Map of life expectancy at birth from Global Education Project.

Friday, December 30, 2011

Donning the Turban

Okay, I promised I'd get around to looking ahead to 2012 in the U.S. and I guess it's now or never. I've been procrastinating because it seems an unpleasing prospect.

I try to avoid the pundit's occupational hazard of presuming magical predictive powers. But I do hereby declare there is a 95% chance that our national conversation will completely miss the point on just about every important subject. That's the basis of my gloom. It's not that we can't make real progress toward solving our problems, it's that we won't even recognize them or talk about them. We'll talk about other problems that we don't have.

Everybody has noticed that we have extreme economic inequality in the U.S., the kind we used to deplore in what were once called Third World dictatorships. Some people on the right don't think this is a problem - those folks with the loot are the "job creators" and if you want a job, you want them to have even more money. Apparently there's a guy who only has $5 billion right now, and once he gets $6 billion, he'll give you a job. The way to achieve this is to stop making rich people pay taxes and to eliminate environmental, worker safety, food and other consumer safety regulations, and allow banks and investment management companies to steal from you.

On the other side we have people who want to increase marginal tax rates on income over a million dollars a year by 2%, and slash federal spending on stuff like health and other scientific research; technology investment; infrastructure maintenance, repair and construction; health care for the poor and elderly; education; and basic needs for poor children, in order to reduce the federal budget deficit in 2030. Oh yeah, meanwhile they want to give you a break by underfunding Social Security. Those are the liberals.

What we won't talk about is the absolutely critical need to invest everything we can right now, while we still have the resource and time, in a post-fossil fuel energy regime; to dismantle our globe girdling military empire; to prepare our young people for the demands of the knowledge-based economy; to save the ecosystem services of forest, grassland and ocean; and to destroy the power of the psychopathic, soulless corporations that are running the world right now. Because we won't even talk about any of the above . . .

We will continue our national decline. Our economy is controlled by people who have no loyalty to the United States or its citizens, who will extract whatever they can from the public infrastructure without paying for it, and send the proceeds wherever in the world they can loot at an even higher profit.

Our remaining national strength is squandered on a useless military behemoth designed to fight World War III on its own against the rest of the planet combined, but unable to defeat a few hundred men with homemade bombs. (Why we want to defeat them in the first place is a profound mystery.)

More and more of our children will go hungry. People who have worked and saved all their lives suddenly find themselves with their savings and careers destroyed, architects and engineers taking the jobs their teenage children would have had ten years ago. Higher education will be impossibly out of reach for more and more of those kids even as their elementary and secondary schools deteriorate.

And almost in the background, noticed only to be denied, the weather will grow more and more destructive, whole regions of the country will become essentially uninhabitable, agriculture will decline, mass extinctions of plants and animals will continue, and the ecology of the world ocean will collapse.

What do you expect the political campaigns next year will be all about?

Wednesday, December 28, 2011

Odd thoughts

I came into work today, even though the university is closed, because of some pressing duties. Providence is a college town, so downtown seems to have been hit by a neutron bomb. I was the only person in the restaurant where I ate lunch. This week generally has a slow, subdued, and slightly lonely quality, a suspension of normal time.

In fact there is a great deal of consequence going on in nation and the world right now, but for whatever reason, the TV news focuses on a disconcerting polarity of heartwarming holiday tales and horrific tragedies. I don't expect there are more deadly house fires and auto crashes this time of year, but we certainly hear a lot more about them. One such was a fire in a Victorian mansion in the tony New York suburb of Stamford CT that killed three children and their grandparents.

It turns out that before retiring for the night, somebody removed the hot coals from the fireplace and put them out in the mudroom in a bag. This behavior is so daft that I thought there must be some deeper meaning to it. The proper place for hot coals, of course, is the fireplace. It is built to contain fires. Just leave them there.

Could it be that the Martha Stewartian perfection of the home seemed impaired by the thought of -- shudder -- ashes in the fireplace? Whatever the case, the fireplace was once as essential to the functionality of a house as indoor plumbing and electricity are today. I grew up in a farmhouse built in 1835, which had two big stone fireplaces on either side of a central chimney. The fireplace in what is today the dining room has a steel rod on a swivel built into one wall, which was used to hang cooking pots over the fire; and a dutch oven on the side. You put coals in the bottom half of the oven and baked in the top half. That room was both kitchen and dining room. The room that is today the kitchen was a transitional room, an unheated anteroom which undoubtedly held firewood and whatever tools and gear were needed to venture out of doors, and probably a well pump. (The only surviving well from those days is out of doors, so I'm not sure about that.) Beyond that, fully attached to the house, was a stable where animals spent the winter.

