Map of life expectancy at birth from Global Education Project.

Thursday, June 30, 2005

Is Our Children Learning?

Visitors to this site in the past have seen me have all sorts of fun explaining the 2004 presidential election. For example, there is a moderate, but highly significant correlation between life expectancy in a state and the percentage of the vote that went to Emperor Chimpoleon I -- specifically, where the Culture of Life™ is strongest, the people have a perverse tendency to die the earliest.

But now I have found the true key to the election. Here it is.

What this means is, the more a state spent per pupil in 2001 and 2002 on public elementary and secondary education, the smaller the percentage of the vote for ol' Chimpy. The correlation coefficient (Pearson's r) is -.522 (which in a context like this is huge), p <.0005. Gee, what do you think this could mean?

(Source for per-pupil spending is a U.S. census bureau report on state and local government finances. BTW, some of the very rural states, such as Alaska, spend an unusually large amount on non-instructional expenses, presumably student transportation. I suspect that correcting for this would result in an even stronger correlation.)

Edit: Phew, I'm glad I got the picture fixed . . .

Shit is happening

And by shit, I mean shit -- junk, smack, H, horse, manteca, heroin, the cure for morphine addiction.

Trends are similar in much of the country, but I'll just concentrate on Massachusetts which has exceptionally good data. Annual hospitalizations for opioid related conditions (for overdoses, detoxification, complications of drug injection) started to bump up in 1997 and really took off in 2000. From about 8,000 in 1996, to 12,000 in 2000, to 18,000 in 2003. Fatal opioid overdoses went from 94 back in 1990 to 449 in 2002. (There's always a lag in this sort of data, but there is no reason to think these trends haven't continued.) We see the same sorts of trends in ER admissions for substance abuse related causes, and the other available indicators. (Here is some info from the Mass. Dept. of Public Health if you're interested.)

The really bad news? State spending on substance abuse treatment is declining. The Bureau of Substance Abuse services budget was cut from $86.9 million in 2001 to $72.5 million in 2003. Medicaid spending on substance abuse treatment bumped up from 2001 to 2002, but then it fell back again, as eligibility was restricted to throw many addicts off the rolls. Meanwhile, the overwhelming majority of the people we incarcerate have substance abuse disorders.

But our legislators are, as usual, idiots. The cost of substance abuse treatment is recovered 7 times over -- in large part, the savings are state funds, for health care, law enforcement, and imprisonment. (Cost Effectiveness and Cost Benefit Analysis of Substance Abuse Treatment: A Literature Review. The Lewin Group, 2002.)

I don't need to tell you that injection drug use -- which in Massachusetts almost exclusively means heroin -- is a principal means of transmission of HIV and Hepatitis C. And I assume I also don't need to tell you that, while the current heroin epidemic began in the late 1990s, it has been greatly exacerbated in the past two years, as cheap heroin has flooded the world following the fall of the Taliban.

Okay, apart from the availability issue, why is this happening? I can't confidently explain the trend, but I can tell you that the people who are most at risk for heroin addiction are people who don't see a better future for themselves. Quite a few addicts have other psychological problems, of various kinds, from personality disorders to post-traumatic disorders to psychoses, but most don't have other severe mental illnesses. Many are poor, uneducated, lack job skills, and certainly that's part of the risk package but there are exceptions.

What I am saying is that the problem is not that there are evil substances out there. Cervantes himself spent the better part of a week on a morphine drip once and believe me, the one thing I wanted more than anything else was to get off of that shit. But my pain was purely physical, and transient. Heroin addiction is a social problem, not a moral failing. And it's one we can solve. But it appears the country has other priorities.

Wednesday, June 29, 2005

Influenza Primer

Some of you may have clicked over to Effect Measure and discovered that Revere is, well, just a tiny bit worried about a killer flu pandemic. It occurs to me that the average person probably doesn't have all the basic info about this, and certainly isn't getting it from CNN, so I thought I'd give y'all the 411.

There are three major sub-types of influenza virus. B and C don't cause big problems but type A is a major drag on the human condition -- in part because it's also a bummer for pigs, horses, Flipper and Shamu, and birds, which means we can't get rid of it. Influenza A replicates sloppily, which means it is constantly mutating. These small mutations are why the flu shot you got last year won't work this year. But the even worse part is that the virus can swap whole gene segments.

That's bad because the virus has a protein called haemaglutinin (HA) that sticks out from its surface and gets it into cells. There are 15 known major sub-types of HA, in virus that infects birds, but only 3 sub-types are known to have been prevalent in the human population -- called H1, H2, and H3. So, if a variety with, say, H5 were to develop the ability to infect humans, we'd be up a very thick and sticky creek, because nobody on earth has any immunity to H5 influenza.

Starting in 1997, there have been recurrent outbreaks of an H5 strain (specifically H5N1, with the N designating another protein called neuraminidase, which is less important to infectivity) in domestic and wild birds in Asia, which in at least two countries, Vietnam and Thailand, have infected people. This strain causes very severe disease and has killed young and healthy victims. It has also shown (so far) limited ability to be transmitted from person to person. H5N1 is now firmly entrenched in Asian bird populations and it's showing up in all sorts of unexpected places -- even tigers, which is really novel. Many experts believe it is likely only a matter of time before an H5N1 strain hits on the right combination of mutations to become highly infectious among Homo sapiens, and then, Kapow! -- by which I mean millions of seriously ill Americans (not to mention the rest of the world), severe disruptions to international commerce, an overwhelmed health care system, and, if enough people are sick at once, possible break downs in public services causing all sorts of collateral damage.

Other bloggers are on the case regularly, so that's all I'm going to have to say about this for now. Except that, in conclusion, our wartime President has diverted vast quantities of public health funding and planning to the threat of bioterrorism, which has now become largely synonymous with public health emergency preparedness. This has meant not only immediate misdirection of government resources, but also a cultural blind spot. Nature is still out there folks.

Catastrophe theory

While we're all busy trying to predict the future of Social Security, Health Care, the rural landscape, and the Evil Empire (and no, I don't mean the New York Yankees), we might just find that the fully loaded Humvee of American capitalism runs into the ditch before it gets within two fill-ups of where we think we're going.

Michael Klare, here. Personally, however, I don't expect our political "leaders" or the chattering classes to get their heads out where the sun does shine any time soon.

Tuesday, June 28, 2005

The blob that ate the economy

Well, actually there are two such blobs, one being of course the military-industrial complex, but now I'm going to talk about the health care-industrial complex.

We have become so accustomed to growth in spending on health care that when the increase is about what it was last year, we call that "stability." Strunk, Ginsberg and Cookson, writing in Health Affairs (link is on the side folks, and this one is free to non-subscribers) tell us that health care spending increased by 8.2% in 2004. This is, obviously, much faster than the overall growth in the economy, as it is nearly every year.

Of course that means that if we get insurance through employment, our share of the premium has gone up along with our co-pays. If we're taxpayers, we already know that Medicaid is straining our state budgets even as people are thrown off the rolls and their benefits are cut. If we aren't insured, uh oh.

But don't worry, in the future, at least we'll all have jobs. In 2047, just as we finally defeat the insurgents in Iraq, and private Social Security accounts have made all the old folks rich, President Jenna Bush will preside over an economy consisting entirely of health care. We'll all spend 100% of the time in hospitals, giving each other colonoscopies and PET scans, except for the people who spend 8 hours a day manufacturing pills and medical devices before they come home to their hospital beds for an IV, a quick psychotherapy session, and some arthroscopic surgery. Of course, the orderlies and housekeeping staff won't have health insurance, but if they pick up some multi-drug resistant staphylococcus, they can still go down to the Emergency Department and get themselves transferred to the nearest public hospital, in Tijuana.

Or maybe something else will happen.

And speaking of crime . . .

Am I missing something here? 57% of respondents to a poll now say that the Bush Administration intentionally misled the public about the supposed threat posed by Iraq in order to justify the invasion.

Yet the Democrats in Congress, and liberals in the corporate media -- and the blogosphere for that matter, all seem united in the conceit that what is essential now is to look forward, not back. "We" must "succeed" in Iraq. But it's impossible to look forward if you don't understand WTF is happening in the first place!

The Boston Globe elegantly demonstrates how to drink the Kool Aid:

The Ba'athists, radical Islamists, and Sunni factions carrying out car bombings, ambushes, and beheadings are not, as Vice President Cheney claims, in their last throes. So posting a timetable for withdrawal would neither save them from oblivion nor give them a fresh motivation to continue wreaking havoc, as Cheney suggests.

Nevertheless, this would not be the right time to announce a date for removing US forces. The Iraqis are in the midst of forging a new pluralist politics rooted in consensus and respect for minority rights. They are preparing to draft a constitution and elect a representative, sovereign government. It would make no sense to impose a deadline for withdrawal before enough Iraqi forces have been trained to defend the populace and before the new Iraqi government is elected -- expected in December, or by next May at the latest. President Bush will likely make some version of this case in his address tonight.

The Iraqis are in the midst of no such thing. The Globe editors, along with the Democrats in Congress, knowing they've been played for fools, are back at the 3-card monte table to be plucked clean once again. The only bases for politics in Iraq right now are ethnicity and religion. The Kurds have only one goal, which is an independent Kurdistan. They are going through the motions of the U.S. plan for Iraq in order to try to win territorial concessions on the cheap and to please their American patrons, but they have no intention ultimately of subordinating their sovereignty to the Arab majority. The Shiite political parties are religiously based and controlled by clerics. In the Shiite-controlled south, fundamentalist goon squads are already patrolling the streets enforcing religious law. Iranian factions are powerfully influential and the Shiite-dominated government that ultimately has to emerge will be anything but one rooted "in pluralist politics and based on consensus and respect for minority rights." That is a wild fantasy. The Prime Minister has even gone so far as to announce that the private militias of the religious parties will continue to operate with the full support of the state.

