Doctors should talk with each other, usually electronically

At the MacWorld Expo last week, hidden away in a far corner, I was pleased to notice a tiny booth for the medical office and records software product pictured above.The health care reform act aims to improve care and cut costs by providing incentives to get doctors and hospitals to use electronic records. If somebody thinks there is a market for such products that can be reached at a consumer electronic show, that's a good thing.

A searing oped in today's Boston Globe is reminder of why systemic changes that encourage and enable medical practitioners to talk to each other can be life saving. The author (a doctor) and her sister (a lawyer) just shepherded their very ill mother through a hospital admission. Because heart doctors don't talk to diabetes doctors and hospitals don't have integrated medical records, well meaning professionals very nearly killed the sick woman, sending her repeatedly into insulin shock.

Moreover, the lack of integrated records led to the scenario I've seen so many times when helping friends navigate hospitals: every doctor arriving on the scene starts over from the ground up asking the same questions about past illnesses and prescriptions. The sick person can begin to feel she is afflicted by lazy dolts who don't listen to what she has already explained again and again. Then she checks out and starts leaving out parts of the history, doctors miss important data, and even make it the patient's fault because she got frustrated by repeated inquiries.

Dr. Madeleine Biondolillo described how this happened to her mother:

“She’s not able to tell me her history,’’ was the refrain I heard so often from hospital doctors who didn’t know what to make of a well-educated, elderly lady who couldn’t remember what her near-lethal blood sugar level had been after her insulin pump failed and brought on her heart attack. She couldn’t say what her dose of insulin had been changed to during her last visit with her primary care physician. She couldn’t remember these things because she was too sick to remember.

If the hospital doctors had spoken to her primary care physician, they could have had all the information they needed to guide their decisions. But hospital doctors often don’t communicate with office doctors, leaving the patient to fend for herself, just when most vulnerable. In addition, office doctors are responsible for a patient’s care after she leaves the hospital, but frequently don’t even know that she’s been hospitalized until she returns to the office.

When my mother became stable enough to leave the ICU, she was transferred to a step-down unit only two doors away, but with a whole new medical team — doctors, nurses, aides, case managers. And every new clinician had to read the paper chart, or if unable to decipher it, “interview’’ my mother again. “She’s not able to tell me her history. . .’’ over and over again. Exasperated, my sister introduced us with, “Hi, this is my sister, she’s a doctor. And I’m a lawyer.’’

Most of us don't have a doctor and lawyer in the family to get us through this sort of thing. We need the government to push doctors and hospitals to do what they seem unable to do themselves: integrate care so that the medical system passes information seamlessly. Part of this should include incentives to doctors in all parts of the system to communicate; electronic records should make communication cheap enough so the financial incentive need not be exorbitant.

There's money in the health care reform to encourage electronic medical record keeping. Will Congressional Tea Party Republicans cut those funds for so doctors go on endangering patients for lack of incentives to talk to each other?

Democracy struggling to be born in the streets in Egypt

Over the last two days, I've been obsessed with watching the live feed from Al Jazeera English TV from the streets of Cairo. This maybe-revolution is being televised, at least to the extent a few journalists can do it -- those journalists have had their credentials yanked by authorities that may not have much control themselves of the situation, but are still out among the crowds.

I watch filled with a yearning for a successful outcome for the majority of the Egyptian people, knowing I don' t know what that means, though it almost certainly doesn't mean more autocratic rule by some different general.

Dictator-President Hosni Mubarak has done something he never did before during his 30 year rule: he appointed a vice-president. That act takes on more meaning if one is aware that he slipped into his current job because he was vice-president to the previous president -- who was assassinated by members of the army.

His guy, General Omar Suleiman, turns out to be an old friend of the least savory elements in the United States government. Jane Mayer of the New Yorker reminds us that

As laid out in greater detail by Stephen Grey, in his book “Ghost Plane,” beginning in the nineteen-nineties, Suleiman negotiated directly with top [Central Intelligence] Agency officials. Every rendition was greenlighted at the highest levels of both the U.S. and Egyptian intelligence agencies. Edward S. Walker, Jr., a former U.S. Ambassador to Egypt, described Suleiman as “very bright, very realistic,” adding that he was cognizant that there was a downside to “some of the negative things that the Egyptians engaged in, of torture and so on. But he was not squeamish, by the way.”

For those of us who want more decent, democratic government at home, it's easy to identify with Egypt's protesters who have simply had it with a government not responsive to their wishes!

Regular blogging will return tomorrow. For now, back to the TV feed and the Twitter stream (#Egypt).

Housing boom in the Mission?

Yes, for the birds!


Don't know who is putting these up. These are all in a 5 block radius from 24th and Mission.


Have to say, I've seen no sign of any birds anywhere around them.


Apparently the boom in bird houses is not confined to the Mission. Google provides this map which I found via a comment here.

Sparks around a creaking empire

"Leave, leave Mubarak!"

This is the sort of story that tends to disappear down the memory hole, so before it goes, here's what the paper of record tells us:

LAHORE, Pakistan — An American official appeared in court here on Friday on murder charges in the shooting deaths of two Pakistanis during an apparent roadside robbery attempt here. ...

Mr. Davis, who was attached to the American Consulate in Lahore, was shown on Pakistani television, dressed in a checkered shirt and jeans, being escorted by a phalanx of officers to a court in central Lahore. Mr. Sanaullah said that Mr. Davis spoke Urdu, the dominant language in Pakistan, which relatively few American officials speak.

Mr. Davis was driving a white rental car on the congested Jail Road in Lahore on Thursday afternoon when two men on a motorcycle tried to rob him, according to Pakistani police accounts. Mr. Davis shot the two men, police officials said. Police accounts initially differed on whether the two assailants were armed, but according to the official police report released Friday, the police found weapons on the dead men. Mr. Davis did not have a license to carry a weapon, the law minister said.

Mr. Davis called the consulate for help during the episode, and a four-wheel-drive vehicle that tried to come to his rescue hit and killed a third man, said a senior police official, Faisal Rana, on Thursday.

The American Embassy in Islamabad acknowledged in a statement that Mr. Davis was employed by the consulate but did not describe his position. Pakistani police officials described him in various statements as a “security official” or a “technical adviser.”