Imagine, not just the utility, but the meaning of that fireplace. In winter, obviously, it would have burned continually, as not just the focus but the essential source of family life. Here was the one truly warm place in winter, where food was prepared and consumed, water was heated for cleaning and bathing, illumination was available in the evening for reading, the bedwarmers were filled before everyone retired for the night, and everyone huddled together continually in the cold and lean months.

Nowadays, fireplaces are just toys -- dangerous toys, as it turns out, for people who don't understand them. I suppose they are more than toys. They retain symbolic power from the old days, as a symbol of the household community, which is still captured in the word hearth. We have sat around fires for a million years, so the appeal must be built into our nature. But it's just for old time's sake.

Tuesday, December 27, 2011

People are Stupid

That was the opening line of a talk I heard by Isaac Asimov back when I was in college. He was predicting the kind of world we would have in the 21st Century and no, it wasn't about intelligent robots and space travel. It was about how we would have equality for women and limits on population and resource depletion and stuff because if we didn't, we'd be well and truly screwed.

He was right of course but unfortunately we're leaning more toward the latter alternative. "People are stupid" is also what I take to be the core message of this useful handbook on debunking BS from Skeptical Science. (It's a PDF but not huge.)

The basic problem we face in going up against the Limbaughs and Hannitys of this world and their devil-spawn in the Republican primary field is that you don't beat liars by trying to stuff people's heads with more and better facts. If your headline is "It's a myth that climate scientists don't agree about human-caused global warming," the phrase "climate scientists don't agree about human caused global warming" actually has a more powerful effect than the phrase "it's a myth." If you provide 7 arguments as to why you should believe that burning fossil fuels does cause global warming, that's too many, because people don't want to think that hard. If you tell them that the Vulgar Pigboy doesn't know what he's talking about, that's just going to make them hate you because they know and trust the Vulgar Pigboy. (VP=Rush, BTW.) Also, words - too hard to follow. Show them a picture.

And so on. It's well worth a read if a bit depressing, not least because the liars already know all of the above and are highly skilled in implementing it. But the authors hope that if real experts can learn these lessons, the truth can win on a more level field. I hope so.

Saturday, December 24, 2011

It's been a decent interval . ..

So I can repost this, which I wrote a few years back.

Christopher Hitchens, like Lyndon Larouche, used to present himself as a leftist. For many years he had a column in The Nation in which he vied with Alexander Cockburn for the “Most Acerbic” award (a magnificent scarlet inkwell filled with sulphuric acid). Things started to get a little weird in the 1990s when he developed an obsessive hatred of the Clintons. His reasons were partly respectable (triangulating, Dick-Morris-employing betrayers of the revolutionary vanguard) and partly insane (Bill’s serial sex crimes made Ted Bundy look like a boy scout; Whitewater [in which they were guilty, Guilty, GUILTY!) was the financial scandal of the century; Hillary not only murdered Vincent Foster, but conspired with her lesbian lover to seduce, rob and kill dozens of wealthy young fops whose mutilated bodies turned up in seedy alleys all over the DC metro area . .. well, maybe I made up that last one but it’s in the spirit of the thing.) Once he could no longer demonstrate his superiority to the bleating herd of liberal sheep by cheering on Ken Starr, the Iraq war became his next opportunity. His bellicose rantings were enough to drive Dick Cheney to the Quaker meetinghouse. He finally resigned from The Nation, claiming that the refusal of the magazine’s other writers and editors to fall to their knees in grateful acknowledgment of his intellectual and moral superiority on the question of war was proof of their bigotry and hatefulness. He wrote a final hissy fit essay in which he burned every bridge from London to Lompoc.

As some people have noticed, the Iraq war has not turned out the way it was supposed to. Some of the war’s portside chickenhawk supporters have since issued mealy mouthed retractions; others have concentrated on giving Chimpoleon and his pals unsolicited advice about how to do it better. Hitchens, however, has devoted himself to escalatingly vicious and absurd attacks on the war’s opponents. It’s not unusual for polemicists to turn against their own comrades but Hitchens’s case is particularly disgusting and bizarre. I think that chronic alcoholism destroyed brain cells in his cerebral cortex that normally inhibit irrational emotional responses in the limbic system. Something ticked him off around 1994, and the anger just fed into a positive feedback loop that slowly and steadily grows more intense. Eventually, he’ll lose one too many neurons and lapse into a vegetative state.

