Theodicy

According to stories in the newspapers, many of the people left homeless and utterly bereft by the recent hurricanes have said that the experience strengthened and deepened their faith in God. They give thanks to God for saving them from death and giving them the opportunity to start their lives anew.

While I can certainly understand that people desperately need to find solace and some positive meaning in such a devastating experience, that reaction makes no sense to me. For starters, it implies a very pejorative view of God. Thank you for saving my life, and by the way, thanks for drowning my neighbors, destroying my home and community, taking away my livelihood -- God is great, God is good.

The problem of reconciling faith in an omnipotent, omniscient and benevolent God with the manifest non-benevolence of the creation is called theodicy, a term coined by the philosopher Leibniz. In fact, it is logically impossible, therefore much of theology is taken up with creating tortuous labyrinths of verbiage designed to isolate this inescapable contradiction from the apprehension of believers. (The ancient Hebrews, of course, had no such problem because their God was not in the least benevolent, but rather a vicious, vengeful sociopath.)

Fortunately for humanity today, we do not need to turn to God for comfort when disaster strikes. We ourselves have the power to combat evil. We know that the flood walls in New Orleans failed because of the way they were constructed. We know that most deaths and injuries in earthquakes occur because of the way buildings are constructed. In Pakistan, and other areas devastated by yesterday's earthquake, for example, there are many unframed masonry buildings. Wood framed houses don't collapse in earthquakes. We can predict which areas are most vulnerable to hurricane damage and choose not to build where protection is least feasible and to take protective measures where they make sense. We can greatly reduce the danger of fires by regulating construction materials and installing sprinkler systems. And so on.

Just as important, we can create social institutions which assure that people are cared for and that random events produce less injustice. As a highly topical and cogent example, we can have universal, comprehensive single payer national health care. In the short term, we need to extend presumptive eligibility for Medicaid to all the people displaced and impoverished by the recent hurricanes -- something the Bush administration refuses to do.

We can never eliminate disasters or individual misfortune, but we can take great comfort in knowing that we are working together, as a conscious, sentient, and caring species, to protect and take care of each other. God is not doing that, but we can. That's my theodicy.

Plans

Now that the corporate media and the federobble gummint have gotten around to noticing the danger of an influenza pandemic, with the additional inspiration of the Gulf Coast hurricane debacle, everybody is all of a sudden interested in preparedness. Others are all over the quarantine and martial law thing, which certainly tells you a lot of what you need to know about the Chimpoleon administration's world view and ambitions.

Meanwhile, I decided to look up my own state's bio-disaster plans. Of course they're all under the label of bio-terrorism preparedness because terrorism was the only conceivable threat to the U.S. until a couple of months ago, but what the heck, it's all we've got. It's probably not directly relevant to an influenza pandemic until and unless we have the means to vaccinate the population or hand out Tamiflu to everyone (and don't take Mike Leavitt's word for it that the vaccine is on the way, unless you want to be as gullible as Daniel Schorr), but I started out by downloading the Massachusetts state plans for emergency dispensing.

It all sounds great. Every city and town in the Commonwealth is supposed to be all set and ready to go on 24 hours notice to set up emergency dispensing sites that can throughput 5,000 people per day. Each community needs to establish as many sites as it takes to process their entire population in 2 days. Then they're supposed to clean up the shut-ins and social outcasts on day 3. Meanwhile, at each of these sites, all 5,000 people are filling out questionnaires, being vetted for counterindications for whatever pills or vaccines they're supposed to be getting, and evaluated for already having symptoms in which case they're to be transported to the hospital . . . All this without a riot.

Now just think about this. The radio and TV interrupt this program to bring you the following news bulletin. Go immediately to your local junior high school or the YMCA to get a shot or you will die. Not that there is parking there for 5,000 people, but the second 5,000 don't wait until tomorrow anyway. It's impossible to get a motor vehicle within 4 miles of the place. Some of the people in the mob decide that they and their kids need to get to the front, others disagree with that proposition. The first people who manage to get through the process have no way to leave because their cars are boxed in. There's no food, no water, and forget about sanitary facilities. People are fainting, panicking. Some people in the mob have the sniffles. Maybe some of them really do have influenza and now here they are nose to eyeball with the entire town. The ambulances can't get in or out. Realistically, they're lucky if they can process 1,000 people a day anyway. You get the idea.

How about Plan B?

You can check out the rest of the state's rad plans here.

The prescription pad, cont.

While no-one who doesn't work for the grocery manufacturing and meat and potato frying industries any longer disputes that eating your veggies and whole grains is a good way to avoid heart disease and diabetes, the picture got murky for a while on cancer. Epidemiological studies seemed to point to protective effects against cancer of what was also a heart-healthy diet, but when they tried prospective trials using supplements of anti-oxidant vitamins -- the ingredients in veggies thought to be protective against cancer -- they didn't work.

But maybe it wasn't the vitamins after all. A case control study by Matthew Schabath and colleagues in the Sept. 28 JAMA, in which lung cancer patients were matched with controls (mostly smokers, obviously), assumes that it's not the vitamins after all but chemicals called phytoestrogens that do the protecting. These are compounds in plants that resemble the hormone estrogen, but their biological effects are complex. Some may act like a weak version of estrogen, others may block estrogen receptors and reduce the activity of estrogen in some cells. They effect different estrogen receptors in different ways. So we don't have a straightforward explanation of why they might protect against certain cancers.

Nevertheless, the results of this study were quite dramatic. They were more powerful in men than in women (not surprisingly, it would seem, as women have higher estrogen levels than men to begin with). People with the highest levels of phytoestrogen consumption appear to have reduced risk of lung cancer of something like 1/3 to almost 1/2 -- even if they smoke.

The most important sources of these compounds are peas and beans, soybeans and soy products (not a whole lot in tofu, though), and some kinds are also found in leafy vegetables, cruciferous vegetables (eat your broccoli George), fruits, vegetable oils, tea and coffee, although the compounds in tea and coffee don't seem to be as protective.

Anyway, don't sweat the details. Eat legumes for protein, whole grains, vegetables and fruits, and you can't go wrong. Drink tea if you want, it sure won't hurt anything.

Caution: This study design cannot prove that it is actually these foods and these compounds that are protective. It could be other plant compounds that are found along with these, or something else that the people who eat these foods tend to do. But what the hell, it's one more reason to do what you already know is right.

