May 10, 2012

Diabetes on the Go

Blog Photo_Sarah By Sarah Blenner, JD, MPH

If you’ve travelled lately, you know the drill.  You pack your carry-on bag, making sure not to bring any liquids or gels that are in a container larger than 3.4 ounces.  You put the small containers of liquid in one plastic Ziploc bag that is easily accessible so that you can take it out quickly when going through security at the airport.  You know to bring shoes that you can easily slip on and off.  Perhaps, you even avoid wearing any metal or jewelry.  

However, for someone with diabetes, extra precautions need to be taken.  Diabetes is a chronic health condition that must be managed throughout the course of the day, including in the security line.  And a person with diabetes has to be prepared at all times to deal with high and low blood glucose levels—meaning, they need to have supplies such as insulin and glucagon with them at the airport.

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April 28, 2011

You are What You Eat: Vulnerable Populations, Access to Healthy Foods, and Diabetes


Blog Photo_Sarah By Sarah Blenner

As the saying goes, you are what eat.  If that's the case, what are we? Fat and sweet.  The American diet derives approximately 40% of its daily energy from added sugars and fats.  In 2000, low cost potatoes (i.e. potato chips), canned tomatoes, and lettuce constituted 48% of the average American’s total vegetable intake.  It has been well established that poor diet directly correlates with chronic health conditions, such as diabetes and cardiovascular disease.  A disproportionate amount of individuals who are obese or have diabetes and other chronic health conditions are of lower socioeconomic status. Thus, financial constraints coupled with the availability of healthy food options in certain communities play a major role in determining a person’s diet.  In combating what many have termed “the obesity epidemic” and the skyrocketing rates of diabetes (which is estimated to double or triple in the next 40 years), we must cater food policies towards at-risk populations.  Specifically, it will be important to look at food policies geared towards programs which have a significant impact on these populations, such as food stamps, food pantries, and school lunch programs. 

Recently, while sitting in a food pantry, I overheard several women talking about their strategies for getting food.  The women were complaining about the insufficient amount of money they received on food stamps and discussed strategies for stretching food stamps to bring home the most amount of food.  One woman expressed her preference for purchasing hotdogs over healthier options, exclaiming that she makes her decisions based on the maximum quantity of filling foods for the lowest possible cost.

It turns out that individuals like the women I overheard talking in the food pantry are making logical decisions about feeding themselves and their families.  Better to eat unhealthy foods than eat healthy and suffer the consequences of hunger.  Studies have shown that individuals who receive assistance from food pantries, meals on wheels, food stamps, or other forms of food assistance are more likely to face “food insufficiency” (not having enough food to eat because of financial constraints) than other populations.  This can have a serious impact on the health and well-being of individuals with chronic health conditions, such as diabetes.  For example, one study that analyzed hospitalizations at a particular urban hospital found that about 30% of the hospitalizations for individuals with Type 1 diabetes that were due to low blood sugar levels occurred because the individual could not afford to eat.  Another study conducted in Georgia found that elderly individuals who receive or are on the wait list to receive meals delivered to their home are significantly less likely to properly manage medications, which can have a devastating effect on the management of chronic health conditions like diabetes.

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January 11, 2011

PA Webcam Spying Case Resolved

Blog Photo_Jake by Jake Meyer

Everyday for two weeks when high school student Blake Robbins left his school’s campus and went home for the day, the Lower Merion School District covertly followed him home, tracking his position, snapping photographs of him and his family, and recording his activity on his laptop computer.  The school district didn’t send a secret agent to keep tabs on Robbins, but instead had turned his school issued laptop into a remotely controlled surveillance device.  Robbins’ laptop captured over 400 images, screenshots of his activity on his laptop while he typed to friends through an internet messenger service, and photos taken through the laptop’s webcam of Robbins while he slept, pictures of him partially dressed after he got out of the shower, and photos of Robbins’ father and friends.  The laptop transmitted its IP address allowing the school to track its physical location.  The school district had installed this tracking software, TheftTrack, on all of the school issued laptops to be activated to retrieve laptops that had been reported stolen.  Robbins’ original laptop was returned to the school with a broken laptop and the school issued him a loaner laptop.  School district officials knew that he was in possession of the loaner laptop and that it had not been stolen, but activated the monitoring software anyway.  Robbins later learned that the webcam had been activated on his laptop when he was confronted at school by the assistant principal about his possible drug use – it turned out that the webcam had captured him eating Mike and Ike candy.

Blake Robbins and his parents filed a lawsuit against the Lower Marion School District.  The Robbins lawsuit was filed individually as well as on behalf of the class of all similarly situated persons – the students and families of students that had received a laptop with a web camera from the Lower Marion School District.  (The Robbins later moved to have the action certified as a class action and have the Robbins represent the class because joinder of the members of the class would be impractical because of the number of class members.)   The complaint alleged that the school district had "been spying on the activities of Plaintiffs and Class members by [the school district's] indiscriminate use of and ability to remotely activate the webcams," and that the "School District has the ability to and has captured images of Plaintiffs and Class members without their permission and authorization, all of which is embarrassing and humiliating."

