On Liberty

Anyone who teaches in higher education occasionally encounters students who have found the single key that unlocks every puzzle of politics and policy. The highest principle is human liberty, the essence of liberty is control over one's own property, and the greatest threat to that liberty is government. While one might be concerned about problems of justice or social welfare in the absence of government, those concerns are illusory. The Free Market, operating without government intervention, maximizes social welfare and produces justice by rewarding the talented and enterprising. Taxation is by definition immoral, because it deprives people of their property. Regulation is immoral because it restricts people's liberty to do what they wish with their property, and it is harmful to the general welfare because it deprives us of benefits the Free Market would bestow upon all.

It is trivially easy to debunk these arguments. Obviously, it is not only government that can deprive us of our liberty, but also individuals and private interests. At the most basic level, we have police and criminal laws -- government agencies -- to discourage people from robbing us, raping us, kidnapping us, killing us, and taking other actions which might deprive us of our liberties. Libertarians generally concede this, but they somehow can't see the generalizability of the principle, for example to regulation of business enterprises that might deprive us of liberty and property in innumerable ways. Perhaps more centrally, property does not exist by nature, it is bestowed by law and regulation. People gain and lose it not only by talent and enterprise or the lack thereof, but by fortune of birth and timing, ruthlessness and dishonesty or charity and altruism, generosity of others or victimization, and so on. Finally, and most fatally, there is no such thing as a "Free Market." Markets, in complex societies, are creations of government, and can only exist with the benefit of contract law and enforcement, government regulation of the money supply, banking and exchange regulations, and so on. The arguments that markets can maximize allocative efficiency depend on numerous assumptions that can only be made to approximate the truth by extensive government intervention, such as no monopoly power, perfect information, no externalities, and several others. Furthermore these arguments ignore the existence of a public domain. And the truth is that even the most conservative and market fundamentalist economists have no argument that shows that markets produce anything that resembles justice.

So why is this patently absurd and counterfactual philosophy so appealing, and why does it retain a place in the public discourse? It constitutes a defense of privilege, and it is a friend and comfort to the powerful. That is why economics departments and business schools, which are largely endowed by wealthy people and corporations, indoctrinate students with ideas that can be knitted into this cloth. It is useful in politics for the same reason, although corporate interests and wealthy individuals are quite happy to temporarily forget about it whenever they want government to do something for them.

All that is understandable. What I have difficulty understanding is how this supremely amoral philosophy, this apologetic for ruthlessness, greed, and injustice, is now championed by the most vocal and influential politically active Christians in the United States. I received an e-mail from a reader who informed me that Jesus was the first libertarian, and that Christian libertarianism will triumph. Of course these same Christian libertarians, when it comes to examples of your property such as your genitals and your womb, don't agree that you should be free to do with them as you please. Very puzzling indeed.

Hard time in Louisiana

Cervantes is off in the woods building a cabin or something, so I'm keeping the blog warm. Another Hurricane bearing down on the south, but the effects of two hurricanes ago are not close to worn off. Consider this.

Just before Katrina hit the fucked up state of Louisiana, the police there were doing what they do best, protecting everyone by arresting poor folks for minor offenses, like sleeping in public, begging, dealing Tarot cards and being drunk where others can see them. Thousands were in the slammer awaiting initial hearings before local judges when Katrina hit.

Six weeks later. Hundreds are still there, yet to come before a judge. Most should have been free long ago after their 10 day sentences, even if found guilty. Instead they're still locked up.

Local parish prisons—the equivalent of a county jail—in six Louisiana parishes hit hardest by the hurricane held more than 8,500 people when the storm hit. These detainees were evacuated to 43 state and local facilities across the state. Several hundred were sent to Florida as well.

[snip]

Local courts that have the authority to release the detainees remain closed. Although criminal defense attorneys, on October 6, asked the Louisiana State Supreme Court to grant jurisdiction to a single judge to hear all cases originating from the six affected parishes, the court has not yet ruled on the request. If denied, lawyers will be forced to file separate actions in the 26 separate judicial districts where the arrestees are now being kept, a monumental task for the lawyers who are working as volunteers—many of whom are New Orleans evacuees themselves. (Human Rights Watch)

It turns out this isn't just the usual Louisiana dysfunction, either. It's deliberate.

Prosecutors and department of corrections officials have not simply dragged their feet, however. They have also actively sought to impede the release of those who should be free. In habeas and civil rights proceedings brought on behalf of some 200 prisoners, the state’s attorney general, the district attorney, and the department of corrections all argued that the court should delay releasing those who served their time until they could demonstrate that they had somewhere to go when they were released. There is no requirement under Louisiana law, however, that those released after serving their sentence inform authorities of where they intend to go.

A spokeswoman for the department of corrections told the Times-Picayune last week that the department was concerned about the “wave” of prisoners being released into communities throughout Louisiana with “no place to go.” In habeas proceedings in one municipal court, the corrections department has said it would release people in alphabetical order, 35 or so a day, excluding weekends.

No wonder energy and chemical companies love this state.

In More Business News . . .

As I have noted before, the place to find the health care policy news is in the business section -- not that there's anything wrong with that. For example, today the Boston Globe has four stories on the front page of its business section, three of which are about health care, plus teases to two more health care stories inside. So now we know what constitutes the largest industry in the United States, and what really drives our economy.

The stories are about blood clotting associated with coronary artery stents; a Massachusetts Medicaid HMO that is adding dental coverage for its members (Hooray! Worth a story when I get back from the boondocks this weekend); the Cleveland Clinic Foundation stepping up to try to kill what otherwise appeared to be imminent FDA approval of a new drug for Type II diabetes, called Pargluva, which its sponsors Bristol-Myers-Squibb and Merck apparently didn't bother to point out doubles the risk of heart attacks and strokes (Some people are just so hypercritical, aren't they?); Pfizer's earnings get whacked on the Celebrex and Neurontin debacles (which, by the way, is not the fault of the stockholders but they're the ones who pay, not the executives who were responsible. Just sayin'); and finally, the one I'm going to say something about here, which is that community hospitals in Massachusetts are hurting big time.

