North Korea, Blastocystis and Decision Making

July 16, 2010. In March of this year, North Korea attacked and sunk the South Korean warship Cheonan. Secretary of State Hilary Clinton condemned the action, and gave a "stern warning" to North Korean leader Kim Jong-Il. On July 21, the United States announced new sanctions on North Korea for the sinking, and also indicated the US would take place in war games with South Korea which are designed in part as retribution for the sinking.

But how do we know that North Korea sunk the ship? Evidence was collected by professionals, analyzed by US officials, and a decision was made. There are some inherent limitations to such an investigation, as there are in investigation any event which has happened in the past.

The fact is, we make decisions all the time at the Federal level without perfect information. Then we act on those decisions as a nation. Ultimately, there is no such thing as perfect information, and the costs of doing nothing are high enough that we do, in fact, act on the best available information.

This is not the case in infectious disease like Blastocystis, which is now the most prevalent parasitic infection in the United States. Despite the findings from a 15-year NIH-funded study conducted by an NIH scientist, and subsequently over 100 similar studies from around the world confirming this finding, neither the NIH nor the CDC will take any action at the Federal level to help patients get reliable treatments and diagnostics. In fact, after the NIH scientist published one of the longest reviews on Blastocystis in 1993, the NIH shut down all research into the organism, and NIH officials began directing scientists not to apply for grants into studying the organism.

What we can see is the CDC and NIH lack the kind of executive decision making capability that is present in other Federal agencies. Groups like the FBI and CIA routinely collect information and make decisions. Other groups like the USDA and FDA also collect information and make decisions that impact millions of people.

Blastocystis can not be cured unless proper treatments are identified and made available to patients, but the NIH controls most of the country's spending for biomedical research, and had announced that it considers clinical investigation into Blastocystis "infeasible" due to lack of decision over its status as a pathogen. Older drugs like dehydroemetine were used widely un the US until the 1980's, and could possibly be used to cure patients, but their use is controlled by the CDC, and Blastocystis patients do not qualify for the use of them.

This year, or sometime next year, the number of studies indexed in the NIH's database will exceed 1000. Almost all of the studies that have investigated whether the organism produces disease have confirmed it is a pathogen, and new studies show that many patients will stay sick forever unless they are treated. Most of the studies are written in English, and are entirely accessible to the NIH and CDC. Despite this, neither agency has been inclined to make any decisions.

We need to recognize that Blastocystis is more than anything else, a bureaucratic disease. It was created and persists due to negligence from professionals who have been given authority, but refuse to exercise it.