NPR Topics: Science
h/t David
From This Week with George Stephanopoulos, Republican Rep. Marsha Blackburn and Democratic Rep. Debbie Wasserman Schultz get into one of those discussions over this week's breast screening recommendations in which the Republican simply constructs an alternate reality:
BLACKBURN: ... Debbie is right when she says they forgot about people. Indeed, they did. But we have to realize, this group that made this recommendation, this isn't some outside group. This is a part of HHS. And when you look at the...
WASSERMAN SCHULTZ: It's an independent group. That is not accurate.
BLACKBURN: ... 118 -- when you look at the...
WASSERMAN SCHULTZ: It is not a part of HHS.
BLACKBURN: No, it is a part of HHS.
WASSERMAN SCHULTZ: No, it is not.
BLACKBURN: And when you look at what is going to happen with these 118 new bureaucracies with 62 directives that are given by the health choices commissioner on what insurance can be offered in this country after 2013 and what is going to be paid, you know that this is the bureaucrat in the exam room. This is how it's going to happen.
WASSERMAN SCHULTZ: Marsha...
BLACKBURN: And this is the first step.
WASSERMAN SCHULTZ: Marsha, there's an insurance company bureaucrat in the -- in between the patient and her doctor right now.
BLACKBURN: This is breast cancer. Well, and people don't like that, and we need to get rid of...
(CROSSTALK)
WASSERMAN SCHULTZ: And your bill -- your -- your alternative...
(CROSSTALK)
BLACKBURN: We need to get rid of all of those insurance bureaucrats.
WASSERMAN SCHULTZ: ... does nothing to...
(CROSSTALK)
STEPHANOPOULOS: I'm going to have to -- I'm going to have to stop this right now.
Yes, George. Because your job is to provide a showcase. You're not supposed to confront the guests when they make things up.
Joe Lieberman gives us a perfect example why he's a liar in chief.
now with an extra serving of tool-ness:
Sen. Joe Lieberman (I-CT) raised hackles among liberals earlier this week when he claimed that the public option wasn't a part of the 2008 presidential campaign. He repeated that claim to reporters tonight, though acknowledged, when pressed, that then-candidate Barack Obama did in fact include a public option in his campaign health care proposal.
And then there's this: Anyway, I'm opposed to it."
Shorter Lieberfucktard: I don't care what it says: I'm against it. Oooh, LOOK AT ME! LOOK AT ME! LOOK AT ME!!!!
But he's such a serious warmonger that the media loves him.
I'm not feeling incredibly optimistic this morning. Sounds like the most conservative (and most expensive) version of this bill will make up the final version, and I don't see much to celebrate. Is it better to have a crappy bill - or no bill at all?
And why should those be our only options?
The fact is, the Democratic leadership lacks, well, leadership. They think constructing a stage set and acting out a scene that looks like they're leading on the public option is enough to placate the people who so desperately need their help. It isn't. They simply don't get it, and it will cost them:
From the liberal end, Burris repeated a threat made earlier: That if the public option is taken out, he's gone. "I won't vote for it," he said.
"You'll lose people on the left," confirmed Brown.
Reid, aware of the fine line he's walking, told reporters that Landrieu, Schumer and Sen. Tom Carper (D-Del.) are working on a compromise public option, perhaps something that 60 folks could support and save face.
That's what you don't understand, Harry. It's not about "face." But then, it's been so long since you had to worry about paying for your health care, I suppose it's too much to expect.
Yes, this will eventually be good for the country and perhaps our grandchildren - but it won't do much to help the people who need help during these desperate times, and it's certainly going to hurt the Democrats in the midterm elections:
After announcing her intent to support a health care debate this afternoon, Sen. Mary Landrieu (D-LA) told reporters she thinks Senate Majority Leader Harry Reid will soon have to choose between a triggered public option and no health care bill. She also says Sen. Chuck Schumer (D-NY)--the third-ranking Democrat in the Senate one of its most fierce and vocal public option advocates--has been tasked as a point man on the issue.
"I believe it's going to be very clear at some point very soon that there are not 60 votes for the current provision in the bill, and that the leader and the leadership are going to have to make a decision and I trust that they will figure out how to do that," Landrieu told reporters.
Landrieu has been in negotiations with a number of centrist senators about a compromise that would eliminate the public option, except in states where insurance remains unaffordable. Interestingly, though, Schumer is playing a big role in that process.
"Senator Schumer's working on that. He's sort of been tasked as one of the point people," she told me. "He's been tagged as one of the point people to help negotiate that."
Schumer's involvement as a liaison between liberal and conservative Democrats puts the trigger issue in a new light. When Reid announced that he'd include his opt-out plan in the health care bill in lieu of triggers, many, including trigger-author Olympia Snowe, believed the compromise to be dead. But it now appears to be one of the central points of discussion between leadership and conservative Democrats as they try to find 60 votes for a reform bill.
It's half a victory, and a weak one at that.
John Cole finds Chuck Todd wanking away on Twitter.
Shorter Chuck Todd: Its only big news if the Democrats fail!
I guess he didnt pick up on the fact that if they had failed to get the 60 votes, HCR would, for all intents and purposes, be dead in the short run, as the Republicans would filibuster. That is why this is such a big deal- they have overcome the obstructionism of the GOP, and the debate can advance.
Although in fairness to Chuck, he may be more concerned with why Obama didnt reach out more to President McCain. Not to be too subjective, or anything.
