Here’s another “decline of the West” type of factoid: some scientists are beginning to believe that sperm counts have been going down over the last fifty years. Not low enough, on average, to cause infertility, but going down. It is controversial because counting sperm has always been difficult and subject to alteration by changes in method, but many studies are pointing towards declining counts.
The first big study we have is here: http://www.ourstolenfuture.org/newscience/reproduction/sperm/2000swanetal.htm This is a survey of a large number of primary studies gathered together from 1934-1996. The final conclusion, after looking at 101 studies, was that the declines in sperm count are real. It goes on to mention the increases in testicular cancer and cryptorchidism that have occurred during the same time period. The study says at the end that environmental exposures are probably responsible for this increase, although it doesn’t mention any specific exposure.
The numbers were 113 million per milliliter in 1940 and 66 million/ml in 1990.
In 2012, a French study reported in the journal Human Reproduction concluded that there had been a significant decline in sperm count over the seventeen year period from 1989 to 2005; the numbers were 73.6 million per milliliter in 1989 and 49.9 million/mil in 2005.
A contrary study from 1996 showed sperm counts of 72.7 million/ml in California, 100.8 million/ml in Minnesota, and 131.5 million/ml in New York.
Another review concluded that there was no over all decline in sperm count based on a large number of studies done over the period from 1950 to 2000; six studies showed declines, sixteen did not, and five were ambiguous. More importantly, the studies that did not show declines totaled 100,000 subjects and the ones that did show declines only totaled 10,000. Counts varied dramatically based on country studied.
So the most we can say is that there may have been decreases in France, Israel, Greece, Denmark, and Italy, and no decreases in the United States, Denmark, Canada, Spain, Slovenia, Korea, and possibly Japan. Contradictory results were found in Denmark and France (Paris vs. Toulouse.), and in Israel. Eight of the studies that failed to find decreases had less than a thousand subjects, but three (Canada, Spain, and Korea) were very large. In contrast, all but one of the positive decrease studies had over a thousand subjects. Three of the ambiguous studies were over five thousand, including one each in Denmark and France.
There has, however, been a decline (in the United States) in serum testosterone concentrations, and it has been suggested that this is due to increasing obesity.
A study of eighteen year old men having their military physicals in Denmark showed no decline in sperm counts. Unfortunately, the study was never actually published; the data was presented on a web site by the Danish Ministry of Health. This study, of 5,000 men over fifteen years, seems to be the most convincing research yet done, and it is negative.
A comprehensive review published in February 2014 concluded that there is no definite evidence of an overall decline in sperm counts nor a definite sign of an “endocrine disrupter” lowering counts. The review examined epidemiological studies published from 1985 to 2013 and found “no[t] enough evidence to confirm a worldwide decline in sperm counts” and “no scientific truth of a causative role for endocrine disruptors” because of mixed evidence: some studies show a decline, but most do not. The authors of this review emphasize the difficulties in producing reliable counts over long periods of time due to variations in methods and analyses, and especially due to large variations in sperm quality and quantity. There is considerable variation simply from one geographic region to another.
Our conclusion is that there is no definite evidence of a decline in sperm count over the years; it will be necessary to continue large, long-term studies to see if there are any definite variations in the future. This aspect of the “decline of the West” is ambiguous, to say the least.
Placebo effects are getting stronger in the United States, for example, though not elsewhere. Researchers reported last year that in trials published in 1996, drugs for chronic pain produced on average 27 percent more pain relief than placebos. By 2013, that advantage had slipped to just 9 percent. Likely explanations include a growing cultural belief in the effectiveness of painkillers — a result of direct-to-consumer advertising (illegal in most other countries) and perhaps the fact that so many Americans have taken these drugs in the past.
via A Placebo Treatment for Pain – The New York Times.
This is an opinion piece that plumps the value of placebos and warns that opioids have caused thousands of overdose deaths (see also our post on overdose deaths and the dramatic increases recently.)
The statistics are interesting, even impressive; for example, 44 percent of those receiving sham acupuncture had “adequate” relief of symptoms. Even more provocative, if the person who performed the acupuncture was especially “supportive and empathetic”, 62 percent of patients had adequate relief.
There is, however, a significant percentage (almost half, in most studies) of patients who do not receive relief unless they are treated with the “real thing.” Even more distressing is the percentage of patients who do not get relief from any medicine given: perhaps a quarter of those treated are not helped.
Some of those who do not get relief from drug treatment are candidates for surgery, but another group are unable to get relief and do not have a “surgical lesion” (that is, there is no clear reason for operating.) These patients are the most distressed and the most at risk for drug abuse and overdose.