The reason? Almost half the patients in the state are going to the big name, famous teaching hospitals. The community hospitals aren't filling their beds, are losing money, and are having trouble finding capital to modernize and keep up their capacity. Of course, the teaching hospitals are much higher cost providers, which hurts payers and ultimately, consumers and taxpayers as well.

Okay, you are probably saying, but it's only natural that the people want the best for themselves and their families, and of course they go to the academic medical centers where all the Top Docs (as the tabloids will have it) are to be found. Well I've got news for you -- unless you're going for the latest experimental procedure, such as a face transplant, or high risk surgery where your local hospital is not a high volume provider (surgical teams get better with practice), you're much better off going to your friendly, neighborhood community hospital.

If you go to A Major Teaching Hospital of The World's Greatest University, the Top Docs will be around someplace in the building, but the doctors who actually do things to you will be inexperienced residents who haven't slept for 36 hours. Half the people who draw your blood and set your IVs will be doing it for the first time, and you're likely to end up with an arm like a 12 bag a day junky. Not only will the sleepless resident want to stick his finger up your ass, but so will 12 medical students. Every morning, a gang of 8 people will come in at 6:00 am, wake you up, and stand at the foot of your bed discussing you as if you are some non-sentient entity in another state.

Surveys consistently show that patients are much more satisfied with their experience at community hospitals than at teaching hospitals. And for most of the reasons why people go to the hospital, they get equally good or better care. Plus it's a lot easier to park. So take my advice on this one.

Once Again I Beg Your Attention

The corporate media in the U.S. have largely lost interest, but the BBC is still paying attention to the former colony:

The UN says the shortfall in aid for victims of the South Asian quake has made the relief situation worse than after last December's tsunami.

UN emergency relief chief, Jan Egeland, said the organisation had never seen such a "logistical nightmare".

Mr Egeland said an airlift was needed of the proportions of the Berlin blockade of the 1940s, when Allies flew in supplies to the divided city in communist eastern Europe.

He said aid had to be sent in, and tens of thousands of homeless and injured people flown out, of remote regions before winter set in.

Mr Egeland said of the aid sent so far: "This is not enough. We have never had this kind of logistical nightmare ever. We thought the tsunami was the worst we could get. This is worse."

Mr Egeland said only $86m had been pledged of the £312m the UN had asked for to fund the relief operation - and far less actually received in hard cash.

Earlier, UN Secretary General Kofi Annan called for the global relief effort to be increased to help three million people made homeless by the 8 October quake and facing the fierce Himalayan winter without shelter.

"That means a second, massive wave of death will happen if we do not step up our efforts now," he said.

Mr Annan said that in the most affected areas hospitals, schools, water systems and roads had all been destroyed.

He called upon top international representatives to attend a UN-sponsored donors conference in Geneva, Switzerland, next week.

Mr Annan's chief aid co-ordinator in Islamabad, Andrew McLeod, told the BBC: "If the second wave of deaths hit, it's the major donors that are going to have to look at themselves in the mirror and ask why."

Now, I know the U.S. can't possibly afford to give more because we have more essential priorities such as abolishing the death tax and bringing the light of freedom and democracy to the Greater Middle East by means of expensive 500 pound bombs. But I hope that those who can afford to give will do so.

Please see Fouad's post, below.

Playing the Race Card

This is a complicated story, which is difficult to summarize, especially for those who aren't already pharmaceutical policy wonks, but I'll do my best. Pamela Sankar and Jonathan Kahn at Health Affairs tell it in all its horrifying glory.

As readers know, I am very concerned about health disparities, and I believe that health equity is a positive message that progressive activists and political candidates can get behind successfully. But it is the opposite of progress for people to start to claim that disparities are based on biological differences among the "races." Unfortunately, there is a vested interest in the race concept, and it's not just among white supremacists -- it's among people who use race (rather than ethnicity, discrimination, labeling, culture, poverty, and most to the point, racism)as their personal meal ticket. And you know who you are.

Okay. In June the FDA granted approval to a formulation called BiDil, specifically as a treatment for heart failure in African Americans. Note that African Americans are people who belong to an ethnic group -- they are not a "race." Some African Americans have more European than African ancestry. Some people in the U.S. who have predominantly African ancestry are not African American. How could this happen?

It turns out that many years ago, two generic drugs called hydralazine and isosorbide dinitrate, hereafter H/I, when used in combination, were found to be very beneficial to patients with heart failure. So they were combined into a single pill called BiDil. Then, drugs called ACE inhibitors turned out to be even more effective. BiDil is still patented, but the patent runs out in 2007. Meanwhile, there's nothing to stop generic manufacturers from marketing the two components separately. Also, the FDA had not approved BiDil (a separate step from a patent), so the patent wasn't worth anything. That's basically because the original trials weren't intended to win new drug approval, and didn't have good enough design for that purpose. (The generics didn't need approval, and there was no sense getting approval for the combined pill.)

Then, the original developer analyzed the old data by race and noticed that the 49 Black subjects on H/I seemed to do better than white subjects. Given such a small number, this could easily have been a coincidence, but it gave the developer an opening to get a new patent to use H/I specifically to treat heart failure in African American patients, and then get funding for a clinical trial for BiDil (the two drugs in a single pill), as an adjunct to the standard ACE inhibitor therapy in African American patients. Mirabile dictu, it worked. The combination of BiDil and ACE inhibitors was better than ACE inhibitors alone. So now the company, NitroMed, has applied for new drug approval, which will be good till 2020, to market BiDil specifically for African American patients.

Got all that? Sorry, go back and read it again if you have to. The point is, it probably works just as well for everybody. There is absolutely no reason to believe that it is especially efficacious for black patients, or that it won't work just fine for everybody else. But the manufacturers couldn't have gotten a monopoly on that basis. And it will cost almost $11/day, compared with a little over a buck for the two generics. Since doctors know that it really works for everybody, NitroMed hopes they'll prescribe it off label for non-Black patients (wink wink), and they'll make a fortune, but they can only market it to Black people.

