Archive | communication

Obituary: Arnold Relman and the medical industrial complex

 

4 Dr. Arnold Relman, 91, died on June 17, 2014.

Perhaps best known as the editor of The New England Journal of Medicine from 1977 to 2000, Arnold Relman was also an editor for the Journal of Clinical Investigation, a researcher on kidney function, a professor at Boston University, The University of Pennsylvania, Oxford, and Harvard. He contributed frequently to the New York Review of Books.

Relman was outspoken early in his position as editor at The New England Journal of Medicine. On October 23, 1980, he wrote an essay in the Journal in which he targeted profit-driven hospitals and other medical  industries. He was very clear that the desire for profit was adversely affecting patient treatment, and that investor-run companies could never have a primary goal other than profit. It was not a popular stance, and he had many critics who dismissed him as a conspiracy theorist or naive medical Don Quixote.

Aalg relman quote

Relman continued urging a reform of the American health care system, and suggested that a single-taxpayer-supported insurance system replace the private insurance companies. He considered the 2010 USA health care law to be only a partial reform, and said so.

The New England Journal  of Medicine, under Relman’s direction, was the first journal that required authors to disclose any financial arrangements that might affect their judgement of their research and publication. Many journals would follow this disclosure of conflicts of interest, and though there are those who still protest that the source of funding is irrelevant and that trying for such integrity was unrealistic, Relman’s stance was crucial in moving the medical and research culture to the expectation of accountability. (In 2002, under editor-in-chief Dr. Jefrey Drazen, The New England Journal of Medicine reversed the rule for authors for financial disclosure as so few authors had no industry financial ties.)

Relman was fortunate in having a work- and later, life-partner who agreed politically and philosophically with him, Dr. Marcia Angell. They worked together at The New England Journal of Medicine, lived together since 1994, and married in 2009. Together they won the George Polk Award for a 2002 article in The New Republic that documented how drug companies invested much more in advertising and lobbying than in research and development. Angell is now investigating the the influence of drug company money on the prescribing habits of physicians.

The New York Times obituary for Dr. Relman  and a New York Times 2012 interview with Relman and his wife, Dr. Marcia Zuger  are the source of the information of this short posting.

 

 

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Academics and scientists on preventing war

Academics and scientists on preventing war.

I was fortunate to work with a group of public health folks on looking for ways that public health workers  might not not just repair the effects of war, but be able to actually prevent it. The resulting paper in the American Journal of Public Health gives the reasons why war is rationalized, and suggests a curriculum and competencies that could reverse the presumption that war is inevitable.

The Role of Public Health in the Prevention of War: Rationale and Competencies

William H. Wiist, DHSc, MPH, MS, Kathy Barker, PhD, Neil Arya, MD, Jon Rohde, MD, Martin Donohoe, MD, Shelley White, PhD, MPH, Pauline Lubens, MPH, Geraldine Gorman, RN, PhD, and Amy Hagopian, PhD

American Journal of Public Health, Vol. 104, No. 6, June 2014: e34-e47.

http://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2013.301778  to access AJPH website.

(AJPH charges authors $2,500 to make the papers open access. Many academics pay for this through grants, but we were unable to do so- antiwar research isn’t exactly a hot topic for government funding. AJPH refused to waive the fee.)

email kbarkerbtb@gmail.com to see a personal copy of the paper.

Here is a posting by antiwar author David Swanson on the AJPH paper:

Public Health Experts Identify Militarism As Threat

By David Swanson
http://warisacrime.org/content/public-health-experts-identify-militarism-threat
A remarkable article appears in the June 2014 issue of the American Journal of Public Health.

The authors, experts in public health, are listed with all their academic credentials: William H. Wiist, DHSc, MPH, MS, Kathy Barker, PhD, Neil Arya, MD, Jon Rohde, MD, Martin Donohoe, MD, Shelley White, PhD, MPH, Pauline Lubens, MPH, Geraldine Gorman, RN, PhD, and Amy Hagopian, PhD.

Some highlights and commentary:

“In 2009 the American Public Health Association (APHA) approved the policy statement, ‘The Role of Public Health Practitioners, Academics, and Advocates in Relation to Armed Conflict and War.’ . . . In response to the APHA policy, in 2011, a working group on Teaching the Primary Prevention of War, which included the authors of this article, grew . . . .”

“Since the end of World War II, there have been 248 armed conflicts in 153 locations around the world. The United States launched 201 overseas military operations between the end of World War II and 2001, and since then, others, including Afghanistan and Iraq. During the 20th century, 190 million deaths could be directly and indirectly related to war — more than in the previous 4 centuries.”

