Sunday, September 30, 2012


That’s the number, as of September 19th, of Americans waiting desperately for a kidney transplant. “Last year, 4,720 people died while waiting for kidney transplants in the United States. And yet, as in each of the last five years, more than 2,600 kidneys were recovered from deceased donors and then discarded without being transplanted, government data show.” New York Times, September 19th. Huh? OK, some of them just turned out to be unsuitable for one reason or another, but estimates say that around half were indeed viable for a match. It’s an old system, established by the federal government a quarter century ago, based on a first come, first serve priority registry administered through an outsource contract with the non-profit, United Network for Organ Sharing (UNOS). The system doesn’t work well in a modern era and is badly (duh!) in need of updating.
The current process is made inefficient, they say, by an outdated computer matching program, stifling government oversight, the overreliance by doctors on inconclusive tests and even federal laws against age discrimination. The result is a system of medical rationing that arguably gives all candidates a fair shot at a transplant but that may not save as many lives as it could…  ‘There is no doubt that organs that can help somebody and have a survival benefit are being discarded every day,’ said Dr. Dorry Segev, a transplant surgeon at Johns Hopkins University School of Medicine… One recent computer simulation, by researchers with the Scientific Registry of Transplant Recipients, projected that a redesigned system could add 10,000 years of life from just one year of transplants.
“Currently, the country is divided into 58 donation districts. When a deceased donor kidney becomes available, the transplant network’s rules dictate that it is first offered to the compatible candidate within the district who has waited the longest. Additional priority is given to children, to candidates whose blood chemistry makes them particularly difficult to match and to those who are particularly well matched to the donor. If no taker is found locally, the electronic search expands to the region and eventually goes national…  The kidney matching system does not, however, consider the projected life expectancy of the recipient or the urgency of the transplant. By contrast, the systems for allocating livers, hearts and lungs have been revised to weigh those factors.
“As a result, kidneys that might function for decades can be routed to elderly patients with only a few years to live. And when older, lower-quality kidneys become available, candidates atop the list and their doctors can simply turn them down and wait for better organs. If that happens too often, doctors say, a kidney can develop a self-fulfilling reputation as an unwanted organ.” NY Times.  Kidneys have a very short survivability period after being recovered. They really need to be transplanted within 24 to 36 hours. Frustrations with kidneys that failed after transplant and patients who turn down the “what’s next” organ generate doctor resistance to the process that adds a layer of waste to the process.
A special committee established by the UNOS eight years ago to redesign the system is still struggling with age discrimination laws, intense federal oversight and a general resistance to change. Some European systems, such as the organ matching that is used in Germany, will pair donors in older age categories with recipients in the same category… simple but effective. “The number of older kidney donors has more than tripled, and discard rates are less than a third of that in the United States, said Dr. Ulrich Frei, a German nephrologist who has compared the two systems. Studies have found no significant difference in survival rates for older patients in Europe and the United States, he said…  Dr. Frei said he found the discard rate in the United States ‘quite disturbing.’ The reliance on biopsy is misplaced, he said, and valuable hours are wasted in the sequential search for a taker for a lower-quality kidney. That they wind up discarded, he said, is ‘a self-fulfilling prophecy.’” NY Times.
UNOS is offering a new plan that is at best a marginal improvement of what went before: “As with the prior plan, the top 20 percent of kidneys would be matched to the candidates expected to survive the longest, placing older patients at a disadvantage. But the remaining 80 percent would still be allocated primarily by time spent on the wait list.” NY Times. The vote probably won’t come till June, but the fact that there are so many better systems out there, that our computer analytics can handle a more efficient and certainly more rapid matching and implementation system and that there are specific proposals with such better systems proposed by experts in the field… that are being ignored… is beyond disturbing.
The mythology that the United States has the best medical care in the world fails on so many levels, and this is one more example. We need to stop lying to each other about what we have. We have a system that costs the most per capita on earth, still leaves significant numbers of people without access to healthcare (even if they can afford a policy), has the fastest rate of cost increases in the world, protects incumbent industries (like the pharmaceutical companies) from competition and clearly favors those able to pay for the most expensive policies or special upscale hospital care even over those with seemingly solid health insurance. For those with the ability to pay for it, perhaps they have access to the best healthcare system on earth… and can travel to Europe and pay for specialized care when the FDA is still struggling to approve an advanced treatment option.
I’m Peter Dekom, and exactly when are Americans going to fall back in love with facts over slogans?

