Bonus Critter Blogging: Whooping Crane

(Photograph by Klaus Nigge, National Geographic, and published at National Geographic.)

More Than A Bandaid

The New York Times has a a compelling article on a typical evening at one Department of Veterans Affairs suicide hot line. It's sobering to see how active that call room is on any given night. It's also chilling. Suicide hot lines are by definition the last resort for those who are almost but not quite ready to end the suffering. That this particular unit is so busy indicates that our veterans are still not getting the help they need and deserve after their service.

Though suicides among active-duty service members are carefully tracked — they hit a one-month record, 32, in June — no reliable data exists for suicides by veterans.

But estimates, while not universally accepted, seem alarming. According to the Centers for Disease Control and Prevention, veterans account for about one in five of the more than 30,000 suicides committed in the United States each year.

Under growing pressure from veterans groups and Congress, the Veterans Affairs Department in recent years has hired more than 5,000 therapists and counselors and established a system of suicide prevention coordinators at more than 150 medical centers. [Emphasis added]

As the article points out, such hot lines too often are a kind of bandaid which merely covers a long-festering wound, one that should have been diagnosed and treated much, much earlier. Still, it's something which frequently works in both the short and the long term. For some of those who make that last call it works as a gateway to services which are finally available to those with the hidden injuries.

Perhaps if those services had been available a decade ago, that little call center in central New York wouldn't have been quite so busy. And perhaps if the military had gotten out of Patton-think and recognized post traumatic stress disorder as an injury as devastating as a blown-off limb, it wouldn't have been necessary at all. But neither happened, so it is, and that little call center and all those like it will remain busy.

OF course, if our leaders weren't so cavalier about starting wars whenever they feel the nation's pride is suffering or whenever the military industrial complex decides it needs a boost in government money, maybe those call centers wouldn't be necessary at all.

But, then, I suppose that's asking for too much.

Friday Cat Blogging

Just Say No

The Republican party continues to thwart any meaningful legislation that they can, even legislation that would help business, a constituency they claim as their own. In a vote on a bill which would help out small businesses by providing government-guaranteed loans and some tax breaks, a bill that is backed by the US Chamber of Commerce, not one Republican crossed the aisle to move the bill forward.

From the New York Times:

Senate Republicans on Thursday rejected a bill to aid small businesses with expanded loan programs and tax breaks, in a procedural blockade that underscored how fiercely determined the party’s leaders are to deny Democrats any further legislative accomplishments ahead of November’s midterm elections.

The measure, championed by Senator Mary L. Landrieu, Democrat of Louisiana, had the backing of some of the Republican Party’s most reliable business allies, including the United States Chamber of Commerce and the National Federation of Independent Business. Several Republican lawmakers also helped write it.

But Republican leaders filibustered after fighting for days with Democrats over the number of amendments they would be able to offer. A last-ditch offer by Democrats to allow three was refused by the Republican leader, Mitch McConnell of Kentucky. [Emphasis added]

Adding amendments to a bill is a long-established, if lamentable, part of the sausage making process in Congress. Both parties know this, and both parties engage in it. That part of the process might be justified if the amendments bore some kind of relationship to the subject of the bill, but that is too often not the case, and it certainly is not the case here. Democrats decided they could live with three of the amendments because, with a little creative thinking, three of them did have a tangential connection:

The three Republican amendments that Democrats seemed open to debating would eliminate a provision in the new health care law requiring businesses to file 1099 forms reporting when they buy more than $600 in goods from other businesses, extend a tax credit for biodiesel fuel and extend a credit for research and development.

But that wasn't good enough for the GOP. Rather than pass a bill that would help out small businesses, a group Republicans always claims is "the engine that drives our economy", Republicans wanted more. Much more.

Republicans had also wanted amendments on other topics, including the estate tax, nuclear loan guarantees, border security and the expiring Bush tax cuts.

It's not difficult to see what the GOP is engaging in: extortion. Americans don't mind if the tax cuts for the wealthiest expire. In fact, if that happens, the burgeoning deficit which seems to bother some folks might be reduced a bit. The Republicans know that a bill which would extend those tax cuts wouldn't be introduced by the Democrats, and would anger the public if they tried to introduce it. The same goes for the estate taxes, which at the present favor only the super wealthy. Consequently, the Republicans wanted to use the poorly lit back door to keep their donors happy.

And, just as importantly, it's an election year. The Democrats have managed to pass some major legislation, as hackneyed and insufficient as it is. The Republicans didn't want another arrow added to the Democratic quiver. That fact is so clear that the reporter who has the byline on the article, David M. Herszenhorn, embedded it in the story's lede.

Once again, getting re-elected and getting the power back is all that matters to those yahoos. It's nice our press is finally willing to point that out, even if only occasionally. Now it's time for the Democrats to acknowledge that fact and to trumpet it.

It's Back

Yesterday, California Governor Arnold Schwarzenegger announced that state workers would once again be forced to take three days a month off without pay. The governor declared a fiscal emergency, which allows for the cut in pay and services, after the state treasurer announced that he would have to start issuing IOUs because of a cash shortage.

This would almost sound reasonable and necessary if it weren't for the fact that the involuntary furlough program ordered by the governor would last only until he was given a budget he could sign and for the fact that it primarily only affects workers whose unions didn't sign new agreements reducing pension benefits for their newest members.

From the Los Angeles Times:

More than 150,000 California state workers will again face unpaid furloughs, beginning in August, after Gov. Arnold Schwarzenegger on Wednesday declared a financial state of emergency and ordered them to take three days off per month.

Starting the second Friday in August, much of California's government, including Department of Motor Vehicles offices, will be shuttered three times a month at least until a state budget is in place. ...

The governor's order exempted tens of thousands of workers whose unions have struck tentative labor contracts with his administration. Those deals include cutbacks in pension benefits and other concessions.

Al Groh, executive director of the Union of American Physicians and Dentists, said avoiding the new furloughs was a major reason his union made recent contract compromises.

"It's one less anxiety for our members," he said of the union's 1,800 state employees.

Groh said the new furlough order was Schwarzenegger's attempt to push more unions into similar givebacks.

"That's the way he does business," Groh said. "He leverages people very strongly."

Al Groh should get the award for "Understatement of the Year." He should also be in the running for "Spineless Union Leader of the Decade."

And the Governator?

Well, let's just say that he's in a class of his own.

Powerful Secrets

Professor Erwin Chemerinsky, Dean of the UC Irvine Law School, has an important essay in the Los Angeles Times today which examines the uproar over the publication of tens of thousands hitherto classifed documents concerning the US prosecution of the war in Afghanistan. In that essay, he examines the striking parallels between the Wikileaks exposure of government documents and the Pentagon Papers, and concludes that the current hand wringing of government officials is not really over national security.

The most important lesson from the release of tens of thousands of pages of classified information about the war in Afghanistan seems to be getting lost: Far too much information is classified, often simply because it is embarrassing to the government. White House Press Secretary Robert Gibbs said that there "weren't any new revelations in the material,"and nothing has been identified that is likely to be damaging to national security. The question, then, must be why so much of this material was classified and kept from the public? ...

The Nixon administration vehemently opposed the release of the Pentagon Papers even though the documents were largely historical material about what occurred during prior presidencies. The Obama administration has decried the release of the information about the war in Afghanistan even though it appears to be primarily about what happened during the George W. Bush presidency. The reason is the same in both cases: The administrations feared that the disclosures would undermine public support for the wars in question. In both instances, the concern was that the revelations might make it harder to gain continued congressional support and to sustain public support for the war effort. [Emphasis added]

In the Wikileaks case, it almost worked. In fact, to some extent it did work: yesterday's vote in the House on the "emergency appropriation" for continued funding of the war in Afghanistan was far closer than it would have been as some Democrats who know that the public is growing weary of perpetual war were given some cover by the revelations and voted against the appropriation bill.

But the undue government classification of matters as secret for national security purposes does more than shape policy, it hides both embarrassing mistakes made by the government and outright criminal activity engaged in by the government. If it weren't for publication of materials on what was going on at black prisons run by the CIA and the military and on the incredible domestic spying program being run by the NSA, those activities might have continued unabated and even expanded.