There is no popular ideology in Iraq to support a pluralist democracy. That form of nation state is not created at the point of a tank barrel. It requires a democratic political culture, which Iraq does not have. Ergo, the Iraqi forces now being trained are not going to provide security for a pluralist democracy, they are going to end up as the armed representatives of whatever faction they belong to. Responsible reporters have already amply confirmed that fact. Some Iraqi army units are simply relabeled Kurdish Peshmergas whose loyalty is to Kurdistan, not Iraq. Others are part of what is essentially a Shiite army, which has been committing atrocities against Sunni Arab civilians and clerics. Sunni Arabs have joined purely for the money, because there is no work to be had in Iraq. Some of these units have apparently attacked Shiite civilians, and individuals, at least, have attacked U.S. troops. I fervently hope that the Iraqis will be able to come to some sort of a stable conclusion, but it will have to involve some sort of devolution, perhaps with a token confederacy as a transitional state, and its components will not look anything like western democracies, with the possible exception of Kurdistan (which, by the way, was already essentially independent before the war).

The U.S. occupation is not doing anything to help resolve this horrific situation, on the contrary, it is a major irritant which only undermines the legitimacy of whatever political developments take place.

Finally, and most centrally, the Globe analysis continues to take the motives and intentions of the Bush administration at face value. They can only perceive the situation as they do because they have not stopped to consider why the administration launched this war in the first place. A democratic Iraq based on "consensus" is impossible to achieve, obviously, in such a fractious society, but there are a few things all Iraqis can agree on. One is that there should be no U.S. troops in Iraq, or anywhere else in Arab lands, for that matter. Another is that Iraqis should control their own natural resources and that U.S. corporations should have no place in Iraq. Yet another is that Israel is illegitimate. (Although I suppose most people would accept a two-state solution on terms much different than anything Israel seems prepared to agree to now.) And, while there is no consensus about Iran, there is a large Shiite majority such that a "democratic" Iraq will inevitably be closely tied to Iran and its ambitions.

Was it truly the objective of the Bush administration to bring about a regime in Iraq that would pursue these policies? Obviously not. And they aren't going to allow it to happen now, either. Put down the Kool Aid.

Monday, June 27, 2005

Robbery -- and felony murder

An interesting juxtaposition of essays in the latest New England Journal of Medicine. First, Jerry Avorn tells a tale that ought to put the nail in the coffin of the current system of industry-financed pharmaceutical development. As most of you probably know, the issue with cholesterol is more complicated than just the total level of serum cholesterol. So-called Low-Density Lipoprotein, LDL, is the bad stuff, but another kind of cholesterol, High-Density Lipoprotein, actually protects against the artery-clogging effects of LDL.

Statin drugs are good at lowering LDL, but now Pfizer has come up with a drug that raises HDL. It sounds like a possibly useful combination. The problem is, Pfizer is going to test this stuff, called torcetrapib (the names just keep getting weirder and harder to pronounce) in combination with their own, patented statin, Lipitor. What will then get FDA approval is the combination of torcetrapib and Lipitor. It will be impossible for doctors to prescribe torcetrapib except as part of a combination pill. If you want torcetrpib, you will have to take Lipitor. You won't be able to use another statin, even if you can't afford the much more expensive Lipitor, you can't tolerate it (I can't -- it makes me sick, so I take a generic called lovastatin), or you don't need it. But that's the deal folks, take it or leave it, even if it kills you.

On the next page, an actual good guy, Rep. Henry Waxman, discusses the Cox-2 inhibitor Vioxx from his seat on the Government Reform Committee. As we now know, Vioxx approximately quadruples the risk of heart attacks. But as Waxman tells us, the pharmaceutical industry spends $5.5 billion a year to market its products to doctors. The FDA told Merck in Feb. 2001 that it needed to warn doctor's of a trial showing that Vioxx increased the risk of heart attacks. So what did Merck do? They sent a bulletin to their sales representatives saying, "DO NOT INITIATE DISCUSSIONS OF THE FDA ARTHRITIS ADVISORY COMMITTEE . . OR THE RESULTS OF THE . . . STUDY." It told the reps to refuse to discuss the study with doctors, but to show them a card which claimed that Vioxx was associated with 1/8 the cardiovascular death risk of other anti-inflammatory drugs -- a lie. Merck consistently instructed its reps to show doctors only study results that were favorable to its drugs.

As we know, many people -- exactly how many, nobody knows for sure, but quite possibly hundreds -- died after being prescribed this class of medications inappropriately. Aggressive marketing to consumers as well as doctors contributed to massive overprescribing, and this continued even after the drug companies knew about the risks, even after the FDA knew about the risks. The motive was to make money. If you kill people in order to steal their money, there is a word for that.

Sunday, June 26, 2005

Then and Now

Vince Taylor, writing in 1980* (edited lightly for concision):

By becoming massively dependent on Middle Eastern oil, the industrial economies have created a threat to their survival, with which they cannot long live, and yet from which they cannot soon escape. . . .

The present rate of oil consumption is politically and economically unsustainable. To restore a stable situation, nations will need to rebuild their economies to use far les oil than now. There can be no pretense that rapid, forced transition to a less petroleum-intensive economy will be easy, but if a devastating war can be avoided, neither will the outcome be a return to the dark ages. . . .

The wave of growth that swept the globe after WWII could never have moved so swiftly and so far without the incredibly rich oil resources of the Middle East. . . .

The fundamental problem is that the industrial nations need oil so desperately that they are willing to pay for it far more than the small kingdoms of the Middle East can absorb economically, socially, or politically. The wealth represented by the oil deposits of the Middle East -- $270 trillion at $30 per barrel, equal to over 100 years of toal U.S. economic output at current rates, is unprecedented in the history of the world. . .

Saudi Arabian oil has become absolutely crucial to the west . . . . Saudi Arabia is presently ruled by a family with 4,000 members, 200 of whom form an inner ruling circle. The West is ignorant of internal Saudi affairs . . . Tensions in Saudi Arabia and other Middle Eastern nations are being heightened by rapid economic and social changes. The sudden influx of oil wealth has created expectations among both the common people and the upper classes that cannot be satisfied without major changes in society. . . . The masive industrial development programs of the richest oil states are creating serious problems, such as foreign workforces larger than the indigenous ones, extensive coruption in ruling circles (which leads, in turn, to an open display of wealth that is resented by the less privileged), and widespread violations of the Moslem tradition against consuming alcohol. . . .

Oil wealth is, inescapably, propelling the Middle East into unexplored ground. Politics, economics and religion are undergoing dramatic changes. And there is nothing that can be done to guide this process into safe, non-violent channels.. . .

Even if political or social upheavals do not disrupt oil supplies from the Middle East, the industrial world faces rapidly escalating oil scarcity and prices. The root of the problem lies in the overwhelming need of the industrial natios for imported oil, a need so great that the oil countries can raise prices at will. . . .

Many of the developing countries have already borrowed more than they have any hope of rapying, given the level of oil prices; yet unless they receive substantially larger loans in the future, they wll be thrown into depression and bankruptcy. . .

As the dangers inherent in continued oil dependence have become apparent, thoughts, especially in the United States, have turned to military action. Although appealing to many as a solution to the oil crisis, an attempt to gain control of the Middle East by military force poses the gravest danger to the industrial world . . . . Even if the oil facilities were somehow captured intact, keeping them in this state in the face of certain attacks by a hostile population would be impossible. . .

And so on and so forth. Well, we've muddled through for 25 years but we have completely failed to confront the problem or take any of the necessary measures to deal with it, and the dangers have just grown more terrifying, the situation even less tractable.

Here's a story from the only legitimate, non-prostitute corporate news organization in the U.S., Knight-Ridder Newspapers:

Simulated oil meltdown shows U.S. economy's vulnerability

By Kevin G. Hall

Knight Ridder Newspapers

WASHINGTON - Former CIA Director Robert Gates sighs deeply as he pores over reports of growing unrest in Nigeria. Many Americans can't find the African nation on a map, but Gates knows that it's America's fifth-largest oil supplier and one that provides the light, sweet crude that U.S. refiners prefer.

It's 11 days before Christmas 2005, and the turmoil is preventing about 600,000 barrels of oil per day from reaching the world oil market, which was already drum-tight. Gates, functioning as the top national security adviser to the president, convenes the Cabinet to discuss the implications of Nigeria's spreading religious and ethnic unrest for America's economy.

Should U.S. troops be sent to restore order? Should America draw down its strategic oil reserves to stabilize soaring gasoline prices? Cabinet officials agree that drawing down the reserves might signal weakness. They recommend that the president simply announce his willingness to do so if necessary.

The economic effects of unrest in faraway Nigeria are immediate. Crude oil prices soar above $80 a barrel. June's then-record $60 a barrel is a distant memory. A gallon of unleaded gas now costs $3.31. Americans shell out $75 to fill a midsized SUV.

If all this sounds like a Hollywood drama, it's not. These scenarios unfolded in a simulated oil shock wave held Thursday in Washington. Two former CIA directors and several other former top policy-makers participated to draw attention to America's need to reduce its dependence on oil, especially foreign oil.

What's it going to take to get through to Americans, still driving their massive military vehicles to the shopping mall?

*From The Ecologist, Oct.-Nov. 1980. Copyright 1980, Union of Concerned Scientists.

Friday, June 24, 2005

Black helicopters

Some of you no doubt remember when ZOG, the Zionist Occupation Government, was conspiring to merge the United States into the UN One World Order. Thank God we now have a true Christian patriot in the White House, so we don't have to worry about that any more.

Nevertheless, the black helicopters are still out there. While I was at Festus's place last week, one flew over right above the tree tops. This morning, as my truck was rattling up the dirt road onto my own land, another one went right over -- could even have been the same one -- and spent the next hour circling around the area.

