Wednesday, October 15, 2014

Diseased Politics

Only in the fevered little minds of the corporate media could a small but scary domestic outbreak of Ebola be trumpeted as an "October surprise."

It's not so much that this disease is killing thousands of people in Africa, or that stupid cuts in basic domestic public health programs have exposed the most expensive health care system in the entire world as a gigantic slab of Swiss cheese. It's how Ebola will affect the congressional mid-terms.

From The Hill:
The mounting anxiety has made politicians extra attentive to Ebola, with candidates  seizing on the spread of the virus to hammer their opponents.
The issue is particularly fraught for Democrats, given signs that President Obama’s dragging poll numbers could help Republicans take control of the Senate. Though Ebola is unlikely to move the needle in specific races, political strategists say it adds to the darkening public mood. 
While the usual suspects at Fox News and Clear Channel screech that Ebola is sneaking through the borders to kill us all as a result of a presidential terror plot, and Louisiana Governor Bobby Jindal (himself a former public health official) is refusing to allow even the sterile ashes of medical waste to contaminate his state's precious toxic landfills, the Democrats blame Republicans for cuts in public health programs while whining, according to The Hill, that "Ebola is drowning out their main campaign messages, particularly on the improving economy."

Holy Eboley.

Meanwhile, after sending out a near-constant blast of fundraising email spam and raising a record amount of cash on such appealing appeals as "Doomsday!," and "Final Notice!!!!", the Democrats have already preemptively declared defeat on the front page of the paper of record. Makes you want to demand a refund, or sue for political malpractice. (Assuming, that is, that you gave. I still keep getting reminders, in the form of friendly threats, that my payment thus far to the Act Blue collection agency has been a big fat 0 dollars.)

Could you ask for a more diseased duopoly?  It makes you want to don your flimsy corporate-issue protective gear before running straight to the polls to cast your vote for your favorite pathogen. 

The Republicans are perfectly adept at constantly exposing themselves as big fat cynical idiots. But the Democrats need some extra help. About those drastic GOP cuts to the public health infrastructure complained about by the We Suck Less Party? Let the American Public Health Association explain:
President Barack Obama’s proposed budget for fiscal year 2015 makes a number of investments in public health, but also cuts millions of dollars from critical health agencies.
 (snip)
Under Obama’s proposal, the Centers for Disease Control and Prevention would see cuts to its program-level funding of about $243 million, or 3.5 percent, from fiscal year 2014. The agency’s budget would shrink from $6.85 billion to $6.61 billion. As part of that funding, CDC would receive $810 million from the Prevention and Public Health Fund, the landmark fund created by the Affordable Care Act to support prevention programs nationwide.

(snip)
  In a March letter to members of the U.S. House and Senate appropriations committees, APHA noted that Obama’s proposed budget would cut CDC’s budget authority to fiscal year 2003 levels.(my bold)
“While we appreciate some of the targeted increases in the president’s budget, other important CDC programs would face level funding or significant reductions,” said the letter, which was signed by members of the CDC Coalition. “We believe that Congress should prioritize funding for all of the activities and programs supported by CDC that are essential to protect the health of the American people.”

The letter asks Congress to provide $7.8 billion to CDC in its final appropriations legislation.

“While we acknowledge the ongoing fiscal pressures on federal discretionary funding, we are deeply concerned that the administration is proposing deep cuts to CDC’s budget authority, particularly on the heels of the fiscal year 2014 omnibus spending bill that restored some of the prior reductions to CDC’s budget,” (the letter) said. “Ongoing cuts to public health programs continue to leave all of us at risk.”
And about that "darkening public mood?" New York Times columnist Frank Bruni suggests that we Americans (who "do panic really well") just stop with the hysteria, buckle our seat belts, drive off to get tested and treated for Hepatitis C while getting our annual flu shots as we lay off the sugary sodas and give up our gun fetish:
I’m not dismissing the horror of Ebola, a full-blown crisis in Africa that should command the whole world’s assistance. And Ebola in the United States certainly warrants concern. We’re still searching for definitive answers about transmission and prevention.
But Americans already have such answers about a host of other, greater perils to our health, and we’d be wiser to reacquaint ourselves with those, and recommit to heeding them, than to worry about our imminent exposure to Ebola.
Of course he's right about prioritizing. He just forgets to mention that relentless bipartisan fiscal austerity in service to plutocratic greed has put a real damper on American health and a severe dent into our individual economic ability to prioritize. My comment:
Maybe we panic really well because on any given day, 20% of us are in medical collections. Medical debt remains the leading cause of bankruptcy in America.
According to the health care consumer site NerdWallet, American households lost $2,300 in median income between 2010 and 2013, but our health care expenses increased by an average $1,814. Many of us are imprudently putting off that doctor's visit because we'd rather eat.
Have you researched the actual price of those curative Hep-C pills? Gilead, the drug-maker, charges $84,000 for each recommended 12-week course. That's $1,000 a day. Quite the pathological profit for them, given that their actual manufacturing cost for an individual regimen is only $136. To add insult to injury, Gilead avoids US taxes by locating its corporate HQ in Ireland. (They charge poor countries a little less, only because of the agreement the White House made with Big Pharma to forgo price negotiations in order to lower drug costs. It was a quid pro quo for the Affordable Care Act.)