Professor Chemerinsky's conclusion is one that our government, our free press, and we-the-people should always keep in mind:

The free flow of information, at times, may be embarrassing to the government and may keep it from pursuing its desired policies. But that is exactly why it is so important in a democratic society.

Yet Another Fine Mess

Get our your checkbook, folks. A report by a Special Inspector General indicates that billions of dollars of Iraqi oil revenue has been "lost" by the Pentagon, according to the Los Angeles Times.

The Defense Department is unable to properly account for $8.7 billion out of $9.1 billion in Iraqi oil revenue entrusted to it between 2004 and 2007, according to a newly released audit that underscores a pattern of poor record-keeping during the war.

Of that amount, the military failed to provide any records at all for $2.6 billion in purported reconstruction expenditure, says the report by the Special Inspector General for Iraq Reconstruction, which is responsible for monitoring U.S. spending in Iraq. The rest of the money was not properly deposited in special accounts as required under Treasury Department rules, making it difficult to trace how it was spent.

The US justified taking the money from the Iraqi oil revenue during a period when the Iraqi government was too weak and ineffectual to run a reasonable reconstruction program after we bombed the infrastructure for delivering such necessities as water and electricity into the dust, thereby making the Iraqi government weak and ineffectual. When investigators uncovered fraud and mismanagement of those funds by the Pentagon back in 2003, a new system was put in place to avoid any further problems. Apparently the Pentagon simply ignored the new requirements.

Keep in mind that this wasn't the US taxpayers' money that was pissed away, it was money that belonged to the Iraqi people. They're going to want it back, as well they should. At that point it's going to become US taxpayers' money.

I say we cut the Pentagon's budget by exactly that much. Let them run a bake sale to fund the next weapons system.

Some Good News

In the past month I've followed the stories on Avandia, the GlaxoSmithKlein glucose lowering drug for Type 2 diabetics (the last one is here). The drug is effective at lowering blood glucose, but it comes with the increased risk for heart disease, heart attack, and stroke. The manufacturer knew this from the start, but kept that part of the drug information quiet until the deaths began to mount and investigators began looking into the potential link.

That shouldn't have happened. Now, an international agreement to prevent drug companies from keeping unflattering results of clinical trials secret has emerged, and that's very good news.

From an editorial in today's Boston Globe:

LURKING BENEATH some of the biggest prescription drug scandals of our time is the specter of unflattering data that was known to pharmaceutical companies and could have revealed problems sooner had it been made public. Now, an international federation of drug manufacturers, whose members include the industry’s main players, has pledged to submit most clinical trial results for publication in peer-reviewed journals, whether the outcome is positive or negative.

This step should inject transparency into the now-murky process of data disclosure. But it will work only if there is a concerted effort by companies, journals, and regulators to ensure that all trials are published, and in a timely manner. Disclosure of unflattering data doesn’t just provide a fuller picture of how useful and safe a drug might be in treating a given medical condition; it also provides some guidance to researchers studying similar drugs and similar illnesses.

There will be some obstacles to overcome in the introduction of the new protocol. The most obvious one will be to get the journals to publish the results after a careful peer review process. There are only so many medical and scientific journals on the market, and timeliness is the key to this agreement. However, if there needs to be more journals, this agreement just might call them into existence.

But the regulators at the FDA and other federal agencies will also have to do their part in the process. They will have to put aside their rubber stamps of approval and actually do their job, checking to make sure the studies say what the applications claim they say. Regulators will actually have to read the reports of the studies and they will have to make certain that the studies have been published and reviewed by their peers.

If both obstacles are erased by the diligence the new agreement mandates, there will be no more Vioxx and Avandia scandals. Patients and their doctors will be able to make informed choices in treatment options. We'll all be better off.

This time it looks like the pharmaceutical companies have gotten it right.

It's about time.

Sunday Poetry: Octavio Paz

Brotherhood


I am a man: little do I last
and the night is enormous.
But I look up:
the stars write.
Unknowing I understand:
I too am written,
and at this very moment
someone spells me out.

--Octavio Paz

Another Fine Mess

So, what does an army do when it exits another country after pounding it into the dirt? Just go, leaving all the destruction and the base garbage for the conquered nation to deal with?

Oh, no, no, NO! We are being reassured by the military that the troops are busy cleaning up all the hazardous waste it can find in Iraq, labeling it properly, and shipping it out.

Where it's being shipped to exactly is not made clear in this McClatchy DC article (originally written for the Christian Science Monitor with whom McClatchy has an agreement), but what is clear is that the Pentagon got riled by some articles in the world press alleging the US was ignoring the mess it had made, some of it containing hazardous chemicals and materials. So it invited folks from the press and the appropriate agencies of the Iraqi government to tour one of its state of the art disposal facilities in Tikrit.

American commanders in Iraq are working to demonstrate that they are clearing the country of tens of millions of pounds of U.S.-made hazardous waste in an effort to rebut claims that U.S. troops are leaving behind a toxic legacy as they withdraw.

Hundreds of barrels of all types and all colors — filled with everything from discarded lithium batteries and oil filters to powerful chemicals such as hydrochloric acid — are stacked in a dusty compound on a U.S. base at Tikrit, north of Baghdad.

This and a sister facility on another base have so far processed 32 million pounds of "regulated" waste — more than half of it soil contaminated with petroleum products. The material has been decontaminated, crushed or shredded, and then sold as scrap in Iraq, or recycled and shipped abroad. [Emphasis added]

I have to admit that's a pretty impressive undertaking, and I also have to admit that I am glad to see it. What I don't see in the article is the reprocessing of dirt loaded with lead from bullets and shells from their practice ranges or battle sites, but then the military hasn't been real good about voluntarily cleaning the lead out of US bases that were closed, so I guess I shouldn't be surprised.

Nor was their any mention of removing unexploded ordinance (such as cluster bomblets) or nuclear tipped ordinance from the fields of Iraq. Properly disposing of unused paint and paint thinner is nice, but in the long run Iraqi kids are going to lose more limbs from our left behind shells.

But here's the fun part: our military admits that some of the problems are caused by their civilian pals, the contractors. Check out this admission from an officer charged to clean up the mess:

Reports of "regulated waste being left all over the countryside" also prompted the U.S. military to investigate — and then to counter the claims, said Army Brig. Gen. Kendall Cox, the U.S. commander in charge of engineering in Iraq.

"The intent was to insure, through the media ... there's a clear understanding that we are taking every measure possible ... to protect the environment and treat all regulated waste and materials appropriately," he said.

"We have a very systematic process in place to receive materials, treat them and dispose of them properly," he added. "We haven't identified any problems with our processes. What we did identify is potentially there are contractors who aren't dealing with their regulated waste properly." [Emphasis added]

What a surprise, eh?

So, the war is winding down, another 20,000 US troops are scheduled to leave in the reasonably near future (leaving around 50,000 others), and the US is scurrying to clean up one inevitable part of war: the environmental disaster.

Well, sorta. Kinda.

Sunday Funnies

(Political cartoon by Kevin Siers / The Charlotte Observer (July 20, 2010) and featured at McClatchy DC. Click on image to enlarge.)

Bonus Critter Blogging: Green Sea Turtle

(Photograph by Tim Laman and published at National Geographic.)

Dammed Information

Yesterday, McClatchy DC featured a commentary written by Edward Wasserman for the Miami Herald on the continuation by the Obama administration of one of the Bush administration's most egregious faults: the control of information provided to the public. For all of his promises of a more transparent government, Barack Obama has not only embraced the Bush tactics of managing the flow of information, he has, in some instances, extended it.

In at least one area of political life the spirit of bipartisanship is strong, and the Obama administration has picked up pretty much where the Bush team left off.

That's in the realm of information control: treating the news media like a pestilence, using secrecy rules to stem inconvenient disclosures, ducking informed scrutiny in favor of staged encounters, punishing unauthorized leaks vigorously and generally regarding publicly significant information as something officials are entitled to handle as a political resource of their very own.

Wasserman provides a list of examples, including one that has to rank right up there with the worst of those from the Bush-Cheney administration for being downright stupid:

...is national security really at stake in the prosecution of a former senior National Security Agency official named Thomas Drake? He was indicted in April for leaking classified information to a Baltimore Sun reporter about several big NSA programs that, as The New York Times reported, "were plagued with technical flaws and cost overruns."

