Monday, May 4, 2009

Thank you, Wikipedia!

Without you I wouldn't be able to understand some of my Con Law cases.

Friday, May 1, 2009

Swine flu: an overrreaction or not getting the whole story?

At work we're supposed to have patients who are suspected of having swine flu (as well as everyone accompanying them) immediately put on a mask, then bring them right away into a designated room so they don't sit in the waiting room while waiting for their appointment. When our office manager called Infectious Disease at the hospital per their protocol immediately after our patient arrived, the first question she was asked was "does she need to be admitted?" Yet at the same time, we're supposed to treat the patients suspected of having swine flu exactly the same as we treat other patients suspected of having the regular flu. In other words, no special precautions beyond the mask and not having them wait in the waiting room.

This doesn't make sense to me. Any flu is a droplet infection, which means that anyone and anything within 3 feet is considered contaminated. In other words, anything you touch within those three feet can give you the flu if you then touch your mouth, eyes or nose. Either there's something special about the swine flu or there isn't. Either we treat it as something special or we don't, not this halfway stuff. The thing that makes me nervous is that the people dying in Mexico are in their 20s and 30s, which is what flu did during the pandemic of 1918.

Q&A: Why is swine flu such a big deal?
NBC’s Robert Bazell sorts the facts from the fears


By Robert Bazell
Chief science and health correspondent
NBC News
updated 8:01 p.m. ET, Sun., April 26, 2009

As new cases of swine flu emerge around the globe, from Ohio to Nova Scotia to New Zealand, the declaration of a "public health emergency" in the United States has further stoked fears and confusion.

NBC Chief Science and Health Correspondent Robert Bazell answers questions on the outbreak.

If this disease is like a mild flu, why is this being called a public health emergency? And why are officials in the United States concerned?

It's about the potential. It's not about what's happening right now. None of the 40 cases so far in the United States have been very serious. But the virus here is genetically identical to the strain of the virus that is killing people in Mexico.

This is a new virus so there's no natural immunity. It has the potential to spread very widely. That's what raises worries about a possible pandemic.

Don't thousands of people die from the regular flu? What's special this time around?

Generally, people who die from influenza are older people or those who already have respiratory problems. They end up dying of pneumonia. But this time around, the people who died in Mexico are younger. They are apparently healthy people in their 20s, 30s and 40s. That's a big deal. When a virus seems to preferentially affect healthy people, it suggests its a new virus and is causing an overreaction of the immune response. That's what happened with bird flu as well.

Influenza is virus that is always circulating between birds and pigs and people. Some have different genes that make them more or less infectious.

I have symptoms of the flu but haven’t recently been to Mexico? Should I go to the doctor?

You should go to the doctor if you have a fever or are really sick, for instance if you have difficulty breathing, even if you haven't been to Mexico.

The cases in the U.S. are not just among people who have been to Mexico. And the cases in the U.S. are so geographically dispersed and with no obvious connection to each other, that it seems this virus has already spread widely in the United States.

We shouldn’t start overwhelming emergency rooms or doctors' offices with every little sniffle or cough. But fever is the main thing. If you had the flu bad enough to start endangering you, you would feel so awful you would want to go to the doctor anyway.

You should also follow flu etiquette. If you are sick, you should stay home from work or school and limit contact with others.

Why is the disease so much more serious in Mexico than here?

Probably because it started in Mexico. That's going to become a big issue over time. There's supposed to be a pandemic prevention plan to contain a new flu virus by giving people in surrounding area Tamiflu. But it has obviously been spreading in Mexico for up to a month. The new strain of swine flu was discovered in California before the U.S. even knew about cases in Mexico. The virus could also be mutating.

Why is there so much uncertainty about what happens next?

Every epidemic has its own behavior. There's really no way of predicting. This could really just fade out or it could become very serious. Right now we are in a period of great uncertainty. In public health, that's the hardest thing.

© 2009 msnbc.com Reprints

Justice Souter to retire

Souter known as low-key, fierce defender of individual rights

WASHINGTON (CNN) -- David who? was the initial reaction of Americans to a little-known judge from New Hampshire named in 1990 to sit on the nation's highest court. Even the nominee didn't know what to think when President George H.W. Bush called him with the news, telling supporters, "I was in a state of virtual shock."
Conservatives say Supreme Court Justice David Souter, nominated by a Republican, was a dissapointment.

Conservatives say Supreme Court Justice David Souter, nominated by a Republican, was a dissapointment.

David Hackett Souter had only been on a federal appeals court bench for a few months when he was tapped to replace liberal lion William Brennan, a choice many Republicans hoped would move the high court rightward and reshape American law.

"I think that is good news for all of us who are committed to the Constitution of the United States," said President Bush. "He'll be a superb justice for the Supreme Court."

In reality, Souter was in many ways a typical, old-fashioned Yankee Republican -- a moderate with an independent, even quirky streak. Whether he became more liberal in his views after joining the Supreme Court, as many conservatives believe, may depend on your politics.

"Justice Souter will never escape the label of having been an enormous disappointment, a traitor to the right," said Thomas Goldstein, a Washington appellate attorney and founder of Scotusblog.com. "It instead created the opportunity to entrench a series of more liberal rulings. So he became the right's greatest failure and we will forever hear the mantra 'No More Souters' from conservatives."

