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Entries in healthcare (45)


The Future of Human Resilience - or Indulgence?

THERE WILL ALWAYS BE TWO TYPES OF HUMANS: THOSE WHO SEEK TO "SAVE" THEMSELVES AND THEIR FUTURE (BY LIVING CAREFULLY) AND THOSE WHO SEEK TO "SPEND" THEIR LIVES (AND LITERALLY THEIR BODIES) AS AGGRESSIVELY AS POSSIBLE. On the former, think of vegan ascetics; on the latter, think of career military or NFL players. There is no right choice – just the choice. To quote the heavy-metal band MetallicaMy lifestyle determines my death style. Except maybe now, thanks to emerging bio-technologies, it no longer will. At first glance, this is an unmitigated blessing: worn-out or diseased or damaged organs and bones replaced with organic replacements crafted from your own cells! But what happens to human behavior when people start to realize that today's extreme risks can be covered by emerging technological fixes? Are we suddenly braver? More foolhardy? More given to addictions? Less virtuous? In sum, does this form of new-school resilience (break it, replace it) somehow diminish the old-school variant (overcoming damage)?

Whatever the pathway, it seems clear that the nature of humanity's physical resilience will be transformed – profoundly augmented by biotechnologies that allow us to walk away from our mistakes, sufferings, bad luck, bad DNA, bad behavior, etc.

Two stunning examples, the first on 3-D printing:

A new method of 3-D printing can produce human-sized bone, muscle, and cartilage templates that survive when implanted into animals, researchers report.

"It has been challenging to produce human scale tissues with 3-D printing because larger tissues require additional nutrition," Dr. Anthony Atala from Wake Forest School of Medicine, Winston-Salem, North Carolina told Reuters Health by email.

His team developed a process they call "the integrated tissue and organ printing system," or ITOP for short. ITOP produces a network of tiny channels that allows the printed tissue to be nourished after being implanted into a living animal.

The researchers produced three types of tissue - bone, cartilage, and muscle - and transplanted it into rats and mice.

Five months after implantation, the bone tissue looked similar to normal bone, complete with blood vessels and with no dead areas, the research team reported in Nature Biotechnology . . .

Results with 3-D printed skeletal muscle were equally impressive. Not only did the implants look like normal muscle when examined two weeks after implantation, but the implants also contracted like immature, developing muscle when stimulated . . .

"We are also using similar strategies to print solid organs," [Atala] added.

That's the human hardware, so to speak. Now on to the software . . .

Miniature brains [see image above] that show electrical activity akin to “a primitive type of thinking” could revolutionise how some drugs are tested and reduce the need for animals in research, according to scientists who have developed the structures.

Each ball of human brain cells - in all about the size of the head of a ballpoint pen - “represents more or less a two-month-old brain” of a foetus, Prof Thomas Hartung of Johns Hopkins University said, presenting the work at the American Association for the Advancement of Science conference . The cultures also show “spontaneous electrophysiological activity” – their neurons zap off electrical signals to each other without prompting.

“It’s starting to produce a primitive type of ‘thinking,’” Hartung said, though he stressed that the operation is only mechanical. “Obviously there’s no input or output. It is meaningless electrical activity but the neurons are trying to communicate with each other.”

Scientists first developed miniature brains in test tubes in December 2013, but Hartung said that his team has managed to standardise the new “mini-brains” – meaning they can grow hundreds of uniform brain cultures in a single petri dish, rather than a few cultures each grown according to their distinct genetic codes . . .

Hartung said the neural activity, which can be measured with an EEG-like device, creates a “third dimension” for studying the effects of drugs: not only can researchers examine how drugs affect the health and function of brain cells, they can also see what drugs do to neural activity.

An obvious good in terms of drug testing and particularly in attacking brain-centric conditions and diseases like Alzheimer's. But note how quickly the doctor dismissed the notion of actual "thinking" being triggered. That inevitability, plus the comparison to a fetus, starts to feel a lot more God-like.

But, frankly, it's all God-like. In human history, there are two great brakes on behavior: one is the reality of the human body (you will pay for your bad or risky behavior!) and belief in the afterlife (and, if you don't, then God will make you pay for eternity). For now, we seem to be messing only with the first equation – the hard and fast one that only the most genetically fortunate can escape. But yes, we will eventually get around to the second one.

In both instances, though, we're leveling a playing field that's been magnificently tilted throughout human existence, and that is going to revolutionize our sense of risk – both individually and collectively. If you think that technology can save your skin (literally), you'll be more willing to push all manner of envelopes. At first, it will be – as usual – only the rich who can afford such a mindset. You see that today in cosmetic surgery, but these technologies will take that advantage to an entirely new level.

At some point, access to such technologies becomes a political issue – not unlike the shadowy question of who should be prioritized today for donor organs (the virtuous disease-sufferer or the person who destroyed their liver with alcohol). Eventually, expect that access to be defined a "human right" – upon threat of political revolution.

Again, whatever the pathway, these technologies will spread. They will be "democratized" like all before them. And they will dramatically alter human behavior – first individually and then in organizations. Legal and political systems will need to change in response.

And the notion of human resilience will never be the same again.



The Stunning Cancer Experiment That Is China, And How It Might Just Improve The World

IF NECESSITY IS THE MOTHER OF INVENTION, THEN TRAGEDY IS THE MOTHER OF RESILIENCE. Right now China, home to 19% of the world's population, is enduring a national tragedy when it comes to environmental pollution delivering carcinogens to the citizenry, who, in turn, now suffer extraordinary cancer rates. That's the bad news. The good new is that China, like so many economic "risers" before it, is certain to surmount its local pollution issues as its per-capita income reaches that level - seen in previously industrialized nations like the UK and the US - when the public begins to prefer a cleaner environment more than that next additional bit of income.

