How USA spends so much money to fight malaria in other nations

January 2, 2016

Fighting malaria is difficult, and complex, and expensive. No magic bullet can slow or stop malaria.

Reasonable people understand the stakes, not only for Africa, where $12 billion is lost every year to malaria illness and death, according to WHO records; but also for all nations who trade with Africa and other malaria endemic nations in the world.

What should we do about malaria?

Before we leap to solutions, let us look to see what the United States is already doing, according to USAID, the agency which has led U.S. malaria-fighting since the 1950s.

USAID explains on their website:

Fighting Malaria

A mother and child sit under the protection of malaria nets

A mother and child sit under the protection of malaria nets. Learn more about PMI’s contributions to the global fight against malaria. Maggie Hallahan Photography

Each year, malaria causes about 214 million cases and an estimated 438,000 deaths worldwide

While malaria mortality rates have dropped by 60 percent over the period 2000–2015, malaria remains a major cause of death among children. Although the disease is preventable and curable, it is estimated that a child dies every minute from malaria. In Asia and the Americas, malaria causes fewer severe illnesses and deaths, but antimalarial drug resistance is a serious and growing problem.

The U.S. Agency for International Development (USAID) has been committed to fighting malaria since the 1950s. Malaria prevention and control remains a major U.S. foreign assistance objective and supports the U.S. Government’s vision of ending preventable child and maternal deaths and ending extreme poverty. USAID works closely with national governments to build their capacity to prevent and treat the disease. USAID also invests in the discovery and development of new antimalarial drugs and malaria vaccines. USAID-supported malaria control activities are based on country-level assessments, and a combination of interventions are implemented to achieve the greatest public health impact – most importantly the reduction of maternal and child mortality. These interventions include:

  • Indoor residual spraying (IRS): IRS is the organized, timely spraying of an insecticide on the inside walls of houses or dwellings. It kills adult mosquitoes before they can transmit malaria parasites to another person.
  • Insecticide-treated mosquito nets (ITNs): An insecticide-treated mosquito net hung over sleeping areas protects those sleeping under it by repelling mosquitoes and killing those that land on it.
  • Intermittent preventive treatment for pregnant women (IPTp): Approximately 125 million pregnant women annually are at risk of contracting malaria. IPTp involves the administration of at least two doses of an antimalarial drug to a pregnant woman, which protects her against maternal anemia and reduces the likelihood of low birth weight and perinatal death.
  • Diagnosis and treatment with lifesaving drugs: Effective case management entails diagnostic testing for malaria to ensure that all patients with malaria are properly identified and receive a quality-assured artemisinin-based combination therapy (ACT).

The President’s Malaria Initiative (PMI) works in 19 focus countries in sub-Saharan Africa and the Greater Mekong Subregion in Asia. PMI is an interagency initiative led by USAID and implemented together with the U.S. Centers for Disease Control and Prevention. In 2015, PMI launched its next 6-year strategy for 2015–2020, which takes into account the progress over the past decade and the new challenges that have arisen. It is also in line with the goals articulated in the Roll Back Malaria (RBM) Partnership’s second generation global malaria action plan, Action and Investment to Defeat Malaria (AIM) 2016–2030: for a Malaria-Free World [PDF, 18.6MB] and The World Health Organization’s (WHO’s) updated Global Technical Strategy: 2016–2030 [PDF, 1.0MB]. The U.S. Government’s goal under the PMI Strategy 2015-2020 [PDF, 8.9MB] is to work with PMI-supported countries and partners to further reduce malaria deaths and substantially decrease malaria morbidity, toward the long-term goal of elimination. USAID also provides support to malaria control efforts in other countries in Africa, including Burkina Faso, Burundi and South Sudan, and one regional program in the Amazon Basin of South America. The latter program focuses primarily on identifying and containing antimalarial drug resistance.

Do you think the U.S. spends too much on foreign aid, even good aid to fight malaria? How much do you think is spent? Put your estimate in comments, please — and by all means, look for sources to see what the actual amount is.

Malaria Twitterstorm, summer of 2015

August 18, 2015

Several good developments in the War on Malaria, worldwide — along with some alarming signs.  Maybe there will be time to blog seriously about each of these things later. Let’s get them known, and keep discussion going for the best way to beat malaria in a post-DDT world.

QPharm Tweeted about DSM 265, an experimental, one-dose treatment developed by the Medicines for Malaria Venture (MMV); the video is useful for the background those new to the issue can get on the problems of treating malaria, which make great hurdles for campaigns to eradicate malaria.

Here’s the video the Tweet leads to.

MMV said:

DSM265 is a selective inhibitor of the plasmodial enzyme called DHODH. DHODH is a key enzyme in the replication of the parasite. If we can inhibit that enzyme with DSM265, we can stop the life of the parasite.

Voice of America reported on Rollback Malaria’s call for $100 billion to be spent in the next 15 years, to stamp out the disease.

Malaria deaths are, in 2015, at an “all time low.” Deaths hover around 500,000 per year, most in Africa, and most among children under the age of 5. A staggering total, until compared to the post-World War II estimates of more than 5 million deaths per year, or the more than 3 million deaths per year in 1963, the year the World Health Organization (WHO) had to stop its ambitious campaign to eradicate malaria when pesticide DDT, upon which the campaign was based, produced resistance in mosquitoes in areas where the campaign had not yet reached.

Beating malaria is one of the Millennium Development Goals of the United Nations; this year’s report on MDG acknowledged the great progress already made.

Another non-governmental malaria-fighting organization discussed the news; see the press release from Malaria No More.

Medical News Today Tweeted out a tout for its own coverage of malaria — notable for a good, basic explanation of malaria and how to fight it.  I wish critics of Rachel Carson and WHO were familiar with half of these basic facts.

