Tag Archives: corporations

Drug shortages: “We are talking about people’s lives; this is not a cell phone contract”

iv-fluidThe shortage of pharmaceutical drugs is a serious problem in the US. The number of drugs in short supply has tripled since 2007. In an article in The New York Times, Sabrina Tavernise reports that the number of drugs in short supply in 2012 was 456.

The types of drugs affected cover a very wide range and include such things as cancer drugs and nitroglycerine used in heart surgeries. The situation is quite disruptive for hospitals, doctors (especially oncologists), and patients.

IV fluid shortage threatens patient care

This year, in addition to drug shortages, there is a nationwide shortage of IV fluid. Intravenous therapy is essential for treating dehydration and electrolyte imbalances, for blood transfusions, and for delivering medications such as those used in chemotherapy. IV fluid is a hospital staple.

A recent JAMA article quotes Erin R. Fox, director of the Drug Information Service at the University of Utah in Salt Lake City: (emphasis added in the following quotations)

“It’s maddeningly frustrating that we don’t have these basics.” … Fox said that although shortages of drugs, particularly sterile injectables, have become common in recent years, it is unheard-of to have a shortage of such a basic supply. …

Why is the supply chain so fragile that it creates a national crisis? asked Fox. …

“Physicians, nurses, and pharmacists are working together to minimize the harm to patients, but it is really a challenge,” she said.

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Profit-driven medicine: Satisfying patients at the expense of their health

Why would patients who report greater satisfaction with their health care be worse off medically? This JAMA article, Patient Satisfaction & Patient-Centered Care: Necessary but Not Equal, offers an explanation that makes sense. It points to the commercialization of health care – treating the patient as a consumer – as the villain. (All quotations in what follows are from this article.)

The patient (consumer) satisfaction survey

In the US, many doctors are evaluated and rewarded based on patient satisfaction surveys. Motivated to produce high patient satisfaction scores, doctors are inclined to order more diagnostic tests. Why? It’s more than a simple desire to please the patient.

When physicians’ performance evaluations and incomes are tied to patient satisfaction, the situation becomes ripe for overuse and misuse of diagnostic and therapeutic procedures because it allows the physician to rationalize decision making in terms of patient satisfaction.

Pleasing a patient is a conscious, individualized choice. Rationalized decision making can easily become an automatic habit that requires no additional thought. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyContinued from parts one, two, and three.

A year ago, when I decided to call my declining rate of blogging a ‘sabbatical,’ I wrote down some questions to explore while I took time off to read.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

At the time I thought I would read primarily in the history of medicine, and that was how I started. Appreciating the historical context of medicine is important for understanding both how medicine ended up where it is today and what medicine could become. “The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time,” I wrote.

Now that I’ve become more familiar with the social determinants of health, I’m less optimistic about the future. The problem is not simply that the corporatization of health care has increased dissatisfaction among both doctors and patients. The problem is that our focus is so narrowly limited to health care systems that we fail to see the larger issue. As one metaphor puts it, doctors are so busy pulling diseased patients out of the river, there’s no time to look upstream and ask who’s throwing the bodies into the water. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Continued from parts one and two, where I defined the terms used in the following diagram of my blogging interests. Click on the graphic for a larger image.

Blog topics and their connections

If I had written the previous two posts a year ago, I would have realized how much my interests were intertwined. I guess I wasn’t ready to do that. Anyway, in this post I catalog some of the connections.

Healthism

~ Healthism and psychological and physical conformity: Healthy lifestyle campaigns promote an ideal way of life that encourages individuals to alter their behavior and appearance. Although it’s true that we would all be better off if we didn’t smoke, that doesn’t make anti-smoking laws any less authoritarian, i.e., requiring conformity (see the section on anti-authority healthism in this post). The fitness aspect of healthy lifestyles promotes the desirability for both men and women of acquiring (i.e., conforming to) specific body images.

“Self-help is the psychiatric equivalent of healthism.” That’s a slogan I made up. I’m not sure yet if it will stand up to scrutiny. Certainly the self-help industry encourages self-criticism, which leads to a preoccupation with those aspects of personality currently considered undesirable. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Continued from part one, where I discussed the first three of my six interests: healthism, medicalization, and psychological and physical conformity. Click on the graphic below to see a larger image.