*** Update ***
Can anyone imagine the feeding frenzy for the next two weeks if they had failed to get 60 and advance the debate? Can you imagine the Sunday shows tomorrow? Can you imagine all the headlines speculating if Obama was a lame duck? Senate fails to advance health care reform. Is Obamas entire agenda at risk? and Obamas signature legislation killed in Senate. Can he recover? and Republicans, spurred by sagging Obama poll numbers and grass roots support from tea party, stop Obama administration in their tracks.
And Chuck Todd would be leading the goddamned charge with that crap.
Chuck Todd explains in Twitterific form what the Village really thinks. Does he not understand how the legislative process works? Nope. Does he remember that it was a Blue Dog Royal Senator named Max Baucus that helped pass Bush's tax cuts and medicare drug plan:
Some Democrats think Mr. Baucus betrayed the party in 2001 when he supported President George W. Bush's tax cuts, and in 2003 when he was one of two Democrats to help Republicans pass a Medicare prescription drug plan.
If George Bush had failed at getting these through, would Todd be questioning the conservative movement? Nope. They would be telling America that since they elected Bush, the Democrats were traitors to America. But when a Democrat is President all the Villagers look forward to is failure.
As Jed noted "What would a health care debate be without some good ol' fashioned race-baiting from the G.O.P.?" Stay classy Alexander. So let me get this straight...the Democrats want to steal from grandma to give to the "ghetto"...or did I miss something here?
Alexander: Every other word we hear coming from the other side is that this vote tonight is historic. And I agree its historic, but I think my view of why its historic is a little different than their view. And I wonder if my colleagues would not agree with me that this bill is historic in its arrogancein its arrogance that we in Congress are wise enough to take this entire complex health care system that serves 300 million Americans, that is 16% of our economy, and write a, and think that we could write a 2000 page bill and be wise enough to change it allall at once.
Or arrogant in the, in its dumping of 15 million low income Americans into a Medical Ghetto called Medicaid that none of us, or any of our families would ever want to be a part of for our health care.
Or arrogant in then sending to the states, who are going broke a big chunk of the bill for what weve just done. Or arrogant enough to tell Americans that the bill cost $849 billion and think were not smart enough to read the print and figure out that its actually $2.5 trillion when it actually is implemented. Or to tell us that paying for reimbursement for physicians is not an important part of a health care bill, and so they run over here in the dead of nightrun up the deficit another quarter of a trillion dollars.
I can make a long list of reasons this bill is arrogantarrogant enough to cut and tax grandmas Medicare thats going broke according to the trustees in 2015-2017 and then spend it on somebody else other than grandma.
I mean the bill is arrogant in its telling us that its going to reduce premiums for most Americans when in fact it increases premiums for most Americans. So people say Where is the Republican health care bill? and my answer to that Mr. President is dont expect Sen. McConnell to come rollin in here with a wheelbarrow with a 2000 page budget busting, debt ridden, arrogant piece of legislation because thats not what we believe in.
What we need to do as a Congress is re-earn the trust of the American people by setting a clear goal of reducing health care costs, showing some humility and start moving step by step in that direction and I hope during this hour that we have a chance to talk about the specifics steps to reduce health care costs that we Republicans have offered day after day after day to no avail.
Odds are good that at some point in your life you are going to experience some puzzling symptoms. Twisting intestinal pain that never goes completely away, dry mouth, a painful recurrent eye problem, or stabbing back and neck pain that ranges from annoying to excruciating with no rhyme or reason. In most cases it will be misdiagnosed, perhaps for years, before you're finally driven to seek a specialist and the correct evaluation is made: a chronic autoimmune condition. If so you're not alone, millions of Americans deal with these disorders. Thanks to a full blown, classic case of Ankylosing spondylitis, I'm one of them.
Most layman might imagine the brain and central nervous system are the most complex and least understood networks in the human body. But our immune system gives neurophysiology a run for its money. Actually, it's more like immune systems, since there are so many interlocking, overlapping, and at times even conflicting components. Some immune cells are like the blob, they engulf and digest their prey. Others simply stick to invaders like velcro and wrap them up tighter than a mummy. Others sniff around and chemically paint a suspect so that its buddies can glide in on that beacon like laser guided bombs into an enemy bunker. In complex animals like humans, there are even parts of our immune system that have grown so sophisticated they can rewire themselves on the fly. Once they're exposed to a particular germ, assuming they successfully fight it off, they 'remember' that bug and are forever on guard for it.
An autoimmune disorder occurs when one or more components in that vast array gets a little trigger happy and starts going after healthy tissue instead of dangerous microbes or diseased cells. That can happen easier than you might think, and the culprit is good ole evolution.
All kinds of white blood cells and antibodies are ready to lay down their tiny lives for you at the first sign or marauding microbes or misbehaving cells. To do that effectively, they have to be able to distinguish between good cells and bad cells. If they're too easy going, the bad cells might get an upper hand and suddenly you're sick as a dog. If they're too overzealous, they attack good cells and you have an autoimmune disease. So naturally, any enterprising bad guy has a powerful advantage if it can disguise itself as one of the good guys. Viruses and bacteria that can get past some portion of the immune system in this way are more likely to succeed and leave descendants. But the real masters of disguise are malignant (Cancer) cells: they completely fake out the bodies defenses with chemical disguises that tell the immune cells "Nothing here but us healthy cells doing our job, move along," while deep inside they've gone into business for themselves replicating like mad, co-opting, invading, and eventually devouring nearby tissue and organs. There are constant evolutionary skirmishes going on between immune components and bad guys looking to fake them out. The immune system forever walks a fine line between ineffective and overactive.