Medical News Now's Fast Facts on Malaria

Medical News Now’s Fast Facts on Malaria. Notable, that annual deaths now are way below the million mark. Good news!

One malaria vaccine has won approval for final testing. Good news, though anyone who follows vaccines knows it will take a while to test, and anyone who knows malaria fighting knows there are four different parasites, and delivery of any medical care is tough in far too many parts of the world where any form of malaria is endemic. Even small good news is good news.

Are we better informed about malaria now? Do we understand spreading a lot more DDT is not the answer?


Bill Gates agrees: We can eliminate malaria in a generation

January 9, 2015

Do we have the will to do it?


Gates Foundation image:  A nurse dispenses a malaria drug to treat an infected child in Tanzania.

Gates Foundation image: A nurse dispenses a malaria drug to treat an infected child in Tanzania.

Want to do a good turn? Nothing But Nets needs you to save a kid from malaria. It’s cheap.

December 30, 2014

I get e-mail from the good people fighting malaria, those who can take your ten-spot and save an African kid from death by malaria.

Dear Ed,

We have 6,000 nets left to reach our 60,000 goal to protect refugee children and their families in Cameroon from malaria!

But I still need your last-minute help to hit our target before the December 31 deadline.

That’s why a generous donor has extended his extraordinary $500,000 matching gift campaign until midnight, December 31.

I can’t think of a more meaningful way to close out the year than by making a life-saving difference for $10.

Contribute now and your tax-deductible donation will have twice the life-saving impact and help Nothing But Nets and our UN partners protect refugees in Cameroon.


That means your year-end donation of $25 will be worth $50, and a generous gift of $50 will be worth $100.

Thank you for caring enough to help us defeat malaria and protect even more lives.

Chris Helfrich

Chris Helfrich
Director, Nothing But Nets

P.S. Please don’t wait another moment. Contribute now to our 60,000 net campaign for Cameroon and your donation will be matched by an extraordinary $500,000 matching gift provided by a generous donor—doubling the impact of your life-saving gift. Thank you for whatever you can afford.

Donate Now | View in browser

1750 Pennsylvania Avenue NW, Suite 300, Washington, DC 20006
© Nothing But Nets

$10 buys one net, delivered to a family in Africa, usually for a child. When the net is suspended over the bed of the child, mosquitoes cannot bite, and malaria transmission can be stopped. Nets help even if a kid already has malaria, because mosquitoes can’t bite him and get malaria parasites to spread.

Studies over the past 20 years show bednets alone are more effective than Indoor Residual Spraying (IRS), with DDT or any of the other eleven pesticides used.  To increase effectiveness, nets usually come impregnated with an insecticide, so mosquitoes that try to get to the sleeping people inside will die, too.

With the help of the Bill and Melinda Gates Foundation, millions of nets stopped malaria in its tracks in several different African nations; since the campaign got underway in earnest in 1999, malaria deaths have been cut by 45%, from more than a million each year in 1999 to fewer than 610,000 in 2013, according to the World Health Organization (WHO).

Malaria deaths declined from the 4 million per year at peak DDT use, circa 1958-63, to about 1 million per year in 1999 — a reduction of 75% from peak DDT use. Malaria deaths today may be the lowest in recorded human history.

Got $10 to save a life? Cut that death toll even further.

2001 press release from NIAID, mosquito genome sequencing project: “DDT was once a powerful tool”

March 24, 2014

Caption from Vanderbilt University: Figure 1. Anopheles freeborni mosquito taking a blood meal. Image reproduced from the Centers for Disease Control, CDC, public domain.

Caption from Vanderbilt University: Figure 1. Anopheles freeborni mosquito taking a blood meal. Image reproduced from the Centers for Disease Control, CDC, public domain.

Press release from the NIH National Institute of Allergy and Infectious Diseases (NIAID):

Anopheles gambiae Genome Sequencing Project

March 5, 2001


Statement of Anthony S. Fauci, M.D.
Director, National Institute of Allergy and Infectious Diseases

Today, a global network of researchers announced that they are collaborating in sequencing the genome of Anopheles gambiae, the mosquito responsible for most cases of malaria in Africa. The National Institute of Allergy and Infectious Diseases (NIAID) applauds the efforts of the network and their goal of obtaining sequence data by the end of the year.

This information, together with the knowledge gained from the sequences of malaria parasites and the human genome, will provide researchers with a wealth of genomic data necessary for understanding this complex disease. (See the communiqueExternal Web Site Policy.)

The need for a multifaceted commitment to fight malaria and develop new and improved treatments, diagnostics and vaccines has never been greater. According to the World Health Organization, an estimated 300 to 500 million cases of malaria occur annually; in 1999, an estimated 1.1 million deaths were attributed to malaria, most of which occurred in children under the age of 5. Malaria is a public health threat in more than 90 countries, where 40 percent of the world’s population lives. Because of the enormity of this problem, NIAID has made malaria research a central focus of our scientific portfolio and supports a comprehensive research program, which includes basic, field-based and clinical research.

Malaria is caused by a single-celled parasite that is spread to humans by mosquitoes. The control of malaria continues to be a challenge because of the dual problems of increased rates of insecticide resistance in mosquitoes and increased rates of drug resistance in the malaria parasites. Reducing disease transmission by mosquito control has been a mainstay of regional and global malaria control programs. The insecticide DDT was once a powerful tool in global efforts to eradicate malaria. With the development of DDT-resistant mosquitoes, new tools are needed to control this disease. An improved understanding of the basic biology of mosquitoes and their genomes will contribute to our ability to understand and monitor insecticide resistance, develop new insecticides, and ultimately help control the malaria pandemic.