As your mind boggles, consider this:

The financial incentives for drug research and development are completely dysfunctional. What companies are compelled to do to make money has little to do with rational inquiry that will benefit our health.

This sordid story means that the bogus, pseudo-scientific concept of "race" will be reified, not only in FDA policy, in a mass marketing campaign to sell pills.

Meanwhile, the research to prove that H/I is beneficial to everyone, when added to ACE inhibitors, could have been done -- but it wasn't because nobody would make a fortune off of that information. All it would have done is save lives.

Storm Warnings

From AP just now: A U.S. Air Force reconnaissance plane measured maximum sustained winds of 175 mph, with higher gusts, the U.S. National Hurricane Center said.

The plane also recorded a minimum pressure of 882 millibars, the lowest value ever observed in the Atlantic basin. That meant Wilma was stronger than any storm on record, including Katrina, which devastated New Orleans in late August, and Rita, which hit the Texas-Louisiana coast in September.

Okay then. I also read today that with the arctic sea ice disappearing, we're going to have a whole new geostrategic situation, the Panama Canal will become obsolete, and there's going to be an arctic land rush -- tough shit for the Inuit and the polar bears. The glacier on Kilimanjaro will soon be gone. You get the idea.

So, it's basically too late. We aren't going to reduce fossil fuel use any time soon, and global climate change will just accelerate anyway, no matter what. There's probably a positive feedback loop with the arctic ice cap disappearing -- the open water absorbs more sun, rather than reflecting it back like that bright white ice. The surface layer of the ocean has already warmed so it's absorbing less heat. Etc.

The time has come to figure out how we're going to live with this. The debate about Kyoto is over. We still need to accelerate conversion to renewable energy, of course, and it's got to be a political priority to undertake drastic measures to reduce exacerbation of climate change as much as we can. But we need to deal with it as a present reality, not a distant prospect.

I have some thoughts about the likely consequences and how to respond, which I will get to. Anybody else care to weigh in?

Homer J. Simpson, M.D.

I imagine most of my 4 1/2 faithful readers are already up to speed on the Serostim settlement, but here's a synopsis.

The drug maker Serono developed a hormonal treatment marketed for the wasting syndrome associated with AIDS. Unfortunately, the same year they got the patent, 1996, was about when fairly effective drugs to control HIV disease came on the market, and the number of people who suffered HIV-related wasting in the rich countries, who could have afforded Serostim, plummeted.

What to do? They started pushing a test on doctors to measure patients' "body cell mass," which would conclude that some patients were "wasting" even though they did not appear to be, and so needed Serostim -- at a modest cost of 21,000 bucks. (Yup.) Now, body cell mass is a real concept (it essentially means everything that isn't fat), but this test was not approved by the FDA and there was no evidence whatsoever that these patients actually needed treatment for wasting or benefited from Serostim.

Serono also gave a free trip to Paris for doctors who prescribed Serostim. Now, that I can understand. Doctors can be criminals, just like drug company executives. But what about all those doctors who didn't get a free trip to Paris, but just took the company rep's word for it that they should use this magical device and follow its instructions to give people $21,000 worth of hormones? Do they also smoke Marlboros because it makes them manly men, and drink Dr. Pepper so they can do what they do, and drive Dodge Ram pickups so they can grab life by the horns?

Serono has admitted that "this device was not approved for the purposes of diagnosing AIDS wasting." It also admitted to the free trips to France, but the DOJ has not identified the physicians who accepted them. (Wouldn't want to embarass the good doctors, now would we? Not that their patients have any right to know that their doctors are criminals who give them useless and possibly dangerous drugs in order to win free trips.) The scheme was uncovered by whistleblowers who worked for the company. I applaud their ethical passion, but also note that they are getting $10,000,000 each in bounty money -- which can motivate a lot of virtue. However, thousands of people were prescribed Serostim, which means we are probably talking about hundreds of doctors.

Next time you visit your doctor, you might want to check for dementia.

Yabba Dabba Doo

With soon-to-be hurricane Wilma apparently heading toward south Florida and several presidential photo-ops, this seems as good a time as any to reflect on the recent spate of natural disasters.

Yup, it's real. There have been more than the usual number of major catastrophes lately and it's getting to the point where the relief agencies are finding that donors' arms have suddenly gotten too short to reach their pockets. (And by the way, how many of you tossed in a sawbuck for the Kashmir earthquake? I thought so.)

In some circles, of course, the divine vengeance and/or end times theories are popular, but we'll let those circles turn on their own. Over here, I'll say that while many people have the impression that major earthquakes have become more frequent of late, statistically that does not seem to be the case. There probably is something to the theory that global warming is making very powerful hurricanes more likely, and we are indeed in a natural cycle of more frequent tropical cyclones.

But the basic reasons why, over the long term, we are hearing of more and worse natural disasters are: 1) The human population is greater than ever, and more of the earth's surface is densely populated by humans, including coastal areas vulnerable to storms and tsunamis; 2) Modern communications, rapid travel, economic globalization and international affairs have made us far more aware of events in formerly remote places. Even 20 years ago, I doubt that an earthquake in Kashmir would have been very big news in the U.S.

There are rational responses to natural dangers, obviously, but as with every problem there are issues of justice and social class. Poor people are more vulnerable for several reasons. They live in flimsier houses (in the case of Kashmir, in unframed masonry buildings with no chance of withstanding even a moderate earthquake); are more likely to live on low or otherwise vulnerable ground (viz. the 9th Ward of New Orleans); and have fewer resources to escape or recover (ibid).

In an enlightened world, we would anticipate these problems. At the very least, we can account for them in how we recover and rebuild. If the poor people of Kashmir have no option but to once again pile up bricks and concrete slabs, the next earthquake will have the same result. Here in the wealthy U.S., the west coast cities threatened by earthquakes have steadily been improving their buildings and bridges. Some say they haven't done as much as they should, but they've done enough that a major earthquake striking San Francisco Bay or Los Angeles County, while it will be a significant disaster, will probably cause deaths in the scores or possibly hundreds, not tens of thousands as in Kashmir.