When humans abandoned hunter gatherer societies and began living in horrifically unsanitary conditions in close quarters with hordes or other people and domesticated animals, those skirmishes turned into a full fledged war. Suddenly it paid and paid well to have an overactive immune system that shoots first and never asks questions. It might mean that the incidence of other problems caused by enhanced immune components in that population increases dramatically, but as long as some members live long enough to reproduce, in the face of endemic diseases, that trait will become ubiquitous in the population over time.
We all descend from those survivors. Diseases that would have torn through a stone age tribe like a tornado don't even give us the sniffles. The price? Sickle cell anemia for one, and possibly higher numbers of peole suffering lupus, irritable bowel syndrome, and a host of other hard won adaptations that can misfire and cause serious problems, any one of which a research physician could study for a lifetime.
The good news is the outlook for patients has never been better. Moderate symptoms usually respond well to simple aspirin or ibuprofen. As the disease progresses, cortical steroids and narcotic painkillers are effective. In severe cases, immuno-suppressants like Cyclosporin can quell the immune system. In the last decade, a number of new drugs from the family of biologics have been developed that have proven extremely useful. It happens that many of these new drugs are made by biotech companies like Genentech. Scientifically, Genentech has a hell of an interesting science story behind it. Legislatively, that would be the same Genentech that sent an army of Borg lobbyists into DC to assimilate the HCR bill and enslave it in service to their own insatiably greedy corporate culture. Congressional resistance is apparently futile or non existent.
Which brings me back to my own condition. It happens that in AS, there's a genetic precursor called HLA-B27. Over 90% of those suffering from AS are positive for the gene. It's just one small example of numerous disorders with a big genetic component -- some of which can be lethal -- and more are being discovered all the time. I have the AS gene and symptoms, mystery solved, biologic treatment started.
That brings up an interesting point: in a sane world, babies would be checked for all those genes from the moment they come wiggling out of the womb. And parents, teachers, and PCPs would take the necessary precautions and be on the lookout for symptoms, so that any autoimmune or other diseases could be controlled before they flare into a gruesome, bone eating, organ destroying, lifetime orgy of agonizing pain. But in our crazy-ass healthcare system, that's a risk. Because, if a health insurance company finds out that you knew your kid has a genetic marker for a costly disorder, that policy might be null and void on everything they can tie that preexisting condition to, which in the case of some autoimmune diseases and with the judicious assistance of talented lawyers happens to include just about everything you can think of and then some.
A common exercise in any intro statistic class is to split the students into two groups, one group flips a coin 100 times and records the results, another just makes 100 entries up off the top of their heads. The teacher then comes back, looks at the two lists, and usually identifies which is which with hardly a glance. How? The trick is the teacher knows that on the real list, there will be several sequences of four or five in a row of all heads or all tails, whereas on the other list students will tend to stick with a more heads-tails-heads-tails alternating approach.
Now, everyone knew what I meant just now when I wrote trick, right? Nothing deceitful, simply the method used to get an answer to a math problem. With that in mind, let's look at this 1999 email purporting to be evidence of fraud among some climate scientists:
"I've just completed Mike's Nature trick of adding in the real temps to each series for the last 20 years (i.e., from 1981 onwards) and from 1961 for Keith's to hide the decline."
The email is one of thousands sent over a period of ten years by climate researchers and other scientists, journalists, lobbyists, and the occasional flake, stolen from a university network a few days ago. DeSmogBlog has more on the theft. Obviously, emails don't change the observed reality of human assisted climate change in the cryosphere and elsewhere. Nevertheless, climate change denialists have combed through them looking for anything they can pull out of context and pass off as evidence of a global conspiracy. They're getting some media mileage out of it. Even though, so far, the best they've been able to come up with is examples like the above.
The "Mike" is Michael Mann, "hide" means to account for (See also this comment), and the trick referred to is how to resolve a question involving two sets of data. One set is the "real" actual temperature readings, the other is by proxy, tree-rings, corals, ice cores and the like. When reconstructing the temperature record going back a thousand years or more, proxies are all you get -- there were no super accurate thermometers handily placed around the globe during medieval times! But proxies only give an approximation, hence the large variance in the now familiar reconstruction graph affectionately known as the Hockey Stick represented below as shading around the blue and red lines.
But as time rolls by, and proxy data become more plentiful, the error bars (i.e. the variable shading) shrink. Eventually, thanks to the invention of modern thermometers and ships to carry them, precise temperature readings from all over the world become more widely available and increasingly reliable, and there is a relatively short interval where both the proxy reconstruction (blue) and the instrumental record (red) are used. The proxy record ends (1980), but the instrumental record continues through 1999. That was the issue being discussed in the emails: why end the plot in 1980 when there's instrumental data through the 90s? In the original 1998 paper published in Nature, Mann et al showed the instrumental data through the 1990s to complete the plot. The emailer was following suit in his own work. That's "Mike's Nature trick". It really is that simple.
Moreover, both instrumental and proxy records were clearly labeled and delineated in the original papers and many since, so there was no opportunity for any ambiguity as to what was being shown. It makes sense that "Mike" Mann would be mentioned, he has worked extensively with both kinds of data, actual and proxy, and was one of the original paleo-climatologist who developed the Hockey Stick using them. The email is just a tiny snippet of several colleagues in the midst of discussing these points and others.
How hard was it to figure this out? Anyone could have done it, assuming they wanted to. Just like any competent reporter, I asked the people involved, including Prof. Mann:
SA: What was the Mike's "trick"?
