February 2009 Archives

As most people have mentioned, the Oscar's this year didn't offer many surprises. The ceremony was even more boring if you tried to watch it on the internet at oscar.com like me. There you could only view the "backstage happenings", which are to the Oscars like burned toast is to Wonder bread. But this lack of a show gave me time to wonder, aren't there other people besides paid actors who deserve Oscars for their stellar 2008 performances?

For instance if I was in charge, I might have awarded a prize to the heads of the auto industries who flew private jets to Washington to ask for more money, then when chastised by an irate public, redid the journey, driving their company cars most of the way before jumping into their energy efficient concept car's for the final miles. I think the oil industry and banking executives who sat before Congressional hearings and refused to be contrite or to apologize deserved a prize for audacity. That's the Oscar spirit, combining American can-do spirit and fine acting. Hearing committee members deserve special awards too, for acting like disappointed parents when they're actually chuckling to themselves, "each one of you CEO's owes me soooooo big time".

Barbarous Ethics

2008 was a ripe year for Hollywood style performances. Most years seem to have the hint of a theme, have you noticed? Some years, cinema seems to serve up a slew of movies about dysfunctional families, other years the "theater of war" seems to be a dominant subject. In real life, this year's theme seemed to be ethics. For real-life best Oscar performance as a bad guy, I'd choose Golden Boy, former Illinois Governor Blagojevich. For best performance as a good guy I'd choose Senator Roland Burris.

Blagojevich came off as though he were auditioning for the movie sequel to Casino, or Goodfellas, with braggadocio to spare and a prize winning four letter word vocabulary. It was at first a simple tale -- a man of Bosnian descent lives his particular version of the American dream. The story then morphed into a jump the shark endless news that broke up the steady stream of economic bad news in early 2009. The most disconcerting parts, since we all quickly habituated to his prolific use of the word "f*ck", were comments from people who we thought seemed smarter, but seemed incredulous about the Governor's audacity. Prosecuter Patrick Fitzgerald started the trend, expressing shock that Blagojevich continued his shenanigans knowing full well he was being investigated:

"you might have thought, in that environment that pay to play would slow down. The opposite, happened, it sped up. Governor B. and others were working feverishly to get as much money from contractors, shaking them down pay-to-play before the end of the year."

Oh, surprise. Does the prosecutor deserve an award? But of course the Blagojevich scandal was always more than just a crazy hairdo, a weird Nike swish meets Chia Pet diversion. The tale unfolded over time, bloomed like fungus. Then along came Roland Burris, smiling like a Cheshire cat, to secure his place in the Senate. His Senate peers smiled back nodding about what a fine controller he had been. But now of course, when they learn of his little game, they're surprised at Burris's gall. And like all good family ventures, it's not just Burris, there's Son of Burris too. If the audience is still surprised they must be acting.

Ethics Piracy

Blagojevich ran on a platform of ethics, vowing to clean up the state. The voters bought it. But his was a common theme. Bush ran on an ethics platform, promising no hanky-panky in the Lincoln bedroom, and we saw how far his ethical standards got us. Take the Department of the Interior (DOI) and the series of ethics scandals uncovered in recent years. The department's ethics page which I just accessed (02-2009) was last updated before Christmas holiday season in 2007. Hear no evil, speak no evil.

During DOI Secretary Dick Kempthorne's tenure he said that he was routing out the bad apples. The apples were prolifically malignant -- "interfered with Endangered Species Act decisions, convicted of lying to Congress, discovered to have had sex with oil-industry executives and used cocaine and marijuana" -- and those were the ones that got caught. Second in command DOI "COO" and coal lobbyist Steven Griles went to prison for collaborating with Abramoff. Kempthorne himself raised eyebrows with his bathroom remodel. I think the whole cast of DOI deserves an award.

Melting Caps and Visual Effects

For best visual effects as in the movie "The Curious Case of Benjamin Button", we can imagine a movie where George Will et al conjure in their heads the melting polar caps regaining ice, while the commentators insist that global warming is a hoax. As for the miraculous reverse aging process of Mr. Button, I bet Al Franken wishes he had some of that magic so that when his term ends he can erase the worry lines and wash out the gray.

Many other awards are due, for instance Steven Johnson of the EPA, who drew out public comment periods longer then olympic water ballet performers stay under water, so that the the EPA could most effectively thwart environmental protection during the Bush administration. That's persistence. Not Slumdog Millionaire level, but certainly award winning mulishness. When the Bush administration was over the entire cast of the EPA probably felt like the little kid who steps out of the outhouse covered in goo. Shower time.

Lavished, So to Speak

The stimulus package worked out better than it seemed it might when we last wrote about the bill. In the somewhat histrionically titled, "Science Funding Gouged From Stimulus Package", we talked about proposed cuts to the package, including all the intended NSF money. In the end $21 billion dollars of the $787 billion dollar economic stimulus package were allotted to science research and infrastructure. In an article this week, the journal Science called scientists "surprised" to be "lavished" with new funding for beleaguered science institutions, including

• $10 billion to the National Institute of Health (NIH)
• $3 billion to the National Science Foundation (NSF)
• $1.6 billion to the Office of Science in the Department of Energy (DOE)

But lest there be any confusion, "scientist lavished" is quite different from "lavished" as in banking, insurance, and auto industry lavished. We're not talking corporate jets, or $86,000 partridge hunts, Ritz-Carlton junkets, or hundred thousand dollar ads to complain about crack-downs on perks, "lavished". "Scientist lavished" means, wow, we can buy a new beaker? Or -- really? I don't have to mouth pipette anymore?

Surprised scientists may be, as they were habituated to dark downward spirals or plateaus in science and science education funding. Most of the money will be spent, carefully, with what's promised to be diligent oversight, on "shovel-ready" projects -- infrastructure. And it isn't as much money as it seems. As the American Association of Arts and Sciences (AAAS) (publisher of Science) pointed out in an earlier analysis, R&D facilities funding for 2008 was $4.4 billion. Half of that went to the International Space Station. Expenses add up fast. But think of the mileage the US got by **putting a man on the moon**.

