Unless the New York Times thinks that a drug giant paying a $3 billion fine doesn't fit the definition of "health news". I tend toward disagreement. The article about GlaxoSmithKline and its whopper of a fine can be found in the Business section, but it appears nowhere under the health banner. This is particularly unfortunate because I suspect there's a lot of people who scan the "Health" headlines without ever entertaining a thought of browsing the Business stories. And in theory they'd be most interested.
Though tucked away in the wrong spot, the article is a good primer on issues related to inappropriate promotion of drugs by their manufacturers. In this case, GSK was fined for a variety of shenanigans, mostly related to its psychiatric formulary (the details of such misbehaviors, predictable as they are, are briefly sketched out in the article).
Perhaps the article's most important point is that, while seemingly a huge fine, it may be regarded as no more than a parking ticket to company executives. For starters, no individual will face any charges. "What we're learning is that money doesn't deter corporate malfeasance," former NY attorney general Eliot Spitzer is quoted as saying. Stifle the laughter: Spitzer, before his own fall from grace, sued GSK on behalf of New York back in 2004 for similar issues, so he's an appropriate sound bite for the article.
--br
Tuesday, July 3, 2012
Thursday, June 28, 2012
Quick Take on the Supremes and the ACA
In the coming days there will be no end of commentary about the Supreme Court upholding the Affordable Care Act--foolishly called "Obamacare" by both proponents and detractors--in terms of both legal and political analysis. The early reactions are mostly predictable, and the media is running with the "elation among Dems, fury among Repubs" story and milking it for all it is worth.
At the Billy Rubin Blog, however, I'm not feeling so predisposed to shout mighty huzzahs in the face of the landmark ruling. Since I ain't a lawyer or a policy analyst, I can't comment on the ruling's legal aspects or how it will affect the coming elections. But this doesn't seem to be the Great Victory For Progressives that the mainstream media has already made it out to be. Sorry to rain on the parade, folks, but I'm inclined to think of this more like the Battle of Thermopylae: at best it's a rearguard action, and the odds of victory remain quite long since the opponents are determined and numerous. But I hate war metaphors, so ignore that particular piece of poetic excess.
I'm not so cheerful because a huge number of Americans--not millions but tens of millions--have no understanding of the ACA beyond the fact that it's a law and that most people refer to it as "Obamacare". Beyond this, they couldn't explain the law's contents in even the most cursory of fashions. Most, but by no means all, of those tens of millions of Americans are opposed to the law, despite their broad support for the basic points of the law, as this recent poll demonstrates. Simply put, this means that far too many Americans are frightfully uninformed of even the most basic political issues, since this isn't some arcane matter requiring careful reading for months at a stretch (in the way that, say, the Eurozone financial crisis is). Though given that more than 60% of one thousand adults polled didn't think that Obama is a Christian, their inability to understand the ACA is no real surprise. It is difficult (impossible?) to have a functional democracy with this kind of ignorance.
I'm not so cheerful because this bill itself, the very bill that is being hailed by many Democrats as something akin to manna from heaven, is a generally crappy bill that was a far rightward compromise that left true progressives in a state somewhere between disappointed and appalled. Indeed, the "individual mandate" that Fox & Friends yowls about as being pure socialism was essentially invented in the offices of the conservative Heritage Foundation years before. Progressives wanted a single-payer plan: basically, Medicare for everyone. They were willing to settle for what became known as the "public option", where people could opt-in to government health insurance or get their own.
But that's not what they got--despite huge levels of support in the House and commanding levels of support in the Senate. In previous decades, when a majority of both the House and the Senate support legislation, and send it to a sitting President friendly to that legislation, a law gets passed. Only in this case that didn't happen: we got the individual mandate of the ACA because of a few allegedly "centrist" Dems and the fact that the Republican Party over the last generation has decided that--at least when it is not the party in power--Senate majorities must be sixty rather than fifty for a law to pass, and because the Democratic leadership is apparently so cowed by the Republicans that the bill shifted far to the right. Not that it ended up generating one single Republican vote in either chamber, but somehow the bill became a boon to the health insurance industry.
I'm not so cheerful because this President, for whom many of us had great hopes, has turned out to be not the socialist he's constantly accused of being by the imbecilic ranters of Fox and its ilk, but rather as one who starts out with centrist policies that get pushed ever rightward through various phases of acquiescence so that he may appear to be "above" mere partisan politics. We could easily substitute the President's name in this little one-off that describes outgoing Republican Senator from Maine, Olympia Snowe: "if [a Republican] proposed to spend one trillion dollars to erect a 100- foot-tall solid-gold Winston Churchill statue on Mars, [Obama] would no doubt decide, after careful deliberation, that the wise course was to trim the height down to 90 feet and perhaps use a cheaper bronze alloy in the base." Such is the "post partisan" approach of our President. He cut his stimulus package in half in order to entice three Republican Senate votes--votes which were utterly unnecessary for passage.