In his last couple of years, his public face was mostly about atheism, which is fine by me. But people shouldn't forget the rest of it. The guy went seriously off the rails.

Friday, December 23, 2011

Lies, damn lies, and un-lies

I'm sure I don't have to draw readers' attention to the preposterous selection by the self-styled "fact checking" organization Politifact of the "Lie of the Year." This was the claim by many Democrats that Republicans voted to end Medicare, specifically when the House voted to endorse Paul Ryan's long-term fiscal austerity plan. As many a blogger has pointedout, this is not a lie, therefore it cannot be the Lie of the Year. And it wasn't even Democrats who first said it, it was Naftali Bendavid in, of all places, the Wall Street Journal.

PolitFact is defending itself, seeming almost proud to have provoked such a firestorm among liberal bloggers and analysts. They claim that conservatives get all their info from Fox News, while liberals get all their info from Rachel Maddow, so of course we're unable to see that our treasured memes are actually lies.

Well now. Rachel Maddow is highly opinionated, but unlike Fox News, she has respect for actual true facts. That aside, I don't get my information about health policy from Rachel Maddow or anyplace else on TV. I get it from scholarly journals because, unlike the clowns at PolitiFact, I happen to be a genuine, bona fide expert on the subject. I even have a fancy degree in it and everything and I am a professor at one of those pointy headed elitist fancy pants east coast universities.

So here's the genuine information, unfiltered by Rachel Maddow. Medicare is a government sponsored health care plan which covers everybody in the U.S. over 65, and some other folks as well. It's essentially a single payer plan -- Medicare pays for health care services, giving everyone who is eligible a bundle of guaranteed benefits with very low, subsidized premiums and copayments. (People who can't even afford those get extra help from Medicaid.) (Now, you can choose to have Medicare use the funds otherwise allocated to you to buy private insurance. It's called Medicare Advantage. But it turns out to be no advantage at all, because it actually costs the government more.)

That's Medicare. That's what the word means.

The Republicans would instead give you a voucher that you could use to buy private health insurance, but it would not be enough money for most elders to actually afford the same level of benefits they get from Medicare. And it would just get worse and worse over time. And it would be much less cost effective because those private insurance companies would spend a big chunk of the money on marketing, profits, executive salaries, and trying to find ways to stop older and sicker people from doing business with them. (There are plenty of sleazy ways to do that, even if it's supposedly illegal.)

That's not Medicare. It's something else.

There are many other implications of this difference that I won't go into here, mostly having to do with all the ways that Medicare could be even better and would be if the insurance, pharmaceutical and hospital industries didn't own Congress.

The people who run PolitiFact don't understand all that because they are not experts. They have been bamboozled in the name of "balance." They are useless.

Wednesday, December 21, 2011


I have a probably unfortunate habit of looking ahead to the new year here. As far as I can remember I have tended to be mostly right but I don't claim any special powers of prognostication. Anyway, in case anybody cares, here's what I'm worried about, which, alas, is plenty.

Starting in Europe and moving generally eastward:

Don't look now (and few people are) but Greece is already in the midst of a total economic collapse. I mean the kind where refugees flood into the rest of Europe, civil order disintegrates, food rioters break into warehouses, and the country's hard won democracy founders. Really. It's that bad. Greece has long had a dysfunctional economy and political culture, it's a special case and economically, it's basically a minor appendage to Europe, but Europe as a whole is heading into a less dramatic, but still painful recession and its leaders seem collectively insane. They're doing the best they can to make matters worse, while squabbling with each other like schoolchildren who didn't get lunch. In the past -- i.e., for the better part of 2,000 years -- their squabbles have tended to get extremely ugly. I'm not expecting World War III but I do know that the experiment of European unity is in peril. Meanwhile this can't be good for their biggest trading partner, that would be us.

Meanwhile, and again Americans long ago lost interest, but Iraq is skating perilously close to breaking into three pieces -- which will not happen peacefully. The brewing civil war in Syria just exacerbates sectarian tensions in Iraq, since the Shiite government is much more sympathetic to Assad than the Sunni Arabs who are increasingly feeling oppressed and have lost faith in Iraq's democracy. If Iraq does fall apart then it won't be a surprise to see Iranian and Saudi forces enter the country and then, hoo boy. Oh yeah, Iran is hurting big time from the sanctions regime and its own population is simmering while it's elites are increasingly fractious. There is no limit to the amount of shit that might hit the fan in the whole region, and uhh, oh yeah, oil.