Blog topics and their connections

The social determinants of health

Social determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health (including things we’re not even aware of yet), and it can be difficult to isolate and scientifically study some of the ones we strongly suspect, like poverty, isolation, or a sense of being socially inferior.

The medical model is the preferred framework in modern westernized societies for explaining the distribution of health and disease. It emphasizes risk behavior (smoking, diet), clinical risk factors (blood pressure, blood sugar, cholesterol levels), genetics, health care access and quality, behavioral change, and patient education. One common characteristic of the medical model’s explanation of health and disease is that causes are located in the individual (behavior, genes), not in the individual’s economic and social environment. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

It’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

Now that I’ve taken the past year to read and reflect, I find – duh! – that my interests are not as unrelated as I’d assumed. In hindsight, I should have realized this long ago, but, alas, I did not. I’m writing this post to clarify to myself what I now see as the common threads that connect my interests.

Here is a diagram that groups my interests into six categories. (Click on the graphic to see a larger image.)

Blog topics and their connections

Four of the six categories relate to all five of the others. The two outliers (neoliberalism and medicalization) are not as directly related as I feel the others are. Read more

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On sabbatical

Self-reflectionI’m taking a break from frequent blogging – want to take time to read, do some research, reflect, and think about what I most want to write about next. At the moment, my inclination is to concentrate on the history of medicine, starting with the Enlightenment, followed by the transformation of medicine into a science in the 19th century. I want to consider what the past might be able to tell us about the present.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

Medicine is not an abstract science, like quantum physics or mathematics. Scientific biomedicine may have its foundations in the research laboratory, but the practice of medicine takes place in the real, everyday world of doctors, patients, nurses, lab techs, clinics, hospitals, professional associations, patient advocacy groups, drug firms, insurance companies, politicians, the Internet, and the health advice columns of the Sunday papers. It takes place in a particular place at a particular time, and in a social, economic, political, and historical context.

To understand our dissatisfactions with and hopes for medicine – both as patients and practitioners – it helps to examine that context. And the context is easier to see if we step back from the immediacy of the current situation and consider the recent history of medicine. The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time.

“Not to know what happened before one was born is always to be a child.” (Cicero) Or, to expand on that a bit: “He who cannot draw on 3,000 years is living hand to mouth.” (Goethe)

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Can pharmaceutical drugs benefit society?

Goethe quotation: Whatever you can do ...Here in the US, we’re apt to hear about the British health authority NICE (National Institute for Health and Clinical Excellence) when a stage-four cancer patient makes a desperate appeal for access to an expensive drug not in the approved formulary. The British system has been characterized as rationing, and conservative US politicians like to use such incidents to argue against “socialized” medicine, which will surely do away with Granny before her time is up.

There are big changes currently underway in the British health care system, and NICE will actually be replaced by a different decision-making process in 2014. Although health care reform in the US (the Affordable Care Act) rejects the British model, a recent article in the New England Journal of Medicine suggests there’s much we can learn from the British experience.

Why not design drugs to have wider societal benefits?

Of particular interest is the concept of the social value of drugs. The idea is that if a drug demonstrates “wider societal benefits,” the British government would be willing to pay more for the drug. Presumably this financial incentive would lead the pharmaceutical industry to invest more heavily in products with a high value to society.

What might these values be? In discussions of how the new system would work, the only example provided is drugs that benefit the care-takers of patients. The article’s authors, however, suggest a few more: “narrowing health inequalities, advancing children’s life prospects, reducing burdens on social services, increasing tax revenues, and decreasing workforce absenteeism.” Read more

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Patient safety and corporate profits

Patient safety firstThe Supreme Court recently decided, in the case of Bruesewitz v. Wyeth, that Wyeth Pharmaceuticals could not be held liable for injury to the Bruesewitz’ daughter (following a vaccination) because Wyeth was protected by the National Childhood Vaccine Injury Act.

I was reading an article on this controversial issue in the NEJM when I was brought up short by the following sentence: (emphasis added)

Litigation such as the Bruesewitzes’ can help the FDA in its oversight function by revealing important and previously unknown information about product-related risks, especially during the postapproval period, and by deterring manufacturers from acting irresponsibly and engaging in business tactics aimed at increasing product sales at the expense of patient safety.

