Map of life expectancy at birth from Global Education Project.

Wednesday, December 31, 2008

Cross the gypsy's palm with silver . . .

Last year, I predicted we would have a nasty recession. Check. I also predicted that oil prices would stay high regardless. Not so much, although I'm still expecting a rebound. We won't discuss my Superbowl pick.

2009 is a tough year for the prognosticators. The psychics can throw just about anything at the wall and hope something sticks. Yellowstone supervolcano, anyone? Actually I'm not worried about the greatest catastrophe since the emergence of Homo sapiens, destroying Civilizationasweknowit -- not going to happen. However, it's a good bet that there will be a substantial natural disaster somehow somewhere in the US of A. Here's hoping that it doesn't happen before Mr. Obama gets his own team in place at FEMA and he gets unfairly blamed for any screwups. So that brings us to my first real prediction, that whoever he appoints won't have prior experience consisting of investigating alleged liposuctioning of horses' asses.

I'm sure the prognostication everybody really wants from me concerns health insurance reform. Unfortunately, as I have noted many times, the political system is stacked against the changes we really need. The problem, as the Political Scientists say, is one of concentrated vs. diffuse interests. (Political science is not a science. When I pointed this out as a college freshman, my professor, Nannerl Keohane, who had recently married fellow Swarthmore professor Robert Keohane following some sort of rumored love quadrangle [possibly bogus] and then went on to become president of Wellesley College and Duke University [meanwhile my art history professor was changing genders from male to female, but her {formerly his} wife stayed with her so evidently they both became lesbians. It was a regular Peyton Place.] wrote up on the board the word scientia, and asked me if I knew what it meant. I replied, "It appears to be in some foreign language." God, I was insufferable. Actually it's Latin for "knowledge," i.e. science didn't used to mean science as we know it today but just generally knowing stuff, or thinking you know stuff, and that's poli sci.

But I digress. The point is that while the vast majority of Americans would benefit from universal, comprehensive, single payer national health care, for a lot of them it would be, or seems to them to be, only a minor advantage over their current situation, and they have other concerns that seem equally or more pressing. The people who would benefit the most, in fact, have the least political resources and influence. So there just aren't structures that translate this diffuse interest into real clout within the lawmaking institutions.

But for a small segment of the population, which happens to have immense political resources, it's a major threat. For insurance companies, it's life and death; for drug and medical device companies, it's a tragic attenuation of the river of gravy in which they are accustomed to wallow. Both of these industries have very powerful lobbies and own numerous Senators and Representatives. (The medical profession, as embodied in the AMA, for many decades bitterly opposed it as well. Although docs have largely come around, there is still enough ambivalence and dissent within the groves of Aesculapius that the AMA is not likely to be a strong player in this game.) The Free Market™ theology that permeates the political culture is a powerful weapon in the hands of the opposition, since newspaper and TV reporters are too ignorant to know that it's a crock, and it has also been adopted by the right-wing theocrats such as Rick Warren who stuff it into their sheepish followers along with the rest of the horseshit they peddle. All of these powerful actors, including the 43 Republican Senators to whom the pathetic, wimpish Senate Democrats will hand over total control, will fight like pit bulls to stop reform.

Obama's actual proposal, as we know, is modest and incremental. It's fairly similar to the current experiment in Massachusetts and the Swiss system which our friend Ana has described for us, neither of which is entirely successful, to say the least. In fact we're headed for a major crackup here in Massachusetts, where we are about to discover that we just can't pay for it after all. I fear that will become evident before anything moves very far through the Congress, which won't help matters. The lesson ought to be that we need a truly radical reform which can effectively contain costs, but I fear the opposite conclusion will be drawn.

So here's my prediction. What we'll end up with is little more than an opportunity for people to buy into a federally sponsored plan, but with insurance companies sitting in the middle taking a cut for no reason other than they lobbied for it, on a sliding scale which won't really make it affordable for low and moderate income people. Employers could also choose the same plan for their workers. It won't be truly comprehensive and it will have significant co-pays and limitations, e.g. no dental. It will be partially community-rated but will include some age rating, meaning that people in their late 40s through early 60s will be even more likely to be priced out. But it will expand access a little. There will be some other bells and whistles, such as a U.S. equivalent of NICE but with no real powers, just jawboning; maybe some half-decent FDA reform that may last for a little while; and some bargaining between the national plan and the drug companies that will save a few cents on some drugs, mostly just for show.

Then the challenge in coming years will be over the viability of the national plan, whether it can be structured and funded so as to become truly affordable, and outcompete the private plans so as to move toward universality. If the drug and insurance companies perceive it as the camel's nose under the tent, they may stop even that, but perhaps they won't be able to. We shall see.

Tuesday, December 30, 2008

Now This is Just Sick

Bristol Palin could earn $300,000 for baby pics. And here's why I really hate America:

The price didn't soar immediately, according to the sources, because Sarah Palin stories just didn’t sell all that well for the weeklies on newsstands. . . .The drug-related arrest of Johnston's mother, however, caused the price tag for the photos to go up.

Now those are some family values we can believe in! Thank God we live in a Christian nation.

The End Times?

Jonathan Schwartz catches The Mustache of Self-Regard speaking a tiny sliver of truth:

This is from a new interview with Thomas Friedman in Scientific American:

Q: Is it a good idea to meddle so extensively with the free market for energy?

FRIEDMAN: [Laughing] Oh, yeah, a totally free market dominated globally by the world’s biggest cartel, dominated domestically by fossil-fuel companies who have written all the rules in Congress—pages’ worth of depletion allowances and tax shenanigans that these guys have written in to give themselves advantages. We wouldn’t want to upset that free market, would we? There is no such thing as a free market, no more than there is a farm or a garden that grows without fertilizer, without proper plowing, without intelligence brought into it. Markets are shaped by rules, incentives and disincentives, and right now our market is shaped by the dirty fuel system.

Schwartz goes on to display just a few highlights from Tom Friedman's lifelong career spent worshiping and exalting the deity he now admits does not exist. As you may recall, Alan Greenspan also confessed to apostasy before a congressional committee. However, these counter-epiphanies are far from typical. The Free Market™ acolytes who still completely control the intellectual establishment have demonstrated a truly impressive capacity for double-think. Even as they scream and yell for massive government intervention to save their investment portfolios, they still maintain that all this trouble is just a temporary difficulty caused by fair housing laws, capital gains taxes and a few bad apples.

Just you wait -- the instant it suits the interests of wealthy and powerful people to claim that one or another proposed action by the Obama administration violates the sanctity of the Free Market™, it will be back on the altar and the votive candles will glow on every op-ed page and every TV gabfest. You think this is a Christian country? Believe me, the Christian God is a subsidiary deity.

Monday, December 29, 2008

Auld Lang Syne

Sorry to have been away from the blog for a few days. "They" -- the enigmatic repository of all knowledge -- say you shouldn't disrupt your blogging schedule or your readers will all switch their allegiance to Instapundit, but sometimes I've just got problems of my own.

Looking back and looking ahead, as we are all supposed to do at this time of year, I find we have come to a historical moment as substantial as any that has come before. Thinking of the few Great Transformations that humans have experienced, I might list the emergence of Homo sapiens as the ape that talks and the great cultural takeoff of somewhere around 100,000 years ago; the agricultural revolution, of course, and the rise of complex societies. Literacy came along with that very quickly, but for 10,000 years or so further development was evolutionary rather than revolutionary, and even took a big step back in Europe after the fall of Rome. Then came the Enlightenment and quickly thereafter the Industrial Revolution, which destroyed the old structures in a process that culminated in World War I and the establishment of the current system of nation-states, the basic foundations of global finance, and near universality of the industrial system of production fueled by carbon sequestered in the earth in ancient times. (The Great Depression and World War II were not fundamentally transformational, rather they were a sort of adolescent crisis of the new order.)