Some of these patients will chase their pain with higher and higher doses of painkillers or even heroin, and only find relief when they are unconscious or near death. These are the patients most in need of “supportive and empathetic” treatment, a real connection with another person who will listen to them and not abandon them.
This is the most stressful and most crucial task in medicine: to connect with someone and accept the fact that they have untreatable physical and psychic pain.
There is a scene in the Japanese movie “Redbeard” in which a young intern (circa 1868) is given an assignment by an experienced doctor: sit with a dying patient and just watch him die.
The intern wants to rebel and run away, but he finally accepts his role with this suffering man: just to sit there and watch him die. Sometimes we have to accept our suffering because there is nothing we can do about it.
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BioRxiv– the preprint server for biology
Abstract
Negative and positive experiences can exert a strong influence on later memory. Our emotional experiences are composed of many different elements – people, place, things – most of them neutral. Do emotional experiences lead to enhanced long-term [recall] for these neutral elements as well? Demonstrating a lasting effect of emotion on memory is particularly important if memory for emotional events is to adaptively guide behavior days, weeks, or years later. We thus tested whether aversive experiences modulate very long-term episodic memory in an fMRI experiment. Participants experienced episodes of high or low pain in conjunction with the presentation of incidental, trial- unique neutral object pictures. In a scanned surprise immediate memory test, we found no effect of pain on recognition strength. Critically, in a follow-up memory test one year later we found that pain significantly enhanced memory. Neurally, we provide a novel demonstration of activity predicting memory one year later, whereby greater insula activity and more unique distributed patterns of insular activity in the initial session correlated with memory for pain-associated objects. Our results suggest that pairing learning episodes with arousing experiences may lead to very long-lasting memory enhancements.
This study found that associating a pain (heat on the skin) that was intense but tolerable with a random image enhanced remote recall of the image a year later. This implies that memories are enhanced by being associated with painful experiences, not a surprise but comforting to find that it is experimentally detectable. A memory that is enhanced by association with pain describes many of the most common memories that we retain. Think about it: have you forgotten that time you burned your fingers on the waffle iron at age four?
Abstract
Background
Marijuana use is increasingly prevalent among young adults. While research has found adverse effects associated with marijuana use within experimentally controlled laboratory settings, it is unclear how recreational marijuana use affects day-to-day experiences in users. The present study sought to examine the effects of marijuana use on within-person changes in impulsivity and interpersonal hostility in daily life using smartphone administered assessments.
Methods
Forty-three participants with no substance dependence reported on their alcohol consumption, tobacco use, recreational marijuana use, impulsivity, and interpersonal hostility over the course of 14 days. Responses were analyzed using multilevel modeling.
Results
Marijuana use was associated with increased impulsivity on the same day and the following day relative to days when marijuana was not used, independent of alcohol use. Marijuana was also associated with increased hostile behaviors and perceptions of hostility in others on the same day when compared to days when marijuana was not used. These effects were independent of frequency of marijuana use or alcohol use. There were no significant effects of alcohol consumption on impulsivity or interpersonal hostility.
Conclusions
Marijuana use is associated with changes in impulse control and hostility in daily life. This may be one route by which deleterious effects of marijuana are observed for mental health and psychosocial functioning. Given the increasing prevalence of recreational marijuana use and the potential legalization in some states, further research on the potential consequences of marijuana use in young adults’ day-to-day life is warranted.
As nearly as can be determined from the abstract, this study involved forty-three subjects, who each kept a diary for fourteen days. The subjects were selected for an absence of a history of any substance dependence. They reported on their alcohol, tobacco, and marijuana use, and at the same time reported their feelings of impulsivity and interpersonal hostility concurrently. The limitations of this study are clear. There is no report as to whether the subjects kept notes in their diaries on other issues, which strikes me as odd. If one is keeping a diary of feelings and behaviors, one might well report on other things that are going on at the same time, and the fact that this is not mentioned limits the reach of the study. The most serious limitation of this study is the journal in which it is published: “Drug and Alcohol Dependence.”
Driving to Jacksonville– A Short Story
We started out from the dormitory where my mother, my sister, and I had been living. There was a gate and the car backed up to the gate, a big old Nash that had a dull bluish-gray sheen. The trunk was full, but is was big and we didn’t have much stuff. There were a couple of boxes in the back seat that my father threw in at the last minute.
My father and I got in to the car, my mother and my sister waved goodbye to us, and we drove off. We got on the highway right away, and we were driving along as it got dark and my father concentrated on the road.
I said, “Why are we going alone without my mother and my sister?”
He said, “Because we got a divorce and now you’re going with me and your sister is going with your mother. I’m going to get this great new job in Jacksonville, and we’ll have a house to live in, and a new school you can go to.”
