Attack of the Black Swan

My SlideShare Presentation of the National Environmental Health Association AEC 2010 session.

Atack of the Black Swan

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Post NEHA AEC 2010: We've Moved!!!

As part of my new efforts in Environmental Heath, I've moved my blog over to http://ehobserver.wordpress.com/ I might post a few things here in the near future but that will be the place I consolidate my EH communication and education efforts.

I Am Environmental Health

In my heart I am always going to be an Environmental heath professional.

I think in this economy, it is very common for many of us in EH to no longer do what we love so much. In order to put food on our tables and shelter over our heads, we need to get a job elsewhere, and not always in EH, or as least as EH as we know it.

My story is the same. Food safety consulting is no longer something I can make a living at. Between giant corporations undercutting private firms like mine, and an economy which makes me a luxury item that can be cut from a budget, I am no longer in demand.

SO instead of restaurants and food manufacturers, I'm involved with HAZMAT and medical diagnostic device risk assessment. But though many would claim those are not Environmental health, I would.

Years ago came up with a simple and very encompassing definition of environmental heath. At the time I was comparing it to environmental protection. I said that EH was protecting us from the environment while environmental protection was protecting the environment from us. It still serves me well. preventing contamination in a medical device is just as important as in a tuna sandwich, if not more so. keeping chemicals from spilling into soup is really no different than preventing a shipment of ethanol from leaking during transport.

Some might claim that budget cuts, at least till the next major disaster, will destroy our profession. Some claim we need to be more professional, more elite. I believe the opposite. we need to be everywhere. WE have been boxed in for too long into Food, water, sewage and solid waste. For some in our profession sewage and solid waste aren't even in our jurisdiction. The more elite we become and the more defined we become by a particular subject the more we become easy prey to be destroyed in a budget cut.

FDA had three big charges and lots of little ones. Pharmaceuticals, Medical Devices and Food make up the bulk of FDA's inspection duties. Yet I find it telling that a major recall and incident in the pharmaceutical industry had an EH root cause, one a food inspector would have been all over -- spraying pesticides directly on shipping containers.

For EH to survive we need to rethink ourselves. we no longer fit a=in one category of protecting things, such as food. we need to be everywhere and protect the world from ANY kind of contamination. it does not matter if it is a nosocomial infection in a hospital, a stint which failed sterilization, a truck carrying hydrochloric acid, an outbreak in a public school, or a hamburger with E coli O157:h7.

My vision is to see every team in compliance and in quality control, in regulatory, industry and academia, always have an EH specialist included. I have no idea how to get there. I doubt that any association has any idea either, I doubt that is even conceivable by those who painted us into this corner in the first place, and who hand out pink slips in their day jobs. But that is my dream.

I may not have a plan, but I have start. Wherever I end end up, in whatever industry I am in, I will continue to say

In my heart I am always an environmental heath professional.

A Short History of Jewish Handwashing

In honor of Global handwashing day, I thought I’d post a short summary about the history of Jewsh Handwashing, which starts at Sinai and winds all the way to the present. In reality there is a lot more than just this. I could make a dissertation about it. This is based on a letter I wrote to a colleague who asked me about it.

Ready for a wild ride?

Biblically, the first direct mention of Washing of the hands is in Exodus 30:18-21, which instructs to make a handwashing station and to use it, with an interesting reason:

17. And the Lord spoke to Moses, saying, 18. You shall also make a basin of bronze, and its pedestal also of bronze, to wash with; and you shall put it between the Tent of Meeting and the altar, and you shall put water in it. 19. For Aaron and his sons shall wash there their hands and their feet; 20. When they go into the Tent of Meeting, they shall wash with water, that they die not; or when they come near to the altar to minister, to burn offering made by fire to the Lord; 21. So they shall wash their hands and their feet, that they die not; and it shall be a statute forever to them, to him and to his seed throughout their generations.

Here God is clear: Wash your hands or face the possibility of death. Can't get better than that. Supposedly it was one of the sins that caused Aaron’s sons to die in Leviticus 10. Let me point out something most who haven’t read all of Leviticus or Exodus wouldn't know: The burnt offering in many, but not all, cases had some parts that were roasted on the fire then eaten by the priest making the offering. In short the priest was cooking, and was required to wash his hands prior to food preparation.

