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Med School Classes Cancelled in Havana February 20, 2012

Posted by rogerhollander in Cuba, Health, Latin America.
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Roger’s note: I am not an uncritical admirer of Castros’ Cuba.  However, I have made a fairly extensive study of the Cuban revolution, and in the 1980s and 1990s I traveled several times to Cuba, and by car and plane got to know a great deal of the Island.  In general, I found that for the most part the Cubans I met were educated, cultured, “civilized” and with a pride and dignity I have not seen in other Latin American countries.  I have met with veterans of the Bay of Pigs invasion and was given a private tour of the museum at that “sacred” place, where a huge billboard advertises it as the “first defeat of imperialism in the Americas.”  How much of Cuba’s Stalinist Communist rule is a necessity with respect to the US blockade and belligerence and how much a result of failed socialist imagination, is hard to say.  My most memorable experience was when a Canadian with whom we were traveling on our return trip to Toronto had a paranoid attack when we stopped in Camaguay to pick up passengers.  He exited the plane and ran out onto the tarmac.  My belief is that if this had happened the US he would have been shot dead (and questions asked later).  In Cuba, the authorities patiently followed him as he ran about the airfield, amongst both civilian and military aircraft.  When he finally tired out, he was detained with minimal force and taken to a psychiatric facility.  This is what I mean when I use the word “civilized.”

by Don Fitz, www.blackagendareport.com, Feb. 14, 2012

Fidel Castro long ago vowed to make Cuba a “medical superpower.” The country’s healthcare system emphasizes preventive medicine and mobilization of the entire population against threats to health and safety. Medicine is more than a career. Imagine that, at the height of the Katrina disaster, the US closed medical schools in Gulf coast states and coordinated their work of attending to medical and public health needs of the poorest in New Orleans.”

 

Imagine that medical schools across the US sent their students to survey living conditions of poor black, brown, red, yellow and white Americans to determine what causes elevated mortality rates.”

“I’m on pesquizaje,” my daughter Rebecca told me. “All of the third, fourth and fifth year medical students at Allende have our classes suspended. We are going door-to-door looking for symptoms of dengue fever and checking for standing water.” [1]

As a fourth year medical student at Cuba’s ELAM (Escuela Latinoamericana de Medicina, Latin American School of Medicine in Havana), she is assigned to Salvadore Allende Hospital in Havana. It handles most of the city’s dengue cases. Though she has done health canvassing before, this is the first time she has had classes cancelled to do it. It is very unusual for an outbreak of dengue, a mosquito-borne illness, to occur this late in the season. She remembers most outbreaks happening in the Fall, being over before December, and certainly not going into January–February.

Groups of medical students are assigned to a block with about 135 homes, most having 2–7 residents. They try to check on every home daily, but don’t see many working families until the weekend. The first dengue sign they look for is fever. The medical students also check for joint pain, muscle pain, abdominal pain, headache behind the eye sockets, purple splotches and bleeding from the gums. What is unique about Cuban medical school is the way ELAM students are trained to make in-home evaluations that include potentially damaging life styles — such as having uncovered standing water where mosquitoes can breed.

Dengue is more common in Cuban cities of Havana, Santiago and Guantánamo than in rural areas. Irregular supply of water to the cities means that residents store it in cisterns. Cisterns with broken or absent lids and puddles from leaky ones are prime breeding sites for the Aedes aegypti mosquito, the primary vector (carrier) of dengue. [2]

DF and DHF

There is a significant difference between dengue fever (DF) and dengue hemorrhagic fever (DHF). DF is a virus which usually lasts a week or more and is uncomfortable but not deadly. [3] DF has four varieties (serotypes). If someone who has had one type of dengue contracts a different serotype of the disease, the person is at risk for DHF. Early DHF symptoms are similar to DF but the person can become irritable, restless and sweaty, and go into a shock-like state and die. [4]

DF can be so mild that many people never know that they had it and that they are at risk for the far more serious DHF. This is why the Cuban public health model of reaching out to people is important in preventing a deadly epidemic. There are no known vaccines or cures for DF or DHF — the only treatment is treating the symptoms. With DHF, this includes dealing with dehydration and often blood transfusions in intensive care. [3, 4]

DF is a virus which usually lasts a week or more and is uncomfortable but not deadly.”

Each year, there are over 100 million cases of DF, largely in sub-Saharan Africa, the Caribbean, Latin America, Southwest Asia, and parts of Indonesia and Australia. [4] Between 250,000 and 500,000 cases of DHF occur annually and 24,000 result in death. [5]

Dengue was not identified in Cuba until 1943. Epidemics hit the island in 1977–1978 (553,132 cases), 1981 (334,203 cases of DF with 10,312 cases of DHF), 1997 (17,114 DF cases with 205 DHF cases), and 2001–2002 in Havana (almost 12,000 DF cases). [2]

Climate, mosquitoes and health

Climate change could make conditions more comfortable for mosquitoes that are vectors for dengue. During the last half a century, Cuban health officials have calculated a 30-fold increase of Aedes aegypti mosquito. [5] Since the 1950s, the average temperature in Cuba has increased between 0.4 and 0.6°C. Health officials are well aware that “…increasing variability may have a greater impact on health than gradual changes in mean temperature…” [2]

The 1990s were a very hard time for Cuba. Known as the “special period,” this was when collapse of the Soviet Union caused oil to dry up, the nation’s production (including food) to plummet, and illnesses to increase. [6] It was also a time when there was a climb “in extreme weather events, such as droughts, and…stronger hurricane seasons.” [2] Increases in climate variability meant winters have become warmer and rainier.

Conner Gorry, Senior Editor of MEDICC Review in Havana, reports that “My friends and neighbors tell me they can’t remember ever having to fumigate or think about dengue in the winter.” [1] Another consequence of more ups and downs in the climate is “…insults to the upper respiratory tract, increasing viral transmission, particularly among infants and children.” [2]

Mobilization

Medical students in Havana come from 100 countries about the globe. [7] No matter what accent they have when speaking Spanish, they don’t have trouble getting into homes. In Havana, there is nothing unusual about a foreigner in a bata (white medical jacket) walking through homes, poking into yards and peering on roofs to see if there is standing water.

Always in need of extra cash, an enormous number of Cubans have some sort of less than totally legal activity going on in their homes (such as a nail parlor in the living room). But it does not occur to either the resident or the medical student that the inspection would be for anything other than public health reasons.

Cuba has experienced more than half a century of mobilization campaigns like current efforts to control dengue. Soon after the 1959 revolution Cuba mobilized the literacy campaign which sent teachers and students to every corner of the island to teach citizens to read and write. Every hurricane season, the neighborhood Committees for Defense of the Revolution (CDRs) are prepared to move the elderly, sick and mentally ill to higher ground if an evacuation is necessary. Campaigns against diseases like polio and dengue have made Cubans used to the government bringing public health efforts into their homes. [6]

Every hurricane season, the neighborhood Committees for Defense of the Revolution (CDRs) are prepared to move the elderly, sick and mentally ill to higher ground if an evacuation is necessary.”

Beginning in the 1960’s, the CDRs worked with thousands of trainers, who, in turn trained 50,000 more Cubans to teach the importance of polio vaccinations. As a result, Cuba has not had a polio death since 1974. CDRs actively encourage pregnant women to regularly visit their neighborhood doctor’s office and patrol the community to enforce the ban on growing succulents that attract mosquitoes. [6]

Cuba investigates

Cuba places a very high value on researching preventive medicine. MEDICC Review (Medical Education Cooperation with Cuba) is a peer reviewed open access journal which works to enhance cooperation among “global health communities aimed at better health outcomes.” [8]

Cuban researchers have played a key role in developing the widely accepted model that DHF is determined by “the interaction between the host, the virus and the vector in an epidemiological and ecosystem setting” [9] In Cuba, this translates to (a) the most important risk factor for getting DHF is having a second infection of DF which is a different strain; (b) being infected a second time in a specific order of DF strains places children at a higher risk for DHF than adults; (c) white Cubans are at a higher risk for DHF than Afro-Cubans; but, (d) those who already have sickle cell anemia, bronchial asthma or diabetes are at higher risk.

Cuban researchers openly discuss weaknesses in their health care system. One study indicated that there could be a “marked undercounting” of dengue due to missing a large number of cases. This finding occurred even though the study examined data during a time of “maximum alert,” suggesting that undercounting could be very widespread. [10]

A typical finding is that the community must feel that the dengue control program belongs to them if it is to be successful and sustainable. [11] Some of the best work I’ve seen on the role of public health takes an honest look at effects of “the absence of active involvement of the community” in dengue control. The authors felt that Cuba’s outdoor spraying of adult mosquitoes “is of questionable efficacy.” Instead, they focused on “the bad conditions or absence of covers on water storage containers” in the city of Guantánamo. [5]

Those who already have sickle cell anemia, bronchial asthma or diabetes are at higher risk.”

The study had a control group of 16 neighborhoods which carried out the usual practices of home inspections, measuring the degree of mosquito infestation, and larviciding (applying chemicals to kill mosquitoes during the larval stage of growth). In contrast, their intervention group did everything that the control group did, but added intense involvement by local activists. “Formal and informal leaders” of the community worked with health professionals “to mobilize the population and change behavior,” such as covering water containers correctly, repairing broken water pipelines, and not removing larvicide.

