In a New York Times Op Ed, Leonard Rubenstein and Brig. Gen. [ret] Stephen Xenakis discuss the contrast between the investigation of the torture lawyers and the lack of any investigation of the torture physicians and psychologists:
Doctors Without Morals
By Leonard S. Rubenstein and Stephen N. Xenakis
After five years of investigation, the Justice Department has released its findings regarding the government lawyers who authorized waterboarding and other forms of torture during the interrogation of suspected terrorists at Guantánamo Bay and elsewhere. The report’s conclusion, that the lawyers exercised poor judgment but were not guilty of professional misconduct, is questionable at best. Still, the review reflects a commitment to a transparent investigation of professional behavior.
In contrast, the government doctors and psychologists who participated in and authorized the torture of detainees have escaped discipline, accountability or even internal investigation.
It is hardly news that medical staff at the C.I.A. and the Pentagon played a critical role in developing and carrying out torture procedures. Psychologists and at least one doctor designed or recommended coercive interrogation methods including sleep deprivation, stress positions, isolation and waterboarding. The military’s Behavioral Science Consultation Teams evaluated detainees, consulted their medical records to ascertain vulnerabilities and advised interrogators when to push harder for intelligence information.
Psychologists designed a program for new arrivals at Guantánamo that kept them in isolation to “enhance and exploit” their “disorientation and disorganization.” Medical officials monitored interrogations and ordered medical interventions so they could continue even when the detainee was in obvious distress. In one case, an interrogation log obtained by Time magazine shows, a medical corpsman ordered intravenous fluids to be administered to a dehydrated detainee even as loud music was played to deprive him of sleep.
When the C.I.A.’s inspector general challenged these “enhanced interrogation” methods, the agency’s Office of Medical Services was brought in to determine, in consultation with the Justice Department, whether the techniques inflicted severe mental pain or suffering, the legal definition of torture. Once again, doctors played a critical role, providing professional opinions that no severe pain or suffering was being inflicted.
According to Justice Department memos released last year, the medical service opined that sleep deprivation up to 180 hours didn’t qualify as torture. It determined that confinement in a dark, small space for 18 hours a day was acceptable. It said detainees could be exposed to cold air or hosed down with cold water for up to two-thirds of the time it takes for hypothermia to set in. And it advised that placing a detainee in handcuffs attached by a chain to a ceiling, then forcing him to stand with his feet shackled to a bolt in the floor, “does not result in significant pain for the subject.”
The service did allow that waterboarding could be dangerous, and that the experience of feeling unable to breathe is extremely frightening. But it noted that the C.I.A. had limited its use to 12 applications over two sessions within 24 hours, and to five days in any 30-day period. As a result, the lawyers noted the office’s “professional judgment that the use of the waterboard on a healthy individual subject to these limitations would be ‘medically acceptable.’”
The medical basis for these opinions was nonexistent. The Office of Medical Services cited no studies of individuals who had been subjected to these techniques. Its sources included a wilderness medical manual, the National Institute of Mental Health Web site and guidelines from the World Health Organization.
The only medical source cited by the service was a book by Dr. James Horne, a sleep expert at Loughborough University in Britain; when Dr. Horne learned that his book had been used as a reference, he said the C.I.A. had distorted his findings and misrepresented his research, and that its conclusions on sleep deprivation were nonsense.
Dr. Horne had used healthy volunteers who were subject to no other stresses and could withdraw at any time, while C.I.A. and Pentagon interrogators used a broad array of stresses in combination on the detainees. Sleep deprivation, he said, mixed with pain-inducing positioning, intimidation and a host of other stresses, would probably exhaust the body’s defense mechanisms, cause physical collapse and worsen existing illness. And that doesn’t begin to acknowledge the dire psychological consequences.
The shabbiness of the medical judgments, though, pales in comparison to the ethical breaches by the doctors and psychologists involved. Health professionals have a responsibility extending well beyond nonparticipation in torture; the historic maxim is, after all, “First do no harm.” These health professionals did the polar opposite.
Nevertheless, no agency — not the Pentagon, the C.I.A., state licensing boards or professional medical societies — has initiated any action to investigate, much less discipline, these individuals. They have ignored the gross and appalling violations by medical personnel. This is an unconscionable disservice to the thousands of ethical doctors and psychologists in the country’s service. It is not too late to begin investigations. They should start now.
