Morning Fog

Dies'l Kill Ya!

It's rather amazing to hear that a pending study on the health effects of diesel fuel exhaust in certain enviroments, conducted by two respected government agencies, has been pending for 20 years because private industry hates even the idea of such a study, and even now its publication has been further delayed by mining companies and others who fear its conclusions, and would like to control them.

Amazing, because it is so clearly a false story, made up of whole cloth.  Against the assertions made in the article, we have only to juxtapose what we know from experience and common sense, to wit:

Any fool knows that companies, especially mining companies, set safety as their number one priority and never, ever let the making of a profit stand in the way of their workers' well-being.

It's a longstanding tradition in our country that business interests actively welcome government regulations and standards.

As the Republican Chairman of the House Committee on Education and Workforce has suggested in this article, the Republican party is only interested in assuring that the report meets the "highest standards" of science.  We can take his word for that, because we are all aware that Congressmen generally, and especially Republican ones, are highly trained in science and competent to correct "errors" that less competent scientists might make.  They've already told us, for example, that climate change is a hoax; they've warned us away from the dangers of stem-cell research; and kept us from being led down the garden path by those who claim human history goes back more than 4,000 years.    

If all that weren't convincing enough proof that Mr. Morris's article is irresponsible misinformation (maybe the poor fellow was duped), we can just turn to the evidence of our own senses.  We've been breathing diesel fumes for years, and not just in mines.  We're still alive, so it's obvious that diesel exhaust could not possibly have a deleterious effect on anything or anyone.  Diesel exhaust is not harmful; quite the contrary, it's refreshing and makes us feel happy.  Why else do people go out of their way to get trapped behind a bus in traffic?   Or, take my own experience:  One of the things I recall with greatest joy from my younger years is my experience at Fort Knox being trained as a "tank platoon leader," sitting atop a tank belching diesel fumes for hours on end, making my eyes stream tears, irritating my nasal passages....

Well, that certainly brings me to my senses!  Let's get serious for a minute.  We really can turn to our common sense on this, and we probably don't need no stinkin' report to tell us that diesel cannot conceivably be all that different from other fossil fuels, like wood, refined gasoline, and coal, all of which are known to have deleterious effects on various aspects of human health.  So we know ahead of time what the report will say, and so do the mining companies and Republican politicians who seek to suppress it. 

Basic Scientific Research

Annalee Newitz's defense of basic scientific research (and of funding for government entities to conduct it) is a good review of the essential truths about the subject:  Private interests generally do applied research that is focused on their specific products or product areas or which clearly promises a profitable way of using it; yet most of the more far-reaching scientific breakthroughs have resulted from "basic" research, which is focused on understanding something without knowing in advance how it might be utilized or where it might lead.

Politicians have sought to cut funding for government scientific research on the grounds that it duplicates, or competes with, industry research.  These are often the same politicians who have denied climate change, done nothing about environmental issues, and believe that "creationism" should be taught in schools. 

That's all pretty well known, so when I read Newitz's article the other day I didn't think of it as unusual, or particularly important.  Today, I saw it in a different light.

Cigarette companies are fighting in court based on their "freedom of speech" to prevent the rather gross illustrations the FDA wants to require on their packages.  A federal district court judge has sided with the companies, bought into the spurious argument that corporations are "people" with free speech rights, and prevented the new labeling from being implemented for now.  

I think people ought to know by now that smoking is dangerous and make their own decisions.  On the other hand, cigarette companies haven't played responsibly and still don't.  So I don't much care about the eventual decision on the packaging.  The labels are extreme, but largely irrelevant. 

But I did start to think again about the need for basic research.  The cigarette companies are a prime example of why we must have basic research being conducted outside of, and independently of, business interests.  Where would we be today in our knowledge of the nexus between smoking and health if cigarette companies had monopolized scientific research on the topic?  We don't have to guess about the answer; back in the 1960s, when in fact they still did monopolize research on the topic, the companies' efforts mysteriously couldn't find any conclusive link between smoking and cancer.