These facts, footnoted in the article, are more useful than ever in the face of the current academic trend in the United States of proclaiming the death of war. By re-categorizing many wars as other things, minimizing death counts, and viewing deaths as proportions of the global population rather than of a local population or as absolute numbers, various authors have tried to claim that war is vanishing. Of course, war could and should vanish, but that is only likely to happen if we find the drive and the resources to make it happen.

“The proportion of civilian deaths and the methods for classifying deaths as civilian are debated, but civilian war deaths constitute 85% to 90% of casualties caused by war, with about 10 civilians dying for every combatant killed in battle. The death toll (mostly civilian) resulting from the recent war in Iraq is contested, with estimates of 124,000 to 655,000 to more than
a million, and finally most recently settling on roughly a half million. Civilians have been targeted for death and for sexual violence in some contemporary conflicts. Seventy percent to 90% of the victims of the 110 million landmines planted since 1960 in 70 countries were civilians.”

This, too, is critical, as a top defense of war is that it must be used to prevent something worse, called genocide. Not only does militarism generate genocide rather than preventing it, but the distinction between war and genocide is a very fine one at best. The article goes on to cite just some of the health effects of war, of which I will cite just some highlights:

“The World Health Organization (WHO) Commission on the Social Determinants of Health pointed out that war affects children’s health, leads to displacement and migration, and diminishes agricultural productivity. Child and maternal mortality, vaccination rates, birth outcomes, and water quality and sanitation are worse in conflict zones. War has contributed to preventing eradication of polio, may facilitate the spread of HIV/ AIDS, and has decreased availability of health professionals. In addition, landmines cause psychosocial and physical consequences, and pose a threat to food security by rendering agricultural land useless. . . .

“Approximately 17,300 nuclear weapons are presently deployed in at least 9 countries (including 4300 US and Russian operational warheads, many of which can be launched and reach their targets within 45 minutes). Even an accidental missile launch could lead to the greatest global public health disaster in recorded history.

“Despite the many health effects of war, there are no grant funds from the Centers for Disease Control and Prevention or the National Institutes of Health devoted to the prevention of war, and most schools of public health do not include the prevention of war in the curriculum.”

Now, there is a huge gap in our society that I bet most readers hadn’t noticed, despite its perfect logic and obvious importance! Why should public health professionals be working to prevent war? The authors explain:

“Public health professionals are uniquely qualified for involvement in the prevention of war on the basis of their skills in epidemiology; identifying risk and protective factors; planning, developing, monitoring, and evaluating prevention strategies; management of programs and services; policy analysis and development; environmental assessment and remediation; and health advocacy. Some public health workers have knowledge of the effects of war from personal exposure to violent conflict or from working with patients and communities in armed conflict situations. Public health also provides a common ground around which many disciplines are willing to come together to form alliances for the prevention of war. The voice of public health is often heard as a force for public good.
 Through regular collection and review of health indicators public health can provide early warnings of the risk for violent conflict. Public health can also describe the health effects of war, frame the discussion about wars and their funding . . . and expose the militarism that often leads to armed conflict and incites public fervor for war.”

About that militarism. What is it?

“Militarism is the deliberate extension of military objectives and rationale into shaping the culture, politics, and economics of civilian life so that war and the preparation for war is normalized, and the development and maintenance of strong military institutions is prioritized. Militarism is an excessive reliance on
a strong military power and the threat of force as a legitimate means of pursuing policy goals in difficult international relations. It glorifies warriors, gives strong allegiance to the military as the ultimate guarantor of freedom and safety, and reveres military morals and ethics as being above criticism. Militarism instigates civilian society’s adoption of military concepts, behaviors, myths, and language as its own. Studies show that militarism is positively correlated with conservatism, nationalism, religiosity, patriotism, and with an authoritarian personality, and negatively related to respect for civil liberties, tolerance of dissent, democratic principles, sympathy and welfare toward the troubled and poor, and foreign aid for poorer nations. Militarism subordinates other societal interests, including health, to the interests of the military.”

And does the United States suffer from it?

“Militarism is intercalated into many aspects of life in the United States and, since the military draft was eliminated, makes few overt demands of the public except the costs in taxpayer funding. Its expression, magnitude, and implications have become invisible to a large proportion of the civilian population, with little recognition of the human costs or the negative image held by other countries. Militarism has been called a ‘psychosocial disease,’ making it amenable to population-wide interventions. . . .