Oh yeah, weren't those hippie wackos saying all this 30 years ago?

Keeping your family safe

A major reason for the popularity of SUVs, aside from the TV ads showing glow-in-the-dark suburban families climbing vertical cliff faces in Arizona and consorting merrily with the mooses, is that they have been sold as being safer than those sissy little automobiles. It is true that in a collision between an SUV and a car, the car, being lighter, gets the worst of it. Here we have an excellent example of a negative externality -- the consumer tries to buy safety for herself and her children, but makes others less safe.

It turns out that the externality extends to pedestrians. When a car strikes a pedestrian, the front bumper is at knee level or below. The pedestrian falls onto the hood, and then perhaps on the ground. The most serious injuries are likely to be to the legs -- unfortunate but not fatal. (You've all seen the Hollywood stunt people do the trick of being hit and rolling over the hood.) The higher front of the SUV strikes people higher up, and knocks them straight to the ground. Massive internal injuries, head trauma and death are likely to ensue. Another disturbingly common event consists of parents backing over their children in the driveway, because the driver's blind spot behind an SUV is much greater than it is behind a car.

But guess what? The driver and passengers aren't really safer anyway, because SUV's are prone to rolling over, and since they are classified as trucks, lack the safety features required in automobiles. Rollover crashes are the most dangerous to the occupants, who end up getting crushed.

Then of course there is that fuel comsumption issue. 95% of the people who buy these vehicles have absolutely no use for them -- the are not going to climb Pike's Peak or drive out to the Alaskan wilderness. They drive their kids to soccer practice, and go grocery shopping. Once again, the advertising man has screwed us.

Split Screen . . .

GW Bush, 10/6/05:

Mr. Bush likened the ideology of Islamic militants to communism. And he said they are being "aided by elements of the Arab news media that incites hatred and anti-Semitism."

"Against such an enemy, there's only one effective response: We never back down, never give in and never accept anything less than complete victory," Mr. Bush declared.

"With every random bombing. And with every funeral of a child, it becomes more clear that the extremists are not patriots, or resistance fighters," Mr. Bush said. "They are murderers at war with the Iraqi people themselves."

Robert Dreyfuss, 10/06/05

Last week, I reported on the fear of Shiite militias and death squads as reported by Aiham Al Sammarae, an Iraqi oppositionist and former minister under the interim government in 2004 who is trying to broker a deal with the Iraqi resistance. Since then, other reports have surfaced concerning the extensive violence carried out by paramilitary forces tied to SCIRI and to Al Dawa, SCIRI's partner in the Shiite religious bloc in Iraq. By now it is clear that if Tony Soprano lived in Iraq, he'd be a member of the Shiite militia. Consider the following report from CBS News:

CBS News correspondent Lara Logan reports there is a secret, ruthless cleansing of the country's towns and cities. Bodies -- blindfolded, bound and executed -- just appear, like the rotting corpses of 36 Sunni men that turned up in a dry riverbed south of Baghdad. CBS News traced 16 of those men to a single street in a Baghdad suburb, where family members showed CBS News how the killers forced their way into their homes in the middle of the night and dragged away their sons and fathers.

"My uncles were tortured, they even poured acid on them," a young boy told CBS News.

Clutching photographs of the murdered men, the women and children left behind came together to grieve. One woman said as her husband was marched away she sent her son after him with his slippers, but his abductor sent the child back with a chilling message: No need for slippers -- he will come back dead. They were targeted for one reason alone: all were Sunnis.

Or this, from the Chicago Tribune:

In the dead of night, bands of armed men in Iraqi commando uniforms stormed Baghdad's Hurriyah neighborhood in late August, breaking down doors with sledgehammers and grenades. If the family inside was Shiite, the gunmen moved on to another house, witnesses said. If the family was Sunni, the gunmen tore through the building, demolishing furniture and manhandling those inside. More than 70 young Sunni Arab men were whisked away.

Countless atrocities, too, have been perpetrated by Sunni gangs and by terrorists associated with Abu Musab Al Zarqawi. [Editors note: that would be the fictitious character Abu Musab Al Zarqawi.] But the killings by the Shiite militias are far more chilling because they have an entirely different quality: They are carried out by gunmen tied to the U.S.-supported regime in Baghdad. They don't draw criticism from U.S. officials, and most American media reports continue to portray the Shiites as victims and the Sunnis as aggressors.

SCIRI and DAWA are the parties that control the Iraqi government that those 140,000 U.S. troops are defending in Iraq.

In local news . . .

The Massachusetts Public Health Association and allies are backing a bill in the Massachusetts legislature, sponsored by Rep. Peter Kotoujian, that would ban junk food -- which is carefully defined based on sugar and fat content -- from public schools. Naturally, major opposition to the bill comes from the Grocery Manufacturers Association.

The idea of "manufacturing" food seems a bit odd to begin with. In any case, the main argument of the "manufacturers" is "this:

"Restrictions do not educate," said Susan Connelly, senior manager of state affairs for the Grocery Manufacturers Association, or GMA. "Restricting or prohibiting certain foods will almost certainly not work, as these policies will do nothing to help people choose the right foods for their own dietary needs."

We can certainly thank the food manufacturers for all of their educational efforts in the public service. As Kotoujian points out, according to the Boston Globe article, "children are exposed to 20,000 advertisements a year, the majority of which are about unhealthy foods, such as candy, soda, and fast food."

Hey silly rabbit, tricks are for lobbyists.

Libertarianism

I will discuss the libertarian ideology at greater length soon, but here's a quick item to ponder. A study by the National Highway Traffic Safety Administration finds that deaths of motorcycle riders in Florida rose by 81% when Florida repealed its mandatory helmet law. Libertarians call these laws paternalistic and a violation of personal freedom. After all, it's the rider's own life that is at risk when (usually) he chooses not to wear a helmet. Bikers are grownups, why is it any of our business whether they choose to wear a helmet. Oh yeah -- "The . . . study also found that motorcycle injuries have become more expensive to treat. The average hospital cost to treat a head injury was $45,602, more than four times the $10,000 in insurance that nonhelmeted riders are required to carry."

Also, dead and brain injured people can no longer support their dependents. In fact, brain injured people often require that other people take care of them. So, is it really just a question of individual freedom? What about my freedom not to pay taxes to take care of brain injured motorcyclists?

