Wednesday, November 30, 2005

Stopping Flu's Bacterial Partner

Often in fatal flu cases, the complication that overwhelms the patient is bacterial pneumonia. Thus, as Michael Alderman writes in the NY Times, our national flu strategy should include mass immunization against pneumococcus, the most common cause of pneumonia. He writes:

While not all bacterial pneumonia is attributable to the pneumococcus bacteria, it is the most common variety, and the one for which a vaccine exists. It is estimated that pneumococcal vaccination could prevent half of these bacterial-related deaths.

Developed 30 years ago, the vaccine is recommended by the Centers for Disease Control's National Immunization Program for people over 65, or with chronic diseases or damaged immune systems. Since 2001, a form of the vaccine has been administered to nearly all infants. The vaccine, which helps protect against 23 strains of pneumococcal bacteria, has only very minor side effects, works for 5 to 10 years, and can be extended by a booster.

The vaccine has other advantages. At a time when bacteria have become increasingly resistant to antibiotics, including penicillin, prevention is our most dependable line of defense.

Thinking about pneumococcus in addition to influenza vaccination is an example of what I wrote about in a prior post about what the adminsitration's avian influenza plan needs to do better--integrate flu preparedness with the public health response to ongoing infectious disease threats. We can't allow narrow focus on the flu allow us to become more vulnerable to the host of diseases the public health system keeps at bay like TB and West Nile Virus--or to complications of flu like pneumococcal pneumonia--especially since with good planning, improvements in infectious disease surveillance, vaccination plans, quarantine, and other public health measures should be synergistic among disease preparedness plans.

Students' Day Celebrated in Iraq

Check out these pictures of Iraqi schoolkids on Students' Day.

Thursday, November 24, 2005

Weed for What Ails You: Medical Marijuana

The medical marijuana case Gonzales vs. Raich has been remanded by the SCOTUS to the 9th circuit, reports Volkh Conspiracy. Along with Dispatches, I will leave it to the legal experts to comment on the constitutionality of Congress invoking the Commerce Clause to regulate an activity which is neither interstate nor commerce.

While I once agreed with those who asserted there was minimal evidence that marijuana causes lasting biological harm or addiction, there is new evidence not everyone may be aware of. In particular this large study documenting cannabis use associated with development of psychotic disorders (schizophrenia and schizoaffective disorder), this is a metanalysis showing increased risk for schizophrenia with cannabis use, and this review goes over some bench-science data and epidemiological data to the same effect.

I agree it's pretty inconsistant to argue that alcohol should be legal but cannabis illegal, given the overall burden of harm caused by each substance to society. But we shouldn't pretend there are no dangers to cannabis use at all.

However, the potential harms we've found for cannabis, so far, are unlikely to accrue to people with terminal diseases using marijuana to control nausea, for example. There are those who argue that we have not enough evidence that it is efficacious, or that we have other medicines that work. It is too easy though to succumb to the temptation to believe that average effects seen in studies of hundreds of people are directly translatable to every given patient. Just by chance, there will be some cancer patients for whom Anzemet is ineffective, and marijuana is effective. Those people deserve a chance to try marijuana.

The stickier case is the chronic migraineur or irritable bowel patient who wants to try marijuana. In these folks, I think that in general the potential harms--inducing mood disorders in particular--really do outweigh the short-term symptom relief marijuana can provide, especially in younger patients. Cannabinoid analogues like marinol may be a good choice, but smoked marijuana has too quick an onset, thus too much reward circuit activation, to be safe as a long-term treatment.

In the end though, if society trusts doctors to prescribe oxycontin with appropriate regulation (and I think it should), then it ought to trust doctors to prescribe marijuana.

Wednesday, November 23, 2005

Voting and Alzheimer Disease

Balancing civil rights and the needs of society in patients with mental illness in general and Alzheimer disease in particular is a thorny business. This month's American Journal of Psychiatry reports a study purporting to show how a structured interview can predict if a person with Alzheimer disease meets the requirements for voting as established in the Doe precedent.

