Psyche, Science, and Society

Secret clinical trials research puts patients at risk for no benefit

[UPDATED with link to article] An article in the Canadian Press raises serious new questions about the dangers posed to research participants by our corporate-dominated drug development system. Patients were enrolled in clinical trials of a type of blood replacement product despite previous research indicating that these products posed serious risks. The Canadian Press reports that new article in the Journal of the American Medical Association [Available here. Also see accompanying editorial.] pooled data from 13 published studies and three unpublished ones. Their review “showed people who got blood substitutes were 30 per cent more likely to die than those who did not.” These researchers were unable to obtain data from other unpublished studies conducted by companies.

There appear to be several major ethics issue here.

Participants in these studies, who supposedly give informed consent, were not told that prior research suggested these products were harmful. Nor, apparently, were the ethics committees [IRBs] that approved these studies and the informed consent procedures told about the dangers.

The results of several clinical trials were never published, presumably because they produced results indicating the products were harmful. Thus, important information was withheld from the public, putting patients recruited for additional clinical trials at risk.

Lead author Dean Fergusson, a clinical trials expert, said the withholding of the negative results meant ethics boards and trial participants could not accurately weigh the risks and benefits of the research.

“How can patients or their decision makers make truly involved consent without all this information? I think that’s a huge message,” said Fergusson….

The lack of disclosure suggests company stock prices were placed at a higher priority than the safety of people being asked to go into clinical trials, experts suggest.

An additional concern is whether ir is ethical to recruit people for clinical trials, placing the participants at potential risk — which is always the case in drug trials — and then not publish the results. A critical consideration in obtaining approval for research from IRBs is supposed to be a balancing of risks and benefits. Often, the benefits are not to individuals, but to society. If the results are not published, these benefits are not realized. So people are put at risk for no benefit, which is supposedly unethical. It would seem that a commitment to publish the results should be required of any study where there is a serious risk to participants. Otherwise these studies should not be allowed. Note that this argument is different than the argument, with which I also agree, that these studies should be published for the good of the public and that corporate profit should not be allowed to trump public good.

Finally, there is a question of whether these trials should have been undertaken in the first place, given the bad track record of this type of blood replacement products in prior research. The JAMA authors apparently believe the answer is “no”:

The authors were critical of the FDA for not requiring the companies to publish their findings, and for allowing additional trials to be conducted after the risk should have been apparent.

“At some point, somebody should have realized that we’ve tried it in trauma patients, we’ve tried it in surgical patients, we’ve tried it in stroke patients, we’ve tried many different formulations and we keep finding the same result,” said Dr. Charles Natanson, lead author of the meta-analysis, a technique in which data from a number of trials are combined and re-analyzed.

“At some point, and we sort of argue in the paper that may have been the year 2000 . . . it was time to put a halt” to additional trials, Natanson said.

This information raises profound questions about our entire drug development system. The corporate dominance of drug development creates inherent conflicts of interest that put both clinical study participants and the public at risk. Either we need to find ways of overcoming those conflicts of interest or we need to develop a new system for drug development. How many scandals will it take till the health professions, policy-makers, and the public are fed up?

Add comment April 30th, 2008

Almerindo Ojeda: Guantánamo healthcare providers serve interrogators

Last week the Washington Post reported that Guantánamo and CIA detainees alleged that they were given strange psychoactive drugs by force. Jeff Stein of CQ had reported a similar things a few weeks ago. I wrote about this in my piece Involuntary Drugging of US Detainees. In response to the Post article, Almerindo Ojeda wrote a letter to the Post detailing additional evidence that the provision of health services and interrogations at Guantánamo have been intimately linked, with health providers serving the abusive interrogation regime.

Almerindo is the Director of the Center for the Study of Human Rights in the Americas at the University of California at Davis, where they have a wonderful archive, the Guantánamo Testimonials Project with testimony from many sources on the conditions at the prison. The Project — by typing out many handwritten documents, transforming them into searchable text ,and carefully organizing them– is one of the premier sources for such materials as detaneee or FBI accounts of abuses there. My colleagues and I use it all the time.

In any case, the Post did not print Almerindo’s letter. He has thus revised it slightly and given me permission to post it here:

A recent article in the Washington Post (Detainees Allege Being Drugged, Questioned, 04/22/08), quotes Pentagon spokesman Cmdr. J.D. Gordon as saying that interrogations at Guantanamo do not affect or influence medical treatment of the detainees held there. Unfortunately, the evidence suggests otherwise.