Several states have severely cut back on their annual free flu shot clinics this year. And as cruel as the Republicans are, even the 2015 White House budget calls for a $1.3 billion cut in discretionary public health programs. This includes a $36 million cut in the CDC's immunization services and $54 million from its public response and preparedness programs.

The only things we have to fear are unregulated capitalism and corrupt politicians.
Austerity kills.

 

26 comments:

Denis Neville said...

Great comment! Karen.

Unfortunately, in politics and our dumb-downed society, stupidity is not a handicap.

For me, stupidity is the same as evil judging by the results.

“For at least two thirds of our miseries spring from human stupidity, human malice and those great motivators and justifiers of malice and stupidity, idealism, dogmatism and proselytizing zeal on behalf of religious or political idols.” - Aldous Huxley

Texas GOP Rep. Pete Sessions wants to ban flights from western Africa countries.

As Jon Steward pointed out, Texas has suffered from measles, whooping cough and flu outbreaks.

A Texas anti-vaccine megachurch was the epicenter of a measles outbreak in 2013.

Why?

Vaccine denialism in conservative Texas politics.

From the Texas Republican Party’s draft platform:

“Immunizations: All adult citizens should have the legal right to conscientiously choose which vaccines are administered to themselves, or their minor children, without penalty for refusing a vaccine. We oppose any effort by any authority to mandate such vaccines or any medical database that would contain personal records of citizens without their consent.”

“I would prefer an intelligent hell to a stupid paradise.” - Blaise Pascal

annenigma said...

Karen, thanks for the much needed laughs (the We Suck Less Party and Holy Eboley) and insights. Your closing statement said it all.

annenigma said...

So now we find out the latest Ebola patient was not ordered or even advised to avoid airline travel or to isolate herself after caring for the Ebola patient who died. Isn't isolation of direct, high risk contacts even in their protocols? Yikes!

With the government so far botching the Ebola response every step of the way, their incompetence only gives support to those who want to privatize government services.

The government itself lists Ebola as a HIGH-PRIORITY CATEGORY A Bioterrorism Agent/Disease yet they stumble and bumble along like it was nothing special since Day 1. "Don't worry, we've got everything under control". What a disconnect! This is surely Obama's Katrina. I heard he's finally going to take time out from fundraising to address this. Maybe he'll fly over Dallas and wave while he gives them his dazzling shit-eating grin.

This is the CDC's definition of the HIGH-PRIORITY Category A Bioterrorism Agents/Diseases which includes the hemorrhagic fevers of Ebola and Marburg, along with just a handful of other agents:

"High-priority agents include organisms that pose a risk to national security because they
-can be easily disseminated or transmitted from person to person;
-result in high mortality rates and have the potential for major public health impact;
-might cause public panic and social disruption; and
-require special action for public health preparedness"

http://www.bt.cdc.gov/agent/agentlist-category.asp

Wow, they actually state it requires SPECIAL ACTION. From whom exactly? Our own government appears to be the biggest threat to our national security - NOT terrorists.

Denis Neville said...

What we are witnessing in Texas is just the tip of the iceberg.

Many, many patients are victims of preventable infections, injuries, and deaths due to substandard care in our nations’ hospitals.

The profit motive totally dominates health care today. Hospitals are run by non-medical MBAs bean-counters seeking maximum profits. The rise of corporate medicine in the United States, a culture of seeking profits at the expense of best practices, has had consequences.

“Doing more with less” was the mantra where I worked and it's the culture of the US health care system.

Working short was the norm. Decisions to “cut corners” by not providing adequate nursing staff were made on a daily basis. Intentional under staffing was a business decision made by the CFO. There is a direct link between staffing, the number of nurses providing patient care, and patient outcomes.

Nursing is very complex, hard work with many moving parts at the edge of chaos. When nurses are chronically stressed and feel unsupported in their work environment, it can lead to lapses in infection control practices:

According to a 2012 study by Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing for every extra patient added to a nurse’s workload, there is one hospital acquired infection for every 1,000 patients.

Another study by the American Journal of Infection Control showed that for each 10 percent jump in the proportion of nurses who logged high levels of burnout, there was roughly one additional catheter-associated urinary tract infection per 1,000 patients and almost extra two surgical site infections per 1,000 patients.

While these studies may not sound significant, a hospital acquired infection can kill because it is usually caused by antibiotic-resistant bacteria that are difficult to treat.