Surely secrecy laws aren't being applied to save face, are they?

Good question.

The answer probably explains why several journalists have been banned from Guantanamo Bay for doing their job too well and why the administration is only too happy to exclude reporters from coverage of the Gulf oil spill and its clean-up under threat of huge fines and imprisonment.

Yet the American press has been rather reticent to complain about the obstruction, something which Mr. Wasserman notes, but partially excuses. It is as if journalists became so accustomed to being used as stenographers for eight years that they've settled into continuing that role for at least another eight. It's the path of least resistance, even if it does mark a profound betrayal of the goals of a free press.

That said, however, at least Wasserman has noted the problem:

So the governmental overreaching continues. The temptation among those in power is to view themselves as the owners of public information when they are, in fact, only its custodians, and their job is to ensure its free flow. Obama pledged to roll back some of the harsher strictures of the Bush years, and it's a promise he has yet to deliver on.

Now, if only the press would push back we might get somewhere.

Friday Cat Blogging

Lies, Damned Lies, And Polls

George Skelton has an interesting column in the Los Angeles Times today. After reviewing the latest Field Poll he concludes that Barbara Boxer is in a tough race with Carly Fiorina for the senate seat Boxer has held for a long time, primarily because the electorate in California has been hit with anti-incumbent fever.

But this, of course, is not a normal election year. Voters either are struggling financially or are worried they soon could be. California unemployment is hanging above 12%.

It's possible that stands on so-called social issues, even abortion, will not provide the litmus tests for voters that they did in Boxer's past reelection snoozers.

The three-term incumbent faces her toughest fight since she first was elected to the Senate from the House of Representatives in 1992 over conservative commentator Bruce Herschensohn. That was "the year of the woman." This is the year of the grump.

The latest Field Poll shows Boxer with a narrow lead, 47% to 44%, a tiny gain since March.

Fiorina, who out-conservatived her opponents in the GOP primary, hasn't moved from that stance: she is still a "proud pro-life conservative," one who would allow abortion only in cases of rape, incest, or when the life of the mother is at risk. That stance is hardly one that should resonate in California. The poll numbers Skelton references throughout his column, however, indicates that no single progressive issue will be determinative in this election because the economy in general, and unemployment in particular, is what concerns the voters.

That being said, Skelton then proceeds to outline the differences in the candidates, and by doing so signals to the Boxer campaign what he thinks should be its focus:

If voters look beneath the superficial slogans and sound bites, they will see that the two candidates do hold sharply contrasting views.

Fiorina supports more offshore oil drilling, the Iraq war, the Bush tax cuts for the wealthy and Arizona's new law targeting illegal immigrants. Boxer opposes all.

Boxer favors a national ban on assault weapons, the president's timetable for troop withdrawal in Afghanistan, the federal stimulus package and California's anti-global-warming program to curb greenhouse gases. Fiorina opposes all.

If Sen. Boxer doesn't start running on those issues, and doesn't point out the outsourcing that went on at Hewlett-Packard during Fiorina's reign as CEO (a job from which she was fired), those poll numbers are going to stay close.

Congress will take its summer recess shortly, so Sen. Boxer can concentrate on the race. She might want to take a close look at Mr. Skelton's column when doing so.

And she just might want to send the columnist a thank-you note. He's done her a big favor by publishing the column.

Landing On Their Access

For some, government work is a sweet gig: work for a couple of years as a congress critter, aide, or civil servant and then leapfrog into a high paying lobbying job for such organizations as those representing the oil industry. Today's Washington Post details just how government grooms people for the promotion:

Three out of every four lobbyists who represent oil and gas companies previously worked in the federal government, a proportion that far exceeds the usual revolving-door standards on Capitol Hill, a Washington Post analysis shows.

Key lobbying hires include 18 former members of Congress and dozens of former presidential appointees. For other senior management positions, the industry employs two former directors of the Minerals Management Service, the since-renamed agency that regulates the industry, and several top officials from the Bush White House. Federal inspectors once assigned to monitor oil drilling in the Gulf of Mexico have landed jobs with the companies they regulated.

The analogy that immediately comes to mind is that of a professional sports, with the government serving as the minor leagues training ground for many who move on to the high-paying big leagues. The sad part is that the system is being gamed by both sides of the aisle:

The analysis suggests the industry has focused on hiring former lawmakers from oil-producing states. Fifteen of the 18 former members of Congress who now lobby for oil and gas firms are from Texas, Louisiana, Mississippi, Oklahoma or Kansas.

Dozens more previously worked as aides to lawmakers from those states. At least three industry lobbyists, for example, previously worked for Sen. Mary Landrieu (D-La.), an outspoken critic of President Obama's oil-drilling moratorium in the gulf.

The article mentions some of these movers as collecting from their future employers even while still in the minor leagues, listing a couple who've been busted for their larceny.

As outrageous as this seems, it gets worse. The door between the government and the oil companies has long swung both ways, with the most successful in the private sector able to return to government in powerful policy making slots, thereby greasing the appointee's return to the private sector.

There's something dreadfully wrong with this picture.

Not The Worst Person In The World

Sen. Chuck Grassley (R-Iowa) may be lock stepping with his party on almost everything else, but when it comes to investigating the unseemly connection between doctors and pharmaceutical companies and medical equipment manufacturers, he has done the country a great service. He has managed to rein in even prestigious medical schools when it comes to shilling for drugs and medical devices by doctors, as this Boston Globe article makes clear. His work is beginning to bear some fruit:

Harvard Medical School will prohibit its 11,000 faculty from giving promotional talks for drug and medical device makers and accepting personal gifts, travel, or meals, under a new policy intended partly to guard against companies’ use of Harvard’s prestige to market their products.

The conflict-of-interest rules also place stricter limits on the income faculty can earn from companies for consulting, joining boards, and other work; require public reporting of payments of at least $5,000 on a medical school website; and promise more robust internal reporting and monitoring of these relationships.

This is a key announcement. While other medical schools and major hospitals have been developing new ethical guidelines for doctors in the face of Sen. Grassley's congressional investigation, Harvard's program will garner a lot of attention and many plans will be tightened up even further to keep pace.

The Harvard program doesn't ban its medical personnel from participating in research in conjunction with drug companies, nor does it ban them from serving on advisory panels for those companies, and understandably so. Patients benefit from such work, if done honestly and openly. The trick will be in the implementation and enforcement of the new rules, so Sen. Grassley's work is not over.

Still, my hat is off to the Iowa Republican. He's done a good job, one that transcends politics as usual. I also tip my beret to the Boston Globe, which has provided a remarkable series of articles over the past several years examining the payola doctors have received from the drug and device companies and detailing the lack of guidelines in the connections between those companies and doctors, hospitals, and medical schools.

Sometimes the system works.

The Message, Not The Messenger

I hardly expected an opinion piece in support of trying alleged terrorists in civilian courts rather by military commissions to be written by Sen. Dianne Feinstein (D-CA), yet that's just what I found in today's Los Angeles Times. Sen. Feinstein is not exactly the most liberal of Democrats, yet even she is aware of the success stories from the federal court system.

After noting the recent guilty pleas from three men in three separate cases, the senator also recites the statistics on similar cases prosecuted in the civilian forum:

Swift guilty pleas and cooperation are hardly the stuff of a weak justice system. And it's important to note that cooperation happens often in federal criminal prosecutions, but not in military commissions. Terrorist conviction statistics, provided by the Justice Department's National Security Division, are impressive:

• By mid-March of this year, 403 terrorism suspects had been tried and convicted in federal district courts since the Sept. 11, 2001, attacks.

• Of these, 159 were convicted of Category I crimes — violations of federal statutes directly related to international terrorism.

• The other 244 were convicted of Category II crimes — violations of fraud, immigration, firearms, drugs and other statutes in cases with identified links to international terrorism.

A dozen of these convicted terrorists were sentenced to life in prison. One was sentenced to 155 years, and 18 others received sentences of 20 years or more.

The average sentence handed down to defendants charged with terrorism, between 2001 and 2009, is 19.7 years, according to the Center on Law and Security at New York University's School of Law.

