Posts filed under 'Healthcare'

IMF loans linked to increased TB

The New York Times reported yesterday on a new study concluding that receipt of loans from the International Monetary Fund is associated with increased tuberculosis cases. The bottom line, from the Editors’ Summary (posted below the article):

“[T]hese results challenge the proposition that the forms of economic development promoted by the IMF necessarily improve public health”

Here is the Times article:

Rise in TB Is Linked to Loans From I.M.F.

By Nicholas Bakalar

The rapid rise in tuberculosis cases in Eastern Europe and the former Soviet Union is strongly associated with the receipt of loans from the International Monetary Fund, a new study has found.

Critics of the fund have suggested that its financial requirements lead governments to reduce spending on health care to qualify for loans. This, the authors say, helps explain the connection.

The fund strongly disputes the finding, saying the former communist countries would be much worse off without the loans.

“Tuberculosis is a disease that takes time to develop,” said William Murray, a spokesman for the fund, “so presumably the increase in mortality rates must be linked to something that happened earlier than I.M.F. funding. This is just phony science.”

The researchers studied health records in 21 countries and found that obtaining an I.M.F. loan was associated with a 13.9 percent increase in new cases of tuberculosis each year, a 13.3 percent increase in the number of people living with the disease and a 16.6 percent increase in the number of tuberculosis deaths.

The study, being published online Tuesday in the journal PLoS Medicine, statistically controlled for numerous other factors that affect tuberculosis rates, including the prevalence of AIDS, inflation rates, urbanization, unemployment rates, the age of the population and improved surveillance.

The lead author, David Stuckler, a research associate at Cambridge University, defended the study against the fund’s criticisms, noting that the researchers considered whether increased mortality might have led to more loans rather than the other way around.

Instead, they found that the increase in tuberculosis mortality followed the lending; each 1 percent increase in credit was associated with a 0.9 percent increase in mortality. And when a country left an I.M.F. loan program, mortality rates dropped by an average of 31 percent.

“When you have one correlation, you raise an eyebrow,” Mr. Stuckler said. “But when you have more than 20 correlations pointing in the same direction, you start building a strong case for causality.”

The study can be read here. Here is the Editors’ Summary for the article:

Editors’ Summary

Background.

Tuberculosis—a contagious, bacterial infection—has killed large numbers of people throughout human history. Over the last century improvements in public health began to reduce the incidence (the number of new cases in the population in a given time), prevalence (the number of infected people), and mortality rate (number of people dying each year) of tuberculosis in several countries. Many authorities thought that tuberculosis had become a disease of the past. It has become increasingly clear, however, that regions impacted by health and economic changes since the 1980s have continued to face a high and sometimes increasing burden of tuberculosis. In order to boost funding and resources for combating the global tuberculosis problem, the United Nations has set a target of halting and reversing increases in global tuberculosis incidence by 2015 as one of its Millennium Development Goals. Yet one region of the world—Eastern Europe and the former Soviet Union—is not on track to achieve this goal.

Why Was This Study Done?

To achieve these targets, the World Health Organization (WHO) and tuberculosis physicians’ groups promote the expansion of detection and treatment efforts against tuberculosis. But these efforts depend on the maintenance of good health infrastructure to fund and support health-care workers, clinics, and hospitals. In countries with significant financial limitations, the development and maintenance of these health system resources are often dependent upon international donations and financial lending. The International Monetary Fund (IMF) is a major source of capital for resource-deprived countries, but it is unclear whether its economic reform programs have positive or negative effects on health and health infrastructures in recipient countries. There are indications, for example, that recipient countries sometimes reduce their public-health spending to meet the economic targets set by the IMF as conditions for its loans. In this study, the researchers examine the relationship between participating in IMF lending programs of varying sizes and durations by 21 post-communist Central and Eastern European and former Soviet Union countries and changes in tuberculosis incidence, prevalence, and mortality in these countries during the past two decades.

What Did the Researchers Do and Find?

