Egg whites to treat moderate burns? Do the intertubes really know better?

An odd thing happened on Facebook the other day.

S--, a former colleague, posted the unhappy news that she had "just burned the F*CK out of my left index finger" while making dinner. A bunch of her Facebook friends chimed in immediately with sympathy and suggestions, led by her mom ... who offered the sensible advice that she cool the injury immediately in ice water. I didn't see the post until nearly an hour later, but thought I'd suggest -- for next time -- a folk remedy my family learned from another when I was a wee lad: after a minor to moderate burn, crack an egg over the injured area to coat it in raw egg white (it's a better idea to cool the injury under cool running water, then crack the egg).

Apparently this was novel advice to S-- and those of her friends who were weighing in on the What Is To Be Done question raised by her not-uncommon kitchen mishap. She was certain that the burn was severe enough to blister, and it was still hurting an hour later, so -- better late than never -- she tried the egg treatment, and found that the pain went away. S-- wrote that she was "happily flabbergasted."

I was flabbergasted too. Not because the egg trick had worked, I was pretty certain it would -- but because the treatment seemed to be unknown to S-- and her circle. So I turned to the hive mind to find out whether Everybody Knew that raw egg white helps to treat moderate burns, or if I had been living in an alternate universe since the 1970s.

It seems that everybody knew I'd been living in an alternate universe.

From Snopes, my favorite repository of hoax-debunking wisdom:

Akin to another Internet-spread rumor regarding the treatment of burns (which involved placing the injured extremity into a bag of flour), this seemingly helpful heads up also began making the online rounds in March 2011. In a nutshell, don't do it, because the danger of introducing salmonella into an open wound should not be toyed with.

The Internet-spread egg white remedy is somewhat more reliable in its approach to treating minor burns at home in that it outright states one should first cool the injured area completely with cold water before applying anything to the wound, yet even in regard to that exhortation, it's a bit off the mark [...]

If egg white is at all effective in treating burns (and we're not at all convinced that it is, 100+ year medical references to the contrary), it's as an occlusive dressing that would keep contamination out of a raw wound, not as a magical curative of burned flesh. Its effect on the healing process wouldn't have anything to do with its collagen content or that it's a "placenta full of vitamins," but rather that it's a thickish liquid that would form a barrier. (In other words, motor oil — which has no collagen to it at all — would work equally as well.)

As to what to do with all this confusion, even when the burn is minor and the injury is fully cooled before anything else is done to it, there is a downside to coating such an injury with egg white. Raw eggs sometimes contain or have resident on their shells salmonella, a deadly bacteria. Introducing salmonella into an open wound would be a dangerous idea. Says a physician friend of ours, "Burn-injured, denuded skin is an excellent culture medium, and a contaminated egg white applied to his burn could readily cause severe damage or death to the patient."

Oh, c'mon, I thought. Really? Salmonella? Motor oil?

But then I turned to the Journal of Emergency Nursing, and read of a study published in March 2010, First-aid Home Treatment of Burns Among Children and Some Implications at Milas, Turkey submitted by Banu Karaoz, whose abstract reads as follows:

This descriptive study was conducted among 130 families in Milas, Turkey, who have children ages 0 to 14 years. Among the 130 families, a total of 53 children (40.8%) experienced a burn event. Twenty-seven subjects (51%) had treated the burn with inappropriate remedies including yogurt, toothpaste, tomato paste, ice, raw egg whites, or sliced potato. Of the 28 subjects (52.8%) who had applied cold water to the burn site, 21 patients (39.6%) applied only cold water and 7 patients (13.2%) used another substance along with cold water. In addition, 13 subjects (24.5%) applied ice directly on the skin at the time of the burn. Excluding the subjects who had treated their burns with only cold water or with only ice, raw egg whites were the most commonly used agent, both alone (n = 3) or accompanied by cold water or ice (n = 6) in a total of 11 subjects (21%) who applied eggs. Based on these observations, it is suggested that educational programs emphasizing first-aid application of only cold water to burn injuries would be helpful in reducing morbidity and mortality rates. A nationwide educational program is needed to ensure that young burn victims receive appropriate first aid and to reduce the use of inappropriate home remedies and burn morbidity.

Burn morbidity. That sounds pretty grim.

I learned about burns and egg whites on a family car-camping trip in the mid-seventies. It was a multi-family camping trip, including mine and that of a postdoc in the Stanford University lab where my father was earning a degree in medical microbiology. The postdoc -- now a decades-long family friend -- was from Japan, and he was already, by the time he came to Stanford, a medical doctor (and therefore, going back to the Snopes screed, a physician friend of ours). He went on to become a professor and internationally respected research scientist before retiring a few years ago. But it was his wife, E--, who taught us about burns and egg whites.

At the time of this camping trip my brother was eight or so years old, plus or minus, and while our families were preparing a meal he burned his hand on a hot pan, cast iron if memory serves. Shocked, hollering bloody murder, in the middle of nowhere and hours from the Stanford Medical Center, E-- lunged for the ice chest, found a raw egg, and -- you guessed it -- cracked it over my brother's throbbing hand, slathering his injury in albumen.

It worked. The pain subsided, my brother calmed down, then my parents calmed down, and eventually we ate.

I remembered this trick when I was working in a restaurant some fifteen years later. I don't recall what I was making, but it involved a 10" All-Clad skillet and a very hot oven. Short story, I was doing five or six things at once -- S.O.P. for an on-duty cook -- and managed to forget to wrap a towel around the skillet's handle when I grabbed it and pulled the pan from the oven.

Hot? Let me tell you ... the whole palm of my hand and the inside of all my fingers went instantly bright, angry red, and I hurt like I'd never imagined.

It was a kitchen, probably not fundamentally different from yours at home, so a sink, ice, and a big metal bowl were mere steps away. I ran water over my right hand before plunging it in ice water, then did my best to get on with pumping out my station's dishes, one-handed. After a few minutes, in a moment between plating antipasti, I cracked a couple of eggs over still throbbing hand, wrapped it in a clean towel, and finished my shift. Miraculously, the burn didn't blister and the pain had subsided altogether by the time the kitchen closed. I was back behind the stove the next night.

I posted a letter to Japan shortly afterward, thanking E-- for saving me from a second degree burn over a distance of 5,000 miles and a fair few years.

So what's a person to do when folk wisdom -- verified by repeated, first-person, empirical experience -- contradicts medical authority?

I'm not going to try to give a general answer to that question.

But in the case of egg whites and kitchen burns? I'm thinking that if "only one in every 10,000 to 30,000 supermarket eggs is typically infected with salmonella enteritidis" (without clear evidence that free range organic chickens lay fewer infected eggs, so don't get cocky, as it were, if your fridge is stocked with the good stuff) -- even so, it's got to be way safer than crossing the street to go with the egg white treatment, unless a burn injury involves broken skin.

But caveat lector: I'm not a doctor, and I don't even play one on the intertubes.


Related posts on One Finger Typing:
Amateur food porn from Austria and Italy
One hundred trillion bacteria: the microbiome within you and without you
Broken food chains
Eating insects

Thanks to Samuel M. Livingston for the photo of a cracked egg, via Flickr.