And all of this happened in a venue bound by constitutional guarantees for the defendants, including the right to know what evidence will be introduced by the prosecution and the right to cross-examine witnesses produced by the prosecution, guarantees that don't exist in the dog-and-pony shows known as military commissions.

Fair trials don't weaken our national security, they enhance it. A dry recitation of the facts may not be as inspiring as a passionate appeal to the brilliance of the US Constitution, but it can be just as effective. It certainly was in this case.

And for that I am grateful to Sen. Feinstein.

Patience

Last week I posted on a new proposal for the diagnosis of Alzheimer's disease, one that will allow doctors to make that diagnosis earlier so that treatment can begin earlier. Later in the week, the New York Times reported what I consider to be equally important news with respect to that earlier treatment.

The article, while lengthy, is an excellent one. It details the history of the discovery of the disease and the ongoing research into its source and progressive nature. For that alone, the article deserves a close reading. However, it also provides an important view on the caution which the Food and Drug Administration is exercising with respect to current and future clinical trials being run by pharmaceutical companies with new drugs that are designed to combat the disease by slowing and eliminating the development of the amyloid plaque in the brain.

The reason for that caution is a good one: about 90% of researchers believe that the plaque tangles are not just a symptom of the disease but are rather the source for the destruction of brain cells leading to the loss of memory and the later horrific ravages of the disease which lead to death. That's the current scientific model for the disease, but it's not one which is universally accepted. What happens if it's wrong? What happens if the drugs currently being developed do in fact remove the amyloid plaque, but the disease is not affected? What happens if the drug's side effects are, in the long run, just as bad as the disease itself?

Dr. Russell Katz, director of the F.D.A.’s division of neurology products, is in a quandary about Alzheimer’s drugs. What, he must decide, should be the criteria for showing that a drug works?

Should the F.D.A. say it is sufficient to show that a treatment prevents or lessens the formation of plaque?

The agency is not ready to do that, Dr. Katz said.

“You only care if down the road the patient gets better,” Dr. Katz said. “What we are concerned about is approving a drug based on a lab test and being wrong about what happens to the patient clinically.”

With Alzheimer’s, Dr. Katz said, “the great fear is that maybe amyloid has nothing to do with the disease.” If that were the case, and the agency approved a drug that blocked amyloid formation, millions of healthy people could end up taking something useless or even dangerous. And because it takes so long for Alzheimer’s to develop, it could be decades, if ever, before anyone knew the drug did not work.

While nothing would make me happier than to have a new drug available in the next five years to fight Alzheimer's, a disease that has ravaged my family, I think Dr. Katz's caution is laudable. It doesn't mean that the drug makers should back off; what it does mean is that they will have to use the same caution and to exercise a little patience. And that's why the change in the diagnosis protocols for Alzheimer's was such a big deal. Researchers will be able to start the clinical trials earlier, giving the drugs a chance to prove their efficacy in removing the amyloid and in changing the course of the disease.

Patience is not my long suit, but I'm beginning to learn its importance.

Sunday Poetry: Marge Piercy

(I am just saying...)

The Low Road

What can they do
to you? Whatever they want.
They can set you up, they can
bust you, they can break your fingers, they can
burn your brain with electricity,
blur you with drugs till you
can't walk, can't remember, they can
take your child, wall up
your lover. They can do anything
you can't stop them
from doing. How can you stop
them? Alone, you can fight,
you can refuse, you can take what revenge you can
but they roll over you.

But two people fighting
back to back can cut through
a mob, a snake-dancing file
can break a cordon, an army
can meet an army.

Two people can keep each other
sane, can give support, conviction.
love, massage, hope, sex.
Three people are a delegation,
a committee, a wedge. With four
you can play bridge and start
an organization. With six
you can rent a whole house,
eat pie for dinner with no
seconds, and hold a fund raising party.
A dozen make a demonstration
A hundred fill a hall.
A thousand have solidarity and your own newsletter;
ten thousand, power and your own paper;
a hundred thousand, your own media;
ten million, your own country.

It goes on one at a time,
it starts when you care
to act, it starts when you do
it again after they said no,
it starts when you say We
and know who you mean, and each
day you mean one more.

--Marge Piercy

Sunday Funnies

(Political cartoon by Lee Judge / The Kansas City Star (July 16, 2010) and featured at McClatchy DC. Click on image to enlarge.)

Bonus Critter Blogging: Manta Ray

(Photograph by Michel Braunstein, My Shot, and published at National Geographic.)

Madness As Usual

Here we are, the third week in July, and once again California doesn't have a state budget. The state legislature and the Governator are still light years from reaching any kind of agreement, which in this state is hardly new news.

Last year, to "save costs", Arnold Schwarzenegger forced state employees into a 15% pay cut by mandating a 3 day a month furlough. That order expired at the end of the fiscal year (June 30). This year, the governor came up with a new plan: reduce state workers' pay to the federal minimum wage until a budget is passed and signed. He admits that the move won't actually save the state any money (workers would get their pay back once a budget is signed), but he wanted to bring pressure on the legislature to get a budget passed. He claims state law allows him to use state employees as a pawn in the budget battle, and, unfortunately, he may be right.

There's just one problem: the state controller claims that because of the outdated computer system he has to work with, the order cannot be implemented. Yesterday, a Sacramento Superior Court judge ruled that John Chiang's argument had some validity and blocked the implementation.

From the Los Angeles Times:

More than 200,000 state employees will receive their full wages in July and August after a state judge on Friday denied an injunction sought by Gov. Arnold Schwarzenegger to cut their pay.

The Schwarzenegger administration had asked the court to order that the employees' pay immediately be reduced to the federal minimum wage of $7.25 an hour because there is no state budget in place.

The governor has maintained, and two courts have agreed, that state law requires the reductions as California enters the third week of the fiscal year without a spending plan. But state Controller John Chiang, who prints the paychecks, has insisted that he cannot implement the order because of the state's outdated computer system.

Judge Patrick Marlette of Sacramento County Superior Court said that although Chiang was breaking state law by failing to issue the smaller paychecks, he could not discount the computer argument as "frivolous."

The judge's ruling gives both state employees and the state legislature a little breathing room, which is certainly welcome, but the issue still looms for most, but not all, state employees. You see, those unions which met with Schwarzenegger earlier in the process and agreed to reduce state pension contributions for new hires were exempt from the pay cut. So were state legislators and state officials. (That doesn't matter to the governor who is very proud of the fact that he accepts no salary from the state because he is so wealthy he can serve without pay.)

So it's back to the budget table for those who purport to govern our state. Legislators will go back to trying to find where to cut services and costs because raising taxes and cutting business subsidies are off the table. With state unemployment still in double digits, there is little hope that state revenue will rise in the forseeable future.

Dysfunction, thy name is California.

Friday Cat Blogging

Too Damned Hot To Blog

I had a somewhat delayed reaction to the heat which snuck up on us in Southern California. My brain is fried. If it weren't, I would no doubt have a few words to say about this op-ed piece about former attorney Lynne Stewart.

It's an outrageous column. Go read it and, if you're so inclined, leave a comment here.

Duelling Studies

The past few weeks I've been monitoring the news on Avandia, the glucose lowering drug for Type 2 diabetics produced by GlaxoSmithKline. The drug does indeed do a good job at lowering blood glucose, but it also has some nasty side-effects, including an increased risk for strokes, heart attacks, and heart failure in, according to some of the studies produced at an FDA advisory panel meeting, up to a third of those using the drug.

After reviewing the studies presented, that advisory panel sent a mixed recommendation to the FDA, which will make the final decision on the drug in the near future.

Faced with conflicting and less-than-conclusive scientific evidence, a Food and Drug Administration advisory panel recommended Wednesday that the controversial diabetes drug Avandia remain on the market — but with tighter supervision and increased warnings about the danger of heart attacks. ...

Reflecting the difficulty of balancing potential risks and benefits for individual patients, 10 members of the 33-member panel voted to keep Avandia on the market under close supervision, seven voted to permit continued marketing but with stronger label warnings, and three favored the status quo. One member abstained. Twelve members voted to remove the drug from the market.

