MD-Writer Blog

On Labor Day, President Obama finally turned to focus on jobs. So far this year, other items have dominated the agenda: financial reform, the BP oil leak, the Afghanistan war, the Middle East peace process. Now, less than two months before the mid-term elections, the president has begun to address the main issue on most people’s minds—the economy and jobs.

Speaking to a union crowd in Milwaukee yesterday, Obama called for $50 billion to rebuild 150,000 miles of roads, 4000 miles of rail, and 150 miles of airport runway. The program would create jobs by early next year with a quick injection of money. The federal government would establish a financing bank to make loans for infrastructure projects.

Predictably, Republicans nixed the idea, calling it more “out-of-control spending.” The GOP message has resonated with the public, which, by a wide margin of 55% to 39%, now has more confidence in that party’s approach to government policy, according to a Washington Post poll reported today.

But though most Americans are not convinced, the evidence shows that the president’s stimulus did work to add a millions of jobs and several percent economic growth. Indeed, Paul Krugman, the economic columnist for the NY Times, has long urged much more stimulus spending and has warned against ending fiscal support for the economy too soon. Yesterday Krugman detailed the parallel between now and the late 1930s, when FDR reigned in spending and prolonged the Great Depression until the hyper-stimulus of World War II took over and galvanized the economy:

President Obama’s economists promised not to repeat the mistakes of 1937, when F.D.R. pulled back fiscal stimulus too soon. But by making his program too small and too short-lived, Mr. Obama did just that: the stimulus raised growth while it lasted, but it made only a small dent in unemployment — and now it’s fading out. And just as some of us feared, the inadequacy of the administration’s initial economic plan has landed it — and the nation — in a political trap. More stimulus is desperately needed, but in the public’s eyes the failure of the initial program to deliver a convincing recovery has discredited government action to create jobs.

The Republicans, of course, know this history as well as the Democrats. But seeking to return to majority power in the Congress, they have done everything they can to foil proposals to improve the economy and try to convince the public that government spending does nothing to help. It is of course politics-as-usual, but we cannot easily dismiss their rhetoric, when so many people remain unemployed and suffer financial hardship as the result of their obstructionism.

Current education policy has moved away from No Child Left Behind, President Bush’s program, which emphasized standardized tests, to Race to the Top, President Obama’s initiative, which continues the testing but adds a focus on individual teachers and students.

Like most Americans concerned about the future of our nation and the upcoming generation of students, I’ve been troubled by our problems with education. But now I feel encouraged. I think the policymakers have finally got it right.

Last January, the president spoke about the new policy at an elementary school in Virginia. He said, “We urged states to use cutting-edge data systems to track a child’s progress throughout their academic career, and to link that child’s progress to their teachers so we know what’s working and what’s not working in the classroom.”

Perhaps in that spirit, this week the L.A. Times announced the upcoming publication of a new database tracking the performance of public school teachers in that city. The news organization analyzed seven years of students’ math and English test scores, obtained from the L.A. school system, to estimate the effectiveness of teachers. According to the article, the statistical method, called “value-added analysis,”

rates teachers based on their students’ progress on standardized tests from year to year. Each student’s performance is compared with his or her own in past years, which largely controls for outside influences often blamed for academic failure: poverty, prior learning and other factors.

Jason Felch, the reporter on the investigation, interviewed on NPR’s “All Things Considered” last evening, explained the reasons for tracking teachers and publishing the database:

Well, the big takeaway from our series and after, you know, spending a lot of time analyzing this data is that individual teachers really matter. The difference between teachers can be enormous, and which teacher a child gets is often left up to chance. So it would be difficult to have the information about which teachers are effective and which teachers are less effective and not make that public.

I remember my fifth grade teacher. It took me years to realize that for personal reasons of her own, she actively sought to undermine my education. One day during an assembly of the students, I competed against other students answering questions on science. She arranged for my correct answer to be announced false to eliminate me from the competition and teach me a lesson.

In contrast: My high school physics teacher, who was motivated by the subject and his passion to teach. Physics and math were beautiful things to him. He wrote the equations on the blackboard in an elegant hand that expressed his love for the subjects. His enthusiasm and his conceptual clarity transferred themselves to my classmates and me.

