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Entries for July 2007

July 31, 2007

The dangerous consequences of a militarized foreign policy

Chalmers Johnson is a former CIA consultant and a professor of Asian studies at Berkeley, and was an avowed cold-war warrior during the Vietnam war era. He has written a very interesting article titled Evil Empire: Is Imperial Liquidation Possible for America? He points out the Iraq war as an unmitigated disaster on many levels and the failure of the media as culpable.

The people of the United States became mere spectators as an array of ideological extremists, vested interests, and foreign operatives -- including domestic neoconservatives, Ahmed Chalabi and his Iraqi exiles, the Israeli Lobby, the petroleum and automobile industries, warmongers and profiteers allied with the military-industrial complex, and the entrenched interests of the professional military establishment -- essentially hijacked the government.
. . .
One subject that the government, the military, and the news media try to avoid like the plague is the racist and murderous culture of rank-and-file American troops when operating abroad. Partly as a result of the background racism that is embedded in many Americans' mental make-up and the propaganda of American imperialism that is drummed into recruits during military training, they do not see assaults on unarmed "rag heads" or "hajis" as murder. . . Some militarists will reply that such inhumanity to the defenseless is always inculcated into the properly trained soldier.
. . .
Imperialism and militarism have thus begun to imperil both the financial and social well-being of our republic. What the country desperately needs is a popular movement to rebuild the Constitutional system and subject the government once again to the discipline of checks and balances. Neither the replacement of one political party by the other, nor protectionist economic policies aimed at rescuing what's left of our manufacturing economy will correct what has gone wrong. Both of these solutions fail to address the root cause of our national decline.

I believe that there is only one solution to the crisis we face. The American people must make the decision to dismantle both the empire that has been created in their name and the huge (still growing) military establishment that undergirds it.

He points to the hidden and bloated budget of the defense department and calls for a dismantling of the vast network of foreign military bases stretched over the globe. Many people are unaware of the vastness of the network of military bases that the US maintains around the world, emblematic of a nation that sees itself as an empire. Johnson sees this notion of empire as having disastrous long-term consequences and calls for a scaling back.

As part of the process of de-garrisoning the planet and liquidating our empire, we would have to launch an orderly closing-up process for at least 700 of the 737 military bases we maintain (by official Pentagon count) in over 130 foreign countries on every continent except Antarctica.
. . .
Equally important, we should rewrite all our Status of Forces Agreements -- those American-dictated "agreements" that exempt our troops based in foreign countries from local criminal laws, taxes, immigration controls, anti-pollution legislation, and anything else the American military can think of. It must be established as a matter of principle and law that American forces stationed outside the U.S. will deal with their host nations on a basis of equality, not of extraterritorial privilege.
. . .
As part of an attempt to right the diplomatic balance, we should take some obvious steps like recognizing Cuba and ending our blockade of that island and, in the Middle East, working to equalize aid to Israel and Palestine, while attempting to broker a real solution to that disastrous situation. Our goal should be a return to leading by example -- and by sound arguments -- rather than by continual resort to unilateral armed force and repeated foreign military interventions.
. . .
Normally, a proposed list of reforms like this would simply be rejected as utopian. I understand this reaction. I do want to stress, however, that failure to undertake such reforms would mean condemning the United States to the fate that befell the Roman Republic and all other empires since then. That is why I gave my book Nemesis the subtitle "The Last Days of the American Republic."

The whole article is well worth reading.

POST SCRIPT: Tom Friedman's moustache of understanding

Tom Tomorrow's cartoon describes the 'thinking' of one of the most over-rated pundits, the originator of an endless stream of banalities and the famous Friedman Unit, in which one always waits for another six months to get enough information to make a decision.

July 30, 2007

Evolution-16: The evolution of the eye

(Please see here for previous posts in this series.)

The eye is one organ almost invariably brought out by creationists to argue against evolution. How could something so complex have possibly evolved incrementally, they ask?

Darwin himself suggested the way that the eye could come into being. Due to the fact that eyes don't fossilize and thus leave a permanent record, it is hard to trace back in time and see the various stages in the evolution of the eye as linear developments. So he looked instead at the eyes of currently existing different organisms at intermediate stages of development, and concluded (On the Origin of Species, 1859, p. 188):

With these facts, here, far too briefly and imperfectly given, which show that there is much graduated diversity in the eyes of living crustaceans, and bearing in mind how small the number of living animals is in proportion to those which have become instinct, I can see no very great difficulty (not more than that in the case of many other creatures) in believing that natural selection has converted the simple apparatus of an optic nerve merely coated with pigment and invested with transparent membrane, into an optical instrument as perfect as is possessed by any member of the great Articulate class.

Steven Pinker (How The Mind Works, 1997, p. 159) describes how Darwin established how the eye could have evolved, according to the step-by-step process that I have described earlier, each step having a low probability for an individual but becoming likely when large numbers of organisms are involved over long times.

By looking at organisms with simpler eyes, Darwin reconstructed how that could have happened. A few mutations made a patch of skin cells light sensitive, a few more made the underlying tissue opaque, others deepened it into a cup and then spherical hollow. Subsequent mutations added a thin translucent cover, which subsequently was thickened into a lens, and so on. Each step offered a small improvement in vision. Each mutation was improbable, but not astronomically so. The entire sequence was not astronomically impossible because the mutations were not dealt all at once like a big gin rummy hand; each beneficial mutation was added to a set of prior ones that had been selected over the eons.

Still think it is implausible? Once again, using mathematics and computer simulations based on strict natural selection principles and starting, as Darwin himself suggested, with a light-sensitive nerve, it is possible to estimate how long the process of eye evolution took (Pinker, p.164):

The computer scientists Dan Nilsson and Susanne Pelger simulated a three-layer slab of virtual skin resembling a light-sensitive spot on a primitive organism. It was a simple sandwich made up of a layer of pigmented cells on the bottom, a layer of light sensitive cells above it, and a layer of translucent cells forming a protective cover. The translucent cells could undergo random mutations of their refractive index: their ability to bend light, which is real life often corresponds to density. All the cells could undergo small mutations affecting their size and thickness. In the simulation, the cells in the slab were allowed to mutate randomly, and after each round of mutation the program calculated the spatial resolution of an image projected onto the slab by a nearby object. If a bout of mutations improved the resolution, the mutations were retained as the starting point for the next bout, as if the slab belonged to a lineage of organisms whose survival depended on reacting to looming predators. As in real evolution, there was no master plan or project scheduling. The organism could not put up with a less effective detector in the short run even if its patience would have been rewarded by the best conceivable detector in the long run. Every change had to be an improvement.

Satisfyingly, the model evolved into a complex eye right on the computer screen. The slab indented and then deepened into a cup; the transparent layer thickened to fill the cup and bulged out to form a cornea. Inside the clear filling, a spherical lens with a higher refractive index emerged in just the right place, resembling in many subtle details the excellent optical design of a fish's eye. To estimate how long it would take in real time, rather than compute time, for an eye to unfold, Nilsson and Pelger built in pessimistic assumptions about heritability, variation in the population, and the size of the selective advantage, and even forced the mutations to take place in only one part of the "eye" each generation. Nonetheless, the entire sequence in which flat skin became a complex eye took only four hundred thousand generations, a geological instant.

In his book The Ancestor's Tale, Richard Dawkins points out (p. 388) that after the evolution of light-sensitive cells in worms about 600 million years ago, the kinds of image-forming optics that we now call the eye is estimated to have independently evolved more than 40 different times in various parts of the animal kingdom. Vastly different eye forms like the human eye and the compound eye of the crustaceans evolved differently and independently from a primitive common light sensitive cell that formed a proto-eye.

So far from being an event of unimaginably breathtaking improbability, the evolution of the eye is relatively mundane, although the organ itself is quite remarakable.

That is exactly the point that those opposed to natural selection refuse to acknowledge when they act as if all the parts of the eye must have come together almost at once. What is highly improbable to happen in one fell swoop becomes possible when it happens gradually.

Richard Dawkins in his book Climbing Mount Improbable looks at case after case of things that seem to be very complex and how they could have come about by natural selection. But Darwin did not need Dawkins to be convinced. In his own day, he had enough evidence to satisfy him. "If it could be demonstrated that any complex organ existed, which could not possibly have formed by numerous, successive, slight modifications, my theory would absolutely break down. But I can find no such case." (Darwin, p. 189)

He further added (Darwin, p. 109): "Slow though the process of selection may be, if feeble man can do so much by his powers of artificial selection, I can see no limit to the amount of change, to the beauty and infinite complexity of the coadaptations between all organic beings, one with another and with their physical conditions of life, which may be effected in the long course of time by nature's power of selection."

POST SCRIPT: Great moments in the evolution of technology

Have you seen the the sideways bike?

July 27, 2007

Evolution-15: How species evolve

(Please see here for previous posts in this series.)

The final feature that needs to be addressed is the probability of mutations cumulating to produce new organs and species.

This question lies at the heart of many people's objections to evolutionary ideas. They cannot envisage how infinitesimal changes, each invisible to the eye, can add up to major changes. That is because they tend to think that the two foundations for this to occur (the occurrence of successful mutations and the mutations then spreading throughout the population) are both highly unlikely, and so that the chance of a whole sequence of such processes occurring must be infinitesimally small.

What this series of posts has shown is that given large population sizes and the long geological times available, not only are those two things not unlikely, they are almost inevitable. The mathematical results discussed in the previous posts have shown two very important results. The first is that when the large sizes of populations and the long times involved are taken into account, the probability of favorable mutations occurring is quite high. The second is that the probability of a single favorable mutation spreading to every organism in the population is also high. These two results undercut the arguments of those who simply throw their hands up in the air and declare that evolution is extremely unlikely to have occurred.

Once that is understood, it is not hard to see how successive mutations that each have a selection advantage can pile one on top of another to produce new species leading to the diverse and complex biological system that we see today. The history of twentieth century biology is the discovery of case after case of the evolutionary history of organisms. Richard Dawkins's book Climbing Mount Improbable describes many such cases.

In order to understand how speciation comes about, we need to understand better what constitutes different species. As pointed out by biologist Steve Jones, "Species are divided from each other in many different ways – by space, by time, by mating preference, by the inability to fertilize an egg or produce healthy young, or by the sterility of the offspring." (Almost Like a Whale, p. 231)

The most famous historical example is that of the finches of the Galapagos Islands. During his five year trip on the Beagle Darwin had periodically shipped various specimens back to England to specialists to study them, and a respected ornithologist John Gould had agreed to study the birds. Soon after his return to England in 1836, Darwin met with Gould who gave him the surprising news that birds that Darwin had thought were different species like wrens and finches and orioles were actually all different kinds of finches. Furthermore, Gould had also found among Darwin's specimens three mockingbird species, each set of which came from a different island in the Galapagos. (The Reluctant Mr. Darwin, David Quammen, (2006), p. 24)

This fueled Darwin's suspicions that these birds had evolved from a single species that had somehow made the difficult journey to the Galapagos from the South American mainland, and after spreading out to each island had then become isolated from the others and evolved into separate species under the different selection pressures they experienced on the different islands.

Darwin decided to devote himself to the study of speciation and in order to do so, started with the breeding of animals in captivity. He extensively studied another bird (the pigeon) that was highly popular among breeders in England at that time and for which there existed a huge number of breeds. By studying pigeons (the first chapter of On the Origin of Species deals exhaustively with them), Darwin satisfied himself that all the species of pigeons were descended from a single type, the rock pigeon. "Great as the differences are between the breeds of pigeons, I am fully convinced that the common opinion of naturalists is correct, namely, that all have descended from the rock-pigeon (Columba livia)." (On the Origin of Species, Charles Darwin, (1859), p. 23)

In an interesting follow up to the Darwin finch story, Rosemary and Peter Grant spent twenty years in the Galapagos studying the finches and they actually observed the evolution that Darwin could only speculate about. For example, Darwin had noticed that the finches' beaks "resembled different kinds of pliers: heavy duty lineman's pliers, high-leverage diagonal pliers, straight needle-nose pliers, curved needle-nose pliers, and so on. Darwin eventually reasoned that one kind of bird was blown to the islands and then differentiated into thirteen species because of the demands of different ways of life on different parts of the island, such as stripping bark from trees to get at insects, probing cactus flowers, or cracking tough seeds." (How the Mind Works, Steven Pinker (1997), p. 163)

Darwin felt that such changes would occur too slowly to be observed. But what the Grants did 150 years later was to show that such changes could in fact be observed in real time. They "painstakingly measured the size and toughness of the seeds in different parts of the Galapagos at different times of the year, the length of the finches' beaks, the time they took to crack the seeds, the numbers and ages of the finches in different parts of the islands, and so on – every variable relevant to natural selection. Their measurements showed the beaks evolving to track changes in the availability of different kinds of seeds, a frame-by-frame analysis of a movie that Darwin could only imagine." (Pinker, p. 163)

Evolution is a fact. Natural selection is far and away the only theory that comes even close to explaining in detail how it happened, although will always be many things as yet unexplained. As biologist Steve Jones writes, "Although biologists still argue about how the process works, fossils make it impossible for anyone, biologist or not, to deny that it happened." (Almost like a Whale, 1999, p. 306)

Next in the series: The evolution of the eye

POST SCRIPT: The Darwin Year 2008-2009

This series of posts was inspired by the fact that 2009 will be the 200th birth anniversary of Charles Darwin and the 150th anniversary of the publication of On the Origin of Species. Case is planning a year long celebration of this event for the 2008-2009 academic year.