Attached to a recent motion on behalf of Guantanamo prisoner Salim Ahmed Hamdan are medical records stating that, on 8/28/02, an ointment was applied to Mr. Hamdan’s lower back and then covered with moleskin–a treatment which the attending medic described as a “special request for medical attention per FBI“. In addition, a medical record for the same detainee dated 2/19/04 carries the annotation “no rec time per Intel“–or “no recreation time per Intelligence” (I understand that exercise is an important component treatment of sciatica, which Mr. Hamdan suffered from then).
Moreover, one of the “counterresistance techniques” approved on December 2, 2002 by then Secretary Rumsfeld against Guantanamo detainees was the use of isolation facilities for up to thirty days. Here, and for selected detainees, “the OIC [or Officer in Charge], Interrogation Section, will approve all contacts with the detainee, to include medical visits of a non-emergent nature.” Although blanket permission to use this and other techniques was rescinded by then Secretary Rumsfeld a month later, their use was still allowed on a case-by-case basis and with approval of the Secretary of Defense (see memos 16-23 in The Torture Papers, by Greenberg and Dratel).

Similarly, section 30-6-d of the 2004 Camp Delta Standard Operating Procedures posted recently by Wikileaks reads as follows:

Detainees who are on self-harm precautions [i.e. those at high risk for suicide or other self-injury] that are scheduled for interrogation will have their clinical status and risk assessment verified by the licensed Behavioral Health staff prior to leaving the block. Detainees on self-harm precautions are generally not clinically stable enough to leave the block.

So the needs of interrogation may trump the reasons for placing a GTMO prisoner in a mental health ward. And this as a matter of standard operating procedure.

Almerindo Ojeda, Director
Center for the Study of Human Rights in the Americas
University of California at Davis
http://humanrights.ucdavis.edu

Add comment April 28th, 2008

Loosing a home in Katrina predics psychological distress

The University of Michigan has released a press release on a new pilot study of Katrina victims which finds that those who lost a house were five times as likely to suffer serious psychological distress. They also found that blacks, the poor, and those who were born in Louisiana suffered more distress. However, these categories were undoubtedly overlapping, so, in addition to traditional caveats, one should be extra careful drawing causal conclusions. It should also be noted that the small scale of the study (N=144) means that the five-fold figure should not be taken very seriously except as an indicator of a large effect.

On te other hand, the study is based on systematic probability sampling in order to represent the population and includes follow-up with many who moved away.

Here is the press release:

No place like home: Katrina’s lasting impact

ANN ARBOR, Mich.—New Orleans residents who lost their homes in Hurricane Katrina were over five times more likely to experience serious psychological distress a year after the disaster than those who did not.

That is one of the findings from a study presented at the annual meeting of the Population Association of America in New Orleans.

The study, conducted by University of Michigan researcher Narayan Sastry and Tulane University’s Mark VanLandingham, examines the mental health status of pre-Katrina residents of the City of New Orleans in the fall of 2006—one year after the hurricane. It also describes and analyzes disparities in mental health by race, education and income.

Based on a pilot survey that drew a stratified, area-based probability sample of pre-Katrina dwellings in the city, the study is one of the first to provide data representative of the pre-hurricane population. It was designed by the RAND Corporation, a nonprofit research organization.

A total of 144 individuals participated in the pilot study, including many who moved away from the area after the disaster and had not returned a year later. More than half the study participants were black, nearly two-thirds had a high school diploma or less education, and nearly 60 percent were unmarried. Nearly three-fourths were employed in the month before the hurricane hit.

According to Sastry, who is affiliated with RAND and with the U-M Institute for Social Research (ISR), about 60 percent of study participants had no psychological distress at the time of the interview, while about 20 percent had mild-to-moderate mental illness and another 20 percent had serious mental illness.

To assess mental illness, respondents were asked a series of questions from a widely used measure of general psychological distress. How often during the past 30 days, they were asked, did you feel nervous, hopeless, restless or fidgety, depressed, that everything was an effort, and worthless”

Blacks reported substantially higher rates of serious psychological distress than whites, Sastry and Van Landingham reported. Almost one-third of blacks were found to have a high degree of distress, compared to just six percent of whites. Those with higher incomes and more education were much less likely to experience serious psychological distress, and those born in Louisiana were much more likely to have serious distress.

The researchers also examined how the extent of housing damage was related to psychological distress a year after the disaster. They found that those who lost their homes were five times more likely than those who did not to have serious psychological distress. In all, about 66 percent of the respondents reported that their homes were badly damaged or unlivable.

“Our findings suggest that severe damage to one’s home is a particularly important factor behind socioeconomic disparities in psychological distress, and possibly behind the levels of psychological distress,” Sastry said. “These effects may be partly economic, because, for most families who own their home, home equity is the largest element of household wealth.

“Apart from the financial losses, severely damaged or destroyed housing may prevent people who want to return to New Orleans from doing so because they lack a place to live. This affects their social ties, their employment, and many other factors.

“The magnitude and permanence of a housing loss suggests that for many people, the psychological consequences of this experience could be profound and lasting.”

Sastry and VanLandingham emphasize that these findings are preliminary, and that a larger study is now being planned.