“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm.” - Florence Nightingale, the founder of modern nursing

As Charlie Pierce wrote today: “National Nurses United is raising the correct kind of hell on behalf of the grunts on the front lines of the fight against this disease…There are people down in Texas being very brave right now, including Amber Vinson and Nina Pham, who are fighting their own personal battles. It is likely that they got sick because the CDC didn't get to Dallas fast enough to knock some sense into that hospital. They looked it in the eye. The union is supposed to keep all of the rest of us from forgetting that. Unions are important that way.”

annenigma said...

The whole public health system is broken. There are mandatory reporting laws requiring immediate reporting of even the suspicion of certain diseases, such as Ebola, as well as the reporting a diagnosis of about 50 others of lesser but serious concern. Do doctors ever report them? No. They never even test or diagnose them. Eventually one patient among many will finally find a doctor who tests them (probably because they demanded it), then as you trace contacts back, you discover there were tons of doctors who saw and sent home patients with the same condition, or gave them useless antibiotics and none ever reported anything.

These diseases are almost all discovered when the right labwork is finally done, but it's the Lab that sends the automatic computer generated report a month later to the health department, never the doctors. So contract tracing is belated and everything has to start from scratch.

Health inspections of restaurants is often spotty and large outbreaks of foodborne illnesses are kept hushed up for fear of harming the busine$$. One memorable case I had was where the same Mexican restaurant had large outbreaks two summers in a row and still wasn't shut down despite measures to help them clean up their act. I was part of the team inspecting the problem facilities but the only person advocating for the public.

One patient was admitted to the hospital and diagnosed with appendicitis without even having had a stool sample taken and tested beforehand. His appendix was fine after they took it out but the incision opened up afterwards and he developed a massive infection and had to stay in the hospital even longer. Glad he didn't die. There were 60 other people sickened - that I could locate.

That is just the tip of the iceberg. I could write a book.

Karen Garcia said...

Anne,

I used to cover the county public health beat, and my newspaper had to threaten to sue under the FOIA to let us see their weekly restaurant inspection reports. (They were afraid the truth would drive the eateries out of business). So finally they relented and I reported only on the major "redline" violations -- those with the potential to cause food-borne illness. Most involved not reheating food to safe temps before refrigerating. What was truly amazing is that the county would very rarely shut these places down, even after repeated, egregious violations, like mouse droppings in pancake batter and insecticides stored near food products. So we were doing a real public service by outing the culprits every Wednesday. I got plenty of nasty phone calls.(Of course, when Rupert Murdoch bought the paper, the inspection reports stopped, and so did several reporters' jobs, including mine.)



What I learned: avoid Chinese restaurants, esp. buffets, and salad bars (those sneeze guards don't do shit.)

Kat said...

Denis is right. The problem is chronic understaffing. A 24/7 schedule requires some flexibility, but administrators have taken it way too far. They always err on the side of having a lean staff. No amount of training is going to make up for understaffing. They could hire a dozen nurses for every vice president of transformational excellence" that they have.
From time to time in places such as the NYT you will read a comment along the lines of "we don't have health care in this oountry-- we have sick care. If that were the case, then what would be wrong with that? That is what hospitals should be for. Instead, our hospital systems seem to be intent on providing hotel like amenities and inviting you to "get a heart heath check up". Don't get me started on breast cancer month.
Infectious diseases- well, you don't hear too many commercials for that do you? It is not one of their more profitable product lines. One of our hospitals here is worried about their profits after going on a building spree and they stated they would be making some layoffs. Physicians with unfunded research will be let go.
The CDC has lost its way. When I think of the CDC I think they should be doing things such as investigating cancer clusters and tracking infections. Instead we they massage data to create "the obesity epidemic"-- as if obesity is a disease that may be transmitted from person to person.

Kat said...

Speaking of reporting-- there was finally some reporting by the AP about the contagiousness of ebola! Get everyone worked up into a panic first, though!
People do seem to have a tendency to conflate lethality and contagiousness.

Jay - Ottawa said...

Diseased Priorities

Part I

I appreciate how Denis, here and elsewhere, puts in a good word for the nurses. Another box of chocolates from another doctor specialty at Christmas was all we were accustomed to in my unit. And that was a Magnet Hospital.

There are so many tacks on which to address the failings of the medical system. I will limit myself to one corner of the hospital system. The following rant is not the whole story by far, but herewith the first things that to come to mind when I look at the past week (with Ebola) and a little further back in time at the situation of hospitals generally.

Three or four generations ago, the main obstacle to good hospital care was ignorance. Compared to our day there was much less information in texts on pathology, few real medicines from the pharmacy and even fewer complex and invasive procedures.

Doctors back then became astute at diagnosis if they had famous teachers, read widely, were quick learners and exceptionally observant. With experience they could accurately identify and mark the course of common diseases. So they waited by the bedside through the night for that fever to break –– or not. Then they could tell you what would happen next. They had few real remedies for what they accurately diagnosed. They supported nature. Today, in the light of remarkable bench and field research and given the proper resources, they can often bend nature to their will. Impressive.

