hennepin County Sheriff's Office is implementing a new program within DARE (drug abuse resistance education - btw have I mentioned how annoying I find cutesy acronyms?). I'm glad they're being creative about personnel resources. I know it's been around a while, but I don't know if it's really been demonstrated to be effective. Given the teenage drinking rate is chronically increasing, I'm not sure if it's so worthwhile.

Drugs & alcohol are some of the few things that worry me about being a parent ... I cannot remember ever being even vaguely interested in trying anything. Alcohol was always an ordinary part of life: I've never seen either of my parents intoxicated. Albeit, this is no doubt part of a child's perception of things - - but still, being intoxicated was always seen as something stupid, just as doing drugs was seen as something stupid.

Yet, I never got any peer pressure to do either. My high-school classmates drank - yet the rebellious aspect always seemed to be the simple "look at what I can get away with". Getting drunk didn't seem to be the goal. Admittedly, since I was never part of the social circles, this is a perception from outside.

Still, both of my parents smoked, and I was also never tempted to smoke either. I didn't see it as bad or good, just something that seemed like "mom and dad do it". Unlike drinking, which I assumed all adults did, smoking seemed to be more of a personal choice.

My brothers & I got wine at the big holiday dinners (Thanksgiving, Christmas & Easter) - just a little bit. I think I was 12 the first time I did. I distinctly remember it, since it seemed to be such a big deal.

I once wondered if being Roman Catholic might make drinking less of a mystery. We normally let children take communion when they're around 9 or 10 and we use real wine. Never the less, I'm sure Catholics are just as likely to drink underage as any other group, so my assumption is likely empty. (let's not even get into what 'underage' is or ought to be)

There are so many things that are critical to a child having a healthy, well-adjusted life, e.g. reading, respecting others, personal faith. In the grand scale of things, I'm more worried about the boys avoiding the life-destroying activities (drugs/teenage sex) than whether they read at age 5 or 6. Yet, I can influence the reading far more than the others.

500 cal/day v. 300 cal/hr

The standard figure cited for breastfeeding is that it uses an extra 500 calories per day; an incentive to loose the pregnancy weight.

The English National Health Service (their agent of evil socialism), reports something even better. Sex will use up 300 calories per hour. Giving you a whole-body cardiovascular work-out and reducing the risk of heart disease. I suppose this figure depends upon how ... enthusiastic ... you are.

And, yet again even better:

If you're worried about wrinkles - orgasms even help prevent frown lines from deepening
.

Cooking Tip: burns

When you're standing with oven mits on,
to protect your hands from the metal handles of the roasting pan ...
and you've been doing it for a couple minutes, because you're basting the ham (other piece of meat) ...
and you think "I need to handle something with dexterity",
and want to take the oven mit off,
but the other hand is still holding the roasting pan,

don't tuck it under your armpit while wearing a short sleeved shirt.

just don't.

Class v. Status

I wrote quite a bit this summer for my socio-behavioral-whatever course. I've used the term 'socioeconomic status' several times, as well as other PC terms. I finally had a breakthrough finishing my last assignment, which was a brainstorming project to facilitate the development of an intervention to reduce childhood obesity (how's that sound for socio-behavioral b.s.?)

Obesity is a result of our culture's class system: we (the huddled masses yearning to breathe free) wanted to be like the rich. The rich who had an abundance of food in general, and who were able to eat lots of different kinds of food. The rich who didn't need to spend 14 hours per day doing back breaking labor in a factory or on a farm. When presented with the opportunity to be less active, we took it; when presented with abundant food, we took that too.

After writing 'residue of a class system' for the paper, I've subsequently been thinking much on class as a factor in public health. Yes, people will assure you that class is important. But I think too many people look at race rather than class. Focusing on "race" lets rich white Americans think we're doing something good for the poor blacks we've been oppressing over the centuries and therefore lets us lie to ourselves that we're not oppressing anyone anymore.

I think that this whole "race card" does get played waaaaay too often. It keeps the poor disenfranchised, because the poor aren't one color or one race. "Race card" is also a euphemism for "relations with African-Americans" and is racist in and of itself by excluding the rest of the races.

It's a pity Society doesn't look at socioeconomic class: it is far, far, faaar more quantifiable than some chromosomal chromatograph of one's skin color.

