China has been enriched by American-supplied jobs, making most of the destined-for-the-dump merchandise you find on store shelves all over America, every piece of plastic you can name, as well as Apple products, Barbie dolls or Nike LeBron basketball shoes retailed in the United States for up to $320 a pair. “The uplifting of impoverished people” was one of the reasons Phil Knight, Nike’s co-founder, gave in 1998 for moving his factories out of the United States.
The Chinese success, helped by American investment, is perhaps not astonishing after all; it has coincided with a large number of Americans’ being put out of work and plunged into poverty.
Source: The Hypocrisy of ‘Helping’ the Poor – The New York Times
Paul Theroux has written a provocative essay, published in the NYT online October 2, 2015, that links the impoverishment of the American “middle class” to “offshoring” or moving manufacturing jobs from the US to China and Vietnam. A few American investors have become immensely rich by taking factories from American cities and moving them to China and other Asian venues.
This move is the logical extension of the manufacturers’ previous move, from the Northeast to the South in the early part of the 20th century. This move imposed the same mass unemployment on Northeastern towns back in the 1920’s that was imposed on the South in the late 20th century. The earlier move was motivated by the same reasoning, the search for cheaper labor, as the later move.
Asian workers are cheaper, out of desperation; they are recruited from the terribly poor and hungry, usually rural, lower class of Asian unemployed. American workers are more expensive; they require union representation, workers compensation, overtime, sick pay, vacations.
Mexican workers in maquiladoras are almost equally economical and they are available close by, manufacturing goods cheaply with minimal interference from worker’s rights agitators.
There is a counter-example, however: the German model. In the German system, there are exports of expensive, high-quality manufactures, and the workers are fully protected and given complete health coverage. The difference is that the goods manufactured for export in German factories are known for their superior quality and durability, making them well worth their extra cost. This higher-cost, higher-quality manufacturing system supports premium worker’s rights protection and health care coverage. The result is a highly paid, well satisfied worker population and a higher standard of living.
In order to get out of the trap represented by mass production of medium quality low priced goods imported from countries that are in the process of developing themselves, emulating the German system would be a better way to go. It would be quite straightforward to design a manufacturing process that deliberately creates products that are extremely high quality, through precision machining, superior quality control, hand finishing, and so on. The extra cost of manufacturing would be supported by premium pricing and a deliberate advertising policy emphasizing superior quality.
The alternative would be to legislate made-in-USA manufacturing requirements similar to those that are currently in place for automobiles. Current laws require a certain percentage of passenger automobiles to be made in the US. This requirement is the only thing that has prevented the complete destruction of the domestic automobile industry.
Another change that has resulted in imposed poverty instead of distributed benefits is the increase in productivity, partially related to automation. Productivity improvements have resulted in the production of a larger quantity of finished goods with less labor. Instead of distributing productivity improvements by shortening worker’s hours with the same number of workers, owners have kept the hours the same and reduced the number of workers, creating unemployment instead of prosperity. This will be further addressed in a later post.
Service in Medicine
One thing that medical students are not taught is the essential transaction that is part of every encounter between doctor and patient. The doctor should go in to the patient thinking that he wants to give the patient something and that the patient is asking for that something. The first question is “what does the patient want?” and “how can I give it to him?”
The thing that always intruded between me and the patient in the above-described type of encounter was that the patient seemed to be wanting something that was inappropriate. There is no annoyance, to a doctor, so large as when the patient says he wants drugs, narcotic pain-killers for example. This type of request often comes from a relatively young man who doesn’t seem to have much wrong with him.
There is nothing so destructive as the loss of concentration on this basic transaction. No matter how annoying the patient can be, the doctor must ignore these annoyances and focus on providing the patient with what he wants, treatment or explanation, usually a prescription.
The loss of focus and surrender to the annoyances leads to a destructive and obstreperous encounter with the patient. Harsh words that are not retracted cannot be retracted later. There’s no exception to the demand to just give the patient what he wants in the real world.
In the world of interpersonal relation harsh words can never be taken back.
