Problems with "cap and trade"

http://www.npr.org/templates/story/story.php?storyId=123037162

While the US Congress is still wrangling over the implementation of a "cap and trade" market in the US (and its passage through the Senate is doubtful), it is already up and running in Japan, New Zealand, and the EU. So for Obama to claim at this week's State of the Union that the US is "leading" the effort to curb climate emissions is just hysterical. Those other nations pollute far less than us per capita, and are at least a decade ahead of us in terms of emissions management. For the record, Obama's actual quote was, "[The US has] gone from a bystander to a leader in the fight against climate change." Maybe he meant to use the future perfect tense.

First implemented to curb acid rain and now used for CO2/methane after the UN Kyoto summit, the cap and trade system works basically by the government imposing pollution limits/credits on various emitters. If company X exceeds its quota, then it must buy unused credits from cleaner companies (on an emissions market), or "offsets" that neutralize their pollution overage with green initiatives (investment in a wind fam, tree plantings, etc.). The global climate market is now worth $150B, and emissions offset certificates are the fastest-growing commodity in history. A previous posting described how celebrated NASA climatologist R. Hansen is against this system, so I won't repeat his arguments (http://worldaffairs-manwnoname.blogspot.com/2009/12/top-climate-scientists-slams-copenhagen.html).

Markets do have the ability to maximize wealth/efficiency, reveal true value, and improve conditions for millions of people, and they have in the past. But we also know that markets can degenerate into giant scams that benefit the super rich and those privy to extra information. Ironically, the corporate sector is at odds about America's involvement in global cap and trade. The energy industry is of course fiercely opposed (and has spent millions on ads and lobbying Washington), but Wall Street was actually disappointed that Bush pulled us out of Kyoto. They have lobbyists on the opposite side of the climate debate pushing for America's participation in the emissions market. Each day Congress stalls, they miss out on a ton of easy money, even more than what is being made at the current London-based climate exchange. Already Goldman, JPMC, Citi, Bank of America, Barclays, and others have trading desks there. 2 major entities are being traded: climate offset resources/credits and speculative derivatives based on carbon futures, with the latter just being a gambling hall for the price of carbon, similar to currency markets. Brokers and polluters are scouring the globe to find potential "green" projects that could qualify as carbon offsets to be sold to the highest bidder.

You can see that there are two major problems associated with the system. The first is inaccurate measurement/pricing, and the second is turning a "promise" into a tangible commodity. For the first, how do you accurately measure carbon emissions, avoid fraud/tampering, and decide how much pollution is tolerable by various industries? I believe the EU erred on the conservative side and flooded the market with too many emissions credits, thereby depressing their value. And how do you calculate if a solar farm in the Mojave Desert is offsetting a coal plant in Napoli? The UN, which manages the market under the Kyoto protocols, relies on "validation" companies to audit emission valuations (like how S&P or Moody's rate stocks). These companies assess the various polluters and offset projects, and assign appropriate emission values. But the UN actually had to take the 2 largest companies offline after investigations showed that they lacked sufficient expertise and quality control to make accurate assessments in 50% of their studies (accounting for 1/4 of the total market). The UN determined that some carbon offset projects were inflated at 15-35% higher CO2 savings than what they could reasonably provide. And in fact, that percentage probably holds true for the overall EU carbon market as well. Call it the carbon bubble.

Second, commodities markets rely on certain delivery. When you buy oil or pork bellies futures, you know you will receive ownership of those products at the amount, price, and time you agreed on. But carbon futures are promises and assumptions. Speculators buy offsets that claim to save X tons of carbon over Y months. But wouldn't it make more sense to buy and sell carbon savings that has already happened for sure? I will buy the 2009 carbon savings from this geothermal plant for Z dollars to offset my 2010 pollution overage. Some of the proceeds will go to fund future green projects, which in turn will be sold on the market AFTER they have delivered their climate benefits. What if your wind farm is sabotaged by rebels, or a storm wipes out your newly planted forest, or your resource doesn't even get built (since most offsets are not finished at the time of sale)? Since many offset projects are in undeveloped areas, there is less security and oversight. You already paid for the offsets and the government expunged your pollution, so contract-wise everything is fine. But the planet doesn't get the emissions savings it was promised.

If we really want to efficiently limit emissions, we first need a carbon tax, and then some elements of cap and trade can work properly. Because cap and trade on its own creates a huge, expensive, confusing bureaucratic infrastructure to manage. Half of the effort is wasted on upkeep and middle men each taking their cut. But if we had perfect information about pollution and offsets, as well as perfect pricing and monitoring, then of course the market would work. But all the corruption problems plaguing Wall Street also exist for cap and trade, though with less oversight resources and less institutional knowledge for the latter.

http://www.rollingstone.com/politics/story/31633532/as_the_world_burns
http://www.pbs.org/frontlineworld/stories/carbonwatch/
http://www.harpers.org/archive/2010/02/0082826

How the bail bonds industry is scamming us

‘We [bail bondsmen are] tenacious; we do our job," Spath says. "People should not just be released from jail and get a free ride. I mean, this is the way the system's got to work."

http://www.npr.org/templates/story/story.php?storyId=122725771&ps=rs

In addition to overcrowding in state or federal prisons, county jails are also bursting at the seams due to many petty-theft offenders (shoplifting and bureaucratic violations, not GTA or anything violent) stuck there due to our idiotic bail system. 0.5M Americans have paid their pennance and are still behind bars only because they can't afford their bail payments, sometimes as low as $50. That is 2/3 of the total jail population. But the legal system mandates that authorities keep them there, even at great expense to taxpayers (>$1k to house each person per month, which adds up to $9B nationally per year in a recession). Some counties are spending 1/4 of their budgets on jails. Apart from the wasted taxes, imagine the lost economic productivity and human costs from all these incarcerated people. Now that surplus inmates are even forced to live in storage closets (many US jails were built during John Dillinger times), governments are responding to the crisis, not by reforming the bail process, but by building new costly mega jails.

I am no expert, but it seems defendants are required to post bail before their release from jail as collateral to guarantee they will show up to court later (and then maybe get reimbursed). Historically, those released on their own recognizance usually don't flee and do appear at trial. It is not legally required, but bail bondsmen often push their services on people as bail intermediaries. Like shady mortgage brokers, they are mostly useless middle-men who somehow have justified their parasitic cut to the powers that be. If you thought Blackwater was bad in Iraq, commercial bail bondsmen are often lowlifes with less than 20 hours of official training (some states don't even require bondsmen be certified). Only Illinois, Kentucky, Oregon, Wisconsin (fairly progressive states) prohibit for-profit commercial bondsmen, and their court systems provide the service instead.

Why prohibit commercial bondsmen? Because it's an outright scam. Inmates typically pay a nonrefundable fee (10% of bail amount + possible extra penalties) to bondsmen to win their release. If the person pays the bail back and shows up for trial, everything is rosy and the bond agency makes easy money as a loan shark. If the person flees, rarely are they caught by the bondsmen's bounty hunters (contrary to that stupid reality TV show). They are mostly caught by county sheriffs enforcing the warrant and working on the taxpayer dime. Bond companies are only required to pay back 5% of the bail to the courts if a customer flees, and many are way behind on their repayments (bondsmen owe CA $150M in back fees as one example). They're supposed to pay the full bail amount as punishment for letting their guy slip away, but it isn't enforced. So even Las Vegas would be jealous of a virtually risk-free business where a 10% fee is collected up front and at worst they have to give back half of it to the court under rare circumstances, and much later on. What is their overhead for this "vital" service - a few minimum-wage paper-pushers? Find desperate people, and you'll find vultures preying on them.

As an alternative, there is pretrial release, where prescreened poor people don't post bail but wear an ankle transponder so they can be tracked as they maintain their jobs and take care of their families. Escapes are rare as well, and tracking costs 3-5% the price of keeping that person behind bars. These programs were set up by county officials who benefit from the bondsmen lobby's campaign funding and favors, so the marginalized programs often remain local, understaffed, underfunded, and unable to meet the demand for the service from qualifying inmates. Of course the other option is to post bail with your own cash (like Madoff did). But many lower-income uneducated people aren't aware of this, and the courts don't bother to inform them, so the bond sharks step in.

In one Florida county (Broward), pretrial reduced their unconstitutionally overcrowded jail population to a manageable level, and saved the county $20M in one year. Defendants were showing up to court as they should. Everyone was happy but the bondsmen. So they hired a lobbyist and invested $23k to sway the county commissioners and mayor. Later the commission inexplicably called a surprise session to scrutinize what seemed to be a very successful program. They sharply narrowed the eligibility criteria for pretrial, and cut funding just 2 years after they voted to double it. Other bondsmen took notice and are trying similar strategies in their counties. They claim that they are patriots who want to keep Americans secure and save us money, just like Blackwater said. Yes, I'm so glad that the guy who forgot to renew his car registration is locked up so he doesn't terrorize my family, and he only regains freedom by paying blood ransom to the bondsmen.

The American work-family conflict

http://www.americanprogress.org/issues/2010/01/three_faces_report.html

A recent study from the Center for Am. Progress and UC Hastings College of Law recently published a study demonstrating that the US is the most difficult nation for working families in all of the industrialized world. Comparing US families from today and 30 years ago, it shows that we now work 11 more hours per week vs. 1979, which is now longer hours than any other nation, even Japan and South Korea. The modern workplace is still designed for the 1960 worker (males who can work longer hours freely, since his stay-home spouse attends to nearly all the child and home care), even though the US workforce is demographically much different today. 70% of moms work today vs. 20% in 1960.