Reaping the whirlwind

In his press conference yesterday, the Resident insisted that we would pay for "hurricane reconstruction" -- meaning handouts to major contributors to the Republican Party -- by cutting "mandatory spending." The corporate media, generally, didn't bother to explain to the public what that means.

Mandatory spending refers to funds not controlled by annual decisions of Congress, but automatically obligated by virtue of previously-enacted laws. They consist principally of Medicare, Medicaid, veterans benefits, and Social Security. Just so you know. I haven't heard anybody in the Congress objecting to this plan as of yet.

This administration is torturing me

In the Sept. 28 JAMA (subscription only) Leonard Rubenstein, Christian Pross, Frank Davidoff,and Vincent Iacopino discuss the policies issued in June by the Department of Defense regarding participation by medical personnel in interrogations. As the authors put it:

The new guidelines are troubling, however, because they do not come to terms with the participation of physicians and other health care professionals in officially authorized interrogation practices that are absolutely prohibited by international human rights law, the Third Geneva Convention, and US military and domestic law that criminalizes torture, including psychological torture.

Indeed. The American Medical Association endorses standards first established by the World Medical Association, prohibiting physicians from any role in "torture or cruel, human or degrading treatment." There are corresponding UN principles. Physicians may not use their knowledge and skills to assist in interrogations, or to certify people as physically capable of withstanding ill treatment.

Well, if they work for the Department of Defense, they can. According to Rubenstein et al,

Under the DoD guidelines, the proscription against participation in any activity other than to evaluate, protect, or improve the physical and mental health of detainees applies only to health care personnel who are actively engaged in clinical treatment of detainees. A recent review of medical care of detainees ordered by the DoD and conducted by the office of the US Army surgeon general affirmed, pending further review, that psychiatrists and other physicians who do not provide clinical care can participate in the interrogation process. . . .

[T]he DoD guidelines allow physicians to “assist in the interrogation of detainees” and to participate in the certification of the fitness for treatment or punishment so long as it is in accordance with “applicable law.” . . . [O]ne of the hallmarks of current US interrogation policy has been reinterpretation of the Geneva Conventions, the Convention Against Torture, and US domestic criminal law against torture to permit aggressive interrogation techniques that previously have been understood to constitute torture or ill treatment. In an inquiry into allegations by US Federal Bureau of Investigation (FBI) agents regarding abuse of detainees at the Guantanamo Bay facility, Lt Gen Randall Schmidt determined that the following interrogation techniques were considered by the DoD to be humane and permitted by its interpretation of law: isolation for more than 5 months, sleep deprivation lasting 48 to 54 days during which interrogation took place 18 to 20 hours per day, degradation, sexual humiliation, military dogs to instill fear, and exposure to extremes of heat and cold and loud noise for long periods—and combinations of these techniques.

Now that sounds like torture to me. James Yee, the former military chaplain who was falsely accused of espionage, has written a book in which he alleges that Major General Geoffrey Miller and other officers encouraged the abuse of prisoners at Guantanamo. Miller was then sent to Iraq "“to review current Iraqi theater ability to rapidly exploit internees for actionable intelligence” and to review the arrangements at the US military prisons in Iraq," then placed in command of "detainee operations" in that country, with well-known results. He is now Assistant Chief of Staff for Installation Management, based at the Pentagon, while low-ranking soldiers who carried out his orders have been prosecuted. This year, Mr. Bush (whose portrait appears at the top of this page) threatened to veto the defense appropriations bill if it restricted his ability to continue to torture prisoners.

The policy of torturing prisoners in Iraq is still in effect, by all indications. Any medical personnel -- physicians, psychiatrists, nurses, medical corpsmen -- have a clear ethical duty not to participate in such practices, and to publicly report any incidents of which they gain knowledge. If they are ordered to participate, they have a clear ethical duty to refuse those orders. Let's see if any of them do.

Meanwhile, the responsibility for these crimes, ultimately, lies with the Commander in Chief. Who is a Christian.

The Prescription Pad

Quick - Who is the Surgeon General of the United States? (His name is Richard Carmona, but who cares?) I had the opportunity to meet David Satcher, a Surgeon General you have probably heard of. Dr. Satcher had a habit of writing special Surgeon General's prescriptions for people, but they weren't for drugs. He'd write a prescription to eat vegetables, walk to the commuter train instead of driving, spend more time with your kids, that sort of thing.

I thought of Dr. Satcher's prescriptions when I read about a new study in the Annals of Internal Medicine -- reported here by Alex Dominguez for the AP -- that suggests a 90% lifetime risk for overweight among men and 70% lifetime risk for women. Many people who make it well into middle age without becoming overweight ultimately succumb. For weird and objectionable historical reasons this study, based on a cohort of children of the original Framingham Heart Study cohort, is limited to white gringos; the reality is probably even worse for the total population.

If you want to know why we're in such danger, just take a look at a picture of Henry VIII. That's what can happen to you when food is in unlimited supply, and His Royal Highness need not bestir himself to obtain what is needful. In Genesis we are told that Man is condemned to a life of toil but like many of the Bible stories, that turns out not to be true after all. It used to be that poor people did hard work and rich people didn't, but today's low-paying jobs at desks or behind retail counters don't include physical exertion. Rich people actually pay for the privilege of exercising, by joining "health clubs" in order to spend a few hours a week engaged in physical toil for its own sake, usually consisting of extremely boring activities like walking or jogging on a treadmill. Usually they don't manage to keep it up for more than a few months.

Since the Surgeon General isn't writing prescriptions any more, here's what David Satcher would have told you. We need to make physical activity a part of our lives, not something we take on as an extra burden. For urban apartment dwellers, in the 15 minutes you spend waiting for the bus, you could have walked to your destination. You can throw a frisbee in the park for free and there's no law that says you can't do it when you're sixty. If you're in the burbs you can ride a bike to the 7-11 for the quart of milk, you don't have to drive. Get into gardening, build a stone wall, learn how to do things. If you can work up to strenuous exercise so much the better, but even a half hour a day of moderate exercise makes a huge difference.