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Leonard S. Rubenstein is a visiting scholar at the Johns Hopkins Bloomberg School of Public Health. Stephen N. Xenakis is a psychiatrist and a retired Army brigadier general.
March 1st, 2010
A couple of years ago science writer Gary Taubes published Good Calories, Bad Calories, which argued that the conventional view that obesity was due to overeating was inconsistent with the evidence was likely false. Yaubes argued, rather, that it was more likely, and more consistent with the evidence, that carbohydrates in the diet were the problem. He also argued that the evidence that saturated fats were the cause of heart disease was extremely weak. He then went on to argue that many other conditions may be associated with increased carbohydrate consumption.
I am not a medical doctor, a biochemist, not nutrition expert. But I am a researcher and methodologist. From that perspective, I was extremely impressed with the quality of his argument. He convinced me that his argument was a very serious and important one.
As a researcher and methodologist, I know that we never trust people, especially in medicine and the human sciences, who have discovered that received belief is wrong. It is all too easy to become convinced by good rhetoric. Therefore, I sought out critiques of his work. At least at the time, a few months after the book came out, most critiques I could find were hatchet jobs. In one instance an author claimed that Taubes misquoted him. Taubes, however, produced the entire email from this researcher in which his meaning was clear. But Taubes went further. He showed that he had sent a followup email to this researcher asking if he really meant to say what Taubes interpreted him to say. The researcher was unambiguous in reioterating the correctness of Taubes’ interpretation.
Other critiques simply reiterated received wisdom on the value of low fat, high carbohydrate diets, with no real presentation of evidence, and essentially accused Taubes of being a danger to society. When I saw the quality of these “critiques,” I figured he likely has such a command of the facts that few were willing to challenge him at that level.
Taubes recently summarized his argument regarding obesity at the Dartmouth-Hitchcock Medical Center in a lecture: Why we gain weight. Judging from the questions, he received a very sympathetic and open-minded response. Perhaps at least parts of medicine are finally ready to take seriously this evidence-based challenge to received wisdom.
Watching the lecture, I was again reminded of the power of his argument and his mastery of a vast amount of evidence. He concludes. “I’m not trying to convince that it’s true. I’m trying to convince you that it’s worth taking seriously.” In that spirit, I recommend the lecture, and the book, very highly.
Watch it here. Do not take Taubes’ position to be the truth. But do try and encourage experts in relevant fields to seriously engage with it. Even if wrong, the science can only advance by taking this sophisticated argument seriously.
January 9th, 2010
One of the most popular academics supporting the Senate-Obama health plan has apparently failed to disclose his $297,600 contract contract with the Department of Health and Human Services. From emptywheel. As pointed out below, he is a major source for claims that taxing “expensive” health plans is effective policy:
Jonathan Gruber Failed to Disclose His $297,600 Contract with HHS
By emptwheel
MIT health economist Jonathan Gruber has been the go-to source that all the health care bill apologists point to to defend otherwise dubious arguments. But he has consistently failed to disclose that he has had a sole-source contract with the Department of Health and Human Services since June 19, 2009 to consult on the “President’s health reform proposal.”
He is one source for the claim that the excise tax will result in raises for workers (though his underlying study is in-apt to the excise tax question). He is the basis for the argument that the Senate bill reduces families’ risk–even if it remains totally unaffordable. Even Politico stenographer Mike Allen points to Gruber’s research.
But none of the references to Gruber I’ve seen have revealed that Gruber has a $297,600 contract with HHS to produce,
a technical memorandum on the estimated changes in health insurance coverage and associated costs and impacts to the government under alternative specifications of health system reform. The requirement includes developing estimates of various health reform proposals on health insurance coverage and cost. The alternative specifications to be considered will be derived from the President’s health reform proposal. [my emphasis]
(h/t Mote Dai)
The President’s health reform proposal? But I thought this was the Senate’s health reform proposal?!?!? (wink!)
Now, HHS says they had to put Dr. Gruber in charge of evaluating health care reform proposals because he’s got,
a proven micro-simulation model with the flexibility to ascertain the distribution of changes in health care spending and public and private sector health care costs due to a large variety of changes in health insurance benefit design, public program eligibility criteria, and tax policy.