Solomon By the way went wild in his hand sink system for the Temple in Jerusalem in I Kings 7. It included, if I did the math correctly the "sea" (i.e. water retention system) that could hold somewhere around 1700 gallons of water. And there were ten water basins, presumably the handsinks filled by the "sea". Today a similar device, though much smaller, is used to dispense wine on the Sabbath in some Orthodox homes.


Leviticus 15:11 mentions handwashing in terms of contamination with a person who has a "discharge" which many modern scholars believe to be Gonorrhea:

11. And whoever he, who has the discharge, touches, and has not rinsed his hands in water, he shall wash his clothes, and bathe himself in water, and be unclean until the evening.

Biblically at least innocence is often associated with the washing of the hands as in Deuteronomy 21:6-7 for the ritual of the case of an unsolved murder. The prophetic literature (e.g. Isaiah 1:15-16) and psalms follow suit but even more metaphorically.For example Ps. 26:6 “I wash my hands in innocency; so will I go around your altar, O Lord!” I’m not sure since that’s “out of my jurisdiction”, but Pilate’s comment might be based on this concept.

After the destruction of the temple nineteen hundred and twenty three years ago, there was a change. Since there were no more sacrifices, then the Temple practices were transferred to some other place, in this case the dinner table. Since the Bible said the priest was to wash the hand prior to sacrifice, when the temple’s sanctity was transferred to a man’s dining room table here too he washed his hands before blessing anything and then eating.

The Talmudic Rabbis did a lot with handwashing, even writing a whole tractate of the early part of the Talmud called Yadayim (in translation “hands’) all about handwashing, how to do it, what was considered clean water to perform the procedure etc.

“Hand washing” as A phrase occurs 345 times in the Talmud (approx 70-500 CE) so its importance was paramount. There is even a case where a man was excommunicated for doubting the sanctity of handwashing [Ber 19a]

I could give you all 300 some cases, but I’m not Here’s a few choice ones note the prevention of the fecal oral route in the first one, which is a sequence of things to do when one gets up in the morning:

R. Johanan also said: If one desires to accept upon himself the yoke of the kingdom of heaven in the most complete manner , he should consult nature then wash his hands then put on tefillin then recite the Shema’ and say the tefillah:(i.e. the morning prayers) this is the complete acknowledgment of the kingdom of heaven. R. Hiyya b. Abba said in the name of R. Johanan: If one consults nature and washes his hands and puts on tefillin and recites the Shema’ and says the tefillah, Scripture accounts it to him as if he had built an altar and offered a sacrifice upon it, as it is written, I will wash my hands in innocency and I will compass Thine altar, O Lord.[Ber 14b]

Our Rabbis taught: R. Akiba was once confined in a prison-house [By the Romans] and R. Joshua the grits-maker was attending on him. Every day, a certain quantity of water was brought in to him. On one occasion he was met by the prison keeper who said to him, ‘Your water to-day is rather much; do you perhaps require it for undermining the prison?’ He poured out a half of it and handed to him the other half. When he came to R. Akiba the latter said to him, ‘Joshua, do you not know that I am an old man and my life depends on yours?’ When the latter told him all that had happened [R. Akiba] said to him, ‘Give me some water to wash my hands’. ‘It will not suffice for drinking’, the other complained, ‘will it suffice for washing your hands?’ ‘What can I do’, the former replied: ‘when for [neglecting] the words of the Rabbis one deserves death? It is better that I myself should die than that I should transgress against the opinion of my colleagues’. It was related that he tasted nothing until the other had brought him water wherewith to wash his hands. [Eiruvin 21b]

There was also some demon superstition associated with handwashing:

The genius [i.e. Spirit/Angel] appointed over sustenance is called Neki'ah [Cleanliness]; the genius appointed over poverty is called Nabal [Folly or Filth] . Dirt on the spout of a pitcher leads to poverty. He who drinks water out of a plate is liable to a cataract. He who eats cress without [first] washing his hands will suffer fear thirty days. He who lets blood without washing his hands will be afraid seven days. He who trims his hair and does not wash his hands will be afraid three days. He who pares his nails and does not wash his hands will be afraid one day without knowing what affrights him. [Pes 111b-112a]

R. Judah the son of R. Hiyya said: Why did [the Rabbis] say that it was a bounden duty to wash the hands after the meal? Because of a certain salt of Sodom which makes the eyes blind.2 Said Abaye. One grain of this is found in a kor of ordinary salt.[Hullin 105b]

Suffice it to say that handwashing was a critical part of Jewish practice. One story tells of a Jewish innkeeper during Roman times who kept himself hidden from the Romans. He identified Jews by who washed their hands. If someone washed their hands he served Kosher lamb or beef. Anyone who didn’t he served pork.
Be aware ritual hand washing was not completely sanitary and didn’t make sense from a public health standpoint all the time though. There is always the shared pitcher shown on the right in the photo. Even today the ritual does not require soap, as can be seen missing in this hand sink in the Tel Aviv Sheraton. Anyone feeding someone else does not have to wash their hands for example, which has led to several cases among the Satmar sect of Hasidim in New York State having outbreaks of shigellosis.