Add comment April 21st, 2008

California legislative resolution targets health providers aiding torture

One of the most exciting new developments in the fight against psychologist and other health provider collusion in torture are bills in several state legislatures on the issue. In California, Senate Joint Resolution 19 is scheduled to come to a vote any day. [See my earlier coverage here, here, and here.] The Sacramento Bee recently covered the issue. [Note: the vote has been delayed several times since this article on April 5.]:

State senator targets torture
By Aurelio Rojas - arojas@sacbee.com

The California Senate is preparing to weigh in on the hot-button topic of torture, with a twist that combines elements of the Hippocratic oath and the military oath.

Under a resolution that state Sen. Mark Ridley-Thomas plans to put to a vote Thursday, California regulators would notify physicians and other health professionals that they could lose their license and be prosecuted by the state if they are involved in the torture of suspected terrorists.

The Los Angeles Democrat chairs the Senate Committee on Business, Professions and Economic Development, which oversees boards that license health professionals in the state.

During a committee hearing in January, Ridley-Thomas said there is evidence that physicians, psychologists and nurses licensed by the state “have participated in torture or its coverup against detainees in U.S. custody.”

He cited “confirmed reports from the International Red Cross, New England Journal of Medicine, military records and first-person accounts.”

“California has the obligation, I believe, to notify its licensees of laws pertaining to torture that may result in prosecution,” Ridley-Thomas said.

The senator said physicians have reportedly advised interrogators whether prisoners were fit enough to survive “physical maltreatment, informed interrogators about prisoners’ phobias and other psychological vulnerabilities that could be exploited.”

Invoking the Hippocratic oath that physicians traditionally take, he said the state can “withdraw its consent to torture by demanding that its health professionals remember their oath to first do no harm.”

Dr. Vito Imbascini, state surgeon of the California National Guard, said “a few Californians were among the practitioners in the healing arts involved in torture” at U.S. military facilities at Abu Ghraib prison in Iraq and Guantánamo Bay, Cuba.

“But given the tiny number of renegade offenders, we think a more effective approach (than the resolution) would be to target those offenders,” said Imbascini, who represented the 35,000-physician California Medical Association at the hearing.

Neither Senate Republican leader Dick Ackerman nor incoming GOP leader Dave Cogdill was available for comment Friday. But Senate Joint Resolution 19 is likely to provoke spirited debate between Democrats and Republicans in the state Senate, similar to that seen in Congress since 2004 when accounts of abuse, torture, sexual exploitation and homicide at Abu Ghraib came to public attention.

President Bush – with an emphatic “We do not torture” – has defended U.S. interrogation practices and called the treatment of suspected terrorists lawful, despite similar reports of torture at U.S. facilities at Guantánamo and Bagram Air Base in Afghanistan.

Bush has repeatedly noted the world has changed dramatically since the Sept. 11, 2001, terrorist attacks on New York and Washington and says the United States must defend itself with “enhanced interrogation techniques,” which critics contend is a euphemism for torture.

Over the years, the Legislature has weighed in on complicated national issues over which it has no jurisdiction, such as wars and international treaties. But in this instance, it does appear to have some legal standing.

Dr. Richard Fantozzi, president of the California Medical Board, which licenses physicians, cited a 2005 legal opinion by the state attorney general’s office that concluded the state has jurisdiction over licensees serving in the military or practicing in federal facilities.

Fantozzi said the state Supreme Court has also ruled that a state licensing agency may discipline a licensee for conduct occurring outside the state.

But Fantozzi cautioned the committee that under the doctrine of sovereign immunity, if the military does not cooperate, the state “would be prevented from conducting an effective and thorough investigation.”

Barbara Olshansky, a New York attorney, told the committee “all our military laws and regulations, from the field manual to the manuals on interrogation, prohibit torture.”

She said the U.S. Supreme Court also has affirmed that courts have the responsibility to stop torture.

But Olshansky, who filed the groundbreaking suit in which the Supreme Court ruled that U.S. courts have jurisdiction over claims brought by Guantánamo detainees, said there is ample evidence of torture at U.S. facilities.

“We can prove that medical personnel reviewed detainee medical treatment for serious conditions or allowed treatment only on the condition that they cooperate with interrogators,” said Olshansky, who has assembled a network of 750 attorneys representing Guantánamo detainees.

She alleged American medical personnel have also assisted in drugging detainees during interrogations.

But Imbascini, a colonel in the U.S. Medical Corps, said that during two decades of service he has been responsible for hundreds of detainees and has never witnessed “a single act that could construed as abuse.”

“In fact, I can say quite proudly that the care that I and other Californians rendered to detainees and POWs was identical to that provided our own sick and wounded soldiers,” Imbascini told the committee.

Add comment April 14th, 2008

Statistical tools help guide responses to human rights crises

Science News discusses the complexities of using statistics to guide humanitarian responses, using the issue of estimating Iraq mortality as an example:

Humanitarian Statistics
Statistical tools help guide responses to human rights crises

Julie J. Rehmeyer

In late 2006, a statistical study of deaths that occurred after the invasion of Iraq ignited a storm of controversy. This Lancet study estimated that more than 650,000 additional Iraqis died during the invasion than would have at pre-invasion death rates, a vastly higher estimate than any previous. But in January, a World Health Organization study placed the number at about 150,000.

