Sunday, January 31, 2010

This Recession is Hard to Swallow

Meat isn’t the only thing that’s tough in the restaurant business, an industry that reflects societal confidence – we can afford to splurge a little bit, because we are relatively certain about tomorrow. When restaurants suffer, it’s more than a business sector that is experiencing a downturn or a small local entrepreneur losing a livelihood; it’s a statement to ourselves that reflects a loss of hope. Yeah, folks can say “recovery” all day long and point to the recent “growth” statistics, but reality for most Americans is very different.

When our futures look bleak, and cutbacks are the rule; perhaps we can still indulge the gentle pleasure of an inexpensive treat, a pint of Häagen Dazs, but we look for patterns where costs drop fast… luxury clothing, a distant vacation or a once routine trip to a nice, not even super-expensive, eatery. A cold beer can ease the pain and not cost an arm or a leg, and a chomp on a candy bar may be a poor substitute for the neighborhood cheesecake special, but it is a substitute. For the struggling small business-owners, bereft of credit and light on customers, it is a slow agonizing death of a thousand cuts. A waiter’s tips drop by a third, and his or her expenditure trickle into belt-tightening in the swath of other small businesses than he or she can no longer afford.

By my own culinary estimates, Los Angeles is one of the best restaurant cities on earth. Deep in ethnic diversity (we are the second largest Korean city on earth!), we have thousands of inexpensive but wonderful places to eat. From the $7 meal-in-a-bowl of Vietnamese Phở (pronounced “fuh”) to $12 all-you-can-eat dim sum extravaganzas in one of three Chinatowns or crispy tacos or melt-in-your mouth burritos from East LA, we’re lucky to have such choice. The upscale restaurants, movie-star laden bistros and chi chi “hot spots,” well… the whole sector isn’t doing so well. The story travels across American, from Seattle to Chicago, from Cleveland to Atlanta, from Boston to New York. It’s easier to get a reservation at all but the most exclusive restaurants, but restaurant owners and their employees are not having a good time.

‘Twas the season to be going to office parties, bashes at the best, parties at the posh and dining at the decadent… except not this past Christmas. The Los Angeles Times and consumer-tracking company, NPD Group, took a closer look at the restaurant scene, all reflected in an article in the November 23rd edition of the Times. Local restaurants are offered loyalty discounts, special packages, overall discounts and major price reductions for larger groups. Still, business is really down, all across the country. “‘It is not a pretty picture,’ said Bonnie Riggs, a restaurant industry analyst with NPD in Chicago. ‘Consumers have pulled back so much.’ In 33 years of tracking restaurant traffic, NPD ‘has never seen this type of a weakness for this long of a period,’ Riggs said. ‘The industry really has its work cut out for it.’” The number of people going to restaurants has dropped for four consecutive quarters.

The entire spectrum of genuine, sit-down restaurants is hurting: “It isn't only mid-priced family restaurants that people are avoiding. Upscale chains such as McCormick & Schmick's, the seafood house, and Morton's, the steak purveyor, saw same-store sales, or sales at restaurants open at least a year, fall 18.8% and 16.8%, respectively, in the third quarter compared with a year earlier, according to Bellwether Food Group, a food industry consulting firm… Bellwether doesn't project an industry rebound to pre- recession levels until 2012. The recession has taught consumers to eat out less often and to order less -- skipping alcoholic beverages, appetizers and desserts -- when they do, Bellwether said…”

“Christmas-season spending at bars and restaurants this year [was] about $7.8 billion, according to IbisWorld Inc., a market analysis firm in Santa Monica. That's one of the rosier industry estimates -- up almost 6% from [2008], but that's only because last Christmas was so lousy, the company said. It is still down 11% from the pre-recession level of $8.8 billion in 2007… ‘I think it will only get tougher. People are still losing their jobs, credit is still tight, and we could see another wave of foreclosures,’ said Erik Oberholtzer, co-owner of Tender Greens, a group of three restaurants based in Culver City[, California] that emphasizes locally grown food.”

Lots of restaurants have gone, you should pardon the expression, belly up, but the once-too-proud-to-market chi chi eateries are giving way to pragmatic marketing efforts. The notion of getting customers in the door, at an affordable price, was the idea behind “restaurant week” in many major cities. It’s even being done in the home city of the Wall Street piglets: “‘Restaurants definitely didn’t like participating in Restaurant Week in the past. But in the recession we need it,’ said Eric Hara, executive chef at the Oak Room at the Plaza Hotel. ‘Before, no one did it for dinner. We would never even consider doing it for dinner. But as the recession came into play, dinner came into play.’” January 20th

The stock market may be up (well, higher than it was after the crash), companies have jacked up their earnings by obliterating costs (by cutting lots of jobs, thus reducing America’s buying power proportionately), and with the dollar falling, folks are stuffing their mattresses with stocks, but they sure aren’t stuffing their faces at the neighborhood dinner. When restaurant business returns to “normal” in America, then, and only then, will anyone convince me that the “recovery” we have all been promised will really have taken hold.

I’m Peter Dekom, and I’ve gotten to be a whole lot better cook of late. Oooops, gotta go out to the movies tonight. Wonder what NetFlix choice my wife made this week?

Saturday, January 30, 2010

Crazy in Peshawar

Post-traumatic stress disorder is a common response in soldiers who have battled in combat zones, particularly arenas when enemy strikes are constantly imminent. We’ve seen movies about returning soldiers, wrapped in this theme, for just about every modern war our nation has fought. Vietnam and Iraq are the most recent examples, but less focus is addressed to the impact on the civilians whose lives are defined by turmoil, death, destruction and explosive violence. And even less attention has been paid to those cross-border Pakistani regions where our soldiers have not often crossed, but where drones and internal strife take as many casualties as in the active combat zones in present-day Afghanistan.