This man is not bold, he is not a shrewd negotiator, and we are stuck with him, or rather worse, for the next four years.
I'm not so cheerful because despite the fact that Constitutional Law scholars overwhelmingly agree that the ACA was constitutional and that the rationale for the challenge was weak, somehow the legality of the law was seriously in doubt, and most of those very ConLaw scholars figured the law would be overturned. When 90 percent of lawyers are in accordance that a law is both valid and likely to be declared unconstitutional, you are living in a country where significant chunks of the judicial branch are little more than formally robed hacks in service of a partisan machine, no more or less different than the judges who were part of Tammany Hall.
I'm especially not cheerful because the swing vote in this case was written by a man who is nearly certain to be under enormous pressure from various attachés of the Republican Party in the months to come for having deviated from the pre-defined script. And besides that, although I am no legal scholar, there was something quite peculiar in his holding: some think that Roberts is using this opportunity to forestall criticism of a string of highly partisan 5-4 future decisions such as the gutting of the Voting Rights Act among others; others still believe that Roberts's tepid support of (and perhaps switch to?) the majority will allow for a later successful challenge anyway.
Even though the law has just barely squeaked by, it is still very much in jeopardy. The House will almost certainly remain Republican, and the White House and Senate are up for grabs. My only political forecast of this column: if the Republican Party can win the Senate but lose the White House, expect the law to be repealed, followed by a veto, followed by an impeachment. Would that the Democratic party possessed such fierce determination and rigid discipline within its ranks.
That's the view from here tonight. As we are fond of saying at the Billy Rubin Blog: cheer up, the worst is yet to come.
--br
At the Billy Rubin Blog, however, I'm not feeling so predisposed to shout mighty huzzahs in the face of the landmark ruling. Since I ain't a lawyer or a policy analyst, I can't comment on the ruling's legal aspects or how it will affect the coming elections. But this doesn't seem to be the Great Victory For Progressives that the mainstream media has already made it out to be. Sorry to rain on the parade, folks, but I'm inclined to think of this more like the Battle of Thermopylae: at best it's a rearguard action, and the odds of victory remain quite long since the opponents are determined and numerous. But I hate war metaphors, so ignore that particular piece of poetic excess.
I'm not so cheerful because a huge number of Americans--not millions but tens of millions--have no understanding of the ACA beyond the fact that it's a law and that most people refer to it as "Obamacare". Beyond this, they couldn't explain the law's contents in even the most cursory of fashions. Most, but by no means all, of those tens of millions of Americans are opposed to the law, despite their broad support for the basic points of the law, as this recent poll demonstrates. Simply put, this means that far too many Americans are frightfully uninformed of even the most basic political issues, since this isn't some arcane matter requiring careful reading for months at a stretch (in the way that, say, the Eurozone financial crisis is). Though given that more than 60% of one thousand adults polled didn't think that Obama is a Christian, their inability to understand the ACA is no real surprise. It is difficult (impossible?) to have a functional democracy with this kind of ignorance.
I'm not so cheerful because this bill itself, the very bill that is being hailed by many Democrats as something akin to manna from heaven, is a generally crappy bill that was a far rightward compromise that left true progressives in a state somewhere between disappointed and appalled. Indeed, the "individual mandate" that Fox & Friends yowls about as being pure socialism was essentially invented in the offices of the conservative Heritage Foundation years before. Progressives wanted a single-payer plan: basically, Medicare for everyone. They were willing to settle for what became known as the "public option", where people could opt-in to government health insurance or get their own.
But that's not what they got--despite huge levels of support in the House and commanding levels of support in the Senate. In previous decades, when a majority of both the House and the Senate support legislation, and send it to a sitting President friendly to that legislation, a law gets passed. Only in this case that didn't happen: we got the individual mandate of the ACA because of a few allegedly "centrist" Dems and the fact that the Republican Party over the last generation has decided that--at least when it is not the party in power--Senate majorities must be sixty rather than fifty for a law to pass, and because the Democratic leadership is apparently so cowed by the Republicans that the bill shifted far to the right. Not that it ended up generating one single Republican vote in either chamber, but somehow the bill became a boon to the health insurance industry.
I'm not so cheerful because this President, for whom many of us had great hopes, has turned out to be not the socialist he's constantly accused of being by the imbecilic ranters of Fox and its ilk, but rather as one who starts out with centrist policies that get pushed ever rightward through various phases of acquiescence so that he may appear to be "above" mere partisan politics. We could easily substitute the President's name in this little one-off that describes outgoing Republican Senator from Maine, Olympia Snowe: "if [a Republican] proposed to spend one trillion dollars to erect a 100- foot-tall solid-gold Winston Churchill statue on Mars, [Obama] would no doubt decide, after careful deliberation, that the wise course was to trim the height down to 90 feet and perhaps use a cheaper bronze alloy in the base." Such is the "post partisan" approach of our President. He cut his stimulus package in half in order to entice three Republican Senate votes--votes which were utterly unnecessary for passage.