Now, on a time scale roughly another order of magnitude faster, we confront another Great Transformation, in which we will either achieve a self-aware, responsible and effective global society, or enter a new Dark Age. We will have to overcome multiple challenges including developing a new technological basis for civilization, and perhaps most important, achieving the universality of science and reason as the basis of understanding and the ground for action. That means the grip of religion on human societies will have to end, and with it the childhood of our species. In the year ahead, I will am committed to spending more time on the latter problem.

On a personal note, this is also a time of transition for me, in various ways. I'll let y'all in on some of it, as seems appropriate, but if posting gets a little erratic, I hope you'll understand. I'll do my best to keep it up.

Wednesday, December 24, 2008

Solstice best wishes

I expect to be disconnected from Your Intertubes until Sunday or thereabouts, unless I get the odd opportunity to check in with the universal matrix. So I thought I'd leave you with some holiday cheer in the form of a favorite carol. Some people like Weeth, Reeking of Aurien Tar, but I share my favorite with Pogo Possum. Good cheer to all.

Deck us all with Boston Charlie,
Walla Walla, Wash., an' Kalamazoo!
Nora's freezin' on the trolley,
Swaller dollar cauliflower alley-garoo!

Don't we know archaic barrel,
Lullaby Lilla boy, Louisville Lou?
Trolley Molly don't love Harold,
Boola boola Pensacoola hullabaloo!

Schtickdreck of the year

I normally avoid writing about the subjects that everybody else is talking about, unless I really have something original to add. This post may not qualify, but I feel the need to say something about Bernie Madoffwiththedough just because I'm as fascinated by the whole thing as you are.

Many people are concerned that the case will encourage antisemitic stereotypes, but I'm not so worried about that. People who already believe in such stereotypes will no doubt see it through that lens, but I don't think it will create antisemitism where it doesn't already exist, for several reasons. First of all, many of the most prominent victims were Jewish charities. It doesn't make a whole lot of sense to say, "Those greedy grasping Jews, serves them right to lose all that money they were planning to give away." Furthermore, people already believe that Wall St. wheeler dealers of every ethnicity are crooks, so the only thing special about Bernie is the scale and brazenness of his deceit.

To the extent that Bernie's Ponzi game preyed on his fellow Jews -- and that was only one of the strategies he used to recruit victims -- it was entirely typical of Ponzi and pyramid schemes. (Actually the Madoff fraud was a little bit of both, of which more below.) The SEC even has a term for this -- affinity fraud:

Affinity fraud refers to investment scams that prey upon members of identifiable groups, such as religious or ethnic communities, the elderly, or professional groups. The fraudsters who promote affinity scams frequently are - or pretend to be - members of the group. They often enlist respected community or religious leaders from within the group to spread the word about the scheme, by convincing those people that a fraudulent investment is legitimate and worthwhile. Many times, those leaders become unwitting victims of the fraudster's ruse. . . .

Many affinity scams involve "Ponzi" or pyramid schemes, where new investor money is used to make payments to earlier investors to give the false illusion that the investment is successful. This ploy is used to trick new investors to invest in the scheme and to lull existing investors into believing their investments are safe and secure. In reality, the fraudster almost always steals investor money for personal use. Both types of schemes depend on an unending supply of new investors - when the inevitable occurs, and the supply of investors dries up, the whole scheme collapses and investors discover that most or all of their money is gone.

So Bernie's game was just the same old tired out story, writ large. So many of the victims were supposedly sophisticated investors and business people -- it just shows that human nature is the same all over, rich or poor. It's in human nature to lie, but lying wouldn't work if it weren't in our nature to trust as well. We tend to trust people who seem familiar, who are part of our own group and who are somehow like us, so Madoff was the perfect con man to prey on wealthy Jews. Sociopaths can show up anywhere, alas, but if we went through life suspecting everybody we meet of being undetectably morally depraved we couldn't function.

The scheme, as I say, was a pyramid scheme on top of a Ponzi scheme. Madoff created a multi-level marketing structure in which lesser investment managers took people's money and passed it on to him, skimming a portion for themselves. In some cases we know that at least a third layer existed, and perhaps there were four or more somewhere. Originally, these also preyed on the original population but as Madoff grew more and more desperate for new investors the pyramid game reached out more broadly, including Europe and WASPy Greenwich.

The only interesting lesson here is that the pyramid game turns out to be, in and of itself, not only legal but perfectly standard Wall Street practice. There is a whole industry of "funds" that will take your money, take a cut, and invest it with yet another manager who will also take a cut and who may actually manage the investment for you or who may just turn around and pass it on to someone else, who will continue the scam. Even the people who do invest the money themselves are merely leeching on you; for every buyer of a stock there is a seller, for every winner there is a loser, so on balance, the industry cannot possibly be providing any benefit to its customers. It's all a scam, every bit of it. These people are purely parasites on society, whether their activities are technically crimes or not, and they get fabulously rich just by sucking blood.

The whole enterprise of financial asset management and trading is nothing but a giant tapeworm in the guts of society. Everyone involved in it, all of them, to a woman and man, are thieves.

Tuesday, December 23, 2008


The two-faced God is supposed to inspire us to look both back and forward at this time of year, so let's start with the backward look. This has been, shall we say, an interesting year. They say that alcoholics have to hit rock bottom before they come out of their state of denial, and that's pretty much what we did as a country. We started to face up to the cold facts about ourselves just in time, and it's a damn good thing because there was nobody out there to do an intervention on us, no matter what we had done to others.

That doesn't mean we're all the way into the action phase.* The party of denial got almost half the vote. It turns out that the basic division in U.S. society is not between differing political philosophies, interest groups, or value orientations. It's between people who believe in reality, and people who belief stuff that is not what we deep philosophers refer to as "true," i.e., actually factual or, in lay terms, corresponding to what is rather than what is not.

To be a Republican nowadays, you have to believe that the earth is 6,000 years old (allowance is made for those who push it back to 10,000), that all the flora and fauna were created in a day, and then we were made in the "image" of God, who therefore must be a guy with two arms, two legs, one nose and one wiener (presumably a big one) living somewhere up in the sky.

You also have to believe that spewing CO2 into the atmosphere does not affect the climate; that consuming arsenic in drinking water and mercury in the diet is harmless; and that when scientists say that a species is in danger of extinction, they're just making it up.

You have to believe that Saddam Hussein was the perpetrator of the Sept. 11 attack, and that he possessed Weapons of Mass Destruction™ which he either planned to use against the United States directly, by spraying anthrax over east coast cities from his fleet of unmanned aerial vehicles; or by giving nuclear weapons to Osama bin Laden. At least 30% of the country does believe this, specifically the Fox News audience and Christopher Hitchens.

You have to believe that it's in the best interest of semi-skilled workers making $40,000 a year to make sure that people making a million dollars a year pay the lowest possible taxes. Of course it's in their interest -- its Economics 101!™ And Economics 101!™ also says that the magical Free Market™ will guarantee the greatest prosperity for all if the government just makes sure not to do anything to interfere with the decisions of the mighty captains of finance and industry. Economics 101!™ is just like the Bible, which is the source of scientific understanding of nature. The Gospel According to Friedman teaches us everything we need to know about social policy. It's in the Good Book. Just believe.

