15 years later, the rock and roll community reflects on the anthrax attacks

The rock and roll community reminesces about the anthrax attacks of 2001 in a very different light. It seems that the rock band, Anthrax, was on tour during the anthrax attacks of Sept. 11, and they dutifully suspended their tour. For their next appearance at a charity show in New York City, they took the stage wearing white jump suits with the words "WE'RE NOT CHANGING OUR NAME" according to the online reporter, ultimate classic rock. It was reported they raised $90,000 that was given to the New York Police & Fire Widows & Children's Benefit.

If you are wondering how a story about the music entertainment business ended up on this rather serious blog, it is because the music group "Anthrax" has been coming up in internet searches for real anthrax, for the last 15 years! So congratulations to Anthrax for not changing their name and being defiant in the face of terrorism!

Photo credit to http://ultimateclassicrock.com/anthrax-refuse-to-change-name/ .

Smallpox in 1721 may have changed the course of American History

    Albert Coss has written an interesting book on how the 1721 smallpox outbreak in America, changed the course of history, even inspiring the Revolutionary War. The PRI global network interviewed the author on Sept. 24, 2016 and it is worth the 16 minutes. Coss paints a picture of the political and social forces that smallpox created but so often not recognized in American history.
    He points out that smallpox got out of control in Boston because the government was in such conflict over what to do. You may remember the famous U.S. Supreme Court case, which established that states have the sovereign power to demand vaccinations which outweigh the individual Constitutional liberty when the public health is more critically important to society.
    Coss also points out that Cotton Mather, famous for his role in the Salem Witchcraft Trials was among the first advocates for innoculation, the procedure that saved 100s or 1000s of lives in Boston. Ironic.
     Coss further ties in the American Revolution by exploring the free press finding that it really emerged during the smallpox epidemic when information was vital, and public opinion was loud. Benjamin Franklin wrote in the Boston Globe and was a big leap in his journalism activity, propelling him into the public eye as a public commentator, like maybe the modern day, Bill O'Reilly.

Anthrax confirmed in deer in Texas--NBD

There is nothing like waking up to a warning of anthrax, which I discovered is no surprise in Texas. This news release came from the Texas Animal Health Commission, today, and Every year, Texas sees several cases, typically near the border.  It is also important to remember that the great cattle trails beginning in the 1800s drove cattle and some of them had anthrax, and anthrax spores can survive for decades or centuries.  Only a dozen or so states have animal health commissions that regulate livestock, and a state without an animal health commission would likely rely on their natural resources government unit to address these risks in wildlife. Anthrax Confirmed in Kinney County  White-Tailed Deer

FOR IMMEDIATE RELEASE September 20, 2016     AUSTIN - Texas Animal Health Commission (TAHC) officials confirmed Anthrax in white-tailed deer in Kinney County on September 16, 2016. The affected premises is located approximately 12 miles east of Brackettville. The premises has been quarantined and TAHC rules require proper disposal of affected carcasses and vaccination of livestock on the premises prior to release of the quarantine.   "The TAHC will continue to closely monitor the premises," said Dr. T.R. Lansford, TAHC Assistant Executive Director for Animal Health Programs. "Producers are encouraged to consult their veterinary practitioner or local TAHC office if they have questions about the disease in livestock and a medical professional if they have concerns about personal anthrax exposure."   Anthrax is a bacterial disease caused by Bacillus anthracis, which is a naturally occurring organism with worldwide distribution. Anthrax periodically emerges in the southwestern part of Texas. A vaccine is available for use in susceptible livestock in high risk areas.   Acute fever followed by rapid death with bleeding from body openings are common signs of anthrax in livestock. Carcasses may also appear bloated and decompose quickly. Livestock displaying symptoms consistent with anthrax should be reported to a private veterinary practitioner or a TAHC official. If affected livestock or carcasses must be handled, producers are encouraged to follow basic sanitation precautions such as wearing protective gloves, long sleeve shirts and washing thoroughly afterward to prevent accidental spread of the bacteria to people.   For more information regarding Anthrax, contact your local TAHC region office or call 1-800-550-8242.   To learn more about Anthrax, visit the TAHC's brochure athttp://www.tahc.texas.gov/news/brochures/TAHCBrochure_Anthrax.pdf

As predicted, TB arrives with the refugees

As predicted by this blogger, the combination of widespread tuberculosis and polio in Syria with the breakdown of health services for years, plus the complete abdication of responsibility by the federal government to screen incoming refugees before forcibly demanding that states accept them, as resultes in bringing more TB to the U.S. It has been reported that two refugees in Nebraska with TB were identified near the time of their arrival while a couple others were identified years later. It seems that the health care screening of refugees is something the Federal government "forgot" about? While health law is a power of the state, at the point of immigration it is the clear constitutional responsibility of the federal government. The Federal government and its poorly functioning CDC have been avoiding this inherent responsibility of protecting American citizens from danger, yet one of the most obvious risks which can be screened for at immigration has been ignored.