Environmntal_Kuznets_CurvePer the observed Kuznets Curve on environmental damage suffered by industrializing nations, we know that countries, when they traverse a certain per-capita income trajectory, begin to clean things up.  London's famous "fog" of the 19th century was really coal-burning-generated smog, and New York of a century ago was amazingly unhealthful due to local pollution.  But each metropolis, reflecting larger national trends, eventually cleaned themselves up. Better-off citizens simply began prioritizing that demand in political discourse, elections, candidates and the like. Didn't happen overnight, but like with everything witnessed in today's globalization era, we should expect it to happen at record speed with China.

(And yes, the environmental Kuznets Curve is subject to two key criticisms: 1) nations often clean-up by moving their dirtier industries to other nations (pollution haven effect); and 2) the notion applies well to local pollution, but not to global pollution of the sort represented by CO2 emissions. Of course, from my economic determinist perspective, these caveats only highlight the need to bring along - even faster - the less-developed parts of the global economy, so that they too reach proper national "incentivization" levels.)

But no matter how fast it happens, China's frightening cancer experiment is just beginning. Yes, we can cite the high smoking rates of the sort not seen in the U.S. since the 1940s-50s - a development that led to our own cancer-treatment boom in the 1960s-70s (when systematic work on virtually all of today's treatment protocols began).  But that's only responsible (it is estimated) for roughly one-quarter of China's current explosion of cancer cases. Another huge chunk is due to the population's unremitting exposure to carcinogens in their environment - the dark cost of the nation's rapid industrialization of the past several decades.

Now we get word of just how costly that trajectory, which lifted hundreds of millions out of poverty, is turning out to be in the realm of cancer.

From the Medical Daily website (along with the scary photo above, credited as bl  michael davis-burchat, CC by 2.0):

new report illuminates one aspect of this country’s current reality — the health of its citizens. Researchers estimate China endured 2.8 million cancer deaths during 2015 and 4.3 million new cancer cases, with lung cancer the most common of all.

“Cancer incidence and mortality have been increasing in China, making cancer the leading cause of death since 2010 and a major public health problem in the country,” wrote the researchers. Quality data from population-based registries has recently become available through the National Central Cancer Registry of China, giving researchers a better view of the country's health.

The key to the new understanding is meta-analysis of cancer registries around the country - in other words, Big Data to the rescue:

To penetrate the shadows and learn more about the current situation, a team of scientists from the American Cancer Society, University of Sydney, and National Cancer Center Beijing used mortality data compiled by 72 local cancer registries to estimate the numbers of cancer deaths in China in 2015.

Given the recent, rapid industrialization and the relative infancy of anti-smoking public campaigns in China, it's no surprise that the nation "outperforms" it global population share of 19% by accounting for 22% of new cancer diagnoses and a whopping 27% of global cancer deaths. But what really sticks out is the distribution of cases across organs:

Specifically, the four most common cancers diagnosed in China are lung, stomach, liver and esophageal cancer, representing 57 percent of all cancers diagnosed in the country. By comparison, these cancers account for only 18 percent of total incidence in the United States.

Have no doubt, Chinese are living longer and - in general - more healthy lives. As the study also notes, mortality rates have plummeted in the last decade alone - 21 percent for both males and females.  That's amazing.

But that also makes the spiking rise of invasive and fatal cancer cases all the prominent. People are living longer in China, but dying harder - and local pollution is the rising killer.

“Outdoor air pollution, considered to be among the worst in the world, indoor air pollution through heating and cooking using coal and other biomass fuels, and the contamination of soil and drinking water mean that the Chinese population is exposed to many environmental carcinogens,” wrote the authors.

Some efforts are being made to reduce the burden of environmental pollution in China, they say. Though the effects of these endeavors will not be felt immediately, the rates of cancer deaths could be reduced by increasing the effectiveness of care and treatment, particularly among the disadvantaged and those living in rural areas, the researchers conclude.

Having spent a lot of time in China over the past decade, I can attest to the scary nature of the air quality. Typically, I just start on antibiotics the minute my jet touches down, knowing that the expose will send my sinuses into acute infection - like clockwork. Frankly, it's why I turned down a full-time job offer last year from a Chinese enterprise: it wasn't just the personal health cost I feared, but what it would do to my kids once they made it over. It's when highly-skilled and globally mobile workers - both outside and inside China - start basing job decisions on local pollution that the political tipping point gets reached, simply because the profound economic costs begin to make themselves readily known.

China will process its peaking pollution by massing state resources and power to make it happen, and the government will do this - to a great extent - to avoid the public's political wrath.  The same will happen with China's burgeoning cancer treatment industry. Both efforts will leave China far more resilient on the far side of this development "hump," and the world will likely benefit greatly from the nation's great push on both subjects - just like it did before when Western economic giants went through similar growing pains.


The Extremes To Which Non-Resilient National Medical Systems Must Go When Facing a Potential Epidemic

LATIN AMERICAN COUNTRIES, EXPERIENCING OUTBREAKS OF A PREVIOUSLY MUNDANE VIRUS (ZIKA) THAT HAS APPARENTLY MUTATED TO THE POINT OF TRIGGERING DEVASTATING BIRTH DEFECTS, ARE TAKING THE UNPRECEDENTED STEP OF ASKING WOMEN TO DELAY PREGNANCIES - IN ONE CASE UNTIL 2018. Mosquito-borne, Zika seems to be expanding its reach with climate change and the heightened international travel dynamics associated with globalization. In other words, this growing medical challenge feels like a glimpse of the world's near-term collective future, one which places unusual and profound pressures on the resilience of national medical systems. (The map above comes from the CDC).