Proceeding on to Pakistan, it is very likely that the pretense of civilian rule will dissolve. Pakistan's military and security services are riddled with highly ideological religio-nationalists who have shown themselves perfectly capable of creating irrational provocations to India and which have designs on wielding influence in Afghanistan through precisely the people who we now call the insurgency and who are blowing up our fine young soldiers. Oh yeah, they have a large nuclear arsenal.

I'm actually not particularly worried about North Korea but I don't like to see millions of people starve. China will probably see some economic difficulties but they'll muddle through.

Before I cross the Pacific, I'll just say that Africa, for all its troubles, is actually doing okay compared to previous decades. And, proceeding to Latin America, they're doing quite well these days. The big players, Argentina and Brazil, are actually doing jes' fine, with stable democracies, strong economies, and steady progress against their long standing problems. (Not so much the Amazon rain forest, however.)

Now, proceeding north from Brazil . ..

To be continued

Tuesday, December 20, 2011


I'm sorry for not posting for a few days. As I may have mentioned before, I'm selling my home of more than 20 years in Boston and finally have an imminent closing, so that's made me very busy, not least of all with getting the last of my stuff out of there. In the process of closing down the old homestead and moving, I think I've gotten rid of about 50% by volume of all the crap I had. As much as possible, I talked the thrift store into taking stuff or found a way to give it to someone directly, but the piles of trash are still immense.

How did this happen? How did I end up with mass quantities that I don't need, don't want, don't even want to store? And why, since I actually have more crap than I want, do family members insist on giving me yet more crap that I probably don't want every December 25? For years now I've been trying to break them of this habit. I make a contribution to charity -- specifically Oxfam but it could be any charity that gives to people who actually need it. I send everybody a card saying I did that. They all seem happy with that and not offended by it, but they still just have to give me something.

I asked my mother what she wants for Christmas and it turns out she's as sensible as I am -- she said she wants people to come to her house and take stuff away. But even the combined influence of the two of us can't overcome the deeply felt need to have a mass celebration of buying and having stuff, more and more stuff, more and more useless and superfluous stuff, every December.

With the planet in peril from overconsumption, and literally billions of people who actually could stand a little of your generosity, this makes no sense at all. Including if you are a Christian. Lillies of the field and all that, remember?

So let's win the war on Christmas. Enough stuff.

Update: Almost forgot to share Tom Lehrer's Christmas Carol. (Full lyrics here.) Final verses:

Relations, sparing no expense'll
Send some useless old utensil,
Or a matching pen and pencil.
"just the thing I need! how nice!"
It doesn't matter how sincere it
Is, nor how heartfelt the spirit,
Sentiment will not endear it,
What's important is the price.

Hark the herald tribune sings,
Advertising wondrous things.
God rest ye merry, merchants,
May you make the yuletide pay.
Angels we have heard on high
Tell us to go out and buy!

So let the raucous sleigh bells jingle,
Hail our dear old friend kris kringle,
Driving his reindeer across the sky.
Don't stand underneath when they fly by.

Friday, December 16, 2011

End of an era

As those of you who have checked out the sidebar know, I have for many years contributed to the blog Iraq Today. When I first started, it was called Today in Iraq (it's a long story why we had to change) and it was one of the most heavily trafficked blogs on foreign affairs. We were linked from Atrios and Riverbend and I regularly got e-mails from everyone from Iraqi officials to U.S. army publicists to reporters and pundits complaining about stuff I had said about them. We also heard from military, military spouses and war widows, usually to thank us but sometimes to accuse us of disloyalty because they didn't think it was possible to simultaneously support the troops and oppose the war.

As Iraq faded from the consciousness of Americans, so did the attention people paid to Today in Iraq. But we kept it going, because we felt it still ought to matter to English speaking readers, particularly Americans (although we have had contributors from Europe and readers from all over the world).

Today, the U.S. handed over its last remaining base to Iraqi control and ended its military operations in the country. I still care as much as ever about the long-suffering people of Iraq, and I still believe that the United States bears some responsibility for their future, but our armed forces will no longer be involved. That's what we've been advocating for from the beginning. I am very glad about it, although I look to the future in Iraq with great concern. There's not much good news these days so I'll take what I can get.