In Pakistan’s Northwest Frontier Province (NWFP), where Peshawar is the main city, men walk the streets carrying machine guns or rifles with straps of bullets across their chest. Peshawar has become the city of lost souls. “Thousands of men, women and children [who minds have been destroyed by incessant violence] wander Peshawar's anarchic streets. They are the forgotten victims of the war between Pakistan's army and Islamic militants. The city is where the mad come for solace, pouring in from war-torn regions of the Pakistani frontier and even farther afield in search of a disturbingly scarce resource: psychiatric aid… Most find little relief in Peshawar, where the streets are lined with barbed wire and punctuated by checkpoints, and where bomb blasts are an almost weekly occurrence.” (January 10th)

A doctor at the Shafique Psychiatric Clinic, a local specialized hospital, estimates that as many as 70% of the population of NWFP suffer mental illness by reason of the violence. Depression, anxiety, agoraphobia are everywhere. It is a land where might makes right, where religious zeal creates emotional calluses that allows vicious attacks with little concern for any semblance of innocents and non-combatants; everyone is expendable for the “cause.” Bad things happen to good people every day. “Incessant violence is the reason. In the NWFP alone, more than 400 people have been killed in terrorist attacks since October 2009, nearly matching the total number of civilian deaths in the province for all of 2004. A truck bomb killed nearly 100 people at a New Year's Day volleyball tournament in Lakki Marwat near the South Waziristan tribal agency, where an ongoing military operation has prompted the Pakistani Taliban to unleash a wave of attacks across the country…. Yet as violence escalates in Pakistan, there has not been any effort to confront the psychological effects of it. According to [a local doctor], there are fewer than 30 qualified psychiatrists in the NWFP and a mere 250 psychiatric beds available for a population of more than 25 million. ‘But that's just the NWFP,’ he adds. ‘We're also dealing with patients coming over from the border in Afghanistan. There are no facilities there for them, so they come here to Peshawar.’”

Imagine a 12-year-old child being told by a Taliban operative that if he fails to plant a bomb, his family will be slaughtered. Or children so terrified by not having any means to retaliate that they join one faction or another just to get a gun in their hands and soldiers at their back. “Children are some of the worst affected by the violence in NWFP, says Dr. Sayed Mohammad Sultan, head of the psychiatry department at the Khyber Teaching Hospital in Peshawar. ‘We are seeing a lot of children suffering from phobic anxiety disorders. They are in a constant state of fear – of Taliban attacks and from seeing dead bodies hanging in trees.’ The long-term effects could be devastating, he warns.”

A war without end… America caught in the middle, taking its share of innocents with each attack. Militants without conscience, believing that God has sanctified their killing and maiming, raining terror down on their own people. This is the daily lot of millions… trapped in the only homeland they have ever known. It is a part of war that none of us should ever forget.

I’m Peter Dekom, and I wonder how human beings can do this to each other in the name of God.

Friday, January 29, 2010

The Ultimate Afghan Strategy

President Obama wants to save money, cutting programs that contribute neither to national security nor the economic recovery. Okay, that’s a fairly obvious path given recent voter reactions. Healthcare? Fareed Zakaria, writing for the January 25th Washington Post, reminds us that 85% of Americans are concerned with rising medical costs and only 15% prioritized extending coverage to those currently without insurance. But the healthcare “reform” on the table succumbed to pressures from Big Insurance and Big Pharma, preserving their profit structures pretty much intact while making sure there was not the slightest hint of cost-reducing competition. What a surprise? The voters didn’t like what they saw.

But, Mr. President, if you really want to cut the budget, take a real good look at that war we are waging in Afghanistan, the one where we are sending even more American sons and daughters – 30,000 additional soldiers to be exact – to fight and perhaps to die. Look at the government we are supporting, long known to be corrupt and ineffective. The administration put pressure on the Hamid Karzai government to change its evil ways. Doesn’t look like that happened or will happen any time soon. Most of Karzai’s post-questionable-reelection cabinet appointments were so completely below grade that they weren’t able to pass the legislative confirmation that was mandatory before they could assume office.

And now there are these two communications from the U.S. Ambassador to Kabul – Karl W. Eikenberry – sent to his bosses in Washington (as reported in the January 25th New York Times) that have surfaced: “The United States ambassador in Kabul warned his superiors … in November [of 2009] that President Hamid Karzai of Afghanistan… ‘is not an adequate strategic partner. The proposed counterinsurgency strategy assumes an Afghan political leadership that is both able to take responsibility and to exert sovereignty in the furtherance of our goal — a secure, peaceful, minimally self-sufficient Afghanistan hardened against transnational terrorist groups…. Yet Karzai continues to shun responsibility for any sovereign burden, whether defense, governance or development. He and much of his circle do not want the U.S. to leave and are only too happy to see us invest further,’ Mr. Eikenberry wrote. ‘They assume we covet their territory for a never-ending ‘war on terror’ and for military bases to use against surrounding powers’…

“The cables — one four pages, the other three — also represent a detailed rebuttal to the counterinsurgency strategy offered by Gen. Stanley A. McChrystal, the top American and NATO commander in Afghanistan, who had argued that a rapid infusion of fresh troops was essential to avoid failure in the country…. They show that Mr. Eikenberry, a retired Army lieutenant general who once was the top American commander in Afghanistan, repeatedly cautioned that deploying sizable American reinforcements would result in ‘astronomical costs’ — tens of billions of dollars — and would only deepen the dependence of the Afghan government on the United States.”