This kind of personal advice is worth listening to, but there are also important social issues here. Patterns of residential and retail development based on the assumption of the automobile have made it much more difficult. Urban neighborhoods where people don't feel safe to walk the streets or let their children play in the park are even worse. The seduction of the television is literally killing us. The epidemic of obesity is threatening to reverse the gains in health and longevity we made during the 20th Century. It really is that bad. We need to get moving.

We are definitely nuts . . .

. . . if we let the Bush administration turn adolescence into a disease. A couple of months back I posted about the rising prevalence of psychiatric disorders, which is a function not of changes in our well-being but of the constant invention of new disease labels for various states of unhappiness or social deviance. Over at Effect Measure, I talked about Bush administration plans in motion to screen the entire population for mental disorders, and then prescribe them pills according to an algorithm developed by drug companies.

It seems the first steps are underway. According to Jean Lenzer writing in the British Medical Journal,

The parents of an Indiana teenager have filed a suit in a federal court in the state's Northern District, charging that school officials violated their privacy rights and parental rights by subjecting their daughter to a mental health screening examination without their permission.

The suit is seen as significant because President Bush has promoted a controversial plan to encourage widespread mental health screening for people "of all ages" in the United States (BMJ 2004;328;1458). The screening programme at the centre of the legal suit, TeenScreen, was endorsed as a "model" programme by President Bush's New Freedom Commission on Mental Health.

The complaint, filed on 19 September, charges that in December 2004 Chelsea Rhoades, then a 15 year old student at Penn High School, Mishawaka, was told she had obsessive compulsive disorder and social anxiety disorder after she took the TeenScreen examination. Chelsea has spoken out against the screening and, with her parents, alleges in the complaint that "a majority" of the students "subjected to TeenScreen" with her were also told they had "some mental or psychological disorder."

As Michael Wilkes points out in the same article, adolescents have their moods. They don't have a prom date, they think a friend betrayed them, they fumbled in the big football game, whatever. Screen them on that day, they will test as depressed. Then, according to the next step in the administration plan, the Texas Medication Algorithm Project, you give them Prozac. Then Eli Lilly gives more money to the Republican Party.

Who says perpetual motion is impossible?

A tip . . .

Juan Cole's column today is a scream. Check it out.

Exceptionalism

Big thanks to Revere for bringing us some hard news we can use.

The anthrax story is just one more example of the culture of American Exceptionalism: the assumption that the rules that apply to other nations don't apply to the United States. During most of my lifetime, the U.S. was said to derive its unique status from some mystical force of history, a special dispensation given to "Great Powers." Hence aggressive warfare is a crime, unless it is undertaken by the U.S. Indeed, it is an obligation of Great Powers to attack other nations when circumstances require it. What those circumstances might be shift with the aggression for which a rationale is needed, but no matter. During the Cold War, although one might have thought the Soviet Union was also a Great Power, Soviet aggression was evil, while U.S. aggression was pure.

In fact, such actions as the coups engineered by the U.S. against Iranian President Mohammed Mossadegh, and Chilean President Salvador Allende; the invasion of the Dominican Republic in 1965 to prevent the replacement of a fascist regime by a constitionalist regime; the arming of the Nicaraguan "Contras" for the purpose of overthrowing an elected government; the invasion and savaging of Vietnam in order to prevent elections from taking place; and countless other illegal actions by the U.S. over the years were undertaken to defend the interests of U.S. businesses.

The present occupant of the U.S. presidency has said that "Democracies don't seek to acquire weapons of mass destruction." Evidently he does not consider the United States to be a democracy, since it is obviously the United States that possesses by far the greatest capability in Weapons of Mass Destruction, however one wishes to define the term. The United States refuses to endorse the International Criminal Court unless U.S. citizens are exempted from its jurisdiction -- alone among nations. The U.S. alone among nations reserves the right to undertake peremptory warfare against any nation its leaders, on their own authority, assert might one day acquire the capacity to threaten the U.S. And so on. Nowadays, we are more likely than we were a few years ago to hear that these special privileges derive from God, who has uniquely blessed the U.S. and chosen it for leadership among nations.

While I doubt very much that the Almighty called upon us to "smite Saddam," as Mr. Bush told the Israeli leadership, or has singled out the U.S. for any of these special privileges, there is one respect in which the U.S. is indeed exceptional. This country has the highest degree of religiosity among the wealthy industrialized countries, and relgiosity here takes the most conservative and retrograde form.

Michael Powell in the Washington Post tells of a new $25 million "science museum" about to open in Kentucky. (Link is to the Boston Globe reprint, for reasons having to do with my overall contempt for the Washington Post.) Its Vice President tells the reporter, "When people realize the T. rex lived in Eden, it will lead us to a discussion of the Gospel. The T. rex was once a vegetarian too." Kenneth Ham, President of Answers in Genesis U.S.A., which sponsors the museum, says that "Evolutionary Darwinists need to understand we are taking the dinosaurs back." The museum teaches that baby dinosaurs rode in Noah's ark.

There are bound to be nut cases in the world, but polls show that more than half of adult Americans believe this raving nonsense. Half of Americans believe the world is 10,000 years old or less. This has nothing to do with spirituality, or even with belief in God. It is just an insistence of believing in children's stories in place of indisputable evidence. And I need hardly point out that there is no mention of dinosaurs in the Bible. The embarassing, and unavoidable fact of dinosaur fossils forces creationists, who claim to believe in the literal authority of the Bible, to ignore its literal text. Surely if baby dinosaurs rode in Noah's ark, the Bible would mention the 120,000 pound adults who were getting into the ancient Hebrew's wheat fields.

It utterly baffling to me why so many Americans are so deluded, all the more so because in the rest of the developed world, these ideas are simply considered laughable. Revere today links to a study that shows that in international comparisons, higher rates of belief in a creator correlate with higher rates of crime, STDs, and other social problems. The less devout a nation, the healthier and better behaved are its citizens. The U.S., with its great burden of piety, is the most socially dysfunctional of the developed democracies. Perhaps believing in idiotic fantasies is not good for you, after all.

New car smell

Guest blogging for the redoubtable Cervantes while he is off doing whatever it is he does on Saturdays. Building a house with his own two hands, as I recall. Strange interests, this Cervantes.

His only stricture was I wasn't to blog about influenza. So what to blog about. Something different. Hmmm.