Saturday, September 29, 2012

Asking and Telling

In 1993, a law was passed to stop the witch-hunts for gays in the military. Known simply as the “don’t ask, don’t tell” (DADT) statute, it was the law of the land until the military adopted a new policy of open service a little over a year ago. Social conservatives predicted erosion in the effectiveness of our fighting forces, difficulties in living conditions within military barracks or in makeshift field accommodations and disciplinary issues that would arise by reason of gays seeking partners (“converts”) in the ranks. A year later, it seems that the only friction generated from this open service policy has been among the critics and defenders… the soldiers in the field could give a damn.
The military has been changing, from top to bottom. Understanding there are under 100 active duty Army generals (at any level), of which very few are women (we have only one female four-star general, Ann Dunwoody), it may have been a big shock to critics of the open service policy that an openly gay woman, 26-year veteran Tammy Smith, was appointed to the rank of Brigadier General just this August. “Smith’s promotion is significant on its own military merit, but the new brigadier general gave the country another kind of amazing example by doing something as loving and normal as having her spouse at her side [above] for her swearing-in.” Washington Post, August 14th. But to most in the military, it’s just the way it is. A new report tells us that very little seems to have changed based on the new open service policy.
Before I summarize the result of the Palm Center study that purports to provide this opinion, I think it matters to understand the source of the report. “The Palm Center, founded in 1998, originally was known as the Center for the Study of Sexual Minorities in the Military [CSSMM]. In 2006, in recognition of a $1 million dollar endowment gift from the Michael D. Palm Foundation, the Center was renamed. In 2011, the Palm Center became a distinct Center under the Williams Institute at the University of California Los Angeles, School of Law.”
“[The report] found that there has been no overall negative impact on military readiness, unit cohesion, recruitment, retention or morale… The authors of the study, who included professors at U.S. Military Academy, U.S. Naval Academy, U.S. Air Force Academy and U.S. Marine Corps War College, arrived at this conclusion after soliciting the views of 553 generals and admirals who predicted that repeal would undermine the military, as well as with expert opponents of DADT repeal, a number of watchdog organizations and more than 60 active-duty heterosexual, lesbian, gay and bisexual troops from every service branch.
“They also observed several military units and administered several surveys, analyzed relevant media articles published during the research period and conducted secondary source analysis of surveys independently administered by outside groups… ‘For almost twenty years, experts predicted that allowing gays and lesbians to serve openly would harm the military,’ said Aaron Belkin, the founding director of the Palm Center and lead author of the study. ‘Now the evidence is in, and the conclusion is clear: repealing 'don't ask, don't tell' did not harm the military, and if anything made it easier for the Pentagon to pursue its mission.’” Huffington Post, September 10th.
In short, the ability to recruit a better qualified class of sailors, soldiers, airmen and marines has been made easier, the list of qualified candidates has been expanded, and the viability of a military career has been made attractive to a whole new cadre of applicants. America has changed, will change and many of these new social vectors are now as much a part of our social fabric as the First Amendment. There are many who hate the new America of racial integration, acceptance of people with different values on marriage and dating and the empowerment of women in the work force, desperately wanting to go back to the “good old days.” But since the new America is the only America that is, isn’t the only thing they are saying is that they really just hate America? And if it doesn’t go back….
I’m Peter Dekom, and the one constant, I like to keep repeating, is change.