The collapse of our Afghan strategy of passing responsibility to the Karzai government is particularly hopeless given Defense Secretary Robert Gates’ rebuff earlier in January from the Pakistani military in connection with his attempt to get Pakistan to take seriously Taliban/al Qaeda infiltration from Pakistan into Afghanistan and back again – effectively making the Pakistani border region a military sieve and a safe haven for our enemies. Eikenberry’s assessment of this shortfall? Writing in November: “Pakistan will remain the single greatest source of Afghan instability so long as the border sanctuaries remain… Until this sanctuary problem is fully addressed, the gains from sending additional forces may be fleeting.” Well, Mr. Eikenberry, Pakistan has rejected any reasonable solution to that problem.

Many suggest that the administration’s escalation in its combat role in Afghanistan is only a prelude to deal, as uncomfortable at this may be, with the Taliban from a position of greater strength. Think this is far-fetched? Look at this report in the January 29th New York Times: “Kai Eide, the United Nations’ special representative in Afghanistan, met with a group of Taliban leaders in the days leading to [a recent] international conference in London, where President Hamid Karzai invited the Taliban to enter peace talks… ‘He wanted to test for himself the mindset of some of the Taliban leaders,’ said Secretary of State Hillary Rodham Clinton, who was briefed by Mr. Eide on the talks. The discussions were confirmed by a United Nations official in Kabul.”Just think of the lovely choices we face: support a corrupt government that clearly does not work, make peace with our tormentors (an untrustworthy and brutal group, who harbored Osama bin Laden), just leave or stay in Afghanistan… for a very, very long time.

We are not protecting the United States by remaining in Afghanistan. We are not even in a battle where winning is one of the alternatives, and expecting a corrupt and ineffective government to pick up the slack has already been proven to be a failed policy. We had our chance in Afghanistan early, after the 9/11/2001 attacks, but we chose to deploy to Iraq instead. The opportunity is long lost; it’s time to allow pragmatism to “redeploy” our scare tax dollars – literally hundreds of billions per year – out of a wasteful military expedition with virtually no chance of success and into domestic programs that are woefully underfunded. Should militants choose to use Afghanistan to launch another strike against the United States, we most certainly will retain the right and the power to retaliate in strength… but this slow sapping of our national spirit and flushing of billions of deficit tax dollars down a Central Asian drain has simply got to stop!

I’m Peter Dekom, and this war failed war strategy is getting old and worn.

The Little Stories that Can Kill You

In everyone’s life, while horror, terror and threats of the apocalypse dominate the headlines, it is your predicament, your environment, your family and your local government and economy that concern you most. Those rescue workers in Haiti have selflessly redirected their personal efforts toward this incredibly needful humanitarian effort, hoping that the world won’t soon forget the ongoing and long-term needs of this decimated island nation. But they are in competition with almost 7 billion agendas that are struggling with the “me first” (and “me only”) calamities that surround each of us.

I took at glance at some of those “other stories” drifting about the press these days, and thought of how many more individuals are struggling with personal difficulties every day. Here are some of those “little” stories, not always on page one of your local paper (if you have one anymore): Osama bin Laden, taking credit for the Christmas day crotch-bomber, is threatening the United States with many more attacks. Or this one from the Korean peninsula: “North Korea threatened South Korea with war [January 24th] after Seoul warned it would launch a pre-emptive strike if the North was preparing a nuclear attack - the latest salvo in a battle of rhetoric despite signs of improved cooperation across the militarized frontier.” Washington Post, January 24th.

Lest we think that the Israeli-Palestinian conflict has gone away, there is this little tidbit in the January 24th New York Times: “The Israeli military is completing a rebuttal to a United Nations report accusing it of grave violations of international and humanitarian law in its Gaza invasion a year ago. Its central aim is to dispel the report’s harsh conclusion — that the death of noncombatants and destruction of civilian infrastructure were part of an official plan to terrorize the Palestinian population.” But wait, there’s more….

Pakistan, thought to be providing safe harbor to the militants who are attacking U.S. forces in neighboring Afghanistan and may even be sheltering terrorists like Osama bin Laden himself, is rebuffing U.S. efforts to align American interests with a Pakistani struggle with Taliban militants of their own. Defense Secretary Robert Gates just traveled to Islamabad to ask for increased Pakistani cooperation in this anti-terrorist/militant effort. It was clear that ” Pakistanis, who are angry about the Central Intelligence Agency’s surge in missile strikes from drone aircraft on militants in Pakistan’s tribal areas, among other grievances, and showed no signs of feeling any love… At the same time, the Pakistani Army’s chief spokesman told American reporters at the army headquarters in Rawalpindi on Thursday that the military had no immediate plans to launch an offensive against extremists in the tribal region of North Waziristan, as American officials have repeatedly urged… And the spokesman, Maj. Gen Athar Abbas, rejected Mr. Gates’s assertion that Al Qaeda had links to militant groups on Pakistan’s border. Asked why the United States would have such a view, the spokesman, General Abbas, curtly replied, ‘Ask the United States.’” Gates has obviously struck out… with a nation that hold an estimated 60-70 nuclear weapo ns and the missile delivery system to make them work.

Speaking of nuclear radiation… If these stories are too distant and abstract to send shivers down your spine, how about this excerpt from a Times article examining the damage from the overuse and misuse of radiation in both medical diagnoses and treatments: “As Scott Jerome-Parks lay dying, he clung to this wish: that his fatal radiation overdose — which left him deaf, struggling to see, unable to swallow, burned, with his teeth falling out, with ulcers in his mouth and throat, nauseated, in severe pain and finally unable to breathe — be studied and talked about publicly so that others might not have to live his nightmare… A New York City hospital treating him for tongue cancer had failed to detect a computer error that directed a linear accelerator to blast his brain stem and neck with errant beams of radiation. Not once, but on three consecutive days.” Apparently, according to the Times, damage from radiation overdoses, being exceptionally difficult to detect, are growing by the thousands.