The gist from a great WAPO piece over the weekend:

The rapid spread of the Zika virus has prompted Latin American governments to urge women not to get pregnant for up to two years, an extraordinary precaution aimed at avoiding birth defects believed to be linked to the mosquito-borne illness.

What until recently was a seemingly routine public health problem for countries that are home to a certain type of mosquito has morphed into a potentially culture-shaping phenomenon in which the populations of several nations have been asked to delay procreation. The World Health Organization says at least 20 countries or territories in the region, including Barbados and Bolivia, Guadeloupe and Guatemala, Puerto Rico and Panama, have registered transmission of the virus.

Although the Zika virus has been documented since the 1940s, it began its assault on Latin America in the past several months. The hardest-hit country has been Brazil, where more than 1 million people have contracted the virus. In the past four months, authorities have received reports of nearly 4,000 cases in which Zika may have caused microcephaly in newborns. The condition results in an abnormally small head and is associated with incomplete brain development. Colombia, which shares an Amazonian border with Brazil, reacted to its own Zika outbreak, numbering more than 13,000 cases, by urging women not to get pregnant in the next several months. Other countries, including Jamaica and Honduras, also have urged women to delay having babies.

After more than 5,000 suspected Zika cases were reported last year and in the first weeks of 2016, El Salvador on Thursday took the most extreme stance so far: Deputy Health Minister Eduardo Espinoza urged women to refrain from getting pregnant before 2018.

Culture-shaping is the operative term here. We've long associated globalization with culture/society-shaping dynamics - particularly in the violent responses it can spawn in terms of insurgencies and terrorist movements designed to "safeguard" locals from its perceived pernicious effects (often surrounding the social standing of women who are disproportionally empowered by gender-neutral networks that invade traditional societies in globalization's wake). But climate change will clearly fall into the same category of impact: social behavior will be transformed. Here, we're talking overwhelmingly Catholic societies being asked to embrace birth control by states fearful of medical costs associated with an unfolding epidemic.

But as we've learned with "the pill," AIDS epidemic and abortion rights, it gets really hard to alter that most intimate of social behaviors.

Outside the National Maternity Hospital in San Salvador, Selina Velasquez Cortez, a 30-year-old employee of a sardine factory who has been trying to get pregnant for two years, said there is no way she will stop trying now.

Clearly the US is already taking note and following a similar path of prevention - for now:

The Centers for Disease Control and Prevention on Friday added eight to a list of 14 countries and territories it has urged pregnant U.S. women to avoid because of the risk associated with Zika outbreaks. So far there is no vaccine for the virus.

Having the right vaccine is the ultimate resilience reservoir, as we've learned across the 20th century, when the biggest killer (at 300 million) by far was chicken pox - not warfare. Humanity basically doubled its life-expectancy at birth from 1900 to 2000 (from low-30s to mid-60s globally), and early childhood vaccines were the primary engine of that amazing achievement. Prior to vaccines, that life expectancy at birth measure hadn't move much at all over the previous 10,000 years of human existence.

But now humanity enters into a new age (Anthropocene, as some in the scientific community call it) where our cumulative and growing impact on the planet doubles back upon us with sped-up evolutionary challenges that not only trigger one of Earth's biggest extinction spasms (loads of species disappearing in a massive die-off) but likewise force nations to rethink what it means to have truly resilient national medical systems.




(RESILIENT BLOG) Rating US Healthcare Systems On Infectious Diseases: Which US States Are Most Resilient?

IN THE ADVANCED WEST, WE'VE LONG AGO SHIFTED OUR THINKING ON HEALTHCARE FROM INFECTIOUS DISEASES TO CHRONIC OR "LIFESTYLE" DISEASES.    Why?  Vaccines, antibiotics, and better sanitation in general put most infectious diseases (and subset communicable diseases) in the West's rearview mirror, compared to the East and South. Plus, they've been our biggest killers for a long time, thanks to modernization. Moreover, the big medical gains that we've seen with globalization's spread include a strong shift from infectious to chronic diseases in the "rising" East and a similarly unfolding shift across the South.  Now, of the top-ten killers in the world, according to the WHO, seven are considered chronic problems  That's the good news ...



(RESILIENT BLOG) How Climate Change Will Test Our Resilience On A Very Local – Even Intimate – Level

gr1LIVING IN THE NORTHERN UNITED STATES, ONE DOESN'T EXPECT TO CONTRACT ESSENTIALLY TROPICAL DISEASES LIKE MALARIA (see Lancet's chart on left), and yet, would you be surprised that, in the early-to-mid-19th century, Norwegian pioneers settling in Wisconsin - as a rule - feared malaria significantly more than cholera?  Malaria actually remained endemic in much of the United States (more in the South, obviously) through the 1940s, whereas today in a state like Wisconsin, virtually all cases that present themselves (roughly a dozen a year) feature travelers just back from tropical locations.  But that's changing, per a great WAPO in-depth story of a few days back ...



(RESILIENT BLOG) Resilience Begins In Your Head – Or, You’re Only As Brittle As You Think You Are

Image courtesy of nattavut at FreeDigitalPhotos.netAGE IS WHATEVER YOU THINK IT IS.  YOU ARE AS OLD AS YOU THINK YOU ARE - MUHAMMAD ALI.

Well, a couple of new medical studies suggest that your lifelong attitude toward aging and cognitive decline may significantly shape your risk of suffering Alzheimer's Disease in your elder years:

In the first study, researchers looked at data from 158 healthy people without dementia enrolled in the Baltimore Longitudinal Study of Aging (BLSA). In order to find out how people in the study felt about age stereotypes, researchers used a scale with statements like “older people are absent-minded” or “older people have trouble learning new things.” People in the study gave these answers when they were in their 40s ...



