August 2009 Archives

Summer Politics: Cut and Dried

On the 40th anniversary of Woodstock, people reminisce about large public gatherings in open spaces. Central Park used to be a mecca for such events, not just music, but serious political gatherings. On June 12, 1982, a million people assembled in the park to protest the nuclear arms policies of the Reagan Administration. Each person had traveled by bus, car, or train to offer their voice and show patriotism. A million people all simultaneously caring about the same issue took time off from work to collectively send a message to government -- just like democracies encourage people to do. Shortly after they convened, Reagan opened nuclear arms talks with the Soviet Union. The Cold War waned. To date, the 1982 protest remains one of the largest in America's history.

Grassroots Change

Today, we all see very few of these grassroots assemblies. Of course, people explain, there's work and family that get it the way, less leisure time, and entertainment dependent on television "reality" shows. Governments play a role too. They have much less tolerance for public gatherings.

Take Central Park, for instance. After three years of "litigation" over the of the park for peaceful protest by several left wing groups prior to the Republican National Convention, New York City decided to address the question by conducting a formal study on "the optimum and sustainable use of the Great Lawn for large events".

It was a very particular study, though, limited to figuring out how the grass would endure the weight of humans. After careful deliberation, scientific, of course, the study's soil scientists, plant pathologists, and groundskeepers recommended limiting the use of the Great Lawn in Central Park to 55,000 people for 'safety reasons and to protect the grass'.

True, The Great Lawn cost millions to restore, but the decision rankled some people. A lawyer for the Partnership for Civil Justice told the NYT: "We would call it junk science except that it's not science". Rather, she said, the report supports: "a political declaration of intent by the mayor to limit free speech rights by New Yorkers." The decision of belied ideas about the park's original purpose. Central Park historian Sarah Cedar Miller once told a reporter: "Parks are a gathering ground and where democracy happens. Literally, the grassroots happen on the grass." ¹

Even the current US President, Barack Obama has often talked about the importance of grassroots action to motivate change. In "Dreams From My Father", he wrote about his decision in 1983 after graduating from Columbia College to become a community organizer:

Said Obama: "....There wasn't much detail to the idea; I didn't know anyone making a living that way. When classmates in college asked me just what it was that a community organizer did, I couldn't answer them directly.

Obama continued: "Instead, I'd pronounce on the need for change. Change in the White House, where Reagan and his minions were carrying on their dirty deeds. Change in the Congress, compliant and corrupt. Change in the mood of the country, manic and self-absorbed. Change won't come from the top, I would say. Change will come from a mobilized grass roots."

Grassroots From the White House?

Twenty-six years later Obama resides in the White House after campaigning on a platform of Change. In his acceptance speech he attributed his victory to a strong "grassroots" campaign. Obama assured his grassroots supporters that corporations wouldn't have all the seats at the table. He urged them to continue their grassroots fight for the causes he would champion during his presidency.

But of course President Barack Obama also won the presidency by effectively implementing well-organized fund-raising to corral not only onesie-twosie grassroots donors, but large donors and bundlers as well. Now, as constituents, stakeholders, and lobbyists wrestle over American healthcare, headlines detail the president's sincere efforts to appease those non grass-roots, large-donor interests.

Last week, we learned of the president's concessions to the Pharmaceutical Research and Manufacturers of America (PhRMA). The White House will oppose drug importation in return for the hazy promise by PhRMA to cut government and citizen pharmaceutical expenses "up to" $80 billion (that's $0 - $80 billion)

Also, last weekend, Health and Human Services Secretary Sebelius declared the public option was not an important component for agreement -- therefore the public option off the table.

Obama promised that pharma wouldn't have the only seats at the table when he campaigned. But now it seems that if there are any other seats for non-pharma, they're rickety chairs in the peanut gallery, and when people dareth speak from those chairs, they're ejected by security.