This man is not bold, he is not a shrewd negotiator, and we are stuck with him, or rather worse, for the next four years.
I'm not so cheerful because despite the fact that Constitutional Law scholars overwhelmingly agree that the ACA was constitutional and that the rationale for the challenge was weak, somehow the legality of the law was seriously in doubt, and most of those very ConLaw scholars figured the law would be overturned. When 90 percent of lawyers are in accordance that a law is both valid and likely to be declared unconstitutional, you are living in a country where significant chunks of the judicial branch are little more than formally robed hacks in service of a partisan machine, no more or less different than the judges who were part of Tammany Hall.
I'm especially not cheerful because the swing vote in this case was written by a man who is nearly certain to be under enormous pressure from various attachés of the Republican Party in the months to come for having deviated from the pre-defined script. And besides that, although I am no legal scholar, there was something quite peculiar in his holding: some think that Roberts is using this opportunity to forestall criticism of a string of highly partisan 5-4 future decisions such as the gutting of the Voting Rights Act among others; others still believe that Roberts's tepid support of (and perhaps switch to?) the majority will allow for a later successful challenge anyway.
Even though the law has just barely squeaked by, it is still very much in jeopardy. The House will almost certainly remain Republican, and the White House and Senate are up for grabs. My only political forecast of this column: if the Republican Party can win the Senate but lose the White House, expect the law to be repealed, followed by a veto, followed by an impeachment. Would that the Democratic party possessed such fierce determination and rigid discipline within its ranks.
That's the view from here tonight. As we are fond of saying at the Billy Rubin Blog: cheer up, the worst is yet to come.
--br
Wednesday, June 27, 2012
Germany Figures Out How To Unite Jews and Muslims
Pretty simple, actually: try to ban circumcision.
They seem to be taking rather the opposite approach in Zimbabwe, where male legislators set an example for their citizenry recently by having become circumcised as part of a concerted effort to control the HIV epidemic, since circumcision dramatically reduces HIV transmission. "Members of both main parties--normally bitter rivals--had the surgery," the article notes. This is leadership!
As the data on circumcision and HIV transmission are pretty widely known in public health circles, and given that there is other data suggesting other health benefits of circumcision, we at the Billy Rubin Blog suspect that the German court ruling is little more than anti-semitism masquerading as concern for children. But at least in this case the term "anti-semitism" joins those two normally factious cousins under one banner. Well done, members of the Fatherland!
--br
They seem to be taking rather the opposite approach in Zimbabwe, where male legislators set an example for their citizenry recently by having become circumcised as part of a concerted effort to control the HIV epidemic, since circumcision dramatically reduces HIV transmission. "Members of both main parties--normally bitter rivals--had the surgery," the article notes. This is leadership!
As the data on circumcision and HIV transmission are pretty widely known in public health circles, and given that there is other data suggesting other health benefits of circumcision, we at the Billy Rubin Blog suspect that the German court ruling is little more than anti-semitism masquerading as concern for children. But at least in this case the term "anti-semitism" joins those two normally factious cousins under one banner. Well done, members of the Fatherland!
--br
Sunday, June 10, 2012
The Ongoing Yutz Chronicles of Ross Douthat
Every once in awhile I decide to tempt fate and find out whether I can stomach a Ross Douthat column in the New York Times. Invariably I find I cannot, though I hold out hope that someday he'll stop writing like a first-semester undergraduate straining to maintain that there really are simple and tidy answers to the world's ills--or indeed, that the world is in fact quite a simple place to begin with.
Today's column caught my eye because Douthat takes on the topic of eugenics. He notes, with partial accuracy, that eugenics were central to American progressive political philosophy 100 years ago, and key proponents included Planned Parenthood founder Margaret Sanger, a fact well known among antiabortion activists (as can be found here for example). The accuracy is merely partial in that he ignores how readily eugenic philosophy was absorbed by political thinkers on the other side of the spectrum as well, and hardly needs pointing out unless one has never encountered the word "Nazi". And while that particular political brand never caught on in the US, there were plenty of establishment types who had no love of progressive ideals and yet justified their politics through the work of Herbert Spencer and Francis Galton.
There's some potentially interesting stuff here given that prenatal testing and (so far) legal abortion may lead to a variety of ethical conundrums well beyond what we already face. But Douthat really seems to be interested in tarring perceived political opponents rather than exploring ideas, so he uses the Sanger connection to call the process of aborting a fetus with Down Syndrome "liberal eugenics". Curiously, he notes that approximately 90% of all parents who receive a "positive" test indicating they are carrying a Down baby will elect to terminate the pregnancy. Is this some kind of liberal affliction?
I am of the view that if Douthat could only figure out a way to point out that murder should really be called "liberal murder", he would have it on the pages of the Times forthwith. We'll have to stay tuned, I guess.
