Blogger on Ice

Once again Egypt's Hosni Mubarak shows zero tolerance for a secular democratic dissenter.

THE BUSH administration has tolerated Egypt's brutal crackdown on domestic dissent and the broader reversal of its democratic spring of 2005 in part because President Hosni Mubarak argues that his adversaries are dangerous Islamic extremists. It's true that the largest opposition movement in Egypt is the Muslim Brotherhood; how dangerous it is can be debated. But what is overlooked is that Mr. Mubarak reserves his most relentless repression not for the Islamists -- who hold a fifth of the seats in parliament -- but for the secular democrats who fight for free elections, a free press, rights for women and religious tolerance.

The latest case in point is a blogger named Abdel Kareem Nabil Soliman, who was sentenced to four years in prison last week on charges of religious incitement, disrupting public order and "insulting the president."..

Bargaining Down the Price of that CT Scan is Now Possible

Click here for an interesting dialogue on health care pricing at the New York Times.
Here is a sample letter:
17.
February 27th,
2007
7:00 am
I would like to know who told you that Physicians negotiate pricing with insurance companies? And have you ever looked at the size of a CPT Code Book that contains Common Procedural Terminology that physicians must use correctly inorder to get reimbursed? Doctors themselves do not know what they are going to get reimburse because the Usual and Customary Rate changes by region. In New Jersey it was or is being modified from Regions A,B, and C to Regions 1 and 2. This is determined by Zip Code. Then the insurance companies utilize data from a company like Ingenix (owned by United Healthcare) to determine a fee. This data is accumulated by Ingenix to help the insurance industry keep track on the cost of services by code. In addition, they provide physicians with a Fee Analyzer (all is not fair in love and war!) to modify their fees or price themselves in line with the average price in the Region 1 and 2. It really doesn’t matter because the physician could charge $500 for an Office Visit or $100 and they still receive what the Usual and Customary Rate is. In addition, the physician never knows what percentage the insurer is paying because the deductible, co-pays, primary and secondary payors vary for each indivdual plan. The insurance industry is a shell game, or as I call it the best form of organized crime. Their is no transparency in the insurance industry. There is no professionalism (look at the people that are physician provider relations representatives) you cannot get a response from them nor can you get someone on the phone. Based on anti-trust laws, if a physician was able to publicly post his pricing, I assume that he would then be able to share what he is reimbursed with his fellow doctors and the patients. Yet, medicine is not like going to Jiffy Lube, only politicians and CEO’s like to make you think it is that easy. Most consumers are uneducated and overwhelmed when they get sick or hurt and do not know what to think when they get diagnosed or hurt. Let’s be realistic, the internet can only provide you with information, it cannot help you truly understand the ramifications of your decisions or the complexities of your disease or injury. One thing always leads to another. Let’s not make healthcare a doctor/patient issue. Let’s make it a people and money issue. Too many CEO’s are making windfall profits and walking away with absurd sums of money as golden parachutes (see William McGuire from United), too many trial lawyers are only interested in suing on behalf of their clients (what ever happened to all this talk about tort reform Mr. President?) Doctors still make a great living, they need to entrust their business to business people especially when they haven’t received reimbursement increases from insurance companies for 3 years sometimes (you and I wouldn’t run a business if we received no COLA or inflationary adjustments) and the consumer needs to understand that medicine is more art and not accounting. Until individual states Department of Banking and Insurance are made up of individuals with diverse backgrounds, not just directors that are former insurance executive awaiting their next big job after their terms are over, nothing will ever change.
— Posted by John Nieradka

As U.S. Puts Pressure on Iran,Gulf's Religious Rift Spreads

Should be required reading for all members of Congress, many of whom don't know (incredibly) the difference between Sunni and Shiias...
Sunni States See Rise In Anti-Shiite Actions; Scare Tactics in Bahrain
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Washington views Iran as a rogue nation that arms militias in Iraq, wants to build a nuclear bomb and seeks Israel's destruction. From Arab kingdoms on the Persian Gulf to Lebanon on the Mediterranean, however, Iran is also viewed through another prism, as a non-Arab, and, for some, heretical power intent on expanding the clout of itself and fellow Shiites at the expense of the region's Sunni establishment.Shiites make up 15% or less of the world's Muslim community, but in many Sunni eyes they hold outsize influence because of Shiite-ruled Iran, which now rivals and sometimes even eclipses Israel as an object of loathing. On the gallows in Baghdad at the end of December, Saddam Hussein used his last words to denounce Americans and "Persians," or Iranians. He didn't name Israel.
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Saudi Arabia, a prime source of toxic jihad theology in the past, now also churns out bile against Iran and Shiites. At the end of December, Abdel-Rahman al-Barrak, a senior cleric, labeled Shiites "more dangerous than Jews and Christians." King Abdullah, in a recent interview with a Kuwaiti newspaper, predicted defeat for what he suggested was an Iranian-backed campaign to convert the Sunni world to Shiism and "to diminish [the Sunnis'] historical power."

