Later On

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Archive for the ‘Healthcare’ Category

Israeli Defense Force medics don’t hold with “First, do no harm”

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Robert Mackey reports on mass demonstrations in Israel to support the Army medic who shot and killed a wounded Palestinian who was lying on the ground and posed no threat:

Thousands of Israelis rallied in Tel Aviv’s Rabin Square on Tuesday in support of an army medic who was caught on video last month apparently executing a wounded Palestinian suspect following a knife attack in the occupied West Bank.

The medic, Sgt. Elor Azaria, 19, was charged with manslaughter by an Israeli military court on Monday for firing a single bullet into the head of Abdel Fattah al-Sharif, killing him, on March 24 in the city of Hebron. Sharif was one of two young Palestinians suspected of lightly wounding an Israeli soldier in an area of the city inhabited by Jewish settlers.

Crowd chants “Elor the hero” and “death to Arabs.” This seems more like a celebration of murder than

— Dan Cohen (@dancohen3000) April 19, 2016

Video of the incident recorded by a Palestinian witness and posted online by B’Tselem, an Israeli human rights group, showed that Sharif was lying prone on the ground, already immobilized by previous gunshots, when Azaria cocked his gun and shot him.

Haaretz, the Tel Aviv daily, reported that his supporters shouted slogans including, “He’s a hero,” and “Release the soldier.” The soldier’s mother thanked the crowd of about 5,000, according to a police estimate, and reminded her son that, “From a young age, you wanted to be a combat soldier and give back to your country.” . . .

Continue reading.

Written by LeisureGuy

19 April 2016 at 4:17 pm

The Science behind the DEA’s Long War on Marijuana

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David Downs writes in Scientific American:

Speculation is growing about the possibility that the U.S. Drug Enforcement Administration (DEA) will review by summer its “Schedule I” designation of marijuana as equal to heroin among the world’s most dangerous drugs. Very few Americans know of or understand the DEA’s drug-ranking process, and a review of cannabis’s history as a Schedule I drug shows that the label is highly controversial and dubious.

Disgraced Attorney General John Mitchell of the Nixon administration placed marijuana in this category in 1972 as part of the ranking or “scheduling” of all drugs under the 1970 Controlled Substances Act. Schedule I drugs are deemed to have no medical use and a high potential for abuse. Cannabis has been there ever since. “As of today, marijuana has never been determined to be medicine,” says Russ Baer, staff coordinator in the Office of Congressional and Public Affairs at the DEA. “There’s no safe, effective medical use, and a high abuse potential, and it can’t be used in medical settings.” This determination has come to be insulated by a byzantine, Kafkaesque bureaucratic process now impervious to the opinion of the majority of U.S. doctors—and to a vast body of scientific knowledge—many experts say.

“Of course cannabis has medical uses,” says University of California, San Francisco integrative oncologist Donald Abrams, one of the few researchers who have been able to obtain extremely limited, government-approved supplies of research cannabis for human trials. “It’s pretty clear from anthropological and archaeological evidence that cannabis has been used as a medicine for thousands of years—and it was a medicine in the U.S. until 1942,” Abrams adds. “I’m an oncologist and I say all the time, not a day goes by when I’m not recommending cannabis to patients for nausea, loss of appetite, pains, insomnia and depression—it works.”

Marijuana’s placement in Schedule I did not happen in a vacuum, historians note. Overt racism, combined with New Deal reforms and bureaucratic self-interest are often blamed for the first round of federal cannabis prohibition under the Marihuana Tax Act of 1937, which restricted possession to those who paid a steep tax for a limited set of medical and industrial applications. (Cannabis was removed from the official U.S. Pharmacopeia in 1942.) “In segregated America newspapers were saying, ‘this stuff makes white women and black men have sex,’” notes historian Martin Lee, author of Smoke Signals: A Social History of Marijuana.

The American Medical Association initially opposed prohibition. Cannabis was medically useful, says William Woodward, association counsel. “Congress being what it was at the time, you could ram things through just by bullshitting,” Lee adds. “Who’s going to be stepping up to the plate [in 1937] to defend a drug that blacks, Latinos and jazz musicians use?”