Curiously, politics in Europe, Canada and elsewhere around the world are not organized along these lines. Sometimes ethnic groups, or economic or other interests vie for power, more or less overtly; sometimes factions organize on nakedly behalf of their own power, and political institutions allow them to prevail; in the liberal republics, arguments occur over values and social theories, but people generally stipulate to roughly similar sets of facts. In the United States, however, our parties inhabit different worlds.

I could go on. In one world, having everybody carry concealed, loaded pistols everywhere they go -- in schools, in church, in shopping malls, in parks, and of course at home -- makes us all safer. In the other world, guns are considered dangerous. In one world, rich people will stop investing and managing businesses if they have to pay 30% of their income in taxes instead of 25%; while poor people only work hard when they are paid very little. In the other world, most of what rich people do is useless and they get paid millions whether they succeed or fail anyway, and they certainly aren't going to stop accepting those millions if a little bit of it gets skimmed off to pay for the airports they fly in and out of and the roads their chauffeurs drive them on.

But you get the idea. Maybe the two faces of Janus have a second connotation as well.

*For those of you who aren't in the addiction biz, there's a standard model of behavior change, called the Transtheoretical Model for reasons I won't go into here, that says people may be in the pre-contemplation phase, when they aren't even thinking about kicking the junk; contemplation, where they're at least thinking about it; action, where they're really, truly trying but may relapse from time to time; and maintenance, where they're "in recovery" and living sober.

Sunday, December 21, 2008

We're all nuts!

Watching Governor Badrugovich proclaiming his purity and virtue, and vowing to fight for the right of the good people of Illinois to be governed by His Bewigged Holiness, I found myself thinking, as have many others, "Is this guy nuts or what?" But that doesn't mean that the I believe the proper disposition for him is a course of Risperdal. My diagnosis is arrogance, greed, and vanity, but none of those are to be found in the Diagnostic and Statistical Manual of mental disorders.

Actually, reading the DSM is enough to give me Intermittent Explosive Disorder. The DSM first came out in 1952, and it listed 106 forms of wackoness. the DSM-II, published in 1968, identified 182 specific categories of nutzo. By 1980, with version III, we had 265 ways not to be playing with a full deck, enhanced to 292 in a 1987 revision, and the current version, DSM-IV, gives us 297 specific kinds of screwiness. Now they're working on the DSM-V -- in intense secrecy, nobody's allowed to know what they're cooking up -- but there are folks out there pushing candidate methods of failing to get your elevator to the top floor, including compulsive shopping and binge eating.

What these diseases have in common is that, once the shrink gives you the official news that you have one of them, your insurance company will pay for pills to fix you. Astonishingly, one pill can straighten out the vast majority of your mental diseases and defects. It turns out that a deficiency of the chemical serotonin sloshing around in your brain causes sadness, restlessness, lassitude, excessive sleepiness, insomnia, shyness, fear of loneliness, sloppiness, excessive tidiness, grouchiness, indifference, compulsions, revulsions, aggression, passivity, recklessness, timidity, and hair pulling.

If a serotonin booster doesn't fix you after all, you can try a tranquilizer, a sedative, a stimulant, an antipsychotic, or an anticonvulsive. After a little trial and error, with the right combination of chemicals, your compulsive shopper will be darning socks and drying out paper towels for re-use; your uncle Louis will no longer curse and throw his dentures at the TV every time Daisuke issues ball four, but will sit in Zen-like impassivity as the bases fill in the fourth inning; and your wallflower daughter who can't get a date will be screwing the entire hockey team. The DSM-V will offer all of these wonderful scientific breakthroughs. Look for them at your neighborhood drug store.

Saturday, December 20, 2008

Bonus Post

I'm normally disconnected from Your Intertubes on Saturdays, doing my big construction project in deepest Connecticut, but I'm snowed in (or out) today, so here's an extra two cents.

In answer to Kathy's question regarding my previous post, I was mostly thinking about economic nationalism -- the sort of Lou Dobbs populism that infects some quarters of liberalism and promotes policies that aim to protect American workers and farmers at the expense of much poorer people elsewhere. I believe that our working class and our rural communities can prosper without harming people in Africa, Asia, and Latin America, but we need to be fully committed to both ends of that equation.

However, I am also thinking about the cultural divisions within the United States. I see this most directly when city slickers move out to the country and start complaining about deer hunters and the stink of manure and the noise of chain saws and stump grinders, and guys who run small engine repair businesses from their homes and have a lot of junky looking machinery in their yards. Hey, they were there first, and they are trying to create a sustainable rural economy.

But I extend the zone of respect more broadly, even to issues where I am convinced some particular liberty claim ultimately fails. Examples include motorcycle helmet laws, a considerable scope of regulation of firearms, and even the claims about the moral status of embryos and people in irreversible comas.

I may find that guys who want to take their own chances when it comes to smashing their brains on the pavement are not entitled to take a big risk that can be substantially reduced for a trivial amount of money, and make the rest of us pay to scrape them off the pavement, and then for their their trauma care, long-term rehabilitation and the support of their dependent children. Society has a right to insist on a certain degree of individual responsibility, on behalf of the liberty interest of all of us.

Nevertheless, when there is a substantial segment of the population that feels seriously oppressed and offended by an imposition, we do have to weigh their feeling fully in the balance, and seriously look for solutions that honor their claim. For example -- and this might be unenforceable, it's just a thought experiment -- people who want to ride motorcycles without helmets could be allowed to do so if they purchase insurance policies that indemnify all the possible social costs of their actions, including not only their own medical and long-term custodial care but support of their dependents. That would probably not be affordable, but it would at least take the mystery out of the underlying case and be difficult to argue against.

As for the "Right to Life" jive, I have been at great lengths here to deride it as nonsensical and morally idiotic. In fact, it's not about life at all, in my view, it's about sex, for which the right to lifers have both a neurotic aversion and a deeply unhealthy obsession. Nevertheless, it probably doesn't help to negotiate with them on that basis. Given the intensity of their feelings, there is a case to be made for offering them as much respect as does not greatly compromise the liberty interest of others. I don't hold out much prospect for common ground, but we have to work toward it somehow or we'll be bollixed up over this issue forever.

Friday, December 19, 2008

On Liberty

I happened to have a couple of interesting discussions lately about one of the central problems of political philosophy, one that is particularly salient in the field of public health, and extremely prominent in political rhetoric in the United States. Liberty is a term much abused. Often the people who yell about it most vociferously in one field of action oppose it equally in another. The problem of securing it is sufficiently vexed and fraught with paradox that Orwell's dystopian slogan Slavery is Freedom is a realistic representation of some people's beliefs.

The Republican coalition, over the past 8 years in particular, has exposed some of these contradictions so glaringly that it surprises me I have seen so little exploration of the problem in popular commentary. On the one hand they claim to be staunch defenders of freedom by going as far as they can to eliminate regulation of commercial activities and finance, environmental protection, and safety regulations. On the other hand they staunchly oppose personal freedom in choice of marriage partner, reproduction, and use of some drugs but not others. They insist that people have no right of privacy vis a vis the government. They insist that the president, on a whim, can make any human disappear forever into a secret dungeon, without any legal recourse or accountability, there to be tortured to death -- and the justification for this is the defense of our freedom.

While all of these positions are no doubt offensive to most of my readers, it is difficult to show convincingly that they are more contradictory than our own. The nub of the problem is that the liberty of one person in a given situation compromises that of another. The fundamental failure of the libertarian philosophy is its tacit, generally unrecognized assumption, that only government can deprive us of freedom. But obviously, so can non-governmental institutions, both formal and informal, and individual actors. Giving a corporation the liberty to pollute the air and water deprives me of the liberty to breathe and drink without becoming ill. Giving my neighbor the right to build without any zoning or other restrictions allows him to deprive me of sunlight, the view I once enjoyed, or other amenities that pertain to my property.