I haven’t researched the period of the inquisition, but it would not surprise me if this was a way to identify non Christians who would the only ones so obsessed with handwashing due to its spiritual nature. I don’t know a lot about Islam but I do know that the Koran (5:6) as well had requirements for Muslims, with a requirement almost identical in language to Ber 14b in the Talmud of washing up before prayer, though in their case any prayer. Those who washed their hands were most likely observing other religious practices: Jews and Muslims. I don’t know about handwashing practices of Christian or orders like the Jesuits who the Inquisition picked on as well.

Hope that’s enough to keep you busy. If you have any other questions, let me know.

Mommy, What causes Diarrhea?

A presentation I gave at the IEHA Food Safety Conference in Elgin IL on August 28, 2008 on the causes of Diarrhea on the cellular level.

What causes Diarrhea IEHA 2008

View SlideShare presentation or Upload your own. (tags: diarrhea)

Blogging 101's Powerpoint

Here is the PowerPoint presentation for the Blogging 101 session at the National Environmental Health Association AEC in Tucson AZ. For audio go to the podcast post on this blog. This uses the SlideShare.com service as a way of posting PowerPoint to web sites and blogs.

| View | Upload your own

Blogging 101: The podcast

During the Blogging 101 session at the NEHA AEC in Tucson, I recorded myself during the session. Since my presentation is not on the CD-ROM, I have posted it on the blogs for you to listen to or download.

To Listen: Left Click the button below. It's about 50 minutes long so you might want to download.

To Download to listen in your MP3 player: Right click the button below and select Copy Link Location or Save target as. Save on your drive. and play on your computer or move it to your MP3 Player.

My Response to the NEHA Keynote

As a consultant who dances on a narrow bridge between Regulatory and Industry, with education as a balancing pole for seventeen years, I love this profession.

I was therefore disappointed in the Keynote -- there was too much silence in what was said.
While I was crawling all over the floor shooting the pictures in the post above, two voices were suspiciously silent up at that podium. We heard from government at all levels and from associations of government officials.

But I heard no one from Industry
I heard no one from Education up there at the podium. There was of course one Educator who got up first with her comments. She should have been up there at the podium, not down at the comment mike.

The question of environmental health’s identity and future cannot be answered by only one core constituency. If we are in the crisis of ED as discussed during the keynote, it may not need pills but passion. When one note is sounded too much it’s not a key note, but monotonous. When a vision is monochromatic and grey, it fails to be seen.

Educators and industry are present at the NEHA AEC, yet we are still a silent minority much of the time. If we create a vision which integrates EH professionals in Industry and Education instead of making them separate-but-equal partners to regulatory, we bring even greater insight from very different perspectives. If we increase the palette, we can render our vision for Environmental Health more colorful and more attractive.

Much of the discussion referred to EPA. At one point the difference in the agencies was summarized by stating EPA was an agency run by lawyers, while CDC an agency run by doctors. In my view the difference between environmental protection and environmental health is environmental protection protects the planet from us, while environmental health protects us from the planet. That is of course simplistic, and the number of times one affects the other are countless on this planet. Environmental protection does do some environmental health, as well as we do some environmental protection.

But the biggest thing we can take from EPA is not tax dollars, but something far more valuable. Deep in the heart of EPA is not just a profession, but a movement. Its success integrating diverse elements at its inception stems from the ecological movement. Otherwise it never would have been created. We need to make environmental health a cause not only for our profession, but for all the people we protect with our efforts. The crisis which can create a movement is certainly there, with tomatoes only the latest chapter in that crisis. Environmental health professionals need to drive that movement, lest elements of the uninformed public drive it for us. This will need an integrated industry, educational and regulatory vision to work. It will require each of us to personally believe in a vision that we are the men and women who protect the people of our community from the dangers, lurking in the environment.
In my view, one open to lively debate, we need to reclaim our ancient role from the times before science. As young as we think EH is, it is also older than medicine. EH was the role of the Shaman, prophet and priest. They may have used magic, but we can use technology. They may have called them demons; we call them pathogens and toxic substances. Both they and we ward off disease that came from the environment around us. Who we need to be and the path we need to tread is to reclaim that ancient heritage. We no longer need to be the invisible profession, nor the orphans of public health.