Obama encouraged his grassroots organization to continue their work when he was in office. But when it comes to healthcare, he'd rather not hear from them. And besides, among Obama's once 13 million strong grassroots supporters, who among them has the time, attention, or money for politicking? Furthermore, if the president's supporters did have time and knew what they were supposed to be rooting for -- not a viable public option, that's not allowed -- how would they express their opinions? Are we even a "grassroots" kind of country anymore?

Is It All Astroturf or Have We Changed?

Public protests and large gatherings of past decades can't be idealized. They've always been contentious affairs, with riot police, shootings, covert and overt suppression. There was a certain community achieved by those Central Park protesters in 1982, who all gathered in one place to express the hope for a less nuclear world. But that was almost three decades ago, in a different place and time. Central Park was overgrown and scary then, and New Yorkers say they invited anyone to the park just to keep the more dangerous criminal elements at bay.

Today, large protests are not necessarily a viable option for petitioning the government. Not only is there a personal inconvenience of taking the day off to march around in a park, there's violent government aggression, arrests. The Department of Defense (DOD) recently labeled protests "low-level terrorism".

Businesses surrounding Central Park, the ones that contributed to Obama's campaign, have no use for a bunch of protesters agitating outside their windows, challenging the very premises of their businesses. They may want the park to serve as their private conference room backdrop. For all those frenzied deal negotiations, a lush, peaceful, untrammeled million-dollar-grass lawn, as far as the eye can see.

Perhaps a manicured lawn is not an asset to be trifled with. Even Obama wasn't explicit about which turf he wants grass-roots activism to happen on. Protestors can always be routed by riot police to cement, or the unkempt DC mall. Or, perhaps, if in 2009 public protests are limited on Central Park's Great Lawn, they will continue to flourish at "town halls".

Townhalls -- "A Dip In A Cool Stream?""

Town halls, after all, can idealistically be an idyllic way to exchange ideas. Obama wrote about his experience when he was an Illinois State Senator in the book: "The Audacity of Hope":

"One of my favorite tasks of being a senator is hosting town hall meetings....And as I look out over the crowd, I somehow feel encouraged. In their bearing I see hard work. In the way they handle their children I see hope. My time with them is like a dip in a cool stream. I feel cleansed afterward, glad for the work I have chosen"

You may say that today's town halls are a quite different brand of love-in than Obama's. Sure, there may be some heart-felt questioning, but too often that's drowned out by individuals ferociously confronting their representatives with apparitions they've concocted in their heads about government. This week they're yelling about the scurvy of government-run healthcare. Next week the topic will be the upcoming the energy bill.

Fox News insists that this brand of town hall "anger is not 'manufactured' it's REAL". Others say that corporations, are helping manufacture the town-hallers' messages against change, that is, townhalls aren't "grassroots" at all, they're corporatized astroturfing. Either way, it's certainly a different beast from the "cool stream" Obama described. Some representatives probably want to shower after their events.

Nancy Pelosi (D-CA) says the Democrats running town halls can handle it, but they need to "know the difference between grassroots and astroturf." While elected officials may be able to distinguish between astroturf and grassroots; however, the broader audience is reached by TV. And television news does not necessarily differentiate between astroturf and grassroots protests, it duly broadcasts discontent. Unfortunately but importantly, whatever the source of townhall agitation, even if it's astroturfing, everyone's paying attention to it.

TV Cameras on the Ruckus -- The Limits of Technology

The internet remains an alternative grassroots medium mobilized to good effect by MoveOn.org and the Obama campaign. But even if Obama's grassroots organization were to see fit to mobilize and use the internet to its previously powerful effect, it would be a very quiet effort.

As Obama said last week "TV loves a ruckus". Email campaigns don't attract television cameras the way even the smallest collection of agitated people waving scrawled signs do, email campaigns are quiet click, click, clicks. Which is why businesses vigorously oppose 200,000 people gathering in Central Park, and it's why they send their own messengers to town halls.

A million emails don't make a televise-able ruckus. Perhaps the literal grassroots protest is a bygone era and nothing is lost by limiting people's right to protest on public greens. Perhaps email is not only quieter but better suited to our "service economy", no tiring marching, exposure to the elements...