The conflicting findings highlight just how difficult it is to gather reliable information in a war zone. But they also show the increasing involvement of statisticians in informing responses to humanitarian crises. In addition to the work in Iraq, statisticians have gathered evidence that has aided in the prosecution of Slobodan Milosevic, guided reparations for the civil war in Sierra Leone, and helped determine the needs of Katrina survivors, among many other projects.

“You can go to a congressional hearing or an international war crimes tribunal and you can hear the stories,” says Lynn Lawry of the International Medical Corps. “But how many are we talking about? How many people are at risk? How many people are affected?”

Statisticians are well-suited to answer these questions because they have the tools to put together partial information into a global picture. For example, even if complete records can’t be gathered, a statistician can survey a small number of randomly chosen people affected by a crisis and infer from their experiences the likely impact on the population as a whole. For example, Jana Asher of Carnegie Mellon University in Pittsburgh, Pa., developed an estimate of the rates of rape across Sierra Leone by determining how many women from a national sample had been raped.

But humanitarian crises pose huge challenges. Little information may be available—even from before a crisis—about how many people live where. Even if a previous census was taken, the high birth and death rates in developing countries tend to quickly make censuses outdated. Areas within continuing war zones can be unsafe for survey workers.

“When you have a displaced population that has been forced to flee their homes, all the traditional census methods really break down very badly,” says David Banks, a statistician at Duke University in Durham, N.C. “The refugees don’t have addresses. They’re wandering from one camp to another. Communication is poor.”

These challenges have to be met with very carefully designed protocols. For example, the Lancet study of Iraq, with the shockingly high mortality rates, was initially criticized for not surveying people who lived in back alleys because the areas were too dangerous for surveyors. Les Roberts, who was at Johns Hopkins University in Baltimore at the time but is now at Columbia University, and his collaborators on the study argued that the critics had misunderstood their randomization technique.

Random surveys are not the only useful statistical method. To tally the number of deaths related to the conflict in Timor-Leste, Romesh Silva and Patrick Ball of the Human Rights Data Analysis Group combined incomplete datasets to generate a broader picture of events. The Indonesian military claimed that its occupation of Timor-Leste had caused no deaths. Many stories had been told of killings and famine, but Silva and Ball wanted solid evidence.

Along with gathering about 8,000 personal accounts conveyed to the Commission for Reception, Truth and Reconciliation, Silva and Ball conducted a census of public graveyards including 319,000 gravestones and a survey of a random sample of 1,400 households about displacements and deaths. The researchers found that the different lines of evidence corroborated one another strongly, adding to the strength of each approach. In addition, Silva and Ball could observe how often names recurred across the different databases and get a much better estimate of the total number of deaths across the country.

They found that Indonesian occupation of Timor-Leste from 1974 to 1999 led to more than 100,000 deaths beyond what would have been expected in peacetime, through a combination of direct killings, famine, and illness.

The conflicting studies in Iraq show just how tricky it is to apply these methods in messy real-life situations. About the Lancet study, Asher says, “I don’t think there was anything obvious in what they did that someone can point to and say this method is flawed. But the WHO study used appropriate methodology too.”

The most suspect part of the Lancet study, Asher says, is that the researchers didn’t supervise the survey workers closely. On the other hand, the World Health Organization relied on government workers to administer the questionnaires. People can be intimidated by government workers and be less inclined to say much, a phenomenon that is particularly common in unstable countries. The only way to resolve the conflict, Asher says, is to do yet another study, with an even more careful design.

If you would like to comment on this article, please see the blog version.

References:

Asher, J., D. Banks, and F.J. Scheuren, eds. 2008. Statistical Methods for Human Rights. New York: Springer. See www.springer.com/statistics/social/book/
978-0-387-72836-0.

Iraq Family Health Survey Study Group. 2008. Violence-related mortality in Iraq from 2002 to 2006. New England Journal of Medicine 358(Jan. 31):484-493. Available at http://content.nejm.org/cgi/content/full/358/5/484.

Burnham, G. . . . and L. Roberts. 2006. Mortality after the 2003 invasion of Iraq: A cross-sectional cluster sample survey. Lancet 368(Oct. 21):1421-1428. Abstract available at http://dx.doi.org/10.1016/S0140-6736(06)69491-9.

Silva, R., and P. Ball. 2006. The Profile of Human Rights Violations in Timor-Leste, 1974–1999. A report by the Benetech Human Rights Data Analysis Group to the Commission on Reception, Truth and Reconciliation of Timor-Leste. Available at www.hrdag.org/resources/timor_chapter_graphs/
timor_chapter_page_01.shtml.