So this marks a bit of a change in my life as well. The blog will become Today in Afghanistan, and I will henceforth spend more time studying that country and its troubles. I am not abandoning Iraq -- I'll check in on it every Sunday -- but it will be a weaker tie, something like a friend who has moved out of town, I suppose. Anyway, I hope you'll look in on Today in Afghanistan as Whisker and I develop the site and our style of aggregating and commenting on the news from that country.

Thursday, December 15, 2011

This should be obvious . . .

But it still bears repeating because it doesn't seem to live comfortably in the political consciousness. A major point of Lawrence Lessig's new book is that as important as the corrupting influence of money in politics is to determining the outcome of the political process, it's just as important in determining what we talk about. One of his big examples is the major focus by Congress this past winter on whether banks could charge transaction fees on debit cards -- while spending less time on unemployment, global warming, health care, the various wars in which the country was engaged, or the deficit. I would add that we wouldn't be talking about further cutting wealthy people's taxes either, and we never would have cut them in the first place back in 2002.

I would also add that while all of the above is important, the simple fact is, as Tom Murphy explains so even a historian can understand it, civilization as we know it is doomed. It will not be possible to produce enough liquid fuel to sustain the existing society, let alone the growth anticipated in India, China and elsewhere, within a very short time. Even if we want to do shale oil and tar sands and coal liquification, climate be damned, those resources cannot be developed fast enough. and we face the Energy Trap no matter what we do -- it takes energy to develop renewables or unconventional oil sources or infrastructure that promotes conservation such as mass transit. No matter what direction you want to go, we need to use the fossil fuels we have no in order to get there, but if we don't start investing now, if not yesterday, those fuels will get more and more expensive and will be in too short supply to support that development.

So we need to deal with this immediately, radically, and with full commitment. But all we're talking about is financial deregulation, repealing the Affordable Care Act, and lower taxes for billionaires. See you 'round the apocalypse.

Ooooghh: Tangential but, Revealed: huge increase in executive pay for America's top bosses. From The Guardian:

Exclusive survey shows America's CEOs enjoyed pay hikes of up to 40% last year – with one chief executive earning $145m. Chief executive pay has roared back after two years of stagnation and decline. America's top bosses enjoyed pay hikes of between 27 and 40% last year, according to the largest survey of US CEO pay. The dramatic bounceback comes as the latest government figures show wages for the majority of Americans are failing to keep up with inflation.

The guy who scooped up $145 million? That would be John Hammergren of McKesson, which is a pharmaceutical and medical supply distributor. Now you know why we can't have single payer national health care.

Wednesday, December 14, 2011

Hillbilly heroin

I've kinda changed my mind -- kinda -- about opioid prescribing. I used to lean toward emphasizing that doctors are often too reluctant to prescribe opioid analgesics, that they can be a tremendous boon to people in chronic pain, and that a) short term use for pain relief seldom leads to addiction and b) if people who need them basically forever technically become addicted, who cares? Biologically, maintenance on a steady level of opioids can have some side effects, such as constipation, but people can function perfectly well and in fact better than they would in chronic pain.

But, as CDC reports here, we have a large and growing problem with prescription opioid abuse and the ultimate manifestation, that we can't look away from, is death by overdose. It turns out that by 2008, death from prescription drug overdose rivaled death from motor vehicle crashes, the leading cause of unintentional injury death (36,450 vs. 39,973). Since motor vehicle deaths are declining (due to socialist fascist nanny state regulations such as air bags, antilock brakes, etc.), and prescription opioid ODs are increasing, those lines will probably cross soon if they haven't already. (By the way, it's non-Hispanic whites who are at by far the highest risk. African Americans and Hispanics have much lower rates of death from misuse of opioid pain relievers. They're much more likely to end up in jail for drug offenses, but they commit them less often. This is another national scandal.)

However, I've only kinda changed my mind. As the linked report also states, it has been found that 3% of physicians account for 64% of opioid prescriptions, and there's plenty of evidence that most of this epidemic is linked to "Pill Mills" -- unscrupulous operations that hand out scrips without appropriate medical indication, evaluation, or follow up. Astonishingly, the governor of Florida, the state with the highest concentration of these operations, long resisted efforts to crack down. It's still likely that many physicians are withholding relief from some people who ought to get it. But we need to stop these criminals.

Tuesday, December 13, 2011


Bissinger that is. He was Buzzy in prep school but he's dropped the diminuitive now that he's all grown up and he's just Buzz. (I was acquainted with him but didn't know him well. His real given name is Harry BTW.) He's very well known for documenting the culture of sports in the U.S. so Tweetie* has been having him on the program regularly to discuss the Jerry Sandusky/Penn State child rape mess.