As part of this, the Common Book Reading committee has selected David Quammen's The Reluctant Mr. Darwin as the book that all incoming first-year students in fall 2008 read, and will also try to expand the program to make it a campus-wide reading experience.

Quammen has agreed to be the fall convocation speaker in September 2008. There are also plans to have E. O. Wilson (one of the most eminent evolutionary biologists and author of Sociobiology), Sean B. Carroll (The Making of the Fittest), and Rosemary and Peter Grant also give talks during that year.

July 26, 2007

Single payer health universal insurance coming to Ohio?

(For previous posts on the topic of health care, see here.)

Efforts are underway to try get a universal, single payer health care system in Ohio. The group behind it is the Single-Payer Action Network Ohio (SPAN Ohio), which is supporting legislation instituting such a plan. Their website provides more information about their initiatives and meetings.

The Health Care for All Ohioans Act has been introduced in the Ohio House (H. B. 186) and the Senate (S. B. 168).

The main points of the legislation can be seen here but here are the highlights:

  • Patients get free choice of health care providers and hospitals.
  • When you go to your own personal physician for visits, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
  • When you get your prescription filled by your pharmacist, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.
  • If you need hospitalization, there are NO premiums, NO co-payments, NO deductibles, NO one excluded. You pay nothing.

In each case, the health care provider is reimbursed from the Ohio Health Care Fund.

So how does the Ohio Health Care Fund get its money? Under the proposed plan, people who earn less than the Social Security tax cap (currently $97,500 per year) pay no additional taxes. The money to fund the system comes from a variety of sources: up to 3.85% payroll tax paid by employers; up to 3% gross receipts tax paid by businesses; 6.2% tax on individual compensation in excess of the Social Security tax cap; 5% surtax on adjusted gross income over $200,000; funds from other government sources. Remember that currently employers that provide private health insurance have to pay for it. That money can now be directed to the Ohio Health Care Fund instead.

An Ohio health care agency runs the program and its governing board consists of the state director of health and fourteen other members, two from each of the seven regions that make up the state. The two members are elected for two-year terms by a regional health advisory committee, which in turn is elected by a meeting convened of the county and city health commissioners of each region.

Since there are many misconceptions (often deliberately perpetrated by the health care industry and its allies in the media) about what a single payer system involves, here is a handy document that compares the myths with the realities.

One of the big distortions that will be perpetrated by the health insurance and drug industries and politicians is to treat 'universal' and 'single-payer' as if they are synonymous terms. They are not and people should be vigilant when that sleight-of-hand is attempted. 'Universal' refers to the fact that every person should be covered, with no exceptions. 'Single payer' refers to the mechanism by which the health care system is financed and health care providers reimbursed.

It is not difficult to provide 'universal' private health insurance coverage, if that coverage is bad. All one needs to do to achieve that is to compel everyone to purchase some kind of health insurance, like the way people are compelled to buy auto insurance in order to drive, and some states have gone that route. But all that achieves is people or their employers being forced to purchase high-deductible, low-treatment coverage. Such policies will not result in better and more accessible treatment for more people or reduce the frustrating bureaucracy that we all encounter now. In fact, it will be a profit windfall for the private insurance companies as they get even more people into their nets. Such 'universal' programs would not be an improvement on the current system, though it will be touted as such by the health-care industry and their apologists.

'Single-payer' means something different, that there should be just one single entity, preferably run by the government or at the very least a non-profit publicly accountable board, that collects the money and spends it on the health care system. The single payer plan calls for the complete elimination of profit-driven private health insurance companies from the health care system, and has to be an essential component of any meaningful health care reform. As Sicko pointed out, the introduction of profit-making bodies between the patient and the doctor is the single feature that has resulted in the health care system in the US being so inferior to its peer countries.

Candidates should not be able to evade the issue by saying they support universal health-care. The question that should be asked is whether they support single-payer universal health care. Of all the presidential candidates in both parties, only Dennis Kucinich is calling for such a universal single-payer system, although many of the other Democratic candidates have signed onto the vague 'universal' health care part.

A petition has also been started by SPAN Ohio to gather signatures to put the legislation onto the statewide ballot. This petition contains the officially approved summary of what the legislation contains, as well as the full text of the bill. It is a parallel track strategy to the bills in the state legislature to get the same results.

I am collecting petition signatures so if anyone wants to sign it, or collect signatures as well, please contact me or SPAN Ohio. My petition form is limited to those who reside in Cuyahoga County.

The Cleveland branch of SPAN Ohio meets at 7:00pm on the first Monday of each month at the ACLU building, 4506 Chester Avenue. Other branch locations and meeting times can be found on their website.

POST SCRIPT: Handy guide to candidates

With so many people running for president, it is hard to compare their stands on the various issues. One enterprising website has done us all a favor by preparing a table that gives capsule summaries of their views. Of course, you will need to look elsewhere for more details and nuances.

July 25, 2007

Evolution-14: How a single mutation spreads everywhere

In the previous post, we saw that if we start with a trait that is present in just 0.1% of the population (i.e., f=0.001), and if this has a small selection advantage of size s=0.01, this will grow to 99.9% (F=0.999) in just under 1,400 generations, which is a very short time on the geological scale.

But in a population of one million, an initial fraction of f=0.001 means that we are starting with about 1000 organisms having the favorable mutation. But it could be argued that new mutations usually start with just a single new kind of organism being produced in one single organism. How does that affect the calculation?

Suppose that you have a population of organisms of size N and they all start out having the same gene at a particular position (called the 'locus') on one of the chromosomes that make up the DNA. Now suppose a random mutation occurs in just one organism, the way that it was described in an earlier post in this series describing the shift from violet to UV sensitive sight in some birds. Most of the time, even a favorable mutation will disappear because of random chance because (say) that mutated organism died before it produced any offspring or it did produce a few and that particular gene was not inherited. But on occasion that mutation will spread. How likely is it that such a single mutation will spread to every single organism (i.e., become 'fixed' in the population)?

When one is not dealing with deterministic systems involving smoothly varying numbers (as was done in the previous case), a different kind of calculation (based on probabilities and known as 'stochastic') has to be done, and in this case the expectation value for the number of generations T taken for the single new mutation to spread all over and become fixed in the population (i.e. to spread to 100% of the organisms) is given by T=(2/s)ln(2N) generations, where 'ln' stands for natural logarithms. (Molecular Evolution, Wen-Hsiung Li, 1997, p. 49)

Even if s is taken as a very small advantage of size 0.01, for a population of N=one million, the average time taken for just a single mutation to become fixed is just 2,900 generations. So we see that mutations occurring in a single organism can become universal in a very short period on the geological time scale.

There are two important points that need to be emphasized.

There first is that even a very small selection advantage is sufficient to have that mutation dominate the species. This means that the advantage may not be even visible in the organism itself, which may look like every other organism in the species. For example, an eye mutation that works better by just a tiny bit may look like every other eye. Thus we should not think in terms of big changes for natural selection to work.

The second point is that even starting from a single mutation, as long as it takes hold (which has a probability of 2s of happening) and does not disappear and has an selection advantage however small, the mutation can spread surprisingly rapidly in the population and become universal and form the basis for future mutations.

It is interesting that even if there is no survival advantage to the new gene (i.e., s=0 and the mutation is said to be 'neutral'), the mutation can on occasion still spread and become fixed, except that now the average time taken is much longer and given by T=4N generations. So that for a population of one million it would take on average about 4 million generations for a neutral mutation to spread everywhere, as compared to just 2,900 generations for a selection advantage of 0.01.

Darwin did not have access to this kind of mathematical analysis, which came long after his death. It is a tribute to his genius that he intuitively sensed the power of cumulative change over long time scales.

So far, I have shown how the first two items in the three components of natural selection, although seeming to have small probabilities of occurring, actually are quite likely. The third aspect of natural selection that has to be looked at is how the cumulative effects of small changes lead to big changes.

POST SCRIPT: Some real fact-checking

In yesterday's post, I spoke about how the media does almost no fact-checking on Bush. Well, except for Jon Stewart who catches Bushies making up stuff about Iraq.

July 24, 2007

CNN, Michael Moore, Sicko, and fact-checking as propaganda tool

(For previous posts on the topic of health care, see here.)

All Michael Moore's films deal with very serious topics in ways that are both informative and entertaining. His films have dealt with corporate greed, violence in society, the Iraq war, and now the health industry. Along with Robert Greenwald's Brave New Films, he provides a perspective and viewpoint that is almost completely absent from the mainstream media.

What is curious is the response to his films. People seem to find it hard to accept that his critiques are largely accurate and desperately seek to find something, however trivial or immaterial to his main point, that is wrong so that they can discredit his entire case. They seem to be eager to characterize Moore as not being a "serious" person.

The so-called "fact-checking" by CNN medical correspondent Sanjay Gupta, for example, has to be seen to be believed. He accused Moore of "fudging facts" but got his own facts wrong, and the only "expert" his report showed was an academic who did business with the medical industry, although this fact was not pointed out. Gupta accused Moore of cherry-picking data, when the same charge could be leveled at CNN, and the differences in any case were small and immaterial to the case Moore was making.

I am all for fact-checking statements made by public figures, and Moore should not be exempted. But the point is that while CNN enthusiastically "fact-checks" anti-establishment figures like Moore, they almost never do similar things for the statements by government and industry personnel. This is characteristic of the media propaganda model that was pointed out by Noam Chomsky and Edward Herman in the classic work Manufacturing Consent. Moore rightly chastised Blitzer for the fact that the mainstream media uncritically passed on all the outrageous statements by Iraq war advocates leading up to the 2003 invasion. They are doing a similar thing now with respect to Iran. Where is their vaunted "fact-checking" on those important issues? To find any serious fact-checking of statements by Bush or Cheney or any administration spokespersons, one needs to read blogs.

There is no question that big media outlets are completely beholden to the medical and drug industries because of the extensive advertising revenue they receive from them, and thus avoid taking a hard line against them. If Gupta or Blitzer did a really serious comparison of the US and (say) French health care systems and concluded that the French were better, the CNN top brass would get stern calls from the health-related industry and they would feel the heat. The point is not that Blitzer and Gupta are deliberately hiding the truth (though that might be the case), it is that the way the media filters operate is that only people who think like them, who are already sympathetic to the US health care industry and will bend over backwards to show them in a good light, will get to the position they currently occupy. So the fact that they effectively act as shills for the health industry should not come as a surprise. (See my previous post and here for more on how the media works.)

It seems that if you are well-dressed, articulate person from a so-called "respectable" institution like a think-tank or government or academia or the media (I am thinking of people like William Kristol, Charles Krauthammer, Mitt Romney, Alan Dershowitz, Rudy Giuliani, Joe Lieberman, and the innumerable loyal Bushies and Cheneyites), you can say the most outrageous, even borderline insane, things (such as advocate torture and indefinite detention without trial or access to lawyers, undermine the Bill or Rights, attack Iran, link Iraq to al Qaeda and 9/11, and not even rule out the use of nuclear weapons) without being challenged and fact-checked, as long as you are promoting the pro-establishment or pro-war or pro-business point of view. Running fact-checks on what these people say, especially George Bush during his public speeches and press conferences, would be very helpful but is rarely done.

But when it comes to Michael Moore, the mainstream media are eager to trot out their "fact-checking" teams to scrutinize him, because he is challenging the joint war/business establishment of which they are an integral part. The news media tends to assume that when Moore (a big fat guy in an open-neck shirt and unkempt hair stuffed under a baseball cap and looking like a trucker) comes ambling along, he must be simply shooting from the hip, as sloppy with the facts as he is with his appearance.

The reality is that Moore is a sharp guy who has a research team in place to back up the statements in his films. He is not a just-off-the-boat bumpkin that his cinematic persona projects and he knows that all the big establishment guns are just waiting for him to make a mistake so that they can pounce and use that single slip to discredit his whole thesis, a common tactic used by big corporations. It is not an accident that he can provide immediate refutations of Gupta's allegations. His research team has probably anticipated every possible challenge to his film and prepared a counter-offensive before even releasing the film. (CNN has now responded to Moore's charges against them.) See also Moore's website on the detailed documentation behind his film.

This is why CNN was reduced to desperately looking for something, anything, to support their contention that he "fudged the facts," and resorted to distortions when they couldn't find anything substantive. But people who condescend to Moore and take him lightly because he does not talk or look or act like a sophisticated intellectual are falling into a trap because they tend to underestimate him, and then are taken by surprise when he slaps them down with facts and reason, as Blitzer and Gupta experienced. When directly challenged, Gupta could not provide even a single example of how Moore "fudged the facts," and was reduced to whining about Moore using different sources for his data (even though all the sources used were authoritative) and how Moore described the health care systems of other nations as "free" when they were funded by taxes. This alone shows how far Gupta is stretching to try to discredit Moore. Does Gupta think we are so stupid that we believe that all the services we all commonly describe as "free" (libraries, parks, public schools etc.) magically appear as gifts from Santa Claus and are not funded by our taxes? The point is that "free" in those contexts is commonly understood as meaning that we can access those services at any time without having to produce cash or prove that we can pay.

And most importantly, in the other countries which have universal, single-payer health care systems, not a single person goes bankrupt or loses their home or has to forego other of life's essentials because of their health care needs. That is what "free" means, as Gupta must know but chooses to obfuscate.