In the end, we are all human beings – at any given moment, one group is clearly having a lot better luck than another somewhere else. Throw in a 9/11 attack on the United States or a destructive California quake or a Louisiana hurricane, and the mass of personal tragedy swings back to our shores. For those who have lost their homes and their jobs, particularly older Americans with little hope to reclaim their future, they have their own personal headlines. But at our core, perhaps it is this infinite litany of personal tragedy that links us together on a planet that would self-destruct without efforts to try, at least, to help each other. Perhaps we would be living in a vastly worse place if we were unable to generate both empathy and sympathy for the losses of those “others” who share their time on earth together. “Me first” may be acceptable in many circumstances, but “me only” or “my way or the highway” can only make life worse for everyone body else.

I’m Peter Dekom, and I wonder how we really can help each other along the way.

Wednesday, January 27, 2010

Bad Medicine for a Sick Country

The current healthcare plans being considered by the House, and as referred by the Senate, have eschewed the right of members of the American public to buy their prescription drugs from legitimate European or Canadian sellers. The big drug companies cried “importing drugs eliminate the ability of the government to protect its citizens from bad or impure drugs.” Obviously, Canadians and Europeans must have healthcare systems that delight in exposing their people to sub-par prescription drugs if not downright poisonous substitutes. The Canadian and European governments were delighted at the failure of the U.S. to recognized their pharmacies as being “good enough”… since in no way do they want Americans creating greater demand, which might increase their local prices.

The American pharma industry (a $315 billion/year business sector) has pledged to the President to implement serious cutbacks in the cost of prescription drugs in order to help institute overall healthcare reform… $80 billion worth over a decade. However, if you raise prices enough and then cut them, you look like you are making a big concession… but you’re not! Want some serious evidence of this nasty tendency? How about this from (January 14th): “Given that pharmaceutical companies have been accused of hiking drug prices ahead of the passage of health care reform, perhaps nobody will be surprised to learn that the industry has a history of passing big price bumps on to their customers. Even so, the magnitude will no doubt raise an eyebrow or two: The Government Accountability Office has found that between 2000 and 2008, the prices for 321 different brand-name drugs soared from 100% to more than 2,000%.

“The GAO found that from 2000 to 2008, 416 drug products (which in some cases include multiple dosages of a single drug) had such extraordinary price increases. Most often, these extraordinary price increases ranged from 100% to 499%, but in a few cases, prices were raised by 1,000% or more and in nine cases, the prices soared by over 2,000%. The number of extraordinary price increases each year jumped from 28 in 2000 to 71 in 2008.”

In addition, the GAO cited a number of basic reasons for the above increases (from

  1. Lack of competition. In many cases, “there was a lack of therapeutically equivalent drugs on the market -- both generics and other brand-name drugs used to treat the same condition -- due to patent protections for new drugs. Similarly, by extending patents for existing drugs that have been modified, and receiving market exclusivity rights, drug manufacturers have been able to limit competition.”
  2. Particularly for very narrowly focused treatments, “the size of the market for a given drug can reduce competition.”
  3. “[T]he transfer of the rights to a drug and corporate consolidations among drug companies may result in fewer drug options and contribute to extraordinary price increases.”
  4. “[M]ore than half of all extraordinary price increases were for repackaged brand-name drug products, meaning third parties firms, which purchased drugs from manufacturers or wholesalers and resold them in smaller packages to health care providers, were the cause of the price hikes.” Sneaky, huh?
  5. “[U]nusual events -- such as disruptions in production due to shortages of raw materials -- and other factors may also contribute to some extraordinary price increases.”

Sure the U.S. dollar is falling, and that is also going to continue to drive up costs, notwithstanding that our general cost of living has dropped generally in this country. But in the end, we probably need some serious explanations from this out-of-control industry which charges Americans the highest prices on earth for prescription drugs. They seem to have purchased the right politicians to guarantee that we Americans are still number one in at least one major category!

I’m Peter Dekom, and I approve this message.

Tuesday, January 26, 2010

Where Private Contributions Can Change the World

We all know of the extraordinary generosity of some of America’s wealthiest citizens. Warren Buffet. Bill and Melinda Gates. But what we might not know, and what is worthy of reporting, are the contributions of some of the world’s most powerful pharmaceutical companies, seldom known for their altruism. Indeed, I have blogged against many of the policies embraced by these behemoths – and my passions continue to be equally committed to those efforts to create accountability and competition in the world of American prescription drugs – but at some point, even I have to present moments when drug companies have shined brightly. And in the world of open-source solutions to some of this planet’s complex medical issues, two particular examples of game-changing contributions from this pharma world come to mind.

Merk: Some problems are so massive and obviously impossible to solve that they invite a massive collaboration effort, often spurred on by the government. So was the case of the DNA-focused Human Genome Project, begun in 1990 led by James Watson at the U.S. National Institutes of Health, with the goal of identifying all of the individual genes that make up the human species. Battles over the right to patent such discoveries by individual contributors increased the complexity of the task, even though a completed research project was essential to enable the future of medical research.

By the mid-1990s, about 20% of gene research was covered by private patents. In 1995, one holder of many of these patents, Merck Pharmaceuticals, realized the magnitude of the blockage that such private research meant for the entire process and released 15,000 human gene sequences to the general public through its Merck Gene Index. In 1999, a non-profit consortium of eleven pharmaceutical companies opened up collaboration to create “a public biological blueprint for all human life.” By 2003, the basics of the entire genome had been identified, and in 2006, the significance of the Human Genome Project reached a new plateau as the sequence for the last unmapped human chromosome was published. With this profoundly complex body of knowledge, the pharmaceutical and academic worlds were empowered to develop an entirely new body of medical solutions for the benefit of all of us.