But they aren't looking for patriot militias so they can move in and disarm them as soon as the satanic plot to repeal the Second Amendment succeeds. As Festus said, and as you have no doubt already guessed, that's the Pot Chopper. As a matter of fact, it turns out they found some, on the state land across the street from me, and we not only had the black helicopter, but a bunch of black hummers and guys in black storm trooper outfits with their pants tucked into their black jackboots, black body armor and black automatic rifles, out rounding up the terroristic baby plants. You never know, one of them might just be faking being a vegetable and plotting to explode as soon as the marines get too close.

Way back in October 1980, the British magazine The Ecologist published a special issue called Hempathy. John Hanson contributed an overview, called An Outline Hemp Strategy for Great Britain. Hanson recalls that Carl Sagan in The Dragons of Eden speculated that hemp cultivation may have led to the invention of agriculture, and so to civilization. (Hemp is the same plant as marijuana, cultivated for fiber rather than its psychoactive properties.)

Through most of human history, up till the early 1900s, hemp was one of the most important crop plants. Hemp was a source of fiber, as most people know, but also of food, medicine, shelter. Hemp fiber was used for rope, hunting and fishing nets, clothing, helmets, baskets, oil seed, and paper. Hanson quotes S.S. Boyd, writing in 1900:

The hemp plant is the most widely diversified . . . and the most important plant in Europe. Hemp fiber is acknowledged to be the standard fiber in the world. . . . The hemp plant is the most simple and the most widely adapted to cultivation in all climates . . . and the most universally adapted to the production of fine, strong fibers for teh widest character of products from coarse, strong cordage to threads and yarns for the finest linens. . . "

Hemp cultivation was nearly eradicated world wide by the decision of the United States to proscribe it, along with the mechanization of the pulp and textile industries. "The USA's Marijuana Tax Act of 1937," writes Hanson, "was engineered by a powerful clique of vested interests [including] the alcohol, tobacco, pharmaceutical and wood-pulp lobbies."

Hemp is particularly well-suited to intensive, small scale cultivation and processing. It could substitute for much of the forest land now devoted to wood pulp production, for synthetic fibers made from fossil fuels, and for the less ecologically friendly cotton plant. Writes Hanson (with extensive footnotes):

Hemp rewards diligence, and to achieve the almost exponential increase in value that care and husbandry bring, by the increase in quality and subsequent market price, it follows that small-scale farming and production, under wide-spread cooperatives, is a more individually satisfying, and universally rewarding, method of cultivation and manufacture.

In both the growing and processing of the crop ... substantially less land, machinery, energy inputs and capital are required than either timber and wood-pulp processes, or the majority of other fibres and their manufactures.

Other articles in the issue review the medicinal potential of marijuana -- still largely unexplored due to draconian restrictions on research. As an update, we all know that people have discovered, FDA-approval or not, that it is useful for relieving pain, nausea and anorexia caused by cancer chemotherapy, HIV disease and drug side effects, and multiple sclerosis. The present administration is doing its best to make sure people do not have access to marijuana for these purposes, even as Glaxo Wellcome is preparing to apply for a patent and FDA approval for a system that will deliver actual marijuana extract as a spray. (Gary Greenberg will have an article on this out soon in Mother Jones.) Yup, it's going to be perfectly legal -- as long as you buy it from a multinational corporation and pay their monopoly price. Earlier research, stopped by legal obstacles in the 1950s, showed that marijuana has promise for many other medical uses.

In the Hempathy collection, Don Aitken and Tod Mikuriya write,
The first and most impressive lesson [from the history of marijuana as a medicine] is how sheer prejudice and superstition can lead to the total abandonment of medicinal use and even of medical research into what was once a therapeutic substance of major importance. The second is how rapidly experience of its use even in the very recent past can be denied or forgetten.. . .

This article, by the way, comes with 103 footnotes.

Other articles concern the war on drugs -- a war on the poor indigenous people of Latin America, and an inseparable alliance between the gangs of vicious criminals who import and distribute it, and the gangs of vicious law enforcement authorities who depend on the criminal gangs for their own jobs and prestige. Make it legal, and the whole thing goes away.

Oh yeah, there's one off-topic article in the issue -- The End of the Oil Age, by Vince Taylor. He writes -- in 1980 --
The current conflict int he Gulf has shown, once again, the vulnerability of our oil supplies. How much longer can we continue to rely on Middle East oil? . . . By becoming massively dependent on the Middle East for oil, the industrial economies have created a mortal threat to their survival . . . No resolution to this situation is in sight that is compatible with continuing to make economic growth the primary goal of the industrial world . . . The United States is preparing for military confrontation in the Middle East. War, if it comes, will not avert but hasten economic collapse and carries with it the risk of far greater catastrophe.

Taylor goes on to prophesy with terrifying power. His worst fears have yet to be realized but seem more imminent and vivid than ever. Perhaps we'll have more space to discuss this fascinating essay, and its relevance to the hemp question, in coming days.

Thursday, June 23, 2005

I could have told you this in 1986 . . .

I can't give you a link because it hasn't even been published yet, but JAMA gives a heads up to a study soon to appear in Environmental Health Perspectives.

A new study involving 18,782 farmers in North Carolina and Iowa has revealed that agricultural insecticides can cause neurological symptoms, even when the products are no longer being used. [i.e., long term, possibly irreversible damage.]. . . Farmers completed questionnaires that asked about lifetime exposure to herbicides, insecticides, fungicides, and fumigants, and their history of 23 neurological symptoms. The data . . . linked use of insecticides, including organophosphates and organochlorines, to reports of recurring headaches, fatigue, insomnia, dizziness, nausea, hand tremors, numbness and other neurological symptoms. . . .[M]ore than 25% of . . . farmers who used insecticides on more than 500 days in their lifetimes had 10 or more symptoms. About 16% of farmers who had used insecticides on less than 50 days had 10 or more symptoms.

I did a literature review on organophosphate insecticides almost 20 years ago, and it was already known that chronic, low level exposure caused long-term brain damage in monkeys. I met the director of one of our county mosquito control programs, and his neurological symptoms were immediately obvious, even without asking Sen. Frist to view the videotape.

But I can give you the link to a study that is already out in EHP, which tells you something else I already knew as a graduate student 20 years ago: glyphosate, the "active" ingredient in the popular herbicide Roundup™ isn't half as dangerous as Roundup™. The safety testing was done on glyphosate only, but Roundup™ also contains so-called "inert" ingredients which are, in fact, highly toxic, particularly a surfactant (essentially, a detergent, used to make the herbicide stick to leaves better and penetrate plant cells). A study had already shown that the wives of male farmers exposed to glyphosate herbicides in Canada had increased risk of miscarriage and premature birth. Now a study has found that Roundup™ kills human placental cells at concentrations "far below those used in agricultural practice." I knew that Roundup™ was more toxic than glyphosate alone because studies had already shown that the surfactant killed fish and other aquatic organisms. Yet licensing and regulation were based on tests of glyphosate alone.

So you could have asked a graduate student 20 years ago, or you could have waited until today for the official word. Meanwhile, these poisons were still being sprayed on fields, harming farmers, farm workers, and their offspring, and getting into the food you eat. There is a little bit of good news in that organochlorine and organophosphate insecticides are now more strictly regulated in the U.S. than they were 20 years ago. But I have an even better idea: let's stop using this stuff.

From the American Public Health Association

And as long as we're discussing the culture of life, let's not forget this:

In September 1999, the federal government filed a landmark lawsuit against cigarette companies that seeks to hold them legally accountable for years of illegal and harmful practices including withholding the health risk of smoking and marketing to children. The trial began on September 21, 2004 and has lasted until June 9, 2005.

In this lawsuit the government requested that the judge impose several remedies including a recommended 25-year, $130 billion program to help smokers quit. Astonishingly, during the government’s final argument, they requested only a 5-year, $10 billion program.

APHA believes that this change is offensive and places the financial interests of the industry above fighting this nation’s leading cause of death.

Judge Kessler has given the government a deadline of June 25, 2005 to submit a proposed remedies order which will detail all of the remedies it is seeking.

Action Needed

Click on the link below to send a letter to President George W. Bush and Attorney General Alberto Gonzales urging them to insist on the strong remedies recommended by their own expert witness, including fundamental reform of the industry’s harmful marketing practices; the establishment of a well funded, sustained, nationwide prgram to prevent kids from smoking and help smokers quit; and impose financial penalties against tobacco companies should they continue these practices.

Take Action Now!

APHA action link


This young man grew up near my place in Connecticut. He died for the sake of lies told by a gang of megalomaniacs, whose only motives are power and greed. He believed he was serving us all, but he was only being used by people to whom human life means nothing, except as a resource to be exploited for their personal gain. Their names are Bush, Rumsfeld, Cheyney, Wolfowitz, Bolton, Feith, Gonzales . . . They are murderers.

Addendum: As we all know, this isn't about oil, okay? You people are so cynical.

Wednesday, June 22, 2005

Bet you didn't even know this was happening . . .

World Tribunal on Iraq.


I'm sure you'll hear all about it on CNN.

A Hot Link

This is from a monograph called The Bias of Science, by Brian Martin, an Australian mathematician. (This quote is from Ch. 9, Part IV of the web version of the book.)

A second important problem area in meteorology is weather prediction and control. Indeed, air pollution meteorology can be considered to be one aspect of this general problem. Once again, this work may seem worthwhile on the surface. But in the context of how it is done, who funds it and has access to research results, and what it is useable and used for, research on weather prediction largely serves to support the existing power structure.

There is relatively little research on weather that is tailored to the needs of small-scale farmers, for example, who might find it useful to have local rules for estimating when freezing will occur or to conveniently determine distributions of sun and wind for use in constructing solar or wind energy collectors. Most research in weather prediction and control is motivated by possible military applications or is oriented towards large-scale studies and interventions that help groups such as airlines and mass production farming operations more than they help small farmers. Furthermore, the research is done by specialists and communicated hierarchically, and is not used to increase the understanding of the people who are affected by its results.