The new, use it or lose it funding fulfills intentions Congress laid out in the in the America Creating Opportunities to Meaningfully Promote Excellence in Technology, Education, and Science (COMPETES) Act -- H.R. 2272, which wasn't funded. The COMPETES Act was co-sponsored by many legislators, including Barack Obama and Joe Biden and reflected years of rhetoric about making the US more competitive in science and technology.

But The Labor is Cheap

Science is a good investment. Research is expensive, true. But think of all the technology born in academic labs. Very low paid graduate students at schools and universities all over the US execute experiments towards diverse inventions like computers, life-saving drugs, space exploration, and medical technology.

Taxpayers get a good deal with scientists. $500,000 salary limits would be no problem, since the majority of scientists working in the US don't make a 20th of that. Grads in labs are paid a fraction of what a newly minted banker earns to enter your deposit onto their balance sheets. Another nice think about scientists is that they don't amass fortunes of $billions of dollars absconded from investors. Rather, shunning office Armani for denim and sneakers, the science corps work away, sometimes cheerfully, hoping for the best from every plate pulled from the incubator, until one day, somewhere down the line, a company announces a drug that prolongs the life of your loved one, and you think, wow, where did that come from? Or not -- but it most likely started as some inkling idea then was developed in a government funded lab, before being passed on to the private sector.

Some scientists have expressed concern that the mass dollar infusion won't be sustained with consistent budgets in future years. We'll hope for the best.

Originally posted under the title: "Peanut Crimes The FDA and You"

When the FDA Fails, Have Your Day In Court?

FDA Scientists are desperate to get the word out that the medical devices section of the FDA is dysfunctional. A couple of weeks ago 9 FDA scientists who work in the device division wrote a letter to Barack Obama in an effort to bring problems with device testing to his attention. The scientists had first written to former FDA Commisioner von Eschenbach, then to members of the House and Senate, then to the president's transition team before addressing Obama in an effort to get their complaints heard.

The scientists maintain that the FDA has put them under criminal investigation as retribution for their public demands that the agency change how it regulates devices. The current methods for testing Class III devices are outdated, so devices like pacemakers and replacement heart valves can enter the market without adequate testing. An urgent report from the Government Accountability Office (GAO) also found device testing inadequate in an investigation it published this January.

The Minneapolis Star Tribune reported last year on a case where several hundred patients filed a suit against Medtronic for injuries suffered from faulty implanted heart valve replacement devices. A cracked lead in certain Sprint Fidelis models caused strong intermittent shocks to the heart, which apparently felt to the patient like getting kicked in the chest by a horse. One 68 year old woman interviewed by the Tribune said in one hour she was shocked 54 times. The Medtronic device received FDA approval as a Class III device.

The suit brought by the hundreds of patients with faulty Medtronic valve replacement with cracked leads was dismissed by a US District Court in St. Paul Minneapolis, who based his decision on a Supreme Court case that protected medical device makers from product liability cases after the products had been through FDA review. The Supreme Court ruling was for a different Medtronic product, the balloon catheter.

FDA Meets With Industry: 113, FDA Meets With Consumers: 5 -- Who Wins?

While regulation can hamper markets, inadequate regulation leads to dangers for citizens that also, in the end, hamper markets. Baseball with no rules would no longer a fun game that millions of fans pay exorbitant amounts of money to watch. From the Harper's Index, January, 2009:

"Number of times FDA officials met with consumer and patient groups as they revised drug-review policy in 2006: 5. Number of times FDA officials met with industry representatives: 113." (Source: FDA)

Perhaps the FDA met with business because of logistics, or because they were there, or perhaps because companies have more money than a 68 year old women with heart problems. Many would probably like to get rid of government so that companies (or as PJ O'Rourke would have it, community organizations) could save their lobby money and put it right back into shareholder's pockets the economy.

But we too will grow old and just might need such a device to continue on with our lives (in order to continue contributing to the economic well-being of our country). Then who should we trust so as not to get kicked in the chest by a horse 50 times an hour? The system that will revamp the FDA? Or the system that advocates handing all oversight to "independent" contractors hired by the companies selling the products? Your choice.

PCA Maneuvers

The Peanut Corporation of America (PCA), responsible for over 630 illnesses and nine deaths from reactions to Salmonella infected peanuts, filed for bankruptcy liquidation. Culpability? The Consumer's Union (CU) reports that the bankruptcy will protect the company from lawsuits. The company listed one to ten million dollars in liabilities and coincidentally, one to ten million dollars in assets.¹ The Washington Post elaborates that lawyers will move to have the stay preventing new lawsuits lifted. CU called on the Food and Drug Administration (FDA) to "oversee food processors so that unscrupulous behavior can be detected, prevented, and deterred".

But in order for that oversight to happen, the journal Nature writes, the FDA needs at least a new commissioner and more staff to replace those lost in the past 5 years. Said Michael Taylor, a former deputy commissioner for policy at the FDA: "Members on both sides of the aisle are getting that there is a system-wide problem here, that there has to be institutional change." Nature reports that even food corporations represented by 10 organizations have appealed to congress for food safety reforms enacted through the FDA. (Wadman, M. "Obama puts focus on FDA after peanut poisonings" Nature 457, 770-771 (2009) | doi:10.1038/457770a)

The agency has been significantly weakened in a worldwide spiderweb of pharma and food production companies that generate increasing threats to consumers and that need more oversight. The FDA however is failing to keep up, and has for years been routinely paraded across the news with systemic problems. The problem is cyclical. Nature's story about the weakened agency has strong similarities to the one told in 1989 by the New York Times.

In 1989 the FDA was "ailing", reported the NYT. Reagan had eviscerated the agency in his deregulatory zeal, and Dr. Samuel Thier, president of the Institute of Medicine in the National Academy of Sciences, told the newspaper: "the Food and Drug Administration is a demoralized group, being asked to do too much with too few resources.'' As was reported this week about the state of the FDA, 20 years ago the NYT reported with an air of dropped-jaw breathlessness: "the situation has gotten bad enough that the industry regulated by the agency has begun to press for a stronger agency".