In order that we all have the liberty to walk freely in our communities, we must have criminal law and police officers, who have the power to deprive of their liberty those who grossly violate the liberty of others. We hedge this around with procedures and rituals and, perhaps most important, the right to trials by jury which place the ultimate power to deprive people of the usual share of liberty in the hands of representatives of the community. Nevertheless, in the end, my liberty depends on restraining yours, and vice versa.

Many political philosophers argue that there is an inevitable tradeoff between liberty and equality. I am not so sure. It seems to me that it is precisely through inequality that we fail to achieve the greatest possible share of liberty. It is very tempting to try to resolve the contradictions among the liberties of various people by defining some as within the circle of protection and others as outside of it. These distinctions may be made of social caste, possession of property, gender, religion, or whatever other characteristic people may seize upon. Then we can proclaim that we are defending our liberty by depriving those others, whose liberty doesn't really count.

That has been the conservative strategy. But does the same trap yawn before us? Think hard about that.

Thursday, December 18, 2008


Leviticus 13:

43 Then the priest shall look upon it: and, behold, if the rising of the sore be white reddish in his bald head, or in his bald forehead, as the leprosy appeareth in the skin of the flesh;

44 He is a leprous man, he is unclean: the priest shall pronounce him utterly unclean; his plague is in his head.

45 And the leper in whom the plague is, his clothes shall be rent, and his head bare, and he shall put a covering upon his upper lip, and shall cry, Unclean, unclean.

46 All the days wherein the plague shall be in him he shall be defiled; he is unclean: he shall dwell alone; without the camp shall his habitation be.

Pastor Warren and all of his followers who wish to live biblically should consider this passage. Social rejection of people with disease goes way back. This has something to do with fear of contagion, of course, but that is not the whole story, and the stigma often persists in spite of proof that the fear is irrational. Although HIV emerged in 1981 and the pathological agent was identified in 1983, Ronald Reagan never mentioned HIV or AIDS publicly until 1985, when he said the word AIDS once, in response to a reporter's question. Reagan again mentioned AIDS in a 1986 message to congress, but the federal government made no real effort to educate the public about how to prevent HIV infection until 1988, when the U.S. mailed a brochure called "Understanding AIDS," by Surgeon General C. Everett Koop, to every U.S. postal address. In the meantime, more than 25,000 Americans are known to have died of AIDS -- a number which would explode in coming years as people already infected became ill.

Here is Reagan's press secretary, Larry Speakes, in 1982:

Q: Larry, does the President have any reaction to the announcement ­ the Centers for Disease Control in Atlanta, that AIDS is now an epidemic and have over 600 cases?
Q: Over a third of them have died. It's known as "gay plague." (Laughter.) No, it is. I mean it's a pretty serious thing that one in every three people that get this have died. And I wondered if the President is aware of it?
MR. SPEAKES: I don't have it. Do you? (Laughter.)
Q: No, I don't.
MR. SPEAKES: You didn't answer my question.
Q: Well, I just wondered, does the President ­
MR. SPEAKES: How do you know? (Laughter.)
Q: In other words, the White House looks on this as a great joke?
MR. SPEAKES: No, I don't know anything about it, Lester.
Q: Does the President, does anyone in the White House know about this epidemic, Larry?
MR. SPEAKES: I don't think so. I don't think there's been any ­
Q: Nobody knows?
MR. SPEAKES: There has been no personal experience here, Lester.
Q: No, I mean, I thought you were keeping ­
MR. SPEAKES: I checked thoroughly with Dr. Ruge this morning and he's had no ­ (laughter) ­ no patients suffering from AIDS or whatever it is.
Q: The President doesn't have gay plague, is that what you're saying or what?
MR. SPEAKES: No, I didn't say that.
Q: Didn't say that?
MR. SPEAKES: I thought I heard you on the State Department over there. Why didn't you stay there? (Laughter.)
Q: Because I love you Larry, that's why (Laughter.)
MR. SPEAKES: Oh I see. Just don't put it in those terms, Lester. (Laughter.)
Q: Oh, I retract that.
MR. SPEAKES: I hope so.

There was never any reason to fear infected people -- HIV is transmitted only through sexual intercourse, contaminated injection equipment or blood products, and perinatally from mother to baby. Nevertheless, people living with HIV found themselves subject to shunning and discrimination. They were denied jobs or fired from jobs, denied housing, expelled from school, and even driven from communities. In 1986, three brothers in Arcadia, Florida were diagnosed with HIV infection, which they contracted from blood transfusions to treat their hemophilia. They were expelled from school. After their parents successfully sued to have them reinstated, somebody set fire to the family home, and they were forced to move from Arcadia.

The stigma associated with HIV is obviously particularly strong because the disease is associated with a despised group, homosexuals. Congress finally got around to creating a program to assist people living with HIV in response to a crusade by Ryan White, another hemophiliac who had been banned from school because of HIV infection. White, who was widely described as an "innocent" victim, died a few months before passage of the Ryan White CARE act in 1990. In that same year, the New York offices of ACT-UP (AIDS Coalition to Unleash Power), a largely gay advocacy organization, were destroyed in an arson fire.

Today, stigmatization of people with HIV and discrimination are less widespread, but far from eliminated. Many people who my agency counsels feel they are unable to disclose their HIV status to family members or employers. Some have been kicked out of their homes and shunned by relatives who did find out. While it is illegal to discriminate against people with HIV -- due to state law in many cases, and the Americans with Disabilities Act -- it is very difficult to prove discriminatory intent in many cases and discrimination most certainly continues.

The decision of some celebrities, such as Magic Johnson and Rock Hudson, to disclose their HIV status, has helped, as have efforts by community based organizations and some public health departments. Nevertheless, stigma remains a substantial obstacle to HIV prevention, medical care, and the quality of life of people with living with HIV.

Wednesday, December 17, 2008

Disculpa mi ausencia

Honestly, I don't know how some of these high powered people keep up daily posting. Yesterday I had to do a training all morning, then spent the afternoon in a big, ponderous meeting. So I just didn't have time to post and wasn't up for it in the evening. Today I had meetings all morning, another coming up in a few minutes, then I'm doing a focus group. Tomorrow I'm doing a training all morning, then meetings in the afternoon . . .

So anyway, I'll do my best to fit in a substantive post, maybe the promised one on disease-related stigma and discrimination. But for now, it's just a fart in a whirlwind, but I do want to add my little peep to the chorus of astonishment and the viewing with alarm and all that over the deterioration of our political culture. You have the Vice President going on TV and saying sure, I committed war crimes, what's wrong with that? A Senate committee quietly issues a report saying the former Secretary of Defense, the Veep and the Preznit are war criminals, but none of the Senators and nobody else in the Congress as far as I can tell goes on teevee and says, this is outrageous and disturbing and appalling, they just ignore it. So do the reporters and pundits.

In fact, we've known that the U.S. committed an illegal war of aggression, justified by a concerted campaign of lies, and committed massive, systematic violations of human rights, for years now, and it's been the official, repeatedly affirmed position of the Democratic leadership in Congress that there will be no accountability and nothing will be done about it. What has become of us?