We need to be those who protect the orphan; we need to be the prophets of public health.

Steven Lipton M.Ed. LEHP CP-FS
President, Biotest Services Inc.
Des Plaines IL


Let NEHA know what you think. Post comments on this and the keynote directly to their blog at nehaaecexhibition.blogspot.com

YouTube: Death by Powerpoint

In my Small Wares: How to tell a memorable story class I mentioned emulating stand up comics to help with your delivery of stories and public speaking. Here's one example, in the wake of an overdose of PowerPoint presentations during NEHA AEC 2008

Powerpoint: Death by powerpoint

After all those PowerPoint presentations, I though you might like some tips on PowerPoint. Here's an example of using slideshare:

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NEHA Session Review: How to Prepare When the Budget is Bare

Michele was clearly very passionate about the subject of Emergency Preparedness and committed to getting the "message" out.  And she shared her experiences for doing it on a shoestring!  In rapid-fire and animated presentation, Michele reviewed a number of agencies, information sources and web sites that provided resources on emergency response and health education at NO COST.  She stressed the need to be flexible and innovative in promoting the preparedness message - adapting and piggybacking on the topic du jour.  An interesting example how they conducted a Pandemic exercise as part of a mobile Flu Clinic.

Michele provided a wealth of information, and some excellent examples of how to implement processes with almost no budget.  As this is a common situation for most of us, the presentation (available on the Conference CD) is a valuable resource.


Dan Richen
Senior Advisor
Environmental Public Health
David Thompson Health Region

A short biography of Joseph Lister.

Over at Microbiology Bytes, AJ Cann has a short but very informative podcast Biography of Joseph Lister, arguably the man who pioneered preventing cross contamination and the man Listeria monocytogenes is named for.


http://microbiologybytes.wordpress.com/2008/06/23/joseph-lister/

NEHA Session Review: Predicting Foodborne Outbreaks at Restaurants

By Dan Richen

I attended the lecture on “Predicting Foodborne Outbreaks at Restaurants: Results of a Risk Assessment Model” presented by Heidi Sato. This was a VERY popular presentation as they brought in a lot more chairs and there were still more people standing in the hall outside the room. Heidi presented the results of a research project she conducted with the LA County Health Department that involved reviewing violations observed in restaurants that were involved in foodborne illness outbreaks, and then comparing risk factors between those restaurants and selected restaurants that were NOT associated with outbreaks (Case – Control). Normally a review of Odds Ratios, Confidence Intervals and Statistical Significance would be pretty dry, but the subject matter was obviously of great interest to those in attendance. While standard factors of food safety (type of foods served, extent of preparation, etc.) showed up as predictors, some other – more unusual - factors seemed to play a greater role in outbreaks. Factors like Ownership Type (Corporate versus Franchise versus Private), Entrée Price and Number of Customers seemed to be better predictors of outbreaks than the food safety issues. Using structured equation modeling, Heidi found that the factors of Number of Customers (0.33), Critical Violations During Inspections (0.21) and Use of Raw Foods (0.15) were the strongest predictors of involvement in a foodborne illness outbreak. There were quite a few questions at the conclusion of the presentation, as it seemed that people were trying to relate the information with their own experiences. As with most research, the statistical details of this presentation will need to be interpreted so as to be useful in the field – there was a lot of information to digest and a lot of work will be needed to determine how it can be integrated into our daily activities and programs. A very interesting presentation.

a sample blog entry

Hello world !

Adding links to comments

As one gets into blogging more, it becomes helpful to leave live links in a comment or post. While most text editors will take care of posts, this is not the case for most comments, which are primarily straight text. Yet most commenting dialog boxes like the one here for blogger allow the use of some of the most common HTML tags in order to allow for some formatting of a comment.

There are three primary HTML tags you might use <b>, <i>, and <a>. Each of these tags allows you to control the formatting of your text in your comment, which can be very useful. I’m not going to teach everything about HTML here just some very simple basics so you can use these three in comments.