In his report, Gupta also seemed to act like he had made a big journalistic scoop by 'discovering' that Cuba was at rank #39 (behind the US at rank #37) in the overall health care quality ranking. In fact, Moore's film clearly showed the two rankings. It was Gupta's CNN report that implied that Moore's film hid this fact by themselves hiding Cuba's on-screen ranking in the film behind a caption, as can be seen below where the left is from the film and the right is what was shown by CNN. This was a truly outrageous thing for a so-called journalist to do. So it was Gupta and CNN who were "fudging the facts."

sicko_facts_up_front_th.jpg cnn_covers_up_cuba_th.jpg

(Pam Martens points out that Gupta co-hosts a TV show called AccentHealth that is sponsored by drug companies likeMerck, whose products Gupta has been praising. And here is some background on Sanjay Gupta that suggests that he is a Deepak Chopra wannabe, using the same kind of medical-related, feel-good, pseudo-scientific mumbo-jumbo that seems to appeal to a lot of people.)

What I find odd is that even some people who share Moore's politics tend to try and distance themselves from him and treat him as a gadfly. One of the best analyses of the responses to Moore and his film was done by James Clay Fuller and it is well worth reading in its entirety. As Fuller says: "Apparently there is a rule in corporate journalism that every mention of Moore and his films, or Moore without his films, must contain at least two snide observations about his biases, his ever so naughty attacks on rich and powerful but somehow –- in the eyes of the corporate journalists -- defenseless people such as the chairman of General Motors, and, if you can slide it in, Moore's physical appearance." Another good analysis of the facts in Moore's film can be heard in this Fresh Air interview with Jonathan Oberlander.

You should really see Sicko if you have not already done so.

POST SCRIPT: Michael Moore with Stephen Colbert

It was a great interview. See the clip.

July 23, 2007

Evolution-13: Differential rates of survival

(Please see here for previous posts in this series.)

Of the three stages of natural selection outlined before, the only one that occurs purely by chance is the first one, that of the occurrence of mutations. I discussed how although the chances of producing a favorable mutation by changes in any individual site in the DNA (called 'point mutations') on an individual member of the species is very small, when the number of individuals in a species and the long times available for the changes to occur are factored into the calculation, the result is that such mutations are not only likely, they are almost inevitable to occur and furthermore are likely to occur many times.

The Hardy-Weinberg law showed that if natural selection was not at work (along with some other conditions), populations settled into stable equilibrium values after just one generation of random mating. The next question to be addressed is to see how the populations change when natural selection is allowed to act. How likely is it that favorable mutations produced in the set of genes (the genotype) that characterize the organism (the phenotype) will end up with that actual organism predominating in the species? (Recall that natural selection acts on the phenotype and not the genes directly, while mutations act only on the genes and inheritance is passed on purely via the genes. A genetic change that has no effect on the phenotype will not influence the fitness of the organism.)

It is not the case that this happens every time. Most mutations are deleterious and do not spread and even favorable changes usually disappear by chance before they can spread to become a significant number in the population. But when the favorable mutations do take hold, that particular variety becomes widespread and dominates the population.

There are many such cases that have occurred in nature. The most famous and widely quoted example of this kind of growth of a favored phenotype is the case of the peppered moths in industrial areas of England and America. As a result of the pollution that created dark backgrounds on the lichen covering the trees where the moths rested, the darker varieties of the moths were camouflaged better from predators than the lighter ones and thus had a significant survival advantage. From 1848 to 1896, the darker forms grew to as much as 98% of the population. Subsequently, with the advent of pollution control measures that cleaned up the environment and reduced the soot pollution, the dark moth population decreased to as low as 10%. In The Making of the Fittest (2006, p. 52-53), Sean B. Carroll points out that peppered moths are not the only such examples, that many similar changes in coloration due to selection pressures have occurred in land snails, ladybird beetles, desert mice, and other species.

The way that even a very small natural selection advantage can result in that variety dominating a species can be appreciated using the more familiar example of compound interest. Suppose a parent gives each of two children $1,000 at the same time. One of the children invests in a bank that offers an interest rate of 5.0% while the other, being slightly more thrifty, shops around and invests in a different bank at 5.1%. Although they start out with the total money being split 50-50, in 7,000 years the second child (or rather that child's descendents) will have 99.9% of the total money, thanks to that very small advantage in the annual rate of return.

It is exactly this kind of differential survival rate that plays such an important role in natural selection. Even minute differences in fitness can result, over the long term, in the runaway domination of a preferred variety. To see how fast this can happen, population geneticists have carried out calculations.

Suppose one variety has a mutated gene that has a very slight fitness advantage over the existing gene. 'Fitness advantage' can be quantified by defining the fitness w as the measure of the individual's ability to survive and reproduce. (The concept of fitness is a combination of the organism's ability to survive for any length of time (at least until its reproducing age is over) and its fecundity in terms of the number of offspring it produces.) Suppose the original gene has fitness w=1 and the new mutation has fitness w=1+s, where s is the selection advantage.

The selection advantage is a measure of how much more likely it is that that particular variety will propagate itself in future generations when compared with the standard type. So if, on average, the new mutated variety produces 101 fertile adult descendents while the same number of the standard organism produces 100, then s=0.01.

When this selection advantage is included in the calculation, the number of generations T it will take for a mutation to increase its frequency in the population from an initial value of f to a final value of F is given by the formula T=(1/s)ln[F(1-f)/f(1-F)], where 'ln' stands for the natural logarithm. (Molecular Evolution, Wen-Hsiung Li, 1997, p. 39)

So if we start with a trait that is present in just 0.1% of the population (i.e., f=0.001), and if this has a small selection advantage of size s=0.01, this variety will grow to 99.9% (F=0.999) of the population in just under 1,400 generations, which is a very short time on the geological scale.

But in a population of one million, an initial fraction of f=0.001 means that we are starting with about 1000 organisms having the favorable mutation. In reality, we are likely to begin with just one mutation in one organism. How does that affect the calculation?

That will be discussed in the next post in the series.

POST SCRIPT: Lil George and evolution

This clip from a cartoon show I had never heard of (probably because it is on cable) is pretty funny.

July 20, 2007

Evolution-12: Population genetics and the Hardy-Weinberg law

(Please see here for previous posts in this series.)

In the previous post, I discussed the puzzle posed by a naïve understanding of Mendelian genetics, which was that one might expect that organisms that displayed recessive gene traits would slowly disappear in a population while those with dominant gene traits would grow in number. But if that were true that would prevent new mutations from gaining a foothold in the population and growing in number, if it happened to be a recessive trait.

The crucial work that formed the breakthrough that revived the theory of natural selection was done in 1908 by G. H. Hardy (a Cambridge University mathematician and author of a fascinating book A Mathematician's Apology) and Wilhelm Weinberg (a German physician), working independently. What is nice is that the result is quite simple to derive, and surprising.

The main result is that whatever the distribution of gene pairs AA, Aa, and aa you start with in a population, after just one generation the number of people with those distributions will reach an equilibrium value that will never subsequently change. In other words, the numbers of the different types of genes in a population are stable. So traits, once they appear, do not disappear simply because of the accidents of random mating. This counters the 'blending inheritance' objections to Darwin's theory.

The proof of this result assumes that certain conditions apply so that only mating effects are at play: that the total population is large enough (effectively infinite for statistical purposes) to avoid the phenomenon of genetic drift, whereby the ratio of a particular gene varies purely due to statistical fluctuations (i.e., say the population with a particular gene happens to breed disproportionately, thus causing that gene's frequency to change), is diploid, that the population reproduces sexually and that mating within the population is totally random, that natural selection is not working to change the distributions of the genotypes, and that other factors like genetic mutations and migrations in or out of the population are not occurring (i.e., no gene flow).

Here's the result. Suppose that you start with a population in which AA types occur with probability p, Aa types occur with probability 2q (where the 2 is inserted just to make the arithmetic a little simpler), and aa types account occur with probability r. Since the total population must add to 100%, this means that the total probabilities p+2q+r=1.

Under the conditions given above, the Hardy-Weinberg result says that: (1) after just one generation, the AA types occur with probability P where P=(p+q)2, Aa with probability 2Q where Q=(p+q)(q+r), and aa with probability R where R=(q+r)2; and (2) these new probabilities will remain unchanged with each succeeding generation.

As an example, if we started with the population of AA being 50% (p=0.5), Aa being 40% (2q=0.4), and aa being 10% (r=0.1), then after just one generation, the Hardy-Weinberg result predicts that the proportions will be P=0.49 or 49% for AA, 2Q=0.42 or 42% for Aa, and R=0.09 or 9% for aa, and remain fixed at these values forever afterwards.

The proof of this result is quite simple and elegant and here it is:

If there is random mating, then the probability of any particular mating combination is just the product of their individual probabilities.

The probability of an AA mating with another AA is p2. The offspring will get just one gene from each parent, and in this case the result will always be AA.

The probability of an AA mating with an Aa is 4pq (the extra factor of 2 comes from the fact that this mating combination can occur two ways, that either the father could be AA and the mother Aa, or the father could be Aa and the mother AA) and there is a 50% chance that the offspring will be an AA and 50% chance of being an Aa.

Similarly, the probability of an AA mating with an aa is 2pr. The offspring will get just one gene from each parent, and in this case the result will always be Aa.

The probability of an Aa mating with an Aa is 4q2 and there is a 25% chance that the offspring will be AA, 50% chance of being an Aa, and 25% of being an aa.

The probability of an Aa mating with an aa is 4qr and there is a 50% chance that the offspring will be Aa and 50% chance of being an aa.

The probability of an aa mating with another aa is r2. The offspring will get just one gene from each parent, and in this case the result will always be aa.

When you add all the probabilities for each type of offspring together, the probabilities of getting AA and Aa and aa are just the expressions for P, 2Q, and R given above.

What Hardy and Weinberg noticed was that if, by some chance, the starting values p, q, and r were such that they satisfied the equation q2=pr, then after one generation, P=p, Q=q, and R=r. In other words, if the starting values satisfied that particular relationship, the probabilities are unchanged from one generation to the next.

Of course, the values of p, q, and r we actually start with for a random population can have any value, as long as p+2q+r=1. But after the first generation of mixing, the values P, Q, and R actually do satisfy the relationship Q2=PR, irrespective of the starting values of p, q, and r.

Since the values of P, Q, R that are obtained after one generation become the starting values to calculate the distributions for the subsequent generation, and since P, Q, R satisfy the required relationship Q2=PR, these values will remain the same for every succeeding generation after the first.

What I found particularly surprising is that usually equilibrium conditions tend to be approached gradually and even asymptotically. Here, whatever the starting point, you get equilibrium after just one iteration.

The stability of population distributions under conditions of random mating is an important result. It implies that gene distributions do not change due to mating but only under some kind of pressure to do so..

From the year 1908 onwards, mathematical biologists proceeded to make rapid advances in the embryonic field now known as population genetics. The names of R. A. Fisher, Sewall Wright, and J. B. S. Haldane are the ones associated with the birth of this field and by the 1930s or so, their work had put Darwinian natural selection and Mendelian genetics on a firm scientific and mathematical footing (William B. Provine, The Origins of Theoretical Population Genetics, 2001).

In the next post in the series, I will look at how natural selection causes the population distributions to shift.

POST SCRIPT: Iraq war lies

Watch this video to see the brazenness with which the country was lied into war.

July 19, 2007

Oh, and about those wait times for medical treatment. . .

When all their other arguments about the advantages of the current US health care system compared to universal, single-payer systems in France, Canada, England, Germany, etc. are shown to be false, apologists for the US health care system turn to their trump card: alleging that wait times to see a doctor in those countries is longer than it is in the US. This statement by the lobbying group America's Health Insurance Plans is typical: "The American people do not support a government takeover of the entire health-care system because they know that means long waits for rationed care."

The problem with this type of allegation is that the US does not systematically collect data on wait times, whereas the other countries do collect the data and make them public. The assumption seems to be that in the US, if there is no data, then the wait times must be zero. No data, no problem!

But using the scant data that is available, BusinessWeek points out that except in a few selected, non-emergency situations, even this charge is false: "In reality, both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems."

As Paul Krugman points out in his New York Times July 16, 2007 column:

[B]y and large, opponents of universal health care paint a glowing portrait of the American system that bears as little resemblance to reality as the scare stories they tell about health care in France, Britain, and Canada.

The claim that the uninsured can get all the care they need in emergency rooms is just the beginning. Beyond that is the myth that Americans who are lucky enough to have insurance never face long waits for medical care.
. . .
[N]ot all medical delays are created equal. In Canada and Britain, delays are caused by doctors trying to devote limited medical resources to the most urgent cases. In the United States, they're often caused by insurance companies trying to save money.

This can lead to ordeals like the one recently described by Mark Kleiman, a professor at U.C.L.A., who nearly died of cancer because his insurer kept delaying approval for a necessary biopsy. ''It was only later,'' writes Mr. Kleiman on his blog, ''that I discovered why the insurance company was stalling; I had an option, which I didn't know I had, to avoid all the approvals by going to 'Tier II,' which would have meant higher co-payments.''

He adds, ''I don't know how many people my insurance company waited to death that year, but I'm certain the number wasn't zero.''

(You can read about Kleiman's plight here, which occurred despite having what he calls "fancy-dancy health insurance through my employer, which as it happens also owns one of the world's dozen best medical centers".)

And what about that favorite of US health care apologists, the waiting time for hip replacements? Krugman looked at that too:

On the other hand, it's true that Americans get hip replacements faster than Canadians. But there's a funny thing about that example, which is used constantly as an argument for the superiority of private health insurance over a government-run system: the large majority of hip replacements in the United States are paid for by, um, Medicare.

That's right: the hip-replacement gap is actually a comparison of two government health insurance systems. American Medicare has shorter waits than Canadian Medicare (yes, that's what they call their system) because it has more lavish funding -- end of story. The alleged virtues of private insurance have nothing to do with it.