The Tax Act passed amid New Deal reforms, and the first marijuana peddlers were arrested and jailed that year. Science reared its head within a decade, though. In 1944 the La Guardia Committee report from the New York Academy of Medicine was the first in a long line of official bodies to question the prohibition. The committee found marijuana not physically addictive, not a gateway drug and that it did not lead to crime. But Harry Anslinger, head of the then–Federal Bureau of Narcotics, labeled the report unscientific and prohibition rolled on. “Every 10 years since then—although we’re a bit off schedule—some august governing body has reviewed the data and come up with the same finding [against prohibition],” Abrams says.

The Tax Act’s mode of federal cannabis prohibition became illegal in 1969 with the case Leary v. United States, which found that purchasing a marijuana tax stamp amounted to self-incrimination. The verdict spurred Congress to repeal the Tax Act and replace it with the more comprehensive Controlled Substances Act of 1970.

Marijuana was placed in Schedule I in 1971 provisionally, until the science could be assessed. But Pres. Richard Nixon saw pot prohibition as a way to destroy the antiwar left, according to clandestine recordings made by Nixon in the White House as well as statements from his staff to the press. Nixon convened The National Commission on Marihuana and Drug Abuse (what became known as the Shafer Commission) to engineer scientific support for cannabis’s Schedule I placement. “I want a goddamn strong statement on marijuana,” Nixon said in tapes from 1971. “Can I get that out of this sonofabitching, uh, domestic council? … I mean one on marijuana that just tears the ass out of them.”

The Shafer Commission found in 1972 that cannabis was as safe as alcohol, and recommended ending prohibition in favor of a public health approach. But by then the Federal Bureau of Narcotics had been removed from the Treasury Department and merged into the U.S. Department of Justice—where Nixon’s ally, Attorney General John Mitchell, placed cannabis in Schedule I in 1972; that same year he resigned to head Nixon’s re-election committee. (He later stood trial in 1974 over the Watergate scandal and served 19 months of a prison sentence for conspiracy, perjury and obstruction of justice.] “You want to know what this was really all about?” Nixon aid John Ehrlichman told journalist Dan Baum in 1994, according to an article published in Harper’s Magazine in 2016. “The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

Anyone can petition the DEA to reschedule any drug, Baer says. The DEA takes advice from the U.S. Food and Drug Administration, Department of Health and Human Services, the DEA’s administrative law judges, along with others, but “the buck stops here. We have final scheduling authority,” he says. “Really it comes down to science. That’s the foundation of the argument. We’re bound by that scientific and medical evaluation.”

Many would disagree. Decades ago the DEA’s own administrative law judge, Francis Young, recommended unscheduling cannabis in response to a petition from activist groups. Young ruled in 1988 that “marijuana, in its natural form, is one of the safest therapeutically active substances known to man. By any measure of rational analysis marijuana can be safely used within a supervised routine of medical care.” The DEA denied the petition anyway.

In 1999, in response to California medical legalization, the Institute of Medicine found that marijuana had medical uses and a relatively low potential for abuse, leading to another round of petitioning. The DEA denied a petition again in 2011, citing a lack of available research specifically on smoked marijuana in the U.S.

Researchers say this represents a classic catch-22, as the paucity of research is the direct result of a federal blockade on such research by the DEA and the National Institute on Drug Abuse (NIDA). . .

Continue reading.

Written by LeisureGuy

19 April 2016 at 3:14 pm

Why the GOP cannot come up with an Obamacare replacement

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Paul Krugman points out the impossibility of the task the GOP has assigned itself: to formulate a conservative alternative to Obamacare. (Liberal alternatives are easy, as he points out: a single-payer system, for instance, or a national health service). He posts in his blog:

Hype springs eternal — certainly when it comes to Paul Ryan, whose media image as a Serious, Honest Conservative and policy wonk seems utterly impervious to repeated demonstrations that he is neither serious nor honest, and that he actually knows very little about policy. And here we go again.

But what really amazes me about the latest set of stories is the promise that Ryan will finally deliver the Republican Obamacare alternative that his colleagues in Congress have somehow failed to produce after all these years. No, he won’t — because there is no alternative.