China has to learn how to take better care of its own

NYT front-pager on how new model of outreach and service to HIV community is being appreciated as possible approach to host of underserved populations currently in the official shadows, to include the mentally ill, the extremely impoverished, and the environment. The key is letting NGOs rise as part of a general maturation of civil society.  The simple but harsh reality for the Party is that, by spending so much time obsessing over political speech (Kristof's point in his op-ed of same day), it's losing ground on a host of government support/regulation areas where the public desperately needs help.  The result?  Rapacious behavior all around, but especially on the part of the elite - a growing problem that only hyperventilates the already profound populist anger.

The conundrum is solved, in both instances, by the Party actually extending more trust to the public it claims to represent, because, right now, the combination of over-exertion on political speech and under-exertion on everything else is a losing battle.  As progressive agenda items pile up (what is more progressive than extending coverage to the underserved?), the Party ends up looking like it's only concerned with its own power - along with its own greed (all that corruption).

You put that all together, and I don't know how pundits see a triumphant Chinese model, because it's stalling at the same point that all industrializing powers do, and the answers are still the same - more and better democracy, or more opportunity extended to the people to take more responsibility for themselves and each other.

China's model is not "better" than ours by any stretch.  Instead, it's an insult (growing) to the Chinese people, who prove themselves to be smart and responsible and capable the world over - whenever they're extended the chance to prove that.

The Chinese Communist Party lives in fear of its own people, and that's sad - and ultimately self-limiting for all.

That's why democracy is coming.  People want more and achieving more requires it.


Chart of the day: globalization vastly improves death

NYT story.  Simply fascinating.

There's no arguing this:  over the last 20 years, or the apogee of globalization's rapid expansion, more babies live into childhood, more children live into adulthood, and adults live longer.

So much for globalization impoverishing everyone and making their lives more miserable.

Check it out:  communicable yields to lifestyle diseases.

The tough work for any global progressive effort is already done.  Now it's all about living that much longer - primarily - because we'll eat that much healthier.  Obesity feeds all the major lifestyle diseases.

Overall, striking evidence that globalization has improved lives the world over:

The shift reflects improvements in sanitation, medical services and access to food throughout the developing world, as well as the success of broad public health efforts like vaccine programs. The results are striking:infant mortality declined by more than half from 1990 to 2010, and malnutrition, the No. 1 risk factor for death and years of life lost in 1990, has fallen to No. 8.

At the same time, chronic diseases like cancer now account for about two out of every three deaths worldwide, up from just over half in 1990. Eight million people died of cancer in 2010, 38 percent more than in 1990. Diabetes claimed 1.3 million lives in 2010, double the number in 1990.

“The growth of these rich-country diseases, like heart disease, stroke, cancer and diabetes, is in a strange way good news,” said Ezekiel Emanuel, chairman of the department of medical ethics and health policy at the University of Pennsylvania. “It shows that many parts of the globe have largely overcome infectious and communicable diseases as a pervasive threat, and that people on average are living longer.”

The truth is good.



Turning point on US obesity epidemic?

From NYT:

After decades of rising childhood obesity rates, several American cities are reporting their first declines.

The trend has emerged in big cities like New York and Los Angeles, as well as smaller places like Anchorage, Alaska, and Kearney, Neb. The state of Mississippi has also registered a drop, but only among white students.

“It’s been nothing but bad news for 30 years, so the fact that we have any good news is a big story,” said Dr. Thomas Farley, the health commissioner in New York City, which reported a 5.5 percent decline in the number of obese schoolchildren from 2007 to 2011.

The drops are small, just 5 percent here in Philadelphia and 3 percent in Los Angeles. But experts say they are significant because they offer the first indication that the obesity epidemic, one of the nation’s most intractable health problems, may actually be reversing course.

Crucial to get kids less fat, because fat kids are almost totally doomed to be fat adults, burdened by all manner of lifetime medical ailments.  Our obesity epidemic began with kids and it will end with kids.

Especially tough since so many kids eat majority of their weekday food at school (breakfasts + lunch + snacks). Health advocates have to fight food and beverages industry on this.  Good example:  big push to get sodas out of schools and Coca-Cola and others fire back with "energy drinks" that are just as sugary.  Sugary drinks are believed to account for half of the obesity epidemic.  

Then there are those cheap-skate Republicans in Congress who insist on labeling pizza a "vegetable," while insisting on more tests and thus less phys ed.  I can tell you that Indiana is nuts on that score (testing):  my kids are forced to prep and take these mindless (and useless) tests ALL YEAR LONG.  What a way to prep kids for the 21st century!

But I digress ...

Researchers are trying to figure out what's working.  All they know is this: "declines occurred in cities that have had obesity reduction policies in place for a number of years."

Looking ahead:

Though obesity is now part of the national conversation, with aggressive advertising campaigns in major cities and a push by Michelle Obama, many scientists doubt that anti-obesity programs actually work.

Exercising is required, but it never does it alone (and never will).  Key is reducing all those empty calories and portion sizes ("Want some fries with your pizza and Gatorade?").

What we eat in America is what is most profitable for US food companies and ag corps to sell - plain and simple. We subsidize grains big time and do virtually nothing for fruits and vegetables.

We've got a nanny state alright, and she's telling us that fat is good.

I admire Michelle Obama for working this issue.  Exactly the right focus for her right now.  Because when we solve the tripling of obesity that's unfolded over the past three decades (stunning, really), we solve a good deal of our healthcare crisis.


Obesity epidemic: one variant of the punitive approach

WSJ headline says Denmark scraps it's "much-maligned 'fat tax' after a year."

Danish lawmakers have killed a controversial "fat tax" one year after its implementation, after finding its negative effect on the economy and the strain it has put on small businesses far outweigh the health benefits.