GlaxoSmithKline: Malaria has been the scourge of impoverished nations for as long as history has been recorded. Sapping the strength – even the very life – out of impoverished people in poor and underdeveloped nations, malaria has stood in the way of progress and general improvements in the quality of life long before the HIV epidemic took its toll. In Africa alone, mosquito-borne malaria kills a million people a year; 300 million a year are afflicted all over the earth.

The January 20th notes: “GlaxoSmithKline will allow free access to 13,500 molecules that represent potential malaria treatments and pour millions of dollars into an ‘Open Lab’ for independent research teams to investigate other tropical diseases… The London-based Glaxo, the world's third-largest drug company, is testing its malaria vaccine on 16,000 people and will post its information to scientific journals. It will also cooperate with other companies in Europe and the United States, as well as disease research centers. It hopes to have the vaccine ready for approval by 2012…‘This is the furthest anybody's gone,’ Glaxo's chief executive, Andrew Witty, said in an interview with Bloomberg News. ‘Nobody has put in the public domain the product of a two-million screen’ of small molecules, he said… These are essentially the building blocks from which all of our drugs eventually come.’” They could have opted for the billions of additional dollars in global revenues that such a vaccine could represent. Instead, they have invited the open collaboration to this entire industry to create a solution that does not rest on one company’s making massive profits from preventing his horrific disease.

Sometimes, I fight against these big companies. Sometimes, I don’t.

I’m Peter Dekom, and fairness is important to me.

House Calls

Not many Americans are old enough – or rich enough – to remember when a physician routinely made house calls to visit sick patients. We see the phenomenon in old black and white movies running at odd hours on often obscure networks, but the memory of those days gone by barely triggers the slightest nostalgic moment; almost every American alive today only knows being dragged to a doctor’s office or to an emergency room where pain and contagion loom large. Of folks in Europe, their national health care still provides this basic service on a fairly routine basis. With so many Americans living without healthcare or having limited means of transportation – particularly when there are down and very out – there is clearly a need to reach out into grassroots communities simply to identify exactly what health needs remain unfulfilled.

Then there is this little experiment in Mississippi, a state where health problems per capita seem to rise well above the American norm. The January 24th Los Angeles Times writes about a courageous Delta doctor with an even more courageous desire to go down a road that would make most Americans wince: “Dr. Aaron Shirley has devoted his career to serving the rural poor in the Mississippi Delta [he was Mississippi’s first black pediatrician, back in 1965], but now the 77-year-old pediatrician believes the key to reducing the nation's highest infant mortality rates lies in a surprising place: The Islamic Republic of Iran.”

According to a piece in the November-December, 2009 National Institutes of Health Global Health Matters: “After decades of frustration and millions of dollars invested with dismal results, Mississippi health care pioneer Dr. Aaron Shirley knew he needed a fresh approach. In some parts of his state, the infant death rate for nonwhites is on a par with Libya and Thailand. Mississippi's health consistently ranks dead last among states in annual tallies produced by the United Health Foundation. It has the highest rates of obesity, hypertension and teen pregnancy in the country, with about 20 percent of its population lacking health insurance…. Together with James Miller of the Oxford International Development Group, Shirley reached out to Iranian health care experts for advice. He knew WHO and World Bank evaluations indicate positive outcomes from Iran's novel health house concept and thought it might provide the solution for his own population…. He discovered his Iranian counterparts are dealing with many of the same issues he faces: lack of funding and trained personnel. And yet they are having stunning successes, reducing child mortality rates by about 70 percent since 1980 and increasing contraception rates to 90 percent, even in rural areas.”

It seems he heard of neighborhood “health houses” (Iran has 17,000 of them) of healthcare professionals in Iran whose job it is to keep tabs on the status of health in local communities. These weren’t doctors, but nurse and even nurses aids who go door-to-door to take blood tests, check blood pressure, advise on sanitary conditions and just make general observations about what they see. They make necessary referrals when they note a more complex problem. With special dispensation from both Washington and Tehran, “[i]n May, Shirley and two colleagues flew to Iran for 10 days to study a low-cost rural healthcare delivery system that, according to the World Health Organization, has helped cut infant deaths by 70% over the last three decades.” The LA Times. Later that fall, Iranian medical personnel reciprocated and visited the Mississippi Delta, again with blessing from the warring factions in Washington and Tehran. These Iranian doctors were shocked at scenes of brutal rural poverty and wide-spread unemployment, completely unexpected visions of America – blighted communities with run-down housing, weed-filled lots and battered old roads overflowing with mud.

But they also found a spirit in these Americans they had not expected. “‘We played black gospel and blues for those Iranians,’ recalled Sylvester Hoover, 52, owner of Baptist Town's only business, a one-room grocery, laundromat and barbecue grill. ‘They were just hugging us they were so excited. They loved it.’” LA Times. Funny how this little political bridge succeeded when so many overtures at higher levels have collapsed and burned so many times. “Tensions between the United States and Iran dominate daily headlines, but both governments have given quiet support to the little-known initiative in the Delta… In Tehran, the Foreign and Health ministries approved a memorandum of agreement to authorize collaboration between Shiraz University of Medical Sciences and Shirley's team, which includes Jackson State University.”