I said, “It must be your fault you got divorced.”
He said, “No, your mother asked for a divorce from me.”
I made myself as small as I could in the passenger side of the car. I tried to hide in the corner of that big seat. I was crying, I know, but I don’t remember that. I cry easily, sometimes even at the doctor’s office. It’s embarrassing, but I can’t help it.
First we drove to Colby, Kansas, 210 miles as the crow flies from Denver, but at a steady 50 miles an hour, it would take over four hours to get there. It actually took five, and our gas tank was almost empty when we got to Colby. I was tired and sleepy, but I stayed awake for most of the time. I got out and walked around while my father filled up the tank. I don’t know how long it took to do it; five minutes. The attendant checked the oil and wiped the windshield with his rag.
The attendant looked at me and then at my father as he handed him the money for the tankful of gas: ten dollars. He went inside to get the change. My father put a nickel in the Coke machine and got a Coke to drink on the way.
After a few minutes, we drove on into the night. I began to get really sleepy, and the warmth coming from the heater vents under the dashboard made me drift into a fitful slumber.
We lived in a house with a staircase, and we drove in a car. I looked out the car window and saw the telephone wires over the street. I must have been about four years old, and we lived in Oakland. Later, we were living in Hawaii. We lived in a two story house and Miss Ogasawara lived upstairs.
There was a hurricane. The day before the hurricane I went to the hospital to have my tonsils out. I felt as if I were falling. After I woke up, my mother insisted on taking me home immediately.
The next day, the hurricane came. My sister and I crouched under the kitchen table. We were looking out the window; we saw the garage flip over and crash to the ground behind the cars.
My father climbed up on the dining room table and chopped a hole in the ceiling with an axe. Water came pouring down from upstairs; the windows were broken and letting the rain in. Miss Ogasawara wasn’t home. The eye of the hurricane came, and all of us were evacuated to the school. This was a big brick building with special glass that looked as if it had chicken wire molded into it. We sat out the rest of the hurricane in the safety of the school.
After the hurricane was over, we went home and found the tree next to the house hadn’t fallen on the house, but to the side. We cleaned up and lived as before. The dragonflies floated over the field again, eating flies.
One day, I was playing with my saw and my hammer. They were steel, and had wood handles. I left them on the ground when I was finished playing. The next day, I came back, and they were all rusted. My father told me, “you see, this is what happens if you don’t take care of your things; you have to pick them up and put them away when you’re done with them, or they won’t last.”
There is a photograph of three of us, my sister, my self, and a neighbor child sitting in front of the house playing with what looks like a tin pot.
After stopping in Colby, KS, we turn southeast with the highway and travel hundreds of lonely miles late at night. Our headlights show the road ahead. There are cars coming, their white lights growing then turning to red and fading away. There is the light from the dashboard, showing the speedometer and faintly outlining my father’s face. He drives impassively, calmly, without want or passion.
I am asleep. I see the lights but I don’t hear the sound of the engine. There is grief lining my face. There is nothing to see except the swishing of the lights that show through my closed eyelids like ghosts rushing through walls and across rooftops. Lost, I float with the ghosts into unconsciousness.
I was four when we moved to Hawaii, and six when we went back to California. We flew to San Francisco, and my mother, my sister, and I moved in with my mother’s mother. I don’t know where my father was at that time; I didn’t know that my parents had already gotten a divorce before they left Hawaii.
My mother argued a lot with her mother. One night someone upstairs was making noise and my grandmother started banging on the ceiling with a broom. She was angry, at the upstairs neighbors and at my mother.
Outside her house were pink and yellow sticky flowers with thick green leaves. My grandmother told me these were chrysanthemums.
We moved to Davis, where my mother enrolled in the University of California, Davis for graduate school. I learned how to ride a bicycle in Davis. My mother put me on the bicycle and I rode straight; I couldn’t turn. I rode across the parking lot and into the middle of an outdoors basketball game but I couldn’t turn aside.
We moved to Denver and there I started seeing a lot more of my father. Apparently he had been working and going to school at the University of Denver the entire time. My mother, my sister, and I first lived in a nice brick house which had a basement bedroom where my sister and I stayed. At Christmas I got an Erector set, and my mother made stuffed animals for us.
My mother stitched a large number of stuffed animals; my sister arranged them all on her bed so that there was just room for her to lie down surrounded by stuffed animals. We clung together, uncertain about the future and what would happen to our parents.
There is a monotonous series of towns that we drive through in the deep night-time: Hayes, Salina, Junction City. Kansas City is always another hundred and fifty miles away. Darkness envelops us; all we can see is the pavement ahead of us, dim in the headlights. Buildings and trees are mere shadows on the side of the road. We travel in a dim tunnel, flooded grey.