Unprecedented CDC warning to avoid neighborhood -- does business interruption insurance cover it?

   When CDC issued a formal warning for pregnant women to avoid the Wynnwood arts district neighborhood of Miami because of the discovery of six Zika cases from mosquito transmission there, it triggered concern for the disruption of business in that tourism-dependent area.

   Business owners who pay for business interruption insurance may feel this should be covered, but an interesting analysis of the typical insurance provision by John Camp and Carlton Fields shows this is a wrong assumption. Here's what they wrote:

A typical provision covering lost income reads something like this:

We will pay the actual loss of ‘business income’ you sustain due to the necessary suspension of your ‘operations’ during the ‘period of restoration.’ The suspension must be caused by direct physical loss of or damage to Covered Property and result from a Covered Cause of Loss.

Thus, a typical provision contains critical limitations: not every “suspension of operations” will trigger coverage. Rather:

• the business interruption must have been caused by physical loss or damage;

• the damage must be to covered property; and

• the damage to covered property must be the result of a covered cause of loss.

For Wynwood businesses harmed by the Zika outbreak, the critical missing element is direct physical loss of or damage to covered property. Courts have routinely held that an insured seeking business interruption coverage must establish that the loss was caused by property damage, and not by some other factor or factors. See, e.g., Roundabout Theatre Co., Inc. v. Cont’l Cas. Co., 302 A.D.2d 1 (1st Dept. 2002); Harry’s Cadillac-Pontiac-GMC Truck Co., Inc. v. Motors Ins. Corp., 486 S.E.2d 249, 252 (N.C. Ct. App. 1997).

  While there is a federal statute to cover loss of agricultural animals in a declared quarantine, if certain conditions are met, there appears to be no federal "fix" for CDC's warnings that can cause business devastation. In general, government warnings which cause business loss, like the various vegetable "scares" over the past decade, are generally not covered by insurance business interruption or even market interruption clauses, according to these authors.
   Click here to go to the article.

First cases of Zika transmission in the U.S. are reported in Florida today

Today, CNN was the first to break the story that four cases of Zika have been found in Miami-Dade and Broward Counties, Florida. The Florida governor made the announcement at a press conference. In an unprecedented legal step, the counties' public health authority is going door to door to test the urine of residents in this one zip code area to determine if there are other infections. The urine test is less invasive of privacy interests than a blood test, and will also be easier to administer with less skill required to do the testing. Based on the call for voluntary testing from the public health department in other notices, this door-to-door testing is likely voluntary, not mandatory. It will be interesting to see how the county may deal with refusals for a urine test. If the public health authority ordered the residents in the zip code to submit to a urine test, the judicial test to issue an order would be that the public health interest outweighed the privacy interest, and there was no less invasive way of accomplishing the governmental goal. It is unlikely we will see that case, but the question may arise in some other context in the future. 

A Legal anthropological look at the impact of Zika in Brazil

The prevalence of Zika in Brazil is a national crisis. There may be some irony in the quandry of a nation that is 65% Catholic being faced with knowledge that many of their next generation of children have microcephaly at the first or second trimester, making this all the more painful and gut-wrenching for the Brazilians, as the rest of the world looks on. As of early July 2016, the World Health Organization reports there have been 1656 confirmed cases of Zika in Brazil, a number that dwarfs every other country by almost 100 times. Zika, the documentary, a resource noted by the Medical Anthropology section of the American Association of Anthropology (of which I am a member) highlights the flow of expectant mothers into the clinic who are told their babies have been affected by their infection with Zika, displaying the harsh reality of the decisionmaking process. 

Most of the parents seem accepting and are often given hope by the medical advice that it is the degree of microcephaly that is important. The possibility of Guillain-Barré Syndrome (GBS) is another diagnosis that could come later, and not mentioned, at least in the film. What this film adds to dozens of internet videos on Zika is the impact on the lives of Brazilians and the future of a generation or more of children with microcephaly, as well as the mental anguish and family impact of the experience with the pregnancy, birth and afterbirth period. As depicted in the film, the resources for traveling to clinics for "stimulation" or for treatment, as well as other care is a government benefit, and many are still waiting for it. Clinics that care for infants with microcephaly are state-supported, as well. One mother was unable to continue working due to the requirements of care of her infant with microcephaly. Many other families may have husbands who are out of work, and the mother's job was the only one providing resources for the family. 