Although, I’m not an expert in education, I’ve had some degree of educational success, graduating from an Ivy League college and a top tier medical school. I think standardized learning—measured by tests—and the learning of fundamental concepts—imparted by excellent teachers—are both important for educational success. But teachers tip the balance.

At last, the country is moving ahead on education. The first leg was the standardized learning and the tests to measure it, under President Bush’s program. Under President Obama, the second leg is the excellence of performance by teachers. The nation is stepping forward, perhaps soon to walk, eventually to run.

This weekend, the NY Times ran a story on the Obama’s administration’s covert war on al Qaeda. But war is not the right word. What the reporters described is a clandestine Special Forces campaign.

The reporters wrote that the CIA has become a paramilitary organization, conducting attacks with missiles and other weapons, and the Pentagon has be come like the CIA, conducting spy missions. Private companies under government contract have also participated.

Such operations have played major roles in the wars Iraq and Afghanistan and in operations in Yemen. Congressional oversight has lagged, because existing legislation doesn’t apply to these special military programs, the Times reports.

I read the story with ambivalence. On the one hand, I know in my heart that if I were president, I would, like Obama, authorize any covert operation that could reasonably succeed in tracking down and eliminating Bin Laden and other terrorists.

On the other hand, I imagine and worry about the possible misuse of such capabilities by a future government of the United States. In the nightmare scenario I envision, Will Smith plays Robert Dean fleeing agents of the NSA in the 1998 movie “Enemy of the State.” Dean, an innocent bystander caught up in a rogue security operation, possesses a videotape showing a murder committed by the agents of the government.

In the most hellish scene, Smith runs and jumps from rooftop to rooftop, dashes up and down stairs, sprints down streets and through tunnels, etc., in Washington, DC, pursued by agents in helicopters, cars and on foot, all the while tracked by surveillance cameras.

Back when the movie was filmed, there were no drones. But if there were an actual Robert Dean today, he could be surveilled from on high by drones and targeted by missiles.

Ours is a nation that was founded in rebellion. The signers of the Declaration are reputed to have joined in rebellion because Benjamin Franklin told them, “We must hang together, gentlemen…else, we shall most assuredly hang separately.”

What would happen today if an unjust government misused its power against the citizenry? I don’t mean the stuff of Tea Party paranoia, which is making the rounds today on some networks on the internet. I mean suppose it really happened. What would happen if the government started using some of the awesome counterterrorism capabilities it is now developing to pursue al Qaeda on American citizens inside this nation?

I worry about that when I read a story such as this one in the Times Saturday. I applaud the aggressive pursuit of Bin Laden at the same time as I remember that the existence of al Qaeda itself is attributable to blowback from CIA clandestine operations. Could the blow one day come back to our own nation?

A new test to diagnose Alzheimer’s disease (AD) at an early stage may be at hand. Until now, the definite diagnosis of this most common form of dementia required an autopsy to demonstrate plaques of amyloid-ß protein and tangles of tau protein in the brains of deceased patients. A test that would diagnose the disease before death would permit trials of drugs on living patients who test positive, a critical requirement for development treatments. The ability to diagnose early may also be a critical requirement for developing effective treatments of AD-associated brain degeneration, ones that can be administered before irreversible brain damage has occurred.

The new test assays the levels of amyloid-ß and tau in the cerebrospinal fluid (CSF), the liquid that surrounds and bathes the brain and the spinal cord, supplies these organs with nutrients and removes their waste products. The research by scientists in Europe and America, reported this week in the Archives of Neurology, found that amyloid-ß was reduced and tau was elevated in the CSF of the AD patients.

A report by Gina Kolata in the NY Times on Monday suggested that the test “can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease.” But although it may turn out to be highly accurate, the reporter’s assertion of perfect accuracy may have conveyed an erroneous impression.

The researchers found that the statistical distribution of amyloid-ß levels was bimodal, i.e., there were two clearly defined peaks, indicating that CSF amyloid-ß level probably reflects a single disease process affecting the patients suffering from AD.