What is so refreshing about the whole process is that this time it was played out in full view of the American public. Most, if not all, of the major newspapers covered the story. My brief and admittedly incomplete scan of today's editions shows that the Boston Globe, Los Angeles Times, New York Times, and Washington Post all had stories, columns, and/or editorials on Avandia. The Los Angeles Times and New York Times have been following the Avandia saga for quite a long time, given the usual short attention span of today's media.

And that coverage has had an effect: prescriptions written for Avandia have dropped over the past few years:

At the peak of its popularity in 2006, 13 million prescriptions were written, according to IMS Health, a pharmaceutical market research company. By 2009, the number had declined to about 2.6 million, the firm said. GlaxoSmithKline, the drug's maker, said about 550,000 Americans took medications containing Avandia in the last year.

Dr. Jacob Warman, chief of endocrinology at the Brooklyn Hospital Center in New York, said he expected use of the drug to drop further.

"There is so much negative press that lay people are going to say, 'Why are you giving that to me? Why don't you give me the other drug?' Doctors are not going to fight the patients," he said.

"It's not officially dead in the water, but practically speaking, it should be," he added.

In other words, the press has done its job, and done it well with respect to educating the public and offsetting the millions of dollars of pharmaceutical advertising.

Just as important, however, is the fact that the press has also brought some pressure to bear on the Food and Drug Administration. When it comes to Avandia, the FDA doesn't dare ignore the studies and recommendations from its own panel by simply rubber stamping the manufacturer's assertions of safety. Here's how an editorial in today's NY Times put it:

The clearest lesson to emerge from the hearings and other recent revelations is that GlaxoSmithKline, the maker of Avandia, can’t be trusted to report adverse clinical results fairly. The company must be watched like a hawk as additional trials that it sponsors go forward.

Bingo!

Another Step Down The Road

As cautiously as this NY Times article is phrased, I still got excited at the news that scientists and clinicians are considering changes in the way Alzheimer's is diagnosed. Technically speaking, up to this point the only time a formal diagnosis of the disease can be made is after death when an autopsy shows the tangled web in the brain known as plaque. That's not much help for the victims, and it certainly isn't much help for the researchers looking for ways to halt the progress of the disease. Now, thanks to advances in the ways we can look at the brain, the disease can be tracked far earlier, modifying ways we can actually treat the disease, and, hopefully someday, ameliorate the symptoms.

The current formal criteria for diagnosing Alzheimer’s require steadily progressing dementia — memory loss and an inability to carry out day-to-day activities, like dressing or bathing — along with a pathologist’s report of plaque and another abnormality, known as tangles, in the brain after death.

But researchers are now convinced that the disease is present a decade or more before dementia.

“Our thinking has changed dramatically,” said Dr. Paul Aisen, an Alzheimer’s researcher at the University of California, San Diego, and a member of one of the groups formulating the new guidelines. “We now view dementia as a late stage in the process.” ...

“Over all, I think this is a giant step in the right direction,” said Dr. P. Murali Doraiswamy, a psychiatry professor and Alzheimer’s disease researcher at Duke University who was not involved with making the guidelines. “It moves us closer to the cause of the disease rather than just looking at symptoms.” [Emphasis added]

Of course, one of the problems with the proposed changes under consideration is the expensive testing that will be required. The various types of brain scans which will be used are costly, but, then, so is the management of the disease in its end stages. Tracking the development of the disease at the early stages will enable researchers a more complete picture of just what is going on in the patient's brain, which should lead to more effective and earlier intervention.

Just as important, however, is that an earlier diagnosis gives the patient and the family of the patient an opportunity to make the plans necessary to cope with the progress of the disease as it takes its toll. Knowing, I have discovered, is much better than not knowing.

All things considered, I think this is good news.

One Of These Is Just Like The Other

Somebody must be spiking the NY Times's tea: for two days running, The Gray Lady has been taking some hard looks at how unrestrained capitalism operates these days. Today was even a two-fer: GlaxoSmithKline and BP were both examined in terms of their corporate mentality when it comes to safety.

First, a lengthy article which examines BP's history of calamitous failures caused by more attention being paid to the bottom line than to reducing risks.

Instead, the rig, which was supposed to produce about 20 percent of the gulf’s oil output, became a symbol of BP’s hubris. A valve installed backward had caused the vessel to flood during the hurricane, jeopardizing the project before any oil had even been pumped. Other problems, discovered later, included a welding job so shoddy that it left underwater pipelines brittle and full of cracks. ...

The problems at Thunder Horse were not an anomaly, but a warning that BP was taking too many risks and cutting corners in pursuit of growth and profits, according to analysts, competitors and former employees. Despite a catalog of crises and near misses in recent years, BP has been chronically unable or unwilling to learn from its mistakes, an examination of its record shows.

Second, an article which looks at when GlaxoSmithKline, then known as SmithKlineBeecham, learned of the increased risk of heart attacks in patients taking the new glucose-lowering drug Avandia:

In the fall of 1999, the drug giant SmithKline Beecham secretly began a study to find out if its diabetes medicine, Avandia, was safer for the heart than a competing pill, Actos, made by Takeda.

Avandia’s success was crucial to SmithKline, whose labs were otherwise all but barren of new products. But the study’s results, completed that same year, were disastrous. Not only was Avandia no better than Actos, but the study also provided clear signs that it was riskier to the heart.

But instead of publishing the results, the company spent the next 11 years trying to cover them up, according to documents recently obtained by The New York Times. The company did not post the results on its Web site or submit them to federal drug regulators, as is required in most cases by law.

The business of business is business. The business of government, however, is supposed to be governance, including the protection of citizens from the dangerous depredations of business. It does this by regulating certain aspects of business and depends on the regulators not being in bed with the very people they are supposed to be keeping an eye on. That has clearly not been the case in the US for decades.

If the corporations are going to be such lousy citizens, then they need to be punished by the government for their criminal behavior. And if the government as currently constituted is unwilling to do the job, then we need to elect one which will.

As to the NY Times, both articles constitute what I consider to be good, solid journalism, which is the job of a free press and what the citizenry requires. At least in these two instances, someone is getting it right.

Monday Lift

There aren't too many better ways to start a work-week than reading an editorial like this one published in the NY Times. Imagine: The Gray Lady taking on big oil! The editorial really nails it, albeit in abbreviated form, when it comes out in support of ending the corporate welfare for companies such as BP:

President Obama’s 2011 budget, proposed before the spill, would eliminate $4 billion in annual tax breaks for oil and gas companies. Bills in both houses introduced after the spill would achieve many of the same results. Industry has spent $340 million on lobbying over the last two years to block these sorts of initiatives, and until recently Congress has been eager to do its bidding. This year could be different. ...

Industry argues that these and other breaks are vital to robust domestic production and that both investment and employment would fall if they were eliminated. These arguments, which may have made sense years ago, are much less compelling when oil prices are hovering near $80 a barrel and oil companies — including BP — have been racking up huge profits.

Moreover, a Treasury Department analysis says that ending these breaks would reduce domestic production by less than 1 percent. A separate study by Congress’s Joint Economic Committee says that ending the biggest of the deductions — 9 percent of qualified income from gas and oil produced in the United States — would have zero effect on consumer prices.

That "robust domestic production" has actually declined over the decades as the easily accessible oil has been pumped. To keep profits as healthy as the mega-corps would like they've gone to the riskier sources, those located miles below the surface of the ocean. We see what that can bring. Maybe cutting out all the breaks will discourage oil companies from such endeavors. That wouldn't bother me one bit.

Nor would I mind busting their chops for avoiding any corporate taxes by moving their corporate offices out of the US. Talk about a perversion of the "pay, go" principle!

No, let's cut out that corporate welfare. Instead, as the editorial concludes, use the money for cleaner, more sustainable forms of energy, such as solar, wind, and wave research and technology. The seeds have already been planted, but the necessary investment hasn't been forthcoming.

As to the job loss issue, I figure that we could easily underwrite the cost of retraining oil industry employees to work in safer fields. In fact, many community colleges are itching to expand those opportunities now, but they don't have the funding.

The trick, of course, is getting the necessary movement in the Congress. It would require our elected officials to close the door on lobbyists coming in with satchels of money and require them to do the jobs we elected them to do. I'm not as optimistic on this front, but apparently the NY Times is. I sincerely hope they're right.