To examine how participation in IMF lending programs affected tuberculosis control in these countries, the researchers developed a series of statistical models that take into account other variables (for example, directly observed therapy programs, HIV rates, military conflict, and urbanization) that might have affected tuberculosis control. Participation in an IMF program, they report, was associated with increases in tuberculosis incidence, prevalence, and mortality rate of about 15%, which corresponds to hundreds of thousands of new cases and deaths in this region. Each additional year of participation increased tuberculosis mortality rates by 4.1%; increases in the size of the IMF loan also corresponded to greater tuberculosis mortality rates. Conversely, when countries left IMF programs, tuberculosis mortality rates dropped by roughly one-third. The authors’ further statistical tests indicated that IMF lending was not a positive response to worsened tuberculosis control but precipitated this adverse outcome and that lending from non-IMF sources of funding was associated with decreases in tuberculosis mortality rates. Consistent with these results, IMF (but not non-IMF) programs were associated with reductions in government expenditures, tuberculosis program coverage, and the number of doctors per capita in each country. These findings associated with mortality were also found when analyzing tuberculosis incidence and prevalence data.

What Do These Findings Mean?

These findings indicate that IMF economic programs are associated with significantly worsened tuberculosis control in post-communist Central and Eastern European and former Soviet Union countries, independent of other political, health, and economic changes in these countries. Further research is needed to discover exactly which aspects of the IMF programs were associated with the adverse effects on tuberculosis control reported here and to see whether IMF loans have similar effects on tuberculosis control in other countries or on other non–tuberculosis-related health outcomes. For now, these results challenge the proposition that the forms of economic development promoted by the IMF necessarily improve public health. In particular, they put the onus on the IMF to critically evaluate the direct and indirect effects of its economic programs on public health.

Additional Information.

Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0050143.

Add comment July 23rd, 2008

Accountability for torture at last?

Are we to have accountability for torture at last? two new developments give hope that an accountability moment may yet occur.

Rendition Investigation Reopened

In the first development, the Homeland Security Inspector General told Congress he is reopening an investigation into the “extraordinary rendition” of Canadian Maher Arar. Arar, as you may recall, was arrested as he was switching planes en route home from vacation in Switzerland and sent to be tortured in Syria. For the first time a US official admitted that there is evidence that Arar was sent to Syria because it was expected that he would be tortured there.

Skinner’s testimony said officials “concluded that Arar was entitled to protection from torture and that returning him to Syria would more likely than not result in his torture.”

The Canadian government acknowledged error, apologized to Arar, and issued reparations. The US government refused to allow him to enter the country to give Congressional testimony.

More information on the Arar case and the IG investigation can be obtained from Scott Horton’s posting, which includes his testimony to Congress this week. As Horton summed up his view of the hearings:

The hearing revealed some remarkable facts. First, that Deputy Attorney General Larry Thompson made a key finding that facilitated Arar’s shipment to Syria (a determination that it was against U.S. interests for him to be returned to Canada). Second, that the INS had determined that Arar would more likely than not be tortured if he was returned to Syria. Third, that his shipment to Syria, overriding normal procedures, occurred after tremendous pressure had been brought to bear from the office of the Deputy Attorney General.

The hearing was remarkable in that, although pretty harsh criticism was doled out by Committee members and myself, IGs Skinner and Ervin largely agreed that the criticism was well-founded, that the conduct involved was inexplicable or inexcusable, and that a further investigation was necessary.

Even more amazingly, the entire panel of speakers (including the two IGs) agreed that it would be appropriate for a criminal investigation to be commenced looking into violations of the anti-torture statute by those involved in the case, particularly figures in the Deputy Attorney General’s office.

Congress Members Urge Special Counsel

In the other development, nearly 60 members of Congress have written the Attorney General (aka, Director of Torture Cover-up), requesting that a Special Counsel be appointed to investigate Bush administration involvement in torture. [The letter to Mukasey can be read here.]