One day my father told me that we were going to move to a new place, that it would be good for me. I had already had a number of tests of intelligence and creativity, part of his thesis for his doctorate in psychology. He was studying at the University of Denver to get his PhD in psychology. He said that because he was getting a doctorate, he would be able to take this really good job in Jacksonville.
I only found out years later that my father had told my mother that he had gone to a judge to change their child custody agreement. He said that he had gotten custody of me and left my sister with my mother. He said the judge had ordered him to pay child support to my mother for my sister. That was part of his motivation for taking me with him when he moved to Jacksonville.
The part about going to a judge was all a lie; he had never gone to a judge, but he felt that telling her that would make it easier for her to comply with what he thought was right.
He felt that my mother wouldn’t raise me right and that I would be intellectually stunted if he left me with her. My mother told me that I didn’t have to memorize the multiplication tables, that I was too smart for that, and I should be studying other things. In fact, I finally did learn to memorize the multiplication tables and it took just a few minutes of study. After memorizing the tables, I was able to do all those things, multiplication and division, in my head, and that made things a lot easier.
It is early morning. The sky is just beginning to turn grey. We run out of gas a mile from town. My father sets off into town, carrying a gas can. I am left by myself in the silent car, starting to get cold. Time passes, and I am restless, no longer sleepy. I feel abandoned.
Finally, my father returns with the full gas can. The sky is blue all over and the sun is about to appear on the eastern horizon. He pours gas from the can into the filler neck of the car. He gets in and turns the key; the engine turns over but doesn’t catch. He stops, then tries again. This time the engine catches and comes to life.
As a faculty member, my father was allotted housing, a first floor apartment in a house owned by the college, across the street from the library. The second floor was occupied by a language laboratory, where students listened to taped lessons in their chosen language.
The first thing I noticed when I lay down in bed was that the sounds from the language laboratory could be heard through the ventilator shafts, which were large and made of sheet metal. Even at night, it seemed, I could hear people talking in French, Spanish, German, Russian, or unintelligibly in some unknown language.
Later when I was really upset, after we had been in Jacksonville for a few months, I started thinking about how I could get back to Denver. I knew it was eight hundred miles, but I thought, “If I start walking now, maybe someone will pick me up and take me along.” I thought of all the cold and snow on the way, but I was so upset I just wanted to get up and start walking back to Denver.
I got sick and had a fever, and I wanted to see my mother, but she couldn’t come. I felt really small, like a bug on the bedspread, and everything was as big as mountains. I walked and walked along the spread, and I was still in the same place. Then everything reversed and I felt vertiginous as the scale seemed to slide back into place.
I was on the bed, covered with a sheet and a blanket, and my head was on the pillow. I felt normal again, but I didn’t know what day it was. It seemed as if it were 1968.
We drive on, through Kansas and to Kansas City. We cross the Kansas River, and we are in Missouri. Most of Kansas City is in Missouri, but there is no time for sightseeing. We drive straight through the city, stopping to fill up again with gasoline.
The Nash Ambassador has an integrated heating and ventilation unit that was innovative for its time. There is no air conditioner; this option cost $345 and was optional, although Nash was first to offer an integrated front-end air conditioning system in 1954, the year of my birth.
Now, I am eight years old and it is 1962. According to Wikipedia, on September 12, President Kennedy makes a speech in which he “ reaffirms that the U.S. will put a man on the moon by the end of the decade.” On August 27, Mariner I is launched. I don’t know what day it is, just that school has already started and I am two days late.
I sleep through much of the trip, although my dreams are troubled. I imagine that there are many serious problems ahead of me, and I only want to stay here, alone, in this traveling space, never stopping, never arriving.
I wanted to get a cat, but my father said no, you can’t have a cat. He decided I should have a dog, as that was a more manly type of pet. We went to a farm outside of town and he got me a puppy, a beagle. We tried to keep him in the house, but he couldn’t be paper-trained. Nothing would induce him to poop in the right place.
One day the dog pooped on the floor right in front of the front door. My father came in from class and stepped right into it, almost slipping on it. That was the last of the dog. My father gave the dog to our neighbors across the alley, who kept the dog tied up in the back yard.
I wanted a monkey, but the man at the pet store said that they were nasty and would bite you. He seemed to know what he was talking about. He suggested hamsters
My father got me two hamsters, a boy and a girl, and I played with them a little bit. Sometimes they got out of their cages and I had to go looking for them under the sofa.
One day I was playing outside by the stoop, a concrete projection from the side of the house by the kitchen door. A small gray mouse was darting in and out of a hole in the base of the stoop. I spent some time watching the hole and the mouse’s movements.