“The United States is responsible for 41% of the world’s total military spending. The next largest in spending are China, accounting for 8.2%; Russia, 4.1%; and the United Kingdom and France, both 3.6%. . . . If all military . . . costs are included, annual [US] spending amounts to $1 trillion . . . . According to the DOD fiscal year 2012 base structure report, ‘The DOD manages global property of more than 555,000 facilities at more than 5,000 sites, covering more than 28 million acres.’ The United States maintains 700 to 1000 military bases or sites in more than 100 countries. . . .

“In 2011 the United States ranked first in worldwide conventional weapons sales, accounting for 78% ($66 billion). Russia was second with $4.8 billion. . . .

“In 2011-2012, the top-7 US arms producing and service companies contributed $9.8 million to federal election campaigns. Five of the top-10 [military] aerospace corporations in the world (3 US, 2 UK and Europe) spent $53 million lobbying the US government in 2011. . . .

“The main source of young recruits is the US public school system, where recruiting focuses on rural and impoverished youths, and thus forms an effective poverty draft that is invisible to most middle- and upper-class families. . . . In contradiction of the United States’ signature on the Optional Protocol on the Involvement of Children in Armed Conflict treaty, the military recruits minors in public high schools, and does not inform students or parents of their right to withhold home contact information. The Armed Services Vocational Aptitude Battery is given in public high schools as a career aptitude test and is compulsory in many high schools, with students’ contact information forwarded to the military, except in Maryland where the state legislature mandated that schools no longer automatically forward the information.”

Public health advocates also lament the tradeoffs in types of research the United States invests in:

“Resources consumed by military . . . research, production, and services divert human expertise away from other societal needs. The DOD is the largest funder of research and development in the federal government. The National Institutes of Health, the National Science Foundation, and Centers for Disease Control and Prevention allocate large amounts of funding to programs such as ‘BioDefense.’ . . . The lack of other funding sources drives some researchers to pursue military or security funding, and some subsequently become desensitized to the influence of the military. One leading university in the United Kingdom recently announced, however, it would end its £1.2 million investment in
a . . . company that makes components for lethal US drones because it said the business was not ‘socially responsible.'”

Even in President Eisenhower’s day, militarism was pervasive: “The total influence — economic, political, even spiritual — is felt in every city, every statehouse, every office of the federal government.” The disease has spread:

“The militaristic ethic and methods have extended into the civilian law enforcement and justice systems. . . .

“By promoting military solutions to political problems and portraying military action as inevitable, the military often influences news media coverage, which in turn, creates public acceptance of war or a fervor for war. . . .”

The authors describe programs that are beginning to work on war prevention from a public health perspective, and they conclude with recommendations for what should be done. Take a look.

David Swansons wants you to declare peace at http://WorldBeyondWar.org His new book is War No More: The Case for Abolition. He blogs at http://davidswanson.org and http://warisacrime.org and works for http://rootsaction.org. He hosts Talk Nation Radio. Follow him on Twitter: @davidcnswanson and FaceBook.

Sign up for occasional important activist alerts here http://davidswanson.org/signup

Sign up for articles or press releases here http://davidswanson.org/lists

This email may be unlawfully collected, held, and read by the NSA which violates our freedoms using the justification of immoral, illegal wars absurdly described as being somehow for freedom.

 

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Union of Concerned Scientists: How to talk with journalists.

Wordsalad Scientists are urged to communicate, to talk with journalists about their own work as well as larger political and scientific issues, but it isn’t so easy to know how to do it. Great help is available from the Union of Concerned Scientists, and 3 of their latest webinars are a jumpstart to getting your thoughts and your research out there in the bigger world beyond the the bench.

“Communication science amid confusion: How to deal with tough questions,” was given on September 17th by Nick Schrope and Rich Hayes, who wrote one of my favorite communication books, “A Scientist’s Guide to Talking with the Media.” (2006, Rutgers University Press). This theme was carried further on September 19 with “A Scientist’s Guide to the Media: Sharing a Compelling Message with the Press.” Rich Hayes gave this webinar as well, joined this time by Brenda Equizol.

Some of the key points of these lectures are:

Be prepared to actively seek out opportunities to communicate.  Make sure the communication center at your workplace knows about your work, and understands the significance of interesting results: they may put out, with your help, a press release. Pitch your own stories and ideas directly, as well. If you want to comment on issues beyond your immediate research, consider writing an op-ed or letter to the editor to your local paper. Contact a local reporter, offer to be a resource, or suggest stories.

