Friday, March 24, 2017

Health Care in America - Paying More and Getting Less

With Obamacare and Trumpcare taking up a great deal of the media's attention over the past month, I wanted to take a look at a little-discussed aspect of health care in the United States, how spending on health care in America compares to that of other nations.

According to the Peter G. Peterson Foundation, here is a graphic showing how health care spending compares among developed nations:

You'll notice that U.S. per capita spending on health care is more than twice the OECD average of $3,620.

Actually, higher spending levels on health care in the United States could be a good thing if improved health outcomes reflect the additional spending.  As shown here, that is far from the case for many health issues:

A study by Goran Ridic, Suzanne Gleason and Ognjen Ridic compares the health care systems of Canada, Germany and the United States, all of which are highly advanced economies.  Both Canada and Germany have a national health care system (some would call it socialism) with universal health insurance coverage and a system where governments are responsible for providing social benefits, including health care, equally to all citizens.  This is in sharp contrast to the United States where private health care insurance costs are borne by individuals and there is no single nationwide system of health insurance.  From the study which uses data from the OECD in 1998, here is a table showing the life expectancy at birth and life expectancy for adults aged 65 as well as the infant mortality rate:

In fact, according to the World Health Organization (WHO),  the situation has not improved for the United States since 1998 with Canada now having a life expectancy at birth of 82.2 years, Germany now having a life expectancy of 81 years and the United States having a life expectancy of 79.3 years.  As well, in 1998, the United States also had, by a relatively wide margin, the highest infant mortality rate among the three nations in the study.

Here is a map from WHO showing how life expectancy in the United States is definitely not among the world's longest among when compared to its OECD peers in Europe and the South Pacific:

When looking at the entire list of nations, the United States has the 31st longest life expectancy, after Italy, Israel, Chile, Cyprus, Slovenia and Costa Rica. 

While Washington continues to play political games with how health care is offered in the United States, it spends almost no time on actually improving the health outcomes and longevity of Americans, the most important health care issue of all.  Americans have a long tradition of paying more for their health care and getting less in return. 

Chemicals In America - Who's Protecting Us?

With the Trump Administration planning significant changes to the Environmental Protection Agency (EPA) and signalling that it could cut the EPA's budget by up to 25 percent, one has to wonder who will be there to protect Americans.  Fortunately, the recent launching of a new initiative that has sprung up out of nowhere gives us a sense of how future consumer protection could evolve, particularly when it comes to the chemicals that we find in the environment today.

Here's the announcement of the formation of the Campaign for Accuracy in Public Health Research (CAPHR), a rather warm and friendly-sounding name for a new initiative:

After all, in this age of fake news, who doesn't want more accuracy in everything!

Here's a screen capture from CAPHR's new website:

The banner at the top of the website quotes Galileo Galilei...

"By denying scientific principles, one may maintain any paradox."

One of the axes that CAPHR has to grind is its distain for the International Agency for Research on Cancer (IARC), a group that was established in 1965 as an affiliate of the World Health Organization.  The IARC's mission is as follows:

"The objective of the IARC is to promote international collaboration in cancer research. The Agency is inter-disciplinary, bringing together skills in epidemiology, laboratory sciences and biostatistics to identify the causes of cancer so that preventive measures may be adopted and the burden of disease and associated suffering reduced. A significant feature of the IARC is its expertise in coordinating research across countries and organizations; its independent role as an international organization facilitates this activity. The Agency has a particular interest in conducting research in low and middle-income countries through partnerships and collaborations with researchers in these regions.  

Emphasis is placed on elucidating the role of environmental and lifestyle risk factors and studying their interplay with genetic background in population-based studies and appropriate experimental models. This emphasis reflects the understanding that most cancers are, directly or indirectly, linked to environmental factors and thus are preventable. The IARC Monographs Programme is a core element of the Agency's portfolio of activities, with international expert working groups evaluating the evidence of the carcinogenicity of specific exposures. The Agency is also committed to studying approaches for the early detection of cancer and in evaluating prevention strategies."

The IARC publishes a series of IARC Monographs which identify factors that can increase the risk of human cancer including chemicals, complex mixtures, occupational exposures, physical agents, biological agent and lifestyle factors.  Since 1971, IARC has evaluated 988 agents of which more than 400 have been deemed carcinogenic, probably carcinogenic and possibly carcinogenic to humans.  Here is a link to the latest volume of IARC Monographs and a sample showing part of the monograph for glyphosate, the active ingredient in Monsanto's Roundup product line and other herbicides:

In addition to the chemical properties of glyphosate, the IARC Monograph includes a very thorough review of research that has been done on glyphosate and its link to various cancers in humans and small mammals and amphibians as shown on these sample pages:

To summarize, in this case, the IARC considers glyphosate to be "probably carcinogenic".  