  

Military Health Care Premiums

There's an interesting debate pending over the premiums to be paid by military retirees for their health care.  The Defense Department has proposed that such retirees pay an additional $5 per month, which would raise their annual premium for family coverage to $520 per year. 

The system, known as Tricare, is the military equivalent of Medicare, and its costs are rising just as quickly as Medicare's.  Also in parallel to Medicare, there are military groups that equate loosely to AARP (the Military Officers' Association of America is one) that see Tricare as an entitlement, a reward to service members for their sacrifices, so they naturally oppose increases.  In this case, MOAA has conceded a small increase may be necessary but wants to limit future increases to the pace of inflation (3%) rather than the pace of actual costs (6%).  Some in Congress join MOAA in opposing an increase.

Though some of these issues supposedly were to be decided in Congress last week, I have been unable to find any report that they actually were.  The results will be interesting to see.

It seems self-evident to me that if we're going to fix our budget deficit problems, we will need not just cuts in the non-military discretionary portion of the budget, but also in the main (civilian) entitlement programs and in military spending.   A slightly higher health care premium would certainly be a sensible part of the latter, though I'm sure there are far greater savings to be found in the costs of military hardware and supplies.

It goes beyond reducing the deficit, however; it's also a matter of what is fair and reasonable, to service members and to the society they serve.  The overall package of benefits we provide our military personnel is generous -- I invite any reader, for example, to compare his retirement health care costs with those stated above.   And it must remain generous enough to provide both security and incentive, but we need to think about them in the right contemporary context.  

Our thinking about compensating our armed forces originated in the era of a citizen army with conscription.  People from all walks of life were called on, often randomly, and possibly against their "druthers," to perform a dangerous duty for their country, while their neighbors, friends, or relatives were not.  That's no longer the case, and we may need to adjust our thinking accordingly.  

 

 

Planning For The End

A friend pointed out to me a recent CNN piece which is truly an excellent reminder for all of us - old and young alike - about the value of planning ahead for a loved one's death, or even your own. 

In today's busy world, many of us have trouble thinking ahead even about positive things, like what sort of life we'll want in retirement, let alone the more unpleasant topics like DYING.  It seems there's a tendency to think that "it can't happen to us," although the odds are heavily against that.

The article highlights a serious political point, too.   The author, Kristi Guillory, notes how the Obama administration's seemingly worthy efforts to focus attention on such planning have now been abandoned.  The whole issue of end-of-life planning became a political football when a certain former Alaska Governor decided that discussing such matters with your doctor equated to "death panels."  This foolish nonsense was picked up and echoed by other Republicans, who -- lacking rational arguments for opposing universal access to health care -- were desperate for any pretext to fan the flames of irrationality to kill the health care legislation. 

On this issue, at least, that tactic succeeded.  End-of-life planning became pure political poison, and will remain in legislative limbo for the foreseeable future.  The fact that it won't be provided for in any version of health care, of course, is not a reason to overlook doing such planning.  (You may want to hurry, before the GOP starts legislating against any sort of EOL planning, even on the state or private level.)

Meanwhile, the whole episode should be a reminder, as we have just emerged from a minor skirmish over budget issues and face more serious ones in the near future, what serious consequences the willful misrepresentations of a relative handful of extremist politicians can have. 

"Ignorance" is an interesting word, used contemporarily almost as a synonym for "uneducated."  But its root of course is "ignore," suggesting that the ignorant person knows certain facts, but chooses to overlook them.  In that sense, some of today's politicians are truly ignorant.  They should truly be ignored. 

Allergies: Folk Wisdom vs. Medical Science

I never noticed that I had much in the way of allergies until my mid-twenties, when a couple of days on field maneuvers in the hot, dusty summer of central Kansas (Fort Riley) suddenly turned me into a wheezy, teary-eyed mess, literally unable to function. 