--br
Today's column caught my eye because Douthat takes on the topic of eugenics. He notes, with partial accuracy, that eugenics were central to American progressive political philosophy 100 years ago, and key proponents included Planned Parenthood founder Margaret Sanger, a fact well known among antiabortion activists (as can be found here for example). The accuracy is merely partial in that he ignores how readily eugenic philosophy was absorbed by political thinkers on the other side of the spectrum as well, and hardly needs pointing out unless one has never encountered the word "Nazi". And while that particular political brand never caught on in the US, there were plenty of establishment types who had no love of progressive ideals and yet justified their politics through the work of Herbert Spencer and Francis Galton.
There's some potentially interesting stuff here given that prenatal testing and (so far) legal abortion may lead to a variety of ethical conundrums well beyond what we already face. But Douthat really seems to be interested in tarring perceived political opponents rather than exploring ideas, so he uses the Sanger connection to call the process of aborting a fetus with Down Syndrome "liberal eugenics". Curiously, he notes that approximately 90% of all parents who receive a "positive" test indicating they are carrying a Down baby will elect to terminate the pregnancy. Is this some kind of liberal affliction?
I am of the view that if Douthat could only figure out a way to point out that murder should really be called "liberal murder", he would have it on the pages of the Times forthwith. We'll have to stay tuned, I guess.
--br
Wednesday, May 23, 2012
Annoying & Misleading Health News Titles
From the New York Times today comes this question: "Is Marathon Running Bad for the Heart?" Since one would normally assume the answer to be "no", the only logical conclusion one can reach is that the story casts doubt on the conventional wisdom, and perhaps the cardiac benefits of long-distance running aren't so great after all.
Yet the story basically does conclude that marathoning is quite safe for prepared athletes, and that heart attacks are extremely rare events. When such an event occurs, and a runner dies on the course, it makes big local headlines, thus warping the relative danger of the event. "The science suggests that, over all, distance running and racing are extremely unlikely to kill you — except when, in rare instances, they do," the article notes, although here at Billy Rubin central we don't understand why they added on the last caveat, since it appears to be redundant. Anyway.
Guess I would have preferred a title more along the lines of, "Study Confirms Running Still Safe for the Heart" or "Deaths from Marathons Extremely Rare but Dominate News Coverage After Races". The content of the story I wouldn't change, but I'm wondering how many people didn't read the story, glanced at the headline, and thought, "See? I knew running wasn't a good idea", as they sit on their couch watching the second hour of SportsCenter.
--br
Yet the story basically does conclude that marathoning is quite safe for prepared athletes, and that heart attacks are extremely rare events. When such an event occurs, and a runner dies on the course, it makes big local headlines, thus warping the relative danger of the event. "The science suggests that, over all, distance running and racing are extremely unlikely to kill you — except when, in rare instances, they do," the article notes, although here at Billy Rubin central we don't understand why they added on the last caveat, since it appears to be redundant. Anyway.
Guess I would have preferred a title more along the lines of, "Study Confirms Running Still Safe for the Heart" or "Deaths from Marathons Extremely Rare but Dominate News Coverage After Races". The content of the story I wouldn't change, but I'm wondering how many people didn't read the story, glanced at the headline, and thought, "See? I knew running wasn't a good idea", as they sit on their couch watching the second hour of SportsCenter.
--br
Wednesday, April 25, 2012
Blood, Death, Children, and Movies
I've just shown my 10 year-old children their first R-rated movie. Before you call the cops on me, I'd note that simultaneously, I've forbade my children to see a different movie--though it got a PG-13 rating.
Essentially, the first movie, despite its rather ominous rating, was a movie that I thought a child of ten years might be able to handle, though I knew it would stretch their limits. The second, PG-rated movie, despite several warm reviews I've heard not only from professional critics but friends as well, remains to my mind out-of-the-question as out-of-bounds despite lots of moviegoers singing its praises as its haul passes the $500 million mark in just over a month.
The envelopes, please? The latter movie is, of course, The Hunger Games, based on the trilogy by Suzanne Collins, a dystopian fiction that has been massively popular in its own right. From what I can tell, The Hunger Games seems a savvy commentary on mass communication, the reach of governmental power, the mechanisms by which people in positions of power are capable of maintaining their power, et cetera. I say that it seems that way because I haven't seen the movie and don't intend to. And I certainly don't believe that my children should be seeing it, now or anytime between now and, oh, say, their sixteenth birthday. Why's that?
Kids killing other kids. I heard Kenneth Turan's review on NPR while commuting to work, and when he explained the general plot outline, I had heard enough.
I don't mean to say that I think that The Hunger Games is necessarily a bad movie and that it shouldn't be seen by anyone. Far from it, it sounds like a provocative film (maybe: hard to tell) and by all means let adults and young adults flock to it. But I don't think children need to see a movie about children killing other children. I don't really care how well the movie is made, nor how deep its philosophical preoccupations. I'm simply astonished that a movie involving a plot line in which kids kill other kids could possibly receive a PG rating. Indeed, I'm appalled. Do we collectively think this is an acceptable story to tell our children?!