A possible explication of this rather sketchy account: a U.S. spook was driving in Lahore, a city of over 6 million people that is one of Pakistan's economic hubs, and acted like a cowboy when confronted with robbers. Though I imagine we'll buy our guy out, impunity for U.S. agents is badly eroded these days.

Meanwhile, here's Harvard international relations professor Stephen Walt looking at exploding developments in the countries of the southern and eastern Mediterranean:

... it begins to look like the U.S. position in the Middle East, which seemed so dominant after the fall of the USSR and the first Gulf War, is now crumbling. Hezbollah just formed a government in Lebanon, ... Iraq is now governed by a Shiite government with extensive links to Iran, and is denying the U.S. any future military role there. A democratic government in Turkey, while not anti-American, is charting an independent course. The Mubarak government in Egypt, long a close U.S. client, has been shaken, and even if it survives the current turmoil, its long-term status is up for grabs.

The problem is this: the United States has no idea how to deal with a Middle East where the voice of the people might actually be heard, rather than being subject to the writ of various aging potentates. ...

Aroused people -- maybe they want to run their own countries? -- keep taking to the streets. The empire creaks and complains, but may no longer have the power to impose its will.

We live in a time when people in the United States are going to have to notice that the era of U.S. world domination is over. Our rulers over-reached and their house of cards is falling. Most of us didn't want to dictate to the world anyway, though we didn't mind being loudly "NUMBER ONE!" either. Can we adjust gracefully? Can we help our rulers adjust as well?

UPDATE: The Egyptian government may have succeeded in taking the internet down within that country, but the live feed from Al Jazeera English has terrific pictures and some on the scene interviews.

Some places, they just kill the queers

Since the Tucson shootings we've had the usual back and forth in the United States about whether hate rhetoric can really be blamed when some individual, with whatever unknowable stew in his brain, acts out the violence that others airily chatter about.

In Uganda, it's pretty clear that the verbal violence of homophobia became reality with the murder of David Kato. Kato was one of Uganda's most visible gay activists.

NAIROBI, Kenya -- An outspoken Ugandan gay activist whose picture recently appeared in an antigay newspaper under the headline “Hang Them” was beaten to death in his home, Ugandan police said Thursday.

David Kato, the activist, was one of the most visible defenders of gay rights in a country where homophobia is widespread and government leaders have proposed executing gay people. Mr. Kato and other gay people in Uganda had recently warned that their lives were endangered, and four months ago a local paper called Rolling Stone published a list of gay people, with Mr. Kato’s face on the front page.

He was attacked in his home Wednesday afternoon and beaten in the head with a hammer, said Judith Nabakooba, a police spokeswoman. But police officials said they did not believe this was a hate crime.

“It looks like theft, as some things were stolen,” Mrs. Nabakooba said.

Gay activists disagreed and said Mr. Kato was singled out for his outspoken defense of gay rights.

“David’s death is a result of the hatred planted in Uganda by U.S. evangelicals in 2009,” Val Kalende, the chairwoman of one of Uganda’s gay rights groups, said in a statement. “The Ugandan government and the so-called U.S. evangelicals must take responsibility for David’s blood!”

New York Times, 1/27/11

Cops seldom will admit that hate crimes occur in their jurisdictions: they too often share society's prejudices or just want to 'protect' against their city or country getting a 'bad' rep.



The tabloid newspaper that repeatedly fanned the flames of anti-gay hatred (which has no relationship to the US magazine with the same name) bills itself grandly as "Uganda's leading investigative political newspaper." They may be overdoing it making that claim, but there's no doubt that this sort of paper can be influential. See our own New York tabloids stoking outrage about the downtown Islamic Cultural Center last summer.

On the particular tabloid cover pictured above (there were a series of these inflammatory covers, I believe), that's Mr. Kato on the left and the Rt. Rev. Bishop Christopher Senyonjo, the former Anglican bishop of Western Buganda in Uganda on the right. Bishop Christopher has spoken out for years against attacks on gay Ugandans, simply pointing out that these despised people are human beings too. More on Bishop Christopher here.

Mr. Kato is dead -- and that's all the more reason why LGBT people and their friends in safer places need to demand that Ugandan authorities stop the violence. The notorious "Anti-homosexuality Bill" that would criminalize gay lives and even gay advocacy isn't dead; its author, M.P. David Bahati, who has been lionized by U.S. evangelicals, intends to bring it back after Parliamentary elections. President Obama and Secretary of State Hillary Clinton have denounced the legislation. They need to be heard again. In the United Kingdom, the government needs to look again at asylum claims from Ugandan gay people; for some people, this is a matter of life or death.

"Until when are we going to stay here?"

Witness Against Torture spent the last two weeks in Washington protesting the failure of the Obama administration to act on its promise to close the shameful US gulag in Cuba. The media yawned, but, if we choose to look, at least we can see these protesters.

According to human rights lawyer Andy Worthington, prisoners at Guantanamo were carrying on their own protest at the same time. A prisoner was able to tell pass on to his lawyer the following account:

"We decided to protest … The entire camp made sign boards saying 'it's unacceptable to keep detaining us because of what's going on outside,' [meaning, incidents like the Detroit underwear bomber or unrest in Yemen]. Why are we being punished for the bad acts others are doing outside?"

"The construction work going on here is giving us the impression that we are going to be here forever. People detained here are feeling this."

[In Tunisia,] "After 23 years of injustice, finally people decided to liberate themselves and seek freedom. Now we need to struggle for ourselves."

"We have children, wives, families. It is not only Americans who are human beings. Our families are crying and asking, 'Where are our fathers? Where are our sons? We want to be treated like human beings."

"We can no longer tolerate this situation. It seems to us we are being treated in a very racist way, exactly how black Americans were treated. We're 100 Yemenis, 10 Saudis -- and we don't know why they are keeping us here."

"Honestly we have lost any trust in the American government. But we still have some hope. A mistake was made and maybe it will be corrected. It's not a shame to make a mistake. The shame is to continue [the same way after the mistake]. The American government needs to understand that it made a mistake and correct the mistake. Shame on the American government. They are acting like the Tunisian dictators."...

