Map of life expectancy at birth from Global Education Project.

Tuesday, September 30, 2008

Get it, Nancy?

John Cole blows their cover.

Like I said -- hornswoggled, bamboozled, and conned

It seems the Treasury Dept. held a private conference call with Wall St. Execs before the bailout vote, which was infiltrated. You might want to call Barney Frank's office and ask him about the following:

1. The tranching is a mere formality, and the Treasury boys as much as said so. They could take the $700 billion max as soon as the bill has passed,. . .

3. There seemed to be a lot of tap dancing about what price they will pay for assets and no straight answer about their policy on warrants. They did say that if the amount sold was greater than $100 million, they would take warrants. FYI, the current draft allows them to pay up to the price at which the assets were initially booked (yikes) . I wonder if this is obfuscation, if they have an idea of what the plan to do but will not admit it in any public forum. . . .

5. The exec comp provisions sound like a joke, They DO NOT affect existing contracts, they affect only contracts entered into during the two years of the authority of this program and then affect only golden parachutes. More detail on that point, but I don't need more detail to get the drift of the gist.

Now remember, they had to have the bill now, now, NOW! or we were all gonna die -- but it also turns out they didn't plan to do anything with the money for at least a couple of weeks, presumably so they can do some dealmaking with their banker friends about who gets how much sugar -- and sugar it is, clearly they are planning to overpay for the assets.

Now look who's saying we've got to go back and pass this bill or we're all gonna die -- George (the boy who cried) W(olf) Bush. The Democrats believed him about Iraq, they believed him about the Patriot Act, they're believing him again about this, which is nothing but a plot by rich people to loot the treasury. What the hell is wrong with them?

Monday, September 29, 2008


Like Bobo and the Mustache of Self Regard, I occasionally have an imaginary conversation with a fictitious cab driver in order to pull a column out of my ass.

Bernie was one of that rare breed of taxi operators whose first language is English. He had 25 pounds of extra belly sitting in his lap and peeking out between the buttons of his Hawaiian shirt. Chewing on an unlit cigar, speaking in his unmistakable Dorchester (Dawchesteh) accent, he went off.

"Those politicians get all their money from the bankers and stockbrokers and rich people and like that, and that's who they're gonna take care of. What do I care if some guy who already made millions is gonna lose half of it? If I'm losing my job or my house they aren't gonna bail me out. Tough shit, pal, that's capitalism, am I right? But they've just got to grab more of my money to help out some snot noses in 3-piece suits.

"Now they're saying if they don't do it, there's gonna be a recession. Tell me about it. My business is already off twenty five percent and the fares barely pay for the gas anyway. How about giving me a bailout?

"Y'know, I was starting to feel okay about that colored fella after all, but now I'm not so sure. It seems like it's George Bush and the Democrats who behind this thing. I hear the Republicans are mostly against it. McCain's half wacko but he hasn't said he's all for it and if he really tries to stop it . . . "

In case you think I'm way out there on this, what David Sirota says. Which is what I'm saying. The Democratic party is following George W. Bush over a cliff. Again. The second time, the third time, and the fourth time -- it's still tragedy, not farce.

Sunday, September 28, 2008

People unclear on the concept

The Boston Globe (may ask for a relatively painless registration) offers a crash course for us dummies on the financial crisis and why we have to pony up the $700 billion. They offer three case studies of people who can't get credit and why that is bad.

First there is Don Castle, a probation officer:

Since buying his Lynn bungalow with no money down three years ago, Castle has used his first home like an ATM. He's refinanced twice to help pay for more than $35,000 in home improvements, including installing 24 new windows, renovating the kitchen, building a deck, and replacing the roof.

Castle had big plans to turn his second-floor attic into a huge living space by adding new wiring and insulation. But the well of cash has run dry. Several local banks and online lenders recently rejected his applications for a $20,000 home equity loan. So instead of spending his days designing a master suite, Castle, 41, took a "Get out of Debt" class at Salem State and is now looking for a part-time job.

Now that is truly sad. The bank won't loan the poor guy any more money that he can't afford to pay back, and now he can't remodel his attic. If that's not enough to convince you to spend the $700 billion, there's this:

Roberta O'Connor knew it was a tough time to start a business when in May she opened the doors to Cabin Fever, a vintage Brazilian furniture store in downtown Salem. Shortly before the shop's debut, Washington Mutual, which was seized by federal regulators on Thursday, cut a home equity line she planned to use for inventory and daily business operations, despite her high credit score.

So the 35-year-old mother of two tapped into her savings and ran up $40,000 in credit card charges to cover the gap. But nothing could have prepared her for the recent financial meltdown on Wall Street and Main Street, when sales at her business dropped 40 percent over the past two weeks alone. "Everyone's in panic mode and people aren't spending," said O'Connor, a former marketer.

With her inventory starting to run low, O'Connor is considering applying for a small business loan to finance a $50,000 buying trip to Brazil. Watching the collapse of major financial institutions over the past two weeks has only made O'Connor more nervous about getting access to capital.

So, unless the taxpayers do something about it, Ms. O'Connor won't be able to borrow $50,000 to go to Brazil and acquire inventory that nobody wants to buy. Economic catastrophe!

Finally, there's this:

For once, [Don] Chiofaro is not rushing to break ground on a bold new development in downtown Boston. That's because he knows the timing for a large project could not be worse. Construction costs are sky high. Commercial banks and other lenders are in turmoil. And accessing a loan is more difficult than it's been in two decades.