Their data show that this structured interview's results correlate with the degree of dementia as measured by the standard Folstein MMSE, but I think this study misses the point of Doe. According to this article itself, the case was decided on the matter of whether the state of Maine could categorically deny the right to vote to individuals who had an appointed legal guardian--the court ruled that it could not, for the law violated the right to due process. But the court deliberately established very loose criteria to be able to vote, to ensure it would be difficult to take that right away.

The power to disenfranchise an American citizen has enormous potential for abuse--witness literacy requirements in the Jim Crowe era. To have an established structured procedure to prevent people from voting is an invitation to abuse. And the harm to society of a few Alzheimer patients voting is far less than the danger from establishing and delegating a state authority to disenfranchise.

No Child Challenge Stymied: Federalism Suffers

A federal judge threw out a case brought by several states, including Vermont, Texas, OH, PA and others, asserting that the No Child Left Behind Act mandates too much state expenditure. The NY Times reports:

Chief U.S. District Judge Bernard A. Friedman, based in eastern Michigan, said, ''Congress has appropriated significant funding'' and has the power to require states to set educational standards in exchange for federal money.

If it has the power, should it use that power? No Child Left Behind is an unprecedented federal intrusion into the state/local government function of education. That its champion should be a Republican president is astonishing and disturbing. Fear of losing NCLB monies is becoming a primary overarching concern of school districts. Rather than fostering a culture of excellence among teachers, NCLB engenders a cynical attitude which is an obstacle to real achievement.

But the NEA and the states mentioned have gone to court rather than to the American people to counter NCLB. It's time that we repealed this counterproductive law in a definitive way, through the legislature. Contact your US Representative and write a quick note.

Tuesday, November 22, 2005

Withdraw or withstand?

Over at Centerfield a commenter has sparked a lively discussion by breaking down the Iraq withdrawal question into some bite-sized chunks. Here are my own comments (in italics) on this way of analyzing the situation.

1. What would the effect of withdrawal be on Iraq in terms of:

a)the level of violence in Iraq

The immediate effect of withdrawal would most likely be destabilizing to provinces where the US presence acts to reassure minorities that they are protected. Other areas where jihadists cause the majority of violence would lose their main hard targets and initially disperse, but it is clear that the presence or absence of US troops does not definitively prevent civilian-targetted bombings (witness Jordan's recent tragedy). In sum, the pattern of violence would shift, but it's not clear the total level of violence would change markedly. What matters more long term than the level of violence, though, is the political implications of what violence occurs.

b)political developments in Iraq -- stability, healing or exacerbating the ethnic divide, more secular or theistic leadership, unified state (if that indeed should be our goal), human rights, emergence of liberal-democratic institutions

Withdrawal of US forces would provide a great test of the institutions we have helped the Iraqis set up. The underlying question is legitimacy--at the moment the authority of the central government is no longer bolstered by US boots, has it built up enough of its own legitimacy to stand or not? Legitimacy in this context is closely tied to familiarity and trust. It takes time for ethnic Kurds to deal with Shia or Sunni leaders over issue after issue, gradually experiencing fair treatment and adherence to agreed-upon rules, until trust accumulates. Only people intimately involved with both parties will have a sense of the extent that this has happened. The greatest value, then, in US participation in these talks is not to affect the actual outcome of the constitution or specific policies, but to attain the intelligence of the parties' level of trust, which is so key to determining if the central governement can withstand the shock of US withdrawal.

c)infrastructure reconstruction

US troops' presence affect on reconstruction is largely tied to provision of security rather than direct reconstruction efforts which is largely carried out by private contractors. Worsening security around Baghdad, Basra or other trade hubs would be expected to cause a cascade of stagnation as supplies for reconstruction dry up to even the most peaceful provinces.

d)the influence and involvement of border states -- esp. Turkey, Iran, Syria and Saudi Arabia

Each state has interests tied to the US presence in Iraq that are more complicated than I have the space or expertise here to describe. In brief though, I think it's safe to say that each of these states would be emboldened to take interventionalist policies toward a newly de-Americanized Iraq.

e)what effect would the Murtha proposal of stationing troops in the area "just over the horizon" following withdrawal have on this?

The Murtha Reserve's effect would be proportional to its size, rapid deployability, and the credibility of the resolve to use it. Those are all matters for debate.