Now, I know corporations sometimes put profits before consumer safety (I once owned a Ford Pinto). And I know that, starting in the late 20th century, medicine became driven by corporate profits rather than traditional medical professionalism. (This is not to say that medical professionalism has disappeared. Merely that there has been a shift in values.) But it still troubles me to read a casual reference to profits being more important than patient safety. It’s an acknowledgment that such practices are an everyday occurrence, imperfectly dealt with by regulations and legislation, and are not a matter of what’s ethically right or wrong.

For-profit medicine drives increased use and costs

I believe medicine – which deals with life, death, pain, suffering, and disability – is not just another business like selling consumer goods. (See From MD to MBA: The business of primary care.) Other industries –automobiles, airlines — may need to consider life-threatening safety issues. But the primary focus of those industries is to sell a particular product or service, not to keep people alive and well. Read more

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From healthism to overdiagnosis

H Gilbert Welch OverdiagnosedIn his new book, Overdiagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch enumerates how the cutoff points that determine whether a patient should be treated for a disease – diseases such as high blood pressure, diabetes, osteoporosis — have been creeping inexorably lower over the years.

Take diabetes. The cutoff point used to be a fasting blood sugar level of greater than 140. In 1997, the number was lowered to 126. This immediately created 1.7 million new diabetes patients.

In a highly publicized study that began in 2003, one group of patients with type 2 diabetes received “intensive therapy” to make their blood sugar “normal.” The control group – the other half of over 10,000 patients – received treatment to lower their blood sugar, but not to the new normal level. The trial was stopped in 2008 when it became clear that there was about a 25% increased risk of dying for the intensive therapy group.

Dr. Welch’s comment on this: “If it’s not good to make diabetics have near normal blood sugars, then it’s not good to label those with near normal blood sugar diabetics. Why? Because doctors will treat them. People with mild blood sugar elevations are the least likely to gain from treatment – and arguably the most likely to be harmed.”

High blood pressure (hypertension) was also redefined in 1997. Instead of the cutoff points being 160 systolic over 100 diastolic, the numbers dropped to 140 over 90. This created 13.5 million new patients.

The definition of high cholesterol (hyperlipidemia) changed following a 1998 clinical trial. The definition of “abnormal” total cholesterol fell from 240 to 200. This created 42.6 million new patients, an increase of 86% over the previous number of patients.

It’s the same with the definition of osteoporosis. A bone mineral density X-ray produces a T score. It’s a way to compare an individual’s bone density to what’s considered “normal.” For women, normal is defined as the bone density of an average white woman aged 20 to 29 (a T score of zero.) If your T score is less than zero, it’s assumed you have an increased risk of fracture.

In 2003 the definition of osteoporosis changed from having a T score less than -2.5 to less than -2.0 (i.e., closer to normal). This created 6.8 million new patients, an 85% increase in those now eligible for treatment with drugs that turned out to have significant side effects – as virtually all drugs do. Read more

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Joseph Stiglitz on inequality

Income inequality waiting onlineGreat essay by Joseph Stiglitz on income inequality: “Of the 1%, by the 1%, for the 1%” in Vanity Fair.

As we gaze out at the popular fervor in the streets [of the Middle East/North Africa], one question to ask ourselves is this: When will it come to America? In important ways, our own country has become like one of these distant, troubled places.

Alexis de Tocqueville once described what he saw as a chief part of the peculiar genius of American society—something he called “self-interest properly understood.” The last two words were the key. Everyone possesses self-interest in a narrow sense: I want what’s good for me right now! Self-interest “properly understood” is different. It means appreciating that paying attention to everyone else’s self-interest—in other words, the common welfare—is in fact a precondition for one’s own ultimate well-being. Tocqueville was not suggesting that there was anything noble or idealistic about this outlook—in fact, he was suggesting the opposite. It was a mark of American pragmatism. Those canny Americans understood a basic fact: looking out for the other guy isn’t just good for the soul—it’s good for business.

The top 1 percent have the best houses, the best educations, the best doctors, and the best lifestyles, but there is one thing that money doesn’t seem to have bought: an understanding that their fate is bound up with how the other 99 percent live. Throughout history, this is something that the top 1 percent eventually do learn. Too late.

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Down so low we dare not speak

Despair and pessimismDue to multiple, largely uncontrollable influences that include both nature and nurture, individual outlooks on the world are arrayed along a continuum from bright to dark. I tend to land on the dark side.

Three weeks ago I read a darkish blog post that made a strong impression on me. I was especially struck by its characterization of the current political/economic climate as so depressing one hesitates to speak of it. I understand that sentiment.

