Patrick Hahn's Open Salon Blog

Goodbye to all that

Sun, 27 Sep 2009 09:09:33 -0400

Well, I’m outta here. It’s been fun. They say every academic’s secret desire is to write freelance magazine articles, and I figured this blog would be a good place to start. I don’t imagine J.K. Rowling is losing any sleep over me, but I’m gratified that every one of my posts has garnered hundreds of hits.

I chose overmedicalization as my main topic. It’s a huge issue. I teach biology, and so many of my students want to become physicians or other health professionals, and of course I want to see them do well, but I started looking into these matters a couple of years ago, and it’s been like finding out the emperor has no clothes. I think most people would be astounded if they knew how little good and how much harm is done by the medical profession.

Our Medical-Industrial Complex has swollen to engulf one sixth-of our entire economy, while killing 200,000-plus people a year. I say “200,000-plus” because nobody knows the true number, and nobody seems very interested in finding out.

It’s also an area in which so many big questions come into focus – questions about what kind of society we want to live in, and what it means to be a human being. My work here has even led to a gig as a medical journalist for another online publication. I do everything real reporters do, except get paid.

But, it’s time to move on.

I’m an adjunct professor, which means I do the work of two professors, for half the salary of one. I can handle that. I’ve handled that for my entire career. But I can no longer handle that and maintain a family on the other side of the planet.

I got married in Ghana on December 31, 2007, and after dicking us around for a year and a half, USCIS finally sent me a letter telling me they might not grant my wife’s visa for years. In shock, I called up the NGO that sponsored me in Ghana and asked me if I could have my old job back. They told me they didn’t have anything in Ghana for me, then asked me, “How would you like to go to Ethiopia?” I called my wife and asked her what she thought.

She said, “Let’s go.”

Remember, you heard it here first: this country is on the verge of a massive third-world style brain drain.

May I be permitted a personal anecdote? When I was in graduate school at the University of Arizona, we had several Chinese students in our department, who were funded by their government, not ours. I had a drinking chum who worked part-time in the department office, and he peeked at the disbursements, and he told me that the Chinese government was paying their students two-and-a-half times what we were getting paid.

Imagine that: while this country was mining its intellectual capital, they were investing in theirs.

And now we’re reaping the rewards. The days when we could cherry-pick the rest of the world’s best and brightest are rapidly drawing to a close. A story in the New York Times reported that growing numbers of educated Indian and Chinese professionals living in this country are returning to their home countries, because they can live better there. That would have been unthinkable thirty years ago.

If you’re anywhere near my age (I’m 48), then most likely your father, like mine, was born during the Great Depression, and came of age during the post-war economic boom, a time of wealth creation unparalleled in human history. I get the impression our fathers thought this was the natural order of things, something that would continue without any further intervention on anyone’s behalf. And while a generation of Rip van Winkles snoozed in front of their television sets, their elected representatives were busy shredding the social contract that made it possible for them to go from hardscrabble beginnings to comfortable affluence in half a generation.

The American Century is over. Almost exactly one hundred years after my mother’s father came to this country in search of a job, I’m leaving – for the exact same reason.

So, I’m off. I can’t say for sure I’ll never post here again, but if I do, I’m sure it will be less frequently. I don’t know what I’ll find, but don’t worry about me. At least I have somewhere to go. (I’ll even have health insurance!) I don’t know what the rest of you are going to do. Good luck to you all.

President Obama, healthcare reform, and "Animal Farm"

Tue, 22 Sep 2009 22:09:59 -0400

One of the unintended effects of the debate on healthcare “reform” is to highlight just how out of touch our rulers are with the rest of us.

In a statement, Senator Max Baucus told the Senate Finance Committee “All Americans should have access to quality, affordable health care coverage.” Guess who gets to define what “affordable” means?

Originally, his plan called for anyone making three times the official poverty level to be forced to hand over as much as 13% of his gross income to the health insurance companies. Let’s see now – three times the official poverty level is $32,490 a year. Thirteen percent of that is $4227.