2. How will staying in Iraq (postponing our withdrawal to some future date or benchmark) increase the likelihood of having positive outcomes to a,b,c and d above and are there any different steps we should we now take in Iraq to increase that likelihood?

Postponing withdrawal indefinitely will have little direct impact on the short term level of violence. But commitment to long-term occupation will strengthen resistance recruiting efforts and make it difficult for pro-democracy factions to maintain nationalist credentials. But more important than the pro- or anti- democracy divide is the ethnic divide, and it is harder to predict its effect on ethnic leaders.

3. What effect would withdrawal have on political developments in the border states? What would the effect of Murtha's proposal be? Where might troops be stationed "just over the horizon"?

Withdrawal may embolden our enemies short-term, but it would be an evanescent effect. Murtha's proposal's effect will be determined by the amount of sovereignty that the host country is perceived as retaining in its relationship with the US. That is, the less like a colonized puppet its government looks, the better its chance of evading extremist retaliation. Though several countries like Kuwait and Turkey might be attractive, it could be wiser to station a brigade of Marines in the Gulf as a very rapid reaction force, with reinforcing Army units farther away in Diego Garcia or somewhere less visible in the Arab political world.

4. What effect will continued long-term deployment of US troops with the present level of attrition have on the US military in terms of flexibility, readiness, resources, recruitment and morale? What will be the effect of withdrawal on these?

The balance between hits to morale from attrition due to the current deployment situation and from withdrawal is difficult to estimate, especially for a non-military person.

5. What effect does continued deployment or withdrawal have on the ability of the United States to achieve broader foreign policy objectives and project its power abroad?

This is the key question. There's no question that the Iraq deployment is a major drain on the treasury, and that itself is a significant obstacle to accomplishing other foreign policy priorities. Despite arguements from war opponents, though, I think the foreign policy political capital could be salvaged if the US adopted a more pragmatic approach--describing the botched intelligence candidly and casting the current situation as a problem to fix rather than as a victory to achieve. Such a reframing will make the administration's tenor more in line with the view of the rest of the world, without substantively changing our goals and methods.

Monday, November 14, 2005

Bush to Worship in China

GW Bush has asked the Chinese government for an opportunity to attend worship services during his upcoming trip. Here's how Imagethief (an American in Beijing) describes what this means:

Of course, there are officially sanctioned churches here, and I suppose something could be arranged, but I rather imagine that the Chinese government will look upon this rather like the US government might look upon a request from the Chinese to hold a pro-North Korea rally on the Mall. Or to serve the White House dogs, Barney and Ms. Beazley, at the state dinner when Hu Jintao goes to the US. At the very least there would be distaste and offense.

Just as cultural conservatives complain that the secular media/movie establishment can be insensitive to their values by downplaying religious expression, they must understand that not everyone looks at public religious displays as innocuous. What's more, moral decay is not a prerequisite to holding that view. Religious or secular reformers in China may actually be harmed by being seen getting explicit support from a US president.

There's nothing morally wrong about a head of state asking to worship in public on a visit to an officially atheist nation, but the administration should realize the extent to which this will impede dialogue on goals like furthering human rights and reasonable trade policies. I just don't think the statement is worth it--unless the intended audience is domestic.

Hat tip to Simon World.

Thursday, November 10, 2005

The Net of Indra and UU Politics

There aren't many Unitarian-Universalist Republicans, but I think there should be more.

The UU Principles and Purposes cites Respect for the interdependent web of all existence. Often the part of the web of existence most emphasized is the ecological balance of the natural world and the network of our interpersonal connections, and these are certainly very important pieces. But between the cosmic and the interpersonal, lie the economic and political webs of the world, which are subject to the same types of balances, though that's often overlooked.

In fact, I find it very interesting that those who are appropriately concerned about the detrimental effects of human activity in pursuit of economic aims on the balance of the natural environment seldom acknowledge the damage to the balance of the economic system when social aims are pursued by various interventions, whether by government or other social institutions.