Even assuming that Gruber is the only one in the world who can run these simulations, don’t you think it’s rather, um, dubious that the guy evaluating the heath care reform–for $300,000–is also the package’s single biggest champion?
And no one has been transparent about this contract?
January 8th, 2010
From Norway comes news of a simple, but effective, solution to the problem of Methicillin-resistant Staphylococcus aureus (MRSA) or “superbugs” that, as they spread, pose extreme dangers to us and our healthcare system. In the US and other countries, a visit to the hospital means worrying about exposure to MRSAs. There are 19,000 MRSA deaths in the US every year. But not in Norway.
The reason: Norwegians stopped taking so many drugs….
Norway’s model is surprisingly straightforward.
• Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.
• Patients with MRSA are isolated and medical staff who test positive stay at home.
• Doctors track each case of MRSA by its individual strain, interviewing patients about where they’ve been and who they’ve been with, testing anyone who has been in contact with them.
They allow minor illnesses to take their course:
“We don’t throw antibiotics at every person with a fever. We tell them to hang on, wait and see, and we give them a Tylenol to feel better,” says Haug.
However, Norwegian society has a crucial difference that allows them to wait. They have a social democracy:
All workers are paid on days they, or their children, stay home sick.
Can you imagine such a radical idea in the US?
Acting reasonably also pays off in reduced costs:
Norway responded swiftly to initial MRSA outbreaks in the 1980s by cutting antibiotic use. Thus while they got ahead of the infection, the rest of the world fell behind.
In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.
In the U.S., cases have soared and MRSA cost $6 billion last year. Rates have gone up from 2 percent in 1974 to 63 percent in 2004. And in the United Kingdom, they rose from about 2 percent in the early 1990s to about 45 percent, although an aggressive control program is now starting to work.
Alas, Norway is not separate from the rest of the world. It’s success may not last:
But Elstrom [Norway's MRSA control director] worries about the bacteria slipping in through other countries. Last year almost every diagnosed case in Norway came from someone who had been abroad.
“So far we’ve managed to contain it, but if we lose this, it will be a huge problem,” he said. “To be very depressing about it, we might in some years be in a situation where MRSA is so endemic that we have to stop doing advanced surgeries, things like organ transplants, if we can’t prevent infections. In the worst case scenario we are back to 1913, before we had antibiotics.”
Fortunately, Norway’s success is replicable elsewhere:
But can Norway’s program really work elsewhere?
The answer lies in the busy laboratory of an aging little public hospital about 100 miles outside of London. It’s here that microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly low Nordic MRSA rates while facing her own burgeoning cases.
So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish, asking doctors to almost completely stop using two antibiotics known for provoking MRSA infections.
One month later, the results were in: MRSA rates were tumbling. And they’ve continued to plummet. Five years ago, the hospital had 47 MRSA bloodstream infections. This year they’ve had one.
“I was shocked, shocked,” says Liebowitz, bouncing onto her toes and grinning as colleagues nearby drip blood onto slides and peer through microscopes in the hospital laboratory.
When word spread of her success, Liebowitz’s phone began to ring. So far she has replicated her experiment at four other hospitals, all with the same dramatic results.
“It’s really very upsetting that some patients are dying from infections which could be prevented,” she says. “It’s wrong.”
Around the world, various medical providers have also successfully adapted Norway’s program with encouraging results. A medical center in Billings, Mont., cut MRSA infections by 89 percent by increasing screening, isolating patients and making all staff — not just doctors — responsible for increasing hygiene.
In Japan, with its cutting-edge technology and modern hospitals, about 17,000 people die from MRSA every year.
Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, says doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.
Hori now limits antibiotics only to patients who really need them and screens and isolates high-risk patients. So far his hospital has cut the number of MRSA cases by two-thirds.
In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh about conducting a small test program. It started in one unit, and within four years, the entire hospital was screening everyone who came through the door for MRSA. The result: an 80 percent decrease in MRSA infections. The program has now been expanded to all 153 VA hospitals, resulting in a 50 percent drop in MRSA bloodstream infections, said Dr. Robert Muder, chief of infectious diseases at the VA Pittsburgh Healthcare System.