Now, 32k a year isn’t doing much better than keeping your head above water. So Max Baucus expects somebody who is just barely scraping by – and likely cobbling together three or four part-time jobs in order to do so – to have four thousand dollars lying around he can just hand over to the health insurance companies for their worthless services. And those who can’t afford to pay up will be fined. That’ll teach ‘em.

On what planet do people like Baucus live, anyway?

Yes, I know, Baucus promised yesterday his bill would include subsidies to help “moderate-income” people purchase insurance. How big a subsidy, he didn’t say. And no doubt the individuals who get the subsidies will have to undergo the same humiliating means testing now required for Temporary Assistance for Needy Families.

At a campaign-style rally at the University of Maryland, President Obama tried to scare healthy young people into believing that forcing them to shell out money for health insurance is for their own good. Apparently it’s not enough for him that a university diploma – almost the only ticket left to the middle class – is virtually unobtainable without incurring a five- or six-figure indenture. We have to turn the young people into cash cows for the health insurance companies, as well.

And for what? The health insurance companies aren’t the solution – they are the problem. People don’t need health insurance – they need health care. You can buy health insurance, and pay your premiums in good faith every month, and if you become seriously ill they can and will cancel your insurance. It’s all perfectly legal. You won’t even get back the premiums you paid.

Yes, I know – the “Healthy Future Act” will prevent insurance companies from doing that anymore. And if they think that we think that will solve the problem, then they must think that we’re a bunch of fools. As if the people who were venal enough to come up with the idea of recission won’t come up with something just as bad. Of course they will. They’ll be perfectly happy to offer you something called “health insurance,” but it will come at a price you can’t afford, or it won’t cover what you need. Count on it.

This Rube Goldberg scheme of insurance mandates and subsidies and fines for non-compliance has nothing to do with a healthy future. Much less does it have anything to do with a “free market.” It’s about preserving and expanding the health insurance companies’ profits, and damn the cost (financial and otherwise) to anyone else. Does anyone doubt their profits will be fatter after health care “reform” is passed?

It’s also about ensuring a fearful and compliant workforce. People who are saturated with the message that we are all fragile creatures who need expensive medical interventions all throughout their lives to keep them from falling over dead, AND who live in perpetual dread of losing their health insurance, aren’t very likely to call out their boss for doing something unethical or illegal. Or to quit and start a rival company.

The rest of the world is shaking its head at the convulsions we are having over this matter that every other developed country has already settled. What’s the solution? Simple – single-payer health insurance, like they have in the UK. How do we pay for it? Again, simple – we’re already paying enough in taxes for it. 58% of all healthcare expenses in this country are paid for by the taxpayers. That’s more than total spending on health care in all but three other countries. We could indemnify everybody in the country and save billions.

I know, that isn’t going to happen any time soon. But there is plenty we could do right now to rein in soaring medical costs that threaten to bankrupt us all, without revamping the entire system. If Medicare would pay the same prices for prescription drugs the Veterans’ Administration currently pays, that right there would save us three hundred billion dollars over the next ten years.

Yes, I know, the drug companies did agree to roll back their prices by eighty billion dollars, in exchange for the White House agreeing not to seek deeper cuts. But if they’re gouging us out of three hundred billion dollars, and giving us back eighty billion, that’s not such a good deal, now is it?

Even that three hundred billion dollar figure is a lowball estimate, because there’s plenty more we could be doing to cut the cost of prescription drugs. Currently, in order for a drug to be approved by the FDA, all that is required is two clinical studies showing the drug to be better than a placebo -- in other words, better than nothing. There is no requirement that new drugs be any more effective than existing generic ones, or for that matter, better than some home remedy your great-grandma could have cooked up on her kitchen stove. If we required that new medicines be shown to be better than old medicines before they could be approved, that would save untold billions.

We also ought to forbid Medicare from indemnifying any drug which is advertised. There is no good reason why the taxpayers should be paying for the drug companies’ advertising budgets.

While we’re at it, why don’t we stop Medicare from paying doctors to refer patients to diagnostic centers owned by the same doctors who are making the referral in the first place?