Measuring the number of mosquitoes in the two groups revealed dramatic results. The authors concluded that “Community based environmental management integrated in a routine dengue prevention and control program can reduce level of Aedes infestation by 50–75%.” [5]

Imagine

Rebecca told me that when medical students inspect the homes of Havana residents, they find that the overwhelming majority comply with pubic health policy. But some do not. A few cannot afford the proper lid for cisterns. Some have mental problems that limit their ability to cooperate. And a very few just don’t give a damn, even if they could be raising mosquitoes that infect their neighbors. Cuban-style public health research is critical in identifying barriers that communities need to overcome if they are to protect themselves from disease.

Do you remember Katrina and the number of New Orleans residents who languished while the state and national governments did nothing meaningful? Do you remember the photos of 1000 Cuban doctors in batas ready and waiting to come to New Orleans just like they went to Nicaragua, Honduras, Haiti, Venezuela, Sri Lanka, Pakistan and dozens of other countries hit by disasters? Do you remember the government that would increase the suffering of its own people rather than accept help from Cuba?

It may be difficult, but imagine that, at the height of the Katrina disaster, the US closed medical schools in Gulf coast states and coordinated the work of attending to medical and public health needs of the poorest in New Orleans. It may contradict your lifetime of experiences, but imagine that medical schools across the US sent their students to survey living conditions of poor black, brown, red, yellow and white Americans to determine what causes elevated mortality rates and then announced that no one would return to medical school until they were part of a national plan to resolve health care needs.

It may bend your mind to the border of hallucination, but imagine that health care professionals throughout the world demanded that people of the Global South be spared the mosquito infestations, rising waters, droughts, floods, species extinctions and all other manifestations of climate change brought on by the gluttonous overproduction of the 1% in the Global North. Imagine new medical care based on help going to those who need help the most rather than obscene wealth going to those who invest in the sickness industry.

Imagine citizens welcoming health professionals to walk through their homes because they do not fear being reported to the police and because they have seen mobilization after mobilization improve their lives rather than ensnare them in empty promises. Imagine a new society.

Don Fitz (fitzdon@aol.com) is editor of Synthesis/Regeneration: A Magazine of Green Social Thought. He is Co-Coordinator of the Green Party of St. Louis and produces Green Time in conjunction with KNLC-TV. He can be contacted at fitzdon@aol.com.

Notes

1. My Spanish-English dictionary does not include “pesquizaje;” but Conner Gorry, Senior Editor of MEDICC Review says that Cuban health professionals use “pesquizaje active” to mean “active screening” when they go door-to-door. Email message from Conner Gorry January 24, 2012.

2. Lázaro, P., Pérez, Antonio, Rivero, A., León, N., Díaz, M. & Pérez, Alina (Spring, 2008). Assessment of human health vulnerability to climate variability and change in Cuba. MEDICC Review, 10 (2), 1–9.

3. Dengue fever, A.D.A.M. Medical Encyclopedia. PubMed Health. Retrieved on February 6, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002350/

4. Dengue hemorrhagic fever, A.D.A.M. Medical Encyclopedia. PubMed Health. Retrieved on February 6, 2012 from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002349/

5. Vanlerberghe, V., Toledo, M.E., Rodriguez, M., Gómez, D., Baly, A., Benitez, J.R., & Van der Stuyft, P. (Winter 2010). Community involvement in dengue vector control: Cluster randomized trial. MEDICC Review, 12 (1), 41–47.

6. Whiteford, L.M., & Branch, L.G. (2008). Primary Health Care in Cuba: The Other Revolution. Lanham: Rowman & Littlefield Publishers, Inc.

7. Fitz, D. (March 2011). The Latin American School of Medicine today: ELAM,” Monthly Review, 62 (10) 50–62.

8. Medical Education Cooperation with Cuba. Retrieved February 6, 2012 from http://www.medicc.org/ns/index.php?s=3&p=3.

9. Guzmán, M.G. & Kouri, G. (2008). Dengue haemorrhagic fever integral hypothesis: Confirming observations, 1987–2007. Transactions of the Royal Society of Tropical Medicine and Hygiene. 102, 522–523.

10. Peláez, O., Sánchez, L, Más, P., Pérez, S., Kouri, G. & Guzmán, M. (April 2011). Prevalence of febrile syndromes in dengue surveillance, Havana City, 2007. MEDICC Review, 13 (2),47–51.

11. Díaz, C., Torres, Y., de la Cruz, A., Álvarez, A., Piquero, M., Valero, A. & Fuentes, O. (2009). Estrategía intersectoral y participativa con enfoque de ecosalud para la prevención de la transmisión de dengue en el nivel local. Cadernos Saúde Pública, 25 (Supl. 1), S59­S70. http://dx.doi.org/10.1590/S0102-311×2009001300006

U.S. apologizes to Guatemala for infecting prisoners with syphilis October 2, 2010

Posted by rogerhollander in Latin America, Human Rights, Health, Foreign Policy, Guatemala.
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(Roger’s note: an apology without compensation, SOP for the US.  I beg to differ with the article’s conclusion.  To the Obama government, nor any of its predecessors, it really does not matter how they treat other countries except when it suits their geopolitical interests.  By their own admission dozens of experimental abuses were carried on during this period.  Imagine the pain and suffering to indefensible innocents.  Today’s experimental abuses involve, among other things, using unmanned missiles to terrorize civilians in Pakistan and Afghanistan.  Interesting to note that the abuses were easier to carry off in Guatemala because of the control that the United Fruit Company had over the local government (and when that government was democratically replaced by a popular one, the CIA overthrew it).  Again, SOP for US foreign policy vis-à-vis Latin America, the intimate relationship between corporate needs and government policy.  Secretary of State Hillary Clinton, the author of the hollow apology towards Guatemala, is the same one who, along with her husband gave aid and comfort to the illegal coup in Honduras and couldn’t wait to embrace the illegitimate de facto government of Porfirio Lobo.  Americans whine: why do they hate us?  I ask you what is the real difference between the grotesque and barbaric experiments the US government carried out in Alabama, Guatemala and dozens of other places and those carried out oin the name of science by the Nazis in Germany.)

Toronto Star, October 2, 2010

By Olivia Ward Foreign Affairs Reporter

It was a reality that mimicked a horror film: Guatemalan prisoners coerced to have sex with prostitutes who were infected with syphilis. Prostitutes who were healthy smeared with the bacteria. Mentally ill inmates inoculated with syphilis.

It was not a deadly biowar experiment, but an American-backed attempt to test whether newly discovered penicillin could prevent the sexually transmitted disease. And it took place in deeply impoverished Guatemala between 1946 and 1948 without the consent of the experiment’s 696 victims.

On Friday, U.S. Secretary of State Hillary Clinton and Health Secretary Kathleen Sebelius issued a startling apology to Guatemala, saying that “although these events occurred more than 64 years ago, we are outraged that such reprehensible research could have occurred under the guise of public health.”

In another chilling admission, Dr. Francis Collins, who heads the National Institutes for Health, told reporters that the Guatemalan experiments were among dozens of abuses by Washington over years of loose standards.

The government “could identify more than 40 other studies where intentional infection was carried out with what we would now consider completely inadequate consent, in the United States,” he said.

The Guatemala experiment — in which subjects were treated with penicillin after attempts to infect them — was uncovered by Wellesley College medical historian Susan Reverby, whose earlier research on an infamous experiment on 500 poor African-American men near Tuskegee, Ala. won a public apology from President Bill Clinton.

The same U.S. Public Health Service researcher, Dr. John Cutler, took part in both experiments.

In Alabama the men were already suffering from syphilis, but scientists merely studied them under the pretence of treating them for “bad blood,” even after penicillin was a known cure. During the 40-year study, beginning in 1932, many of the men died, their wives became infected and children were born with congenital syphilis.

Leaked reports brought the experiment to a halt, and sparked higher standards and closer monitoring of human medical research.

On Friday, Clinton and Sibelius said that the government was launching two investigations into the Guatemala case, including a review by a high-level presidential commission to ensure current medical research met “rigorous ethical standards.”

The hundreds of Guatemalans used in the U.S. study are either very elderly or dead by now, though their photos in research files are silent testimony to their participation. The question of compensation for their relatives is still unanswered. And, Reverby said, the experiments brought no apparent advances in medical science.

Her research in the study’s records found that in spite of penicillin treatment, “not everyone was probably cured” of syphilis after they had been infected. And she said, “what’s interesting about it is (the scientists) knew the study had an unethical edge.”

In fact, the experiment was moved to the small Central American country because the American team could work there with greater freedom, with the co-operation of a government that was promised badly needed medical aid in return. It was not clear whether senior American politicians were aware of the experiments.

Guatemala was an easy target for unbridled research, Reverby said, because the American-owned United Fruit Company controlled much of the country. Washington later helped to overthrow Guatemala’s elected government, and backed the brutal dictatorships that replaced it.

Now, said Reverby, the Obama government has shown it wants to draw a line under that dark history.

“It believes that how we treat other countries does matter.”

Obama Breaks (Another) Campaign Promise: on AIDS May 9, 2009

Posted by rogerhollander in Barack Obama, Health.
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WASHINGTON  – U.S. President Barack Obama’s failure to lift a federal funding ban on syringe exchange — a policy that allows intravenous drug users to swap used needles for clean ones — is a blow to AIDS-prevention efforts, says a global health group.