Meanwhile, I couldn't help but chuckle as we sat in our family room watching the R-rated The Red Violin, likewise a movie focused (in part, at least) on children, death, and blood, though to my mind in a manner entirely acceptable for a child of ten. The R rating is due to a brief moment of tush and breast--in a manner that can only, in this desensitized age, be described as "mildly erotic at best"--and a scene in which a male actor basically makes love to the eponymous violin. (Owing to the time-honored double standard of male and female nudity, however, no actual cock makes it way onto the screen.) For the nude scenes in question, my daughter hid her eyes unbidden behind a pillow; my son didn't make a peep, so hard to know precisely what was going on in the moment with him. I could speculate. At any rate, The Red Violin is a movie as much about love as about death, and it is most definitely not about killing.
Side by side, seeing these two ratings matched against each other, it is hard for me to feel anything but despair that our national ratings board would discourage pre-teen children from watching a movie in which the naked human form is displayed (briefly!) in an otherwise heartwarming tale about love conquering time and death, while simultaneously being apparently nonchalant about the visual portrayal of the most grotesque actions imaginable in cinema. The Hunger Games may be deep; it may be reflective; it still sounds like Snuff to me.
Might those astounding box office draws have played a role in the rating so as to allow for the largest possible audience? Hmm.
--br
Essentially, the first movie, despite its rather ominous rating, was a movie that I thought a child of ten years might be able to handle, though I knew it would stretch their limits. The second, PG-rated movie, despite several warm reviews I've heard not only from professional critics but friends as well, remains to my mind out-of-the-question as out-of-bounds despite lots of moviegoers singing its praises as its haul passes the $500 million mark in just over a month.
The envelopes, please? The latter movie is, of course, The Hunger Games, based on the trilogy by Suzanne Collins, a dystopian fiction that has been massively popular in its own right. From what I can tell, The Hunger Games seems a savvy commentary on mass communication, the reach of governmental power, the mechanisms by which people in positions of power are capable of maintaining their power, et cetera. I say that it seems that way because I haven't seen the movie and don't intend to. And I certainly don't believe that my children should be seeing it, now or anytime between now and, oh, say, their sixteenth birthday. Why's that?
Kids killing other kids. I heard Kenneth Turan's review on NPR while commuting to work, and when he explained the general plot outline, I had heard enough.
I don't mean to say that I think that The Hunger Games is necessarily a bad movie and that it shouldn't be seen by anyone. Far from it, it sounds like a provocative film (maybe: hard to tell) and by all means let adults and young adults flock to it. But I don't think children need to see a movie about children killing other children. I don't really care how well the movie is made, nor how deep its philosophical preoccupations. I'm simply astonished that a movie involving a plot line in which kids kill other kids could possibly receive a PG rating. Indeed, I'm appalled. Do we collectively think this is an acceptable story to tell our children?!
Meanwhile, I couldn't help but chuckle as we sat in our family room watching the R-rated The Red Violin, likewise a movie focused (in part, at least) on children, death, and blood, though to my mind in a manner entirely acceptable for a child of ten. The R rating is due to a brief moment of tush and breast--in a manner that can only, in this desensitized age, be described as "mildly erotic at best"--and a scene in which a male actor basically makes love to the eponymous violin. (Owing to the time-honored double standard of male and female nudity, however, no actual cock makes it way onto the screen.) For the nude scenes in question, my daughter hid her eyes unbidden behind a pillow; my son didn't make a peep, so hard to know precisely what was going on in the moment with him. I could speculate. At any rate, The Red Violin is a movie as much about love as about death, and it is most definitely not about killing.
Side by side, seeing these two ratings matched against each other, it is hard for me to feel anything but despair that our national ratings board would discourage pre-teen children from watching a movie in which the naked human form is displayed (briefly!) in an otherwise heartwarming tale about love conquering time and death, while simultaneously being apparently nonchalant about the visual portrayal of the most grotesque actions imaginable in cinema. The Hunger Games may be deep; it may be reflective; it still sounds like Snuff to me.
Might those astounding box office draws have played a role in the rating so as to allow for the largest possible audience? Hmm.
--br
Sunday, April 15, 2012
Physician-Assisted Suicide in the US: Don't Compare it To Europe
Earlier this week the New York Times held a "Room For Debate" roundtable on Physician-Assisted Suicide that left me mostly frustrated. Each of the eight participants took no more than about four paragraphs to share their viewpoint, which is far too brief to introduce laypeople to some of the minefields associated with the practice. The topic is just too complicated for that kind of brevity by my reckoning. None of the authors gave more than a glancing nod to issues surrounding palliative care, a huge omission since it's at least possible, if not likely, that many people who support PAS do so out of a largely erroneous belief that people with terminal diseases, especially cancer, often die horribly painful deaths that modern medicine simply could not prevent. I'm assuming that these writers, several of whom are renowned experts in this field, eschewed writing about palliative care not by choice but by length limitations imposed by the editors, but that's just a guess. Hey Times--give 'em eight grafs! I promise your readers will read it!