I drive a ten year old shitbox car I hate (I won't say what kind, other than that it is a 1995 Volvo 940 sedan). So I have been fantasizing about how nice it would be to have a brand new automo-thing.

Ahh, the "new car smell." Nothing else smells like it. Nothing except a mixture of volatile organic compounds ( VOCs) you wouldn't want in your drinking water or food (like the carcinogens formaldehyde and styrene). The VOCs come from plasticizers, glues, paints and other items in the car's interior. Some people complain they get headaches, sore throats, drowsiness and queasiness similar to symptoms of "sick building syndrome."

Just sitting in a new car can subject riders to toxic emissions several times the limits deemed safe for homes or offices by some health authorities, though the problem tends to dissipate after about six months, according to a 2001 study by Australia's Commonwealth Scientific and Industrial Research Organization.

"We find new car interiors have much higher VOC levels than any building we've researched," research leader Steve Brown said. "Ultimately, what we need are cars with interior materials that produce lower emissions." (USA Today, byline Hans Greiml)

"Ultimately" is already here if you buy a Japanese car. Japanese car makers are trying to reduce VOCs to the point the air in a car meets the standards for air in a building, and they are cutting levels of 13 compounds, including formaldehyde and styrene. The top makers like Toyota, Nissan, Honda, Mitsubishi and Mazda are now marketing cars touting the lower VOCs. Great if you buy a Japanese car. And the rest?

The U.S. Environmental Protection Agency sets no guidelines for volatile organic compounds in non-industrial settings, though formaldehyde is regulated as a carcinogen by the Occupational Safety and Health Administration.

The Washington-based Alliance of Automobile Manufacturers, which represents nine carmakers including General Motors, Ford and DaimlerChrysler, says it does not follow the issue of volatile organic compounds. DaimlerChrysler said it has no initiatives on the volatile organic compound-induced new-car fumes.

Oh. I see. They don't follow the issue. Just the Japanese follow the issue. Strange interests, those Japanese.

US anthrax buy

The US government is making a big anthrax buy. Not an anthrax vaccine buy. An anthrax buy. They want to buy large quantities of anthrax for the Dugway Proving Ground in Utah, one of the government's germ warfare testing grounds.

The ever-valuable Sunshine Project has discovered contracts for the production of bulk quantities of non-virulent anthrax and associated equipment that can be used to produce large quantities of biological agents.

According to New Scientist,

One "biological services" contract specifies: "The company must have the ability and be willing to grow Bacillus anthracis Sterne strain at 1500-litre quantities." Other contracts are for fermentation equipment for producing 3000-litre batches of an unspecified biological agent, and sheep carcasses to test the efficiency of an incinerator for the disposal of infected livestock.

Although the Sterne strain is not thought to be harmful to humans and is used for vaccination, the contracts have caused major concern.

"It raises a serious question over how the US is going to demonstrate its compliance with obligations under the Biological Weapons Convention if it brings these tanks online," says Alan Pearson, programme director for biological and chemical weapons at the Center for Arms Control and Non-Proliferation in Washington DC. "If one can grow the Sterne strain in these units, one could also grow the Ames strain, which is quite lethal."

The US renounced biological weapons in 1969, but small quantities of lethal anthrax were still being produced at Dugway as recently as 1998.

Neither The Sunshine Project nor New Scientist had any idea what the purpose of these contracts was. The Sunshine Project's Ed Hammond speculated they might be part of a testing process to see how easily the spores dispersed from various weapon delivery systems.

Dugway has said these contracts are still in the "pre-solicitation phase" and no delivery of material has been made as yet. If we believe them. Even if we do, the action is certainly provocative:

Whatever use it is put to, however, the move could be seen as highly provocative by other nations, he says. "What would happen to the Biological Weapons Convention if other countries followed suit and built large biological production facilities at secretive military bases known for weapons testing?"

Once again, Bush's "Biodefense Strategy" makes us less safe rather than more safe. In a special irony, it was alleged evidence that Iraq had these kinds of facilities that Bush used as evidence Saddam had Weapons of Mass Destruction. Presumably this would be grounds for some other country launching a pre-emptive strike on the US.

Or have I got my logic wrong.

[cross-posted at Effect Measure]

Gloss on the below, and administrative statements

Speechless's comment on the previous post is quite apropos: "Isn't it bizaare? As if the system the institution takes on a life of its own that demands primacy over the needs of the patient. The institution comes to exist for its own purpose, and has lost sight of those it was created to serve."

Hospitals are organized and managed for the convenience of the staff, principally physicians and then nurses. Patients are just the raw material they process. It is nearly impossible to get any rest, or a decent night's sleep, in a hospital. Patients' personal needs or suffering are basically just a pain in the ass. Don't get me wrong -- most of my nurses were personally compassionate and caring -- I happen to have described an exception -- but the supply of caring they had available was often insufficient.

Hospital staff see so much suffering that they inevitably become callous, by ordinary standards. My agony would have been perceived as a major emergency anywhere but a hospital. Imagine if it had happened in a workplace, or in front of my family. But in a hospital, the only emergency is imminent death. Intestinal cramps weren't going to kill me, so my situation was just something that somebody would get around to eventually. If it took three hours, so be it, people had work to do.

Now, I am honored to announce that Revere, the editor(s) of Effect Measure will be joining this blog. Revere will make sure that we don't have that downtime on Saturdays, and other times when I am unable to post. We're having technical difficulties as I write this, which I hope we can resolve before I leave the planet today. If that doesn't work out, you may have to wait a bit, but with luck you'll be hearing from Revere this weekend, so please do stop by.

Finally, this is a big news day. I'm always tempted to comment on compelling events, but I think my job here is to try to discover whatever is original or unique that I can offer. I'm sure you'll find all the topical commentary you can handle at Eschaton, America Blog, Talking Points, Today in Iraq, and all the other fine current affairs blogs. But I do need to say that the notion that Judith Miller had to make some sort of a noble sacrifice in order to "protect" Scooter Libby is more ludicrous than giving Henry Kissinger the Nobel Peace Prize. Protect him against what, exactly? Retaliation for doing what Karl Rove wanted him to do? She was "protecting" her confidential source against public scorn, and criminal prosecution. Reporters are not doing their jobs, or serving the public, by giving sources protection against the morally appropriate consequences of their actions. That is the precise opposite of the theory behind the protection of sources. Will Bill Keller ever figure this out?