Of the protesters in front of the White House and Department of Justice on January 11, which marked the beginning of a decade of arbitrary detentions at Guantanamo: "We'd like to thank the protesters from the depths of our hearts. They are asking for justice even though they are not imprisoned."

There's an amazing faith in those words -- a belief that people are good, that if they paid attention to the prisoners (who have not been convicted by any tribunal but some kangaroo military boards) as other human beings they'd object to their treatment, that even the United States government should be able to admit mistakes.

Maybe we should be glad that there has been so little media attention to protests in DC or Guantanamo. If these events were more publicized, the government might simply end phone calls to lawyers.

I'm reminded of an observation by Eleanor Roosevelt:

To undo a mistake is always harder than not to create one originally, but we seldom have the foresight ...

Even if the administration has given up on closing Guantanamo and repudiating indefinite detentions without trial, we can't.

A WTF State of the Union

We watched the speech. I wasn't sure I wanted to. President Obama has been a disappointment. I didn't want to watch him double down with his banker buddies, with the Billionaire Boys Club blundering about in education, with the generals and spooks with their boundless wars. I feared he'd repeat his neat trick of negotiating with himself, giving the Republicans their wish list, usually tax breaks for rich people, before getting anything in return.

Well, he did a a little of that latter -- a theoretical spending freeze, malpractice "reform" (that one means keeping injured people from getting their care them paid for). I'd worry about these more if I thought they would happen; even a few sensible or mercenary Dems can probably swat them away.

But he didn't offer to trash Social Security or threaten to invade anyone, so I wasn't horrified by the speech. That's the standard to which my judgment of Obama has fallen these days. If he's not bloody awful, he'll do.

Then I got this from Organizing for America this morning, asking me to sign on to the President's "vision":

We must out-educate, out-compete, and out-innovate the rest of the world. We must deal with our deficit and reform our government -- and it will only happen if we come together.

That work begins right now, with each of us committing to the work necessary to bring it about.

The future is ours to win, but to get there, we can't just stand still.

Join the fight to make the President's vision a reality.

WTF? The dude is pandering to our national addiction to a permanent war posture, a war against countries full of brown people where the populations are finally achieving living standards little dreamed of by their parents. Can't we figure out how to live with a rising China and India? Can't we learn how to be in the world, rather than try to run it?

For that matter, can't we turn our national attention to sensible projects to arrest and mitigate human-induced climate changes?

Naw -- we have to "Win The Future"! Vacuous nonsense from the Obama White House, again. You had me neutralized, but now I'm reminded that any human-serving accomplishments in the next few years will come despite "our leader," not because of him. The real future belongs to people(s), making it together.

The State of the Union address I would like to hear...

has already been given.

The old philanderer from Buffalo did himself proud on the way out.

From History Network News.

Real Social Security stories

This short film won a contest to show 'How Social Security Has Made a Difference in My Life' put on by the Open Government Initiative of the Social Security Administration. Erica Solway, Lindsay Trapnell, Laura Hunt, Alex Butterwick, and Kate Schriver topped the competition.

I imagine there are detractors who think it is a misuse of government resources to sponsor such a contest; I don't think there was a material prize. The winners just got bragging rights. I think this was an interesting exercise in participatory democracy.

Republicans and right wingers need new writers...thoughts for a cold snap

Since Social Security is likely to be on the chopping block this political season, I thought I'd better learn something about it beyond my casual impressions. The accessible book seems to be Nancy J. Altman's 2005 work, The Battle for Social Security. She tells the history of the program clearly if a little drily; I will probably write more about how she explains the program when I've finished the book.

What isn't so dry is the tale of the hissy fits thrown by the opposition to enacting an insurance program for elders at every stage of the legislative and political process. Depression-era Republicans foresaw terrible consequences if government stepped in to help old people:

Representative John Taber (R-N.Y.) speaking in support of the Treadway motion, charged, "Never in the history of the world has any measure been brought here so insidiously designed as to prevent business recovery, to enslave workers and to prevent any possibility of the employers providing work for the people." Representative Daniel Reed (R -N.Y.), who in 1952 would become chairman of the Ways and Means Committee, also spoke: "The lash of the dictator will be felt and 25 million free American citizens will for the first time submit themselves to a fingerprint test." Representative James W. Wadsworth (R-N.Y.), added his thoughts, "This bill opens the door and invites the entrance into the political field of a power so vast, so powerful as to threaten the integrity of our institutions and to pull the pillars of the temple down upon the heads of our descendants."

The Roosevelt administration's painstakingly designed plan was denounced over the conservative talk radio of the day by Fr. Coughlin. Altman points out that Coughlin's CBS radio show, the Golden Hour of the Little Flower, "had a larger share of the listening audience than today's Howard Stern, Rush Limbaugh, Paul Harvey, and Larry King put together."

There was a (sadly familiar) strain of crazy zeal in the opposition to Roosevelt. Organizations claiming to be outside the political parties threw themselves into his re-election campaign.

The American Liberty League wanted desperately to defeat Roosevelt. In 1935, the league spent twice as much in this pursuit as the Republicans. Among other efforts to discredit the president, the league prepared and widely distributed pamphlets comparing Roosevelt to Stalin, Hitler, and Mussolini. Some of Roosevelt's initiatives were fascist; others were communist. Social Security was, the pamphlets proclaimed, "the end of democracy."

William Randolph Hearst's newspapers knew they couldn't directly stop the old age insurance initiative, but they could claim they had a better idea -- and make the Republican candidate for President Alf Landon tow their line.

"... Social Security 'must be along AMERICAN lines,' unlike Roosevelt's program, which will "reduce millions of Americans to the condition of 'STATE PARASITES.'" The editorial further made clear that Landon would never support legislation "based on COLLECTIVIST DELUSIONS or that is plainly UNCONSTITUTIONAL."

It's interesting to see that print publications of the 1930s used the same convention of all caps to indicate shouting as internet forums do today.

Landon went down to defeat in 1936, still whining about the intrusions that the Social Security program would inflict on the people.

Landon asked, "Imagine the field opened for federal snooping. Are there 26 million going to be fingerprinted? Are their photographs going to be kept on file in a Washington office? Or are they going to have identification tags put around their necks?"