 

[AIDS activists rally in support of US President Barack Obama in Washington, DC., last November. President Obama's failure to lift a federal funding ban on syringe exchange -- a policy that allows intravenous drug users to swap used needles for clean ones -- is a blow to AIDS-prevention efforts, says a global health group. (AFP/Paul J. Richards)]AIDS activists rally in support of US President Barack Obama in Washington, DC., last November. President Obama’s failure to lift a federal funding ban on syringe exchange — a policy that allows intravenous drug users to swap used needles for clean ones — is a blow to AIDS-prevention efforts, says a global health group.(AFP/Paul J. Richards)

Although Obama pledged on the campaign trail to overturn the federal ban on funding for syringe exchange, he refrained from doing so in his proposed 2010 budget. “Providing clean syringes is proven to be one of the most effective public health interventions since the polio vaccine,” said Jennifer Flynn, managing director of Health Global Access Project (GAP). “It is clear that it works, but yet, we now have to wait for Congress to act to have the freedom to use every possible resource to make it widely available.” (See Health GAP’s full statement below.)
 

Overall, U.S. health advocates were extremely disappointed by the health provisions in the president’s 2010 budget, unveiled yesterday. “Our analysis of the information provided by the White House today show that the president’s FY10 global health budget essentially flat-lines support for global health and ignores the president’s campaign promises to fully fund PEPFAR (the President’s Emergency Plan for AIDS Relief) and to provide a fair-share contribution to the Global Fund to Fight AIDS, TB [tuberculosis], and Malaria,” said Paul Zeitz, executive director of the Global AIDS Alliance. “This proposal is even worse than we had feared,” added Christine Lubinski, director of the Center for Global Health Policy. “With this spending request, Obama has broken his campaign promise to provide 1 billion dollars a year in new money for global AIDS, and he has overlooked the growing threat of tuberculosis.”

Just after Obama’s election, AIDS activists spoke of high hopes for a renewed U.S. commitment to fighting the disease. Last month, however, a U.S. health care foundation said Obama’s first official plan to fight domestic HIV/AIDS “falls far short” of what is needed to confront the growing epidemic. The $45 million media campaign, launched in early April, aims to raise awareness about domestic HIV/AIDS over the next five years. “If this proposal is any indication of how President Obama and his Administration intend to address the AIDS epidemic domestically or globally, we are deeply disappointed,” said Michael Weinstein, president of the AIDS Healthcare Foundation.

* * *

PRESIDENT BREAKS ANOTHER CAMPAIGN PROMISE

From: Health Global Access Project (GAP)

Federal Ban on Funding for Syringe Exchange Remains in Budget

Washington, DC — President Obama’s budget does not follow through on one of his key campaign commitments – to lift the ban on federal funding for syringe access. Before and since taking office, President Obama has repeatedly asserted his support for syringe exchange programs. This latest disappointment comes on the heels of a newly announced six-year global health initiative that would actually reduce spending on global AIDS by $6.6 billion.

“Providing clean syringes is proven to be one of the most effective public health interventions since the polio vaccine. It is clear that it works, but yet, we now have to wait for Congress to act to have the freedom to use every possible resource to make it widely available,” said Jennifer Flynn, Managing Director of Health GAP. Flynn lost a family member in 2005 to hepatitis C contracted from sharing used syringes. “If needle exchange programs were around when my cousin was injecting heroin, he would be alive today. President Obama could have done something simple to save lives. Now Congress needs to take action,” she continued.

Jeff Crowley, national AIDS czar, said that the “President doesn’t think policy should be done in the budget process.” However, the federal ban on funding syringe exchange is housed in each annual appropriations bill, and must be removed from there to allow federal funds to go to these lifesaving programs. Removing the language would allow syringe exchange to be included in the HIV prevention toolkit, and as a result, HIV infections would be reduced. Crowley continued to say that syringe access will be discussed during the National AIDS Strategy. When asked for the time frame of this plan, he said that they are working on it as we speak and did not commit to a final due date. “When you are dealing with the containing the spread of a deadly virus, and you know something works, you don’t need to wait for a “strategy” as well. Taking your time to develop a National AIDS Strategy is no excuse for NOT implementing lifesaving public policy now. Furthermore by NOT taking action, President Obama did set policy on this issue. The right thing to do is to remove the ban in the budget so that we can discuss using federal funds for this lifesaving program,” said Kaytee Riek, Director of Organizing for Health GAP.

The federal ban on syringe access does not formally apply to programs outside of the United States, but under the previous administration, the ban became policy for foreign aid funding as well. That has meant that countries receiving funding from US-supported programs fighting AIDS could not use it to pay for syringe access programs.

“It is sad that my President broke his campaign promise by leaving the funding ban in the budget. Congress must now act and lift the funding ban when they take up the budget next week.” said Jose DeMarco, Health GAP Board member, long-time member of ACT UP Philadelphia and founder of Proyecto Sol Filadelphia.

The Morning After Pill Conspiracy March 24, 2009

Posted by rogerhollander in Health, Women.
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by Cristina Page

If Bush waged a war on science then yesterday the war crime tribunal spoke. The U.S. District court of the Eastern District of New York ruled that the Bush administration had politicized a once respected regulatory agency, the FDA, for bending the law to its right wing purposes. The court’s condemnation was comprehensive and brutal, all but labeling the Bushies political criminals. At issue was the FDA’s decision to overrule its staff recommendation and restrict access for adolescents to one of the most effective methods of preventing unwanted pregnancy, emergency contraception. The Court, in one excoriating stroke, reversed the first (and let’s hope last) ideological decision the FDA ever made.

The decision could not have been more dismissive of the Bush administration’s maneuverings. Mincing no words, the Court concluded that the FDA “acted in bad faith and in response to political pressure,” “departed in significant ways from the agency’s normal procedures,” and engaged in “repeated and unreasonable delays.” The court also found that the FDA’s justification for denying over-the-counter access to minors “lacks all credibility,” and was based on “fanciful and wholly unsubstantiated ‘enforcement’ concerns.” The Court ordered the FDA to reconsider it’s decision based on scientific evidence alone. In the meantime, it ordered the agency to make the contraceptive available over-the-counter to 17-year-olds within 30 days as it now does for adults.

The decision comes amidst news that US teen birth rates are spiking for the second year in a row. Those Bush era virginity pledgers are shifting smoothly into teen motherhood — the legacies of ignorance-only sex education and restricted access to and information about contraception.

The decision was prompted by a case, Tummino v. von Eschenbach, brought by the Center for Reproductive Rights (CRR) in 2005. The plaintiffs in the case were a grassroots groups called the Morning After Pill Conspiracy along with over 70 medical and public health organizations, scientists, and parents. For those who did not follow the case closely it’s worth reviewing not only how the Bushies imposed their theological agenda, but how they indifferently bent regulatory procedures. The administration ruthlessly ignored the facts and coerced FDA scientists to implement its anti-science agenda. According to a CRR press release, “Before its action on Plan B (emergency contraception) the FDA had never restricted a non-prescription drug based on a person’s age, nor had the Bush Administration ever been consulted by the FDA about an over-the-counter drug application. Depositions of senior FDA officials by the Center in 2006 indicated that the Bush Administration sought to unduly influence the agency during the Plan B application review process. Testimony also indicated that officials involved in the decision-making process were concerned about losing their jobs if they did not follow the administration’s political directives.” It was in other words, get with the program.

CRR continued: “Other evidence uncovered during the lawsuit showed that the agency repeatedly departed from its own established procedures during the FDA case, from filling the reproductive health committee with political “operatives” to making a decision to reject over-the-counter access to Plan B before completion of the standard review.”

For years, I’ve been following the right’s takeover of what had been a scientifically driven process. In researching a book, How the Pro-Choice Movement Saved America, I studied the violation of the FDA in detail. One fundamental thing I learned: anti-contraception crusaders were not just interested in limiting access for minors. Their true intent was to prevent all women from easy access to the pregnancy prevention method. Their more uncensored leaders, like Judie Brown of the American Life League, admitted as much, explaining, “the best thing the FDA can do now for the American women and their progeny is to take the next logical step and remove these pills for the market altogether.”

In the service of this goal, it seemed that nothing was off limits, not scientific integrity nor the will of the majority. The decision to limit minors’ access to emergency contraception was based on phony arguments put forth in particular by Bush appointee to the FDA panel, David Hager, a long-standing opponent of contraception. Hager’s supposed concern was that the proven usefulness of the medication would be overshadowed by 9 and 10 year olds who would “abuse” the drug, as if it were some sort of crack for kids. During the application review process, Hager called for unavailable research to quell his “concerns” that the drug would be abused by pre-teens. “The plans for introduction of Plan B into the non-treatment setting need more evaluation if it is going to be generalizably available to a nine year old regardless, a ten year old regardless of, you know; there’s no restriction,” Hager explained.

This line of argument shocked other panel members. One, Dr. Abbey Berenson, a professor of pediatrics and ob/gyn at University of Texas, countered, “I would just like to make a point that it is extremely rare that the nine or ten year old has menstrual cycles and so if we’re going to talk about adolescents, let’s talk about the mean age of menarche in this country is 12, and I can’t imagine where a nine-year-old would get $40 to go buy Plan B over the counter and who would buy it for this nine year old.”

The drug had been studied as part of the effort to determine whether EC was safe. Females from twelve to fifty had been sampled, including sixty-six between the age of twelve and sixteen years old. Adolescents understood 60 to 97 percent of the drug-product package directions and materials, at a comprehension level similar to that of women as a whole and one that easily met standards previously accepted for the approval of the other over-the-counter drugs.