It is important to remain aware of the social and political context of research. The context of weather research is one in which a small percentage of farmers and marketers make a large share of the profits; in which surplus production coexists with malnourished and starving people, both in industrialised and non-industrialised regions of the world; in which the primary reason why centralised monocultures, pesticides and food additives are a normal part of the production of food is not consideration of the needs of the people, but the making of profits, the controlling of markets and the transfer of control over decisions from individuals to companies, bureaucracies and experts. Research on weather prediction and control works within this state of affairs and hence to some degree supports it.

Precisely, and of course the same can be said for insect biology and pest management, plant biology, management science, economics, you name it.

And, we can say the same thing about medical research. Compared to the hundreds of billions spent developing pharmaceuticals, usually no better than ones we already have but potentially marketable, we spend a pittance investigating ways of preventing people from needing those drugs in the first place. How can we prevent so many kids from getting fat and developing diabetes and hypercholesterolemia? How can we intervene more effectively to prevent HIV transmission? Give me a billion dollars, and I can probably get you some good answers. (Or else buy an island in the Caribbean and start my own country.)

Back to Nature?

Ted Kaczynski, who is precisely 83.27% nuts, went back to "wild nature" by living in a plywood house, hunting rabbits with a rifle, and riding his bicycle to the town library to read magazines and books. That's in between manufacturing bombs using high explosives and sophisticated electrical devices.

Ted's problem is that, like it or not, he's a creature of the enlightenment and he lives in the industrial age. He was trying to use his power over the genie to order it to put itself back in the bottle, but that's one wish -- maybe there are others -- that is not its command.

As much as I admire and believe in the work of people like Festus and my late friend Bert DeLeeuw, I don't want people to get the wrong idea about it. They aren't re-creating an older way of life, they are creating something new.

Festus owns six tractors, five of which actually work. The price of diesel matters to him a lot. He also uses gasoline to drive his truck to his markets, to pick up compost, etc. He has built hoop houses (for the agriculturally naive, a common style of inexpensive greenhouse) out of PVC piping and polyethelene film. He uses a synthetic textile for row cover. He has noticed very specifically that the price of his petroleum-based inputs has been going up. He uses phosphate rock mined in Florida -- and by the way the Florida mines are expected to give out soon and we'll be importing most of our phosphate from North Africa.

The people who buy his produce of course earn their money in the industrial economy. His techniques depend on a knowledge base that did not exist until recently. The price of farmland depends on its value for other uses, and farming in most of New England would be nearly impossible without tax breaks. His business operates in the context of a modern, complex economy and society in which all of current history intrudes on his fields, as much as he tries to hide from it.

So, inevitably, we come back to petroleum. On the one hand, we suspect that as the price continues to rise -- and over the coming decades it will, even if it dips a bit over a shorter horizon -- intensive organic farming serving local markets will gain a better competitive position. On the other hand, in some ways it will get harder, not easier. Individual farmers and the economic, social and political networks of which they are a part will have to adapt. Jim Kunstler looks at the geopolitical big picture. Each of us needs to be thinking about our locality as well.

Tuesday, June 21, 2005

Don't stop the carnival!

Carnival of the Uncapitalists, hosted this week at Guerilla Science, has linked our post on farming. Check it out for a lot of good links.

And while we're posting links, Riverbend has blogged again. As usual, heartbreaking, enraging, straight from the heart, the truth about "liberated" Iraq. The distance between the river of horseshit that flows from the mouths of our political leadership through the corporate media to your ears and eyeballs, and that once respected place called reality, has become a vast dark canyon.


Since I got into a bit of a scuffle with one of those Michigan Militia types (apparently) over on another site, I thought I might let people know what I personally feel ought to be our firearms policy.

Lots of people have perfectly good reasons for owning guns. I asked Festus what he does about the deer and the woodchucks, and he said, "I blast 'em. I come out every morning and I shoot at chucks, and I come out every night I shoot at deer." I told him one guy I knew used to shoot one chuck and leave it in the garden as an example to others. He said, "Nope, we usually stew 'em up."

Festus's neighbor Earl moved in a couple of years ago and planted a garden. He couldn't bear to kill the woodchucks so he got a Hav-a-Heart trap and baited it with a piece of broccoli. He came over one afternoon and he said, "Festus, I caught a chuck, you gotta shoot it for me." So Festus went over and shot the chuck. Then Earl took the bloody piece of broccoli and threw it back in the trap. The next day, he came over again. "Festus, I got another one, you gotta shoot it for me." So Festus went over and shot the chuck, then Earl threw the broccoli back in the trap. Sure enough, Earl was over again the next day. Festus shot the third chuck then he said, "That's it, from now on you gotta shoot your own chucks. You got the same moral responsibility whether you do it yourself or you get me to do it for you." Festus thinks Earl might be a little bit mad at him but what can you do?

That's pretty funny and it makes you think that everybody out there just ought to get his or her own gun. But the next story isn't funny at all. I had some friends named Bert and Lina who moved out to Pennsylvania and started farming. A couple of years later my girlfriend got tired of me and she went out there to be the business manager for the farm cooperative they belonged to.

Bert got into some sort of a squabble with a neighboring farmer about Bert's dogs. One day Bert and Lina were sitting in the kitchen with their baby in Lina's lap when the guy walked in and shot Bert dead. The murderer was over 70 years old and apparently he was demented.

From my urban point of view, there's no obvious reason to have a gun in the house at all except because you're afraid of other people who have them. Bert owned a gun but obviously it didn't do him any good. The data show that if you own a gun, it's much more likely to end up being used for suicide or hurting somebody accidentally than it is to be used to protect you. That's why a lot of people, mostly city people who have a lot of problems with gun violence, are likely to think the best thing to do is have fewer of them altogether.

Here's the way I see it, and to me it seems obvious. Guns are dangerous. So are automobiles. If you want to drive an auto, you have to take a test to prove you know how to do it safely. You have to get a license, and they can take it away from you if you misuse it, or if you can't see well enough to drive or you're demented. If you want to own a car, you have to register it. You have to get it inspected for safety and the manufacturer has to meet safety standards as well.

So we ought to do the same thing with firearms. That doesn't violate anybody's rights, it's just common sense. And we shouldn't let people register weapons that there is no good reason for them to own, like 50 caliber rifles. If shooting a 50 caliber rifle is somebody's idea of a good time, let them be stored at licensed shooting ranges and used right there. We don't let people drive formula one race cars on the street either.

There, was that so hard?

Addendum: I originally thought I wouldn't be totally specific about the story of Bert and I even changed the facts slightly to protect people's privacy, but then I realized this was a pretty well-documented and publicly recognized event. People may be interested in the full story, here.

Monday, June 20, 2005

Oh, and how could I forget?!

One more item in BMJ: the winner of the "polymeal" recipe competition. Instead of gulping pills, we can protect ourselves against heart disease almost as effectively by, yes, eating the right foods! It's a scientific fact.

The winner, Heather A. Haywood, M.D. of Falkirk, England offers roasted red pepper and almond dip with crudites; cod with red win sauce; and marbled chocolate fondue. (The fish recipe includes bacon and chicken stock; you could substitute for those ingredients.)

Bon apetit!

BMJ does it again

My job is too easy. All I have to do is refer y'all to the British Medical Journal.

  1. I believe somebody was asking about head lice. Burgess, Brown and Lee compared an insecticidal treatment -- phenothrin, related to resmethrin -- with a treatment based on a silicone compound that suffocates the bugs (dimeticone). Dimeticone was almost as effective and much less likely to cause irritation. Phenothrin is not very toxic to humans, supposedly, but actually we don't know. It's a suspected endocrine disrupter and its carcinogenicity is unknown. It is highly toxic to fish and other aquatic organisms, and of course resistant strains of lice are virtually certain to emerge. Dimethicone kills lice by a physical process, so resistance seems implausible.
  2. I wrote a while back about aspirin. It is protective against heart attacks and strokes, but carries some risk of gastrointestinal bleeding. There is a dialogue between Elwood and Baigent about whether everyone over 50 (or maybe 60) should take low dose aspirin, or just people with known vascular risk. The editorial conclusion is that it needs to be a personal decision. For me, the major importance of this debate is that it points up once again that the drug companies have invested billions of dollars in developing and marketing analgesics to replace aspirin, purely because they were patentable and hence highly profitable, while aspirin was actually better -- and safer -- for most people all along.
  3. Pregnancy is not a disease, so why do we treat it as a medical emergency? Johnson and Daviss find that home deliveries, supervised by midwives, result in less medical intervention (such as caesarians and episiotomy, etc.) than hospital deliveries, but are just as safe for mother and baby.
  4. The Drugs for Neglected Diseases Initiative has launched an international appeal for increased research and development to address diseases which are endemic only in poor countries, and therefore don't offer the drug companies the lure of huge profits. These include leishmaniasis, Chagas' disease, and sleeping sickness.
  5. The Proceedings of the National Academy of Sciences has withdrawn a paper from publication after the Assistant Secretary of HHS complained that the information in it could be useful to terrorists. (It concerned possible deliberate contamination of milk.) Of course, it could also be useful to citizens who were concerned about public safety and wanted to hold officials democratically accountable. Revere has devoted considerable space to this question of secrecy surrounding bioterrorism preparedness. I'm with him. What I don't know can hurt me.

So why can't the United States have a medical journal like that?


Okay, there is a lot going on with this question of farming. Others might want to parse the issues differently but here's one way, emphasizing the public health perspective:

  1. What we eat, and why. The biology, economics and culture of food
  2. The externalities of farming (here I refer mostly to environmental issues, social externalities are considered below)
  3. Farming in the context of the community, the social organization of farming
  4. Separated from the above for adequate consideration, the conditions of farm labor
  5. Seasonality and locality. New Englanders are always going to want their coffee, orange juice, and fresh produce in January. We need relationships with farmers in distant places as well as nearby. How should those relationships be organized?
  6. Back to nature? Sustainable, organic farming in the industrial age.
  7. The farming way of life -- not for everybody!
  8. The democratization of knowledge -- who owns agricultural science, what kind of knowledge does it produce, and how is that related to all of the above?