So these events are natural, but their disastrous nature is to some extent amenable to human control. Never forget that.

None Dare Call it Treason

College-educated east coast liberals are often baffled, bothered and bewildered by most of what passes for political discourse in this country. How can it be that the events of Sept. 11, 2001 were supposed to be a reason to vote for George W. Bush in 2004? Why does the prospect of lesbians and gay men getting married in Massachusetts send the voters of the Midwest into a raging panic over the pending destruction of their own families? (Huh?) Why are people who stock shelves in WalMart passionately committed to cutting the capital gains tax and eliminating the estate tax?

But some the weirdest events since the alien invasion concern that flagship institution of east cost liberal elitism, you know what I’m talking about, it’s the All the News that Fits, $60 dollar entrée restaurant reviewing Newspaper of Record, the New York Times.

In the 1990s, the Times developed an obsessive, pathological hatred of the Clintons, who they pursued like furies with an almost weekly outpouring of 2- and 3-page stories relating incomprehensible details of fictitious scandals, and near-daily editorials calling upon them to be tarred, feathered, pilloried, imprisoned, drawn and quartered, hung, stretched on the rack, burned at the stake, keelhauled, flogged and made to sit in the corner – all over a campaign of scurrilous rumor and slander financed by a wealthy far right fanatic, and even though that same editorial page was in perfect lockstep with Clinton administration policies.

In the 2000 presidential campaign, their political coverage devolved to the level of giggling schoolgirls, obsessed with the color of Al Gore’s suits and endlessly recycled falsehoods about trivial things he had supposedly said in informal settings; while showing not the slightest curiosity about George W. Bush’s past or the blatant lies and contradictions in his campaign promises. Once the Republican aparatchiks on the Supreme Court appointed Bush president, the newspaper’s White House bureau had the hounds of hell put down and started concentrating on the new president’s wondrous affability and his favorite flavors of ice cream. No scandals in the Bush administration, no sir!

Then, after a bunch of buildings in their own city got knocked down while their best buddy was listening to a story about a goat, they started channeling the Office of Special Plans, a propaganda organ set up in the Pentagon to concoct phony intelligence about Saddam Hussein building nuclear weapons to give to Osama bin Laden. The medium, of course, was "reporter" Judith Miller, who had her stories dictated by Douglas Feith and the Pentagon's candidate for future president of Iraq, convicted embezzler Ahmad Chalabi. After they would plant a story in the Times, the Vice President, Secretary of Defense, and various minions would go on TV talking head fests to say, "See, even the pointy head liberal New York Times says it so it must be true."

Now we have the mind-boggling affaire Plame. Patriotic Americans tried to call the war plotters on their lies were excoriated by the Vice President and DoD officials as appeasers, dupes, haters of America, collaborators with terrorists, and the corporate media was happy to pile on. Then Ambassador Wilson was sent by the CIA to check out allegations (that turned out to be based on mysteriously forged documents), which had been used by Mr. Bush as a central justification for war in his State of the Union speech. Wilson publicly declared the allegations to be false, so the conspirators started spreading the lie among reporters that he had been nominated for the job by his wife, who by the way is a CIA agent responsible for investigating chemical, biological and nuclear weapons in the Middle East, thereby destroying her operation and possibly endangering the lives of her collaborators and informants.

And we have sacrificed 2,000 of our young people's lives, forever broken the bodies of 20,000 more, killed more than 100,000 Iraqis, spent more than 200 billion dollars with no end in sight, brought shame and dishonor upon the country and won the contempt and anger of the whole world precisely why? They told us that the reason was to stop the development of chemical, biological and nuclear weapons in the Middle East.

One of the people they discussed this classified information with was Judith Miller, who was not writing a story on the subject. Rather than testify as to who at the highest levels of government had committed an act of treason in order to protect previous treasonous lies, Ms. Miller declares herself a martyr to journalistic integrity and principle and spends 80 days in jail. The Times writes weekly editorials extolling her noble cause, gushing tears of pain and anger over an out-of-control prosecutor who would expect reporters and public officials to obey the law, and claiming without a trace of shame that the public interest depends on journalists concealing the truth from the public when their powerful friends commit treason. In furtherance of this ethical stance, the Times does not cover the story in its news pages.

The final denoument is if anything even more bizarre, but I won't waste your time pounding on what others have already beaten to a pulp. (I recommend Wolcott as a good starting point if you have yet to explore the blogosphere on this.)

What the hell is going on here?

Accountability

Discussion of my earlier posting on the participation of physicians and other medical professionals in the torture of prisoners in Iraq, Afghanistan and Guantanamo Bay centered on whether the perpetrators can be held accountable by licensing boards.

Steve Hellig of the Cambridge Quarterly of Healthcare Ethics and colleagues Phillip Lee and Marcus Conant, in a letter to NEJM, call for precisely that:

Those who have served in the U.S. military know that there is a documented chain of command for every action. Health care personnel serving in the military all work under the authority of licensed military physicians, who are responsible for actions performed under their authority. We therefore call on the AMA and the American Psychological Association to request that relevant authorities act, at a minimum, as follows. First, the military must provide full disclosure of all medical personnel involved, directly or by chain of command, in the treatment of detainees in Iraq, Afghanistan, and Cuba - and elsewhere if relevant - since September 11, 2001. Second, the records and conduct of these personnel should be reviewed by the medical licensing boards, other responsible licensing authorities in each state where the military physicians are licensed, or both. Independent expertise in bioethical standards should be sought in conducting these reviews. Third, appropriate disciplinary action should be taken on the basis of the results of the reviews, and these actions should be made publicly available.