Microbiome research vaults science and politics in reach of Lao Tzu

I believe that our dawning understanding about how deeply individual living beings interdepend on other living beings -- not just at the species and interspecies levels but as individuals -- is the next huge thing in human apprehension of what it means to be. As I wrote this summer, in One hundred trillion bacteria: the microbiome within you and without you:

What I find staggering is how this newly-understood scope of the human microbiome impacts any conceivable concept of "self" -- a topic of interest to narcissists, philosophers, and readers of Ayn Rand throughout the ages. What does "I" mean when each of us is a massively populated ecosystem? When each of us is, so to speak, a teeming zoo enclosed in a bag of skin.

But enough about me. Let's turn to an exhilarating article Michael Specter recently published in The New Yorker: Germs Are Us: Bacteria make us sick. Do they also keep us alive? I include excerpts in this post, but I recommend the entire article, whether you find it in your personal stash of unread magazines, at your local public library, or in the on-line New Yorker Archives, where one can purchase digital access to the issue of 22 October 2012.

Specter's piece begins with an introduction to the bacterium Helicobacter pylori.

H. pylori is a creature that co-exists with -- a.k.a. "infects" -- more human beings than all other bacteria combined, according to Specter. In 1982, a couple of scientists, Barry Marshall and J. Robin Warren, discovered the bug was responsible for gastritis and peptic ulcers in humans. Marshall and Warren later won the Nobel Prize for this work. Following their discovery, a long period of discussion and experimentation around a quest to rid human beings of H. pylori altogether ensued.

Luckily, this effort didn't succeed.

Why luckily? Because H. pylori does more than wreak havoc on human digestive systems. As the chair of NYU's Department of Medicine, Martin J. Blaser, put it to Specter:

"Germs make us sick [...]. But everyone focusses on the harm. And it's not that simple, because without most of these organisms we could never survive." [...]

"I love genetics [...]. But the model that places our genes at the root of all human development is wrong. By itself, it simply cannot explain how rapidly the incidence of so many diseases has risen." He stressed that genes matter immensely, but that one must take into account more than just the twenty-three thousand genes we inherit from our parents. The passengers in our microbiome contain at least four million genes, and they work constantly on our behalf: they manufacture vitamins and patrol our guts to prevent infections; they help to form and bolster our immune systems, and digest food. Recent research suggests that bacteria may even alter our brain chemistry, thus affecting our moods and behavior.

The article goes on to describe the mass extinctions [the phrase is mine in this context] of the microbiome in the bodies of people who live in developed countries and subject themselves to regular courses of antibiotics; as well as the loss of microbiome among babies delivered by Cesarean section (our first romp in the microbial fields naturally occurs in the course of vaginal birth, during which a child is draped in the protective mantle of her mother's microbiome).

Neither Dr. Blaser nor other responsible scientists dispute the effect and value of antibiotics, specifically the relationship between application of these treatments and freedom from disease. Put simply, without antibiotics, lots of people who are alive now would be dead. Antibiotics have dramatically increased longevity among populations to whom they are available when needed. Moreover, doctors' ability to safely and routinely perform Cesarean section has similarly saved millions of lives, both of mothers and their babies.

And yet.

Experiments conducted by Blaser, his NYU colleague Yu Chen, and Ann Müller of the University of Zurich, strongly suggest a relationship between absence of H. pylori and the occurrence of asthma. Similar findings are reported by Blaser's lab and others in relation to stomach hormones that regulate appetite, suggesting a relationship between absence of this bug -- so recently on most doctors' hit list -- and prevalence of obesity.

From Specter's article:

He [Blaser] took the theoretical case of a woman who was born at the turn of the twentieth century and possessed then thousand species of bacteria. Beginning in the nineteen-thirties, with the advent of antibiotics, most people began to have one or two courses of antibiotics in their lives. After the war, hygiene improved as well. The result: fewer bacterial species in our microbiome. "Let's say that the woman is down to nine thousand nine hundred and fifty," he went on. "And then she has a daughter. That child is likely to take many more antibiotics than her mother did. She starts life with fewer species, adn she will lose more as she goes along." Project this trend forward a few generations, and the implications are worrisome. "A lot of things are happening at once," he said. "The rise in obesity, celiac disease, asthma, allergy syndromes, and Type 1 diabetes. Bad eating habits are not sufficient to explain the world-wide explosion in obesity."

[...] "We are not talking about illnesses that are increasing by ten per cent," Blaser said. "They are doubling and tripling and quadrupling. With each generation there is heavier impact on the early-life microbiome. And it means we are less and less able to metabolize the food we eat."

It's complicated. And that, really, is the point.

At the risk of introducing a sour aftertaste of the 2012 election season that many would prefer to put behind, here's a short passage of President Barack Obama's speech to the Democratic Party convention on 6 September, as transcribed in the Washington Post:

We don’t think the government can solve all our problems. But we don’t think that the government is the source of all our problems, any more than are welfare recipients, or corporations, or unions, or immigrants, or gays, or any other group we’re told to blame for our troubles.

Because -- because America, we understand that this democracy is ours.

We, the People, recognize that we have responsibilities as well as rights; that our destinies are bound together; that a freedom which asks only what’s in it for me, a freedom without a commitment to others, a freedom without love or charity or duty or patriotism, is unworthy of our founding ideals, and those who died in their defense.

As citizens, we understand that America is not about what can be done for us. It’s about what can be done by us, together, through the hard and frustrating but necessary work of self-government. That’s what we believe.

What does a political convention speech have to do with the science of species interdependence? Queue up that second-to-last sentence from the exerpt, above:

It’s about what can be done by us, together [...]

Here's the thing.

Whether you're interested in effective action in the realm of politics, medicine, food policy, or energy investments, alignment to the world's reality is prerequisite -- including alignment to the existential truth of deep and pervasive interdependence. We've known this at least since Lao Tzu gave humanity the Tao Te Ching. In Stephen Mitchell's translation:

In harmony with the Tao,
the sky is clear and spacious,
the earth is solid and full,
all creatures flourish together,
content with the way they are,
endlessly repeating themselves,
endlessly renewed.

When man interferes with the Tao,
the sky becomes filthy,
the earth becomes depleted,
the equilibrium crumbles,
creatures become extinct.

The Master views the parts with compassion,
because he understands the whole.
His constant practice is humility.
He doesn't glitter like a jewel
but lets himself be shaped by the Tao,
as rugged and common as a stone.

Here's hoping we all -- not just the recently-reelected POTUS -- can find our way forward in harmony with the Tao through these staggeringly complex and dangerous times.



Thanks to Dr. Laughlin Dawes and radpod.org for the image of a ulcerated tumor that is not associated with H. pylori.


Related posts on One Finger Typing:
The controversy machine v the reality machine
Monoculture v complexity; agribusiness and deceit
One hundred trillion bacteria: the microbiome within you and without you

The Affordable Care Act in two essential points

With all the bazillions of words spewed on the Affordable Care Act (ACA), the Supreme Court decision to uphold it, and the asinine teeth-gnashing offered up by politicians and pundits on all sides -- do we really need more?