Sunday Poetry: W. S. Merwin

Ogres

All night waking to the sound
of light rain falling softly
through the leaves in the quiet
valley below the window
and to Paula lying here
asleep beside me and to
the murmur beside the bed
of the dogs' snoring like small
waves coming ashore I
am amazed at the fortune
of this moment in the whole
of the dark this unspoken
favor while it is with us
this breathing peace and then I
think of the frauds in office
at this instant devising
their massacres in my name
what part of me could they have
come from were they made of my
loathing itself and dredged from
the bitter depths of my shame

-- W. S. Merwin


(Found at Poets Against War.)

Addiction

I usually am not impressed with opinion pieces which state the obvious, but on occasion it actually is necessary to state the obvious because too many people are overlooking it. Such was the case with this article from Chile's La Nacion. The subject is that of the US addiction to oil and the repercussions of that addiction.

It is common sense that if the United States wishes to reduce their oil dependency, they should use fewer vehicles than they do. Today, nearly every American licensed to drive has a car. Of each 1,000 potential drivers, 981 have a car. It is by far the highest percentage in the world. ...

The society and economy generate dynamic contradictions. It is common sense that if the U.S. seeks to reduce its dependence on oil, they should use fewer vehicles than they do. In spite of this, on account of the economic crisis triggered in 2008, one of Obama’s first moves was to rescue General Motors and offer a stimulus so that Americans could exchange older cars for new machines. These transactions were subsidized by the U.S. Treasury with thousands of dollars. In order to stimulate public works, he assigned funds for highway construction. It was an opportunity to direct major investments to railroads, in order to decrease the generalized use of airplanes and cars and stimulate public transportation.

The oil spill in the Gulf of Mexico is already the biggest ecological disaster in the history of the U.S. Public opinion blames, with good reason, BP. But in terms of addressing oil consumption as an addiction, society as a group should assume their share of responsibility. For example, in the case of drugs, the producing countries and the drug traffickers should answer for their actions. But consumers are also guilty for creating a demand that, if it did not exist, would not give rise to the supply. In the same way, excessive consumption of oil pushes businesses to look for it in the depths of oceans, each time with more difficulty than the last. As a consequence, the possibility of a leak or spill is great and the methods of containing it are more problematic.

There, pretty much in a nutshell, is why BP is running the show in the Gulf and why we will continue to have more disasters there and everywhere else the oil companies choose to drill. That said, however, I would not ration out the blame so even-handedly, at least not at this point.

One of the jobs of whoever sits in the Oval Office is to lead his/her country into saner policies. President Obama had that chance right from the start, even in the midst of the financial meltdown. In fact, that financial meltdown gave him the ideal opportunity to persuade the nation that that we absolutely had to reset our economy and not just in terms of the financial machinations which brought on the chaos.

He could have used his bully pulpit to urge Americans to embrace the goal of alternative energy sources. He could have detailed a proposal to ensure the development of replacements for carbon-based energy sources and made that a proposal a national priority, with federal funding at the research level and federal subsidies for those entrepreneurs already working at that goal.

He also could have sternly scolded us for our own wasteful use of petroleum, using our cars to drive to the corner grocery store and then bringing home our goods in plastic bags. He could have rescued the term "conservation" from the dirty-word lexicon former Vice President Cheney placed it in.

He could have, but he didn't.

Instead, he spent the first year of his administration defending the bail-out of the banksters his predecessor ordered. His stimulus package was done on the cheap, with the result that unemployment is still the main drag on the economy. He politely asked the banks to loosen credit for businesses, especially small businesses, so that those businesses could hire. When the banks refused, he merely shrugged his shoulders.

So much for change.

Sunday Funnies

(Political cartoon by Rex Babin / Sacramento Bee (July 9, 2010) and featured at McClatchy DC. Click on image to enlarge.)

Bonus Critter Blogging: Aberdeen Basket Star

(Photograph courtesy David Shale and published at National Geographic. Click on the link to find out more about the discovery of new species in the Atlantic.)

More On Avandia And The FDA

Last week, I took a look at the latest news on some unholy side effects of the glucose lowering drug Avandia. The FDA has also been taking a look, a long hard one, and the agency might finally be gearing up to take the drug manufactured by GlaxoSmithKline off the market.

From the NY Times:

A federal drug official on Friday dealt a severe blow to the popular diabetes drug Avandia, issuing a scathing review of a major clinical trial that its manufacturer has been using to argue that the drug was safe.

The reviewer, Dr. Thomas Marciniak of the Food and Drug Administration, found a dozen instances in which patients taking Avandia appeared to suffer serious heart problems that were not counted in the study’s tally of adverse events.

Such repeated mistakes “should not be found even as single occurrences” and “suggest serious flaws with trial conduct,” Dr. Marciniak wrote.

The detailed report could prove crucial next week, when a panel of experts will meet to consider whether to recommend to the F.D.A. that the manufacturer, GlaxoSmithKline, withdraw Avandia from the market or restrict its sale. [Emphasis added.]

The clinical trial was paid for by GlaxoSmithKline, which apparently is not unusual. The FDA doesn't have the budget to run such trials. What is unusual is the strong suspicion that the drug-maker might have improperly influenced the reportage of that trial, resulting in the omission of some of the critical findings.

Dr. Marciniak works in a section of the FDA which has been supportive of Avandia all along. His about face on the drug doesn't bode well for next week's meeting of the panel which advises the FDA on such issues.

And the pharmaceutical company's response to this latest assessment?

Mary Anne Rhyne, a spokeswoman for GlaxoSmithKline, said the study demonstrated that Avandia is safe and added, “The Record study was conducted according to good clinical practices and the data are reliable.”

No surprise there, eh?

It's time to take Avandia off the market before more people die from taking it.

Friday Cat Blogging: A Reprise

Some Good News

The Washington Post has published some good news for our veterans with Post Traumatic Stress Disorder: the VA is loosening the rules for disability benefits for this class of injury.

The Department of Veterans Affairs is to announce Monday that veterans will no longer need to provide detailed documentation proving they experienced a traumatic event during combat in order to file PTSD disability claims, congressional aides and veterans advocates said.

Eligible veterans instead will be screened by VA medical staff to confirm that claims are consistent with the location and circumstances of military service and PTSD symptoms, which often include nightmares, flashbacks, irritability and deep depression.

The changes follow more than a year of work by Obama administration officials, lawmakers and veterans advocates. VA officials declined to comment ahead of Monday's anticipated announcement.

While the details of the changes are absent from the article (they will be unveiled on Monday), the overall tone of the responses from those who have viewed the changes is positive. The military and the federal government are finally confronting the fact that mental injuries are every bit as debilitating as physical injuries.

This is especially good news for one particular class of veterans: women who have served in Iraq and Afghanistan, but who have had a harder time than their male counterparts in getting the treatment and the benefits they deserve.

And female veterans should have an easier time earning benefits, because Pentagon rules prohibiting front-line action make it difficult to prove stressful combat events, advocates said.

Women often face more skepticism about PTSD claims during visits to male-dominated VA medical centers, said retired Army Sgt. Carolyn Schapper.

"If you happen to go once and the first person you speak to questions the authenticity of your story, you're less likely to go back," she said. "That's true for men and women, but women are more likely to be questioned than men."

She had an easier time filing disability claims because of her rank, she said.

But "if you think you have PTSD because a mortar was hitting your forward operating base, you more than likely don't have paperwork," Schapper added.

Apparently VA officials hadn't yet heard that wars are no longer being waged in the classical mode. There are no trenches and few pitched battles. Many of our veterans have been injured by more insidious forms of warfare, suicide bombers and IEDs, as well as mortar shelling of bases often designated as "safe." Women have been exposed just as much as men to the horrors of this new form of combat. They too have seen their comrades blown to bits, have had to drive supply trucks down a road potentially lined with explosive devices in trucks that have not been up-armored.

It's way past time for these changes to be made. Yes, it will be expensive, but it is all part of the true cost of war, something our government needs to understand.