NIAID conducts and supports research—at NIH, throughout the United States, and worldwide—to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site at

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit

NIH…Turning Discovery Into Health ®

Some points to ponder, 13 years later:

  1. Dr. Fauci notes that DDT was, at one time, a powerful tool to fight malaria — but no longer.  DDT resistant mosquitoes means new tools must be found to replace DDT.
  2. Fauci makes no mention of a shortage of DDT for any reason.  It appears from the press release that DDT’s widespread use is compromised only by its decreasing effectiveness, not by any ban from any governmental entity.
  3. In 1999, 15 years ago now, about 1.1 million people died from malaria annually; estimates cited here are that 300 million to 500 million people actually got a bout of malaria through the year.  This compares with 2012 figures of fewer than 700,000 dead, and fewer than 250 million infections.
  4. Fauci said that, if malaria is to be defeated, it must be attacked on multiple fronts.  Spraying insects alone is not enough, increasing medical care alone is not enough — no single action provides a panacea.


Obamacare: Still the better way, still saving money, still a good deal

January 20, 2013

A guy named William Duncan at a blog called Sensible Thoughts posted something I found inherently unsensible a while back.  He listed six reasons why he thought the Affordable Care Act should be repealed. (“A while?” “Yeah, July 2012 is ‘a while.'”)

His sixth point was the old canard about Congress and the President being exempt.  Of course they are not exempt, and so I told him.

Your sixth reason is in error. There is no provision to exempt either the president or Congress from the act. There is no language in the bill such as you describe. Language from page 114 can be found here:

At some length, Mr. Duncan removed that point, but said he still thinks the law should be repealed on the other five points I hadn’t dealt with.

Thank you for the correction on point #6. I have gone back and looked at this, and you are absolutely right. Although the Wall Street Journal and folks like Sean Hannity reported that the President and members of Congress are exempt from participation in the Affordable Care Act, in the end that did NOT make it into the language of the legislation. I have deleted point #6 from the post as a result. Thank you for the correction. Now, if you copuld only prove me wrong on the rest of the points listed…. Unfortunately, this remains a bill the the American public did not want, and was purchased by shenanigans that the Administration should be ashamed of.

A quick and dirty response; we may need to put more meat on these response bones in the next couple of months, because the opposition to ObamaCare relies on severely distorted claims about the law and what it actually does.  Much if not most of the good stuff in the law is completely ignored by these critics, and we should point that out, too.

I responded (images added here):


What makes you think Americans didn’t want it? There was a whale of an anti-health care campaign after the act passed, but when it passed, it enjoyed a majority of support. And, when we take each provision of the bill and ask people about that provision, they approve overwhelmingly.

English: Depiction of the House vote on H.R. 3...

Depiction of the House vote on H.R. 3590 (the Patient Protection and Affordable Care Act) on March 21, 2010, by congressional district. Democratic yea, dark blue; Democratic nay, light blue; Republican nay, red; No representative seated, white. Image from Wikipedia

For example, not even you are opposed to continuing the Reagan-era program that encourages medical schools to train more general practitioners. No one seriously objects to the provisions that pay physicians to practice in under-served areas, like West Texas, Iowa, and West Virginia. No one objects to the provisions that train more nurses. Only the most rabid racists complain about continuing and expanding the health care clinics on Indian reservations.

The law has dozens of provisions like those, and no one in their right mind objects to them.

Your other five points?

  1. The Supreme Court killed that one for you. They said that, even if you call it a fine, it’s a tax. And at that, it’s a helluva bargain. For those who do not purchase health insurance because they can’t afford to, they must pay $695 additional tax, per year. That’s about what I’d pay monthly on the open market.In any case, there are no fines, according to the Supreme Court.
    English: Depiction of the Senate vote on H.R. ...

    Depiction of the Senate vote on H.R. 3590 (the Patient Protection and Affordable Care Act) on December 24, 2009, by state. Color code is difficult to decipher; let it suffice that if there are two Democratic yea votes, the state is colored deep blue; if two Republican nay votes, very red. Image from Wikipedia

    But I can’t imagine why you oppose bargains in health care, especially when they lower the costs of health care to the insured, who will no longer pay the 15% to 25% premium to cover indigent care.