Add comment March 31st, 2008

NPR downplays Iraqi dead

FAIR has issued an Action Alert: NPR Underreports Iraq Deaths, dealing with an NPR report by Scott Simon in which he stated:

“This coming Wednesday marks the fifth anniversary of the start of the war in Iraq. So far 3,975 U.S. service men and women have died. Estimates on the number of Iraqis killed range from 47,000 to 151,000, depending on the source.”

These numbers are, of course, silly. The 151,000 presumably comes from the recent World Health Organization/Iraqi Ministry of Health study recently reported in NEJM. FAIR speculates that th 47,000 is from Iraq Body Count, but it is their estimate of those killed as of June 2006 [In the email below I erred and said August] and is considerably higher now, around 85,000. And other studies from the Lancet and the British polling firm ORB yield far higher estimates of around one million [extrapolating the Lancet study]. Thus, the number of dead from violence is almost certainly at least 250,000 and most likely higher, perhaps far higher. NPR miserably failed its listeners, the Iraqi people, and the truth in this instance. Alas, this is far from the only time that NPR has been a vessel for propaganda supporting the war.

FAIR calls upon concerned listeners to write the NPR ombudsman and ask for an investigation. Here is my email:

I hope that you will look into the very misleading figures in the March 15 braodcast in which Scott Simon described estimates of Iraqis killed since the war began as from 47,000 to 151,000. As a researcher, I have followed this area closely. I can imagine no credible source for the 47,000 figure as Iraq Body Count (IBC, which counts those dead reported in the Western media, puts the current figure of such reported deaths as over 80,000.  IBC is certainly a radical undercount given the exigencies of reporting in a war-torn country where over 100 reporters have been killed and many others kidnapped or arrested.

Further, the 151,000 figure, from the World Health Organization and Iraqi Ministry of Health, was as of August 2006, before the most intense violence.

Further, several additional studies from Johns Hopkins epidemiologists (published in the Lancet) and from the British ORB polling organization have arrived at far higher figures. Johns Hopkins estimated around 600,000 victims of violence by summer 2006 and the ORB estimated around 1,000,000 by the end of 2007.

Surely NPR listeners, as they weigh the five years of war deserve accurate information on the current state of knowledge on the true costs of that war.This Ameriacan Life has reported on the Lancet studies. Surely over reporters should as well. Much as I love Scott Simon, in this case, his report was grossly deceptive at best. The purpose of NPR is to create an informed citizenry. In this instance you failed your mission.

Please investigate and make sure that such an egregious error does not recur.

Thank you very much.

Post your email here.

Add comment March 26th, 2008

Palast: God Damn America — Especially Pennsylvania

Greg Palast, in his inimitable way, illuminated Pastor Wright’s relevance to Pennsylvania whites:

God Damn America — Especially Pennsylvania
by Greg Palast

[Sunday, March 23, 2008, Forest City, PA ]

The kids were snoozing so I drove along the back roads skirting the Lackawanna River on a dawn hunt for black coffee and a newspaper.

I think even Norman Rockwell would have found this place too sticky sweet, too postcard: the weathered barns, the fallow fields perfectly snow-frosted; red, white and blue flags already up on the clapboard farmhouses and the white-washed church in the valley already full for Easter prayers.

At a gas station, I scored the paper and coffee, spilled some on the front page – the closest thing I’ve got to a religious ritual – then parked in front of a row of insanely pretty salt-box houses shining like mad teeth on the river bank. One was missing a pick-up in the driveway; its screen door was left half-open, and there was a letter taped to the window. The Sheriff’s Notice of eviction. Another foreclosure.

God damn America.

I know that’s what Obama’s spiritual guide would say.

But why? It seems likes He’s already done a pretty good job of damning these United States.

And He seems to have really taken it out on this corner of Pennsylvania.

The gargantuan Bethlehem steel works have dwindled to a few robot-operated mills controlled from Mumbai, India. The only remainders of nearby Carbondale’s mining industry are in display cases at the ageing Coal Inn. But you could still get out by selling your home to ski tourists from New York – until this year when mortgage markets turned cancerous.

That leaves Forest City’s one industry, lumbering – which we can kiss goodbye since a recent ruling by the NAFTA board which allows the import of cheap Canadian wood.

Some local kid has made the paper having been thrown, helmet first, into the volcano called Iraq. The Scranton Times-Tribune, two pages after the photo of a priest blessing a bowl of who knows what, noted that three soldiers killed in yesterday’s bombing are, “pushing the death toll in the five-year conflict to nearly 4,000” – which is true if you don’t count Iraqi dead. But Someone must be counting them. (From way up in heaven, I wonder if we look like a nation of Christians – or an empire of Romans.)

Phil Ochs, before he killed himself, wrote,

“This is a land full of power and glory,
Beauty that words cannot recall.
But her power shall rest on the strength of her freedom.
Her glory shall rest on us all.”