“It’s kind of a no-brainer,” he said. “You save people pain, you save people the work of taking care of them, you save money, you save lives and you can export what you learn to other hospital-acquired infections.”
Pittsburgh’s program has prompted all other major hospital-acquired infections to plummet as well, saving roughly $1 million a year.
“So, how do you pay for it?” Muder asked. “Well, we just don’t pay for MRSA infections, that’s all.”
Will this approach catch on?
Meanwhile, the Norwegian experience is another reminder that, in healthcare, less is not always worse. If only the breast cancer “advocates” who came out so strongly against the reasonable new recommendations of the US Prevention Task Force that not all women between 40 to 50 need to be screened and that, for many other, biannual screening is enough had understood this lesson.
January 3rd, 2010
ur country is in a violence crisis. Those with power, either a little power or a lot, seem determined to use it. Raw Story brings us this report of a man in the Chicago suburbs who was tasered 11 times because he inadvertently hit a cop while unconscious during a diabetic seizure. Apparently the cop, and his colleagues who didn’t make any effort to stop the brutalizer are still employed. We can only assume that the police department in this community has no problem with its officers tasering unconscious people who are having seizures. It should not take a lawsuit to achieve accountability for this horrific incident:
Chicago cop tasered unconscious diabetic 11 times
By Raw Story
Police officers from two Chicago suburbs are being sued after one of them allegedly Tasered a man having a diabetic seizure because the diabetic involuntarily hit the officer while being taken to an ambulance.Prospero Lassi, a 40-year-old employee of Southwest Airlines, filed the lawsuit (PDF) with a federal court in Chicago last week, following an April 9, 2009, incident in which Lassi was taken to hospital following a violent diabetic seizure — and being Tasered 11 times while unconscious.
That day, Lassi’s roommate found the man on the floor of his apartment having a seizure and foaming at the mouth, according to the statement filed with the court. The roommate called 911 for help, and police officers from the Brookfield and LaGrange Park police departments arrived to help with the situation.
As police officers were helping the paramedics move Lassi to an ambulance, Lassi — still in the midst of the seizure and described as “unresponsive” — involuntarily smacked one of the officers with his arm.
“Reacting to Mr. Lassi’s involuntary movement, one or more of the [officers] pushed Mr. Lassi to the ground, forcibly restraining him there,” the complaint states. “[LaGrange Park Officer Darren] Pedota then withdrew his Taser, an electroshock weapon that uses electrical current to disrupt a person’s control over his muscles, and electrocuted Mr. Lassi eleven times.
“Mr. Lassi remained immobile on the floor and was unable to defend himself during this attack. None of the other LaGrange and Brookfield Defendants attempted to interrupt Defendant Pedota’s repeated use of the Taser.”
The filing says that Lassi spent five days in hospital, and “as a result of this incident, Mr. Lassi has permanent scars on his skin, including a scar on his face. Mr. Lassi has also suffered, and continues to suffer, neurological and musculoskeletal injuries, among other injuries.”
According to Courthouse News, Lassi is seeking “punitive damages for battery, excessive force, and failure to intervene.”
January 2nd, 2010
NPR recently had an amazing story by Alix Spiegel of how pharmaceutical company Merck help turn a research term, osteopenia, into a diagnosis “treated,” often ineffectively, by Merck’s drug Fosamax. The story involves the creation of osteopenia, a supposed subthreshold version of osteoporosis or low bone density. I also involves the systematic dissemination of inexpensive “diagnostic” machines for the new disorder that, however, fail to assess bone density where most breaks occur, that is, where it really matters. It involves Merck funding a number of organizations to lobby for the Medicare law to be changed, allowing doctors to be reimbursed for using these new machines of questionable utility. And it involves Merck selling a lot of Fosamax to women with the new “disorder” and making a lot of money. And it involves questions as to whether Fosamax is actually helpful, or may even be harmful, in these women who a few years ago were only experiencing normal aging. It also involves a lack of any plans to conduct the long-term follow-up studies necessary to determine if this treatment is helping, useless, or harmful.