Ileus . . .

is not a legendary Greek hero.

For those of you who are newcomers to this site, a while back I started to tell the story of my own disemboweling by surgeons who were under the erroneous impression that I had colon cancer. I digressed to tell about the disgraceful and appalling treatment of my Russian roommate, who spoke no English. Now I owe the rest of my story, so here’s the next installment. It's too long for a blog post but that can't be helped.

I’m still hooked up to a urinary catheter, a morphine drip, a nasogastric tube continually pumping out my stomach, and plastic sleeves on my calves that continually inflate and deflate. I haven't had anything to eat or drink for several days.

Normally, waves of contraction travel continuously down the intestines, moving the food along as it is digested, and eventually out the exit. Now think of your distant ancestor whose abdomen is mauled by a saber-toothed tiger. His only hope of surviving is for the system to shut down, so that feces aren't pumped into the abdominal cavity and lacerations have a chance to heal. Actually, it's probably not a bad idea for even the carefully re-sewn juncture created by surgery -- called an anastomosis -- to have a chance to knit free of strain.

Also, my fever was too high. Usually, this is a sign that the patient is failing to clear the lungs, because of shallow breathing and inability to cough. I would just have to cough. Alas, it was impossible.

A woman came with a plastic device that could measure the volume of my inhalations. Every hour, I was to suck on this thing ten times and try to make the little yellow cylinder rise as high as possible. What they didn't tell me was that I would be billed $25 for her 30 second visit and $39 for the plastic doohickey, which was easily worth $4.50. Actually, they billed me for two visits by the respiratory therapist, one of which never happened.

It was a great day, though. The head surgeon came to see me and I asked him to get the damn tube out of my nose. He did it! He told me to take a deep breath then he pulled it right out. Then I asked him to get those damn inflating booties off me. He made a deal with me. He would do it if I would walk. It didn't seem possible, but I was willing to do anything. Nurses came and pulled off the booties. Then they took the catheter out of my penis. They waved a syringe at me the size of a coke bottle, but not to worry. The syringe was to draw out water through a little bypass off the main tube. The principle of the thing turned out to be a water-filled balloon inside my bladder that kept the catheter in place. Once the balloon was deflated, they just pulled the whole apparatus out. The sensation startled, but it was tolerable.

Now the trick was to stand. I still couldn't sit up on my own, but the magic bed could get me into a full sitting position and, with the help of the morphine button, I could get my legs over the side and slide my feet down to the floor. With a nurse pushing the IV pole, I walked down the hall 20 feet and back. I needed someone to lift my legs back into the bed, but you have to admit, all of this was progress. It was painful and strenuous, but was advertised as having multiple benefits. Not only would it prevent blood clots from forming in my legs, then breaking off and killing me, but it was the only known way to encourage the bowels to start operating again. My assigned goal in life now was to pass gas. I should let them know right away if any should depart my posterior.

Then the chief surgeon came again and told me I could have something to drink immediately. He put me on what is called a Full Liquid Diet. He gave me his card. "After you're discharged, I'll want to see you in a couple of weeks. In the meantime, if you have any problems or questions, just call." The card read: "Beth Israel Hospital, a major teaching hospital of Harvard University. Andover G. Knozall, Instructor in Surgery."

Debbie, my regular nurse, was off that day. Nurse Huang gave me a lunch menu. Mirabile dictu! I could order tomato soup, vanilla pudding, cream of wheat. I lustfully circled my choices. Then Ms. Huang told me I could get juice from a refrigerator across the hall.

It turned out the juice came in a little container that looked like a urine sample. I drank some apple juice, trying to be cautious, but it was gone in a minute. I will not try to describe this experience; you can imagine what it meant after nearly a week with nothing getting past my front teeth except a wet sponge on a stick.

I waited a half hour or so and still felt fine, so I went for a urine-sample container of orange juice. I was on my way out of there! I got a little anxious, though, the next time I got up to walk and discovered that my abdomen had blown up into a hard, geometric hemisphere. When my lunch came, I was too bloated to eat. I was sick, getting steadily sicker.

I began to feel surges of pain in my abdomen, always in the same place directly below my navel. As each one subsided, my diaphragm would spasm and acid would burn through my chest and into my throat. My friend Peter, who is a physician, came with his eight-year-old son. JJ had brought me his electronic baseball game, to help me pass the time.

In the end, that people care for you is the meaning of life. But pain, in its time, is the whole universe. The cramps came every minute, and grew stronger every time. They would start in a tight focus just below my navel. Then pain would swirl through my belly and explode into my groin and up through my chest and neck like a cluster bomb, trailing acid fire into my throat. After every attack, I violently gulped the air I would need to make it through the next one. My memory of this whole episode is a blur of agony, but I am sure that my nurse knew that I was in serious distress before Peter and JJ came. She paged the intern on duty right away, but he didn't come for more than three hours. By the end of that time I thought the spasms would break me in half.

Peter did everything he could to help. Even though he is a doctor, it was not his place to intervene. He tried to talk me through a meditation exercise to conquer the pain, but I could not concentrate. I was not simply in pain: I was possessed. My body was no longer my own. I wanted JJ to leave, afraid he would be hurt and disturbed by what he was seeing, but I didn't want to send him away either because I wanted him to know that I liked having him care about me. It was up to Peter, anyway, and Peter let him stay.

Peter urged nurse Huang to page the intern, again and again. She argued with him, defending her own conduct. Finally he threatened to call my attending physician -- Andover Knozall -- at home. Five minutes later, the intern came. His name was Dr. Huang. No relation? I don't know.

"Ileus", he said to Peter, who agreed with him. That's a fancy word for the paralysis of the bowels I'd had all along. Peter had explained to me that the cramps came from the bowels starting to work, but without coordination. One section might start a wave of contraction that met up against another section that was locked up tight. The problem came, ultimately, from the apple juice I had drunk that morning. My stomach was trying to send it on down to intestines that just weren't ready.

Dr. Huang said he was going to pump out my stomach. Peter and JJ left the room. Dr. Huang had a little roll of thin orange tubing. He cut off a piece and dipped one sharp looking end in some vaseline. Then he stuck it up one of my nostrils. It felt exactly as though he had stuck a burning match up there. "Don't do that don't do that don't do that" I yelled. I couldn't yank my head back because it lay against the mattress. I couldn't struggle with him because I was paralyzed by another cramp. The match burned back through my skull and down into me. "Where is it?" Dr. Huang asked.