These historical oddments make it clear that the howls we're hearing out of DC Republicans, media celebrities peddling resentment, and the Tea Party have been around for a long time. Experience with Social Security and Medicare doesn't seem to moderate whatever anxieties underlie them. More calculating entities, like corporate medicine and insurance companies that profit from the status quo, exploit them still.

I have sympathy with President Obama's instinct to tell people to just calm down -- clearly the country needs, again, a good dose of that. But he also needs to call out the entities that stir this pot of chronic anxieties to enhance their own power and profits. It would be great to hear from him occasionally the sort of thing Roosevelt was able to say at his second inaugural:

"Dante tells us," he reminded the cheering throng, "that divine justice weighs the sins of the cold-blooded and the sins of the warm-hearted in different scales. Better the occasional faults of a Government that lives in a spirit of charity than the consistent omissions of a Government frozen in the ice of its own indifference."

If this is help, run while you can!

Veteran and organizer Joe Callan talks about the campaign to stop deployment of traumatized troops.

We know that lots of troops coming back from Iraq and Afghanistan have had experiences that make them pretty crazy. A distressing number of them commit suicide -- this was a report a year ago:

"Of the more than 30,000 suicides in this country each year, fully 20 percent of them are acts by veterans,'' said VA Secretary Eric Shinseki at a VA-sponsored suicide prevention conference on Monday. "That means on average 18 veterans commit suicide each day. Five of those veterans are under our care at VA."

I've been catching up on my podcasts -- listening to episodes of NPR's Fresh Air interview show that I missed. I've just gotten up to mid-November when I heard an exchanged that about floored me.

I have to ask, if you were in the military, would you want to be "helped" by this guy, Dr. Craig Bryan, who is the lead consultant to the U.S. Air Force for psychological health promotion initiatives as well as the U.S. Marine Corps' Suicide Prevention Program? He also treats active-duty serviceman and veterans for PTSD. From the interview transcript:

TERRY GROSS: You know what I'm thinking must be difficult for you as a psychiatrist -I mean, in the civilian world, I think any kind of therapist tries to help their patients exercise their own free will in the most productive way that they can. But free will is a little bit limited when you're in the service and, you know, the Pentagon has decided that, you know, you are going back for another deployment - and you don't want to.

Dr. BRYAN: Right.

GROSS: You don't have a choice there. So then what becomes your role as their psychiatrist, when they don't have a choice, and they're being told to face death and to face the possibility of having to kill when they feel like, I'm done with that; I can't do that anymore.

Dr. BRYAN: Right. First off, I'm a psychologist, not a psychiatrist.

GROSS: Okay. Thank you for correcting me.

Dr. BRYAN: So just a quick clarification. I know that sometimes we play similar roles, but slightly different training. But as a psychologist, I'll do mostly, you know, behavioral therapy - sort of the classic talk therapy. And the way I approach that - because you do find that interesting dynamic within the military quite often, not necessarily related only to deployment but many aspects of military life, in that a huge part of it is to help service members understand that actually, they do have a choice. They do have the ability to exercise free will, although maybe the options that they have available to them are more limited than it would be if they were, you know, not in the military.

And kind of to illustrate this, or to provide an example is, if you had a service member like this who doesn't want to deploy again but yet, you know, they have received orders to deploy overseas, what I would work with or talk with that individual about is, you know, why did they join the military? And oftentimes, I will pose to them - it's like, well, fine then, don't deploy. You don't have to deploy. And, of course, they usually say I'm crazy and say - or I'll - well, I'll end up in jail. If I don't do it, I'll be a deserter, and I'll end up in jail. And then I point out to them, so there you go. So your choice is deployment or jail. And it's not a good choice, by any means.

And then what we do is, we start talking with them about their ideals, their principles, what is it they value in life, you know, what type of a person do they want to be, why did they join the military. And of course, what you usually get from these individuals, you get themes like, well, I stand for honor, integrity. I care about my family. You know, I want to provide for my spouse or for my children. You know, you get these - you get them connected with what they consider to be important, and who they want to be.

And then once we've identified that, you really kind of pose that choice to them again and say, you know, you've made a commitment to the military. And part of that commitment is a sacrifice of some of your individual autonomy. And so as you consider whether or not you're going to deploy with the military or go to jail, which of these two options will help you to be the man or woman of honor, integrity, a good parent, a good spouse - you know, all of those ideals.

And when you frame it in that way, usually people start to realize that okay, I do have a choice and I don't like it - and I never ask a service member to like the choice. I'm just asking them to make the choice that will help them be the person that they want to be so that, you know, they feel comfortable with all of the decisions that they've made in life even when they're not the decisions they want to be making.

GROSS: And I'm going to tell you - listening to that, I know that the correct answer is supposed to be: So I will deploy and continue with my military responsibility - as opposed to going to jail. But really - like, if you pose that choice to me, I might think: Maybe I'll go to jail because probably I won't get killed there.

Dr. BRYAN: Mm-hmm.

GROSS: ...whereas if I go to Iraq, I might get killed and then my children might not have a father and, you know, my spouse might not have a spouse and...

Dr. BRYAN: Right.

GROSS: Do you know what I'm saying? It doesn't - I'm not sure that that choice makes it - would make it any easier for me.

Dr. BRYAN: Mm-hmm.

GROSS: I'm not in that position, so I can't say.

Dr. BRYAN: Yeah. And, you know, if a service member were to respond with that, you know, I certainly can't force you to make one choice or another.

And what we would do is engage in a conversation about what the consequences are associated with okay, I'll go to prison instead. Say, okay, so how does that help you become, you know, all of these things that you want to be? And if that's your choice, then that's your choice.

And, you know, I certainly cannot force your mind, in many ways. All I can do, as a psychologist, is help you to understand the ramifications of the decision you make and hopefully, help you to make the decision that is in your best interest, and that sort of most matches and aligns with who you are as a person because really, that's the pathway to, you know, reduced suffering in life.

At least someone in this conversation is showing some insight and compassion. I'm with Terry. Jail it is.

This is not medical help -- it's treating a damaged person as a disposable replacement part to be used up by the government. No surprise really; war is like that. Nor is it any surprise that so many vets take their own lives, if this is the quality of "help" the military offers.

You can say that again ...

The new Republican leaders in the House have received millions of dollars in contributions from banks, health insurers and other major business interests, which are pressing for broad reversals of Democratic policies that affect corporations, according to disclosure records and interviews.