"It's impossible to break ground right now," said Chiofaro, who is waiting out the financial tumult before proceeding with a planned development at the site of the Harbor Garage along the city's waterfront.

So Don Chiofaro can't borrow $100 million dollars to build a new housing at a time when unsold houses and condominiums are blighting neighborhoods from Long Island to Lompoc. We've got to fix that problem! We've got to loan Don the money!

Or maybe, just maybe, the time has come for Americans to stop borrowing more and more money to fuel consumption that they can't afford. And maybe the banks have figured that out -- too late for them, but that's not my problem -- and that's why they aren't making loans any more to people who can't pay them back. And maybe, just maybe, we should finally come to our senses. This is a feature, not a bug. It's not a problem to be solved, but rather one to be endured. Under the circumstances, we can make much better use of the $700 billion.

Friday, September 26, 2008

And by the way, I actually do have some idea what I'm talking about

I started Stayin' Alive as a public health blog, but for those of you who don't already know, my degree is in social policy and I did have to endure the study of economics and pass qualifying exams in that "discipline." What I principally learned, as I have made clear enough, I think, is that economics is largely a crock. However, there are some people who practice the profession who are not ideologues or theologians, and who do actually try to make a study of reality, rather than imposing their a priori theories on an unreceptive universe.

One of them is James K. Galbraith, with whom I essentially agree:

It's more hype than real risk. A nasty recession is possible, but the bailout will not cure that. So it's mainly relevant to the financial industry.

Actually, a nasty recession is more than possible, it will happen. It is happening already. The housing bubble was the last spasm of our latest Gilded Age, which is now over. We've been living beyond our means, on money borrowed from foreigners, and we can't do that any more. People who spent their lives nurturing small businesses will see their creations destroyed. People who struggled all their lives to build a modest nest egg will see their retirement dreams evaporate. Hunger and want will grow in the land. This will not happen because the credit markets lock up and hedge funds and investment banks fail. It will happen regardless.

There is much that the federal government can do to ameliorate the pain and hasten the day of recovery. In addition to enhancing the safety net for the people who will be seriously hurt, we need to invest in a sustainable future, in real job creating and wealth producing activities. What we don't need to do is rescue the socially destructive, unproductive and parasitical financiers of Wall Street from the horrible prospect of losing a portion of their billions and ending up as mere millionaires.

The legislation the Congressional Democrats are talking about now is certainly more defensible than the outrage Henry Paulson tried to impose on us, and it might even have some desirable elements such as help for distressed homeowners and limits on executive compensation. Best of all, they're talking about committing only a portion of the money, maybe $150 billion, and taking another look before they pony up the rest. A case can be made for passing something like that, so everybody calms down and the markets stabilize and we can get past this and go on to a serious discussion about the nation's future. But right now, we aren't having that.

Thursday, September 25, 2008

We aren't supposed to pay any attention to this . . .

because politicians' personal conduct is nobody's business but their own. And fortunately, the Republican party has always held strictly to that standard.

Well, if George W. Bush says we have to do it

then I guess that settles it.

Meanwhile, back in the real world, Sarah de Ferranti and David Ludwig in NEJM discuss the recommendation by the American Academy of Pediatrics to give statins to children as young as 8 if they have elevated serum LDL. They seem reluctant to offend their colleagues in AAP, so they lay out issues without bluntly coming to conclusions. Allow me then.

Cholesterol is an essential component of cell membranes, and an essential compound in the pathway that synthesizes the steroid hormones, which include the sex hormones and others which have major importance in the development of children into adults. Cholesterol is particularly important in the central nervous system, and plays a key role in its development as well as its functioning.

There is zero -- zip, zilch, nada, nothing, bupkis, the null set, boy and bull are gone -- evidence regarding the long-term effects of giving statins to children. On the other hand, one can certainly hypothesize that drugs which inhibit the synthesis of cholesterol would have effects on sexual development and the development of the brain in children which cannot be assessed in any way based on experience with adults.

Now, why do children have elevated LDL? With the rare exception of genetic disorders, it's because they are physically inactive, overweight, and eat too much saturated and trans-fat. What do we do about it? Throw up our hands and start giving them pills, that might just be very dangerous, because actually fixing the problem would require a fundamental reorganization of how we do the business of health in this country. We have money to pay doctors and buy pills to try to fix the damage from the way we live -- although we might just be making it worse -- but we don't have the resources or the political will to fix the way we live.

And if we allow the Bush administration to complete its 8 year project of looting the treasury on behalf of the obscenely rich greedheads who control the Republican Party, we'll have no chance at all. You knew they were going to try to find a way to clean out the last dollar, but the audacity of this scheme is breathtaking. Check this link, you might find a rally tonight near your home to stop it. Good luck to us all.

Tuesday, September 23, 2008

Now, back to our mission.

I get a lot of e-mails from various pitchpersons, and I probably ought to pass more of these along because they are sometimes worth checking out. This link comes from a flack working for the U.S. Dept. of Health and Human Services, and it's your government's official portal to the world of health advice. I took a quick look and I will say that, while there is some evidence of the unavoidable influence of commercial pressures (e.g., advice to eat lean meat and poultry, fish, beans and, yep, eggs; followed immediately by advice not to consume cholesterol) they offer a huge catalog of links to sound resources inside and outside of government, without fear or favor, for every kind of health-related issue. I find generally fair and balanced treatment of complementary and alternative medicine, resources from both professional and consumer perspectives, and a well-organized format that makes it pretty easy to find what you need. So it might be a reasonable place to start if you have a specific health-related concern or question.