"My throat my throat my stomach my stomach take it out take it out." Then I gagged and vomited onto Dr. Huang's shirtfront. I vomited again, and a third time. By then, he had a bowl under my chin. The tube came up with the brown glop in my stomach, and I pulled it out of my nose. The cramps eased.

Peter came back in and he helped Dr. Huang change my smock. "Actually," Dr. Huang said, "I'm more concerned about his fever. It should be going down by now. It's still 102." I was lying back exhausted. Peter and Dr. Huang left. I still had cramps, and they still came every minute, but they stayed in that tight little focus under my navel, no longer exploding through my vitals. Every minute, a little surge of pain. But no more cluster bombs, no more back arching and throat clenching.

Nurse Huang came in. "I did everything correctly from the standpoint of nursing. Your friend was wrong to say he was going to call the attending." She leaned over to lecture me. Yes, the nurse actually made a point of coming in to berate me. Now think about it. If this had happened to me on the sidewalk in front of the hospital, somebody would have called 911 and I would have had help within minutes. My mistake was to have a medical emergency in the hospital.

I think we're all bozos on this bus

Health Affairs has a special web issue on the future of Medicare and the health of American elders. And, mirabile dictu, it's open access!

Much of the material centers on a computer simulation by Dana Goldman and colleagues at the RAND Corporation (the folks who brought you the Vietnam counter-insurgency tactics, but we're over that, right?) which with the help of a lot of sometimes dubious assumptions projects the health, longevity and health care costs of the elderly population out to the year 2030. Then they try adding various prospective new medical technologies to the stew to see how it comes out.

The first thing you need to know is that, even as the health of the elderly in the U.S. has been improving in recent decades, the health of younger people has been getting worse, for exactly one reason: the epidemic of obesity and Type 2 diabetes. You can worry about terrorism or bird flu all you want, but this is for real, it's here, it's now, and it's threatening to undo the progress we made throughout the 20th Century in population health and longevity.

Anyhow, for present purposes, the assumptions we make about where the obesity problem is going affect the health status of people turning age 65 and entering the simulation. Less healthy people cost more per year, but they don't live as long. The consequences for Medicare spending tend to cancel each other out, since longer-lived people are still around to spend money on. Eventually they will get sick and die. About 30% of all Medicare expenditures are on people in the last year of life, from which you can run, but you can't hide. As a result, for budgetary purposes, it doesn't much matter how healthy people are when they enter the program. Without assuming any major technological breakthroughs, total Medicare spending increases from about $300 billion today, to $600 billion (in 1999 dollars) in 2030.

But won't those medical breakthroughs reduce the burden of disease and end up saving money? Sadly, no, as the cool kids say. For example, we already have implantable defibrillators. These may be used in increasing numbers of people. They cost about $40,000 to implant. That saves no money to speak of because it stops people from dropping dead suddenly, which is a relatively inexpensive event. At the same time, it causes people to live longer, get other diseases, and cost Medicare more money. Other potential advances may cost less (others cost more), and even reduce the burden of disease and disability, but in the simulation, none of them ends up saving Medicare money in the long run -- even though most of them are cost-effective from the point of view of the individual.

The most cost-effective intervention is a magic pill that extends life by 10 years. If it costs as much as other pills like statins, that you have to take every day, it only costs $8,790 per year of additional life, assuming that those extra years are healthy years. But by 2030, it adds 13.8% to overall health spending, because presumably everyone would take it, and that is the greatest increase in cost of any of the hypothetical new technologies. (If those extra years are unhealthy years, the cost effectiveness is far worse.) Anti-angiogenesis compounds -- drugs that stop cancers from growing by cutting off their blood supply -- cost half a million dollars per year of life added. But they would add only about 8% to total annual costs because fewer people would receive them, and for only a short time, since many of them would soon die anyway.

Advances in medical technology make health care more expensive. That isn't always the case, but it's true in the aggregate. As Goldman and the gang put it, "Many of the new treatments will be expensive and hence will raise the cost of health insurance for the non-elderly, and fewer people will be able to afford comprehensive coverage. In fragmented health insurance markets and incomplete health insurance coverage, the fruits of medical progress will be distributed unevenly. Furthermore . . . if we design cures for the diseases of "rich people" -- as cardiovascular disease once was -- then gradients in health are likely to widen." Indeed. This is already happening. Fundamental reform is unavoidable -- and we will either have rationing by ability to pay, as we do now; or rationing by transparent social choice, as sanely governed countries do.

The Unbridgeable Chasm

That's the one between the reality of Iraq and the political discourse in the United States. I read those eastern elite pointy-headed liberal newspapers, the Boston Globe and the New York Times. I occasionally look in on the TV network news so I'll know what drivel is being fed to the people. I get a sampling of the coverage of other newspapers over the Internet. I listen to NPR quite a bit with at least half an ear.

Then, I get the truth. I read the analysis -- the Informed Comment, as he accurately describes it -- of Juan Cole, with whom I often disagree but who is definitely reality based. I read the admirable news aggregation site Today in Iraq. I regularly visit Iraq Coalition Casualty Count. I read Riverbend's blog. (Which she understandably has had trouble keeping up recently.) I read the reporting of Robert Fisk and Dar Jamail and other courageous, enterprising journalists at Information Clearinghouse. I read the thoughtful, in-depth reporting of such journalists cum social scientists as Mark Danner in the New York Review of Books.

This is the truth. There is no good news from Iraq. The "democratically elected" government is controlled by two Shiite religious parties, with the cooperation of Kurdish representatives whose only long-term goal is independence but who are playing along for now in order to win territory on the cheap. The Shiite parties also envision an independent Shiite theocracy closely associated with Iran's clerical rulers. These factions wrote the new constitution in order to achieve these ends. The only effective units of the Iraqi army are actually militias of these Shiite and Kurdish parties who wear Iraqi Army uniforms, and these are the "Iraqi" soldiers who now fight alongside U.S. forces against Sunni Arabs -- when they aren't commiting atrocities on their own.