Guns Shoot People as Well as Prairie Dogs
I like guns, especially for shooting prairie dogs, but I think they’re dangerous, a “two-edged sword” so to speak. Most people have no business handling guns, either because they don’t know what they’re doing or they’re not mentally capable of safely handling them.
Here’s the abstract of a study that concludes that gun ownership is related to firearms homicide rates:
Objectives. We examined the relationship between levels of household firearm ownership, as measured directly and by a proxy—the percentage of suicides committed with a firearm—and age-adjusted firearm homicide rates at the state level.
Methods. We conducted a negative binomial regression analysis of panel data from the Centers for Disease Control and Prevention’s Web-Based Injury Statistics Query and Reporting Systems database on gun ownership and firearm homicide rates across all 50 states during 1981 to 2010. We determined fixed effects for year, accounted for clustering within states with generalized estimating equations, and controlled for potential state-level confounders.
Results. Gun ownership was a significant predictor of firearm homicide rates (incidence rate ratio = 1.009; 95% confidence interval = 1.004, 1.014). This model indicated that for each percentage point increase in gun ownership, the firearm homicide rate increased by 0.9%.
Conclusions. We observed a robust correlation between higher levels of gun ownership and higher firearm homicide rates. Although we could not determine causation, we found that states with higher rates of gun ownership had disproportionately large numbers of deaths from firearm-related homicides.
Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301409?journalCode=ajph%29&
And a study that concludes that higher gun ownership is related to higher death rates of policemen from being shot:
Objectives. In the United States, state firearm ownership has been correlated with homicide rates. More than 90% of homicides of law enforcement officers (LEOs) are committed with firearms. We examined the relationship between state firearm ownership rates and LEO occupational homicide rates.
Methods. We obtained the number LEOs killed from 1996 to 2010 from a Federal Bureau of Investigation (FBI) database. We calculated homicide rates per state as the number of officers killed per number of LEOs per state, obtained from another FBI database. We obtained the mean household firearm ownership for each state from the Behavioral Risk Factor Surveillance System.
Results. Using Poisson regression and controlling for factors known to affect homicide rates, we associated firearm ownership with the homicide rates for LEOs (incidence rate ratio = 1.044; P = .005); our results were supported by cross-sectional and longitudinal sensitivity analyses. LEO homicide rates were 3 times higher in states with high firearm ownership compared with states with low firearm ownership.
Conclusions. High public gun ownership is a risk for occupational mortality for LEOs in the United States. States could consider methods for reducing firearm ownership as a way to reduce occupational deaths of LEOs.
Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2015.302749
Finally, a study that concludes that higher gun ownership is related to higher nonstranger shooting deaths:
Objectives. We examined the relationship between gun ownership and stranger versus nonstranger homicide rates.
Methods. Using data from the Supplemental Homicide Reports of the Federal Bureau of Investigation’s Uniform Crime Reports for all 50 states for 1981 to 2010, we modeled stranger and nonstranger homicide rates as a function of state-level gun ownership, measured by a proxy, controlling for potential confounders. We used a negative binomial regression model with fixed effects for year, accounting for clustering of observations among states by using generalized estimating equations.
Results. We found no robust, statistically significant correlation between gun ownership and stranger firearm homicide rates. However, we found a positive and significant association between gun ownership and nonstranger firearm homicide rates. The incidence rate ratio for nonstranger firearm homicide rate associated with gun ownership was 1.014 (95% confidence interval = 1.009, 1.019).
Conclusions. Our findings challenge the argument that gun ownership deters violent crime, in particular, homicides.
Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2014.302042
Notice that we say “is related to” rather than “causes” because these studies only show a correlation and do not prove causation. Nonetheless, these striking findings suggest that the presence of guns merely relates to more people getting shot, which is pretty simple. Guns certainly do not relate to any protective effect against getting shot, nor do they protect policemen from getting shot. It is hard to get away from the logical conclusion that guns cause people to get shot.
Guns are useful devices, but in the hands of fallible humans they go off, causing sometimes fatal wounds, when you point one at someone and pull the trigger. Having one doesn’t necessarily protect you from someone else who has one. Not having one leaves you defenseless, but if no-one other than a policeman has one, the fatality rate is lower– these studies show that.
