What I do for a living

I use a pseudonym here because I want freedom to speak in a voice that is not exactly consistent with my professional role. And in fact, I realize that I have written rather little about the issues I deal with every day, in my real life. I probably should let folks know something about that.

First, I work as evaluator for some federally funded programs in substance abuse treatment, mental health services for people living with HIV, and HIV counseling and testing. An evaluator doesn't give a report card or tell the funder that a program is successful or unsuccessful. Rather, we collect information about programs and clients that helps the program staff meet client needs, and helps funders think about the best ways to support programs in the future and the kinds of program models to fund. I try hard to appreciate the views of both clients and providers, and to serve as a bridge between their worlds.

The federal government once was committed to actually solving social problems -- the philosophy expressed in Lyndon Johnson's Great Society, and actually carried on by Richard Nixon who by today's standards was, in domestic affairs, a liberal. That is no longer true. We are left with pilot projects, demonstration projects, capacity building -- that means that organizations receive funding for 3 to 5 years, then they have the rug yanked out, leaving the clients on the floor. For example, one program of the federal Substance Abuse and Mental Health Services Administration, called the HIV and Mental Health Services Collaborative, funded 20 programs nation wide. In 15 months, that money will go away. People with HIV have very high rates of emotional distress and psychiatric morbidity. A study of middle aged and older persons living with HIV in New York City and Wisconsin found that 27% had thought about suicide in the prior week. A study of HIV seropositive women found that 38% reported needing mental health services in the prior six months. A study I did found that, among Latino men and Latina women living with HIV in one city, a history of mental illness and reported psychiatric symptomatology was associated with an extraordinarily high rate of a history of homelessness -- among women, 80% had been or were homeless. Some - but not all - of these clients will qualify for Medicaid once the federal funding runs out, but even that will pay only for a part of what they need.

Another area where I work is in health policy, particularly as it relates to racial and ethnic disparities in health and health care. Although the Clinton administration established a national goal to eliminate disparities by 2010, we are nowhere near meeting that goal, we will not meet it, and in many respects, we are not even making progress. Since we know that the federal government is no longer interested in pursuing the goal of health equity, the coalition I work with is concentrating on state policy. But as a colleague of mine said, here in New England, we live in a blue bubble. We have a chance to make significant gains at the state level, but those states where the inequalities are the greatest are politically much less receptive to addressing them.

Finally, I study physician-patient communication and relationships, the therapeutic alliance, and how people understand and take care of their own states of health and illness, as compared with the theories their doctors use. There is a big gap. I study these issues both qualitatively -- through observational and ethnographic research -- and quantitatively. I have developed a system for coding and analyzing communication which parses speech into separate dimensions of interaction process (or social exchange), and topic or informational content. In a few weeks, I will begin work under an NIH grant to fully develop and implement this system in a study of communication about taking HIV medications.

When I first started this blog, I thought that I would write mostly about these issues. Everybody is interested in their own relationships with physicians, and while most people like and trust their doctors, communication is often not fully satisfactory. And of course, for a lot of people, relationships with doctors go obviously and painfully wrong sometimes.

Unfortunately, the world has intruded very forcefully. It is hard to concentrate on these matters, as important as they are, while disaster overtakes the country I grew up in and to which, by heritage and identity, I belong. Nevertheless, I do plan to try to pull Stayin' Alive back on topic, where I hope I have something special and unique to offer. Not that I won't still address matters that I feel compelled to talk about, that are highly salient, or just interesting or fun. But there are plenty of effective general political ranters out there, I don't want to be just one more.

Please let me know what you are interested in, if there is anything you would like me to discuss, or if you have questions I might be able to answer.

And then there are those liberated Iraqis. . .

I read the NYWT every day and yesterday they have a huge graphic on the op-ed page showing how much better things have been getting in Iraq.

Hmm. Funny thing about that. The liberated folks at the Iraqi Ministry of Planning and Development don't seem to think so. From David Cortright in the Christian Science Monitor:

The Bush administration continues to insist that progress is being made in Iraq, but the last two years have brought deepening misery for Iraqis. That is the inescapable conclusion of a report released in May by the UN Development Program (UNDP) and the Iraqi Ministry of Planning and Development Cooperation.

The "Living Conditions in Iraq" study is based on a 2004 survey of more than 21,000 households. It shows the Iraqi people are suffering widespread death and war-related injury, high rates of infant and child mortality, chronic malnutrition and illness among children, low rates of life expectancy, and significant setbacks for women.

snip

The innocent and vulnerable populations of Iraq are suffering the most. Malnutrition among small children is widespread. Nearly one quarter of Iraqi children suffer chronic malnutrition, and 8 percent suffer acute malnutrition.

Illness levels among Iraqi children are also high - due in part to a growing lack of safe drinking water and sanitation. Forty percent of urban households report sewage in the streets of their neighborhoods.

Infant and child mortality rates remain abnormally high in Iraq, though there is much uncertainty about the exact numbers.

snip

Iraq's alarmingly high child mortality rate translates into thousands of 'excess' deaths every year. These are the quiet, unseen victims of the continuing tragedy in Iraq.

The new report also sheds light on the number of Iraqi deaths directly attributable to the US-led invasion and occupation. As of mid-2004 the war had caused 24,000 Iraqi deaths, the study estimated. This is the number for all deaths, civilian and military, in the immediate aftermath of the 2003 invasion.

The death toll in Iraq has continued to climb, of course, especially in recent weeks, so these numbers are larger now than when the survey was conducted last year.

Etc. Funny how I didn't see anything about that on the news. Oh well, maybe they're saving it for a prime time special.