Woodstock is overrated, NYT columnist Gail Collins writes, forty years later. Too much mud; not enough sandwiches; mind-boggling traffic jams. She describes her experience with detached amusement, as if obliged to watch youthful antics on a scratchy home video pulled from a trunk at a family gathering.

But can we trivialize a whole era that way? And how will the current brand of town hall protests look forty years from now? If pundits and participants don't think back fondly on Woodstock today, how will they recall the shouted, spit-laden confrontations from people insisting that healthcare reform is facism, death panels, and communism all wrapped up in one ideologically impossible hairball of anti-reform? Not "Change" or "No Nukes" -- but "NO-CHANGE!", ie: "Long-Live the Uninsured!" -- delivered with a swagger that only a pistol strapped to one's leg can assure.

I'm not trying to idealize the old, flowers in your hair days that I didn't even live through. But does an insistence on pretty, well-kempt lawns discourage the public's inclinations to join a peaceable protest? To express views about the government? Isn't something lost if we've reached an age when the TV news will never again televise over a million individual people (not organized by business, gathered in a park with a vision of a changed and better world? When "Astroturf" -- always capitalized for the always capitalist world striving to prevent change and progress -- is for all intents and purposes the only "grassroots" we know?

¹ Arkansas Democrat-Gazette, October 17, 2005

• HRT Therapy Evidence Ghostwritten: The New York Times reports on a joint effort by the Times, "PloS Medicine, and the Washington DC law firm Public Justice, to compel the Federal court to release documents showing that medical research papers bylined by respected researchers were actually written by a firm hired by the pharmaceutical giant Wyeth. The "ghostwritten" papers promoted the benefits of using the Wyeth estrogen product Prempro to prevent wrinkled skin, dementia and other effects of menopause. However the papers didn't give adequate attention to the risks of HRT treatment: stroke, heart attack, blood clots, cardiovascular disease, and cancer. Once these risks were revealed, doctors stopped recommending hormone replacement therapy (HRT) to menopausal women.

• They Got The Same Results We Did!(?): In a recent editorial, Nature Medicine provides a warning about scientists who plagiarize previously published science articles. Nature refers to a recently published paper in a journal they magnanimously refer to as "Journal B", which had appeared in Nature six years earlier.

  Why would a research scientist so plagiarize? One reason, Nature suggests, is that plagiarism could boost a scientist or student's academic profile in a down economy. The journal provides a how-to:

  "use a solid paper as your base; carry out a parallel set of experiments in your favorite model; tweak the data so that the numbers are not identical but remain realistic; and, when you're ready to write it all up, paraphrase the original paper ad libitum. Last, submit your new manuscript to a modest journal in the hopes that the authors of the paper you used as 'inspiration' won't notice your 'tribute' to their work..."

  Nature also lists less obvious forms of plagiarism, such as lifting sections of text that adequately express ideas in a language that's not the scientist's primary one, lifting and rephrasing result sections, or scientists' misunderstandings about what is and isn't plagiarism.

• When Bad Apples Fall Near The Tree: Talking Points Memo challenges lobbyist Jack Bonner's statement that some "bad employee" sent the forged letters to Congress opposing climate change legislation. The letters were supposedly sent from minority groups, but as it turns out, Bonner's firm was working on behalf of the coal industry. As TPM reports, this was not an isolated incident from a temporary employee but modus operandi for the firm where each employee works first as a temp.

• Stem Cell Research Doesn't Always Get Retracted: Really. But lately the Stem Cell Institute at the University of Minnesota in Minneapolis isn't helping prove the point. New Scientist recently raised questions about research from several stem cell labs at the institute. One scientist reprimanded for academic misconduct had so many papers containing errors that three had to be corrected and one retracted.

  The journal then decided to look at all the papers coming out of the lab that that former student worked in and found possible duplications in seven papers from another researcher affiliated with the institute. Stem cell scientists made comments to New Scientist, expressing discouragement about the spate of problems at the one institute that happened to be under the spotlight. Given the pressure in the field, these scientists wondered how widespread the problems elsewhere could be.