Unfortunately, laws won’t reduce the number of guns floating around; illegally obtaining a gun is not difficult in most cities because there are so many in circulation. At last count, there were almost 300 million firearms in the US; a minority of people actually have them, and those that do usually have several on hand.
Reducing the gun homicide and suicide rates would be most effectively approached by dramatically increased investment in mental-health treatment, conflict-resolution teaching, and anti-poverty programs, particularly programs to provide well-paying jobs to disadvantaged youth, especially those of color, the most likely victims and perpetrators of gun homicides.
Removing a significant number of guns from circulation would require an enormous, unconstitutional search-and-confiscate mission which would likely miscarry because people would be forewarned and would hide their guns away. There really is no clear solution that doesn’t involve massive investment in mental health and anti-poverty programs.
I’m actually paying money to do this
My primary domain name is conradseitz.com and references to conradseitz.wordpress.com will redirect to here. This is because I paid eighteen dollars to wordpress to activate a simpler name. Everything else will remain the same. I’m paying fifteen dollars a month to read New York Times online ad libitum and I pay a hundred dollars a year to New Yorker for a subscription and access to their web site. Not to mention Science News, which has gone to $16 a year for online access.
The Internet may be “free” but the perks are extra.
Here is another example of pharmaceutical company price-gouging and opportunism: a drug company has patented a delayed-release preparation of doxylamine and vitamin B6, previously marketed under another name at much lower price in an immediate-release preparation. It is possible to obtain the exact same ingredients over the counter, and the price differences impressive: the OTC combination costs a little over $20 a month, while Decligis costs between $350 and $700 a month, depending on the needed dose. This is a price differential of twenty times in order to get a delayed-release preparation which has never been tested head to head against the OTC combination.
Who in his right mind would pay twenty times the price for an unproven “improvement” which makes it possible to take the drug twice a day as needed instead of four times a day as needed? Patients with mild-moderate nausea could probably get by with the OTC preparation two or three times a day. The funny thing about delayed-release preparations is that they are not reliably time-released. Sometimes the contents are all dumped into the blood stream at once; at other times, sometimes depending on food content in the stomach, the preparation will not fully dissolve by the time it exits the body in the fecal stream.
Insurance companies should refuse to authorize payment for prescriptions of this drug– it takes money away from higher health priorities (not that morning sickness is not a dreadfully unpleasant, and rarely, a life threatening illness). At the very least, the insurance companies should include the OTC preparation in the formulary that they WILL cover; and the Diclegis should only be available to patients who have failed the OTC version.
The fact that Kim Kardashian is pushing this drug indicates the market for which it was intended: the top 0.1% on the income ladder.
Here is a quote from an excellent blog post by Dr. Jen Gunter describing the outrages committed by this drug company (who will remain nameless for the moment):
Yes, while you can buy Diclegis as a prescription it is just a combination of two readily over-the counter (OTC) medications –vitamin B6 and doxylamine (an antihistamine) with slightly different dosing. When taken together doxylamine and vitamin B6 are mildly to moderately effective for nausea and vomiting in pregnancy. The difference between the prescription and the OTC is a minor variation in dose and the prescription is delayed-release so it is only taken once a day. However, there has been no head to head comparison between the OTC and prescription so we have no idea if the delayed-release offers any advantage beyond the convenience of one-daily dosing.The big difference between the OTC option and Diclegis is price. You can buy 100 doxylamine 25 mg tablets for $12.79 and 100 vitamin B6 tablets 25 mg for $7.29 (see below) and you can bet the manufacturers are still making a profit. Diclegis, if you have a coupon, is $345 for 60 tablets. The dose is two tablets a day, but some women need four tablets so the cost for could be $690 a month (with discount coupon!). Some may get it covered by insurance, but even then co payments are likely to be $20 or more. You will pay at most $25.20 a month for OTC (less if you don’t need four pills a day and/or take advantage of the buy one get the other 50% off at Walgreens). The other advantage of the OTC route is you can start with vitamin B6 and if that doesn’t work then add in the doxylamine. After all, we recommend a step wise approach to nausea and vomiting.Let’s compare OTC doxylamine/vitamin B6 with Diclegis. The OTC dosing is not identical but close enough and before 2013 (when Diclegis wasn’t available) we managed just fine using these slightly different doses. Check out this table:
Diclegis– if you have to ask the price you can’t afford it.