Whatever. It’s a difficult place to be an atheist, in this America, surfeited as it is on every vista with signs of His overwhelming grace and His exasperated wrath. It’s as if the Lord Himself is just as confused and frustrated and disappointed as the rest of us by blessings so abused.

There’s one consolation. He has apparently granted Pennsylvanians the privilege, come April 22, of choosing which Democrat will lose in November.

Which may not mean much to Sandy Ryder on whom the spirit of Easter has landed like a ton of bricks. Sandy, says the flyer tacked up at the Bingham diner, was, “Recently diagnosed with Inflammatory Breast Cancer.” She’s a, “Single mother of two – Tony and Brandon – and Grandmother of one – Jason.”

And there they were in a photocopied portrait, the earnest elder son and little Jason to her right, the young slacker (Tony? Brandon?) slouched to her left. The town’s hawking a benefit for Sandy, $10 at the door, “including Food and Beverage” and a “Chinese auction.”

(I’ll bet Al Qaeda could pick up some recruits here – if Osama would offer health insurance.)

Whatever. This is, after all, Holy Week, which marks the anniversary of the grounding of the Exxon Valdez, the day the giant oil corporation soaked 1,200 miles of Alaska’s coast with crude sludge. March 24 marks 19 years since the grounding and 19 years since Exxon’s promise to compensate the ruined fishermen. You should watch the 19-year-old video-tape of Exxon’s man in Alaska. I especially like the part where he tells the fishermen, “You have had some good luck – and you don’t realize it.”

I know some of the fishermen on the TV footage, like the Anderson family, Eyak Natives. I can tell you, the Eyak don’t feel so lucky, still waiting for the Supreme Court to act on Exxon’s latest stall on payment. They’ve seen plenty of Sheriff’s Notices these past 19 years.

So Happy Easter.

George Bush tells us he’s, “feeling just fine.” And we should be glad for him, I suppose.

Bush ends his most belligerent speeches by saying, “God bless America.”

So, why hasn’t He?

Maybe you can tell us, Mr. President: Why hasn’t He?

***************
Greg Palast is the author of the NY Times best-selling books Armed Madhouse and Best Democracy Money Can Buy. Read his reports at www.GregPalast.com and sign up for the audio podcasts RSS here.

Add comment March 24th, 2008

PBS series on health disparities: Unatural Causes

Apropos the New York Times article I posted earlier today o increasing health disparities between rich and poor in the US, a friend has just sent this notice of a related upcoming PBS series, Unnatural Causes, which asks “is inequality making us sick?” that starts this week. Here is the series summary that she sent:

UNNATURAL CAUSES sheds light on mounting evidence that demonstrates how work, wealth, neighborhood conditions and lack of access to power and resources can actually get under the skin and disrupt human biology as surely as germs and viruses. But it’s not just the poor who are sick—so are the middle classes. At each descending rung of the socio-economic ladder, people tend to be sicker and die sooner. What’s more, at every level, many communities of color are worse off than their white counterparts. Compelling personal stories—spanning the country—demonstrate how social conditions are as vital to our health as diet, smoking and exercise.  As Harvard epidemiologist David Williams points out, investing in our schools, improving housing, integrating neighborhoods, better jobs and wages, giving people more control over their work, these are as much health strategies as smoking diet and exercise. And these are the stories that UNNATURAL CAUSES tells.

HOUR ONE: In Sickness and In Wealth (56 mins) What are the connections between healthy bodies and healthy bank accounts? In Louisville, Kentucky, the issues faced by a CEO, a lab supervisor, a janitor, and a welfare mother bring into sharp relief how socio-economic status shapes opportunities to lead healthy lives.  People of color face an additional burden. Solutions, public health officials believe, lie not in more pills but in better social policies.

HOUR TWO: When the Bough Breaks (28 mins) and Becoming American (28 min)
Why do African American infant mortality rates remain more than twice as high as white Americans? Researchers are circling in on a provocative hypothesis:  the chronic stress of racism can become embedded in African American mothers’ bodies and take a toll on their children even before they leave the womb.

In contrast, recent Mexican immigrants, though often poorer, tend to be healthier than the average American. But the longer they live here, the worse their relative health becomes. What’s protective about new immigrant communities that we can all learn from? And what erodes this shield over time?

HOUR THREE: Bad Sugar (28 min) and Place Matters (28 min) The O’odham Indians of Arizona suffer one of the highest rates of Type 2 diabetes in the world. But is this due to their genes, or is it part of the body’s response to decades of poverty, oppression and historical trauma? A new approach rooted in the community re-gaining control over its destiny offers hope where medical-only interventions have failed.

Why is your street address such a good predictor of your health? How can your surrounding built and social environment get inside your body like smog and toxic waste? As recent immigrants move into long-neglected African American urban neighborhoods, their health is beginning to deteriorate too. What can be done to create healthy communities?