The first mouse I caught died almost immediately. I think that I hurt it when I was catching it. The second mouse survived and appeared well. It was in fact small and grey, with tiny whiskers sticking out of his face behind his nose. I decided that the mouse was a he, although I had no way of knowing.
I only knew from what the man at the pet store said, not from personal observation, that my two hamsters were a boy and a girl. So the sex of the mouse was indeterminate.
I introduced the mouse to my hamsters. That is, I showed them to each other at a distance of a couple of feet. I was not sure, but I thought I saw a tiny black flea flying from the mouse to the hamsters. Or maybe it was my imagination. The next day, all three were dead. I don’t know whether I imagined the flea then or afterwards.
After Kansas City, we are driving in full daylight. We travel through interminable canyons of tall, tasseled corn. The road hums as the wheels caress it.
Next stop is Columbia, 120 miles east of Kansas City. I don’t know it now, but a couple of years from now my mother and sister will be living here and I will fly down from Springfield in a DC-3 to make my first air trip. It seems that I am only just begun on a long road trip, by plane, train, and automobile, even by foot, from San Francisco to here, with a few stops on the way.
Before we drove to Jacksonville, my father began dating a woman that he met in his psychology class (he was a student instructor, already having his master’s degree.) He had already been divorced from my mother and moved to another city, so he didn’t think there would be any conflict with her any more.
After he got the job in Jacksonville, he proposed marriage to her (although he had already made sure of her by taking her to bed.) She was very taken with him and accepted.
During the Christmas vacation, they got married while I stayed with my mother and sister. My mother was crying and I didn’t know what had gone wrong, but much later I realized that she was crying because she still loved him and didn’t want him to get married again. She couldn’t live with him because of the arguments so she had asked for a divorce; but she couldn’t avoid him completely, depending on him for money, for one thing. After the divorce, she only asked for child support for myself and my sister. Even so, it was hard on him.
We drove back to Jacksonville, the three of us, after Christmas. I had met Vicki, my new stepmother, before, and I had thought she was very nice; in fact, I preferred her over the other girl that my father had suggested to me for a new mother. I’m not sure, but I think he was pleased with my choice because he preferred Vicki too.
Many years later, Vicki told me that Ted had laid down some rules for her to follow. She told me that he had said that she should never touch me, not even a hug or a kiss. I was to be kept in the dark as much as possible with regards to her and she was to stay fully dressed whenever she was around me.
Nonetheless, Vicki and I developed a close friendship and we played word games and other little amusements. I don’t remember exactly what we did but I learned to communicate with her and she was very affectionate.
When we got back to Jacksonville after Vicki and my father had gotten married, we opened the front door to find the apartment completely filled with steam and water all over the floor. The pipes in the bathroom had frozen and burst, and there was a natural ice sculpture with icicles hanging from the ceiling. Apparently the heat had been left off while we were gone and it got so cold that the water in the pipes froze. When it thawed, the pipes that had broken open started spurting water everywhere.
When I went to school, I found that classes had already started, and I was a few days behind. Everyone stared at me. I was not surprised to see a few black faces in the class, although I had never seen a Negro before. My father had told me that there would be black people here and explained that they were exactly the same as everyone else except that their skin color was darker.
He told me to treat everyone the same. I didn’t understand at first what he meant, but later I realized that not everyone thinks the same way. I ignored what other children said and treated all of them the same. The black people that I came into contact with seemed to appreciate that and were friendly.
I got into trouble one day when I passed a note to Stuart Freiburg that had a naughty word in it, “shit” or something like that. The teacher sent me home with a note and I had to explain it to my father.
He said that there are several words that people don’t want to have heard in public, and it was just a social convention. He said that I should not use those words with other people, but when I was grown up, it wouldn’t matter so much.
At first, I thought my father was an evil bastard, even though he seemed to know everything and could worm anything out of me; but after several years I began to question his judgement. The place where he succeeded the most was in making me get good grades.
He paid me, for example, ten cents for every “outstanding”; if I got a “satisfactory” I got nothing. If I got a “needs improvement” then I lost ten cents. We got report cards every six weeks and there were some thirty or forty marks on each card. There was a chance I could get as much as three dollars on a single report card.
After he instituted this system, my grades picked up rapidly. Within six months, I was making two dollars or more on every report card.
My best friend in grade school was Lynn Ruby, a short, slight kid, with dark hair; we hung out together because he appreciated my wit and we were both ostracized by the main kids at school.
I was bullied mercilessly, starting in second grade in Denver, and only getting worse year by year into junior high school, when I finally became very tall and popular with the girls. Then the teasing finally stopped.