The upshot is that Brazil is in for a massive requirement for resources in so many ways for the future, that it is frightening, for any country no matter how wealthy. This will include special education, special care, workforce shifts, national productivity, increasing burdens on social benefits that are going to be reduced by the drop in productivity and potentially a drop in GDP, a measure of the health and stability of a government. 

As a largely Catholic country, the termination of pregnancy is highly unlikely unless the health of the mother is at risk. However in 2012, the Supreme Federal Court ruled that a pregnancy could be terminated for anencephaly, or the absence of part of the brain. In at least one case in the film, the cerebellum was missing from the baby. But it was not without a fight. It started in 2004 when the National Federation of Health Workers filed a case to declare women who could not legally abort a fetus that was destined to die within 24-48 hours after birth because it was a violation of human dignity, i.e., the UN Declaration of Human Rights. The Attorney General brought the 2012 case, but over the objection of the Council of Bishops in Brazil.  The Supreme Federal Court vote was 9-2 in favor of changing the law to include anencephaly to rape and life of the mother reasons for abortion. 

Zika is making its way on a rapidly unfolding global itinerary and there is little to no plan to address it. The EU just had its first case of microcephaly attributed to Zika. Who/WHO should be leading an effort to confront this global threat? Is WHO doing enough? On February 1, 2016, rather late, the WHO took action under international law, using the International Health Regulations to declare a Public Health Emergency of International Concern (PHEIC). Since, WHO has deployed 95 WHO experts, globally as of July 16, 2016 in their mission to address Zika. Is there a cohesive strategy? The WHO strategy for the Americas is simply to diagnosis and research the problem, and not one word is expended on killing mosquitos, which is the most effective way to avoid the problem.  However, by March 2016, recommendations were finally issued by the WHO Public Health Emergency committee convened under the International Health Regulations which focused on mosquito control.

Always worry when Russia has an anthrax outbreak

The report of an anthrax outbreak and evacuation in Russia in the Yamalo-Nenets autonomous region of northern Russia where 1200 reindeer "suddenly" died is not typical of a few reindeer being exposed to an unearthed diseased animal, the Russian's stated diagnosis. The last time there was an outbreak in what is now Russia, and a swath of sheep "suddenly" died, with a few dozen humans; the USSR claimed it was caused by contaminated meat that was purchased on the black market. Thirty years later, the true reason came to light, that the source of the anthrax infection was actually a leak from a bioweapons plant in Sverdlovsk. If you try to do a Google search today for Sverdlovsk, you probably will not find very much about the city -- they changed the name of the city after the incident.

The reported evacuation of 63 nomadic families in the region and emergency evacuation of two children, is not an infection from contaminated reindeer, but suggests inhalation anthrax, a highly uncommon infection unless spores are aerated and present in a high enough concentration to cause infection -- also inconsistent with a claim that an infected animal was unearthed by a few reindeer.

Getty images

Reportedly, the last anthrax outbreak in the region was 1941. 

Let's hope we don't have to wait 30 years this time to find out the reason for an anthrax outbreak that covers a land mass the size of Turkey.

Forgotten Tragic Deaths from Smallpox in the Revolutionary War

The notice of a ceremony to recognize those prisoners of war who were disgorged onto the Long Island to die by a British warship, reminded me of how horrific the threat of smallpox was during the Revolutionary War, yet it is rarely mentioned as a cause of so many casualties. But this ceremony to honor those who died of smallpox is a story that will make you grimace. 

The American soldiers were captured in the Battle of Long Island, August 27, 1776, the first major battle on American soil after the USA declared independence in July. By December 1776, the British must have decided the prisoners of war, who were all sick with smallpox, would just be left to die when they dumped them on the shore of Long Island Sound. Note the temperature was probably in the 20s given the historical record of the Battle of Trenton in December 1776.  