Nations including Switzerland, the U.K, and Germany have held up the tax, which applies to any food containing more than 2.3% saturated fat, as a potential model for addressing obesity and other health concerns. But in Denmark, it has been a source of pain for consumers, food producers and retailers as the nation's economy struggles.

"The fat tax is one of the most maligned we [have] had in a long time," Mette Gjerskov, the minister for food, agriculture and fisheries, said during a news conference Saturday announcing the decision to dump the tax. "Now we have to try improving the public health by other means."

The failure of Denmark's fat tax is a demonstration of how difficult it can be to modify behavior by slapping additional duties on products seen by many as essential staples, especially during tough economic times. Products such as butter, oil, sausage, cheese and cream were subject to increases of as much as 9% immediately after the new tax was enacted.

"What made consumers upset was probably that an extra tax was put on a natural ingredient," said Sinne Smed, a professor at the Institute of Food and Resource Economics.

The fat tax comes to an end after netting an estimated €170 million ($216 million) in 2012 in new revenue. Danish lawmakers will slightly raise income taxes and reduce personal tax deductions to offset the lost revenue. The lawmakers also decided on Saturday to reverse an earlier decision to create a sugar tax.

"This is not what is needed in the current economic situation," said Holger Nielsen, Denmark's minister for taxation.

Human bodies are designed to crave fat, especially when we're stressed.  The body is telling us to store up because things seem dangerous.  This is evolution talking:  if things are going south, better to stockpile fat now for the bad days ahead.

Problem is, modern life creates all sorts of stresses and modern food companies love moving this sort of product, because it nets them the highest profits.

End result:  an obesity epidemic.  The food companies know how to trigger our interest, and life provides all manner of stimuli that triggers our desire.  The cost is pushed downstream.  

Governments want cheap food but then regret the healthcare bill that follows.  Governments then try to go punitive - actually on the consumer - by issuing a fat tax that the sellers pass on directly.  Consumers get mad, tax gets scrapped.

Conservatives yell, "nanny state."  But in truth, Western governments already lavish the ag and food industries with subsidies that encourage all this, meaning the nanny state is already here, she's just encouraging us to eat the worst sorts of food (or the most profitable to sellers).  In relative terms, veggies and fruits aren't subsidized, grains are.  So we're being fatted up by our nanny state for the healthcare providers.

Governments can't disincentivize bad eating by taxing people.  They need to rejigger the already bad incentive system for ag and food companies.

Still, the fact that states are trying is an indicator of the progressive agenda that eventually must come.

But Big Food wins another round ("See, the evil government is trying to deny you your bad diet!"  Cha-ching!)


Greece: how bad does it get?

Malaria still existed throughout much of the US in the 1930s/40s.  Since then it has gotten much warmer throughout the US.  But malaria is basically gone now.  Why?  Rising incomes.

So the point on global warming is, it'll create real problems wherever states and societies don't have the money to deal with the challenges - such as insect migration.

Now take a look at this chart from the WSJ and realize what happens when incomes fall - and how quickly.

Recently, Wikistrat ran a sim where we discussed the possibility of states making sovereign land sales.  Several analysts said that, while that happened in previous centuries (note how most of America was acquired), nobody would consider that now.

My comeback was, if the financial situation gets bad enough, countries will sell just like people get rid of an underwater house.

Greece is looking pretty bad, and I think it's a harbinger of massive debt issues to come for a demographically aging West.

The discussion we had was about the Arctic and the possibility of some Arctic Council members selling out to non-members so as to tap the finance needed for exploitation of opportunities.  After all, the US bought its seat at the table - aka, Alaska.


The coming global progressive era will focus on healthcare


WSJ story on Kremlin ordered crackdown on smoking rates, right after China "plans 'harsh' anti-smoking rules.

This is the reality:  with globalization and development comes heightened smoking rates, which in turn triggers massive healthcare costs.

Then there's the secondary reality that Old Core North America, sick of smoking a while ago, sent Big Tobacco packing (globally) and that led to those companies going heavy into emerging markets, spreading their . . . whatever.  So Big Tobacco is going to be given its second great historical "boot," which will push it into even more emerging markets and the merry chase continues - much like with anti-globalization terror networks (another great purveyor of death).

What does NorthAm Core turn to now as its own progressive era kicks in?  Bloomberg has already given you the clue with the mega soda pop ban.  It's obesity. 

We'll see that crusade shift to New Core in about a decade.


Cancer to go global - along with globalization and the rising income reality it creates


From FT story about advances in cancer treatment.

Me?  I see a fairly scary map that says higher cancer frequency is sure to spread rapidly over next couple of decades as massive global middle class comes online in emerging and developing markets.  

What this map tells me is high rates of cancer come with economic advance, meaning we're looking at a vast global industry within a generation.


Why the Chinese military can only get so big

Pentagon hawks tend to do these wonderful extrapolations of Chinese defense spending: taking the highest estimates of gross economic size and then imagining that nothing changes in Chinese politics or economics or society that would threaten the military's share.

This is, of course, complete and utter nonsense, to wit:

WSJ interview with CEO of Frensenius, one of the largest health-care companies in the world.  Based in Germany, already huge around the planet (one-third of the dialysis in US), and gearing up for a big push into China.

The focus?  Dialysis.

What? China has all these patients all of a sudden?

Well, yes.

Yes in that it's always had a sizeable portion of people who've needed it, but maybe had their demand unmet due to poverty.

Yes also in that dialysis requirements tend to rise with the wealth of a country.  The truly poor tend to go without, but the middle class and rich, as their numbers swell . . . tend to demand it - go figure.