We at the Billy Rubin Blog are strongly opposed to PAS--a topic that we have briefly touched on in our discussion of the profound media misrepresentation of Jack Kevorkian, as cold-blooded a murderer as has ever walked the earth and who got away with over 100 butcheries by cloaking himself in self-righteousness and preying on the public's abject fear of (mostly) cancer. There are more judicious docs who support the practice, such as Timothy Quill, who proposed a "constitutional right to suicide" that the US Supreme Court didn't come close to buying (it was rejected 9-0). While I respect guys like Quill and don't think they need to be stripped of their licenses (unlike Kevorkian), I do believe it is unethical to participate in suicides, even if some Northwestern States give it their legal imprimatur.
Too-abbreviated a discussion or not, one excellent point kept cropping up by the PAS opponents. PAS supporters are fond of invoking the situation in the Netherlands, where the practice has existed for decades and doesn't appear to be highly controversial today, nor does it appear to have become a back door for euthanasia as many in the US fear it will. But this is most definitely not an apples-to-apples comparison, since US health care mostly functions as a free-market phenomenon, where secondary incentives can play a role in motivating patients, families, and insurance companies to nudge people along the path. As this article notes, at least one such scenario like this has already played out in PAS-legal Oregon.
We'd prefer the Dutch abandoned the practice altogether, but either way we heed this observation from Dr. Petra de Jong, the head of Right to Die Netherlands: "Euthanasia and assisted suicide can only be legalized in a country with optimum health care, including palliative care. But most of all, with citizens having access to good health care, regardless of their income." Yep.
--br
We at the Billy Rubin Blog are strongly opposed to PAS--a topic that we have briefly touched on in our discussion of the profound media misrepresentation of Jack Kevorkian, as cold-blooded a murderer as has ever walked the earth and who got away with over 100 butcheries by cloaking himself in self-righteousness and preying on the public's abject fear of (mostly) cancer. There are more judicious docs who support the practice, such as Timothy Quill, who proposed a "constitutional right to suicide" that the US Supreme Court didn't come close to buying (it was rejected 9-0). While I respect guys like Quill and don't think they need to be stripped of their licenses (unlike Kevorkian), I do believe it is unethical to participate in suicides, even if some Northwestern States give it their legal imprimatur.
Too-abbreviated a discussion or not, one excellent point kept cropping up by the PAS opponents. PAS supporters are fond of invoking the situation in the Netherlands, where the practice has existed for decades and doesn't appear to be highly controversial today, nor does it appear to have become a back door for euthanasia as many in the US fear it will. But this is most definitely not an apples-to-apples comparison, since US health care mostly functions as a free-market phenomenon, where secondary incentives can play a role in motivating patients, families, and insurance companies to nudge people along the path. As this article notes, at least one such scenario like this has already played out in PAS-legal Oregon.
We'd prefer the Dutch abandoned the practice altogether, but either way we heed this observation from Dr. Petra de Jong, the head of Right to Die Netherlands: "Euthanasia and assisted suicide can only be legalized in a country with optimum health care, including palliative care. But most of all, with citizens having access to good health care, regardless of their income." Yep.
--br
Sunday, April 1, 2012
The Story of Haiti's Cholera: No Silver Lining
Today's New York Times has a long report about the history of the introduction of cholera to Haiti following the earthquake. Introduction is the operative word there: despite all of the calamities that have befallen this most downtrodden of nations, cholera had spared the little half-island, despite outbreaks in nearby Latin America in the 1990s.
Cholera was absent before the earthquake, at any rate, and it ended quite likely with the arrival of Nepalese soldiers working for the United Nations. The short version is that it now appears that these soldiers unwittingly harbored the bacteria in their guts ("asymptomatic carriage" is common for diarrheal diseases like cholera and typhoid fever), and the bacteria was introduced to the water supply by inadequately-dug latrines leading to overflow into tributaries of the Artibonite, Haiti's principal river and the Haitian equivalent of what we think of as the municipal water supply--meaning the river in which hundreds of thousands of people bathe & wash.
After the bacteria took up residence in the guts of the locals, the outbreak was on, and since then 7,000 people have died, and we may be in for more as the rainy season begins anew. As we have noted before, this is a tragedy on a massive scale, and is getting scant play in the American news media, NYT and National Public Radio notwithstanding. The TV bigs must think that the quake makes for so much more exciting viewing. Maybe thousands of new graves in the coming months will change their minds.
The article does a good deal of post-hoc finger-pointing at the breakdowns in communication, coordination, and general inability to react quickly to the rapidly emerging threat of cholera in early 2011. I am a bit skeptical of its "if we had only done this" tone: there were so many moving parts, so many decisions that required coordination, so many barriers to organizational cross-talk that no single change would likely have prevented the outbreak. Which is not to say that there aren't important lessons to be learned, especially as we head into the rainy season, but it always seems so easy to identify problems through the retrospectoscope.