But getting serious about cutting soaring medical costs entails taking on wealthy and entrenched special interests. And so far, Obama has shown no desire to do such a thing. It’s much easier to attack the uninsured, a group of Americans who are just scraping by as it is, who lack the time and the money and the knowledge to lobby the system for their own benefit.

It’s all very sad. Less than a year ago, in a triumph of hope over fear, the people chose a young African-American community organizer and first-term senator to be their president. I assume the reason they elected him was because they were tired of the same ol’ same ol’, because they thought here was a man who would stand up for the people against rapacious corporate interests. And at every step of the way, he’s backed down and kowtowed to those same corporate interests.

The whole spectacle calls to mind the closing lines of Orwell’s Animal Farm:

“ The creatures outside looked from pig to man, and from man to pig, and from pig to man again; but already it was impossible to say which was which."

Animal experimentation and the shining city on the sea

Sat, 12 Sep 2009 19:09:44 -0400

”The Ones Who Walk Away From Omelas” by author Ursula K. LeGuin may be the most disturbing short story ever written. The story begins with the opening of the Festival of Summer in Omelas, a shining city on the sea (set in the future? The past? Some alternate reality? We never find out.) The Omelans are dancing, feasting, and laughing as a group of children on horseback line up for the start of a race. An old woman passes out flowers to the crowd, while a small boy plays a tune on his wooden flute. Omelas is portrayed as a kind of Paradise on Earth, a place of peace, prosperity, and harmony, of beauty and sensuality, where life is an unending celebration.

But beneath it all lies a terrible truth.

Somewhere in the city, locked in a closet in a damp basement, there is a tiny child (no one is even sure if it is male or female), starving, terrified, covered with festering sores, squatting in its own excrement. This situation is no secret, nor an accident. This child’s confinement is the price the Omelans pay for their carefree existence, in a terrible pact made with some unnamed entity. The terms of this pact are stark and clear: no one may so much as speak a kind word to this child, else all the Omelans have will crumble into ruin, into chaos and anarchy.

Every Omelan learns about the existence of this child upon coming of age. Predictably, they are shocked, outraged, horrified by the revelation, but, as the author tells us, “It is the existence of the child, and their knowledge of its existence, that makes possible the nobility of their architecture, the poignancy of their music, the profundity of their science. It is because of that child that they are so gentle with children. They know if the wretched one were not there snivelling in the dark, the other one, the flute-player, could make no joyful music as the young riders line up in their beauty for the race in the sunlight of the first morning of summer.”

Most of the Omelans come to terms with it. Some never do. Instead they walk away from Omelas and all it has to offer. As to where they go or what happens to them, we are told, no one seems to know.

When I read this story immediately I thought of our pharmaceutical industry.

I’m not even so much concerned with the deaths of untold millions of laboratory animals every year. Every living thing must die. I am more concerned with their existence while they are alive – endless hours imprisoned in tiny cages, morbidly obese and depressed, punctuated with moments of stark terror as they are restrained and jabbed with needles or worse. What does this do to our collective soul? Are these animals the real-life equivalent of that terrified child locked in the closet?

And the fact of the matter is, our shining city on the sea isn’t really all that shiny anyway. While it’s true that life expectancy has increased dramatically in the past century or so, medicine has had very little to do with that. Most of the increase is due to improvements in sanitation, nutrition, hygiene, occupational safety, automotive safety, and the like – not to new medicines.

Still, I would be greatly remiss if I did not acknowledge that medicine has made some contributions. There was a time, within living memory, when a diagnosis of Type I Diabetes was a death sentence. Today, with the aid of an inexpensive drug regimen, individuals with this condition can have decades of productive existence. Certain kinds of cancer – notably testicular cancer, Hodgkin’s’ lymphoma, and certain kinds of leukemia – are now entirely curable by modern medicine. Antibiotics have saved untold millions of lives.

But, I think we’ve already picked all the low-lying fruit. We still grow old and die. That hasn’t changed. Once you get past the age of eighty or so, there will be multiple competing causes of your death, and the best you’ll be able to hope for will be the one that carries you off most gently. And prior to that, probably most of the disease burden in the developed world is due to lifestyle choices – smoking, excessive drinking, and failure to exercise and eat sensibly. Many of these new “medicines” the drug companies are coming out with are nothing more than “me-too” drugs for conditions which are better managed with existing generic drugs (e.g., high blood pressure), or by lifestyle changes (e.g., high cholesterol, depression), or by not regarding them as problems at all (e.g., “restless leg syndrome”).