Hager continued to create a straw man, or in this case, straw girl, that defenseless nine or ten year old, and then imagined that she was taken advantage of. It was an argument that none of his illustrious fellow panel members thought had merit. Hager nonetheless persisted: “Well I’m sorry, but there are young women that age [under twelve] who do start menstrual cycles and although the numbers aren’t large, it is enough of a concern that if there’s an 11-year old who is having a menstrual period and becoming sexually active, then she chooses to access this means of emergency contraception, and my only point is not the number. It’s that we don’t have any information available on that younger age population.”

Of course, less than six percent of girls younger than age eleven have started their menses, and 4.2 percent of girls under age thirteen are sexually active. Take that microscopic demographic and divide it by the percent that know EC even exists and who also have $40 to drop and you have the nearly non-existent basis for Hager’s, and what would eventually be the FDA’s, argument against extending over-the-counter access to EC for minors.

After the FDA decision to restrict minor’s access to the contraceptive method, several panel members who favored over-the-counter access expressed their outrage at the decision, writing, “If groups with moral objections wish to prevent the sale of a class of drugs, they should proceed through the legislative process. They should not corrupt the scientific review process of the FDA to achieve their ends. We believe it will be very hard to put this genie back in the bottle. We squander public trust at out peril.”

Today, the US district court finally got the anti-contraception genie, and some of the bullying lawless politics of the Bush era, back in the bottle, at least for now. As for the public’s trust, that’ll take a little longer to fix.

For breaking news on threats to birth control access and information visit birthcontrolwatch.org.

Cristina Page is author of How the Pro-Choice Movement Saved America: Freedom, Politics and the War on Sex and spokesperson for birthcontrolwatch.org. Page also is a consultant for several national pro-choice groups and her policy proposals have been adopted by Mayor Michael Bloomberg, the Washington State legislature and the New Jersey State legislature.

Creature Comforts January 5, 2009

Posted by rogerhollander in Human Rights.
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It’s no longer just guide dogs for blind people. Service animals now include monkeys for quadriplegics, parrots for psychotics and at least one assistance duck. Should the law recognize all of them?
New York Times Magazine, January 4, 2009

ON HALLOWEEN NIGHT IN A SUBURB of Albany, a group of children dressed as vampires and witches ran past a middle-aged woman in plain clothes. She gripped a leather harness — like the kind used for Seeing Eye dogs — which was attached to a small, fuzzy black-and-white horse barely tall enough to reach the woman’s hip.

Dilip Vishwanat/Getty Images, for The New York Times

Sadie talks Jim Eggers down when he’s on the verge of a psychotic episode.

 

Jeff Riedel for The New York Times

Ann Edie and her guide miniature horse, Panda, checking out at Staples.

“Cool costume,” one of the kids said, nodding toward her.

But she wasn’t dressed up. The woman, Ann Edie, was simply blind and out for an evening walk with Panda, her guide miniature horse.

There are no sidewalks in Edie’s neighborhood, so Panda led her along the street’s edge, maneuvering around drainage ditches, mailboxes and bags of raked leaves. At one point, Panda paused, waited for a car to pass, then veered into the road to avoid a group of children running toward them swinging glow sticks. She led Edie onto a lawn so she wouldn’t hit her head on the side mirror of a parked van, then to a traffic pole at a busy intersection, where she stopped and tapped her hoof. “Find the button,” Edie said. Panda raised her head inches from the pole so Edie could run her hand along Panda’s nose to find and press the “walk” signal button.

Edie isn’t the only blind person who uses a guide horse instead of a dog — there’s actually a Guide Horse Foundation that’s been around nearly a decade. The obvious question is, Why? In fact, Edie says, there are many reasons: miniature horses are mild-mannered, trainable and less threatening than large dogs. They’re naturally cautious and have exceptional vision, with eyes set far apart for nearly 360-degree range. Plus, they’re herd animals, so they instinctively synchronize their movements with others. But the biggest reason is age: miniature horses can live and work for more than 30 years. In that time, a blind person typically goes through five to seven guide dogs. That can be draining both emotionally and economically, because each one can cost up to $60,000 to breed, train and place in a home.

“Panda is almost 8 years old,” her trainer, Alexandra Kurland, told me. “If Panda were a dog, Ann would be thinking about retiring her soon and starting over, but their relationship is just getting started. They’re still improving their communication and learning to read each other’s bodies. It’s the difference between dating for a few years and being married so long you can finish each other’s sentences.”

Edie has nothing against service dogs — she has had several. One worked beautifully. Two didn’t — they dragged her across lawns chasing cats and squirrels, even pulled her into the street chasing dogs in passing cars. Edie doesn’t worry about those sorts of things with Panda because miniature horses are less aggressive. Still, she says, “I would never say to a blind person, ‘Run out and get yourself a guide horse,’ because there are definite limitations.” They eat far more often than dogs, and go to the bathroom about every two or three hours. (Yes, Panda is house-trained.) Plus, they can’t curl up in small places, which makes going to the movies or riding in airplanes a challenge. (When miniature horses fly, they stand in first class or bulkhead because they don’t fit in standard coach.)

What’s most striking about Edie and Panda is that after the initial shock of seeing a horse walk into a cafe, or ride in a car, watching them work together makes the idea of guide miniature horses seem utterly logical. Even normal. So normal, in fact, that people often find it hard to believe that the United States government is considering a proposal that would force Edie and many others like her to stop using their service animals. But that’s precisely what’s happening, because a growing number of people believe the world of service animals has gotten out of control: first it was guide dogs for the blind; now it’s monkeys for quadriplegia and agoraphobia, guide miniature horses, a goat for muscular dystrophy, a parrot for psychosis and any number of animals for anxiety, including cats, ferrets, pigs, at least one iguana and a duck. They’re all showing up in stores and in restaurants, which is perfectly legal because the Americans With Disabilities Act (A.D.A.) requires that service animals be allowed wherever their owners want to go.

Some people enjoy running into an occasional primate or farm animal while shopping. Many others don’t. This has resulted in a growing debate over how to handle these animals, as well as widespread suspicion that people are abusing the law to get special privileges for their pets. Increasingly, business owners, landlords and city officials are challenging the legitimacy of noncanine service animals and refusing to accommodate them. Animal owners are responding with lawsuits and complaints to the Department of Justice. This August, the Arizona Game and Fish Department ordered a woman to get rid of her chimpanzee, claiming that she brought it into the state illegally — she disputed this and sued for discrimination, arguing that it was a diabetes-assistance chimp trained to fetch sugar during hypoglycemic episodes.

Cases like this are raising questions about where to draw the lines when it comes to the needs and rights of people who rely on these animals, of businesses obligated by law to accommodate them and of everyday civilians who — because of health and safety concerns or just general discomfort — don’t want monkeys or ducks walking the aisles of their grocery stores.

A few months ago, in a cafe in St. Louis, I met a man named Jim Eggers, who uses an assistance parrot, Sadie, to help control his psychotic tendencies. Eggers looks like a man who has been fighting his whole life. He is muscular, with a buzz cut, several knocked-out teeth and many scars, including one that runs ear-to-chin from surgery to repair a broken jaw. Eggers avoids eye contact in public — he walks fast down streets and through stores staring at the ground, jaw clenched. “I have bipolar disorder with psychotic tendencies,” he told me as he sucked down a green-apple smoothie. “Homicidal feelings too.”

Eggers’s condition has landed him in court several times: a disturbing-the-peace charge for pouring scalding coffee onto a man under his apartment window who annoyed him; one-year probation for threatening to kill the archbishop of St. Louis because of news reports about church money and molestations by priests in other cities (which the archbishop had nothing to do with). In describing his condition, Eggers says it’s like when the Incredible Hulk changes from man to monster. His vision blurs, his body tingles and he can barely hear. According to his friend Larry Gower, who often serves as a public liaison for him, in those moments, Eggers gets extremely loud. They both agree that Sadie is one of the few things keeping Eggers from snapping.

Sadie rides around town on Eggers’s back in a bright purple backpack specially designed to hold her cage. When he gets upset, she talks him down, saying: “It’s O.K., Jim. Calm down, Jim. You’re all right, Jim. I’m here, Jim.” She somehow senses when he is getting agitated before he even knows it’s happening. “I still go off on people sometimes, but she makes sure it never escalates into a big problem,” he told me, grinning bashfully at Sadie. “Now when people make me mad I just give them the bird,” he said, pulling up his sleeve and flexing his biceps, which is covered with a large tattoo of Sadie.

Soon after what he calls “the Archbishop Incident,” Eggers got Sadie from a friend who owned a pet store. She’d been neglected by a previous owner and had torn out all her feathers, so Eggers nursed her back to health. He didn’t initially train her as a service animal, he says; she did that herself. When Eggers had episodes at home, he’d pace, holding his head and yelling: “It’s O.K., Jim! You’re all right, Jim! Calm down, Jim!” One day, Sadie started doing it, too. He soon realized that she calmed him better than he calmed himself. So he started rewarding her each time it happened. And he has had only one incident since: he dented a woman’s car with his fist on a day when he’d left Sadie at home.

 

 

Eggers didn’t think to use any special language to describe Sadie until he tried to take her on a bus and the driver said that only “service animals” were allowed. Eggers went home and looked up “service animal” online. “That’s when it all fell into place,” he told me. He learned that psychiatric service animals help their owners cope with things like medication side effects. Eggers takes heavy doses of antipsychotics that leave him in a fog most of the day. So he trained Sadie to alert him with a loud ringing noise if someone calls, or to yell “WHO’S THERE?” when anyone knocks on the door. If the fire alarm goes off, Sadie goes off. If Eggers leaves the faucet running, Sadie makes sounds like a waterfall until he turns it off.