In a letter to Attorney General Michael B. Mukasey, the lawmakers cited what they said is “mounting evidence” that senior officials personally sanctioned the use of waterboarding and other aggressive tactics against detainees in U.S.-run prisons overseas. An independent investigation is needed to determine whether such actions violated U.S or international law, the letter stated.

Apparently referring to a recent ABC News report that US torture was micromanaged out of the White House by the so-called Principals Committee — which included Vice President Richard Cheney, Condoleezza Rice, Donald Rumsfeld, Colin Powell, George Tenet, and Attorney General John Ashcroft – with President Bush’s knowledge and approval:

[W]ithin the last month additional information has surfaced that suggests the fact that not only did top Administration officials meet in the White House and approve the use of enhanced techniques including waterboarding against detainees, but that President Bush was aware of, and approved of the meetings taking place.

They go on to summarize the implications of the revelations of White house micromanaging of torture:

“This information indicates that the Bush administration may have systematically implemented, from the top down, detainee interrogation policies that constitute torture or otherwise violate the law,” it said. The letter was signed by 56 House Democrats, including House Judiciary Committee Chairman John Conyers Jr. (D-Mich.) and House Intelligence Committee members Jan Schakowsky (D-Ill.) and Jerrold Nadler (D-N.Y).

As Rep. John Conyers explained:

“We need an impartial criminal investigation,” said Conyers, who called the detainee controversy “a truly shameful episode” in U.S. history. “Because these apparent ‘enhanced interrogation techniques’ were used under cover of Justice Department legal opinions, the need for an outside special prosecutor is obvious.”

Fiven the determination of Attorney general Mukasey to carry out his primary duty of protecting the torturers, there is little chance the recommendation in this letter will be acted upon during this administration. When a new administration takes power on January 20, there will be great pressure to forget the wrongs committed by the Bush administration. We are likely to be told by the opinion makers to “let bygones be bygones” and to look ahead. It is up to us concerned citizens to keep the pressure on for accountability for Bush administration crimes, among the foremost of which is the open legalized use of torture. Only truth and accountability can inhibit a recurrence when the next crisis hits our country.

Health Professions’ Accountability

While the lawyers and others who made possible the Bush regime abuses are starting to receive the scrutiny they deserve, we should not forget the need for psychologists and other health professions to establish accountability for our professions’ aiding and abetting Bush’s torture regime. It is well known that the American Psychological Association worked hard to provide cover for Bush administration actions. But the other health professions, while taking stronger positions regarding their members’ participation in detainee interrogations, have not acted to discipline or condemn the actions of their members aiding the torture regime.

It is openly acknowledged by both the Defense Department and the CIA that their “harsh interrogations” (aka “torture”) are conducted under medical supervision. Yet neither the AMA nor ANA have acted to investigate nor discipline members performing these functions. And official and unofficial reports have consistently pointed to the failure of medical professionals, in most cases, to stop or report abuse of detainees, even as they stitched up the wounds and medicated the damaged souls.

None of the health professions should be proud of how it responded to this crisis of human rights and of human decency. We need a Health Professionals Truth Commission to investigate and produce a definitive account of the collaboration of members of our professions in detainee abuses. We further need an analysis of the policy errors and institutional pressures that inhibited our professions from doing the right thing and putting “do no harm” at the top of our agenda.

Add comment June 8th, 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

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

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

Action Opportunity for California Residents: Get health professionals out of interrogations!

This is an urgent opportunity for action for residents of California who are concerned about the role of psychologists and other health professionals in torture and abuse of U.S. detainees.

A broad coalition of health, human rights, and legal organizations in California are working to encourage the State of California to:

Notify all state-licensed health professionals of their legal and professional obligations not to participate in torture.

Notify them that participants in torture may be subject to prosecution.

Request that the U.S. Department of Defense and the CIA remove all California-licensed health professionals, including psychologists, from participating in prisoner interrogations.

If you would like to know more about this initiative, or sign a related online petition, go to the following web page, posted by the American Friends Service Committee:

http://www.afsc-pswro.org/crm/licensingpetition.php?