Those Attacks on Planned Parenthood
This is an old story but it bears repeating during the current attack on Planned Parenthood by the Republican Congress: the former Kansas Attorney General who filed 107 charges of performing illegal abortions against Planned Parenthood lost his law license over this behavior and other outrages. The Kansas Supreme Court took away his license indefinitely over 11 charges of misconduct in office as well as unprofessional conduct. Read this Raw Story report from 2013: http://www.rawstory.com/2013/10/kansas-supreme-court-indefinitely-suspends-license-of-former-attorney-general-who-speciously-prosecuted-planned-parenthood-and-george-tiller/
One of the most egregious (but typical) of the actions Phill Kline was disciplined for: he appeared on Fox News with a radical anti-abortion television news “commentator” whose show was called “Tiller the Baby Killer.”
You’ll recall that Dr George Tiller, one of three doctors in the US who provided rare late-term abortions, was shot to death by an anti-abortion assassin, in 2009, after a first attempt left him with bullet wounds in both arms in 1993. When Phill Kline, the Kansas attorney general, filed 19 counts of violating the law by using an employee to provide second opinions (required for late-term abortions), Tiller was acquitted on all counts. This was one of the charges Kline was disciplined for. The campaign of harassment and murder directed against Dr Tiller was not organized by Phill Kline, but he fed into the insanity of trying to prosecute a doctor for saving the lives of women who had nonviable late-term pregnancies (most with major developmental defects like hydrocephalus that were incompatible with life.)
Another of Kline’s unlawful actions was “speciously” filing 107 charges of illegally performing abortions on underage women; he somehow got his hands on the clinic records of a large number of women who had been treated by PP and picked up these 107 counts by combing through the charts. This was while he was Johnson County District Attorney (Johnson County is the most populous in Kansas.) The Court found that he repeatedly lied about how he had gotten access to all those charts. All of the charges were eventually dismissed but it took until 2012 to clear this up.
It seems that the radical Republicans were so charged up by their success in destroying ACORN, an organization dedicated to registering people to vote, by using doctored videos taken by hidden cameras, that they couldn’t wait to attack Planned Parenthood. PP is an organization that spends 97% of its time giving Pap smears and breast exams to poor women so that they can take birth control pills and thus avoid the need for abortions. In fact, when a PP clinic was shut down in one county, it was followed by an epidemic of HIV infections. PP is primarily a women’s health care provider for poor people, most of whom can’t get reasonable access to doctors even when they have Medicaid. A small proportion of its business, provided at a minority of its clinics, is providing abortions to women who pay cash for the procedure. Most of these women were using birth control and/or are financially unable to support another child (most already have children.)
The effort to destroy PP started with the creation of a sham organization that claimed to procure fetal organs for research; this allowed them to schedule meetings with PP administrators and invite them out to dinner. After secretly recording these meetings, filled with leading questions and wrong assertions by their spies, they selectively edited them and added words to the transcripts to make it appear as if the PP administrators were actively attempting to profit from the sale of fetal organs (“baby parts.”) Studies made of the videos after they were released showed that they were edited in such a way as to remove any denials by the administrators of the spies’ statements and make it appear that the administrators were agreeing with the outrageous lies told by the spies. In addition, they provided transcripts which were falsified; correct transcription showed that the administrators did not make the statements that the transcript attributed to them.
The saddest part of this scandal was that a major Republican Party candidate, Carly Fiorina, claimed that she saw things (“a baby with its heart beating and legs kicking”) that weren’t on the videos. She even claimed that she heard a PP technician say “we have to keep it alive so that we can harvest its brain.” (Does that statement make any sense? Why would someone say that about an aborted fetus (“baby”)?? As Star Trek fans would say, “He’s dead, Jim.”) When questioned about these claims, she “doubled down” and repeated her hallucinatory observations. That’s probably all I’m going to say about Carly Fiorina, despite my urge to mention all the candidates for President; she is so delusional that there is little else to say.