Friday, September 28, 2012

Blue About Green on Blue

Where our attack on Iraq has yet to find any justification in why we did it (there just weren’t any weapons of mass destruction) or how it benefited us (we literally handed over control of the country to the clearly-pro-Iranian majority), our attack on Afghanistan was a direct response to the Taliban’s rather open and direct support of the al Qaeda attackers who fomented the 9/11 decimation of the Twin Towers and the crash into the Pentagon. We toppled the regime, invaded… and then withdrew critical forces to Iraq to fight “the other war.” The Taliban had time on their side and used it well.
Not only did we pull troops out to fight in Iraq long before there was the slightest semblance of stability in this rugged and desolate nation, not only had we armed and trained the mountain guerilla fighters who now opposed us when we funded the Mujahedeen in their war against the Soviets but we imposed a government that redefined cronyism and corruption to levels that even that nation had never seen before. The Karzai regime, hated by almost all, never controlled much more than the area around the capital city of Kabul… war lords and Taliban controlled the rest, letting go when NATO forces attacked, returning when they left (as they always did).
The Taliban smiled as the U.S. economy groaned and sank. They knew whether it was next year, next decade or whenever, NATO forces would leave. And when they did, since they already controlled most of the countryside, taking over completely would be very, very easy. Watch. The people figured out pretty quickly that there was zero percentage in backing Karzai or the NATO forces. Not only were these American allies failing to spread the Kabul government into the rest of the country, but they were actually having little or no impact on the reduction of Taliban control. It paid to cooperate with the Taliban.
As time passed, the Taliban grew bolder. With “insiders” working at every strategic military installation as members of the Afghan military, they infiltrated cadres of police officers and local governmental operations, punishing fiercely anyone who really was working against them. Taliban spies and saboteurs were everywhere. And the locals knew that they pretty much better tow the Taliban party line, since they clearly were the successors on the rise. No longer content with withdrawal and return when allied forces targeted a given region, the Taliban became strong enough to attack the strongest bases inflicting death and destruction at level paralleling a mainstream military attack. Their “green on blue” plants – soldiers and police trainees who were being trained by NATO forces to replace them when NATO forces departed as scheduled in 2014 – turned on their NATO compadres with increasing frequency, shooting and blowing them up when their backs were turned. They pointed out weakness and created new plans of attack.
After a September 14th attack on NATO Camp Bastion/Camp Leatherneck (see map above), the main base in the country for U.S. Marines and U.K. forces, that killed 2 Marines and destroyed six Harrier jet aircraft, as explosive attacks and violent protests followed the YouTube airing of an anti-Muslim film all across the land, NATO had had enough: “After years of tightly intertwining its forces with Afghan troops, the American-led military coalition has sharply curtailed ground-level operations with the Afghan Army and police forces, potentially undercutting the training mission that is the heart of the Western exit strategy… The new limits, which were issued [September 16th] and require a general’s approval for any joint work at the small-unit level, were prompted by a spike in attacks on international troops by Afghan soldiers and police over the past six weeks. There was also fear that anger over an anti-Islam video could prompt more of what the coalition calls insider attacks, American officials said…
“Coalition officials stressed that their officers would still be paired with higher-level Afghan units, and that the basic concept of training, advising and fighting alongside Afghan units in the field to ready them to fight on their own remained at the core of war strategy… Coalition officers said the order to curtail direct cooperation covers all work done with Afghan forces below the level of a battalion. An American battalion has about 700 to 800 troops, though some are larger or smaller, and is designed to be the smallest unit that can fight independent of a higher command. .. But in Afghanistan, where the Taliban blend easily and often strike in small groups, most of the combat goes on far below the battalion level, with small squads of about 10 men or platoons of about 15 to 40 soldiers or Marines.” New York Times, September 18th.
We lost the war in Iraq. With every car bomb blast in Baghdad, with every sign of the growing alliance between Iraq and Iran, surely we lost any possible benefits for America in that dreaded war. We strengthened our enemy Iran, infuriated so many in the Middle East who believed we were waging a war against their religion, fanned the recruiting flames of militant Islam, decimated our own nation with crippling deficits needs to fight these prolong struggles and lost  thousands of soldiers in the process. Now, in giving up our training mission in Afghanistan, no matter the lip service about training the leadership (they don’t fight the relevant battles) even though we aren’t training the implementing forces, there isn’t the slightest justification for our remaining in Afghanistan. None.
We need to rethink why we have an incessant need to invade nations that attack us. In recent years we not have fared well in distant lands with different cultures and religions where we will always be viewed as foreign invaders. I agree that a military response is usually the correct response when some nation or group attacks America or its forces around the world.
What would have happened if all we did was use our massive fire power to wreak havoc across the Taliban-controlled universe back in 2001? The message would have been beyond clear. Invasion was not necessary in that circumstance, but it was consistent with our pattern of conduct.
We don’t need to deploy U.S. forces within offending nations; we are not responsible to rebuild the damage we inflict on them for supporting unprovoked attacks against us. Of course, there are appropriate places for boots on the ground, but our leadership seems addicted to that course of action notwithstanding decades of devastating “unintended consequences.”
I’m Peter Dekom, and I am reminded of one definition of insanity: “repeating the same behavior and expecting a different result.”