The California State Senate will be holding a hearing on Monday afternoon, Jan. 14th, on a proposed resolution on this matter. Contact the California State Senate Committee on Business, Professions and Economic Development, at 916-651-4104, for more information about that resolution and hearing.

Daily Kos blogger Valtin has more information on this. Go read his post. From it I reproduce the actual bill:

AUTHORS COPY
10/15/07 08:1OAM
58048 RN 07 29989 PAGE 1
LEGISLATIVE COUNSEL’S DIGEST
as introduced, Ridley-Thomas.

General Subject: Health professionals: torture.

This measure would request all relevant California agencies to notify
California-licensed health professionals about their professional obligations under international law relating to torture and the treatment of detainees, as specified, and to also notify those professionals that those who participate in torture, among other forms of treatment, may be subject to prosecution. In addition, the measure would request the United States Department of Defense and the Central Intelligence Agency to remove all California-licensed health professionals from participating in prisoner and detainee interrogations

Fiscal committee: yes.

WHEREAS, Health professionals licensed in California, including, but not limited to, physicians, osteopaths, psychologists, psychiatric workers, and nurses, have and continue to serve nobly and honorably in the armed services of the United States; and

WHEREAS, United States Army regulations and the War Crimes Act and, relative to the treatment of prisoners of war, Common Article III of the Geneva Conventions and the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment (CAT) require that all military personnel report and not engage in acts of abuse or torture; and

WHEREAS, CAT defines the term “torture” as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person for such purposes as obtaining from him or a third person information or a confession, punishing him for an act he or a third person has committed or is suspected of having committed, or intimidating or coercing him or a third person, or for any reason based on discrimination of any kind, when such pain or suffering is inflicted by or at the instigation of or with the consent or acquiescence of a public official or other person acting in an official capacity”; and

WHEREAS, In 2002, the United States Department of Justice reinterpreted national and international law related to the treatment of prisoners of war in a manner that purported to justify long-prohibited interrogation methods and treatment of detainees; and

WHEREAS, Physicians and other medical personnel and psychologists serving in noncombat roles are bound by international law and professional ethics to care for enemy prisoners and to report any evidence of coercion, or abuse of detainees; and

WHEREAS, The World Medical Association (WMA) issued guidelines stating that physicians shall not use nor allow to be used their medical knowledge or skills, or health information specific to individuals, to facilitate or otherwise aid any interrogation, legal or illegal; and

WHEREAS, The guidelines issued by the WMA also state that physicians shall not participate in or facilitate torture or other forms of cruel, inhuman, or degrading procedures of prisoners or detainees in any situations; and

WHEREAS, The American Medical Association’s (AMA) ethical policy prohibits physicians from conducting or directly participating in an interrogation and from monitoring interrogations with the intention of intervening; and

WHEREAS, AMA policy also states that “(t)orture refers to the deliberate, systematic or wanton administration of cruel, inhumane > and degrading treatments or punishments during imprisonment or detainment. Physicians must oppose and must not participate in torture for any reason … Physicians should help provide support for victims of torture and, whenever possible, strive to change the situation in which torture is practiced or the potential for torture is great”; and

WHEREAS, In May 2006, the American Psychiatric Association stated that psychiatrists should not “participate directly in the interrogation of persons held in custody by military or civilian investigative or law enforcement authorities, whether in the United States or elsewhere,” and that “psychiatrists should not participate in, or otherwise assist or facilitate, the commission of torture of any person. Psychiatrists who become aware that torture has occurred, is occurring, or has been planned must report it promptly to a person or persons in a position to take corrective action”; and

WHEREAS, In August 2006, the American Psychological Association stated ___ that “psychologists shall not knowingly participate in any procedure in which torture ___ or other forms of cruel, inhuman, or degrading treatment or cruel, inhuman, or degrading punishment is used or threatened” and that “should torture or other cruel, inhuman, or degrading treatment or cruel, inhuman, or degrading punishment evolve during a procedure where a psychologist is present, the psychologist shall attempt to intervene to stop such behavior, and failing that exit the procedure”; and