Yes. But not very much more. I'll try to be brief...

The thing is, if you're distracted by Congressman Mike Pence, running for governor of Indiana and likening the SCOTUS ruling on the ACA to the 9/11 terrorist attacks; or Breitbart.com editor-at-large Ben Shapiro tweeting that the decision is the end of America as we know it; or Rush Limbaugh calling the Supreme Court a "death panel"; or any other silly, irrational, socially-corrosive hysteric -- you could well be missing two essential points.

(1) LaLaLaLa I can't hear you!

The Kaiser Family Foundation released a poll on Tuesday. Based on a survey taken on the day of and two days following the Supreme Court decision upholding the Affordable Care Act, KFF found that 41% of Americans didn't know the ruling had been announced, or knew there had been a ruling but didn't know what decision SCOTUS had come to.

The Pew Research Center released a similar poll on the same date. Results from Pew are ... worse:

Despite extensive public interest in the court’s ruling, just 55% of the public knows that the Supreme Court upheld most of the health care law’s provisions; 45% say either that the court rejected most provisions (15%) or do not know what the court did (30%).

If what people don't know won't hurt them, 45% of Americans might never need a doctor. Wheeee!

Essential point #1, then, is that for all the yammering about a question that impacts just about everybody (because everybody who doesn't die suddenly and unexpectedly will need health care sometime, whether or not they're able to afford it), a shockingly large fraction of citizens in our ostensibly democratic polity aren't paying attention.

(2) ACA is a stake in the ground

Is the Affordable Care Act -- pioneered by Mitt Romney, realized by Barack Obama, upheld by Supreme Court Chief Justice John Roberts -- all good?

No! Of course not! It's riddled with Byzantine concessions to a rapacious health care "industry" concerned with maximizing profit irrespective of benefit to public health. (I'm talking about insurance companies, in case anybody's wondering.)

That is to say, the ACA is faulty because it's not single-payer. So say I, anyhow.

But if you disregard the pols and pundits currently telling any pandering, hyperbolic lie that they imagine will give 'their side' an edge in the November elections, and recall that every major policy initiative in the history of the United States evolved over time after its initial passage, what you're left with is a very simple conclusion.

What we have now in the ACA is an opportunity -- a compelling opportunity -- to fix deeply broken, staggeringly wasteful, and poorly focused health care policy and infrastructure.

Eugene Robinson said this very nicely in the Washington Post the day after the SCOTUS ruling:

Rather than seek a radical reshaping of the health-care system, Obama pushed through a set of relatively modest reforms that will expand insurance coverage to a large number of the uninsured — about 30 million — but still not all. He also tried to use free-market forces to “bend the curve” of rising costs, slowing but not halting their rise.

The result — the Patient Protection and Affordable Care Act — is a huge, complicated, unwieldy piece of legislation. I would have loved to see the president try for something simpler and more elegant, perhaps a “Medicare for everyone,” single-payer system. Maybe that’s where we’ll end up someday.

But despite all the rhetoric we’ll hear from Romney and the GOP until Election Day, health-care reform is here to stay. Provisions such as guaranteeing insurance coverage to those with preexisting conditions are too consumer-friendly to be taken away, and once these measures take effect, which happens in 2014, insurance rates would rise sharply — and unacceptably — without the individual mandate.

And medical costs will continue to soar, despite the law’s efforts to contain them. Inevitably, if only because of deficits and the national debt, Congress will have to revisit the health-care issue with an eye toward more radical changes.

When that next big push takes place, it will be with the underlying assumption that health care should be available to all who need it regardless of their ability to pay — that it is not a privilege but a right. Progressive presidents since Theodore Roosevelt have tried to enshrine this principle. Barack Obama did it.

Essential point #2, then, is that the ACA is not only not "the end of America as we know it," it's not even the end of health care reform.


Whether you're paying attention or not, the real work has just begun.


Related posts on One Finger Typing:
Acting like citizens about health care
Socialized medicine: an inside scoop
G.O.P proposes a death panel plan for health care


Thanks to the White House for the Reality Check image; and to The Alliance for Democracy for catching Dan Wasserman's on-point 2008 cartoon in the Boston Globe.

Acting up, fighting back: AIDS activism in the '80s and '90s

The other day I was leaving Moe's Books in Berkeley with a fresh-bought copy of Ann Patchett's State of Wonder in my bag when a newspaper on the free-newspapers rack by the door caught my eye. It was this week's edition of the Bay Area Reporter, and the headline article is what grabbed my attention: 25 years later, activists recall ACT UP's legacy, by longtime B.A.R. journalist Liz Highleyman.

There were a few things about this article that made me take another look, then pick up a copy of the paper and read.

First, I was involved in the early days of AIDS activism, though I worked more closely with a group called Stop AIDS Now or Else than with ACT UP per se. SANOE started as a sort of underground spinoff of ACT UP, a group that formed to plan a disruptive political action that would have been thwarted if it were planned publicly. Surprise was our friend. We surfaced for the first time to blockade the Golden Gate Bridge in 1989, and continued to work in a similar vein over the course of several years. I went to a few ACT UP meetings in San Francisco and found the scene too sprawling to feel I had a place there.

Anyway, second: it was sobering to see a political movement of which I was a part being remembered as quarter-century old history.

Third, the front page photo, snapped by photographer Rick Gerharter (who I remember as a camera-wielding fixture at demonstrations in the 1980s) included two people I recognized immediately. One was an old friend, comrade, and fellow student of Tai Chi whom I haven't seen in quite a few years. The other was a former lover, who lost his war with HIV not many years after our brief relationship.

The article is a well-drawn encapsulation of a political movement that substantially changed how people relate to doctors and the health-care industry in the U.S. Before ACT UP, people by-and-large trusted their doctors to know best. Doctors and scientists were the ones with the training, the degree, the authority. Since ACT UP, and especially now with the help of the intertubes, patients advocate for themselves individually and in organized groups. ACT UP was a game changer in the history of U.S. health care, and, as Highleyman's article points out, a deep and lasting influence in late-twentieth and this century's U.S.-based social justice movements.

But the photo also served to remind me that an inescapable legacy of that era is the loss of friends, lovers, and comrades who didn't survive the ravages of AIDS. Everybody of a certain age, in pretty much any of my circles -- professional, political, artistic, local -- can reel off a long, sad list of friends and lovers who died way too young. These many years later the wounds are old scars, the sort one has learned to live with. David S-- was in his early thirties when we were an item, and he gave me a hard time when he imagined that I imagined him perhaps a smidgen too old for me. I was six or seven years younger.

Not long afterward David was gone. Nowadays, "early thirties" strikes me as wet behind the ears more often than not.

David had an empowering time at the October 1988 ACT UP demonstration at the offices of the FDA in Rockville, Maryland, which is where the image accompanying this week's B.A.R. article (and this post) was photographed. As a souvenir he brought back one of my all-time favorite Demonstration Chants In History. When police readied themselves to haul away protestors blockading the FDA building they donned rubber surgical gloves, to protect against the imaginary danger of becoming infected by touching someone infected with HIV. In response, demonstrators scolded them for their distressing fashion faux pas: "Your gloves don't match your shoes! Your gloves don't match your shoes!"