There were no governing laws of war in 1776 other than international humanitarian customary laws of war, some of which had begun to build on humanitarian customs.  Gen. George Washington, after the Battle of Princeton, January 1777, put in charge Lt. Col. Samuel Blatchley Webb, to ensure British soldiers were treated in a humanitarian manner. Gen. Washington wrote, "You are to take charge of privates of the British Army . . . Treat them with humanity, and Let them have no reason to Complain of our Copying the brutual example of the British Army." (See, Gary D. Solis, The Law of Armed Conflict: International Humanitarian Law in War, p.14, Cambridge Univ Press, 2016). One can only assume, Gen. Washington might have included in his reference the treatment of smallpox-infected prisoners of war. 

So, what was the motive in dropping off 46 smallpox-infected prisoners of war on the shores of Connecticut in Milford, a heavily populated area for the time, if not in hopes that they might all disperse to their homes and infect the civilians of Connecticut? A possible biological attack that has been overlooked? The British were fans of biological terrorism which we know from Sir Jeffrey Amhearst's letter outlining his plan to give infected smallpox blankets to the Pequots. We may never know.
    

Lessons from the Black Death

I have always believed that there are many lessons to be learned from the Black Death because of its epic spread and magnitude of the death rate. Estimates that 1/4 to 1/3  of the entire world's population died from the plague, presents a unique case study and one that should not be dismissed as mere history that cannot repeat itself. But the 1348-51 Black Death is not the only outbreak of plague, although it is certainly the most notorious.

A couple of epidemiologists at Imperial College in London have made a new finding based on the voluntary isolation of  the "plague village" during the plague outbreak of 1665-66 in the UK. Due to the voluntary "quarantine" of the village, the transmission of plague is evaluated from one point of transmission -- some plague-carrying-flea-invested cloth received from London. The researchers determined that 75% of the transmission came from human-to-human infections, and only 25% from flea/rodent infections. This is also consistent with the finding that the wealthy were less likely to be infected with the plague, probably due to their lower probability of coming into contact with rodents and village folk.

This finding could be very helpful in assessing effectiveness of countermeasures in future outbreaks in this millenia.

The article and link to the scientific publication can be found here. 

Biocrime Games Children Play

In my routine tour of amazon for new books on bioterrorism, I was surprised to find this product. Apparently this kit is being sold as a game for children. The object of the game? A bioterrorism scenario, leads to taking a DNA fingerprint of a crime scene and then to determine if it is smallpox. The new millenia chemistry kit gift for kids.

Since the kit "contains no smallpox" it seems safe enough, but having a kit that has a component that presumptively will test positive for smallpox presents an opportunity for a hoax waiting to happen? 

Despite the smart move of Cong. Lamar Smith introducing a federal criminal statute to address the anthrax hoaxes that proliferated after 9/11, the Senate failed to pass The Anti-Hoax Terrorism Act of 2001 (H.R. 3209), a statute meant to address the flood of anthrax hoaxes. Instead, the WMD statutes and "communications of false information" crimes continue to be the available criminal statutes against bioterrorism hoaxes, which carry penalties of reimbursement to law enforcement responders as well as possible prison time.

Here's the product: 

Edvotek 124-C DNA-Based Screening for Smallpox 
Edvotek Inc 
Link: http://amzn.com/B004W7XRH0

Vermont's GMO Label Legislation--worrying about the wrong risks

    Vermont passed a statute in 2014 requiring GMO labelling, to take effect July 1, 2016.
    The controversy about food labeling laws from Vermont is not new. It started long ago with their first labeling law, passed in 1994, against milk containing added rBST a hormone that already exists in milk, and an FDA approved process.  The Vermont law was struck down as an unconstitutional burden on the "right not to speak", because making companies' label products that was contrary to the FDA finding that there was no difference in milk with added rBST and any other milk would mislead the public into thinking there was a risk. Many believed it was a state protectionist law to promote Vermont milk sales, which is also unconstitutional. Vermont is now at it again, this time labelling GMO foods.
     Pres. Obama promised to "immediately" start labeling GMO food in his campaign promises in 2007. The Obama Administration which purports to care about science-based decisionmaking was going off the rails, already. They responded to their squeaky wheel group of people who are obviously not interested in scientific evidence but believe they should have this statement on the labels with food containing GMOs like this one required in the Vermont law: "potentially pose risks to health, safety, agriculture, and the environment".
     This is a good example of using up resources on a no risk problem when there are much more serious problems like processed sugar, excessive fat in American diets -- proven risks--but that is something no one wants to hear about in a campaign stump speech.
    Let's consider the right to know if you are eating GMOs and how to make that palatable for groups who have this misplaced sense of risk. There is no "right" but let's go on the presumption that we need to meet this need, legislatively and constitutionally. Manufacturers could be facing 50 different state laws on GMO labeling with different requirements. The action that would remedy this burden would be to have a federal law to avoid the constitutional "substantial burden on interstate commerce". If there is a uniform label in federal law, then manufacturers would not have to create 50 different labels for potentially 50 different state laws, and thereby passing the "substantial burden" test. However, the U.S. Congress recently blocked a bill that would have made at least voluntary labeling, uniform. One has to wonder if there is a strategy to allow this "substantial burden on interstate commerce" to play out with the Vermont law, the test for an unconstitutional statute, so that the federal courts can strike down the Vermont law, yet again.
   This squeak wheel group has created a new market for those companies which market primarily on the claim they sell non-GMO foods, so why not just buy the non-GMO products? They would be doing something positive in the market to encourage and grow these industries. But that is not what this coalition has chosen to do. For these people it seems they are out to punish GMO manufacturers because they clearly have an alternative way of shopping for non-GMO food.