Contact your senators and your representative in Congress. Tell them that the United States must confront its recent past. Impeachment is not reserved for current office holders -- the process is fully applicable to people who have left office. Furthermore, Barack Obama's Justice Department can and must prosecute criminals, with the full support of the Democratic leadership in Congress. All criminals, no matter what high positions they have held. We must do what we can to recover our national honor.

Update: In response to a request for more info, I recommend starting with Glenn Greenwald here. Continue to read GG, and he also has links and references.

Monday, December 15, 2008


In 1987, the FDA approved the first drug to combat HIV, most commonly called AZT, generic name zidovudine, also called Retrovir. Doctors began to prescribe it in high doses to control replication of HIV and, presumably, the progression of HIV disease. Technically, AZT is what is called a nucleoside analog reverse transcriptase inhibitor, a class of drugs which people with HIV know by the slang term "nukes." Reverse transcriptase is the enzyme which causes the HIV genome to be incorporated into the DNA of the host cell, the signature process of a retrovirus. NRTIs like AZT work by mimicking one of the chemicals that constitutes a "letter" in the genetic code. They get picked up by reverse transcriptase which attempts (pardon the attribution of intention, it's a convenient figure of speech) to incorporate them into the growing DNA chain, but they don't work properly, and the transcription process terminates.

In the early 1990s, I had occasion to talk with many people living with HIV, in focus groups, formal research interviews, and informally. Some people were taking AZT, but at least as many told me that as far as they were concerned, it was worse than useless. Some of them had tried it and had suffered intolerable side effects. All of them had watched friends take it and seen them suffer side effects, and nevertheless sicken and die from AIDS.

During this era, many people came to the conclusion that the story scientists were telling about HIV was erroneous, that HIV was not the cause of AIDS. Some even described it as a fraud. Among these were some prominent virologists, who eventually convinced among others Thabo Mbeki, who became president of South Africa in 1999. The story of so-called AIDS Denialism is complicated, but the evident ineffectiveness of AZT, even as scientists and doctors continued to push it aggressively as the treatment for HIV disease, was a main fuel of the movement. You can sample their arguments here. This is a link page which I utterly abjure, repudiate, reject and denounce. I offer it as a social artifact of considerable importance. Click on the home page link, and you will get an overview of the movement and, in particular, its association with now former president Mbeki.

Well guess what? In 1993, a British study called the Concorde trial proved definitively that AZT, by itself, did nothing to delay progression to AIDS or to increase life expectancy. All those regular folks were right, and the doctors were wrong. We have visited this issue here many times -- approval of drugs because of what are called "surrogate" endpoints. AZT was approved because it inhibits viral replication and reduces viral load, not because it had been shown to have any clinical benefits.

It turns out that AZT is useful after all, but only in combination with other drugs. A so-called "cocktail" of antiretroviral drugs can suppress viral replication sufficiently to delay progression of HIV disease, even to bring back people who are near death to a state of reasonably good health. (AZT, by itself, is also useful for preventing transmission of HIV from mother to baby, although it is no longer the drug of choice for this purpose.) But by the time this was understood, it was too late to stop the denialism movement from doing grave harm, particularly in South Africa.

Next: Stigma, prejudice, and HIV as an instrument of oppression

Friday, December 12, 2008

Before the Fall

I'm going to have to interrupt the HIV series to address exigent matters. If we must live under capitalism, then we must accept continual destruction as the price of economic dynamism. The Polaroid Corporation used to have its headquarters in that mystical, magical land across the river, The People's Republic of Cambridge. Then one day they woke up and realized they owned a buggy whip factory. Today, I use file cabinets we bought in their bankruptcy sale.

But the determination of the Senate Republicans to allow the U.S. auto industry to collapse invites a resolution of a different order. The death of Polaroid was the price of the rise of a whole new industry. A few thousand lives were disrupted, but there were other jobs to be had and investment losses were soon enough made up elsewhere. What we confront now, however, is very likely the end of an epoch. Karl Polanyi, in The Great Transformation, illuminated the origins of the age in which we have been living, the post-war economic order of the last half of the 20th Century. He describes the system which pertained before, and its end:

The key to the institutional system of the nineteenth century lay in the laws governing market economy. Our Thesis is that the idea of a self-adjusting market implies a stark utopia. Such an institution could not exist for any length of time without annihilating the human and natural substance of society; it would have physically destroyed man and transformed his surroundings into a wilderness. . . .Such an explanation of one of the deepest crises in man's history must appear all too simple. Nothing could seem more inept than the attempt to reduce a civilization, its substance and ethos, to a hard and fast number of institutions; to select one of them as fundamental and proceed to argue the inevitable self-destruction of civilization on account of some technical quality of its economic organization.

And yet, here we are again. Even George W. Bush now appears to get it -- but it is likely far too late. Hang on for a hard ride.

Thursday, December 11, 2008

The Plague Years

Doctors noted within a few months after the emergence of what they called GRID that gay men were not the only people affected. The mysterious disease showed up in injection drug users, recipients of blood transfusions, and some people who had none of these evident risk factors. Nevertheless, the epidemic -- which soon came to be called Acquired Immune Deficiency Syndrome, AIDS -- was associated in the public mind with homosexuality for many years.

And indeed, it did highly disproportionately affect gay men, as it still does in the U.S. today, to a lesser extent -- though not everywhere in the world. One of the most notable impacts of the epidemic was the transformation it wrought on gay culture in the U.S., and also on the relationship between the gay sub-culture and communities, and the rest of society.

I'm not an expert on this subject, which is complex and filled with controversy and polemic. I will just say that the community I interacted with at the celebration in 1980 was exuberant and also, for want of a better word, licentious. Released from literally centuries of being forced into the shadows, persecuted, marginalized, and criminalized for being who they were, gay people erupted like volcanoes of sexuality. HIV forced a reappraisal of sexual expression, and its social organization within the gay community. I believe there is a strong argument to be made that it at least accelerated, if not strongly determining, the evolution of gay institutions and activism toward the normalizing and integration of gay life and identity. Back in the 1980s, marriage and commitment and starting families were not high on the agenda. Now the right to marriage is the central demand of gay politics. The community had to confront and reconsider promiscuity, and social and economic institutions that were built around it; and redefine sexuality to include responsibility.

In the meantime, of course, a central focus of activism vis a vis the larger society became biomedical research, care for people living with the disease, and prevention of HIV transmission, all of which required as a necessary condition combatting the stigma associated with the disease, which in turn meant combatting the stigma associated with homosexuality. It was not enough for gay people to be out in their own communities and building their own institutions. They had to be able to draw on the same reserves of communal good will and social solidarity as every one else in the face of the crisis.

As we approach the 30th year of the epidemic in the U.S., we can honestly say that we have come a long way in that regard. The passage of Proposition 8 is a bitter defeat, to be sure, but 20 years ago it would have been unimaginable that it could even be an issue. Here in Massachusetts, that battle is over, and human rights and dignity are victorious. I'm sure we'll get there in the rest of the country in time -- although it is still true that justice too long delayed is justice denied. However, I doubt you'll find many people who will say it was worth it. I have met too many who remember those terrible years, when they buried one friend after another who had died in the awful way that HIV kills.

I myself lost friends, suddenly and cruelly, but my experience was nothing like that of gay men whose entire communities and social networks were devastated. Among my neighbors are a couple who moved from San Francisco to Boston because the associations were too painful to endure. I once interviewed a man living with HIV, one of those rare people called long term non-progressors whose immune system, for unclear reasons, is able to suppress the virus. He told me that living in New York in the 1980s, he had lost every single friend he had, and whenever he made new ones, they would die too. He lives in a kind of survivor's daze, unable to account for or accept his own existence.