Nothing like a little farce to lighten up a demonstration about life-and-death access to health care.

It turns out you can glimpse David S-- speaking to a camera through the narrow window of a police bus after his arrest outside the FDA headquarters in How to Survive a Plague, a film directed by David France that chronicles AIDS activism in the U.S. The film showed at Sundance earlier this year, and this weekend in Manhattan (it'll also be shown at MOMA in New York tonight at 6pm Eastern). The film will soon be broadly released.

Amy Goodman interviewed the director and founding ACT UP member Peter Staley this past Friday on Democracy Now! David S--'s few seconds in How to Survive a Plague is excerpted at ~37:30 of the DN! video, embedded in the linked article. Says Peter Staley toward the end of the interview with Amy Goodman: "Anybody who wants to change the world should run to see this film."

David S--, Stephen, Jason, Jay, Bob, Roger, Colin, David E--, Paul, Tom ... and so many more. Gone, but not forgotten.



Thanks to friend, fellow-writer, and longtime comrade in the AIDS movement and beyond, Kate Raphael -- quoted in this week's B.A.R. article -- for calling my attention to Amy Goodman's interview on Democracy Now!

Acting like citizens about health care

As the G.O.P.'s prospective candidates for president in 2012 slowly emerge out of the tea leaves, the national debate about health care policy gets weirder and weirder. What's a party whose raison d'être is to regain power to do (cf. Mitch McConnell)?

According to the Republican Party's playbook, trumpeting the signature achievement of a (currently) leading candidate when he served as a state governor is off the table. Why? Because Mitt Romney's signature achievement as governor of Massachusetts was signing a health care reform that was rational, pragmatic, economically viable, medically sound, and a boon to public health. Not perfect, to be sure. But better. Way better.

Oh, but wait ... it also served as a model for national health care reform signed into federal law by President Obama last year.

The story has been told, is being told, and will continue to be told, by talented professionals at greater length and in greater detail than you need to hear from me. Check out Ryan Lizza's story in the 13 June issue of The New Yorker for a comprehensive analysis, Romney's Dilemma, available from your local public library if you don't subscribe to the magazine. For a shorter survey that isn't limited to subscribers, try Dr. Aaron Carroll, Associate Professor of Pediatrics at Indiana University, via his piece on CNN.com, Romney's contortions on health care.

Let's take a small step to the side and have a look at what Michael Specter has to say on controversies over vaccination in the 30 May issue of The New Yorker. In the article, Specter gives an airing to reservations & resistance to government-mandated vaccination, making clear in this specific aspect of public health policy the issues that are currently shaping the larger national debate on health care -- specifically, the tension between individual liberty and responsibility to community. Here's how Specter lands in his consideration of the topic:

But the social calculus of vaccination can never be reduced to the estimation of individual benefit. When most members of a community are vaccinated, they protect those who are not by eliminating the viral reservoirs in the population. The effect is known as herd immunity. Some people, because they are too young or have particularly weak immune systems owing to cancer or other illnesses, cannot be vaccinated. For them, herd immunity is the only defense. As long as the majority are vaccinated, then, a few can decline without courting harm, but when vaccination rates fall below a certain level this protection quickly begins to vanish. At that point, someone who refuses a vaccine imperils not only his own health but that of everyone he encounters.

Clear enough? Here he is again, reducing the issue to an even sharper point:

After all, what makes it easy to be a vaccine dissenter these days is the fact that most people aren’t. Because of routine vaccination, measles -- which kills at least a hundred and fifty thousand people in the developing world each year -- long ago ceased to be a significant threat in the United States. This creates a paradox. Public-health officials must struggle constantly with the consequences of their own success [...]

In this reader's opinion, that's just about the same point that Ryan Lizza makes in his article about Romney, here quoting Timothy Murphy on a requirement that individuals purchase health insurance. This so-called "individual mandate" is a key element of both Romney's and Obama's health care policy reforms. (Murphy served as one of several Romney advisers on health-care policy during his term as governor of Massachusetts.)

According to Murphy, Lischko, and Gruber, Romney believed that the logic in favor of a mandate was impeccable. Federal law requires emergency rooms to treat patients regardless of their ability to pay. "This is not Calcutta," Murphy said. "We don't let people go and die in the street. And then the question is, Who bears that cost? Those costs get paid by increased premiums for the people who do buy insurance, or they get paid for through socialized costs and claim our tax revenues and come at the expense of other things that people might want to do, like building roads and bridges. And in the Republican Party that I grew up in -- go back to the welfare debate, it's about personal responsibility -- that seems pretty reasonable."

Does individual liberty matter? Of course it does! But it's not the only variable in the equation. As individuals, we have ego and superego to balance id. As societies we have government, compromise, and rule of law to bound purely self-determined exercise of will and power. Where to draw the lines between individual liberty and social obligation will (I hope) be a topic of spirited disagreement and debate for centuries to come. But that's not the same thing as saying it would be okay to let Tea Party lunatics drive national policy.

In response to Congressman Paul Ryan's plan to gut Medicaid and Medicare, from which the party has been forced to beat a retreat for now, I wrote in early April: "Pander to the rich. Leave the poor to die in squalor. That's the cliff over which the G.O.P. wants to drive a nation they would rather damage than govern."

Mitt Romney, in his willingness to contort a once-pragmatic approach in order to align himself with extremists, seems well-qualified to hold the reins if the G.O.P. is successful in its bid to plunge the nation into an abyss.




Related posts on One Finger Typing:
G.O.P proposes a death panel plan for health care
Post-ideological health care



Thanks to DonkeyHotey for the caricature of G.O.P. presidential candidate and former Massachusetts governor Mitt Romney, via Flickr.

Socialized medicine: an inside scoop

Kaiser Permanente is a non-profit health plan & medical group practice that gestated as a means to care for tens of thousands of workers streaming into Richmond, California shipyards as the U.S. geared up for World War II. The not-for-profit medical plan was formalized at the end of the war, as employment at the shipyards fell off. The organization is well-known for emphasis on preventative care and its public health orientation, and provides members with the convenience of making most services available at campuses that cluster medical clinics, labs, hospitals, and treatment centers in a single location. The numbers involved are large: over 8.5 million members in ten states; 35 hospitals; 15,000 doctors; $42 billion in operating revenue in 2009.

Kaiser's mode of managing health care, a product of industrial need and medical efficiency, has been tarred with the "socialized medicine" brush from the start. According to Rickey Hendricks in an article titled Medical Practice Embattled... published in the Nov 1991 Pacific Historical Review, "local medical societies rejected applications for membership from Permanente doctors who they implied were champions of socialized medicine."

