Words, what they mean and perhaps more importantly, when they mean...

Chris Hedges burrows right into my own "1984" paranoia about the democratic right of dissent. A healthy society doesn't just support the right of dissent, it in fact requires it to remain healthy. We've heard a lot of negative commentary about being "politically correct", but somehow we continue to miss this more obvious and insidious target against free speech.

"Meh" you say? Well perhaps.

One Day We'll All Be Terrorists
By Chris Hedges, Truthdig
Posted on December 29, 2009, Printed on December 29, 2009
http://www.alternet.org/story/144833/

This article first appeared on TruthDig.

Syed Fahad Hashmi can tell you about the dark heart of America. He knows that our First Amendment rights have become a joke, that habeas corpus no longer exists and that we torture, not only in black sites such as those at Bagram Air Base in Afghanistan or at Guantánamo Bay, but also at the federal Metropolitan Correctional Center (MCC) in Lower Manhattan. Hashmi is a U.S. citizen of Muslim descent imprisoned on two counts of providing and conspiring to provide material support and two counts of making and conspiring to make a contribution of goods or services to al-Qaida. As his case prepares for trial, his plight illustrates that the gravest threat we face is not from Islamic extremists, but the codification of draconian procedures that deny Americans basic civil liberties and due process. Hashmi would be a better person to tell you this, but he is not allowed to speak.

This corruption of our legal system, if history is any guide, will not be reserved by the state for suspected terrorists, or even Muslim Americans. In the coming turmoil and economic collapse, it will be used to silence all who are branded as disruptive or subversive. Hashmi endures what many others, who are not Muslim, will endure later. Radical activists in the environmental, globalization, anti-nuclear, sustainable agriculture and anarchist movements—who are already being placed by the state in special detention facilities with Muslims charged with terrorism—have discovered that his fate is their fate. Courageous groups have organized protests, including vigils outside the Manhattan detention facility. They can be found at www.educatorsforcivilliberties.org or www.freefahad.com. On Martin Luther King Day,  this Jan. 18 at 6 p.m. EST, protesters will hold a large vigil in front of the MCC on 150 Park Row in Lower Manhattan to call for a return of our constitutional rights. Join them if you can.

The case against Hashmi, like most of the terrorist cases launched by the Bush administration, is appallingly weak and built on flimsy circumstantial evidence. This may be the reason the state has set up parallel legal and penal codes to railroad those it charges with links to terrorism. If it were a matter of evidence, activists like Hashmi, who is accused of facilitating the delivery of socks to al-Qaida, would probably never be brought to trial.

Hashmi, who if convicted could face up to 70 years in prison, has been held in solitary confinement for more than 2½ years. Special administrative measures, known as SAMs, have been imposed by the attorney general to prevent or severely restrict communication with other prisoners, attorneys, family, the media and people outside the jail. He also is denied access to the news and other reading material. Hashmi is not allowed to attend group prayer. He is subject to 24-hour electronic monitoring and 23-hour lockdown. He must shower and go to the bathroom on camera. He can write one letter a week to a single member of his family, but he cannot use more than three pieces of paper. He has no access to fresh air and must take his one hour of daily recreation in a cage. His "proclivity for violence" is cited as the reason for these measures although he has never been charged or convicted with committing an act of violence.

"My brother was an activist," Hashmi's brother, Faisal, told me by phone from his home in Queens. "He spoke out on Muslim issues, especially those dealing with the wars in Iraq and Afghanistan. His arrest and torture have nothing to do with providing ponchos and socks to al-Qaida, as has been charged, but the manipulation of the law to suppress activists and scare the Muslim American community. My brother is an example. His treatment is meant to show Muslims what will happen to them if they speak about the plight of Muslims. We have lost every single motion to preserve my brother's humanity and remove the special administrative measures. These measures are designed solely to break the psyche of prisoners and terrorize the Muslim community. These measures exemplify the malice towards Muslims at home and the malice towards the millions of Muslims who are considered as non-humans in Iraq and Afghanistan."

The extreme sensory deprivation used on Hashmi is a form of psychological torture, far more effective in breaking and disorienting detainees. It is torture as science. In Germany, the Gestapo broke bones while its successor, the communist East German Stasi, broke souls. We are like the Stasi. We have refined the art of psychological disintegration and drag bewildered suspects into secretive courts when they no longer have the mental and psychological capability to defend themselves.

"Hashmi's right to a fair trial has been abridged," said Michael Ratner, the president of the Center for Constitutional Rights. "Much of the evidence in the case has been classified under CIPA, and thus Hashmi has not been allowed to review it. The prosecution only recently turned over a significant portion of evidence to the defense. Hashmi may not communicate with the news media, either directly or through his attorneys. The conditions of his detention have impacted his mental state and ability to participate in his own defense.

"The prosecution's case against Hashmi, an outspoken activist within the Muslim community, abridges his First Amendment rights and threatens the First Amendment rights of others," Ratner added. "While Hashmi's political and religious beliefs, speech and associations are constitutionally protected, the government has been given wide latitude by the court to use them as evidence of his frame of mind and, by extension, intent. The material support charges against him depend on criminalization of association. This could have a chilling effect on the First Amendment rights of others, particularly in activist and Muslim communities."

Constitutionally protected statements, beliefs and associations can now become a crime. Dissidents, even those who break no laws, can be stripped of their rights and imprisoned without due process. It is the legal equivalent of preemptive war. The state can detain and prosecute people not for what they have done, or even for what they are planning to do, but for holding religious or political beliefs that the state deems seditious. The first of those targeted have been observant Muslims, but they will not be the last.

"Most of the evidence is classified," Jeanne Theoharis, an associate professor of political science at Brooklyn College who taught Hashmi, told me, "but Hashmi is not allowed to see it. He is an American citizen. But in America you can now go to trial and all the evidence collected against you cannot be reviewed. You can spend 2½ years in solitary confinement before you are convicted of anything. There has been attention paid to extraordinary rendition, Guantánamo and Abu Ghraib with this false idea that if people are tried in the United States things will be fair. But what allowed Guantánamo to happen was the devolution of the rule of law here at home, and this is not only happening to Hashmi."

Hashmi was, like so many of those arrested during the Bush years, briefly a poster child in the "war on terror." He was apprehended in Britain on June 6, 2006, on a U.S. warrant. His arrest was the top story on the CBS and NBC nightly news programs, which used graphics that read "Terror Trail" and "Web of Terror." He was held for 11 months at Belmarsh Prison in London and then became the first U.S. citizen to be extradited by Britain. The year before his arrest, Hashmi, a graduate of Brooklyn College, had completed his master's degree in international relations at London Metropolitan University. His case has no more substance than the one against the seven men arrested on suspicion of plotting to blow up the Sears Tower, a case where, even though there were five convictions after two mistrials, an FBI deputy director acknowledged that the plan was more "aspirational rather than operational." And it mirrors the older case of the Palestinian activist Sami Al-Arian, now under house arrest in Virginia, who has been hounded by the Justice Department although he should legally have been freed. Judge Leonie Brinkema, currently handling the Al-Arian case, in early March, questioned the U.S. attorney's actions in Al-Arian's plea agreement saying curtly: "I think there's something more important here, and that's the integrity of the Justice Department."

The case against Hashmi revolves around the testimony of Junaid Babar, also an American citizen. Babar, in early 2004, stayed with Hashmi at his London apartment for two weeks. In his luggage, the government alleges, Babar had raincoats, ponchos and waterproof socks, which Babar later delivered to a member of al-Qaida in south Waziristan, Pakistan. It was alleged that Hashmi allowed Babar to use his cell phone to call conspirators in other terror plots.

"Hashmi grew up here, was well known here, was very outspoken, very charismatic and very political," said Theoharis. "This is really a message being sent to American Muslims about the cost of being politically active. It is not about delivering alleged socks and ponchos and rain gear. Do you think al-Qaida can't get socks and ponchos in Pakistan? The government is planning to introduce tapes of Hashmi's political talks while he was at Brooklyn College at the trial. Why are we willing to let this happen? Is it because they are Muslims, and we think it will not affect us? People who care about First Amendment rights should be terrified. This is one of the crucial civil rights issues of our time. We ignore this at our own peril."

Babar, who was arrested in 2004 and has pleaded guilty to five counts of material support for al-Qaida, also faces up to 70 years in prison. But he has agreed to serve as a government witness and has already testified for the government in terror trials in Britain and Canada. Babar will receive a reduced sentence for his services, and many speculate he will be set free after the Hashmi trial. Since there is very little evidence to link Hashmi to terrorist activity, the government will rely on Babar to prove intent. This intent will revolve around alleged conversations and statements Hashmi made in Babar's presence. Hashmi, who was a member of the New York political group Al Muhajiroun as a student at Brooklyn College, has made provocative statements, including calling America "the biggest terrorist in the world," but Al Muhajiroun is not defined by the government as a terrorist organization. Membership in the group is not illegal. And our complicity in acts of state terror is a historical fact.

There will be more Hashmis, and the Justice Department, planning for future detentions, set up in 2006 a segregated facility, the Communication Management Unit, at the federal prison in Terre Haute, Ind. Nearly all the inmates transferred to Terre Haute are Muslims. A second facility has been set up at Marion, Ill., where the inmates again are mostly Muslim but also include a sprinkling of animal rights and environmental activists, among them Daniel McGowan, who was charged with two arsons at logging operations in Oregon. His sentence was given "terrorism enhancements" under the Patriot Act. Amnesty International has called the Marion prison facility "inhumane." All calls and mail—although communication customarily is off-limits to prison officials—are monitored in these two Communication Management Units. Communication among prisoners is required to be only in English. The highest-level terrorists are housed at the Penitentiary Administrative Maximum Facility, known as Supermax, in Florence, Colo., where prisoners have almost no human interaction, physical exercise or mental stimulation, replicating the conditions for most of those held at Guantánamo. If detainees are transferred from Guantánamo to the prison in Thomson, Ill., they will find little change. They will endure Guantánamo-like conditions in colder weather.