This is a story that tells us so much about what is wrong with our healthcare system. Questionable diagnoses created and treatments administered to make money for large corporations. Alas, the recent reactions to the changed breast cancer screening guidelines suggest that once a constituency of doctors, drug dealers companies, and advocacy groups sees “benefits” from a new prevention approach, it will be extremely difficult to change.
Read or listen to the story here.
January 1st, 2010
As Bob Herbert points out today, the Senate-Obama health plan wants to decrease my access to healthcare and reduce my wages. For, you see, my health plan is on the verge of being one of those Cadillac plans that only workers get. and everyone knows that workers get too much of everything.
The Senate has decided that, rather than tax the wealthy, they will try and destroy the healthcare received by many of us. I live in Massachusetts. Healthcare costs are high here and rising rapidly. Our insurer, ever concerned about keeping costs down, raised the insurance rate 22% this year. My employer, suffering its financial problems of its own, decided to pass on all the costs. Fortunately, we could increase costs by only 15% by switching to a worse plan. But even that plan is so expensive it is on the verge of being a Cadillac plan, being taxed at 40%.
This is what Senate Dems and Obama call reform? If the final bill includes this awful tax, it will be a disaster for millions. Bob Herbert explains:
A Less Than Honest Policy
By Bob Herbert
There is a middle-class tax time bomb ticking in the Senate’s version of President Obama’s effort to reform health care.
The bill that passed the Senate with such fanfare on Christmas Eve would impose a confiscatory 40 percent excise tax on so-called Cadillac health plans, which are popularly viewed as over-the-top plans held only by the very wealthy. In fact, it’s a tax that in a few years will hammer millions of middle-class policyholders, forcing them to scale back their access to medical care.
Which is exactly what the tax is designed to do.
The tax would kick in on plans exceeding $23,000 annually for family coverage and $8,500 for individuals, starting in 2013. In the first year it would affect relatively few people in the middle class. But because of the steadily rising costs of health care in the U.S., more and more plans would reach the taxation threshold each year.
Within three years of its implementation, according to the Congressional Budget Office, the tax would apply to nearly 20 percent of all workers with employer-provided health coverage in the country, affecting some 31 million people. Within six years, according to Congress’s Joint Committee on Taxation, the tax would reach a fifth of all households earning between $50,000 and $75,000 annually. Those families can hardly be considered very wealthy.
Proponents say the tax will raise nearly $150 billion over 10 years, but there’s a catch. It’s not expected to raise this money directly. The dirty little secret behind this onerous tax is that no one expects very many people to pay it. The idea is that rather than fork over 40 percent in taxes on the amount by which policies exceed the threshold, employers (and individuals who purchase health insurance on their own) will have little choice but to ratchet down the quality of their health plans.
These lower-value plans would have higher out-of-pocket costs, thus increasing the very things that are so maddening to so many policyholders right now: higher and higher co-payments, soaring deductibles and so forth. Some of the benefits of higher-end policies can be expected in many cases to go by the boards: dental and vision care, for example, and expensive mental health coverage.
Proponents say this is a terrific way to hold down health care costs. If policyholders have to pay more out of their own pockets, they will be more careful — that is to say, more reluctant — to access health services. On the other hand, people with very serious illnesses will be saddled with much higher out-of-pocket costs. And a reluctance to seek treatment for something that might seem relatively minor at first could well have terrible (and terribly expensive) consequences in the long run.
If even the plan’s proponents do not expect policyholders to pay the tax, how will it raise $150 billion in a decade? Great question.
We all remember learning in school about the suspension of disbelief. This part of the Senate’s health benefits taxation scheme requires a monumental suspension of disbelief. According to the Joint Committee on Taxation, less than 18 percent of the revenue will come from the tax itself. The rest of the $150 billion, more than 82 percent of it, will come from the income taxes paid by workers who have been given pay raises by employers who will have voluntarily handed over the money they saved by offering their employees less valuable health insurance plans.
Can you believe it?
I asked Richard Trumka, president of the A.F.L.-C.I.O., about this. (Labor unions are outraged at the very thought of a health benefits tax.) I had to wait for him to stop laughing to get his answer. “If you believe that,” he said, “I have some oceanfront property in southwestern Pennsylvania that I will sell you at a great price.”