Addendum: Here's the direct link to the UN Development Program home page on the report:

Iraq Living Conditions Survey 2004

Okay, now that I've gotten that over with . . .

you might want to check out Nicole Colson's story in Counterpunch about the young people maimed in Iraq coming through Walter Reed army hospital -- usually brought in at night to avoid publicity.

So, I wonder when the Michael Jackson jury will reach a verdict? And who will save those 400,000 precious little frozen embryo pre-born babies? And what kind of ice cream does George W. Bush like?

The memory hole

About the worst thing that can happen, from a public health point of view, is war. In Iraq today, the public health infrastructure has collapsed, millions of people don't have clean water, hospitals lack basic supplies and equipment and, oh yeah, electricity, tens of thousands of children are malnourished, and then there are those pesky explosions and 50 caliber bullets. As far as the United States is concerned, the close to 2,000 deaths of troops, plus another 300 or so mercenaries and non-combatants, and the 6,000 or so serious injuries, may be a drop in the epidemiological bucket (it's a big country), but the moral responsibility for the disaster is none the less for it. The more than $4 billion a month we're paying for this monstrous folly is money that could go a long way toward meeting some of our serious problems at home. Then there is the PTSD, the suicides, the disrupted families, aborted careers, bereaved families and communities. It's really bad, folks. It's really hurting us.

So it is fully on topic for me to address the collective insanity of our corporate mass media and our political discourse -- for which Democrats are as much, if not more to blame, than Republicans. The central narrative of the collective consciousness is now supposed to be that George W. Bush has put forth a doctrine of spreading freedom and democracy throughout the world, starting with a place called the Greater Middle East, and the war in Iraq is the first major step in this world historical visionary struggle which we must win in order to secure peace and prosperity for the planet.

Damn funny thing about that story, it does not correspond to reality. Remember reality? I know it's obsolete but some of us are old fashioned.

What I am about to write is actually true, although you will not read it in the New York Times or see it on TV.

In 1997, much of the Republican foreign policy establishment, out of power since 1992, established a think tank called the Project for the New American Century. Founders included Dick Cheney, Donald Rumsfeld, Paul Wolfowitz, John Bolton, and Richard Perle. PNAC’s staffers were veterans of the Contra war against Nicaragua and the Committee on the Present Danger, which promoted war with the Soviet Union. Jeb Bush, Eliot Abrams, Zalmay Khalilzad (now U.S. ambassador to Afghanistan) and William Kristol were also close to the group and signed some of its policy documents, including one called “Rebuilding America’s Defenses: Strategy, Forces and Resources for a New Century.” (Go here for all the info you could want.) This document called for the United States to achieve global military domination, including permanently positioning forces in the Gulf region. It stated, “The United States has for decades sought to play a more permanent role in Gulf regional security. While the unresolved conflict with Iraq provides the immediate justification, the need for a substantial American force presence in the Gulf transcends the issue of the regime of Saddam Hussein.” It did not at any point identify Saddam Hussein as a threat to anyone, nor say anything about his developing Weapons of Mass Destruction™ or being linked to al Qaeda. Actually it never mentioned al Qaeda or terrorism. Even so, they knew that the public would not accept their project without a transforming event, a “new Pearl Harbor.” (Funny thing isn't it? They got one.)

They selected a naive, easily manipulated empty suit to be their candidate for president. Bush campaigned in 2000 on a platform of a “humbler” foreign policy, and pointedly rejected the idea that the U.S. should be involved in “nation building.” Shortly after the Supreme Court appointed Bush President, in February, 2001, Colin Powell stated in a news conference, “Frankly, [the sanctions against Iraq] have worked. He [Saddam] has not developed any significant capability with respect to weapons of mass destruction. He is unable to project conventional power against his neighbors.”

But in fact, according to former Treasury Secretary Paul O’Neill, the Bush regime was plotting to invade Iraq from the day it took office. Former chief terrorism advisor Richard Clarke has said the same thing. On September 12, 2001, according to Clarke, Bush took him aside and told him to find a way to pin the 9/11 attack on Iraq. The Bush Administration undertook a successful disinformation campaign to do just that, spearheaded by Dick Cheney, with remarks by Bush himself carefully scripted to conflate Saddam with Osama bin Laden, and they managed to convince a majority of the public. Cheney made frequent trips to the CIA to make it clear to career civil servants there that the administration wanted evidence showing that Iraq had banned weapons and weapon development programs. Rumsfeld set up a special operation in the Pentagon to produce such evidence, and accompanying propaganda. The administration undertook a campaign of bombing Iraqi air defenses in an effort to provoke an incident that would provide justification for war. The administration paid a convicted thief, Ahmad Chalabi, who had not set foot in Iraq since 1979, to feed false information to the CIA and to Judith Miller of the New York Times, about Iraq’s nonexistent weapons programs.

On February 5, 2003, Colin Powell made a speech to the UN Security Council in which he presented various pieces of evidence to the effect that Saddam Hussein possessed banned weapons, including as much as 25,000 liters of anthrax, mobile biological weapons production facilities, thousands of tons of nerve gas, was actively attempting to produce nuclear weapons, and was allied with Osama bin Laden and the global jihad network. Every single factual assertion in Powell’s speech was false – every single one -- and most were widely reported to be false in the European press in the days immediately following. But the U.S. news media swooned in admiration for the Secretary's brilliant, incontrovertible performance.

We now know that in July 2002, the director of British intelligence told the British cabinet that Bush had already decided to invade Iraq. But since Iraq was not in fact a threat to its neighbors or anyone else, the “intelligence was being fixed around the policy.” Everybody who was sentient in those days knows that the Bush administration – led publicly by Cheney, Rumsfeld and Bush himself – whipped up the public and the corporate media into a frenzy over the supposed threat posed by Saddam Hussein’s Weapons of Mass Destruction and his alliance with al Qaeda, and on the basis of that “imminent” threat to the United States, obtained congressional authorization and corporate media support for war.