And The Hits Keep Right On Coming

I frequently criticize the Los Angeles Times, especially its "center left" editorial board, for wrongheadedness, fuzziness, and outright deceptive news coverage. However, I'm more than willing to admit that the paper's ongoing coverage of the health insurance industry, especially in California, has been excellent. An article in today's edition continues in that tradition. The focus today is on a pending lawsuit against Blue Shield.

A Los Angeles woman sued Blue Shield of California on Wednesday, accusing the nonprofit health plan of overcharging thousands of policyholders who bought safety-net insurance for people who were sick or jobless.

Amalia Lample said in her lawsuit that Blue Shield, the state's second-largest not-for-profit insurer, knowingly exceeded maximum insurance rates set by the state and falsely reported to regulators that the charges stayed within official guidelines.

Ms. Lample's law suit may be a difficult one to sustain, not because it is frivolous, but because state law is apparently ambiguous when it comes to how premiums are to be calculated, something that the state agency involved is urging the legislature to fix.

Blue Shield denied two refund requests by Lample, who filed a complaint with the California Department of Managed Health Care. Regulators said they could not conclude that Blue Shield had violated state law.

But Wednesday a department spokeswoman said the law's definition for calculating maximum rates was ambiguous, making it difficult to determine whether health plans were charging too much.

The department is sponsoring a bill in the Legislature to "eliminate any question" on rates insurers can charge, said the spokeswoman, Lynne Randolph.

The comment from the state agency makes it clear that not only Blue Shield has been playing around with the ambiguities, and the article also details some of the shenanigans of Anthem Blue Cross in the same arena.

While I am appalled that the health care insurers continue to gouge the public, I am pleased by the coverage the L.A. Times has given the issue the past couple of years. Now, if the editorial board would just get the picture right and call for the obvious cure for this public malady (a single-payer system), I just might re-subscribe.

Two Words: John Bolton

The White House has announced that President Obama will make at least one recess appointment in the coming days: Dr. Donald Berwick, an expert in health care quality, will take over the top spot at the Center for Medicare and Medicaid. The announcement has already twisted Republicans' knickers, something I always approve of.

Berwick, 63, is a leading advocate of expanding research into the comparative effectiveness of various medical treatments, a major focus of the new healthcare law that many experts think is crucial to improve the quality of care that Americans receive and cut waste in the system.

He has been praised by the American Medical Assn., healthcare groups, consumer advocates and former CMS directors, including Dr. Mark McClellan and Thomas A. Scully, both of whom served in the George W. Bush administration.

But GOP senators accuse Berwick of embracing cutbacks to Americans' access to healthcare, citing his laudatory comments about the British healthcare system, which evaluates the cost of medical treatments in making coverage decisions.

"The decision is not whether or not we will ration care," Berwick told an interviewer last year. "The decision is whether we will ration with our eyes open. And right now, we are doing it blindly."

That last statement by Dr. Berwick is what the Republicans are using for their rallying cry: the rationing of health care. You see, on their planet, insurance companies don't ration health care, even when it makes sense to do so.

Dr. Berwick is one of those pests who points to the uncomfortable fact that in most cases of simple back strains, the expensive diagnostic test known as an MRI is unnecessary unless there are certain neurological findings (for example, drop foot or incontinence). The latest and far more expensive drugs for the control of hypertension often don't do the job any better than older and much cheaper drugs, and people like Dr. Berwick have a bad habit of citing the peer-reviewed studies which establish that fact.

And what really outrages the GOP is that Dr. Berwick's appointment is coming via a recess appointment, thereby frustrating their plans for additional obstructionist delays to show just how tough they are. To that I reply with only two words: "John Bolton." As the article quoted above notes, recess appointments have a long and storied history with presidents of both parties: President Clinton made 139 of them and President George W. Bush made 171.

This time President Obama got it right. Dr. Berwick was nominated in April, and that nomination was going nowhere. CMS needs a strong leader, which Dr. Berwick will be, and it needs it now.

So, pass the popcorn. This is going to be fun to watch for a few days.

Some Grounds For Optimism

I can't think of too many tougher activist chores than going door to door in 110 degree heat in Arizona to register Latino voters. Yet that is just what some people are doing to offset the passage of the horrid anti-immigration law recently passed by the Arizona state legislature and signed into law by the state's governor.

Activists hope that SB 1070, which Republican Gov. Jan Brewer signed into law in April and is scheduled to take effect July 29, will generate enough angry new Latino voters like Robles to reshape this state's hard-line approach to immigration.

As they fan out across sun-bleached barrios this summer, the activists cite the example of California.

More than 1 million California Latinos became citizens after the passage of anti-illegal immigrant Proposition 187 in 1994, putting the state solidly in the hands of Democrats and pushing immigration crackdowns to the margins.

Many analysts and political scientists predict a similar outcome — eventually — in Arizona. Latinos, 30% of the population, are the fastest-growing and youngest demographic group in the state.

"It's the same energy I saw with 187," said Ben Monterroso, a Service Employees International Union official who spearheaded voter registration in California in 1994 and now oversees the Arizona operation. "People are saying enough is enough."

In terms of eligible voters, Arizona has a lower percentage from the Latino sector than California did at the time of Prop 187, but the outrage stirred by that misbegotten proposition got the ball rolling, just as the organizers of the voter registration drive in Arizona hope their work will provide the impetus to moving Latinos to the polls this November and every election thereafter.

It's a tough road the young activists are walking, one with more than few dangers, but it's the kind of work that must be done. Righteous anger isn't worth much if isn't channeled into some positive action. The founders of this country knew that, and the Tea Partiers are demonstrating that they have learned that as well. It's time for our side to make the kind of commitment, and some people in Arizona are taking up the challenge.

Good on them.

Taking A Day Off

I guess I partied too hard with the folks in the apartment building last night because I am in no mood to blog this morning. That's a shame, too, because normally an article about earmarks like this one would have sent me through the roof.

Remember how the House promised "no more earmarks" to benefit for-profit companies? I sure do, and I was pleased by the announcement for some very good reasons:

Adopted because of repeated scandals over wasteful spending — the bridges to nowhere and expensive pet projects like a water-taxi service — the ban was intended to help eliminate earmark abuses. Critics say spending on earmarks, which added $16 billion to the federal budget last year, diverts money from higher priorities, typically does not require competitive bids and is often directed to experimental research that will never be used.

Well, thanks to some sneaky lobbyists, some ethically challenged members of the House (many of them Democrats), and some of our major universities, creative ways around the rule have been paved.

But I'm tired, my sinuses ache from all the fireworks smoke I inhaled, and I have a touch of dyspepsia from all the rich food I ate, so I'm not going to summon what little energy I have this morning to issue any kind of rant.

Go read the article and then bust some china. Or go back to bed and pull the covers over your head, which I what I am going to do.

Sunday Poetry: W. S. Merwin

(A tribute to our new Poet Laureate)


ANY TIME

How long ago the day is
when at last I look at it
with the time it has taken
to be there still in it
now in the transparent light
with the flight in the voices
the beginning in the leaves
everything I remember
and before it before me
present at the speed of light
in the distance that I am
who keep reaching out to it
seeing all the time faster
where it has never stirred from
before there is anything
the darkness thinking the light

--W. S. Merwin

Sunday Funnies

(Political cartoon by Tom Toles and featured in Washington Post. Click on image to enlarge.)

The Declaration of Independence

(Because it is just as important today as it was last year, and the year before that, and the years before that.)



When, in the course of human events, it becomes necessary for one people to dissolve the political bands which have connected them with another, and to assume among the powers of the earth, the separate and equal station to which the laws of nature and of nature's God entitle them, a decent respect to the opinions of mankind requires that they should declare the causes which impel them to the separation.

We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable rights, that among these are life, liberty and the pursuit of happiness. That to secure these rights, governments are instituted among men, deriving their just powers from the consent of the governed. That whenever any form of government becomes destructive to these ends, it is the right of the people to alter or to abolish it, and to institute new government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their safety and happiness. Prudence, indeed, will dictate that governments long established should not be changed for light and transient causes; and accordingly all experience hath shown that mankind are more disposed to suffer, while evils are sufferable, than to right themselves by abolishing the forms to which they are accustomed. But when a long train of abuses and usurpations, pursuing invariably the same object evinces a design to reduce them under absolute despotism, it is their right, it is their duty, to throw off such government, and to provide new guards for their future security. --Such has been the patient sufferance of these colonies; and such is now the necessity which constrains them to alter their former systems of government. The history of the present King of Great Britain is a history of repeated injuries and usurpations, all having in direct object the establishment of an absolute tyranny over these states. To prove this, let facts be submitted to a candid world.

