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Pakistan- Blog II

Note: August 19 and 20 I spent in Pakistan and wrote three postings about the experience on my way back from the region. Regrettably, in the interim, terrorists bombed the Marriott Hotel in Islamabad killing 53 people. I want to acknowledge that tragedy, express my condolences to the Pakistani people, and put my writings into proper time context.

The difference in security level for my visit to Pakistan and most other countries I visit was evident immediately. I arrived in Islamabad late in the evening. We were taken immediately to the Embassy where Ambassador Anne Woods Patterson invited me to stay. It felt good to sleep in a Marine guarded place.

Early the next morning, I met with the Ambassador Anne W. Patterson and the U.S. Embassy's Deputy Chief of Mission, Peter Bodde, for a country briefing. They confirmed what I already knew. Pakistan was at an historic juncture with President Musharraf having resigned the afternoon before.

My meeting with Minister of Health Sherry Rehman was surrounded by an atmosphere of political excitement and some intrigue. Minister Rehman is a significant player in the Pakistan Peoples Party (PPP). As I mentioned in my last blog, she had been deeply involved in events leading up to the resignation of President Musharraf. In addition to her role as Minster of Health, she is also the Communications Minister and hence a frequent public spokesperson for the party’s interests.

Minister Rehman was moving in and out of meetings involving the difficult task of holding together a governing coalition after the resignation of President Musharraf. She provided me with a certain amount of commentary on their progress as we moved throughout the day. I won’t repeat any of the specifics, because they were private conversations, but it was clearly not going to be easy.

I had similar conversations with Prime Minister Raza Gilani, whom I met with during the afternoon. Then in the evening, I had dinner with a group of leaders from throughout the government. Obviously, the President’s resignation the day before was the primary topic of conversation, and it was hard to resist focusing on their speculation. The buzz was the same; the coalition was going to be difficult to hold.

As it turns out, the governing coalition was not able to stay united. Ultimately, because the party of Nawaz Sharif, (whom Mr. Musharraf had ousted as Prime Minister in a 1999 coup), and the PPP was divided on a question related to reinstatement of some judges who had been fired by the former President. The worry was that failure of the coalition could send the country into early elections.

The PPP was able to engage another small party that allowed them to claim a coalition and win the election of President Asif Ali Zardari in the electoral college, which consists of the Pakistani Senate, National Assembly, and the Provincial Assemblies.

My timing was fortunate. Standing on the periphery, as an event of historic importance took place in a foreign government, is not likely going to happen to me again.

When events put control of a government into play, security concerns go up. Pakistan is a nation where rival parties routinely attack each other with bombs and other means of destruction. Islamabad is not as pronounced as Karachi that way. The security arrangements for my visit reflected the risk.

During my visit in Pakistan, a number of terrorist bombings occurred killing almost 200 people, and I read in the news about an unsuccessful attack on an American diplomat in one of our Consulate cities. Driving through Karachi on Wednesday of that week, the Consul General at Karachi, Kay Anske, who has spent many years in Pakistan on various assignments, began to tell me about the level of violence that routinely occurs there. Often, rival political factions battle each other. So, the violence is not always targeted at foreign governments.

As the Consult General and I drove thru Karachi, things just seem so normal here. It is hard to imagine a car bomb just exploding on an ordinary street on a regular day. I wondered out loud, about how much the threat of such violence inhibits the normal life of people?

My impression is that it doesn’t inhibit life much. In every society, there is a definition of normal. People just learn to live with the risks. I would not enjoy life in such a risky place, but the people of Pakistan (and our courageous diplomats) for the most part, don’t have a choice, and they just live with it.


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That’s a chilling account, Mr. Secretary. Thank you for sharing it. I love my country and when I read of life in nations like Pakistan I appreciate it even more. You’re correct that healthcare can reach the hearts and minds of the underprivileged all over the world; however, there are so many in need of it in America too, shouldn’t our focus be here?

By subsidizing mini-clinics, increasing federal funds to safety net hospitals and promoting telehealth technologies, our country’s poor would have greater access to healthcare and pressure could be relieved on our overcrowded emergency departments.