Bin There, Eat That

As our American Congress ponders falling off a cliff, as Germans demand increasing levels of austerity form Eurozone nations seeking financial support as the debt crisis there is anything but stable, as India wrestles with a corrupt and tanking economy and as China struggles with stacks and piles of unsold inventory and crashing real estate prices, the world creaks and moans to find growth, but for the PIIGS (Portugal, Italy, Ireland, Greece and Spain), the plight of those at the bottom is particularly ugly. The world has drilled down on Greece, because it was extreme and obvious. Greece still cannot get its billionaires to pay taxes, and the notion of growth in a world of sole proprietorships and less-than-stellar education seems miscast in a nation that had to fudge its financials just to get into the EU.
But with almost five times the population than Greece and ranking as the fourth largest economy in the Eurozone, Spain’s troubles are vastly more impactful on Europe. The Spanish political structure is a system of relatively autonomous communities (including two cities) – where regional power is determinative – but where local economic problems mirror the overall financial instability that is present in southern Europe. As these communities run out of money, they turn to the central Spanish authorities for a bailout, just as Spain itself looks to the European Central Bank for support. Any large community running out of money – happening a lot recently – can destabilize the entire Spanish economy.
Catalonia (the economic giant which is mumbling about separating from the rest of the nation) needs $6.5 billion, Andalusia $6.3 billion and so it goes. On September 25, mirroring widespread parallel anti-austerity protests all across Greece that were even more violent, thousands of angry demonstrators descended on the Spanish parliament, fighting barricades and 1,400 riot police ringing the building, to protest the nation’s austerity program. Prime Minister Mariano Rajoy “finds himself in an increasingly tight bind between Spanish voters who oppose further cuts and investors and European finance officials demanding reassurance that Spain can meet budget deficit targets.” New York Times, September 25th.  
The decisions facing the PM are anything but pretty in country that is exhausted from austerity. Rajoy is “preparing to roll out tough measures to bring the 2013 budget in line with its target — 4.5 percent of gross domestic product, from the 6.3 percent targeted for this year… Spain, which had already received a promise of up to 100 billion euros, or $129 billion, to restructure its shaky financial sector, is hoping to avoid the type of full bailout that Ireland, Portugal and Greece have already received, and more importantly, the constraints on government action such bailouts have entailed.”  New York Times, September 27th. Budget cuts of $51 billion will undoubtedly further slam Spain’s staggering 25 unemployment rate, and a run on regional banks from a lack of confidence will is leading to a massive bailout of some of Spain’s largest financial institutions.
Because the euro is the standard across those EU nations who adopted the currency, like Greece there is no separate Spanish currency to be devalued to implement adjustments. And much more than is the case with Greece, a Spanish departure from the Eurozone anytime soon would have a devastating effect on the viability of the EU. As austerity measures are implemented, gross domestic product in the targeted countries continues to fall (the definition of recession), even as debt loads are slowly reduced. The result? Massive suffering and no positive change in the truly meaningful measurement of the program’s success: the ratio of debt to GDP. No wonder the people are angry.
Yet the austerity mandates have choked the life out of many struggling Spanish citizens, and the underlying statistics are abysmal. With half of the youngest members of the labor force out of a job, and the unemployment benefits for discharged workers running out among many, the prospect for many in this beautiful country is nothing short of bleak. The local Catholic charity, Caritas, is feeding double the number of people it helped in 2007, value-added taxes on consumer goods is rising, and small chips and cuts (like the popular school lunch programs) are taking away little benefits that sustained those at the bottom.
The sadness of this nation is particularly well-expressed by looking at the reality of trash bins scattered about the land. Folks have taken to “collecting ‘a little of everything’ from the garbage after stores closed and the streets were dark and quiet… Such survival tactics are becoming increasingly commonplace here, with an unemployment rate over 50 percent among young people and more and more households having adults without jobs. So pervasive is the problem of scavenging that one Spanish city [Girona, where the above picture was taken] has resorted to installing locks on supermarket trash bins as a public health precaution…
“For a growing number, the food in garbage bins helps make ends meet…  At the huge wholesale fruit and vegetable market on the outskirts of this city recently, workers bustled, loading crates onto trucks. But in virtually every bay, there were men and women furtively collecting items that had rolled into the gutter.” New York Times, September 24th. It seems a lot like The Great Depression than a seemingly endless recession, and one has to wonder with pressure on Congress to cut the deficit including ending unemployment relief, could this actually happen here?
Caritas has been looking at this Spanish pervasive push at the bottom very carefully, and recently released a study on what they saw. “The Caritas report also found that 22 percent of Spanish households were living in poverty and that about 600,000 had no income whatsoever. All these numbers are expected to continue to get worse in the coming months. … About a third of those seeking help, the Caritas report said, had never used a food pantry or a soup kitchen before the economic crisis hit. For many of them, the need to ask for help is deeply embarrassing. In some cases, families go to food pantries in neighboring towns so their friends and acquaintances will not see them.
“In Madrid recently, as a supermarket prepared to close for the day in the Entrevias district of Vallecas, a small crowd gathered, ready to pounce on the garbage bins that would shortly be brought to the curb. Most reacted angrily to the presence of journalists. In the end, few managed to get anything as the trucks whisked the garbage away within minutes… But in the morning at the bus stop in the wholesale market, men and women of all ages waited, loaded down with the morning’s collection. Some insisted that they had bought the groceries, though food is not generally for sale to individuals there.” NY Times.
Europe is a cluster of bad news and falling consumer confidence: “The European Commission reported from Brussels that its economic sentiment indicator for the 17-nation euro zone fell by 1.1 points, to 85.0, a seventh month of decline.” New York Times, September 27th.  Austerity seems to be failing fast on the continent, and in the U.K., voter sentiment has turned heavily against the ruling coalition government that was elected to implement an austerity platform. “Across Europe, six countries are in recession and economists predict the entire region could be heading for recession by the end of the year.”, September 27th. Yet austerity is the growing cry on this side of the pond, to stop supporting the unemployed and cut non-defense spending to the bone.
American cries to end safety net payments, that there are too many people dependent on a handout, seem to suggest that those receiving aid actually have alternatives. Most want jobs, but jobs numbers are going the other way in an austerity-driven economy. Exactly what those at the bottom can do to stand up and support themselves remains a mystery, but the Spanish example provides too many of “those people”  increasingly becoming experts at trolling the repositories of refuse for sustenance. It is painful and ugly to watch, and only those with an incredible lack of empathy seem to think that these unfortunates are simply expendable.
Funny how implementing the same kind of austerity measures that Europe has swallowed are principal platforms in many American politicians’ baskets… and we don’t remotely have the kinds of safety nets in place in Europe. Debt reduction with negative growth accomplishes nothing, literally, and austerity measures that cut the wrong programs (yep, back to education, infrastructure and research) insure a future with significantly reduced competitive power, further contracted upward mobility and a much lower quality of life for most of us. Still, so many Americans refuse to watch the failures of these programs in Europe… and want to see them implemented here.
I’m Peter Dekom, and I truly do fear that such remarkable and pathetic scenes could find their way to our shores if we fail to invest in ourselves and our own future.