I've been a member of Kaiser Permanente in Oakland since shortly after I graduated from college. I've been pretty fortunate, as these things go, to have required care only occasionally and in moderation. Over the course of several decades I've known dozens of others who are also Kaiser members, with a variety of health profiles. For all the fearmongering about scarcity of access under managed care plans, never mind the Tea Party whack-jobs fantasizing about death panels, I haven't heard a lot of complaints. I have none.

Well, okay, let's keep this fair and balanced.

There was one opthomologist I saw quite a few years ago following an injury -- some idiot-drunk high school kid tried to brain me with a wine bottle then kick my head off when I dropped to the sidewalk, because he thought I had disrespected his girlfriend (he turned out to be looking for somebody else ... idiot-drunk, like I said). The doctor I saw roughed me up a bit as he examined my eye to see if any glass slivers had lodged where they weren't wanted (luckily not) ... his examination hurt and he sure didn't seem to give a toss that I was squirming, in obvious distress ... but even there, a brusque chair-side manner might have seemed less caring than it actually was, exacerbated by muscle trauma he couldn't see despite a pretty awful mass of bruising. Believe it or not the guy's name was Dr. Yacht -- I am not making that up. Can you imagine going through life as a physician wearing that name tag? I didn't bear a grudge ... in the end, I was glad to know that high school kid from Gehenna hadn't cost me my eyesight.

But I'm telling you all this as preamble to last week. I'm not going to go into gory medical details, that would be yukky. This is a sanitized story:

I'd been feeling kind of crappy for a few days, but I really do try to avoid doctor visits unless I have an unavoidable need. My symptoms were getting worse, though, so I called in to what the folks at Kaiser call an "advice nurse." The advice nurse performs a sort of telephone triage. You tell what's going on, s/he asks questions, then s/he suggests that you take two aspirin and call if it doesn't get better; or gets your doc to write a prescription that you can pick up directly without an office visit; or instructs you to get to a doctor's office pronto. Depending.

I called the advice nurse number a little after three. The usual automated greeter put me on hold for two or three minutes. When the nurse to whom my call was routed came on the line I explained what was going on. She asked me to take my own temperature while she waited on the phone (I hoped she had a good book to read, or recordkeeping to catch up on). She must have asked me twenty questions, and in the end she said, look, it's late in the day but I'm going to have your regular doctor give you a call within the hour. If he doesn't call within the hour, call back and ask for me by name.

My regular doctor called in about thirty minutes. He said, why don't you just come in and we'll have a look. Not a long conversation. These doctors are scheduled by efficiency experts, I swear.

Traffic was crappy, parking was scarce, it took me a half-hour to get to his waiting room. That said, my doctor saw me within 10 minutes of when I sat down. He looked, poked, probed, palpitated, all that intrusive stuff doctors have to do, and then he said I'd better see a surgeon for a simple outpatient procedure. He could schedule me for the next morning, or call down to see whether they could squeeze me in right then, while I was at the medical center.

I voted for "let's get it over with" and the surgery clinic squeezed me in.

I hustled over to the building next-door and found my way to surgery. A medical technician called me back into the procedure room within 10 minutes of when I sat down in their waiting room (are you seeing the pattern yet?). They looked, poked, prodded, palpitated, prepped, all that intrusive stuff surgeons and surgical nurses have to do. Then they had me lie down on a table, shot me up with a local anesthetic, did the deed, and dressed the wound where they'd cut me open. It was five o'clock. They shooed me off in the direction of the pharmacy -- the one just down the hall -- to pick up meds before it closed. When I got to the counter the prescription wasn't in the system yet. After about half a minute of poking around the clerk exclaimed, O, there it is! Hot off the press. I had my little bottle of pills -- wait for it -- within ten minutes of walking into the pharmacy.

Did I feel processed? Molested? Crammed into a mold and shrink-wrapped?

Heck no. I felt as if I had called my medical provider at 3 pm with a minor problem I didn't quite understand, and within 2.5 hours I'd consulted with a nurse, seen my regular physician, been referred to a surgeon, undergone an outpatient surgical procedure, and picked up the medication I was meant to take in order to clear up my problem once and for all. Why did I feel that way? Because that's exactly what had happened.

Oh, and then there was the follow-up visit to the surgery clinic the next afternoon, for which an appointment slip had been scribbled out just before I left the procedure room. The ten minute rule? Still applied. Terrific nurse, funny, friendly, had a look at the scene of yesterday's scalpel-play and showed me how to change the dressing myself until the mess heals up. For good measure she gave me a fistful of gauze pads and a roll of surgical tape. They didn't even ask for a co-payment for that visit.

The moral of this story?

This is what I think of when I think of "socialized medicine": a medical organization funded by a community of members, and tuned for efficiency to respond appropriately to patients' needs.

Bring it on, I say.

And yes, I would be happy to pay more taxes to support provision of just this sort of socialized medicine for everybody who lives in my community.

Indeed, in October 2004, Steve Lohr of the NY Times asked Is Kaiser the Future of American Health Care? That wouldn't be the worst outcome possible in this member's view.

For a window into a much worse outcome, I refer you to Congressman Paul D. Ryan's plans for eviscerating Medicaid and Medicare (which I blogged about last month: G.O.P. proposes a death panel for health care ... the backlash has begun, says Associated Press -- let's hope it's got legs).

My thanks to Kaiser Permanente, and the dozen or so medical and administrative staff that made it swift and painless to get the treatment I needed last week.




Thanks to Coolcaesar and Wikimedia Commons for the image of an office tower bearing the Kaiser Permanente logo in downtown Oakland.

G.O.P proposes a death panel plan for health care

You've undoubtedly heard about Rep. Paul D. Ryan's (R-Wisc) plans for Medicaid and Medicare, which ultimately aim to leave each person and family to shift for themselves when it comes to health care. Under the plan Ryan put forward as the Republican party's point man on budget, if you've got enough income or assets you get modern medical care sufficient to address your medical needs. If you don't have enough money to pay your own way, the federal government won't help you enough to matter.

What will that mean in reality? It will mean that millions of people for whom our nation, the world's wealthiest, currently provides care will be left on their own to grow sicker and die sooner. So much for compassionate conservatism.

Remember Sarah Palin's "death panel" canard? C'mon, you couldn't have forgotten a propaganda blitz that was voted the biggest lie of 2009 by "Politifact.com, the nonpartisan, Pulitzer Prize-winning Truth-O-Meter run by the St. Petersburg Times." The G.O.P. broadly, deceptively, and despicably applied the "death panel" canard to national health care reform measures enacted in 2010.

Well, in the words of dead former-president Ronald Reagan, lying on the topic of health care in 1980, there [they] go again. This time, though, the death panel is the Republican majority of the House Budget Committee, chaired by Rep. Ryan.

The mild and reasoned summary from the NY Times:

But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states. [...] if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs. [...] About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled.

Compare that to a response that does not pull its punch, from Steven D on Daily Kos:

So you won't have insurance worth spit if you to make it to 67. You will die earlier than you should so rich people can receive more tax breaks. I think the Republicans had a word for that back in 2009 when they opposed health care reform: Death Panels. Well, that usage was a lie. The health care reform act contained no "death panels" who would decide who would live and who would die. But the Republicans in Congress and anyone else who supports the elimination of health care is acting in effect as a death panel. If their bill passes, and Medicare is eliminated, guess who would be selected for "early retirement." Well unless you are filthy rich and can afford a gold plated health care plan, the people selected to die early and suffer great misery while awaiting that early death from lack of sufficient health care would be you and me.