Next: Science marches on

Wednesday, December 10, 2008

The beginning

We now know that HIV originated in Africa, quite possibly as long as 100 years ago based on one recent estimate, definitely before 1959, as HIV has been found in a blood sample preserved from an African man who died in that year.

However, no-one was aware of the disease we now call AIDS until it surfaced in the United States, in 1981. Africans back then got sick and died all the time of who knows what, and nobody outside of their communities even noticed. Here in the United States, however, we had advanced health care and public health systems, and mechanisms for reporting and sharing information about unusual events.

In 1978 and again in 1980, I was in charge of stage security for Gay Pride day in Washington, D.C. Really! Even though I am a person of heterosexuality, this came about because of my friendship with Robert Belanger, a prominent gay activist. Bob, who I have written about here before, was an early member of the Mattachine Society, and he was the society's second president, succeeding founder Frank Kameny after an ideological schism. Despite their differences back in the day, Bob had nothing but respect for Dr. Kameny and always spoke of him with admiration. (Google those names if you're interested in knowing more -- a ton of info will pop right up.)

Anyway, the point is, I encountered the gay movement at a point when the prevailing mood was exuberant celebration. Kameny and Mattachine had at first worked in the shadows, then stepped forward into the light in a small way, in a mode of protest. But by 1980, tens of thousands of people paraded to Rock Creek Park and held, not a protest rally, but a party. The highlight of the day was not a political speech, but a performance by the drag queen Dana Terrell, and the police, who used to beat up transvestites, escorted her(?) into the party.

Then, in 1981, doctors noticed an outbreak of an unusual cancer, called Kaposi's Sarcoma, among gay men in New York and San Francisco, while emergency rooms suddenly saw young men coming in with intractable fevers and a disease seen only in people with defective immune systems, called Pneumocystis pneumonia. The Centers for Disease Control labeled this complex of symptoms Gay Related Immune Disorder. The mysterious gay plague had started.

The worst offense

I'm going to have to briefly interrupt the HIV saga -- and don't worry, I'll get back to it -- for an exigent commentary. Gov. Blagojevich's most egregious misdeed is the worst wig since the days of Moliere. Blagojevich would be summarily drummed out of the Hair Club for Men. Sy Sperling would personally cut the buttons off his jacket and flog him on the way out. I have to disagree with other commentators -- no self-respecting dying rodent would crawl onto a human head and end up looking like that. The anaerobic conditions under that thing must be causing necrosis of the scalp and probably a dangerous build up of botulism. It's a good thing for Blago that he won't be allowed to wear it in jail -- it's a hiding place for contraband. In fact I think that makes him a net winner in this whole thing.

And there you have the key to the mystery: delusional vanity.

Tuesday, December 09, 2008

Case Study

As readers will have gathered by now, much of my work in public health has concerned HIV. This is partly an accident of timing -- I got into the field in the early 1990s when HIV was the biggest thing going. And I have to admit that HIV exceptionalism -- the perhaps disproportionate amount of funding that goes to HIV-related programs and research -- has helped to keep this particular problem more or less front and center for me. It's certainly not the only focus of my work, and to the extent it is a focus, I think of it as a more broadly instructive example, not a universe unto itself.

But HIV is uniquely instructive, for a medical and public health sociologist. This virus -- a little bit of genetic information that got adrift in the world, a microscopic, mindless, lifeless fragment of chemistry -- brings into sharp relief some of the most important issues in fields as disparate as health promotion and disease prevention, clinical practice, the organization and financing of health systems, and the sociology of science.

A frequently productive intellectual trick is to organize a discussion around a theme that crosses conventional boundaries, so we serendipitously discover linkages and resemblances. For example, a professor might teach a course entitled "Chocolate." Students sign up because they like chocolate, and they end up learning about botany, tropical agriculture, colonialism, African politics and economics, international trade relations, the organization of the food industry, industrial processes, product marketing, and the biology of human sensory perception and psychological reward. These all get fit together to help fill in our picture of the world, and the observed patterns and connections extend far beyond the various meanings of a flavorful bean.

HIV is biologically similar everywhere, but its socially constructed meaning differs radically from place to place, to some extent in a causal dance with the epidemiology but also independently. The sociology of HIV has changed just as much over time, as HIV has transformed the cultures around it, as the epidemic has evolved, and as medical science has changed the nature and context of HIV disease. HIV reveals so much that is central to our interests here, so I'm going to spend some time in the coming days on its story.

Monday, December 08, 2008

The argument from authority

The CBS News web site is headlining the story that Luc Montagnier, who is about to receive a Nobel prize as co-discoverer of HIV, thinks there will be a therapeutic vaccine within 4 to 5 years. The reporter at least has the wit to add "He did not elaborate as to why he believed scientists were close."

Indeed, that is a puzzle. Montagnier is certainly outside of the consensus of scientific opinion on this question. It is puzzling and a bit unsettling that he would say this, since any statement by him on this subject is bound to become a major news story. Montagnier's current work does focus on approaches to an HIV vaccine, but this doesn't necessarily constitute an endorsement of his views. It is an occupational hazard for scientists to be overly optimistic about the prospects for their own work.

A balanced, in-depth view of the current state of the quest is given by Anthony Fauci in this interview with Scientific American's Nikhil Swaminathan. When Motagnier first discovered HIV, people assumed it would be only a matter of a few years before a vaccine could be developed. Bill Clinton set a goal of developing a vaccine by this year; but in fact we're nowhere close. As Fauci puts it, in a nutshell, vaccines work by mobilizing the body's natural defenses against a pathogen; but humans do not mount an effective immune response against HIV in the first place. You can't boost what doesn't exist.

Actually it's more complicated than that. The immune system does keep HIV in check for quite a while. Untreated people do not develop AIDS for several years, typically a decade. But their immune systems do not prevent the virus from replicating or eliminate it from the body. Rather, the cells that HIV preferentially destroys, immune system cells called helper T-cells, continue to reproduce as fast as HIV destroys them; but eventually, the virus wins the race.

The two major reasons why HIV defeats the immune system are a) its envelope proteins hide, they aren't readily recognized by the cells that normally produce antibodies against viruses; and b) HIV mutates rapidly, so that a vaccine that might be effective against a given strain will not be effective against the multitude of strains that infect any single individual. Another big problem is that there are long-term reservoirs of HIV in infected people that are completely inaccessible to the immune system, or to antiretroviral drugs, from which the virus can continually re-emerge. (By the way, it has been shown that people are initially infected by only one or two viral particles, and early in the course of infection have homogeneous virus; but the virus quickly mutates into multiple varieties.)

Unfortunately, there is no solution to these problems on the horizon. It would be unfortunate if Dr. Montagnier's optimism deflects our attention from what we already know how to do: prevent transmission of HIV by encouraging safe behavior. In this field, many of the most important principles of public health are highly salient. More to come on that subject.

Friday, December 05, 2008

We're Number One!

In addition to state-by-state rankings and statistics, America's Health Rankings, on page, offers some comparisons of the United States with some of the other comparatively wealthy countries. They lifted their data from the WHO, by the way, but they've organized it for us conveniently.

As I mentioned when I redesigned this page, the U.S. does not do particularly well on the life expectancy front. In so-called "Healthy Life Expectancy" -- "Average number of years that a person can expect to live in "full health" by taking into account years lived in less than full health due to disease and/or injury," according to the WHO -- Japan ranks number 1, at 75 years, and the U.S. ranks 28th, at 69 years -- tied with Slovenia.