Or maybe I should say that there is no alternative to the right. Alternatives to the left do exist. True socialized medicine — an American NHS — would be feasible economically; so would single-payer, in the form of Medicare for all. The reasons we aren’t doing those are political.

But on the right, is there a more free-market, more privatized system that could replace the Affordable Care Act without causing the number of uninsured to soar? No, as some of us have tried to explain many times.

Once again: a useful starting point is the problem of people with pre-existing conditions. . .

Continue reading.

Written by LeisureGuy

11 April 2016 at 12:32 pm

A good thing for parents to teach their kids: The 6-step handwashing method

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That’s from this article in Motherboard by Sarah Emerson, which has more details.

Written by LeisureGuy

8 April 2016 at 7:04 pm

More about hyperparathyroidism and the dangers of waiting it out: You die

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Sometimes a wait-and-see strategy is an enormously bad idea, and unfortunately some doctors still think they can wait out hyperparathyroidism—which, I suppose, is accurate: the doctor can indeed wait it out, but the patient cannot: s/he might die in the meantime.

I blogged yesterday to link to James Fallows’s account, and today he has some follow-up from readers, including one whose doctor was waiting it out for nine years, and apparently would be waiting it out still except the patient self-referred and got the surgery to cure the problem.

Written by LeisureGuy

2 April 2016 at 11:44 am

Posted in Healthcare, Medical

How the GOP destroyed itself under Obama

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Martin Longman has a very interesting piece in the Washington Monthly:

When President Obama invited the congressional Republicans to Blair House to discuss his comprehensive health care reform bill on February 25th, 2010, he had a variety of motives. Despite passing the Affordable Care Act through the House on November 7th, and through the Senate on Christmas Eve, the bill had not gone through the conference process that reconciles House and Senate versions of a bill into one piece of legislation which must then be passed (again) by both houses to become a law. On January 19th, Scott Brown unexpectedly won a special election in Massachusetts to fill the seat of the recently deceased Sen. Edward Kennedy, and the Democrats lost the 60th vote they needed in the Senate to reconcile their bill with the House’s version.

At that point, the bill was truly endangered, and the only way to save it was to use a controversial parliamentary procedure that I won’t go into in detail here. Suffice to say that some Democrats were feeling skittish about it, particularly in the House, because the procedural move required the House to pass the Senate version of the bill with no changes. Meanwhile, the Republicans were hammering the president for breaking a campaign pledge to conduct the health reform negotiations publicly and transparently on C-SPAN.

So, the president asked the Republicans to Blair House and put the whole thing on C-SPAN and made a big show of inviting them to provide their input to improve the bill. Looming over the whole thing was the obvious threat that the Democrats would pass the bill as it was if no Republicans came forward who were willing to trade their support for inclusion of some of their ideas.

Now, the Blair House meeting was naked political theater, but it didn’t have to be. The Republicans had adopted a policy of opposition in principle, meaning that the details of the bill were irrelevant. If you doubt me, Mitch McConnell twice went on the record to prove that I am right.

Only a few weeks after the Blair House meeting, McConnell explained to the New York Times why the details of the bill never mattered:

“It was absolutely critical that everybody be together because if the proponents of the bill were able to say it was bipartisan, it tended to convey to the public that this is O.K., they must have figured it out.”

A year later, in early 2011, he told Joshua Green of the Atlantic:

“We worked very hard to keep our fingerprints off of these proposals. Because we thought—correctly, I think—that the only way the American people would know that a great debate was going on was if the measures were not bipartisan. When you hang the ‘bipartisan’ tag on something, the perception is that differences have been worked out, and there’s a broad agreement that that’s the way forward.”

This obstructive strategy wasn’t restricted to the health care bill. It was across the board. And historians will debate how long it took President Obama to figure out that he was dealing with adversaries of zero good faith. But the president wasn’t deluded into thinking the Blair House meeting would create some kind of breakthrough. It was strictly for optics and to sooth anxiety in his own caucuses.