And, also excerpted from Daily Kos, another, from Joan McCarter:

Let's reiterate a point here -- a quarter of Medicaid spending goes for long-term care for the elderly. If Medicaid is not there to pick up those costs, it falls to families. There's already an explicit tax hike for the middle class in Ryan's plan. Taking Medicaid funding from families with disabled children and parents and grandparents in nursing homes compounds that. Plenty of middle-class families only remain middle class because they're spared crippling medical and long-term care costs. A decade or two of the Ryan plan, and there will be no more middle class in America.

Rep. Paul D. Ryan said on Tuesday morning: "This is not a budget, this is a cause."

Daily Kos diarist Giles Goat Bay wrote in response to Ryan's assertion:

The Republican majority in the House of Representatives are not there to govern. They are not there to make and defend tough choices. They are not there to hammer out a deal that would require genuine shared sacrifice. In short, they are not there to deal with reality. They are there as ideologues.

That's what it looks like to me too.

Here's an opinion piece featured yesterday on the front page of FoxNews.com, in case the NYT and Daily Kos aren't sufficiently fair or balanced for this post's readers. From yesterday's The Federal Budget Crisis Hoax, by Sally Kohn:

[...] the extent of the federal budget crisis as a whole is being wildly overblown to scare us toward drastic measures rather than rational solutions. [...] big corporations and their lobbyists have literally been manipulating our government --- both Republicans and Democrats --- to grease the wheels for big business while putting up more and more obstacles for working families, small business owners, homeowners, etc. [...] And so, at their behest, politicians of both parties --- as well as the media owned by the very same big businesses --- tell us that the government is broke and our debt level is unsustainable and, therefore, we’re going to have to cut things like unemployment benefits and funding for public school teachers. Wall Street doesn’t care.

Ms. Kohn quotes economist Dean Baker of the Center for Economic and Policy Research (CEPR), so I will too -- with a special shout-out to readers who imagine that my habit of quoting Nobel prize-winning economist Paul Krugman implies he is alone in his expert judgement:

[...] deficit hawks have gone on the warpath insisting that we have to start worrying about bringing the deficit down. [...] This is, of course, complete nonsense. Larger deficits in the current economic environment will only increase output and employment. In other words, larger deficits will put many of our children's parents back to work. Larger deficits will increase the likelihood that parents can keep their homes and provide their children with the health care, clothing and other necessities for a decent upbringing. But, the deficit hawks would rather see our children suffer so that we can have smaller deficits.

Pander to the rich. Leave the poor to die in squalor. That's the cliff over which the G.O.P. wants to drive a nation they would rather damage than govern.

Post-ideological health care

Haves and have-nots

In A Tale of Two Moralities (13 Jan 2011, NY Times) Paul Krugman describes a fundamental divide among Americans about "what constitutes justice." In a couple of sound bytes, Krugman categorizes Americans into two groups: those who believe it's right "for the affluent to help the less fortunate," and those who believe "people have a right to keep what they earn." It's a compelling opinion by a thoughtful essayist, and worth reading.

Needless to say, not everyone will agree with Krugman's ontology. Some of the 763 comments to his op-ed point out that people can help others without the government playing the role of broker or enforcer; or that the federal government can step back and let state governments do the brokering. And, yes, both of those are possible in some bravely imagined universe. But stretch that brave imagination a little further.

Those who believe it's right for those who have more to support those who have less consider such support a moral imperative -- something we're all obligated to do, not something people can do if and when they feel like it.

Those who believe they have a moral right to direct how much of their wealth gets shared with those who have less, and which of those who have less, and under what idiosyncratic conditions, do not believe that moral imperative applies. In diametric opposition, they insist on a moral right to disburse their wealth as they see fit, if they see fit.

Individual rights. Social obligations. The tension is not a new one. (Which leads one to wonder whether the advocates for each of these have changed political 'brands' since Isaiah Berlin's time. I'm not sure John Boehner would take kindly to be lumped in with the liberals, but he and his buddies do love to call the Prez a Marxist. Puzzling.)

Krugman wrote, "In future columns I will no doubt spend a lot of time pointing out the hypocrisy and logical fallacies of the 'I earned it and I have the right to keep it' crowd. And I’ll also have a lot to say about how far we really are from being a society of equal opportunity, in which success depends solely on one’s own efforts." I'll look forward to that (and will circle back to the next of Krugman's NYT op-eds in a few paragraphs).

For a moment, though, let's set aside moral rights and imperatives. Let's consider dollars and cents.


Investment in health care reduces health care costs

Atul Gawande is a surgeon, a professor of health policy management at Harvard, a 2006 recipient of the MacArthur Award (a.k.a. the "genius grant"), and a staff writer for The New Yorker. His latest article in today's issue of that magazine is The Hot Spotters (24 Jan 2011). The article describes provision of extra care dispensed to a fraction of the very small percentage of people (1%) whose medical care costs a lion's share (30%) of what Camden, New Jersey spends delivering medical services .

These super-consumers of health care resources turn out to be some of the poorest, least organized, most drug-addled people in Camden's population. They're often not the sort that your average taxpayer, worried about how much of an uncertain paycheck the government is going to appropriate, would naturally bump to the front of the Let's Help This Person line. Often they look like they can't be helped. Some aren't willing to be helped. In some healthier people's view, individual agency -- real or imagined -- in the degree to which a complex illness has devolved actually disqualifies a human being from 'eligibility' for social assistance. Go figure.

And yet, through the efforts of a doctor named Jeffrey Brenner, engaging activist providers -- and social workers or "health coaches" to aggressively manage care and give follow-up support such as encouraging patients to take prescribed medicines, keep doctor appointments, cook nutritious meals, and so forth -- dramatically reduced the cost to the government of the net services used by those receiving the "resources and brainpower," as Gawande puts it, directed their way.

The raw reduction in costs? In Camden, 56% in bills for hospitalization. True, the net savings will be lower after taking account of a complex basket of medical costs and what-if outcomes in addition to reduction in hospital bills. But Gawande characterizes the health savings in Camden as "revolutionary" (uh-oh, does that make him a Marxist too?). Other examples described in his article (some summarized below) suggest these savings are not a fluke.

And if the government saves money, that means taxpayers do too. We are, after all, funding the operation.

In fact, identifying patients whose medical expenses are bloated not because of their conditions per se, but because their conditions aren't well-managed is big business for a company outside Boston. The company is called Verisk, and it analyzes data about delivered care to help employers reduce their health benefit spending. According to Gawande's article, a medical doctor named Nathan Gunn, Verisk's head of research: "uses his company's medical intelligence software program to zero in on [...] patient[s] who are sick and getting in adequate care. 'That's really the sweet spot for preventative care, Gunn said.'"