Our descent is the familiar disease of decaying empires. The tyranny we impose on others we finally impose on ourselves. The influx of non-Muslim American activists into these facilities is another ominous development. It presages the continued dismantling of the rule of law, the widening of a system where prisoners are psychologically broken by sensory deprivation, extreme isolation and secretive kangaroo courts where suspects are sentenced on rumors and innuendo and denied the right to view the evidence against them. Dissent is no longer the duty of the engaged citizen but is becoming an act of terrorism.
Copyright © 2009 Truthdig, L.L.C.


Chris Hedges, a Pulitzer prize-winning reporter, is a Senior Fellow at the Nation Institute. He writes a regular column for TruthDig every Monday. His latest book is Empire of Illusion: The End of Literacy and the Triumph of Spectacle.
© 2009 Truthdig All rights reserved.
View this story online at: http://www.alternet.org/story/144833/

Remembering the October Surprise

That's no moon, or how the Reagan team used the American hostages held in Iran as tools to get elected.


Published on The Smirking Chimp (http://www.smirkingchimp.com)
The October Surprise Crystal Balls
By Robert Parry
Created Nov 14 2009 - 12:39pm


In fall 1980, as President Jimmy Carter struggled to free 52 American hostages in Iran and as American voters focused on a crossroads election, key supporters of Republican candidate Ronald Reagan were confident not only of Reagan's victory but that the hostages wouldn't be released until after Reagan was sworn in.

That confidence has been one of the sub-plots linked to the political mystery known as the October Surprise case, which centered on allegations that Republicans went behind Carter's back to contact Iranians and sabotaged his hostage negotiations, thus guaranteeing Reagan's resounding victory.

The accumulated evidence – including government documents and statements from some two dozen witnesses – now points to a conclusion that the Reagan campaign did develop covert contacts with Iranian officials and that those dealings did undermine Carter's efforts. The hostages were freed after Reagan's was sworn in as President on Jan. 20, 1981.

An October Surprise conclusion that the Republicans were guilty of a political dirty trick bordering on treason also puts into a more sinister light those crystal balls of GOP operatives who foresaw the hostages returning only after Reagan got into office.

While those predictions might be explained away as lucky guesses or astute analyses, the timing assessment from three figures in particular raise eyebrows: former Secretary of State Henry Kissinger, neoconservative activist Michael Ledeen and legendary CIA officer Miles Copeland. All three have been linked to the October Surprise mystery.

Copeland, who had taken part in the CIA's covert operation to oust Iranian Prime Minister Mohammed Mossadegh and replace him with the Shah back in 1953, told me during an interview in 1990 that he and some of his old CIA colleagues, including Iran hand Archibald Roosevelt, were in touch with Republicans regarding Carter's Iranian hostage crisis of 1980.

Copeland said the CIA old boys drafted their own plan for a hostage rescue and passed it along to both the Carter administration and to former President Richard Nixon and Kissinger. However, after Carter's own failed rescue attempt in April 1980, Copeland said the Republicans in his circle concluded that a second rescue attempt was both unfeasible and unnecessary.

These Republicans were talking confidently about the hostages being freed after a Republican victory in November, Copeland said.

"There was no discussion of a Kissinger or Nixon plan to rescue these people, because Nixon, like everybody else, knew that all we had to do was wait until the election came, and they were going to get out," Copeland said.

"That was sort of an open secret among people in the intelligence community, that that would happen. … The intelligence community certainly had some understanding with somebody in Iran in authority, in a way that they would hardly confide in me."

Copeland said his CIA friends had been told by contacts in Iran that the mullahs would deliver the hostages to Reagan.

"At that time, we had word back, because you always have informed relations with the devil," Copeland said. "But we had word that, 'Don't worry.' As long as Carter wouldn't get credit for getting these people out, as soon as Reagan came in, the Iranians would be happy enough to wash their hands of this and move into a new era of Iranian-American relations."

In the interview, Copeland declined to give more details, beyond his assurance that "the CIA within the CIA," his term for the true protectors of U.S. national security, had an understanding with the Iranians about the hostages. (Copeland died on Jan. 14, 1991, before I could interview him again.)

Kissinger's Crystal Ball

Though Copeland was coy about describing Kissinger's precise role in the October Surprise case, Kissinger was among the Republicans who was confidently looking forward to a hostage release once Reagan took office.

After this year's death of longtime CBS anchor Walter Cronkite, one of our readers was examining Cronkite archival footage and was surprised to find a clip of Cronkite leading a discussion of CBS correspondents on Election Night 1980 about why Reagan had won a landslide after the pre-election polls had shown a much closer race.

Correspondent Leslie Stahl noted how the coincidence of the first anniversary of the Iran hostage-taking falling on Election Day had forced Americans to relive the year-long humiliation and thus they turned to Reagan, a perceived hard-liner who would confront American adversaries.

That comment reminded Cronkite of an earlier interview he had done with Henry Kissinger who, Cronkite said, was "suggesting tonight that he thinks that Reagan being in the White House will help get [the hostages] back and he bets they'll get back shortly after the Inaugural. Well, that's still some time. That means that Henry Kissinger must be thinking in terms of long negotiations in order to put the package together."

As it turned out, of course, Kissinger's prediction was right on the money. Immediately after Reagan was inaugurated on Jan. 20, 1981, the hostages were freed and Reagan basked in the perception that his tough-guy persona had done the trick.

But Kissinger wasn't just some distant observer when it came to the hostage crisis. He had been there from the outset, in 1979 when he worked with Chase Manhattan Bank chairman David Rockefeller – who had been the Shah's banker – to pressure President Carter to admit the exiled Shah into the United States for cancer treatment.

According to Rockefeller's autobiography Memoirs, Kissinger's role was "to publicly criticize the Carter administration for its overall management of the Iranian crisis and other aspects of its foreign policy" while other Rockefeller associates made private demands for the Shah's admission.

Carter's decision to relent – and let the Shah in – provoked radical elements in Tehran to target the U.S. Embassy for a takeover. When they stormed the Embassy on Nov. 4, 1979, the hostage crisis began.

A Lingering Presence

Over the next year, Kissinger remained a behind-the-scenes figure in the crisis, as Copeland noted in the interview.

"There were many of us – myself along with Henry Kissinger, David Rockefeller, Archie Roosevelt in the CIA at the time – we believed very strongly that we were showing a kind of weakness, which people in Iran and elsewhere in the world hold in great contempt," Copeland said. (By 1980, Roosevelt also was working for Rockefeller as a consultant.)

The Rockefeller group was in contact with Reagan's campaign director William Casey who was at the heart of the October Surprise mystery, with a number of witnesses claiming that Casey met secretly with cleric Mehdi Karrubi and other Iranians involved with the hostage crisis.

Evidence from Reagan's campaign files revealed undisclosed contacts between the Rockefeller group and Casey. For instance, a visitor log [1] for Sept. 11, 1980, showed David Rockefeller and several aides signing in to see Casey at the campaign headquarters in Arlington, Virginia.

With Rockefeller were Joseph Verner Reed, whom Rockefeller had assigned to coordinate U.S. policy toward the Shah, and Archibald Roosevelt, the former CIA officer who then was monitoring events in the Persian Gulf for Chase Manhattan. The fourth member of the party was Owen Frisbie, Rockefeller's chief lobbyist in Washington.

Kissinger also was in discreet contact with Casey during this period, according to Casey's personal chauffeur whom I interviewed.

The chauffeur, who asked not to be identified by name, said he was sent twice to Kissinger's Georgetown home to pick up the former Secretary of State and bring him to the Arlington headquarters for private meetings with Casey that were kept off the official visitor logs.

On Sept. 16, 1980, five days after the Rockefeller group's visit to Casey's office, Iran's acting foreign minister Sadegh Ghotbzadeh spoke publicly about Republican interference.

"Reagan, supported by Kissinger and others, has no intention of resolving the problem," Ghotbzadeh said. "They will do everything in their power to block it."

So, when Kissinger spoke to Cronkite on Election Night 1980, he may well have known a great deal about the timing of the hostage release because he was working closely with some of the Republicans who allegedly were arranging the release and the timetable.

The Ledeen Connection

A third figure who has been connected to hostage negotiations with Iranians – and who reportedly foresaw a hostage release after Reagan took office – was Michael Ledeen, a neoconservative intellectual and author.

Journalist Richard Sale, who had worked with Ledeen on an article for The Washington Quarterly, said he and Ledeen were keeping in touch after the publication when Ledeen confidently predicted that the hostages would be released upon Reagan's inauguration.

In a recent e-mail to me, Sale said he asked Ledeen how he knew about the timing and how the release was being arranged. "I will always remember his smug, 'All it took was a few phone calls,'" Sale wrote.

When I contacted Ledeen about Sale's recollection, Ledeen responded by e-mail, claiming "Sale has written outright lies about me, as I told him to his ear. At one point he promised to apologize but never did. I wouldn't listen to anything he had to say."

When I asked Sale about Ledeen's "outright lies" claim, Sale noted that Ledeen offered no specifics of any supposed lies, and Sale denied having "an acrimonious exchange, not ever" with Ledeen. "I would have had no reason to apologize nor did he ever demand one," Sale wrote in an e-mail.