What does CAPPR have to say about the IARC Monographs in light of its mission for accuracy in public health research?   It claims that the IARC relies only on studies that are in the public domain and ignores proprietary research done by other groups.  According to CAPHR, only one out of 998 agents that have been assessed since 1971 have been determined to "probably not" cause cancer in humans while all of the rest were identified as possible, probable or certain carcinogens as shown here:

While there is no doubt that IARC's findings are controversial at times and confusing at others, there is something that you should know about the Campaign for Accuracy in Public Health Research.  Here is a link to the full regular membership list of CAPHR's parent organization, the American Chemical Council and here are a few examples that you may be familiar with:

BASF Corporation
Bayer Corporation
BP Lubricants USA, Inc.
Chevron Phillips Chemical Company LP
Eli Lilly and Company
ExxonMobil Chemicals USA, Inc.
March & Co., Inc.
Methanex Corporation
Monsanto Corporation
NOVA Chemicals Corporation
Proctor & Gamble, Chemicals Division
Shell Chemical LP

It reads like a "who's who" of America's chemical industry, doesn't it?

So, if you are looking for "accuracy in public health research" when it comes to the chemicals in your life, you now have a new source of information including this conclusion about the aforementioned glyphosate:

"Glyphosate is less toxic than either caffeine or table salt. Over the last 40 years, the herbicide has been rigorously tested and studied by regulatory agencies worldwide that have found it poses no risk to human health when used as directed." (my bold)

I offer my thanks to the American chemical business for their unbiased opinion that one of their products is less toxic that two substances that most people consume on a regular basis.  I think I'll go have a sip of Roundup.

Thursday, March 23, 2017

The Creation of ISIS

While the new administration in Washington brandishes its anti-terrorism mantra, a look back in time explains why the situation in Iraq and Syria devolved to the point where the Islamic State, the current global "terrorism boogeyman" arose to such prominence.  This background information came to light when Judicial Watch published a series of documents in May 2015 about the attack on the U.S. embassy in Benghazi.  While most of the mainstream (i.e. the "real media") focussed on the State Department and its foreknowledge of the Benghazi attack, in fact, another document shows how the United States and its allies in the region were complicit in the creation of ISIS and how the group could be used in the West's anti-Assad program.   

Here is the heavily redacted formerly "Secret/No Forn" document from the Defense Intelligence Agency  in its entirety:

The Department of Defense Information Report on Iraq begins by noting that there are two sides to the situation in Syria:

1.) Supporters of the Assad Regime - Russia, China and Iran

2.) Supporters of the Opposition to Assad - the West, Gulf Countries and Turkey

Since the Sunni - Shia split is critical to understanding the Middle East, let's start by looking at a map of the region showing which nations have Sunni and Shia majorities and which nations are currently experiencing internal and external sectarian violence:

It is also key to note that al-Qaeda and ISIS are both Sunni; ISIS believes that in order to purify Islam, Shia Muslims must die.  As well, Syria's ruling class is Alawi, an offshoot of Shia as shown on this complex diagram:

It is also important to look back at a bit of history; Al-Qaeda in Iraq (AQI) became the Islamic State in Iraq and Syria (ISIS) in April 2013 when it began to operate in both Iraq and Syria.  In February 2014, al-Qaeda officially renounced any connection with ISIS after attempts at reconciliation between the leader of al-Qaeda, Ayman al-Zawahiri, and the leader of ISIS, Abu Bakr al-Baghdadi, failed. 

Let's go back to the Department of Defense document.  The document notes that the Muslim Brotherhood and AQI (Al-Qaeda in Iraq) are the major forces that were driving the insurgency in Syria and that, from the beginning, AQI supported the Syrian opposition because it considered Assad's government to be a sectarian regime which was targeting Sunnis.

The document goes on to explain the situation in Syria and Iraq, and makes the following conclusions:

1.) The Assad regime will survive and control Syria.

2.) A proxy war will develop with the regime getting support from Russia, China and Iran to aid the Assad regime in retaining control the coastal territories of Syria (i.e. western Syria).  Opposition forces, supported by the West, Turkey and the Gulf States, want to retain control of the eastern areas that are immediately adjacent to the western Iraqi provinces of Mosul and Anbar.

3.) As the situation evolves, there is the possibility of establishing a Salafist principality (Salafists are a branch of Islam that is most puritan and doctrinally rigid, seeking to imitate the life of Mohammed in every aspect of their lives.  It is most often associated with the jihadist movement).  Here's the key paragraph from the document:

Basically, in 2012, the Western powers, the Gulf States and Turkey were quite comfortable using AQI/ISIS to achieve their goal of removing Bashar al-Assad from power.  This map shows the Pentagon's intentions:

With the benefit of knowing what has happened since 2012, it is quite obvious that, in their haste to overthrow Bashar al-Assad, the United States and the Obama Administration, in particular, made a grievous error by assuming that they could use Al-Qaeda in Iraq to achieve their goals of regime change in Syria.  The evolution of AQI into the now-much dreaded ISIS is yet another fine example of an unintended consequence of a poor understanding of the geopolitics and religion of the Middle East by those who "lead" us.