That is what happened. This freedom and democracy thing is a new story they started telling only after the Weapons of Mass Destruction™ and al Qaeda conspiracy lies were fully and finally exposed. Having been exposed, they are now forgotten, once Bush got done making fun of them at the annual Washington press dinner. But of course the freedom and democracy story is equally false and nonsensical. Everybody knows that freedom and democracy do not issue from the barrel of a tank or rain down as shrapnel from a 500 pound bomb. The last thing the Bush administration will ever allow in Iraq is democracy, because a legitimate, popular Iraqi government would be inimical to their ambitions to control the region and its natural resources militarily. By freedom and democracy they mean regimes friendly to U.S. ambitions. Any reporter or politician who doesn't know that perfectly well is a fool. Yet they seem grateful for being lied to, and they keep begging for more. It is incomprehensible.

Over the centuries, there have been many crimes committed in the name of the United States, by our government – slavery, the dispossession and genocide of the original inhabitants of the land, imperialist conquest of Mexican territory, the Spanish-American War, the Vietnam War. Feel free to propose your own. It seems pointless to rank them.

But this one is unusual in one respect. We now know, while Bush is still in office, that the war was based entirely on a campaign of lies. Slavery and genocide were crimes which, sad to say, were committed openly, with the support of the people. The Tonkin Gulf incident which helped accelerate U.S. involvement in Vietnam was a fabrication, but the Vietnam atrocity evolved over time with diffuse and ambiguous responsibility. This particular world historical crime is unambiguously the work of readily identifiable conspirators, many of whom I have named above, and the damage to the United States is also obvious and need not await the verdict of history.

George W. Bush and his cronies are criminals. They are liars, thieves, murderers. They do not believe in freedom, or democracy, nor do they care one whit for the U.S. national interest if we define that as what is in the best interest of the people. They care only for power and greed. It is long past time for prominent people to stand up and say so.

medical science, quackery, and democracy

A few months back I read a full-page ad in the NYWT, attacking the pharmaceutical industry, placed by Matthias Rath, M.D. For the most part, the ad made valid or at least defensible points. I got a minor tickle of pleasure from seeing somebody spend a lot of money to say many of the same things I have said here, but in a place where a few people might actually read it.

Yes, drug companies use misleading advertising to sell overpriced and even dangerous products to people who don't really need them. Yes, they invest billions in developing new drugs that offer marginal benefit to humanity but which they can overhype in order to extend their patent monopoly. Yes, they neglect to test, develop and market natural products with therapeutic promise that they can't control by patent and which therefore offer limited potential for profit. Yes, they conceal or underplay the risks and harms of their products. Yes, they manipulate physicians by bribery and deception. Yes, they use the immense profits they extract from the sick and suffering to control politicians and capture the regulatory apparatus.

So why am I not cheerleading for a medical doctor with the guts and resources to take them on?

Because he is even worse. Rath claims that antiretroviral drugs cause AIDS, and that large doses of vitamins prevent HIV disease. He is an important force behind the skepticism over HIV pharmacotherapy in South Africa, where, by an interesting coincidence, he markets his vitamins -- no doubt that helps to explain how he can afford full page ads in major newspapers. He claims that nearly all diseases are caused by a deficiency of lysine and vitamin C. There is a scientific term for Dr. Rath's claims: bullshit. Dangerous, deadly, destructive bullshit.

But Rath, Deepak Chopra, Andrew Weil, and other prominent dissenters from medical orthodoxy, are seen by many people as politically and socially progressive. Medicine is indeed big business. It has traditionally been paternalistic, hierarchical, authoritarian. Many of its ideas seem impenetrable to average people. It extracts enormous wealth from society, and physicians get a major chunk of that. By most people's standards, doctors are wealthy and highly privileged, they inflict pain on us and give us potions that frequently make us sick, and most of the time, they can't cure us of our most troubling problems.

To many people whose instincts are to distrust authority, to denounce privilege, and to promote the power and autonomy of ordinary people, Rath and the gang seem to be offering a message of liberation, to be standing with the peasants against the feudal lords. In fact, they are nothing but thieves. Worse than that really, if they convince people to forgo effective medical treatments in order to pursue their phantasms of hope.

Medicine is imperfect. It is corrupted in many ways by avarice. It is infested with stultifying traditions and prejudices. It is undemocratic, mysterious, insular, self-involved, sometimes inhumane, sometimes incompetent. But it does have an essential saving grace: the fundamental attitude of science. In the end, medical practice will stand or fall based on reference to reality. Experimentation, systematic collection of data, logical analysis. The drug companies may sell us snake oil for a few years, surgeons may perform unnecessary procedures because their financial self-interest subtly influences their decisions, effective treatments may go unrecognized for a time because the financial incentive to pursue them is lacking. But the truth is out there, and it can only win in the end.

The problem of democratizing science and medicine is one of the most critical challenges we face, not only in the U.S., but as a species. I'm almost as afraid of technofascism as I am of the horrifying rise of superstition and willful ignorance as popular movements. But replacing science with nonsense is the opposite of a solution.

Visit quackwatch for a boatload of info and opinion. Dr. Barrett goes a little too far sometimes (he's a man on a mission), and he sometimes doesn't realize that he's suffering from the disease I call the orthodoxy of skepticism (there are certain things that skeptics are supposed to believe, even if the evidence is thin). But on the whole, it's a great resource.

Playing along

Revere has asked me to do one of those chain blog things about books. I cannot refuse him anything.