As for nurses back in the day, they served mainly as the clean up crew around patients. They were expected to follow orders like marine recruits. Off shift, they wore those glorious navy capes, white dresses, starched linen tiaras approximating wimples and nursing’s tender smile.

Today, however, physicians have more knowledge than they can handle, whether for diagnoses, meds, technology or procedures, even after the their long art has been divided and re-divided into specialties. Seems like there’s always too much waiting to be learned and too much waiting to be done. Likewise with the nurses, who have dressed down and smartened up beyond recognition. Nightingale would faint if she saw what a good nursing team can do in a big hospital ICU. Nurses also have gravitated into specialties, which they can hardly keep up with, in case you didn’t know.

Time is money, as they say. The big problem facing hospitals today is lack of time, due to lack of money, boutique medicine excepted. Our knowledge outmatches the human and material resources available to follow through properly on what we know works. Too few people to do so much –– just as in so many other lines of work. Trouble is, Mother Nature’s deadlines are hard to put off.

Jay - Ottawa said...

Part II

Today hospital administrators strive to downsize staff even as the work keeps getting more complex, more time consuming. I’m convinced that cognitive dissidence, the juggling of howling contradictions with a straight face, is a required trait for hospital administrators.

Administrators and their bean counters say they are hemmed in by tight budgets. Well, it’s true. So they cut corners and shift the burden of the impossible to the front line by telling them to “work smart.” The implication being that, if you can’t figure out how to fit ten hours of work into five, you’re stupid. So cut corners to make time without of course violating the protocols found in all those manuals administration put on the shelf. As we know, cutting any little corner in health care risks all the good work invested in the patient so far.

Nursing leadership doesn’t help nursing all that much. Maybe that’s why desperate nurses resort to unions. Nursing bosses want to be loved, or at least respected, by suits in the boardroom. Nursing bosses keep their jobs and please the suits by repeatedly selling their “can-do,” super-efficient, high touch reputation to the establishment. They may also have learned that the best way to be heard is to keep your mouth shut. So they welcome new assignments without protest. Then they turn around to tell the front line to –– yup –– “work smart,” which is their way of laying on new responsibilities without supplying additional resources, like more staff.

How do nurses pull it off? Brace yourself: there comes a point when they no longer can. Standards slip. For years they try to do the impossible because they are told they are such dedicated, caring creatures. They hustle through an entire shift, they skip breaks, they skip lunches, they work overtime on short notice, they make appointments with themselves to leave the bedside for a quick pee. Because, at least in an ICU, they must continually record vitals, administer meds at varying speeds, continually adjust meds on several pumps at once, deal with the computer, trouble shoot equipment, deal with the phone, lend a hand to a neighbor, deal with the unexpected and, oh yes, clean up, just as in olden times. Sometimes the patient himself butts in with an unscheduled issue you have to fit it with all the rest. The impertinence!

ICU nurses routinely work 12-hour shifts, which are more efficient and beneficial for the hospital –– if not the home front. Those who are not saints burn out and quit, or find work in a 9-to-5 doctor office, or they maneuver their way to a desk job, thereby depriving the front line of someone who has finally become as smart, experienced, forceful and efficient as you can get.

Scientific expertise, patient-staff ratios in line with reason, and the requisite amount of money are all available (theoretically) to hospitals in a rich country like the US. But, like primitives, the PTB have chosen to sacrifice patients –– along with their caregivers, the beaten down doctors, nurses and technicians –– on the altar of an idol variously called “Efficiency,” “Work Smart,” and “Cost Containment.”

Now for a short survey:

Q. What does boutique medicine have that other systems don’t?
A. (Could it be enough time, talent and money to always do the right thing?)

Q. Isn’t everyone entitled to boutique medicine, or is that only for the divine right rich?
A. (Before you answer, think about the third and last question.)

Q. How you gonna fund top-notch care for all citizens within a one-tier system, even after you rid the landscape of private health insurance companies, as well as the eternal problem of waste, fraud and abuse?
A. _______________________________

Fred Drumlevitch said...

Fine post, Karen, and great detailed comments from Sardonickyans. Yes, the U.S. medical system is irredeemably broken, but again today I don't have the time to really reply or expound on these matters, right now I just want to bring up a new development:

"Airline: CDC Warned 'Possibility' Ebola Nurse Had Symptoms on Plane"

http://www.nbcnews.com/storyline/ebola-virus-outbreak/airline-cdc-warned-possibility-ebola-nurse-had-symptoms-plane-n227046?cid=eml_ntn_20141016

This is admittedly speculation on my part, but wanna bet she flew knowing that she might have Ebola, but did so — very irresponsibly to the greater public, but trying to save her own life while not bankrupting her family — because she didn't have medical coverage (or perhaps not good medical coverage that was valid nationwide), but rather, only local "coverage" (if it can be called that) through the hospital where she worked, either as a "perk" of her employment there, or because of their legal obligation to her as a consequence of her occupational exposure there?

annenigma said...