In 1992 David Thessler was nominated to run the agency, which he did for six years, revitalizing the agency's regulatory authority and working to bring tobacco under FDA control, but drew ire from some businesses.

Privatizing Product Inspection: When It Doesn't Work

Reagan accelerated 'kill the FDA' policy trend, and organizations like Cato and politicians like Newt Gingrich pushed to make shrinking the FDA a public priority. Among their goals, they aimed to privatize inspections. The agency was a "monopoly", they said, responsible for millions of job losses in the US. Articles like Cato's 2001 "How FDA Regulation and Injury Litigation: Cripple the Medical Device Industry", helped convince legislators to loosen regulation and contract out important functions.

But an earlier NYT article reported that when the State Agriculture Department inspected the plant in 2007 and 2008, it found multiple problems, especially of food processing services "not cleaned or sanitized". Why was AIB's inspection lax?

----------------------

¹ There's the movie "The Corporation". Seen it? It's been around for a few years and is available for download on Google.

Acronym Required has been writing about problems at the FDA since 2005, including posts on BPA and the FDA; Commisioner von Eschenbach's confirmation hearings in "The FDA'S 'Medical Ideology'"; on the beleaguered organization in general -- "Resuscitating The FDA"; the FDA in the wake of various fiascoes and staff turnover, at "FDA -- Calling Off The Dogs"; and about general issues recruiting scientists in "Ethics- The NIH and FDA".

• Penguins in Peril

  More penguins are in peril from global warming. Scientists from the University of Washington report that members of the Magellanic penguin colony from Punta Tombo now have to swim 50 miles farther round-trip, to successfully forage for food -- while their mates sit on the eggs. Last month Proceedings for the National Advancement of Sciences reported on the endangered fate of the Emperor penguins. Remember the trials and tribulations in March of the Penguins that we wrote about in March On Penguins? Now it's even harder.

• Interspecies Love

  Scientists know that various forms of gene transfer occur between species, especially in prokaryotes like bacteria and certain eukaryotes like species in the plant genus Senecio. Native to Sicily, Senecio squalidus for instance, was introduced to the UK about 300 years ago. As the flower spread it, it pollinated with an indigenous flower and formed a second form of that British weed Senecio vulgaris (common groundsel). The alternate morphology of the groundsel had petals, making it look perhaps less "vulgaris" and more like a daisy drawn by a child.

  Building previous research, scientists published a paper in Science last fall, which identified a cluster of genes transferred between Senecio species by introgressive hybridization. The cluster seemed to cause the petals in the second form of Senecio vulgaris, which gave plant a genetic leg-up because it could pollinate more easily. The weed could also then be used by humans in "Loves me, Loves me not" trials -- unclear whether that's an evolutionary advantage, to any species.

  Other eukaryote species don't undergo such capricious genetic exchange although evolution seems always unpredictable. In a paper this week in Nature scientists from the University of Washington compared the genomes of macaques, orangutans, gorillas, and chimpanzees. Macaques split from the other three species about 25 million years ago. Building on previous work, scientists looking at the genome found "bursts of activity" that duplicated whole pieces of the genomes, 20,000 base sequences or more, at the same time that single gene changes were slowing down. The bursts of activity happened at key times, like before the chimps and humans diverged about ten million years ago. The duplications occurred where areas of previous duplications occurred, indicating that these areas rapidly evolve.

• Autism Ruling

  A court ruled that three patients whose children were autistic did not present enough evidence to convince the court that vaccines caused the illnesses. (Could you imagine the havoc is they had ruled the other way?) Despite the decision, parents will still be convinced that their children's autism was caused by vaccines. Or rain?.

• Bisphenol A Updates and Ultimatums

  Health Canada's Health Products and Food Branch and the FDA hosted a meeting of manufacturers and users of packaging materials to discuss strategies for understanding bisphenol A and reducing use of the chemical in consumer products. The FDA is scheduled to issue another round of BPA information on the safety of the chemical on February 24th. In the meantime, the city council of Chicago, in the US, is acting to restrict the chemical and has warned that if the FDA doesn't act by April 30th, it will. I'm sure certain chemical and toy associations are bearing down on Chicago as we speak.

Judd Gregg withdrew his name from consideration as Secretary of the US Department of Commerce yesterday. Early in his career, when CATO was pushing the idea and it was trendy, Gregg suggested that the department should be eliminated. This fact got some progressives apoplectic when Obama nominated him, although Gregg had been very supportive of certain parts of Commerce, like the National Oceanic and Atmospheric Administration (NOAA).

Gregg's NOAA sponsorship paid off for New Hampshire, but many Republicans, would abolish NOAA, along with the parts of Commerce that oversee trade, the census, and programs to benefit minority businesses. ¹ The Financial Times noted today:

"The New Hampshire Republicans would have spared himself and Barack Obama...had the measure succeeded. Instead, the commerce department survived and, with it, the job of commerce secretary"¹

Paradoxically, if Commerce had been eliminated, Barack Obama would have been spared Gregg's waffling, but CATO, would-be killer of the Department of Commerce, would be in a pickle. Where would it turn to the get evidence it uses in arguments before Congress for unregulated free trade?

Even considering that Obama has said he is open to doing away with ineffective parts of government, and some arguments that the Department of Commerce is mostly heavy on http://www.politico.com/news/stories/0209/18836.html">partisan perks, it's clear that the appointment was never a good fit. Really, if you need to take the centennial census away from the guy you nominated to the department that oversees the census? Not exactly ISO 9000 level of trust.

But does Gregg's sudden realization that he doesn't want what he asked for, that he's not willing to endure a spot on the team of rivals, bode ill for Obama's "bipartisanship"? Well, the team of rivals is perhaps overrated, apparently "Chase and Seward and Cameron and Stanton were in fact a crew of venomous enemies, all of whom underestimated their leader." Who needs "rivals" when you have bloggers, anyway?

Gregg was apparently pressured by his party. Obama will not cease working across the aisle, said his administration. But Congress? Republicans? GOP strategists eat bipartisanship rhetoric up like the monsters on Rampage World Tour.