Then there's the rising "wealth" of the government itself: China can, and is more willing to, pay for such services as part of government-sponsored health-care:

WSJ: How's the dialysis business in emerging markets?

Mr. Schneider: Fantastically well. [Historically] there's not that much demand for dialysis products or services because it's a fairly expensive treatment. Now, there's a whole lot of catch-up demand. Once a country nears $8,000 to $10,000 in annual per capita GDP, [governments] and insurers really start to pay for dialysis. That's when things take off.

Coincidentally, a lot of non-democratic governments tend to go democratic in that range.


Chart of day: Rapidly falling under-5 mortality across Africa

From Global Development blog via Craig Nordin:

Under-5 mortality (per 1,000 live births) in selected
sub-Saharan African countries surveyed since 2005

Go to the blog post for analysis. My point:  interesting how opening up to globalization coincides with this.  Not arguing initial causality, which is multivariate.  Point is:  opening up to globalization certainly doesn't "impoverish" along these crucial lines.

This joyous development begets a demographic dividend, which sets a clock a'ticking.  How Africa handles this historic opportunity is crucial of course, but clearly this is the best problem yet for the continent.

And what is progress other than moving off worse problems to better ones?

This story is nothing new.  We saw doubling of human life expectancy across 20th century (started in low 30s in 1900 and reached 65 by 2000) and that was almost all about reducing under-5 mortality - and that was overwhelmingly due to vaccines, with clean(er) water a crucial second.


WPR's The New Rules: Extended Life Expectancy Globalization's Next Political Battleground

Human life expectancy at birth, which remained stunningly fixed for thousands of years before suddenly doubling over the course of the 20th century, now seems destined to experience a similarly bold leap across the 21st century. When it does, it will shift human thinking about population control from its present focus on the outset of life to the increasingly delayed final curtain. The problem is that the technological advances that will make extending life expectancy possible are likely to come far faster than our political systems -- including the democracies -- can handle. 

Read the entire column at World Politics Review.


Deficit myths: it's still all about healthcare, so Obama was right to work it. And yet, I want him gone in 2013 [WITH ADDENDUM]


Got asked in Belvoir this last week about the present situation in US and what must be done.  I answered by citing my own household economy as microcosm:


  • Far more competitive world means earning potential is harder to achieve;
  • That income "haircut" means past debt patterns unsustainable, thus the deleveraging that continues (done better by individuals, families, firms, everybody but the Fed Gov!);
  • Housing is key (our move to short sale old house was big financial achievement of 2011), and curing that is key to allowing workers to move (that's why we did it this year, while the right constellation of circumstances presented themselves, in preparation for eventual 2014 move back East for job-related purposes);
  • Education is key (I pay 7 tuitions: 2 preschool, 2 grade school, 1 HS, 1 undergrad and 1 grad) to maintaining future possibilites, so investment trumps damn near everything; and yet,
  • Healthcare is huge drain (I pay my own now and the pre-tax cost, by my estimate, is between $30-40,000, meaning that's how I gotta earn to cover it all from stem to stern).


So larger reality for US not unlike my family: we had to scale back everything to preserve what matters, which is healthcare and education; we had to solve the housing situation to allow for renewed labor mobility; we haven't really seen our standard of living go down at all, and yet we've made wrenching changes to be able to live on a much smaller consumption footprint. All tough adjustments, but incredibly worthwhile.

But again, healthcare is huge and seemingly unassailable from my perspective. We are exceedingly careful about how we spend those dollars, even as that's the last thing - besides education - that we want to scrimp on.

Of course, if we don't have six kids, then my life is dramatically simpler on all scales, but there again, what keeps America strong?  Demographics, so that's worthwhile too.

Citation here is Alan Blinder op-ed in WSJ.  Great stuff.

"Four deficit myths":


  1. Americans now demand deficit reduction like never before. Not true.  Jobs matter far more now, as does healthcare and housing. Just understand, polls on this subject are no more definitive than they were 20-30 years ago.  This is not our current obsession.
  2. Our deficit is so bad right now that massive cuts are required immediately. Also not true. We have no trouble selling debt in this global economy. Yes, long-term deficit issue is acute, but key is setting in place conditions for long boom that takes care of that. See Europe for austerity approach.
  3. The ten-year reduction focus makes sense. Bad thinking. Little can and will be accomplished in any 10-year plan. The problem if far longer in scope - see demographics, and thus the solutions must be similarly gauged.
  4. America has a generalized problem of runaway spending. Very untrue. The only part of the Fed budget that's really exploding is Medicare and Medicaid, so it's still mostly about healthcare.


In short, "we have a humungous healthcare problem."

Anybody familiar with the US defense budget has long said the same thing: we don't have operations or acquisition or training or personnel crises. The "imperial overstretch" argument remains complete academic bullshit.  We primarily have a healthcare crisis that is extended into pension system. Everything else pales.

In my family right now, the biggest short-term threat, now that we're mortgage free and successfully deleveraging across the board, is healthcare. Huge drain.  Big uncertainty. Encourages self-defeating avoidance behavior on many levels (which we try desperately to be smart about). Leaks into everything.

When GOP says Obama went off deep end on healthcare because country didn't want that or didn't elect him for that, they miss the mark.  It is clearly the biggest internal challenge we face - short and long term. It is the hidden villain on everything. Saying it was a diversion is - itself - a diversionary election-centric tactic.  

But still, I would trust a Romney to finesse its implementation better than an Obama, whose political and negotiating skills I no longer respect, and whose stunning ignorance of, and antipathy toward, business has become an unacceptable leadership flaw - given the tough adjustments still to come.

And yes, I LOVE that Romney did it first in Massachusetts - and did it intelligently. That is a huge credentializer in my mind.