Nevertheless, the wheels of the medical research establishment grind on, while most people remain blissfully unaware of the involuntary sacrifice made on their behalf. I’m not sure if that makes it better or worse.

Mouse photo from Wikimedia Commons. All others copyright Brian Gunn /IAAPEA

Fresh takes up where Food Inc. leaves off

Fri, 11 Sep 2009 17:09:07 -0400

Ana Sofia Joanes’s film Fresh forms an obvious counterpoint to Food Inc. Both films detail the manifold problems created by modern industrial-scale agriculture. Both feature shots of cows, chickens, and pigs forced to endure the unspeakable conditions of Concentrated Animal Feeding Operations (CAFO’s). But where Food Inc. focused on problems, Fresh focuses on solutions.

Click here to read the entire article.

The checkup

Thu, 10 Sep 2009 17:09:49 -0400

In this country, going to the doctor for a checkup is like being shot at by someone – the best you can hope for is that he misses, and you end up the same as you were before.

I don’t know why people voluntarily go to the doctor for such a thing. When you think about it, you’re infantilizing yourself. You’re saying, in effect, “I don’t know how I am, Doc – you tell me.”

I know how I feel. I feel great. Oh, I know that theoretically, I could be harboring the beginning of some horrible metastatic cancer, but that’s extremely unlikely, and it’s even unlikelier that medicine could do anything to help me. So I’m not gonna worry about it. I already know I have to die. There’s a long history of death in my family. Every single one of my ancestors had one thing in common – they all died of something,

Nevertheless, I recently accepted a position overseas, and the NGO that is sponsoring me required me to get a thorough physical examination. So off to the doctor's I went.

The office was located in a nondescript building on Falls Road. A sign in the waiting room proclaimed, IF YOU ARE COUGHING OR SNEEZING YOU WILL BE ASKED TO WEAR A MASK FOR THE PROTECTION OF THE OTHER PATIENTS AND STAFF. An obese woman at the front desk took my insurance information, and I was ushered into the examining room.

The doctor was a young Indian woman, rail-thin, chipper, brisk, efficient, and businesslike. She took my personal information – no medications, no smoking, less than one glass of wine a day, six cups of coffee every morning, two hours and twenty minutes of exercise every day. She examined my eyes, my ears, my chest, my abdomen, tested the strength in my arms and legs, and then she left the room. An obese woman came in to take an EKG. She seemed inexperienced and unsure of herself, and another obese woman had to come in and help her.

Afterwards, I was escorted to the lab, where yet another obese woman took blood and urine samples, and I was sent off to the diagnostic center just up the road for a chest X-ray.

The place looked like a luxury resort, with not one but two koi ponds, one with a fountain, and both surrounded by luxurious gardens that exploded in a riot of colors. Two Mexican groundskeepers were hard at work as I entered “Pavillion I” and stepped into an atrium with high vaulted ceilings, deeply burnished wood pillars, and, for my convenience, a Seattle’s Best Coffee bar, just in case I hadn’t had my daily six cups.

I took the elevator up to the waiting room, where another sign informed onlookers that anyone who was coughing or sneezing would be “asked” to wear a mask. What a bunch of fearful little mice we have become, I thought to myself, as another obese woman took my insurance information. Still another obese woman took the X-rays, and we were done.

I left scratching my head. The whole enterprise is supposed to be about health and wellness, and yet I saw precious little evidence of that.

Nevertheless, there was a lot riding on the outcome. I had already told the four universities where I teach that I would not be returning this fall. If I were judged medically unfit for the assignment, I would be unemployed, my health insurance would be canceled, and I would be driven into bankruptcy and permanent unemployability.

So you can imagine my relief two days later when I received a clean bill of health. What’s that Winston Churchill said? Oh yes – nothing is as exhilarating as being shot at without result.