The scientists tested the test in three distinct populations of patients with similar encouraging results. In one carefully selected group, in whom the diagnosis of AD had been made made clinically based on signs of dementia, levels of amyloid-ß were found to indicate AD in all the patients. But in a different group of patients diagnosed after death with autopsies, which is the most accurate method, 94% of the patients with AD had levels of amyloid-ß consistent with the post-mortem findings.

It’s important to bear in mind that the results reported this week came from retrospective studies. Patient-derived data from existing databases of patients, rather than the patients themselves, were the subjects of the analyses. With the outcomes (AD present or absent) known, the scientists “looked back” to the results of previous CSF tests.

A definitive study of the accuracy of the test would have to be done prospectively. Patients whose diagnoses are not known would be followed forward in time until their diagnoses became evident. The results of prospective studies—unavoidably among less carefully selected patients—often turn out less impressive than those of retrospective ones.

The new test would require patients to undergo a spinal tap to obtain CSF for the assay. Some patients and even some doctors might be discouraged by the prospect of the procedure. They need not be. The spinal tap is a fairly routine test, probably done thousands of times a day. It is safe and doesn’t usually cause severe or significant side effects.

Google, the company that some time ago evidently changed its motto to “Do evil,” is teaming up with handmaiden Verizon to influence FCC regulations regarding net neutrality. Their apparent goal is to insinuate preferential treatment into the internet by persuading the commission to establish exceptions to such regulations. The effect would be to create a premium, high-performance tier of internet transmission that would be available at higher cost. What is now a level field and neutral network could become, in part, a telecommunications system that charges extra for enhanced content, more bandwidth and higher speed.

“As Google has gotten bigger and entered new lines of business, it has revised some of its principles — and it is drawing criticism from start-ups and public interest groups along the way,” the Washington Post reported yesterday.

Google and Verizon agreed that telecommunications companies could charge consumers for the quality of the content coming through their networks and even block access to certain content. For example, Verizon could transmit Google’s search engine but block Microsoft’s Bing, the Post said.

The NY Times, however, reported that the two internet giants had proposed that blocking any ordinary internet content would be prohibited. But new services providing enhanced content would be exceptions to the requirements of net neutrality. Such premium content and services would be allowed to transmit via high bandwidth channels, with premium prices set for access to them. For example, the Times said

the Metropolitan Opera might decide to stream its performances in 3-D through such a service because it would otherwise require too much bandwidth.

Support for exceptions to net neutrality may be building in Congress, even among Democrats, who might be expected to try to protect ordinary internet users from higher charges. On Monday, Chris Van Hollen, a Maryland Congressman and chairman of the Democratic Congressional Campaign Committee, wrote in an email response to an inquiry on net neutrality,

I believe that this vast new frontier [the internet] must also have the careful watch of regulators to ensure that no collusion or anti-competitive practices take place and that those who control the distribution channels do not attempt to unduly influence the content. I will continue to support measures to allow fair-use of the internet….

Absent—conspicuously so, in my view—from Van Hollen’s response was any use of the term “net neutrality” or any statement of support for that concept. Instead the Congressman used the phrases “unduly influence” and “fair-use of the internet.” But what constitutes undue influence and fair use? Responsible for raising contributions for Democratic campaigns, I suspect Van Hollen may have agreed with Verizon, Google and other huge companies to try to drill holes in regulatory walls protecting internet neutrality.

If that happens, large corporations and their legal staffs could breed corporate mice to squeeze through the holes in the regulatory walls and then grow to guerilla size. If permitted to exist and grow, these entities would transmit enhanced content and would surely diminish the visibility, audience and influence of ordinary content providers.

The internet would not remain the open, innovative space for new creators of content to work in at minimal initial cost.

The prevalence of obesity in America has risen to 34% of the adult population, the CDC announced last week. An adult is considered obesity if his or her BMI, which is calculated from height and weight, is greater than 30. The public health agency tracks the nation’s average BMI with telephone surveys asking people to report height and weight. Since the respondents often underestimate their weight and overestimate their height, the agency corrects the raw data to compute the actual rate of obesity. Referring to its full report, the CDC said on its website:

The data show a 1.1 percentage point increase—an additional 2.4 million people—in the self-reported prevalence of obesity between 2007 and 2009 among adults aged 18 and over. The report also notes the medical costs associated with obesity are high. In 2008 dollars, medical costs associated with obesity were estimated at $147 billion. People who are obese had medical costs that were $1,429 higher than those of normal weight.