Of course, it is highly unlikely that the military will respond to such a request. The physician and psychologist perpetrators, if publicly identified, would no doubt offer in their own defense the names of the superior officers who ordered them to commit crimes. And as we know, the Department of Defense is not going to allow accountability for these atrocities to climb the chain of command. After all, where would it stop?

It's Hard Work

In ancient times, people looked up at the sky and it appeared that the sun, moon and stars were revolving about them. The ancient Greeks studied the heavens more closely and noticed that, along with the sun and moon which wandered among the apparently fixed stars, there were a few stars that also wandered. Based on the geocentric assumption, Ptolemy devised a mechanical model of the universe in which the heavenly bodies were embedded in crystal spheres, rotating about the center of the earth. (By the way, the Greeks were well aware that the earth was spherical, and even produced a very accurate estimate of its diameter.) Obviously, something must keep the heavenly bodies from falling to the earth as everything does, but that something must be invisible, so crystalline spheres seemed to do the trick.

Over the ensuing centuries, closer observations of the planets challenged Ptolemy's model. They would acclerate and decelerate, even briefly reverse direction. The solution was to make the centers of their spheres themselves rotate about other centers, rather than being fixed. Even these solutions failed upon more exact measurements, and so the epicycles needed epi-epi-cycles of their own.

In 1514 the Polish mathematician Nicolas Copernicus gave a handwritten book to a few of his friends. In it he declared seven of what he called "axioms," though they are in fact deductions:

There is no one centre in the universe.
#
The Earth's centre is not the centre of the universe.
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The centre of the universe is near the sun.
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The distance from the Earth to the sun is imperceptible compared with the distance to the stars.
#
The rotation of the Earth accounts for the apparent daily rotation of the stars.
#
The apparent annual cycle of movements of the sun is caused by the Earth revolving round it.
#
The apparent retrograde motion of the planets is caused by the motion of the Earth from which one observes.

In 1543, shortly before his death, he published the full elucidation of his theory under the title "On the Revolutions of the Heavenly Bodies." He had deduced a much simpler explanation of astronomical observations. Galileo then used a new invention, the telescope, to make observations which conclusively proved the theories of Copernicus. For example, he observed the phases of Venus, which demonstrated that it revolved around the sun. He also discovered moons of Jupiter, which would have smashed its crystalline sphere, although neither he nor Copernicus had any way of explaining what held the heavenly bodies aloft.

As we know, the Pope and his lieutenants refused to look through the telescope. They threatened to torture Galileo to death, in the name of Christ, if he continued to defend the Copernican system, and he relented. But the truth could not be denied. Kepler improved on Copernicus by determining that orbits were not circles, but ellipses; Newton developed a mathematical theory of gravitation which, among other achievements, finally demolished the conception of any "center" of the universe (something which Copernicus had somehow intuited, but not pursued). By the late 19th Century, improved telescopes and observational and analytic methods had made it possible to prove that the stars were trillions of kilometers from the earth, and were objects similar to the sun. By the 1920s, astronomers had determined that the stars occupied a volume a few hundred thousand light years across, the Milky Way galaxy, which they believed constituted the entire cosmos.

Then Edwin Hubble discovered that most of the objects known as nebulae are not, in fact, clouds of gas, but other galaxies beyond our own, millions of light years away. Then he discovered that distant galaxies are moving away from our own at substantial fractions of the speed of light -- that the universe is expanding. From this astonishing revelation, scientists were able to begin to deduce the history of the universe, and to speculate on its ultimate fate. Our universe -- everything we can observe, that is, although quite possibly not everything that is or has been or may be -- is about 13 1/2 billion years old. The earth came along much later, about 4 1/2 billion years ago. The universe is so vast that there is no referrent to human experience in the distance to even the closest star, while that distance is but a hundred thousandth of the width of the galaxy. The nearest galaxy (other than two satellites of the Milky Way), Andromeda, is almost 3 million light years away.

Here is a portion of an image called the Hubble Deep Field, looking out in space and back in time nearly 12 billion years. This is a tiny piece of the sky, smaller than the end of a pencil held at arms length:



Each of the galaxies in the image -- and the tiny red dots are very distant galaxies -- contains on the order of 200 billion stars (as does our own).

These discoveries have smashed completely, and forever, the biblical cosmos. If there is a sentient creator of the universe, the purpose of the creation cannot possibly have had anything to do with us. The universe is utterly indifferent to our existence, which is of not the slightest consequence. A million galaxies like our own could vanish in an instant, and the universe would go on, not recognizably changed. This is the cosmos that we have discovered with our senses, and our reason, and our wondrous tools. But it is very difficult for most people to accept, and most people do not accept it. Two hundred thousand years of cultural development, of attitudes about the world, of explanation, of belief; the bedrock of the social order in religious authority, the answer to the terror of death and the futility of bereavement, the anchor of purpose; all swept away in a few hundred years, in a devastating avalanche of nearly incomprehensible truth.

It is no wonder that we are experiencing a turning away from reason, and truth, a flight into comforting darkness. Perhaps we have elevated such a limited, willfully ignorant man to our highest office precisely because his limitations are comforting. But the dark ages must be over now. If we are going to survive the challenges ahead of us, we must step out into the light, no matter how painful, and never turn back.

Critical MASS

Some of you may remember that in Bill Cosby's version of the story, God tells Noah "I'm gonna make it rain for a thousand days and a thousand nights and drown 'em right out." Noah replies, "Why don't you just make it rain for forty days and forty nights and wait for the sewers to back up?"

Well, here in New England, we're proving that it doesn't even take forty days. Nevertheless, I intrepidly headed out in my amphibious vehicle yesterday to the Critical MASS conference in Shrewsbury, where a determined crowd of fellow water rats met to carry on the movement to eliminate health disparities. That's right, a lot of us think that this ought to be, can be, will be, the next big crusade to make this country better.