1. Number of books I own: No idea. Thousands. My ancestors going back generations have been book accumulators.
   
2. Last book I purchased: Pinker, How the Mind Works. I kind of liked it, although he likes himself more than I like him. My aunt just gave me Barak Obama's book.
   
3. Last book I read: Poisonwood Bible.
   
4. Five books that mean a lot to me: Hmm. That's really not fair. I've always been partial to Moby Dick; the Penguin Complete Shakespeare is one book so there; Taylor Branch's political biography of Martin Luther King Jr. which is two volumes but I'll go with Parting the Waters, the first; and now I'm going to surprise everybody by naming Dan Simmons's science fiction tetralogy Hyperion and finally, I'm going to cheat by adding, not a book, but my subscriptions to Free Inquiry and Scientific American. My grandparents gave me a subscription to Sci-Am when I was 12, I've kept it my entire life, and saved every issue. That overwhelms the importance of any single book in my life.

I'm not going to tag anybody else with the meme, as they say. But if anyone wants to get voluntarily infected, let me know, first five get a free link.

Like Revere, I find it difficult to read books these days. It's not because of blogging though (and I doubt it really is in his case either). In my line of work, I have to read an immense amount of non-book material -- journal articles, consultant and committee reports, magazines. In addition to the rags named above, I subscribe to Harper's, NYRB, The American Prospect, American Journal of Public Health, Public Health Reports, The Nation, and I read JAMA, British Medical Journal, and New England Journal of Medicine every week (not every article, of course), and the NYWT and Boston Globe every day. If I read a lot of books, my retinas would burn out.

Books are mostly for the young, and the retired, unfortunately. I feel bad about it. I often have moments of conscious regret. I remember as a young man sitting in a chair for entire Sunday afternoon and reading The Mill on the Floss, unconscious of the world. When I finally turned the last page and stood up, I passed out. Once I lay awake all night reading when I had to drive from Northern New Jersey to Philadelphia the next day. I had to pull over at a rest stop and sleep in the my car -- which was an Austin-Healey so you can imagine how comfortable I was. That kind of thing can't happen nowadays.

Words fail department

According to Matt Kelley of the Associated Press,

[Donald] Rumsfeld challenged China at a regional security conference here, particularly its placing hundreds of missiles in range of Taiwan. He said China was also sharply increasing its military spending and buying large amounts of sophisticated weapons.

"Since no nation threatens China, one must wonder: Why this growing investment? Why these continuing large and expanding arms purchases?" Rumsfeld said at the conference organized by the International Institute of Strategic Studies, a private, London-based think tank.

I'm not clever enough to add any useful comment. Readers are invited to try.

Help me out!

A quickie before I head to the airport.

ABC News reports on recent research showing that sarcasm is processed by specific neural networks in the brain. In conjunction with the report, they have a poll: Is sarcasm okay?

Obviously, you know what this means to me! Please vote and save sarcasm!

Mailbag

Like Herr Professor Doctor Attaturk, I occasionally pause to take reader's questions.

Q. Why doesn't the media report the good news from Iraq?

A. They do! I've been following the news closely since the invasion and I can tell you that every school in Iraq has been painted at least twice. What's more, we're winning! Donald Rumsfeld said that were about 5,000 insurgents in Iraq in early 2004. Adding up the numbers from reports in the New York Times, we have now killed or captured at least 20,000 of them. That means there are only -15,000 left. No wonder they're desperate.

Q. When will the spendthrift, liberal Democratic Congress start acting responsibly and do something about these massive, unsustainable federal budget deficits? Oh, wait a minute, ahhh . . . Never mind.

Q. Where are the Weapons of Mass Destruction™?

A. We know where they are. They're in Kirtland AFB, New Mexico; King's Bay Naval Base, Georgia; Bangor, Washington; in and around Grand Forks and Minot, North Dakota; Nellis AFB, Nevada; and in Wyoming, Texas, California, Louisiana, Montana, Virginia, South Dakota, Colorado, and at U.S. bases in Germany and the United Kingdom. check it out

Q. My daughter, in college, wants to be a reporter. What advice would you give her?

A. Reporters nowadays need a few skills that it can be difficult for young people to learn. But if she can develop them early, she'll have a head start in the profession.

• First, and most important, she must completely eliminate the habit -- indeed the faculty -- of critical thinking. She must train herself not to compare the pronouncements of government spokespersons, or her sources in government, with reality, or to test them for internal consistency and logic. That's the worst sin a reporter can commit, it's a violation of balance and fairness.
• Second, she must commit to the five noble priorities: Sex, Celebrity, Fear, Power, and Cruelty. These determine the importance of news stories, and their placement in the broadcast or newspaper.
• And finally, she must remember to always, always, follow the herd.

If she can internalize these principles -- live them, inhabit them so fully that she no longer even perceives that she is ruled by them -- she can rise to the heights of Washington dinner party society.

Well, that's all I have time for today. I'm off to DC for the rest of the week, to a grantees' meeting. (Yep, it is the hand that feeds me that I bite.) I may not have access to your internets till Saturday, so don't miss me too badly.

Mosquito control

CDC is now saying that it has received a few (they don't say exactly how many) reports of relatively young, healthy people who develop neurological complications from West Nile Virus -- partial paralysis of a limb, that sort of thing. It seems that people generally recover, but it can take months or as much as two years. And some people miss a week or ten days of work due to the acute illness. It is still true that the vast majority of people who are infected have no symptoms, or only mild symptoms, but it appears the strain prevalent in the U.S. is somewhat more virulent than the most common strains in Africa.