Eggers got a service-animal bus pass for Sadie and began taking her everywhere. (He has special insulated cage panels to keep her warm in winter.) For years, few people objected. Then, in the spring of 2007, Eggers went to have his teeth cleaned at the St. Louis Community College dental-hygiene school, and officials there told him that Sadie wasn’t allowed inside because she posed a risk to public health and wasn’t really a service animal. “All I can say is, they were lucky I had Sadie with me to keep me calm when they said that,” Eggers told me.

He filed a complaint with the United States Department of Education’s Office of Civil Rights (O.C.R.), which initiated an investigation. Its conclusion: the school wrongfully denied access based on public-health concerns without assessing whether Sadie actually posed a risk. (Several top epidemiologists I interviewed for this article said that, on the whole, birds and miniature horses pose no more risk to human health than service dogs do.)

But Eggers is still fighting that fight. According to the O.C.R., the school “exceeded the boundaries of a permissible inquiry” by questioning Eggers about his disability. But that didn’t change the school’s conclusion: it labeled Sadie a mere “therapy animal.” If that label sticks, it will mean that Sadie isn’t covered by the federal law that protects service animals and guarantees them access to public places.

Stories like Eggers’s involve two questions that are often mistakenly treated as one. The first: What qualifies as a service animal? The second: Can any species be eligible?

There are two categories of animals that help people. “Therapy animals” (also known as “comfort animals”) have been used for decades in hospitals and homes for the elderly or disabled. Their job is essentially to be themselves — to let humans pet and play with them, which calms people, lowers their blood pressure and makes them feel better. There are also therapy horses, which people ride to help with balance and muscle building.

These animals are valuable, but they have no special legal rights because they aren’t considered service animals, the second category, which the A.D.A. defines as “any guide dog, signal dog or other animal individually trained to do work or perform tasks for the benefit of an individual with a disability, including, but not limited to, guiding individuals with impaired vision, alerting individuals with impaired hearing to intruders or sounds, providing minimal protection or rescue work, pulling a wheelchair or fetching dropped items.”

Since the 1920s, when guide dogs first started working with blind World War I veterans, service animals have been trained to do everything from helping people balance on stairs to opening doors to calling 911. In the early ’80s, small capuchin monkeys started helping quadriplegics with basic day-to-day functions like eating and drinking, and there was no question about whether­ they counted as service animals. Things got more complicated in the ’90s, when “psychiatric service animals” started fetching pills and water, alerting owners to panic attacks and helping autistic children socialize.

 

 

The line between therapy animals and psychiatric service animals has always been blurry, because it usually comes down to varying definitions of the words “task” and “work” and whether something like actively soothing a person qualifies. That line got blurrier in 2003, when the Department of Transportation revised its internal policies regarding service animals on airplanes. It issued a statement saying that in recent years, “a wider variety of animals (e.g., cats, monkeys, etc.) have been individually trained to assist people with disabilities. Service animals also perform a much wider variety of functions than ever before.”

To keep up with these changes, the D.O.T.’s new guidelines said, “Animals that assist persons with disabilities by providing emotional support qualify as service animals.” They also said that any species could qualify and that these animals didn’t need special training, aside from basic obedience. The only thing required for a pet to fly with its owner instead of riding as cargo was documentation (like a letter from a doctor) saying the person needed emotional support from an animal. Legally speaking, the D.O.T.’s new policy applied only to airplanes — the A.D.A.’s definition of service animal stayed the same. But for those looking online to find out whether they could take their animals into stores and restaurants, the D.O.T.’s definition looked like official law, and people started acting accordingly.

Soon, a trend emerged: people with no visible disabilities were bringing what a New York Times article called “a veritable Noah’s Ark of support animals” into businesses, claiming that they were service animals. Business owners and their employees often couldn’t distinguish the genuine from the bogus. To protect the disabled from intrusive questions about their medical histories, the A.D.A. makes it illegal to ask what disorder an animal helps with. You also can’t ask for proof that a person is disabled or a demonstration of an animal’s “tasks.” There is no certification process for service animals (though there are Web sites where anyone can buy an official-looking card that says they have a certified service animal, no documentation required). The only questions businesses can ask are “Is that a trained service animal?” and “What task is it trained to do?”

If the person answers yes to the first and claims that the animal is, say, trained to alert him or her to a specific condition (like a seizure), additional questioning could end in a lawsuit. And in many cases, according to Joan Esnayra, founder of the Psychiatric Service Dog Society, the outcome of those lawsuits depends largely on the words people use to describe their animals. “If you say ‘comfort,’ ‘need’ or ‘emotional support,’ you’re out the door,” she says. “If you talk about what your animal does in terms of ‘tasks’ and ‘work,’ then you stand a chance.”

Case in point: When the dental school questioned Eggers about whether­ Sadie was a service animal, he said she kept him “calm.” If he had said that she alerts him to things like attacks and doorbells, his case might have been stronger.

According to Jennifer Mathis, an attorney at the Bazelon Center for Mental Health Law, “A lot of times when people with legitimate service animals lose these cases, it has to do with the fact that they don’t explain their service animals well.”

Rather than risk a lawsuit, many business owners simply allow the animals, even if they doubt their legitimacy. Then they complain to the Department of Justice that the A.D.A. is too broad in its definition of “service animal,” and too restrictive of businesses trying to protect themselves from people who fake it. Which many people do.

In October, a man in Portland, Ore., took his dog on a bus, claiming that it was a service animal. While getting off the bus, the dog killed another dog that was riding as a “comfort animal.” (In Portland, comfort animals are allowed on public transportation.) A few days later, an editorial appeared in The Oregonian with the headline “Take the Menagerie Off the Bus.” It opened with: “No offense, ferret lovers. … Your pet … may offer emotional support. But it shouldn’t be roaming the aisles of a … bus or train.” It argued that the story of the dead comfort dog was proof that people had stretched the legal definition of service animals to include a virtual zoo of animals.

 

 

Lex Frieden, a professor of health-information science at the University of Texas Health Science Center at Houston and a former director of the National Council on Disability, sees the issue differently. “People shouldn’t be able to carry their pets on a plane or into a restaurant claiming they’re service animals when they’re not,” he says. “But that has nothing to do with what species a service animal is.” The appropriate response in those situations isn’t a species ban, he says, but rather strict punishments for people who pose as disabled. “It’s fraud,” he points out, “and it results in increased scrutiny of people with legitimate disabilities.”

In June, in an effort to clarify the confusion surrounding service animals, the Department of Justice proposed new regulations to explicitly include psychiatric service and exclude comfort animals. This was part of a sweeping revision of the A.D.A. intended to increase protection and access for the disabled, which was widely applauded. But tucked into that proposal were a few lines that worry advocates and people with disabilities: the D.O.J. proposed limiting service animals to a “dog or other common domestic animal,” specifically excluding “wild animals (including nonhuman primates born in captivity), reptiles, rabbits, farm animals (including any breed of horse, miniature horse, pony, pig or goat), ferrets, amphibians and rodents.”

This summer, the D.O.J. held a public hearing in Washington and invited anyone who would be affected by the proposed changes to argue for or against them. Many pleaded their cases in person, others by letter. The arguments in favor of species restrictions came primarily from businesses concerned about having to alter facilities, rebuilding seating areas, say, to make room for miniature horses. Several service-animal organizations and people with disabilities argued that banning reptiles and insects was fine but that excluding miniature horses and primates simply went too far. In their defense, they cited things like dog allergies, the long life spans of several species and monkeys’ opposable thumbs. After considering the arguments, last month the D.O.J. submitted a final proposal to the Office of Management and Budget. Until there’s a ruling, neither office will comment on the issue or say whether the species restriction was removed or revised after the public hearings.

Jamie Hais, a spokeswoman for the D.O.J., said she couldn’t comment on why the department suggested the species restriction. But its proposal expressed concerns about public-health risks and said that when the original A.D.A. was written, without specifying species, “few anticipated” the variety of animals people would attempt to use.

“That’s simply not true,” says Frieden, who was an architect of the original A.D.A. While drafting the regulations, he said, Congressional staff members had long discussions about defining “service animal” and whether­ a trained pony could qualify. “There was general consensus that the issue revolved around the question of function, not form,” he says. “So, in fact, if that pony provided assistance to a person with a disability and enabled that person to pursue equal opportunity and nondiscrimination, then that pony could be regarded as a service animal.” They discussed the possibility of birds and snakes for psychiatric disorders, he said, but one of their biggest concerns was that the A.D.A. shouldn’t exclude service monkeys, which were already working with quadriplegics. Since then, however, monkeys have become the most contested assistance-animal species of all.

On a rainy day in November, I walked through a T. J. Maxx store in Springfield, Mo., with Debby Rose and Richard, her 25-pound bonnet macaque monkey — one of the most controversial service animals working today. Rose was wearing brown pants and a brown-and-gold-patterned shirt. Richard was wearing a brown long-sleeved polo over a white T-shirt with jeans and a tan vest that said “Please Don’t Pet Me I’m Working.” Richard stood in the child seat of Rose’s shopping cart, facing forward, bouncing up and down, smacking his lips and grinning as Rose pushed him down the aisles.

Richard is a hands-on shopper. If Rose pointed at a sweater or purse she liked, or a pair of shoes, his hand darted out to touch them. As we passed a pair of tan, fuzzy winter boots that Rose particularly liked, Richard leaned out of the cart and quickly licked one on its toe.