Buzz is the veritable paradigm of repressed fury. I keep expecting his hair to burst into flames. And I can understand why, it's how a lot of people feel. Mr. Sandusky is of course entitled to due process, but the disposition of his personal case is not really the point in all this. Whatever the underlying facts, many people in positions of authority, with weighty responsibilities, failed to act appropriately and adequately when presented with credible information that required that they do whatever was necessary to be sure that children were safe. We already know this.

So what do I have to add to the maelstrom of mostly fairly obvious reflections? Just that if we view the sexual exploitation of children as a public health problem, we can think about etiology and epidemiology instead of just foaming at the mouth and having our hair burst into flames. Yes, moral condemnation and righteous fury are essential to reinforcing the social consensus, not to mention they're human nature, and I don't begrudge indulgence in them, but it's even more useful to understand why this happens and how it manages to continue.

I'm not a psychologist so I can't offer any particular expertise in the psychological roots of sexual attraction to children or sexually exploitative behavior. I do know that there is a risk of people who are abused as children becoming abusive themselves, although most of course react in the opposite way and become fiercely angry toward people who do this. (Joshua Komisarjevsky, who was recently sentenced to death in Connecticut, put on a defense based on his having been repeatedly sexually assaulted as a child. It didn't convince the jury but there is undoubtedly something to it.) While many children are resilient and overcome such traumas, others do not and, in one way or another, the consequences ripple out through society and down through time, unto generations. So preventing one incident can have multiplying benefits, while failure is a catastrophe that can extend far beyond a single child.

What is uniquely interesting in the Penn State case, as in the case of the Catholic church, is the sociological dimension. Whatever the reason that many priests and (allegedly) Jerry Sandusky engaged in this behavior, powerful cultural forces protected them. The church is an insular society unto itself, whose transcendent value is institutional aggrandizement. Football is a more complicated phenomenon. Yes, there are little subsocieties of team and university, but they are much more fluid and diffuse than the church -- people come and go, with the exception of Joe Paterno Penn State football and Pennsylvania State University are not life-long commitments, nor are they singular identities. And this scandal leaked well beyond those two institutions to include not only the campus police but also the police of the town of State College, apparently (from what we are starting to hear) a high school principal, charity executives and social workers, and probably many other people who were overawed by the charisma of the football team. Unlike the bishops, they weren't part of the institution they were protecting.

So this story also has resonance pertaining to the role of athletes and sports in our society. Athletes have an expectation of entitlement, which they get from the same wellspring as coach Sandusky. Sports are a public spectacle that stands for accomplishment and virtue. That symbolism largely obscures the reality that what you are watching and passionately adoring is just a bunch of ordinary, flawed people who happen to be skilled at a fundamentally useless enterprise. Many sports, including football, in fact institutionalize and glorify violence, which seems a wrong thing to worship, although I grant it is fun and exciting. (I wrestled in college -- there's nothing more essentially violent than that. The whole object is to physically force your will on the opponent.) But we are strongly committed to the illusion and just can't stand to shatter it.

*For those who are not aware of all Internet traditions, that's Chris Matthews. Some people feel he resembles the cartoon canary. (I tawt I taw a puddy tat!)

Friday, December 09, 2011

Another window into the libertarian paradise

Jerry Avorn, in NEJM (and mad props to them for continuing to make their public affairs material open access) looks back on the thalidomide disaster. The younguns may not know about this (I'm often befuddled when I discover you whippersnappers don't now what Vietnam was all about) so to review briefly:

Fifty years ago, drug manufacturers didn't have to prove that their products were safe and effective in order to sell and market them. Sen. Estes Kefauver introduced legislation to require that they do so but, as Avorn tells us, "Kefauver was accused of trying to unnecessarily expand the power of government, threatening the viability of the pharmaceutical industry, and inserting Washington bureaucrats between patients and their doctors, limiting the freedom of both. His legislation seemed doomed."

Damn right and Don't Tread on Me! I will give up my unstudied drugs when they pry my cold dead fingers from the pillbox.

So it turns out that at about the same time, there was a mysterious epidemic in Europe and Australia of babies being born with their hands and feet attached directly to their torsos. It took some freelancing investigators to figure out that their mothers had been prescribed a drug, marketed heavily for morning sickness (not to mention insomnia, premature ejaculation, menopause, alcoholism, depression . ..) sold under various brand names. Because it was called by so many different names in so many different places, it took a while to get it off the market. In the end, more than 10,000 children were born with devastating birth defects.