The US is the only OECD nation without mandatory paid sick and maternity leave laws. I believe CA has progressive paid maternity laws, and federal employees are also covered, so why wouldn't Congress pass a law for all workers? Corporate resistance? In addition, the US has much less part-time "good employment" opportunities (white-collar work, not just Taco Bell), overtime compensation for salaried workers, and flex-time schedules available for parents. Here, we spend much more time working than we do with our spouses and kids. Think about how obscene that is. Why must we have our Blackberries on at 11PM to put out some fire at the Singapore office (thankless too, since such "dedication" is expected in some jobs), but we get a dirty look from the boss if our kid gets sick and needs to be picked up from day care? These pressures on working families are compounded even further by elderly care, as the grandparents are living longer.

Dual-income working professionals who "take shifts" to cover morning and evening childcare are 3-6X more likely to divorce. I guess they are too exhausted to work out problems, and have less couple time. For lower income parents (who are more often single parents), child care and health care costs are consuming most of their pay. "Unofficial" discrimination against mothers is higher than with most other minority groups. If your employer's HR is good, they will caution you to never ask about kids or pregnancy if you are interviewing a female. But statistics show that employer disapproval of a working mother's time commitments for her kids is manifested in poorer performance reviews for her and even firings. The US is the most gender-friendly workplace for a woman to reach the top, but very hard if that female professional wants to have a happy family too. It's even harder for single professional-managerial women too. Since staying home is not possible and their kids depend on their salary, they may feel more pressure to advance. They tend to work over 50 hours/week at a rate of 32%, vs. 14% for married women. That is insane for single moms to have more parenting responsibilities and also work longer (voluntarily or not).

These conditions also impair US workforce productivity, because good workers are "forced" to quit and stay home if they feel they are neglecting their kids, absenteeism/attrition rates are terrible, and most working parents are not operating at peak performance due to distractions and stress from the unsustainable juggling act. But like PTSD in the military, no one wants to acknowledge this for fear of appearing weak to coworkers.

The last pro-working-family legislation passed was in 1993. Currently there is a bill to provide paid paternity leave for federal workers (benefiting Congress of course), but it hasn't passed the Senate. Childcare tax credits and subsidies are meager help. There is also class hypocrisy. Professional mothers are praised for leaving the workplace to put their kids first, yet lower income moms are labeled as deadbeats if they do the same. It is true that a higher percentage of lower income parents don't work, but this is not due to laziness. Their take-home pay is often less than child care costs, so it doesn't make financial sense for them to work. And since more middle and upper class mothers are working vs. last generation, the household incomes of those classes are rising (and contributing to the widening wealth gap) and making lower class single-income households appear even poorer. Poor mothers have a harder time finding and keeping jobs, especially good stable jobs in this recession, due to their reduced skill sets and social factors. So there is a paradox that richer moms want to work less but can't (unless they quit completely), yet poorer moms want to work more but can't.

If the family unit is the building block of society, and labor is the force sustaining the economy, then how can we and our leaders tolerate this unacceptable situation that compromises both?

http://www.kqed.org/epArchive/R201001260900

NFC Championship Game

Dang quite a game. Of course I was pulling for the Derrty, but actually I am sad how Favre went out. MIN deserved to win that game in every way but TOs. The Saints D was gunning for the old man all day and did get in some cheap shots that weren't called. But at least his line prevented sacks. Apart from Favre's INTs, Harvin and Berrian's fumbles in the red zone were huge. The Saints made their living this season on TOs - everyone knows that.

It was kind of wierd to see Rich Eisen and Mooch literally tear up as they were describing the loss now. For all of Favre's ego and BS in the media, can anyone else in the NFL make grown men get emotional like that? Even for a great player like LT, no one is lamenting his sad decline in SD now. I guess the NFL really needs someone like Favre, a hero that regular (white) guys can relate to and believe in. Yeah hate me for saying it, but would you rather root for the squeaky-clean polished Mannings or the zero-personality Big Bens? At least Favre is a real, flawed, brave guy who puts it all on the line for the game he loves (he wears Wrangler after all!). Yeah he messes up and screws his team over sometimes, but this season proved all his haters wrong. I'm still not a "fan" of his, but the game does suffer without him.

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I thought this was funny... Vikings radio call of Favre's interception. The color commentator gets so angry he sounds like Jesse Ventura cutting a wrestling promo. "This ain't Detroit man! This is the Super Bowl!"

http://sportsillustrated.cnn.com/2010/images/01/25/FavreINT.mp3

I loved seeing New Orleans win. I'm not sad at all about Favre and Childress getting their just deserts. After running up the score for no reason last week against Dallas, this is karmic payback. This isn't college football where you have to impress the pollsters in box scores when they don't even watch the game! You are up by 20 points with 4 minutes left... take your god damn starters out so they don't get hurt! Instead Favre and Chilly are throwing deep TDs... if I were Keith Brooking, instead of running to the sidelines and whining... I'd take the crown of my helmet, fly right at Favre and nail him square in the facemask. That will teach you to keep your precious QB in the game during garbage time.

Call it karma, voodoo or Santeria... somehow the Saints pulled it out!

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Yeah I admit maybe I drank the Kool-aid about Favre yesterday and fell for the emotional manipulations. Heck I had several brews during the game too.

But come on, don't lament them running up the score on Dallas. Fuck Dallas and the Jerry Dome. This is the franchise that believed in TO and Pacman after all. Arrogant Dallas will run up the score on anyone else and laugh about it. They deserve to lose 0-70 every time they go out there, unless they do something about it. There's no charity in the NFL, especially for super-rich franchises on TV all the time. They beat PHI twice convincingly in critical games - good for them. But if they are getting blown out by the NFC 2 seed (with a HOF QB, top 3 RB, and several Pro Bowlers), boo fucking hoo, it's the Playoffs. If Brooking didn't like getting scored on in garbage time, then maybe he should have stepped up like a man and rallied his mates to STOP them on the field. Bitching is for bitches. A loss is a loss, and it doesn't matter if the margin is 1 or 30; they are still going home. You're right that Childress was a moron to risk his people when the game was won, but that wasn't DAL's problem. I was never a Childress fan BTW, especially after his tampering with GB and such.

For the NOR game, just imagine how they would be kissing Favre's ass if MIN somehow pulled it off. Take away one of the Berrian or Harvin fumbles and it's a good bet MIN would have won. They limited Brees to sub-200 yards. They did "enough" to beat NOR, except for literally 2 bad plays and 2 shady ref calls. Brady has thrown 3 picks in Playoff wins before. Teams can survive a few mistakes if they do the rest well. But for Favre's last pick - it was boneheaded to throw across the body/field into triple coverage, but how many times has he pulled that off before? He had a sprained ankle and probably couldn't scramble for 5 yards. And say he got hurt trying, and Longwell missed the FG - then you got Tavaris in OT. I did see he had Taylor by the sidelines near the 30, but a DB was closing. It's tough man - how many QBs besides Manning or Brees could have pulled that play off in his health? Favre already won 2 games for MIN this season on 4th down desperation TDs. He only has so much mojo left.

Haha if Favre and Peterson worked out with this, maybe their wrists would be super strong and they wouldn't make TOs as much!

http://www.youtube.com/watch?v=O7xrr8XQ_-Y

Really I'm at a loss. BTW "dynamic inertia" is an oxymoron in physics haha.

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On running the score up: I gotta agree with T on this one. For one thing, fuck Dallas. Also, this is the pro's, there is no running the score up on other teams. Maybe in college and definitely lower there is something wrong with running up the score as they are supposed to be amateurs. But pros? No. Man up, or don't suck so much. It's still a dick move, but pro's don't get to complain.

On Favre: The thing is, the reason why I hate him so much is partly based on the media's absolute love for him. I'm sure Peter King was knocking on his door last night after the game to offer him pity sex with him. They adore him and I don't understand why. Because he takes stupid risks (I mean because he's a GUNSLINGER!)? Cuz he's white? The thing with the Packers is always presented as Favre gettting his revenge or whatever. What revenge though? He screwed them over then he gets to be the guy who gets revenge? That would be like having your girlfriend cheat on you and later when she marries a rich guy she's getting revenge on you. For cheating on you.

The media's love for him is absurd. As if no one else in the game shows emotion, or "has fun out there" or all the other bs they ascribe to him as being somehow unique. His spat with the packers should show he's not any different from any other asshole out there. Or how he told the Jets to essentially fire their coach, then he doesn't even come back there anyway.

And yeah, I would rather root for Payton Manning. He's a funny, not apparently an asshole kind of guy. Again with Favre, "he puts it all on the line" but so does most other people. Why the fuck did I have to see his wife so goddamn much in that game anyway? They didn't show Brees' wife and I think he's a lot more likable than Farve's prima donna ass.

Oh yeah and the vikes loss was mostly Peterson's and Harvin's fault, their fumbles were the most devastating. I do recognize this. But Favre's interception at the end was still delicious for a hater like me. For years he had thrown dumb interceptions like that because he thinks he still has the same arm strength as he had when he was 30. In the past few years he sucked too, even led the league in interceptions recently. Naturally, the Favre loving media ignored this so when he had a good year like this year, they got to gargle his balls some more.

So to me, the real karma here is tying your fortunes to Favre, and losing because he does what he always does, stupid shit like throwing across your body to the left side of the field when you roll right. He managed to run out there by the way, and he looked alright. He probably could run 15 more feet upfield. Or throw the ball away. If it was anyone else, who doesn't get the media to whore themselves out to him, then it would be completely unacceptable for a "veteran" qb to throw a pass like that. I am very thankful that Favre lost. I wouldn't be able to watch TV for two weeks if the Vikes had won thanks to Farve. I would not want to watch a man get his dick sucked for two straight weeks. Maybe Gala would like that.