As the article details, now the level of trust between the Haitians and at least the UN is dismal. One local authority quoted in the article matter-of-factly discussed killing one of the soldiers--simply to make a political point. To describe this as "ominous" would understate the case significantly. And I'm dubious that such hostilities will be confined only to the UN personnel. If the bodies continue to pile up, the rage will spread like the cholera that came before it, with potentially equally lethal consequences.
--br
Cholera was absent before the earthquake, at any rate, and it ended quite likely with the arrival of Nepalese soldiers working for the United Nations. The short version is that it now appears that these soldiers unwittingly harbored the bacteria in their guts ("asymptomatic carriage" is common for diarrheal diseases like cholera and typhoid fever), and the bacteria was introduced to the water supply by inadequately-dug latrines leading to overflow into tributaries of the Artibonite, Haiti's principal river and the Haitian equivalent of what we think of as the municipal water supply--meaning the river in which hundreds of thousands of people bathe & wash.
After the bacteria took up residence in the guts of the locals, the outbreak was on, and since then 7,000 people have died, and we may be in for more as the rainy season begins anew. As we have noted before, this is a tragedy on a massive scale, and is getting scant play in the American news media, NYT and National Public Radio notwithstanding. The TV bigs must think that the quake makes for so much more exciting viewing. Maybe thousands of new graves in the coming months will change their minds.
The article does a good deal of post-hoc finger-pointing at the breakdowns in communication, coordination, and general inability to react quickly to the rapidly emerging threat of cholera in early 2011. I am a bit skeptical of its "if we had only done this" tone: there were so many moving parts, so many decisions that required coordination, so many barriers to organizational cross-talk that no single change would likely have prevented the outbreak. Which is not to say that there aren't important lessons to be learned, especially as we head into the rainy season, but it always seems so easy to identify problems through the retrospectoscope.
As the article details, now the level of trust between the Haitians and at least the UN is dismal. One local authority quoted in the article matter-of-factly discussed killing one of the soldiers--simply to make a political point. To describe this as "ominous" would understate the case significantly. And I'm dubious that such hostilities will be confined only to the UN personnel. If the bodies continue to pile up, the rage will spread like the cholera that came before it, with potentially equally lethal consequences.
--br
Saturday, March 31, 2012
More False Equivalencies of Shallow Journalists (Or: David Brooks Tries To Think, But Fails Again)
We love reading David Brooks for the occasional laugh. Unlike most other conservative political pundits, who are simply hypocrites and liars and not troubled by the truth, Brooks makes a twice-weekly earnest effort at squaring the circle of his conservative philosophy with what's actually happening in the world. He's the Grantland Rice of the political page, possessing a deft touch for the sentimental phrase, living in a mental state of divorce from harsher realities.
This week's case in point involves his observations about what can only be described as the far rightward drift of the Republican party since the election of Barack Obama to POTUS. Brooks's Thursday NYT column details the fading political fortunes of a Gulf War veteran/San Diego Republican, one Nathan Fletcher. As part of his candidacy for Mayor of San Diego, Fletcher has adopted a few positions that most liberals or lefties would find amusing but irrelevant (he supports bike paths, apparently, which Brooks considers to be of weighty importance). But for that and some moderate stances on immigration and "the environment" he has run afoul of the Tea Partyists, and the hard liners have backed City Councilman Carl DeMaio. As a consequence, Fletcher, who sounds like the classic "good guy with whom you might disagree on political stuff", is leaving the Republican tent.
Now any perceptive, or any sane, observer would note that this represents yet another demonstration of the quantum change in the radicalization of the Republican party from respectable-but-flawed to utterly-nutso. It doesn't take a genius to have seen that process--in which the most dangerous, racist, xenophobic, paranoid elements have chased away any voice of reason--has robbed the party of honorable moderates like Fletcher, Lincoln Chafee, and Michael Bloomberg among others in favor of a rabble of Know Nothings. It doesn't require a political mind like Henry Kissinger's to understand that the ideological progeny of Barry Goldwater and Joseph McCarthy are now firmly in control of the party's destiny, and that at most Barack Obama merely catalyzed an inexorable process that's been rolling since Ronald Reagan's ascendancy.
And what conclusion does the perspicacious David Brooks arrive at? That since it's happening on the right, the same thing must by definition be happening on the left.
No, really. In all his mental arithmetical glory, this is Brooks's last paragraph: "Fletcher...represents a nationally important test case. Can the Iraq and Afghanistan veterans, who were trained to be ruthlessly pragmatic, find a home in either party?...As the two parties become more insular, is it possible to mount an independent alternative?"
That's my emphasis, for he spends an entire column dissecting the far right lurch and then finishes wondering about where a moderate's to go when both parties become so rigidly orthodox. Brooks is apparently unaware, or has conveniently ignored, the political career of Tammy Duckworth, Gulf War veteran and still happily at home within the Democratic tent. Ms. Duckworth, who lost both legs during her tour, ran for Congress in the Illinois 6th district in 2006 and lost a close contest to the Republican candidate after a series of predictably scuzzy political maneuvers. As for other vets who drift Democrat but have been ousted by orthodox lefties, I'm waiting to hear a list of examples from Brooks. And I suspect I'll be waiting for quite a long time.
