Category: The Dish

by Jonah Shepp

Drum defends Obama’s handling of the problems with the Veterans Health Administration:

Under the Obama administration, the patient load of the VHA has increased by over a million. Partly this is because of the large number of combat vets returning from the Afghanistan and Iraq wars, and partly it’s because Obama kept his promise to expand access to the VHA. It was inevitable that this would increase wait times, and the VHA’s claims backlog did indeed increase during the first three years of Obama’s presidency. Over the past couple of years, however, wait times have shrunk dramatically. A digital claims system has finally been put in place, and the claims backlog today is less than half what it was at the beginning of 2013.

What’s more, despite its backlog problems, the VHA still gets high marks from vets. Overall, satisfaction with VHA care is higher than satisfaction with civilian hospitals.

Mark Thompson argues that things aren’t as bad at VA hospitals as the scandal makes them seem:

Perspective is an important element in understanding any problem. “Over the past two weeks, the American Legion has received over 500 calls, emails, and online contacts from veterans struggling with the healthcare system nationwide,” Daniel Dellinger, the Legion’s national commander, told the Senate Veterans Affairs Committee on Thursday. Over that same period, the VA saw a total of about 3.2 million patients. That works out to a complaint rate of 0.015%. Including a wider date range drops that share even lower.

Carl Blake of the Paralyzed Veterans of America suggested the Senate panel go undercover. “If the committee wants to get the truth about the quality of VA health care, spend a day walking around in a major VA medical facility,” he said. “We can guarantee that you will likely hear complaints about how long it took to be seen, but rare is the complaint about the actual quality of care … It is no secret that wait times for appointments for specialty care in the private sector tend to be extremely long.” The public, he says, has gotten a distorted view of the quality of VA care at various field hearings where a handful of those with poor experiences have taken center stage.

Also, as Jonathan Cohn points out, “some of the problems… have very little to do with the VA and a whole lot to do with American health care”:

As Phil Longman, author of Best Care Anywhere, noted in his own congressional testimony last week, long waits for services are actually pretty common in the U.S.—even for people with serious medical conditions—because the demand for services exceeds the supply of physicians. (“It took me two-and-a-half years to find a primary care physician in Northwest Washington who was still taking patients,” he noted.) The difference is that the VA actually set guidelines for waiting times and monitors compliance, however poorly. That doesn’t happen in the private sector. The victims of those waits suffer, too. They just don’t get the same attention.

It’s no surprise, though, that Obama is taking the blame here; he is the president, after all. Furthermore, Elias Groll writes, “The scandal is only made more politically potent by the fact that Obama has spent most of his career as politician describing himself as an advocate for veterans and has repeatedly promised to reform the VA”:

During the 2007 speech, delivered while serving as a senator and a member of the Veterans Affairs Committee, Obama pledged to deliver better service to American veterans and to overhaul a system that has all too often become shorthand for waste, inefficiency, and staggering wait times. “We know that the sacred trust cannot expire when the uniform comes off,” he said. “When we fail to keep faith with our veterans, the bond between our nation and our nation’s heroes becomes frayed. When a veteran is denied care, we are all dishonored.”

Two years later, in 2009, Obama was back before the VFW delivering a similar pledge: “cut those backlogs, slash those wait times, deliver your benefits sooner.” … By the time he returned to the VFW in the midst of his 2012 re-election campaign, Obama’s frustration had only grown. What was once a sense of invigorating optimism had been replaced in part by a weariness and anger at the VA’s practices.  “When I hear about servicemembers and veterans who had the courage to seek help but didn’t get it, who died waiting, that’s an outrage,” Obama said.

In Waldman’s view, Obama can and should turn the scandal around 180°:

As troubling as some of these allegations are, this controversy presents an opportunity for the administration. This isn’t some kind of phony scandal like Benghazi: it’s a real issue with real consequences. But it’s also a set of problems that can be solved, even if some of those problems go back decades. Two and a half years from now, this presidency will be over. If by then officials can say that every veteran who needs care is getting it without having to wait an unreasonably long time, and that every disability claim is being processed quickly, and that the agency as a whole is capable of handling the enormous task it confronts, then they’ll be able to claim an important victory.

That wouldn’t be just a victory for this administration. More broadly, it would be a victory for the liberal vision of effective government. Sometimes it takes some bad news to provide the incentive people need.

Joe Klein suggests he begin by sacking Eric Shinseki:

The question is, How do we change this situation? The simple answer is leadership, which is why some have called (as I did last year) for VA Secretary Eric Shinseki to resign. By all accounts, Shinseki is a fine man who has spent nearly six years lost in the system. An effective leader would have gone to Phoenix as soon as the scandal broke, expressed his outrage, held a town meeting for local VA outpatients and their families—dealt with their fury face-to-face—and let it be known that he was taking charge and heads were going to roll. Instead, Shinseki intoned the words “mad as hell” at a congressional hearing. And White House chief of staff Denis McDonough said the President was “madder than hell” about the situation. Does anyone actually find this convincing?