People may have items to add to that list, or specific issues to propose under any of the bullets. I hope to tackle them all, with your help.

Sunday, June 19, 2005


Free Image Hosting at

(Click the thumbnail for a full-sized picture.) I thought briefly of entering this photo in Dr. Charlie's tomato growing contest, but it would be wrong -- these tomatoes belong to Festus and Mary Lee, and their 16 month old daughter Claire. I did, however, personally plant ever single one of those stakes, of which there are 140. (There will be more, but Festus hasn't finished transplating all his tomatoes.)

Festus is on a mission, to make it possible for people to eat non-toxic food. The repercussions are endless. I'll begin with a couple of high points, but I expect we'll be talking about this for a long time.

First, this farm can only exist because certain social arrangements make it possible. Festus and Mary Lee produce dozens of kinds of vegetables, herbs, maple syrup, shitake mushrooms, and honey. They sell their produce at the food coop in the nearest urban center, and at farmers' markets. The co-op is an essential institution. It began as a consumer co-op but the farmers who supply it now use it as a growers' co-op as well. They put in a joint order to Fedco in Maine every spring for seed and supplies, through the co-op, and Fedco sends down an 18-wheeler.

The produce you see in the supermarket is purchased in enormous quantities. One grower sells tons of those styrofoam tomatoes to a distributor who breaks the truckloads into the smaller quantities that fill the bins at the Stop & Shop. They all have to look uniform, perfectly shaped and unblemished. Producing that sort of product in that sort of quantity is agribusiness -- farming on an industrial scale, using industrial methods, and the industrial form of organization -- large corporations that employ industrial engineers and managers who supervise laborers. These "farms" cover hundreds or thousands of acres, filled with vast monocultures created by first applying herbicides to kill everything that grows, spreading synthetic fertilizer, planting an oceanic expanse of one or another crop plant, and periodic dousing with insecticides. Sometimes they buy systems of herbicides and herbicide-resistant seed from Monsanto, which also sells them the insecticides.

Festus can't sell in that market, no matter what he does. So the co-op is as essential as the land he owns and the tons of compost he gets from his neighbor's dairy farm (more on that later). For today, I'm going to concentrate on the science of organic farming.

Festus never went to college but he is a practicing, creative, and talented scientist. His fields are full of wooden tags. He is constantly experimenting with seed and practices. (He produces a good part of his own seed.) He has almost no trouble with insects because he maintains an intricate system of crop rotation, plant juxtaposition, timing of seeding and transplantation, row covers, etc. While I was weeding his basil he pointed out that insects had been eating the weeds, but not the basil. He actually welcomes certain insects for weed control. He also encourages insects for insect control. For example, he makes sure that he allows some brassicaceous plants to flower because a wasp feeds on the flowers, which in turn lays its eggs in the larvae of an insect that attacks the brassicae. Pesticides are like a narcotics habit -- using them creates the need for more.

Festus and Mary Lee have not gone back to nature, at least not in any obvious sense. Their farm is an elaborate system diligently shaped by human science and artistry. Their food crops could not grow without their constant labor, literally 365 days a year. But it is more like nature than an industrial farm, in important ways. It is a highly complex, diverse ecosystem. The soil is alive, the crops interact with each other and with deliberately maintained fallow areas through soil organisms, insects, and continual recycling through composting and rotation of beds.

Also, like nature, the farm is difficult to understand, and it goes its own way. Festus's success depends on intimate familiarity with the very specific place which he has come to. Instead of radically remaking it, he collaborates with it. And there are enough people in the area who are willing to collaborate with him to make his project possible -- other growers, consumers, and state and town officials and the citizens who elect them are all essential to the social context.

There are profound implications here for all of us -- for how we will live in the future, far beyond the question of what we eat. I am particularly struck by the question of the democratization of science and the social control of technology. Festus remembers the Irish famine as if it happened to him personally, he knows the story of the dustbowl better than John Steinbeck, and he knows all about the U.S. Department of Agriculture and the agricultural industry. He's had to teach himself how to make a different world possible. In coming weeks I'll start to address some specific problems and questions.

Thursday, June 16, 2005

Sorry for being a curmudgeon . . .

And I've given away that I'm old enough to qualify for that title, but I just don't get it. The major theme in the liberal blogosphere today is "Gee, why the heck did they invade Iraq? We just can't figure out their motivations, it's all very mysterious."

I'm talking Atrios, Digby, the whole crowd. They're all mystified. I probably shouldn't have singled out Yglesias except that they all used his weird musings as the hook.

I believe the explanation to which I referred in my previous post is one of which we have all been aware since well before they actually cakewalked to Baghdad. (Too bad that "RPG" turned out not to stand for Rose Petals and Garlands after all.)

They are imperialists. They are bent on world domination. Their motive is power and greed. The oil fields of the Middle East are the Greatest Material Prize in World History and they wish to secure them for their employers, specifically Exxon and Halliburton. They said so. Prior to the 2000 election, although they may have confused some people a bit by labelling the client regimes they intended to install "democracy," which obviously is the precise opposite of anything they would ever tolerate. Now, George W. Bush himself may have had some Freudian hangups about his father and may have had a theory that he had to be a wartime president in order to get his chimpish visage on Mount Rushmore but does anybody actually believe that this was his idea? They hired him to run for president and they tell him what to do. His personal psychology is not the hinge of history, okay?

There now, that wasn't so hard, was it? It takes a medical sociologist to explain it to you guys? WTF? I mean, when your friends are sipping at the Kool Aid it just gets frustrating, you know? Sheesh.

Anyhow, as promised, I'm going to spend the day on the farm tomorrow learning how it's done. Back when I can be. Hopefully I will have calmed down.

Why is there air?

The eternally baffled Matthew Yglesias wanders forlornly in a maze of puzzles within puzzles. Golly, those leaked British memos show that the Bush administration was determined to invade Iraq a year before they actually did it, and all that jive about Weapons of Mass Destruction™ and al Qaeda and the UN was just window dressing. Quite a shock to big Matt, who is not one of those naive, soft-in-the-middle, brie-stuffed liberals who thought the war was a bad idea all along.

But now he wonders, why oh why?

But what was the White House after? Why did they do it? We have plenty of evidence that not only were the specific claims the administration made about WMD false (often knowingly so), but also that all of this was basically irrelevant to their actual thinking about why we should go to war.

But what were they thinking? Lowballing the likely costs of war to build public support makes sense in a cynical-scumbag kind of way, but how is it that these lowballs seem to have become the actual basis for real-world policy? Nobody knows. Nobody knows because all the memos we've seen are British; but the United States surely produces memos of its own.

Why yes Matt, it does. And guess what? Some of them aren't actually secret! Yup, believe it or not, even though you're a "journalist" and I'm not, I know the answer to your question! And you have the power to know what I know. Yes you do. Read this:

By Neil Mackay

15 September 2002: A SECRET blueprint for US global domination reveals that President Bush and his cabinet were planning a premeditated attack on Iraq to secure 'regime change' even before he took power in January 2001.

The blueprint, uncovered by the Sunday Herald, for the creation of a 'global Pax Americana' was drawn up for Dick Cheney (now vice- president), Donald Rumsfeld (defence secretary), Paul Wolfowitz (Rumsfeld's deputy), George W Bush's younger brother Jeb and Lewis Libby (Cheney's chief of staff). The document, entitled Rebuilding America's Defences: Strategies, Forces And Resources For A New Century, was written in September 2000 by the neo-conservative think-tank Project for the New American Century (PNAC).

The plan shows Bush's cabinet intended to take military control of the Gulf region whether or not Saddam Hussein was in power. It says: 'The United States has for decades sought to play a more permanent role in Gulf regional security. While the unresolved conflict with Iraq provides the immediate justification, the need for a substantial American force presence in the Gulf transcends the issue of the regime of Saddam Hussein.'

The PNAC document supports a 'blueprint for maintaining global US pre-eminence, precluding the rise of a great power rival, and shaping the international security order in line with American principles and interests'.

The PNAC report also:

l refers to key allies such as the UK as 'the most effective and efficient means of exercising American global leadership';

l says 'even should Saddam pass from the scene' bases in Saudi Arabia* and Kuwait will remain permanently -- despite domestic opposition in the Gulf regimes to the stationing of US troops -- as 'Iran may well prove as large a threat to US interests as Iraq has';

l spotlights China for 'regime change' saying 'it is time to increase the presence of American forces in southeast Asia'. This, it says, may lead to 'American and allied power providing the spur to the process of democratisation in China';

l calls for the creation of 'US Space Forces', to dominate space, and the total control of cyberspace to prevent 'enemies' using the internet against the US;

l hints that, despite threatening war against Iraq for developing weapons of mass destruction, the US may consider developing biological weapons -- which the nation has banned -- in decades to come. It says: 'New methods of attack -- electronic, 'non-lethal', biological -- will be more widely available ... combat likely will take place in new dimensions, in space, cyberspace, and perhaps the world of microbes ... advanced forms of biological warfare that can 'target' specific genotypes may transform biological warfare from the realm of terror to a politically useful tool';


Glad to be able to help you out Matt. Let us know if you are troubled by any other difficult questions.

* With the U.S. effectively expelled from Saudi Arabia, permanent bases in Iraq became the alternative. And no, they have absolutely no intention of leaving, ever.

Getting past Go

As medical technology continues to present with novel moral questions, we just aren't having the constructive public discussions that we really do need, because we don't get past this "anything with diploid human DNA is human life and all human life is sacred" crap.

Let us stipulate that we never saw the memo from God, so as far as we are concerned an embryonic stem cell is not Uncle Charlie and a human body without a functioning cerebral cortex is not telepathically crying out to be preserved. Nevertheless many problems remain concerning the boundary between life and death, human life and other life, and the moral demands placed on us by humans in various conditions.