BLIND AMBITION Genentech's Big Drug For Eyes Faces a Rival

The Lucentis-Avastin showdown has thrown the pharmaceutical world into a tizzy. Genentech, fearful that a potential billion-dollar-a-year product could be headed down the tubes, is urging doctors to stick to Lucentis and its proven efficacy in treating age-related macular degeneration
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Now the federal government is hoping to settle the dispute by funding a head-to-head comparison of the two biotechnology drugs, the first such trial by the National Institutes of Health. If Avastin works as well as Lucentis, the government's Medicare program for the elderly could save $1 billion or more a year, officials say.

The mutiny by doctors nationwide against a high-priced drug -- and Washington's willingness to go to bat for them -- is triggering alarms in the drug industry. "Industry doesn't want an equivalency trial where there could be decisions on coverage. They are terrified," says William L. Rich, director of health policy at the American Academy of Ophthalmology, which backs the NIH trial.
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Genentech has refused to provide any funding or drugs for the NIH trial, scheduled to start in April.

Deadly drug-resistant TB in HIV patients

A highly drug-resistant form of tuberculosis has killed about 85 percent of South African HIV patients who have become infected, presenting one of the most worrisome problems in HIV and tuberculosis control, researchers reported Sunday.

A Fight to Save Mothers

In many places in Africa, women have a one in ten chance of dying during pregnancy.
There is a good multimedia feature at the linked site as well.

President Bush’s budget request this month proposes that the U.S. cut spending on global maternal and child health programs to $346 million, or just $1.15 per person in the U.S.

To understand what the cuts mean, meet Simeesh Segaye.

Ms. Simeesh, a warm 21-year-old Ethiopian peasant with a radiant smile, married at 19 and quickly became pregnant. After she had endured two days of obstructed labor, her neighbors carried her to a road and packed her into a bus, but it took another two days to get to the nearest hospital.

By then the baby was dead. And Ms. Simeesh awakened to another horror: She began leaking urine and feces from her vagina, a result of a childbirth injury called obstetric fistula.

Ms. Simeesh’s family paid $10 for a public bus to take her to a hospital that could repair her fistula. But the other passengers took one whiff of her and complained vociferously that they shouldn’t have to share the vehicle with someone who stinks. The bus driver ordered her off.

Mortified, Ms. Simeesh was crushed again when her husband left her. Her parents built a separate hut for her because of her smell, but they nursed her and brought her food and water.

In that hut, she stayed — alone, ashamed, helpless, bewildered. She barely ate, because the more she ate or drank, the more wastes trickled down her legs.

Video Games May Boost Surgeons' Skill

Feb. 21, 2007 -- Playing video games may make for sharper surgeons, a new study shows.
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The surgeons with a history of playing video games for more than three hours per week were the fastest and most accurate on the laparoscopy surgery tests.

Those doctors "made 37% fewer errors, were 27% faster, and scored 42% better overall than surgeons who never played video games," write the researchers.

Torture by Worms

Mr. Carter was shaken by the victims he met, including a 57-year-old woman with a Guinea worm coming out of her nipple.

“She and her medical attendants said she had another coming out her genitals between her legs, and one each coming out of both feet,” Mr. Carter added. “And so she had four Guinea worms emerging simultaneously.”

“Little 3-, 4- and 5-year-old children were screaming uncontrollably with pain” because of the worms emerging from their flesh, Mr. Carter said. “I cried, along with the children.”

We tend to think of human rights in terms of a right to vote, a right to free speech, a right to assembly. But a child should also have a right not to suffer agony because of a worm that is easily preventable, as well as a right not to go blind because of a lack of medication that costs a dollar or two, even a right not to die for lack of a $5 mosquito net.

He has led the way in waging that battle. Because of Mr. Carter’s two-decade battle against Guinea worm disease, it is expected to be eradicated worldwide within the next five years. It will be the first ailment to be eliminated since smallpox in 1977, and it has become a race between the worm and the ex-president to see who outlasts the other.

A Film Star in Kampala, Conjuring Amin’s Ghost

I haven't had a chance to see "The Last King of Scotland," yet, which is about how a young, idealistic doctor from
Scotland goes to Uganda to help the poor, but instead has his life changed by his encounter with Idi Amin.
This article comments upon native Ugandans' impression of their history in the film...