Previous Dish on the VA scandal here and here.

by Patrick Appel

Support for marriage equality continues to increase:

Lemieux argues that marriage equality’s success demonstrates the importance of court victories:

There’s no evidence that the public responds to judicial opinions differently than it responds to legislation.  … The lesson is that political conflict cannot be avoided merely by avoiding particular means of affecting social change. When proponents of social reform win, they will likely generate a backlash by supporters of the status quo — no matter what institution creates the policy change. The only way to avoid backlash is simply to not win.

At this point, the success of the gay marriage litigation campaign should be clear. Public opinion has trended in a remarkably positive direction, ultimately reaching the politically cautious occupant of the White House. Same-sex marriage rights have continued to advance at the state level, and such marriages now have federal recognition thanks to the Supreme Court’s Windsor decision last year. Arguments that the judicial decisions favoring same-sex marriage would be a major liability for the Democratic Party have proven to be unfounded.

by Jonah Shepp

The first documented case of a nanotechnology-related workplace injury is raising questions about how little we understand the health risks of nanoparticles:

There is no requirement to label nano stuff as nano even though these extraordinarily small things have extraordinary properties which makes them useful and valuable. Nor are there nano-specific regulations about how to safely handle many of them. Within a week of simply measuring out the one or two grams of powder, the chemist’s throat became congested, her nose dripped and face became flushed. Then her skin began to react to her earrings and belt buckle. Her symptoms continued even after she stopped working with the material and moved to another floor. Once outside her workplace the symptoms improved.

“She can never work inside that building again,” said Dr. Shane Journeay, a medical doctor and nanotoxicologist at the University of Toronto. Journeay coauthored the case study with Dr Rose Goldman of the Harvard School of Public Health. It was just published in the American Journal of Industrial Medicine.

Andrew Maynard thinks the case study overstates its own significance:

For more than a decade now, there has been a massive global investment in research into the health and environmental impacts of engineered nanomaterials. Between 2004 and 2013 more than 6,000 academic papers were published on how these materials possibly cause harm, and how it might be averted. And for decades before this, researchers were studying the health impacts of nanoscale particles arising from natural processes, and as by-products of industrial processes. As a result, we now know quite a lot about how nanoscale materials behave in the human body and how to reduce the chances of harm occurring.

We know, for instance, that inhaled or injected nanoparticles can get to places in the body that larger particles cannot go; that the surface of nanoparticles is important in determining how harmful they are; and that nanoparticles are sometimes less harmful than the chemicals they’re made of. We also know that our bodies have evolved over millennia to handle nanoparticles, and that fine particles are integral to many biological and environmental systems. These studies have also indicated how much we don’t know, which is why research in this area remains a priority. And one area we know less about than many would like is: How dangerous is the stuff people are actually exposed to, as opposed to the pure materials that researchers often use in their studies?

by Patrick Appel

Amar Toor flags a new report on it:

The world has seen an “unprecedented” surge in the production of new synthetic drugs, according to a report released [this week] by the United Nations Office on Drugs and Crime (UNODC). In its latest Global Synthetic Drugs Assessment, the agency says it identified 348 new synthetic drugs in 94 countries as of last year, with the majority emerging between 2008 and 2013. The UNODC received reports on 97 new synthetic drugs in 2013 alone, though it acknowledges that the true number of substances on the market could be much higher.

The agency defines new psychoactive substances as drugs that are not controlled under international conventions, but may pose public health risks. Synthetic cannabinoids — drugs designed to mimic the psychoactive effects of cannabis — comprised the majority (28 percent) of such substances reported to the UNODC between 2008 and 2013, followed by synthetic cathinones, including bath salts, at 25 percent.

Abby Haglage traces the origins of “Spice” aka “K2,” a form of synthetic marijuana. She also looks at how the DEA is cracking down these drugs:

In March 2011, the U.S. Department of Justice placed the five most widely abused synthetic cannabinoids—including Huffman and Pfizer’s—on its Schedule 1 List of banned substances.

The DEA is focusing on moving forward to try to curb the spead of Spice—not back at its origins. On May 7, 45 DEA agents armed with 200 search warrantslaunched a massive nationwide program to eradicate synthetic designer drugs like spice (called “Project Synergy.”) In a matter of hours, the agents had confiscated hundreds of thousands of packets of synthetic drugs and over $20 million in cash. “The chemical aspect of Spice is unique and new,” Rusty Payne, spokesperson for the DEA tells me. “We have to not only establish that someone is trafficking something but we have to go undercover and get it so we can test it. Sometimes it’s a game of whack-a-mole.”