U.S. poll shows little concern about Zika

CDC reports that as of March 30, there have been 312 cases of Zika in the U.S. but 4 out of 10 people have not heard of Zika or have heard very little according to an AP and Univ of Chicago poll during the last week of March 2016. The poll also showed that only 25% of Americans thought the US should pull out of the 2016 Summer Olympics in Rio de Janiero, Brazil, where Zika has been most widely observed.
CDC should take the opportunity as the federal agency give the public health risk communication task for public health emergencies (Executive Order, Bush '43) and provide leadership on this task, describing the ways that Zika can be transmitted, including close intimate contact, etc. and how to prevent infections, what to do to avoid mosquito bites.
Finally, CDC should be showing leadership in advocating the use the Oxitec mosquito  as much as possible to combat Zika gaining a foothold in the U.S.  The genetically modified Oxitec mosquito has been effective in reducing Aedes mosquitoes, those mosquitoes responsible for transmitting Zika as well as Dengue Fever.  Public information campaigns about the use of GMO mosquitoes would go a long way to address any concerns from the public about releasing them into the environment.

WHO ends public health emergency in West Africa

     On Tuesday, March 29, 2016 the WHO ended the public health emergency of international concern (PHEIC) for Ebola, perhaps too soon. The PHEIC designation is a determination by a WHO convened Emergency Committee to determine by an algorithm in the International Health Regulations whether the event continues to be a PHEIC.
     The WHO was slow to designate the Ebola epidemic in West Africa a PHEIC on August 8, 2014 after months of delay, not seeing the eventual catastrophic spread  in West Africa and then into Europe and North America.
     In the Emergency Committee findings on their determination to end the public health emergency, this week, they determined that the Ebola outbreak no longer constituted "an extraordinary event," one criteria for designating a PHEIC. However, a new cluster of Ebola was found on March 17 in Guinea, and a new case arose in Liberia on April 1, 2016.
      Although these may not be connected to original cases, this is something that bears watching under a PHEIC for a longer period to ensure W. Africa continues to have necessary support to respond, despite WHO's determination that they have the capacity to respond, now. Given the collapse of the internal public health systems for usual functions like childhood vaccinations, it is hard to imagine that W. Africa has miraculously caught up on these functions, and built their infrastructure to respond to one of the world's most challenging diseases.
      This should be closely watched by the world.

CIA's Brennan most concerned about cyber-attacks

In this 60 Minutes interview of the CIA Director, John Brennan, 
the headlines show that he spoke about Syria's access to chemical 
and biological weapons. However, in the text and audio version, he 
never mentions biological weapons. This could mean it was redacted 
from the original interview or they just over-reached in their headline. 
What Brennan said that should be noted, however, was that Syria has 
access to chemical weapons, but later remarked, 
"it is cyber that keeps me up at night.". cbsn.ws/213oO8T  