One of my first antagonists was Stuart Freiburg, the son of a physics professor. He was also a friend, as witnessed by the fact that we were caught passing notes to each other in class. We would hang out on the playground together or sometimes get into fights.
Once my father apparently got angry over the fights I had with Stuart. He was having problems with Stuart’s father in faculty meetings. My father offered me five dollars to break Stuart’s nose.
I punched him but I only broke his glasses. My father gave me a dollar for that.
Between Columbia and St.Louis, there are rolling hills and forests. The last light of day is fading in the west as we reach the suburbs, cutting north of St. Louis, passing through St. Peters, St. Charles, Hazelwood, and Florissant; we pass across the Mississippi River on a giant bridge into darkness that is Illinois.
Comment of the Day
Paul
Berkeley 2 hours ago
The government of China, like modern China itself, is a sham. The leaders of that nation’s communist party will do anything- be it correct, incorrect, or plain dumb– to try to keep the economic growth ball rolling because they know that the only thing that keeps them in power is growth. There is no other legitimacy to their leadership. The growth that has occurred over the past 20-25 years was the easy part– low hanging fruit in an era of globalization that favored low-cost manufactured goods, accompanied by historically low shipping rates and near zero interest rates for millions of consumers that wanted such goods. But now that the easy work is history, the leadership doesn’t know what to do next; its clumsiness in attempting to fix the stock market last summer is one indication, and its response over the past week to market volatility is a re-run of that behavior. Who knows what will come next, but one thing is sure: the party leadership is struggling and the odds are that they will fail. Why? The best solution is one they simply cannot abide: abandon their micro-control of the economy and their attempt to micro-control the behavior of the citizens of China. Until this happens, the globalized economy that we have today will suffer many more such episodes of incompetence from the fraudulent leadership of China.
…the majority of people struggling with bills are insured. Of the people in the survey reporting difficulty with their medical bills, 34 percent lacked health insurance, 39 percent had insurance through work, 14 percent were covered through public programs and 7 percent had purchased their own health plans.
One reason, many experts said, is a gradual shift in the norms about the generosity of health insurance. In recent years, health plans have come with growing deductibles and narrowing networks of providers, provisions devised to lower the cost of premiums. Those features have made health insurance accessible to a larger share of the population, but may also be leaving more insured Americans vulnerable.
via Even Insured Can Face Crushing Medical Debt, Study Finds – The New York Times.
The article claims that patients with Medicare are better protected from crushing medical bills and it is true that bills are smaller. People with Medicare, however, have less money in the first place, and even a small deductible or copay can cause financial strain.
The article also notes that the US has the highest health care costs of any nation in the world, typically double the cost of comparable countries. People in other European countries, for example, rarely face bankruptcy from medical bills although this is common in the US.
An article in the New Yorker describes the effect that the sugar lobby has had on Jeb Bush’s governance in Florida. Gigantic lobbying by the sugar industry, a major phosphorus polluter in the Everglades, caused Bush to legislate a change in the laws governing cleanup of the wetlands. The sugar cane growers dump their effluent water into the wetlands, and this causes high levels of phosphorus to stimulate algae growth. The laws, passed in 1994, state that the wetlands should be cleaned up in two stages, but when it came time in 2003 to implement the second phase, the sugar industry started lobbying Bush and the Republican party generally, and the second stage was indefinitely delayed.
The article states that, since 1998, the sugar industry has given over twenty-one million dollars to political candidates in Florida’s elections. This figure was obtained from the National Institute on Money in State Politics. This amount of money is trivial to an industry that has a revenue of over nine billion dollars a year. By spending this money on lobbying, the industry is able to avoid pollution controls that would cost them considerably more, perhaps a hundred million dollars a year.
Clearly, powerful industries and people control politics and cast their influence over whomever they chose to appear at the ballot box. No candidate could avoid their grasp, for hundreds of millions and billions of dollars are at stake. Through its influence, the sugar industry gets tax breaks, price supports, and exemption from pollution regulations. There is no limit to the extent to which private interests will go to obtain the influence they seek.
There is a distinct feeling of “deja vu” about North Korea’s announcement and claim that they have successfully tested a “hydrogen bomb.” The North Koreans have been trying to develop nuclear weapons and delivery systems (missiles) for many years and they have had a few successes. Agreements that we made with them to stop development in exchange for financial and logistical help have not been honored on either side. However, the Clinton administration’s approach to the problem was far more productive than the actions of the Bush boys.