Was everybody in the country born yesterday?

Look here, ye fool Democrats in Congress and ye corporate media yammerers: the "threat" to the economy is not that investment banks and hedge fund managers are going broke. The basic problem -- which is not a threat, but a current reality -- is that we've been living on borrowed money and we have to pay it back. That means, no matter what anybody does, Americans will have to consume less. Our standard of living is going to fall. Our asset prices are inflated and that means stock prices and real estate prices are going to stagnate, at best, for a while. That will happen. Nothing can stop it.

The scenario can vary in important ways, in particular in how the burdens are distributed among rich and middle class and poor; and in whether we work and invest sensibly to improve our situation in the future. If we keep blowing money on military adventures and trying to dominate the world through force, we've got no chance. We have even less chance if we borrow another 2 trillion dollars to save the bacon of a lot of rich, Ayn Rand-worshiping greedheads from the consequences of their own folly.

Democrats: Do not vote for the bailout! Do not give George W. Bush any legislation that he is willing to sign! The people don't want you to, and they will blame you. Do not succumb to threats! Do not succumb to blackmail! No, no, no!

Monday, September 22, 2008

When you find yourself in a deep hole

Stop digging you fucking morons!

We are in a very deep hole because we have been living beyond our means by borrowing trillions of dollars from foreigners. Now we have an enormous national debt that we will have to repay, even as the aging population means we're going to have to come up with more money for Medicare and Social Security, we need a massive investment in renewable energy and environmentally sustainable transportation, and we need to invest even more money in minor projects like moving entire cities away from the rising ocean. So a portion of that debt turned out to have bogus collateral and various institutions that perpetrated the fraud in order to enrich their executives are now going bust as the Ponzi scheme collapses.

So what are we going to do to get through this? Borrow a couple of trillion more dollars and kick the whole mess down the road. CNBC adds it up for us, and the $700 billion Secretary Paulson is demanding to bail out his banker buddies is only the beginning. In fact the total bailout, including what's already been committed and what is being proposed, amounts to $1.8 trillion -- that is 1,800 billion dollars. All of which, 100%, we are going to borrow. From foreigners. That's the plan to "rescue" our economy. (Read it.)

I really don't think so.

Friday, September 19, 2008

Bury it at the crossroads with a stake through its heart

One might think, now that Great Helmsman George W. Bush has nationalized the insurance and mortgage industries, that we will not be hearing so much talk of the Glorious and Omnipotent Free Market in the next few months, at least. I am betting that one would be wrong.

Free Market fundamentalism is a lot like Christian fundamentalism. There are a lot of people out there who actually believe in it -- in the case of Free Market fundamentalism they are mostly hard working drones and mid-level managers in the finance and high tech industries who believed the indoctrination they got in Economics 101 and who enjoy being materially somewhat better off than most of their high school classmates. (For many of them, of course, that's about to change, and we'll see what happens to their faith.)

But in both cases, there are also the political leaders who spout the faith to win their votes. They are generally not so naive as to actually believe in the dogma, nor do they actually implement it as policy. They use it to justify particular policies, but only as it suits them. The reason market fundamentalism, in political terms, has been manifested largely as tax cuts for the wealthy and deregulation of securities markets, but has not led to, say, the elimination of subsidies for agribusiness or the tax breaks for big pickup trucks and SUVs is because wealthy and powerful interests wanted the former and didn't want the latter. It's no-cost for politicians to at least pay lip service to protecting the blastocyst and damning the sodomite, but when it comes to feeding the hungry and clothing the naked and consoling the prisoner, you can forget about it.

Recent events have made it absolutely, incontrovertibly, inescapably, ineluctably clear that there is no such thing as a free market, the very idea is nothing more than fantasy. Even less does anything resembling such a fantasy accomplish "efficiency," or appropriately "allocate resources," or "unleash the creative potential of the economy," or any of the other wonderful stuff it's supposed to accomplish. The function of Free Market ideology is to steal from the poor and give to the rich. That is its only function. It is a crock of shit. Just like creationism. No difference in truth value or social value. Lies intended only to exploit the weak and credulous.

I'm in CT for a couple of days, expect me when you see me.

Thursday, September 18, 2008

Ask Mr. Answer Person

Q: WTF is going on?

A: With all the talk of Collateralized Debt Obligations and Credit Default Swaps and LIBOR + and Shamalamadingdong the average American can be forgiven for thinking that all of this is some weird inexplicable shit that's happening in another dimension and somehow sending an energy beam through the hole into another world to make their retirement savings evaporate. But actually, it's not that hard to explain, not that anybody will, which is why you came here.

For the past 8 years, Americans -- both the people and the government -- have been living beyond their means. Actually we've been doing it for much longer than that, but it's gotten a lot worse recently. The government has been borrowing money from the Chinese and the Saudis to pay for the occupation of Iraq and Afghanistan, on top of $450 billion a year for the so-called "regular" military budget to garrison Germany, Japan and remote islands in the Indian Ocean and the Pacific, for some reason; buy anti-missile-missiles, anti-anti-missile-missile-missiles, gold plated toilet seats, and military bands. Then mortgage brokers started giving loans to people for more than their houses were worth, whether or not they could reasonably be expected to pay the money back, which the people used to buy all kinds of junk from China and oil from Saudi Arabia. The money to give people these loans ultimately came from, yup, China and Saudi Arabia. It had to, because Americans were spending more than they were saving.