WHEREAS, In June 2005, the House of Delegates of the American Nurses Association issued a resolution stating all of the following: “prisoners and detainees have the right to health care and humane treatment”; “registered nurses shall not voluntarily participate in any deliberate infliction of physical or mental suffering”; “registered nurses who have knowledge of ill- treatment of any individuals including detainees and prisoners must take appropriate action to safeguard the rights of that individual”; “the American Nurses Association shall condemn interrogation procedures that are harmful to mental and physical health”; “the American Nurses Association shall advocate for nondiscriminatory access to health care for wounded military and paramilitary personnel and prisoners of war”; and “the American Nurses Association shall counsel and support nurses who speak out about acts of torture and abuse”; and

WHEREAS, In March 2005, the California Medical Association stated that it “condemns any participation in, cooperation with, or failure to report by physicians and other health professionals the mental or physical abuse, sexual degradation, or torture of prisoners or detainees”; and

WHEREAS, In November 2004, the American Public Health Association stated that it “condemns any participation in, cooperation with, or failure to report by health professionals the mental or physical abuse, sexual degradation, or torture of prisoners or detainees:’ that it “urges health professionals to report abuse or torture of prisoners and detainees;’ and that it “supports the rights of health workers to be protected from retribution for refusing to participate or cooperate in abuse or torture in military settings”; and

WHEREAS, The United States military medical system in Guantanamo Bay, Afghanistan, Iraq, and other United States operated foreign military prisons failed to protect detainees’ rights to medical treatment, failed to prevent disclosure of confidential medical information to interrogators and others, failed to promptly report injuries or deaths caused by beatings, failed to report acts of psychological and sexual degradation, and sometimes collaborated with abusive interrogators and guards; and

WHEREAS, Current United States Department of Defense guidelines authorize the participation of certain military health personnel, especially psychologists, in the interrogation of detainees as members of “Behavioral Science Consulting Teams” in violation of professional ethics. These guidelines also permit the use of confidential clinical information from medical records to aid in interrogations and

WHEREAS, Evidence in the public record indicates that military psychologists participated in the design and implementation of psychologically abusive interrogation methods used at Guantanamo Bay, in Iraq, and elsewhere, including sleep deprivation, long-term isolation, sexual and cultural humiliation, forced nudity, induced hypothermia and other temperature extremes, stress positions, sensory bombardment, manipulation of phobias, force-feeding hunger strikers, and more; and

WHEREAS, Published reports indicate that the so-called “enhanced interrogation methods” of the Central Intelligence Agency reportedly include similar abusive methods and that agency psychologists may have assisted in their development; and

WHEREAS, Medical and psychological studies and clinical experience show that these abuses can cause severe or serious mental pain and suffering in their victims, and therefore may violate the “torture” and “cruel and inhuman treatment” provisions of CAT and the United States War Crimes Act, as amended by the Military Commissions Act of 2006; and

WHEREAS, The United States Department of Defense has failed to oversee the ethical conduct of California-licensed health professionals related to torture; now, therefore, be it

Resolved by the Senate and the Assembly of the State of California, jointly, That the Legislature hereby requests all relevant California agencies, including, but not limited to, the Board of Behavioral Sciences, the Dental Board of California, the Medical Board of California, the Osteopathic Medical Board of California, the California State Board of Pharmacy, the Physician Assistant Committee of the Medical Board of California, the California Board of Pediatric Medicine, the Board of vocational Nursing and Psychiatric Technicians, the Board of Psychology, and the Board of Registered Nursing, to notify California-licensed health professionals via newsletter, email, and Web site about their professional obligations under international law, specifically Common Article HI of the Geneva Conventions, the Convention against Torture and Other Cruel, Inhuman, or Degrading Treatment or Punishment, and the amended War Crimes Act, which prohibit the torture of and the cruel, inhuman, and degrading treatment or punishment of detainees in United States custody; and be it further __