MM: All he (apparently) meant by "Mike's Nature trick" was us, in our original '98 Nature article, showing the instrumental record after the proxy record ends (1980). ... Full Text
But consider; it's taken me several grafs, and you a few minutes of reading, just to get a glimmer of what that one email was all about. The same effort would be required to untangle other stolen, out of context emails now brandished by skeptics as evidence of some kind of shadowy conspiracy. That's how easy it is to pluck something out of context and make it sounds ominous, if your goal is to misinform, prostitute yourself to the energy industry, and -- pardon the pun -- trick your readers.
There's no way this complex issue can be covered in one post, but thankfully there have been some really thoughtful pieces written by others that we can pull from. For example, my own comments led to this headline on the AtlanticWire: Politics Beats Science in Cancer Screening Debate, featuring a terrific piece by Kevin Sack in the NY Times (Screening Debate Reveals Culture Clash in Medicine), comments by Ezra Klein (WaPo), Arthur Caplan (MSNBC), and David Dayen (Firedoglake). The author of the AtlanticWire piece jumps to the heart of the issue and writes:
According to the panel, the timing of the new pap smear guidelines is entirely coincidental. But politicians already taking steps to distance themselves from the obviously unpopular mammography guidelines seemed wary Friday. The anger from women, doctors, and advocacy groups over the relaxed screening guidelines is revealing, pundits say. They argue that it reveals a divide between the hard science of cancer screening and the explosive, personal politics of health.
Kevin Sack's piece adds something to the debate in the form of a graphic showing that mammogram utilization has fallen recently in other age groups, and that a steady bit more than 60% of women 40-49 get yearly mammograms (for those interested, a state by state table is here.)
Presumably for the 40% that don't get yearly mammograms, this represents no change. But the recommendations have been presented to younger women as if something important is being taken away from them, rather than what the panel actually said: that the experts suggest that they cannot determine whether yearly mammograms in that age group for low risk women are helpful or harmful and that the best thing to do is discuss it with your own doctor.
The balance of benefits and potential harms, therefore, grows more favorable as women age. The precise age at which the potential benefits of mammography justify the possible harms is a subjective choice. The USPSTF did not find sufficient evidence to specify the optimal screening interval for women aged 40-49.
That, of course, assumes you have a doctor, and that's where the interface between health reform and this topic is most obvious.
As to what the risk is from breast cancer, and why the recommendations were changed away from "just do them", this St. Louis Post-Dispatch piece notes:
The British Medical Journal published an article to help people understand the risk in simple terms.
It means that if 1,000 women don't get mammograms, we can expect four of them to end up dying of breast cancer. If all 1,000 women do get regular mammograms, three will still die of breast cancer.
No matter the odds, many doctors and patients say any life saved is worth everyone getting the mammograms.
"We're all in agreement that this is not the best tool, but does that mean we should take the next step and not screen at all?" said Dr. Burton Needles, medical director of the cancer center at St. John's Mercy Medical Center in St. Louis. "Most of us who treat patients with cancer feel that the benefits still outweigh the risks of screening."
For more details, Kossack charliehall (biostatistician) wrote this more detailed diary on studies available through the Cochrane database, and noted the same result as above: women in the screening group were just as likely to die as women in the no-screening group.
Given that kind of information, the panel suggested individualized care over rote screening for everyone. And on the topic of relying on routine breast self-exam, which was another recommendation from the panel, Orac (pseudonym of a practicing surgeon from ScienceBlog's Respectful Insolence) notes:
The USPSTF's recommendation not to teach breast self-examination (BSE) is another point of controversy. Despite a lot of enthusiasm for the practice, Cochrane Reviews and other evidence have failed to find convincing evidence that routine regular BSE saves lives. I wish it were otherwise, but it appears not to be, even though there are compelling anecdotes out there of women who did find a lump on BSE and it turned out to be cancer. Unfortunately, overall, the evidence to support BSE is weak. On the other hand, even the Cochrane Collaboration, which I have in the past sometimes accused of methodolatry and "nihilism" with respect to screening concluded:
Some women will continue with breast self-examination or will wish to be taught the technique. We suggest that the lack of supporting evidence from the two major studies should be discussed with these women to enable them to make an informed decision. Women should, however, be aware of any breast changes. It is possible that increased breast awareness may have contributed to the decrease in mortality from breast cancer that has been noted in some countries. Women should, therefore, be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer.
Indeed, on a purely practical level, I see nothing wrong with women being taught to be aware of how their breasts normally feel and to bring to a physician's attention any changes that concern them and still encourage that, but there really is no good evidence to support BSE.
To add to that, Our Bodies Ourselves (Boston Womens Health Book Collective) wrote that the case against screening is not new:
New government guidelines recommending that women start screening for breast cancer at age 50 instead of 40 set off a round of criticism this week and caused much confusion for women who for years have been told that early detection saves lives.
But a number of womens health organizations, including Our Bodies Ourselves, the National Womens Health Network and Breast Cancer Action, for years have warned that regular mammograms do not necessarily decrease a womens risk of death. Premenopausal women in particular are urged to consider the risks and benefits.
In fact, the NWHN issued a position paper in 1993 recommending against screening mammography for pre-menopausal women. It was a very controversial position at the time even more so than now. The breast cancer advocacy movement was in its infancy and efforts were focused on getting Medicare and insurance companies to cover mammograms. What the NWHN found and other groups have since concurred is that the potential harm from screening can outweigh the benefits for premenopausal women.
The above statement is important for several reasons. This is not a male view of the world superimposed on women. It's also not a view suddenly brought into the discussion by those wanting to focus on cost and cost alone. it predates this health bill, and it predates cost control discussions in the House and Senate, and in the Obama administration. More from Our Bodies Ourselves:
I dont believe the new guidelines are politically motivated, nor are they "patronizing" to women simply because they call into question the stress related to biopsies and false positive results. Rather, the guidelines provide a useful framework for helping each of us to decide when is the best time to begin screenings and the intervals at which they should be repeated.