Putting Favre aside for a moment, the vikes did give that game away. If I was vikes fan I would have been cringing every time Peterson or Harvin touched the ball. I like the guy but I think Adrian Peterson is officially "Fumble Prone." To give up the ball so much and still almost win speaks poorly of the Saint's really. Payton Manning is unlikely to throw stupid ints and few people are as fumbley as Peterson, so I wouldn't count on that either. Saints will actually have to play some good football, which they really didn't do against the Vikes.

And no, I don't think Aaron Rodgers can the next great white hope. The media had a smear job on him when he started putting together better stats than Favre by saying stuff like "There's no question that team would be better with Farve" or "Most of the sacks the packers have are Rodgers' fault." The next great white hope is definitely Romo, who I've heard "leads the league in smiles." When a player gets some bullshit attached to them to show that he somehow doesn't suck despite a consistent history of choke jobs, well maybe you get to take Favre's place as the great white hope.

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Haha great white hope? That is the Derrty Sanchez (the media love him already, but does he count as white?)! News flash - all the best QBs in the league ARE white (and probably will always be, sorry to my boy Vick). The great white hopes are Welker and Hester. Rodgers had a statistically huge season. He will have a great career if his line can protect him better. He won't be good for long if he keeps taking licks.

Well let me play Devil's advocate on Favre. I usually hate whatever the media love too, but I don't know, this season he just had the magic going and made me feel like a kid watching Montana again. Still hate Kobe and A-Rod though! Favre was pissed that GB decided to invest in their future with Rodgers. Favre's an impetulant child. But GB was his family and he led them to the promised land. They owed him, and he did take them within 1 game of the SB in 2007 (with a lesser team than MIN now). I guess he expected them to keep starting him until he hit Medicare age. They betrayed each other, and Favre has the right to hate anyone he wants - hate by nature is irrational. Look at MJ's HOF speech where he still disses Bryon Russel (even though he beat him). These pathological winners are vindictive fucks, but that's what helps make them great, sadly. At least Favre didn't get Daddy to trade him to NY like Eli, or bitch his way to CHI like Cutler (who showed his true colors this season).

I totally agree that he is a selfish, immature, reckless hillbilly. That is exactly why people love him, same with Dubya. He appeals to that primitive part of our American macho psyche that just wants to be a badass cowboy who don't give a F who we step on to get what we want. He totally messed things up in NY, and his performance after Oct was horrible - but partly because of his injury and the system (and partly because NY's WRs suck ass). And yes, they showed his stupid wife way too often. But that is the Fox producers, not Favre's fault.

I also agree that both Mannings have gotten more likeable since they won rings (beating NE makes you a lifelong friend in my book). The Sony commercials are funny too. But remember that Peyton was the same whiny, irritable, blame-everyone-but-myself guy when IND kept losing to PIT and NE. And Manning lost with a HUGE supporting cast (James, Freeney, Sanders, Vanderjerk in their primes, great O-line). I personally like Rivers and Brees more than the Mannings, but that's just me. For Favre, he is a playmaker like Iverson. You take the good with the bad. But I would rather watch an Iverson/Favre do his (selfish, reckless) thing than a boring-ass "game manager" like Sanchez or Pennington. Favre makes even haters get out of their seats sometimes, and he's fucking 40 for fuck sakes. Seriously we can't discount that. Look how Big Mac and Bonds cheated to keep their edge into older age, but Favre is in a more phsyical, nasty sport and keeps it up (assuming he's clean). Sometimes it's bad to throw the ball away. You got to man up and make a play. Favre has done that more times this season than guys half his age with arguably more physical abilities do their whole careers. From a fan standpoint, you want to see highlights. From a team perspective, you want to win and make the right decisions. More often than not in 2009, Favre has done both. Everyone sucks his cack when he does good, and everyone blames him (or makes excuses for him) when he fails. But clearly MIN is not even as good as GB if Tavaris were running the show.

I feel bad about AP, who is a great guy and great player. He fumbled 3 times but fortunately MIN recovered each time, so it's more forgiveable. But his confidence must be shot. He is mad strong and had very few fumbles before 2009, so I don't think its his technique. Maybe mentally he has a problem, or it's just bad luck. But MIN has a great record when AP rushes for over 100 and 2 scores, which he did yesterday. MIN held NO to 3 of 12 on 3rd downs. They did enough to win, even with those TOs. As D said, NO was not executing as sharply as they usually do. Shockey and Bush were mostly nonfactors, and there were no big passes. MIN can't be perfect, and that day TOs were their weakness. A big ass weakness for sure, but you can't blame it all on Favre's INT. And let's remember that it's damn hard to win on the road in January.

"The White House has squandered the greatest opportunity to change the country and political landscape since Reagan."

http://www.huffingtonpost.com/drew-westen/obama-finally-gets-his-vi_b_429232.html

A very powerful piece of writing that I wish wasn't so accurate. I don't know which meltdown was worse: the Clinton campaign in 2008 or the Obama administration now. As an ABC journalist said, how can a community organizer lose the people's support to the irresponsible, lying, rich-serving GOP?

Obama has been too reactionary and un-aggressive. If he approached other issues like he approached the bailout, then maybe we would get somewhere. It's not like he's not giving full effort, but obviously it's not working. His campaign was innovative, focused, forward-thinking, and agile - everything his administration isn't. But that shows that campaigning and realpolitik are totally different worlds, and just because he is good at the former doesn't mean squat. Bush was a great campaigner too. Obama was supposed to be The One. Health care will probably be his Waterloo. He deferred to Reid and Pelosi too much, pushed imaginary bipartisanship too much, and squandered the summer that was fairly crisis-free (his biggest non-economic worry at the time was what, the Somali pirates?). "Health care" can't be the mission of his presidency (it's big but not enough), especially when he already anointed his campaign as a "movement". He needs a vision for a better America, like FDR and Reagan had. He needs leadership. Really this stuff should be obvious to anyone who got a B in Intro to Poli Sci.

He didn't get his own house in order. How can these few Blue Dogs destroy a super-majority? You didn't see centrists like Snowe and Specter railroading the extremist Bush agenda. As a friend said some months back, corporate interests run antithetical to democracy and progress. Their servants in both parties will see to that. Dems capitulated during the first Bush term and lost Congress anyway. The country suffered for it. I think the GOP took note of that and maybe labeled Obama as "too big to succeed". But the country is in a different place now, and the Congressional impasse is hurting us worse than our belly-flop in Iraq maybe. If this government was back in the 1930s, they would have extended the Great Depression another decade (if WWII never occurred). I feel really down actually, worse than when Kerry lost. At least Kerry was always the underdog, and didn't squander a huge advantage. Do you think it's too late for the Dems? Not that the GOP can field any compelling leaders for 2012, but where do you see the rest of his presidency going?

Other comentators are saying to liberals that this is our fault for pinning our progressive aspirations on a centrist who is further to the right of Hillary. We wanted him to be the liberal crusader he just isn't. Maybe it was just GOP nonsense, but didn't they say that Obama had one of the most leftist voting records in his brief time in the IL legislature and Senate? Well the source below shows that Obama's Senate voting record made him #16 in 2005, #10 in 2006, and #1 most liberal in 2007. So is he a centrist or a liberal or what? He might as well be centrist (or GOP) because he hasn't done much for his liberal base. He's already told the Latinos that he's delaying immigration reform until health care is passed. He didn't fight to get abortion restrictions out of the health bill. He hasn't done much for the poor (Pelosi mostly spearheaded the S-CHIP expansion), though he tried to get 30M more of them insured by 2014. He has really disappointed the anti-war Dems (and just imagine how more belligerent he would need to be if Abdulmutallab succeeded). Many gays feel like he took their vote for granted, and he's too scared to touch "don't ask don't tell" this early and repeat the Clinton mistake. Well, Obama probably figured these folks wouldn't vote for a GOP no matter what he did. But on the other hand, if he didn't treat Wall Street and the Pentagon right, that would cost him in 2012. He's also losing idependents' support like it's going out of style.

http://www.npr.org/blogs/news/2008/01/obama_ranked_most_liberal_sena_1.html

I don't think real change comes from a centrist who is risk-averse. Obama did promise to bring America together too, and it's only gotten more polarized (not all his fault obviously). Much of that is GOP backlash against him (some of it racist-inspired I think) from his many opponents. Maybe Obama doesn't know who he wants to be either. Clearly he is a different politician than 2 years ago, but of course the pressures of the office change a man. But if politics were a baseball game, clearly the Dems just blew a 5-run lead in the 8th inning.

http://www.kqed.org/epArchive/R201001200900

Supreme Court strikes down corporate campaign finance limits

More from the "worst things you'll ever hear" list:

Supreme Court rules 5-4 to strike down corporate and union campaign finance limits (for their support of TV and print ads at least), basically opening up the flood gates for future elections to surpass even the obscene spending total (over 1.5 billion dollars) of Obama-Clinton-McCain in 2008.

"As long as they do it independently, they can spend whatever they want," notes NPR's Nina Totenberg. "It will undoubtedly help Republican candidates since corporations have generally supported Republican candidates more."

How do you prove independence? Just that they're not officially registered with a campaign? Give me a break. The political parties and industry groups/companies do secret deals on policy-for-donations all the time, even while the campaign finance limits were in effect. And we can kiss any hopes of a third party gaining strength goodbye.