Yet the most amusing aspect of seeing this particular argument, that the Dems are headed toward as equally nutty a place as the Republicans, is that it took place as the Affordable Care Act's constitutionality was debated before the Supreme Court. The Billy Rubin Blog staff is too emotionally spent to contribute to any discussion regarding its legitimacy, political or legal; you can guess what we think.
But like the law or no, no matter how loudly Fox News attempts to tell you otherwise, this law was by no means the gem that hard lefties enforced on the moderates of the Democratic party. Rather, it was very much the other way around: a crappy rightward compromise that a small minority of centrists enforced on the vast majority of Democratic congressfolk who preferred either a single-payer system or the so-called "public option". Despite overwhelming support within the party for either of those approaches, the "individual mandate" being argued before the Court this week was one originally developed by the right-wing Heritage Foundation as a free-market solution to universal health care coverage.
The main reason why this took place is because of a weak and largely ineffectual President. Regardless, I think the Democratic party passing a health care law thought up in the war room of the Heritage Foundation hardly qualifies as evidence of the Dems becoming more insular, David Brooks's nonsense to the contrary notwithstanding.
--br
This week's case in point involves his observations about what can only be described as the far rightward drift of the Republican party since the election of Barack Obama to POTUS. Brooks's Thursday NYT column details the fading political fortunes of a Gulf War veteran/San Diego Republican, one Nathan Fletcher. As part of his candidacy for Mayor of San Diego, Fletcher has adopted a few positions that most liberals or lefties would find amusing but irrelevant (he supports bike paths, apparently, which Brooks considers to be of weighty importance). But for that and some moderate stances on immigration and "the environment" he has run afoul of the Tea Partyists, and the hard liners have backed City Councilman Carl DeMaio. As a consequence, Fletcher, who sounds like the classic "good guy with whom you might disagree on political stuff", is leaving the Republican tent.
Now any perceptive, or any sane, observer would note that this represents yet another demonstration of the quantum change in the radicalization of the Republican party from respectable-but-flawed to utterly-nutso. It doesn't take a genius to have seen that process--in which the most dangerous, racist, xenophobic, paranoid elements have chased away any voice of reason--has robbed the party of honorable moderates like Fletcher, Lincoln Chafee, and Michael Bloomberg among others in favor of a rabble of Know Nothings. It doesn't require a political mind like Henry Kissinger's to understand that the ideological progeny of Barry Goldwater and Joseph McCarthy are now firmly in control of the party's destiny, and that at most Barack Obama merely catalyzed an inexorable process that's been rolling since Ronald Reagan's ascendancy.
And what conclusion does the perspicacious David Brooks arrive at? That since it's happening on the right, the same thing must by definition be happening on the left.
No, really. In all his mental arithmetical glory, this is Brooks's last paragraph: "Fletcher...represents a nationally important test case. Can the Iraq and Afghanistan veterans, who were trained to be ruthlessly pragmatic, find a home in either party?...As the two parties become more insular, is it possible to mount an independent alternative?"
That's my emphasis, for he spends an entire column dissecting the far right lurch and then finishes wondering about where a moderate's to go when both parties become so rigidly orthodox. Brooks is apparently unaware, or has conveniently ignored, the political career of Tammy Duckworth, Gulf War veteran and still happily at home within the Democratic tent. Ms. Duckworth, who lost both legs during her tour, ran for Congress in the Illinois 6th district in 2006 and lost a close contest to the Republican candidate after a series of predictably scuzzy political maneuvers. As for other vets who drift Democrat but have been ousted by orthodox lefties, I'm waiting to hear a list of examples from Brooks. And I suspect I'll be waiting for quite a long time.
Yet the most amusing aspect of seeing this particular argument, that the Dems are headed toward as equally nutty a place as the Republicans, is that it took place as the Affordable Care Act's constitutionality was debated before the Supreme Court. The Billy Rubin Blog staff is too emotionally spent to contribute to any discussion regarding its legitimacy, political or legal; you can guess what we think.
But like the law or no, no matter how loudly Fox News attempts to tell you otherwise, this law was by no means the gem that hard lefties enforced on the moderates of the Democratic party. Rather, it was very much the other way around: a crappy rightward compromise that a small minority of centrists enforced on the vast majority of Democratic congressfolk who preferred either a single-payer system or the so-called "public option". Despite overwhelming support within the party for either of those approaches, the "individual mandate" being argued before the Court this week was one originally developed by the right-wing Heritage Foundation as a free-market solution to universal health care coverage.
The main reason why this took place is because of a weak and largely ineffectual President. Regardless, I think the Democratic party passing a health care law thought up in the war room of the Heritage Foundation hardly qualifies as evidence of the Dems becoming more insular, David Brooks's nonsense to the contrary notwithstanding.
--br
Tuesday, March 27, 2012
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