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December 14, 2010

The Rules of Cyber War

Blog Photo_Jake by Jake Meyer

There is a war going on and the U.S. is under attack.  These attacks aren’t on our soil, but they hit us at home and have the possibility of causing severe damage to our infrastructure through computers and internet connections.  These attacks threaten to “destroy databases, communications systems and power grids, rob banking systems, darken cities, knock manufacturing and health-care infrastructure off line” and cause other serious damage.  Cyber attacks have been launched against the U.S., because the U.S. has large systems that offer a large payoff if the systems are compromised -- it’s probable that recent attacks on U.S defense and economic targets were launched by North Korea, China, and Iran.  Over 100 foreign intelligence agencies have attempted to break into U.S. networks.  But the U.S. isn’t the only target as the use of cyber warfare escalates around the world.  Russia has cyber attacked Estonia and Georgia.  And Stuxnet, a worm created to disrupt Iranian nuclear power plants, has been blamed on either the U.S. and Israel, or Russia.  But cyber warfare isn’t just limited to nations attacking other nations -- China has launched coordinated attacks against Google and Gmail.  With all of this conflict on the cyber battlefield, is there any chance of a cyber peace treaty?

The secretary-general of the International Telecommunications Union (an agency of the United Nations), Hamadoun Touré, has called for the creation of a cyber treaty with a built-in legal and regulatory framework and a contingency plan in case of a large-scale attack.  U.S. officials are wary of Touré’s proposal since it would result in “restructuring Internet governance in ways that would boost government controls.”  But the U.S.’s reluctance on such a cyber treaty is not baseless.  There is cause for concern because regulation of the internet by the nation’s governments can result in censorship, limiting the usefulness of the internet.  Russia’s Defense minister has argued that promotion of ideas on the internet, such as democracy should qualify as “aggression” under a Russian-sponsored U.N. initiative introduced to combat cyber attacks, or as Russia prefers -- “information war.”  Although a cyber peace treaty could be unlikely for the near future, there could be an agreement between nations on how a cyber war should be fought.

As nations waged bloody wars with each other through the centuries, rules of war were created by nations.  The modern rules of war are embodied in the Geneva Convention, but there is no such similar Geneva Convention for cyber warfare.  It could be time for rules of cyber warfare to be developed.  Professor Neil C. Rowe of the U.S. Naval Post Graduate School has suggested that cyber warfare should have ethics policies.  Rowe gives examples of possible policies such as an agreement to a “no first use” policy, where participating members would agree to only use cyber attacks in response to other cyber attacks, or requiring that the attacks have distinctive signatures that identify who is responsible and their intended target.

So what is the U.S. government doing to defend itself on this new battlefield?  New organizations in the U.S. Department of Defense are being created to deal with these new threats.  The U.S. formed Cyber Command to defend defense networks and to also launch offensive cyber strikes.  Existing government agencies are also cooperating more to defend the variety of systems that are vulnerable to cyber attack.  The National Security Agency, which is tasked with protecting U.S. national security systems and intercepting communications overseas, and the Department of Homeland Security, which has responsibility for protecting vital systems like power grids, financial services and water purification, have agreed to share their intelligence

Solutions have also been proposed to defend the U.S. in the event of a large scale attack.  The Senate Committee on Homeland Security and Governmental Affairs has approved a bill to allow the President “emergency authority to shut down private sector or government networks in the event of a cyber attack capable of causing massive damage or loss of life.”  This bill, S. 3480, has been described as a “kill-switch” for the internet.  There is some concern with such a system because the power to disable whole portions of the internet is an extreme power, and it’s not clear what the precise circumstances would be for the exercise of such a power.  Larry Clinton, president of the Internet Security Alliance, which represents the telecommunications industry, criticized the bill as “empower[ing] the president to essentially turn off the Internet in the case of a ‘cyber-emergency,’ which they didn't define.”

The strengths of the internet are also what make cyber attacks a serious threat to the security of citizens and countries around the world and also make these same threats difficult to regulate.  The internet “enables communication on an unprecedented scale and is woven into billions of lives around the world.  Its openness, its inclusiveness, its relative lack of regulation make it a fertile field for innovation and competition, an engine for much needed economic growth,” says Rod Beckstrom, President and Chief Executive Officer of Internet Corporation for Assigned Names and Numbers (ICANN).  This engine for economic growth that allows vastly improved communication and near instantaneous access to information benefits from its openness and lack of regulation.  Defending against the threat of cyber attacks will require policy makers to walk a fine line between regulation and openness.