"On its own, [the ruling] will not be responsible to opening the floodgates to corporate money ... because the floodgates were pretty wide open to begin with," [Columbia political science professor N.] Persily says.

And how can we expect the incumbents in government to enact new campaign finance rules, when they are the ones who directly benefit from all the corporate cash to help them stay in office? I suppose the Dems in power would feel more threatened because they are poised to lose seats in November and have (slightly) less corporate support in general.

http://www.npr.org/templates/story/story.php?storyId=122805666

Corporate finance timeline: http://www.npr.org/templates/story/story.php?storyId=121293380
100 years ago, it was actually illegal for companies to donate to campaigns.

Crazy like us: America's exporting of mental health

The quake reminded me of a recent thing I read:

http://www.nytimes.com/2010/01/10/magazine/10psyche-t.html?ref=magazine
http://www.kqed.org/epArchive/R201001110900

This journalist studied how America is exporting our "scientific" views on mental health to the rest of the world, and not always for the better. After the big Asian tsunami, a bunch of "white, upper-middle class" trauma counselors went to Sri Lanka and Aceh to console the locals. The author said that it's the purest form of American hubris to think that comfortable, complacent suburbanites can explain grief to poor people who have lived with war for decades. I know they mean well, but it is somewhat ridiculous. And I'm sure they will try again in Haiti.

Other highlights from his book:

- The author's main thesis is that America is exporting its views on mental health to the world, and actually homogenizing the way humans approach the subject. This is troubling because (1) the American way has its share of flaws and (2) the supplanting of older, local, EFFECTIVE beliefs on the psyche with modern American science has negative consequences, and also results in a loss of precious cultural knowledge. Instead, he thinks we should learn more and teach less, and cherry-pick what works best in various situations instead of completely relying on the American way. Like how herbal and Eastern medicine are popular when Western medicine fails, we should consider alternative approaches to mental health too.

- Clinical depression was very rarely diagnosed in Japan before the year 2000. People just dealt with their sadness privately, and didn't consider it a preventable disease. But then Glaxo-Smith-Kline wanted to sell more of their anti-depressants to the #2 economy, and started a major media campaign to Japanese doctors and such. Now Japanese consume over $1B/year in anti-depressants, yet suicides, happiness indices, and such are not any better.

- Anorexia was very rarely diagnosed in Hong Kong (and when it was, the symptoms were different than Ameican anorexia), but then there was a well-publicized death of an emaciated young woman in 1994. After that, curious media sources wanted to research the disease, and consulted the American psychological reference DSM-IV. By explaining what anorexia was (in the Western view at least), it got many women thinking that that they were afflicted. Eating disorder cases rose over 1000% by 1999, with 3-10% of young women showing some manifestations, this time perfectly in lock-step with the American definition.

- Strangely, with all our resources, "compassion", and science, a 30-year global WHO study showed that schizophrenics have a much lower relapse rate outside of the US and Western Europe, even in very poor nations with no available drug treatments. They attribute this mostly to culture: other "primitive" nations believe in superstitions suggesting that mental disease is not the patient's fault (evil spirits, curse, etc.), and in fact the community has a duty to support the sufferer and drive out the evil. Wheres in the West, we believe in the self-made man, and we believe that we are fully in control of our bodies. If we are sick in the head and not getting better, then we're not trying hard enough. So hovering, meddling relatives often judge and pressure schizos to improve. They think it helps, but it actually increases the chance of relapse. So the author is not saying that we should dismiss science and believe in demonic possession, but the ends can justify the means. If it works better (and costs a lot less) for them, then maybe their way has some value.

- You've all heard of those prison experiments where a subject will hurt a stranger (or thinks he/she is) under various stimuli. Researchers set up a study where a subject would administer a test on a person with mental illness either caused by genetics or by childhood trauma. If the ill person faltered, the subject would have the option to apply an electric shock of varying magnitude. It turns out subjects shocked the "genetically ill" patients harder than the "childhood trauma" ones. Science has tried to uncover genetic causes for various mental illnesses (but hasn't done a very good job so far). They believe that it will reduce the stigma of mental health if the causes are shown to be out of the patient's control. Like homosexuality is not a choice, but just nature. Well, the electric shock study showed that people are actually less compassionate to the mentally ill if they think their condition is genetic rather than social. So are we doing more harm than good?

- Manifestations of mental stress are very local and culturally dependent. Southeast Asia has a syndrome called "amok" (hence the term "run amok") where a young male will go on a violent rage and not remember anything. Victorian England saw many women exhibit "dead legs" and fear of paralysis when actually there was nothing wrong with their legs. This was possibly their subconscious responding to cultural pressures making women into fragile, inferior dolls to be kept by men. I wonder if modern American afflictions (PTSD, bipolar, ADHD, OCD, obesity, the list goes on and on!) are also our subconscious lashing out at social pressures that we can't deal with. We claim we are tough and we can deal, but obviously it's not the case. It's easy to say that it's just genetic and then pop a pill to fix it, instead of carefully examine possible cultural causes of these behaviors. Why is it that US soldiers are experiencing PTSD more frequently than foreign fighters in much nastier warfare situations? Maybe over-eating is a response to all the fast food media and rebelling against the health craze. Maybe ADHD is just bad parenting and a glut of distracting stimuli for youth. Maybe OCD cleanliness and home beautification are the result of all the germophobic paranoia in the mainstream, and the "house porn" on HGTV and such.

An explanation for the Haiti quake

http://www.politico.com/blogs/bensmith/0110/Robertson_Haiti_cursed_since_Satanic_pact.html

So according to Pat Robertson, Haitian rebels made a deal with the devil (yes, Satan) to free them from French rule, but as a consequence god has punished Haiti ever since (poverty, hurricanes, civil war), with this month's earthquake being the most recent manifestation of his wrath. And then Robertson said that he hopes this tragedy will help Haitians turn to god. Hello, Pat? Haiti is a predominantly Christian country (80% Catholic, 16% Protestant). Yes there's some black magic voodoo here and there, but I guess he wants them to all become evangelicals?

Granted that Pat is probably senile (he claimed to bench 300 lbs. or something, right?), his take on history can only be described as "whack". Haitan rebelled from France under Napoleon I, not III. Not sure if the devil had a hand in it, but Napoleon was less interested in France's colonies in the New World, and needed every able soldier for his invasion of Eastern Europe. That's also why he sold us Louisiana on the cheap, because he was desperate for war funds. Pat also said that the Dominican Republic is prosperous with resorts and such, compared to neighboring Haiti. Obviously he has never been there. They are clearly better off than Haiti (not hard to do since Haiti is the poorest nation in the Americas and ranked #157 by IMF's per capita GDP estimate of $1,300), but the DR is ranked #84 with a pcGDP of a mere $8,600. That is good for Central American standards, but they are still pre-industrial. Ask David Ortiz or Vlad Guerrero how wealthy they were growing up.

Part of Haiti's troubles is due to geography and bad luck, but their man-made "curses" are deforestation (logging has destroyed 98% of original forests, ruining farmland and accelerating erosion, which led to famine), colonialism (diseases killed practically all of the native Haitians so the current population are blacks, the US actually occupied Haiti for 20 years, and the dictator Trujillo we installed in the DR massacred thousands of Haitians too), and civil war (Haiti has had 32 coups, and the US took turns supporting and then kidnapping President Aristide, and since we left the nation deteriorated into failed state status).

BTW, Pat didn't seem to care but Int'l Red Cross, Medecins sans Frontiers, and UNICEF (among many others) are all having special collections for Haiti relief.

The CIA in the War on Terror

"And I think what one of the things this incident shows is just how - I mean, you could say desperate, but certainly eager - the CIA is for this kind of intelligence. He was promising kind of the big haul. He was going to give the location or at least give good intelligence about perhaps the number two operative in al-Qaida, Ayman al-Zawahiri. So the CIA brought its number two official from Kabul all the way to Khost for the meeting... I mean, [the drone bombing program is] nothing short of a war. It's a campaign going on, a military, quasi-military campaign that the CIA is carrying out and which the CIA is quite proud of, actually. They think that this is kind of the most effective thing that the U.S. government has right now to deal with al-Qaida."
- M Mazzetti, NYT nat. security correspondent

"If you have different personalities down range, everybody's worried about their rice bowls, and the next thing you know you have this kind of problem. People aren't talking to each other... I don't think we have any choice [that the CIA has to become a stronger paramilitary entity]. I do think we need to get a lot better at it. I don't think we have completed the evolution from a Cold War entity to what we need... I think it's going to take a consensus between the Congress and the president to really say we got to make some fundamental changes... We're still essentially using the same machine we had on September 10th, 2001."
- C Faddis, CIA

--------

Maybe you heard about the "double agent" Jordanian doctor who killed 6 CIA employees and a Jordanian Intel officer at a forward operating base in Afghanistan. Agents were supposedly trying to turn him into an asset, because he claimed to have knowledge of the location of a top Al Qaeda figure. But instead, he detonated a suicide vest during his debriefing, after he was invited to the base and not frisked. So instead of finding Zawahiri, we lost decades of cumulative intelligence expertise and called our entire human intel apparatus in that country into question. The Jordanian used to work in Palestinian refugee camps, and probably witnessed a lot of the suffering caused by the Arab-Israeli conflicts. He was a well-known anti-Western Islamic blogger too, but Jordanian Intel and the CIA seemed to think they had "de-radicalized" him, and he continued to blog just to maintain appearances.