Here are some problems that we need to think about, that don't have simple answers.

We can start with the allocation of resources. I've written before about the Rule of Rescue vs. utilitarian ethics and principles of justice. Terry Schiavo was not sentient, but there are plenty of perfectly sentient people who indeed do want to keep living whose lives are prolonged at a cost of hundreds of thousands or millions of dollars. Simultaneously, there are children in poor countries who are dying by the thousands every day, whose lives could be preserved at the cost of just a few dollars. Come to think of it, there are poor people right here in the United States who die every day from preventable or treatable causes. Why is this acceptable?

So take it a step further. Embryonic stem cell research could, many people hope, lead one day to replacement tissue, even whole replacement organs. Maybe we'll be able to regenerate spinal chords, cure Parkinson's disease, or even grow brand spanking new hearts, lungs, livers, arms and legs, you name it, in vats, with your personal DNA, and they'll be able to install the new parts in you like putting a new transmission in your old pickup truck. Sounds great! But, uhh, how much is it gonna cost and what percentage of the world's people will be financially eligible for the upgrades? How is that gonna make the rest of them feel?

Now here's something a lot of people worry about. Maybe you don't but you're gonna need to talk to the people who do. Why stop at fixing stuff that's broke? We could make improvements. Give you some extra lung capacity, a more powerful heart, stronger arms. Maybe we'll figure out a whole lot of detail about the development of the brain and find ways to make children smarter, or even add some IQ points to adults. Maybe we'll be able to give people equipment and capabilities that nobody ever had before.

Some people are horrified by that prospect. They have a moral revulsion at what they see as a violation of human nature or the opening of a future in which we won't know who's human and who isn't. Or they are concerned, once again, about a new and even more pernicious form of inequality, a two-tiered or multi-tiered human society in which some people are enhanced and others are just what we are now, which will then be inferior, because you can be absolutely certain that whatever the wizards of utopia come up with, it won't be available to everybody.

The main theme here (although there are others) is justice. Obviously, the idea that all aggregations of cells with human DNA are human life, and all human life is "sacred" and has an equal moral claim on the rest of us quickly reduces to the absurd. That's the position the Pope and James Dobson are stuck with, and it makes them self-evidently ridiculous. So get past that. Take the next step. What is right?

Wednesday, June 15, 2005

They say cut back, we say fight back!

The National Health Law Project offers a review of "2005 State Medicaid Eligibility Cutbacks: Proposed & Recently Enacted." (Compiled by Thomas P. McCormack.) Go there to find out which poor kids, disabled people, and sick old folks are getting screwed in your state so that rich people don't have to pay taxes and we can pay for getting rid of all those Weapons of Mass Destruction™ in Iraq.

A sample:

  1. California: new red tape and a reduced income level will take 200,000 parents off the roles. The legislature rejected almost all of Gov. [Gropenator's] proposed cuts for Crippled Children's, ADAP and MediCal, but in early 2005, he proposed premiums for patients with incomes over 100% [of poverty] or the $812 SSI/SSP level,*, forced enrollment of the aged and disabled into HMOs, and an annual patient cap of $1,000 for dental care.
  2. Connecticut: . . . Governor Rell (R ) . . . may again attempt to raise family Medicaid and CHIP premiums to between $10 and $50 monthly, after an earlier attempted increase fizzled. The state already added co-pays of $1 to $3 for doctors; raised Medicaid’s $1 Rx co-pay to $1.50 and $3; upped SPAP premiums from $25 to $30 and its co-pays from $12/$15 to $16.25; imposed a $100,000 SPAP liquid asset test; and required recoveries of SPAP costs from estates of the deceased. It dropped legal aliens from welfare, Medicaid, CHIP and SAGA (state-funded welfare and medical programs). SAGA welfare was reduced from $350 a month to $200; its patients are being forced into HMOs; and its medical budget was capped. The state ended coverage of chiropractic; naturopathy, occupational, physical and speech therapy; and psychology services for adults... .
  3. District of Columbia---the local, DC-funded Health Alliance still covers all uninsured persons under 200% except for Medicare and Medicaid eligibles; yet free city TB and STD clinics remain closed; and city low income clinics no longer give free Rx’s to the needy aged and disabled (who instead must be under 100% to get drugs from Medicaid). The DC Rx Access law offers discounts to those over 62 with incomes under 200% and to others under 350%; but eligibility, provider, delivery and cost-sharing details must still be worked out.
  4. Georgia: the state . . . lowered the CHIP income level from 235% to 200%; and stopped CHIP coverage of dental and vision care. It lowered the Medicaid and WIC level for pregnant women and infants from 235% to 185%, raised CHIP premiums from $10 monthly to $35, ended adult coverage for emergency dental care and artificial limbs and will force 800,000+ patients (including children, the aged and the disabled) into HMOs. The state had already stopped covering adult dental care, orthotics, prosthetics and hospice care; planned time limits on eligibility for patients in the breast/cervical cancer category; capped HCB expenses and CHIP enrollment; and added cost-sharing fees to Katie Beckett waiver care. By May, 2005—when over 45,000 children had lost CHIP---Gov. Pedue (R ) sought CMS approval for a HIFA** waiver to reduce nursing home access, raise Rx and other co-pays (even for children and nursing home patients), add more managed care and health savings account features to Medicaid and other economies in exchange for extra current funding (but which would bring federal matching fund caps that could cut future program funds).
  5. Mississippi: the state, over big protests, lowered its aged and disabled Medicaid level from 135% ($1,068 monthly for one) to $579---causing 65,000 aged and disabled to lose Medicaid; and reduced monthly Rx’s from 7 to 4 brand names plus unlimited generics. The state says it has a waiver to keep using the old, higher aged/disabled level for transplant, dialysis, chemo and mental patients, plus about 7,000 non-Medicare-qualified disabled clients, but it has no ADAP or other funding for the 2,000+ disabled HIV patients losing Medicaid.

And on and on it goes. The news is better in a few states, including:

Massachusetts: almost all of Gov. Romney’s (R ) health cut proposals failed or were reversed by the Democratic legislature. (The state still offers the most generous eligibility in the nation.) For details see “Funding Cuts in Massachusetts..” at By 2005, even Gov. Romney proposed moving toward universal health coverage by voluntarily urging purchase of cheap, limited benefit, high cost-sharing policies by the uninsured and more enrollment in Medicaid by all those eligible. He even wants a higher minimum wage for firms that don’t offer health insurance

Not that Romney's proposals are good, actually, but at least he can't get away with that Bushit here in the People's Republic. What are they getting away with in your state?

*SSI, supplemental security income, is the last resort safety net for elderly or disabled people who don't have enough earnings history to qualify for full social security benefits.
** "HIFA" refers to the Health Insurance Flexibility and Accountability demonstration initiative. Basically it means that states can apply to CMS (the federal agency that administers Medicare and Medicaid) for permission to violate the usual standards for Medicaid benefits in order to cover more people, but give them worse insurance. That basic concept is all the rage these days amongst the Republican champions of the Culture of Life.

Tuesday, June 14, 2005

Getting back to you JB ...

JB, commenting on an earlier post, asked about an article alleging that cattle feed in the U.S. still contains mammalian tissue including cattle parts. As most people presumably know, the disease known as Bovine Spongiform Encephalopathy in cattle, variant Creutzfeldt-Jakob Disease in humans, and popularly called Mad Cow Disease, is transmitted exclusively by eating contaminated tissue. That means that cattle, who are by nature herbivores, get it by canibalism. It was for many years the practice to grind up waste from slaughterhouses, including spinal cord and brain tissue, and add it to cattle feed.


The infectious agent in BSE/vCJD/Mad Cow Disease is called a prion. For a long time, most biologists didn't believe these things even existed, and thought their discoverer, Stanley Prusiner, was a crank. They were wrong! Proteins are long chains of components called amino acids that fold into complex shapes in solution. Prions are abnormally folded proteins, which can catalyze the abnormal folding of similar proteins. Once they get established in a cow's brain, or yours, they spread, causing holes in your brain until you are first insane, and then dead. Prions are not destroyed by cooking.

So, ever vigilant, the FDA banned mammalian nerve tissue from cattle feed in 1997. Whoops. It seems they left a few loopholes, specifically:

  1. They allowed mammalian blood and blood products to be fed to cattle. Apparently they didn't think blood could contain prions. Wrong.
  2. They allowed "poultry litter" to be fed to cattle. That's the chickenshit, feathers, spilled feed and what not that gets shoveled off the floor of the henhouse. I kid you not. The problem is, they allowed cattle parts to be included in the chicken feed and -- you get the idea.
  3. They allowed restaurant table scraps to be added to cattle feed.
  4. They did not require facilities that process cattle feed (cattle parts not allowed) and other animal feed (cattle parts allowed) to use separate production lines, i.e. cross contamination remains possible.
They have now proposed new rules to close these loopholes. WTF have they been thinking for the past 8 years? I'll tell you WTF they've been thinking for the past 8 years, they've been thinking that they don't want to cost the big factory farming operations a nickel if they can help it, even it kills you.

Well, you've got questions, we've got answers.

More on the Ownership Society

As my 4 1/2 faithful readers know, the big Republican push to "reform" health care is based on getting everybody into high deductible, high co-pay insurance plans, and then encouraging them to save up for less than catastrophic medical expenses through tax-advantaged "Health Savings Accounts" (HSAs).

You don't even have to be a policy wonk to see what might be a little questionable about this idea. It discourages people from seeking routine, preventive care, or from taking their blood pressure meds; and people who aren't wealthy a) get very little benefit from tax deductions for HSAs and b) won't have enough in their account, if they have such an account at all, even to cover those deductibles and co-pays should they have major medical expenses.

It might take a little bit of wonkery to understand some of the other reasons why this is an extremely terrible idea. These have to do with some of the idiosyncracies of markets for insurance, and for medical services. I'll wade into those deeper waters anon.