Jacob Sullum expects this strategy to backfire:

As [Dallas ABC station WFAA] explains, “K2 is difficult to regulate because manufacturers switch up the ingredients frequently.” And why do they do that? To stay ahead of the law. The upshot is that a relatively benign ingredient may be replaced on the sly with something less fun or more toxic. And as the DEA implicitly admits, legal restrictions on marijuana—a well-researched drug that humans have been consuming for thousands of years, a drug that the president of the United States correctly calls safer than alcohol—are encouraging people to experiment with novel chemicals that may prove far more dangerous.

by Jonah Shepp

Scientists have proposed a way to make lab-grown meat commercially viable:

As noted, it’s already possible to make meat from stem cells. The technique was devised by Maastricht University physiologist Mark Post, who assembled a 5-oz beef patty from thousands of tiny meat strips cultured from the stem cells of a single cow. It’s a technological advance that ScienceNow‘s Kai Kupferschmidt believes could kickstart “the biggest agricultural revolution since the domestication of livestock.”

But according to biologists Cor van der Weele and Johannes Tramper in a new Science & Society paper, though the potential advantages of cultured meat are clear, there’s no guarantee that people will want to eat it. The mode of production, they argue, makes a difference for appreciation. To that end, they’ve developed an eco-friendly model for producing greener, ethical meat — one that involves small-scale local factories that are not only technologically feasible, but also socially acceptable. As per the title of their paper, they’re hoping to see “every village [with] its own factory.”

Jason Koebler would eat that meat:

Tramper estimates that a normal 20-cubic meter bioreactor, which is the standard for growing cultured animal cells, could easily supply a village of roughly 2,560 people with meat for a year. But creating and selling the meat at the Netherlands’ price of about €5 per kilogram would only yield €128,000 a year “hardly enough to pay the salary of one ‘butcher’ and his/her assistant.” Adding in costs of of growth medium and lab equipment, the price for cultured minced meat would go up to at least €8 per kilogram, which complicates things further.

But at the end of the day, you’re looking at paying roughly $5 a pound for hamburger meat—that’s not totally insane, and that’s with current technology. Cultivating and growing animal muscle cells is a well-understood process, and the technical challenges have been mostly surmounted. It’s also a far superior option to factory-farmed meat, morally speaken. Given all that that, is there any doubt that someone in Brooklyn sets up a lab-grown meat club in the next couple years? I’d be down, and I’d bet that 2,500 other New Yorkers would be, too.

Not everyone is on board with the lab-meat movement, though:

Some critics of industrial livestock operations are intensely skeptical that cultured meat is the solution. Food activist Danielle Nierenberg thinks the “huge yuck factor” is going to limit the future of “petri dish meat.”

“People who wouldn’t eat tofu a few years ago, now they’re going to eat meat grown in a lab?” she asks. A better future, Nierenberg and others argue, would require some degree of returning to the past—eating less meat, as we used to, and producing it in a less intensive way, on farms rather than feedlots.

by Patrick Appel

Chait acknowledges “where the politics of climate change stand at the outset of Obama’s new climate offensive”:

The scientific consensus is stronger and more urgent than ever, while the political consensus is weaker than ever. Republicans are not even considering the notion of asking Americans to spend money to mitigate climate change, and are increasingly uncertain about the notion of even saving money to mitigate climate change. And into this simmering pot of reflexive opposition and anti-empiricism Obama will plop a highly ambitious and not very cuddly scheme to clean up the power-plant sector. It has already drawn strong opposition from the major business lobbies. It is likely to become the major point of conflagration of Obama’s second term.

He compares the climate fight to Obamacare:

The grimmest contrast between power-plant regulation and health care is that regulating carbon emissions creates almost no winners. There will be no equivalent of the millions of people newly granted access to medical care, no heartwarming stories of long-suffering patients seeing a doctor for the first time in years. Climate regulation doesn’t create a benefit. It doesn’t even prevent a loss. Its only goal is to mitigate the extent of the damage.

And this is why, unlike carefully selected election-year issues like the minimum wage or equal pay, Obama is not picking this issue to help his party save Senate seats. He is doing this because, given the enormity of the stakes for centuries to come, there is no morally defensible alternative.

But Nate Cohn notes that El Niño could change the political calculus somewhat:

The return of El Niño is likely to increase global temperatures. [Kevin Trenberth, a climate scientist at the National Center for Atmospheric Research] believes it is “reasonable” to expect that 2015 will be the warmest year on record if this fall’s El Niño event is strong and long enough.

That could make a difference in the battle for public opinion. One-third of Americans don’t trust climate scientists, according to Jon Krosnick of Stanford University, and they make their decisions about climate change “based on very recent trends in warming.” Belief in warming jumps when global temperatures hit record highs; it drops in cooler years.