Krugman's conclusion is right on target:

The bottom line is that the opponents of universal health care appear to have run out of honest arguments. All they have left are fantasies: horror fiction about health care in other countries, and fairy tales about health care here in America.

POST SCRIPT: Déjà vu

As usual, cartoonist Tom Tomorrow succinctly captures how the media is colluding with the administration in fanning the flames for war with Iran, exactly the way it did with Iraq.

July 18, 2007

Evolution-11: The rise of population genetics and the neo-Darwinian synthesis

(Please see here for previous posts in this series.)

The joining of Darwin's theory of natural selection with the Mendelian theory of genetics is one of the great triumphs of biology, now called somewhat grandly the 'neo-Darwinian synthesis'. It forms the basis of all modern biology, and was strengthened by the discovery of DNA as the structure of genetic information and which explained how Mendelian genetics worked on a microscopic scale. The modern ability to map out the entire genome of humans and other species has produced overwhelming evidence in support of Darwin's theory of how organisms evolve and branch out into different forms. The rough tree of life that Darwin sketched out in his book based on the anatomy of biological species has now been made more precise and detailed by the mapping of the DNA of species, showing ever more clearly how species are related to one another and when they separated from a common ancestor.

Mendel showed that genes were discrete objects that retained their identity as they were handed down from generation to generation and that thus any changes in genes, however small, did not get blended away in a regression towards the mean. So you would have thought that the rediscovery and rapid popularization of Mendel's ideas in 1900 would have signaled a resurgence of Darwin's idea that natural selection worked on very small, almost continuous changes, and the defeat of those who argued that one needed discontinuous changes for evolution to occur.

Ironically, the exact opposite happened. Because Mendelian genetics was a discrete mechanism with the genetic information seeming to occur in small lumps that remained intact, it superficially seemed to support the discontinuous model of natural selection, and the proponents of discontinuous changes were able to co-opt Mendel's theory to their cause. By around 1908 or so, it seemed like Darwin's own favored model of small continuous changes leading to large changes was in almost total retreat, actually doomed by the arrival of Mendel. While there was a sprinkling of mathematicians like Udny Yule (what a wonderful name!) who argued that Mendel's theory was compatible with Darwin's model of continuous evolution, their voices were lost in the volume of controversy generated by the competing biological schools. (The Origins of Theoretical Population Genetics, William B. Provine, 2001, p. 85)

Part of the problem was that scientists were still struggling to understand the workings of both Darwin's theory and Mendelian genetics and many misunderstanding of each were then prevalent. For example, one thing that was puzzling about genetics (and puzzled me for a long time too) was this whole business of dominant and recessive genes and how it affected population distributions.

It was Mendel's work that argued for the existence of these two types of characteristics, the actual mechanism of which became better understood with the discovery on DNA and increased understanding of the way that chromosomal information was handed down from parent to child.

Simply put, each person has pairs of genes, one from each parent on the respective inherited chromosome. To be concrete, we can look at the gene for eye color. Each gene may be of a dominant type (denoted by A, for say brown eyes) or a recessive type (denoted by a, for say blue eyes). So a person would have one of the pairs AA, Aa, or aa on the pair of chromosomes that contain the genes for eye color. Since A is the dominant one, it always wins, and so those people with either AA or Aa will have the characteristic A (brown eyes) manifest itself in their features, and only the person who has aa will display the characteristic a (blue eyes). Each parent will also have AA, Aa, or aa, and will randomly pass on just one of the pair of genes it possesses to the child.

It seems intuitive that if a population starts out with some distribution of AA, Aa, and aa types, and there is random mating in the population, then the number of people displaying the dominant characteristic A will steadily increase in the population, while the manifestation of the recessive characteristic a will decrease and perhaps eventually even disappear altogether, since only someone possessing the relatively unlikely combination aa will manifest it. Since regressive characteristics did not seem to be disappearing in real life populations, and in fact seem quite stable in their numbers, early geneticists had some doubts about whether they were interpreting Mendel's model correctly.

But starting around 1908, things started to change as better experiments were done and more mathematical versions of the two theories started being used. Mendelian and Darwinian theories started to get quantified and people began to realize that Darwin's version of natural selection with continuous changes was in fact compatible with Mendel's theory. By 1918, the reversal was complete and Darwin was ascendant and has remained so ever since. This was largely due to the rise of the field now known as population genetics, whose practitioners developed mathematical models that looked at the consequences of Mendelian genetics in natural selection.

What started the shift was the result now known as the Hardy-Weinberg law, which will be discussed in the next posting in this series.

POST SCRIPT: American beliefs about evolution

Gallup has done one of its periodic surveys about Americans views on evolution

These results show that:

  • 24% of Americans believe that both the theory of evolution and the theory of creationism are probably or definitely true.
  • 41% believe that creationism is true, and that evolution is false.
  • 28% believe that evolution is true, but that creationism is false.
  • 3% either believe that both are false or have no opinion about at least one of the theories.

That first group of 24% is definitely confused, since there is no way that evolution could have occurred in the 10,000 years or less allowed by creationism. The survey creators speculate that these were people who believed that god influenced evolution and somehow wanted to incorporate that view and responded in contradictory ways depending on which question was asked.

Also:

  • The reasons for rejecting evolution were mostly religious.
  • The more regularly you attended church, the less likely you were to believe in evolution.
  • Republicans were less likely to believe evolution (30%) than Democrats (57%).

Summary:

It is apparent that many Americans simply do not like the idea that humans evolved from lower forms of life. This appears to be substantially based on a belief in the story of creation as outlined in the Bible -- that God created humans in a process that, taking the Bible literally, occurred about 10,000 years ago.

July 17, 2007

Hidden costs of US health care

(For previous posts on the topic of health care, see here.)

In my previous posts following on the film Sicko (Haven't seen the film yet? It is well worth it.) I have been focusing on the tangible costs and benefits of the US health care system compared to those of other developed countries, and showing why the US system comes out badly in comparison. The chief culprit is the insertion of profit-making private health insurance companies between the patient and health care providers, creating an immediate trade-off between profit and providing care that is detrimental to the latter.

But there are several intangibles that are also important. The main one is that having one's health insurance tied to one's place of employment highly distorts the basis on which people make important life decisions. Right now, many people make decisions of what job to take and where to live based on the health care provided by employers. People with families and young children are especially caught in a bind. Some people spend their entire lives in dead-end jobs that they hate, trapped because of the fact that they cannot afford to leave and lose the health benefits. This is especially so if they or a member of their family has a health problem that becomes a non-covered 'pre-existing condition' in their new workplace, and thus denied coverage, at least for a limited time.

What is the cost of this? For one thing, it discourages entrepreneurs and freelancers. A person who wants to quit his or her job to start their own business or implement an innovative idea is strongly discouraged from doing so, especially if they have families. Not only is the cost of purchasing private insurance for themselves prohibitive, so is the cost for providing it for their employees. In 2004, the average cost of health insurance for family coverage was $9,950, which means that it is likely to be around $12,000 in 2007. This is close to the amount earned annually by a full-time minimum wage worker. How many business ideas have never seen the light of day, how many jobs never created, because potential innovators just could not bring themselves to risk the health of their families by leaving their jobs?

Health insurance tied to businesses also discourages the creative arts. Painters, writers, sculptors, poets, actors, dancers, and musicians are people who add enormously to the quality of life of a community. A community that has a vibrant arts community is one that is lively and healthy. Most artists do not go into it for the money (although they have dreams of their work becoming widely recognized someday) but because they really love what they do and are willing to suffer some hardship for it. They are willing to forego luxuries and live fairly Spartan lives with respect to housing, food, clothing and the like, just to have the opportunity to create art. Many are willing to take part-time jobs to cover life's essentials so that they have the time and freedom to devote to their passion. But the biggest single expense for such people is the cost of buying health insurance as private individuals. Many simply do not do so, gambling that they will not get very sick.

Then we have young people, straight out of high school or college who may want to experience a carefree life for at least a short time before settling down, and maybe travel around this vast country doing various jobs, seeing new things, meeting new people, and learning about the various communities they pass through. Maybe they want to work in underprivileged areas. Right now, the only way to safely do that is to do it through an organization that provides health insurance. If they go on their own, they have to buy expensive private health insurance or take the risk that they will not need health care. Even for the volunteer organizations that provide health insurance, providing it is a big headache and expense.

Then there is the problem of transitioning between jobs and between school and jobs. There are often gaps between the times when students leave college and start their first jobs. Because they have left school, they no longer are covered by their family or school health insurance policies. They have to shop around for some coverage for the transition period until they get their first job. People who have a gap when they move from one job to another can sometimes use COBRA coverage during the transition.

Even people who like their jobs and have health insurance plans to choose from (the so called 'lucky ones') face all kinds of irritations. The family may select an insurance plan and from it choose pediatricians for their children, an internist for the parents and a gynecologist for the mother, all within that one plan. The next year, they are likely to find that some of the physicians are now on different plans. So you have to repeat the process of comparing health care plans, weighing the costs and benefits, comparing physician lists, and trying to figure out who and what to keep and to jettison. This has to be done every year. And then you have to keep track of all the paperwork and receipts and co-payments. I think people have got so beaten down that they simply do not realize how much time goes into taking care of all these details. It is only when they get drawn into the bureaucratic nightmare that results when coverage is denied or some major illness strikes that they realize what a crazy system they are in.

Why have people in the US become so numb and accepting of this state of affairs? In surveying the responses to the film Sicko, James Clay Fuller makes a good point:

Not one mentions the comments by Tony Benn, a former member of Britain's Parliament. Yet Benn's statements probably are the most profound element of the film.

He notes, as other good people often do, that "if we have the money to kill (in war), we've got the money to help people."

But, more importantly, Benn tells Moore, that all of Europe and many other places have good health care systems while the United States lacks such a basic service because in Europe and elsewhere, "the politicians are afraid of the people" when the people get angry and demand some action. In the United States, he observes, "the people are afraid of those in power" because they fear losing their jobs, fear being cut off from health care or other services if they speak up and make demands.

"How do you control people?" Benn asks, and he answers: "Through fear and debt."

His point is that in the United States we have a great overabundance of both.

When are people going to get angry enough to say "We're mad as hell and we're not going to take it anymore"?

POST SCRIPT: The invertebrate Congress

On Bill Moyers' show, Conservative Bruce Fein argues why Bush should be impeached and criticizes a spineless Congress for not doing so, and John Nichols (author of the book The Genius of Impeachment) agrees.

Here is a transcript.

Another conservative Paul Craig Roberts (Assistant Secretary of the Treasury in the Reagan administration and former Associate Editor of the Wall Street Journal editorial page and Contributing Editor of National Review) has also called for the immediate impeachment of both Bush and Cheney.

The idea of impeachment was inserted into the US constitution as a vital check against the president assuming dictatorial powers akin to those of a king. It was almost tailor-made to deal with situations like that which currently exists. But the Democratic Party leadership seems unwilling to do this.

July 16, 2007

Evolution-10: The debate over natural selection in Darwin's own time

(Please see here for previous posts in this series.)

In Darwin's own time, there was a three-way dispute concerning the theory of evolution. Strange as it may sound these days in the US where so many question whether evolution even occurs at all, the idea that evolution had occurred and new species were being created and old ones dying out was not such a major problem in the mid-to-late 19th century. Elite opinion of that time had been exposed to that idea and had accepted it even before Darwin because of all the fossil records that were being discovered all the time. Even Darwin's own grandfather Erasmus Darwin, a freethinker, had around 1795 published a book Zoonomia that had floated the idea that species had evolved, but he used a Lamarckian model. What religious people mostly shied away from was the idea that human beings were also part of the evolutionary process and shared common ancestors with other species, a reluctance that still persists.

In Darwin's time what the dispute mainly centered on was the mechanism of evolution and how it operated.

Apart from Biblical literalists and believers in special creation, there were those of a religious bent who argued that god had to intervene somehow at least occasionally to create new species (especially humans) and this view persists down to this day among people who seek a tangible role for religion. At the very least, believers in an immortal soul needed a god to insert it into humans at some point in that person's development.

But the more interesting dispute was among those scientists who were not invoking religious ideas. Their dispute centered on the scale of the mutations necessary for natural selection to work.

Due to all the buffeting that Darwin's theory had received from those who argued that the age of the Earth was too short for evolution to have occurred and that mutations would get blended away, in the later editions of his book, Darwin himself started qualifying some of the more ambitious claims that he had forthrightly stated in the 1859 edition. As a result, his later editions lost some of the directness and clarity of his first edition, and scholars now recommend reading the first edition as being the best. I personally found it a fascinating book, remarkably accessible to the layperson.

For example, his first edition contained a rough estimate by him, based on geological phenomena he observed in England, that the Earth was about 300 million years old, which was in his view sufficient time for evolution to have occurred. He arrived at this by assuming that the Weald, a valley in the south of England, had been created by erosion that had always occurred at the same rate it was occurring now. He removed this claim in later editions, presumably due to unease over physicist William Thomson's calculations that the Earth was only 30 million years old. As it turns out, Darwin had no need to be worried since the current age of the Earth is calculated to be more than ten times his own estimate.

But while willing to give ground on some peripheral issues, Darwin steadfastly stuck until his death (in 1882) to one central idea, and that was that natural selection was able to act on even extremely small advantages in the fitness of some organisms, causing them to grow in the population, and that it was the cumulative effect of these minute changes that led to new species.