I couldn’t remember where I read it and recently tried in vain to locate it in all my usual web haunts. Then last night it popped up like an old friend. It’s called “The New American Pessimism,” and it’s written by the Serbian-American poet Charles Simic, a Pulitzer Prize winner, among other things. Here’s an excerpt. (emphasis added)

It must be difficult for any hostess nowadays to stop her dinner guests from reciting to each other over the course of an evening the endless examples of lies and stupidities they’ve come across in the press and on TV. As they get more and more wound up, they try to outdo each other, losing all interest in the food on their plates. I know that when I get together with friends, we make a conscious effort to change the subject and talk about grandchildren, reminisce about the past and the movies we’ve seen, though we can’t manage it for very long. We end up disheartening and demoralizing each other and saying goodnight, embarrassed and annoyed with ourselves, as if being upset about what is being done to us is not a subject fit for polite society. …

By the president’s calculation, telling the truth to the American people would doom his reelection campaign, since he would not be able to raise the billion dollars he needs this time around. The kind of people who have that kind of money and will agree to contribute to his campaign know very well what informed voters in a working democracy would to do to them once they understood just who has depleted the national treasury to line their own pockets. No doubt, he and his political party will do anything to avoid the truth and will propose outwardly attractive solutions—like the health care bill that not only expands coverage but greatly benefits insurance companies and does little to reduce healthcare costs. They hope that these kinds of measures will lure the majority of voters who won’t bother to learn the details, but they will also send a clear signal to the moneyed classes that they won’t be inconvenienced in the least. … Read more

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What Wisconsin hath wrought

Wisconsin protestsFrom a long piece by John Nichols in The Nation on the spirit of Wisconsin, written early in March. (emphasis added)

One of the most popular signs on the streets, distributed by National Nurses United, said, Blame Wall Street. Instead of concessions, the nurses argued, it’s time to focus on the corporate CEOs and speculators; as they point out: “In U.S. states facing a budget shortfall, revenues from corporate taxes have declined $2.5 billion in the last year. In Wisconsin, two-thirds of corporations pay no taxes, and the share of state revenue from corporate taxes has fallen by half since 1981.” The same is true in other states. These facts must be stressed, repeatedly and aggressively, if the debate is going to shift from cuts in public services and education to demands for fair taxes and the revenues necessary for services and schools.

When I read polling statistics, I get the impression Americans don’t hold corporations or the finance industry accountable. This article provides evidence to the contrary, at least in Wisconsin. Read more

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From MD to MBA: The business of primary care

Business of primary care physicianYou could argue that medicine was never meant to become a for-profit business the way selling cars, cosmetics, and fast food are businesses. Among the differences between being a patient and being a consumer of non-medical goods and services:

  • There’s an asymmetry in the knowledge available to patients and doctors – a patient can’t possibly be as informed as a doctor about what’s wrong and what’s needed.
  • Patients can’t predict when they’ll need medical care and often seek care when their health is threatened and when decisions must be made quickly.
  • It’s the supplier – the doctor – who determines what the patient needs.
  • There’s an ethic that assumes doctors will not sacrifice the medical needs of a patient to make a profit.
  • There’s a very steep entry cost to becoming a doctor.
  • The health care market is basically not price competitive – a patient contemplating brain surgery is not going to be tempted by a surgeon offering a deep discount.
  • What’s at stake in health care – the consequences of making a mistake – is death and disability, not simply a case of buyer’s remorse.

And yet, in the United States, health care has become a for-profit business. The story of how this happened is complex, but decisive elements include the advent of Medicaid and Medicare in 1966 and the widespread availability of employer-sponsored health insurance, which got a boost during the wage freeze of World War II. Once patients no longer needed to know the true cost of health care, business interests were free to create what Dr. Arnold Relman called the “medical-industrial complex.”

Regardless of how and why it happened, we now accept that medicine in the US is a profit-generating business, where many segments of the “industry” aim to reward investors, not patients. As a result, health care has become too expensive for many patients, for employers, and for the government. Everyone agrees that costs are out of control, but – with so many competing economic interests — the solution is extremely elusive.