But . . .

The drug, generically called thalidomide, was never sold in the U.S. because an FDA employee named Frances Kelsey took it upon herself to conclude that evidence of safety was inadequate. Once this story came out, Kefauver's legislation passed. We still have a long way to go -- the deficiencies in the FDA approval process, even today, have been well-covered here. But, after a few more disasters in recent years, we've made some progress.

Listen up Dr. Paul. The drug companies, if left to their own devices, would be selling us arsenic. Liberty does not emerge from the mist if you take away government. On the contrary, we will find ourselves at the mercy of ruthless, greedy, powerful forces that we have no way to resist or even understand. Freedom is a product of democratic government, there is no other way for it to exist.

Wednesday, December 07, 2011

In case anybody wanted to know what I do for a living . . .

Right now I have funding to do a study called Explanatory Models if Illness and Decision Heuristics in HIV Care. What I'm doing in this first stage is having semi-structured interviews (that means essentially a guided conversation, no check boxes or fill in the blanks) with people living with HIV, in which I ask them what their concept is of HIV, HIV disease, and treatments, and how they work, and why they should or should not take the pills, etc. This is actually very important because over the years I've found that a lot of people have theories about all of the above which don't correspond to the theories their doctors have, and which cause them not to take the pills regularly, which their doctors think is a really bad idea.

I am also involved in a project where we are training physicians in a counseling technique called Motivational Interviewing, to see if they can't learn how to do a better of job of counseling their patients about taking pills and other health related behaviors. Mostly, before we train them, they just scold people, which doesn't work.

I have also developed methods for coding and analyzing clinical communication. We're steadily publishing papers from that work, and they tend to prove what I said in the preceding paragraph.

I'm curious, in case anybody wants to play this game. How would you explain what a virus is? How does it reproduce? How does it make people sick? That's in general. How about HIV? (Hint: It's different from most viruses. Do you know why?) Why can't your body get rid of it, as it does with a cold or flu? How do the drugs work to control it? Why do you have to take them right on schedule?

If you don't have a clue, that's okay too. If you think your idea is probably wrong or dumb, don't worry about it -- believe me, most people don't know the technical details, it's just interesting how folks think about it given that they weren't biology majors.

Tuesday, December 06, 2011

Knowledge is good?

You may not have caught the news about a Dutch virologist who has cooked up a genetically engineered strain of influenza which he claims could kill half of humanity. I was tempted to say that how I feel about that depends on which half, but on second thought, I'd call that a bad idea regardless.

What he has done, as I understand it, is to marry the lethal properties of the H5N1 avian flu virus that has been bouncing around Eurasia for a while with properties that make the virus highly contagious among humans. He's just guessing what the consequences would be of letting it loose but nobody wants to find out for sure.

He thinks he should publish his work so that people who want to come up with defenses against bioterrorism will have a heads up. Others think that would be not smart. I tend to agree with Others. We already grok the concept, which is about all you need to know to think about preparing. Publishing the details would make it easier for the Gingrich administration to actually make the stuff to use in the War on Terror, as any smart historian would do.

All that said, there are too many people in the world, and there will be way too many more in due course. For the past 20 or 30 years, it has been unfashionable for environmentalists to focus on the size of the human population. This is because it was considered more philosophically correct to worry about the other factor, the net negative environmental impact per person. Supposedly if we could make that low enough it would be cool for there to be zillions of people.

I say pish tosh. Of course we need to live more sustainably, but you have to multiply the burden each of represents by how many of us there are to get to the total problem and frankly, we're heading in the wrong direction on the first factor. The International Family Planning Conference just concluded, to exactly zero interest on the part of the U.S. corporate media. The truly bizarre, ugly and evil religious fanaticism that says giving people, notably women, control over their own reproduction is immoral must be relegated to the netherworld of ideas where racism and fascism now reside.

Otherwise, we will indeed experience a major reduction in the human population, the hard way.

Monday, December 05, 2011

This really frosts my pumpkin

Let there be no doubt whatsoever. Donald Berwick was, is and ever more shalt be the best person to head CMS. He is the most qualified, has the best ideas, and has the strongest resume to be in charge of making medical care in this country better for patients, cheaper for payers -- including the taxpayers -- and more satisfying for providers. If you don't understand why, or what the man is all about, please do read the linked article.