As Shirley and his colleagues apply for $30 million of federal funding for a three-year pilot program for many Delta communities, it is clear that he is trying a very different approach from the traditional American treatment paradigm. The NIH report cited above: “In Iran, preventive care is a priority and special attention is paid to high-risk groups such as mothers and children. Health care workers are chosen and trained within each community. Preventive and curative programs are integrated seamlessly. The system is decentralized, which encourages regional facilities to become self-sufficient and empowers local communities… In contrast, Mississippi has a fragmented ad-hoc system of hospitals, health clinics and individual medical practices, says Miller. ‘Our public health programs and services aren't integrated and are anything but user friendly. Our health research is often too narrowly focused on specific risk factors and, like the rest of the U.S., we place the emphasis on curing existing conditions rather than preventing them in the first place.’”

Kind of funny the kinds of issues that tear us apart, resulting in military threats and profound exchanges of bludgeoning insults… Then there are those wonderful moments when we see how people are just human beings, facing the same problems, maybe in differing ways. Thank goodness for these terrific little connections.

I’m Peter Dekom, and there is hope out there… sometimes from where you least expect it.

Sunday, January 24, 2010

Haiti – An American Colony Again?

Balance the complete collapse of government and infrastructure, a reign of chaos and lawlessness, the inability to reach survivors or rescue victims without massive manpower, and the efficiency of using disciplined military troops to make up for these deficiencies against a morbid fear of another American occupation. Why would we ever occupy Haiti? We’ve done it before, from 1915 to 1934, resulting in a serious depletion of Haitian banks in favor of moving that money to U.S. financial institutions, and as recently as 1994, US forces entered Haiti under orders from President Bill Clinton to restore a president following a coup (we failed).

We are drawing international criticism and fear from local Haitian leaders – the locals already fear that their political destiny is determined in Washington, D.C. anyway – that this represents another potential American take-over of this impoverished and dysfunctional island nation. Tell that to the people who are receiving help from the troops.

Despite France’s horrible history of brutally occupying Haiti in times past, France's international cooperation minister, Alain Joyandet, recently accused Washington of trying to ‘occupy’ Haiti; he implored the the United Nations to investigate. The January 21st “Joyandet complained after a French aid flight carrying a field hospital was turned back from Port-au-Prince's overtaxed airport last week. The angry minister reportedly got into a physical confrontation with the U.S. official in charge of air traffic control. The French plane landed safely the next day… French President Nicolas Sarkozy intervened quickly, praising Washington's ‘exceptional mobilization’ and ‘essential role ... on the ground’ in Haiti. But the whole row was embarrassing, especially with so many Haitians still suffering.”

There are 12,000 American troops in Haiti (with lots of ships off-shore), and from their command posts all over the capital city (and beyond), they are in charge of just about everything from police activities, routing relief supplies to air traffic control. They have taken over the National Palace in Port-au-Prince as their central earthquake aid depot, and as the stench of death and disease make the vast concentrations of impoverished humanity increasingly vulnerable to greater jeopardy, US forces have elected to big to move 400,000 human beings out of a very dangerous Port-au-Prince area to safer temporary shelters.

The toll of death and destruction are staggering, even as the Haitian government is ending the search for survivors. On January 23rd, the government estimated that 150,000 bodies have been buried to date, 250,000 are known to be homeless, 200,000 have left the capital city, most of which remains in unusable ruin and aftershocks continue to inflict additional damage. Exactly what would those remaining do without the power of a massive organized relief effort, supported with the organization of an experienced military force? And exactly what would the U.S. government do with a land that has been depleted beyond words, whose limited infrastructure has been impaled by the quake, where buildings and structures literally need to be razed and rebuilt and where an uneducated and horribly impoverished people can only take with virtually nothing to give?

While “the usual suspects” – like Venezuela’s Hugo Chávez – speak of America’s “hidden occupation” and there are indeed bureaucratic mix-ups that may inconvenience foreigners in Haiti, the hard reality remains that only a significant military force can achieve that kind of organization necessary to bring the fastest relief to these poor people. We didn’t and still don’t have time for UN votes and then to gather and send in the blue helmets in a few weeks. If the UN wants to make a huge commitment and join US forces (and there are UN forces there as well right now), so be it, but right now, Haitians need massive help… and fast. America may have had a checkered past with Haiti, but it is time for us to make good on helping them make it through… and I believe that we most certainly have no serious intentions of colonizing Haiti or even “occupying” it in any meaningful sense of the word. We can be a very generous people, if given the chance. This time, we’re doing it right.

I’m Peter Dekom, and I too have trouble looking at those photographs of Haiti.

Saturday, January 23, 2010

Running from Fundamentals

When you read about ancient mega-societies – Rome, Incas, the Chinese Ming dynasty, Persians, Ottomans – you think about their glory… and then their downfall. Often these great civilizations, lasting two to four centuries on average, began a period of serious decay, eventually falling to military defeat or internal fractionalization… before dropping into history. Even the famed British Empire, of which we were once part, could no longer make the claim that “the sun never sets on the British Empire” after Hong Kong was ceded to China in 1984. England is still around, but she is hardly the superpower of even a century ago and is facing worse economic problems than we are right now.

So ever ask yourself, “when is it our turn?” We’re touting the 21st century as the Time of Asia, particularly China with a touch of India, but where is the United States in all this? Are the social safety nets that we, and our Western brethren, created for society’s betterment of our standards of living unaffordable drains on our economies, destined to drag us down into that period of historical decay that seems almost unavoidable? Or can we wage “wars for national security” without so decimating our economic ability to survive that we effectively kill ourselves in an effort to preserve what we believe we have. How long can you cut educational programs before you destroy your future?