Plague

Earlier today Xinhuanet.com reported that a fourth pneumonic plague patient is near death and one more is in serious condition in the town of Ziketan, a remote northwestern village in Qinghai Province in the Hainan Tibetan Autonomous Prefecture. 12 people have been hospitalized and three or four have died. Chinese officials have quarantined the town of about 10,000 and are killing rats and fleas to prevent further spread of the disease. Later today Xinhaunet.com reported that officials have now effectively controlled the plague.

Pneumonic plague infects the lungs and is caused by the bacteria Yersinia pestis. This bacteria also causes septicemic plague and bubonic plague -- the form of plague depends on the the route of transmission. Pneumonic plague is transmitted by aerosolized bacteria, which cause pneumonia, progressive organ failure, and often swift death if left untreated.

Because these bacteria are carried through the air in droplets, the disease can spread from humans to humans or animals to humans, and is considered highly contagious. If the infection is diagnosed quickly and antibiotics given promptly, patients will make a full recovery. The World Health Organization is working with Chinese officials and monitoring the plague outbreak.

The Center for Disease Control (CDC), has an interesting page on the history of the plague. Until Alexandre Yersin and Shibasaburo Kitasato determined the cause of the disease in 1894, many people died and many more attributed the massive deaths to the wrath of gods.

After the scientists identified the cause bacteria Yersinia pestis, people adapted to the fact that the disease spread between animals, often rats, via fleas. The mere sight of a dead rat sometimes causes people to flee their homes and towns. Plague can cycle for years between rats and fleas without infecting human populations, but inevitably, every few years an outbreak occurs. The CDC article notes that the catastrophic loss of life associated with historic plagues -- even today -- gives people a heightened fear of "the plague".

Zoonotic Disease Update

Plague is in the large group of zoonotic diseases that pass from animals to humans, or from humans to animals -- also called reverse zoonosis. In other zoonotic disease news, French scientists isolated a new group of HIV-1 from a Cameroon woman, which they're calling group P. The scientists found that this strain originated in gorillas rather than chimpanzees. The woman had recently moved to Paris from Cameroon and had tested seropositive for HIV-1 but didn't have signs of acquired autoimmune deficiency (AIDS). The researchers are tracking different strains of HIV virus, and they generally identify an unusual strain when AIDS symptoms are present in someone who tests negative for the virus. In this case the opposite situation occurred.

Although various viral load tests were positive, the researchers tested the woman's viral DNA against the known groups of HIV-1, referred to as M, N, and O, and found that whatever virus she was testing positive for didn't match these groups. The researchers then sequenced the viral genome and performed evolutionary analysis, which showed that the virus sequence was closer to a known simian immunodeficiency virus (SIV) found in gorillas, called SIVgor, than to the chimpanzee SIV from which HIV-1 groups M, N, and O derived.

Scientists who had analyzed the SIVgor virus recently found that it had the capacity to infect humans, however this is the first identified case. Scientists here knew the results of both viral testing and acquired immunodeficiency status which gave them the opportunity to identify the new strain, however; there may be other people infected with the same or similar gorilla derived viruses. Nature published the report.

Also this week, the scientists proposed in Proceedings for the National Association of Sciences (PNAS) that malaria may have originated in chimpanzees.

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Acronym Required writes frequently on infectious diseases such as malaria, H5N1, H1N1 and AIDS, and once on bats and Hanta virus.

Doctors Fret On Behalf Pharma: Pro Bono For What? No Free Lunch?

Vermont and Massachusetts recently passed strict conflict of interest laws that require certain drug and medical-device manufacturers to inform state health officials of gifts made to doctors. At least half a dozen states have similar laws. Pharmaceutical companies spent $2.93 million on marketing in Vermont in 12 months. Payments and gifts to some Vermont psychiatrists totaled more than $100 thousand dollars a year. Nationwide, pharmaceutical companies spend between $20 billion and "$57 billion per year" on marketing per year.