Americans' distrust and anger toward globalization and big business is stunningly misplaced. Globalization has made the world so much better, but it now challenges us in ways we've long gotten used to avoiding because of our long-term privileged position in the global economy, which itself reflected gross historical injustices stemming from colonialization, WWII, socialism in the East, etc. None of those things were our fault, and we took the lead in overcoming them all, but we did live in a pretend world of superiority on that basis across the second half of the 20th century.

That world is gone, and good riddance, say I, because it was supremely unfair to the majority of the planet, and I don't want to live in this world by exploiting others unnecessarily.

So our succees in spreading American-style globalization now comes back to haunt us, demanding we adjust. That's not about demonizing business, even as it is about cleaning up some incredibly bad form on Wall Street (a regular task, just bigger this cycle). It's also not about demonizing China, who is our biggest ally in the global economy going forward - like it or not.

Romeny will say stupid things on China to win the GOP nomination. Obama is already doing stupid things. On the business, it's clear who's hostile and who's not.

Looking ahead, I want a dealmaker, a difference-splitter, a realist on business who acts based on experience and not sterile theory. I also want somebody who can rationalize our military budget and global presence without resorting to idiotic, default targeting of the Chinese.

Romney is far from ideal on all those scores, but he does beat Obama, in my mind, on every one of them.

I stil maintain Obama was the best choice of the two in 2008. I would still vote for him all over again, given the repeated chance. I do think America, however, would have been much better served by a Hillary presidency (I voted for her in the primary), and since I can't get that this time around, I'll make do with the alternative, who I think will have a far better chance of working with a Republican House and Senate than Obama will - given overall Boomer political proclivities (most Boomer politicians are just above cartoon-grade in their motivations, skills and intelligence).

No, I would take Obama over the two jokers (Santorum and Paul) and the complete wild card (Gingrich). And yes, this would be my first vote for a GOP presidential candidate in my entire life.

And my logic on all this if decidedly unemotional (can I toss in that I'm the father of two African-come-to-America daughters, just to be safe?).

This isn't personal in the least; this is strictly business.


I don't use that political term of art (anti-business), because I don't think it's true. I don't think his policies have been particularly anti-business.

I think he doesn't understand business (ignorance) and on that basis tends to vilify and scapegoat business (antipathy) for our continuing poor recovery. The silliness over "taxing millionaires and billionaires" is, to me, just rhetorical nonsense. Those people pay plenty, but no matter how much more we tax them (I am indifferent on the subject), it won't change our fundamental issues. So, to me, rolling with political gamesmanship like that says serious change isn't what he's looking for, otherwise he would have gone with Bowles-Simpson and not ignored what everyone said were sound recommendations.

I also cite the ignorance issue for what I consider to be generally bad-for-business-but-bad-for-everybody-else-too policies in combating the crisis. The administration just hasn't done enough to encourage deleveraging throughout the economy, instead preferring stimulus spending to cure a financially-driven overhang crisis, which, per Rogoff, is the wrong medicine chasing the wrong disease.

I won't claim to have tracked the US economy enough to have said, I told you so way back when, because I most certainly did not. But it's hard for me to accept that a guy as smart as Obama couldn't find enough people around him who were smart enough to realize that stimulus splurging after a financial crisis only gets you a follow-on fiscal crisis without actually improving the financial hang-over/debt overhang. They still don't seem to get that, and as long as they don't, I think business will hold off on investment and hiring because consumers are forced to keep their spending low (I certainly am).

So all I am left assuming is that he doesn't know business (ignorance) and made patently bad choices out of some antipathy to business (it is hard to advise the guy who's certain he's always the smartest guy in the room). I say that because business has largely argued for a far stronger deleveraging focus versus the path Obama has taken. That path did include bailouts for Wall Street firms (not sure history will be kind there) and Detroit (am certain history will be kind there and have said that throughout in posts and speeches - but there I cite the global car industry, which is something I have tracked).

Finally, if Obama were both smart on business and less into his business-can't-be-trusted mode, I think he would have pursued opening up the US economy to Chinese investment instead of staying stuck on the RMB's value and this bizarre strategic "pivot" to East Asia, where apparently our weaponry and national "will" is going to keep us economically engaged in the region despite openly targeting the biggest economy there, a country, by the way, that we expect to finance this military buildup in the Pacific. But that's just me saying I don't trust how he views or understands global business.

In general, I do think Obama is a smart guy, but he's displayed enough dumb/antipathy WRT business for me to want him swapped out versus keeping him another four years. The global economy right now is in fairly precarious shape, and I don't see his administration being able to work with a GOP congress over the next four years any better than he has the past 3. We can say it's all GOP hostility but Bill Clinton managed that, and Reagan did with the Dems. Obama is just not that guy. He matches the GOP's Manichean view with too much of his own, along with a pride and self-confidence in his supreme intelligence that I think is his biggest weakness.

We've have world-class brain presidents (Hoover, Carter, Obama) and they manage to have attract hard economic times. I have come to greatly prefer emotionally intelligent presidents (FDR, Reagan, Clinton) or incredible dealmakers (Johnson, Nixon). That's why I will take Romney and his blandness and his difference splitting and flip-flopping and non-agenda. I want a manager who moves the process along for the next four years, rather than the perceived/actual ideologue who attracts more fight than he's worth and isn't clever enough to realize when he needs to bend instead of stand proud.


Time's Battleland: "Does al-Qaeda go the way of AIDS?"

Nice piece in WAPO about Ayman al-Zawahiri taking over al-Qaeda from the recently assassinated Osama bin Laden. Story leads with remembrances from a guy who knew him back in the day:

He was arrogant, angry and extreme in his ideas,” said Azzam, 40, son of a radical Palestinian ideologue who had become bin Laden's mentor. “He fought with everyone, even those who agreed with him.”