Our new War on Terror is a bizarre chapter in the history of combat, because literally we have the conventional armed forces, private mercenaries, and the CIA all waging parallel wars and conducting independent operations in the same theater of battle. And in some cases, maybe the parties are not fully cooperating or even aware of the other's actions, but in fact are competing for targets/intel and unintentionally undermining overall strategy. Maybe you heard about reports of Blackwater Worldwide employees working with the CIA on raids in Iraq, or in some cases working on their own (under who's orders?), which has angered many in DC. Actually no different than the insurgents, the mercenaries were not trained by our government and have no legal accountability. Their only legitimacy is a contract from Baghdad (that we forced them to sign) permitting them to do business in-country until a given expiration date. Yet they are highly paid, heavily armed, and (were) pursuing high-value targets in Iraq. Since Afghanistan is even more Wild West (they don't even have a single km of railroad), I can only imagine what unauthorized activities may go unmonitored. Though due to the terrain and lack of infrastructure, aerial drones seem to be the tool of choice.

I guess a lot of the War on Terror is assassinations and intel gathering (and torture), so of course the CIA should play a prominent role, but they are also used to working without rules and oversight. They have already received some bad publicity over rendition flights, Abu Ghraib, and Gitmo, but they have probably also gathered intel (by what means, we may never know) that helped prevent some attacks on the West. Prior to our full invasion of Afghanistan after 9/11, the CIA and special ops forces did heavily pursue Al Qaeda at the end of 2001 and decimate much of Osama's core members (they may have even wounded him at Tora Bora). But political hesitation and territorial disputes by Bush's cabinet stalled their advance and allowed the Al Qaeda survivors to escape to Pakistan.

Also the CIA may not have the best reputation in Afghanistan due to the events at the end of the Soviet occupation. While the CIA unofficially armed and trained the Mujahadeen, through Pakistan's Inter-Services Intelligence, to improve their insurgent capabilities (as depicted in "Charlie Wilson's War", and see my previous posting: http://worldaffairs-manwnoname.blogspot.com/2008/05/charlie-wilsons-war-and-bs-revisionist.html), after the Soviet withdrawal the US let the nation deteriorate into civil war and Islamic fundamentalism. Stemming from Vietnam, I think the US defense establishment is very sensitive about being labeled as people who abandon their friends. But the perception in Afghanistan was that the CIA was only interested in using the Muslims to spill blood fighting the rival Soviets, and afterward the US couldn't care less about their problems.

I have no doubt that many in the CIA are dedicated patriots with great talent for their difficult job, and they have saved American lives over the years. But they also have that reputation (deservedly in some cases) of just using people to accomplish their narrow objectives. As depicted in films like "Spy Game", "Syriana", and "Body of Lies", the CIA are arrogant, cocksure, scheming, pathologically ambitious, and uncaring. Flesh and blood people become expendable "assets", little respect is shown to allies, pissing contests abound, and the mission always comes first despite what broken laws or collateral damage may ensue. Obviously Hollywood's depiction is sensational, but also plays out in reality: the Iran-Contra scandal, and more recently Extraordinary Rendition, and just last year 2 high-level employees were dismissed for a sex scandal and corruption.

If many Americans are already suspicious of the CIA after Watergate and whatnot, just imagine how the rest of the world, and specifically parts of the Muslim world caught in our wars, feel about the CIA. I know it is a dirty job and the CIA works with lying, treacherous scumbags. You use me and I use you. I think we all accept that as part of the spy game, but then they shouldn't expect locals to go out of their way to help us, especially when helping us could be viewed as a betrayal of their faith and heritage. They know that we don't give a hoot about them, and when they are no longer useful to us, we will cut them loose (like all the Iraqi translators who risked their lives and their families to help us, and we don't even compensate their next of kin with money or visas after they are killed). Potential assets and their affiliates also know that we are very interested in them, which may leave us vulnerable as we saw in Afghanistan. Many foreign intelligence agencies that we work with also probably know that the CIA looks down on them and won't share much useful information. In a more public example, our close ally Italy has issued warrants for the arrests of several CIA operatives relating to the kidnapping of an Islamic cleric in Italy. Though there probably was a secret NATO agreement to permit CIA agents to "do their thing" in Europe, Italian laws were broken. Everyone's a liar and there is no trust; actually it's a miracle that anyone can get reliable human intel these days. Maybe the CIA officers who were killed by the Jordanian bomber were so ambitious to get credit for assassinating some Al Qaeda big shot, that they ignored their better judgment and suspicions about him. Obviously they violated base security protocol to allow the bomber to do such damage, and we may never know what really happened.

But tragic events such as this, or the public burning of private security guards in Iraq a few years ago, should show that occupied peoples do not approve of some of our methods. I would hope that the Cold War taught us that it's wrong for global powers to meddle in Third World nations and treat their people like chess pawns in a high-stakes power game. True alliances and partnerships are built on honesty and respect. That is why I am dubious of our uniquely intimate alliance with Israel, since Israel doesn't seem to heed our concerns very often (calls to end heavy shelling in Gaza or settlement building in the Occupied Territories often go ignored), and Mossad agents are occasionally caught spying in the US. If that is how Israel treats its closest friend, I wouldn't want to be her enemy. But getting back to the CIA in the War on Terror, I know a lot of the challenges they face are unprecedented. So maybe new approaches and more sensitive techniques are appropriate, instead of the same old macho spycraft. Fortunately much of our intel is gathered electronically, thereby reducing the human evil factor. I know CIA agents can't coddle terrorists and take them to tablecloth dinners (well, the Algiers station chief dismissed over his sex scandal often took assets to strip shows to turn them), but we have to move beyond turf wars and waterboarding. Many government agencies resist change or outside advice, and I think the CIA takes it to another level. After almost a decade since 9/11, they and the military still have a recruiting shortage of Arabic speakers and Mideast experts.

Expanding these points to the larger War on Terror, it is clear that there is a sea change. Domestic law enforcement apprehended more suspected terrorists (and foiled potential attacks) in 2009 than the previous 4 years combined. This coincides with increased covert drone attacks and raids on the Pakistani border that claimed to kill Al Qaeda leaders. In fact, under Obama we have killed more alleged Qaeda leaders than during Bush's last 3 years in office. So Al Qaeda is hurt badly, getting desperate, and forced to adapt. They are stepping up their plans to attack the West, and since all failed, we can only assume that they were more rushed and frantic with their planning. But another new development is that the alleged attackers were mostly non-Arabs from Al Qaeda affiliate groups. They visited Somalia or Yemen. So Al Qaeda rebuilt after 9/11 and gained enough strength to destabilize Pakistan and Afghanistan in recent years. But now they are getting hit harder, and forced to go underground again. But they are sending their people to friendly organizations in other parts of the world under less US scrutiny. And that seems to be where this new breed of attacker is emerging from. This illustrates the problem with counter-terrorism and unconventional war in this globalized world. We might smash the vase, but the fragments of porcelain spread everywhere and slip through our fingers. So now we have a bigger mess on our hands. Maybe it was better when Al Qaeda was more complacent and contained in the Pakistan border areas. Just like our mistake with Saddam and Iraq, sometimes it's better to tolerate a monster in a cage, then try to completely destroy that monster and create dozens of new ones.

" 'In essence, these [Al Qaeda] operatives are being sent out as force multipliers, to plus up or strengthen or to enhance the capabilities of local and region allies,' says [Georgetown Univ. security expert B Hoffman]. He believes they are attempting to 'overwhelm the U.S. and other enemies with a strategy that amounts to death by 1,000 cuts.' "
-NPR

So even though we lucked out on Christmas, we can't be lucky forever. Maybe we should rethink our tactics, because a minimal, contained, centralized terror threat, while worse than an absence of terrorism, is much better than a dispersed, multiplying terror threat.

http://www.npr.org/templates/story/story.php?storyId=122436089
http://www.npr.org/templates/story/story.php?storyId=122319659
http://www.defpro.com/news/details/12317/
http://en.wikipedia.org/wiki/CIA_activities_in_Afghanistan
http://www.washingtonpost.com/wp-dyn/content/article/2009/12/10/AR2009121004700.html?wprss=rss_politics
http://www.washingtonpost.com/wp-dyn/content/article/2009/03/19/AR2009031904134.html
http://thestar.com.my/news/story.asp?file=/2010/1/12/worldupdates/2010-01-12T023641Z_01_NOOTR_RTRMDNC_0_-453165-1&sec=Worldupdates
http://news.bbc.co.uk/2/hi/europe/6732897.stm

Fallout from the lap bomber

We are very lucky that Abdulmutallab's device malfunctioned and hundreds of lives were spared. Yes it's unfortunate that intelligence agencies couldn't share information more freely (8 years after 9/11), and red flags weren't raised by his father's concerns and his cash purchase of an airline ticket. The media are going bonkers over this with 24-7 coverage and nonstop speculation, outrage, snap judgments, finger-pointing, or a combination of those. But for the millions of airline passengers who enter and leave our country every year, it's impossible to conduct thorough background checks and body searches, or run them through million-dollar scanners, unless we want our homeland security costs to eclipse our health care spending (and our civil liberties to be trampled). Plus it's quite a challenge and maybe foolhardy (or illegal) to investigate the millions of people who browse violent, religious, or anti-Western content on the Web, or are affiliated with someone who does. The Secret Service doesn't even have the manpower to fully investigate all the threats against Obama (up 400% vs. Bush).