Look at the simple signs. A massive trade imbalance tells us we consume more than we produce. A massive budget deficit tells us we live beyond our means, and someday we will have to pay the piper… is that day coming soon? China has trillions of U.S. dollars in reserve, is luring research scientists back to the mainland, just as we have a huge negative bank account with a falling dollar value. The fact that the U.S. dollar is fighting to be a bigger part of that “special drawing right” currency intended to replace the dollar as the global currency reserve tells us that the global community no longer has faith in the stability of the U.S. economy. That the U.S. political and economic structure clearly favors special interests over the general welfare of her people, such that virtually everyone seems out only for themselves these days, regardless of the impact on everyone else tells us we are in a desperate free-for-all fighting for limited resources.

Factions each want to govern everybody else’s behavior in conformity with their needs to political choices – freedom’s become just another word for nothin’ left to lose. Wall Street wants to be unregulated to create new “profit-making” bubbles (they make money only when an economy is moving, up or down), with government support if something goes wrong. As the President tries to reign them in with restrictions on banks’ investment rights (especially against their own clients’ positions), watch the special interests administer a full-court lobbying press, particularly now that the Supreme Court has removed the restriction on their campaign actitivies. Many religious groups each seek that their view of the universe becomes the law for everyone else, whether they accept the underlying faith or not. The First Amendment needs to be repealed, if you follow their dictates. Farmers want subsidies, the NFL wants a blanket antitrust exemption, oil companies want special depreciation rules, Nebraska doesn’t want to pay its fair share of Medicaid, and each little bit adds up to…. Well, we aren’t really that concerned with the “us” in U.S. anymore… only how we individually are impacted by the rules of state.

And Americans are scared… even if we don’t look at the bigger questions. At least at a gut level, we see the writing on the wall. Little things – like the fall in December retail sales – tell me how scared we really are: “From supermarkets to department stores, sales fell 0.3 percent from November, a decline that economists attributed to a persistent reluctance by Americans to open their wallets. Analysts, encouraged by signs that consumers were regaining confidence and the labor market was improving, had expected sales to rise 0.5 percent.” January 14th New York Times. Unemployment number stabilized for a while… and have begun to slide back up again. How many of those who lost their jobs in this mess will actually return to their former industries in remotely comparable jobs? Little things, like California’s jobless rate rising from 12.3% to 12.4%... “little” unless it was your job… or higher weekly applications nationally for unemployment benefits.

The collapsed economy has dominated the headlines for the last year and a half, and we are all looking for signs of a recovery. But has this economic malaise simply accelerated and then masked a much bigger reality? Is this reality a time of transition, of the ebbing of America as a viable political entity? Are we in that kind of decay that ends political structures and relegates them to the trash heap of discarded history books? And if these signs are so completely obvious, why aren’t they the basis for a rallying cry for good Americans to do incredible acts to sustain a great nation?! Or are we willing to slide into footnotes and chapter headings in some academic PhD thesis about the “decline and fall” of the United States of America?

I’m Peter Dekom, and I approve this message.

Politicians and Tea Leaves

Can’t have a tea party without tea leaves, and by all accounts, the Democrats read them horribly wrong. 18% of the Massachusetts voters who just elected a Republican senator voted for Obama in the Presidential election. The heartland has spoken, and Republicans are jubilant; the independents who defected have returned to the conservative fold… or have they? Exactly what are the voters saying? That Democrats are bad and Republicans are good… or is it a deeper message that lies in wait for the unwary of both parties. Somehow, the Republicans, who are the bastions of deregulation and lower taxes for the rich, have pushed Obama and the Democrats into a corner in which the latter are being blamed for big spending to resuscitate a truly arrogant and ungrateful Wall Street seemingly without doing anything visible for the average American.

Fed Chairman Ben Bernanke is losing his solid Democratic constituency – “Sens. Barbara Boxer (D-Calif.) and Russell Feingold (D-Wis.) said [January 22nd] that they would vote against Bernanke, following the lead of Sen. Byron L. Dorgan (D-N.D.) a day earlier. Many senators who had been viewed by Senate leaders as safe votes for Bernanke said they were undecided.” (1/22 Washington Post) While he is credited for a reasonable response to the financial crisis, Bernanke’s not having seen it coming and having looked the other way as Wall Street pigs gorged on the overleveraged bubble that made them rich might become fatal to his bid to extend his Fed chairmanship beyond the January 31st expiration date.

Where 40% of the unemployed have been out of a job for over six months, where the true unemployment rate (which count part-timers and those who have given up looking) is closer to 17%, where there are six people applying for every job that comes up, where seniors have lost their savings and homeowners their home values, where small businesses are failing in droves topped only by the number of good people facing foreclosure, where a horse-traded-into-oblivion healthcare reform plan lets insurance and pharmaceutical companies have their way while folks are watching the possibility of costs continuing to rise and benefits falling even as Nebraska wants to avoid paying their fair share of Medicaid costs and where individual Wall Street bonuses for oh-so-many exceed the lifetime earnings of most Americans… what exactly do you think America wants?

Religious groups are toasting over the death of liberal social issues… or at least they think that’s what the tea parties were all about. Fiscal conservatives are toasting that the days of profligate spending on social programs are over, that all attempts to tax and regulate big business must now fall by the wayside… but Americans seem to be saying that they want their economy saved first, and everything else can wait… and if you are spending billions… no trillions… and the only winners are the fat cats, it’s time to replace the party that made that happen.

As big business celebrates the Supreme Court decision that they think will allow them to buy business-friendly candidates into office so that the rich get richer… doesn’t anybody really understand what this is all about? Americans are seeing massive new spending proposals, rich winners who got bailed out and an economy that everyone keeps saying is out of the recession but is clearly still a depression for a huge number of unemployed and underemployed Americans… the rest of America is just plain scared that they will be next. We do not believe the recession is over! We do not believe that the recovery is beginning! We do not believe much of anything you are telling us, and people who say otherwise and are not taking steps we can understand will help the average American – Republican or Democrat – are going to be pushed out of office! This isn’t against healthcare reform, it’s about priorities and ending the rein of special interests over all of us!