I've decided that I'm going to ditch the use of "status" in regards to most of my writing. Screw it. It isn't socioeconomic 'status' - it's a class. It is an acknowledgment that we live in a class system just as much as the poor schmos in India - we just don't have the decency or self-awareness to acknowledge it.

A Class System is one where you are simply born into your lot in life. You're working class or Upper Class or whatever, because you're parents are. Or possibly because you managed to eek your way into that class (usually by marriage or falling out of a higher one). Being in a "status" sounds so ... transitory ... Like the boarding gate status for your flight. As if it's going to change, and you'll like the change. The term "status symbol" has an inherent meaning of "status of being rich/wealthy". When I was in high school, Calvin Klein Jeans were the 'status symbol' d'jour. No one mentioned that ratty worn-out hand-me-downs were a status symbol too. Because it was a status we didn't want to have.

Being at the bottom of the socioeconomic cesspool of life isn't a "status" - it's a way of life. Which you will in a probability never escape. See ya soon!

polio pilgrimage

I guess occasionally an oppressive unilateral empire might do something useful:

Saudi Arabia has announced that everyone arriving for the annual pilgrimage to Mecca in November will have to swallow a dose of oral polio vaccine under the eyes of health officials.

Multi-Species Health Care Options

Walgreen's has a prescription assistance program. No qualifying criteria; anyone can join. It's an annual fee to get certain generic drugs cheaper than normal by selling them in 3-month quantities rather than 1- month.

Raven - our cat - now has an insurance policy. I pay $12/mo rather than $18/mo.

So, my cat can get prescription assistance because I can fork out $20 and pay for 3 months at a time?

I have actually never understood the conservative position that public health care is evil. It's obvious listening to their rhetoric that they have absolutely no clue what Socialism is. But what is this option bad? "It just is" fails to move me. Repeating stupidity fails to move me, too.

I suppose I'm glad we can afford our cat - she's been horribly expensive this month.

The cat + the car + my education = breaking the bank this month.

Raven is okay - she finally put on weight. Unfortunately, she hasn't stopped caterwauling or slobbering. That's why I wanted a cat - they don't slobber. Except mine. ... ah, well. I hope when I'm that old, no one complains about me drooling.

[def.] Knowledge

Additional research based knowledge of the costs imposed on people ....ref.1

I cannot imagine a chemist or physicist (or industrial hygienist) writing this sentence. How does one make any claim to anything in a scientific peer-reviewed journal if it isn't researched based? I suppose the assumption excludes personal opinions and the editorial section.

I've seen this several times in this course's readings. It's even defined somewhere in the text. It's the social science method to claim scientific validity for a subject most physical scientists don't think is science.

(ref.1) Warner, et. al. 1995. Criteria for determining an optimal cigarette tax: the economist's perspective. Tobacco Control, 4, 380-386.

Hee Hee Health Care

Saying you're going to do health care reform without a public option is kind of like saying you're going to fight Al Qaeda in Afghanistan by invading Iraq. It misses the point -- on purpose.

Business bonus points

Last night I was at the Varsity Theater over in Dinkytown. Behind the bar were two signs:

Bottled water: $1.50

Ear plugs: $1


Just as I'm in the midst of a series of papers on occupational hearing loss for PubH 6020 ... perhaps I'll mention it in my next paper. At least if I decide to go back there for a concert, I won't need to worry about having my own ear plugs. I'm curious to know whether or not the employees there have to wear them during shows?

Teflon Coated Danger?

PTFE (polytetrafluoroethylene) is Teflon(TM), which people will tell you causes cancer or whatever. It might. If you ever get exposed to it.

People scream about "Risk!" without comprehending what it really means, even qualitatively.

Risk = exposure * hazard. therefore .... No exposure = no risk.


regarding your Teflon coated cookware which you threw out after being told that it would give you cancer:

The science is absolutely clear: Teflon-coated pans are safe up to about 780F, a temperature at which anything in the pan will have caught fire.

So, as a rule of thumb, you should be careful when flames start shooting out of your nonstick pan. Soon it might get hot enough to emit toxic Teflon particles.

.

TV makes you stupid

Mayo Clinic researchers demonstrate that TV makes you stupid, if you think CSI-ETC is vaguely connected to reality.

The Refashioning of Our World

In yesterday's post, I referred to a book written about something I was interested in when I was a child. This is from the author of that book, Infections and Inequalities as soon as I get a chance to finish it, I'll probably put a review here.