Know your core message. Before a media interview, find out from the reporter or interviewer what the topic will be. Never, if possible, do any interview without at least a few minutes preparation time: it is quite okay to say on the phone, “Could you call me back in 30 minutes.” Use the time to think about what you want to say- and what you don’t want to say.

Prepare your message for the audience, not the reporter, and help the reporter give your message. Have a quote or two ready- reporters will almost always like to have a quote for the story. Perhaps have an astute quip or metaphor ready, even a cliche, if that will help the audience understand your point. Avoid science jargon, however- even words as seemingly innocent and clear as aerosols might mean only spray cans to some members of the public. Anticipate questions: you can ask your public affairs office, or a non-scientist friend, what questions they would have for your topic.

Everything is on the record! (Even if the reporter says it isn’t.)

Practice the bridge! Transition back to your core message! The reporter may have another agenda (sometimes curiosity, sometimes hostility), or you may see that the point of the interview is getting lost in unrelated or difficult questions. Acknowledge the question, and redirect the topic. The bridge can also be used if you don’t know the answer. Some examples might be: “That is a matter that is still confusing to scientists. But what I can tell you is that…” or “The short term effects are certainly a problem, but the long term effect has been described in this study…”

Don’t be afraid to make a mistake. Our fears are greater than reality here, as journalists are generally trying to honestly reflect scientist’s views. Prepare, and make sure your core message comes through, and don’t worry too much about being misquoted. There is a slight chance someone may push your words to enhance controversy, but at the worse scenario, you can ask for a retraction. As for fear of omission, very common among scientist’s- prepare beforehand, and remember that no one

Don’t be afraid to say what you don’t know! One attribute of science (and scientists) that is often misunderstood is the changing nature of what is known.  I heard a great example last week of this at a seminar given by Peter Doherty, who won the Nobel Prize in Physiology or Medicine in 1996. He has written several books for the public and was in Seattle on a book tour. He urges scientists to speak out about climate change, and said about himself, “With climate change, I don’t follow all the math, and tend to accept the conclusions, but with biology, I can understand it and see the effects.”

Think like a scientist- and a citizen. You are both.

The 3rd seminar in the mini-series, “Advocacy for the Aware but Busy Expert,” perhaps should have been the first seminar, as it was a good introduction to both the Union of Concerned Scientists (UCS), and a bit of the history of scientists speaking out to the public about science issues. Speaking were Peter C. Frumhoff, Director of Science and Policy at UCS, and Michael Halpern, Program Manager for the Center for Science and Democracy at the UCS.

Whether or not scientists should be involved in the use of science in society is still debated, but the UCS always made such activist work central to the organization. UCS was founded by physicists at M.I.T. in 1969, while the U.S. war on Vietnam was being waged to great protest in the U.S. The founders wanted to advocate as physics practitioners  for environmental protection, and this continues as the mission today, with a focus on climate change and clean energy sources.

Peter Frumhoff gave the introduction to UCS, and to some of the opposing viewpoints scientists working on climate science encounter today. He gave two quotes from scientists with differing opinions on the role of scientists as activists:

“If you believe that you have found something that can affect the environment, isn’t it your responsibility [as a scientist] to actually do something about it, enough so that action actually takes place….we just have to be clear when we are speaking as scientists and when we are expressing values.” 2001, Mario Molino, UCS member and 1995 Nobel Prize winner in Chemistry for the study of depletion of stratospheric ozone.

versus

“I became a climate scientist because I care about the environment but we have a moral obligation to be impartial” said Tamsin Edmonds of the University of Bristol in the UK, quoted in The Guardian on July 13, 2013.

Speaking out, not speaking out- each is framed as a moral issue. Our training is in objectivity in observation and decision making, and this idea that we must be impartial is deep, almost as deep as the idea that science is done to better mankind.  Peter noted an important addition to the arguments: that scientists are members of the public and have a right to express their convictions (found in the 2009 3rd edition of “On Being a Scientist,” by the  National Research Council). They are citizens and scientists, both, with the rights and responsibilities of both.