Like others, Mr. Kizito said that after all the Rambo movies, Hindi films and second-rate European action flicks he has sat through, it was a joy to see his own country on film and to learn more about an era of Uganda’s past, much of which is still shrouded in mystery.
Amin, a charismatic army sergeant and fearsome boxer, seized power in 1971, promising to shake off the vestiges of colonialism. Instead, he plunged his country into a bloodbath, brutally eliminating his enemies — sometimes quite personally, with a hammer — until he was overthrown in 1979. More than 300,000 people are believed to have been killed.

The movie tracks those events through a fictional relationship with a young, gullible Scottish doctor, but one reason it seems to resonate with audiences here is because so much of it is true.
The Amin family, meanwhile, is not so happy. Relatives said that the former president, who called himself the “Lord of All the Beasts of the Earth and Fishes of the Sea” and “The Last King of Scotland,” among other things, was not the madman that Mr. Whitaker portrayed him as being.

TimesSelect The Health Care Racket

Is the health insurance business a racket? Yes, literally — or so say two New York hospitals, which have filed a racketeering lawsuit against UnitedHealth Group and several of its affiliates.
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But it’s a fact that insurers spend a lot of money looking for ways to reject insurance claims. And health care providers, in turn, spend billions on “denial management,” employing specialist firms — including Ingenix, a subsidiary of, yes, UnitedHealth — to fight the insurers.

Of course, rejecting claims is a clumsy way to deny coverage. The best way for an insurer to avoid paying medical bills is to avoid selling insurance to people who really need it. An insurance company can accomplish this in two ways, through marketing that targets the healthy, and through underwriting: rejecting the sick or charging them higher premiums.
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One major factor is that we spend $98 billion a year in excess administrative costs, with more than half of the total accounted for by marketing and underwriting —

And this is just part of the story. McKinsey’s estimate of excess administrative costs counts only the costs of insurers. It doesn’t, as the report concedes, include other “important consequences of the multipayor system,” like the extra costs imposed on providers. The sums doctors pay to denial management specialists are just one example.

Incidentally, while insurers are very good at saying no to doctors, hospitals and patients, they’re not very good at saying no to more powerful players. Drug companies, in particular, charge much higher prices in the United States than they do in countries like Canada, where the government health care system does the bargaining. McKinsey estimates that the United States pays $66 billion a year in excess drug costs, and overpays for medical devices like knee and hip implants, too.

To put these numbers in perspective: McKinsey estimates the cost of providing full medical care to all of America’s uninsured at $77 billion a year. Either eliminating the excess administrative costs of private health insurers, or paying what the rest of the world pays for drugs and medical devices, would by itself more or less pay the cost of covering all the uninsured. And that doesn’t count the many other costs imposed by the fragmentation of our health care system.

GOLLUM & SMEAGOL SING BARRY WHITE.BLUE VERSION. AMDSFILMS

Icy Waterfall in Kiev

From an HDR master:

Africa's Last Best Chance

The long-stalled Doha round of trade talks recently had, in the words of WTO Director-General Pascal Lamy, a jolt of "new energy" after the recent meeting of key trade ministers in Davos. What is not clearly understood is that if a successful agreement is reached, it will be especially good news for Africa.

Failure, conversely, would have tragic consequences for the continent. It would lead the United States and the European Union to negotiate more bilateral free-trade agreements with key countries, but not with sub-Saharan Africa and other poor countries, which offer few attractive markets for developed countries' manufactured goods and services. Africa, which has seen its share of world trade shrink in recent years, would fall even further behind.
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For the Doha round launched in 2001, however, there is a development agenda. At its heart is agriculture -- a politically sensitive sector in the EU and the U.S. but the largest employer in low-income countries, accounting for about 60% of their labor force and 25% of their GDP. The World Bank estimates that these agricultural products face what former U.S. Trade Representative Robert Portman observed is a practically insurmountable global average tariff rate of 62%, and that 93% of the benefits from a successful Doha round would come from improved market access for developing nations' agricultural products.

Farmers represent less than 5% of the labor force in industrial countries, but they have very substantial political power in the U.S., EU and Japan. These political forces, especially in the EU, led to the eventual derailment of the Doha round last summer. But as the Doha talks take on new life, Congress and the Bush administration need to stay true to the commitments of the Doha Development Agenda, especially in agriculture.

Two weeks ago the administration proposed ending subsidies for 80,000 wealthy farmers, substituting trade-distorting subsidies with cash payments to farmers, and trimming traditional agriculture programs by $4.5 billion over the next decade. These proposals, if approved, would directly benefit some of the poorest people on earth, save lives and ultimately reduce American foreign aid, while helping Susan Schwab, the U.S trade representative, put wind in the sails of the ministers' pledge in Davos to restart serious talks.