As heard on NPR's Weekend Edition Sunday, December 21, 2008.

I believe in health care as a human right. I’ve worked as a doctor in many places, and I’ve seen where to be poor means to be bereft of rights. I saw early on, still just a medical student, the panicky dead-end faced by so many of the destitute sick: a young woman dying in childbirth; a child writhing in the spasms of a terrible disease for which a vaccine has existed—for more than a century; a friend whose guts were irreparably shredded by bacteria from impure water; an eight-year old caught in cross-fire. Li mouri bet—what a stupid death, goes one Haitian response.

Fighting such “stupid deaths” is never the work of one, or even of a small group. I’ve had the privilege of joining many others providing medical care to people who would otherwise not be able to get it. The number of those eager to serve is impressive, and so is the amount that can be accomplished. I believe that stupid deaths can be averted; we’ve done it again and again. But this hard and painful work has never yet been an urgent global priority.

The fight for health as a human right, a fight with real promise, has so far been plagued by failures. Failure because we are chronically short of resources. Failure because we are too often at the mercy of those with the power and money to decide the fates of hundreds of millions. Failure because ill health, as we have learned again and again, is more often than not a symptom of poverty and violence and inequality—and we do little to fight those when we provide just vaccines, or only treatment for one disease or another. Every premature death, and there are millions of these each year, should be considered a rebuke.

I know it’s not enough to attend only to the immediate needs of the patient in front of me. We must also call attention to the failures and inadequacy of our own best efforts. The goal of preventing human suffering must be linked to the task of bringing others, many others, into a movement for basic rights.

The most vulnerable—those whose rights are trampled, those rarely invited to summarize their convictions for a radio audience—still believe in human rights, in spite of—or perhaps because of—their own troubles. Seeing this in Haiti and elsewhere has moved me deeply and taught me a great deal.

I move uneasily between the obligation to intervene and the troubling knowledge that much of the work we do, praised as “humanitarian” or “charitable,” does not always lead us closer to our goal. That goal is nothing less than the refashioning of our world into one in which no one starves, drinks impure water, lives in fear of the powerful and violent, or dies ill and unattended.

Of course such a world is a utopia, and most of us know that we live in a dystopia. But all of us carry somewhere within us the belief that moving away from dystopia moves us towards something better and more humane. I still believe this.


Dr. Paul Farmer is a founding director of Partners In Health, an international organization providing health care to people living in poverty. He is also a professor in the Department of Global Health and Social Medicine at Harvard Medical School.

"The Refashioning of Our World," Copyright ©2008 by Dr. Paul Farmer. Part of the This I Believe Essay Collection found at www.thisibelieve.org, Copyright © 2006-2009, This I Believe, Inc. Reprinted with permission of This I Believe, Inc. -- yes, really, I asked for permission.


... and, of course, they want you to know...
This I Believe is an international project engaging people in writing, sharing, and discussing the core values that guide their daily lives, and is based on the popular 1950s radio series of the same name hosted by Edward R. Murrow. To read and hear other essays, and to submit your own, visit www.thisibelieve.org.
There are some fantastic essays, both from the 50s and now. Submit your own essay ... I dare you.

Do Overs

If you could do it over, would you?

While suggesting an author to interview for an MPR program, I noted: When I was 12, this is what I decided I wanted to do with my life.

... would I want a 'do over' for my life?

If I weren't married, I would have been in the middle of (or perhaps done with) my MPH. Except ... I would have enrolled in the infectious disease program. I had been looking at the other U of M and Johns Hopkins before moving here. Had that panned out, then yes I would have been back on the path I wanted 31 years ago, especially if I'd gone to Johns Hopkins.

It's odd how Life's path lead me back so close to my original goal. So close, and yet so far away.

I want to go back and try to avoid the all-too-many examples of "God, I was Young and Stupid", as well as the all-too-many examples of "God, I'm Not So Young, but I'm Still Stupid". No, I don't need to get a 2nd chance -I just want to have not done it in the first place.

Epilepsy

NPR's Talk of the Nation broadcast recently Living with the Uncertainty of Epilepsy. A classmate of mine called me in the middle of the afternoon to tell me it was on. It's a great discussion.