The executives of big financial institutions booked these loans as assets, pretending that they would be paid back, and used the resulting accounting profits to pay themselves 8 and 9 figure salaries (which they get to keep, by the way). But like all Ponzi schemes, it eventually had to collapse, and now it has. All those trillions of dollars in phony wealth are evaporating, and now Americans are going to have to buy stuff with money they actually have, instead of money they borrowed from China. That means they will have to buy a lot less stuff, which means that restaurants and stores are going to close, airplanes will sit idle, hotel rooms will be empty, factories will shutter their doors, and lots of people will be out of work completely. Which of course means that even more restaurants and stores will close and so on until . . . who knows when?

And meanwhile, we still have to pay all that money back to the Chinese and the Saudis. The alternative, which is also pretty ugly but which has actually started to happen, is that the U.S. government just prints up a whole lot of $100 bills. That will mean your paycheck, if you're lucky enough to have one, will be worth even less, and your savings, what's left of them, will just keep evaporating. Good luck with the bean patch and the home canning.

Q: Will President Obama bring about change?

A: Things are going to change, alright.

Tuesday, September 16, 2008

Democratization of Science Part II:

Community Based Participatory Research

And now we come to the actual conduct of research. Community Based Participatory Research (CBPR) is a concept – a movement really – that is grounded mostly in environmental and other public health research that focuses on specific geographic areas or clearly definable groups of people. The Large Hadron Collider or Mars lander missions probably cannot be conducted according to CBPR principles, although they could devote even more resources than they do to public programming and dialogue. The job description of principal investigators for such Big Science projects should be 50% public engagement, in my view.

But the potential role for broad public involvement, not only setting overall priorities, and being informed about results, but in directly shaping specific aims of individual research projects, study design, and the analysis of results is much stronger when the research is actually about them. First and foremost, people are likely to be more motivated to participate. Second, what questions matter the most depends a lot on what matters to them, as does the most meaningful and useful interpretation of results. Third, the use to which new knowledge is put, the possible impacts on public policy or practices, depends on what happens after the findings are published, and that hinges on politics.

So it sounds like a good idea for academic investigators to partner with community groups and interested citizens under many circumstances. But there are many problems and pitfalls in doing so, and I think that universities and scholars, if we’re serious about democracy, have to be committed to understanding what they are, continually vigilant, and working actively to overcome them.

University mucketymucks value CBPR only to the extent that they are getting a payoff for their investment. Mostly that means bringing in research grants, although I suppose they give a bit of extra credit for more amorphous stuff like favorable publicity. They no doubt have some vague idea that CBPR wins good will from the indigenous people, to whatever extent they value that, but they aren’t particularly hot to provide resources in support of that objective.

The agencies that provide funding for research give money to academic investigators, not to community groups. Universities apply for the funding, universities receive the funding awards, and universities dole out whatever (almost always comparatively small amounts) go to their community “partners.” In this situation, of course, they aren’t really partners, they’re sidekicks.

Even when they explicitly claim to fund CBPR, the funding agencies judge projects by criteria that are different from the criteria by which community residents and community organizations value research. These are the same criteria by which academic investigators are judged, and reports are reviewed for publication. For some funders, some scholars, and some journals, community participation might sweeten the pot a bit, but it’s no substitute for the main stuff. Funders and the academic community with which they are completely incestuous value:

· Hypothesis driven research. Communities just want their questions answered.
· Generalizability. Communities want to understand their specific, local, unique circumstances.
· Established theoretical frameworks. Communities approach problems in the light of direct experience and felt need.
· Priority given to evidentiary rigor, requiring such tools as probability sampling and control groups. Communities are interested in fairness and inclusion, which is frequently in conflict.
· Specialized language and arcane modes of organizing discourse. Communities want accessibility and common sense reasoning.
· High value placed on credentials, titles (take it from an Assistant Professor), and institutional prestige. Nuff said.

So, if you want the money, you have to go to them with as much as you can of the first item in each bullet. The second items just get in the way.

Furthermore, obviously, the university has vastly more resources than typical CBOs. The university can invest in years-long processes of developing, revising and resubmitting proposals, but it’s very difficult for CBOs to come along for that ride while sucking fumes all the way. Community representatives can give their input to the process of developing projects, but ultimately, they have to defer to the academic investigators whose names are on the proposals as PIs and who draw more than decent salaries (by community standards) throughout the process, in part to go through the process of seeking research funding.

Once the money comes in, the PI is still the boss, and still gets much more of his or her time supported by the grant, and it’s still his or her main job, whereas it’s a secondary responsibility for the CBO staff and yup, volunteers. Meanwhile, however well the investigators understand all this, and however committed they are to greater equality and real partnership, they’re being judged by tenure and promotion committees, and academic officials, who do not share their values. No matter what, they have to publish in peer-reviewed academic journals, and bring in more research dollars. Popular publication is not only not valued, but can actually be held against them.

There aren’t necessarily any definitive solutions to all this available to us, but to me, it does point to one clear necessity. For CBPR to be fully realized, it needs resources which are not controlled by the university and not dependent on the traditional criteria for funding academic investigation. It needs resources which are truly controlled by a partnership in which community players are equal, and which can provide financial support for community involvement at every step of the way, from identifying questions, to designing studies, to developing proposals, to carrying out research, to analyzing findings, to communicating results. We know that we will have to satisfy the traditional academic criteria at every step, but we can do our best to find common ground with the community criteria along the way if and only if the communities are adequately supported to advocate for themselves.