But there is one category in which the U.S. absolutely blows away the competition, one important health-related area in which we have no peers, no challengers, nobody even threatening to come anywhere close to us in the foreseeable future. We're the top! We're the Coliseum. We're the top! We're the Louvre museum.

Yep, you guessed it, that is fatness. 33.2% of our adult women are overweight, and 31.1% of the men. New Zealand comes in a pathetic second at 23.2% for women, while Malta is lapped by our guys at 25%. Japan isn't even trying -- 3.3% and 2.9% is all the fatness they can muster.

I don't know why you think this is amusing. Obesity -> diabetes -> amputations -> kidney failure -> billions and billions of dollars spent on treatment, and lost to disability, and human misery. Oh yeah, heart disease, strokes, arthritis, cancer -- this is a slow motion public health disaster that will bankrupt this country faster than imported oil and exported military empire. It's a huge, terrifying crisis. It's no joke.

Thursday, December 04, 2008

Voting Republican is Bad for Your Health

Okay, I can't really prove that directly. But I'm using the conceit to draw attention to the new America's Health Rankings report. This comes out every year, from the United Health Foundation and big time partners such as the American Public Health Association, and it ranks the states on a wide range of variables related to health outcomes, risk factors, and public health infrastructure. They also compute an overall index so they can put all 50 states in rank order of general healthy goodness. That may be kind of bogus, but you know how it is -- people like contests, so it helps sell the concept.

As I have done in the past, I decided to examine the relationship between each state's ranking and the percentage of the vote that went to the Democratic candidate for president, i.e. Barack Obama. There is a significant positive correlation -- r=.427, p < .001 -- which means that the two variables are somehow related. There are outliers, however -- exceptions. Here's what the plot looks like:

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You'll notice that there are three comparatively healthy states that went heavily for McCain, in the upper left hand corner. These are Utah, Wyoming, and Idaho. Utah always ends up being healthier than most factors would predict, because the Mormons eschew tobacco -- and probably to a lesser extent because they don't use alcohol either. Wyoming and Idaho are sparsely populated, rural states. According to the report, Idaho benefits from low rates of infectious disease, clean air, and relatively low income inequality. Wyoming has similar advantages. Take away these three, and the association is much more consistent. (D.C., unfortunately, is not included in the health rankings and would no doubt violate the pattern in the other direction.)

What is it about those unhealthy, McCain - loving states? They have high child poverty rates, low spending on public health, high rates of smoking and obesity, lots of people without health insurance, low average educational attainment -- all problems the Democrats want to do something about and Republicans typically don't. The more things change, the more they stay the same.

Wednesday, December 03, 2008

That ol' Rule of Rescue

Gardiner Harris in today's Gray Lady has a long piece on Britain's NICE, which we have much discussed here. It's got a lot of good information, but is a bit short on the deep thinking. Unfortunately, here in the U.S. we're going to have to do some of that deep thinking if we're ever going to get our knickers untwisted. Harris begins with a little case vignette:

When Bruce Hardy’s kidney cancer spread to his lung, his doctor recommended an expensive new pill from Pfizer. But Mr. Hardy is British, and the British health authorities refused to buy the medicine. His wife has been distraught.
“Everybody should be allowed to have as much life as they can,” Joy Hardy said in the couple’s modest home outside London.

And he ends with the Hardys as well (just like they taught him to do in J school):

Meanwhile, Mr. Hardy waits. In recent weeks his growing tumor has pressed on a nerve that governs his voice. He can barely speak and is increasingly out of breath. The Hardys are hoping that in January NICE will approve the use of Sutent, allowing Mr. Hardy further treatment.

"It’s hard to know that there is something out there that could help but they’re saying you can’t have it because of cost,” said Ms. Hardy, who now speaks for her husband of 45 years. “What price is life?”

In between is a lot of facts and history (including that Sutent can be expected to buy Mr. Hardy 6 months of life, at a cost of $54,000) but little reflection on Ms. Hardy's moral position. Should "everybody be allowed to have as much life as they can?" Does life have a price? What if we were to answer, as Ms. Hardy would like us to, "yes" and "no" respectively? What would be the logical consequences?

If the British National Health Services -- rather, the British taxpayers -- are obliged to spend the $54,000 to buy Mr. Hardy those six months, what else are they obliged to do? Dare we even ask that question?

Tuesday, December 02, 2008

And while we're on the subject . . .

of Weapons of Mass Confusion, you have no doubt viewed with alarm the prediction, pulled out of the collective orifices of a government commission, that the U.S. will be attacked with "Weapons of Mass Destruction" by 2013. Now, they can't even predict the weather a week from now, so this is pretty dubious. But . . .

let's talk about biological weapons – pathogens such as anthrax. Anthrax is not contagious. The idea that a small quantity of anthrax spores could kill thousands or millions of people – such as Colin Powell favored us with before the UN Security Council in February 2002 -- is grossly exaggerated. Powell’s calculations assumed that the exact minimum number of spores needed to cause disease could be distributed precisely into each individual's lungs. By the same sort of calculation, 50 pounds of TNT could kill thousands of people because you could divide it precisely into thousands of firecrackers and insert them into thousands of orifices.

If someone were to spray anthrax spores into the air, most of them would never be inhaled and would never harm anyone. (Did you know? Much of the soil in the Southwest United States is already contaminated with anthrax spores.) Only people unlucky enough to inhale a sufficient number, and to be susceptible (susceptibility varies hugely, for unknown reasons) will be affected. Anthrax can be used to sicken or kill a relatively small number of people, in most plausible scenarios. It's scary because you probably won't know you've been exposed until some time later, and if you don’t get the proper diagnosis in time the disease of inhalation anthrax is fatal, although the terror factor has notched down considerably, or should have, since we have learned that it is fully curable.

As we have seen, creating anthrax contamination can cause a substantial economic cost and disruption, as well as kill or harm some people. The anthrax mailer demonstrated a technique of mass disruption that has unique features, no doubt about it. But a truck bomb is a more effective and more certain way to kill large numbers. Even more laughable is the alarm raised by David Kay over a vial of botulism in the back of an Iraqi scientist’s refrigerator. Botulism is anaerobic, which means it can’t grow in the presence of oxygen; therefore the organism is useless as a weapon. The toxin it makes, which is the bad stuff, may be found in refrigerators throughout Beverly Hills, where people inject it into each other’s faces.

The hysteria over botulin toxin is similar to the hysteria over ricin. Ricin is not really a "biological weapon," although for some reason it’s often called one. It's a toxin that happens to be derived from a plant, as are most common poisons. Cyanide, atropine, all the good murder mystery poisons, come from plants. Ricin’s claim to fame is potency by weight, but it's not outstandingly useful as a military or even terrorist weapon (however defined). As a dry powder, it’s not volatile, not easily dispersed. You could open a 50 pound bucket of it in the subway and it would just sit there. However, during the WMD hysteria leading to the attack on Iraq, the federal government and the corporate media had a grand time creating immense conniption fits about ricin. It's easy to make and various common criminals and nut cases have been found with it, so regular yelping about ricin helped maintain the desired atmosphere of fear and hysteria. But there are plenty of perfectly good ways to poison people, available at your corner hardware store.

Then there are chemical weapons, another category of so-called Weapons of Mass Destruction (where ricin really belongs). The Aum Shinrikyo cult in Japan managed to kill 11 people by releasing sarin gas in the subway, but more recently, a man killed hundreds in the subway in South Korea by starting a fire with a milk carton full of paint thinner. Chemical weapons aren’t even especially daunting as battlefield weapons because protective clothing and/or chemical antidotes render them ineffective, just as a vaccine defeats anthrax. No such protection is possible from high explosive and projectile weapons.