As Harris Meyer writes, "[I]t's difficult to find any health care stakeholder groups that express anything less than glowing praise for Dr. Berwick's performance at CMS." But, president Obama had to put him in office through a recess appointment because the brain dead Republicans in the Senate threatened to filibuster his confirmation on account a he's a soshulist and he's for rashuning. Then they wrote a letter saying don't even come back and try for a regular appointment.

Evil idiots. That's all they are. Why anyone would even contemplate voting for Republicans candidates, who all hate America, I cannot begin to fathom.

Friday, December 02, 2011

Yeah, it's personal

An important twist in my long and winding road was when I resigned from my job at United Way in Boston, at the same time as my friend Wayne S. Wright, and for basically the same reasons. (No reason to go into that, it's a good organization that's worthy of your support.) I set up a consulting practice to work my way through grad school, and Wayne became the first real executive director of the Multicultural AIDS Coalition in Boston. (I say "real" because there was a caretaker exec appointed to guide the nascent organization while they sought a permanent incumbent.) Wayne started referring me to various community based organizations involved with HIV prevention and services.

At that time -- the early 1990s -- there was no effective treatment. HIV meant you eventually get AIDS and then you die, in a very unpleasant way. And that was happening to a whole lot of people including, ultimately, Wayne. Unfortunately, I can't find his full obituary free on line but but this is the lede and it should give you a pretty good idea of what a great fellow he was. I was luckier than many people, I just had a few friends die of AIDS, but I've talked with a lot of gay men for whom the plague years meant one funeral after another and the destruction of entire communities -- very much like the Black Death and other plagues must have been before real medical science came along.

Effective treatment for HIV became available just the year after he died, and everything changed. One of the most prominent AIDS-related service organizations, the Hospice at Mission Hill, closed because HIV was no longer about death. In its place rose the Boston Living Center, where people go to help themselves do just what the name says. As a matter of fact, people who were in the hospice, weighing 80 pounds and ready to die the next day, rose from their beds and their bodies astonishingly reconstituted and they suddenly had to contemplate the sorrows of life as vigorous and healthy young men once more. We call this the Lazarus syndrome.

So when I read that the Global Fund to Fight AIDS, Tuberculosis and Malaria is too broke to make any new grants for three years my blood boils. We've given up on the goal of treating everybody because, well, we just can't afford it apparently. There's something else we need to do, although I'm not clear what that is. And in case you hadn't heard, people who get treatment and have suppressed viral loads are not infectious. That means, if we treat everybody, we can end AIDS forever. We can eradicate it. But it just isn't worth it.

Thursday, December 01, 2011

Hey indeedy

James Michael Crotty discusses the Republicans' elevation of ignorance and stupidity to a virtue. His basic explanation is that it's the only way to preserve ideological purity, especially when your ideology is entirely counterfactual. Fair enough, but obviously it begs the question.

Why are so many Americans passionately committed to absurd beliefs? Obviously they are continually exposed to propaganda, but wealthy greedheads and religious con artists have the same opportunities in Europe Canada that they do here -- Fox News is huge in the UK BTW -- but the worship of idiocy is much less common elsewhere. If I tried to engage a Republican primary voter in a discussion about health care policy, it would be a big mistake for me to mention that I have a Ph.D. in the subject, and study it for a living. It's even worse -- I do that at an Ivy League university and I got the doctorate from Brandeis which is, well, you know. (It rhymes with U.) All that means is that I have no standing on the subject whatsoever, because I'm a pointy headed elitist.

I don't know the full explanation, but one hypothesis is that it's partly because higher education in this country is a luxury good largely reserved for the children of the affluent. The reason Scott Brown can attack Elizabeth Warren for her association with Harvard is that Harvard really is a marker of privilege. It makes sense intuitively for non-privileged people to doubt that people associated with ruling class institutions are actually on their side.

(So how do you explain George W. Bush? Well, he did go to Harvard (and Yale) but it obviously didn't rub off on him. He had a phony cowboy accent, had difficulty producing syntactically well formed sentences, and didn't believe in that ungodly science baloney.)

It would help a lot if higher education was free to everyone, with admission based on credible measures of people's prior preparation and potential to make good use of their education, and no account whatsoever for their parentage or financial resources. That would do a lot, I think, to change the cultural dynamic.

On another note, I should say something about World AIDS Day, even though it's basically a marketing tactic like National Pickle Week. It's still an occasion to reflect and take stock. I'll probably get around to it a day late.