Now, this is still not really any big deal -- I promise that no matter where you are, you have bigger things to worry about. Nevertheless, this news is bound to ratchet up political pressure for intensified mosquito control efforts. (WNV is spread exclusively by mosquitoes.)

Now, that's where the real danger lies, in my view. Some years ago I did a literature review on the environmental fate of pesticides used in mosquito control, for the Massachusetts Audubon Society. We have an indigenous virus here called Eastern Equine Encephalitis. Every two or three years, two or three humans come down with EEE, which can be fairly serious. For decades, this problem, which I would label as rare, provided the impetus for a very substantial state-funded permanent infrastructure, administered at the county level, which geared up and sprayed our wetlands with a pesticide called malathion every time a case was reported. (The county level administration is one indication of how archaic this program was. The only other responsibility of county government in Massachusetts is the operation of jails.)

It turns out that the situation with pesticides is even worse than the situation with pharmaceuticals. Many approved pesticides have had inadequate testing for human and environmental safety. Most of the research that is done is funded by pesticide manufacturers, and the journals that publish the research are oriented toward people employed in the industry. The spin on some of these research reports is absolutely ludicrous. Malathion is a member of the class of chemicals called organophosphates, originally developed by German scientists during World War II as chemical weapons. Malathion is less potent, but works in exactly the same way, as Sarin, the nerve gas Saddam Hussein was falsely accused of possessing by the Bush administration. There is a substantial body of evidence, based on primate research, that chronic, low-level exposure to organophosphates, which causes no acute symptoms, causes permanent brain damage, and there are lots of case reports of individual humans who suffered acute poisoning from malathion in everday use. Yet the conclusions from these articles always were written so as to downplay the practical importance of these findings.

Well guess what? According to a Reuters report today:

Gardeners should wear protective clothing when using pesticides, say scientists who have concluded in a new study that the chemicals can increase the risk of Parkinson's disease. Researchers at the University of Aberdeen in Scotland have discovered that the more pesticides gardeners are exposed to, the more likely they are to develop the degenerative brain disease. Anthony Seaton and his team in Aberdeen interviewed 767 Parkinson's sufferers and 1,989 healthy people about risk factors for the disease, including their use of pesticides. They found that people with the chronic, irreversible illness were more likely to have used pesticides; amateur gardeners were 9 percent more likely to suffer from the disease than nonpesticide users.

Now this study can't distinguish which pesticides are responsible, but I'm willing to bet a case of Cutter's that organophosphates are the culprit. But wait, there's more. In the U.S. we moved away from use of another class of insecticides, the organochlorines (such as DDT and Methoxychlor) because they bio-accumulate in fish, mammals and fowl. Organophosphates, in contrast, are broken down by enzyme systems in the vertebrate liver. That may be good news for bald eagles, but it's no consolation to every insect, slug, snail, or earthworm exposed to organophosphates. They are completely non-selective and will kill your ladybird beetles and butterflies right along with your mosquitoes. They are also quite toxic to reptiles and amphibians, and oh yeah -- to human children, whose liver enzyme systems have not fully developed.

As Revere helpfully corrected me, the chemical used by the Boston Public Health Commission in response to mass hysteria over the West Nile Virus was resmethrin, which is a synthetic version of rotenone, a naturally occurring compound. Resmethrin is not highly toxic to humans or fowl, but it is extremely toxic to fish -- in fact, it is used by South American Indians as a fish poison. That does make it a rather odd choice for mosquito control. The spraying was done in my neighborhood precisely because I live near a chain of ponds and waterways. And of course, resmethrin is equally non-selective when it comes to insects and other invertebrates.

There are smart ways to control mosquitoes. Malaria is indigenous only to the tropics. Our mosquito born diseases are far less of a concern. Use of toxic chemicals to kill adult mosquitoes is a cure worse than the disease. People who are worried about West Nile Virus (and again, I would say you have bigger worries) can use mosquito repellent, according to directions. (Personally, and this is a controversy we don't have room for here, I would not use DEET on young children. Maybe I'll do that one another time.) Don't allow casual standing water on your property. Ponds can be stocked with fish that eat mosquito larvae, and dragonflies are also helpful. Mosquitoe larvae can be suffocated by spraying ponds with a micro-layer of vegetable oil, which will quickly degrade. There are other tricks available -- in general, it's much better to plan ahead and make the larvae's lives miserable, rather than attacking adults. (Draining swamps, however, is also a cure worse than the disease.) Spraying insecticides around to kill adult mosquitoes is evidence of imprudence, bad judgment, and usually, hysterical overreaction due to mass media hype, encouraged by people with a vested interest.

Heroism

The year I turned 18 happened to be the last year of the Vietnam era draft. I was certain that the war was immoral, pointless, a world historic atrocity, that had been sold to the people by a pack of lies. I knew I could not be involved in killing Vietnamese people for the sake of Richard Nixon's phony macho image, which by then was all that was left of the case for the war . But I was also well aware that if I was drafted and I refused to fight, someone else would have to take my place. As I did not follow any organized religion, it would have been very difficult for me to win conscientious objector status (yes yes, a violation of the First Amendment, but that's how it was), and my likely alternative would have been prison. As it turned out, I drew a high lottery number and I never had to make that hard decision. But something like a million young men did.

One who fought was Col. David Hackworth, who is one of the most decorated war heroes in our history. His funeral is tomorrow, at Arlington National Cemetery, but the nation's top military leadership will not attend. Col. Hackworth was recommended for the Congressional Medal of Honor, for riding a helicopter into the middle of a battle and running repeatedly through a wall of fire to carry wounded men to safety. But he never received the award. In fact, he spent much of his life in virtual exile, in Australia. Reporter Bryan Bender of the Boston Globe explains why:

Hackworth's most enduring foe was not the communists he fought. He earned a a chestful of medals, including two Distinguished Service Medals, 10 Silver Stars, eight Bronze Stars, and eight Purple Hearts. His adversary became the US military bureaucracy, which he railed against for 30 years on grounds that it failed to put the troops first. He also opposed military action in Bosnia, Kosovo, and especially Iraq.