Let's not forget, in spite of the appalling state of politics in this country right now, and the descent of journalism into the lowest depths of whoredom, in my not yet terribly long life we have traveled forward a long way. We had the Civil Rights Movement, and while racism certainly hasn't gone away and the right to vote is under assault, racial discrimination is illegal and far fewer people are disenfranchised today than in 1960. We had the Women's Movement and while we are still facing a backlash anybody who doesn't think it made a huge difference hasn't been paying any attention. We passed Medicare and Medicaid and again, they're under pressure, but they aren't going away. Even the Gay Rights Movement has changed the terms of discourse, and made a major difference in the culture in some parts of the country. Our leaders still lie to us, but we're less tolerant when they do. It took the people too long to catch on to the ways they had been deceived and manipulated into war in Iraq, but it happened much faster than it did in the case of Vietnam.

Now we happen to think that if we can raise consciousness enough, organize effectively, frame the issues in the right way, the American people won't tolerate the huge differences in health, life expetancy, and the adequacy and quality of health care that people get because of their race, ethnicity, culture, or the kind of work they do and where they happen to live. It just isn't right, and I happen to think that the American people are good people and most of us won't put up with it.

We have a coalition here in Massachusetts, and even political leadership in Rep. Peter Kotoujian, Sen. Diane Wilkerson, and many of their colleagues, who are ready to take on this fight. There isn't any reason why we can't find people to join with in our neighboring states, and the rest of the U.S., to make this an effective national movement. How about where you live?

The Produce Section

David Bacon in The Nation, Oct. 24 tells us about indigenous people from Central America and southern Mexico who travel north through Mexico, working on plantations, and on to California. (The full article is available to subscribers only, but if you haven't subscribed yet, now's the time.) Their community endures although their place is lost. One of the places he mentions, on the journey north, is San Quintin in Baja California.

I visited San Quintin some years ago. Heading south from Ensenada, the trans-penninsular highway is a black thread through sand to the horizon. Even the sparse cacti are small and very mean, with needle-like thorns longer than their barrels are thick. Every forty miles or so a sign with a place name points west toward the ocean, marking a barely discernible track of tire marks. Every 100 miles, a Pemex station and a tiny huddle of cinderblock houses, with a patch of wilting cabbages and a starving cow. On this alien planet, battered flatbed trucks with high wooden panels roar past in the single northbound lane, heaped with tomatoes, grapes and bell peppers.

Then you go over a mountain pass and spread out below is a glistening emerald valley. Come a couple of miles further on down the slope and you'll see it resolve into endless rows of tomatoes and grapes, here and there a small cloud of dust raised by gangs of workers. An actual paved side road, the first in a hundred miles, leads toward the ocean. The road is washed out in places, but still passable in our old Buick. Lined by majestic, but dying eucalyptus trees, it leads to a resort called Cielito Lindo -- a cluster of cabins in the style of a 1950s New Jersey motel, a coffee shop, a restaurant and bar, and a campground with RV hookups for surfers. Just across a narrow inlet is a luxury hotel with a helipad, called El Presidente, owned by the Mexican government as a resort for wealthy Mexicans. The sand is just like granulated sugar with flecks of cinnamon, the sun and surf never end. The ocean, frigid from the Alaksa current, keeps the days just warm and the evenings cool in this tropical desert, while three miles inland the afternoon temperatures are 120 degrees.

A jug of water sits by the sink in every cabana. The tap water has been ruined by salt water intrusion, from years of pumping out the aquifer to water the plantation up in the desert valley so the tomatoes and grapes could be sent on to California canneries and wineries. About a dozen American retirees lived in Cielito Lindo, in dirt cheap luxury. They hadn't bothered to learn a word of Spanish. They would order the servants about imperiously in English, and just yell at them when they didn't understand. Back up by the highway is the village, a huddle of 400 square foot cinderblock boxes. There's a grassy meadow with a sign reading "No Cazar," no hunting, and a man sitting on a horse with a gun across his lap to make sure it doesn't happen. The locals have some sagging corn stalks and bug-eaten cabbages, but without any rights to irrigation water, they can barely pull a week of lunches out of the ground in a year. Down the road a bit, and closer to the shore, a weathered sign reads, in Spanish: This is the ejido of the Happy Valley. The government gave this land to the peasants, for ever. Ejidos were supposed to be communal estates awarded to peasants in a land reform program. This land is clay, salted from the occasional hurricanes that wash the ocean over it, deepy gullied, barren and useless.

With my wretched Spanish I got the whole story from the locals. The plantation, and the resort, were owned by a man who now lived in Palm Springs California. In an amicable divorce, he had given his American wife ownership of the resort. Their daughters came down during the summer to spend time with their mother, learn Spanish, and get to know the empire they would inherit. There were almost no working age men in the village. They were all north in California, where the money was better. Those lucky enough to have jobs in the resort or the hotel had better housing on the premises. A few survived by fishing and crabbing in the shallow, muddy bay, and there was the proprietor of the general store and the manager of the Pemex station.

Labor on the plantation was done by women, a few old men, and indigenas from the south, who lived in barracks. The indigenas would learn some Spanish and the ways of plantation labor, before they too headed north for the agricultural minimum wage in the U.S., to be replaced by a new cohort of Mayans. Some old Indian women, instead of working in the fields, would sit on the beach with piles of clams to sell to the gringo tourists.

On the side of every building there were spray-painted slogans of the Socialist Workers Party. But when they counted the votes, the PRI always won.

Do the Right Thing

From my friend Fouad Pervez:

I never do these appeals, but with all the natural disasters hitting this past year, it might be high time.

The news out of the regions struck by the massive earthquake this past weekend is heartbreaking. Around 40,000 dead, and that total may climb significantly, 2.5-5 million homeless...the worst part is that the worst-hit villages are only now starting to get aid. People have been starving (it's Ramadan, many of these people were fasting when this hit) and freezing while they brave the elements outside (the weather can be brutal this time of year - they already were out in a hail storm, heavy rain...and now snow might be moving in the Kashmir area). Two big tremors hit, 5.3 and 6.2 on the richter scale. The UN and other relief agencies on the ground are asking governments and people for as much help as possible. People don't have blankets, food, basic medicine, any shelter, etc. A total catastrophe, and it's probably getting worse by the minute.