Don’t get me wrong – you can definitely kill people with anthrax or poison and that is a very bad thing to do. But think about it: sarin, ricin, anthrax – all these are Weapons of Mass Destruction, while cluster bombs, Daisy Cutters, MOABs, Fuel Air Explosives, Tomahawk cruise missiles, aircraft strafing cannons – the weapons that have already killed thousands of Iraqi civilians and military conscripts, among other accomplishments – aren’t.

How come? Not because category A is inherently more massively destructive than category B. Rather, it’s because the U.S. military has a lot of those high explosive and projectile weapons, and the means to deliver them, and it uses them. The monopoly of massively destructive so-called "conventional" firepower by the world's military powers means we don't call those things Weapons of Mass Destruction.

So what about nukes? Those are definitely Weapons of Mass Destruction, by anybody’s definition, including mine. Well, it's okay for us to have them, and Israel, China, Russia, France, UK, and now Pakistan and India. It's just not okay for anybody else to have them. So let's be clear about the terms of this discussion.

The whole point of the WMD category is not about what kinds of technologies do and do not inherently threaten the most horrible consequences. It’s about who gets to monopolize the use of deadly force. Nerve gas and anthrax do nothing to equalize the battlefield, in reality, but they make for good copy. And even though they seem to really scare people as potential terrorist weapons (we can worry about the exact definition of that another time) it isn’t clear why it’s less scary to contemplate being done in by a fertilizer bomb. Saddam is said to have gassed Kurdish civilians (with the blessing of Ronald Reagan and George Bush the First, so I guess poison gas wasn’t yet a WMD back then) which is indeed a terrible crime. So it would have been alright if he had blown them to pieces instead?

Weapons of Mass Destruction means weapons that relatively weak states or non-state actors might obtain, that we don't want them to have, or that we really don’t care whether they have or not, but which create a useful excuse for belligerence. High explosives can do a lot of damage even without sophisticated delivery systems, as Tim McVeigh and others have proved, but they really become WMDs when married to guided missiles, B1-bombers, and tanks.

So let’s drop this bogus dichotomy. There aren’t two kinds of weapons in the world: Weapons of Mass Destruction, that only we are allowed to have, because we can be trusted not to use them; and every other kind of weapon, that it’s okay for anybody to have even if most people can’t afford the best ones. Possessing sarin or anthrax wouldn’t have made Saddam a threat to his neighbors, and certainly not to the United States. He was militarily impotent with or without them. The lie was not only that he had such weapons, but that it even mattered.

Your Liberal Media: Lazy, Incompetent, or Dishonest?


WASHINGTON: The outgoing US President, George Bush, says his biggest regret in office was US intelligence that incorrectly stated Saddam Hussein had weapons of mass destruction.

"A lot of people put their reputations on the line and said the weapons of mass destruction is a reason to remove Saddam Hussein," Mr Bush said in an interview with the US ABC TV network.

"It wasn't just people in my Administration. A lot of members in Congress, prior to my arrival in Washington DC, during the debate on Iraq, a lot of leaders of nations around the world were all looking at the same intelligence. I wish the intelligence had been different."

A little over a year ago:

By Sidney Blumenthal Sept. 6, 2007 | On Sept. 18, 2002, CIA director George Tenet briefed President Bush in the Oval Office on top-secret intelligence that Saddam Hussein did not have weapons of mass destruction, according to two former senior CIA officers. Bush dismissed as worthless this information from the Iraqi foreign minister, a member of Saddam's inner circle, although it turned out to be accurate in every detail. Tenet never brought it up again.

Nor was the intelligence included in the National Intelligence Estimate of October 2002, which stated categorically that Iraq possessed WMD. No one in Congress was aware of the secret intelligence that Saddam had no WMD as the House of Representatives and the Senate voted, a week after the submission of the NIE, on the Authorization for Use of Military Force in Iraq. The information, moreover, was not circulated within the CIA among those agents involved in operations to prove whether Saddam had WMD.

On April 23, 2006, CBS's "60 Minutes" interviewed Tyler Drumheller, the former CIA chief of clandestine operations for Europe, who disclosed that the agency had received documentary intelligence from Naji Sabri, Saddam's foreign minister, that Saddam did not have WMD. "We continued to validate him the whole way through," said Drumheller. "The policy was set. The war in Iraq was coming, and they were looking for intelligence to fit into the policy, to justify the policy."

Now two former senior CIA officers have confirmed Drumheller's account to me and provided the background to the story of how the information that might have stopped the invasion of Iraq was twisted in order to justify it. They described what Tenet said to Bush about the lack of WMD, and how Bush responded, and noted that Tenet never shared Sabri's intelligence with then Secretary of State Colin Powell. According to the former officers, the intelligence was also never shared with the senior military planning the invasion, which required U.S. soldiers to receive medical shots against the ill effects of WMD and to wear protective uniforms in the desert.

Instead, said the former officials, the information was distorted in a report written to fit the preconception that Saddam did have WMD programs. . . .

We don't bother to report: you decide.

Monday, December 01, 2008

A day of mixed feelings

I do feel obligated to do a post for World AIDS Day. I laid out some of the basics about the global HIV epidemic while I was in Mexico City for the IAS conference in August. It's obvious that while almost everyone in the rich countries who needs them has access to antiretroviral drugs, there is a major injustice in that 2/3 of the people in poor countries who should be getting these drugs are not, and we're falling further behind every day, as more people become infected. Actually, based on the latest indications for treatment, the gap is even bigger than that, more like 3/4 who are not being treated who should be. The cost of first-line regimens in the poor countries -- due to agreements wrested from the pharmaceutical companies with great difficulty -- is $95/year per person, which means it would cost about a billion dollars a year to buy the meds for people who currently aren't getting them.

It would cost a good deal more than that to actually deliver them to places that currently lack basic health care infrastructure, and many people argue that "HIV exceptionalism" -- placing HIV ahead of other important public health problems -- is distorting spending on global health and making it less cost-effective. It costs much less, for example, to provide people with insecticide-treated bed nets to prevent malaria -- just a couple of bucks -- and the payoff is at least as great. But that's a false comparison, because what matters isn't an abstract cost-effectiveness analysis of existing spending, what matters is what is politically possible. There is vastly more than enough money available to do both, and a lot more than both, if we had the political will.

The powerful movement and infrastructure to combat HIV and AIDS in the poor countries is of immeasurable strategic value. This infrastructure exists in large part because people living with or affected by HIV in the U.S. and Europe, after campaigning for universal treatment, prevention programs, and client care services in their own countries realized that it would be hypocritical of them not to work just as hard on behalf of people less fortunately situated, particularly in Africa. Rather than get into a squabble with this movement over the allocation of resources, advocates for broader public health measures need to support it in exchange for leverage.

Building public health and health care infrastructure in poor and remote places will do a lot more than facilitate the delivery of ARVs. The same distribution routes and workforce that dispense ARVs can provide immunization, health education including not only HIV prevention but practices to provide safe drinking water and otherwise promote community health, midwifery services, and the other basics. These programs can employ women and combat gender, ethnic and caste discrimination. We can build on HIV care to find and treat tuberculosis and parasitic diseases.

So, my mixed feelings are whether we should have a World AIDS Day and not just a World Health Equity Day. But I'm willing to take the situation where I find it. Let's build on the movement to combat HIV and AIDS, eliminate associated stigma and discrimination, and elevate the principles of justice in HIV prevention and treatment, and extend those values and that energy to global justice in every realm.