Personal health remains just that: personal. Note what the World Health Organization has to add on BSE:
There is no evidence on the effect of screening through breast self-examination (BSE). However, the practice of BSE has been seen to empower women, taking responsibility for their own health. Therefore, BSE is recommend for raising awareness among women at risk rather than as a screening method.
++++++
So what do you do when you feel you are sitting on data that contradicts the status quo? How do you convey that information to the public? It's not like there's nothing written on the topic. Recognizing the political and social impact of the guidelines is a must, and failure to do so is a mistake, one that science and government types seem to make a lot. These particular guidelines won't be implemented immediately in any case. Physicians and the public still need to read and accept them. The likelihood of any such thing happening, or participatory and reasoned dialog occurring with the public with the current political atmosphere, is nil (now, those are odds we can all understand.) But if the recommendations make sense, further supporting data will present itself and the discussion will go on.
Note that none of the above has anything to do with insurance companies. That's a side issue, more likely to be settled in the health reform debate than with these recommendations. But if Republicans want to make an issue of this (and they will), they are going to have to make an issue of evidence-based medicine.
Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).
EBM recognizes that many aspects of medical care depend on individual factors such as quality- and value-of-life judgments, which are only partially subject to scientific methods. EBM, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable.
Our own Christopher Hughes recently wrote a diary on evidence-based vs anecdotal medicine.
"Experience," or anecdote, is sometimes helpful in medicine, but often harmful, because we physicians often internalize our experience into hard rules about treating patients. This often leads us down dangerous paths.
Evidence based medicine is long overdue counterweight to this kind of medical practice. EBM, when evidence is available, makes us think hard about our practices: Are we doing this because that's the way we've always done it, or because we have scientific research to back up our decisions?
That is the future of medicine. These guidelines will stand or fall on their merit, but given the fact that the US is 19th of 19 in preventable deaths, the way we do things is going to have to change. And that may mean recognizing when cancer screening is helpful and useful (colonoscopy) and when it's not (Pap smears before age 21.) And it may also mean allowing ourselves to debate the issue without accusing each other of trying to kill women. Personally speaking, I really haven't tried to kill any women all this week, and I don't intend to start this weekend. But if we don't discuss this, we won't make any progress on preventable deaths. And that, my friends, is progress that has to happen.
For the meantime, I am sorely tempted to suggest that if you want people to get mammograms, tell them they can't, and if you want to get people not to get flu shots, tell them they have to.
Sunday punditry. Read it early, talk about it late.
Frank Rich on Sarah Palin:
But no matter how much Palin tries to pass for "center-right," shes unlikely to fool that vast pool of voters left, right and center who have already written her off as unqualified for the White House. The G.O.P. establishment knows this, and is frightened. The demographic that Palin attracts is in decline; theres no way the math of her fan base adds up to an Electoral College victory.
Yet among Republicans she still ties Mitt Romney in the latest USA Today/Gallup survey, with 65 percent giving her serious presidential consideration, just behind the 71 for her evangelical rival, Mike Huckabee.
Yet Democrats would be foolish to write off her visceral power.
As Judith Doctor, a 69-year-old spiritual therapist, told The Washington Posts Jason Horowitz at Palins book signing in Grand Rapids, Mich., "Shes alive inside, and that radiates energy, and people who are not psychologically alive inside are fascinated by that."
No one should confuse winning the GOP nomination (which she can do) with winning the election (when 60% think you are not qualified, you can't.) Maureen goes to to say Obama's too intellectual, blah, blah, blah.
Ron Brownstein via Ezra:
"I'm sort of a known skeptic on this stuff," [MIT health economist Jonathan] Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."
Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. "The bottom line," Nichols says, "is the legislation is sending a signal that business as usual [in the medical system] is going to end."
More of same from Center on Budget and Policy Priorities:
The health reform bill that Senate leaders unveiled yesterday meets two rigorous fiscal tests: it reduces deficits over the next decade and beyond, and it puts long-term downward pressure on health care costs.
There are, however, still issues with affordability:
The health reform bill that Senate leaders unveiled on November 18 makes health coverage more affordable for millions of households of modest means, as compared to the bill that the Senate Finance Committee approved last month. The amounts that many families and individuals would pay for coverage would be less than under the Finance Committee proposal.
For people between 134 percent and 154 percent of the poverty line, however people with incomes around $25,000 to $28,000 for a family of three premiums would actually be higher than the already significant amounts they would have to pay under the Finance Committee bill. Modifications are needed at some point as the legislation moves forward to ensure that near-poor families and individuals do not face insurance premiums and cost-sharing charges that many of them could have difficulty affording.
David Broder does his own rigorous analysis, Beltway style: he asks "every expert" that agrees with him what they think of the new health care bill and ignores the CBO and the ones that don't.
Via Jay Rosen on twitter, this:
The job cuts at the Washington Post on Friday have produced a round of comments, broadly summed up by Steve Yelvington earlier today. They certainly begged the question that occurred to me as a former employee of both the Post and WPNI, its soon-to-be merged online operation: "What explains this kind of decision?"
They've decided the dead tree paper is more important than the web site.
Health officials in Wales today announced the identification of a cluster of patients in a Cardiff hospital who are infected with oseltamivir-resistant pandemic H1N1 influenza.
Also today, Duke University Medical Center in Durham, N.C., reported that oseltamivir-resistant H1N1 viruses were found in four very sick patients hospitalized there over the past 6 weeks. A Duke press release said all four patients had been in the same hospital unit, but it did not specify how many were there at the same time.