But while the military leadership may be absent from the funeral, hundreds -- and probably thousands -- are expected to attend. The numbers would be larger, except that many who consider him a hero aren't in Washington. Hackworth became a touchstone for soldiers in the Middle East who questioned the Pentagon but didn't feel comfortable raising complaints with superiors.

Col. Hackworth threw his purple hearts away. I wonder how the Swift Boat Veterans for "Truth" feel about that?

I have no right to presume how Col. Hackworth would feel about it, but personally I am very glad that the cowardly liars who are today sending young people to the slaughter for the sake of their megalomaniacal fantasies will not be at his funeral. They would profane it.

Why am I not giddy with excitement?

To quote a journalist with the unusual name of Globe Staff (an alias, I think, for "we're really the New York Times"):

A politically eclectic group has been meeting in secret for months in an effort to craft a proposal that will expand healthcare coverage to as many people as possible.

I always figured that "as many people as possible" meant, like, everybody. But in the faith-based society, it appears that not all things are possible.

The cast of characters for these secret meetings includes the AARP and the AFL-CIO, the American Hospital Association, "America's Health Insurance Plans, the trade association for health insurers," Pfizer, the Blue Cross and Blue Shield Association, and the U.S. Chamber of Commerce. It turns out that "the liberal Families USA and the conservative Heritage Foundation are also participating."

In other news, the Mafia is having a meeting of all the family heads to propose a solution to the problem of organized crime. John Walsh and Whitey Bulger are said to be participating. Most likely the Bush Administration will adopt whatever proposal they come up with.

Can I take Viagra till I need glasses?

Yeah yeah, I'm sure a million people have already used that line but what the heck.

It may well turn out that Viagra does not increase the risk of blindness, but regardless, the latest post-marketing drug safety flap reminds us of something very important. As Paracelsus (1493-1541 wrote, "All substances are poisons; there is none which is not a poison." Pharmaceuticals are, by definition, powerfully biologically active substances. Most of the stuff in your medicine cabinet would kill you if you swallowed only a few grams of it. Indeed, on that basis -- the dose required to kill the average person -- nicotine is 100 times as toxic as DDT. But of course we have banned the use of DDT in the United States, while it is perfectly legal to purchase and ingest nicotine (although not recommended), although DDT has a legitimate economic use and nicotine is simply an addictive drug.

Drugs inevitably come with risks as well as benefits. Our problem is not that the FDA approves drugs which turn out to be unsafe. That can't be helped. The problem is that we often find out about risks of drugs only after they have been approved and widely marketed, and those unpleasant surprises often mean that people would have chosen not to take the drugs after all. This is difficult to avoid entirely, but the problem is greatly exacerbated by our system for evaluating the safety and effectiveness of new drugs. For the most part, the manufacturers pay for drug trials, and they frequently make investigators sign contracts that give the drug companies control over the data and publication of results. They suppres unfavorable information, and design trials so as to show their products in the most favorable light -- as by comparing them with alternatives they already know are not the best available, limiting trial subjects to people with comparatively low risk of adverse effects, limiting the length of follow up, etc.

This system needs to be radically redesigned, to serve the public interest rather than the profit interest of manufacturers of proprietary drugs. We'll discuss some options here in the days ahead.

Why read the book . . .

when you can read the review?

And why read the review, when you can come here? Crusading docs Steffi Woolhandler and David Himmelstein, in the new JAMA, review "Uninsured in America: Life and Death in the Land of Opportunity," by Susan Starr Sered and Rushika Fernandopulle (U. of Cal. Press).

As you already are sick of hearing, if you've visited here before, we keep seeing the number of uninsured Americans go up, year after year. Steffi and David review the retrograde politics of the problem: Harry Truman called for national health insurance; Richard M. Nixon, not known as a socialist, called for universal coverage through employer mandates; the Clintons tried to create a byzantine, incomprehensible monstrosity in order to achieve something close to universal health care without having to call it a government program. Today, the Democratic Party's champion John Kerry is way out there on the radical left by wanting to expand Medicaid to cover a few more poor kids.

Today in the culture of life, according to the Institute of Medicine, 18,000 adults die every year because they are uninsured. Yawn. To quote Steffi and David (they wont' mind):

Sered and Fernandopulle's book is an effort to reawaken outrage, to restore the tears that are too often wiped away as people are transformed into statistics. The authors, an anthropologist and a health policy expert, journeyed around the United States interviewing the uninsured and recording their stories.

The suffering is legion, washing over the reader in chapter after chapter of ruined bodies, financial disaster, and families pulled into an inexorable downward spiral—what the authors label a “death spiral.” Even temporary gaps in coverage often breed disability, eg, from untended fractures, untreated psychiatric disease, preventable cardiovascular events, or dental disease, compromising future employability. In some cases a brief spell of bad luck snowballs into a lifetime of disaster, as for a middle class woman whose divorce and consequent lapse in coverage coincided with the discovery of a breast cancer. The case studies are varied: 20-somethings recently dropped from their parents' policies; self-employed carpenters, acupuncturists, even dentists who find coverage hard to come by; factory workers forced off their jobs and out of their coverage by illness or the need to care for a sick family member.

As the docs point out, we squander $300 billion every year on adminstrative costs which are principally directed at denying care and extracting profits. Gosh, with that kind of money, we could even afford to invade and occupy Iraq, which would be a better deal because we could easily kill 5 times as many people. Oh wait, we're already doing that too.