Contrasted with Darwin's continuous model of change were those scientists (including even Darwin's staunch defender and ally Thomas Huxley) who argued that natural selection could not really work with very tiny changes because they would get washed away because of blending inheritance. These people argued in favor of a discontinuous model which only valued those mutations that produced significant changes in the organism that represented a new and stable phenotype whose qualities were robust enough that they would not get blended away by breeding.

To better understand the difference, compare a sphere and (say) a twenty-sided die, which is almost a sphere, both resting on a table. The sphere can be shifted by any small amount and would stay in that new position. The die on the other hand, if tilted slightly and released, would revert to its original position unless the tilt were sufficient to topple it to rest on the adjacent flat face. Then it would be stable in the new position and would resist any further shift, even back to its original state. One faction led by Darwin was arguing that natural selection could act on the continuous changes represented by the sphere while others said that only the changes beyond a certain critical amount and represented by the die were stable enough for selection to work on.

It must be emphasized that both sides supported the mechanism of natural selection for driving evolution. They simply disagreed on its ability to act on very small changes. While we may think that this was a small issue to disagree on, in actual fact the debate was fierce and very acrimonious, with both sides trying to marshal evidence for their side and picking holes in the evidence of their opponents. William B. Provine in his book The Origins of Theoretical Population Genetics (2001) gives a fascinating account of this controversy, the personalities involved, and the heated nature of the exchanges, which grew increasingly bitter by the time 1900 rolled around.

The rediscovery of Mendel's work on genetics (he was a monk who lived from 1822-1884 and published his major work in 1865, but it remained obscure until it was rediscovered in 1900) provided new fuel to the controversy. Scientists quickly recognized the significance and importance of Mendel's work. While Mendel's model was accepted as having finally produced the correct theory of how inheritance works, this did not immediately resolve the dispute because there was still disagreement about what Mendel's theory actually implied and how it fitted into Darwin's theory.

Next in this series: The synthesis of Mendelian genetics and natural selection.

POST SCRIPT: Why a secular public sphere works best

As I understand it, both US houses of Congress open with a ceremonial prayer which hardly any members bother to attend. Although each house has an official chaplain, it has become the practice to make this event more inclusive and ecumenical by having people of diverse faiths give the prayer.

For the first time last week, a Hindu was invited but his prayers were disrupted by hecklers from a Christian group, who saw this as an affront to their own god. See the video here.

Steve Benen provides some background on what happened.

Interestingly, some Christians see the saying of Hindu prayers in Congress as a sign that the end of the world is almost upon us, and their anger about this act of sacrilege is mixed with eager anticipation at seeing Jesus any day now.

One doesn't know whether to laugh or cry. I think I'll laugh.

July 13, 2007

Evolution-9: Early challenges to Darwin's theory

(Please see here for previous posts in this series.)

In an earlier post in this series, I listed the three stages involved in natural selection, each of which seemed to have seemingly small probabilities. In the previous post, I showed how because of the large numbers of organisms and long time scales involved, the first item got converted into a very high probability event.

The next item in the list, the issue of how a mutation with a small advantage in the properties of an organism can end up with that property dominating the species, was both Darwin's greatest challenge and his greatest triumph.

The triumph came from a crucial insight that Darwin had concerning the importance of varieties within species. Recall that Platonic ideas were dominant at that time, and that laid the emphasis on the idealized forms of things. So for example while a real triangle drawn on paper would contain imperfections, these were considered incidental, the drawing being a mere approximation to the idealized triangle that one could envision in some abstract space.

In Darwin's time, the biological equivalent of this thinking was that while it was plain to see that (say) chickens were different from one another in small ways, these differences were not considered important. They were considered mere approximations to an idealized chicken that represented the essence of chickenhood (so to speak), and it was the latter that was important.

But Darwin realized that the variety that he saw in species, rather than distracting from an understanding of the ideal, was important in its own right. In fact, he recognized that the diversity within a species was so vast that it was often hard to say what was a variety within a species and what was a different species altogether. As he wrote, "[I]t will be seen that I look at the term species, as one arbitrarily given for the sake of convenience to a set of individuals closely resembling each other, and that it does not essentially differ from the term variety, which is given to less distinct and more fluctuating forms" (Charles Darwin, On the Origin of Species (1859) p. 52). It was this wide variety that allowed some animals to survive better than others and was the driver of natural selection. The existence of variety lay at the heart of his theory.

(The problem with all classification schemes is that it is often impossible to specify both necessary and sufficient conditions to make unerring judgments as to which category some organism belongs. The fact that there is often no sharp line that can be drawn between varieties within species and differences between species should put to rest the artificial distinction made by intelligent design creationists who say they have no trouble with what they call 'microevolution' (what they define as change within a species) but cannot accept 'macroevolution' (the creation of new species). This is a distinction without much merit.)

But Darwin faced a serious problem. Even though people might accept his idea that one variety of an species might be more suited to survive than another, the lack of a real understanding at that time of the mechanism of inheritance worked against him. It was believed that sexual reproduction resulted in features being mixed (called 'blending inheritance'), with the child of parents being intermediate in terms of properties such as height, skin color, etc. Hence even if an occasional particular mutation had better chances for survival, it was believed that its advantageous properties would soon get diluted and disappear by mating with those animals that did not have this same property. This is the well-known phenomenon of 'regression towards the mean,' first articulated by the polymath Francis Galton, a cousin of Darwin.

In artificial breeding one could avoid this blending outcome by simply restricting the breeding of animals to those organisms with the desired properties and thus preserve and enhance desired changes. But in the wild, organisms would mate more indiscriminately and this raised the question of how advantageous mutations could be preserved.

Around the same time that Darwin's theory was already reeling from estimates of a short age of the Earth from William Thomson (aka Lord Kelvin), Fleeming Jenkins wrote a long article in 1867 criticizing Darwin's theory on precisely the blending inheritance issue. In addition, the co-discoverer of natural selection Alfred Wallace (who had initially been seen as an even more zealous advocate of natural selection than Darwin) had become interested in spiritualism and in 1869 unexpectedly published a paper in which he asserted that natural selection, although it could explain everything else, couldn't account for the human brain, and he even went so far as to espouse an early version of intelligent design creationism saying that while the living world is governed by laws, "an Overruling Intelligence has watched over the action of those laws, so directing variations and so determining their accumulation" in order to produce the wonderful thing that is the human brain (David Quammen, The Reluctant Mr. Darwin (2006), p. 215). (The idea that the workings of the human brain, and that the mind and consciousness lie outside the realm of natural selection and the laws of biology, is something that persists down to this day, a topic I will examine in the future when I look at what we are now learning about the nature of consciousness.)

There was nothing much that Darwin could do about Thomson's criticism but hope that someone else would prove the physicist wrong, which did happen with the discovery of radioactivity in the first decade of the 1900s. There was also nothing that Darwin could do about Wallace going against one of the fundamental precepts of natural selection, although Darwin felt that the whole idea of natural selection was meaningless if an outside 'intelligence' could drive organisms towards a pre-ordained result. Darwin simply wrote "No!!!" in the margins of Wallace's paper.

As for Jenkins's criticisms, Darwin had not been unaware that this would be a problem for his theory and had tried to anticipate it by suggesting that successful mutations would take hold in only those cases where the mutations appeared concurrently in numerous individuals and that these would then breed with each other, allowing that variety to grow and take root in the population. (Quammen p. 212)

Darwin's defense was not very persuasive but it was all he had. Although the real defense against Jenkins's critique was already at hand in the form of Mendel's theory of genetics (which showed that genes are discrete entities that remain intact on breeding and do not get blended away), Mendel's work was not widely known at that time and Darwin's theory had to wait until its rediscovery in 1900 to fully overcome objections of the type put forward by Jenkins.

Darwin the man and the scientist are fascinating character studies. He was painstakingly thorough in his work and conscientious about the need to amass evidence to buttress the main argument he was making. But once he felt convinced by the evidence that the theory of natural selection was sound, he was determined. While he was willing to give ground on the periphery of his theory, he was firm in his commitment to its core ideas, and one of these was that his theory would make no sense if you allowed an outside agency (an 'intelligence' or whatever name you gave to a god-like power) to intervene in the process at any time in any way. He was a methodological naturalist, a necessary condition for any good scientist.

But it is a very thin line that separates methodological naturalism from philosophical naturalism (or atheism) and this, at heart, which is why Darwin's theory is so subversive to beliefs about god.

Next in this series: The debate over natural selection in Darwin's own time

POST SCRIPT: Science? Evidence? Who cares?

In congressional testimony this week, outgoing US Surgeon-General Richard Carmona spoke of how in the Bush administration, ideology trumped science every time, with constant political interference muzzling him on scientific issues like embryonic stem cell research. He said, "Anything that doesn't fit into the political appointees' ideological, theological or political agenda is ignored, marginalized or simply buried."

His testimony reminded me of this Tom Tomorrow cartoon from February 27, 2007.

Meanwhile, Secretary of Homeland Security Michael Chertoff's extraordinary statement, also this week, that he felt 'in his gut' that a terrorist attack might occur in the US this summer reminded me of astronomer Carl Sagan's reply when an interviewer pressed him for his 'gut feeling' as to whether there was life elsewhere in the universe. Sagan replied, "But I try not to think with my gut. Really, it's okay to reserve judgment until the evidence is in." (Richard Dawkins, The God Delusion, p. 47.)

Chertoff would be well-advised to follow Sagan's advice.

July 12, 2007

How universal single-payer systems protect us against catastrophes

(For previous posts on the topic of health care, see here.)

I think almost everyone across the political spectrum would concede the fact that the fifty million Americans currently without health insurance would definitely benefit from the adoption of a universal, government-run, single-payer health care system. The reason that it has not been adopted is that many of the remaining 250 million have been frightened into thinking that their medical coverage would decline from what they have now.

This feeling that "The present system works for me so why tinker with it?" is based on the assumption that our lives are stable and that things will continue just as they are into the foreseeable future. I am not so sanguine about this, perhaps because I am older and have repeatedly seen and experienced how the slings and arrows of outrageous fortune can strike anyone at any time and dramatically change lives. As a result I think it unwise to base our policy decisions on the rosy assumption that what is true for me now will continue to be true for me tomorrow. All it takes is a single catastrophe that causes the loss of our job, which could happen to any of us at any time, and all our comfortable assumptions about the future can end up in the trash can.

It is not uncommon for people who are incapacitated by an illness or an accident to themselves or someone in their family to lose their jobs and not be able to get another one with health benefits. As a result, such families are faced with stark choices: suffer or die for lack or treatment or have the family risk bankruptcy paying for it.

US News & World Report summarized the findings of a study that looked at a representative sample of bankruptcies across the country:

We have health insurance for several reasons, but one of the big ones is to protect us from high medical bills when we get sick. But insurance, it turns out, may not be the protection that many people think it is. Illness and medical bills are big reasons behind fully half of all personal bankruptcies, affecting about 700,000 households per year, according to a new study. And most of those households had insurance.
. . .
These were working- class or middle-class people, and 76 percent of them had health insurance when they first got sick. (Many lost this coverage because the insurance was through their jobs, so it disappeared when they couldn't work.) Half of the bankruptcies were caused, in part, by illness and medical debt. Their median debt was about $16,500, and the major part of that debt was payments to doctors and hospitals. Families initially tried to pay the debt for several months, says Elizabeth Warren, a bankruptcy expert at Harvard Law School. Sixty-one percent went without needed medical care to make payments, 30 percent had a utility shut off, and 22 percent cut back on their food.

If you simply ask around, you will find many examples of people who have been forced to make drastic decisions because of their health care situation. A couple I know moved to Mexico because they could not afford to pay for their health care here.

But even if people are willing to shut out from their minds the possible of such an unfortunate turn of events happening to them personally (and human beings are very skilled at avoiding thinking about such things), surely they would like to feel that their families and children and grandchildren and great-grandchildren will not have to suffer? The odds are very high that several people in each one of our extended families will face a health-related crisis in their lives that will threaten to send them into destitution. Even if we are blasé about ill health striking total strangers, surely we cannot be so complacent about our own descendents?

David U. Himmelstein, MD and Steffie Woolhandler, MD provide a detailed case (scroll down) for "Why the US Needs a Single-Payer Health System" outlining the toll the present system in the US takes on both patients and health care professionals, and the increasing monopolization of the system by a few giant corporations. They describe the huge amounts of paperwork that doctors in the US have to do because of the complicated and cumbersome health insurance system here. They have to employ a number of clerical staff simply to process the different paperwork with all the different insurance companies and then haggle with them over payment and treatment. In addition, the health insurance companies have to negotiate contracts with different companies in different states with different laws and regulations. As a result, "Blue Cross in Massachusetts employs more people to administer coverage for about 2.5 million New Englanders than are employed in all of Canada to administer single payer coverage for 27 million Canadians."

Perhaps we should start by providing single payer health care coverage to all children. Children are not responsible for their lot in society and should not be deprived of basic needs of food or shelter or clothing or education or health care.

There was a very sad story in the film Sicko. (Although I keep talking about the sad stories in it, I should emphasize that Sicko is also a very funny film.) It was about a little girl who was taken to a hospital emergency room with very high fever. They refused to provide treatment because she was not 'entitled' to be treated there, and insisted that she be transferred to a hospital across town, the place where she was 'supposed' to go to. She died during the time that she was transferred from one hospital emergency room to another.

To be denied treatment for purely bureaucratic reasons is unconscionable. It puts the health care professionals also in an impossible situation. If the emergency room physicians and nurses at the first hospital had realized that the child had a life-threatening condition, I am certain that their natural humanity would have taken over and they would have treated the child irrespective of whether she qualified or not. But if they had treated the child and it was something that could have waited, they might have been reprimanded for providing treatment to an 'unauthorized' patient. Why should health care professionals have to be put into making such kinds of bureaucratic decisions instead of doing what they are trained to do, which is simply treating the patient in front of them as best as they can?