The thing is, the unwillingness of the Republicans to negotiate was their decision.

Keep that in mind when reading Daniel Henninger’s piece in the Wall Street Journal.

Barack Obama will retire a happy man. He is now close to destroying his political enemies—the Republican Party, the American conservative movement and the public-policy legacy of Ronald Reagan.

Today, the last men standing amidst the debris of the Republican presidential competition are Donald Trump, a political independent who is using the Republican Party like an Uber car; Ted Cruz, who used the Republican Party as a footstool; and John Kasich, a remnant of the Reagan revolution, who is being told by Republicans to quit.

History may quibble, but this death-spiral began with Barack Obama’s health-care summit at Blair House on Feb. 25, 2010. For a day, Republicans gave detailed policy critiques of the proposed Affordable Care Act. When it was over, the Democrats, including Mr. Obama, said they had heard nothing new.

That meeting was the last good-faith event in the Obama presidency. Barack Obama killed politics in Washington that day because he had no use for it, and has said so many times.

I don’t know if Henninger believes a single word of what he wrote there, but none of what he wrote about the Blair House summit is true. There was nothing “good faith” about the summit on either side, although, as I’ve said, there was also nothing precluding the Republicans from engaging in the legislative process. The “detailed policy critiques” the Republicans supposedly supplied that day were talking points that ignored the analysis of the non-partisan Congressional Budget Office. Virtually nothing they said or predicted turned out to be true. And no Republican offered to support the bill if only some of their concerns were addressed.

Henninger has correctly recognized that the president has presided over the destruction of his political enemies, but his analysis of how and why this happened reflects his permanent residence in a giant bubble of epistemic closure where the only sound is the chords of the Mighty Right-Wing Wurlitzer that plays all day long, every day.

For example:

After Mr. Obama won in 2008, Democrats controlled the Senate and House with large majorities. Normally, a party out of power is disabled but not destroyed by the presidency’s advantages. Democrats, when out of power, historically remain intact until the wheel turns again. Their ideology has been simple: tax and spend.

The minority Republicans began well. In 2010, ObamaCare passed with zero Republican Senate votes, and Dodd-Frank with only one Republican Senate vote. It was a remarkable display of party discipline.

Whatever you want to say about the ideology that drove Democrats to support theAffordable Care Act, it ought to be generously recognized that providing people access to health care was the priority, not taxing or spending to provide that access. As for the Republican opposition to the Dodd-Frank bill (and the American Recovery Act), this was more than a remarkable display of party discipline. It was an appalling display of refusal to take any responsibility for running the global economy into the Great Recession. When Dick Cheney justified Bush’s giant tax cuts by saying that Ronald Reagan had proven that budget deficits don’t matter, there was barely a peep of objection from conservative Republicans, but once Obama needed spending to save the economy, they suddenly thought the deficit was the biggest problem facing the country. They did nothing as the housing bubble inflated, pumped up by toxic under-regulated financial products and mortgage lending standards, and they bemoaned the bailout of failing colossal banks, but they couldn’t be bothered to support legislation designed to prevent a repeat of those mistakes.

For Henninger, this performance amounted to the Republicans “starting well” at the beginning of the Obama presidency.

In his opinion, things didn’t begin to go wrong until after Obama was reelected, and:

The right began demanding that congressional Republicans conduct ritualistic suicide raids on the Obama presidency. The MSM would have depicted these as hapless defeats by presidential veto, but some wanted the catharsis of constant public losses—on principle.

By early 2015, when the primary season began, virtually all issues inside the Republican Party had been reframed as proof of betrayal—either of conservative principle or of “the middle class.” Trade is a jobs sellout. Immigration reform is amnesty.

With his Cheshire Cat grin, Barack Obama faded into the background and let the conservatives’ civil war rip. For Republicans, every grievance, slight or loss became a scab to be picked, day after day.

In time, the attacks on “the establishment” and “donor class” became indiscriminate, ostracizing good people in the party and inside the conservative movement. The anti-establishment offensive created a frenzy faction inside the Republican base. And of course, it produced Donald Trump.