In 1994, there was a crisis in relations between North Korea and the United States. President Clinton plausibly threatened to attack North Korea over its announced intention to begin reprocessing spent fuel rods from its shuttered nuclear reactor. Reprocessing would have allowed the North Koreans to extract plutonium, which is an essential raw material for nuclear weapons as an alternative to uranium. The North Korean leader, Kim Il Sung, threatened to take the reprocessing step as part of its long-term plan to develop an atomic bomb.
In response to Kim’s announcement, Clinton had the Pentagon send an advance team of 250 specialist soldiers to South Korea to manage a buildup of bombers, jet fighters, Bradley fighting vehicles, Apache helicopters, Patriot anti-missile missiles, and fifty thousand troops. This strategic move convinced Kim Il Sung that Clinton really intended to attack, or at least to mount a strike against the nuclear fuel reprocessing facility which they had already built, if the North proceeded with reprocessing and repudiation of the Non-Proliferation Treaty (NPT.)
At the same time, Clinton sent former President Jimmy Carter to North Korea on an ostensibly private mission to negotiate with Kim. Carter created a deal which went far beyond what Clinton had asked for, but it was merely an agreement and thus did not need to be ratified by the Senate as a real treaty would have. Under the deal, Kim undertook to lock up his spent fuel rods and place them under international supervision; the South Koreans agreed to build two light-water reactors in the North, and the US agreed to supply North Korea with large quantities of fuel oil (desperately needed in a country already on the edge of famine.) The US also agreed to say that it would not attack the North.
This agreement was not honored. The South Koreans did not build the light-water reactors, and the US ended its supply of fuel oil. Financial assistance for construction and the delivery of oil was not forthcoming from the Senate, nor from the South Koreans. The North Koreans secretly started to supply Pakistan with missile technology in exchange for Pakistani uranium centrifuges. Nonetheless, negotiations began between the US and North Korea. A framework deal was hammered out, but it was too late to accomplish anything during Clinton’s presidency. Clinton spent his last months as President unsuccessfully trying to work out a peace deal between the Israelis and the Palestinians.
When Bush became President, he named General Colin Powell as his Secretary of State. His policy stance, however, was in contradiction to Powell’s inclinations. Bush was aligned more closely with his National Security Adviser, Condoleeza Rice, who took a conservative, “principled” stance. At the same time, there were new leaders in both North and South Korea. Kim Il Sung died and was replaced by his son, Kim Jong-Il; Kim Dae Jung was democratically elected as President of South Korea. Kim Dae Jung had run on a platform of improved relations with the North, but his desire to negotiate with the other Kim was stymied by Bush’s new “no negotiation” stance.
Bush and his cronies claimed that negotiating with North Korea (or any other power he claimed was illegitimate, or in his words, “evil”) was rewarding them for bad behavior. At the same time, he had his hands full with preparations for attacking Iraq. It is ironic that Bush attacked Iraq for supposedly having “weapons of mass destruction” (which Saddam Hussein had already destroyed in the settlement after the first gulf war), while at the same time doing nothing to a country that really did have the capability to produce nuclear weapons.
There was no viable response to the North Korean threat other than negotiation because the US had no intelligence information about the North and little capability for invading them. They were too close to a powerful ally– China. So the Bush administration, aside from a trivial threatening gesture without substance, ignored the threats that Kim made and made his own insincere counter-threats.
When North Korea baldly admitted that they were acquiring centrifuges from Pakistan to convert their uranium to the fissionable form, U-235, there was nothing Bush could do about it other than negotiate. He had already ruled out negotiating with Kim Jong-Il, in fact, he openly stated that he “loathed” Kim. Thus, the North Koreans were free to do whatever they wished. Economic sanctions, even at their most stringent, could not bring the North Koreans to heel because Kim Jong-Il didn’t care if his people starved; he only cared about his own diet, which was more than adequate.
The North Koreans expected the US to behave as it had in 1994: openly threaten an attack, but quietly negotiate behind the scenes. The Bush administration made a weak, obviously token threat to attack (this was just after Congress had authorized an attack on Iraq), but failed to do anything about actually negotiating because of its “principles.” The North Koreans approached Bill Richardson, formerly US ambassador under Clinton, but the Bush people, wanting to preserve “moral clarity”, ignored their overtures.
Months later, Bush ordered several attack planes, B1’s, and B-52’s to our air base in Guam, in range of North Korea, but there was no accompanying Army or Navy preparations and no indications that Bush seriously planned to show readiness for an attack. At the same time, the Army was leading an all-out invasion of Iraq and Bush was incapable of leading a war on two fronts. No attempts to negotiate were made, and in April 2003, Secretary of Defense Rumsfeld advised Bush to take a policy of “regime change” towards North Korea. No actual preparations for creating a “regime change” were made other than trying to organize an economic quarantine.