Doing the wrong thing for the right reasons?

The military is having a recruitment crisis for the obvious reason that young people today wish to retain their body parts.

Kos, who is a veteran, is missing the good old days when poor, minority kids like him had a way up and out by joining the army. Indeed, the U.S. military since the days of Harry Truman has ranged far ahead of the rest of our society in combatting racial and ethnic discrimination and operating as a true meritocracy, albeit using a definition of merit that I wouldn't particularly like to see applied elsewhere. It should give us pause that the most prominent minority soldiers and ex-soldiers in the U.S. include such people as Colin Powell (whose ethic of obedience trumped all other considerations of conscience), Ricardo Sanchez (who presided over Torture, Incorporated in Iraq) and Samurai Surgeon General Richard Carmona who considers most sickness to be a result of personal moral failure. (Of course, the military continues to discriminate against women and homosexuals.)

But I also had this to say in response to Kos.

It's also sad when the only opportunity available to many of our young people is the military.

I have to say, there is simply no good reason for the United States to maintain a military even 1/4 as large as we have now. U.S. military spending is nearly as much as that of the rest of the world put together -- and we have no meaningful national enemies at all. The military has very little, if anything, to do with protecting citizens against the kinds of attacks that non-state actors such as Islamic jihadists or Christian fundamentalist fanatics have undertaken. The military we have now is not intended to defend the country, it is intended to project power into the world on behalf of corporate interests.

Rather than being nostalgic for the good old days when a poor kid could join the army as a way up and out, let's have:

• Universal access to higher education, not just for children of the affluent;
• A full employment economy and a guaranteed living wage;
• Safe workplaces;
• Universal health care;
• Affordable child care;
• Investment in sustainable energy and environmental protection;
• High quality, affordable mass transit;
• National investment in culture and in basic science;
• And all the other policies that will create real opportunity for everybody.

The money we are squandering today on the military is more than enough to do all of that, and if we repeal Bush's tax cuts for the wealthy, we can assure the future of social security and Medicare as well.

Remember when this website, The Cost of War, was in the news? The worse the news from Iraq gets, the less we seem to talk about the dollar cost. Those dollars also represent human lives, and the quality of human lives, that we are sacrificing on the altar of Mars.

Demilitarize. Build the great society.

Beyond Anger

Can the United States sink to yet lower depths of disgrace and shame? Now that Amnesty International has called upon governments throughout the world to prosecute the U.S. officials responsible for systematic torture in military gulags, can we anticipate seeing George W. Bush and Donald Rumsfeld in the dock at a Nuremberg style trial in, say, Nuremberg?

George Annas, writing last week in the New England Journal of Medicine, makes it clear where the legal and moral responsibility lie for these atrocities, although he does not fully spell it out. Annas writes, "The road to torture at Abu Ghraib begins arguably with the president's decision in February 2002 that the Geneva Conventions would not apply to 'enemy combatants' jailed at Guantanamo Bay. This decision was made over the strong objections of . .. Colin Powell and without any meaningful input from career lawyers in the armed services. . . . The reasons [sic] given for taking prisoners to Guantanamo was that the global war on terror was a 'new kind of war' that made the Geneva Conventions inapplicable and that Guantamo . . . should be used as an interrogation center . . . that was outside the jurisdiction and . . . oversight of U.S. Courts."

The administration decided that the Constitution and international law were inapplicable in Guantanamo, and Rumsfeld specifically approved torture methods to be used there. What particularly interests Annas, and what is most relevant for this site, is the involvement of physicians in torture practiced by the United States in Cuba, Afghanistan, and Iraq. Rumsfeld's directive specifically said that prisoners must be medically cleared before they were tortured.

Annas doesn't specifically say so, but military physicians are known to have taken part in torture in all three countries, by certifying that prisoners could survive proposed torture techniques, by failing to report torture, and by failing to provide appropriate medical care and pain relief to torture victims. In a case recently exposed by an Army criminal investigation reported in the New York Times, physicians in Afghanistan were evidently mistaken, and two prisoners -- both, if it matters, apparently entirely innocent -- died under torture.

The Bush administration's moral values have corrupted the military, the State Department, and the intelligence services, as well as our public discourse and politics. They have also corrupted members of the medical profession. I would hope that the identities of physicians who have participated in war crimes will be made known, and if the authorities refuse to prosecute them, at the very least state licensing authorities will not allow them to practice medicine any longer. That seems an anticlimactic way to end this post, but unfortunately I cannot be very hopeful that the persons most reponsible -- including the strutting, self-adoring, morally depraved fool who occupies the presidency -- will ever be made to answer.

More News That Isn't Fit to Print

Okay, how many of you already knew that there is a conference going on at the UN right now to review the status of the nuclear Non-Proliferation Treaty? Hands please! That's what I thought.

According to Louis Charboneau of Reuters, "The United States spent the first two weeks of the conference quietly seeking to block discussions of nuclear disarmament-related commitments and decisions reached at the 1995 and 2000 NPT review conferences."

Gee, that's funny. During the 2000 presidential campaign, the current White House occupant called for unilateral reductions in the U.S. nuclear arsenal. According to Newsweek (June 25, 2001), Bush was "stunned" when he was told in May of that year about the size of the U.S. nuclear arsenal. "I had no idea we had so many weapons," he said.