Resolved, That the Legislature hereby requests all relevant California agencies ___ to notify health professionals licensed in California that those who participate in torture and other forms of cruel, inhuman, or degrading treatment or punishment may one day be subject to prosecution; and be it further

Resolved. That the Legislature hereby requests the United States Department of Defense and the Central Intelligence Agency to remove all California-licensed health professionals, including, but not limited to, physicians and psychologists, from participating in any way in prisoner and detainee interrogations, in view of their respective ethical obligations, the record of abusive interrogation practices, and the Legislature’s interest in protecting California health professionals from the risk of criminal liability; and be it further

Resolved, That the Secretary of the Senate transmit copies of this resolution to the United States Department of Defense, the Central Intelligence Agency, and all relevant California agencies, including, but not limited to, the Board of Behavioral Sciences, the Dental Board of California. the Medical Board of California, the Osteopathic Medical Board of California, the California State Board of Pharmacy, the Physician Assistant Committee of the Medical Board of California, the California Board of Pediatric Medicine, the Board of Vocational Nursing and Psychiatric Technicians, the Board of Psychology, and the Board of Registered Nursing.

The American Psychological Association is working to weaken this bill to meaninglessness. It is up to concerned health providers in California to organize to see that doesn’t happen.

3 comments January 10th, 2008

Bush admin bureacrats foster hhospital infections

Revere at Effect Measure on the bureaucrats at the federal Office for Human Research Protections working to shut down a simple checklist that reduced a type of hospital-induced infections by 2/3. Another Bush administration nightmare of incompetence:

Who will protect us from our protectors?

I guess there are a lot of things in the newspapers that leave you shaking your head, but a recent Op Ed by surgeon Atul Gawande left both Mrs. R. and me shaking our heads simultaneously, accompanied by jaws headed south and and eyes bulging. Quite a visual, I admit. But consider the source. I’ll let Gawande describe it:

“In Bethesda, Md., in a squat building off a suburban parkway, sits a small federal agency called the Office for Human Research Protections. Its aim is to protect people. But lately you have to wonder. Consider this recent case.A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.” (New York Times; hat tip GH)

Two thoughts about this occur to me. Well, maybe three. Thought number one. These guys are the counterpart to “Corporate Legal.” Interpret everything in the most conservative possible manner. In this case, that the checklist is an alteration in the usual standard of medical care and collecting information on it is research, research that might put doctors at risk by showing they weren’t doing the right thing. the second thought is that they saw themselves as protecting doctors against predatory trial lawyers. The third is probably closest to the truth: another example of colossally incompetent bozos at the wheel of a Bush federal agency, driving it off the road and killing by-standers.

I’m not a lawyer basher or a federal agency basher. We need lawyers. They preserve our legal rights and represent us in an extremely complicated system. We need federal agencies, too. Research subjects need to be protected. But we also need to be protected from lawyers and agencies with no common sense or worse, no intention of using their abilities and authority for the public good.

Concerning the main point, damage done specifically by a complex and chaotic medical care system is increasing as pressure on everyone in it increases. Much of this damage is avoidable, caused by inappropriate human actions if not error. Human error is hard to prevent completely, but you can minimize it by training and by routinizing critical tasks. Checklists are an important tool for accomplishing this. Evaluating a checklist’s efficacy should be encouraged, not punished. If they had just put up a checklist without evaluating it, presumably this wouldn’t have been a problem.

So I’ve got a checklist item to pin to the wall of everyone who works at the Office for Human Research Protections:

Step One: Remove head from up your ass.

Feel free to evaluate it at your leisure. Which I hope you’ll have a lot of when the nightmare of this administration is finally over (385 days, 23 hours, 21 minutes and 43 seconds at the instant of finishing writing this post).

1 comment January 1st, 2008

Claims military overmedicating soldiers

ABC News reports that the military, presumably in a rush to get soldiers back in the field, is overmedicating them. ABC News claims that this reliance on drugs can teach soldiers to rely on other drugs, including illegal ones, leading to a rising addiction rate.