Doctors caught in the middle

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The new economic reality

Global super elite executivesWriting in The Atlantic, Chrystia Freeland describes a new breed of business executives – the global super-elites. Think Bill Gates, Mark Zuckerberg, George Soros, plus hedge fund managers like Raj Rajaratnam whose names are not quite household words. They work hard, succeed based on their accomplishments, and feel little or no loyalty to the country of their birth or residence. This last quality has serious implications for the well-being of America’s middle class. (emphasis added)

The good news—and the bad news—for America is that the nation’s own super-elite is rapidly adjusting to this more global perspective. The U.S.-based CEO of one of the world’s largest hedge funds told me that his firm’s investment committee often discusses the question of who wins and who loses in today’s economy. In a recent internal debate, he said, one of his senior colleagues had argued that the hollowing-out of the American middle class didn’t really matter. “His point was that if the transformation of the world economy lifts four people in China and India out of poverty and into the middle class, and meanwhile means one American drops out of the middle class, that’s not such a bad trade,” the CEO recalled.

I heard a similar sentiment from the Taiwanese-born, 30-something CFO of a U.S. Internet company. A gentle, unpretentious man who went from public school to Harvard, he’s nonetheless not terribly sympathetic to the complaints of the American middle class. “We demand a higher paycheck than the rest of the world,” he told me. “So if you’re going to demand 10 times the paycheck, you need to deliver 10 times the value. It sounds harsh, but maybe people in the middle class need to decide to take a pay cut.” Read more

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Do gruesome graphics deter or promote smoking?

New US cigarette package labelingIn 2009 the FDA finally acquired the authority to regulate the production and marketing of tobacco. On the marketing front, the tobacco industry fought back with a legal challenge. It claimed the new Congressional law violated the industry’s right to free speech. If cigarette packaging had to feature strong graphic images – one of the provisions of the bill — the industry would required to “stigmatize their own products through their own packaging.”

The lawsuit is still pending, but the results of new marketing requirements have begun to appear. The question remains: Will they be effective?

Scary labels may be counter-production

Martin Lindstrom, a former ad agency executive and expert on the science of marketing, has used neuroimaging to study what makes people buy. In his bestseller Buyology: Truth and Lies About Why We Buy, he describes a study he conducted on cigarette advertising. He found that especially vivid anti-smoking warnings actually increase a smoker’s craving for cigarettes.

There’s a possible explanation for this in a concept called Terror Management Theory, which includes the idea that a threat to one’s life increases the need for self-esteem. Read more

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Water privatization in South Africa: Victory and reversal

Children collect water South AfricaFollowing the 2005 fire in Soweto (South Africa) when prepaid meters shut off the water and two children died, the residents of the Phiri neighborhood challenged the use of prepaid meters in a lawsuit. They claimed the practice violated South Africa’s basic water policy of a constitutionally guaranteed right to water.

The High Court ruled in favor of the residents in April 2008 — a jubilant legal victory. The daily water allotment was increased from 25 to 50 liters per person per day. The forced installation of prepaid meters was declared unlawful and unconstitutional.

The case was appealed, however, to the Constitutional Court of South Africa. Here’s a video from Friction Films that describes the struggle up to this point. Read more

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Water privatization in South Africa: Prepaid meters

Water for profit South AfricaThe struggle to provide safe, adequate water and sanitation in South Africa is a more complicated story than the events in Cochabamba, Bolivia. South Africa — a democracy since the end of apartheid in 1994 — is one of the few nations that guarantees a constitutional right to “sufficient” water: “Everyone has the right to have access to … sufficient food and water.” The country has not been able to deliver enough water to many of its poorer citizens, however.

The system for providing water in South Africa is complex. It includes government policy makers, Water Boards, and local municipalities. With the end of apartheid, some cities turned to giant water corporations in France and Britain to manage their water utilities. In other cities, water utilitites remained public, but began to operate like a private business. For the poor, the experience was the same – water sold for a profit.

The World Bank has encouraged a policy of water privatization ever since the neoliberal policies of Reagan and Thatcher came into favor in the 1970s. The Bank acknowledged that the poor would stop paying for water once the cost was more than five percent of income. In South Africa, privatized water can cost up to 20 per cent of income. The poor were forced to choose between water and food. Read more

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The Cochabamba water wars

Bolivian woman confronts policeWater is not free. Even if there’s an abundant supply, there are costs associated with making it safe to drink, delivering it to homes, and removing wastes (sanitation).

I live in a US city where water is a public utility. Home owners get a bill for their water and sanitation fees. Renters pay the cost in their monthly rent checks. The homeless depend on the faucets and restrooms of public buildings, such as libraries.