Thus, experts are now saying that al-Qaeda will suffer under his leadership:

U.S. intelligence officials, terrorism experts and even the Egyptian's former cohorts say a Zawahiri-led al-Qaeda will be far more discordant, dysfunctional and perhaps disloyal than it was under bin Laden.

Just to cover rear-ends, though, the story's next statement leaves open the question whether or not the group will be more or less effective (terrorism experts must always do this to make sure they can win big when the next strike comes and they told us so!).

Read the entire post at Time's Battleland.


Under the knife: revision tympanoplasty

Illustration found here.

A tympanoplasty, as defined by Wikipedia:

Tympanoplasty is the surgical operation performed for the reconstruction of the eardrum (tympanic membrane) and/or the small bones of the middle ear (ossicles). The term 'myringoplasty' refers to repair of the tympanic membrane alone[1].

There are several options for treating a perforated eardrum. If the perforation is from recent trauma, many ear, nose and throat specialists will elect to watch and see if it heals on its own. After that, surgery may be considered. Tympanoplasty can be performed through the ear canal or through an incision behind the ear. The surgeon takes a graft from the tissues under the skin around the ear and uses it to reconstruct the eardrum. One of the most common graft sites is from the tragus. The surgery takes ½ to 1 hour if done through the ear canal and 2⅓ to 3 hours if an incision is needed. It is done under localor general anesthesia. It is done on an outpatient basis and is successful 85-90% of the time.

Both my eardrums fell apart in my youth, after countless ear infections.  I had my right ear drum grafted big-time in high school, and my left one done in college.  Both surgeries were successful.

I have never had any trouble with the left one, but about six months ago I got a perforation on the right.  At first, it was thought to be a cyst, since it was high up on the membrane versus the usual hole at the bottom. CT said otherwise, so just a simple hole requiring a patch and no work on the bones behind.

What I have today is thus defined as a revision of a previous tympanoplasty. I am eager to have it done, because the hole creates a certain amount of dizziness and constant ringing in my right ear - two things I remember from the previous situation. 

No complaint, as the original graft held for over three decades.


A good measure of social stress in China--and rising expectations

Great reporting piece in the NYT.

The guts:

Forget the calls by many Chinese patients for more honest, better-qualified doctors. What this city’s 27 public hospitals really needed, officials decided last month, was police officers.

And not just at the entrance, but as deputy administrators. The goal: to keep disgruntled patients and their relatives from attacking the doctors.

The decision was quickly reversed after Chinese health experts assailed it, arguing that the police were public servants, not doctors’ personal bodyguards.

But officials in this northeastern industrial hub of nearly eight million people had a point. Chinese hospitals are dangerous places to work. In 2006, the last year the Health Ministry published statistics on hospital violence, attacks by patients or their relatives injured more than 5,500 medical workers.

“I think the police should have a permanent base here,” said a neurosurgeon at Shengjing Hospital. “I always feel this element of danger.”

In June alone, a doctor was stabbed to death in Shandong Province by the son of a patient who had died of liver cancer. Three doctors were severely burned in Shanxi Province when a patient set fire to a hospital office. A pediatrician in Fujian Province was also injured after leaping out a fifth-floor window to escape angry relatives of a newborn who had died under his care.

Over the past year, families of deceased patients have forced doctors to don mourning clothes as a sign of atonement for poor care, and organized protests to bar hospital entrances. Four years ago, 2,000 people rioted at a hospital after reports that a 3-year-old was refused treatment because his grandfather could not pay $82 in upfront fees. The child died.

Such episodes are to some extent standard fare in China, where protests over myriad issues have been on the rise. Officials at all levels of government are on guard against unrest that could spiral and threaten the Communist Party’s power.

Doctors and nurses say the strains in the relations between them and patients’ relatives are often the result of unrealistic expectations by poor families who, having traveled far and exhausted their savings on care, expect medical miracles.

But the violence also reflects much wider discontent with China’s public health care system. Although the government, under Communist leadership, once offered rudimentary health care at nominal prices, it pulled back in the 1990s, leaving hospitals largely to fend for themselves in the new market economy.

By 2000, the World Health Organization ranked China’s health system as one of the world’s most inequitable, 188th among 191 nations. Nearly two of every five sick people went untreated. Only one in 10 had health insurance.

Over the past seven years, the state has intervened anew, with notable results. It has narrowed if not eliminated the gap in public health care spending with other developing nations of similar income levels, health experts say, pouring tens of billions of dollars into government insurance plans and hospital construction.

The World Bank estimates that more than three in four Chinese are now insured, although coverage is often basic. And far more people are getting care: the World Bank says hospital admissions in rural counties have doubled in five years.

“That is a steep, steep increase,” said Jack Langenbrunner, human development coordinator at the World Bank’s Beijing office. “We haven’t seen that in any other country.”

Still, across much of China, the quality of care remains low. Almost half the nation’s doctors have no better than a high school degree, according to the Organization for Economic Cooperation and Development. Many village doctors did not make it past junior high school.

Primary care is scarce, so public hospitals — notorious for excessive fees — are typically patients’ first stop in cities, even for minor ailments. One survey estimated that a fifth of hospital patients suffer from no more than a cold or flu. Chinese health experts estimate that a third to a half of patients are hospitalized for no good reason.

Once admitted, patients are at risk of needless surgery; for instance, one of every two Chinese newborns is delivered by Caesarean sections, a rate three times higher than health experts recommend.

Patients appear to be even more likely to get useless prescriptions . . ..

There are plenty of such Marxian dynamics on the road of rapid development--when rising expectations outstrip the ability of the state to respond.

And when that state is non-democratic, the public tends to go to extremes to express its displeasure.