---------------------------

¹ The photo was taken by NOAA. It shows Judd Gregg's wife signing the keel of a newly built NOAA ship in 2004. The ship was named by high school students as part of a program to engage students with scientific studies. The ship was named after Henry Bryant Bigelow, an oceanographer who worked as a researcher, instructor and professor of zoology at Harvard from 1906 to 1962, and who founded Woods Hole Oceanographic Institution in 1931. The former Senator Trent Lott (R-MS), Senator Judd Gregg (R-NH), and Senator Thad Cochran (R-MS) were thanked at the "traditional keel laying ceremony".

Today is Charles Darwin's 200th birthday. Everyone knows about the HMS Beagle and his "On the Origin of Species", published in 1859. His work outlining evolution underlies much of science, studies of biology, animal behavior,evolution, microbiology, zoology.

His "On the Origin of Species" is considered his greatest contribution to science, but Darwin was also an avid geologist. Prodigious chronicler that he was, his theories were precipitated by lots of observation, collaboration, and, to be real, some humdrum moments that every scientist lives. Darwin published "Note on a Rock Seen on an Iceberg in 61o South Latitude", in the Journal of the Royal Geographical Society of London, Vol. 9, (1839). From the mate of a ship skippered by a colleague who had sailed in the Antarctic, he wrote of "a black spot" on "a distant iceberg." Learning the dimensions estimated by observation and drawing, Darwin wondered about the origin of these "erratic boulders", rocks deposited by glaciers, which he had been studying.

Based on the course of his colleagues vessel, and what was known of the area from "Cook in the year 1773", he thought the rock fragment must have rafted on an ice sheet from a distant land mass. At the time geologists debated about the existence of an ice age or a great flood. Boulders were part of the puzzle. Prevailing thought was that rocks were not transported by glacier movement. His pondering on erratic rocks continued, and in 1841 he published his influential "On the distribution of the Erratic Boulders and on the Contemporaneous Unstratified Deposits of South America".

As exciting a time as it was in the 18th century, it was also slow going. Correspondence occurred by letter, of which Darwin wrote over 2000. He triangulated his geographical knowledge of landmasses in the area of the dark spot his colleagues spied, with information for from over half a century earlier. Patience and perseverance, as well as creativity and insight, brought progress.

The excellent Darwin Correspondence Project collects Darwin's >2000 letters. "Darwin 200", from the London's Natural History Museum, lists some events celebratory events marking Darwin's birthday, some occurring throughout 2009.

The Politics of Problem Solving in the US. One: Know Your Audience

Michael Moore's 2007 film Sicko was familiar to me even before I watched it last night, because the media dissected all parts of the film with yeahs or boos when it opened two years ago. Moore's concise editorial on the US health care system didn't muddle his position that nationalized health is superior by dwelling on gray areas or discussing exceptions or contradictions. It was a simple tale, US health care: bad; Canada, Cuba, Britain, France health care: good. Criticism about Moore's lack of journalistic rigor was fair, but I found the film surprisingly refreshing.

We've been living an unfolding disaster, whereby politicians meander down the middle of the road, hopping to one side or the other as dangerous objects from the other side veer too close. Always on the path to the next election, they can never stray too far from the middle. Progressive public relations 2009 dictates that you deliver uplifting rhetoric, then when your actions fail to bring the change you promise, you must call everything a giant success anyway. Journalist, activist or politician, you win support and earn money by appealing to all sides and botoxing a cheerful smile on your face.

The Democrats didn't bemoan the cuts after the House and Senate reached agreement on the stimulus package. The bill lost education and state aid, but the centrist crafters beamed on the podium. Susan Collins, Senator from Maine, toed her own Republican party line when announcing the final package of $789 TRILLION dollars. "It is a fiscally responsible number", she said brightly, without choking, sputtering, or falling backwards in a recoil effect from the force of the lie.

While politicians need to wag this way, there's none of this middle of the road stuff for Moore and his "Dog Eat Dog Films". US health care is rotten to the core, and Moore says so, pulling no stops and corralling the most unlikely players -- Cuba, Britain, and sick 9-11 workers -- to play their parts.

Moore focuses on the high profit US insurance industry and the managed care system. He tells real, scary accounts of insurance denials for services that led to the illnesses or deaths of patients. The story appealed to his select audience, but of course the problem is more complicated than greedy insurance companies. Moores' nationalization solution necessarily cuts out all the complications and idiosyncrasies implicit to delivering health care in a 21st centure US. So he was rightly criticized.

Two: Isolate the "Problem" and Develop a "Simple" Solution

But criticize away, every solution proposed for every complicated problem simplifies, whether Barack Obama proposes the solution, or Michael Moore does. When we look to solve complicated system failures, we tend to herd ourselves towards solutions that fall within the bounds of the current broken system. The solution of nationalized medicine for the healthcare problem isn't necessarily simple but Moore makes it look as simple and straightforward as an Old West movie gunfight.

Moore tried to sell a simple solution by making it look easy. Politicians, for lack of imagination, political will and guts, craft simplistic solutions. As it turns out, often the solutions involve technology, which has universal appeal and people don't know how hard it is.

What was the cause of the economic meltdown? It was people who bought mortgages that they didn't understand, like ARM's that ballooned. This caused massive foreclosures. I'll label this the "stupid homeowner" theory of economic meltdown. How do we dust our hands of this problem? Cass Sunstein and Richard Thaler come to the rescue in "Human Frailty Caused This Crisis", published by the Financial Times:

Regulators therefore need to help people manage complexity and resist temptation.... Regulators can reduce the chances of a future meltdown by making it easier to understand financial products....Fine-print disclosure should be supplemented by machine-readable files enabling third-party websites to translate hidden details of the terms.

A preposterous solution to the financial crisis.

Here's a different example, this time the media comes up with the solution. Why is the US health care system flagging? According to USA Today and ABC News, it's because of illegal immigrants. The audience tested "solution" is so self-evident that it needs no explanation. Of course the "problem" is simply not true.

Three: Shut Down Any Solution that Disturbs the Current Paradigm.