Certainly, the danger of overemphasizing the need to preserve the balance of the cultural/economic system is to grow complacent about injustices embedded in it--that's the most important critique of Hegelianism. But as a physician, I tend to look at complex systems like the human body. Doctors grow a certain humility about the complexity of illness and the body's response to it, so that we don't always know what the consequences of a given treatment will be--we often talk about such things in terms of probabilities of cure or side effects. We don't let the uncertainty of the effect of treatments paralyze us, but we don't pretend that there's mathematical certainty about our predictions either.

The complexity of the economy is something like the same order of complexity as the body. If injustice and poverty are like diseases of the economy, we don't always know what the side effects are or the chance for cure, but we make the best guess we can.

Along this spectrum, conservatives sometimes end up like the nervous patient who refuses minor surgery for an easily treated problem until it grows much worse--such as defunding Head Start. Liberals can seem like the scalpel-happy surgeon who see people as diseases instead of patients--eg extensive funding of job training programs that don't work.

Similar reasoning applies to government actions in the realm of culture, an example being the ongoing reassessment of the canon of Western literature. Conservatives emphasize the need for a common cultural vocabulary of symbols and ideas, while liberals point out the social damage resulting from the act of exclusion of certain texts from the canon. At stake is the very shape of our cultural environment. The challenge is to find a compromise that connects as much of the interdependent web of American society together while still producing a managable and useful canon.

A more nuanced view of the interdependent web of existence would temper both liberal and conservative camps' tendencies, and provide a framework to allow them to talk to each other better. I see no inherent reason why one should emphasize one part of the web over another--disruption of the environment causes ecological damage, and disruption of the economic/cultural web causes poverty and social strife. Indeed, UUs may be well situated to foster this kind of dialogue, since they already are used to emphasizing interdependence as an overarching concern.

Wednesday, November 09, 2005

The Death of the European Dream

The two best analyses of the roots of the French riots I've seen so far:

Ehsan Ahrari's overview of the French government's betrayal of the North African "Harkins" who sided with France in the Algerian war, and were subsequently moved to French slums.

Joel Kotkin's piece on how the French economic system's rigidity has made immigrants' ability to assimilate economically and culturally much harder in France than in the US.

H/T Middle Earth Journal and Centerfield.

Cyber Bullying

The explosion of communication technologies has created a new venue for the timeless adolescent phenomenon of bullying. VPR reports

According to researchers at Clemson University 25 percent of middle school girls and 11 percent of middle school boys say they have been electronically bullied at least once in the last two months...

Nancy Willard of the Center for Safe and Responsible Internet Use says parents should also be more proactive about checking computer files.

(Willard) "Finding out where your child has registered, find out what your child has posted in his or her profile, what your child is posting online. These are all public places. Now your child may say, 'Oh, you can't invade my privacy.' But guess what? This is public information and they're posting it for the world to see. Certainly you as a parent ought to be able to look at it."

(Keck) For parents who don't know how to do this, Willard suggests asking for help at a local computer store. She's also written a parent's guide that's available on her Web site.

Anecdotally, much electronic bullying is associated with mass circulation of embarassing pictures or text about the victim, and involves more of a theme of exclusion than physical threat when involving girls. But electronic bullying is only an old problem with a new face.

Bullying is associated with poor physical and emotional health consequences, as well as legal consequences (60% of kids classified by teachers as bullies in grades 6-9 had a criminal conviction by age 24, and 40% had three).

The bullying problem garnered some attention after the wave of school shootings in the 1990s, but we need to continue to address the problem to prevent the long-term social costs of dealing with the self-perpetuating problems that bullying fosters. This Dept of Justice report discusses the 'whole school' approaches pioneered by Olweus in Norway in the 1970s which have the best evidence documenting efficacy in reducing bullying and improving the school environment, also benefitting other aspects of school performance.

School climate is a local school problem, and needs to be addressed locally. Our local Vermont school district has made the reduction of bullying a priority, and is participating in an Olweus program. I would encourage you to see what your district is doing.

PA School Board Ousted

The Dover, PA school board members who wanted a statement on Intelligent Design read in biology classes were ousted in yesterday's elections.

"My kids believe in God. I believe in God. But I don't think it belongs in the science curriculum the way the school district is presenting it," said Jill Reiter, 41, a bank teller who joined a group of high school students waving signs supporting the challengers Tuesday.