This is what we dread. Small numbers, but keep an eye on this.
Like a gift from God, Sarah Palin's Rogue-A-Palooza tour (w/special guest) descended on America this week.
Over the next few months, hundreds of millions of Palin's Facebook friends will visit book stores many for the first time to meet their idol face to face.
And a sexy time will be had by all.
Meanwhile, the Jews will be flocking to Israel.
What if the answers are as simple as this?
What if the answers are as simple as this?
I received this email from a friend a couple of days ago and i think it raises some good points. I love the simple solutions in life... that's where wisdom truly resides.
Here is an exert from it, it's UK oriented and offers a solution to the economic and employment crisis facing the UK:-
"Dear Mr Darling,
Please find below my suggestion for fixing Britain's economy.
Instead of giving billions of pounds to banks that will squander the
money on lavish parties and unearned bonuses, use the following plan :
There are about 20 million people over 50 in the work force.
Pay them £1 million a piece severance for early retirement with the
following stipulations:
1) They MUST retire. Twenty million job openings - Unemployment fixed.
2) They MUST buy a new British CAR. Twenty million cars ordered -
Auto Industry fixed.
3) They MUST either buy a house or pay off their mortgage - Housing
Crisis fixed.
4) They must send their kids to school / college /university - Crime rate fixed
..."
Well, what do you think? It certainly has merit in it's simplicity in addressing these issues and would create an immediate change in the employment and economic climate, no doubt.
But it brings me back to these questions... where does the money go?, what is a depression?, where does it come from and who benefits from it?
Yes, we are all fed a whole bunch of rhetoric and explanations from the "experts" and politicians as to the reasons why and quickly scapegoats have to be found to eliminate further investigation but to be quite frank i think it's a load of "cod's wallop"!
Lets look, now with the benefit of hindsight, as to what really happened with the latest market crash and economic depression.
One day some news media journalists announced that the housing development in the US was contracting. OK... big deal, so what?... the cycles of the markets and businesses do this all the time. Up one year down the next and up again... it's the nature of the universe... things never stay the same, winter follows summer... why should it be possible for economies and businesses to continually expand upward, especially at the levels desired by the greed demands of the investors in the stock exchanges.
Why shouldn't a business remain strong and healthy by intentionally staying at a comfortable level of size, just expanding enough to balance inflation and not go seeking to expand beyond it's means and so get trapped into borrowing and then into the investor return expectations and over extend itself in the process, all too often collapsing under the pressure.
OK, what happened next... within a day or less, the whole world's media bombards us with copious reports every day that things are getting worse within the property development market... escalating the intensity of the reports and surmising the worst is yet to come and so putting the fear of God into the average person in the street.
These fears are calculated to draw a reaction and a reaction they will obviously get with so much hyping and coverage that takes place.
The next minute, the property development crisis spawns a general property slump... of course it will... if everyone is told that the property market is heavily over subscribed then prices will naturally fall... and so the spiral starts.
Yes, greed and over extension can be laid at the door of the collapse but the SPEED of this collapse and the widespread knowledge of this situation has to be laid at the door of the media. As if with planned synchronicity, all the media jumped onto the fear instilling platform, so much so that even the poor peasant in foothills of outer Mongolia was concerned if he would be able to sell his mud hut to the next herdsman.
I can hear voices that say... "Yes, but technology is to blame for the speed and the widespread nature of communications in the world today"... agreed... but humans are the ones that create the content and are responsible or NOT for the message that is conveyed using it!
Very shortly, the news storm pelts us with reports that the Banks are in crisis, they are heavily over exposed to the mortgage loans that are now no longer assets but have turned into liabilities in over valued properties in a down turned property market.
The everyday person now is fearful of their savings in the banking system and specifically the banks that have been 'spotlighted' by the media as the worst hit. Runs on banks ensue but most often the news is so immediate that it is not possible to remove one's savings before the particular bank refuses withdrawals because they do not have the liquidity to cough up the dough.
Superheroes to the rescue... many governments start to step in (with almost deliberate lethargy and pontification to create the best terms of negotiation) to bail out the banks... the media making a big noise throughout and the politicians trying to earn "Brownie" points by pretending to be the peoples 'Knight in Shining Armour'.
Behind the scenes, what really was the result of all this?... the governments succeeded in owning most of the banks they lent money too... this was the most effective nationalisation of the banks that has ever been undertaken. Those banks that didn't tow the line were allowed to languish (irrespective of the people's interests!) and some countries that didn't tow the line had their economies crippled.
I found the minister's remark about a bank in the UK that rather than take the offered bail out package from the government, proceeded to successfully raise it's needed capital from a Middle Eastern source, which comment to the effect of "they were very unpatriotic", was to ram home the deliberate strategy of the (lets say) government to own the banks in this game of kill the goose and anything else that gets in the way.
Why should anyone be at all negatively concerned if a bank effectively rescued itself and in the process did not have to give away any equity for doing so in the process... why should they be seen as unpatriotic by anybody!... other than an enraged player who was defeated in this game of chess by a more savvy opponent who realised what the game play was all about!
So getting back to the suggestions above to help solve the crisis that started this post... I fear they would never be implemented, no matter how simple and effective they could be, because in the solution outlined there is no real benefit or gain to be had by (lets say) the governments, in that they don't gain anything in the process other than fix things for the betterment of the people... which we would hope was really their only agenda but sadly this is not true i fear.
So, it doesn't take any degreed degree of grey matter to work out why all of this media hysteria has finally led us into a depression.