Washington Post, 1/21/11

The Republican Party is the ultimate astroturf organization.

DemfromCT, DailyKos, 1/22/11

Maybe I should just make that headline a perennial.

Photo of Rep. Fred Upton (R-MI) from the Post story.

Australian aboriginal story

Two Men from Dominic Allen on Vimeo.

This fits with how I often feel these days.

Not the way to go about this ...

Michelle Obama is flacking for Wal-Mart's new push to bring more produce to its stores, according to the Washington Post. It's part of her effort to encourage better nutrition for poor families and kids. Her endorsement seems pretty gushing.

Obama called Wal-Mart's effort "a huge victory for folks all across this country" and said it has the "potential to transform the marketplace."

"When I see a company like Wal-Mart launch an initiative like this, I feel more hopeful than ever before," said Obama, who has made fighting childhood obesity and increasing nutritious food options in poor neighborhoods a top priority. "We can improve how we make and sell food in this country."

I get it; so-called "food deserts" are real; I can easily think of poor neighborhoods that have NO sizable retail food markets. Poor people can't very well eat healthy food if they can't buy it

But I don't like it. I don't like seeing the First Lady speaking out for a company whose retail strategy has been to prey on and kill off small competitors. Too many small downtowns in rural areas have died when Wal-Mart moved in on edge of town. Sure, folks got lower prices, but pretty soon every town looked just like every other, nobody had a job except at the big box store, the kids moved away looking for work.

In the cities, Wal-Mart seems to intend to put a few of their big boxes in genuinely poor neighborhoods, but, like more upscale chains, they'll mostly go where small retailers have already proved there is a market -- and take the business. I've described the extremely healthy array of small immigrant-owned stores and vendors in my poor neighborhood. These enterprises prove the existence of a market. Around the more upscale edges of the 'hood, we already see a high class chain store, Whole Foods, chipping away customers. I will not be surprised if we later see Wal-Mart trying to ride in and scoop up the low end of this proven market. That really would be desertification.

Wal-Mart is also far from a responsible corporate citizen -- and the First Lady should know it. When the Prez was running for office and needed union support, he said he wouldn't shop at this union-buster and she quit the corporate board of a Wal-Mart vendor. But now they are buddies again.

Meanwhile, Wal-Mart is asking the Supreme Court to kill a law suit involving potentially 1.5 million women employees who claim they were discriminated against in pay and promotions. More here. If Wal-Mart successfully argues that the class of injured people is simply too large to be allowed to sue, not only will its female employees loose out, but the general principle that injured citizens can go to civil court to win redress will be undercut. Every individual who thinks s/he is harmed will be on their own against each corporate behemoth. Does Obama really support that?

The President has been a deep disappointment because he seems to have an instinct to give away positions before even negotiating with forces that oppose his aims -- think the medical industry and the oil companies. It's sad to see Michelle Obama taking the same tack with the grocery business.

Friday cat blogging: they watch us from their perches

I see you. You see me. What of it?


What do you want?


I have to be alert, because you are looking at me.


See, when they go by, you can stare at them. Sometimes they are entertaining.


I'd love to come out and play -- but is it safe?

Civility, Budrus, and nonviolent struggle

In the wake of the Tucson shootings, we're deluged in calls for "civility." I suppose we'd be a more tranquil country if the temperature of our political interactions could be lowered a little, but I'm suspicious. When I was a student at Berkeley in the 1960s, the administration responded to student activism by calling for "civility" as embodied in compliance with "time, place and manner" rules that essentially meant you could speak out as long as no one had to hear you or be disturbed by you. Naturally we broke the rules. While I am sure there are still people who think we did a terrible wrong thereby, I still think racial justice and struggling to end a wrongful war were worth a little incivility.

So I'm underwhelmed when James Fallows of the Atlantic passes on this from a reader:

These three assumptions about one's opponent, his decency, honesty, and possibility that he's right, seem to me the essence of civil argument.

I refuse to assume, for example, the "decency" of hate mongers who stir up fear of Muslims building a mosque, or the "honesty" of professional right wing celebrities who made a living posturing on Fox, or that a former vice-president who enthuses over torturing prisoners "may be right." Nor do I much respect those who ask me to do so.

Recently, economist and New York Times columnist Paul Krugman described succinctly the conflicting moral beliefs that dominate our current political landscape.

One side of American politics considers the modern welfare state -- a private-enterprise economy, but one in which society’s winners are taxed to pay for a social safety net -- morally superior to the capitalism red in tooth and claw we had before the New Deal. It’s only right, this side believes, for the affluent to help the less fortunate.

The other side believes that people have a right to keep what they earn, and that taxing them to support others, no matter how needy, amounts to theft. That’s what lies behind the modern right’s fondness for violent rhetoric: many activists on the right really do see taxes and regulation as tyrannical impositions on their liberty.

There’s no middle ground between these views.

That rings true to me. And, as a convinced member of the first camp, I feel no compunction about calling the members of the other camp "ignorant," "heartless" and "selfish," civility be damned. That doesn't mean I think the other side should be lined up and shot -- but I do think they belong back in kindergarten, learning that civilization requires us to play well with others. And don't tell me to be more civil.***It was in this slightly cranky frame of mind yesterday that I went to see Budrus. The project website describes it like this:

Budrus is an award-winning feature documentary film about a Palestinian community organizer, Ayed Morrar, who unites local Fatah and Hamas members along with Israeli supporters in an unarmed movement to save his village of Budrus from destruction by Israel’s Separation Barrier.

I was skeptical. I was very aware that just a couple of weeks ago, a Palestinian woman, Jawaher Abu Rahmah, had been killed during an Israeli tear gassing of protesters at Bilin. I've lived with awareness of the violence that the Wall is doing to Palestinians longer than most, since the antiwar project I work with, WarTimes/Tiempo de Guerras, reported on it in April 2003 and that piece was named one of the most under-reported stories of the year by Project Censored.The injustices of the Israeli occupation of Palestine are so clear and cruel, that I leap quickly into red hot anger when I stare at them.