Eventually a trip to an allergist demonstrated that I had reactions to many allergens, including most pollens, some molds, and cat dander.  For a while I took injections, but these proved to be of little value and plenty of cost, so I stopped.  For several more years I took over-the-counter antihistamines.  Some were more effective than others but none provided more than partial palliation, and I didn't like being sleepy, so I stopped those too and for the past 25 years or so, have just put up with whatever symptoms I develop.

All this background is by way of saying that I have been "out of the loop" on allergy treatment for close to three decades. 

That's why I was surprised last week by "The Peanut Puzzle," an article by Jerome Groopman in The New Yorker about the current scientific advice regarding allergies.  If you're a subscriber to the New Yorker online magazine, you can read the whole article there but the theme was that medical science is now rethinking its approach to allergies, and may move away from the theory that children should be protected from allergens in their first year or so.

The surprise for me was in the "rethinking" part.  I couldn't, and can't, conceive how such advice had ever become standard.   It's like building two different engines for the same plane, i.e., completely counterintuitive.  It just seemed to me that - as with bacteria and at least some diseases - too clean an environment as a child could leave you defenseless against various "bugs" later in life. 

After 30 years working mostly outside the U.S. in a variety of different regions, a doctor found my blood showed signs of immunity to the most common form of hepatitis (whichever that is).  I didn't get to that point by avoiding seafood in developing countries - I got there by way of eating mussels, shrimp, fish and such from all sources in Vietnam, Turkey, and parts of Africa.  And since I quit taking anything for my "hay fever" allergies, they haven't got any worse.  Or, recall the gent I met once, the head of the Miami Serpentarium, who had accidentally been bitten by snakes so frequently that his blood was a registered anti-venom for the bites of some of the more esoteric breeds of snake.

So how could doctors figure that staying away from potential allergens would help prevent allergies?  The article above certainly doesn't point to any huge body of convincing medical data to support that.  They might have noticed that as we all got more urbanized and less exposed, the cases of serious allergies seemed to increase.  Or, they should have listened instead to their grandmothers, who knew that exposure - at least to the everyday products of nature, if not contagious disease - was the best medicine. 

With luck we may be moving back toward that view. 

Safe Food - Can We Afford NOT To Have It?

Food safety has been a big issue lately, as some of the Bush Administration's chickens (i.e. the gutting of regulatory agencies and an endemic lack of concern about effective oversight in the most basic processes of food production) came home to roost in the form of illnesses and death in a number of food categories -- eggs, spinach, jalapeno peppers, lettuce, peanuts.

This is an area where Republican legislators make no bones about their interest in undercutting recently passed legislation by denying or cutting funding for effective regulation.  (The same process led to many of the problems we've experienced in food safety.) 

Currently, the new Republican chair of the appropriations subcommittee that has to authorize the FDA's funding (Rep. Jack Kingston of Georgia) is justifying his concerns about "possible overreach" on the basis of competing demands for limited funds.  That's an easy course when the economy is still widely viewed as weak.

The fact is, though, that a shortage of funds is not the real problem.  When the economy was booming, Republicans still failed to enact rules to enforce penalties for gross health code violations.  And when the economy is regaining momentum (as it is doing now), they'll still be engaged in foot-dragging and obstructionism on anything involving possible limitations on businesses' "right" to do as they see fit, regardless of the consequences for public health.  Since they tend to be staunch friends of business, these party dogmatists might want to consider that the U.S. is a major exporter of agricultural products, and that as our produce gets an ever more degraded reputation abroad, our markets shrink. 

As with health care, education, feeding the hungry, and other issues, it's just plain ridiculous to say that we "can't afford" to do far better in all these areas, because most other developed countries with per capita GDP and incomes DO afford them, surpassing us in providing basic essential government services to their citizens.  Even one food-health scare, of the kind we've had several of recently, would be nearly unthinkable in most of Europe or in Japan. 