The majority of Americans approve of the measures. In a survey of the public opinion, 64% of Americans think it's important to know their physician's financial ties to pharmaceutical companies and 68% support legislation requiring pharmaceutical companies to disclose gifts to doctors according to the results of a Prescription Project survey.

The regulations aim to bar some gifts from industry to doctors and researchers and more closely monitor which doctors and researchers pharma pays. The Vermont Medical Society supported the new regulations, noting that trust is necessary to build doctor patient relationships. The president of the physicians group commented: "Gifts from the pharmaceutical industry can create at least the appearance of conflict of interest, so in our minds that has a negative impact on our relationship with patients."

Just Don't Say "Corrupt"

However, opposing the conflict of interest regulation is the Association of Clinical Researchers and Educators (ACRE), a group of 100 physicians led by Harvard hematologist Thomas Stossel.¹ ACRE acknowledges that some physicians or researchers may take too much money from industry but argues that regulation of conflict of interest is not the answer. ACRE says that regulation will encroach on the free give and take between industry, physicians, and researchers that has yielded great research and medical progress. Nature reported frustration on the part of physicians who attended ACRE's July 23rd meeting:

"One attendee complained that he couldn't buy a $12 hamburger for a consultant who had agreed to speak for free. 'They're giving us a pro bono service and we're going to ask them to pay for their own lunch?' he lamented." ²

Really? Should free consulting from a pharma representative or consultant raise feelings of obligatory angst in attendees? If a pro-bono talk motivates such laments, what guilt do free samples provoke? What about a vacation trip? Will a $12 dollar hamburger fulfill the obligation? Or perhaps just a few prescriptions orders for patients?

ACRE's Stossel objects to the gift ban because it suggests that physicians have "'have a corruption problem'". In Marcia Angell's January, 2009 NY Review of Books article, "Drug Companies & Doctors: A Story of Corruption", the author reviewed three books on pharmaceutical corruption.^3,4 The books were published after the congressional inquiry into drug company payments that uncovered quantities of drug money flowing into psychiatry doctors' pockets.

A Senate investigation led by Chuck Grassley (R-IA) (pdf!), uncovered payments to three Harvard psychiatrists who received over a million dollars each over a several year period. One psychiatrist at Stanford and one at Emory also received payments of over a million dollars.

A study in 2007 by Columbia University researchers showed that doctors don't feel that their personal integrity is compromised by taking gifts or money from pharmaceutical companies. But they do feel that other doctors would be compromised by such gifts. Chimonas et al concluded: "Our findings suggest that voluntary guidelines, like those proposed by most major medical societies, are inadequate. It may be that only the prohibition of physician-detailer interactions will be effective."

Marcia Angell points out that although the cases highlighted by the media tend to be more extreme, most physicians (94%) do have some relationship with drug companies. And certainly many of these payments are inconsequential and/or don't sway research or influence prescribing patterns. But clearly many do, or else pharmaceutical companies wouldn't be spending tens of billions of dollars on doctors and research.

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¹ The group is now supported by membership fees, according to Nature and the organization website. However in 2008, according to a note accompanying a British Medical Journal article, Stossel was on the boards of several pharmaceuticals, and received fees for speaking to corporations and other organizations about conflict of interest.

² Willard, Cassandra, "Physicians fight back against disclosure rules" Nature 460, 556-557 (2009) | doi:10.1038/460556b. Also published in Nature Medicine.

³ The NY Review of Books received a letter from the legal representative of one of the doctors covered in her article, complaining about the use of the word "corruption" in the headline and text of Angell's review, because it inferred the doctor had been engaged in "bribery" or "similar dishonest dealings". The weekly disagreed.

⁴ The three books are: Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial by Alison Bass (Algonquin Books of Chapel Hill); Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs by Melody Petersen (Sarah Crichton/Farrar, Straus and Giroux); and Shyness: How Normal Behavior Became a Sickness by Christopher Lane, (Yale University Press).