Bad driving (not wearing seat belts, DUI, cell phone use) and medical malpractice claim more lives each year than terrorism, but we accept those ills to a certain extent, or at least we acknowledge that a "zero tolerance" mandate is impossible. We do what we can to minimize the risks with legal penalties and technology safeguards, but we concede that some lapses will occur. But with terrorism, why do we have to be so irrationally rigid? Now many air travelers are worried that they will be next, and even Des Moines airport is on high alert. But each time we drive to work, do we fear that we will become the next roadkill? Instead we're probably speeding because we're late, or calling a loved one, which ironically increases our chance of dying. So why the paranoia over terrorism? I know premeditated murder out of hatred or an extreme agenda is more jarring to the soul, but all preventable deaths are equally tragic. I think in risk consulting, they calculate the risk level by multiplying the likelihood of occurrence by the magnitude of harm (simplified I know). A driving death is higher on the former and lower on the latter (globally), and terrorism is the inverse. Maybe the actuaries can determine which one we should be more scared of, but I doubt it's terrorism.

Yes it's true that a major, traumatic event like 9/11 can disrupt the global economy and set our country back for years, not to mention all the lives and resources lost. We should do our best to prevent the big attacks, but independent "lone wolves" like Abdulmutallab (assuming he was not helped on scene) are impossible to thwart 100% of the time. We didn't stop the home-grown Unabomber and DC snipers until it was too late either. It is disconcerting that terrorists seem fixated with air travel instead of the other more vulnerable soft targets (smuggling a bomb in ship cargo, attacking commuter trains like in India, even cyberwarfare). Probably the fact that we are so obsessed with air safety makes them more motivated to defeat us there. Clearly our enhanced surveillance and tighter visa restrictions have helped keep us safe (though also created major headaches for innocent immigrants and students), and the proof is zero Americans killed on US soil by terrorists since 9/11. Even our hundreds of foreign missions abroad haven't been attacked (apart from our 2 war zones). But the blowback from our foreign military actions may take another decade to fully develop and sting us.

Americans are obsessed with guarantees and control. We expect our stock portfolios and home values to rise indefinitely. We expect to get promoted if we work hard. We expect that our flights will be on time and our cars won't break down. We expect that our government will keep us safe. Much of the time those things happen, but life is unpredictable. Several Americans just died from freak accidents while I typed this paragraph. But because we demand such flawless performance and guarantees of life, liberty, and happiness, we may over-react and resort to extreme measures in a futile attempt to maintain our values through adversities beyond our control. Afghans and Iraqis live with the very real possibility of a fiery death each day, but they are not paralyzed by fear, obsessed with security, and violent towards any perceived threat. The Serenity Prayer reads, "God grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference." I think America's counter-terrorism efforts, while so far successful in keeping us safe, are lacking in all three. Maybe the last portion of the Serenity Prayer should read, "And when I fail in those attempts, God grant me luck to survive my shortcomings." Those survivors of the Northwest flight are alive today more due to luck than our counter-terrorism efforts.

In keeping with tradition, when the US is attacked (or almost attacked) from abroad, we respond by bombing some poor bastards within a month. As we speak, the Pentagon is making a list (and checking it twice) of potential Yemeni targets. The Muslims spoiled our day to celebrate the birth of the Prince of Peace (even though more people were murdered in Jesus' name than Muhammad's so far), so now Santa has a big lump of coal for Al Qaeda and any bystanders in their vicinity. CNN reported that we have a classified agreement with the Yemeni gov't to fly cruise missiles, fighter jets, and armed drones against targets in Yemen. So we have even more leeway than Pakistan, and in fact have bombed a suspected Al Qaeda camp there in early December. Well, Obama is sending 30,000 more Marines to Afghanistan, a nation with fewer than 200 original, Arab Al Qaeda members. Yemen, on the other hand, may have several hundred Al Qaeda fighters as well as high-ranking leaders, so I suppose an attack there would be more justified. But as many analysts have already warned, the Somalia and Pakistan examples show us that brash military strikes by a foreign power (even against legitimate, dangerous targets) may provide some strategic gains, but ultimately undermine the fragile local government and actually make failed state conditions more likely (an eroded rule of law and increased violent extremism against foreigners and their local allies).

http://www.cnn.com/2009/WORLD/meast/12/29/us.yemen.strike.targets/index.html

Comparing the House and Senate Health Bills

Kind of funny (or not): in order to get conservative Dem. Senator Nelson from Neb. to vote for the health bill, Reid and Co. cut a deal.

"The Nebraska compromise, which permanently exempts Nebraska from paying Medicaid costs that all other 49 states must pay, may violate the United States Constitution — as well as other provisions of federal law," Texas Attorney General Greg Abbott said.

... [The Senate] bill was amended to shield Nebraska from the expected $45 million annual cost tied to expanding Medicaid programs.

Comparing some aspects of the House and Senate bills:

http://buzz.yahoo.com/buzzlog/93274

http://www.bloomberg.com/apps/news?pid=20601070&sid=aim3g2AJwUHI

Obama's (d)evolution on the public option:

Candidate Obama, 2008: The Obama plan will establish a new public insurance program available to Americans who neither qualify for Medicaid or SCHIP nor have access to insurance through their employers, as well as to small businesses that want to offer insurance to their employees. And again in another statement.... For those without health insurance I will establish a new public insurance program. (though he never once verbalized this in a speech)

President Obama, July 2009: I am pleased by the progress we’re making on health care reform and still believe, as I’ve said before, that one of the best ways to bring down costs, provide more choices, and assure quality is a public option that will force the insurance companies to compete and keep them honest.

President Obama, Aug-Dec 2009: [The public option was only a] sliver of my health care proposal.... I didn't campaign on the public option.

http://salon.com/news/politics/barack_obama/index.html?story=/politics/war_room/2009/12/22/obama_public
http://www.whitehouse.gov/the_press_office/Statement-from-the-President-on-Health-Care-Reform/

Got Merck? A day in the life of Big Pharma

Move over milk... Merck is so determined to help your grandma maintain strong bones that you won't believe the lengths they've gone.

With our female family members nearing retirement age, I am sure you've seen a bottle of calcium supplements or other bone-promoting medications on their kitchen table. Clearly osteoporosis is a health concern (especially for women, who lose bone more rapidly than men due to hormone changes after menopause), and we all know of a senior citizen whose quality of life was really impacted by broken bones from a fall (even 1 in 5 elderly women will die a year after a broken hip, due to other health complications associated with their disability). In the last decade or two, new specialty drugs have emerged that proactively reduce the chance of osteoporosis, and have blossomed into a multi-billion-dollar industry (since the trick with preventative drugs is you never know if you'll truly be at risk, so you better take them for the rest of your life to be safe).

Obviously osteoporosis doesn't occur overnight; there is a gradual loss of bone tissue, like how mild senility precedes dementia and Alzheimer's. So the "onset" of osteoporosis is named osteopenia, or bone thinning. But like senility, humans lose bone mass normally with age. So when is bone loss pathological? When do women reach the osteopenia zone (I'll refer to it as OP from now on)? Well, the cutoff point was literally decided arbitrarily by a room of bone experts at a WHO summit (they drew a line on a graph and that settled it). Unfortunately, many human diseases are not understood and merely classified by a set of symptoms that reach an arbitrary degree of severity, with clinical depression being an obvious example. Getting back to OP, the "disease" was decided to apply to people who were hovering near the osteoporosis cutoff.

Merck happened to have a bisphosphonate drug (later marketed as Fosamax) that inhibits the cells that digest bone. So without those cells' normal or pathological activity, osteoporotic people will lose bone slower. The problem is that bone is like a highway. It needs to be maintained and repaved occasionally from all the wear and tear. Those cells don't eat bone to be mean. They clear out old or weakened bone so other cells can lay down new, stronger bone. The renewing miracle of life. And the bone-laying cells do so very messily, like a kid with paint. The bone-eating cells are critical to remodel the bone, repair micro-cracks, and make it more structurally sound. Addition by subtraction. So actually a femur with more bone mass may be weaker than a thinner femur that is remodeled correctly by the bone-eating cells. So it's good that Fosamax stops over-active bone-eating cells from making a person's bones dangerously thin, but then over time the patient also loses some ability to maintain the strength in their bones through normal remodeling. In addition, Fosamax-type drugs are implicated in dozens of side-effects, and over 400 lawsuits were filed against Merck for the disease ONJ (in brief, wasting away of the jaw due to inability of that bone to heal after dental work, etc.).

But no bother, Merck wanted to sell Fosamax to the droves of aging people who were living longer, and would need to pop these pills for decades. Their major problem was people weren't using Fosamax, because they weren't getting diagnosed with osteoporosis until after they'd had an accident and doctors could examine their bones. Old people get more frail and reduce their activities. No one thinks that could be the sign of disease. Whole-body DEXA bone scans did exist in the 1990s, but they were costly ($200-300, and not covered by insurance) and there weren't many clinics that had the bulky pool-table-sized devices (~200 in the entire US). So Merck hired a team of consultants to fix the dismal situation. Bone scanners would be in every town, and older people would get scanned often (if they were successful).

So Merck set up a shell nonprofit called the Bone Measurement Institute (that employed an entire one person), and some top orthopedists became affiliated. They pushed doctors to use a peripheral, portable bone scanner that measured forearm or heel bone density, in order to extrapolate that to spine and hip bones (the bones that, if broken, would cause the most trouble for an osteoporotic patient). But doctors were hesitant: bone is highly dynamic and responds to the specific local loads upon it, and a vertebra is a lot different than a mandible (so you can't know the weather in London by looking out your window in Paris). The manufacturers of the traditional bone scanners were irate about this new competition in their niche market. Since they sold few traditional scanners per year, they needed to make them very expensive to recover costs. When Merck's portable scanner project didn't pan out, they decided to buy a traditional bone scanning company instead. Merck then slashed the cost of traditional scanners, forcing competitors to do the same or go out of business (and some did). So Merck won two-fold: they got revenge on the scanner companies who obstructed them, and cut the cost of scanners to facilitate their dissemination across the country (and reduce the scan costs to patients, making it more likely that they would seek one). They closed their scanner company soon afterward.