  2. With all the “new taxes,” CBO, the non-partisan group that scores these issues for Congress, projects the bill will decrease federal spending and cut the deficits annually, when fully enacted in 2014 and all out years.Do you oppose deficits or not?All the other taxes are fair, strike only the tippy-top income tiers, and are cheap at that.These taxes make the system more fair. It’s stacked against anyone making less than $150,000 a year, now. That’s most of us. I don’t like it when government helps the rich, at the expense of the poor — that’s contrary to moral standards my church holds, for example, and it tends to damage the economy.So I think more fair taxes, and lower costs, will be quite popular, once we see them.So, new taxes aren’t a good justification to oppose the law.
  3. Speaking of fallacious accounting — CBO, the group you cite, says the bill will reduce the deficits. You assume the Law won’t work, while small portions of it have already slashed inflation in health care costs, from 20% in 2009 to 4% in 2011 and 2012.But, what about repeal? CBO looked at that, too — repeal of the law will increase deficits, not decrease them. It’s only $109 billion increase in deficits, but these number directly refute all claims that repeal would be cheaper. See the analysis gateway here:
  4. This Medicare issue was hashed out, accurately and well I thought, in the campaign. Medicare costs will be reduced by holding costs down — benefits will not be reduced. Eric Cantor and Paul Ryan ran into some difficulty with this, because their budget plans assumed the savings from the Affordable Care Act, while eliminating the law that produced the savings.I’m sure there will be some adjustments required. Medicare seems a little ham-fisted when it comes to dealing with local and regional cost differences, but nationwide, over the past 40 years, enormous savings have been realized by reducing some reimbursements for procedures that once were uncommon and expensive, to a less expensive rate, now that they are more common. On the whole, over 40 years, over thousands of procedures, physicians have changed their expectations, and things have worked fine. Oh, there have been grumblings, I know. But the cuts in costs, without cuts in benefits, have stuck.Under the Affordable Care Act, we hope a lot more people will move to company plans from Medicare, or at least to the exchange plans offered in each state.One of the changes already introduced is working [link added here]. Rather than pay providers for each procedure, Medicare now reimburses hospitals for effective hospitalization — that is, when a patient is discharged and then re-enters a hospital for the same complaint, the hospital will lose money. Hospitals are keeping patients a few days longer on many procedures, to insure that one hospitalization is all that is required. Savings are already being made in costs, while improvements have resulted in the health care – better health in the patients!In all, CBO says costs will come down with the Affordable Care Act, as advertised, and costs will rise and deficits will rise if the Act is repealed.
  5. Your abortion argument is too metaphysical, and not enough real-world. Do you want to reduce the number of abortions? Then provide health care, make sure contraception is freely available (not for free, but freely), and stand back. Those two things reduce abortions, as they did during the Clinton administration.Restrictions on abortion, on the other hand, make it more likely a woman will choose to terminate a pregnancy under a number of circumstances: She doesn’t have health care coverage, her coverage does not cover pre-natal care, her coverage won’t cover a new infant, the pregnancy is unplanned due to lack of good information on family planning or lack of access to affordable contraception.You can choose: Restrict abortions and increase the number of abortions, or provide health care, and reduce the number of abortions.It may be a bit counter-intuitive, but you’d better study the issue. The Affordable Care Act’s provisions, Obamacare, have over the years reduced abortions where applied; cutting off that care has increased the number of abortions.My advice would be, don’t kill the babies to make a political point.

I am concerned that you don’t appear much familiar with what the bill actually does. Here are a few reasons to keep the law.

  1. We need more physicians, and the bill provides them.
  2. We need more physicians in underserved areas, and the bill provides them.
  3. We need more nurses, and the bill provides them.
  4. We need more community clinics in underserved urban areas [link added here], where illnesses and injuries frequently go untreated until extreme trauma results, and the victim must get extremely expensive care in an emergency room. This will be one of the biggest cost savers — and the law provides those clinics.
  5. The law will cut the private bureaucracy, and completely dismantle the private death panels set up by insurance companies, saving at least 10% of every health care dollar, applying that money to care instead of bureaucracy. This is already occurring.
  6. Preventive care under the Act is greatly encouraged — if we can boost flu vaccines by another 10%, it will save thousands of lives annually, and millions of dollars in hospitalization costs. Flu shots came with no co-pay this year — did you notice? — so that anyone with any insurance at all could drop by any pharmacy offering flu shots and get one with no out-of-pocket expenses.
    This is huge. Everyone agrees the cheapest health care is for healthy people. The Affordable Care Act changes the way health care is delivered, to emphasize prevention of disease and injury, instead of triage. Prevention usually costs about 10% what the triage would cost.
  7. Removing the lifetime cap on insurance payments, per patient, will save a few thousands of lives, annually. It should kill the phenomenon where many families, hit with a costly disease or accident, had to declare bankruptcy as a result. A significant portion of all bankruptcies have been “not adequately-insured” cases. Those should almost disappear.
  8. Allowing children to stay insured, on a parent’s plan, for those critical years after high school and college and into the second job, with benefits has already benefited millions of Americans, saving millions of dollars and probably a few lives.

I cannot imagine why anyone would want to go back to 20% annual health care cost inflation, the highest per capita health care costs in the world by a factor of two, while leaving one out of every seven people uninsured even though we were paying amounts more than the insurance would have cost.

Obamacare reduces the deficits, and puts our health system on the path to catch up to the rest of the industrialized world, with better care for less cost.

I’ll keep it, thank you.

(See this, too: “More good news about Obamacare: CBO says it will save money”


Lancet special issue on malaria eradication: No call for more DDT

October 30, 2010

Lancet is one of the premiere research journals in the world for all of science, but especially for issues of health and medicine.

Image from Lancet illustrating malaria story

Image from Lancet –
Mother and child under a mosquito bite-preventing bednet.

On October 29, 2010, Lancet published a special report, “Malaria Elimination.”  Much science.  Much history.  No call for more DDT.

A plan for research is laid out.  Plans to eradicate malaria from more than 90 nations are laid out, explained and debated.  Calls for more research are made.  Calls for disciplined action from nations and health care organizations, and donor organizations.

But no call for more DDT.

Go take a look at the issue.  Several of the articles are available for no charge, out from behind the usual Lancet paywall.

Get the real science, real history, real policy.  Environmentalists are not evil villains there.  malaria is the villain in that story, and serious health care researchers and deliverers discuss serious methods to beat the disease.  Consequently, DDT has only a bit part.


DDT and birth defects: South African television asks questions

July 23, 2010

Steven Milloy, Roger Bate, and Richard Tren hope you never see this television production — they hope you never even hear about it.  It’s one more indication that Rachel Carson was right.

They hope you never even hear about it.  It’s set for telecast in South Africa next Tuesday:

Special Assignment to broadcast episode on ‘Collateral Damage’

Published: 22 July 2010

This week, Special Assignment looks at those affected by the dangerous DDT chemical and also those who say it is a necessary evil to prevent many South Africans from dying.