Watch no less than five CNBC commentators taking on Nouriel Roubini and Tassim Taleb, trying to force them into making economic turnaround predictions. When Bill Gates comes to listen to you at Davos, chirps one commentator, isn't that "a data point" that indicates imminent economic recovery? Roubini and Taleb persevere through this ridiculousness, counseling how we must change the banks, the compensation, the culture, and everyone running it, "that class of people" who "failed and will fail again". The five person news team clamors noisily for investment advice. The five don't and won't get it, maybe since they're actually still all employed to prattle on like this. They tell the economists that they're there as a sideshow -- Roubini and Taleb have entered the mental ward that is this CNBC show.

The problems plaguing health care are as complex as fixing finance and the solutions offered are also simplistic. For health care, Obama drives towards electronic records. There's something to this, to having all the patients records in one place and accessible, no one can deny that, and we certainly support it. But technology is not the solution, it's another layer of abstraction on top of a broken system, a pay for service (not for health), for profit, high throughput scheme that focuses on "managing" patients, privatizing care, cutting costs, and improving efficiency. This focus on efficiency may work for churning out auto parts, but you can't care for humans via an assembly line.

When It's Not About Technology

Electronic records will help doctors and patients but most of all it will help the current winners, the insurance companies and for-profit entities that stand between to doctors and the patients. Doctors who currently have electronic record systems complain that they're not give time to respond to email, to enter records or to speak with patients, never mind diagnose them. Electronic records will certainly help "manage" costs. But "managing" costs and the endless drive to "efficiency" is what brought the system to its knees in the first place. The focus is wrong and the system is broken.

The New York Times had an interesting account this week by a patient who fared very differently than Michael Moore's sick, helpless lambs. Jay Neugeboren tells the story of how he was given a clean bill of health by his doctors and cardiologist. But shortness of breath and a burning pain in his back motivated him to call on some friends who were doctors. One of them recommended he go to the hospital, where he got an electrocardiogram which showed three arteries totally blocked, and one 90% blocked. Now, ten years after his quintuple bipass surgery, he's doing fine. Neugeboren emphasizes how lucky he was. His clinical profile -- lipid panel, blood pressure, weight, diet, exercise, lifestyle -- was excellent. Without his friends who took the time to listen to his problems, he said, no test or technology predicted how close to death he was. ¹

One caveat to the author's story is this: "I had no conventional risk factors or symptoms", he writes in the NYT. However in an excerpt listed on Amazon, he says: "My father, who died of emphysema at the age of seventy-two, had had a heart attack when he was fifty-nine, but he never exercised, had been overweight, and had smoked three packs of Chesterfields a day throughout his adult life." His father had a heart attack at the same age he did. Which suggests that he did have a conventional risk factor, genetic predisposition. But the author doesn't write that. Apparently he thought his lifestyle would trump genetics, and apparently his doctor thought so too. In his case it didn't. Disease is not necessarily predictable, for patients or doctors.

Because disease is not predictable, and because on so many levels we don't understand health, we need doctors to spend time with patients, to be detectives, first to sort through the patient history, then to decide what that history demands. Is the patient understating the problem or a hypochondriac. Technology shortens time with patients, but who does that benefit? Technology will give more information, but it will most reliably improve statistics with which insurance companies place bets about patient's health and improve their bottom line.

But it's not the solution to the health care crisis, if the crisis is one about poor care -- which it is. Technology seems like a nuts and bolts solution to many people but is as ephemeral as the placebo offered to a villager who sees a doctor for the first time and wants a token to feel better.

------------------------

¹ Neugeboren wrote a book about his experience.

• Globalization 3.0 -- Sneakers, Call Centers, Banking?

  When the Obama administration suggested a cap executive salaries for banks on national dole, news quickly bubbled up about all the loopholes behind the announcement. Bankers bristled at the mere idea of caps. It occurred to Bank of America that they really didn't need any federal money after all. Deutsche Bank cheekily predicted that US bankers would defect to Europe. But according to this news report, bankers don't earn as much in Europe or anywhere else as they do in the US. Not only that, excessive banker salaries are being criticized in Europe, Japan, and China, although in Japan and China bankers make about $400K per year. So far China's not recruiting US bankers, although they are recruiting scientists. Maybe someday soon, when bankers think the rules are too tough to grapple with in the US, they'll be able to seize the day in China.

• California Floods of the Future

  Rain may be causing consternation about flash floods in California, but scientists are thinking about even more intense flooding when global warming causes the seas to rise. A study by the University of Oregon and University of Toronto published last week in Science, found that the melting Antarctic and resultant collapse of the ice sheet would cause sea levels to increase differently in different parts of the world.

  The Intergovernmental Panel on Climate Change (IPCC) has warned that as the Western Antarctic ice sheet melted it cause the sea level to rise 5 meters. However this uniform rise of sea levels may not happen. Instead the seas will rise more in some places, like North America and the Indian Ocean, than others, like Antarctica.

  The paper's authors discuss with the NSF three effects that will contribute to the uneven rise in sea levels. Now, because of the ice-water gravitational attraction, the Antarctic ice sheet draws water to it. But as the ice sheet melts, less water will be drawn to it and more will flow to North America. Second, the Antarctic ice sheet now sits in a hole, caused partly by the weight of the ice mass. As that mass melts, the depression will become smaller -- so more water will flow to North America. Finally, the melting ice sheet would alter the rotational force of the Earth, so the South Pole will move, shifting water away from the pole to other places, like the west coast of the United States.

  In California, climate change has the potential to endanger $2.5 trillion in real estate assets.

• Dams for Water -- And Quakes?

  Speaking of water damage, was the earthquake in China hastened by the dam? Scientists are suggesting that the weight of water in the Zipingpu reservoir, created by the massive Zipngdu dam in the Minjiang river affected the seismicity of the Beichaun fault a mile away and perhaps contributed to the timing and dynamics of the 7.9 Sichuan earthquake. (The excellent movie "Up The Yangtze" followed the dam building on the lives of one family.)

• Worst Job -- Marine Biologist?