Stolen kids turned into terrifying killers

(CNN) -- Warlords are forcing children in conflicts around the world to become killing machines -- nothing more than what one child advocate calls "cannon fodder."

Some children are kidnapped from their schools or their beds, some are recruited after seeing their parents slaughtered, some may even choose to join the militias as their best hope for survival in war-torn countries from Colombia, and across Africa and the Middle East, to south Asia.

Once recruited, many are brainwashed, trained, given drugs and then sent into battle with orders to kill.

There is no escape for what the United Nations and human rights groups estimate are 250,000 child soldiers today. These children, some as young as 8, become fighters, sex slaves, spies and even human shields.

Spread of Religion

Religion spread animation (flash animation)

Maps of War

Maps of War (flash animation)

How Not to Talk to Your Kids

An interesting article that counteracts to some extent my current parenting paradigm

That sold me. I’d thought “praise junkie” was just an expression—but suddenly, it seemed as if I could be setting up my son’s brain for an actual chemical need for constant reward.
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Offering praise has become a sort of panacea for the anxieties of modern parenting. Out of our children’s lives from breakfast to dinner, we turn it up a notch when we get home. In those few hours together, we want them to hear the things we can’t say during the day—We are in your corner, we are here for you, we believe in you.

In a similar way, we put our children in high-pressure environments, seeking out the best schools we can find, then we use the constant praise to soften the intensity of those environments. We expect so much of them, but we hide our expectations behind constant glowing praise. The duplicity became glaring to me.

Eventually, in my final stage of praise withdrawal, I realized that not telling my son he was smart meant I was leaving it up to him to make his own conclusion about his intelligence. Jumping in with praise is like jumping in too soon with the answer to a homework problem—it robs him of the chance to make the deduction himself.

But what if he makes the wrong conclusion?

Faces, Faces, Everywhere

Why do we see faces everywhere we look: in the Moon, in Rorschach inkblots, in the interference patterns on the surface of oil spills? Why are some Lay’s chips the spitting image of Fidel Castro, and why was a cinnamon bun with a striking likeness to Mother Teresa kept for years under glass in a coffee shop in Nashville, where it was nicknamed the Nun Bun?

Patenting Life

YOU, or someone you love, may die because of a gene patent that should never have been granted in the first place. Sound far-fetched? Unfortunately, it’s only too real.

Gene patents are now used to halt research, prevent medical testing and keep vital information from you and your doctor. Gene patents slow the pace of medical advance on deadly diseases. And they raise costs exorbitantly: a test for breast cancer that could be done for $1,000 now costs $3,000.

Why? Because the holder of the gene patent can charge whatever he wants, and does. Couldn’t somebody make a cheaper test? Sure, but the patent holder blocks any competitor’s test. He owns the gene. Nobody else can test for it. In fact, you can’t even donate your own breast cancer gene to another scientist without permission. The gene may exist in your body, but it’s now private property.

TimesSelect Death by Dollars

So I’m against economic sanctions in almost every case. But Sudan is an exception, a rare instance where narrowly focused divestment makes practical as well as moral sense. Partly that’s because Sudan’s economy depends on foreign oil companies, giving the outside world leverage. And 70 percent of Sudan’s oil revenue goes to weaponry, like bayonets used to gouge out people’s eyes. The oil companies in Sudan aren’t American; the biggest players are Chinese companies. Pressure on them is also one way to get the attention of the Chinese government, which is Sudan’s main protector in the U.N. Security Council.


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Fortunately, the Darfur divestment campaign has been remarkably restrained in choosing targets. Organizers are not seeking divestment from all of the more than 400 foreign companies that operate in Sudan, but only from a few dozen that are complicit in genocide without helping ordinary Sudanese. (See the guidelines at www.SudanDivestment.org, developed largely by a recent U.C.L.A. graduate, Adam Sterling.)

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More than other money managers, Fidelity has resisted the pressure and clung firmly to Sudan-related investments. So Darfur campaigners are urging investors to avoid Fidelity mutual funds: more information is at www.FidelityOutofSudan.com.

The biggest U.S. investor in Class H shares of PetroChina, a Chinese oil concern whose parent company is active in Sudan, is Warren Buffett’s Berkshire Hathaway. I have huge respect for Mr. Buffett, and he may be thinking: My obligation is to make money for shareholders, not to use their investments in a dubious attempt to save the world. But surely if Berkshire Hathaway and Fidelity mutual funds saw lucrative opportunities in selling bayonets to the janjaweed, they would balk at that. We do have limits; the question is where we draw them.