It's all a lot to process. I have a lot of family in northern Pakistan where this hit. The 20-story building that collapsed in Islamabad is pretty close to where some of them live. Everyone over there is completely petrified.

Lots of people have been asking how they can help in the relief effort. I can think of 2 ways:

1) Call up your Senators and Representatives...encourage them to push for more aid. Last I checked, the US pledged $50 million, less than what we spend in Iraq each day. While $50m isn't nothing, it's less than small countries like Qatar and Kuwait have given. (And no, we haven't done nearly enough in response to Katrina, either - unbelievable, we'll spend billions to bomb and occupy, but have to be shamed to spend anything to save lives). Pakistan is an incredibly poor country, they just don't have resources to handle this, and need all the help they can get.

2) Donate if you can. Best places to give:

Islamic Relief (appointed lead NGO for the earthquake)

Oxfam


International Committee of the Red Cross

-Fouad

You heard the man. Get going.

Now this is really getting to be a bit much. . .

My colleagues the Reveres and I are often asked why we discuss religion so much on our public health blogs. For me, it's largely pragmatic. I tried to move my more basic, philosophical concerns off of this site to the Dialogue blog. (Which is in suspended animation right now, but I'm still hoping to find some participants who are willing to represent the side of religion.) However, there are essential problems in public health in which religion is deeply entangled.

These include the allocation of potentially life saving and health producing resources, end of life treatment and extension of life, abortion, embryonic stem cells, contraception, HIV and STD prevention, drug abuse treatment and prevention and harm reduction . . . All of this is obvious because these are issues prominent in current political controversies. There happens to be a faction of Christians in this country right now, who have effective control of the Executive Branch and dispositive power in the Congress, whose beliefs about all of these issues stand in the way of what scientific knowledge and rational analysis show to be the policies that would bring about the greatest enhancements in population health and longevity.

Now, I admit there is an underlying conceptual principle of the good on which they may differ with me. Their preferred policies would result in more babies being born in the first place, and if someone believes that constitutes The Good, then I'm a bad guy. But those babies would have worse lives, unhappier lives, and shorter lives, than would the fewer babies born in my world. They would have less freedom, less personal autonomy, suffer more sickness, and be materially poorer. Perhaps some people think that is a price worth paying, but I am making my own position clear: it is not. It is also entirely unclear to me what these purportedly Christian views have to do with Jesus, but perhaps that is beside the point.

I bring this up now because Mr. Bush has declared that the reason he believes Harriet Miers should be a Justice of the Supreme Court is that she is an evangelical Christian, whose faith condemns abortion and homosexuality. Mr. Bush's friends James Dobson and Pat Robertson enthusiastically endorse that view and threaten Senators who vote against her with political extinction.

We face a profound historical crisis in this country. Secularists -- and that includes athesists, agnostics, and people of all faiths who believe that religion is a personal matter and that government must represent all people without regard to their religious persuasion -- must stand up proudly, confidently, and publicly and declare that the United States is a pluralist democracy, committed to the advancement of religious and intellectual liberty, and that George W. Bush, James Dobson, and the entire movement that they represent is antithetical to our traditions, our values, and our hopes for the future. And then we need to throw them onto the dustheap of history.

Crime

Many a heart is aflutter over speculation that Special Prosecutor Patrick Fitzgerald may be journeying into the heart of darkness, past the mere trading outpost of l'affaire Plame to the very conspiracy that gave us the Iraq war. As Nostradamus, Jean Dixon and Thomas Friedman all prove, one need not lose credibility for making false predictions, so I'll go ahead and say that I can't see the criminal investigation going significantly beyond unauthorized disclosure of classified information and some ancillary perjury and conspiracy to obstruct justice. That certainly shouldn't disappoint anyone, but the speculation about busting the gang for conspiracy to commit war points to a larger truth.

The Iraq war is, of course, a crime, and its architects and perpetrators -- who are at the summit of power in the world -- are criminal conspirators. We can label the crimes mass murder, the theft of billions of dollars, treason, and they've even thrown in sexual assault and rape to make it a complete package. But those are only crimes in a certain vernacular sense. No doubt the right prosecutor, judge and jury could find the defendants guilty of various provisions of the criminal law along the way, but that will never happen. For a president to order U.S. troops to kill innocent foreigners, no matter how false the pretenses, will never be construed as a crime, so long as the U.S. political structure remains intact.

Richard Nixon was impeached and removed from office for, in essence, conspiracy after the fact in a burglary. Some members of Congress moved to include an indictment for the secret bombing of Cambodia, but they failed. Lyndon Johnson used false pretenses to get authorization for massive escalation of the Vietnam war, but it never occurred to anyone to prosecute him. Ronald Reagan and his Vice President George Bush the First sold sophisticated weapons to Iran's ayatollahs and donated the proceeds to Nicaraguan terrorists. The price they paid was some inconsequential congressional hearings which converted bag man Oliver North into a hero. Bush the First and Donald Rumsfeld conspired with Saddam Hussein to bring about the slaughter of millions in a pointless war with Iran, but that was just the conduct of foreign policy. I could go on for pages but you get the idea.

Some relatively trivial conduct of Rove and Libby may get them into some fairly minor trouble, though one would hope at substantial political cost. But that is the worst the law will do in this matter.

It is indeed necessary that people with very heavy burdens of command have some immunity from judgment in hindsight. Any military action, after all, would be criminal in a different context. It is the job of soldiers to kill, and it is the job of presidents, at times, to order them to do so. Pacifists may wish it were otherwise, but so it is. Sometimes those orders will be based on erroneous beliefs, or bad judgment. We cannot ordinarily define such mistakes as crimes, no matter how awful the consequences. Power to make consequential decisions is a burden that magnifies human frailty, but still must be wielded by humans. Turning to my own field of expertise, consider physicians. Every single one of them has made mistakes that have hurt or even killed people, but they are not criminals, or bad people, just mortals.