Wednesday, September 26, 2012

Is the Economy Even Fixable?

While it is true that the world is governed by economic cycles, it is equally true that harsh times can last for many years before rolling back into positive territory. It took until 1954 for the stock market to recover from the 1928 crash that initiated the Great Depression. Japan’s economy fell off a cliff in 1991 and has yet to recover. And fortunately or unfortunately for the rest of us, we are so intertwined with each other as trading partners, competitors for global commodities and resources and as cost-efficient manufacturers/providers of goods and services that the whole planet seems to be sliding up and down slippery economic slopes together… with those with more “assets” withstanding the pain better than the rest.
Let’s take a look at what happened in this country. Because of overleveraging, values of companies, real estate and other “assets” were inflated to justify the debt that was applied against them. When folks began, rapidly and sequentially, to recognize that the emperor truly had no clothes, that valuing an asset in order to justify what was loaned against it did not actually mean that was the real value, the house of cards fell quickly. A vast number of Americans lost their net worth as housing prices plunged, and while such real estate prices may move a percentage or two in any direction once and a while, without the jobs and the buying power necessary to create demand in the housing market, the notion of restoring home values in anything like a near term is nothing more than an elusive fantasy.
Further, the older workers who lost jobs and have not been in the work world for a few years are too old to retrain for jobs that pay salaries and wages comparable to what they made, have lost the momentum of learning the “new” that would have occurred had they remained employed, and many have been pushed out because the companies they worked for fell off the obsolescence cliff (and those that survived had to retool with the “new next” productivity methods). Younger educated potential workers, denied access to the fields for which they were trained, have entered the labor market at lower levels… with starting pay upon which future raises will be based sufficiently lower so as to have a material negative impact on lifetime earnings… for those lucky ones who found work. No wonder so many have just given up looking. Exactly how do you put those people to work… under any plan other than the government’s just hiring them directly? What kinds of jobs can they do?
With dwindling consumer demand (it spiked for a moment) and confidence, demand for products and services is insufficient to create any required increase in new jobs. Without a showing of such demand, a tax break for the rich won’t push the wealthy to spend those savings to create new jobs to provide more goods and services that consumers are not willing to buy. Further, with austerity measures in the offing, as Congress wrestles with deficits, a contraction in government spending – that stopgap that sort of covered the reduction in consumer demand – is likely to create a parallel contraction in new jobs.
With China and India in economic crisis as well (as I have blogged in recent days), and Europe still not really solving the debt crisis in its weakest nations under a unitary currency, global demand is contracting, and global inventories of unsold goods is rising, all factors that will further contract job growth. Clearly, American goods and services will not find the solution to weak consumer demand in their traditional export markets, which are slammed even more than our own.
Nothing illustrates the linkage between the U.S. economy and the vagaries in other countries better – proving how the world is irretrievably linked – than checking out the U.S. stock markets immediately after the EU announces any “good news” or a “plan” to ease the debt crisis in its PIGGS European “at risk” economies. On September 6th, for example, when the EU announced a plan to use bonds to buy out underperforming PIGGS debt, the Dow instantly soared by 244 points. If Europe weren’t linked to the U.S., the markets wouldn’t have budged.
Since there are so many diverse forces pulling at the global economy, and only so much any one nation can do to control anything beyond its borders, we all are at the mercy of each other’s actions, doing the best we can in a sea of hurt. Maybe no political candidate can make enough of a difference to reverse what only a very long absorption of our excess will be able to accomplish.
How do global economists look at this mess? From an annual gathering of experts, sensing that a “perfect storm” of global malaise could further unravel what little economic progress we have made, our bad economic behavior followed by over-reaction that ultimately may have made matters even worse, the word isn’t particularly optimistic: “Many attendees at the annual Ambrosetti Forum at Lake Como on [September 7th] fretted about mounting U.S. debt and the Europe's inability to balance electorates' apparent insistence on national sovereignty with the need for regional coherence to salvage the teetering euro… But economist Nouriel Roubini predicted years of gloom almost regardless of what is decided.
“That analysis is rooted in the specific nature of this crisis, a downward spiral in which a financial meltdown largely caused by excess credit was defused by a blast of public spending; that 2009 stimulus, widely credited with avoiding a global depression, pushed some governments too far into the red for the markets’ liking – a ‘sovereign debt crisis’; and this is turn was attacked through severe austerity measures that suppressed spending to the point that countries cannot grow their way back to prosperity.
‘History suggests that whenever (there is) a crisis with too much private debt first and public debt second you have a painful process of deleveraging,’ said the famously apocalyptic New York University professor, a glowering fixture at such international talk-shops… ‘That would imply many years, up to a decade, of low economic growth. And guess what? Economic recovery in the U.S. has been unending and in the eurozone and U.K. there's outright economic contraction right now, and that's not going to change unfortunately in the next few years.’” Huffington Post, September 7th.
Economists speak of a “re-set,” which is nothing more than getting used to the new normal of less. Of course we will adjust. Of course there will be new winners and new losers no matter how slow the recovery. But it is a time to for the government to invest – versus just spend – in what they can. Education, infrastructure and research. If what exists isn’t good enough or strong enough to lift us out of the mire, it’s time to build the next, something Americans, when they aren’t terrified of themselves or their future, have been pretty damned good at inventing. And if we deploy that spirit properly, America can actually lead the rest of the world back to the “next new normal” – reasonable and sustainable growth.
I’m Peter Dekom, and the huge missing factor in so much of what so many American policy wonks are proselytizing is common sense.