HOUR FOUR:  Collateral Damage (28 min) and Not Just a Paycheck (28 min)

Globalization and the U.S. military have disrupted the lives of Marshall Islanders. Many have ended up in the unlikely place of Springdale, Arkansas where a legacy of poverty and powerlessness continues to take a toll on their bodies.

In western Michigan, a factory closure undermines the lives and health of a white, working class community. But the same company shut down their Swedish plant with hardly a ripple thanks to very different social policies.

http://www.unnaturalcauses.org/

Add comment March 23rd, 2008

May 3: Torture and the American Psyche

For those in the Boston area, here’s an announcement of a forum that I am both helping to organize and speaking at. A flyer, suitable for printing and posting, is available here:

Torture and the American Psyche:
Blurring the Boundaries Between Healers and Interrogators
Saturday, May 3, 2008,
9:30 am – 12:30 pm

First Parish Unitarian Church,
382 Walnut Street,
Brookline, MA
http://www.firstparishinbrookline.org

admission is free

DESCRIPTION:

Every day the news brings further details about our country’s recent use of torture and other detainee abuse in national security, and of the debates among our leaders and citizens of practical, legal, and ethical implications of this use. We invite concerned citizens and members of the mental health professions to join together in an open discussion of the far reaching human and moral implications of our nation’s use of torture.

We will discuss the emotional and ethical consequences of being members of a society that sanctions torture and that uses psychologists to make sure abuse is medically and “ethically” conducted. We will have three speakers, followed by a discussion among the panelists and with the members of the audience on the diverse aspects of this topic. Our aim is to facilitate a discussion which will include the emotional, ethical and spiritual dimensions of this topic and allow room for all to participate.

We understand that the topic will give pause to all who consider attending and care will be taken to ensure that the discussion will not devolve into a political diatribe or an immersion into a graphic depiction of torture. We hope that some perspective on feasible actions may emerge from the discussion.

SPEAKERS:

Eric Fair currently a divinity student at Princeton will speak from his experience as a civilian contract interrogator in Baghdad, Fallujah, and Abu Ghraib in early 2004. He will lend his first person account to our conversation.

Leonard Rubenstein, J.D. President of Physicians for Human Rights, a Nobel Prize winning organization, is an attorney and veteran of many human rights struggles. He will speak of the role of torture in our contemporary political culture.

David Sloan-Rossiter, Ph.D. will bring his long standing interest in using a psych oana¬lytic perspective to aid communities to the role of moderator of the program. He is co-chair of the Curriculum Committee at Boston Institute for Psychotherapy and Massachusetts Institute for Psychoanalysis.

Stephen Soldz, Ph.D. a local psychoanalyst, social activist and Professor at the Boston Graduate School of Psychoanalysis, is one of the nation’s leaders in opposing psycholo¬gist participation in torture and abuse. He will speak to the history of that struggle in the context of the broader struggle for human rights.

SPONSORS:

Boston Graduate School of Psychoanalysis, Institute for the Study of Violence
Boston Institute for Psychotherapy
Boston Psychoanalytic Society and Institute
Brookline PeaceWorks
Coalition for an Ethical Psychology
First Parish of Brookline
Massachusetts Association for Psychoanalytic Psychology
Massachusetts Institute for Psychoanalysis
Physicians for Human Rights
Psychoanalytic Institute of New England
Psychologists for Social Responsibility–End Torture Action Committee

Registration is not required but would help us anticipate attendance. If you are interested in attending this program, please email MLoug23@aol.com by Monday, April 28, 2008.

Download flyer here.

CONTINUING EDUCATION

The Massachusetts Institute for Psychoanalysis (MIP) offers Continu¬ing Education for psychologists and social workers. MIP is approved by the American Psychological Association to sponsor continuing education for psychologists. MIP maintains responsibility for this program and its content.
For further information, please contact Mary Loughlin at (978) 692-4790.

Learning Objectives
1. Participants will gain a greater understanding of the way that torture affects all members of a society not just the tortured.
2. Participants will have deeper appreciation of how psychologists’ presence at Guantanamo endorses the United States government stance that torture is morally acceptable.
3 Participants will appreciate the importance of engaging political issues from multiple perspectives including ethical, emotional, spiritual and psychological.

Suggested Readings:
Fair, E. (2007, February 9). An Iraq Interrogator’s Nightmare.
Horton, S., & Rejali, D. (2008, February 13). Six Questions for Darius Rejali, Author of ‘Torture and Democracy’.
Physicians for Human Rights, & Human Rights First. (2007, August). Leave No Marks: Enhanced Interrogation Techniques and the Risk of Criminality.
Soldz, S. (2007, April 13). Aid and Comfort for Torturers: Psychology and Coercive Interrogations in Historical Perspective.

1 comment March 23rd, 2008

Do “free markets” increase life expectancy disparities?