This is not the way CBPR typically happens today. If funders are serious about it, they will have to change the way they do business.

Monday, September 15, 2008

Uh oh

My mother remembers the Great Depression, although she was just a little girl. My grandfather was a professor at New York University, and never lost his job, but my mother remembers that men used to come to the back door, and my grandmother would make sandwiches for them. At the height of the Depression, the official unemployment rate in the United States was above 30%. Stock prices fell to 20% of their peak value in 1929, banks and corporations failed and a whole lot of bonds became worthless as well. Most ordinary people's life savings were wiped out.

The catastrophe happened because working people didn't have enough income to buy the potential output of U.S. businesses, so, lacking sound investment opportunities, the upper middle class and the wealthy created an immense bubble in stocks and real estate. When the bubble collapsed, it took the economy with it.

There were important differences between the 1930s and today. For one thing, international financial relations are more or less reversed. The Depression spread to Europe because European economies were dependent on loans from the United States. When cash-stressed American banks called in those loans, it pulled the rug out from under Europe. Today, the U.S. is a debtor nation, so there is an opposite danger: if foreign investors lose faith in U.S. financial assets, we'll just go down harder. The Depression also led nations, including the U.S., to throw up barriers to trade, bringing global commerce to a near halt. That hasn't happened yet, but we'll see. Here's a little history lesson for those who are interested.

Today, we also have what are called "automatic stabilizers," created during the New Deal, in response to the Depression. These are unemployment insurance, and Social Security. Of course the Republicans want to largely do away with these. They reduce the risk of a deflationary spiral and an economic collapse, but whether they eliminate it? Well, I don't know. But I do know that John McCain believes the fundamentals of our economy are strong, by which I assume he means that a depression won't be so bad for the beer business. In fact, we may be in for some trying times indeed. I'm not sure I put a whole lot of faith in President Palin's leadership.

Friday, September 12, 2008

The Democratization of Science

And why it's really, really important.

Ask yourself why we have such widespread scientific illiteracy in what is supposed to be the best educated country on earth, and why at least half of the population rejects scientific inquiry and the scientific understanding of the world entirely. The reason is because science is entirely remote from most people. It’s just an alternative priesthood. I’ve got my religion, you’ve got yours. If I’m a Baptist, and you’re a Hindu or a Moslem, we believe different things and you’re just wrong. I don’t know anything about the Upanishads or the Koran, and I can’t read them anyway because they’re in a very strange foreign language.

Science is no different in that respect, but it’s even worse. I’m allowed to convert to Islam, and they’ll gladly let me into the mosque and teach me the doctrines, but I’m not allowed to walk into the university in the morning and declare that I want to become a scientist. First they will give me all sorts of tests of my aptitude and past intellectual accomplishments, and even if I pass those, I’ll have to spend a dozen years and come up with a hundred thousand dollars before they’ll let me be one of them.

In other words, scientists are an exclusive, arrogant elite. They don’t even talk to me, they only talk to each other. A subscription to a scientific journal costs hundreds of dollars a year, and the university won’t even let me into the library. Even if I could get a hold of one of those journals, I wouldn’t be able to read it because it isn’t written in English. The questions they study don’t mean anything to me, the answers don’t make any sense, and if I try to question them, they just call me an ignorant idiot. So why should I believe them, especially if it’s more pleasant, or more profitable, or more popular with my friends and neighbors, to believe something else?

Meanwhile, as fast as scientific discovery and new technologies are changing the world, I’m not getting any better off. People are struggling as hard as ever, social inequality is growing throughout the world, and the familiar communities and environments that nurture people physically, emotionally, and spiritually are continually eroded and often just destroyed.

So this, to me, is a fairly big deal, and it encompasses a lot of issues. For example, I’m a big booster of open access publishing, but to me, that has to go further than putting the journals on the web where anybody can read them. It also means that the research reports need to be accompanied by parallel essays in accessible language, and that the journals need to publish periodic reviews that give an overview of the current state of the field so that readers have context for individual findings. I don’t necessarily think a lot of lay people would take advantage of these resources, but it would be a tremendous boost to science in the poor countries, where journals are unaffordable and educational opportunities limited. It would also help to equalize the opportunity for bright young people to educate themselves. (My grandparents gave me a subscription to Scientific American when I was ten years old. It changed my life.)

It means there needs to be a more open and democratic process for setting government funding priorities. And no, I’m not talking about Congress earmarking research funding. (God forbid.) Specific research proposals should certainly be reviewed by people with appropriate technical expertise and funding awarded on the merits by non-political judges. But there are plenty of ways to make the process more open, and with meaningful opportunities for broad participation by advocacy organizations and the general public. I won’t go into details here, but perhaps at another time.

And no we come to the actual conduct of research. Community Based Participatory Research (CBPR) is a concept – a movement really – that is grounded mostly in environmental and other public health research that focuses on specific geographic areas or clearly definable groups of people. The Large Hadron Collider or Mars lander missions probably cannot be conducted according to CBPR principles, although they could devote even more resources than they do to public programming and dialogue. The job description of principal investigators for such Big Science projects should be 50% public engagement, in my view.