People stared as we walked. “Why do you have him?” they’d ask.

“He’s a service animal trained for my disability, kind of like a seizure-alert dog,” Rose told them, again and again.

“Can I pet him?”

“He doesn’t like to be touched,” she’d say, “but you can give him five.”

People raised their hands, and Richard gave them five.

 

 

That Rose isn’t bothered by people looking and asking questions is impressive, considering that she has agoraphobia and severe anxiety disorder with debilitating panic attacks. Until getting Richard four years ago, she required heavy doses of anti-anxiety drugs just to go out in public. “I couldn’t have come in this store before Richard, let alone handled all these people talking to me,” she said. “Now I like it.”

Rose adopted Richard in 2004; he was badly neglected and near death. She and two of her six children — whom she raised as a single mother — run an exotic-animal shelter. Rose says she believes that Richard was trained as a service animal for his previous owner, an elderly woman whose son gave Richard away when she died. He had been neutered, and his tail had been surgically removed. He’d also had his large and potentially dangerous canine teeth pulled, a procedure commonly done with service monkeys for safety (and often cited as one of several ethical concerns with using wild instead of domesticated species for such jobs).

As Richard returned to health, Rose realized that he had begun to recognize her panic attacks before she did. Her doctor suggested that she train him to help with her disorder, then wrote a letter approving of him as a service animal, saying that Richard was “a constructive way to avoid use of unnecessary medications.” Rose took that letter to the Springfield-Greene County Health Department, got permission for Richard to accompany her in public and has been drug-free ever since. She ordered a service-animal ID certificate online; she even got a restriction on her driver’s license saying that she can’t operate a car without a monkey present. Now he sits in her lap with a hand on the wheel while she drives, and she never leaves home without him.

But the number of places Rose and Richard can go is decreasing. In September 2006, after receiving complaints that Richard was sitting in highchairs in restaurants, touching silverware and going through a buffet line with Rose, the Health Department sent a letter to all local restaurants announcing that Richard was a risk to public health and not a legitimate service animal. It instructed businesses to refuse him access and to call the police if Rose protested. Businesses posted the letter on their doors and in their bathrooms; soon Cox College of Nursing and Health Sciences, where Rose was attending nursing school, refused Richard access, too. Stories­ started appearing about Rose and her monkey in the newspaper and on TV. “Suddenly,” she told me, “everyone knew I had a mental disorder.”

Rose dropped out of school and filed a lawsuit against her local Health Department, the nursing school, Wal-Mart and several other local businesses that had forbidden Richard access, saying that they violated the A.D.A. Kevin Gipson, director of the local Health Department, told me that he had asked Rose to show him what “tasks” Richard performed that would qualify him. “She couldn’t,” he said.

Defining “task” is often a point of contention in these cases, especially with psychiatric service animals, whose work generally can’t be demonstrated on command. Before going to T. J. Maxx, I saw Rose begin to panic while sitting in her lawyer’s office talking about her case. Her face flushed; her voice quivered. Richard, who had been dozing in the chair beside her, leapt onto her arm and began stroking her hair. He hugged her, rubbed her ear and cooed while she talked. She immediately calmed down. “He snaps me out of it before the attacks happen,” she said. “If they start at night, he’ll turn on the light and get me a bottle of water.”

For Gipson, that’s really beside the point. “Even if Richard is a legitimate service animal,” he told me, “if he poses a public-health risk, the A.D.A. says he can be excluded. And we believe primates pose a significant health risk.”

Rose says that Richard is perfectly safe and immaculately clean. She showers and blow-dries him every day and uses hand sanitizer on him regularly, and he always wears diapers. But that doesn’t impress the Health Department. Monkeys can carry viruses, like herpes B, which are essentially harmless to them but usually deadly to humans. Those viruses can be transmitted through saliva and other bodily fluids. In 1998, the Centers for Disease Control and Prevention published a study titled “B-Viruses From Pet Macaque Monkeys: An Emerging Threat in the United States?” saying that 80 to 90 percent of adult macaques like Richard carry herpes B. It’s possible to test them for viruses, which Rose does every year with Richard, but those tests often give false negatives. Plus, Gipson told me, “he could catch it any time from contact with other monkeys, which we know he’s had.” Five days before the Health Department banned Richard, a local newspaper ran pictures of him and several other monkeys hanging out at Rose’s family’s sanctuary.

According to Frederick Murphy, former head of viral pathology for the C.D.C. and co-discoverer of the Ebola virus, the threat that viruses from service monkeys present to humans is essentially unknown. There have been a few cases of primate-lab workers contracting herpes B from macaques — mostly from being bitten — but no cases of people being infected by service monkeys, which are usually capuchins.

The bigger concern, according to several experts, is potential aggression. “People think monkeys are cute and like humans, but they’re not,” says Laura Kahn, a public-health expert at the Woodrow Wilson School of Public and International Affairs at Princeton. “They’re wild animals, and they’re dangerous.”

Critics of noncanine service animals tend to focus on disease perhaps because that’s the only way to legally exclude any service animal under the current A.D.A. But on the whole, Bradford Smith, former director of the University of California Davis Veterinary Medical Teaching Hospital, says, “I would tend to think the disease argument is really a proxy for other concerns, like having to let any person who says their parrot or horse is a service animal enter into public areas.”

Rose’s case is sometimes held up as an example of why the A.D.A. should be rewritten to exclude primates as service animals. But in fact, Frieden says, it’s an example of how the original A.D.A. works well as it was written, since it allows broad use of service animals while still leaving room to protect the public health. “Some situations have to be dealt with on a case-by-base basis,” he says. “You can’t legislate fine lines — that’s just not a functional law.”

Frieden is very clear about his belief that it would be a huge loss if concerns about specific cases jeopardized the use of all noncanine service animals, especially the capuchin monkeys trained to help quadriplegics. The capuchins attend “monkey college” at Helping Hands, a nonprofit organization in Boston, where they fetch remote controls, put food in microwaves, open containers, vacuum floors and flip light switches, all in exchange for treats. Helping Hands capuchins are captive bred, which minimizes the risk of picking up diseases, and they’re provided specifically for in-home use. The proposed species restriction might make it impossible for people to transport capuchins or keep them in their homes because of zoning restrictions. The thought of this makes Helping Hands’s founder, M. J. Willard, shudder. “There ought to be a more nuanced way if somebody just thinks it through,” she says. “Even just minor requirements of verifying the legitimacy of a service animal would solve a lot of the current problem.”

Frieden agrees. He suggests that perhaps a national committee could be appointed to develop certification standards for all service animals as well as a formal process for preventing and punishing service-animal fraud. Doing so might solve part of the controversy, he says. But not all of it. Particularly when it comes to species questions.

“Many people try to make this issue black and white — this service animal is good; that one is bad — but that’s not possible, because disability extends through an enormous realm of human behavior and anatomy and human condition,” Frieden told me. In the end, according to him, the important thing to remember is this: “The public used to be put off by the very sight of a person with a disability. That state of mind delayed productivity and caused irreparable harm to many people for decades. We’ve now said, by law, that regardless of their disability, people must have equal opportunity, and we can’t discriminate. In order to seek the opportunities and benefits they have as citizens, if a person needs a cane, they should be able to use one. If they need a wheelchair, a dog, a miniature horse or any other device or animal, society has to accept that, because those things are, in fact, part of that person.”

Rebecca Skloot teaches nonfiction at the University of Memphis. Her first book, “The Immortal Life of Henrietta Lacks,” will be published by Crown in spring 2010.

————————————————————————————————

This article has been revised to reflect the following correction:

Correction: January 4, 2009
An article on Page 34 of The Times Magazine this weekend about animals that help disabled people misidentifies the location of the Woodrow Wilson School of Public and International Affairs, one of whose public-health experts commented on the topic. It is at Princeton, not Harvard.

 

Adentro Barrio Adentro: An American Medical Student in Venezuela December 9, 2008

Posted by rogerhollander in Education, Health, Venezuela.
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Written by Rebecca Trotsky-Sirr    www.upsidedownworld.org
Thursday, 04 December 2008
ImageSource: Social Medicine Vol 3 No 4 (2008)

By the time I finished my second year of medical school in a large Midwestern university, I genuinely feared that I was losing the passion that had led me to choose medicine as a career. As medical students quickly discover, the focus in our medical education system is on the hard sciences rather than on any integrated critical analysis of issues related to social justice or the larger societal context in which we will ultimately practice. Lamenting that we no longer had time to volunteer, let alone read anything beyond required text books, we placed a part of our souls on a shelf, agreeing that after board exams, we’d return and dust off our interests in social justice, women’s health, and our international community. Throughout my pre-clinical years, that choice nagged and pulled at me, a voice constantly asking: was I selling out?

In my medical school in the North, I reluctantly accepted the presumption that medicine best-served the lucky few with resources and health insurance. Labeled ‘naïvely optimistic’ if I earnestly proposed universal health care, I longed to live in a country where comprehensive health care was a right of all citizens. Most importantly, I wanted to hear firsthand the stories of transformations from a marketbased health care system to one in which medical services, regardless of the level of complexity, are universally guaranteed and provided at no cost to the patient. During 2004, I began reading articles about Venezuela’s political changes and notably the redesign of their health and education systems. The government of socialist president Hugo Chavez created a new public health initiative called Barrio Adentro and, through a cooperative agreement between Venezuela and Cuba, was able to bring thousands of Cuban primary care doctors to underserved Venezuelan neighborhoods. Bottom line: a six-fold increase in free clinic visits in six months. Critics asserted that, while hundreds of free clinics opened in just a few years, there were problems with the quality of services. “This is too crazy to be real”, I thought to myself, simultaneously discrediting while secretly yearning to believe in Barrio Adentro.