Meanwhile, with little attention from the media (somehow that liberal bias doesn't seem to be working in this instance), we're already getting on down that road quite a ways. A new Commonwealth Fund report in Health Affairs reveals the consequences. Here's the abstract:

Health insurance is in the midst of a design shift toward greater financial risk for patients. Where medical cost exposure is high relative to income, the shift will increase the numbers of underinsured people. This study estimates that nearly sixteen million people ages 19-64 were underinsured in 2003. Underinsured adults were more likely to forgo needed care than those with more adequate coverage and had rates of financial stress similar to those of the uninsured. Including adults uninsured during the year, 35 percent (sixty-one million) were under- or uninsured. These findings highlight the need for policy attention to insurance design that considers the adequacy of coverage.


Information Clearinghouse

And another damn thing to worry about . . .

People in New England are well aware, and folks elsewhere may have heard, that we are in the middle of the most severe so-called "red tide" event since we started keeping track -- which for practical purposes is only a few decades. Red tides are blooms -- i.e., population explosions -- in coastal waters of algal species which happen to be harmful in some way. These species are generally unicellular, and they don't necessarily turn the water red. They may be invisible to the eye. Hence scientists now prefer to call these events Harmful Algae Blooms, or HABS.

Our problem here at the moment is a dinoflagellate that causes a human disease called paralytic shellfish poisoning. The organism is consumed by filter feeding shellfish, and the poison it produces concentrates in their tissues. The shellfish generally aren't harmed but people who eat them can be. (Birds and whales can also be harmed by the toxin.) As a result of the current HAB, the New England coast from the Canadian border to the east side of Martha's Vineyard has been closed to shellfishing. Species that cause HABs elsewhere can be even more harmful. For example, HABs in the Gulf of Mexico kill fish and even emit toxins into the air where they cause respiratory distress in humans.

According to the Woods Hole Oceanographic Institute, HABs appear to have been growing more frequent around the world, although it is hard to sort out the effect of more knowledge and better monitoring from the actual trend. The question is to what extent human activity may be responsible. Algae blooms occur naturally, and weather is a key variable. (The Woods Hole page includes links to a lot of info including a depiction of the life cycle of the dinoflagellate.) However, where human activity increases the amount of organic nitrogen in the water, algae blooms are enhanced.

We pump in nutrients from sewage, runoff of fertilizer from farms, lawns and golf courses, and from aquaculture. Destruction of coastal wetlands also affects the amount and proportions of terrestrial nutrients that makes it into the ocean. The folks at Woods Hole don't have much to say about this. Some HABs observed in recent years are clearly not associated with pollution but with weather events or natural cycles, but others may have been caused or enhanced by pollution. We just don't know enough, although the hypothesis has very strong face validity.

For this and other very good reasons -- such as eutrophication of ponds and damage to streams -- we need to stop gratuitously spreading concentrated organic nitrogen compounds all over the place. Organic farming techniques, that use compost instead of concentrated nitrogen compounds, result in far less runoff. Spreading fertilizer on lawns is completely frivolous. I'll withold any sweeping comment on golf courses, but they can be managed in a more ecologically friendly way than they are generally.

We always need to remember that what we do in our own town and own backyard affects the whole world.

Monday, June 13, 2005

The last quiet corner . . .

William Yardley in the NYT (for this post only, I'm leaving off the W -- but the W stays for any discussion of David Sanger's whitewash of the latest leak from the UK) writes about the development pressure in Windham County and the struggle to resist it. I'm thinking I may need to start a separate Windham County blog, but for now, we're still here.

The general sentiment in the small towns is to keep things the way they are, as much as possible, but that's very tricky. Zoning, environmental and building regulations have to make a viable rural economy possible, but distinguishing between an organic vegetable farm and a factory hog farm; allowing small scale artisanal manufacturing (like a pottery or decorative wrought iron works) while keeping out the lead smelters; promoting tourism so the locals can sell their maple syrup, herb vinegars, pick-your-own apples and handiworks while stopping the 250 acre Swamp Yankeeland theme park -- all that sort of thing gets very difficult, and contentious.

Rural America is in a quandary, in danger of falling over in any of three directions and trying to find that point of wobbly balance in the middle. Downfall number one is turning into the suburbs, selling off the farms for high-priced subdivisions called Richborough Acres and Hillydale Farms Estates, the general store and the tractor dealer replaced by a shopping center and a Chemlawn franchise. Downfall number two is "anything for a job" syndrome. The latest proposal is a Nascar track, and of course we already have the "Indians" building more hotel rooms and cavernous halls full of money eating machines. Downfall number three is stagnation and decline -- the kids all graduating high school and leaving never to return, the general store shuttered, the last farmers holding onto their operations even as they lose their teeth and their eyesight. At that point, (1) or (2) become inevitable, for those of us not far off the interstate between Boston and New York. (In the Great Plains, the alternative is extinction and tumbleweeds blowing down Main Street.)

Fortunately, New England is the one part of the country where the number of farms is actually increasing -- thanks to small-scale enterprises that grow for the local market, principally. I've been trying since last summer to get Festus to let me spend a day working for him, for nothing, except the knowledge of his operation and how he succeeds. It turns out the reason he was putting me off is that a lot of people want to do exactly that, and he's not interested in being an object of curiosity. He finally agreed, though, and I'm going down on Friday. We'll keep you posted.

An embarassment of riches

As usual, this weeks British Medical Journal is full of great stuff -- it's a theme issue on obesity, and I recommend the commentary by MEJ Lean [yup, that's the good doctor's name. My childhood dentist was Dr. Root.] if you don't have time for the research reports, but what is really jacking up my blood pressure is more on how the FDA works for Merck and Searle and Pfizer, but not for you.

Here's the first two pages of the FDA's review of one of the Cox-2 inhibitors -- you know, those miracle drugs that give you heart attacks?

Credit to some Swiss docs for this, direct link to their article is here. It seems there are certain facts we are not allowed to know about the drugs Searle is selling us because if we did know, it might harm their commercial interests.

Well, that's all I need to know.

Sunday, June 12, 2005

Lion and tigers and bears . . .

We hear a lot about people coming into conflict with wildlife in the west, mostly because former city slickers are building fancy houses on the edge of the wilderness, and also because some of the age old confrontations between ranchers and predators are heating up again as the culture has grown fonder of wolves -- at least in places where people don't have to deal with wolves personally, but those folks do vote.

Here in the east we have almost the opposite problem -- large mammals, herbivorous and carnivorous, are expanding back into their old ranges and are increasingly showing up even in fairly densely populated areas. Growing residential sprawl and the increasing numbers of people living in formerly rural areas who do not have a heritage of close relationship with the land contribute to our difficulties, but in sometimes odd ways.

When I was growing up, I thought coyotes were exotic creatures of the southwestern desert. Now they're as familiar to New Englanders as grey squirrels. A couple of weeks ago, a coyote lunched on a Dandie Dinmont terrier within the Boston city limits. Of course, this was front page news, and led to all sorts of sturm und drang, although obviously cute little dogs get squashed by automobiles every day.

My farmer friends in eastern Connecticut -- and yours truly as a wannabe -- are in a state of war with white-tailed deer. I have read that there are more deer today than before the Europeans came. I talked with some farmers about it yesterday and the situation is becoming absurd. My friend who I will call Festus (about whom I expect to write more) has been forced to fence his entire property with 14-foot wire mesh on wooden posts. A lot of local farmers use electric fencing but Festus prefers low-tech.

The absurd part is that these stockbrokers and cardiologists who buy places out in the woods so they can get back to nature on the weekends actually feed the deer. You can go into the grain store and there are bags marked "deer feed." That's like people in the city feeding the rats. I find it completely incomprehensible. Aren't they content to let Bambi eat their rhodendrons?

The main on-topic public health issue here is Lyme disease. I figured I'd better throw that in to keep myself legit. Deer are the [correction: one -- thanks C. Corax] non-human reservoir for the disease, which is transmitted by ticks. It's pretty much impossible to spend any time in the Connecticut woods these days without getting Lyme disease. Festus gets it every year, each year a little more mildly, so he just accepts it as a fact of life. Some people's immune systems can't cope with it however, and they become chronically ill and need a carpet bombing with antibiotics. The deer overpopulation is killing us.

I can't even pull into my driveway without flushing a deer. I've had to wrap all my pear trees in fencing and enclose my field, which cost me $500 for materials and probably won't be adequate. In fact, when I got there yesterday they had managed to knock down part of the fence and even pull down a section that I had nailed to trees.

However, that may be the least dramatic development. In the Rhode Island/Connecticut border region we once again have moose. Historically, they migrated this far south, and the village of Moosup, near my place, is named after their traditional stopping place before they turned back north in the spring. They had disappeared for most of a century, but now they're back. Festus had a moose come through and wipe out 130 feet of beets, leaving behind great steaming piles of manure which was considerate, but insufficient payment.

The turkeys, which I never saw in my youth, are now ubiquitous. I even saw a turkey in Brookline, on the golf course. The fisher cats and bobcats are back. Oh yeah, black bears. I'm glad for all that, even though the turkeys are also a pain in the neck to farmers, but then there's the Big One. Everywhere you go in the rural east, from the Carolinas to Maine, there are rumors and more than rumors that the mountain lion, the catamount, the panther, is back. The campesinos tell the same story -- there have been sightings, dead cattle, but the authorities are covering it up.

I said to Festus, I'm glad for the coyotes and bobcats, they might pick off a faun once in a while, but if we do have lions, there will be unpleasant repercussions. Festus told me to stop worrying because it's too late, they are around, there have already been repercussions, but the state is keeping it quiet. He seems pretty sure of himself. The problem with Felis concolor is that they have been known to eat not just pesky deer and livestock, but Homo sapiens. The invading flatlanders, standing on out on their decks fattening up Bambi and friends with store-bought corn, aren't going to put up with that and they will demand that SOMETHING BE DONE. They aren't gonna like the bears much either, although that is more out of ignorance. Ecologically speaking, black bears are giant racoons, but they are kind of scary.