Yet there has to be a limit. George W. Bush is a murderer.

From the American Public Health Association

The United States Senate will soon vote on S. 1716, the Emergency Health Care Relief Act of 2005. The bill is sponsored by Senate Finance Committee Chairman Charles Grassley (R-IA) and ranking Democrat Max Baucus (D-MT). This bill would ensure that Katrina survivors have access to health services by providing immediate Medicaid coverage to victims of Hurricane Katrina -- expanding Medicaid eligibility for this population for 5 months, renewable for another 5 months if necessary. The bill would also create an emergency fund for health expenditures that would allow Katrina survivors to maintain their employer-sponsored health insurance coverage and receive financial support for uncompensated care. These two provisions guarantee that Katrina survivors have access to a wide range of services, ranging from primary and preventive healthcare to needed mental health services. Among other things, the bill would provide federal support to the Medicaid programs of Louisiana, Mississippi and Alabama, by fully paying for all program expenditures. States that are hosting Katrina survivors would receive a 100% federal match for services provided to evacuees.

TAKE ACTION NOW. Send an electronic letter to your senators urging them to support S. 1716.

The administration, of course, has been quietly trying to undermine this bill.

Very busy this morning, you'll get something original from me later.

Let's get a couple of things straight . . .

Picking up the NYWT today, I see a piece by Gardner Harris and Seth Mydans, lead:

As worries increase about the possibility of a flue pandemic, public health officials are hoping that this year's flu season will be the first in years with an abundance of vaccines.

They go on to say that demand for vaccines has been up this year, but that there should be plenty to go around in the U.S. Then they talk about Michael Leavitt's trip to Asia to encourage international cooperation in response to the threat of a pandemic.

What they don't seem to understand -- they certainly never say so and clearly imply otherwise -- is that the flu vaccine which will be available this year will be of absolutely no use against a pandemic of the new H5N1 strain of avian flu. In today's editorial on the subject, Gail Collins and the gang don't appear to get it either. They write: "No country has enough medicines or vaccines to control a widespread outbreak of the avian influenza now circulating . . ."

No. Wrong. No country has any vaccines whatsoever to control a widespread outbreak, or for that matter a small outbreak. No vaccine against this threat exists. There is an experimental vaccine against H5N1 flu, which has not been approved for use, for which no production capability exists, and which may not be effective against any actual human transmissible strain which emerges.

I post this because it is so widely misunderstood, not only at the NYWT but among a large segment of the blogosphere and in my own hometown fishwrapper, and I'm sure in lots of other places as well. Now I'm off to write a letter to the editors, which will not be published.

Immigrant workers and occupational safety and health

One of the great things about being a blogger who teaches in higher education is that you get to rip off your students. So thanks to Marlene for getting me a head start on this post. Revere has a post about poultry workers in the U.S. who haven't been informed about the risk of infectious disease from birds. I'm not sure how likely it is that bird flu is actually going to come to the U.S. via poultry, but here are a few facts worth remembering about the people who now bring you breakfast, lunch and dinner in the U.S.

The majority of agricultural workers in the U.S. are immigrants - no surprise. In states with large numbers of immigrants, they also predominate in kitchen work. About half of the immigrant workforce is Latino (people from the Spanish speaking countries of Latin America, predominantly Mexico but increasingly including Central and South America. Puerto Ricans are not considered immigrants, although they are Latino.) Foreign-born Latino workers suffer occupational fatalities at a rate of about 6.1/100,000, compared with 4.6/100,000 for all U.S. workers, according to an analysis by Scott Richardson. Latino men have a 50% higher risk for non-fatal occupational injuries than all workers. And the trend is for increasing rates of occupational injury and death among immigrant workers.

Not only do immigrant workers tend to be in dangerous occupations, they are often unaware that they in the U.S., there are laws establishing workplace safety standards. Undocumented workers, obviously, are generally afraid to assert their rights even if they know about them. Many are paid under the table and their employers do not carry workers' compensation insurance for them. If they are injured, the employer may get them some basic medical treatment, but they will not receive any disability pay or rehabilitation.

The U.S. makes only a symbolic effort to restrict illegal immigration because employers like having a ready supply of exploitable workers willing to work at low pay, in dangerous conditions, who are difficult to organize. By keeping the threat of deportation over the heads of undocumented workers who do surface, while making no real effort to discourage employers from hiring them, the government gives employers exactly what they want. The ethical analysis of immigration of unskilled workers is complicated, and the appropriate policy response is not obvious either. But the fact is, these people are here, getting themselves injured and killed to put chicken on your table.

Different Worlds

Sorry for light posting lately (in case anyone has a jones for this site) but I've had computer problems. I had to restore my operating system, which means also struggling to restore all my applications and security settings. I haven't been able to convince my firewall to work with Firefox yet, so I am violating the essential tenets of my religion by making this post with Explorer. Also no e-mail till tomorrow.

Anyway, this little problem got me to thinking. Most of the people of the earth do not have telephones, let alone computers and blogs. Most people in very poor areas now do have access to information from radio broadcasts, and even remote villages often have a battery operated television, a tiny window into a parallel universe of refrigerators, offices, supermarkets, mothers hauling their daughters to ballet lessons in SUVs. Yet we, who have almost instant access to the libraries of the world, are largely unaware of them. We see the odd famine or natural disaster on the nightly news, but in the wealthy countries, it is only a small minority who pays any attention to what life is like in most of the world in ordinary times.

I have hammered away on this theme of the so-called Christian ideology of a "culture of life" in a world in which far more thinking, feeling, suffering people die every week of HIV than there are comatose people on life support in all the world. Every year, six million children starve to death before their fifth birthdays, while there are about 1.2 million abortions in the United States. Like me, these rich, well-fed, well-housed, politically well represented Christians have time, money, and access to channels of communication to press their causes. They claim to speak for those who cannot speak for themselves. It is nonsensical to imagine what a fetus would say if it could speak, since it has no awareness and no experience. But I know what those starving children are saying.

Here's the Millenium Development Project again.