On CNN, a clip was shown of Congressional Republicans questioning an administrator for PP. The questioner claimed that PP used $22 million of federal dollars for lobbying. The administrator pointed out that none of that was federal money and all of it came from donations; when PP receives federal money, it is specifically reimbursement for expenses it incurs in providing health care and contraception to poor women. So Republicans are even attacking PP for lobbying to defend itself and are claiming that PP fraudulently uses the money it gets for health care for other purposes. This is absurd when we consider the minimal amounts of money that Medicaid pays for medical services, not even enough to fully reimburse a clinic for its expenses.
There is no logic or sense in destroying an organization that primarily provides birth control to poor women because the lack of birth control will lead to more pregnancies, all of them unintended and unwanted, and more abortions. This is the distorted and misogynistic thinking of radical Republicans.
Scientists have confirmed by observations from the Mars Orbiter, which has been taking close-up pictures of Mars for several years, that streaks of flowing water have been found in several places. Thousands of dark streaks that appear to lighten over periods of days have been seen. They are almost certainly water with high concentrations of perchlorates, which keep the water from freezing. It is very unlikely that anything could live in such salty water, but it appears that there is a great deal of underground water that is likely to be more pure and thus capable of supporting life. It looks as if there are large reserves of ice under the surface, which could easily melt under certain circumstances and provide a habitat for Earth-like micro-organisms.
Unfortunately, while the Mars Rover is on the ground only a few miles from one of these sets of streaks, scientists are reluctant to approach it because the Rover was not completely sterilized before leaving Earth. Some have suggested that after several years on the surface of Mars, with its harsh ultraviolet illumination because of the thin atmosphere, the vehicle may be sterile enough to avoid contamination. The only question is whether the Rover can survive another two years, long enough to reach the streaks. If it can approach a streak, the laser photometer on it that is specifically designed to vaporize samples and measure their spectra can shine on the streaks and directly test their water content.
It is already established that running increases one’s blood levels of endorphins. The same is true of anandamide, the body’s analogue to cannabinoids; running for 30 minutes increases blood levels of anandamide. More recently, blood levels of leptin have been found to change in relation to exercise.
In humans and most mammals, leptin, a hormone produced in fat and circulated in the bloodstream, reduces the appetite and indicates to the body that there is sufficient energy available. Fasting and running are associated with reduced levels of leptin, and faster running is associated with even lower levels.
Most recent, though, is an experimental setup in which mice had their STAT3 receptors deleted genetically. These receptors, in dopamine neurons, are associated with the mediation of the the leptin response in these neurons, which are important for their association with rewarding stimulation. In the absence of these internal mediating receptors, the neurons are continually stimulated and the mice respond by running twice as much as normal.
Mice do normally run several kilometers a day voluntarily on treadmills. But in the absence of the STAT3 receptors, they ran as much as 11 kilometers a day. The researchers say that they gave leptin to normal mice (intra-tegmentally) and they stopped running. The mice with the genetic deletion of the leptin mediator didn’t respond to leptin injections and kept running. The odd thing was that the leptin deficient mice didn’t have any changes in eating behavior. This receptor deletion study was published this month, here.
The trend of research recently has been towards multiplying the known endohormonal systems that are associated with changes in the individual’s metabolism and activities. There has been, over the last fifty years, a plethora of discoveries of new hormones and receptors. First, there are the brain and gut receptors that correspond to specific drugs: opioids, known as endorphins, that are subdivided into mu1, mu2, mu3, k1, k2, k3, d1, d2, and ORL1; GABA-A and GABA-B; nicotinic receptors, subtypes composed of twelve different subunits, and muscarinic, five subtypes; serotonin 1A-1F, 2A-2C, 3-7; endocannabinoid 1, 2, and possibly 3-5; testosterone, estradiol, and progesterone, using four types of nuclear receptors, luteinizing hormone, chorionic gonadotropin and follicle stimulating hormone, using membrane receptors ; oxytocin; finally there are the metabolism-related hormones insulin (probably the first) and glucagon, leptin, and ghrelin. There may be numerous others. In addition, the five known types of endovascular nitric oxide should be mentioned. Some of these function as both neurotransmitters and hormones, such as oxytocin.