Other evidence also has linked Ledeen to the October Surprise case. A "secret" draft report by a 1992 House task force which investigated the October Surprise allegations stated that Ledeen and another prominent neocon Richard Perle participated in meetings of the Reagan campaign's "October Surprise Group," though "they were not considered 'members.'"

The campaign's "October Surprise Group" was assigned the task of preparing for "any last-minute foreign policy or defense-related event, including the release of the hostages, that might favorably impact President Carter in the November election," according to the task force findings.

The draft report also mentioned a Sept. 16, 1980, meeting on something called the "Persian Gulf Project" involving senior campaign officials, including William Casey and Richard Allen. According to the draft report and Allen's notes, Ledeen also participated in that meeting.

However, both references to Ledeen were removed from the House task force's final report that was overseen by task force chief counsel Lawrence Barcella, a longtime friend of Ledeen's.

Ties That Bind

The Barcella-Ledeen relationship dates back several decades when Barcella sold a house to Ledeen and the two aspiring Washington professionals shared a housekeeper. According to Peter Maas's book Manhunt regarding Barcella's work as a prosecutor on the case of ex-CIA officer Edwin Wilson who collaborated with Libya, Ledeen approached Barcella about the case in 1982.

Ledeen, who was then working as a State Department consultant on terrorism, was concerned that two of his associates, former CIA officer Ted Shackley and Pentagon official Erich von Marbod, had come under suspicion in the Wilson case.

"I told Larry that I can't imagine that Shackley [or von Marbod] would be involved in what you are investigating," Ledeen told me in an interview years later. "I wasn't trying to influence what he [Barcella] was doing. This is a community in which people help friends understand things."

Barcella also saw nothing wrong with the out-of-channel approach.

"He wasn't telling me to back off," Barcella told me. "He just wanted to add his two-cents worth."

Barcella said the approach was appropriate because Ledeen "wasn't asking me to do something or not do something." However, Shackley and von Marbod were dropped from the Wilson investigation.

Ledeen's associate, Shackley, also had a connection to the October Surprise case in 1980, having worked with then-vice presidential candidate George H.W. Bush on the Iran hostage issue. [For more on Shackley's role in the October Surprise case, see Robert Parry's Secrecy & Privilege [2]. For a document on Shackley's October Surprise work with Bush, click here [3].]

In the context of Barcella's role on the House task force, the Ledeen connection raised another conflict-of-interest question, after task force investigators were told that Barcella's friend, Ledeen, was an informal member of the Reagan campaign's "October Surprise Group."

Like the Wilson case, it appears that Ledeen convinced his friend Barcella to go in a different direction. When the House task force's final report was released in January 1993, the draft's references to Ledeen were all deleted. [To read a portion of the "secret" draft report, click here [4].]

In my recent e-mail exchange with Ledeen, he said, "Yes, I believe I spoke to Larry Barcella about the October Surprise investigation. … And I undoubtedly told him what I have always said, namely that, to the best of my knowledge, the October Surprise theory is nonsense."

Ledeen also denied having any contact with William Casey before 1981 and added, "I was not involved in the Reagan campaigns. I was not in any 'Persian Gulf Project' or 'October Surprise Group.' I can't answer your questions about alleged Republican contacts with Iran because I don't have any reason to believe that there were such contacts. If there were, I don't know anything about them."

In an e-mail to me, Sale noted that Ledeen's sweeping denials must always be taken with a grain of salt. Sale wrote that when Ledeen is confronted with troublesome evidence, he behaves as if "disinformation is perfectly permissible and deserved. Michael's tragedy is that he has chosen to service such ignominious causes."

Ledeen and other defenders of Ronald Reagan's legacy did win out in the House October Surprise task force's conclusions. With Barcella and his team deleting the references to Ledeen and concealing other incriminating evidence, the task force – headed by Reps. Lee Hamilton, D-Indiana, and Henry Hyde, R-Illinois – rejected the allegations of Republican dirty tricks regarding the Iran hostage crisis.

However, it turned out that even chief counsel Barcella had doubts about those findings. He told me years later that so much evidence poured in near the end of the investigation that he lobbied Hamilton to extend the inquiry for several months so the new material could be evaluated. Barcella said Hamilton turned him down and insisted that the debunking report go forward.

For Official Washington in early 1993 – as the iconic Ronald Reagan struggled with early Alzheimer's disease and the well-liked George H.W. Bush left office – it was easier to sweep the disturbing evidence of Republican misconduct under the rug.

But the October Surprise mystery -- and the curious predictions of a hostage release upon Reagan's inauguration -- have never been fully explained.

[For the fullest account of the October Surprise case, see Parry's Secrecy & Privilege [5], or the first two parts of the Consortiumnews.com series, "How Two Elections Changed America [6]," and "The Crazy October Surprise Debunking [7]."]

Strange New World

It has been very interesting to watch this iteration - the post-Obama anti-intellectual movement - take the reigns of the Republican party and lead it off into the wilderness. I think that in some part it is a reaction to the strong anti-Bush commentary that ran throughout his term but picked up steadily during his last few years. The ultra-conservative wing of the Republican party was appalled that anyone could doubt, much less actively criticize, "their" president. And the wounds of those years of Bush's every movement, speech and activity captured in real-time by a very responsive group of bloggers and activists left the hyper-conservative right deeply scarred. I have often lamented the death of the 4th Estate over the last several years as the consolidation of media outlets under a very select number of corporate owners whittled and changed - to my eye - the very nature of journalism. That said, I did not really see the logical extension of that to the wounded hyper-conservative press. I think Boehlert has the right of it this time - from the Fox led "tea parties" to Beck's 9/12 project, there is a new game afoot. I do feel deeply for authentic conservatives - old school conservatives - whose belief in limited government, states rights and fiscal restraint were based in genuine and principled belief that, where government was concerned, less was more. I look forward to seeing their champion return and watching the battle for the convservative soul - it will be a good fight to watch.


Glenn Beck, Sean Hannity, Rush Limbaugh Stoking GOP Civil War
By Eric Boehlert, Media Matters for America
Posted on November 11, 2009, Printed on November 11, 2009
http://www.alternet.org/media/143868/glenn_beck,_sean_hannity,_rush_limbaugh_stoking_gop_civil_war?page=entire

It's not easy to flip a congressional district that's been Republican since the late 1800s, but after being willingly hijacked by the right-wing media -- after getting steamrolled by Fox News' embrace of third-party candidate Doug Hoffman -- Republicans managed to hand Upstate New York's 23rd District to Democrats last week. And they did it just in time for the newly elected Democrat to help (barely) push health care reform through the House of Representatives during Saturday night's historic vote.

Doug Hoffman was, first and foremost, a media candidate (a media creation), which means we are entering a very new and different realm in American politics. We're entering a sort of Fox News Era where media outlets -- where alleged news organizations -- essentially co-sponsor political campaigns. We've moved well beyond the time when Fox News, for instance, leaned right and gave conservative candidates more air-time and tossed them lots of softball questions. We're now watching unfold a political reality where Fox News literally selects candidates and then markets them through Election Day.

There's a reason Hoffman described Glenn Beck as his "mentor" and pledged his "sacred honor" to uphold the "9 Principles and 12 Values" of Beck's 9/12 Project. There's a reason Sean Hannity wanted to "declare" Hoffman the election winner, and why Fox News' on-screen graphic read "Conservative Revolution?" when Hoffman was being interviewed (i.e. prematurely crowned) by Hannity on the eve of Election Day.

Hoffman's outsider bid, originally opposed by the Republican Party, was a media production, plain and simple, which means his loss was a media loss, as well.

Former Republican House Speaker Newt Gingrich had it right when he told The Washington Times that Hoffman's rise as a third party candidate was the "result of Glenn Beck, Rush Limbaugh, Sean Hannity, Fox News." Gingrich, who originally opposed Hoffman's candidacy, added: "This was not an isolated amateur; this is an entire movement."

Indeed, it's a media movement that's doing it's best to obliterate the line between journalism and politics.

As I've been noting for some time, Fox News has transformed itself into the Opposition Party of the Obama White House. So it makes sense that, as a purely partisan player, Fox News would immerse itself in backroom horse-trading. It makes sense that rather than covering the campaigns and the candidates, Fox News would insert itself as a political player within Republican contests and throw its support behind a specific candidate, the way it did in NY-23.

The looming problem for the GOP, though, is that the right-wing media can't pick winners and stands poised to rip the Republican Party apart. (Did you notice how Limbaugh last week claimed "Newt" had "screwed the whole [NY-23] thing up"?)

It's yet more evidence that during President Bush's pro-war tenure, far-right radio and TV talkers, along with fringe bloggers, convinced themselves they represented the mainstream -- the majority -- of the GOP. But they don't. They represent the radical CPAC wing of the GOP, and it shows on Election Day. We saw that in 2008, when bloggers and talkers opposed Sen. John McCain in the GOP primaries yet were completely unable to sway Republican voters in the process. In the immortal words of Republican strategist Mike Murphy, "These radio guys can't deliver a pizza, let alone a nomination."

 What's different now, though, is that the right-wing media have become even more powerful within conservative circles, while the Republican National Committee and traditional Republican leaders have receded even further into the background. (Does anyone really see Senate Minority Leader Mitch McConnell as the leader of anything?) That power vacuum means it's Fox News that sets the conservative agenda in America. It's at Fox News where partisan strategies are hatched, rallies are marketed, and smear campaigns are launched. And it's Republican politicians and traditional Beltway professionals who are forced to play catch-up to the conservative media.

In other words, in just the last 12 months, the balance of power within the conservative movement has completely swung in the direction of the right-wing press, which is stoking the flames of the GOP civil war. It's a partisan press corps that no longer documents internal Republican squabbling; it initiates the infighting.