The Trumpians and Cruzians, who of late have been knifing one another in a blind rage, say this is a rebirth. So was Rosemary’s baby.

Where’s the recognition that the overheated rhetoric of the first term led to the calls for ritualistic suicide missions in the second? And, let’s be honest. The Republicans didn’t wait until the second term to begin the suicide missions. According to a tally kept by the Washington Post, the Republicans had already voted to repeal all or part of Obamacare 33 times by Election Day in 2012.

Now, for my money, the key moment that set the Republicans on the course of destruction didn’t come at the Blair House of February 25th, 2010. It came at the Republican retreat in Baltimore on January 29th, 2010. That’s when the president responded to a question from Rep. Marsha Blackburn of Tennessee about his health care bill: . . .

Continue reading.

Written by LeisureGuy

1 April 2016 at 9:00 am

Six years after Obamacare’s signing, Republicans still don’t have a health-care plan — or a leg to stand on

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James Downie has an excellent column in the Washington Post showing the GOP vacuum regarding healthcare:

Six years ago, President Obama signed the Affordable Care Act into law. Before and after the stroke of the president’s pen, Republicans predicted doom and gloom for an Obamacare-infected United States: skyrocketing health-care costs, a ruined economy, the end of freedom and so on.

It didn’t take long to see that these predictions proved just as true as Ronald Reagan’s prediction that Medicare would lead to a future where “you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” Twenty million people have gained health insurance from the Affordable Care Act — a number that would be higher but for the 19 red states that have rejected the law’s Medicaid expansion. The percentage of Americans without insurance has declined from 17.1 percent to 11.9 percent in the past two years. A new report from the Robert Wood Johnson Foundation, as reported in Forbes, found states “that expanded Medicaid under the Affordable Care Act saw more job growth, lower health inflation and spent less on social and health services unneeded once more residents had medical coverage.” Initiatives in the ACA designed to encourage hospitals to reduce errors are credited with helping to save 87,000 lives (and nearly $20 billion). Premium increases on the Obamacare exchanges last year averaged less than 4 percent — before tax credits. And the law hasn’t just preserved the decline in health-care spending growth; it has also accelerated it.

To be sure, the law isn’t an unmitigated success. Fewer people than projected have signed up on the exchanges, which could be a challenge to their long-term stability in some places (though that has led to the law being cheaper than expected). Half the co-ops set up under the law have failed. But overall, the law looks to be a clear victory. Perhaps as a result, Republicans have quietly dialed down the anti-Obamacare rhetoric. Two of the three remaining Republican candidates embrace key parts of the ACA, and few GOP Senate candidates in close races are trumpeting their opposition to the law. (It can’t help that some conservatives, including Supreme Court justices, still need versing in the law’s basics.)

Yet even if Obamacare were the train wreck that Republicans claim it has been, their failure to unite around a replacement would then be all the more incredible. Two thousand and two hundred days after Obamacare became law, there have been zero Republican votes on a replacement. In that time, Taylor Swift became a pop artist, the House and the Senate have changed hands in separate elections, Obama won reelection and millions of women have reaped the benefits of free birth control.

All of which brings me to Paul Ryan (R-Wis.). The House speaker’s speech last week was mostly covered as an implied rebuke to the outrageous rhetoric of Donald Trump. Some — rightly — took him to task for not mentioning Trump by name. But that dodge was merely a matter of degree. What differentiated Ryan’s speech from a mere critique of Trump’s tone was what he offered against it. “Ideas, passionately promoted and put to the test—that’s what politics can be,” he said. “That’s what our country can be.” Praising Jack Kemp’s push for tax cuts, he said, “All it took was someone willing to put policy on paper and promote it passionately. This is the basic concept behind the policy agenda that House Republicans are building right now.”

Except the “policy on paper” is nowhere to be found. In December, Ryan promised to introduce an alternative to Obamacare this year. Then he began to edge away from that. (His office tried to spin it as staying out of the process of assembling an alternative, dodging the reality that choosing a specific GOP alternative will require the speaker to rally support around it.) . . .

Written by LeisureGuy

30 March 2016 at 4:46 pm

Posted in Congress, GOP, Healthcare


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