I'm not going to say that Budrus left me with warm fuzzy feelings. But I had to be impressed and thrilled to see a case study of an episode of Palestinian resistance that involved more peace-making than posturing between often acrimonious Palestinian factions, brought women centrally into the struggle along with men, and enlisted a few of the best Israeli activists in action for justice. There was (and is) nothing easy about any of that. Here's the trailer; it's a deeper film than this might suggest.



Budrus reminded me that nonviolent struggle doesn't mean no one will get hurt -- as the method's U.S. theorist and activist Barbara Deming explained:

The oppressors may well escalate their violence at first, since they face no violence in return. The nonviolent activists will probably take more casualties than their opponents. But nonviolence does not count its victories in terms of who receives fewer casualties. It defines victory as a change in the opponents' policies and behaviors. And in the long run, nonviolence will de-escalate the violence and there will be fewer casualties.

This is what we see in this film. Watching nonviolent struggle in action is a privilege -- and a good antidote to shallow calls for "civility." If the film is anywhere in your orbit (check the website) it's well worth it.

Bye bye Joe Lieberman

... and good riddance to ya. Lots of good posts around the 'sphere today trying to sum up the noxious career of the Senator from Connecticut who announced he is calling it quits in 2012.

The photo above is from Juan Cole's contribution to the Lieberman-leaving meme.

For a sharp history of this opportunist's trajectory, I strongly recommend Steve Kornacki's "The making (and unmaking) of Joe Lieberman." This reminded me that Lieberman was the occasion of one of my most atypical political acts: when this misogynist enthusiast for the death penalty first sought a senate seat in 1988, I made a small contribution to his opponent, a Republican!

The senator Lieberman defeated, Lowell Weicker, was everything Lieberman was not: pro-choice, a critic of Reagan's Central American wars, a supporter of school integration through busing if necessary, and an advocate for AIDS funding when that was a tough stand. He had put country above party as member of the Watergate Committee that formulated charges against Richard Nixon. After losing his senate seat, Weicker went on to serve as governor of Connecticut.

Kornacki sums up Lieberman neatly: he

settle[d] into the same role nationally that he first perfected in Connecticut back in 1988: Every Republican’s favorite Democrat.

Health care reform shorts: Who will still not get care under reform?

While Republicans in the House of Representatives grandstand against the insurance reform act passed last year, we need to remember that there are lots of us who don't like the bill because it failed to go far enough in improving access to doctors. Polls that measure attitudes to the law show that roughly 40 percent claim to approve of it and 41 to disapprove -- but some of the later just wanted something better.

"Overall, it didn't go as far as I would have liked," said Joshua Smith, 46, a sales consultant to manufacturers who lives in Herndon, Va. "In a perfect world, I'd like to see them change it to make it more encompassing, but judging by how hard it was to get it passed, they had to take whatever they could get."

CBS News, January 16, 2011

"Whatever they could get" means that in 2019 there will still be 22 million people in this country without the rudiments of access to medical care should they get sick. According to Ezra Klein,

• About one third of them will be undocumented immigrants. If we can't manage the political will to solve the injustices created by allowing employers to attract cheap workers with no rights and no way to get legalized, we'll go on having this class of absolute outsiders in our midst.

• Another set of the uninsured will be the abysmally poor who have avoided contact with the social welfare system. The new mandate that people must buy health insurance exempts people for whom this would cost more than 8 percent of monthly income. They'll be in big trouble, just like today, if they need care. But the system will have a huge incentive to try to get them on some form of Medicaid, state-level government provided health coverage subsidized by the Feds.

• Finally there will be the inevitable set, most young and feeling invincible, who just blow off the whole system, figuring they'll pay the $750 penalty for failing to carry insurance if they have to. The law with its penalty simply recognizes we are that kind of country, though the benefits of being insured ought to become more and more obvious to anyone who looks around.

The United States should have health care reform that covers everyone; most developed countries manage this through some form of single payer (we'd probably call it "Medicare for all") or very heavily regulated private insurance. But we will only get that if our powers-that-be become willing or able to take on the mess of drug companies, doctors, hospitals and medical device merchants that collude to squeeze private profit out of sick people. That's who really stands in the way health care reform. Those Republicans are just performing theater on behalf of their sponsors.

Empires reach limits and fall

Back during a time that feels like (and was) several lifetimes ago, I was a graduate student of European history, interested among other topics in the First World War (1914-1918) that blew away the continent's social arrangements, fed the Bolshevik Russian Revolution, and marked the emergence of the United States as what Madeleine Albright called "the indispensable nation" and less sanguine observers labelled simply "top nation." Every once in a while I return to this interest.

Lately I've been dipping into David Fromkin's A Peace to End All Peace: The Fall of the Ottoman Empire and the Creation of the Modern Middle East. This 1989 volume is a diplomatic history, apparently largely based on British records, of the flounderings of British officialdom in the war years. It is history told from the outside and from above; the unfortunate indigenous inhabitants of the region barely appear as Fromkin describes imperial officials trying to figure out whether and how to overthrow the Ottoman regime, Zionists and their sympathizers in Britain asserting their claims to Palestine, and Arab nationalism(s) beginning to surface amid a welter of local rivalries. A mix of confusion, avarice and imperial competition led to the drawing of the boundaries of states between Turkey and Iran, most of which lines still hold today.

If so many people hadn't died, so many lives not been destroyed, and so many future territorial conflicts set up, this story of imperial folly might be humorous -- or perhaps could have been for a detached western hemisphere observer before watching the very similar flounderings of the US empire over the last few decades.

World War I-era imperial Brits were woefully ignorant of opinion in the lands they intended to re-arrange.

A characteristic flaw in the information-gathering ... was that they frequently accepted information supplied by a single informant without testing and checking it. Instead they seemingly relied on [a] sort of intuitive ability ... the gift of being able to divine the extent to which any native is telling the truth.

...In evaluating reports that there was dissatisfaction with Ottoman rule in some sections of the empire, British Cairo particularly misunderstood one of the salient characteristics of the Moslem Middle East: to the extent that it was politically conscious, it was not willing to be ruled by non-Moslems. ... They regarded rule by a Christian European power, such as Britain, as intolerable. ... Wrong-headed and professionally ambitious, Britain's men on the spot supposed that Arabs wanted to be ruled by Europeans ...