@Fred

Dr. Friedan testified to Congress today that the second nurse took the initiative of calling the CDC to report a low grade fever and ask if she could fly. Dr. Friedan said he hadn't read the transcript of that conversation so he didn't know exactly what was said but that the nurse was not asked to avoid taking the flight so she took it. She is getting married soon and her trip was related to preparations for her upcoming wedding.

Her fever was 99.5 and their guideline is 100.4. Apparently there was no consideration of the critically important fact that she had direct contact with the index case. She probably spoke to a CALL CENTER employee in India who didn't know anything about the case. I find it hard to believe she spoke to anyone directly involved with this particular case. I worked with a CDC team from Atlanta on a whooping cough outbreak and found them to be very cautious and diligent. With Ebola they'd be even more so.

Zee said...

Q. How you gonna fund top-notch care for all citizens within a one-tier system, even after you rid the landscape of private health insurance companies, as well as the eternal problem of waste, fraud and abuse?

A. I dunno.

First, I suppose one has to define—and reach national concensus on—what actually constitutes “top-notch care for all citizens” before one can even begin to consider the funding issue.

WRT the United States, looking at how other countries managed to do that might be the place to start. I would be curious to know how the Canadians and the British arrived at their “concensuses.” (Or should it be “concensi?”)

But in the end, someone is inevitably going to feel that his/her condition has been given short shrift, so “top-notch care for all citizens” is a chimera. It will inevitably devolve to “the best we could do for most of our citizens,” which should come as no surprise to anyone.

Denis Neville said...

The quality of American health care is an index of American civilization - opulent splendor (an opiate for the American public) and shocking deprivation (so ungenerous and inegalitarian) side by side.

America’s hospital industry has reverted to its origins at the onset of the twentieth century. Although established under the law as charitable trusts, hospitals, despite being the embodiment of ideal American altruism (charity balls and charitable giving and charitable trusts, i.e., trickle-down generosity), have in reality provided relatively little charity care throughout their history. They have instead promoted health care as a private consumer good to be purchased, not as a social service (as in Canada and Europe).

The unfortunate truth is that millions of our suffering poor, uninsured sick are denied access to the care that hospitals routinely provide to those who have insurance and are able to pay.

It is paradoxical that at a time when scientific progress of medicine has reached such heights that the neglect of the social roots cripples its effectiveness. Medicine if it is to improve public health must attend both its biologic and its social underpinnings. Poverty and inequality influence any population’s morbidity and mortality.

“It is manifestly contrary to the law of nature that a handful of men should gorge themselves with superfluities while the starving multitude goes in want of necessities. The loss of equality was succeeded by the most appalling disorder. It was at last impossible for men not to devote some thought to this awful situation and the calamities that had befallen them.” – Jean-Jacques Rousseau

The poor, they say, will always be with us. If this is true, then so will infectious diseases and the plagues that the rich, in vain, are attempting to keep at bay.

“Medical statistics will be our standard of measurement: we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged.” – Rudolf Virchow, 1848

voice-in-wilderness said...

Thanks to a NYTimes reader comment, combined with some of my own Googling, I discovered that Anne Bass is the chair of the board of Texas Health Resources, the Uber entity that owns "Presby."

Instead of the media stopping with Dr. Vargas as sacrificial spokesperson, I'd like to see the media try to get a sound bite from her!

BTW, if like me, you don't find Anne Bass to be a household name, her main claim to fame may be that Sid Richardson Bass divorced her a couple of decades ago so he could marry Mercedes Bass (aka "the Iranian firecracker"), though since divorced.

annenigma said...

Can you imagine the compliance of these hundreds (so far) of people who are self-monitoring, self-isolating, and/or otherwise on virtual house arrest for 3 weeks when they won't even keep their dogs on a leash in public? Good luck keeping Americans on a leash! You can bet they'll pull a Snyderman.

Being residents of an officially recognized (by POTUS) 'Exceptional Nation', it's only natural that we'd consider ourselves exceptional too - meaning we except ourselves from the rules, laws, ordinances, standards, and protocols that apply to everyone else.

Free-dumb! Free-dumb!

Denis Neville said...

“There are in fact two things, science and opinion; the former begets knowledge, the latter ignorance.” – Hippocrates

Guess who’s winning the “war on terror?”

It is the simpler life forms, the viruses and microorganisms that live in or on us.

It is not only the world that neoliberalism creates, it is also the dangerous and deadly result of science deniers that poses the serious threat to society. Their subversion of the truth and the resultant widespread scientific ignorance has increased the risk of global catastrophes and deaths due to the spread of diseases that could easily be prevented.

“Reality must take precedence over public relations, for Nature cannot be fooled.” – Richard Feynman

Peter Doherty, “In writing ‘Their Fate is Our Fate: How Birds Foretell Threats to Our Health and Our World,’ what I came to appreciate is the enormous importance of the “citizen science” done, for example, by Audubon Society members as they record the numbers and distribution of different avian species. Then, as the first person with a veterinary training to win a Nobel Prize, I’ve been privileged to hear intriguing stories about how birds monitor the world for environmental toxins, global warming and the habitat degradation that is an inevitable consequence of human development.”