He has refused his assent to laws, the most wholesome and necessary for the public good.

He has forbidden his governors to pass laws of immediate and pressing importance, unless suspended in their operation till his assent should be obtained; and when so suspended, he has utterly neglected to attend to them.

He has refused to pass other laws for the accommodation of large districts of people, unless those people would relinquish the right of representation in the legislature, a right inestimable to them and formidable to tyrants only.

He has called together legislative bodies at places unusual, uncomfortable, and distant from the depository of their public records, for the sole purpose of fatiguing them into compliance with his measures.

He has dissolved representative houses repeatedly, for opposing with manly firmness his invasions on the rights of the people.

He has refused for a long time, after such dissolutions, to cause others to be elected; whereby the legislative powers, incapable of annihilation, have returned to the people at large for their exercise; the state remaining in the meantime exposed to all the dangers of invasion from without, and convulsions within.

He has endeavored to prevent the population of these states; for that purpose obstructing the laws for naturalization of foreigners; refusing to pass others to encourage their migration hither, and raising the conditions of new appropriations of lands.

He has obstructed the administration of justice, by refusing his assent to laws for establishing judiciary powers.

He has made judges dependent on his will alone, for the tenure of their offices, and the amount and payment of their salaries.

He has erected a multitude of new offices, and sent hither swarms of officers to harass our people, and eat out their substance.

He has kept among us, in times of peace, standing armies without the consent of our legislature.

He has affected to render the military independent of and superior to civil power.

He has combined with others to subject us to a jurisdiction foreign to our constitution, and unacknowledged by our laws; giving his assent to their acts of pretended legislation:

For quartering large bodies of armed troops among us:

For protecting them, by mock trial, from punishment for any murders which they should commit on the inhabitants of these states:

For cutting off our trade with all parts of the world:

For imposing taxes on us without our consent:

For depriving us in many cases, of the benefits of trial by jury:

For transporting us beyond seas to be tried for pretended offenses:


For abolishing the free system of English laws in a neighboring province, establishing therein an arbitrary government, and enlarging its boundaries so as to render it at once an example and fit instrument for introducing the same absolute rule in these colonies:

For taking away our charters, abolishing our most valuable laws, and altering fundamentally the forms of our governments:

For suspending our own legislatures, and declaring themselves invested with power to legislate for us in all cases whatsoever.

He has abdicated government here, by declaring us out of his protection and waging war against us.

He has plundered our seas, ravaged our coasts, burned our towns, and destroyed the lives of our people.

He is at this time transporting large armies of foreign mercenaries to complete the works of death, desolation and tyranny, already begun with circumstances of cruelty and perfidy scarcely paralleled in the most barbarous ages, and totally unworthy the head of a civilized nation.

He has constrained our fellow citizens taken captive on the high seas to bear arms against their country, to become the executioners of their friends and brethren, or to fall themselves by their hands.

He has excited domestic insurrections amongst us, and has endeavored to bring on the inhabitants of our frontiers, the merciless Indian savages, whose known rule of warfare, is undistinguished destruction of all ages, sexes and conditions.

In every stage of these oppressions we have petitioned for redress in the most humble terms: our repeated petitions have been answered only by repeated injury. A prince, whose character is thus marked by every act which may define a tyrant, is unfit to be the ruler of a free people.

Nor have we been wanting in attention to our British brethren. We have warned them from time to time of attempts by their legislature to extend an unwarrantable jurisdiction over us. We have reminded them of the circumstances of our emigration and settlement here. We have appealed to their native justice and magnanimity, and we have conjured them by the ties of our common kindred to disavow these usurpations, which, would inevitably interrupt our connections and correspondence. They too have been deaf to the voice of justice and of consanguinity. We must, therefore, acquiesce in the necessity, which denounces our separation, and hold them, as we hold the rest of mankind, enemies in war, in peace friends.

We, therefore, the representatives of the United States of America, in General Congress, assembled, appealing to the Supreme Judge of the world for the rectitude of our intentions, do, in the name, and by the authority of the good people of these colonies, solemnly publish and declare, that these united colonies are, and of right ought to be free and independent states; that they are absolved from all allegiance to the British Crown, and that all political connection between them and the state of Great Britain, is and ought to be totally dissolved; and that as free and independent states, they have full power to levy war, conclude peace, contract alliances, establish commerce, and to do all other acts and things which independent states may of right do. And for the support of this declaration, with a firm reliance on the protection of Divine Providence, we mutually pledge to each other our lives, our fortunes and our sacred honor.

Signers:

New Hampshire: Josiah Bartlett, William Whipple, Matthew Thornton

Massachusetts: John Hancock, Samual Adams, John Adams, Robert Treat Paine, Elbridge Gerry

Rhode Island: Stephen Hopkins, William Ellery

Connecticut: Roger Sherman, Samuel Huntington, William Williams, Oliver Wolcott

New York: William Floyd, Philip Livingston, Francis Lewis, Lewis Morris

New Jersey: Richard Stockton, John Witherspoon, Francis Hopkinson, John Hart, Abraham Clark

Pennsylvania: Robert Morris, Benjamin Rush, Benjamin Franklin, John Morton, George Clymer, James Smith, George Taylor, James Wilson, George Ross

Delaware: Caesar Rodney, George Read, Thomas McKean

Maryland: Samuel Chase, William Paca, Thomas Stone, Charles Carroll of Carrollton

Virginia: George Wythe, Richard Henry Lee, Thomas Jefferson, Benjamin Harrison, Thomas Nelson, Jr., Francis Lightfoot Lee, Carter Braxton

North Carolina: William Hooper, Joseph Hewes, John Penn

South Carolina: Edward Rutledge, Thomas Heyward, Jr., Thomas Lynch, Jr., Arthur Middleton

Georgia: Button Gwinnett, Lyman Hall, George Walton

Bonus Critter Blogging: Tokay Gecko

(Photograph by Erin Yard and published at National Geographic.)

Mama Said There'd Be Days Like This

I'm frequently torn between believing that our political leaders are inherently evil and believing that they are wilfully stupid. The stupid is winning out these days, especially after the responses by both major parties to Michael Steele's latest verbal gaffe. Here's what the RNC head said:

Video footage that emerged Friday shows Steele referring to the conflict as "a war of Obama's choosing" and implying that the effort is doomed to fail.

"If he's such a student of history," Steele said, referring to President Obama, "has he not understood that, you know, that's the one thing you don't do, is engage in a land war in Afghanistan? Everyone who has tried, over 1,000 years of history, has failed."

While it's pretty clear that what Mr. Steele said about land wars in Afghanistan is actually quite true, the rest of his statements reach into the very depths of Colbertian Truthiness. "Aha!" I thought, "The Democrats have some ammunition," forgetting what Democrats like to do with ammunition. They pack it away in waterproof boxes so as to keep the powder dry, which is what they did once again in this instance.

Instead of pointing to the fact that the "land war" was initiated by George W. Bush, a Republican President, with the assistance of the Authorization of Military Force handed to him by Congress, then led by Republicans, the Democrats lamented the poor taste of Mr. Steele in undercutting our brave men and women serving in Afghanistan. Instead of noting that we are still in Afghanistan because President Bush soon lost interest in that war and pretty much ignored it while he started another one in Iraq (where our troops still remain and where the suiciders continue wreaking havoc), the Democrats used the same lines that President Bush used to justify the start of the bombing in Afghanistan: "We were attacked!"

And instead of thinking seriously about the issue and realizing that this is a war just like Iraq and just like every other war that should never have been started, a war with which Americans are growing weary, instead of responding with an honest assessment that maybe we should just get the hell out of there, the Democrats, like their Republican counterparts, preferred to wrap themselves in a flag, now tattered and soiled by the shame of the last ten years.

Nope, no change here, and not under the coffee table either. I looked.