It’s important to help other nations, but we must also help our own.

Michael McBride
Health Management Technology Magazine

Posted by: Michael McBride | September 25, 2008 at 09:05 AM

September 29, 2008

Dear Mr. Secretary:

In reference to your Pakistan-Blog II (September 24, 2008), I agree with you that often "people just learn to live with the risks" because "for the most part, don't have a choice". This is a political risk that citizens of any country in danger of violence due to political turmoil are aware of "and they just live with it". But back home in the US, many of us may be unknowingly living with a serious health risk even health officials are unaware of.

It has come to my attention that our new finding raises a concern that there may be a potential link between type A influenza virus and cancer which warrants further investigations in a timely manner. It appears that the polymerase (PB2) of type A influenza virus (including H1N1, H3N2, and H5N1) and reverse transcriptase subunit of telomerase (an abnormal protein observed in about 90% of all human tumors) have many amino acid sequence motifs in common throughout their protein sequences including regions where cap binding of the host cell pre-mRNAs by PB2 is concerned. Cap binding is the first step to initiate flu viral RNA transcription for virus replication inside the host cells. Under this premise, can influenza virus replication inadvertently trigger the synthesis of telomerase needed for tumor development over time? Likewise, is it possible that less similarities (as indicated in our research data on their sequence motifs) between PB2 of type B influenza virus and reverse transcriptase subunit of telomerase caused the host cells (HeLa cells, a type of cancerous cell commonly used in experiments) to favor transcription of the viral protein over telomerase during an in vitro chronic infection as seen in one previous study? Until now, there is a lack of study to explore their relationship.

Every year about 30-50 million Americans would get sick with the seasonal influenza viruses (H1N1 and H3N2 of type A, and type B) and about 1.4 million Americans would be diagnosed with cancer, but only about 36,000 people may die of flu related complications while over 500,000 people may die of cancer (the second leading cause of death and the second most expensive medical condition in the US) in 2008. It is mostly unknown what factor(s) millions of people have in common that may have triggered the activation of telomerase to cause the immortality of cancerous cells. Our new finding may shed some light on these two big human health issues facing Americans today. Although this is not about pandemic influenza which may cause thousands of deaths in a short time, given the enormous pain and suffering of so many cancer patients, even a slight suggestion that a common flu virus capable of infecting millions of people every year may unknowingly play a critical role in human cancer development deserves further investigation.

As you know, millions of Americans will get the flu shots including the live attenuated flu vaccine this year ahead of the flu season (typically from November to March). To err on the safe side, would it be important to investigate the presence or the lack of a potential cause-effect relationship between replication of influenza virus and cancer before millions of Americans may be at risk taking the live flu vaccine which contains live attenuated flu virus intended for limited replication in the host cells? In the short term, I believe that there are few experiments which may provide significant preliminary data quickly to help address this concern: Does replication of influenza virus (type A and/or B) directly or indirectly activate/increase (if any) the production of telomerase in human cells and for how long?

With your leadership to push for more studies on this potential health danger, this may be one risk that we can have a choice not to live with.

Jennifer Lo

Posted by: Jennifer Lo | September 29, 2008 at 05:45 PM

Dear Mr. Secretary,
I just thought it would e nice for you to read a posting from an ordinary, every day citizen of our great nation. I wonder if the commentors thus far realize how momentous a time in history this is for the Pakistani people...funny how people can work their agendas into any conversation.
I have met (online) several Pakistanis. I know the horrible problems that people in the villages have accessing good health care. I know the death rate from common, treatable diseases is terribly high. The NGO's work hard to educate the villagers about health issues but there is no good source of funds to help recruit volunteers/activists. And, you are right...normal is different for all of us in one way or another. These people seem to be in some kind of denial that they live in a violent society but, it is their norm.
What a remarkable time in the history of Pakistan for you to be visiting. It is so important that we, as a nation, keep our friends close...especially in that particular part of the world.
Thank you for your service to our country.

Posted by: Virginia Lanier | September 30, 2008 at 12:11 PM

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