Merck funded clinical trials and submissions to the FDA to also get the peripheral scanners approved as diagnostic tools. They literally went door-to-door and even organized leases with doctors. Such measures to get more patients on their drug. Just imagine if they invested all that effort and resources into science, to actually understand human diseases better and design drugs more intelligently. But they're not a charity after all. Though of course better drugs will sell themselves and cost the company less in failed multi-million-dollar clinical trials and litigation. Anyway, Merck didn't stop there. They funded some third-party org's to lobby Congress to pass the Bone Mass Measurement Act in 1997, which made bone scans eligible for Medicare reimbursement (and some private insurance did the same). Now pay-for-service physicians could make good money on simple-to-perform bone scans. But for all its inefficiencies, Medicare conducts periodic cost effectiveness analyses, and they have wizened up to the game. In 2007 they decided to cut bone scan reimbursement from $140 to $60, based on expectations that the scanners should get cheaper with scale, and the procedure was much less laborious to doctors than previously assumed.

Of course those groups and the bone-related medical community were outraged, and the decision may get overturned. They want every woman over 65 to get scanned yearly, and maybe some men too. But mass screening is a double-edged sword. They help identify truly needy patients, but also flag many false-positives. That is why the NIH recently changed its mammogram guidelines for women, raising the recommended starting age from 40 to 50. This decision is controversial, but their complex data suggested that the scans don't improve public health enough to justify their costs (worrisome specks on a scan require the patient to get a biopsy, which ends up causing stress and revealing nothing).

Merck also won approval for a low-dose version of Fosamax targeted for potential OP patients. So even though their risk of a debilitating bone break was no different than their general demographic, they could be put on a daily regimen just because a bone scanner reported that they were in the vague OP risk zone. Even some athletic, pre-menopausal women were classified as osteopenic (though that is no guarantee they will be osteoporotic later in life). "Mild bone thinning" isn't so bad, like graying hair or wrinkles. It's part of aging. But "osteopenia" sounds scary, right? Gradually wasting away, and maybe losing your freedom and mobility from a sudden fall. No one wants to die like a zombie in a hospice facility. So take this magical pill every day and rest easy. And of course Merck blitzed the media with direct-to-consumer advertising, and word spread among seniors. From 1994-1999, the number of bone scans performed in the US increased from 77K to 1.5M (yet still only 13% of women over 65 get the scan, so Merck has more work to do), and orders for scanners went up 500%.

This is great news, right? There are several positive Fosamax papers published, but a recent study from the Univ. of Washington concluded that Fosamax was only effective in reducing the risk of spinal fractures (especially for patients who have already had a break), which is only a tiny subset of total fractures for the elderly. That makes sense, since your bones respond to a fracture by dumping a bunch of new, low-quality bone on the injury site (like a quick and dirty spot-weld), so Fosamax's mechanism of action should preserve that from deterioration. Though the injury site may never recover to original strength with impaired bone-eating cells. For the prevention of more common hip or leg breaks, the drug was no better than placebo. So even though it results in denser bones biologically, if that doesn't translate into better clinical outcomes, then what's the point? If grandma falls on her driveway, probably 2% more bone density won't save her. Unfortunately no studies are planned to examine the long-term effects of Fosamax, which bewilders me because I thought the FDA requires that. But researchers are concerned that the drug may actually increase fracture risk over time, since it impairs micro-damage healing. If you just dump a bunch of steel onto an already craggy bridge, you may be doing more harm than good (as we in the SF area know).

In closing, the Fosamax story mirrors many drugs out there in your parents' medicine cabinet. Fosamax sales doubled from 2001-2004, and are now over $3B/year. It is on the top-10 list of all-time blockbuster drugs. Although Merck's patent recently expired, brand-name Fosamax costs $90/month, which translates to $16.2K for a patient taking it from age 70 to 85 (excluding medical labor costs). Yes it's true that the drug does help a subset of patients who really need it, and has allowed some seniors to enjoy life longer. But the caveat with preventative drugs is we'll never know if the patient would have been relatively okay without them. The drug has also sickened and killed others. Eating right, weight-bearing exercise, and vitamins also promote bone strength (and don't have side-effects). And to be clear, Fosamax doesn't generate more bone for seniors, it just slows normal or pathological bone loss (so it can't "reverse" OP). But don't worry, the industry took notice and next-generation bone drugs are in development. The "business of medicine" is not so altruistic. Sometimes pharma will persuade doctors, device makers, and the government to tailor diagnoses (or even invent diseases) to fit their drug. And if demand isn't high, they will make it so with marketing campaigns, lobbying, and low-dose or "preventative" formulations for people who "could be at risk". Too bad nothing exists in the 2009 health reform bill to expose or regulate this.

http://www.npr.org/templates/story/story.php?storyId=121609815
http://en.wikipedia.org/wiki/Fosamax

Health care bill making progress

By DAVID BROOKS
Published: December 17, 2009 NYT
Times Topics: Health Care Reform
Readers' Comments

Readers shared their thoughts on this article.

* Read All Comments (190) »

The first reason to support the Senate health care bill is that it would provide insurance to 30 million more Americans.

The second reason to support the bill is that its authors took the deficit issue seriously. Compared with, say, the prescription drug benefit from a few years ago, this bill is a model of fiscal rectitude. It spends a lot of money to cover the uninsured, but to help pay for it, it also includes serious Medicare cuts and whopping tax increases — the tax on high-cost insurance plans alone will raise $1.3 trillion in the second decade.

The bill is not really deficit-neutral. It’s politically inconceivable that Congress will really make all the spending cuts that are there on paper. But the bill won’t explode the deficit, and that’s an accomplishment.

The third reason to support the bill is that the authors have thrown in a million little ideas in an effort to reduce health care inflation. The fact is, nobody knows how to reduce cost growth within the current system. The authors of this bill are willing to try anything. You might even call this a Burkean approach. They are not fundamentally disrupting the status quo, but they are experimenting with dozens of gradual programs that might bend the cost curve.

If you’ve ever heard about it, it’s in there — improved insurance exchanges, payment innovations, an independent commission to cap Medicare payment rates, an innovation center, comparative effectiveness research. There’s at least a pilot program for every promising idea.

The fourth reason to support the bill is that if this fails, it will take a long time to get back to health reform. Clinton failed. Obama will have failed. No one will touch this. Meanwhile, health costs will continue their inexorable march upward, strangling the nation.

The first reason to oppose this bill is that it does not fundamentally reform health care. The current system is rotten to the bone with opaque pricing and insane incentives. Consumers are insulated from the costs of their decisions and providers are punished for efficiency. Burkean gradualism is fine if you’ve got a cold. But if you’ve got cancer, you want surgery, not nasal spray.

If this bill passes, you’ll have 500 experts in Washington trying to hold down costs and 300 million Americans with the same old incentives to get more and more care. The Congressional Budget Office and most of the experts I talk to (including many who support the bill) do not believe it will seriously bend the cost curve.

The second reason to oppose this bill is that, according to the chief actuary for Medicare, it will cause national health care spending to increase faster. Health care spending is already zooming past 17 percent of G.D.P. to 22 percent and beyond. If these pressures mount even faster, health care will squeeze out everything else, especially on the state level. We’ll shovel more money into insurance companies and you can kiss goodbye programs like expanded preschool that would have a bigger social impact.

Third, if passed, the bill sets up a politically unsustainable situation. Over its first several years, the demand for health care will rise sharply. The supply will not. Providers will have the same perverse incentives. As a result, prices will skyrocket while efficiencies will not. There will be a bipartisan rush to gut reform.

This country has reduced health inflation in short bursts, but it has not sustained cost control over the long term because the deep flaws in the system produce horrific political pressures that gut restraint.

Fourth, you can’t centrally regulate 17 percent of the U.S. economy without a raft of unintended consequences.

Fifth, it will slow innovation. Government regulators don’t do well with disruptive new technologies.

Sixth, if this passes, we will never get back to cost control. The basic political deal was, we get to have dessert (expanding coverage) but we have to eat our spinach (cost control), too. If we eat dessert now, we’ll never come back to the spinach.

So what’s my verdict? I have to confess, I flip-flop week to week and day to day. It’s a guess. Does this put us on a path toward the real reform, or does it head us down a valley in which real reform will be less likely?

If I were a senator forced to vote today, I’d vote no. If you pass a health care bill without systemic incentives reform, you set up a political vortex in which the few good parts of the bill will get stripped out and the expensive and wasteful parts will be entrenched.

Defenders say we can’t do real reform because the politics won’t allow it. The truth is the reverse. Unless you get the fundamental incentives right, the politics will be terrible forever and ever.