An article published in the Australian Geographer last week related the oral traditions of twenty-one locations around the coast of Australia that described sea-level rises, occurrences that are reliably dated to 7-13000 years ago. The oral histories are in the form of myths that describe magical people and animals who induce the water to rise, in some cases suddenly, inundating passages between islands, creating bays, and sometimes submerging entire islands. All of these things happened during the last Interglacial sea level rise, occurring after the end of the last Ice Age 20,000 years ago. Since that time, for the last 7000 years, the sea level has been relatively constant; yet all of the coastal cultures seem to have these myths that describe a sudden sea level rise.
The paper is long and carefully reasoned, and worth reading if you are interested in Aboriginal myths. The article also mentions myths of the Great Flood and of Gilgamesh in passing, but these myths are quite different and speak of a permanent rise in the sea level of a relatively moderate degree. In all, I rate the reasoning as credible, and that it is possible for some cultures to retain in oral traditions, memories of events as much as 7000 years ago.
On May 20, about 100 stock analysts gathered in the ballroom of the Hyatt Regency Hotel in New Brunswick, New Jersey, to hear good news from top executives at Johnson & Johnson: The company had 10 new drugs in the pipeline that might achieve more than a billion dollars in annual sales.
For 129 years, New Brunswick has served as the headquarters of J&J, America’s seventh most valuable public company. With consumer products from Band-Aids to baby powder, Neutrogena to Rogaine, Listerine to Visine, Aveeno to Tylenol and Sudafed to Splenda, Johnson & Johnson is the biggest and, according to multiple surveys, most admired corporation in the world’s most prosperous industry—healthcare.
But the real money—about 80 percent of its revenue and 91 percent of its profit—comes not from those consumer favorites, but from Johnson & Johnson’s high-margin medical devices: artificial hips and knees, heart stents, surgical tools and monitoring devices; and from still higher-margin prescription drugs targeting Crohn’s disease (Remicade), cancer (Zytiga, Velcade), schizophrenia (Risperdal), diabetes (Invokana), psoriasis (Stelara), migraines (Topamax), heart disease (Xarelto) and attention deficit disorder (Concerta).
via America’s Most Admired Lawbreaker – The Huffington Post.
This is the beginning of a 58,000 word document that lays bare Johnson and Johnson’s crooked doings.
Johnson and Johnson had sales of $30 billion dollars; compared to that, the fine of $2 billion levied by the federal government for misrepresenting the effects of Risperdal was manageable. Johnson and Johnson profits make the $100 million that will be made from jacking up the price of a drug that only gets 10,000 prescriptions a year seem like small time money.
The medical industry is enormous and enormously profitable. The medicines sold don’t always do what they are advertised to do. There is something ugly about the prime time television commercials for Johnson and Johnson’s drugs. What right does a pharmaceutical company have to advertise drugs that consumers can’t directly buy and thereby put pressure on practicing physicians to prescribe? How can a patient judge what medicine is best for her condition?
The solution to these problems is a vastly strengthened FDA, to regulate the drug companies and reduce the excessive profit-taking that occurs daily, not to mention the drugs that are known to be ineffective or unsafe. There is no private solution that can stand up to $30 billion in sales a year. Only the government can develop the power to regulate this vast industry, and only with a restriction on lobbying.
A perfect example of what is wrong with the present system is President Obama’s nominee for FDA chief, a cardiologist who is accustomed to working closely with the drug industry in the research laboratory as well as clinically. This nominee’s potential conflicts of interest ran to twenty pages on his last published paper. It would be hard to find someone more in bed with the drug industry than this man. That demonstrates Obama’s obligations to drug lobbyists; the ACA demonstrated his obligation to health insurance lobbyists. There is no politician, whether Democrat or Republican, who is not in the pockets of any number of lobbyists who have paid for the campaign and expect recompense.