More people die every year from epilepsy than breast cancer., according to the guest speaker. Hmmm... According to the American Cancer Society, 40,930 people are expected to die from breast cancer this year. How many people die from epilepsy? Well, drowning because you have a seizure is likely to be reported on the death certificate, since the person drowned, regardless of the cause. There is a small number of people who do die directly from seizures. It is quite certainly not over 40k. Who among the listeners questions that statement, if they have a loved one with epilepsy?

Well, I did, simply becuase I wanted to know how many people do die. I've seen the figure 812/yr, but it was from a semi-reliable source (which means it might be right). It wasn't from MMWR or some other über-reliable source.

There isn't even a single definition of what constitutes epilepsy. It's usually like Stewart & pornography: I won't try to define it, "but I know it when I see it."(1)

Take one guess about who gets more money? Dispersal of money for medical research is a boutique solution. It's like pets: the cute animals get picked first. The obsession with modern feminism has made breast cancer chic. Women with it look just like women without it. Unless she's going through chemo, it isn't going to be noticeable. Breast cancer shows up later in life; she's likely live most of her life without it. Epilepsy shows up with little children and often lasts the rest of your life. Breasts are more attractive than brains.

A description of the drug I take: The exact way lamotrigine works is unknown. You tell me whether people have anti-cancer drugs that are used without understanding how they work?

In the past two years I've had more problems with managing my epilepsy. ("more" being a pretty relative term, compared to others' "1 per day" or "4 or 5 per day".) I switched medications. I've had wierdo events that I'm not even sure if they're seizures, I'm assuming they are simply because I have epilepsy. But my neurologist opines that one simply doesn't remain aware during seizures, therefore this couldn't be a seizure. I had a seizure when I was 8 months pregnant with Jr.Gopher#2. The idea of going swimming with Mr.Gopher in lake Michigan was nice ... but so far away from the rest of the world with relatively trecherous water ...? No. One of the editors at the Lansing State Journal had a daughter who drowned at the age of 25, from a seizure. I was at her funeral. While I cry at funerals anyway, this seemed to be the end of such a full life. I was 37 or so at the time.

Yet I am left with a large minority who have well-controlled seizures for whom the only major inconvenience is remembering to take my medicine twice each day. Well, actually pacifying the Minnesota DMV is really annoying, but only an annual intrusion. I'm horrified at the stories of the majority of people with epilepsy, especially parents/kids coping with the idiots inhabiting our society. I told my classmates I have epilepsy, and their response was either "oh?" or "are you doing okay with school?" I didn't have anyone run away from me. I'm sure their response would have been the same if it was one of my kids. Jr.Gopher has epilepsy? Sure, we can get together on Sunday for the kids to play together. As opposed to people who get freaked out about it.

If you have the chance to convince some millionare to spend her money on something worthwhile, try the Epilepsy Foundation.


(1) Jacobellis v. Ohio, 378 U.S. 184, 197 (1964)

holy cow ...

It's always nice to know one's professional opinion is valued. Sure, the annual "you didn't totally screw up" review from you boss is the ticket to the "oh, well, you can't have one" bonus.

10 Ten best things about swine flu: #1 is from yours truly.

I'm suddenly struck by the fear that someone is going to write MPR and say "what a total screw up, why did you listen to her?" Although one would also hope that they asked someone else before quoting me..... Somehow the idea of telling my employer/employees this pales in comparison to the biggest radio station in the state quoting me.

I wish I'd ...

There's an ad for the Peace Corps on several of the bus stops around town, with the slogan "Means you'll never have to say I wish I'd ..." A post on the News Cut blog on MPR was The War on Parenthood about how pop culture claims we influence our children's eventual moral and character development.

I thought about this, and my immediate response was there are two major rules to parenting:

Recommendation 1: Do the best you can. What else can the world reasonably expect of you?

Recommendation 2: There is absolutely no way you can possibly control the actions or thoughts of another person (like your children). Don't bother trying.

If my children become self-sufficient men capable of loving others, and respecting and loving themselves, I will have succeeded as a mother. Anything else is icing on the cake of life.

Then I thought about it some more during my 15 minute break from the panic of turning in homework late. and later. and an exam due in a few days that I haven't started ...

This obsession with blaming me for anything wrong in the future with my kids is simply a left over of the eugenics "your children are born with their character already predestined, which is why you're so poor and I'm not".

The journalist did a series of interviews with college students (of all ages) at the smaller colleges in Minn. One of them gave up her dreams of being an artist because her parents said "you can't make any money at it".