Politicians who deny reality with the "we can't afford it" mantra are pushing us down the road toward developing-nation status.  Some may be too ignorant to see it; others may act out of venality (wasn't that rat-infested peanut factory in Georgia?), but it's a shame that such out of touch, head-in-the-sand types still exist, let alone get elected to Congress.   

The GOP needs to foster more original thinking on such issues, and to break out of thrall to business interests.  That would help the party to regain long-term political competitiveness, and help the nation to maintain its international competitiveness too.  Otherwise, countries more successful in controlling their food supply and agricultural production are going to eat our lunch (though in a literal sense they wouldn't, because they'd be concerned about whether it was safe for consumption). 

Eggs And Salmonella: A Civics Lesson

The whole escalating furor over unsafe eggs being shipped even when they were known to contain salmonella strikes me as a perfect object lesson for those who think government is not worth a dime - until it's needed.

As a Republican President and a Republican majority pretty much let businesses dictate their own terms for most of the decade, one result was a considerable lessening of regulatory controls on a wide variety of American business; businesses would henceforth regulate themselves, obviating government watchdogs.  At the same time, advocates of so-called "small government" pushed tax cuts (but not war spending), hoping to "starve" government à la Reagan; this led to budget cuts in many areas, but especially in those "unnecessary" regulatory commissions and agencies.

We've seen the result in the financial and real estate markets, and in coal mining, and have been dealing with it for some time now.  But we've also begun to see it in food safety - tomatoes, nuts, jalapeno peppers, pet food.  Now eggs.  This latest case stands out because here, the media are working hard to stir outrage that salmonella was detected as early as last spring in the two companies now in the spotlight, but regulators did nothing about it.  Yet regulators at all levels, thanks in large part to budget cuts and staffing reductions, are understaffed and until July, didn't even have the power to shut down a plant producing tainted food. 

The lessons are just plain common sense, if you've ever heard the adage about the fox and the henhouse: (a)  Given the opportunity, some businesses will inevitably cut corners to reduce costs, even where public health is involved; (b) no institution can be counted on to regulate itself; (c) there is a legitimate role for government regulation; (d) like anything else, government services have to be paid for and (e) the way that's done is through taxes.  The whole conflation of small-government, no-tax, pro-business "concepts" that was so popular with the Bush crowd is nonsense.

There will, of course be compromises.  I doubt that any of us would care to pay the full costs of (say) weekly inspections of the thousands of food companies across the country.  Yet clearly, a budget that allows for only a dozen inspections a year (across the many thousands) is inadequate.  There must be balance, but overall, there's room for a good deal more to be done.

Often, regulation is best when it's preventive.  However, there's constant resistance, in many sectors of business, to any standards that raise costs.  That's why we have power lines strung through the trees, subject to interruption in every rainstorm; and it's why we have food production facilities that aren't built to keep out rats, flies, and other disease carriers.  It's not impossible, as this article regarding practices in Denmark suggests.

Currently, the advice is to avoid many common brands of eggs, or to be sure your eggs are "fully cooked."  Yet the best ways of eating eggs are those that leave the yolk runny:  soft-boiled, poached, or sunny-side up.  Should we just adapt to having our eating practices dictated by the failure of producers to work to prevent problems?   Maybe.  We've done that in many instances.  (Remember when you could eat a steak rare without worrying about dying?) But it's getting tiresome. 

(This post is also being cross-posted on The Tin Lizard .)

Crisis In Childbirth Death?

ABC News reports, with considerable excitability, a California study documenting increased rates of death, almost triple what it was ten years ago, among women who have recently given birth.  Two reporters got to the point of nearly screaming -- "unacceptable!" -- " how can this happen in America?." 

Still, I guess they should be given credit for at least admitting that the "trend" is probably statistically insignificant.  It reflects 95 deaths out of 2 million or more deliveries.  The trend, it is explained, may be explained by two factors, an increase in obesity of expectant mothers, and an increase in Caesarean sections.  Both increase risks, but the former cause was mentioned only to be dropped; while the reporting focused on C-sections.  (No way we would want to make overweight patients feel responsible for their own problem, now is there?)