Systemically speaking: "The critical flaw in our health care system [...] is that it was never designed for the patients who incur the highest costs."

Is there hope that our behemoth system can be redesigned? Maybe.

A program you might have heard of -- Medicare, in which the federal government acts as a single-payer insurer for 80% of medical expenses for people over 65 years old -- is running programs to incent the kind of care management practiced by Dr. Brenner in Camden and encouraged by Dr. Gunn of Verisk. It's working at Massachussets General, to the tune of a 15% reduction in emergency room visits, and the program is just coming into its stride.

A radically-redesigned practice in Atlantic City, New Jersey that adds social work and "health coaches" to the medical care mix reduced emergency room visits and hospitalizations by 40%. In a small preliminary study comparing this practice's patients with a group managed more traditionally, a 25% reduction in overall costs was realized.

The common denominator here? Investment in additional care, targeting prevention and health maintenance to reduce need for emergency intervention. Note the first word of that last sentence: investment.

(To read The New Yorker's article in full requires a subscription, or a trip to your local bookstore or public library; but Gawande's interview of 19 Jan on the radio program Fresh Air can be heard on-line. Visit Lowering Medical Costs By Providing Better Care for the article and podcast. The good doctor is as articulate and engaging when he speaks as he is in print.)


Lies about federal health care reform

Back to Krugman, who did not win a genius grant ... but was awarded the Nobel Prize in Economics in 2008.

In his NY Times piece of 16 Jan 2011, The War on Logic, Krugman enumerates a slew of lies and misdirection that Speaker of the House John Boehner (R-Ohio) and his party are employing to build an illusion that their interest in rolling back health care reform enacted in March of last year has to do with deficit reduction. I won't repeat the facts he cites; read Krugman in his own words, The War on Logic is short and clearly focused.

As Krugman summarizes his argument, "The key to understanding the G.O.P. analysis of health reform is that the party’s leaders are not, in fact, opposed to reform because they believe it will increase the deficit. [...] They’re against reform because it would cover the uninsured -- and that’s something they just don’t want to do."

Maybe so. While that seems pretty illogical to me, the "reasons" Boehner and company advocate for scuttling health care reform are pretty illogical too. So maybe we've got a syllogism here? That's the power of ideological opposition to health care reform.

Go back a few paragraphs. To the part of this post explaining how recent studies demonstrate that by providing health care, health management, and social support to the least fortunate among us, society as a whole can reduce health care costs.

Is that an idea worth pursuing? I sure think so.

Is that where President Obama's health care reform is headed? Well, actually, yes.

What does the Party of No propose as an alternative to reducing costs? Are we to barricade public hospitals to people who don't have health insurance, like Camden's 1%?

That would be cheaper even than the rational sorts of health care described by Gawande in The New Yorker and on NPR. If such people -- it's human beings we're talking about -- were left to die in the gutters, society could save a fortune in medical care costs.

Maybe that's what Rep. Boehner has in mind when he spews tricksy lies about health care reform and deficit reduction? A sort of right-wing homecoming to Social Darwinism, where if you can't disprove evolution you employ it to wipe out poor people?

Me, I'll take post-ideological health care any day of the week. Starting last week.


Thanks to AmericanLibraries for the image of Dr. Atul Gawande published on Flickr.

Broken food chains

I wrote in late May about industrial food production, as an exemplar of a general thesis that complexity breeds collapse. And here we go again: news in the U.S. press this week skews heavily toward eggs contaminated with salmonella. Not just one or two eggs. We're talking "recall of a half-billion eggs from two mega-farms in Iowa" according to Friday's San Francisco Chronicle.

Who are the culprits? You guessed it, factory farmers using "battery cages," that strangle, deform, and mummify laying hens in massive operations like Wright County Egg and Hillandale Farms, the Iowa farms whose product is making people sick. Many argue that battery cages also contribute to diseased food products.

Austin "Jack" DeCoster owns Wright County Egg, and it turns out he's been branded a "habitual violator" of Iowa's environmental laws.

'He's been trouble ever since he came here from Maine,' said former Iowa Gov. Terry Branstad, who said the 75-year-old DeCoster had unfairly hurt the reputation of Iowa farmers.

That's from Saturday's SF Chron. Congress will ask DeCoster and the owner of Hillandale

to explain how eggs from their facilities were linked to more than 1,300 cases of salmonella poisoning.

Inquiring minds want to know.

But here's what you'd really, really rather not know. Associated Press reports, by way of the Dallas Morning News, that

Millions of eggs from the Iowa farms at the heart of a massive salmonella recall are not destined for the garbage but for a table near you.

(Eeeew!)

The recalled eggs that were already shipped to grocery stores and restaurants are being dumped by the truckload. But the eggs still being laid by potentially infected chickens will be pasteurized to kill any bacteria. Then they can be sold as liquid eggs or put in other products such as mayonnaise or ice cream. It's a common if little-known practice in the food industry – salvaging and selling products that may have been tainted with disease.

Mmmmmmmmm ... ice cream.

Californians passed Proposition 2 in 2008, which will ban "battery cages" for egg-laying hens in the state by 2015. In a recent move to broaden the effect of the law and protect California's egg producers, California's Governator signed a law

that will ban all eggs coming from outside the state that fail to comply with the battery-cage ban.

Sorry 'bout that Iowa.

Why the seven year delay? Because the food production economy is a very very big ship. It turns very very slowly.

Americans might be relieved to know that it's not only the biggest economy in the world that can't handle food production and distribution safely. The second biggest economy -- China's -- is similarly broken. It's not just melamine contaminated milk, as I wrote about in Digging Deeper Holes. Now it's crayfish.

Dozens poisoned after eating 'washed' crayfish says the Global Times.

Dozens of people in Nanjing, Jiangsu Province, suffered from food poisoning after eating crayfish suspected of being contaminated by a type of powder used to wash them, according to local hospitals.

The powder, says my local translator of Chinese-language news sources (People's Daily), is a melange of citric acid and sodium sulfite.

According to Wikipedia, sodium sulfite has the following applications:

Sodium sulfite is primarily used in the pulp and paper industry. It is used in water treatment as an oxygen scavenger agent, in the photographic industry to protect developer solutions from oxidation and (as hypo clear solution) to wash fixer (sodium thiosulfate) from film and photo-paper emulsions, in the textile industry as a bleaching, desulfurizing and dechlorinating agent and in the leather trade for the sulfitization of tanning extracts. It is used in the purification of TNT for military use. It is used in chemical manufacturing as a sulfonation and sulfomethylation agent. It is used in the production of sodium thiosulfate. It is used in other applications, including froth flotation of ores, oil recovery, food preservatives, making dyes.

In China, they use sodium sulfite to wash crayfish, it seems. This, though it seems to fall someplace near the "food preservatives" category called out above, apparently causes a certain sort of collateral damage. To wit, muscle pain and kidney failure, diagnosed by doctors as "rhabdomyolysis, the rapid destruction of skeletal muscle."