“Birds in the wild function as a roaming, natural detection system… Birds detect danger to our health and the environment before we do…our free-flying, wide-ranging avian relatives serve as sentinels, sampling the health of the air, seas, forest and grasslands that we share with them and with the other complex life forms on this planet… they are like the proverbial canary in a coalmine… harbingers of danger – particularly in relation to climate change and environmental degradation.”

“The basic message is that any sudden, human-induced change has consequences when it comes to natural ecosystems, which is just one of the many reasons why widespread ignorance of science and the resultant failure to grapple with reality are dangerous.”


Doherty notes, “It says something profound about the human condition that history takes much greater account of wars and military mayhem than of the enormous losses caused by communicable disease…as recently as the 19th century, people made no connection between infestation with visible parasites like worms and ticks and the unseen world of infection with microbes.”

Zee said...

Kat remarks:

“The CDC has lost its way. When I think of the CDC I think they should be doing things such as investigating cancer clusters and tracking infections. Instead we they massage data to create 'the obesity epidemic'—as if obesity is a disease that may be transmitted from person to person.”

One need only look at the detailed budget for the CDC to see how far astray it has wandered from tracking, stopping and treating communicable diseases:

http://www.cdc.gov/fmo/topic/Budget%20Information/appropriations_budget_form_pdf/FY2015_Budget_Request_Summary.pdf

Under the major program category of “Chronic (Note: NOT “Infectious”) Disease Prevention and Health Promotion” ($1.078B) one finds significant sums of money being spent on such things as “Tobacco,” “School Health,” “Diabetes,” “Preventive Research Centers,” “Safe Motherhood/Infant Health,” “Arthritis and Other Chronic Diseases,” “Racial and Ethnic Approaches to Community Health,” “Partnerships to Improve Community Health,” “Healthy Weight Task Force/Early Child Care Collaboratives” and “Hospitals Promoting Breastfeeding,” in addition to Kat's “Obesity” program. None of these programs seem to have anything to do with infectious diseases, and some of the programs such as “School Health” and “Racial and Ethnic Approaches to Community Health” are so vague as to be meaningless.

There are numerous other major program categories that seem to have absolutely nothing to do with tracking, stopping and treating infectious diseases, such as “Birth Defects, Developmental Disabilities, Disability and Health,” ($0.132B) “Environmental Health,” ($0.168B) “Injury Prevention and Control,” ($0.194B) and “Occupational Safety and Health” ($0.281).

Taken together, these major categories add up to $1.853B, or fully 28% of the $6.6B 2015 budget request.

I'm not saying that these areas of research have no place in government. But I don't think that they have any real place within the CDC, and some, such as “Environmental Health,” “Injury Prevention and Control,” and “Occupational Safety and Health” may even be duplicative of efforts underway at the EPA, OSHA, and MSHA, for example.

But, as with any government institution, eventually the imperative become less about doing and more about growing. It is the unimaginative—or overly honest—government bureaucrat who can't think of multifarious ways in which his/her institution can slice off a portion of the other guy's agency's pie, or better yet, to get funding for his/her own institution in order to “contribute” to the other guy's mission in some allegedly "unique" way.

That, IMHO, is what has happened at the CDC.

Jay - Ottawa said...

This just in. The CDC is out of line tending to chronic diseases, especially when sited in zones of poverty.

It would be uncharacteristic –– perhaps chimeric –– to have the US and France switch national mottos in the way opposing soccer players trade jerseys. One jersey, “In God We Trust,” lacks élan and is so tight it chokes; the other, “Liberty, Equality, Fraternity,” is too loose and soon in tatters. It would hang from Uncle Sam like moss on the trees of a Carolina swamp, much like what’s happening to the social safety net in the US.

The American Revolution was not a revolution in the usual sense. It was a colonial war pitting the oligarchy on one side of the Atlantic against its counterpart on the other side.

The French Revolution was a class war in place, a very rough shift from monarchy to republic kicked off by the Paris mob. Louis XVI hesitated too long. Napoleon was not yet tapped to disperse the rabble with his “whiff of grapeshot.” Still, there seems to be a lot more equality "over there."

America, since at least Shay’s Rebellion, is much more adept at dispersing mobs and respecting money. Levelers are suspect, royalty less so. Most of the loyalists in the colonies did not decamp to Canada. They stayed in the US and, from the looks of it, they multiplied fruitfully.

Now, to healthcare in modern times. Healthcare is big business, not a charitable endeavor. The blind hand of the marketplace knows best how to hold the scalpel and apply the band aid.

Ghetto clinics and the community health concerns of the CDC notwithstanding, the health establishment was never geared to help all the sick people. The upper classes should be left to decide how much goes to the inner city.