But the potential role for broad public involvement, not only setting overall priorities, and being informed about results, but in directly shaping specific aims of individual research projects, study design, and the analysis of results is much stronger when the research is actually about them. First and foremost, people are likely to be more motivated to participate. Second, what questions matter the most depends a lot on what matters to them, as does the most meaningful and useful interpretation of results. Third, the use to which new knowledge is put, the possible impacts on public policy or practices, depends on what happens after the findings are published, and that hinges on politics.

So it sounds like a good idea for academic investigators to partner with community groups and interested citizens under many circumstances. But there are many problems and pitfalls in doing so, which I will discuss anon.

Thursday, September 11, 2008

Talking Points

I don't really know what I can add to the most excellent rants which have been appearing in the past few days, whether from former GW Bush and Iraq war booster Andrew Sullivan, or former conduit for Rovian narratives Joe Klein, or long-time critic of stupidity and lies Paul Slansky. But I will try to put my own gloss on what we are all seeing.

It's certainly nothing new for politicians to lie. But even after the horrors of Republican campaigning and governing since Richard Nixon, culminating in Saddam Hussein being responsible for the attack five years ago followed by bogus "terror alerts" every time the Cheney administration faced bad news, John McCain has established a new standard.

McCain's campaign is nothing but a tissue of lies. He doesn't just use lies, he doesn't just lie when he needs to, he does nothing else. The entire campaign narrative is fabrication. Let's begin with the Sarah Palin character -- a tough minded, fiscally responsible reformer who eliminated wasteful government spending and rejected pork even when Congress offered it. This is the precise opposite of the truth, of course. Josh Marshall takes the lipstick off that particular pig with this amusing video. Yet, even though innumerable very mainstream, corporate media outlets from ABC News to the New York Times have completely debunked it, Palin continues to say, every day, that she told Congress "No thanks" to the Bridge to Nowhere, and gets enthusiastic applause. The truth is the exact opposite. The precise, perfect, 180 degree, platonic ideal of opposite. She campaigned for governor on a platform of taking the money and building the bridge, and was still for it one year after Congress has eliminated the earmark, but ultimately kept the money and used it for other largely senseless purposes.

But it doesn't matter. McCain says that Obama will impose "painful tax increases" on people making $45,000 a year, even though Obama has specifically promised to cut their taxes. McCain says that Obama wants to teach comprehensive sex education to 5 year olds, when in fact he voted to teach them how to protect themselves from pedophiles. McCain says that Obama called Sarah Palin a pig. He didn't, of course, even though Sarah Palin is in fact a pig. The corporate media dutifully note, once, that none of this is true, but McCain keeps saying it.

And it works. The people who see the ads or hear the candidates or surrogates utter these lies may hear a news story set up as "McCain says X, Obama says it isn't true," and if they're inclined to like McCain in the first place, that means Obama is a liar, right? But they probably won't even hear that. There is no penalty for being a habitual, remorseless, relentless liar, on national television, while running for president. There's a reward. It works. You win.

Tuesday, September 09, 2008

Up to my ass in alligators

I'm under fierce deadline pressure right now, so I'm afraid I may be dark for a bit.

Meanwhile, just a thought for the day. By now, everybody who is not a blithering idiot (and half the people who are) has already decided how to vote in November. Therefore, the campaign will be fought over the votes of blithering idiots. And obviously, Senator Obama has a disadvantage with that particular -- and depressingly large -- segment of the electorate.

That's why the campaign is what it is. They aren't talking to you.

Monday, September 08, 2008

Dr. Science, contnued: Proteins

We all know that we need protein in our diets, but what is that stuff, anyway? Proteins are very large molecules consisting of long chains of smaller molecules called amino acids. There can be anywhere from a few hundred to a couple of thousand amino acids in a protein.

There are 20 different kinds of amino acids in proteins. Depending on the sequence of amino acids, the proteins fold up into specific complicated shapes in the cytoplasm (that fluid inside the cell, which is basically salt water, by the way). Each protein has a different function in the cell or in the body.

Some proteins, for example, carry signals between cells or broadcast signals widely throughout the body (such as the hormone insulin, which stimulates cells to take up sugar from the bloodstream).

Other proteins serve as structural elements of the cell or the body -- such as keratin, which is the main ingredient in your hair.

Other proteins, as I noted last time, control what gets in and out of the cell. And, to be more precise, some proteins in the cell membrane transmit signals from other proteins into the cell, without necessarily letting those signaling proteins in.

Some proteins do the contracting that makes our muscles work.

But most proteins are what are called enzymes. They control the chemical processes in the cell -- or occasionally outside of it, such as enzymes in our stomachs that digest particular kinds of molecules in our food. By convention, the names of enzymes end in -ase. If you are living with HIV, or know people who are, you are probably familiar with the names of some enzymes including protease, and reverse transcriptase.

The next subject is the most interesting thing about biology, as far as I'm concerned, and the key to understanding what a retrovirus is. That's the relationship between proteins, and the molecules that embody the genetic code, which are called DNA and RNA.

Saturday, September 06, 2008

Viruses for Dummies

There are plenty of excellent on-line biology courses, and I'm not trying to compete with them. If you really want to spend the time and effort to get into it, this is not a bad place to start learning about human cells. I'm not even a real doctor -- I'm a doctor of philosophy -- and I'm not even a real scientist -- I'm a social scientist -- so it would be ridiculous for me to try to reinvent the excellent work of biologists who totally know their stuff. But what I want to do here is something different. This is a practical experiment in health communication.