  Rising seas, more marine biology? It was my dream job as a child, but apparently it doesn't suit everyone. Unable the get a job for three years as a graduating economist from UC Davis, Daniel Seddiqui set out to try 50 jobs in 50 states. His best job so far, he says, was border patrol, tracking immigrants on the border. His worst? Working as a marine biologist in Seattle. "Boring", he said. At the moment you can't find out the details of his ennui on account of the 404, but a couple other scientific-ish careers seemed to please him more. See him on Fox News or wait for the book.

• A World of Cheaters and Crooks?

  Some of Obama's recent picks for leadership positions have stepped aside with tax payment problems. Tom Daschle will not head Health and Human services. Nancy Killefer withdrew her name as chief performance officer. And Friday the Senate committee reviewing Rep. Hilda Solis's nomination for Labor Secretary canceled their meeting because of outstanding liens -- some 16 years old -- on Solis's husband's business. Timothy Geithner managed to get through with his much larger unpaid tax obligations, that's before we understood how popular tax evasion was.

  While Republicans rally for some populist rage around these tax missteps, one "senior Democratic official" told the Financial Times (Feb. 3, 2009): "In practice, you have to make exceptions for individuals. Very few people can withstand such scrutiny." Really?? I will never apply then. How embarrassing would it be to admit to some wealth-conscious senatorial committee that my only perk is an annual Medecin Sans Frontieres map of the world's trouble spots?

• The Consumer Product Safety Improvement Act: Senators Sing, Dance, and Beg for Phthalates and Lead

  The Consumer Product Safety Improvement Act that goes into effect Tuesday will make it illegal for stores to sell products for children under twelve that contain dangerous levels of lead, and products for kids under three that contain dangerous levels of phthalates that cause deleterious effects on development in babies. Consumer groups were denied their request to delay the law by federal Consumer Product Safety Commission last week.

  But some US senators chafe at the idea of losing toys like the Valentine's Day mechanical singing-and-dancing plush animals with red plastic guitars -- the toxic lead containing "Wild Thing Gorilla", "Ain't Too Proud to Beg Dog", the "Sing & Dance Puppy". The LA Times reported last week that Sen. Robert F. Bennett (R-Utah) "introduced a bill Thursday that would postpone the law, and Sen. Jim DeMint (R-S.C.) introduced a stimulus package amendment that would block the law.

The Senate reached agreement on the stimulus bill, paring it down to around $800 billion dollars. Two of the categories of items we value, education and science, were lopped out of the bill. One of the education cuts the Senate made for instance, was to slash $40 billion from state governments' education costs.

Talking Points Memo (TPM) obtained an early version of programs likely to be axed. Some departments lost 100% of the money originally allotted to them. Here's a couple of items the Senate considers not worth funding:

• $500,000,000 from the US Department of Agriculture (USDA)
• $750,000,000 from the National Aeronautics and Space Administration (NASA)
• $1,402,000,000 from National Science Foundation (NSF)
• $427,000,000 from the National Oceanic and Atmospheric Administration (NOAA)
• $14,000,000 from DHS Cyber Security Research
• $5,185,000,000 Prevention and Wellness. $75M for smoking cessation, $400M for HIV testing, $60M for surveys, $1B for diabetes screening/detection, $870M for Pandemic Flu.

These cuts all have stories behind them, most of which we're not privy to. Senator Chuck Grassley (R-IA), for instance, threatened to cut all NSF funding earlier this week. According to these initial cut proposals, it seems his threats materialized.

On the chopping block is NOAA, which is part of Commerce. NOAA is one of the departments that the "drown it in the bathtub" cabal always threatens to do away with. Sen. Judd Gregg (R-N.H.), who was chosen by Obama to lead the Department of Commerce, himself wanted to get rid of Commerce, however Gregg has always been highly supportive of NOAA, leading funding efforts for the agency.

Some of Congress's recent cut to the stimulus package make sense -- in a very macabre way. For instance once the Senate does away with:

• 1,000,000,000 from the DOE for Energy Efficiency & Renewable Energy, and
• 4,500,000,000 from the Energy Independence and Security Act of 2007 (EISA) energy technology loan guarantee program, and emasculates other alternative energy programs aimed at energy efficiency and attenuating global warming.

Then we really won't be needing:

• $122,500,000 for the polar icebreakers and cutters. We'll just sail right through.

The Senate cleverly kills many birds with one stone.

Some of these cuts seem ill thought out, but there are still more negotiations to come. Hopefully our representatives will rally to restore some funding, or get critical items like science and education into different legislation.

-------------------------------------

Update I : Many of these cuts were updated in negotiations in the Senate, and between the Senate and the House before the final bill was passed.

Update II 02/19: We updated the situation with science funding in "Science in the Stimulus Package, Part II"

Grapevine of Worry

Lucy Kellaway wrote in the Financial Times a couple of days ago that her own "mild fearfulness" about the economy had ballooned to hyperventilating paranoia after she spent time surfing the web and opening e-mail.

"Through blogs, websites and e-mails the world's economic ills are fed to us on a drip all day long. It is not just that we hear about bad things faster, we hear about more of them and in a more immediate way. My worries become yours, and yours become mine."

Since I don't "sit over my computer all day and feed my anxiety", I disagree. I don't succumb to bad news, rather I cheer myself when Obama talks about limiting publicly financed executive pay, or when the head of the Bureau of Land Management puts a hold on the drilling leases near national parks auctioned off by the Bush administration. In dire moments, I distract myself with unicorn chasers and happy news. Don't you? I walk away from the computer at will. I turn it off.

Back To Math Class You Go

But lets move beyond my anecdotal evidence. Lucy Kellaway speaks, as always, slightly tongue in cheek, but other news stories might convince you that the internet truly does harbor inescapable and vile corruption that needs to be caged. Take for instance, the New York Times piece yesterday about MySpace and their campaign to purge registered sex predator names from their site. According to the NYT, MySpace turned over 90,000 names to Attorney General Richard Blumenthal of Connecticut and Attorney General Roy Cooper of North Carolina.