Tuesday, September 25, 2012

Send in the Clones

My friend Janet Zucker, film producer extraordinaire, is known in some circles as a stem cell zealot-guru, a life focus born of her daughter’s struggles with type 1 diabetes. She has raised awareness, money and passion for the growing field of stem cell research… and if you want to know where science and medicine have reached at any given moment, Janet’s your gal. With health issues in my own family, stem cells may be the only path for life-sustaining solutions for some in my world, so naturally Janet has become a resource.
Most of us think that medical doctors are only ones leading this research charge, but while MD’s are clearly very much in this mix, they have been joined in this cutting-edge research by an army of cellular biologists. We’ve mapped the human genome and we are clearly on the path of finding ways to regenerate failed organs and body parts to give new life to old ailments and injuries. Can we generate a pancreas that can handle blood sugar levels and end diabetes? Will we be able to regenerate parts of the human heart decimated by a heart attack? Can an auto-immune-impaired body be given a new disease-fighting series of restored organs to allow life without constant injections and infusions? Can dialysis become a distant memory as kidney capacity is restored?
Janet will tell you, “not yet,” but she will also fill your heart with hope as medical science is beginning to find examples of what we can do or will in the very near future be able to provide to those in need. It’s not about whether or not stem cells work; it’s about targeting stem cells to replace or restore a specific organ or body part. So Janet sent me a piece on MSNBC’s website (September 11th) that drilled down on what researchers are beginning to do with human beings, particularly soldiers whose bodies have been wracked with the destruction from improvised explosive devices (IEDs) that have blown away significant sections of their bodies.
The stories of success are beginning to roll out. Take for example the work of Dr. Anthony Atala at Wake Forest University. “He’s already grown bladders using a patient’s own cells, and he’s made penises that rabbits were able to put to their proper use, fathering litters of new little bunnies. He hopes to use this expertise to help rebuild the bodies of veterans wounded in Iraq and Afghanistan, as well as men and boys injured in car accidents… Atala is one of the pioneers of regenerative medicine. But the field has taken off in a big way, attracting biotechnology companies, the U.S. military and academic labs, which are working to literally make the blind see and the lame walk again. They’re perfecting spray-on skin and aim to mass-produce new body parts using bioprinters based on the jet printers attached to your home computer.
“‘Right now, the way these organs are made is creating them one by one. By bringing the bioprinting in, we can scale it up,’ says Atala, whose lab has contracts with the four-year-old Armed Forces Institute of Regenerative Medicine (AFIRM), biotechnology companies and private foundations… All of this technology is years away from the doctor's office. The most advanced treatments have just begun the very earliest stages of human testing. But all evidence points to the tantalizing prospect of grow-your-own organs and possibly even limbs within a decade or so, and some approaches, such as muscle transplants and spray-on skin, are helping a lucky few now.” MSNBC. Most of his techniques involve stem cells from the patient him or herself. Spray on skin, noted above, starts with a micro-thin layer based on the patient’s own genetic code and if performed properly, generates further skin growth fairly quickly.
Facial disfigurement has also seen significant progress as spray on skin applied over a pre-shaped ear form and attached to the patient’s own skin has been successfully used to create a new “ear” where the ugly impact of an IED explosion destroyed the old one. For the soldiers who sacrificed their bodies in combat, this surgery is nothing short of a miracle.
But wait, as the TV huckster would tell you, there’s more: “In January, scientists at Advanced Cell Technology, a company based in Massachusetts, reported they had used some of these human embryonic stem cells to partially restore vision in two legally blind patients. First they ‘trained’ the cells by incubating them in a nourishing soup of chemicals designed to make them differentiate into retinal cells. The stem cells, infused directly into the eye, regenerated cells known as retinal pigment epithelium cells.” MSNBC.
And while we are making progress, there are setbacks that we don’t fully understand: “[Experiments have begun with] Lou Gehrig’s disease, medically known as amyotrophic lateral sclerosis or ALS. It attacks nerves called motor neurons, gradually and inexorably paralyzing its victims. It’s always fatal as patients lose every bit of their ability to move, even to breathe. There’s no treatment and no cure… [40-year-old] Ted Harada had a second infusion of stem cells last [in August]. Harada is hopeful enough to have tried the highly experimental treatment not once but twice. It’s painful – surgeons have to cut open his spine and infuse the stem cells right into his spinal fluid. But the last time Harada was treated, he went from walking with a cane to running with his kids – a transformation that made him an instant television celebrity.
“‘The results I saw were nothing short of miraculous,’ says Harada, who lives in Georgia and who got treated at Emory University. ‘Within two weeks I started feeling my legs getting better. I was afraid it would be a dream and I would wake up and it would be gone again.’… And the effects did gradually wear off, Harada says. ‘All of a sudden I started noticing fatigue in my legs,’ he told NBC News. ‘I started noticing trembling, shaking in my legs. If you do a lot of weight lifting you know that rubbery feeling your legs get when they are spent?’ That’s how he felt.” MSNBC We have move forward significantly, but for those who cling to an diminished and impair lifespan, they dream of more… faster.
I’m Peter Dekom, and our ability to find these solutions offers hope to millions plus the promise of new jobs in a new technology that saves and improves the human condition.