National political parties go through all kinds of evolutions; all kinds of natural expansions and contractions over time. (Barry Goldwater, for instance, oversaw perhaps the GOP's most radical contraction in modern times.) It's quite rare, though, for the catalyst of that change to be external media forces. Sure, permanent Beltway insiders such as Bill Kristol have routinely hopped back and forth between "the role of Republican flack and alleged journalist without changing even a comma in his prose 'style'," as columnist Eric Alterman noted last week.

But what we're seeing unfold in 2009 is something entirely different. This isn't a few conservative pundits dipping their toes into Republican political waters during election cycles and trying to generate an electoral wave. And this isn't like 1994 when AM talk radio morphed into an RNC echo chamber and helped spread the Republicans' anti-Clinton message.

This is a case where huge swaths of the conservative media, including television, radio, and online, have shed any façade of being journalists and embraced their king-making role. Or, if savaging a GOP candidate is what's needed, as was the case in NY-23 and Dede Scozzafava, then they'll do that as well.

Looking forward, it's inevitable that during the 2012 GOP Republican primary season, there will be, for the lack of a better term, a Fox News candidate in the field. There will be a far-right darling of the Tea Party movement (cough, cough, Sarah Palin) who has both the official (Limbaugh, Beck, Malkin) and unofficial (Fox News) endorsement of the right-wing media.

But will that do any good in the real world? Ask Doug Hoffman.

Beck, Hannity, Limbaugh, and Malkin, among others, all put their reputations on the line in NY-23, touting the contest as a referendum on the anti-Obama, Tea Party movement in America. And they lost, big time. Not unlike the way the same right-wing media leaders put their reputations on the line in early 2008 and went all-in against McCain in the South Carolina Republican primary. (FYI, McCain wasn't sufficiently conservative.) Result? McCain won the SC contest in a walk.

See a pattern here? Me, too. The Republican Party is now attached to a political movement -- a media-led movement -- that cannot win elections. It's a movement that cannot even win elections in traditionally red districts (NY-23) or in very red states (SC). By refusing to separate itself from media players who claim the president of the United States is a racist and a Nazi, the GOP may be assigning itself a permanent minority status.

And I'm sorry, but belated and feeble attempts by Republican leaders such as Rep. Eric Cantor to create the slightest glimmer of daylight between the GOP and the right-wing media aren't going to do the trick. (For the record, comparing health care reform to the Holocaust was the line Limbaugh and company recently crossed, according to Cantor. Good to know.) Republican politicians in 2009 have made it blindingly obvious that they lack both the courage to consistently stand up to the far-right media's hate merchants and the resources. Meaning, without the energy of the fringe activists who insist Obama is destroying America on purpose, the Republican Party would be virtually kaput today.

Disillusioned "Right Wing" blogger Rick Moran, recently bemoaning what he sees as the rise of an "anti-reason" movement on the far right, may have put it best when he asked, "What is it that possesses certain conservatives to fool themselves so spectacularly into believing that they can create a majority out of a minority?"

His definition of "anti-reason" conservatives, who now anchor the right-wing media, seemed dead-on, as well: "[T]hose who reject reality in favor of persecution complexes, wildly exaggerated hyperbole, and a frightening need for vengeance against their imagined 'enemies.' "

Moran actually penned that lament before the votes were counted in the NY-23 congressional race. And incredibly, the "anti-reason" fanatics Moran described were encouraged by the results in Upstate New York, which, in a strange way, actually made sense. Of course anti-reason conservatives would celebrate as a victory the fact that a district that hadn't elected a Democrat to Congress in nearly 150 years did so last week. Of course they'd announce that it was good news that by backing a candidate who did not even live in the district and who, according to a local newspaper editorial board, was woefully ill-informed about local issues, the movement had helped toss a Republican seat to the Democrats.

Anti-reason conservatives watched Hoffman go down in defeat and immediately announced they were going to target more Republican candidates, which means the right-wing media stand poised to unleash even more wingnuttery on the GOP establishment.

Grab the popcorn. This is going to be fun to watch.

 


© 2009 Media Matters for America All rights reserved.
View this story online at: http://www.alternet.org/story/143868/

Pretty amazing use of statistics to tell the story of the "developing countries"

Hard to seperate fact from profit on this one...

There are some good articles starting to pop-up on this topic lately. Frankly, I'm at a loss to be able to divine the truth, but I find it interesting that:

1) Both Republicans and Democrats in Congress have come out in favor of the vaccination and
2) Both Bill Maher and the Republican Noise Machine primary spokespeople, Hannity and Limbaugh, agree that it is not a good thing.

Borders on the comical if you think about it. There are a few articles that I've read recently that are bending me toward skepticism, but only ever so slightly. Until I started going to India a few years ago, I hadn't had a vaccination since I was a kid. I have to admit - I do not have a good sense for the right of this one (not like its the first time for that :)

From The Atlantic:

Whether this season's swine flu turns out to be deadly or mild, most experts agree that it's only a matter of time before we're hit by a truly devastating flu pandemic—one that might kill more people worldwide than have died of the plague and aids combined. In the U.S., the main lines of defense are pharmaceutical—vaccines and antiviral drugs to limit the spread of flu and prevent people from dying from it. Yet now some flu experts are challenging the medical orthodoxy and arguing that for those most in need of protection, flu shots and antiviral drugs may provide little to none. So where does that leave us if a bad pandemic strikes?

by Shannon Brownlee and Jeanne Lenzer

Does the Vaccine Matter?

Image credit: Jason Reed/Reuters/Corbis

Drive too fast along Red Lion Road, beside Philadelphia's Northeast Airport, and you will miss the low-rise cement building where the biotech company MedImmune has been quietly pumping out swine flu vaccine at about a million doses a week. Through the summer and fall, workers wearing protective gear that covered them from head to toe brewed up batches of live, genetically modified flu virus. Robots then injected tiny doses of virus-laden fluid into glass vials, which were mounted into nasal spritzers, labeled, and readied for shipment at the direction of the Centers for Disease Control and Prevention, in Atlanta, which is helping to coordinate the nation's pandemic-preparedness plan. In the most ambitious vaccination program the nation has mounted since the anti-polio campaign in the 1950s, the federal government has commissioned MedImmune and four other companies to produce enough vaccine to cover the entire U.S. population.

Vaccination is central to the government's plan for preventing deaths from swine flu. The CDC has recommended that some 159 million adults and children receive either a swine flu shot or a dose of MedImmune's nasal vaccine this year. Shots are offered in doctors' offices, hospitals, airports, pharmacies, schools, polling places, shopping malls, and big-box stores like Wal-Mart. In August, New York state required all health-care workers to get both seasonal and swine flu shots. To further protect the populace, the federal government has spent upwards of $3billion stockpiling millions of doses of antiviral drugs like Tamiflu—which are being used both to prevent swine flu and to treat those who fall ill.

Also see:

Q&A: "Facts About Swine Flu"

The authors answer practical questions about H1N1 diagnosis and immunity.

But what if everything we think we know about fighting influenza is wrong? What if flu vaccines do not protect people from dying—particularly the elderly, who account for 90 percent of deaths from seasonal flu? And what if the expensive antiviral drugs that the government has stockpiled over the past few years also have little, if any, power to reduce the number of people who die or are hospitalized? The U.S. government—with the support of leaders in the public-health and medical communities—has put its faith in the power of vaccines and antiviral drugs to limit the spread and lethality of swine flu. Other plans to contain the pandemic seem anemic by comparison. Yet some top flu researchers are deeply skeptical of both flu vaccines and antivirals. Like the engineers who warned for years about the levees of New Orleans, these experts caution that our defenses may be flawed, and quite possibly useless against a truly lethal flu. And that unless we are willing to ask fundamental questions about the science behind flu vaccines and antiviral drugs, we could find ourselves, in a bad epidemic, as helpless as the citizens of New Orleans during Hurricane Katrina.

The term influenza, which dates back to the Middle Ages, is taken from the Italian word for occult or astral influence. Then as now, flu seemed to appear out of nowhere each winter, debilitating or killing large numbers of people, only to vanish in the spring. Today, seasonal flu is estimated to kill about 36,000 people in the United States each year, and half a million worldwide.

Yet the flu, in many important respects, remains mysterious. Determining how many deaths it really causes, or even who has it, is no simple matter. We think we have the flu anytime we fall ill with an ailment that brings on headache, malaise, fever, coughing, sneezing, and that achy feeling as if we've been sleeping on a bed of rocks, but researchers have found that at most half, and perhaps as few as 7 or 8 percent, of such cases are actually caused by an influenza virus in any given year. More than 200 known viruses and other pathogens can cause the suite of symptoms known as "influenza-like illness"; respiratory syncytial virus, bocavirus, coronavirus, and rhinovirus are just a few of the bugs that can make a person feel rotten. And depending on the season, in up to two-thirds of the cases of flu-like illness, no cause at all can be found.

Nobody knows precisely why we are much more likely to catch the flu in the winter months than at other times of the year. Perhaps it's because flu viruses flourish in cool temperatures and are killed by exposure to sunlight. Or maybe it's because in winter, people spend more time indoors, where a sneeze or a cough can more easily spread a virus to others. What is certain is that influenza viruses mutate with amazing speed, so each flu season sees slightly different genetic versions of the viruses that infected people the year before. Every year, the World Health Organization and the Centers for Disease Control and Prevention collect data from 94 nations on the flu viruses that circulated the previous year, and then make an educated guess about which viruses are likely to circulate in the coming fall. Based on that information, the U.S. Food and Drug Administration issues orders to manufacturers in February for a vaccine that includes the three most likely strains.