Why on earth the United States would be spending blood and treasure to advance these objectives is incomprehensible. Opposing this project through guerilla warfare are secularist Iraqi nationalists, principally Sunni Arabs who were associated with or had a stake in the former regime; and Sunni Islamic factions including Iraqis and a small number of foreigners. The Shiite movement of Muqtada al Sadr, who has a huge following, opposes the present government politically and is allied with the Sunni insurgency against the intended breakup of Iraq. Although his fighters have been observing a cease fire for more than a year now, that appears to be breaking down, and U.S. forces are again skirmishing with his Mahdi Army.

Meanwhile, there is no basic security or civil order in Iraq. Gangs of vicious criminals operate freely, commiting kidnappings for ransom and robberies that have the Baghdad middle class huddling behind closed doors. Women and girls are afraid to leave the house, and the social equality and freedom they enjoyed under the secular Baath regime has been lost. Child malnutrition is widespread. Most people with the means to get out of the country are doing so, notably the physicians and other professionals who would be essential to the rebuilding of Iraqi society. The police and other security forces, as well as the government ministries, are completely corrupt, and loyal to their factions. The police are as dangerous as the criminals, or perhaps indistinguishable from them.

Daily attacks on the oil infrastructure have reduced production to below pre-war levels. Electricity in Baghdad is available for only a few hours a day. Sewage still flows in the streets. The government hides behind 12 foot blast walls in a closed zone of central Baghdad controlled and secured by the American occupiers, to which American "reporters" (actually transcriptionists of Central Command briefings) are confined.

And then there is the occupation. War is not glorious, or pure, or honorable. It is brutalizing, grotesque, beyond morality. The Americans drop bombs on houses from airplanes, killing people indiscriminately. They fire 50 caliber machine guns at cars that they think have approached them too closely, and at everyone in sight if they have been attacked. They break down doors in random searches of entire neighborhoods, destroy and loot people's property, beat and humiliate ordinary citizens. They routinely abuse and torture people they arrest, and they hold tens of thousands of prisoners, the vast majority on nothing but slight suspicions, under grim conditions. They besiege and demolish entire cities, driving their inhabitants into squalid refugee camps.

They do this even though they do not understand who they are fighting and they have no evident goal or cause. Some of them have taken to posting photgraphs of themselves laughing at the gory remains of Iraqis on an Internet porn site. Ironically, that's about the only place Americans can see for themselves the reality of war, because the television and the newspapers won't show it to us.

The whole world knows all this. But our political leaders, of both parties, and our corporate media, will not confront the truth. There is a cancer on our national soul.

Anybody who isn't paranoid these days is nuts

As we have just seen to our horror, it is important to have it all figured out ahead of time who is going to be in charge in an emergency. The World Health Organization, as those of you know who have surfed on over to Effect Measure, is considerably worried about the prospect of a worldwide pandemic of a particularly virulent strain of influenza, which is currently percolating away among birds, including domesticated fowl in Asia and migratory birds which have now made it to Eastern Europe. Many readers here are familiar with the basics, but it won't hurt to do a brief review.

As a reminder of the technical background, the problem is that this strain of influenza virus has a form of the protein hemmaglutinin on its outer coat that humans have not previously been exposed to. (That's what the "H5" means in the name of this strain, H5N1, with N1 being the form of another protein called Neuraminidase.) That means we have no immunity to this particular strain. So far we know of a few dozen people who have become infected, about half of whom have died, but it appears they either became infected directly from birds, or from very close contact with severely ill people. Unfortunately for people and birds, influenza virus evolves rapidly, both by mutation and by genetic reassortment, including swapping genes with other strains.

Once a variant of H5N1 influenza acquires the means to be transmitted efficiently from human to human, the pandemic will begin. That may be happening right now in Indonesia. In any event, WHO and most experts believe it is only a matter of time. A strain that easily spreads among people will likely be less lethal, but it will be lethal enough. Ordinary seasonal influenza kills people, but mostly people who are already debilitated or immunocompromised. Frail elderly people are particularly at risk. Like the 1918 strain of flu, however, an H5N1 pandemic is expected to be potentially lethal to young, healthy people. And it will make a lot of people very sick.

Far beyond the direct effects of the virus, a pandemic will create enormous social disruption. Undoubtedly countries will try to protect themselves by restricting travelers from abroad, even suspending all air traffic. If many people in essential occupations such as police, firefighters, physicians and nurses, even trash collectors are sick at the same time, public services will be disrupted including health care, just when we need it most. Internal commerce may also be disrupted, shortages of food and other goods could appear in particular cities, and so on. Undoubtedly many people with the means to do so will flee affected cities for what they consider to be safer retreats in the countryside, leaving yet more jobs unfilled. All of this will pass -- the pandemic will sweep through a region and move on in a few weeks -- but it won't be pleasant.

Naturally, the WHO is calling upon all nations to prepare. They've even given us a handy checklist. Here's one item:

1.2 Command and control

In order to be able to make clear and timely decisions and to have a uniform policy that is endorsed by all officials, it is essential to know who is in charge of different activities within communicable disease control, and how that might change if a limited outbreak becomes a major emergency. In addition, it is essential to know who is in charge of key elements in the response (e.g. travel or trade bans, enforcement of quarantine).

As we saw in the recent unpleasantness in New Orleans and points south and east, the federal gummint hadn't figured that out when it comes to natural disasters. Is it CDC, DHS, local officials? Fearless Leader has the answer! It's the army.

Now, you'd think that people at the Centers for Disease Control and Prevention would have the appropriate expertise here; and that FEMA ought to know something about disaster response. What the army is extremely good at is blowing stuff up and killing people. Hey, that's their job. They have also shown themselves to be highly capable at rounding up large numbers of people and imprisoning them. (Not that there's anything wrong with that.) I don't think that's exactly what's needed, although, as WHO also tells us:

1.5.1 Legal issues
Rationale
During a pandemic, it may be necessary to overrule existing legislation or (individual) human rights. Examples are the enforcement of quarantine (overruling individual freedom of movement), use of privately owned buildings for hospitals, off-license use of drugs, compulsory vaccination or implementation of emergency shifts in essential services. These decisions need a legal framework to ensure transparent assessment and justification of the measures that are being considered, and to ensure coherence with international legislation (International Health Regulations).

Well, one possible legal framework would be the declaration of martial law and the assertion of presidential emergency powers. Of course, we can count on that being reversed once the emergency is over, right?