If you tell enough people "watch out we are in a depression", often enough then we will be in a depression, because every Tom, Joe, Sue and Sally will hold onto and stop spending their money because they will fear for their future and their jobs and by the mere act of not spending in an economy that bases it's foundation on spending, we will have what the orchestrators planned... a deep depression... simple truth!!
I will leave you with the thought on "Where does the money go?"... if the banks didn't have enough and the stock exchanges and investment houses didn't have it... where did it all go to?... is it hidden under a huge lot of mattress? Lets discuss this another time.
My final parting words... stop listening to the garbage the news media pelts you with... ignore the politicians lies and dribble... we are adults right?
Its easy, just turn off this invasive brainwashing instrument called the 'News Media' and focus on getting on with your lives as normal and you know what?... we wouldn't be in this depression if we had all done that a year ago!
What if there was no money to me made from vaccines?
What if there was no money to me made from vaccines?
Lets say that all vaccines had to be provided free by all pharmaceutical companies in the world by decree from the United Nations to control the world's pandemics... well, why not have the hugely rich corporations give something back to the people that make them obscenely rich in the first place? The same people that die or end up as vegetables in order to further the research or add to the coffers (interesting close proximity to the spelling of 'coffins') of the drug companies while they experiment with their next 'gold mine' under the comfort and protection of the law against legal responsibility for their products and deeds.
If this happened, I wonder if we would still see the regular invasion of a new strain of flu virus every year, if there was no profit to be had in selling drugs to combat it?... I have a strange suspicion that suddenly the media would go quiet on the subject and seasonal morphing flu viruses would be a thing of the past.
The birds and the pigs could relax and get back to their old habits of singing and grunting their way through life... nature would be happy to concentrate on addressing the weather patterns and not be so concerned about how it could invent another new strain of the flu virus, on time, that would successfully mutate, sufficiently well enough, to be able to infect and be transmitted throughout the human population... thus making the pharmaceutical companies richer and richer and giving the media, waiting in the wings, another great arsenal of fear inducing stories to assist their bosses quest for more obscene wealth and control.
Don't get me wrong, I am not advocating that anyone should willingly accept vaccines... far from it!!... I think if you google the history of and side effects of vaccines, you would never allow anyone, least a member of your family, to take a vaccine, least of all a flu vaccine which in effect was prepared to address the flu strain of the previous year!
I won't go into the depths of those discussions here but if you are interested enough to save your lives and those of your family's, there are enough reports by 'qualified' scientific mind now (as opposed to just conspiracy pundits) on the net to add enough doubt to the purity and bona fides of this health solution... there is no smoke without fire and there is an awful amount of smoke around!
Lets exercise a modicum of intelligence here.. If something is as good as a vaccine purports to be... why would a government have to threaten (under the Patriot act) to enforce that every citizen that would refuse to have a vaccine, if told to do so by the government, would be treated as a terrorist and would be imprisoned? Surely if the vaccine was a good thing we would willingly take it?
Interesting that when the same government's leader was asked in an interview... "have you had the vaccine Mr President?" he replied "NO, I don't need one"... LOL... please, please... lets wake up here!
Anyway, back to the start of the post... I think the easiest test case as to the truth of whether the yearly mutations of the flu virus are created in a laboratory or they are the efficient intent of nature to target the human species would be finally and easily answered by taking the profit out of the equation...
My naive view is... NO profit in colds and flu remedies... then NO more morphing of the flu virus on a seasonal regularity!
What if the LAW was the LAW?
What if the LAW was the LAW?
and not some individuals opinion of what it is!I am often exhausted trying to keep up with the legal issues of copyright, plaigarism, fair use, service agreements, terms and conditions... and all the various expert interpretations of the law... because they are all just that... interpretations!
Have you noticed how lawyers never seem to give you a de facto answer in most advices... is it to protect their revenue source, their on going billing engine?... i think it could be just that... because, if there were definitive answers to the law then one could just simply have a database, matching subject to answer and... 'Bob's not your Uncle'... problem solved... he is your Aunt!
Simple... and in the enlightened age of the Internet, one could just go to a website, enter the question needing clarity on the law and out pops a definitive answer... just for a few cents or better still a free public service.
Yes, there are some so called free services you can use, but they generally limit you to a simple question and answer... promoting that you will need to engage an attorney (of theirs generally) and pay a lot more money to get a more comprehensive (read expensive) answer. And if you do just that and ask the attorney for a definitive answer, he/she will invariably say "well, that is my opinion".
Unfortunately, if you act on his advice and end up in a court of law, your justice will depend not on his opinion but on the 'opinion' of someone completely different!!! .... what a joke!... unfortunately in most cases it is not a funny joke!
So what is the problem? Well most friendly lawyers... there are some... will tell you that it is because the law is so badly written... and because the process 'we' (who?) have adopted is to allow the changes to fix the badly written law of the first instance, forming a chain of modifications that take a team of agile and intelligent minds to unscramble and try and make some sense of... and then present that opinion to a wise old person to give their opinion about their interpretation... convoluted?... you bet!
This is, of course, further complicated by another team of agile and intelligent minds trying to find an opposite opinion that is also believable... in order to present same to the same wise old person, to get agreement on their interpretation!
And all of this process has to be paid for by the poor innocents who are caught up in this grandiose game of 'Find the flaw in the Law'.
Well to hell with paying for the mistakes of someone else who was already paid (taxes) by us to define the law correctly in the first instance.
My naive mind tells me, lets scrap all those laws that can't be clearly understood by reading a couple of clearly understandable sentences and have them rewritten by someone who does understand what they are doing and can clearly communicate what should or should not be done in reference to that law.