Every once in a while, however, a very different bug pops up and infects far more people than the normal seasonal flu variants do. It is these novel viruses that are responsible for pandemics, defined by the World Health Organization as events that occur when "a new influenza virus appears against which the human population has no immunity" and which can sweep around the world in a very short time. The worst flu pandemic in recorded history was the "Spanish flu" of 1918–19, at the end of World WarI. A third of the world's population was infected, with at least 40million and perhaps as many as 100million people dying—more than were killed in World Wars I and II combined. (Some scholars suggest that one reason World WarI ended was that so many soldiers were sick or dying from flu.) Since then, two other flu pandemics have occurred, in 1957 and 1968, neither of which was particularly lethal.

In August, the President's Council of Advisors on Science and Technology projected that this fall and winter, the swine flu, H1N1, could infect anywhere between one-third and one-half of the U.S. population and could kill as many as 90,000 Americans, two and a half times the number killed in a typical flu season. But precisely how deadly, or even how infectious, this year's H1N1 pandemic will turn out to be won't be known until it's over. Most reports coming from the Southern Hemisphere in late August (the end of winter there) suggested that the swine flu is highly infectious, but not particularly lethal. For example, Australian officials estimated they would finish winter with under 1,000 swine flu deaths—fewer than the usual 1,500 to 3,000 from seasonal flu. Among those who have died in the U.S., about 70 percent were already suffering from congenital conditions like cerebral palsy or underlying illnesses such as cancer, asthma, or AIDS, which make people more vulnerable.

Public-health officials consider vaccine their most formidable defense against the pandemic—indeed, against any flu—and on the surface, their faith seems justified. Vaccines developed over the course of the 20th century slashed the death rates of nearly a dozen infectious diseases, such as smallpox and polio, and vaccination became one of medicine's most potent weapons. Influenza virus was first identified in the 1930s, and by the mid-1940s, researchers had produced a vaccine that was given to soldiers in World WarII. The U.S. government got serious about promoting flu vaccine after the 1957 flu pandemic brought home influenza's continuing potential to cause widespread illness and death. Today, flu vaccine is a staple of public-health policy; in a normal year, some 100 million Americans get vaccinated.

But while vaccines for, say, whooping cough and polio clearly and dramatically reduced death rates from those diseases, the impact of flu vaccine has been harder to determine. Flu comes and goes with the seasons, and often it does not kill people directly, but rather contributes to death by making the body more susceptible to secondary infections like pneumonia or bronchitis. For this reason, researchers studying the impact of flu vaccination typically look at deaths from all causes during flu season, and compare the vaccinated and unvaccinated populations.

Such comparisons have shown a dramatic difference in mortality between these two groups: study after study has found that people who get a flu shot in the fall are about half as likely to die that winter—from any cause—as people who do not. Get your flu shot each year, the literature suggests, and you will dramatically reduce your chance of dying during flu season.

Yet in the view of several vaccine skeptics, this claim is suspicious on its face. Influenza causes only a small minority of all deaths in the U.S., even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly. When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly. So how could flu vaccine possibly reduce total deaths by half? Tom Jefferson, a physician based in Rome and the head of the Vaccines Field at the Cochrane Collaboration, a highly respected international network of researchers who appraise medical evidence, says: "For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That's not a vaccine, that's a miracle."

The estimate of 50 percent mortality reduction is based on "cohort studies," which compare death rates in large groups, or cohorts, of people who choose to be vaccinated, against death rates in groups who don't. But people who choose to be vaccinated may differ in many important respects from people who go unvaccinated—and those differences can influence the chance of death during flu season. Education, lifestyle, income, and many other "confounding" factors can come into play, and as a result, cohort studies are notoriously prone to bias. When researchers crunch the numbers, they typically try to factor out variables that could bias the results, but, as Jefferson remarks, "you can adjust for the confounders you know about, not for the ones you don't," and researchers can't always anticipate what factors are likely to be important to whether a patient dies from flu. There is always the chance that they might miss some critical confounder that renders their results entirely wrong.

When Lisa Jackson, a physician and senior investigator with the Group Health Research Center, in Seattle, began wondering aloud to colleagues if maybe something was amiss with the estimate of 50 percent mortality reduction for people who get flu vaccine, the response she got sounded more like doctrine than science. "People told me, 'No good can come of [asking] this,'" she says. "'Potentially a lot of bad could happen' for me professionally by raising any criticism that might dissuade people from getting vaccinated, because of course, 'We know that vaccine works.' This was the prevailing wisdom."

Nonetheless, in 2004, Jackson and three colleagues set out to determine whether the mortality difference between the vaccinated and the unvaccinated might be caused by a phenomenon known as the "healthy user effect." They hypothesized that on average, people who get vaccinated are simply healthier than those who don't, and thus less liable to die over the short term. People who don't get vaccinated may be bedridden or otherwise too sick to go get a shot. They may also be more likely to succumb to flu or any other illness, because they are generally older and sicker. To test their thesis, Jackson and her colleagues combed through eight years of medical data on more than 72,000 people 65 and older. They looked at who got flu shots and who didn't. Then they examined which group's members were more likely to die of any cause when it was not flu season.

Jackson's findings showed that outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did, lending support to the hypothesis that on average, healthy people chose to get the vaccine, while the "frail elderly" didn't or couldn't. In fact, the healthy-user effect explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all. Jackson's papers "are beautiful," says Lone Simonsen, who is a professor of global health at George Washington University, in Washington, D.C., and an internationally recognized expert in influenza and vaccine epidemiology. "They are classic studies in epidemiology, they are so carefully done."

The results were also so unexpected that many experts simply refused to believe them. Jackson's papers were turned down for publication in the top-ranked medical journals. One flu expert who reviewed her studies for the Journal of the American Medical Association wrote, "To accept these results would be to say that the earth is flat!" When the papers were finally published in 2006, in the less prominent International Journal of Epidemiology, they were largely ignored by doctors and public-health officials. "The answer I got," says Jackson, "was not the right answer."

The history of flu vaccination suggests other reasons to doubt claims that it dramatically reduces mortality. In 2004, for example, vaccine production fell behind, causing a 40 percent drop in immunization rates. Yet mortality did not rise. In addition, vaccine "mismatches" occurred in 1968 and 1997: in both years, the vaccine that had been produced in the summer protected against one set of viruses, but come winter, a different set was circulating. In effect, nobody was vaccinated. Yet death rates from all causes, including flu and the various illnesses it can exacerbate, did not budge. Sumit Majumdar, a physician and researcher at the University of Alberta, in Canada, offers another historical observation: rising rates of vaccination of the elderly over the past two decades have not coincided with a lower overall mortality rate. In 1989, only 15 percent of people over age 65 in the U.S. and Canada were vaccinated against flu. Today, more than 65 percent are immunized. Yet death rates among the elderly during flu season have increased rather than decreased.

Vaccine proponents call Majumdar's last observation an "ecological fallacy," because he fails, in their view, to consider changes in the larger environment that could have boosted death rates over the years—even as rising vaccination rates were doing their part to keep mortality in check. The proponents suggest, for instance, that influenza viruses may have become more contagious over time, and thus are infecting greater numbers of elderly people, including some who have been vaccinated. Or maybe the viruses are becoming more lethal. Or maybe the elderly have less immunity to flu than they once did because, say, their diets have changed.

Or maybe vaccine just doesn't prevent deaths in the elderly. Of course, that's the one possibility that vaccine adherents won't consider. Nancy Cox, the CDC's influenza division chief, says flatly, "The flu vaccine is the best way to protect against flu." Anthony Fauci, a physician and the director of the National Institute of Allergy and Infectious Diseases at the NIH, where much of the basic science of flu vaccine has been worked out, says, "I have no doubt that it is effective in conferring some degree of protection. To say otherwise is a minority view."

Majumdar says, "We keep coming up against the belief that we've reduced mortality by 50 percent," and when researchers poke holes in the evidence, "people pound the pulpit."

The most vocal—and undoubtedly most vexing—critic of the gospel of flu vaccine is the Cochrane Collaboration's Jefferson, who's also an epidemiologist trained at the famed London School of Tropical Hygiene, and who, in Lisa Jackson's view, makes other skeptics seem "moderate by comparison." Among his fellow flu researchers, Jefferson's outspokenness has made him something of a pariah. At a 2007 meeting on pandemic preparedness at a hotel in Bethesda, Maryland, Jefferson, who'd been invited to speak at the conference, was not greeted by any of the colleagues milling about the lobby. He ate his meals in the hotel restaurant alone, surrounded by scientists chatting amiably at other tables. He shrugs off such treatment. As a medical officer working for the United Nations in 1992, during the siege of Sarajevo, he and other peacekeepers were captured and held for more than a month by militiamen brandishing AK-47s and reeking of alcohol. Professional shunning seems trivial by comparison, he says.

"Tom Jefferson has taken a lot of heat just for saying, 'Here's the evidence: it's not very good,'" says Majumdar. "The reaction has been so dogmatic and even hysterical that you'd think he was advocating stealing babies." Yet while other flu researchers may not like what Jefferson has to say, they cannot ignore the fact that he knows the flu-vaccine literature better than anyone else on the planet. He leads an international team of researchers who have combed through hundreds of flu-vaccine studies. The vast majority of the studies were deeply flawed, says Jefferson. "Rubbish is not a scientific term, but I think it's the term that applies." Only four studies were properly designed to pin down the effectiveness of flu vaccine, he says, and two of those showed that it might be effective in certain groups of patients, such as school-age children with no underlying health issues like asthma. The other two showed equivocal results or no benefit.