As Martin Luther King, Jr. said, "Of all the forms of inequality, injustice in health care is the most shocking and inhumane."

POST SCRIPT: Where's Freud when you need him?

Comedian Craig Kilborn gets a laugh out of our ability to see sex symbolism everywhere .

July 11, 2007

Evolution-8: The sufficiency of the mutation rate

(Please see here for previous posts in this series.)

One of the challenges faced by Darwin was whether the rate at which mutations creating new favorable varieties would occur was sufficiently rapid for his purposes. Since during his time the laws of inheritance were not known and neither was the mathematics involved, advocates of natural selection had to assume that things would work out eventually.

In his excellent book The Making of the Fittest (2006), Sean B. Carroll demystifies the various numbers and calculations involved in natural selection using our current knowledge.

Recall from the previous post in this series that DNA is made up of a string of bases A, C, T, and G. New genetic information is created when there is a change in the DNA and the most basic (but not the only) way that this can occur is by mutations acting at the level of a single base site in the DNA, changing one of the bases A, C, T, and G to a different one.

This long string of bases that constitute DNA is split into chromosomes. As one travels down the length of a chromosome, one encounters strings of bases that are called genes and these contain the code for manufacturing the vital proteins. Proteins are made up of strings of amino acids and the genes specify the arrangement of amino acids that are to be lined up, one after another, in each protein. The code for specifying which amino acid is to be added on is made up of three consecutive base sites, each triplet being either a code for one of the twenty amino acids or a code to stop the manufacturing process and release what has been created so far. Think of the whole process as a tape recorder with the DNA string being the tape being read and the tape recorder as a machine that produces the amino acids depending on what it reads in sequence on the tape.

There are 64 possible combinations of three sites made up of four distinct bases (64=4x4x4). But since there are only twenty amino acids, this allows for some redundancy to be built into the system. For example, the amino acid serine is coded for by any of the six triplets TCT, TCC, TCA, TCG, AGT, and AGC, while the amino acid cysteine is coded for by just two triplets TGT and TGC. The three triplets TAA, TAG, and TAA represent the 'stop' code that says that the process of adding on amino acids is to be halted and the completed molecule released into the body.

Because of this redundancy, some random single site mutations (say from TCT to TCG) will have no effect on the coding of the amino acid or the resulting protein. This is a good thing since it reduces the chances of the production of 'good' proteins being destroyed by a random mutation. Alternatively, a single base switch from TGT (cysteine) to TGA (stop) will result in the protein manufacture being prematurely halted and could be calamitous for the organism.

But if there is a random mutation at a single site that changes AGT to TGT, then we see that a cysteine amino acid will be added on instead of a serine in the creation of the protein. It turns out that which of these two codes for amino acids occupies the sites numbers 268-270 of the gene to produce an opsin protein determines whether the organism's eye is sensitive to violet light or to ultraviolet (UV) light. Certain birds (ducks and ostriches) are sensitive to violet while others (zebra finch, herring gull, budgerigar) are sensitive to UV light. There are four different orders of birds that contain both violet or UV sensitive species, suggesting that this switch between base A and base T in location 268 of this opsin gene has occurred on at least four different occasions in evolutionary history. Given that there are over one billion base sites in the genome of birds, is this switch in one particular site likely to occur even once, let alone on four different occasions?

The instinctive conclusion is of course 'very unlikely', but Carroll (p. 156-158) says we need to get beyond that initial guess and actually crunch the numbers to see what is involved, taking into account the size of populations and the long time scales involved.

The per site rate of mutation averages between 1 per 500,000,000 bases in DNA in most animals – from fish to humans. This means that the exact A in position in position 268 in one copy of the bird SWS [short wavelength sensitive] opsin gene will be mutated, on average, about once every 500 million offspring. It has two copies of the gene, so this cuts the average to 1 in 250,000,000 chicks. However, there are three possible kinds of mutations at this site: A to T, A to C, and A to G. Based on the genetic code, only the A to T mutation will create a UV-shifting cysteine. If the probability of each mutation is similar (they aren't but we can ignore the small difference), then one out of three mutations at this position will cause the switch. One A to T mutation will occur in roughly 750,000,000 birds (that's 750 million).

Seems like a long shot?

Not really. It is important to factor in the number of offspring produced per year. According to long-term population surveys, many species consist of 1 million to more than 20 million individuals. With annual reproduction, a plentiful species like herring gull will produce at least 1 million offspring in a year (probably a very conservative number). Divide this into the rate of one mutation per 750 million birds; the result is that the serine-to-cysteine switch will arise once every 750 years. This may seem like a long time in human terms but we need to think on a much longer timescale. In 15,000 years, a short span, the mutation will have occurred 20 separate times in this species alone.

The four orders that these birds belong to are ancient – their ancestors have had tens of millions of years to evolve UV or violet vision. At the rate calculated in gulls, the A to T mutation will occur more than 1200 times in 1 million years in just this one species. Getting the idea?

Steve Jones (Almost Like a Whale, p. 149) estimates that among domestic cats there occur around 200,000 genetic changes each year in London alone. He adds, "Worldwide, any mutation is almost a certainty. If it is useful it will at once be picked up by natural selection." He also discusses (p. 176) how a mutation in a single base site (similar to the serine to cysteine switch) enables the bar-headed goose better able to bind oxygen to haemoglobin and thus enables it to migrate at an altitude of over five miles (i.e., the height of Mount Everest), a height where humans would collapse and die within a few hours.

So small probability events cannot be considered in isolation. When factored in with large populations and long time scales, they not only become likely, they become almost inevitable.

But changes in single sites are not the only way that changes in DNA occur. They can also occur when entire chunks of the DNA molecule are changed during reproduction in the formation of the sex cells (meiosis) because of copying errors, duplication, recombination, insertional mutations, transposition, and translocation. (See here for fuller descriptions for some of these mutations.)

For example, humans have three kinds of opsin genes that code for three different proteins that are important for color vision. LWS [long wavelength sensitive] opsin enables us to see in the long-wave or red portion of the spectrum of light, MWS [medium wavelength sensitive] enables us to see in the medium-wave or green portion of the spectrum, and the already mentioned SWS type works for the short wave or blue region. It is the presence of all these three opsin proteins that gives us the full color spectrum vision humans enjoy. We share this ability with colobus monkeys, chimpanzees, and other primates such as all apes and all African and Asian monkeys.

But most other mammals have only dichromatic vision, having only two (SWS and MWS) opsin genes and consequently seeing only blue and yellow. They cannot distinguish between red and green. How humans and other primates achieved tricolor vision is by one of the dichromatic genes (the entire gene, which can consist of hundreds of thousands of bases) being erroneously duplicated during the copying process, resulting in three genes being created, and then one of the duplicate genes later undergoing changes in its bases similar to the way the violet-to-UV switching occurred, resulting in the creation of red-sensitivity in our eyes. (Carroll, p. 97)

But although this calculation shows that favorable mutations are by no means as rare as one might naively think, and are in fact quite likely when the large size of populations and long times are taken into account, how likely is it that a mutation that occurs in a single organism will succeed in ending up dominating the species? After all, even a few hundred mutations in a population of millions may not seem like a significant amount.

That question will be examined in the next posting in this series.

POST SCRIPT: Michael Moore blasts CNN and Wolf Blitzer

Michael Moore goes on CNN and blasts Wolf Blitzer and their resident medical apologist for the health industry Dr. Sanjay Gupta for effectively acting as shills for the medical industry, not to mention their abandonment of any real journalism prior to the invasion of Iraq. This is a must-see video.

Moore followed up with a detailed analysis of Gupta's shallow reporting.

July 10, 2007

Time for 'socialized' medicine in the US?

(For previous posts on Sicko and the merits of a government-run, universal, single payer health care system, see here and here.)

Michael Moore's excellent film Sicko has cinematically exposed the deep flaws of the US health system. His film scarcely touches on the awful plight of the 50 million people who have no insurance at all. That would have been bad enough but instead he sought to highlight the plight of those who do have health insurance and think they are secure, but discover to their horror that their insurance companies let them down in their moments of greatest need.

He emphasizes the fact that when you introduce profit-making entities in between the patient and the health care providers, you have guaranteed that attempts will be made to deny health care as much as possible. The insurance companies actually have employees whose task is to dig deep into your past to see if they can find anything, anything at all, that would enable them to invoke the fine print in their policies and deny coverage. Hence many people receive nasty shocks that they are not covered just as they are reeling from the discovery that they have a serious illness.

And this is why in the US you have a system in which the minority who are rich and powerful and influential have access to very good health care because they are in a position to create trouble for the insurance companies, while the vast majority are vulnerable to finding out that getting ill can mean ruin.

One of the curious things about the health care debate in the US is that the opponents of a government-run, single payer, universal health care system try to portray it as this mysterious, unknown, complicated, untried, massively bureaucratic, expensive system that one should not experiment with.

This is ridiculous. It is the system in the US that is mysterious, complicated, massively bureaucratic, and expensive. Government-run, universal, single payer systems are the norm in the developed world and in many countries of the third world. There are any number of working models that have been in existence for over half a century for which cost-benefit analyses exist and the operating structures are well known. It is the US, almost in isolation, that has a bizarre, labyrinthine, bureaucratic, and expensive system.

The basic concept of how single payer health care works is very easy to understand as this wonderful little animation illustrates. What is needed is to select the model that might adapt best to the US and modify it to meet our needs. The only difficulty to doing that would be to combat the vested interests of the health insurance and drug interests who will fight tooth and nail to keep making massive profits off the sickness of people.

Even magazines like BusinessWeek concede that the French system is superior to the US:

In fact, the French system is similar enough to the U.S. model that reforms based on France's experience might work in America. The French can choose their doctors and see any specialist they want. Doctors in France, many of whom are self- employed, are free to prescribe any care they deem medically necessary. "The French approach suggests it is possible to solve the problem of financing universal coverage...[without] reorganizing the entire system," says Victor G. Rodwin, professor of health policy and management at New York University.
. . .
France also demonstrates that you can deliver stellar results with this mix of public and private financing. In a recent World Health Organization health-care ranking, France came in first, while the U.S. scored 37th, slightly better than Cuba and one notch above Slovenia. France's infant death rate is 3.9 per 1,000 live births, compared with 7 in the U.S., and average life expectancy is 79.4 years, two years more than in the U.S. The country has far more hospital beds and doctors per capita than America, and far lower rates of death from diabetes and heart disease. The difference in deaths from respiratory disease, an often preventable form of mortality, is particularly striking: 31.2 per 100,000 people in France, vs. 61.5 per 100,000 in the U.S.

There will still be some bureaucracy because it will be needed to do all the paperwork to run the health care system. But the point is that this bureaucracy is invisible to the patients. As far as the patient is concerned, you go to the doctor and you get treated. That's it. You do not have to fill in any forms. The paperwork goes on behind the scenes between the government, the drug companies, hospitals, and the health professionals. Even for the doctors the paperwork is simplified because they are now dealing with just a single payer of their services and don't have to keep track of multiple health insurance companies, each of which has different rules for what they can and cannot do. This is why the entire health system in Canada has fewer workers (scroll down) to serve its population of 27 million than Blue Cross requires to service less than one-tenth that population in New England alone.

But while the surface debate is about policy, the deeper debate is about a fundamental difference in philosophy

At one extreme, there are those who take the view that it is up to each one of us to look after our own interests and feel perfectly comfortable ignoring the needs of others. Such people take the point of view that each person is responsible for their health care. The 'free market' should operate and people should shop around for what works for them. If they do not have the means to do so, then that is their own fault or their own tough luck. They have failed to provide for themselves and cannot expect the rest of society to look after them, except for what private charities might provide.

At the other end (which is where I am) are those who feel that when it comes to basic issues like health care, it is the responsibility of every one to look after everyone else. Decent health care is not a commodity like toothpaste to be bought and sold on the market. It is a fundamental right that everyone (especially children and the elderly) is entitled to, irrespective of their ability to pay, and should be seen as a collective social obligation. Most such systems are based on spreading risk over a large number of people and because of that principle, while there are options for people to buy supplemental insurance on the private market, there cannot be an opt out provision, just as there is no opt out for police or fire systems or trash collection or libraries or parks or all the other similar collective systems that we currently have in place.

Those who oppose single payer health care systems try to frighten people with all kinds of bogeymen. The extent to which they are willing to go sometimes reaches levels of downright lunacy. In the wake of the release of Sicko, some have even said, if you can believe it, that adopting a single payer system could result in more terrorism! There are no depths of fear-mongering to which they will not sink.

But the tried and true standby to try and frighten people is the charge that single payer systems equate to 'socialized medicine', as if that is an automatic disqualifier.

It is a tribute to the success of the propaganda model that simply the word 'socialism' strikes such fear in so many people in the US. But the fact is that the word is ill-defined in this context. There are some health care systems where the hospitals are actually run by the government, and the health care professionals are government employees. This is perhaps closest to what might be meant by 'socialized medicine' and is close to what England has with its National Health Service. Then there is the French system where things are a mix of public and private, and the government mainly acts as the sole entity financing the system, collecting money in the form of taxes and using that to pay for services.

If the scaremongers want to invoke the word 'socialized' so broadly as to mean the spreading of the risk across the whole population, then that is no strange concept to the US because then socialism is already rampant in the US.