Colleagues dismiss suggestions that liberal colleagues on the bench helped move Souter to the left.

"I find that incredibly unbelievable," said Rebecca Tushnet, a former Souter law clerk and professor at Georgetown Law Center. "He was faced with different issues on the Supreme Court than he was as a state official. A Supreme Court justice requires you to make different decisions, ones that aren't always consistent with your politics. And remember the Republican Party of Nixon is a different party than the one we have today, and we have a number of judges who came out of that earlier Republican Party who may not be in line with the priorities of people in power in Republican circles today."

The stealth candidate

Souter had a long career in public service. He was New Hampshire's attorney general and a trial judge who later sat on the state's supreme court.

Senate confirmation hearings to the high court were a breeze, because his federal experience was brief and his public stance on hot-button issues like abortion remained fuzzy.
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* Justice Souter to retire

"I have not got any agenda on what should be done with Roe v. Wade if that case were brought before me," he told senators. "I will listen to both sides of that case. I have not made up my mind."

That didn't stop women's rights groups from sounding the alarm. At rallies during his confirmation, abortion rights activists held up signs opposing Souter and chanted, "This is nobody's body but mine."

Similar concern came from movement conservatives. "At the time, he was called the 'stealth candidate,' " said Douglas Kmiec, a law professor at Pepperdine University who worked on high court nominations in the Reagan and Bush administrations. "So it was tabula rasa when he showed up at the bench and it was a surprise thereafter."

One of the first "surprises" came in 1992 when the Supreme Court reaffirmed the fundamental right to abortion in "Planned Parenthood v. Casey." Souter was part of a three-justice coalition that ultimately decided the case. In doing so, the "no undue burden" legal test was established when states were considering limiting a woman's access to abortion.

"What was clear to me was that he hadn't decided that case before he heard it" at oral arguments, recalled Peter Rubin, one of Souter's law clerks that term. "The law for him, unlike many of his conservative colleagues, was not an abstract set of rules totally divorced from its effect in the real world. It wasn't just an intellectual puzzle for him."

One puzzle for Souter was technology. He famously told Congress he would allow cameras in his courtroom only "over my dead body."

He shunned cell phones and pagers, and wrote drafts of his opinions in longhand, while a court-issued computer gathered dust in his chambers. Friends laugh recalling that for years he owned only an old black and white TV that was never plugged in.

So it surprised many when in 2005 Souter wrote a landmark cyber-age ruling in the so-called "Grokster" case. The court made software companies liable for misusing their file-sharing services and allowing copyrighted material to be easily and illegally downloaded.

"I am willing to bet Justice Souter had never seen a file-sharing application," said Tushnet, who is also an expert on cyber-age legal issues. "I would stake my life he had never used one, and would never use one. And yet his opinion reflected an understanding of how it works on the technical level, and how it affects a legal analysis of whether or not the supplier of the program should be held liable for what the people who use it do with it."

Man behind the robes

Souter's personality made him stand out on the Supreme Court, despite all efforts to avoid the spotlight. A lifelong bachelor, he lived alone in a tiny Washington apartment, escaping often to his family farm in rural New Hampshire.

He kept comfortably to routine, bringing a daily lunch of an apple and yogurt in a plastic grocery bag, eating alone in his chambers. Friends -- and he had few close associates -- say his favorite pastimes were reading, jogging and hiking in the New Hampshire mountains, activities he almost always did by himself.

The thrifty Souter shunned the trappings of power and privilege that came with being a Supreme Court justice.

"People didn't know him," said Goldstein. "He didn't go to parties, he didn't do speaking events. David Souter was really an isolated individual very much by choice."

Colleagues dismiss reports Souter was ready to quit the court after the 2000 Florida ballot disputes handed the presidency to George W. Bush. But they privately confirmed what a personal blow the rulings had on the integrity of the court he loved.

"He was very aggrieved by December 12, 2000," said Ralph Neas, former director of the liberal advocacy group People for the American Way. "He believed it was the ultimate politicization of the Supreme Court."

To critics, Souter siding with the liberal bloc only reaffirmed their view of him as a disappointment.

"He has not made a name for himself in any large body of jurisprudence," said former top White House lawyer Kmiec. "He's been kind of a go-along guy, in the context of the liberal or progressive side of the court. I think George Bush wanted more out of his judicial nominee than that, but that's what he got."

But others think history will judge Souter in kinder terms:

"A judge's judge," said Tushnet, "someone with deep respect of the institution and a deep faith in the ability of Americans in all branches to work things out."

Former law clerk Rubin remembered, "That sense of responsibility, that kind of care in deciding each individual's case is a hallmark of Justice Souter, of the man and his jurisprudence."

As for Souter, a man of few words, his brief remarks at a public White House ceremony after he was sworn in as a Supreme Court justice offer a capsule of his outlook on life and the law.

"What we try to do is pass it on, to make the gifts and kindnesses that come to us the kind of human currency that goes on traveling," he said. "I will try to preserve it, transmit it, I hope refreshed, to another generation of the American republic, which is the inheritance of us all."