Flu researchers have been fooled into thinking vaccine is more effective than the data suggest, in part, says Jefferson, by the imprecision of the statistics. The only way to know if someone has the flu—as opposed to influenza-like illness—is by putting a Q-tip into the patient's throat or nose and running a test, which simply isn't done that often. Likewise, nobody really has a handle on how many of the deaths that are blamed on flu were actually caused by a flu virus, because few are confirmed by a laboratory. "I used to be a family physician," says Jefferson. "I've never seen a patient come to my office with H1N1 written on his forehead. When an old person dies of respiratory failure after an influenza-like illness, they nearly always get coded as influenza."

There's one other way flu researchers may be fooled into thinking flu vaccine is effective, Jefferson says. All vaccines work by delivering a dose of killed or weakened virus or bacteria, which provokes the immune system into producing antibodies. When the person is subsequently exposed to the real thing, the body is already prepared to repel the bug completely or to get rid of it after a mild illness. Flu researchers often use antibody response as a way of gauging the effectiveness of vaccine, on the assumption that levels of antibodies in the blood of people who have been vaccinated are a good predictor—although an imperfect one—of how well they can ward off the infection.

There's some merit to this reasoning. Unfortunately, the very people who most need protection from the flu also have immune systems that are least likely to respond to vaccine. Studies show that young, healthy people mount a glorious immune response to seasonal flu vaccine, and their response reduces their chances of getting the flu and may lessen the severity of symptoms if they do get it. But they aren't the people who die from seasonal flu. By contrast, the elderly, particularly those over age70, don't have a good immune response to vaccine—and they're the ones who account for most flu deaths. (Infants with severe disabilities, such as leukemia and congenital lung disease, and people who are immune-compromised—from AIDS, or diabetes, or cancer treatment—make up the rest. As of August8, only 36 deaths from swine flu had been confirmed among children in the U.S., and the overwhelming majority of those children had multiple, severe health disorders.)

In Jefferson's view, this raises a troubling conundrum: Is vaccine necessary for those in whom it is effective, namely the young and healthy? Conversely, is it effective in those for whom it seems to be necessary, namely the old, the very young, and the infirm? These questions have led to the most controversial aspect of Jefferson's work: his call for placebo-controlled trials, studies that would randomly give half the test subjects vaccine and the other half a dummy shot, or placebo. Only such large, well-constructed, randomized trials can show with any precision how effective vaccine really is, and for whom.

In the flu-vaccine world, Jefferson's call for placebo-controlled studies is considered so radical that even some of his fellow skeptics oppose it. Majumdar, the Ottawa researcher, says he believes that evidence of a benefit among children is established and that public-health officials should try to protect seniors by immunizing children, health-care workers, and other people around them, and thus reduce the spread of the flu. Lone Simonsen explains the prevailing view: "It is considered unethical to do trials in populations that are recommended to have vaccine," a stance that is shared by everybody from the CDC's Nancy Cox to Anthony Fauci at the NIH. They feel strongly that vaccine has been shown to be effective and that a sham vaccine would put test subjects at unnecessary risk of getting a serious case of the flu. In a phone interview, Fauci at first voiced the opinion that a placebo trial in the elderly might be acceptable, but he called back later to retract his comment, saying that such a trial "would be unethical." Jefferson finds this view almost exactly backward: "What do you do when you have uncertainty? You test," he says. "We have built huge, population-based policies on the flimsiest of scientific evidence. The most unethical thing to do is to carry on business as usual."

Just after 6 p.m. on a warm Friday evening in July, Dr. David Newman is only minutes into a 10-hour shift in the emergency room of New York City's St. Luke's Hospital, and already he has assumed responsibility for 11 patients. The young Italian tourist sitting on the bed in front of the doctor has meningitis, and through an interpreter, Newman tells him he almost certainly has the viral form of the disease, which will do nothing more than make him feel ill for a few days. There is a tiny chance, says Newman, that the illness is caused by a bacterium, which can be deadly, but he is almost positive that's not what the tourist has. He says to his patient, "I can't tell you with 100 percent certainty that you don't have it, but if you do, you'll begin to feel worse and you'll need to come back." The tourist, on learning that he might be infected with a potentially lethal disease, looks down at his feet and confesses that he is much more worried about another illness: swine flu. Newman smiles patiently. "It would be nice if you had swine flu," he says. "Compared to bacterial meningitis, swine flu is safe."

Late last spring, as headlines and airwaves warned of a possible pandemic, patients like Newman's began clogging emergency rooms across the country, a sneezing, coughing, infectious tide of humanity more worried than truly sick, but whose mere presence in the emergency room has endangered the lives of others. "Studies show that when there is ER crowding, mortality goes up, because patients who need immediate attention don't get it," says Newman, the director of clinical research in the Department of Emergency Medicine at the hospital, which is affiliated with Columbia University. In an average year the ER at St. Luke's, a sprawling 1,076-bed hospital on 113th Street, takes in 110,000 patients, some 300 a day. At the height of the summer swine flu outbreak, that number doubled. The vast majority of panicky patients who came in the door at St. Luke's and other emergency departments didn't actually have the virus, and of those who did, most were not sick enough to need hospitalization. Even so, says Newman, when patients with even mild flu symptoms show up in the hospital, they vastly increase the spread of the virus, simply because they inevitably sneeze and cough in rooms that are jammed with other people.

Many of the worried sick come to St. Luke's and other hospitals in search of antiviral drugs. The CDC recommends the use of two drugs against H1N1: oseltamivir and zanamivir, better known by their brand names, Tamiflu and Relenza, which together form the second pillar of the government's anti-pandemic-flu strategy. Public-health officials at the state and local levels are also recommending the drugs. Guidelines issued by the New York City Department of Health, says Newman, "encourage us to give a prescription to just about every patient with the sniffles," a practice that some experts worry will quickly lead to resistant strains of the virus.

Indeed, that's already happening. Daniel Janies, an associate professor of biomedical informatics at Ohio State University, tracks the genetic mutations that allow flu virus to develop resistance to drugs. Flu can become resistant to Tamiflu in a matter of days, he says. Handing out the drug early in the pandemic, when H1N1 poses only a minimal threat to the vast majority of patients, strikes him as "shortsighted." Indeed, samples of resistant H1N1 were cropping up by midsummer, increasing the likelihood that come late fall, many people will be infected with a resistant strain of swine flu. Alarmed at that prospect, the World Health Organization issued an alert on August 21, recommending that Tamiflu and Relenza be used only in severe cases and in patients who are at high risk of serious complications. By mid-August, two U.S. swine flu patients had developed Tamiflu-resistant strains.

The U.S. first began stockpiling Tamiflu and Relenza back in 2005, in the wake of concern that an outbreak in Southeast Asia of bird flu, a far more deadly form of the disease, might go global. On November 1, 2005, President George W.Bush pronounced pandemic flu a "danger to our homeland," and he asked Congress to approve legislation that included $1billion for the production and stockpiling of antivirals. This was after Congress had already approved $1.8billion to stockpile Tamiflu for the military, a decision that was made during the tenure of Defense Secretary Donald Rumsfeld. (Before joining the Bush Cabinet, Rumsfeld was chairman for four years of Gilead Sciences, the company that holds the patent on Tamiflu, and he held millions of dollars' worth of stock in the company. According to Roll Call, an online newspaper covering events on Capitol Hill, Rumsfeld says he recused himself from all government decisions involving Tamiflu. Gilead's stock price rose more than 50 percent in 2005, when the government's plan was announced.)

As with vaccines, the scientific evidence for Tamiflu and Relenza is thin at best. In its general-information section, the CDC's Web site tells readers that antiviral drugs can "make you feel better faster." True, but not by much. On average, Tamiflu (which accounts for 85 to 90 percent of the flu antiviral-drug market) cuts the duration of flu symptoms by 24hours in otherwise healthy people. In exchange for a slightly shorter bout of illness, as many as one in five people taking Tamiflu will experience nausea and vomiting. About one in five children will have neuropsychiatric side effects, possibly including anxiety and suicidal behavior. In Japan, where Tamiflu is liberally prescribed, the drug may have been responsible for 50 deaths from cardiopulmonary arrest, from 2001 to 2007, according to Rokuro Hama, the chair of the Japan Institute of Pharmacovigilance.

Such side effects might be worth risking if the antivirals prevented serious complications of flu, such as pneumonia, hospitalization, and death. Roche Laboratories, the company licensed to manufacture and market Tamiflu, says its drug does just that. In two September2006 press releases, the company announced, "Tamiflu significantly reduces the risk of death from influenza: New data shows treatment was associated with more than a two third reduction in deaths," and "Children with influenza [are] 53 percent less likely to contract pneumonia when treated with Tamiflu." Once again cohort studies (the same kind of potentially biased research that led to the conclusion that flu vaccine cuts mortality by 50 percent) are behind these claims. Tamiflu costs $10 a pill. It is possible that people who take it are more likely to be insured and affluent, or at least middle-class, than those who do not, and a large body of evidence shows that the well-off nearly always fare better than the poor when stricken with an infectious disease, including flu. In both 2003 and 2009, reviews of randomized placebo-controlled studies found that the study populations simply weren't large enough to answer the question: Does Tamiflu prevent pneumonia?

As late as this August, the company's own Web site contained the following statement, which was written under the direction of the FDA: "Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza." An FDA spokesperson said recently that the agency is unaware of any data submitted by Roche that would support the claims in the company's September 2006 news release about the drug's reducing flu deaths.

Why, then, has the federal government stockpiled millions of doses of antivirals, at a cost of several billion dollars? And why are physicians being encouraged to hand out prescriptions to large numbers of people, without sound evidence that the drugs will help? The short answer may be that public-health officials feel they must offer something, and these drugs are the only possible remedies at hand. "I have to agree with the critics the antiviral question is not cut-and-dried," says Fauci. "But [these drugs are] the best we have." The CDC's Nancy Cox also acknowledges that the science is not as sound as she might like, but the government still recommends their use. And as with vaccines, she considers additional randomized placebo-controlled trials of the antiviral drugs to be "unethical" and thus out of the question.