The President’s State of the Union message on Wednesday will try and convince America that it would have been much worse for the average American had the stimulus programs not passed, that a new and second stimulus program is essential and that, as he said, “I just want to have some rules in place so when these [Wall Street] guys make dumb decisions, you don't end up having to foot the bill.” He’ll make a populist appeal for a downsized healthcare plan, but “populism” is the name of his new game. His most recent proposal for bank reform would prohibit banks from owning hedge funds and private equity funds that might engage in high-risk trades that could endanger the health of the nation's banks or run counter to the best interests of the banks’ customers. The message sent stocks plunging to their greatest drop in ten months with Wall Streeters muttering how such regulatory efforts would prevent restoration of the credit markets for small businesses and consumers. But now it’s people against the evil banks, so maybe that will sell.

It is amazing how many times this phrase is repeated, but it is even more amazing how many times politicians seem to forget their priorities. IT’S THE ECONOMY, STUPID!

I’m Peter Dekom, and there is a forest among these trees somewhere.

Thursday, January 21, 2010

The President’s Big Mistake

The semaphore of favoring special interests over the lives of most Americans has been President Obama’s weak link among those who supported his presidential campaign but feel he has failed them ever since. The signs are everywhere. We have a massive deficit, but the only clear winners are the big Wall Street financial institutions, to whom we have provided zero interest loans and emergency capital on their balance sheets. The healthcare plan stinks from special interest accommodations. The big pharmaceutical companies promised huge price reductions for the new health reform legislation and promptly raised prices so that they could reduce them back to where they were.

Nebraska Democrat Ben Nelson traded his vote in favor of the Senate version of the healthcare plan provided that his state were exempted from its share of Medicaid contributions for a decade, placing that burden on US taxpayers. He promptly became the poster-child for everything wrong with the Democratic leadership, and with the help of such destructive antics, helped place a Republican Senator in Massachusetts ; Nebraska doesn’t even benefit from his failed and profoundly selfish act now that the Senate version of the bill is dead! The loopholes in all versions of the proposed healthcare legislation clearly favor the insurance giants, just as they could have generated 30 million new customers, with very few incentives to contain costs.

The January 21st Washington Post: “The number of newly-laid off workers seeking jobless benefits unexpectedly rose last week, as the job market recovers at a slow and uneven pace. The Labor Department said Thursday that initial claims for unemployment insurance rose by 36,000 to a seasonally adjusted 482,000. Wall Street economists had expected a small drop.” Unemployment isn’t budging, and the alternative measurement of folks looking for full-time work but only getting occasional or part-time jobs or those who have simply given up looking increases the jobless number by almost 70%. With six people looking for every job available, the forecast looks bleak.

Foreclosures are still rolling through the market, and housing prices have taken another plunge in the last few months, consumers are not spending, and there is virtually no lending for smaller and mid-sized businesses, contrary to what the President promised would happen when he took care of the big boys… financial institutions that used the money to support their own internal trading accounts instead. Defense contractors are licking their lips, but our war in Afghanistan is only supporting a hopelessly corrupt and ineffective regime; lost American lives and an even bigger budget deficit are our only reward.

The underlying message appears to be clear: if you can’t support the little guy – the average American in need – as a Democrat, but are incurring a massive deficit anyway, we might as well support a Republican, who may not help us that much, but at least they won’t keeping raising the deficit for programs that haven’t reached most of us. Americans have forgotten the profligate ways of the Bush administration, have seen the horse-trading and internal bickering that has made the Democrats look weak and corrupt, and simply are getting tired of a system that selectively benefits a few (usually those at who have the money to get politicians elected) but inflicts the burden of those benefits on everyone.

The Washington Post summarizes President Obama’s realization of this massive failure: “Obama said the relentless pursuit of his domestic policies -- and a failure to adequately explain their virtues -- had left Americans with a ‘feeling of remoteness and detachment’ from the flurry of government actions in Washington …. ‘We were so busy just getting stuff done and dealing with the immediate crises that were in front of us that I think we lost some of that sense of speaking directly to the American people about what their core values are and why we have to make sure those institutions are matching up with those values,’ he told ABC's George Stephanopoulos.”

The independents that tilted the scales to elect Obama in the first place seem to have moved into the other camp. Ignoring the heartland – the middle class – can be fatal. The results of an AT&T/Yahoo poll taken on the 21st seem to say it all:

Q. The president's progress with the battered economy has been both praised and criticized. How well are his efforts measuring up with you?

Extremely well. We are undoubtedly moving in the right direction.


Fairly well. There's still a long way to go.


Not well at all. His plans are hurting more than helping.


Not sure/No opinion.


Horse-trading for stupid and selfish concessions (pork of the most unacceptable kind) and supporting a few at the expense of many cost the Democrats Massachusetts … that and the kind of hubris that takes winning the election for granted. Mid-term elections are rapidly approaching, and politicians from both sides of the aisle should take a really good look at a sure way to lose an election: giving special interests the winning hand at the expense of the rest of us… and even if those special interests are busy funding election bids before anyone else contributes… sooner or later, a politician will pay for that money with a crushing loss of power and a very short tenure as an elected representative. You’ve heard the wake-up call – and Republicans should read the message as equally applicable to them – but is it too late to make a difference? All this as the United States Supreme Court has just ruled that it is unconstitutional for Congress to enact legislation to forbid corporations and labor unions to fund ads for and against candidates.

I’m Peter Dekom, and why do I get this feeling that our politicians don’t even know how to change?