Instead of providing proper counseling and care for Iraq war veterans suffering from physical and psychological pain, too often the U.S. military is trying to medicate the problem away, according to drug counselors and therapists.

Andrew Pogany, who works with service members nationwide as an investigator with the veterans advocacy group Veterans for America, said overmedicating veterans is a common problem.

“Pretty much every person in my caseload is medicated, heavily medicated,” said Pogany. “There’s potential for them to become addicted.”

According to Pogany, a reliance on prescription drugs often leads veterans to reach for other coping mechanisms — illegal drugs such as marijuana, cocaine and crystal meth.

The report attributes the overmedication to a lack of counseling resources.

 But Andrew Pogany said the reason why vets suffering from PTSD are not afforded better psychiatric care is clear — a lack of resources on the part of the military.

“Do they have enough trained providers to provide individual care? The answer is no,” he told ABC News.

And the military apparently agrees. Results from the DOD (Department of Defense) Task Force on Mental Health released in June 2007 find that “the military system does not have enough resources, funding or personnel to adequately support the psychological health of service members.”

“Handing somebody a bag of medication and then seeing them once a month for a half-hour appointment, that’s not adequate,” said Pogany.

Another factor that may contribute I’ve heard about from some vets, and from reporters investigating the issue is that military commanders simply cannot accept that military experience could lead to trauma, as in PTSD. These sources feel that the pervasive denial contributes to some of the abuses os soldiers and vets that have recently been reported in several media sources.

2 comments December 2nd, 2007

Avian flu and public health’s Maginot Line

I haven’t mentioned avian influenza for a long time. But that doesn’t mean that the threat is gone. As Revere points out at Effect Measure, the threat is the same it always was. As in all things human, it’s a matter of probabilities ad possibilities, never certainties. Revere today points out that the appropriate public health response our government should be taking would be good for all of us:

Public health’s Maginot Line

Influenza A/H5N1 (bird flu) bubbles away this year much as in past years and public health professionals continue to wait with bated breath for the other shoe to drop. It could happen this year, next year or not at all. That’s the way the world is. Betting on “not at all” isn’t considered prudent by most people in public health, despite the fact that it’s possible. So given the uncertainty, what is the best strategy?

It is a bit disconcerting to see that the overwhelming preponderance of resources to pandemic preparedness resources are going into influenza-specific counter-measures, particularly vaccines and antivirals. If a pandemic doesn’t materialize not all of it is wasted. The boost that the threat of a pandemic has given to vaccine technology is real and significant and will pay off in the long run for diseases other than influenza for which vaccination is a reasonable preventive. So that’s good. Antivirals are more narrowly specific to influenza. Both are narrowly conceived, however, and are framed in terms of an uncertain event. But they are not the only reasonable response, nor even the ones where, if we were gaming out the possibilities, the likelihood of biggest pay-off would come. What are we suggesting?

In our view the biggest benefit comes with investment in public services which strengthen the community’s response to health threats of all kinds. Investment in routine public health — vital data and surveillance, substance abuse, elder care, maternal and child health, infectious disease control, human resources, social service support for the ill in the community and all the rest of it — is the place where we would put most of the money. If national planners are reluctant to give up the “magic bullet” approach of vaccines and antivirals then we are talking about additional investment. Given that every dollar invested in infrastructure is almost certain to pay off in multiple dollars of saved expense, we can afford this. And if a pandemic does come, it will pay off handsomely there, too. Vaccines and antivirals still depend upon the public health system. They don’t work at a distance.

We’ve been saying this for three years. It is not a change in attitude occasioned by a new threat assessment. On the contrary, our threat assessment has not changed at all. Only the virus changes. Whether the viral changes we are seeing is bringing us closer to a pandemic, farther away from one or are neutral in that regard we don’t know. So we have to respond in the most rational way.

The strategy of vaccines and antivirals appears to us a public health Maginot Line. Effective if the enemy comes that way. But if it goe

Add comment November 9th, 2007

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