Sometimes US 'socialism' occurs a highly distorted form, where the risks are spread around to everyone but the benefits accrue to a wealthy few. Consider for example the FDIC insurance that banks carry. Every person is underwriting that insurance through our taxes, but it benefits the banks and those who have money to deposit. The past US government bailouts of the auto and airline industries when they were in trouble are examples where the costs and risks are borne by all of us, but the benefits accrued to a select few. The savings and loan debacle of the 1980s was again an instance of the risks and costs being 'socialized' (i.e., spread over the entire population), irrespective of whether people had money in the savings and loans institutions or not.

The better form of 'socialized' services is where everyone pays for services and everyone also benefits, such as is currently the case in the US with 'socialized' fire departments, 'socialized' police departments, 'socialized' parks, 'socialized' libraries, 'socialized' trash collection, 'socialized' hurricane and weather forecasting, 'socialized' air traffic control, 'socialized' roads, the list goes on endlessly. All these function on the assumption that there are certain things which are a collective good, and that we all should contribute to their maintenance so that we benefit as needed. 'Socialized' medicine should be seen as a natural addition to such existing 'socialized' public services, not some strange alien concept.

No health system is perfect. There will always be people who suffer and die because of the lack of equipment or drugs or incompetence. But no one should suffer and die because of the lack of ability to pay or because of bureaucratic hurdles erected in their path in order that some people can make a profit.

In the next post in this series on Thursday, I will look at the "But I'm ok, aren't I?" attitude that opposes change in the health care system because the speaker thinks that he or she is secure now.

POST SCRIPT: Health care industry contributions to candidates

Michael Moore is helping us keep tabs on how the health care industry is contributing money to presidential candidates of both parties.

Of course, the industry is doing this purely out of a sense of public service and for the sake of supporting democracy, and not to bribe the candidates to make sure that a government run, single payer, health care system is never seriously considered, whoever happens to win.

July 09, 2007

Evolution-7: Genes, chromosomes, and DNA

(Please see here for previous posts in this series.)

In order to understand how inheritance works and the mathematics involved, it may be helpful to have a quick summary of some basic facts about genetics (a little simplified), using the human genome for concreteness.

All the genetic information in our bodies is found in the DNA, whose famous double helix structure was discovered in 1953. Thanks to the Human Genome Project, we now have a complete map of the DNA of humans, called the human genome, and know that it consists of a sequence of 3.1647 billion sites arranged in a row, each site containing one of four complex molecules (called bases) labeled A, C, T and G. It is this long arrangement of the four bases that define each of us genetically. Almost 99.9% of the arrangement of these bases is identical in all humans, and about 98% is identical between chimpanzees and us.

Human DNA is not a single long strand of bases however, but is broken up into 23 pairs of chromosomes, one of each from each parent, making 46 chromosomes in all. A gene is a contiguous string of sites on a chromosome that on average contains 3,000 sites, although the sizes vary greatly, with the largest gene being 2.4 million sites long. Each gene contains the code for manufacturing a specific protein in the body and it is these proteins that determine how the various systems and organs in the body function.

The first 22 chromosome pairs referred to above have the same sequence of gene arrangements along their length, but the two specific genes (called 'alleles') that they contain at any given gene location could be different. So while both chromosomes would have genes for eye color at identical locations along the chromosome, one might code for blue eyes while the other might be slightly different and code for brown eyes. One of the genes might be dominant and the other recessive, resulting in just the dominant quality being the one that is seen in the actual organism.

Hence in 22 pairs of the chromosomes, each member of the pair contains the same kind of genetic information, which differ only in detail. Only the two in pair #23, which consists of the X and Y chromosomes that distinguish the sexes, differ considerably in basic structure. So it is sufficient for the purpose of cataloging the human genome to identify the arrangement of just 24 chromosomes, one from each of the first 22 pairs, plus the X and Y from pair #23. These 24 chromosomes vary in length from 50 million to 250 million bases,

The genes specify the code for manufacturing proteins and each protein is made up of a string of amino acids. How the genes specify the order of amino acids to be put together to make up the proteins to be produced is that three consecutive base sites in the gene either specify the identity of a single amino acid to be made or alternatively signals an end to the process if the protein has been completed. There are twenty distinct amino acids in all and as you read along the string of gene bases, every three consecutive sites specify which amino acid is to be added on to what has already been produced. The process continues until a sequence of three bases signals that the process should stop since the required protein has been completed. That protein is then released into the body.

The total number of human genes in the DNA is now estimated to be about 20,000-25,000, about the same as possessed by mice and fish. Even the lowly nematode worm has over 20,000 genes, while the fruit fly has over 13,000 and yeast has over 6,000. Bacteria such as E. coli, and those that cause salmonella and staph infections have genes that number in the range 1,500 to 4,500. (The Making of the Fittest, Sean B. Carroll, 2006, p. 77) About a thousand genes are found in every single organism, evidence of how we are all linked together, descended from a common ancestor who lived over a billion years ago. (Almost Like a Whale Steve Jones, 1999, p. 376)

For humans, all the genes are distributed in the chromosomes, with chromosome #1 containing the most genes (2,968) and chromosome Y containing the fewest (231). Although the portions of the DNA that contain genes are the most useful functionally (since they are the ones that cause proteins to be produced), they constitute less than 2% of the DNA, and of these genes, the functions are still unknown for over 50% of them. Repeated sequences of bases in the DNA that do not cause proteins to be made are called "junk DNA" and while they seem to have no known function (although very recent research throws this assumption into doubt), they can shed a lot of light on how life evolved.

The double helix structure of DNA explains how it is that cells can multiply by copying themselves with such accuracy during normal cell growth (called mitosis). If the copying mechanism were perfect, then no new genetic information would be created and species would never change. But fortunately for evolution, the copying mechanism is subject to small errors and when this happens during the creation of germ (or sex) cells that are the cells that are involved in reproduction (i.e., the sperm and ovum), the resulting changes are then passed on down to the next generation. (The creation of these germ cells by the body is called meiosis.) This is how random changes in genetic information leads to the next generation of organisms having new properties.

We now have, with the discovery of the double helix of DNA, far more detailed knowledge than Darwin ever had about how these mutations occur. The next question to be examined is whether these mutations occur at a sufficiently rapid rate to explain the facts of complexity we see around us.

Next in this series: The sufficiency of the mutation rate

POST SCRIPT: Impeachment

There is an increasing sentiment in the country to impeach Bush and Cheney.

Independent documentary filmmaker Robert Greenwald has made a short film making the case for impeaching Cheney, and there is also a petition that you can sign.

July 06, 2007

Discussing health care seriously

In my discussions with people on serious and controversial topics, I have some simple rules of thumb to tell me tell whether the discussion is worth pursuing or whether the other person is not serious and talking further is a waste of time.

For example, when discussing evolution, as soon as someone says something along the lines of Mel Gibson's "If we descended from monkeys, then how come there are still monkeys? How come apes aren't people yet?" then you know that you are dealing with someone who is either being willfully dishonest or is so ignorant of the basic facts of the topic under discussion that it is not worth continuing unless one is willing to spend a lot of time to bring that person up to speed. The wrongful use of the second law of thermodynamics is another example of a warning sign.

A similar situation applies to global warming when, during a cold or snowy spell someone triumphantly suggests that this has conclusively proven that global warming is a myth.

In discussing politics, the signal is when one makes a criticism of some action of the US government (such as its decision to ignore habeas corpus, or to invade Iraq, or its numerous covert destabilization actions in other countries) and the other person replies "If you don't like it, then why don't you go to Russia/France/China/Cuba/Sweden/(fill in the blank for whatever other country the speaker does not like)?"

In all these cases, the signs are clear that there has been no attempt by the other person to really engage with the issue and he or she has resorted to what he or she thinks is a clever debating point but in actuality has little or no content behind it.

In the case of the debates over the merits of a universal, government run, single-payer health care system, the signal that someone is not serious is when he or she trots out the waiting times for hip replacements in Canada as an argument about how the Canadian system is so terrible in comparison to the US. In the wake of the release of Michael Moore's film Sicko, we can expect to see this being trotted out repeatedly, as indeed it already has.

As Kevin Drum pointed out a few months ago, the hip replacement argument is a sign of egregious cherry picking of data.

When comparing huge and complex systems like the health care or education systems in different nations, making point-to-point comparisons of isolated cases is of little use. No system is going to be better at every single thing, so this kind of debate results in each side selecting just those pieces of data to suit its purposes. There are probably some elective procedures for which there are longer waiting times in other countries than for those with high quality insurance plans in the US. It would not surprise me in the least if access to tests using expensive equipment like MRI machines is easier in the US (for those who have the requisite insurance coverage, of course) than it is for people in other countries. Health care in the US is aimed at servicing the well-to-do, because it is they who are the decision and policy-makers and as long as they are kept content, they are unlikely to want to make changes that reduce the profits of the health care industry, let alone eliminate them entirely, even if the changes benefit the general public.

One needs to look at aggregate measures to better compare quality and cost across nations. For example, the World Health Organization in 2000 put out The world health report 2000 - Health systems: improving performance in which it used the following measures for the comparison for health systems, using measures of both goodness and fairness:

  1. overall good health (e.g., low infant mortality rates and high disability-adjusted life expectancy);
  2. a fair distribution of good health (e.g., low infant mortality and long life expectancy evenly distributed across population groups);
  3. a high level of overall responsiveness;
  4. a fair distribution of responsiveness across population groups; and
  5. a fair distribution of financing health care (whether the burden of health risks is fairly distributed based on ability to pay, so that everyone is equally protected from the financial risks of illness)

Based on these criteria, according to the WHO study (p. 152), the US comes in at #37 in rank internationally, compared to France (#1), England (#18), Canada (#30), and Cuba (#39).

Michael Moore's Sicko (which you should really see) points out that on measures like life expectancy at birth and infant mortality rates (i.e., the number of infants who die before reaching the age of one year for each 1,000 births), the US lags behind its developed world counterparts, even though its spends far more on health care as a fraction of its GDP (13.6% in 1998) than its nearest competitor Germany (10.6%). Per capita spending is also highest is the US ($4,178) with the next highest being Switzerland ($2,794).

The reason the US gets so much less for the money it spends on health care is because of the vast amounts siphoned off to the insurance and drug companies, partly due to profits and partly due to a huge bureaucracy to handle the complex billing and processing process involved with private health insurance. Such costs account for between 19.3 and 24.1% of health care spending in the US compared with between 8.4 and 11.1% in (say) Canada.

 image001.pngThere is a strong (negative) correlation between infant mortality and life expectancy, as can be seen from this graph, where each dot represents the data for a country, along with a linear regression line. The implication is clear that the best way to improve life expectancy is to reduce infant mortality. The reason that many developing countries have high infant mortality rates and resulting low life expectancy is that lack of access to clean water results in diarrhea and this leads to dehydration, which is often fatal for infants. (As an aside, the international conglomerate Nestle deserves widespread condemnation for its policy of marketing infant formula in the developing countries, despite the lack of easy access to clean water to prevent infection. Breastfeeding is always preferred except in exceptional cases, but because of the Nestle marketing campaign became perceived as inferior to formula.)

But when comparing the US to the rest of the developed world, access to clean water is not the main issue, so widespread access to health care emerges as the prime suspect for its low ranking. For example, infant mortality rates for non-whites in US cities are two to three times as high as the national average.

What really irks many people in the US about Moore's film is perhaps not so much the adverse comparison with Canada, England and France. People who for some reason are enamored of the system here will complacently trot out once again hip replacement waiting times to claim a spurious superiority. It is the fact that among the 221 countries listed, Cuba's infant mortality rate (6.04, rank 40) and life expectancy rates (77, rank 56) are almost identical with the US infant mortality (6.37, rank 42) and life expectancy (78, rank 45) that really rankles.

The US government's implacable animosity to Cuba, trying to strangle its economy with boycotts and embargos and repeated attempts at destabilization and even assassination of its leaders, has to be one of the cruelest policies ever implemented towards a country that is not a threat to its security. And yet despite that deliberate attempt at destroying the Cuban economy, Cuba has managed to create a public health system that is a model for third world countries, and produces results in key indices that are comparable with the US. Cuba is legendary among third world countries in its generosity, sharing its medical personnel and expertise around the world.

Kevin Drum wonders if Moore's use of Cuba in his film was a clever public relations strategy, knowing that it would trigger the almost reflexive anti-Cuba venom that exists in certain quarters in the US and that they would make a huge fuss, thus giving him free publicity. "Moore's brilliance at getting his mortal enemies to do all his publicity for him is unparalleled."

Drum may be right. In the weird media world we live in, it is not enough for Moore to accurately portray the scandal that is the US health system compared to its peer countries. That information has been out there for a long time, and ignored by the power elites. He had to create a fuss and by going to Cuba, he did so.

POST SCRIPT: This Modern World

Cartoonist Tom Tomorrow sums up the predictable responses to Sicko by the apologists for the US health care industry.

July 05, 2007

Evolution-6: The probabilities of natural selection

(Please go to 'Categories' and choose 'Science' to see the previous posts in this series.)

There are three mathematical ideas that one needs to come to terms with in order to get the full flavor of how natural selection works.

  1. One is the rate at which favorable mutations occur in organisms. These do occur by chance and the question is whether the frequency of such occurrences is sufficient to explain evolution.
  2. The second is the rate at which favorable mutations become more numerous in the population. It is not enough to produce a single favorable organism. The population of varieties with advantageous properties has to eventually grow to sufficiently high numbers that it dominates the population and can form the basis for yet further mutations.
  3. The third is whether the rate at which repeated small and favorable mutations build on each other is sufficient to produce major changes in complex systems (the eye, ear, and other organs for example) and even entirely new species.