I'm imagining that I'm talking to somebody who has been diagnosed with HIV infection, who maybe didn't pay a whole lot of attention in high school biology class. The person might have gone on to college and majored in art history, or might never have graduated from high school. Either way, I don't want to confuse you, and I don't want to bore you, but I want to tell you what you need to know to understand what's going on with your health and your treatment. Maybe that's you, with or without the HIV, in which case you can critique my success in communicating; or maybe you know a lot about biology, in which case you can critique me for accuracy and completeness. I can take it.

This will take a few posts, so let's get started.

I've said before that while the question "what is life" may be philosophically profound in some ways, if we're talking about life on earth, there's a simple answer. Life is cells. There isn't anything we call life that doesn't consist of cells. There are these things called viruses which are not cells, but they are not alive. They are just little pieces of some of the kinds of chemicals that make up cells, floating around loose. They can't eat, can't grow, and can't even reproduce by themselves. So that's number one: don't take it personally. They aren't out to get you. In fact, they aren't out to do anything. They're just really tiny little pieces of dead stuff that happen to mess up your body.

It's important to say that because lots of doctors and nurses and people who produce what they consider to be "educational" materials about HIV talk about the virus as though it's intelligent -- it can "outsmart" the drugs; it's malevolent -- the virus is like enemy soldiers and we need to keep our own soldiers in the field; and it's even drawn as an ugly monster with teeth and claws. It's nothing like that, all that is a load of crap and it isn't helping anybody understand anything.

So before we can understand what a virus really is we have to understand cells. We seem to be pretty solid -- we have lumps of stuff inside, such as muscles and our brain and our liver and so on, with blood flowing through tubes and what not and a solid fabric of skin stretched over the whole thing. But if we could shrink down to incredibly small size it would look completely different. It's all made out of cells, which are in the range of 30 millionths of a meter across, much too small to see although it's easy to see them with a microscope, and we have, get this, about 50 trillion of them, i.e. 50 times a million times a million. That's a lot.

You usually see complicated pictures of them, but I'm going to start off really simply. The cell is actually three dimensional, of course. They can be just about any shape but we'll imagine that this one is more or less spherical, and I've cut it in half so we're looking at a cross section. It's a membrane filled with a fluid. The fluid is called the cytoplasm, in case you want to build up your vocabulary, but that's not important, it could be called anything. For now, I'm not showing anything of what's inside, I'm just showing the outside.

You'll notice in my highly artistic drawing that there are a bunch of things sticking through the membrane. These are molecules called proteins. There are all kinds of different proteins and they perform many different functions in cells. These proteins let specific kinds of things in and out of the cell, or actively move them in and out. Some small molecules, such as gases, can move through the membrane on their own, but for the most part these proteins control what goes in and out.

Next time: More about proteins.

Friday, September 05, 2008

Biological literacy

I made a presentation yesterday consisting of a summary of the scientific news out of the International AIDS Society Conference. (Here's a sample of my live-blogging from the conference -- check posts before and after this one if you missed them and you're really interested.) I realized that before I could get into the (bad) news on attempts to develop an effective vaccine, and find a cure, I had to make sure everybody understood just what exactly a retrovirus is in the first place.

I think I did a pretty good job of compressing a semester of college biology into six minutes, but still, it seemed necessary to go back to the very basics of how cells are designed and the underlying DNA-RNA-protein system; and the principal mechanisms of the immune system. Oh yeah, evolution happens to be essential to this story also.

It troubles me greatly that many people with HIV, and other serious disorders, don't really understand what is happening to them. Unfortunately, the explanations they get from professionals and even people who consider themselves advocates often consist of misleading metaphors or awkward and inaccurate attempts to hook onto familiar concepts. The resulting inaccuracies in understanding really matter. For example, many people with HIV interpret drug resistance as their body, rather than the virus, becoming immune to the drugs. (I know this because I have interviewed dozens of people living with HIV about their medical treatment.) This matters a great deal for both their own future health and public health more broadly, because it means they do not understand a principle reason why it is important to avoid reinfection, and re-transmission of the virus to already infected people.

I believe that it is possible to explain the fundamentals of biology to people who have limited formal education, or whose education has failed them -- most often because of political interference from people of "faith," which is a fancy word for willful ignorance. I did a primer on statistics here a while back which was surprisingly well received. Would people put up with a primer on cell biology? Even if you already know it, I'd like to see whether I can create an accessible, systematic exposition and this seems like a good place to try it out.

Thursday, September 04, 2008

One way to save on health care costs

In Massachusetts, we once had a strong tobacco control program, funded at a level of about $50 million per year using taxes on tobacco products. However, former Governor Mitt Romney, in the interest of fiscal responsibility, eliminated the program.

Now Lightwood, Dinno and Glantz, in PLoS Medicine, find that the California tobacco control program reduced health care expenditures by 7.3% by 2004, saving about $86 billion over four years, compared with its total cost of $1.8 billion -- about a 50-fold return on investment.

There are substantial uncertainties in these estimates, of course, but still -- it's just one more example, particularly obvious and straightforward, I suppose, of how public investment in public health can have huge payoffs, which private economic activity cannot produce. Indeed, in this case, the public health enterprise is to combat the (fictitious) "free market," in which investors spend billions to market tobacco products, thereby sickening and killing people and costing both public and private payers hundreds of billions of dollars every year.

Think about this as you contemplate (if you can stomach it) Mr. Romney's speech last night.