Despite the economic sanctions, the North Koreans have continued their work on atomic weapons and missile delivery systems. The most recent announcement from North Korea, that they have successfully tested a “hydrogen” bomb, is almost certainly bombast, but it shows that they have not been frightened away or economically damaged enough to stop development of the very weapons that we destroyed Iraq over.
The weapon that North Korea tested a few days ago was estimated to be only 6 kilotons in yield, far less than the 15 kilotons that the Hiroshima bomb produced. It is extremely unlikely that they tested, even unsuccessfully, a true “hydrogen” bomb because the yield was so small, no larger than the previous tests. It is possible that the claim refers to a tritium-boosted fission device, but even such a device should have had greater yield.
The conclusion that I make is that the Bush administration’s failures in Iraq are equaled by their failure in North Korea. In the first case, we invaded and took over a country on the excuse that they were hiding the components of “weapons of mass destruction” which turned out to be false. In the aftermath of the invasion, we created a failing state and killed hundreds of thousands (no-one is certain just how many) of civilians, a seed-bed for Sunni extremism and the Islamic State. In North Korea, by refusing to followup on the Clinton initiatives and failing to make a credible threat to attack combined with a negotiating offer, we have allowed a ruthless, truly evil state to continue its path of destruction.
Here is an article from the Washington Monthly written by Fred Kaplan in 2004 that details how the Bush and Clinton approaches differed.
There is little that the Obama administration can do about this situation, as the North Koreans have the initiative and Obama’s representatives can’t even get to the negotiating table without making some very embarrassing concessions. The North Koreans have demanded that the US agree to promise not to attack them as a precondition for re-starting negotiations. US policy for many years has been to refuse to promise “no first use” of nuclear weapons; in this, we differ from every other nuclear-capable country in the world.
Saudi Arabia is known for its brutality in carrying out capital punishment, and the murder of Sheik Nimr al-Nimr was no exception. He was only one of forty-nine victims the other day, a high count even for the Saudis. He was said to be guilty of “sedition” in calling for the overthrow of the Saudi royal family. He was more guilty of being a pious and sectarian Shiite cleric, and was an old man unable to harm anybody. Nonetheless, the Saudis found it necessary to commit this act which has divided the Middle East even further. Since the execution, there was a protest in Tehran which resulted in the storming of the Saudi embassy despite the presence of Iranian police, who made numerous arrests. The Saudi government has given the Iranian envoy forty-eight hours to leave the country. There has been no new troop mobilization or any sign that war is imminent, but there also has been no let-up in the civil war in Syria or the war between the Islamic State and the Iraqi and Kurdish governments. A state of war in fact exists; it merely has not been given a name because there are so many named conflicts already.
The only possible escalation would be a direct attack on Iranian territory by a Saudi-flagged armed force. This would be unlikely and redundant. Neither country is capable of sustaining a fully equipped invasion. Saudi Arabia has a large area of territory which is populated by a Shiite majority, centered on Dhahran on the east coast. The large oil fields in this eastern part of the country also correlate with the Shiite population, and there is a risk of rebellion in this area. The Saudi’s response to dissent has always been harsh, and this execution has only made it more so. The friction between Shiite and Sunni threatens to cause even more bloodshed: bombings and massacres, individual suicide attacks and institutional discrimination more vicious than before.
The Saudi execution was one of the most provocative things you could possibly do to a Shiite Muslim. These religious devotees are more than usually sensitive to begin with. They are the same type of people who would murder a man for drawing a picture (any picture, not just a satirical picture) of the Prophet Muhammad. Whether this act was calculated to cause a negative reaction is hard to say, but it could hardly be more provocative if it was designed that way.
There is no credible institutional response to this violence other than expressions of dismay. We as a nation cannot change the behavior of the Saudis or the Iranians. At the same time, it is inappropriate to support the governments that engage in this behavior. We have treated the Iranians to a prolonged negotiation that may lead to improved relations between the US and Iran. We cannot treat the Saudis as friends without taking some action to express our dismay at the murder of Shiek Nimr al-Nimr and forty-eight others for political dissent. Under our laws, this type of punishment is not permitted and we should tell the Saudis that we don’t consider their behavior to be the sort of thing that civilized countries do.
Perhaps we have continued to support the Saudis through their war in Yemen, in which they have killed thousands of civilians in air attacks, because we, like the Saudis, are a more than normally violent people, and we appreciate the position they find themselves in with regards to more civilized countries like Belgium and Denmark. We are, after all, one of the most violent countries in the world, and we possess more firearms per capita than any other country in the world.
Here’s a story from the New York Times blog (that was shut down) back in 2012 about the arrest of Sheik al-Nimr.