I guess these men were the true ancestors of Dick Cheney and Don Rumsfeld -- it's hard to not be reminded of Bushite Washington's enthusiasm for the Iraqi conman Ahmed Chalabi.

After a stumbling start, troops from British India did overrun Ottoman Baghdad and Basra in 1917 -- and then London authorities realized they had no plan how to govern these Iraqi cities.

On 16 March 1917 the War Cabinet created a Mesopotamian Administration Committee under the chairmanship of Lord Curzon to determine what form of government should be installed in the captured provinces. The committee decided that the province of Basra should become British [ruled from Cairo] -- not British-Indian -- while the province of Baghdad should join or should become a Arab political entity subject to a British protectorate. ... It was evident that London either was not aware of, or had given no thought to, the population mix of the Mesopotamian provinces. The antipathy between the minority of Moslems who were Sunnis and the majority who were Shi'ites, the rivalries of tribes and clans, the historic and geographic divisions of the provinces, ... made it difficult to achieve a single unified government that was at the same time representative, effective, and widely supported.

... The Mesopotamian Administration Committee had no ready [replacement] for the Ottoman administration of Mesopotamia had been driven out... It was an inauspicious beginning and suggested the extent to which the British government did not know what it was getting into when it decided to supersede the Ottoman Empire in Asia ....

Naturally these European imperial diplomats never thought of the possibility that the Ottomans, whose empire they considered moribund, might fight them to a standstill. But in fact in the early years of the war, led by modernizing Young Turks, the old empire did just that.

The Ottoman Empire benefited from the fact that it was not the principal theater of war for any of its opponents, all of whose forces and·energies were concentrated elsewhere. Even so, its wartime performance was surprisingly successful. Engaged in a three-front war, the Ottoman Empire defeated Britain and France in the west in 1915-16, crushed the advancing armies of British India in the east at the same time, and in the north held off the Russian invasion forces.

It never occurred to the British that Middle Easterners might resist domination by European conquerors, fiercely and sometimes effectively; the United States made the same mistake in invading Iraq and continues it today in central Asia.

In an afterward, Fromkin explains that, by the end of the exhausting European war, British society had changed so that entrenching the empire in its new Middle Eastern territories was no longer feasible, even if governments didn't yet understand that. He writes:

In 1922 the British government had arrived at a political compromise with British society, by the terms of which Britain could assert her mastery in the Middle East so long as she could do so at little cost. To British officials who underestimated the difficulties Britain would encounter in governing the region--who, indeed, had no conception of the magnitude of what they had undertaken--that meant Britain was in the Middle East to stay. In retrospect, however, was an early indication that Britain was likely to leave.

I believe United States governments will find that our empire too has hit its limits just at the moment when our neo-conservatives thought they had the whole world under their thumb. Let's just hope they don't kill too many more people before they notice.

Spiritual death and hope for life: In remembrance of Dr. Martin Luther King

A nation that continues year after year to spend more money on military defense than on programs of social uplift is approaching spiritual death.

This is not the retroactively sanitized and sainted King we are urged annually to remember. We still need to listen to him.

We must rapidly begin the shift from a thing-oriented society to a person-oriented society. When machines and computers, profit motives and property rights are considered more important than people, the giant triplets of racism, militarism and economic exploitation are incapable of being conquered.

King didn't give up.

And I have not lost faith. I'm not in despair, because I know that there is a moral order. I haven't lost faith, because the arc of the moral universe is long, but it bends toward justice. I can still sing "We Shall Overcome" because Carlyle was right: "No lie can live forever." ...

With this faith we will be able to speed up the day when justice will roll down like waters, and righteousness like a mighty stream. With this faith we will be able to speed up the day when the lion and the lamb will lie down together, and every man will sit under his own vine and fig tree, and none shall be afraid because the words of the Lord have spoken it. With this faith we will be able to speed up the day when all over the world we will be able to join hands and sing in the words of the old Negro spiritual, "Free at last! Free at last! Thank God Almighty, we're free at last!" With this faith, we'll sing it as we're getting ready to sing it now. Men will beat their swords into plowshares and their spears into pruning hooks. And nations will not rise up against nations, neither shall they study war anymore. And I don't know about you, I ain't gonna study war no more.

Full text of this speech delivered at Ebenezer Baptist Church on April 30, 1967 is available here.

Keep your promise!

On Tuesday January 25, President Obama will address the Congress about the "State of the Union." There's an odd anachronism in the age of the 24/7 media circus.

Let's hope he sticks by what he has always said about protecting Social Security from those forces -- Wall Street, some Republicans -- who want to balance the budget by taking from needy elders.



It's depressing to know that we have to be just as vigilant about threats to the safety net from a Democratic as from a Republican administration, but we do.

Blown out of existence in Afghanistan

If this story is the widespread reality, the war is not going anywhere good.

According to journalist Paula Broadwell writing on Thomas Rick's Foreign Policy blog, last October a U.S. army unit in southern Afghanistan was in trouble. It had lost several soldiers killed and wounded and confronted a village where through some combination of recruitment and intimidation, the Taliban had implanted a maze of deadly mines. So they called in artillery and air power and this was the result:





The soldiers promised to rebuild the village if the locals would work on the project, but encountered organizational obstacles. Unaccountably to Broadwell, their efforts were not entirely popular. One vocal villager accused the soldiers of "ruining his life." If I read Broadwell correctly, the troops are still there, still trying get some rebuilding on track.

I'll leave commentary on this minor incident of the war to Joshua Foust, who writes about international security issues at Registan and in numerous print media, including the New York Times, Reuters, The Christian Science Monitor, The Columbia Journalism Review, and World Politics Review.

Look, war is hell. I have no illusions about that. But what is happening right now in Southern Afghanistan is inexcusable. ... I’m really struggling to see how such behavior does not violate Article 33 of the Fourth Geneva Convention -- that is, how this behavior is not a war crime, especially given the explicit admission that such behavior is merely for the convenience of the soldier and not any grander strategy or purpose. ...

What baffles me is, why the hell is Broadwell so pleased with this? Will she ever write a follow up post about where these villagers will be able to live while they wait for the magnanimous soldiers to rebuild the town they erased? The callousness of this account is, literally, breathtaking: if soldiers are razing entire villages to avoid a few IEDs and to preserve their momentum, that should be triggering even token expressions of regret or even concern. Instead, it prompts her to mock the Afghans for complaining about it… as well they should. Those soldiers will be damned lucky if they escape their deployment without any suicide bombs or nasty IED incidents. Because they have certainly earned the fatal, burning wrath of every single Afghan living nearby.