HTML tags are a lot like (parentheses) or “quote marks,” you need a starting mark and an ending mark, and then they do something to your text. The way we make an ending mark is to take a starting mark and add a slash to it. So the mark <b> is completed with </b> for example. Always use a beginning tag and an ending tag, other wise you will get very unexpected results, if the comment page will even let you send it.
To make something bold we use the <b> tag. For example:

I’m gonna make a <b>bold</b> statement

Which when posted reads:

I’m gonna make a bold statement.

Italic works the same way, with the <i> and </i> tags.

The <i>Italic</i> might just be an unsinkable ship

Which when posted reads:

The Italic might just be an unsinkable ship

While <i> and <b> might makes the comment pretty, <a> is very powerful. For brevity, I’m just going to show you one thing they can do: setting up a hyperlink. In the case of <a> there is more included in the tag than just <a>. We also include a notice to the computer that we want to link the stuff in this tag to go to a certain place, usually another web page. To do this the tag lengthens to

<a href= “http://ehblogger.blogspot.com”>

For example if I wanted to go to the website ehblogger.blogspot.com. I can change the address in the tag to go anywhere I want on the web. After the <a> tag begins we then put what will click on to go to the link specified. We end that with the </a> as in the the other cases to make the link. For example:

This link makes you <a href= “http://ehblogger.blogspot.com”> go to EHBlogger</a>

Gives a result of

This link makes you go to EHBlogger

If you click the link, then you will be taken to that web page. As a suggestion for using links in comments, use between the <a> and </a> the actual address so if the link does not work due to security measures on the computer reading it, the reader can cut and paste the link into the address bar. For example:

<a href= “http://ehblogger.blogspot.com”>http://ehblogger.blogspot.com</a>

This does require a lot more typing and you do need to be very careful for typos, but it makes it one step easier for someone to get to the site you want them to visit, and that in turn increases visits.

Any questions please leave comments below. Also try this out in the comments for this post. The worse you can do is get an error message from the blogging software.

The High Concept for EH

There is an idea in the world of advertising called the high concept. Heath and Heath in their book Made to Stick note that high concepts are among the best examples of core and compact ideas. They convey a lot of information in a few words. High concepts are often used to convey an entire plot of a movie or project in five words or less. High concepts usually used a word heavily laden with meaning the listener already has and then qualifies that meaningful idea with one more idea. One of my favorite old cartoons Inspector Gadget could have a high concept of “Get Smart for kids” for example. Get Smart itself might be described as “James Bond as a idiot.” High concepts also can become an important way of unifying people within an organization to a singular vision. As Heath and Heath give the example “the low cost airline” is not just a slogan for Southwest Airlines but their entire philosophy for doing business.

I’ll be talking more about high concepts in my storytelling learning laboratory session Monday afternoon at the NEHA AEC in Tucson, and why they are so useful to storytellers in EH. But the NEHA meeting has a theme struck by the Keynote Who are We and What do We Want to Be? In the Keynote, we will be talking some specifics. I’m interested in the Who are we? question in terms of high concepts. What could be some high concepts describing the identity of Environmental Health Practitioners? What high concept could unify our vision of EH?

So let’s brainstorm a few! Leave a comment below of your high concept. Keep it to less than ten words. Don’t explain yourself. If you want, you can comment on other people’s ideas.

Ladies and Gentlemen, start writing those high concepts!

Using External Software

One possibility for publishing to a blog is to use External software to do so. We have here an example of using the Scribefire add-on to Firefox.

here's a screen shot in action

What is blogging?

by Steven J. Lipton M.Ed. LEHP CFSP
President, Biotest Services Inc.

What is blogging?

Blogging is like a newspaper that people can write responses to
Blogging is freedom of speech
Blogging is a web site without knowing anything about programming for the web
Blogging is remembering everything you did before.
Blogging is just fun!

Welcome Bloggers!!

Welcome to the blog for the National Environmental Health Association 2008 Annual Education Conference and Exposition Blogging 101 session on Sunday June 22nd at 1:00 as a Learning laboratory session . We are here to give you news updates and conversation regarding the Tucson Arizona meeting, on June 22-25 2008 related to blogging. General Information can be found at the NEHA website at http://www.neha.org/AEC/2008/index.html or you can download a brochure by clicking on the picture.

On this site we will be experimenting with how to blog during the Blogging 101 session. As one assignment participants can will be post to this blog of thier experiences at NEHA AEC 2008.

If you are looking for the NEHA AEC blog, go on over to http://nehaaecexhibition.blogspot.com/

After Tucson, we will making this the place to discuss and promote Environmental Health blogging.