“I have problems with my balls,” says ‘George’. “I was born without testicles,” adds ‘Joseph’, yet another man born in the Limpopo area. These two and many other young men in Venda share a common story.

Each year, South Africa sprays more than 90 tonnes of the toxic DDT chemical in homesteads in KwaZulu-Natal and Limpopo areas. Though DDT, a persistent organic chemical which can remain in the environment for as much as 40 years is banned across the world, South Africa still uses it to control malaria in the country. Recent studies have however showed that DDT is harmful to humans with hundreds of kids born in the Venda area showing signs of genital deformities. The chemical has also been associated with breast cancer; diabetes; and spontaneous abortion. Yet it remains South Africa’s best option for the prevention of malaria which kills millions of people each year across Africa. This week, Special Assignment looks at those affected by this chemical and also those who say it is a necessary evil to prevent many other South Africans from dying.

‘Collateral Damage’ will be broadcast on Special Assignment on Tuesday, 27 July, at 20:31 on SABC3.

Tea Party medical care

July 21, 2010

Last spring, as the local Tea Party gatherings were shouting hosannahs to the Constitution, they also advocated not answering the decennial census.  I pointed out that the census is required by the Constitution, and got disinvited.

Unbridled and unquestioning support of what the “founders” did, instead of the laws they wrote, can lead one astray, as this cartoon shows:

Tea Party medical care, based on love for the "founders ways" - atheist

Tea Party philosophy: 'If the founders did it, it's good.'

Tip of the old scrub brush to Job’s Anger.

Utah legislative craziness takes dark turn

March 1, 2010

Today I discussed legislative craziness, and she was surprised to discover Utah’s wackoes like Rep. Chris Buttars are national, and perhaps international stars of legislative dysfunction.  In my e-mail I get notes talking about a silly resolution from South Dakota’s legislature.

Then I stumbled into this:  “Utah bill criminalizes miscarriage.

From what I’ve read of the bill, I agree that’s what it would do.  It’s sitting on the Utah governor’s desk right now, deserving a veto, but probably headed into the Utah Code.

If it becomes law, women might be well advised to avoid any activity while in Utah, certainly not skiing or snowmobiling, nor hiking or river running, nor even jogging.  A woman who had a miscarriage within a week of skiing in Utah would be hard put to provide evidence exculpating her from a charge that her actions caused the miscarriage.  The contest of expert testifiers could be tremendously expensive.  Colorado, Wyoming, Idaho, California and other states offer all of those activities, but without the specter of a murder charge to women who miscarry later.

No, there’s no excuse for a woman who doesn’t know she’s pregnant.

Yes, I know the bill was designed to punish the bizarre behavior of some people who attempt to induce abortion by physical activity early in a pregnancy.  No, I don’t think this bill does that job well, either.

You legislative drafters, take a look at the bill.  The language is bizarre, it seems to me — it backs into a law by defining what is not covered.  I see some great ambiguities.  The bill excuses medical abuse of the fetus — failing to get medical care for the mother, for example, which leads to death of the fetus — but calls into question any action a woman might take in seeking an abortion from a medical practitioner.  It seems to me that the bill directly strives to outlaw all medical abortions, though one section says that seeking an abortion is not covered.

Debaters would have a field day with the enforceability problems of this bill.

Oy.  From Chris Buttars, the craziness disease has spread to the entire Utah legislature.

Is there a quarantine law in Utah, for people who carry dangerous infections?


  • Best description and discussion I’ve seen on the bill, at the New York Times; it confronts head on the chief problem with this proposed law:  It criminalizes the activities of a desperate young woman who needs counseling and other help, but does not need to be jailed, nor deserve it:

Lynn M. Paltrow, the executive director of National Advocates for Pregnant Women, a nonprofit group based in New York, said the focus on the child obscured the bleak story of the teenager, who also deserves, she said, empathy from the world, and the law.

“Almost nobody is speaking for her,” Ms. Paltrow said. “Why would a young woman get to a point of such desperation that she would invite violence against herself? Anybody that desperate is not going to be deterred by this statute.”

Refusing to be shouted down, on rants against health care reform

August 13, 2009

People who just know they’re right, damn the facts, irritate me; I’m allergic to unnecessary bull excrement.

Here, at The Elephant’s Child, I scratched the itch a bit.

The post from Elephant’s Child is answered, ad seriatum.  (I wrote this on the fly, and I may have missed a statistic here or there; if I find errors, I’ll correct ’em.)  EC’s responses are indented:

Remember that this thread starts out with your savaging a program to support child abuse prevention programs.

We will have to agree to disagree. The federal government runs the Indian Health Service which is a disgrace and a tragedy.

Private health care on the Navajo, Hopi, Pine Ridge and other major reservations is [essentially] non-existent. Yes, the IHS is inadequate by any rational standards. It’s also underfunded, and a key problem is that many enrolled members of tribes lack other health insurance.

The federal program may be a wreck, but it’s 1000% better than the private alternative, which in that case is nothing at all.

And this is what I fear: Without government intervention, Indians are left to die from easily preventable and easily treatable diseases. Without government intervention, 50 million other Americans are left to die from easily preventable and easily treatable diseases, and 150 million more have limited access.

For reasons I cannot fathom, you favor letting the people die rather than fixing things. Surely you’re not making that decision on the basis of any rational system of rationing, are you? I don’t think the poor and unemployed “deserve to die.” Talk about death panels!

They run Medicare, which is going broke from waste, fraud and abuse.

Absolutely false. Medicare has problems from rapid inflation by the private sector and other causes. But it is NOT “going broke from waste, fraud and abuse” by any measure. Compared to private health care, Medicare is purer than distilled water.

They run Medicaid, ditto.