Monday, September 24, 2012

California, the New Massachusetts?

Seven million of California’s nearly thirty-eight million people don’t have health insurance, the largest total in the nation. With the Affordable Care Act (AFC) – so-called Obamacare – marching forward, California is only one of 14 states/jurisdictions (Washington, D.C. is included) that is actively in the process of creating a healthcare exchange (the California Health Benefit Exchange), a state-sponsored insurance-pooling effort that will allow the uninsured to seek the cost and coverage benefits of group coverage. These exchanges are focused on providing benefits in at least ten essential categories at affordable coverage rates.
The provisions in the AFC of banning denial of coverage based on preexisting conditions, cutting off coverage under lifetime benefit caps or terminating heavy users of healthcare don’t kick in nationally until January of 2014. That’s also the date that Americans able to afford healthcare either have to have the requisite coverage or pay a fine, but without such implemented exchanges, many will not be able to find the mandated affordable coverage. Under then-Governor Mitt Romney, Massachusetts led the country in creating a viable government healthcare program, since disavowed by that same governor who signed it into law, which embraced a whole pile of people previously unable to afford health insurance. Today, that leadership role seems to be in the process of being passed to California.
Many governors are simply ignoring the need to create such health exchanges, since it is an expensive structure to mount (California is paying $327 million to just one consultant, Accenture, as the primary implementing consultant) under a statute that candidate Mitt Romney has vowed to repeal if elected. The United States is the only developed country in the world that is still without universal healthcare and remains the costliest per capita in this per capita on earth.
But there are also a few Republican governors – even ultra-conservative Arizona Republican Jan Brewer – “working to have a framework ready by Nov. 16, the deadline for states to commit to running an exchange or leave it to the federal government to run it for them. That is just 10 days after Election Day, which is likely to decide the future of the law.” New York Times, September 23rd. You won’t read about these preparations in the headlines, because these Republican leaders – want the law to die – believe that either their revised lawsuits (after the U.S. Supreme Court upheld most of the AFC) will prevail or a new Republican administration will just do away with virtually all of the law. “Given that the health care overhaul remains a lightning rod — [mid-September], Oklahoma revised a lawsuit against it — even the most tentative discussions about carrying it out in Republican states tend to take place behind closed doors or ‘underground,’ as the leader of a health care advocacy group in the South put it.” NY Times. The process of actively setting up a functioning exchange, however, is taking place in more liberal states.
Budget-impaired California faces yet a 16 billion deficit that will decimate that state’s ability to provide basic services if voters reject the tax increases posited for the November election. The costs of the program have been estimated at $2 billion a year, and still, California voters favor the AFC by a whopping 54% vs. 37% against margin according to an August 20th Fields poll. “Support was strongest among blacks (88 percent) and Hispanics (67 percent), who together make up more than 44 percent of the state’s population. Voters of Vietnamese and Korean descent also firmly supported the law, but white and Chinese voters were more divided. The poll of 1,579 voters, conducted in July, has a sampling error of plus or minus 3 percentage points.
“Only 17 percent of respondents said they had seen, heard or read anything about the insurance exchange though. Still, 75 percent of those who are not insured through their employer or Medicare said they would be interested in using the exchange to shop for health insurance.” New York Times, September 14th. What it is fascinating is the resistance shown by so many people to the AFC when clearly the majority of those resisting will, sooner rather than later, without the AFC lose the ability to afford health insurance that is still escalating at a cost multiple several times greater than the general cost of living, and most certainly above any semblance of increases in pay for average working Americans.
Still, with such burning economic issues, California healthcare exchange officials have a more immediate issue to deal with: what to name the program to get people to pay attention. I think that’s a problem they want to solve, although one of the more popular possible names, Avocado, seems a strange (but, like a totally California) approach.
I’m Peter Dekom, and if given a choice between upgrading an F-22 Raptor and getting life-saving medical care, I wonder what those opposed to the AFC would really pick when pressed?