If you’re content with your own situation in the suburbs and laid back about leaving things as they are for the population of the needy, you’re probably a monarchist at heart. Noble blood flows through your veins. Your ancestors must have had land. Equality, be damned, especially if it's put forward as a national goal. Romantics and their ideals!

Compromise is nice, though only up to a point. Americans could meet those French radicals half way by holding on to the tripartite ring of their motto but changing the words slightly to square with facts on the ground over here. Onward!

“Serfdom, Disparity, and Corporatism Forever.”

Kat said...

Jay,
I'm going to assume your comment is aimed at me. You lay it on a little thick-- monarchist?
Could you explain to me how the CDC labeling obesity a disease helps to fund "ghetto clinics"?

Zee said...

Kat--

I was going to let Jay's clever, sarcastic remark go unanswered, but in good conscience I can't let you assume that you were the target of his most recent remark.

I'm reasonably confident that I was the one in his sights--or mostly so--so please let me quietly absorb his slings and arrows, not you.

It's just not worth getting into a pissing contest over.

And that's all I have to say about that.

Jay - Ottawa said...

@Kat
I wasn’t reacting to your comment. At the same time, I am sympathetic with the CDC’s work, even their well-intentioned but sometimes awkward efforts, to deal with obesity, a whopping health issue across the North American population, whether or not obesity is classified as a disease.

What prompted me to comment was the use of your comment as a springboard for Zee to resume his customary snipping at government efforts to help those who live with little or no protection unless big government steps in. Zee goes on to list several CDC programs he thinks are wasteful. Those programs happen to be valuable to many cohorts in need. Isn’t Zee's sniping the usual maneuver on the way to discredit a government social agency? Furthermore, I am not aware that the CDC’s mission statement restricts it to dealing with communicable diseases only. Big government has the resources to provide relief to whole populations; private charities may do exemplary work but spottily for mere fractions of the needy.

We may reasonably argue about the effectiveness of one government program or another. What strikes me as unenlightened and, undeserving of a polite hearing, is the chest-thumping of a self-advertised scientist whose steadfast message puts down government at every opportunity, especially programs that attempt a redistribution in solidarity with the needy. That’s why I tried a new tack of promoting solidarity by expatiating on “Liberty, Equality, Fraternity.” That motto, like science and reason, also traces back to the great minds and souls of the Enlightenment.

The French still quarrel among themselves over monarchist versus republican forms of government, but they’ll never revert to the disparities of the Old Regime. Their revolutionary motto, which is no longer revolutionary, has circled the world for two centuries and advanced thinking in just about every country, even in places still ruled by tyrants.

I am not equating doctrinaire conservatism at home with political tyranny. But I do fault the type of conservatism, beholden to objectivism and libertarianism more than it cares to admit, that persistently undercuts the spirit of solidarity. Solidarity means “liberty, equality, fraternity.” Without solidarity with society’s unfortunates –– the sick. the poor, the ignorant, the unlucky, and whoever we happen to mark as undeserving at the moment –– the middle class will merely live out a dilute form of oligarchic exclusivity. Without solidarity we’ll never approach a real democracy. We’ll be assenting to plutocracy, with great risk of being dragged all the way back to monarchy and tyranny.

@Zee
See above.

Zee said...

@Jay

“ What strikes me as unenlightened and undeserving of a polite hearing” is the narrow-minded notion that only Jay and like thinkers have a corner on the market of “enlightenment” and the right to “a polite hearing.”

That arrogant attitude is, IMHO, the very reason that many, if not most, Progressives will remain a barely-audible cry from the distant reaches of the political wilderness for the foreseeable future rather than ever attaining any political momentum. So plan on being content with being “right” rather than succeeding by accepting the reality of having to listen to—and maybe compromise with—with those who think somewhat differently from you.

Better to fail gloriously than to accept even partial success eh?

I could go on in this vein, but I won't.

However, I do take umbrage at being described as a “chest-thumping...self-advertised scientist whose steadfast message puts down government at every opportunity, especially programs that attempt a redistribution in solidarity with the needy.”

To me, “chest-thumping” connotes “bullying,” and if that were the case, I think Karen would have banned me from the ranks long ago. I think that I've been generally civil, tried to back my arguments with facts, apologized or recanted when I've been wrong, and otherwise behaved myself in this forum. So I reject the charge.

As to being a “self-advertised scientist,” well, that smacks of accusing me of lying about myself, that I've pretended to be something that I'm not in order to bolster my arguments, or perhaps it was even intended as an insult. Well, sorry, but I'm not going to publish my curriculum vitae here for your edification. You seem to desire some measure of anonymity in this forum, and so do I. There are several in this forum who know enough about me to “vet” me via Google Scholar; I don't care one way or another as long as my anonymity is preserved.