I really want to believe that I will never tell my children they shouldn't bother to at least try. The next Steve Yzerman? Go for it. A professional portrait painter? go for it. The next president? You're nuts, but hey, go for it.

Will they actually make it? Maybe not. My brother, STFU&GBTW no doubt heard "there are too many people who all want that job, go do something that you can succeed at". You know what you should do? Go watch his name zooming by on the next James Cameron movie. Or Lord of the Rings. Or whatever it is he's doing.

I read an old Life article when I was about 12 or 13 about a physician somewhere in BFE Appalachia who did housecalls for the destitute (i.e., just about the whole area). I was so inspired. I decided that's what I wanted to do with my life. Not the Appalachia part, but the improving the quality of people's health part. I thought you had to be a doctor to do it. So, I decided to go to med school. (That, at least, generally gets parental emotional support.) After about 3 semesters in college, I realized there was no way in hell I would ever make it through med school. I was so disappointed that I couldn't pursue this career. I didn't know what else to do, so I figured I'd just finish what I started and be a chemist. I am quite certain I would have made a piss-poor doctor.

Fast forward 30 years ...

You know what I really really wanted, back in 1979? I wanted to go into Public Health. A field which doesn't require being a physician (one who deals with the individuals); I wanted the large-scale public aspect of it. Had I ever heard of it? No. Would I have done it then? Yes. Would people have supported my idea of going to some third world country to make their lives better? I'm pretty sure not.

Where am I in 2009? The University of Minnesota School of Public Health. I finally figured out what I wanted. Am I doing it? Nope. I'm sitting in the midst of a good school - (well, I really wanted Johns Hopkins which I would have done, had I not married Mr. Gopher) - with a good global public health infectious disease program. Now that's what I wanted to do with most of my life. Nope, I'm in the Environmental Health Science's Industrial Hygiene program. Most people wonder if I clean teeth.

I'm still stuck in the "I wish I'd ..." If I hadn't been married and forced to confront the reality of balancing my life with someone else? Hell, yes, I'd have popped over to Baltimore for a few years.

But, you know what? That beautiful piece of paper which will say University of Minnesota Masters of Public Health doesn't come with an expiration date. I know what I want. Perhaps one of these days I'll get it. And, unlike the kid nextdoor who idolizes Wayne Gretsky ... at least I'm not too old to pursue what was once my dream.

This I Believe ...

National Public Radio gives access to recorded archives from the original 1950s broadcasts of This I Believe ...

Some of the more intriguing records are from the not-so-famous. If you're interested, however, the NPR archive has 2-4 min. essays from Pres. Harry Truman, Martha Graham, Margaret Meade, Sen. Margaret Chase-Smith, Justice William Douglas, and Jackie Robinson.

I particularly enjoyed one on a Doubting, Questioning Mind.

The page will lead you to the modern essays produced for NPR (rather than the originals for Edward R. Murrow/).
From someone I can honestly say I admire a great deal: Health is Human Right, by Paul Farmer.



Out of the mouths of babes: Thirty Things I Believe In.

Fee for Public Health Compliance

Minnesota is struggling with a budget problem. $6,000,000 of one. So, Gov. T-Paw is searching for ways to "cut corporate taxes" and some how concurrently cut spending without pissing off the electorate toooo much, since he's allowed to run for re-election next year. Minnesota has developed a byzantine system of "fees", rather than "taxes". So, what sort of fees could we start charging? an intriguing question posed by an MPR blog. My suggestion follows STFU&GBTW's complaint about vaccination compliance.

Implement a fee in order to refuse vaccination. You don't want to vaccinate your kid? Okay, but you'll need to pony up $1,000.

$1k too much? Not to the parents of the child who catches whooping cough from your immuno-retarded* kid. Who are going to miss work, since they can't send the child to day care or school. In addition to losing money from lost work, they'll spend more money on doctor's bills, medication, and the extra care items otherwise unnecessary. Renting Bob the Builder, Built to be Wild, so that Jr. doesn't go berserk cooped up in bed for a week or two.

Nope, start collecting the $1k, and use it to subsidize the public health costs.

*immunodeficient or immunocompromised should not be shanghaied by retards who don't believe in scientific theory or Koch's Principles. I advocate immuno-retarded, to incorporate the inherent stupidity of the parents.