How many? The U.S. currently has about 5,400 nuclear warheads on intercontinental ballistic missiles, both land and sea based; 1,750 nuclear warheads loaded or ready to be loaded on B-2 and B-52 bombers; and 1,670 nuclear warheads classified as "tactical." Surprising as that was to C. Bananas at the time, it now appears he has decided that it just isn't enough after all. He has drastically increased spending on nuclear weapons related research and, oh yes, production. Current spending by the United States on nuclear weapons is now over $6 billion a year. In the Clinton administration, it was about half as much -- and that's adjusted for inflation. One project which has gotten some attention is development of new "earth penetrating" nukes to take out underground bunkers, but there's a lot more going on the corporate media apparently doesn't think you need to know, including a renewed effort to produce tritium for hydrogen bombs. (Fred Kaplan in Slate reviewed the administration's nuclear "posture" and plans about a year ago. Nothing has changed.)

It takes a self-confessed war criminal to tell it like it is. Former U.S. Secretary of Defense Robert McNamara told the invisible NPT conference, "If I were to characterize U.S. and NATO nuclear policies in one sentence, I would say that they are immoral, illegal, militarily unnecessary, very, very dangerous in termsof the risk of inadvertent or accidental launch and destructive of the non-proliferation regime that has served us so well."

Now why on earth should Iran not have a right to develop nuclear weapons when it's perfectly okay for the United States, Russia, Israel, Pakistan, India, France, China and the UK to have them -- and for the U.S. to have more than enough of them to destroy all of civilization, and to be aggressively building more and developing new kinds? And why exactly do we need, or want, these weapons? I can't even think of a plausible lie that could explain it.

I know I don't have to tell anybody who comes here about the effects of a nuclear explosion, the ultimate public health disaster.

Culture of Life! Save the blastocysts! Protect the brain dead!

Tell it to God

Astonishingly, over the objections of James "Savanarola" Dobson and his corps of homosexuality detection experts and ninja bodyguards of the blastocyst, the House has voted to ease restrictions on federally funded embryonic stem cell research. Promising to veto the bill, "President" cuckoo bananas says "there is no such thing as a surplus embryo."

I know that scientific knowledge, including arithmetic, is all a satanic plot, but here's what Satan wants you to know about human embryos. The cell that results from the fusion of sperm and ovum is called a zygote. According to the Book of Falwell (a long-lost sixth book of the Torah, recently discovered but evidently having the authentic signature and hard to counterfeit hologram proving that it was indeed written by G. Almighty himself) the Zygote is a Human Being Whose Life Is Sacred.

There's bad news, however. Out of 100 zygotes, about 50 fail to implant in the uterus and uhh, well, there goes a Sacred Human Life down the toilet after the Koran. (Sorry, I retract that.) Of the remaining 50, 30% (that's 15, according to the Satanic Laws of Arithmetic) are simply sloughed off in what appears to be a normal, perhaps late, menstrual cycle and the woman probably will never know that she was preganant. The remaining 35 embryos will last at least 35 days, after which pregnancy may be recognized. Of these, 25% will die in utero, perhaps recognized as a miscarriage. That leaves about 26 of the original 100 zygotes unslain by G. Almighty.

Now that is one hell of a prolific baby murderer.

Perverted Press Priorities

Would you like to know what the really big news is in Massachusetts right now? It was the lead story on every local TV news show last night, with multiple location shots and interviews. It was on the front page of the Boston Globule with a jump to almost a half page inside, featuring interviews with public health officials in two states, and multiple physicians.

Okay, here goes. Three people who received organ transplants from a single donor died from a virus, which the donor had contracted from a pet hamster. This virus (called lymphocytic choriomeningitis virus, LCMV, in case you're interested) is commonplace. It mostly infects rodents but humans can get it. It causes a mild, transient illness, or no symptoms at all. Transplant recipients take powerful immunosuppressive drugs, however, which is why these people died from what is ordinarily nothing more than a nuisance pathogen.

Now, I suppose there is some public interest in this story. It's slightly educational. But what does it mean to us?

• Does it mean we should immediately get rid of our pet hamsters? No, there is no news here whatsoever about pet hamsters or any other kind of pet. This virus has always been around and it has always been a non-problem. It still is.
• Does it in any way change our calculation about whether we should get an organ transplant? No, organ transplantation has always entailed a risk that some sort of pathogen will stow away on the grafts. This incident is not unique and provides no new information about the risk/benefit analysis of organ transplantation.

So why is this the biggest story in New England today? A couple of years ago West Nile Virus was discovered in the U.S. WNV also causes either no symptoms, or mild and transient symptoms in most people. Occasionally, people who are immunocompromised or extremely debilitated will have more severe illness or die from WNV. However, their risk of dying from influenza is thousands of times greater, and more generally, for people in that condition, if WNV doesn't get them something else will.

Yet for a period of more than three months, every time a human being, anywhere in the United States, was diagnosed with WNV, there was a news story about it in the Globe. The Boston Public Health Commission, responding to the public hysteria, drove trucks through the streets of my neighborhood spraying an organochlorine nerve toxin into the air, killing every insect from the ground to 30 feet or more above it, every garden snail and every frog, snake and toad in the park, just in case there were any infected mosquitoes around.

Should the average person worry about LCMV, or WNV? Absolutely not. You should be concerned about keeping your cutting board clean and your refrigerator cold, but cases of home-cooked food poisoning never make the front page of the Boston Globe or Fox News at 10. And as a citizen concerned about public health policy, you should be concerned about the bird flu and Medicaid, which we have not been reading about in the Globule or hearing about on the News at 10. But this incident, tragic as it is for 3 people and their significant others, is of essentially no public policy concern whatsoever.

Why are we given this distorted image of the world? I have my own thoughts, I'd love to hear yours.

A Million Monkeys . . .

Check this out:

Postmodernism generator

Warning: Don't jump to any conclusions about what you are reading till you get to the bottom of the page.