Wednesday, September 03, 2008

Oh yeah, public policy

Marcia Angell has a most excellent rant in the new JAMA, but to their shame, the editors won't let you read it. As you know, the New England Journal of Medicine has adopted a policy of making policy research and commentary of importance to the general public open access, but JAMA has not followed suit. This is greatly to their discredit and shame. At least I can summarize some of the high points for you.

No doubt you have heard about the reports and commentary in NEJM regarding ezetimibe, which they have made available to you here, even though you are just common trash. This is a drug which was heavily advertised on television (although the manufacturers have recently backed off the advertising due to growing controversy) and very widely prescribed, bringing in $5.2 billion to its manufacturers last year, although it has never been shown to be of any benefit whatsoever, to anybody. It was approved on the basis of a surrogate end point - reduction in serum cholesterol - after a very short follow-up period, but subsequent trials have so far failed to show any health benefit. (In case you might be taking it, the brand name is Zetia, and it is most commonly sold in a combination pill called Vytorin. Schering-Plough makes ezetimibe, and jointly markets Vytorin with Merck.)

Now there is an unexpected observation that it may be associated with an increased risk of cancer. As Jeffrey Drazen explains in the editorial, other ongoing trials have not found an association with cancer, but the follow-up period in those trials is still short, so we need to keep watching. Meanwhile, it will be years before we know whether this drug actually does anybody any good -- a question which Merck and Schering-Plough didn't even set out to answer until three years after the drug was approved. It's much more expensive than generic statins, it might be dangerous, nobody knows if it actually does any good -- so why do doctors continue to prescibe it?

Marcia Angell has the answer. The drug companies control clinical trials from beginning to end, including setting up the questions in a way that tends to make their products look good -- e.g. testing them against placebo instead of the established treatments they will compete with, using too little of the competing drug so it seems ineffective, or using too much so their product seems to have fewer side effects, or, as in the case of ezetimibe, looking only at surrogate end points with very short follow-up periods; suppressing unfavorable results by not publishing them at all, or writing articles in a way that puts a positive spin on them; exaggerating favorable results in publications; building financial relationships with researchers so they stand to get rich if the results are favorable, and will promote the use of the drugs in lectures and presentations; and influencing practice guidelines. She concludes:

[I}t would be naive to conclude that bias is only a matter of a few isolated instances. It permeates the entire system. Physicians can no longer rely on the medical literature for valid and reliable information. . . .Clinicians just do no know any more how safe and effective prescription drugs really are, but these products are probably nowhere near as good as the published literature indicates.

Physicians who would be quite skeptical about drug company advertisements and the pitch of sales representatives ten do trust the peer-reviewed medical literature. One result of the bias in this literature is that physicians learn to practice a very drug-intensive style of medicine. Even when lifestyle changes would be more effective, physicians and their patients often believe that for every ailment and discontent there is a drug. Physicians are also led to believe that the news, most expensive, brand-name drugs are superior to older drugs or generics, even though there is seldom any evidence to that effect . . .

Now, our libertarian friends are going to have to admit two things:

1) The "free market" is not giving us safe and effective treatments, or evidence-based medicine;
2) Making patients pay more for their medical care is not going to do anything at all to solve this problem.

This requires major structural reform which confronts the reality that it is market fundamentalist ideology and the subversion of democracy by corporate power which has brought us to this point. So far I haven't heard Obama really take this on, but at least he wants to take small steps in the right direction instead of heading off 180 degrees in the wrong direction as John McCain wants to do. I'll have more to say on the kind of reforms we really need in a bit, but the core remains the same:

We need universal, comprehensive, single payer national health care.

Tuesday, September 02, 2008

I'm not going to write about Sarah Palin . . .

I'm not going to write about Sarah Palin, I'm not going to write about Sarah Palin, I'm not going to . . .

Oh shit. Look, here's the bottom line, as we used to say all the time in my ACORN organizing days. Only in America can one of two major political parties energize its base by nominating to high political office a refugee from the 13th Century. Somebody who believes that students should be taught in science class that the earth is 6,000 years old, that human activity is not making the planet warmer, and that the best way to prevent teenagers from getting pregnant is to teach them not to have sex and not to mention contraception is qualified for one and only one electoral office, and that is secretary of the Patient Advisory Committee at the mental hospital. In every other country on earth with near universal literacy, that's how it is.

We have a very serious, urgent problem in this country, which is that a dangerous, extremist, delusional cult is not just plotting to seize power, but is actually the single most powerful movement in the country and now controls the minds of substantial segment -- perhaps more than 40% -- of the population. They don't just believe in this insanity -- they want to make it the governing ideology of the country and impose it on everybody else, because Jesus is coming back soon and the world is going to end and for some reason that doesn't actually make any sense, that means its the right thing to do. This is not even a little bit funny.

Monday, September 01, 2008

Labor Day photo blogging

So, people want to see pictures of my property in Connecticut. Here's one view of the house, with my tractor for local color. There will be a deck -- soon I hope -- in the space in front of the door. (Click the thumbs for full-size images.)

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I wish this was my farm but it belongs to my friend Festus, who I've written about many times. Just to give you some of the local color. (That's not his house, it's an outbuilding. He did build his own house in a rustic style, but it's actually pretty nice.)

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And finally -- one time only -- here's YT. I very seldom wear a necktie, but I figured for my introduction to the readership something a bit formal was appropriate.

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With that, I'll leave you with my public health thought for the day, which is that no matter how hard you pray, no matter what you tell your children not to do, and no matter how disgusted you are personally by human nature, we are what we are, and we do what we do, and you just need to get over it.