Another issue raised was the sums of money the court case is chewing up, which is not popular with voters--muddying the waters as far as using the election as a gauge for the electorate's sentiments on the issue of ID in the schools itself. But this is clearly a setback for the ID advocates.

Saturday, November 05, 2005

The Humanitarian Case for Free Trade

A recent article in The Quaker Economist argues that the evidence shows that globalization has had a positive effect on the standard of living for the world's poor.

Contrary to what you may read in anti-globalization leaflets and press releases, between 1980 and 2000, 75% of the world's population achieved an enormous increase in both average incomes and living standards due to the effects of globalization. Summarized from Wolf's book in the chapter "Why The Critics Are Wrong" (p. 143), "never before have so many people, or so large a proportion of the world's population, enjoyed such large rises in their standard of living — India produced an approximately 100% increase in real GDP per head and China nearly a 400% increase in real GDP per head." This is an enormous improvement, experienced by some two billion people.

Meanwhile, GDP per head in high-income countries (with only 15% of the world's population) rose by 2.1% between 1975 and 2000, and by only 1.7% per year between 1990 and 2001.

A much shorter piece appeared in the Nov/Dec 2004 issue of Foreign Affairs which helps, along with the data cited above, to explain some of the intense reactions against globalization by the middle class around the world (including many Quakers). The article is "Globalization's Missing Middle" by Geoffrey Garrett. He, too, describes the net positive effect of globalization on the poor of the world and admits that the rich also benefit, but his primary focus is the fact that "middle income countries have not done nearly as well under globalized markets as either richer or poorer countries..."

While the western hemisphere contemplates establishing FTAA, we need to look at the data to understand the effects of NAFTA and CAFTA on the regional economy as a whole, and not get distracted by anecdotes of plant closings and unfair labor practices.

Timothy Taylor at Macalester College makes two arguments for free trade that I find persuasive. To frame the debate, let's realize that the globalization debate amounts to deciding where to situate our policy along the spectrum from free trade to maximum protectionism (high tariffs and nuisance regulation to discourage foreign investment and importation).

First Taylor suggests a thought experiment. Imagine one company develops a technology that increases productivity so much that it will make all its competitors obsolete unless they adopt the same technology. Should the government institute taxes and regulations that make the new technology impractical to protect the competitors? I think most of us would say no. Now imagine that the new technology in question is moving production offshore. In economic terms, there are no differences between these situations. As Rudi Volti notes, technology is most fruitfully thought of as a complex of tools and social organization for economic activity. Except for those who hold on to the ideas that command economies or mercantilism are still better models, there's little arguement that protectionist policies decrease economic growth, and the data support this.

Taylor's other argument runs like this. If we imagine there is a specific industry, automobile manufacturing for instance, which the nation considers to be of strategic or cultural value to protect, we may institute trade barriers to keep the higher prices of domestic cars competitive with those of imported cars. What this amounts to though is a subsidy of this industry--a government policy that augments the income of the industry above what the market would otherwise provide. However, if there is strategic value to keeping the auto industry vibrant, that's a benefit that presumably all citizens share, but only those who buy domestic autos pay for. That's not as fair as providing a direct subsidy to the industry, since then the presumed beneficiaries of the presence of the industry in the country--the taxpayers--share the cost equally. I'm definitely not arguing for subsidies of that nature. My point is that protectionism is a very indirect and inefficient way to support an industry that the market won't support on its own.

A few words about the very important concerns about labor and environmental practices by large firms in the developing world. The main fear here is the 'race to the bottom' theory: that capital will flow from developed nations to the developing ones with the loosest environmental standards and labor laws. Radley Balko cites data that show that this is not happening, however. On the contrary, the degree of liberalization of a country's economic policies correlates with better conditions, not worse. The cause of poor working/environmental conditions in developing countries is the poverty and misgovernment already there--such conditions would exist even without foreign capital. If anything, the foreign investors' public relations needs provide much of what leverage there is in some countries to improve these conditions.

In short, the emperical evidence just does not support these theoretical concerns about free trade.