Sunday, September 23, 2012

Weather or Not We Want It

Take a good look at the photo above. It is the greatest contraction in sea ice since we began measuring this phenomenon over three decades ago. “On August 26, Arctic sea ice extent broke the record low set in 2007, and it has continued to decline since, dropping below 1.5 million square miles. That represents a 45 percent reduction in the area covered by sea ice compared to the 1980s and 1990s, according to the National Snow and Ice Data Center (NSIDC), and may be unprecedented in human history. The extent of sea ice that melted so far this year is equivalent to the size of Canada and Alaska combined.
“The loss of sea ice initiates a feedback loop known as Arctic amplification. As sea ice melts, it exposes darker ocean waters to incoming solar radiation. The ocean then absorbs far more energy than had been the case when the brightly colored sea ice was present, and this increases water and air temperatures, thereby melting even more sea ice… Peter Wadhams, the head of the polar ocean physics group at the University of Cambridge in the U.K., told BBC News on September 6 that the added heat from sea ice loss is equivalent to the warming from 20 years of carbon dioxide emissions. Carbon dioxide is the main greenhouse gas that is causing manmade global warming.” Huffington Post, September 12th.
So the world should be warming really fast… and bitter winters should be a distant memory for hundreds of millions of people right? Well, not exactly… there’s one additional factor: the Gulf Stream… that air flow that sweeps from west to east, moving north or south and changing direction all the time. When it pushes up through colder northern air and then flows down to where temperatures might normally be warmer, that southern climate clearly feels the brunt of the colder air carried in by the Gulf Stream. And vice versa.
Jennifer Francis, an atmospheric scientist at Rutgers University in New Jersey, “published a study last year in which she showed that Arctic warming might already be causing the jet stream to become more amplified in a north-south direction. In other words, the fall and winter jet stream may be getting wavier. A more topsy-turvy jet stream can yield more extreme weather events, Francis said, because weather and climate extremes are often associated with large undulations in the jet stream that can take a long time to dissipate.
“‘We know that certain types of extreme weather events are related to weather that takes a long time to change,’ Francis said… While there are indications that the jet stream is slowing and may be more prone to making huge dips, or ‘troughs,’ scientists have a limited ability to pinpoint how this will play out in the coming winter season… ‘The locations of those waves really depends on other factors,’ Francis said, such as El Niño and a natural climate pattern known as the Arctic Oscillation. ‘I can only say that it’s probably going to be a very interesting winter,’ she said… Francis’ work has linked Arctic warming to the unusually cold and snowy winters of 2009-10 and 2010-11, during which the U.S. East Coast and parts of Europe were pummeled by fierce winter storms and experienced cooler-than-average conditions. The winter of 2011-12 was much milder, by comparison, but Francis said it, too, was consistent with her research.” Huffington Post.
Huh? You mean we could freeze our butts off this winter… and this is a product of global warming? Yep! Or not. The one thing that seems to be happening is the potential for extreme and unpredictable swings in temperatures and weather patterns. If that old cold north wind begins to blow, and the Gulf Stream happens to be “up there” at the time, it will carry that frigid air wherever it goes, but it could equally be picking up warmer air from the south, if the Gulf Stream slips lower, and carrying that to those in northern reaches.
Instability is not particularly good for agriculture, because plants tend to operate within fixed ranges of temperature tolerances… and at specific times in the growing process. Food shortages, new insect migration patterns, etc. could deeply impact the human condition by spreading disease and famine at unprecedented levels. Further, the general increase in overall temperature could have a profound effect on water supplies and drought conditions, making what the West and the Mid-West are experiencing now a more permanent feature.
I’m Peter Dekom, and I suspect that trying not to reduce our food or water supplies or amplify disease patterns might be legitimate individual concerns for each and every one of our elected officials, assuming they care about us at all.