In 2005, the NIH warned that rising obesity rates could reduce Americans’ life spans by as much as 5 years, on average. The health research institute based the projection on a report in the New England Journal of Medicine that estimated a 5-20 year reduction in longevity among the severely obese portion of the U.S. population. The problem could have an especially large impact on young people. The article said,

If the prevalence of obesity continues to rise, especially at younger ages, the negative effect on health and longevity in the coming decades could be much worse. It is not possible to predict exactly when obesity among the young will have its largest negative effect on life expectancy. However, in the absence of successful interventions, it seems likely that it will be in the first half of this century, when at-risk populations reach the ages of greatest vulnerability.

Yesterday, the NY Times reported that more girls are developing breast enlargement at the age of 7 or 8, and “increased rates of obesity are thought to play a major role, because body fat can produce sex hormones.” The article was based on research by physicians at Cincinnati Children’s Hospital Medical Center, who found that overweight girls were more likely to develop breasts. At that young age, girls may be unprepared to deal with the emotional and interpersonal challenges of elevated hormones and sexual development.

There can be little doubt that the diet of Americans, who consume large amounts of high-fat, high sugar foods, is one of the main causes of the epidemic of obesity. And the U.S. food industry has contributed mightily to the problem by selling and advertising many food products with high-fat, high-sugar content, in order to boost sales.

We Americans should at the very least, as national policy, restrict the advertising of these high-calorie food products to children via TV and the internet. And parents should teach their children to eat healthfully.

When I was a schoolchild, my teachers taught that America was first settled by Pilgrims, who sought to worship God in the manner they chose. Practicing their religion was so important that they crossed the treacherous expanse of the Atlantic in the little Mayflower, to begin new lives in the wilderness, thousands of miles from the civilization of their births. My teachers’ point was that freedom of religion is one of the original and central founding principles of our American nation—one worth facing great hardship and sacrifice, including loss of life.

Why is it that so many Americans don’t seem to understand that?

The Anti-Defamation League—of ALL groups—has joined a cacophonous chorus of opposition to the ground zero mosque. According to the statement of purpose on its website, the association is dedicated to “to secure justice and fair treatment to all.” But not including Muslims, apparently. After considering “the anguish of the families and friends of those who were killed on September 11, 2001″, the organization declared:

Proponents of the Islamic Center may have every right to build at this site, and may even have chosen the site to send a positive message about Islam. … But ultimately this is not a question of rights, but a question of what is right.

ADL fights discrimination against Jews, but it apparently doesn’t see a contradiction in supporting discrimination against Muslims. How would ADL react if the religious center were synagogue, I wonder. Would it claim it isn’t “a question of rights?”

But Fox News and its commentators are sounding the sourest notes. A story on the politics of the mosque showed a picture of a demonstrator with a sign equating building the house of worship at that site with glorifying the murders of the three thousand 9/11 victims. It’s clear from the text that Fox News accepts that view and is trying to demagogue it.

Didn’t these people take any American history? We learned about the Pilgrims in elementary school.

Freedom of religion is part of the first of the amendments for a reason. That’s how important the founding fathers thought it was. Since there would be no objections to a church or a synagogue, there should be none to a mosque. That’s how America works, or is supposed to, anyway.

The hullabaloo shows how many Americans, including some of the most fiercely patriotic, have failed to take to heart the history of our country and what the founders intended.

The First Amendment of the Bill of Rights requires that government not favor or discriminate against any establishment of religion. As Americans, we should all uphold that principle, and we should avoid demonizing any single religion and denying its followers their rights because of what a few of them have done.

In January 2008, the CDC and the FDA learned of an unusual number of fatalities among kidney dialysis patients who had received Heparin. The drug, which had been manufactured in China for use in Heparin products marketed by Baxter International, proved to be contaminated with a dangerous ingredient. Following the discovery of the problem and under the supervision of the FDA, Baxter recalled the contaminated Heparin products.