As for the label of “scientist” being a possible insult, well, I wear the label as a badge of honor. We hear a great deal about how a liberal education sharpens “critical thinking,” but, IMHO, nothing sharpens critical thinking more than having to develop, test, express and defend one's ideas—grounded in facts—in a laboratory or before a scientific (or engineering) forum. I did that for almost 40 years not merely as a career, but a calling, and I think that I learned much more about “critical thinking” therein than I ever did, say, arguing with my high school English teachers over the subjective “meaning” of this, that or the other novel, play or poem, respectively.

Which is not to discount the value of the arts and humanities. I have enjoyed my exposure to them, and they taught me how to write. But science and mathematics teach one to think, and the arts and humanities teach one to see different human perspectives, empathize and dissect human nature.

In conjunction with history, the arts and humanities teach anyone who is bothering to think that human beings are generally not be trusted, that governments of any stripe are creations of human beings, and that therefore, governments, like people, should be watched like hawks and mistrusted at every turn until proven otherwise.

You accuse me of trying to undermine the poor at every turn, which is simply not true. But knowing what I do about history and people, and knowing how to think, I know that any government—even one that appears to be “good” on the surface—ain't necessarily the real deal, and needs to be examined and critiqued at every turn. Which is what I have tried to do.

Maybe if we'd spent more time examining and critiquing our government along the way over the past 200+ years, we wouldn't find ourselves in the mess in which we currently find ourselves. Only eight years ago Progressives put their blind faith in untested “hope and change” and here we find themselves.

In any event, I'm tired of explaining and defending my every word at every turn. Enough.

Kat said...

Jay,
I looked at the list of programs that Zee discussed. I don't really know how they work- I know that sometimes there is a wide or not so wide gulf between what they purport to accomplish and what actually goes on. I don't reflexively dismiss all attempts at cultural competence, but I do know that sometimes they can be kind of ham handed. Still some of the programs looked valuable to me.
I don't think of these programs as representing solidarity with the poor in the same way that living wage campaigns, a crackdown on predatory lending, or a jobs bill would. I think our healthcare system has become way too permeated with the values of the marketplace. I see the crusade against the "obesity epidemic" as a turn towards neoliberalism. (I have also read several books that call into question CDC statistics about the epidemic. The Obesity Myth is one such book.) Increasingly too our healthcare system has become another apparatus surveillance state.
I don't agree with everything Zee has to say. I don't think science is non ideological or the only way at arriving at answers. I don't think skepticism of any government program is unwarranted, however. I read a book about a year ago-- The Mendacity of Hope. It was a critique of Obama from the left, but the writer, a former editor at Harper's spoke of the need to make alliances with those on the right that share some of our values as they pertain to empire and civil liberties. Now, I am not going to seek common cause with any racist, but nothing has led me to believe Zee is a racist.

Kat said...

Zee writes "even one that appears to be “good” on the surface—ain't necessarily the real deal, and needs to be examined and critiqued at every turn"
you should read the book I mentioned in my previous post-- he makes the same such point. The write is no conservative but does lament the lack of true conservatism on the right (heirs of someone such as Michael Oakeshott).

Jay - Ottawa said...

Once upon a time, I worked as a state bureaucrat. There were some solid programs, but, as you can imagine, there were also heavily-funded programs, poorly conceived or which served as giveaways to private interest. Then, there’s always the problem of bureaucrats who are out of sympathy with the department’s mission; they revel in administering sound programs with a dull or contrary spirit.

On any average day in the NYS Labor Department, especially after propaganda churned out by think tanks like the Heritage Foundation grew strong in the Seventies, you might find among the department’s bureaucrats more enemies of labor than friends.

Whatever benefit remains after all that bureaucratic slippage remains vital for thousands of people served. There is usually a cadre of dedicated people from top to bottom in these bureaucracies. They hold together what’s left of our social programs.

Do I sound like Obama in asking that we not be purists when it comes to the administration of social programs? The alternative to unemployment checks is soup kitchens. So I’m against kicking bureaucrats because they act like bureaucrats, especially through periods like the present when they’re down –– down because of years of budget and staff cuts, down because politicians appoint incompetent commissioners, down because conservative propaganda works at clouding everyone's vision, down because target populations are now overwhelming.

Yes, I get impatient with cheap shots from familiar sources attempting to further discredit that part of the social contract helping the unlucky. Are there not more worthy targets in and out of government? This is not to ban criticism WHEN it's deserved, which is not ALWAYS. For every dollar misspent by OSHA there are millions wasted by the Pentagon and the Security State. Let's throw our weight behind the reforms of Frances Perkins, not Ayn Rand and the Chicago Gang.

Back to the topic of Ebola, there’s a report in the morning’s Times about Cuba’s medical efforts in Liberia. Imagine, an embargoed, two-bit, rundown country like Cuba exporting health, instead of war. Talk about solidarity. And that’s not a first for the Cuban medical system. Most of the comments that follow the Times article make up for its faint praise.

Now, Kat, let’s step back and lend an attentive ear to a familiar source for the usual critique of socialism or, once again, how devious Cuba is in selling its medical talent for oil.