I'm no doctor, but it seems to me there is probably another good explanation, too:  More women having more babies late in life, when risks are higher; possibly even more women taking risks of the kind we see on TV - any risk acceptable (or ignorable) in hopes of bringing that baby into the world. 

Either way, another "big news" story is born, as long as you can pick the facts you want to emphasize.. 

Claimed Link Between Autism And Vaccinations Debunked

Today, low key reports like this one revealed that the British medical journal Lancet has "retracted" a study published twelve years ago whose author, Andrew Wakefield, suggested that a certain vaccine might cause autism in children.  

The article, because it appeared in an authoritative, reputable medical journal, had been a mainstay of parents and parents-to-be desperately seeking an explanation for autism; it had caused amazingly high percentages of parents to deny vaccination of their children for common childhood diseases. 

The retraction unfortunately comes too late for many, and perhaps too late for the good conscience of the editors of Lancet.  It would be nice to think that this simple step would correct the misconceptions, but a whole industry has grown up around the idea of blaming (and more important, suing) a drug company for "causing" autism.  Lawyers won't let it rest; and these times of recession-driven paranoia, others invested in the unproven link between vaccine and autism will simply believe that this overdue step by the British journal is a conspiracy.  (Check out the "comments" on the Washington Post story linked above.)

By the way, it's interesting to note that Wakefield is reportedly practicing (what?) in the U.S. now.

Cancer Screening

The U.S. Preventive Services Task Force has issued new recommendations that routine screenings for breast cancer should be done only every two years rather than annually, and starting at age 50 rather than 40 for most women.  To the layman, this seems like news to be welcomed.  Reduced frequency of a painful and dreaded screening, with no difference in health outcomes for most patients?  What's not to like?  And indeed, some experts have already applauded these findings. On the other hand, very quickly after the announcement, other voices were raised in a chorus of protest.  Those early negative reactions seem baseless. 

First, the recommendations don't mean "doing away with screening," as one radiology professor complained.  In fact the PSTF's spokesman was at pains to point out the changes relate only to routine screening.  As with other diseases, a patient's history, doctor's advice, and other factors will continue to determine when the "standard" recommendations need to be ignored.  So it seems self-evident that some patients, who might need or want screening earlier than age 50, based on self-examinations, or on a doctor's recommendation, or even just a preference, will obtain it.

Second, the reasons provided for changing the "rules" seem rational:  Data suggest that more is lost under current norms (once a year after 40) in anxiety, false positives, and needless costly/painful procedures, than is gained by the screenings.  In this respect, breast cancer and prostate cancer are similar.  The real message here is that current screening tests for both diseases really don't work very well, and need improvement.

Third, I don't see politics in the situation.  Some have professed to see the PSTF's announcement, coming from a government agency, no less, as a harbinger of "denial of care" or "rationing" that's in store for us under health reform legislation.  But to me, that's seriously paranoid.  You can believe that the government is plotting to ration care and would make that public before any legislation is passed, or you could choose the more likely conclusion that only those opposing health care changes might hope to benefit from announcing these changes now.  In fact, making this announcement before reform bills are passed strongly suggests that the changes are proposed for sound health reasons.

Last, a word about cost.  Some who bemoan the changed recommendations worry that insurance companies might refuse to pay for any screening before age 40.  Undoubtedly that's at least a possibility.  But this complaint also reflects the distorted nature of "cost" perceptions in our health care system.  Existing bills, as many experts have pointed out, may result in more people being insured, or in fewer abuses of policy coverage, but they don't truly deal with the rising costs of most health care.  Here's a case where things do need to change.  When all care is essentially free (ie. covered by insurance), the consumer has no incentive to worry about the cost of what he "wants."  If consumers were focused on costs, a switch that would reduce the frequency of an expensive screening by half would be a no-brainer.  That's the next, and bigger task, for health care reformers.