Officials are pressuring social networking sites to adopt more stringent safety standards to assure children's safety. This is a welcome but confusingly priority since a report by the Internet Safety Technical Task Force, commissioned by 49 state attorneys general found that bullying online was a far more serious problem than sexual solicitation. Nevertheless, Attorney General Blumenthal said in a recent statement:

"Almost 100,000 convicted sex offenders mixing with children on MySpace -- shown by our subpoena -- is absolutely appalling and totally unacceptable...for every one of them, there may be hundreds of others using false names and ages."

I'm all for blocking names. But lets sort through his math. 90,000 names, times "hundreds" of "others". We'll interpret his "hundreds" conservatively, let's say 300-- although perhaps the Attorney General meant 900. So 90,000 * 300 = 27,000,000 sex offenders on MySpace? Maybe up to 81,000,000? The population of the US is ~303,824,640. So on the conservative side, Blumenthal tells us that 1 in 10 US sex offender citizens trolls MySpace. YIKES!

The Times reports later in the story that there are 700,000 sex offenders in the US. The paper doesn't worry with the math discrepancy. Instead they quote John A. Phillips, "chief executive of Aristotle, a company that supplies identity and age verification technologies for companies like the New York State Lottery, breweries and film studios", who is trying to sell his software to Myspace, and so piles on: '"this is just the tip of the iceberg on MySpace".

So, fear for the little children. Fear for the investor class, homeowners, and retirement fund enrollees. Who else?

Fear For the Suggestible, the Unvaccinated

If 1/1000 to 4/1000 registered YouTube users rate vaccination videos with 1 to 5 stars, adding comments like, "your video is stupid, and your a dumbass that's what my mom thinks", should we use this "data" to propagate concern that YouTube feeds the public irrational and dangerous opinions about vaccinations? A year ago the Journal of the American Medical Association (JAMA) published a study that did exactly that.

In December 2007, University of Toronto researchers announced a "first-ever study of its kind". The investigators selected YouTube videos relating to immunizations or vaccinations, and concluded that much of the video content "contradicts the best scientific evidence". The public health community should find this "very concerning", they wrote. The press pounced on this announcement like a starved puppy tossed a Porterhouse steak. Articles titled "YouTube Full Of One-Sided Anti-Vaccination Videos", littered the news.

The authors selected and watched 153 videos. 73 (48%) had so called "positive" messages (in favor of immunization) , 49 videos (32%) had so called "negative" messages, and 31 videos (20%) had so called "ambiguous" messages. The study concluded:

• 1) "negative videos were more likely to be rated by viewers"
• 2) negative videos were more likely to "receive more views"
• 3) negative videos "received a higher mean star rating".

The authors then generated their dire warnings.

Garbage In...

When JAMA published the study I spent some time looking at their data, which I'll briefly highlight here. Unfortunately, it was impossible to repeat the study. Obviously, time had elapsed between authors' video viewing and publication, but also the authors' described their methodology fleetingly: "On February 20, 2007, we searched YouTube (www.youtube.com) using the keywords vaccination and immunization." Straight-forward and repeatable? Hardly. Different permutations of the keywords and Boolean operators yielded anywhere from 63 to 1300 videos, when we copied their methodology. This result may not seem important, but such unreliability prompted us to look at the validity of the study's conclusions.

The authors found that "negative videos were more likely to be rated by viewers." Of 73 "positive" videos, 46 had a rating. Out of 49 "negative" videos, 42 had a rating. But you have to wonder how meaningful a metric like "number of ratings" or "likely to rate" is. Looking at the raw data a different way, you would also learn that more people rate "positive" videos.

We multiplyied 73 "positive" videos by the study's "mean number of positive" video views - 181, which gives 13,213 views. Yet there were only 37 viewer ratings. Multiplying 49 "negative" videos by the mean, 520 views per video, gives 25,480 viewers -- but only only 36 ratings. So yes, there were "more views" of "negative" than "positive" videos, and more negative videos were rated. But also the data showed that an individual is more likely to rate a "positive" video (.28% of viewers rated), than the "negative" video (.14% of viewers rated). Why? Do more people watch "positive" videos to the end? Who knows.

There were other confounding questions unanswered by the study. How long had the videos been posted? Does rating a video actually signal a change in attitude? Behavior? Anything? How many people rate videos -- only registered users can rate videos, so do registered YouTube users represent the vaccinating public? Is a "negative" Gardasil video a "bad" public health message, given the uncertainty about the pros and cons of that vaccine? Moreover, can tabulating viewer ratings translate to anything meaningful? Especially when only ~1-2 in 1000 viewers rates a video?

...Garbage Out

The authors also tallied the YouTube star ratings and concluded that "negative" videos received higher ratings. But in a 1-5 star rating system such as YouTube's, what do we learn from reports that the mean "positive" video rating was 3.5, with 1.5 standard deviations (SD), whereas the mean "negative" video rating was 4.4 with .9 SD?

Does running statistics on shaky data make it more meaningful? According to analyses of 5-Star Rating Systems there are plenty of other problems with drawing many conclusions from ratings. Individual ratings tend to be either very low, or very high (1 or 5), in a bimodal distribution. Problematically, an average score of 3 or 4 might only describe "conflicting opinions". As it turns out, averaging most 5 star ratings gives a mean 3-4 star rating.

Another bias of 5 star rating systems is upward-bias from "fans". For instance, when we looked at available videos in December, 2007, in a video from "House MD", the TV program, a doctor very sarcastically scorns a woman for not vaccinating her child. This ("positive") video got rated very highly (4+ stars). But tans will rate a show highly no matter what the public health message. Problematically, then, the JAMA study uses these crude ratings to make some serious public health claims about the dangers of YouTube.

In December 2007 we did our own little mini-study on YouTube to confirm the JAMA data showing that only 1-5 of every 1000 viewers rated these videos (true). Ironically, at the time, the most popular YouTube video about vaccination was a "positive" one put out by a pharmaceutical company, which only showed up in some searches. This corporate video got almost 800,000 views, more than 10 times the 69,000 total views of the 153 videos the authors studied, far surpassing all the "negative" videos.

The pharmaceutical company was advertising a video contest for homemade videos about getting a flu shot with a $500 prize. The video got negative reviews, but some comments reflected people's annoyance that the contest had ended or they hadn't won. The House MD video was the second most popular video.