A survey of business executives by Mercer, a human resources consulting firm, found that only 16 percent of respondents said they would convert the savings from a reduction in health benefits into higher wages for employees. Yet proponents of the tax are holding steadfast to the belief that nearly all would do so.
“In the real world, companies cut costs and they pocket the money,” said Larry Cohen, president of the Communications Workers of America and a leader of the opposition to the tax. “Executives tell the shareholders: ‘Hey, higher profits without any revenue growth. Great!’ ”
The tax on health benefits is being sold to the public dishonestly as something that will affect only the rich, and it makes a mockery of President Obama’s repeated pledge that if you like the health coverage you have now, you can keep it.
Those who believe this is a good idea should at least have the courage to be straight about it with the American people.
December 29th, 2009
Antony Lerman, writing in the Guardian, calls upon the Israeli Medical Association to investigate reports that Israeli physicians are complicit in torture. The World Medical Association should also stop its double standard and investigate reports of Israeli abuse, just as they responded to reported abuses by Iran:
Israel’s doctors must allay torture fears
Allegations of Israeli doctors colluding in the torture of Palestinians must be investigated
By Antony Lerman
One of the disturbing features of the persistent use of torture by many countries in conflict situations around the world is the role some doctors play in condoning it. The World Medical Association (WMA), which “promot[es] the highest possible standards of medical ethics, [and] provides ethical guidance to physicians”, is crystal clear on this practice. Its 1975 Tokyo declaration states unequivocally that “physicians shall not countenance, condone or participate in the practice of torture or other forms of cruel, inhuman or degrading procedures, and in all situations, including armed conflict and civil conflict”. True to its principles, in October, in response to reports about the possible collusion of doctors in the abuse of prisoners in Israeli and World Medical , the WMA passed a unanimous motion at its annual meeting in Delhi urging national medical associations to speak out in support of the rights of patients and doctors there. But is the WMA being selective in its condemnations?
The specific problem of doctors’ complicity in the torture of detainees in the Middle East was raised at an international patients’ rights conference in Turkey in November. In a presentation she made, Dr Ruchama Marton, head of Physicians for Human Rights-Israel (PHR-I), called for the WMA to play a central role in establishing a network “to voice complaints and provide assistance to those who are willing to struggle against torture”. National medical associations and human rights organisations should work together “to campaign against torture in general and against the participation of physicians in torture procedures”. In saying this, Marton was thinking about what some regard as the very unsatisfactory situation in Israel.
Evidence has been produced by the Public Committee Against Torture in Israel (PCATI) and PHR-I of doctors examining interrogated Palestinians before, during or after torture without documenting, reporting or resisting, and by providing medical documents and information to the bodies responsible for the torturing. These are all expressly prohibited under WMA and Israel Medical Association (IMA) guidelines, as is even the presence of a doctor where there is torture.
These allegations have never been seriously investigated by the IMA, despite persistent urging by PHR-I as part of its long struggle against the use of torture and its bringing of the issue to the attention of the WMA. In the summer the IMA cut ties with the human rights body, accusing it of fomenting antisemitism. Dr Yoram Blachar, the chairman of the IMA, wrote in a letter that “the outrageous situation is that PHR’s activity serves as fertile ground for antisemitism, anti-Israelism and anti-Zionism”.
In May, a letter sent to the WMA council through the chairman, Dr Edward Hill, signed by 725 doctors from 43 countries, and supported by PHR-I, requested that the WMA investigate the IMA for failing to conform to its code on the absolute prohibition of doctors participating in and condoning torture. And it called for the immediate resignation of the then president of the WMA, Blachar. In November, Dr Derek Summerfield of the Institute of Psychiatry at the University of London, convenor of the group who signed the May letter, wrote to the new WMA president, Dr Dana Hanson, on behalf of the lead signatory Professor Alan Meyers of Boston University, and again pressed for action to investigate the IMA. And he also referred to the apparent discrepancy between the treatment of reports of collusion in torture in Iran and in Israel. At the end of October, Meyers spoke to WMA council chair Dr Edward Hill and was told that the WMA would neither be responding to nor commenting on the May letter. So far, that stance seems remain in place.