I cannot comprehend why the deliberate destruction of villages seems to be an official, sanctioned ISAF policy in the South. Is is abhorrent, an atrocity, and there is no excuse for it (nor are there words for the anger it’s stirred in me, reading about it from afar; I suspect Broadwell would sniff at me to stop whining as well, were we to discuss it in person). This should outrage and infuriate everyone who reads about it. But, and this is where I move from rage to despair: how could we ever possibly hope to stop it?

I imagine that, during the Russian invasion of Afghanistan from 1979 through 1989, most Russian citizens didn't have much idea what their troops were doing either. Nor did they understand that Afghans are people with normal human reactions to having their villages -- their lives, their possessions, their memories -- erased by foreigners. The United States has now been mucking about in Afghan lives longer than the Soviets.

Friday cat blogging: meet Emerson

Sometimes he tries to pretend he's a dangerous feral fellow.


But then he makes it obvious he's just a kitten, a pushover for a little tickling.

Accuracy in signage

This is not uncommon along Manhattan side streets this winter.


Someone thought a correction was needed.

Nepal: federalism ahead?

Political graffiti in Kathmandu. I'm sure there was much more, but this was iconography a tourist could recognize, though not necessarily understand.

When one visits other peoples' countries as a tourist, it is sensible to avoid questioning people about their local politics. That's not at all my instinct; I'm too habitually attuned to the push and pull of power in communities not to frame questions. But, of course, I am also too ignorant on a short visit to be able to see and engage with whatever is going on from the local perspective.

So I asked no questions about politics during my brief visit to Nepal in November, even though I knew the country had recently emerged from civil war, had no current central government, and was in a process of writing a constitution.

Today the International Crisis Group issued one of its sober briefing papers on Nepal. ICG represents the more enlightened factions of Western internationalism, sometimes acting as a slightly abashed apologist for American and European hegemony, but also often wise to on-the-ground realities in countries not bathed in a Western media spotlight.

Here are some excerpts from the executive summary of the new Nepal report:

Nepal: Identity Politics and Federalism

Federal restructuring of the state has emerged as a major demand of ethnic and regional activists in Nepal. The debate about it is extremely politicised. Federalism is not simply the decentralisation of political power; it has become a powerful symbol for a wider agenda of inclusion, which encompasses other institutional reforms to guarantee ethnic proportional representation and a redefinition of Nepali nationalism to recognise the country’s ethnic and cultural diversity.

Activists demand the introduction of reservations to guarantee proportional representation of marginalised groups in government and administration. They want provinces to be named after the most numerous ethnic and regional groups and boundaries drawn to make them dominant minorities. Some claim to be indigenous to these regions and demand preferential rights to natural resources and agradhikar -- priority entitlement to political leadership positions in the future provinces.

Ethnic and regional demands were important parts of the Maoist agenda during the civil war; in eastern Nepal, much of their support depended on it. State restructuring became a central component of the 2006 peace deal. ...

Backtracking on federalism is politically impossible. ... deferring crucial decisions, or stalling the constitutional process altogether, could be tempting for those opposed to change. The assumption that the Maoists have both the most to gain and the most to lose from the constitutional process could lend wider appeal to the idea. The risks are hard to calculate. Ethnic and regionalist groups, already suspicious of the major parties’ commitment to federalism, threaten protests and ultimately violent resistance should it not come. Their eyes are on the 28 May 2011 deadline for the promulgation of the new constitution. ...Activists are getting frustrated and the mood is becoming more militant. With an issue to rally around they are likely to coalesce; a politicised population would easily be mobilised for protest movements, should federalism not come.

Not all want federalism. Popular opposition to ethnic federalism in particular is substantial, by virtue of its association with identity politics. Many Brahmins and Chhetris, the dominant caste groups, fear they will lose out from the introduction of ethnic quotas and federal restructuring. But organised resistance is limited and fragmented.

...The structure emerging from the Constituent Assembly, federal but with a strong centre, offers a feasible compromise.

I have no way of knowing whether this is an accurate rendering of the situation. Federalism often seems a mixed blessing in our own country; does it really make sense that so many laws differ between states and that so many responsibilities are so uneasily shared by 50 state governments with the national government? Nepal only has about 35 million inhabitants, though it's people speak 92 separate languages at home and presumably also therefore possess many different cultures.

I can't pretend to understand anything much about Nepal, but I can sure wish this beautiful, hospitable country well as it approaches the deadline for its new constitution.

City in winter

Heavy snow is expected in New York City today; I don't expect to get out much. But on Tuesday the late afternoon view across the reservoir in Central Park was lovely.


This sky did seem ominous.

Sad anniversary; sad capitulation

The U.S. prison at Guantanamo enters its 10th year today. Witness Against Torture will be protesting at the White House and the Department of Justice. There are still people in this country who condemn indefinite imprisonment and abuse without trial or recourse.

Adam Server tracks civil rights, human rights and criminal justice at a blog at the American Prospect. On Friday, he concluded that President Obama has "surrendered".

The president's signing statement on the ban on Defense Department funds [in the Defense Authorization Bill] for trials of Guantanamo Bay detainees suggests he won't be taking the route offered by the ACLU and defying the ban by using funds from other agencies to facilitate federal criminal trials. ...

It sounds to me like the White House just gave up on closing Gitmo and trying the 9/11 conspirators in civilian court. Anytime this administration makes vague promises to "fight" anything, it means they've already given up. They could have fought this by fighting it. They had the last two years to "fight" this. They curled up in a fetal position and let themselves get pummeled to death, all before being unable to prevent a Democratic Congress from severely constraining the president's ability to permanently incapacitate terrorists.

Not with a bang, but a whimper.

My emphasis.

Remember the artist Shepard Fairey, he of the iconic red, white and blue 2008 Obama portrait? These days he's making art to remind us of the evil that is Guantanamo and all the other law-free lockups our rulers persist in creating. These posters are available on eBay as a benefit for Witness Against Torture.