Ditto. Medicaid has problems from overuse because too many people lack private insurance. Waste, fraud and abuse are significantly reduced from private systems.

Which leads me to wonder why you favor a system that is going broke from inflation, waste, fraud and abuse. The denialism runs strong in you.
(No — it’s going broke mainly from uncontrolled inflation — but if you can make wild unsubstantianted charges, I can at least point out that your favored position is worse.)

And they run the VA, which has some bright spots and poor care in general, at least according to vets.

And what does the private insurance system do for vets? Any injury due to war is excluded from coverage.

Again, you choose no coverage over some coverage. Whose side are you on? Not the vets’ side, it appears.

Our current health care system is the best in the world. We have better outcomes for the major diseases, and most people are satisfied with their health insurance and happy with their care.

Except for heart and lung disease, where Canada, France and England lay it all over us, on an epidemiological basis. Their systems do a lot fewer major procedures because there is much less heart disease, and problems are discovered earlier and treated much more effectively and cheaply.

Yes, the U.S. does a lot more heart transplants, easily by double. The problem is we have nearly quadruple the need for heart transplants. Heart disease is often preventable, almost always treatable, well before heart transplant time. It’s cheaper and better for the patient if we treat heart disease before it progresses to cripple the victim.

Yeah, we do more transplants. The tragedy you don’t name is that we need to do them.

We pay more for it in general because we can afford it.

Have you discussed this with small businesses? We can’t “afford” to pay double what every body else pays. These incredible expenses broke Chrysler and General Motors. The cost keeps small businesses from creating plans for employees.

Worse, that $6,000 per capita includes spending for the 50 million people excluded from easy access. We pay double for services, and we pay for a lot that we don’t get. Talk about waste!

Our system spends nearly 25% of every “health care” dollar in insurance administration, mostly designed to keep the minority of uninsured from getting care at all.

Don’t tell me we should spend hundreds of billions of dollars to bar the doctors’ offices doors, and then claim any system is more wasteful. There is no more wasteful system possible, and it’s a moral imperative that we fix it.

We pay double because the system is broken. We can’t afford it.

Medical care has been transformed in recent years with CT scans, MRIs and all sorts of new drugs and treatments that have saved and extended life. That’s expensive, but worth it.

Mostly unavailable to about half of Americans. Insurance plans pay for surgery that costs six to eight times a CAT scan, because it doesn’t like “expensive technology” without justification. If a CAT scan discovers no problem requiring surgery, insurance won’t pay. “Doctor error.” So doctors don’t use the technology as it could best be used.

But when that heart disease that could have been prevented ends up in the surgery theatre, Katy bar the doors on expenses!

The health care bill before Congress is estimated by the CBO to cost $1.2 trillion over the next ten years, and another trillion over the 2nd decade. Health care costs will increase by 8% a year while revenues increase at only 5%.

Without it, health care costs will continue to rise at nearly twice that rate, 15% annually.

Don’t look now, but the lousy bill you don’t like is better than the catastrophe you’re defending.

Yes, I did read the bill. Medicare was estimated by the CBO to cost $12 billion by 1990. By 1990, it cost $110 billion.

Why? Do you know?

Medicare was expanded because it worked so well. Plus, it turns out there was a much greater need than anyone had projected.

In 1994, health care inflation was estimated to run about 8% annually if the Clinton plan didn’t get passed. Instead it ran closer to 16%.

The problem you cite is doubled in private insurance. Don’t tell me you don’t like waste and then propose to double the waste.

Waste is waste whether it’s government-run or private business run, and it hammers costs either way. Greater waste hammers us more greatly.

Government-run health care will cost vastly more than private insurance ever cost.

That’s not so for programs in either Medicaid or Medicare, compared to comparable coverage offered by private companies. The record, in every other nation AND in the U.S., is that government-run systems are cheaper. Especially where government simply takes over the payment, and not the delivery (leaving private health care providers as private health care providers), government systems are vastly less expensive.

This is why the insurance companies started to squawk about how unfair it would be for the government to compete against them. Competition is the key to an effective free-enterprise system — we need to inject some into health care now.

Doctors will leave the profession — Some doctors have estimated that 20% of doctors will retire early.

Compared to the estimates of 30% of doctors are retiring early now, right? We’ve had a physician shortage for 40 years. Here in Texas nearly 20% of our counties have no physicians at all. There is a reauthorization for a 40-year-old program to encourage medical students to graduate and serve these populations — you called it “socialism.”

Or you didn’t know it was in the bill.

Either way, the sensible solution would be to pass the bill and get more doctors for less money to serve the underserved areas, thereby reducing the incredible expenses of health care and even greater expenses of delivering no health care to millions of Americans.

There is nothing whatsoever in the house bill that will reduce costs.

The single most important cost-saving step is to cover people who lack insurance. No program can reduce costs at all without that. That’s a key target in the bill.

The cheapest health care system is the one that delivers care appropriately, on a timely basis. We spend an inordinate amount of money in the last 6 months of patients’ lives — 50% by some estimates — because they lacked good health care that would have kept them more sentient and more ambulatory until death.

The most important thing we can do is move health care delivery from the old to the younger, from the hospital emergency room to the doctor’s office. We can only improve that if everyone has access to a doctor on a timely basis, for the delivery of simply preventive programs, for the delivery of early treatment of disease.

Government health care has failed in Massachusetts, failed in Hawaii, failed in Tennessee, failed in Oregon, and failed in Maine.
To cut costs, which the government will have to do, they will have no choice but to ration.

We ration health care now by cutting out one out of every seven people for no care at all (though we pay for it — they just don’t get it; the money goes to “insurance company administration” instead of health care delivery). We ration health care now by denying technology to most Americans. That rationing saves no money for the nation — it seems to double the cost.