Barbarians on the Net

This idea that the internet will tear down society one way or another by undermining civility, by cultivating irrational fear, spreading disease, crime, or irrational behavior is not new, and in fact reflects various bricks and mortar versions of the same fear-mongering. See for instance, The Coming Anarchy, by Robert D. Kaplan and similar titles. In reality, nation-states quite adeptly control the internet, as they do their roadways, waterways, and airspace.

Despite the constant threat of unreasonableness and anarchy, it is reason that often trumps unreasonable cacophony on the internet, the opposite of what people predict. Would Obama have been elected without the internet? Would the Palin candidacy have met the same fate without TV's internet availability to the hordes who watched Couric and Fey?

The internet has its problems, but I suspect its vagaries offend most people when the internet disrupts the power assumptions they hold dear. One can find all the nastiness, the worry, the fear, and the bizarre opinions of the internet on the streets. In reality, predators pass kids everyday on the street, as anonymously as on the the net.

The internet provides only an illusion of anonymity for ne're-do-wells and oafs, just as your house with its fence and well surveyed lot and planted trees provides an illusion of safety to you. Do those in privileged positions avoid the awfulness of the cement ghetto more easily than they elude the unsettling and unwanted spam in their AM inbox, and thus be more offended by the internet?

Power brokers of course become threatened by the internet. Record companies, the networks, and politicians, and pharmaceutical companies -- they've all had run-ins with the internet. Professors object to "RateMyProfessor", as it mucks up the power structure. But it's certainly helps the public forum.

One needs to exam the data behind assertions that the internet is dangerous. Corporations have far more power on the internet than so called fringe groups -- to advertise, to astroturf, to datamine, and to collect personal information, although they may claim that's not so. The pro-vaccination video put out by the pharmaceutical company, even by the very dubious standards put forth in the JAMA study, was more "influential" then all the rest of the videos on YouTube combined.

Authors, consultants, the media, have always tried to pin down and characterize internet communication trends, but their calculations and predictions often miss because they are only a static snapshot of the evolving internet at a point in time. John Perry Barlow predicted the World Wide Web without a government (1996); consultants predicted internet "content was king" (1997); Cass Sunstein dreamed up regulatory schemes so that the polarizing internet wouldn't destroy democracy (2001); and print journalists talked about how doomed blogging was (2004). They misunderstood the adaptability of the internet as a communication tool and underestimated how individuals, corporations, and governments would continue to shape it to further their own personal wish lists. One day anti-vaccination videos seem prevalent, the next, pharmaceuticals have usurped YouTube just fine thank-you.

The film critic Robert Ebert is right, newspapers can be great to read, (all five of them) they also tend towards banal, narrow-minded, wrong, and biased, so we better get used to the excellent, disparate, positive as well as very negative flux of the internet.

Public Health and the Culture Wars

In our last post, we acknowledged that the GOP attempted to derail economic stimulus efforts by studding the recovery package conversation with fear-mongering blather about STDs and condoms. This is an old trick to peddle failed policies. The Republicans tax-cut centric governance style doesn't work, but when they add rhetoric about promiscuity and condoms, people for some reason go all woozy and vote GOP. With such a recipe for success why change?

Just as evolution keeps bumping up against religion when fundamentalists gate crash the classroom, family planning based on science, statistics, and good public policy will always encounter obfuscatory politicians spurred by religious advocates trying to portray serious conversation as lasciviousness to be resolved by morality talk.

The CDC's annual STD report released January 13th indicated that STD infections were rising in the US. That might be expected. The former president George W. Bush removed birth control education from aid programs in favor of abstinence information doled out by religious organizations. During that dark time, the Republican party corralled the vote of church goers by regaling them with grisly horror stories about the godless amorality and depravity of birth control. The GOP honed this strategy over decades before it began to bear fruit during the Reagan era. It reached a apex (I hope) during the Bush administration.

Still In the 80's?

I was reminded of how long ago the condom tirades started when I came across an editorial from a May, 1987 issue of U.S. News and World Report. The story also reminded me that this wasn't always a Republican strategy.

In 1987 the AIDS crisis was a growing public health threat. New York city Mayor Koch wanted to run 30 second TV spots, print ads, and radio announcement to encourage heterosexual women to use condoms. At that time half a million people in NYC were infected with HIV.

Harold Evans, a contributing editor of US News and World Report reported in "A Necessary Offense", that ABC and CBS refused to run the ads, which Brooklyn Democratic Councilman Noach Dear called "'disgusting'". The stations also opposed the advocacy of Surgeon General Koop, who also recommended using condoms in addition to abstinence and monogamy.

In 1987 religious leaders and network executives protested that advocating condoms would promote promiscuity. However as the US pursued this policy, Denmark and Sweden were publicly promoting condom use, as was Britain. And as Evans wrote on the European policies: "no widespread disorder is reported."

Beyond Fundamentalism

Evans wrote in US News & World Report, "birth control is not only accepted by the majority; it is rightly advocated..." Furthermore, in the context of the AIDS epidemic:

"Minorities cannot reasonably expect to prevail when their scruples threaten not just the right of free expression of a majority but the very existence of majority and minority together."

Twenty-two years later, television stations still "parade" morals with an even steeper gradient of "ultimate hypocrisy". TV programming has of course advanced in licentiousness beyond the "sexual soaps" and "exploitative product marketing" of the 1980's, and the internet takes off where television leaves off. The initial Republican strategy to win votes based on morality plays, once so successful, most recently begot devastating GOP seat losses. Meanwhile, the banking fiasco, health care, climate change and job losses -- all real problems having nothing to do with condoms -- paralyze the legislature. Despite their crushing losses though, some GOP politicians still resort to this cheaper populist strategy in times when clear headed leadership is so critical.

The US touts the superiority of its advanced technology. But if the nation is to be effective against pockets of global fundamentalism as well as the current global economic crisis, politicians best continue to elevate the tenor of their argument beyond reflexive smut and groveling to thoughtful negotiations and leadership. "Tax-cutting" (bolstered by cultural fear mongering) confuses consumer "choice" with democratic freedom and grinds the country down.