This Spring, McNeil Consumer Products recalled numerous batches of its over-the-counter medicines, including pediatric and adult products marketed under the Tylenol, Motrin, Zyrtec and Benadryl brands. Consumers had complained of being nauseated by the smell and experiencing stomach pain, vomiting and diarrhea. The FDA, which regulates drug manufacturers, criticized McNeil for not acting fast enough and failing to keep the agency informed about the problem.

One of the FDA’s most important jobs is ensuring the safety of medicines. But the work has become more difficult in recent years, when the ingredients originate all over the world and the companies that manufacture and market drugs are multinational giants. But this week Sen. Michael Bennet (D-Colo) has introduced new legislation to give the FDA more power to carry out its functions.

The Drug Safety and Accountability Act of 2010, introduced by Bennet on Tuesday would give the agency new powers [pdf] to act on its own authority to order recalls of dangerous drugs. The bill would also grant the FDA new powers to require pharmaceutical companies to document all entities involved in the manufacturing supply chains of drugs and to have management plans in place for ensuring the quality of all ingredients.

Under present law, even when the FDA has reason to believe a drug is harmful, it cannot initiate recalls on its own authority. Rather, the agency must pressure pharmaceutical companies to carry them out. As a last resort, the FDA agency may go to court to have a drug product declared an imminent hazard to public health and to obtain the authority act on its own to seize it. But the FDA is usually reluctant to take such a step. Most often the pharmaceutical companies understand the possibility of an imminent hazard declaration and want to avoid the adverse publicity, and in consequence, the companies usually agree to recalls when the FDA requests them.

Bennet’s legislation would also give the FDA power to subpoena documents and witnesses and to assess civil penalties, and it would authorize the agency to create a database of all manufacturers of ingredients worldwide.

In the case of drug regulation, as in many other governmental functions, long-standing authorizing laws are becoming outmoded. New legislation is often required to allow agencies to carry out their missions in a globalized world. Congress should pass Bennet’s bill or similar legislation quickly. … Unfortunately, that’s probably not likely to happen in the current extremely partisan, pre-election environment.

It’s always reason to rejoice when our American democracy advances equal justice and outlaws discrimination against a group of its citizens. In regard to the ability of gay and lesbian couples to marry, many Americans realize that laws prohibiting such marriage are rooted in prejudice or religious belief and are not grounded in rational considerations. Yet, rarely is the case made out as clearly as did Judge Vaugh Walker, the federal judge who ruled on California’s Proposition 8 prohibiting same-sex marriage. Legal experts agreed that the judge rendered a careful, logical opinion, the NY Times reported today.

The judge’s 138-page decision is worth reading in full, as I did. The judge hit the nail on the head in many passages. Here are several of the most cogent and convincing:

• Marriage is the state recognition and approval of a couple’s choice to live with each other, to remain committed to one another and to form a household based on their own feelings about one another and to join in an economic partnership and support one another and any dependents.
• Sexual orientation is fundamental to a person’s identity and is a distinguishing characteristic that defines gays and lesbians as a discrete group.
• Individuals do not generally choose their sexual orientation. No credible evidence supports a finding that an individual may, through conscious decision, therapeutic intervention or any other method, change his or her sexual orientation.
• Domestic partnerships lack the social meaning associated with marriage, and marriage is widely regarded as the definitive expression of love and commitment in the United States.
• Proposition 8 places the force of law behind stigmas against gays and lesbians, including: gays and lesbians do not have intimate relationships similar to heterosexual couples; gays and lesbians are not as good as heterosexuals; and gay and lesbian relationships do not deserve the full recognition of society.
• The sexual orientation of an individual does not determine whether that individual can be a good parent. Children raised by gay or lesbian parents are as likely as children raised by heterosexual parents to be healthy, successful and well-adjusted.
• The evidence shows that the movement of marriage away from a gendered institution and toward an institution free from state-mandated gender roles reflects an evolution in the understanding of gender rather than a change in marriage.
• The [prohibition of gay and lesbian marriage] exists as an artifact of a time when the genders were seen as having distinct roles in society and in marriage. That time has passed. The right to marry has been historically and remains the right to choose a spouse and, with mutual consent, join together and form a household. Race and gender restrictions shaped marriage during eras of race and gender inequality, but such restrictions were never part of the historical core of the institution of marriage. Today, gender is not relevant to the state in determining spouses’ obligations to each other and to their dependents. Relative gender composition aside, same-sex couples are situated identically to opposite-sex couples in terms of their ability to perform the rights and obligations of marriage under California law. Gender no longer forms an essential part of marriage; marriage under law is a union of equals.
• Many of the purported interests identified by proponents [of Propisition 8] are nothing more than a fear or unarticulated dislike of same-sex couples. … Proposition 8 was premised on the belief that same-sex couples simply are not as good as opposite-sex couples. … Proposition 8 played on a fear that exposure to homosexuality would turn children into homosexuals and that parents should dread having children who are not heterosexual. …
• Proposition 8 enacts, without reason, a private moral view that same-sex couples are inferior to opposite-sex couples.