In contrast, Medicare patients, in the biggest government-run program, are the single least-rationed group.

There will be rationing until we equalize access, which will require more doctors, more clinics, more nurses, less emergency room use and more doctor’s office visits. But that rationing now is draconian and cruel, based chiefly on whether one works for a company with a health plan or not.

That’s unfair and cruel. Worse, it multiplies the costs for everybody. (An enormous part of hospital charges to private insurance-covered people is to provide the pool of money for indigent care.) Multiplies, not “adds to.”

Non-fraudulent waste may be many times fraudulent waste. We need to stop it.

The first step is to cover everybody.

Both presidential health care advisers Ezekiel Emanuel MD, and Peter Orzag, his budget director,have pointed out extensively the high costs of end-of-life care and the need to cut back on those expenses.

Under the present system, yes. Emanuel’s paper in January talked about the rationing decisions made now, how unfair they are, and how they increase pain and suffering.

Damn straight we need to reduce those costs — to increase delivery of health care.

Don’t defend private rationing by pretending it doesn’t exist, or by pretending it’s more fair, when no study shows it is fair or cheap.

Pain pills for the older folks instead of hip replacements or motorized wheel chairs.

That’s what happens today, yes. Unless, of course, they’re on Medicare, the government run program. That’s why the advertising for carts for the immobile notes that the companies selling the carts will take care of Medicare paperwork.

God help you if you’re not on Medicare. Private insurance won’t.

All government-run health care programs ration care. Which they do because they will not do the things that would actually reduce the cost of health care, like tort reform, increasing free market competition, offer insurance across state lines, and offer medical savings accounts, high deductible policies.

Hold on — Medicare and Medicaid allow free market competition, offer insurance nationally (in contrast to private plans), and allow medical savings accounts (though that’s not a viable solution for the poor, unemployed, students and retired people).

Tort costs about 1% of health care — and to my view, it works well. I don’t think swimming pool companies should be able to suck the bowels out of children without paying for it.

We do have a tort problem with OB-GYN, but it is largely caused by the insurance companies’ refusal to defend good doctors. That’s not a tort reform issue.

You cite problems that exist now, problems that are subject to attack by H.R. 3200. We’re not going to get anything at all if yammering yahoos don’t stop fighting against all change.

Doing nothing is cruel and costly. If you want to make a case for adding something to H.R. 3200, make the case.

Defense of current incredible waste is not a rational, moral option.

All health care systems ration health care. Our system rations health care on income and geography, and age. Higher incomes, big-company-employed, urban locations, and higher ages get the care.

Is that smart? It’s not cheap.

I don’t think These all are proven to save costs, but the trial lawyers are second only to the Unions as financial support for Democrats.

Those figures aren’t accurate, or they demonstrate that political giving doesn’t have much effect.

Tort cases take up the slack where government regulation ends. Should we allow McDonald’s to keep burning old ladies almost to death? (I thought you were for reducing costs, no?) Unless you will allow the Ministry of Coffee Temperature to regulate every fast-food drive through, tort cases are real money savers in the long run. (It cost less than $2.00 to fix the Pinto’s gas tank so it wouldn’t explode on impact. How many lives should we have sacrificed instead? I thought you were for reducing pain and suffering.)

I know no Republican or Conservative who does not observe that Liberals want to guarantee equality of outcome.

But none of them can show anyone who actually proposes to do it, not since Lenin abandoned the idea in 1920. I know no Democrat or Liberal or Republican or Conservative who urges equality of outcome. I’ll wager you can’t name major players who do, if you can name anyone at all.

That’s the problem with a lot of Republicans and conservatives — they’re not even tilting at windmills, they’re tilting at wind. We need action to make things better.

You propose we stick with the most wasteful and inefficient health care program in the industrialized world, one guaranteed to bankrupt the nation, or collapse soon.

Better you should tilt at windmills.

It’s obvious in their legislation. All kids get vaccinated, they are required to be vaccinated before they can enter kindergarten, and help is available if they cannot afford it. Silly claim.

All kids getting vaccinated (religious exceptions honored), is a great idea, a high ideal, compassionate, money-saving and wise.

My brother had polio, and the complications killed him early. I’m partially deaf from measles, or maybe scarlet fever. I don’t think vaccinations are bad things at all. Back when we lost 1 out of 3 babies before their second birthdays to infectious disease, the nation was not better off.

Universal health coverage keeps a population healthy, learning and working. You don’t like it? Take a look at any nation where disease is rampant — like malaria in Uganda. The lack of simple preventive measures tends to cripple a nation’s economy and destabilize its government.

That’s not good.

I would challenge most of your claims, but there is no point. According to what I know to be true, you are vastly misinformed, but you probably think that of me. I simply do not have time to carry on pointless discussions.

Who was it who observed, it’s not what we don’t know, it’s what we know that isn’t true that gets us into trouble?


Don’t you be shouted down, either;  Share the facts, with the system of your choice:

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Cargo cults in global warming, and Arthur Robinson

March 14, 2009

Cargo cult science has deep roots among those who deny global warming or who allow that warming is occurring, but claim we can do nothing about it.  So, it’s no surprise that, at the voodoo science 2nd International Conference on Climate Change, somebody would trot out the old falsehoods about DDT.

According to Traditional Catholic Reflections (you can tell its traditional Catholic because it brooks no comments — you can’t correct an error there):

Speaking at the conference hosted by the Heartland Institute in New York City,[Dr. Arthur Robinson, Director of the Oregon Institute of Science and Medicine] said, “There is a current example of genocide by the removal of technology, and that is the ban on DDT, and that has resulted in the deaths of 30 to 40 million people and has left half a billion infected with malaria.”