The situation is different in the developing world, where over a billion people lack access to safe drinking water. Many women spend over six hours a day collecting enough water for their families (and wait until after dark to relieve themselves). When it comes to sanitation, 2.6 billion people do not even have access to “improved” pit latrines – open pits with simple modifications to reduce flies and odors.

The health consequences of unsafe drinking water and poor sanitation include diarrheal diseases (such as cholera), infection with the parasite schistosomiasis (a cause of blindness), and various parasitic intestinal worms. Five million people die every year from waterborne diseases. Read more

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Water privatization: An investment bonanza

Water faucetIn May 2000, Fortune magazine published an article on the financial benefits — benefits for corporations and investors, that is — of privatized water. (emphasis added)

From Buenos Aires to Atlanta to Jakarta, the liquid everybody needs–and will need a lot more of in the future — is going private, creating one of the world’s great business opportunities. The dollars at stake are huge. Supplying water to people and companies is a $400-billion-a-year industry. That’s 40% of the size of the oil sector and one-third larger than global pharmaceuticals. And this is just the beginning. The World Bank estimates that one billion people, one-sixth of humanity, have poor access to clean drinking water, and three billion lack sanitary sewage facilities. Unless governments begin spending much more, the number of people without clean water will rise to 2.5 billion, about one person in three, by the year 2025. …

Water promises to be to the 21st century what oil was to the 20th century: the precious commodity that determines the wealth of nations. … Elizabeth Mackay, chief investment strategist at New York investment house Bear Stearns, calls water “the best sector for the next century.” …

So far [the French company] Suez has had a leg up on its rivals because it understands what’s really needed to turn plain water into big money. … “Where else can you find a business that’s totally international, where the prices and volumes, unlike steel, rarely go down?” he [CEO of Suez, Gerard Mestrallet] argues. …

Here’s how deals work in the developing world. … To turn a profit, it [Suez] must collect far more in water charges than it pays out in salaries, equipment, and interest.

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Support the Fair Elections Now Act

Lobbying: Nobody tells me what doAmericans of all political persuasions can surely agree that Congress is currently dysfunctional. Much of the problem stems from the enormous influence of special interest groups – through lobbyists — on elected officials. The importance of this issue increased last January with the landmark Supreme Court decision, Citizens United v Federal Election Commission, which overturned a ban on political spending by corporations.

There will be a vote in the House of Representatives this week on a bill that addresses the problem of campaign financing. It’s a bipartisan bill called the Fair Elections Now Act. Basically, it provides a way to finance the election campaigns of congressional candidates with contributions from individual citizens rather than special interests.

There is an explanation of how the bill works on the Fair Elections Now website. There’s a difference, for example, between how funds are raised for Senate races and House campaigns.

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Lobbying against formula for babies

Baby drinking from bottleHere’s one small example of what lobbyists can accomplish in Washington.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides formula and food to low-income mothers of small children. Unlike food stamps, WIC is not an entitement. Congress grants WIC a finite amount of money. When that money runs out, the cupboard is bare.

Formula makers are increasingly adding “functional ingredients” – omega-3s, antioxidants, probiotics – to their products. This allows them to charge more. For WIC, that increased cost means formula will cost almost $100 million more.

The budget for WIC is already inadequate. In the past, there’s only been enough money for about half the number of eligible mothers and children. If the cost of infant formula increases, that budget will buy even less, which means even fewer mothers can participate.

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Merchants of Doubt

Merchants of DoubtIt’s easy to understand – if not condone – the behavior of politicians who are financed by tobacco and oil companies. They oppose the regulation of smoking or pollution because they benefit from the financial contributions of those industries.

But what motivates certain scientists to relentlessly cast doubt on peer-reviewed scientific evidence that’s inconveniently contrary to financial interests? A new book, Merchants of Doubt by Naomi Oreskes and Erik M. Conway, attempts to answer this question.

To some extent, the motivation for certain scientists is the same as that of politicians. Those who opposed the issues covered by this book – nuclear winter (could we survive a nuclear war), Star Wars, acid rain, the ozone hole, global warming, DDT, cigarette smoking and second-hand smoke – are frequently members of “institutes” or think tanks heavily funded by tobacco and “dirty” energy donations.