Now, it's certainly true that free trade amplifies the fluidity of the economies involved, and when a new free trade agreement is put into effect there's a fair amount of economic disruption--this causes adjustment pains, and spawns aweful anecdotes of plant closings and sweatshops. Government can and should do much to cushion the transition for displaced workers and industries. And there is a place for activists to ensure good corporate citizenship in the US and abroad. But improving the hours or benefits or child hiring one factory at a time is nibbling around the problem of developing-nation poverty that only endogenous economic growth can truly solve.

To paraphrase Churchill, a liberalized market-oriented economy with free trade is the worst economic system around, except for all the others.

Friday, November 04, 2005

Get Your Flu Shot

WASHINGTON (Reuters) Oct 25 - At least 70 million doses of influenza vaccine will be available for the U.S. market this year and everybody who wants a shot should be able to get one, health officials said on Monday.
The Centers for Disease Control and Prevention opened flu vaccination to everyone on Monday, saying the priority groups, such as seniors, who need the vaccine first had been given plenty of time to get them.

"There is no reason for anyone to delay or go without their annual flu shot," Health and Human Services Secretary Michael Leavitt told reporters in a telephone briefing.

In a statement, the CDC said that providers with adequate supplies of vaccine should broaden their vaccination efforts "to include other people, especially 50-to-64 year-olds, who are interested in getting an influenza vaccination."

Last week the CDC reported that too few Americans are getting vaccinated against flu.

H/T GruntDoc

Judging Judges

Activists at either end of the spectrum are very selective with their facts, and the rhetoric around the Alito nomination is no exception. Blue Mass Group has compiled a list of Alito's rulings that could make him look quite liberal, to demonstrate the point. Siding with a disabled elevator operator, a gay high school student, and having one's decision reversed by Justice Scalia are not positions conservatives find themselves in often.

H/T Dispatches from the Culture Wars

Thursday, November 03, 2005

Redistricting Reform Progress

Redistricting reform is possibly the key centrist issue. If we had congressional districts that produced a real contest between the parties, candidates would have incentive to move toward the center for general elections--in today's primarily foregone conclusions, the incentive is for candidates to be more extreme in order to win the primaries.

Here is an excellent summary of HR 2642, the redistricting reform bill John Tanner introduced in the House this year, with a side by side comparison with a similar bill from 1989. Charging RINO has more on this.

Moderates of both parties need to speak up, or only the voices of the extremists will be heard. Contact your Representative here and support redistricting reform.

Tuesday, November 01, 2005

Bush on the Flu: Reinventing the Wheel

The national response to the threat of bird flu contains many sensible measures, but its compartementalization echoes that of our preparation for terror attacks. Rather than setting up a flexible infrastructure to deal with disaster, it focusses too much on a specific threat.

Firefighters, police, and paramedics know that they perform like they train. A disaster is simply defined as a situation where the needs exceed the resources at hand. When first responders find themselves outmatched by the situation, they (ought to) have a pre-arranged plan for bringing in support. They don't know ahead of time which particular diaster will call for activating this system--a hazmat spill, a train wreck, a multi-vehicle accident--but they know the same principles and systems apply. And by working together on daily problems, they are better able to work together as a team if a larger disaster strikes.

Our mistake after 9/11 was dividing agencies designed to address terrorist acts from those focussing on natural disasters, to the detriment of our day-to-day preparedness for a broad range of threats, as we saw in the Katrina debacle. Let us not make the same mistake in public health preparedness by getting avian flu tunnel vision, and leaving ourselves less protected from chronic infectious threats like TB, or emerging threats like arboviruses (eg West Nile). The response to avian flu should encompass a comprehensive emphasis on public health infrastructure--multiagency surveillance, vaccination, and containment. It doesn't make sense to ask the public health sector to reinvent the wheel with each wave of media attention to a disease threat.

More Alito Blogging

Althouse reviews Alito's ruling on whether Congress has the power under the 14th amendment to enact the Family and Medical Leave Act.

The First Amendment Center summarized and reviewed 20 cases he ruled on.

I'm still in the information gathering phase, as most of us are, but so far he does not seem like an ideologue. I don't know whether I support his nomination on balance yet though.