The judge took an important step toward full inclusion of gays and lesbians in society. Making such advances is, magnificently and marvelously, the special gift and vocation of our great American nation.

The first clinical trial of human embryonic stem cells was given the green light by the FDA on Friday. As has been widely reported, this would be the first time that the use of human embryonic stem cells (hESC) to treat an otherwise intractable medical condition has been attempted. hESC have been the focus of much bitter controversy during the last decade related to the moral issues surrounding them. If the trial succeeds, then the promise of this long-anticipated therapy will have been realized for one actual disease, and the therapeutic claims of the proponents of the therapy will have been partially validated.

The investigation, carried out by the developer of the cells, Geron, will involve people who have sustained severe spinal cord injuries but have not suffered severing of their cords. That kind of trauma results in bleeding and inflammation at the site of the injury, and paralysis of muscles and loss of sensation in the body below the injury. The patients admitted to the study must have been injured in the thoracic (chest) region of the spine and they must be experiencing the most severe form of this type of injury with complete loss of motion and sensation in their lower bodies.

This initial trial will be small, including up to 10 patients, who will have been injured one to two weeks before receiving the stem cells. Studies in animals suggest that once several weeks or months have passed since the injury, scar formation would prevent effective treatment.

The stem cells will be administered to patients by injection through a syringe placed in a specially designed positioning device to ensure that the cells are delivered to the site of the spinal cord injury. Once they have been injected with the cells, the patients will receive an immunosuppressive drug for 46 days to minimize inflammation and stem-cell rejection.

Primarily intended as a “phase I” study of the safety of stem cell therapy, the trial protocol includes a long series of neurological examinations of the participants. Secondarily, the study will assess the return of their sensory and motor functions. The volunteers will continue to be followed for 15 years.

Geron derived the hESC from discarded embryos created as by-products of in-vitro fertilization (IVF) treatments. Using the cells, the company established immortal cell lines, which is possible because embryonic cells express a protein called telomerase that permits unlimited cell division. The company took some of the hESC and used molecular techniques to transform them into nerve tissue precursor cells called progenitor oligodendrocytes.

The study is designed so that the patients in the trial will have suffered the kind of spinal cord injury that causes loss of oligodendrocytes, a type of nerve tissue cell that supports the neurons that transmit impulses along the spinal cord. The underlying rationale of the trial is that by injecting precursor oligodendrocytes, the therapy will replace the kind of cell that was lost as a result of the injury.

Before attempting the trial in humans, Geron tested the rationale, effectiveness, and safety of the treatment in laboratory rodents with the same kind of spinal cord injury. The animal tests indicated that the therapy would likely be effective and safe in humans.

If Geron’s phase I trial shows that hESC therapy is safe and potentially effective, the study would be followed by larger phase II trials of up to 100 patients, and after that, by phase III trials of several hundred patients. The large trials would be used to definitively establish the safety and efficacy of the stem cell treatment and to learn more about how to administer it and which patients benefit from it.

If patients suffering from severe, permanent spinal cord paralysis and anesthesia recover some motion and sensation as a result of the new treatment, it would be a spectacular medical advance. Moreover, the accomplishment would encourage research into hESC therapies for other kinds of intractable injuries and diseases. For example, Geron has established stem cell lines to potentially be used for heart disease, diabetes, osteoporosis, arthritis, and liver disease, in addition to the nerve tissue cells being tested in the current trial.