This is the curious state of debate about the government's two main weapons in the fight against pandemic flu. At first, government officials declare that both vaccines and drugs are effective. When faced with contrary evidence, the adherents acknowledge that the science is not as crisp as they might wish. Then, in response to calls for placebo-controlled trials, which would provide clear results one way or the other, the proponents say such studies would deprive patients of vaccines and drugs that have already been deemed effective. "We can't just let people die," says Cox.

Students of U.S. medical history will find this circular logic familiar: it is a long-recurring theme in American medicine, and one that has, on occasion, had deadly consequences. In 1925, Sinclair Lewis caricatured a medical culture that allowed belief—and profits—to distort science in his Pulitzer Prize–winning book, Arrowsmith. Based on the lives of the real-life microbiologists Paul de Kruif and Jacques Loeb, Lewis tells the story of Martin Arrowsmith, a physician who invents a new vaccine during a deadly outbreak of bubonic plague. But his efforts to test the vaccine's efficacy are frustrated by an angry community that desperately wants to believe the vaccine works, and a profit-hungry institute that rushes the vaccine into use prematurely—forever preempting the proper studies that are needed.

The annals of medicine are littered with treatments and tests that became medical doctrine on the slimmest of evidence, and were then declared sacrosanct and beyond scientific investigation. In the 1980s and '90s, for example, cancer specialists were convinced that high-dose chemotherapy followed by a bone-marrow transplant was the best hope for women with advanced breast cancer, and many refused to enroll their patients in randomized clinical trials that were designed to test transplants against the standard—and far less toxic—therapy. The trials, they said, were unethical, because they knew transplants worked. When the studies were concluded, in 1999 and 2000, it turned out that bone-marrow transplants were killing patients. Another recent example involves drugs related to the analgesic lidocaine. In the 1970s, doctors noticed that the drugs seemed to make the heart beat rhythmically, and they began prescribing them to patients suffering from irregular heartbeats, assuming that restoring a proper rhythm would reduce the patient's risk of dying. Prominent cardiologists for years opposed clinical trials of the drugs, saying it would be medical malpractice to withhold them from patients in a control group. The drugs were widely used for two decades, until a government-sponsored study showed in 1989 that patients who were prescribed the medicine were three and a half times as likely to die as those given a placebo.

Demonstrating the efficacy (or lack thereof) of vaccine and antivirals during flu season would not be hard to do, given the proper resources. Take a group of people who are at risk of getting the flu, and randomly assign half to get vaccine and the other half a dummy shot. Then count the people in each group who come down with flu, suffer serious illness, or die. (A similarly designed trial would suffice for the antivirals.) It might sound coldhearted, but it is the only way to know for certain whether, and for whom, current remedies actually work. It would also be useful to know whether vaccinating healthy people—who can mount an immune response on their own—protects the more vulnerable people around them. For example, immunizing nursing-home staff and healthy children is thought to reduce the spread of flu to the elderly and the immune-compromised. Pinning down the effectiveness of this strategy would be a bit more complex, but not impossible.

In the absence of such evidence, we are left with two possibilities. One is that flu vaccine is in fact highly beneficial, or at least helpful. Solid evidence to that effect would encourage more citizens—and particularly more health professionals—to get their shots and prevent the flu's spread. As it stands, more than 50 percent of health-care workers say they do not intend to get vaccinated for swine flu and don't routinely get their shots for seasonal flu, in part because many of them doubt the vaccines' efficacy. The other possibility, of course, is that we're relying heavily on vaccines and antivirals that simply don't work, or don't work as well as we believe. And as a result, we may be neglecting other, proven measures that could minimize the death rate during pandemics.

"Vaccines give us a false sense of security," says Sumit Majumdar. "When you have a strategy that [everybody thinks] reduces death by 50 percent, it's pretty hard to invest resources to come up with better remedies." For instance, health departments in every state are responsible for submitting plans to the CDC for educating the public, in the event of a serious pandemic, about hand-washing and "social distancing" (voluntary quarantines, school closings, and even enforcement of mandatory quarantines to keep infected people in their homes). Putting these plans into action will require considerable coordination among government officials, the media, and health-care workers—and widespread buy-in from the public. Yet little discussion has appeared in the press to help people understand the measures they can take to best protect themselves during a flu outbreak—other than vaccination and antivirals.

"Launched early enough and continued long enough, social distancing can blunt the impact of a pandemic," says Howard Markel, a pediatrician and historian of medicine at the University of Michigan. Washing hands diligently, avoiding public places during an outbreak, and having a supply of canned goods and water on hand are sound defenses, he says. Such steps could be highly effective in helping to slow the spread of the virus. In Mexico, for instance, where the first swine flu cases were identified in March, the government launched an aggressive program to get people to wash their hands and exhorted those who were sick to stay home and effectively quarantine themselves. In the United Kingdom, the national health department is promoting a "buddy" program, encouraging citizens to find a friend or neighbor willing to deliver food and medicine so people who fall ill can stay home.

In the U.S., by contrast, our reliance on vaccination may have the opposite effect: breeding feelings of invulnerability, and leading some people to ignore simple measures like better-than-normal hygiene, staying away from those who are sick, and staying home when they feel ill. Likewise, our encouragement of early treatment with antiviral drugs will likely lead many people to show up at the hospital at first sniffle. "There's no worse place to go than the hospital during flu season," says Majumdar. Those who don't have the flu are more likely to catch it there, and those who do will spread it around, he says. "But we don't tell people this."

All of which leaves open the question of what people should do when faced with a decision about whether to get themselves and their families vaccinated. There is little immediate danger from getting a seasonal flu shot, aside from a sore arm and mild flu-like symptoms. The safety of the swine flu vaccine remains to be seen. In the absence of better evidence, vaccines and antivirals must be viewed as only partial and uncertain defenses against the flu. And they may be mere talismans. By being afraid to do the proper studies now, we may be condemning ourselves to using treatments based on illusion and faith rather than sound science.

The Natural World

This is an interesting read for anyone that has been watching Ken Burns documentary on National Parks. While it is easy to become depressed about the disappearing natural world, I think Gibson accurately captures an underlying spirit that is becoming stronger within American society.

The Politics of Enchantment
The quest for a new kinship with nature might just save us.
By James William Gibson October 7, 2009

Like Special Forces commandos, the L.A. County Sheriff's deputies and firefighters came at 2 a.m., Jan. 10, 2002, when they knew their enemy would be asleep. After a 71-day siege, the lone warrior knew the end was coming and chained himself into place for one last stand.

Mesmerized, the public watched the arrest of a tree-sitter, who was charged with trespassing. For just over two months, 42-year-old John Quigley, a well-known local environmentalist, had lived amid the boughs of a 400-year-old oak tree, trying to save it from a developer's bulldozer.

The oak stood at the entrance to a new subdivision of several hundred homes in the Santa Clarita Valley, north of Los Angeles. The Los Angeles County Board of Supervisors had ruled that the tree had to go because it blocked the planned expansion of a two-lane road into a four-lane thoroughfare.

The media loved the story. Parents brought their children to bear witness. Native American groups drummed and danced in solidarity. As posters, poems and tributes collected at its base, the oak started to resemble a monument or memorial.

To millions living in the suburban sprawl of Southern California, the grand old oak had become far more than a tree--it had become a symbol of all the other trees, animal life and open spaces lost to development.

Desires for place and the animal Other

Through the 1990s and early 2000s, a new and striking kind of yearning was evident in the ways ordinary people felt and talked about nature. People were touched by stories of bears who befriended humans, enthralled by the fluid grace of whales, moved to the depths of their souls by majestic trees, newly alive to the sense of mystery, of a world larger than themselves. Some suburban residents came to feel deeply connected to the few remaining open spaces--slivers of forest, wetland, meadow--around them, dedicating years to trying to save them from development. Others restored degraded places such as polluted wetlands and rivers. People began speaking up for the dignity of ordinary domestic animals such as cows and pigs.

How are we to understand this upsurge of feeling? To some degree, it can be considered a product of contemporary environmentalism. But the spreading influence of the environmental movement only partially explains the last two decades' fundamental change of consciousness. No political movement or platform can account for the intensity of feeling expressed by those who long to rediscover and embrace nature's mystery and grandeur, who experience an attachment to animals and places so overwhelming that they feel morally compelled to protect them, and who look to nature for psychic regeneration and renewal. More than an ideology, this quest for connection indicates a fundamental rejection of the most basic premises of modern thought and society.

Those premises center on a view of nature as inert matter, void of spirit and consciousness. For an early scientist like René Descartes, writing in the first half of the 17TH century, animals were simply unfeeling machines, incapable of emotions or pain. As the accomplishments of science earned it increasing prestige, this utilitarian view of nature became the dominant mode, further reinforced by the success of industrial capitalism. As Karl Marx and Friedrich Engels observed in The Communist Manifesto, the modern world was built largely through "the subjection of Nature's forces to man."

This subjection was so complete it eclipsed humankind's past and, with it, the traditional unity between humans and the rest of creation that is typical of premodern societies. Among Native American tribes, for example, animal species were, like other tribes, deemed "nations," such as the buffalo nation or beaver nation.

The premodern cosmos possessed a kind of enchantment. Humans were never alone: The crane flying overhead, the ground beneath one's feet, the great oak tree near the creek, the creek itself, could all be addressed as kin by those who knew the right words and rituals.