Word to the wise: if you see crayfish omlettes on the menu when visiting Nanjing, order something else. In the U.S., if you look at a menu and see mayonnaise, ice cream, cake, cookies, certain kinds of noodles and bread, or -- of course -- eggs whether they are hard boiled, scrambled, fried, or poached ... either run screaming from the restaurant or buckle your salmonella seatbelt.

Seriously, though, what's a person to do?

UC Berkeley journalism professor Michael Pollan has written a book titled Food Rules: An Eater's Manual aimed at helping people avoid the peril of product when what's really wanted is nourishment. The book contains sixty-four rules organized into three categories. The three categories come from Pollan's simple, seven-word formulation that he initially presented on the cover of his previous book, In Defense of Food: An Eater's Manifesto:

Eat food. Not too much. Mostly plants.

Kinda basic. Fewer words in the rules than in the book's title. William Strunk would have been proud...

At the same time, it's clear that a few hundred thousand, or a few million people following three rules, or sixty-four, isn't going to solve the problems complexity imposes on food production and distribution. The food chain is badly fractured, and as fun and delicious as this weekend's Eat Real Festival might have been here in the East Bay, it ain't enough. In fact, the 'incidents' that get reported as news -- salmonella poisoning, melamine contamination, crayfish that'll do a number on your kidneys -- are blips on a much larger radar. Here's more from a piece about Michael Pollan and the excellent, Oscar-nominated 2008 documentary, Food, Inc., in which Pollan is featured, from an article on Oprah.com:

Michael says experiments have found that $1 can buy you 1,250 calories worth of food in processed food aisles. "Take the same dollar to the produce aisle? You will get only 250 calories of broccoli or carrots," he says. "We've made it rational to eat badly."

Of course, "rational" is a relative term, as it were. Pollan says:

"We spend less on our food than any people who have ever lived, than any people anywhere on earth—9.5 percent of our income."

.
And the piece goes on to explain how this oddity is subsidized:

Although "real" food is often more expensive, Michael says you either pay for real food now—or pay the doctor later. In 1960, Michael says 18 percent of our national income was spent on food, and only 5 percent on healthcare. Today, he says 9 percent of our income is spent on food and a whopping 17 percent on healthcare. "The less we spend on food, the more we spend on healthcare," he says.

This is not very different from the subsidized cost of coal and oil (for which future generations will make up the difference by 'paying' for the wreckage left in oceans, deserts, mountains, forests, melted glaciers, and climate change caused by the sum of these); or the investment in roads at the expense of public transit that has subsidized suburban growth and car-culture.

These are colossal problems, and if they're going to be solved they will have to be solved collectively. Give individuals a chance to buy stuff more cheaply, and they will -- hidden costs, subsidized by future generations, be damned.

By "collectively" I mean democratic (small-d) government regulation. Letting 'the market' and profit-driven politics take its course has given us modernity as we know it. Killer.

If we don't pay now, we (and our grandchildren) will pay later.

Hard as it might be to get that ship to turn, the alternative is shipwreck.

Thanks to Farm Sanctuary via Flickr for the photo of hens in battery cages.

Palin is poison, but Jon Carroll stepped in it yesterday

Jon Carroll wrote a column in yesterday's SF Chronicle titled "What's so bad about death panels?" Carroll is a sly and entertaining columnist who often adopts a sort of bumbling, grandfatherly innocence to make his generally liberal, often sympathetic points. I don't read him every day he publishes, but when I do I often admire his point of view. Not yesterday.

Yesterday's column opened with a refresh of the "death panels" gibberish "first floated by Sarah Palin" as flak in the right wing fringe's war against health care reform; correctly points out that "Of course, it was a lie" (no health care reform proposal ever in play had anything to do with or say about "death panels"); and goes on to peg the failed VP candidate "something of an expert in the untruth department."

Check.

Then, he asks, "What's the matter with death panels? I'm serious."

Okay, I get that opening an essay with a bang is good technique for drawing in readers, and drawing in readers is much on the mind of a five-days-a-week newspaper columnist. And I appreciate that Carroll goes on in this essay to confront some hard, important questions:

"As our health care system learns how to prolong life more and more effectively, we are more and more likely to be confronted with the question: to what end? [...] Do you want to spend two years on a ventilator? How does the phrase 'medically induced coma' strike you?"

Read the column. The middle paragraphs are really sharp. Carroll doesn't go deep into it, but the fact is that we as a society decide -- via health care policy in effect today -- what conditions get treated, and how, and for whom, and therefore whether and how many people live or don't. We decide that now, and we decide collectively it for you and for me as individuals (I don't mean to imply here that the 'collective' decision-making process is in any way good, efficient, or fair). The only reason people aren't wigged out about today's heath care rationing is that the status quo is not something people usually notice ... it's when the status quo is tweaked that people get bent. Anyway. As you're reading Carroll's column, and getting toward the end -- hold onto your chair.

Carroll makes a classic liberal argument -- with which I would largely agree -- that

"Government, in its best iteration, is about collectivizing our shared will to help people."

(Warm. Fuzzy. Of course the problem with warm & fuzzy is that it encourages one to glaze over at the key caveats. For example, "in its best iteration.")

But where he really falls down is in the column's next and concluding paragraph:

"So suppose there were panels, funded by the government but not controlled by it, composed of various medical, social and legal experts. A person could go to the panel, present his case and say: Now what? The panel would come up with an answer. The answer would not be mandatory; it would be dispassionate and informed advice."

I just hate it when I agree with people who, in their most hyperbolic manifestations, run around having tea parties in camouflage, carrying weapons that no sensible framer of a constitution ever meant them to run around with, despite what the Roberts court thinks. But when I read claptrap like Carroll wrote yesterday -- "The panel would come up with an answer" -- I get really, really fidgety.

The reason that it's hard to figure out what to do when a person gets very old and/or very sick is that there is no answer. Or, equally, there are lots of answers, none intrinsically better or more true or more fitting than the others. Who are these 'various experts' of whom Jon Carroll speaks? Do they think with one mind, and speak with one voice? Do his experts have the same point of view as my experts? Does someone else's panel of experts include, say, a minister or a priest whose views diverge, sharply, from people with MD and MSW and JD degrees? What in the world could induce a thinking person to fantasize that a "panel" could come up with "an answer" to questions that are deep, complex, contested, shape-shifting, and, in the end, pretty much unanswerable?

I do believe that we should fund health care through our government. Not like the bill that will be voted on this weekend proposes, but through a single-payer system. Why? Because it would cut out (most of) our system's current profit-sucking and net-care-reducing bureaucracy, and more nearly equalize access to the forms of care humans know how to and can afford to provide. Because it would leave doctors free to treat patients rather than spend inordinate fractions of their careers filling out paperwork aimed at maximizing some shareholder's profits (paperwork whose bottom line effect is to deny care to people who need it). How to fund heath care is an economics and organizational question, of a type and in an area of human endeavor that I believe governments, even in their imperfect iterations, are better suited to deal with than the profit-sucking and net-care-reducing "market."

But as to whether a person who is very old or very ill should be advised or directed by a government panel to pursue health care or euthanasia? No. That is not an aspect of life that would benefit from government standardization, streamlining, or any other form of intervention.