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I've gone back and forth on this bill; but in the end, I come out with Krugman and Victoria Kennedy. It's far, far from ideal, but the system it will create is better than what we have now. The fight for a better and democratic (note the lower case "d") health care system will have to continue. For now, the corporate/insurance interests are still controlling the democracy through 'divide and conquer' techniques based on misleading information and arguments. The fact that Palin's 'death panel' arguments (or Glen Beck's idiocies) can resonate with any appreciable segment of the U.S. population tells us all we need to know about the failure of our basic (K-12) education system to teach critical thinking. In the meantime, the fact that 30 million more Americans will be able to get health insurance is no small matter, nor is the fact that a person, who now can't get any insurance because of pre-existing conditions, will be able to (even if the premium will be higher, so long as it can be paid, it beats a family losing everything it owns in order to pay for health care for a sick or injured family member). - - -


Paul Krugman: Pass the Bill
http://www.nytimes.com/2009/12/18/opinion/18krugman.html?_r=3&scp=3&sq=krugman&st=cse

Victoria Kennedy: Health bill 'imperfect' but necessary: Kennedy widow
http://www.google.com/hostednews/afp/article/ALeqM5j0m7LbkCWtIOGK-kQWO3bZQDnuug

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even without lowering the cost, of course the whole point to the health care reform was to extend health care to millions of "healthy" americans without healthcare so that we can keep them healthy and keep them from having catastrophic events that could have been prevented earlier.... this is the biggest way to save healthcare spending in the decades to come. But if we were to simply lower the medicare age, we lose on this point because now we are enrolling younger retired age population who may already have catastrophic event, only now on medicare. without lowering the cost then truly, where is the benefit besides more "old=potentially sick but yet undetected" people get sick on government plan and increase our health care spending. then we fall back to our last weakest point of passing health care reform, we just pass something so that it is easier for us to modify this one in the future than try to write the whole thing from the beginning and also have the pop get used to the idea so that next modification comes around ppl are less scared.. so we hope...

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I see where Krugman is coming from, and if I was a Senator (heaven forbid!), I would be forced to support the bill too. But it's tragic that our legislative system allows one or two senators to take a major historic reform hostage, and it's unfortunate that there is so much misinformation and so little support for single-payer reform and inevitable health care rationing.

Surely passing this bill is preferred to the status quo, and yes some incremental improvements can be made to the legislation over time, but I think the bill squanders our current rare opportunity (with all the stars in alignment) for fundamental reform of cost-incentive-accountability structures that is truly needed. Obama and others have said that if we don't pass health reform now, we'll have to wait another generation as costs continue to rise. Politically that is possible (hard to get a fillibuster-proof majority in the Senate to coincide with an administration of the same party), but I think the huge economic pressures of pricier care, plus the retiring Boomers, will compel us to revisit the health debate more frequently. Who knows if future presidents will be more Bush than Obama, and when the next Ted Kennedy will emerge to keep the Senate morally grounded? I think many progressives are disappointed that this is the best "change" we can get with Obama at the helm and a solidly Democratic (though still centrist-conservative) Senate.

The House version has the public option, foreign drug imports, tougher abortion restrictions, and more mandates for insurers (85% of premiums must be paid out as benefits, more oversight, less monopoly). All of those are toxic to Senators, so they'll probably be scrapped. But without the abortion amendment, I don't know if the Blue Dog House Dems will be on board with 2010 midterms around the corner (does Pelosi have a majority without them, Joseph Cao notwithstanding?). Liberal Reps have a right to be pissed about this bill, but I think they will end up voting for the Senate version rather than causing trouble and fragmenting their own party that is desperate for a political win. The Senate wants to tax Cadillac health plans and curb the wasteful Medicare Advantage program, but both are very unpopular with the rank-and-file, pro-union House Dems. So I guess it's not a sure thing Obama will sign this sucker by Christmas, and of course the GOP will do everything they can to stall and let the holidays sap momentum away.

What sucks is that the "party of no" GOP more or less walks away clean. The right wing spin suggests that they were the "patriots" who fought to protect the "good ol' American values of freedom and small government" in health care from a radical Obama who hates white people, but really they were just boulders in the road of inevitability. They'll declare victory because they killed the public option and "socialized medicine". If we want to go broke continuing to over-medicate patients, over-pay doctors/insurers, and under-perform in this country, then by all means do nothing. But the GOP literally didn't offer any constructive alternatives during this whole 6-month process. Obama should have never tried to take the bipartisan route - he'd have better luck negotiating with North Korea. Did he really expect them to cooperate on making him look good? The minute the right started mouthing off and misbehaving, he should have put them in their place. If he came down on them in the bold, righteous manner that he delivered his Nobel speech, we'd be in much better shape now. But instead the Dems were timid all summer while the tea parties and talk show hosts sowed the seeds of confusion and misplaced anger.

Importing foreign drugs?

Here's another disappointment that isn't totally surprising: there was an amendment under vote in the Senate yesterday on whether to allow cheaper foreign drug imports to the market to keep US drug pricing more honest. But the measure failed 48-51. Sponsored by Sen. Dorgan, he estimates that the provision would save $10B and also includes some rigorous safeguards. A similar measure is already in the House health bill that passed. As you would expect, the Senators who voted nay to block cheaper imports received on average 70% more funding from pharma-related sources than the yay votes (see list in first link at the end). But maybe the vote is a moot point anyway, since the Obama administration already cut a boneheaded deal with PhRMA that I previously emailed about (http://worldaffairs-manwnoname.blogspot.com/2009/08/health-care-overhaul.html), and the Dorgan amendment would violate that agreement.

I know there are safety and quality issues associated with drugs from any origin, but we currently allow imported food, vehicles, toys, building materials, and such - all of which can and have sickened and killed Americans. European laws enabled drugs to cross their borders to different markets for the last 20 years, and their safety record is no worse than ours. Even according to Pfizer's (biggest pharma in the world after merging with Wyeth) former marketing VP Dr. Peter Rost, drugs that are made at the same plant and have the exact same safety profile are sold in the US for prices up to 10X higher. Why? He was fired from Pfizer soon after he made these claims on "60 Minutes". I find this issue ironic because those "socialist Europeans and Canadians" actually maintain a mostly free market for drugs and private insurance, while capitalistic, laissez-faire America practices protectionism and monopoly. And then they play the "safety" card any time their profits are challenged.

Safety huh? Foreign-made stuff is always worse than American (tell that to Detroit). Let's not forget that some "American" drugs are already manufactured overseas for cost savings and tax evasion (but still are FDA-approved as if the plants were on US soil). Pfizer alone has plants in Belgium, France, Germany, Ireland, Japan, and Puerto Rico. In fact they may not have any US manufacturing, or due to the Wyeth merger it will be heavily downsized. Plus plenty of American-made and FDA-inspected drugs have hurt people too (Vioxx, Yaz, Celebrex, heparin, and most recently a recall of H1N1 youth vaccine that isn't toxic but sub-potent).

If the laws are written intelligently and regulators and manufacturers cooperate on due dilligence, then threats to public health should be minimal, or at least not much worse than at present. 6% of the world's people live in North America, yet our region accounted for 43% of global drug sales in 2007. And I don't think most of those drugs went to people in Chiapas or Winnipeg. We are the drug maker's cash cow, so obviously they will do everything they can to preserve the status quo.

http://maplight.org/dems_senate_pharma_prescription_drugs
http://www.seniormag.com/canadianpharmacy/articles/safe-medications.htm
http://www.tmcnet.com/usubmit/2009/11/13/4479586.htm
http://www.cbsnews.com/stories/2005/06/03/60minutes/main699606_page3.shtml
http://www.drugrecalls.com/

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Unfortunately, this is all about what you describe as 'the boneheaded deal with PhRMA.' For some reason, and maybe he was right, Obama felt he had to cut the deal (caveat: I don't think this has ever been officially admitted to) in order to get national health care reform. The deal was apparently intended to get PhRMA on the side of "reform" and not use its vast resources to lobby and advertise against it. A deal with the devil, perhaps, but there's nothing pure or angelic about politics.

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But that's what worries me. Obama stated that he would make the health bill negiotations transparent and even broadcast the Congressional discussion on C-SPAN. That hasn't really happened. I think it's unrealistic to expect lawmakers to go on camera with their various proposals and deals anyway. But there shouldn't be such secrecy with the industry reps either. You're right that the White House initially denied any PhRMA deal, but the Huffington Post obtained a leaked memo, and later the WH eventually admitted to it, as reported by the LA and NY Times.

http://www.nytimes.com/2009/08/06/health/policy/06insure.html?_r=1

It shows disrespect for the public when he claims to shun lobbyists and keep the people first, yet he practices politics as usual (well, not as bad as Cheney and the oil companies at least). Who knows what deals are going on with doctors and insurers now? As you said, Obama needed to get PhRMA on his side of the health debate (or at least not fighting him tool & nail), but that hush-money comes at a huge price. He claims $80B in drug savings over 10 years (meager vs. the total cost of the health bill), but he's also protecting PhRMA's $1 trillion/year (and rising) bloated revenues. Like loan sharking, getting a little now, but paying a lot later. And obviously no business would agree to a deal unless it was a net gain for them (AOL-Time Warner notwithstanding haha). PhRMA's financial analysts are a lot better, and better paid, than Obama's.

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"The FDA has stated that it does not have the funds nor bear the responsibility to inspect on a regular basis overseas manufacturers of active pharmaceutical ingredients such as heparin."

Currently the FDA expects companies to inspect their foreign subcontractors or facilities, and report findings to them. The FDA only has the resources to inspect US sites like once every 1-2 years anyway.

The Chinese case was just plain counterfeiting. They usually sell heparin derived from pig blood, but in the case of Baxter's subcontractor, they diluted the heparin with cheaper, heparain-mimicking chondroitin sulfate from shellfish. So there were allergic reactions and deaths of patients who can't handle shellfish proteins or chondroitin.

http://www.cbsnews.com/stories/2008/03/01/eveningnews/main3896578.shtml
http://www.drugrecalls.com/heparin.html