I decided I had to see it for myself. Had Barrio Adentro been successfully implemented so quickly in such a large and diverse geographic setting? Surely there would be important lessons learned for health care providers across the globe. What worked well? What should be done differently? Applying for a Fulbright grant to study medicine in Venezuela was like sending a message in a bottle to my future self: “Dear Jaded Future-Self, do not give up your dreams of social justice in medicine. Check out the health care system transformations in South America. Love, Idealistic Former-Self.” I wanted to gain direct exposure to the Barrio Adentro program, interview Cuban physicians, and understand the perspective of Venezuelan physicians who often saw Barrio Adentro as a threat to professional organized medicine. Gratefully, I received my Fulbright award in 2006-07 and headed for South America after completing my first clinical clerkships at my medical school.

In spite of good intentions, traveling to Venezuelan as a citizen of the United States presented a number of complications. “Venezuela’s most senior leaders, including President Chavez, regularly express anti-American sentiment. The Venezuelan government’s rhetoric against the U.S. government, its American culture and institutions, has affected attitudes in what used to be one of the most pro-American countries in the hemisphere,” writes the US State Department holding up their side of the international ping-pong game between the US and Venezuela. Understanding the conflicts between the United States and Venezuela meant not only wrestling with economic and historical discourses, but also carefully planning to accurately access both sides of the heated Venezuelan debates about the merits of the new health care policies. Venezuela’s professional class—including many, but not all, physicians—tend to be highly critical of the Chavez government’s reforms and often, their criticisms are repeated in the rhetoric of the US government and mainstream media. Because of assumptions made based on the fact that I was from the United States, those who opposed the Chavez government perceived me as a natural ally. Yet, due to my community-service background and visible interest in public health and preventive medicine, pro-Chavez physicians spoke candidly with me about their fears and hopes for the new policies.

Accepting funds from the United States State Department to travel and study in Venezuela during a time of intense international polarization provided unique access to multiple perspectives. Additionally, studying public health at the local university facilitated introductions to healthcare professionals from broad backgrounds. My classmates included directors of hospitals, physicians, nurses, nutritionists, and accountants. These individuals represented the spectrum of political beliefs in Venezuela—from very pro-Chavez to vehemently anti-Chavez. Finally and perhaps most importantly, by bringing my elementary school-aged child to live and attend school in Venezuela, I unintentionally opened many doors normally shut to outsiders. I was able to network with families in my child’s public school and in our neighborhood, effortlessly creating a base to reality check my ideas with an economically and politically diverse cross-section of Venezuelans.

ImageI divided my time between the Universidad de Los Andes and clinical practicums through Barrio Adentro. At the University, I studied in the department of Community and Preventive Medicine earning a public health certification at one of the oldest and most traditional universities in South America. This provided a substantive and structured counterpart to my community-based clinical work in Barrio Adentro. Although my formal studies inspired me, my everyday interactions within the rural Andean community where I lived and worked effectively contextualized the impact of the new clinics and health policies of the Chavez government.

When Barrio Adentro began in December 2003, few could have foreseen the broad changes ahead for the small villages that are scattered throughout Venezuela. Within months of the proclamation that launched the initiative, more doctors arrived from Cuba and began living in spare rooms within Venezuela’s poorest and most underserved communities. Neighborhoods and villages throughout the country opened their doors to Cuban doctors providing room and board as a way of collaborating with and supporting the community-based initiative. People in the community reported that, initially, the Cuban doctors were viewed with caution as foreigners without critical cultural understanding. However, the initiative continued to grow rapidly, with Cuban health professionals providing community-based primary care as they do in their own country and across the world. Over a period of a few months, Cuban doctors earned the village’s respect by consistently comprehensive services regardless of political affiliation.

In addition to providing direct services in thousands of neighborhood clinics, Cuban physicians are engaged in training Venezuelans in community-based, social medicine. While one of the Cuban doctors I met fell in love with a Venezuelan and intends to raise their family in Venezuela, most of the physicians have families in Cuba and are looking forward to handing over the clinical infrastructure to Venezuelans and returning to their home. Within the first year, Barrio Adentro began training Venezuelan students to take over these community based consultarios. At first, qualified Venezuelan students were sent (free of charge) to study medicine in Cuba. By the time I arrived in Venezuela in September of 2006, local medical schools partnered with community consultorios to train their second year of students. Like many countries across Europe and Latin America, Venezuelan medical schools start immediately after high-school and last for 6 years, as opposed to the United States where medical school requires four years of study that begin after four years of undergraduate college work. A postgraduate fellowship track was initiated within the Barrio Adentro initiative to train Venezuelan physicians in community medicine. This two-year program includes epidemiology, advanced practice in resource poor areas, and community organization. Upon completion, these doctors are equipped to run municipal health care systems. Currently, Venezuelan graduates of this program have also begun training Venezuelan medical students. The object is to create a self-sufficient system that no longer depends on importing human resources from Cuba. The medical students in Barrio Adentro are my kind of people—they are drawn from a crosssection of Venezuelan society and include single moms and youth organizers from underserved communities. They have witnessed the complete transformation of the Venezuelan health system. “We never had a clinic… growing up, if we got sick we waited until we were on our deathbeds before heading down to the city. Even then we had to wait all day to be seen.” More than increased accessibility, there is the perception of heightened understanding, “The doctors in Barrio Adentro didn’t make me feel stupid for not having clean water, and they know what my neighborhood is like because they live here too.”

My day would typically begin by getting my 7-year-old son off to our town’s two room school house. Waiting on the side of the road, we would often meet a respected village resident, Señora Rafaela. Her son Martin attended the same neighborhood school with my son in a mixed second-third-fourth grade classroom that had recently opened as a result of the government’s commitment to provide all day elementary school in rural communities. During these trips to and from school and town, she discussed the positive impact on community health of the new Barrio Adentro ambulatory centers, explaining how the local preventive health care program emerged from years of community organizing work.

As a key organizer of the community council, Señora Rafaela works closely with Cuban and Venezuelan political leaders and doctors to coordinate health fair events. Given her impressive competency in managing budgets, transportation, and logistics, it’s hard for me to imagine that she was unable to finish high school and only recently obtained her high school equivalency through one of = st1 ns = “urn:schemas-microsoft-com:office:smarttags” />Venezuela’s new universal adult educational programs. “Before, no one listened, actually listened, to our community,” she explained to me, “Our neighbors who come from the upper classes, who are college educated and professional, they don’t understand how much has actually changed.”

I would arrive at the one room consultorio (ambulatory clinic) in the morning where my Cuban preceptor and Venezuelan post-graduate fellow would see patients on a walk-in basis until noon. Often we were joined by two Venezuelan medical students who had worked in the clinic as a continuity experience over the previous two years and will continue to work in the clinic throughout their training. Over the course of a typical morning we would evaluate and treat a dozen patients with common complaints such as diarrhea and respiratory illnesses. In our small one-room clinic, a glass display case stood stocked with dozens of commonlyused medicines that were dispensed free of charge and included medicines for hypertension, viral, parasitic, and fungal infections, antibiotics, NSAIDs, prenatal vitamins, and birth control. The staff and students explained to me how previously people in the community would wait to see a doctor until seriously ill. A lack of preventive care, relatively expensive treatment, and clinics inaccessible to those without transportation fueled a disparity of access between rich and poor. When the clinic opened in the neighborhood, the nature of disease changed as more families had access to preventive medicine and attended clinics earlier in the course of a disease. A subtle shift in the sense of security in the community developed as people felt secure in having nearby a clinic, a doctor, and an accessible pharmacy.

After seeing patients, we would spend the afternoon engaged either in follow-up home visits or canvassing the neighborhood to actively seek out our homebound ill neighbors. At other times we would work with community leaders to design and implement simple, but effective, health education projects.

For example, during the spring, our goal was for 100% of the neighbors to obtain a well-person physical. Everyone in our small village received preventive care exams. For many, this visit to the doctor was the first in decades. Families could walk to the local Bolivarian school situated on top of a mountain, where the classroom was temporarily converted to a mobile ambulatory clinic. On the other side of the valley, the two room community center had been transformed into a makeshift clinic intake center. In spite of the non-traditional locations, Misión Barrio Adentro staff provided a very traditional physical exam. The Venezuelan medical students asked about medical history under the guidance of the Cuban physicians, performing a standard 12-point review of systems with the same precision as their medical student counterparts in the United States. With this virtually universal community outreach project, we facilitated wellperson health evaluations and created a community health census.

Although similar in quality to a well-person check up, the spring health census highlighted some of the differences between Venezuelan medical students in Misión Barrio Adentro and their North American peers. By also obtaining a detailed socioeconomic history, Venezuelan students in Barrio Adentro made the significant connections between poverty and health. How many people share each bedroom? Is there enough food and cooking fuel?

Socioeconomic information is charted in personal files and was later aggregated at the district level. In this way, a child’s case of diarrhea becomes an issue that can be tracked to the lack of clean drinking water. Health issues coalesce into projects that the municipality and community can change—wells dug, pipes placed. The community can hold elected leaders responsible for what previously was attributed purely to an individual family’s problem.