It’s malaria that kills people, not a lack of DDT.  The removal of DDT from spraying cotton crops  in Texas and California did absolutely nothing to promote malaria in Africa.  Dr. Robinson needs a basic geography course.  Mosquitoes do not migrate from the U.S. to Africa or Asia.

Stopping the spraying of DDT in the U.S. in 1972 wasn’t a factor in the cessation of usage of DDT in Africa seven years earlier, either.  Dr. Robinson could use some basic math sequencing and calendar reading remediation, too.

Dr. Robinson could use some history and public policy instruction, too.  DDT was never banned in Africa, nor was it banned in India or China which together now produce almost all the DDT used in the world, which is a lot.  There’s no ban on DDT in Uganda, where Dr. Robinson’s friends in the business world are suing to stop the spraying of DDT in huts in affected regions — because they are afraid it will harm their tobacco business.

It’s a heckuva lot easier to throw darts at health care workers and disease fighters than it is to talk about real solutions with these guys.

If Robinson is dead wrong on a one-liner about DDT, how wrong do you think he is in the rest of his presentation on climate change?

Is there any crackpot “scientist” who was not at the Heartland Institute’s wing-ding?

Creationist educational problem

August 10, 2008

Y’all with a smattering of understanding about evolution:  Go to this blog and help straighten out the creationists, will you?

“Creationist medical dilemma” at Unreasonable Faith

This is one of the hottest posts in the WordPress blogging continent at the moment.  Unreasonable Faith posted the old Doonesbury cartoon about the guy whose doctor diagnoses tuberculosis, and then asks the guy whether he’s a creationist before prescribing treatment (if you don’t know the cartoon, go see!).  I don’t think it was intended to attract so much traffic.

In the past three days creationists have moved into the comments section with all manner of creationist misinformation.  Few of the creationists are the hard-shelled, obnoxious type, but they could use some good information on genetics, mutations and evolution rates from someone familiar with the topics.

Redefining “root canal”

June 28, 2008

It happens.  Last night I had a semi-emergency root canal. That’s not why I haven’t blogged, though — I feel fine.  I haven’t used any of the pain medication.  I’ve been able to work without the headache I thought was sinus, but now appears to have been an infected tooth.

But the story is Harry Sugg’s dental practice at Wheatland Dental.

There’s a lesson there for health care.  There’s a lesson there for professional services, like law offices.  There’s a lesson there for schools.

After a half-day wrangling with the dental insurance company — a phone system very unfriendly to clients asking questions, a fellow with bad information about which dentists in the area are on the plan — I got through in the late afternoon to Sugg’s office.  I’m a new patient, and I more than half expected them to offer an appointment late next week.

Instead, the receptionist said the entire staff, but for her, were out celebrating Dr. Sugg’s birthday.  But they’d be back in an hour, and I should be there when they arrived.

The waiting room has massaging chairs, two televisions running different, intrigueing DVDs, and a coffee pot.  Before I’d finished the paperwork I was offered a bottle of water.  Zip, zip, zip.  Oh, and no out-of-date magazines (a few interesting books, on history mostly, and astronomy).  The waiting room was not full at all — not a lot of waiting.  One group appeared to be there to support an aging family member.  They kept up a lively and often funny line of patter with the staff.  It was as if a co-ed barber shop had broken out in the waiting room.

The exam was quick, with digital x-rays, from a woman who noted most of the staff was in a training session in the lunchroom — the Guinness Book of World Records‘s champion speed reader was offering reading tips to the staff.  A quick diagnosis from Dr. Sugg — could I be back at 8:00 p.m. for the procedure?

That’s right:  8:00 p.m.  The office hours run until 9:00 p.m.  Other options were Saturday and Sunday.  It’s a ’round-the-clock, through-the-week operation.

I mortgaged our grandchildren, took the prescriptions to the pharmacy, got a quick dinner and headed back.  Dr. Linda Cha performed the procedure.  She deadened everything before I got a needle — didn’t feel any pain at any time.  Obviously highly skilled, she explained as much of the procedure as I needed, always solicitous to my comfort.

As I left the office at about 10:15 p.m., an attendant gave me a fresh red rose.  Today they called to check on my progress and spend a significant amount of time answering questions.

Could I get used to that kind of care?

So I thought back to the days I aided intake at Legal Services of North Texas — the cattle-call features, the crowded hallways, the lack of restrooms, the vending machines that often didn’t work, the impossible tasks of trying to match a sticky legal situation with an attorney to do the work for free.  Clients weren’t happy with much of anything there.  I did this often while I worked at Ernst & Young — free coffee, free soft drinks, free pastries, client-effusive hospitality.  Lots of training.   And at bigger lawfirms in town, with restroom attendants, shoeshine machines, on-site concierge for employees and clients if needed.

At one of our high schools in Dallas, men’s restrooms for faculty went without water to the sink for months.  The teachers’ “lounge” doubled as a site for a major computer node, so the ambient temperature was generally close to 90 degrees.  A coffee maker looked as though it hadn’t been used in months, nor that it could produce any coffee that wouldn’t resemble industrial sludge.  But teachers only get 30 minutes for lunch anyway.

Anyone who doubts there is a War on Education hasn’t been in most schools lately.

Harry Sugg runs a great business.  Professional offices and other businesses could learn a lot from how he operates his dental clinic.  Schools could learn a lot, too.  He could consult with school districts on how to treat employees and get good results.  I’ll wager the school districts wouldn’t listen.

Teacher meetings?  Frankly, I’d rather have a root canal.  And I’ll pay for the service.

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