It is only the very first item that works by pure chance. The other two are highly directed processes, not because there is an external intelligence at work but because they are subject to the pressures of natural selection, which considerably reduces the contributions of chance to the outcome.

Now it is undoubtedly true that the chance of producing a favorable mutation is small. Most mutations are deleterious to the organism. The chance of a favorable mutation, once produced, taking hold and becoming widespread in a species population is also small. And the chance of favorable mutations building on each other to produce complex organisms is also small. So if we leave things at this high level of generality, skeptics of natural selection can (and do) argue that the complexity of life as we know it is too unlikely to have occurred and that therefore some intelligence must be behind it. To get beyond that superficial argument and appreciate the power of the theory, one has to actually do the calculations.

Darwin himself was well aware of these difficulties but also had the intuitive sense that even events with very small individual probabilities have a good chance of occurring if you wait long enough and have large enough populations. Although he could not quantify it, Darwin knew that he needed a very long time for his theory to work, which is why he viewed with such interest research on the age of the Earth. All three processes listed above must be able to fit within the timeline allowed by the age of the Earth, which is why research in geology and physics have had important implications for the theory of evolution. But since the time scales involved are well beyond our own lifetimes, people have a hard time comprehending the workings of evolution.

As an example of this, take the lottery. The chance of buying one ticket and selecting six numbers from 1 to 49 that match the winning numbers is incredibly small (to be precise 1 in 13,983,816). But you can greatly improve your chances if you buy many tickets and plan to play week after week. The greater the number of tickets you buy, the shorter the time in which you can expect to hit the jackpot. Of course, even if you live long enough and invest enough, the total amount you spend on your tickets will almost always be much more than the amount you win but that is because the organizers of the lottery have pegged the prize money that way so that they can make a profit.

Only the first of the three items listed above for natural selection (the occurrence of favorable mutations) works the same way as the lottery, except that nature hasn't rigged the system against you. Nature just doesn't care. And this means that if there are large enough populations and long enough times available, natural selection will repeatedly hit the jackpot and produce the wonderful complexity we see.

One of the fundamental features of the theory is that mutations, or changes in organisms, occur at random. Most of these mutations are either fatal or sufficiently harmful to the organism so that the mutated variety dies away. After all, if you make random changes in anything (say the wiring of your computer or even your toaster) there is a much greater chance of making it worse than making it better. But on rare occasions, a beneficial mutation will occur that results in that new variety flourishing because it is better adapted to succeed in its current environment.

We now know something that Darwin did not, that these mutations occur at the level of the genes. Although the work that led to the discovery of the genetic laws of inheritance was done by Gregor Mendel at roughly the same time as Darwin and provided the material basis for understanding inheritance, Darwin was not aware of that cloistered monk's research, although Mendel was aware of Darwin's work. Mendel published his seminal paper in 1865 (Darwin's On the Origins of Species appeared in 1859) but it went largely unnoticed until 1900 when several biologists who had been working on the problem of inheritance, independently came across Mendel's work.

The synthesis of Mendel’s work on genetics with Darwin’s theory of natural selection is one of the great advances in modern science and the next post in this series will discuss that relationship.

Next in the series: The effect of Mendel’s work on Darwin’s theory

POST SCRIPT: Onion parody on evolution

The nice thing about this parody is that it captures very well the central problem with the arguments of intelligent design creationists and other religious believers who want to preserve a role for god by carving out a little niche for god to intervene in evolution.

July 04, 2007

Defending the right of free speech and Dennis Kucinich

Since today is a holiday, there will be no original post today. Instead, here are some video clips.

One is of the late Frank Zappa of the group Mothers of Invention on Crossfire talking about the right of free speech.

It is always fun when someone appears on these idiotic talk/yell shows and simply says what he thinks. In this clip from 1986, Zappa drives the person from the Washington Times crazy with his quick-witted defense of free speech and his sardonic sense of humor.

Also, here is an interview of Dennis Kucinich on David Letterman's show. Kucinich is the only candidate for president who takes the correct stands on the two most fundamental issues facing the US: The Iraq war and the need for single-payer universal health care.

July 03, 2007

On the pursuit of happiness

On this day before independence day, I wanted to reflect on what to me is one of the most intriguing phrases in the US Declaration of Independence, and is contained in the famous sentence:

We hold these truths to be self-evident, that all men are created equal, that they are endowed, by their Creator, with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.

I have always found the inclusion of the phrase "the pursuit of happiness" as a fundamental goal to be quaint and appealing. One does not expect to see such pleasing and innocently worded sentiment in a political document, and its inclusion sheds an interesting and positive light on the minds and aspirations of the people who signed that document.

But the problem has always been with how happiness is attained. And in one serious respect, Jefferson's suggestion that we should pursue happiness, while laudable, may also be misguided. Happiness is not something to be pursued. People who pursue happiness as a goal are unlikely to find it. Happiness is what happens when you are pursuing other things. The philosopher Robert Ingersoll also valued happiness but had a better idea about what is would take to achieve it: "Happiness is the only good. The place to be happy is here. The time to be happy is now. The way to be happy is to make others so."

Kurt Vonnegut in his last book A Man Without a Country suggests that the real problem is that we don't realize when we are happy, and that we should get in the habit of noticing those moments and stop and savor them.

I apologize to all of you who are the same age as my grandchildren. And many of you reading this are probably the same age as my grandchildren. They, like you, are being royally shafted and lied to by our Baby Boomer corporations and government.

Yes, this planet is in a terrible mess. But it has always been a mess. There have never been any "Good Old Days," there have just been days. And as I say to my grandchildren, "Don't look at me, I just got here."

There are old poops who will say that you do not become a grown-up until you have somehow survived, as they have, some famous calamity -- the Great Depression, the Second World War, Vietnam, whatever. Storytellers are responsible for this destructive, not to say suicidal, myth. Again and again in stories, after some terrible mess, the character is able to say at last, "Today I am a woman. Today I am a man. The end."

When I got home from the Second World War, my Uncle Dan clapped me on the back, and he said, "You're a man now." So I killed him. Not really, but I certainly felt like doing it.

Dan, that was my bad uncle, who said a man can't be a man unless he'd gone to war.

But I had a good uncle, my late Uncle Alex. He was my father's kid brother, a childless graduate of Harvard who was an honest life-insurance salesman in Indianapolis. He was well-read and wise. And his principal complaint about other human beings was that they so seldom noticed it when they were happy. So when we were drinking lemonade under an apple tree in the summer, say, and talking lazily about this and that, almost buzzing like honeybees, Uncle Alex would suddenly interrupt the agreeable blather to exclaim, "If this isn't nice, I don't know what is."

So I do the same now, and so do my kids and grandkids. And I urge you to please notice when you are happy, and exclaim or murmur or think at some point, "If this isn't nice, I don't know what is."

Good advice.

July 02, 2007

Film review: Sicko

When I was just six years old, I became gravely ill with polio. Although Sri Lanka had first-rate doctors, they felt at that time that they did not have the specialized services to provide the kind of treatment that was best for me and recommended that, if at all possible, my family take me to England. We were not wealthy, just middle class, and did not have the kind of money that would enable my parents to afford this. But by an incredible stroke of luck, my father just happened to work for the Sri Lankan state bank that just happened to have a branch in England. It was the bank's practice to rotate their officers to that branch and my father was due to go in few years but because of the urgency of my illness, his bosses quickly arranged for him to be immediately transferred to the London branch. As a result we arrived in England and simply by virtue of the fact that we now lived there, I was able to get health care through the British National Health Service.

I remember many, many visits to doctors and tests, followed by major surgery that required weeks of recovery in a city hospital followed by months of convalescence and rehabilitation in a country hospital that was more like a country retreat than a hospital. The single-story wards opened out onto rolling fields and woods. The hospital was for people having extended stays and so we had teachers who came every day to help us keep up with our school work and we also had crafts and games and social events.

Six years later the process was repeated when I required a second major operation to consolidate the results of the first.

I remember my hospital experience as a very happy one, with kindly doctors and nurses, and a caring environment. It is because of all this treatment that I have been able to lead a normal and healthy life since then.

And all this treatment was completely free. No paperwork, no deductibles, no applying for reimbursement, none of the headaches and the sheer bureaucratic drudgery that awaits anyone who gets ill in the US. The only thing that my parents had to be concerned about was my health.

All these memories came flooding back to me when I went to see Michael Moore's excellent film Sicko last Saturday. In his bemused everyman persona, Moore visited Canada, Britain, France, and Cuba and talked to doctors and patients and other people about the treatment they receive. Their experience now seemed the same as what I had long ago: When you get sick, you go to the doctor and the hospital and they treat you as best as they can, according to their best medical judgment.

That's it. It is very simple, just as it should be.

Moore compared this with the nightmare that is the health care system in the US, where your ability to pay and the quality of your insurance coverage is the determining factor in your treatment. Anyone who has had even routine treatment knows the rigmarole that one has to go to check whether the doctor is on the plan, whether the visit or treatment or test or facility is covered, what the co-pay and deductibles are, followed by all the stuff that one gets in the mail that are sometimes invoices, sometimes bills, the many phone calls that have to be made to correct errors and find out information, the haggling with insurance companies over complicated details. The list goes on.

Why this difference? Simple. It is in the US that private profit-making agencies have been inserted between the patients and the health care system. In a revealing clip using the famous Nixon tapes, Moore reveals how this came about. In 1971, Edgar Kaiser (founder of Kaiser Permanente), through Nixon's aide John Ehrlichman, presents to President Nixon the idea of having a private profit-making health care industry. Ehrlichman explains the best part of this plan: "Edgar Kaiser is running his Permanente deal for profit. . . .All the incentives are toward less medical care. . . . the less care they give them, the more money they make. . . . the incentives run the right way."

To which Nixon replies, "Not bad."

Once that private profit element is introduced, the rest follows. It now becomes in the interests of the insurance companies to deny or reduce both coverage and treatment because there is a direct trade-off between profit and treatment. The more treatment the patient gets, the less profit the insurance companies make. And the film shows how doctors working for the insurance companies were rewarded by the amount of care they denied, even if patients died as a result. Some of those people who did these things as part of their job were haunted by what they had done to people in order to increase the profits of the insurance companies.

As I watched, it struck me that the two major surgeries that I received for free in England would very likely not have been allowed by the health insurance companies here because at that time they were considered somewhat experimental. As the film shows, the charge of being 'experimental' and 'condition caused by a pre-existing condition' are two of the many, many excuses used by the health insurance companies to deny paying for treatment.

The film also shows how politicians of both parties are bought and sold by the insurance companies, and how their shills in the media fight tooth and nail the idea of universal health care. These shills for the insurance and drug companies also laughably try to make the case that the people in countries like Canada and Britain and France are dissatisfied with their systems, when in actual fact those people think it is bizarre that we have to make our own arrangements to pay for health care, rather than having it taken care of by our taxes.

Of course those systems are not perfect and people do complain about some things. But when the Canadian Broadcasting System held a poll to select the greatest Canadian of all time, the winner was Tommy Douglas, the socialist politician identified as the originator of the state-financed health care system in that country.

Needless to say, this being a Michael Moore film and one that spotlights a huge business-political alliance, there is a vigorous counteroffensive to discredit it. But CNN did a fact check on Moore's assertions and concluded:

Our team investigated some of the claims put forth in his film. We found that his numbers were mostly right, but his arguments could use a little more context. As we dug deep to uncover the numbers, we found surprisingly few inaccuracies in the film.
. . .
Moore says that the U.S. spends more of its gross domestic product on health care than any other country.

Again, that's true. The United States spends more than 15 percent of its GDP on health care -- no other nation even comes close to that number. France spends about 11 percent, and Canadians spend 10 percent.

Like Moore, we also found that more money does not equal better care. Both the French and Canadian systems rank in the Top 10 of the world's best health-care systems, according to the World Health Organization. The United States comes in at No. 37. The rankings are based on general health of the population, access, patient satisfaction and how the care's paid for.

So, if Americans are paying so much and they're not getting as good or as much care, where is all the money going? "Overhead for most private health insurance plans range between 10 percent to 30 percent," says Deloitte health-care analyst Paul Keckley. Overhead includes profit and administrative costs.

"Compare that to Medicare, which only has an overhead rate of 1 percent. Medicare is an extremely efficient health-care delivery system," says Mark Meaney, a health-care ethicist for the National Institute for Patient Rights.

I was expecting be angry by what I saw in Sicko and that did happen. Since this was a Michael Moore film, I also expected to laugh and that also happened because there are scenes that are vintage Moorisms. What I had not expected was to be so touched and moved by the human stories. At heart, ordinary people tend to care for one another. The film recounts one story after another of people reaching out across politics and nationality and class boundaries, because illness touches everyone's sensibilities. Scenes like the Cuban firefighters who wanted to honor the 9/11 rescue workers.

The difference is that in the US people tend to think in terms of helping informally, those whom they might know personally, or through charities. In countries like Canada, Britain, France, and Cuba, they realize that this does not work for something as basic as health care. The health of the people is too big and too important to be in the hands of private profit-making companies or charities. The government has to do such things, just like it does the fire departments and police, and they support it through their taxes. There is the sense in those countries that there is a shared social obligation to provide health care for everyone.

The only people who benefit from the kind of system the US currently has are the shareholders and top executives of health insurance and drug companies, and those doctors who aspire to great wealth.

What the US needs is a government-run, single payer health care system.

See Sicko and you will better understand why.

POST SCRIPT: Michael Moore on TV

See the interview with Jay Leno.

You can also see Moore respond to some questions on Larry King's show.