Do away with precedence and the need to search for precedent and the debate this lengthy and costly (to you again) procedure of other formed opinions by other wise old souls!
Laws from the dark ages should automatically be scrapped and rewritten... as our society and norms and language has changed considerably since the time they were first written.
Why won't this happen unless there is a miracle?... because the industry that thrives on this almost deliberate travesty of justice is the justice industry itself... it is much too profitable to even think of simplifying the law and lose it's carefully crafted and protected revenue streams... just like the power industry won't allow anyone to easily take their market away in order to have a healthier planet to live in!
So, if i end up in court or just disappear after this article... please, someone pass on this message ... on and on and on... and on and on... after all this is one of the benefits of the net, isn't it... free speech!... hmmm... until someone with a lot to lose doesn't like what you say and asks a lawyer to give an opinion and...
"oh no... not again"... that person who penned the defense of 'but don't spill a single drop of blood' now has a lot of blood on their hands!
What if political lobbying was a crime?
What if political lobbying was a crime?
Well, don't you think it should be?Think about it... big business with money, wines and dines political decision makers, offers them fund contributions... for what?... so that their investment interests are protected by the law makers!... at whose expense?... ours... yours and mine and the children of the future!
Read this article for an example of blatant bribery:
Scientists offered cash to dispute climate study
"Scientists and economists have been offered $10,000 each by a lobby group funded by one of the world's largest oil companies to undermine a major climate change report due to be published today....."
Doesn't this get your blood boiling?... Especially as the reality of it all, is that this goes on ALL the time and more so than this example portrays... much more i'm sure!
And we all sit back and say... "Well, that's political lobbying"... SO WHAT!... that is bribery and corruption!... it is a crime in any other jurisdiction ... so why not in political circles?!
Am i being naive here?... shouldn't we the people whose lives are jeopardised by this corruption say "ENOUGH NOW... punish these people for their crimes... outlaw this legalised corruption we so politely call Lobbying!"
What do you think?
What if fear rules?
What if fear rules?
Well, we all have one fear or another about something. I remember the fear i had about the first post i did in a forum of intellectuals... what if they though i was an idiot and proceeded to tell me, how would i take that, how would my ego react? I pondered whether i should submit the post that i had spent much too long forming, editing and re-editing it to perfection... in the end i held my breath and hit the submit button and prayed they would be kind.So what happened in the end?... nothing much, i was treated like anybody else and my confidence grew with every post and i really enjoyed the process.
Then one day i branched out on my first personal blog and the same fear crept in again, but i challenged it the same way and now i embark upon this new adventure and the same fear raises its ugly head again but it gets less and less with every repetition.
So why do i do this?... therapy probably or perhaps, I'll get lucky and be rewarded in attracting greater, wiser minds/souls to help me on my way or just help me to look at things differently... that will be reward enough. But who knows, maybe I'll even manage to help someone else... now, isn't that the best reward anyone could ask for?... along with a bit of Adsense revenue too;)
So onward I go, for doesn't therein lie the value of "Action" .. take that first step down that new road and we will be well on our way to a new adventure... No, we don't know where it will lead us to, that is the whole point isn't it?... there is no adventure or a whole lot of learning walking the same path, doing the same stuff over and over again after you have mastered whatever it is you are trying to master.
Where is the value in seeking to look wonderful just because we have perfected some disciplines, talents, skills etc... does a painter spend the rest of their life painting the same picture, a musician perfecting the one song, a blogger perfecting one post?... No they don't and nor should we, methinks.
Where is the value spending the rest of our lives just repeating the same things over and over in order to show ourselves off to rapturous applause, to bask in fleeting admiration or just to be perceived to be 'so confident'... 'so cool'.
Where is the value in collecting assets, if we have to spend the rest of our lives doing mundane repetitive tasks in order to just maintain our collection and have time for nothing else.
Where do these assets go when we die? What do we take with us in our never ending adventure?... i think we take our experiences and their vibrational influences on us... we take our wisdom... wisdom comes from our experiences, not from reading a book, getting a degree or watching TV... For sure, knowledge accelerates our learning but putting the knowledge into "Action" gives us the experiences which then stay with us forever.
What do we do in the sunset of our lives?... we remember the important, happy events of our lives, we continuously play back these movies... so my advice is make sure your movies are full length feature movies and not just promotional trailers!
No there is nothing wrong with being comfortable, clever, rich or having our toys to play with, but we mustn't become a slave to them and we shouldn't waste our life building an image of ourself which is tethered to our material gains, academic status or other peoples evaluation.
Yes, some things do require regular repetition to keep us healthy and strong, like brushing our teeth, breathing, exercising, maintaining positive thoughts and images in our mind .. and yes we have got to make a living, so some degree of repetition is required to survive but leave time for new adventures, for learning and for new experiences .. don't stand still in the comfort of doing the same old thing, for don't old things invite decay?.. and don't let fear of the new keep you frozen still because you will just end up a very well preserved empty vessel!
So if i let fear rule i would never have had this adventure and many more in my life and i would have been so poor for it.
What if I didn't start this blogzine?
What if I didn't start this blogzine?
Who knows and who cares? .. nobody right!... well that's not quite true because I'm sure the trees care and so does the kind soul that cleans my office and tries to tidy my desk which is often cluttered with pieces of paper recording random thoughts and ideas .. and I care! .. hell, that's important enough for me! .. and so I embark upon a new adventure not knowing where it will lead, not wanting to structure it too much so that it can just flow the course it finds, as does a conversation or discussion, not wanting to inhibit creative expression by being too concerned about grammar and form.
So onward we go .. if you care to comment please be my guest :)
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