Michael discussed the practical aspects of being an outspoken scientist, as the question he often hears at UCS is “What can I do?” It is not always immediately obvious what an individual can do in any particular place, and he suggest each person consider the following points:

1. What issues interest me? Obesity, drug addiction, etc.

2. What parts of my skill set do I want to share? Analyze data, speak out, etc.

3. What time commitment am I willing to make? Long or short term, want to work steadily or in bursts, etc.

4 What activities fit me best? Public speaking, assistant to non-profit, resource for journalists.

5. How do I want to benefit? Build your profile, become a better communicator, shape public opinion, etc.

Michael emphasized that is is a process to know what you want to work on, and gave (besides suggesting contacting USC to plug into already organized and ongoing initiatives) sources of information for getting engaged, such as the American Geophysical Union (agu.org) and Nature (nature.org).

The session ended as did the others with questions from the web audience, many of which concerned communication worries and interacting with members of the media. One subtlety that might be very useful to many is that scientists should not start with uncertainty in dealing with the public, even when trying to counteract political pundits who conversely push certainty without  evidence.

Remember that it is not necessary to transmit every detail of every possible exception, but be as accurate and honest as you can.

Communicating Science Amid Confusion: https://s3.amazonaws.com/ucs-webinars/SN-workshop-9-17-13/index.htm

A Scientist’s Guide to the Media: https://s3.amazonaws.com/ucs-webinars/SN-workshop-9-19-13/index.htm

Advocacy for the Aware but Busy Expert: https://s3.amazonaws.com/ucs-webinars/SN-workshop-9-30-13/index.htm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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The CIA and the museum.

 

cia1
      Maybe it really is innocuous for the Pacific Science Center in Seattle to host “SPY: The Secret World of Espionage.” (http://www.pacificsciencecenter.org/Exhibits/spy)
       The exhibit hasn’t opened yet, so I could only check on line to see if I was being paranoid. 
        The collector of the most of the historic instruments in the exhibit, H. Keith Morton, is known for his many books on spying, the CIA, and military and intelligence history. There is a lovely picture of him in front of his 12, 000 square foot house in Boca Raton, Florida- CIA cheerleading pays better than cancer research, it seems. Clearly, he is pro-espionage, pro-CIA- but how pro CIA can be seen in these quotes from reader Cee Martinez (July 3-25, goodreads.com, http://www.goodreads.com/review/show/181624989) about Melton’s  “The Official CIA Manual of Trickery and Deception”:

     “Many interesting details about the CIA during the MKULTRA years are discussed, including strange ones, such as the CIA use of prostitutes to lure Johns into motel rooms under surveillence so agents could record the Johns’ reaction to various mind altering drugs like LSD. The introduction alone is a must-read for any spy, CIA, or conspiracy geek. Although, a short internet search on the subject of MKULTRA would reveal a far more sinister, and disturbing look into the CIA than this book would ever hint at.

“That’s the main trouble with this book. I didn’t think it could be at all possible to sanitize and neuter the very idea of the MKULTRA project, which included disturbing studies of brainwashing on unwilling and unwitting subjects, some experimented on in mental hospitals, and taken from their own families. This book has done just that.”

      Still, the political beliefs of the collecter might not be embedded in the exhibit: the exhibit might really be only technological wonders of deception, unconnected to a philosophy or even to the CIA. Ah, but there are “educational resources” that accompany the exhibit, two educator guides, one for grades 4-8, another for grades 9-12.
      Both open with a large font quote from former USA President Ronald Reagan:
     “You are the trip-wire across which the forces of repression and tyranny must stumble in their quest for global domination. You, the men and women of the CIA, are the eyes and ears of the free world.”
       And from there we are in experiments, narratives, and timelines that laud the CIA. Neither curriculum makes the whisper of a suggestion that not all the CIA has done has been honorable, quite in contradiction of history and present day newspapers. It is a true trip to the past in the post WWII Cold War rhetoric.

       I dashed off a quick letter to members of the Pacific Science Center leadership, but there haven’t yet been any replies.

 

 

March 20, 2014
Dear Pacific Science Center folks,
I was appalled to see that you will be running an exhibition called SPY: The Secret World of Espionage. Running this exhibit is a tacit approval of the techniques and strategies of the CIA.
Melton’s books gloss over the ethics of the CIA, and your glorification of the his instruments of the CIA will do the same. Would you display instruments of torture? Or a knife used in a rape? How about land-mines and other instruments of war? How is this “science?”
If you want to stretch and call it technology, still it is not appropriate to host that exhibition at the Pacific Science Center. Science and technology (and the information in museums) are not value-free. People will internalize your message. All of us must think ahead to the world we want- and your vision of the world ahead and what you see in science, is grim.
It might bring you money, but it also brings ethical deficit.
Sincerely,
Kathy Barker

 

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