Modernity, as has been widely noted, drained the cosmos of that magic. In Max Weber's formulation, the West's elevation of "rational empirical knowledge" led to the "disenchantment of the world and its transformation into a causal mechanism." Radical and utter isolation followed. Carl Jung, a contemporary of Weber, grasped that loneliness had tragic implications: "Man feels himself isolated in the cosmos. He is no longer involved in nature and has lost his emotional participation in natural events, which hitherto had symbolic meaning for him."

Yet, the idea of the human world as separate from the rest of nature never gained complete acceptance. A few mavericks and romantics have always seen such isolation as wrong in substance and unbearable in spirit. Over generations, they repeatedly fought back, launching waves of protest, both cultural and political.

A rapidly dying world

The current wave of spiritual interest in nature is not simply another outburst of romanticism. For one thing, it is fueled by a new sense of urgency.

In 2005, the United Nations released the Millennium Ecosystem Assessment, the result of a five-year study of the world's environment involving some 1,360 scientists. In its executive summary, "Living Beyond Our Means: Natural Assets and Human Well-Being," the report's authors write, "Human activity is putting such strain on the natural functions of Earth that the ability of the planet's ecosystems to sustain future generations can no longer be taken for granted. "

Global warming looms ominously, with the climate changing faster than anything seen since the end of the last ice age some 10,ooo years ago. The rapid rise in temperature is endangering countless animals. People converted more forests and prairies to cropland from 1950 to 1980 than in the century and a half between 1700 and 1850. The destruction of habitat leaves animals with nowhere to go. The report's authors conclude: "Some 12 percent of birds, 25 percent of mammals, and at least 32 percent of amphibians are threatened with extinction over the next century."

The assessment reads like a funeral oratory.

A new covenant takes shape

Funerary rhetoric marks what is irretrievably gone, but it also reveals a people's fundamental moral values--what the deceased meant to those still living, and what their hopes are for the future. In a growing public acknowledgment of kinship, laments for the deceased are now given on behalf of wild animals and places of all kinds. Such oratory serves as a reveille, a call to make amends for creatures' wrongful deaths by acting to save those who are still left: Outlaw lead bullets, so the few remaining California condors won't die from lead poisoning when they eat carcasses left by hunters. Urgently study the mysterious deaths of whales. Put the U.S. Navy's testing of powerful sonar systems under stringent government regulation.

Increasingly, for every funeral story or call for action there is also a tale of resurrection and renewal. Searches for "ghost" species, for instance, are holy pilgrimages, mythic quests to bring back life from death's grasp. If one near-extinct creature can be restored to a healthy population, then possibly others can, too.

When researchers announced in 2005 that they had videotaped an ivory-billed woodpecker in a forested Arkansas swamp, the first sighting since 1944, government agencies and the Nature Conservancy bought more forested river-bottom lands near the location of the sighting to increase the bird's chances for survival.

The response to the sighting shows a new covenant between society and nature taking shape. As novelist and bird-watcher Jonathan Rosen commented, the return of the ivorybill offers hope: "It somehow suggests that we have found more than just a missing bird and that God, whom we invoked when we conquered the wilderness, is also present in our effort to get it back."

Time for a strategic offensive

The current change in environmental thinking is much broader, deeper, and more varied than what has come before. Virtually every part of contemporary culture, from the highest realms of science to the mundane world of commercial television programming, has experienced its revolutionary influence. Already, mainstream geneticists openly discuss the idea of human-animal kinship.

The ultimate goal of this sweeping change, which I call "the culture of enchantment," is nothing less than the reinvestment of nature with spirit. Flatly rejecting modernity's reduction of animals, plants, places, and natural forces to either matter or utilitarian resource, the culture of enchantment attempts to make nature sacred once again.

People respond to the culture of enchantment because it offers them something they need (and cannot find elsewhere in consumerist America): transcendence--a sense of mystery and meaning, glimpses of a numinous world beyond our own. The spiritual connections made to animals and landscapes almost invariably lead to a new relationship to nature in general. And nature perceived as "sacred" is allowed to exist on its own terms, for its own sake, valuable simply because it is there.

For nature to retain its mystery, it must retain its autonomy: While its products may be used by people, it is not to be exploited or perceived as a mere resource for human consumption. The culture of enchantment, then, alters the fundamental meanings that the West has given the natural world and imagines a new covenant between people, land and creatures.

The implications of this shift are enormous. If 400-year-old oak trees in Los Angeles can be reenchanted, whole forests or entire mountain ranges or coastlines might come to command our love and respect. Even degraded and polluted landscapes--the kind often found in and around cities--might gain our compassion and be deemed worthy of care. In creating spiritual and moral reasons for reconceiving man's relation to nature, the culture of enchantment challenges modern institutions, raising standards that few, if any, can now meet.

The momentum behind this cultural transformation suggests that anyone who cares about the Earth should take heart. It has opened people's imaginations, and in doing so changed the political climate.

The environmental movement and its allies can now shift their strategy from defense to offense. Such an offensive strategy will require a proactive agenda for environmental reform, one in which unambiguous legal mandates against drilling in ANWR and constructing roads in national forests are only the beginning.

The struggle for enchantment is a crucial part of the larger struggle over the kind of culture and society humanity will have.

The reenchantment of nature--if coupled with political courage to act--offers a chance to remake the world. 

This essay was adapted from A Reenchanted World: The Quest For A New Kinship With Nature by James William Gibson. Copyright © 2009 James William Gibson. Reprinted by arrangement with Metropolitan Books, an imprint of Henry Holt and Company LLC.

James William Gibson, a sociologist at California State University, Long Beach, also wrote Warrior Dreams: Paramilitary Culture in Post-Vietnam America (1994) and The Perfect War: Technowar in Vietnam (1986).

Where are the positive stories of US healthcare? (Hint - not here)

Nice contrast...

"Nothing makes me more angry," said Sen. Mitch McConnell at a health care town hall in Kansas City today, "… than the suggestion that America does not already have the finest health care in the world." Sen. John McCain, appearing alongside him, agreed: "The quality of health care in America is the best in the world."
From their closed-to-the-public "Health Care Reform Forum" in Kansas City today of just over 100 folks.

And this, which somehow seems so much more, well, reality-based

Until Medical Bills Do Us Part
By NICHOLAS D. KRISTOF

Critics fret that health care reform would undermine American family values, not least by convening somber death panels to wheel away Grandma as if she were Old Yeller.

But peel away the emotions and fearmongering, and in fact it is the existing system that unnecessarily takes lives and breaks apart families.

My friend M. — you’ll understand in a moment why she’s terrified of my using her name — had to make a searing decision a year ago. She was married to a sweet, gentle man whom she loved, but who had become increasingly absent-minded. Finally, he was diagnosed with early-onset dementia.

The disease is degenerative, and he will become steadily less able to care for himself. At some point, as his medical needs multiply, he will probably need to be institutionalized.

The hospital arranged a conference call with a social worker, who outlined how the dementia and its financial toll on the family would progress, and then added, out of the blue: “Maybe you should divorce.”

“I was blown away,” M. told me. But, she said, the hospital staff members explained that they had seen it all before, many times. If M.’s husband required long-term care, the costs would be catastrophic even for a middle-class family with savings.

Eventually, after the expenses whittled away their combined assets, her husband could go on Medicaid — but by then their children’s nest egg would be gone, along with her 401(k) plan. She would face a bleak retirement with neither her husband nor her savings.

A complicating factor was that this was a second marriage. M.’s first husband had died, leaving an inheritance that he had intended for their children. She and her second husband had a prenuptial agreement, but that would not protect her assets from his medical expenses.

The hospital told M. not to waste time in dissolving the marriage. For five years after any divorce, her assets could be seized — precisely because the government knows that people sometimes divorce husbands or wives to escape their medical bills.

“How could I divorce him? I loved him,” she told me.

“I explored a lot of options with an attorney here in town,” she added. “The attorney said, ‘I don’t see any other options for you.’ It took about a year for me to do the divorce, it was so hard.”

So M. divorced the man she loves. I asked him what he thought of this. He can still speak, albeit not always coherently, and he paused a long, long time. All he could manage was: “It’s hard to say.”

Long-term care constitutes a difficult and expensive challenge in any health system. But the American patchwork, full of cracks through which people fall, has a special problem with medical expenses of all kinds bankrupting couples.

A study reported in The American Journal of Medicine this month found that 62 percent of American bankruptcies are linked to medical bills. These medical bankruptcies had increased nearly 50 percent in just six years. Astonishingly, 78 percent of these people actually had health insurance, but the gaps and inadequacies left them unprotected when they were hit by devastating bills.

M. still helps her husband and, quietly, continues to live with him and care for him. But she worries that the authorities will come after her if they realize that they divorced not because of irreconcilable differences but because of irreconcilable medical bills. There were awkward questions from friends who saw the divorce announcement in the newspaper.

“It’s just crazy,” she said. “It twists people like pretzels.”

The existing system doesn’t just break up families, it also costs lives. A 2004 study by the Institute of Medicine, a branch of the National Academy of Sciences, found that lack of health insurance causes 18,000 unnecessary deaths a year. That’s one person slipping through the cracks and dying every half an hour.

In short, it’s a good bet that our existing dysfunctional health system knocks off far more people than an army of “death panels” could — even if they existed, worked 24/7 and got around in a fleet of black helicopters.

So, for those of you inclined to believe the worst about President Obama, think it through. Suppose he is indeed a secret, foreign-born Muslim agent who is scheming to undermine American family values while killing off as many grandmothers as possible.

If all that were true, why on earth would he be trying so hard to reform our health care system? We already know how to prod families into divorce and take a life unnecessarily every 30 minutes — all we need to do is reject reform and stick with exactly what we have.