The New York Times today documents that the gap between rich and poor in the US involves not just income, but a growing disparity in life expectancy. Before people start complaining about Bush, not that the main data they present concerns the increase from 1980-1982, the beginning of the Reagan administration, to 1998-2000, the end of the Clinton administration. Presumably, Clinton’s free market ideology and policies contributed to the widening disparities.

Gap in Life Expectancy Widens for the Nation

by Robert Pear

New government research has found “large and growing” disparities in life expectancy for richer and poorer Americans, paralleling the growth of income inequality in the last two decades.

Life expectancy for the nation as a whole has increased, the researchers said, but affluent people have experienced greater gains, and this, in turn, has caused a widening gap.

One of the researchers, Gopal K. Singh, a demographer at the Department of Health and Human Services, said “the growing inequalities in life expectancy” mirrored trends in infant mortality and in death from heart disease and certain cancers.

The gaps have been increasing despite efforts by the federal government to reduce them. One of the top goals of “Healthy People 2010,” an official statement of national health objectives issued in 2000, is to “eliminate health disparities among different segments of the population,” including higher- and lower-income groups and people of different racial and ethnic background.

Dr. Singh said last week that federal officials had found “widening socioeconomic inequalities in life expectancy” at birth and at every age level.

He and another researcher, Mohammad Siahpush, a professor at the University of Nebraska Medical Center in Omaha, developed an index to measure social and economic conditions in every county, using census data on education, income, poverty, housing and other factors. Counties were then classified into 10 groups of equal population size.

In 1980-82, Dr. Singh said, people in the most affluent group could expect to live 2.8 years longer than people in the most deprived group (75.8 versus 73 years). By 1998-2000, the difference in life expectancy had increased to 4.5 years (79.2 versus 74.7 years), and it continues to grow, he said.

After 20 years, the lowest socioeconomic group lagged further behind the most affluent, Dr. Singh said, noting that “life expectancy was higher for the most affluent in 1980 than for the most deprived group in 2000.”

“If you look at the extremes in 2000,” Dr. Singh said, “men in the most deprived counties had 10 years’ shorter life expectancy than women in the most affluent counties (71.5 years versus 81.3 years).” The difference between poor black men and affluent white women was more than 14 years (66.9 years vs. 81.1 years).

The Democratic candidates for president, Senators Hillary Rodham Clinton of New York and Barack Obama of Illinois, have championed legislation to reduce such disparities, as have some Republicans, like Senator Thad Cochran of Mississippi.

Peter R. Orszag, director of the Congressional Budget Office, said: “We have heard a lot about growing income inequality. There has been much less attention paid to growing inequality in life expectancy, which is really quite dramatic.”

Life expectancy is the average number of years of life remaining for people who have attained a given age.

While researchers do not agree on an explanation for the widening gap, they have suggested many reasons, including these:

¶Doctors can detect and treat many forms of cancer and heart disease because of advances in medical science and technology. People who are affluent and better educated are more likely to take advantage of these discoveries.

¶Smoking has declined more rapidly among people with greater education and income.

¶Lower-income people are more likely to live in unsafe neighborhoods, to engage in risky or unhealthy behavior and to eat unhealthy food.

¶Lower-income people are less likely to have health insurance, so they are less likely to receive checkups, screenings, diagnostic tests, prescription drugs and other types of care.

Even among people who have insurance, many studies have documented racial disparities.

In a recent report, the Department of Veterans Affairs found that black patients “tend to receive less aggressive medical care than whites” at its hospitals and clinics, in part because doctors provide them with less information and see them as “less appropriate candidates” for some types of surgery.

Some health economists contend that the disparities between rich and poor inevitably widen as doctors make gains in treating the major causes of death.

Nancy Krieger, a professor at the Harvard School of Public Health, rejected that idea. Professor Krieger investigated changes in the rate of premature mortality (dying before the age of 65) and infant death from 1960 to 2002. She found that inequities shrank from 1966 to 1980, but then widened.

“The recent trend of growing disparities in health status is not inevitable,” she said. “From 1966 to 1980, socioeconomic disparities declined in tandem with a decline in mortality rates.”

The creation of Medicaid and Medicare, community health centers, the “war on poverty” and the Civil Rights Act of 1964 all probably contributed to the earlier narrowing of health disparities, Professor Krieger said.

Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” - what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.

Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.

“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.”

A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.”

Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.

Under federal law, officials must publish an annual report tracking health disparities. In the fifth annual report, issued this month, the Bush administration said, “Over all, disparities in quality and access for minority groups and poor populations have not been reduced” since the first report, in 2003.

The rate of new AIDS cases is still 10 times as high among blacks as among whites, it said, and the proportion of black children hospitalized for asthma is almost four times the rate for white children.

The Centers for Disease Control and Prevention reported last month that heart attack survivors with higher levels of education and income were much more likely to receive cardiac rehabilitation care, which lowers the risk of future heart problems. Likewise, it said, the odds of receiving tests for colon cancer increase with a person’s education and income.

1 comment March 23rd, 2008