Now, it's a long story why this is happening, which I may go into another time. On the one hand, I'm very glad about it. I have wished for a recovery of wildlife in the northeast all my life, even though it complicates my life now. But the political repercussions are getting even more complicated, and worrisome. The flatlanders are invading the countryside at the same time as the creatures who were, of course, there first but had been temporarily expelled. They aren't gonna get along but the flatlanders have very strange ideas of what to do about it. They hate deer hunters but they also hate the coyotes, and they sure as hell aren't going to put up with panthers. They won't allow the towns to cull the deer herds but they won't stand for natural predation either.

They're also going to insist that the police and game wardens hunt down the moose and bears, shoot them with tranquilizers, and ship them somewhere else. After a while that's going to get hopeless. Listen up folks -- if you want to go back to nature, you really have to mean it. It's not a theme park.

Friday, June 10, 2005

More news that isn't fit to print

I'm willing to bet a month's supply of Lisinopril that 90% of Americans -- and sadly, that includes you -- don't know what's going on with Medicaid funding right now. It's another four bowler.

But you're in luck, I don't have to worry about covering the stuff you really care about, like Michael Jackson and how we're turning the corner in Iraq. Here's the deal: the Congressional budget resolution requires $10 billion in entitlement cuts in the next five years, and it's pretty much assumed that it's coming out of Medicaid. the Senate Finance Committee and, for some odd reason, the House Energy and Commerce Committee, have jurisdiction over Medicaid, and in the next two months or so, they will come up with the specifics about which poor kids won't get to see a doctor and which old folks won't get their diabetes medication.

To quote Medicaid Matters,

A new Medicaid commission, due to report on September 1, was also created as part of the budget agreement. However, the commission is entirely controlled by the administration and includes no voting members from Congress or consumer representatives. Advocates and Medicaid supporters in Congress have concluded that it has been designed to merely rubber-stamp harmful administration proposals that would undermine benefits, eligibility and affordability in Medicaid and shift costs to the states.

Medicaid Matters has considerably more info and ideas about how the damage can be contained. So check it out, and get on the horn to your prostitutes -- sorry, I meant representatives -- in Congress.

On another matter, regarding the previous post, here's an example of what I'm trying to get at. A few years ago I was hired to help a Haitian community based organization develop some programs. They were interested, among other initiatives, in setting up a soccer league for their kids and they asked me to find published literature on the benefits of sports -- you know, all that character, and teamwork, and keeps 'em out of trouble stuff. It turns out there isn't any. We know exercise is good for you but of course you can get that without competitive sports.

It's just something we take for granted. Kids should be on teams, kids should engage in competitive sports. In fact we know very little about the role of competitive sports, good or bad, in child development. I have seen some recent sociological work that finds that most kids largely stop competing after junior high, mostly because they just aren't very good at sports. Do the jocks then end up better off in life? If so, what is the causal story behind that? If competing in sports is good for you, does that mean we should have more levels of competition, so everyone can play? What would that cost? Would it be worth it? If competing doesn't have any social benefits, why do we spend so much public money on competitive sports programs? If it does have benefits, is it right to spend all that money on the few kids who happen to have athletic ability?

Nobody is really asking these questions. Again, scientists can't answer them, only the citizens of a democracy truly have that right. But we can give people information they need to make up their own minds. So far, not enough people have looked.

I'll be away from your internets until Sunday. Hard work and parties in the back woods await me.

Wednesday, June 08, 2005


I'm not talking about that sissie english game where they run around the field kicking a ball back and forth for an eternity and nothing ever happens.

I'm talkin' 'bout real foobaw. Murrcan foobaw. Where men are men and ligaments are nervous.

Now, everybody knows that you can get hurt playing football. But the question, "How dangerous is football" is a perfect illustration of the limitations of scientific discourse in addressing questions with social or moral meaning. An epidemiologist needs a definition of an "injury," a rate base -- a denominator -- and a source of data. Based on combinations of these choices, one can generate almost any number one wishes.

The following information is from Mueller, Zemper and Peters, "American Football" in Caine, Caine and Lindner (eds.) Epidemiology of Sports Inuries. Human Kinetics, Champaign, IL. (1996)

The most popular definition of a football injury is a lesion that causes the player to miss at least one day of practice. The most popular denominator is called the Athlete Exposure (AE), which means a player attending a game or a practice. Based on these definitions, injury rates in both high school and college, at least up till around 1992, were about6-8 per 1,000 AE. Should this concern us?

Not on its face. After all, these guys presumably want to play football. If the only consequence of an injury is that they miss a day, that's presumably better than not playing football at all and their priority will just be to get back in the game. If a high school player has to spend a week on crutches, he'll probably get more attention from the girls and he might not have to take the trash out that week. That's not such a bad deal. There might be some medical expense for an X-ray or an orthopedist's opinion, but what the hell, football is already expensive -- equipment, coaching, real estate -- so evidently people don't mind paying for it.

So we need a definition of an injury that we really care about. Mueller et al refer to "catastrophic injuries" -- "injuries that result in death or some type of permanent disability." Nearly all deaths from football injuries result from head or neck trauma. The number of such fatalities fell dramatically after 1976 when the rules were changed to prohibit using the head as a ram -- "spearing" -- in blocking and tackling. With the exception of 1986, when there were 11 such deaths, the numbers per year were in single digits from 1977 through 1992 and indeed, in 1989-1992 inclusive there were a total of only nine -- all at the high school level. This is out of more than 1.5 million high school football players, so the risk is lower than the risk of riding in a car. I can tell you that in elite college and professional football, this rule is very strictly enforced.

So-called "indirect fatalities" -- from heat exhaustion or cardiac arrest -- have been more persistent. There were 8 in 1992. Some of these individuals undoubtedly had heart abnormalities and might have died during any form of exertion. Others may have been severely dehydrated. There used to be a widespread belief that athletes should not drink water during practice. This myth has been debunked, and hopefully the number of such incidents is now reduced.

Spinal cord and brain injuries resulting in "incomplete recovery" are slightly more prevalent. Mueller et al do not fully describe the source of their data, so I have no idea how complete or accurate it is, whether it depends on medical evaluation and reporting, or precisely how the concept is operationalized. But evidently beginning in 1977 there has been a reporting system for such injuries. The annual rate per 100,000 high school players (which is probably of more interest to parents than the rate per AE) has ranged from 0.07 to 1.0. The rate for college players, of whom there are only 75,000, has been far more volatile, ranging from 0 (in many years) to a high of 2.67 (i.e., a total of 3 -- also in many years). Continuing improvements in equipment and training methods have no doubt further reduced this number. We don't have much information about the severity of these injuries, which presumably range from total quadriplegia to fairly minor limitations in motor control, but any permanent spinal cord or brain injury is a significant misfortune.

Nearly 100% of professional football players wind up with osteoarthritis, or other permanent damage from wear and tear.

Okay then. Does that mean advocates for public health should campaign to ban football? Hell no. In the first place, you'd have to weigh these costs against the indisputable direct health benefits of vigorous physical activity. Football training includes strenuous aerobic conditioning and also weight bearing exercise which builds bone strength. Advocates for the game think it "builds character" or something like that. I have no idea what the net effect is of playing football on longevity or long-term quality of life, but these numbers alone don't prove that it's negative. (And of course, you have to operationalize those concepts as well, which is a profound difficulty.) You could certainly argue that safer forms of exercise are available, but then you would have to ask how many of the players would engage in them if not for the specific allure of football. Just as important, there is risk in most life activities, which we readily accept -- driving, crossing the street, eating sushi, taking a shower, mowing the lawn, climbing Mt. Everest. The only question is whether it's worth it.

So the argument about the value of football really comes down to its role in the culture and its aesthetic properties. Personally, I happen to like it. I was a Patriots fan when they were a laughing stock, and later during the troubled years when Troy Brown personally constituted their only redeeming social importance. Now I'm in hog heaven. I appreciate the complexity of the game, its extraordinary demands, the courage and skill of the players. American football is, as far as I know, unique in its demand for teamwork. On nearly every play, if just 1 out of 11 players doesn't execute his assignment, the play will fail.

On the down side, football players, like other athletes in popular sports, are often flattered and indulged as youths, and may become arrogant and socially offensive. But that isn't the fault of the game. Football players are often stereotyped as dolts, but in fact, to play the game at a high level requires considerable intelligence and discipline. It seems to many people a distortion of social values that elite professional athletes are so highly paid when social workers and school teachers are impecunious. This is a result of limited supply, of course. Professional sports selects out people with very rare capabilities, who are in a position to demand high pay. We don't have to watch. Part of the aesthetic of football is violent collision and physical intimidation, which people tend to associate with testosterone poisoning. But more and more women are playing football. There are now 3 women's professional leagues in the northeast U.S. One of my coworkers is a professional offensive linewoman. (I know what you're thinking -- she is not a lesbian.)

The point of all this? The science of public health can supply us with facts, but which facts and what numbers it gives us depends on the questions we ask, the categories and definitions that we use, and the reliability (i.e., accuracy) and validity (i.e., applicability to what we really care about) of the data. After that, what we do with the facts, what they mean to us, whether we care about them, what choices they lead to, depend on our values. And the effective functioning of democracy requires the democratization of science. I've deliberately chosen a somewhat frivolous example to introduce this problem.

What else might young people and their parents want scientists to tell them in order to make personal decisions about participating in football? To make decisions about the football program in their own public schools, and state college systems? Who should be responsible for the medical bills and long-term care needs of seriously injured football players? How well can people understand the information that already exists, and how accessible is it? How does the kind of quantitative information presented here, based on strict operational definitions of entities, inform these decisions, if at all? All of these problems are equally vexed in environmental regulation, alcohol and other drug abuse policy, food and nutrition policy, you name it. How can we do science for the people?