The answer is much more complex than money, however. And much more interesting. Read more

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The financial crisis: Blame it on the collapse of Communism

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Why did the global economy collapse so suddenly, seemingly without warning? Economic experts and political analysts continue to offer explanations, but sometimes an outsider’s viewpoint can be especially illuminating.

John Lanchester is a British novelist (The Debt to Pleasure) who stumbled on his insights into the financial collapse while researching a novel. The result is I.O.U.: Why Everyone Owes Everyone and No One Can Pay. (In the UK the title substitutes Whoops! for I.O.U.)

One of his theories about the collapse involves the relation between the fall of communism and the political/economic climate that led to the financial crisis. Before the Berlin Wall came down, East and West were engaged in an “ideological beauty contest”: Which system has the better theories, ideas, and practices. The USSR was portrayed in the West as brutal and hard-hearted. Capitalist countries (not just the US) hoped to maintain public affection by offering, in contrast, liberal social welfare programs.

Once the Wall came down, however, maintaining a benevolent image was no longer necessary. Pure, unrestrained capitalism could have its way with the world, ordinary homeowners and economic inequality be damned.

The ugly side of unbridled capitalism

There’s a nice statement of Lanchester’s argument in a review by Benjamin M. Friedman, who quotes from I.O.U. (emphasis added):

Lanchester believes that the “essential precursor” to what happened was the collapse of international communism, including in particular the demise of the Soviet Union:

“The way in which the financial sector was allowed to run out of control … took place not in a vacuum but in a climate. That climate was one of unchallenged victory for the capitalist system, a clear ideological hegemony of a type which had never existed before.”

Lanchester argues that the West’s decisive victory over communism finally removed the political restraints that had, for nearly a century, held capitalism in check. The ugly side of unbridled capitalism now no longer needed to be hidden. Widening inequality and the increasingly visible excesses of the fortunate few were no longer a problem:

“The good guys won, the beauty contest came to an end, and the decades of Western progress in relation to equality and individual rights came to an end …. The Wall came down, and, to various extents, the governments of the West began to abandon the social justice aspect of the general postwar project.”

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This mess we’re in – Part 3

dollar-sign-shadowPart two of this post discussed disillusion with the idea of progress and a yearning for a higher purpose. How did we end up in this unsatisfactory situation and is there hope that things will change for the better?
I recently read Robert Reich’s book Supercapitalism. I was impressed with the clarity with which he described economic history, from the “Not quite Golden Age” (between the end of World War II and the 1970s) to the supercapitalism that followed.

Supercapitlaism refers to the technological, globalized, deregulated, and privatized economy of the present. Under supercapitalism, politics is dominated by business firms and financiers who successfully lobby government to act in their narrow interests. Meanwhile, this leaves no one responsible for the broader public interest.

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This mess we’re in – Part 2

Part one of this post noted Paul Krugman’s take on the health care legislative process and the political practice of soliciting money in exchange for votes. Beneath these surface issues, however, there’s a deeper sense of disillusion with 20th century progress and with a lack of purpose to modern life. We may tinker with a… Read more

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This mess we’re in – Part 1

Source: Moore’s Lore After all these months of acrimony and hand-wringing, it appears there will be something called health care reform. It may be equally disappointing to both supporters and opponents, but that comes as no surprise. It’s now abundantly clear that the legislative process is hopelessly inadequate when it comes to things like health… Read more

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Health Culture Daily Dose #18

Source: Wunderground When did we start calling the whole day before Christmas “Christmas Eve?” I thought Christmas Eve was the evening before Christmas. But no. Senators voted on health care reform at 1:00 AM on Thursday December 24th. To me, that’s still Wednesday night, but it was widely reported as happening on Christmas Eve. Perhaps… Read more

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Big Pharma tells Santa: All I want for Christmas

Source: FoundMoney Last week it looked like Big Pharma had won the latest skirmish over importing low cost drugs from Canada and other countries. But the battle isn’t over yet. As FiercePharma told its drug company readers today: “And you thought you could stop worrying about re-importation.” Senator Dorgan’s amendment to the health care reform… Read more

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Campaign contributions and the cost of pharmaceuticals

Source: The Heartland Institute Prescription drugs are much more expensive in the US than they are in other countries. Americans pay 36 percent more than Canadians, on average. We pay 39 percent more than Europeans and 43 percent more than the Japanese. Mevacor, a commonly prescribed statin for lowering cholesterol, costs $200 for 100 pills… Read more

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