For Immediate Distribution  |  February 4, 2016  |  (512) 463-1826

Governor Abbott Names Director And Appoints 31 To Task Force On Infectious Disease Preparedness And Response AUSTIN – Governor Abbott has appointed 31 members to the Task Force on Infectious Disease Preparedness and Response and has appointed John Hellerstedt, M.D. as director. The Task Force was created to provide expert, evidence-based assessments, protocols, and recommendations related to state responses to infectious diseases, and to serve as a reliable and transparent source of information and education for Texas leadership and citizens.   James Bass is Executive Director of the Texas Department of Transportation.   Carlos Cascos is the Texas Secretary of State.   Ed Emmett is the Harris County Judge.   Brett Giroir, M.D. is a senior fellow at the Texas Medical Center Health Policy Institute.   Janet Glowicz, R.N. is a public health analyst for the Centers for Disease Control and Prevention.   John Hellerstedt, M.D. is Commissioner of the Texas Department of State Health Services.   Peter Hotez, M.D., Ph.D. is Dean of the National School of Tropical Medicine at Baylor College of Medicine.   Richard Hyde is Executive Director of the Texas Commission on Environmental Quality.   Tim Irvine is Executive Director of the Texas Department of Housing and Community Affairs.   Nim Kidd is Chief of the Texas Division of Emergency Management.   Thomas Ksiazek, D.V.M., Ph.D. is Director of High Contaminate Operations and Director of the Biosafety Level 4 Laboratory, University of Texas Medical Branch, Galveston.              David Lakey, M.D. is Associate Vice Chancellor for Population Health at the University of Texas System.   Binh-Minh “Jade” Le, M.D. is an associate professor in the Division of Infectious Diseases at the University of Texas Southwestern Medical Center.   James Le Duc, Ph.D. is Director of the Galveston National Laboratory at the University of Texas Medical Branch.   Scott Lillibridge, M.D. is Director of Health Initiatives at the Texas A&M University System and professor of Epidemiology at the Texas A&M Health Science Center School of Public Health.   Tony Marquardt is a paramedic with the City of Austin / Travis County Emergency Medical Service.     Muriel Marshall, D.O., DrPH is the Collin County Health Authority.         Steve McCraw is Director of the Texas Department of Public Safety.   Michael Morath is Commissioner of Education.   Kristy Murray, D.V.M., Ph.D. is an associate professor of pediatrics and tropical medicine at Baylor College of Medicine and Texas Children's Hospital.   Major General John Nichols is the Texas Adjutant General.   Dorothy Overman, M.D. is the Comal County Health Authority.   Raymund Paredes, Ph.D. is Commissioner of Higher Education.   Gerald Parker, D.V.M. is Associate Vice President of Public Health Preparedness and Response at Texas A&M Health Science Center.          David Slayton is Administrative Director of the State Office of Court Administration.   Kristina Stillsmoking, Ph.D. is Director of the Simulation Hospital, University of Texas Rio Grande Valley School Of Medicine.   Victoria Sutton, Ph.D. is Director of the Center for Biodefense, Law and Public Policy at Texas Tech University School of Law.   William Tierney, M.D. is the inaugural Chair of the Department of Public Health at the University of Texas at Austin Dell Medical School.                   Chris Traylor is Executive Commissioner of the Texas Health and Human Services Commission.   Dale Wainwright is Chair of the Texas Board of Criminal Justice.   Ben Zeller is the Victoria County Judge.

     This blog focuses on biological threats, but to the extent nuclear weapons are a threat, I thought it would be of interest to post this comparison to the estimated power of the North Korean hydrogen bomb-like test that was reported today. 

     The test was estimated by Norsar to be less than 10,000 KT, and so I have created a chart to compare it to other nuclear explosions, including the two largest nuclear power plant explosions. Since nuclear power plant explosions are magnitudes smaller than modern nuclear bombs (except the first Hiroshima bomb which is comparable), here is how the North Korea test compared to other explosions measured in megatons, which is equivalent to a million tons of TNT, the equivalency measure for explosions.

       Here is a brief overview of the international law issues applicable to North Korea and the recent test of a hydrogen bomb device. North and South Korea were both admitted to the United Nations, giving some legitimacy to North Korea as a legitimate country in 1991.  Both North and South Korea signed a joint declaration on the denuclearization of the Korean Peninsula in 1992. The U.S. and North Korea negotiated the Agreed Framework, with an objective to end North Korea’s nuclear program, in return for food and fuel aid as well as light-water reactors. The Agreed Framework kept open further talks toward normalization relations. North Korean began conducting nuclear tests again in 2006. North Korean is so heavily sanctioned that more sanctions will undoubtedly have little effect. (UN Security Council, Resolution 1695, Resolution 1718, Resolution 1874, and Resolution 2087.) Starving their people is considered a worthwhile tradeoff.  North Korea is the only country to withdraw (2003) from the Treaty on the NonProliferation of Nuclear Weapons (NPT) of the 191 members (although four never joined: Israel, Pakistan, India and South Sudan).  The International Atomic Energy Commission, associated with the United Nations is the international body which monitors nuclear power and non-proliferation. In 2007, the IAEA sent an inspection team to North Korea to ensure nonproliferation.