The current situation is deeply unsatisfactory. Even though Israel’s supreme court in 1999 finally ruled that methods of torture used at that time by the security forces were illegal, a loophole was left for interrogators who tortured in “ticking bomb” situations, which ultimately allowed old forms of torture to creep back in by the mid-2000s, as a 2007 report by PCATI showed. So there is good reason to be seriously concerned about the use of torture today.
It is important to recognise that torture would not be possible without the support and safety net of doctors and that doctors are key in exposing and stopping the practice. Israel therefore needs to do two things. First, allegations that Israeli doctors colluded in torture must be confronted and thoroughly investigated. Otherwise, this ongoing affair can only damage the reputation of the vast majority of doctors in Israel, many of whom belong to PHR-I, who will have no truck whatsoever with torture and who assiduously apply their principles of medical ethics equally to all who come into their care, irrespective of national, ethnic or religious origin.
Second, PHR-I proposals for guidelines to help doctors identify torture and for legislation that would make it obligatory to report suspicion of torture and protect whistleblowers – measures that would protect doctors’ independence and make it much harder for interrogators to use torture – must be adopted by the IMA and the government.
No double standards are being applied to Israel here. By implementing the proposals, Israel would simply be conforming to WMA guidelines – and doing at least one thing that would help repair its international position.
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December 23rd, 2009
Rep. Lousise Slaughter, chair of the House Rules Committee, condemns the Senate bill, though a spokesperson says she may still vote for the final bill:
A Democrat’s view from the House: Senate bill isn’t health reform
By Louise M. Slaughter
Editor’s note: Rep. Louise M. Slaughter, a Democrat, represents the 28th Congressional District of New York. Slaughter is the first woman to chair the House Rules Committee and the only microbiologist in Congress.
Washington (CNN) — The Senate health care bill is not worthy of the historic vote that the House took a month ago.
Even though the House version is far from perfect, it at least represents a step toward our goal of giving 36 million Americans decent health coverage.
But under the Senate plan, millions of Americans will be forced into private insurance company plans, which will be subsidized by taxpayers. That alternative will do almost nothing to reform health care but will be a windfall for insurance companies. Is it any surprise that stock prices for some of those insurers are up recently?
I do not want to subsidize the private insurance market; the whole point of creating a government option is to bring prices down. Insisting on a government mandate to have insurance without a better alternative to the status quo is not true reform.
By eliminating the public option, the government program that could spark competition within the health insurance industry, the Senate has ended up with a bill that isn’t worthy of its support.
The public option is the part of our reform effort that will lower costs, improve the delivery of health care services and force insurance companies to offer rates and services that are reasonable.
Although the art of legislating involves compromise, I believe the Senate went off the rails when it agreed with the Obama Administration to water down the reform bill and no longer include the public option.
But that’s not the only thing wrong with the Senate’s version of the health care bill.
Under that plan, insurance companies can punish older people, charging them much higher rates than the House bill would allow.
In the House, we fought hard to repeal McCarran-Ferguson, the antitrust exemption that insurance companies have enjoyed for years. We did that because we believed firmly that those Fortune 500 corporations should not enjoy special treatment.
Yet the Senate bill does not include that provision — despite assurances from some members that they will seek to add it. By ending that protection, we will be able to go after insurance companies with federal penalties for misleading advertising or dishonest business practices.
The House bill would cover 96 percent of legal residents, while the Senate covers 94 percent. Compared with the House bill, the Senate’s bill makes it much easier for employers to avoid the responsibility of providing insurance for their workers.
And of course, the Senate bill did not remove the onerous choice language intended to appeal to anti-abortion forces.
Now don’t get me wrong; the current House and Senate bills are a significant improvement over the status quo. Given the hard path to reform and the political realities of next year, there is a sizable group within Congress that wants to simply cut any deal that works and call it a success. Many previous efforts have failed, and the path to reform is littered with unsuccessful efforts championed by Franklin Delano Roosevelt, Harry Truman and Bill Clinton.
Supporters of the weak Senate bill say “just pass it — any bill is better than no bill.”
I strongly disagree — a conference report is unlikely to sufficiently bridge the gap between these two very different bills.
It’s time that we draw the line on this weak bill and ask the Senate to go back to the drawing board. The American people deserve at least that.
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The opinions expressed in this commentary are solely those of Louise Slaughter.
December 23rd, 2009