ImageAfter the health census in the spring, we next organized a summertime ‘graduation’ for all of the community infants and their mothers who had successfully completed at least six months of exclusive lactation. It was a very Venezuelan event, with graduation gown, diplomas, and presents for mom and baby. Our public health messages (family spacing, reproductive health, and the benefits of lactation) were featured throughout the day. The celebration provided a successful excuse to Imagecanvass our neighborhood for pregnant women who otherwise would not have initiated early prenatal care. Also, we created a safe place to discuss reproductive health care without preaching or further marginalizing young, poor families.

The year I spent in Venezuela greatly contributed to my professional development. Just as important, through my interactions with Venezuelans and Cubans, I realized there was a much wider breadth of people working and studying to be doctors from the community and for the people. My interest in community-based social medicine had unexpectedly led me to one of the most fascinating social experiments in healthcare systems during recent times: Barrio Adentro. Though initially reluctant, Venezuelans seem to be accepting both the new socialized structure of their public health system as well as the fundamental tenets of social medicine that form its practical and philosophical foundations. Private consultation firm Arthur D. Little and polling organization Datanalisis recently reported that over 80 % of Venezuelans surveyed benefited from Barrio Adentro’s services. While I was pleased to improve my own practice of community-based medicine under the tutelage of Barrio Adentro, importantly I was able to access the critiques of socialized health care reforms to create a broader understanding. Walking between two polarized worlds—21st century socialized medicine and the traditional faculty of medicine, pro-Chavez & anti-Chavez, I learned more than any clerkship or class about the successes and failures of a national health system transformation.

I believe that the United States medical system is at a crisis point, our current practices are unsustainable. The question we need to ask ourselves is “How can we build a sustainable and just health care system for the 21st century?” Looking internationally, Venezuela provides one example of expansive and rapid health care reform that seeks to answer that question. The most critical lesson I witnessed was not about managing a clinic, although that was important. Rather, it was about the need to involve community and professionals in building a new system that is based on shared values, the recognition of underserved and marginalized communities and the importance of not alienating wellresourced professionals. When physicians, medical students, professionals and patients collaborate, we design our own innovative solutions to improve the welfare of our entire community.

Rebecca Trotzky-Sirr graduates medical school December 2009, and will start the best ever Family Medicine residency program (location TBA.) She has weekly Thursday potlucks in Minneapolis, you are invited. Rebecca is the co-founder of a non-existant revolutionary movement, Weather Overground which has higher aims than before. If she could, she would make universally free dignified health care a part of the four basic food groups. Tell her what you are bringing to her next potluck: revolution.is.medicine@gmail.com

 

Heroin Legalization Program Approved By Swiss Voters December 1, 2008

Posted by rogerhollander in Health, Political Commentary.
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Alexander G. Higgins, Huffington Post

November 30, 2008

GENEVA — The world’s most comprehensive legalized heroin program became permanent Sunday with overwhelming approval from Swiss voters who simultaneously rejected the decriminalization of marijuana.

The heroin program, started in 1994, is offered in 23 centers across Switzerland. It has helped eliminate scenes of large groups of drug users shooting up openly in parks that marred Swiss cities in the 1980s and 1990s and is credited with reducing crime and improving the health and daily lives of addicts.

The nearly 1,300 selected addicts, who have been unhelped by other therapies, visit one of the centers twice a day to receive the carefully measured dose of heroin produced by a government-approved laboratory.

They keep their paraphernalia in cups labeled with their names and use the equipment and clean needles to inject themselves _ four at a time _ under the supervision of a nurse, and also receive counseling from psychiatrists and social workers.

The aim is to help the addicts learn how to function in society.

The United States and the U.N. narcotics board have criticized the program as potentially fueling drug abuse, but it has attracted attention from governments as far away as Australia and Canada, which in recent years have started or are considering their own programs modeled on the system.

The Netherlands started a smaller program in 2006, and it serves nearly 600 patients. Britain has allowed individual doctors to prescribe heroin since the 1920s, but it has been running trials similar to the Swiss approach in recent years. Belgium, Germany, Spain and Canada have been running trial programs too.

Sixty-eight percent of the 2.26 million Swiss voters casting ballots approved making the heroin program permanent.

By contrast, around 63.2 percent of voters voted against the marijuana proposal, which was based on a separate citizens’ initiative to decriminalize the consumption of marijuana and growing the plant for personal use.

Olivier Borer, 35, a musician from the northern town of Solothurn, said he welcomed the outcome in part because state action was required to help heroin addicts, but he said legalizing marijuana was a bad idea.

“I think it’s very important to help these people, but not to facilitate the using of drugs,” Borer said. “You can just see in the Netherlands how it’s going. People just go there to smoke.”

Sabina Geissbuehler-Strupler of the right-wing Swiss People’s Party, which led the campaign against the heroin program, said she was disappointed in the vote.

“That is only damage limitation,” she said. “Ninety-five percent of the addicts are not healed from the addiction.”

Health insurance pays for the bulk of the program, which costs 26 million Swiss francs ($22 million) a year. All residents in Switzerland, which has a population of 7.5 million, are required to have health insurance, with the government paying insurance premiums for those who cannot afford it.

Parliament approved the heroin measure in a revision of Switzerland’s narcotics law in March, but conservatives challenged the decision and forced a national referendum under Switzerland’s system of direct democracy.

Jo Lang, a Green Party member of parliament from the central city of Zug, said he was disappointed in the failure of the marijuana measure because it means 600,000 people in Switzerland will be treated as criminals because they use cannabis.

“People have died from alcohol and heroin, but not from cannabis,” Lang said.

The government, which opposed the marijuana proposal, said it feared that liberalizing cannabis could cause problems with neighboring countries.

On a separate issue, 52 percent of voters approved an initiative to eliminate the statute of limitations on pornographic crimes against children before the age of puberty.

The current Swiss statute of limitations on prosecuting pedophile pornography is 15 years. The initiative will result in a change in the constitution to remove that time limit.

Bush Aides Rush to Enact a Safety Law Obama Opposes November 29, 2008

Posted by rogerhollander in Barack Obama, George W. Bush.
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Published: November 29, 2008

WASHINGTON — The Labor Department is racing to complete a new rule, strenuously opposed by President-elect Barack Obama, that would make it much harder for the government to regulate toxic substances and hazardous chemicals to which workers are exposed on the job.

The rule, which has strong support from business groups, says that in assessing the risk from a particular substance, federal agencies should gather and analyze “industry-by-industry evidence” of employees’ exposure to it during their working lives. The proposal would, in many cases, add a step to the lengthy process of developing standards to protect workers’ health.

Public health officials and labor unions said the rule would delay needed protections for workers, resulting in additional deaths and illnesses.

With the economy tumbling and American troops fighting in Iraq and Afghanistan, President Bush has promised to cooperate with Mr. Obama to make the transition “as smooth as possible.” But that has not stopped his administration from trying, in its final days, to cement in place a diverse array of new regulations.

The Labor Department proposal is one of about 20 highly contentious rules the Bush administration is planning to issue in its final weeks. The rules deal with issues as diverse as abortion, auto safety and the environment. One rule would make it easier to build power plants near national parks and wilderness areas. Another would reduce the role of federal wildlife scientists in deciding whether dams, highways and other projects pose a threat to endangered species.

Mr. Obama and his advisers have already signaled their wariness of last-minute efforts by the Bush administration to embed its policies into the Code of Federal Regulations, a collection of rules having the force of law. The advisers have also said that Mr. Obama plans to look at a number of executive orders issued by Mr. Bush.

A new president can unilaterally reverse executive orders issued by his predecessors, as Mr. Bush and President Bill Clinton did in selected cases. But it is much more difficult for a new president to revoke or alter final regulations put in place by a predecessor. A new administration must solicit public comment and supply “a reasoned analysis” for such changes, as if it were issuing a new rule, the Supreme Court has said.

As a senator and a presidential candidate, Mr. Obama sharply criticized the regulation of workplace hazards by the Bush administration.

In September, Mr. Obama and four other senators introduced a bill that would prohibit the Labor Department from issuing the rule it is now rushing to complete. He also signed a letter urging the department to scrap the proposal, saying it would “create serious obstacles to protecting workers from health hazards on the job.”

Administration officials said such concerns were based on a misunderstanding of the proposal.

“This proposal does not affect the substance or methodology of risk assessments, and it does not weaken any health standard,” said Leon R. Sequeira, the assistant secretary of labor for policy. The proposal, Mr. Sequeira said, would allow the department to “cast a wide net for the best available data before proposing a health standard.”

The Labor Department regulates occupational health hazards posed by a wide variety of substances like asbestos, benzene, cotton dust, formaldehyde, lead, vinyl chloride and blood-borne pathogens, including the virus that causes AIDS.

The department is constantly considering whether to take steps to protect workers against hazardous substances. Currently, it is assessing substances like silica, beryllium and diacetyl, a chemical that adds the buttery flavor to some types of microwave popcorn.

The proposal applies to two agencies in the Labor Department, the Occupational Safety and Health Administration and the Mine Safety and Health Administration. Under the proposal, they would have to publish “advance notice of proposed rule-making,” soliciting public comment on studies, scientific information and data to be used in drafting a new rule. In some cases, OSHA has done that, but it is not required to do so.

The Bush administration and business groups said the rule would codify “best practices,” ensuring that health standards were based on the best available data and scientific information.

Randel K. Johnson, a vice president of the United States Chamber of Commerce, said his group “unequivocally supports” the proposal because it would give the public a better opportunity to comment on the science and data used by the government.

After a regulation is drafted and formally proposed, Mr. Johnson said, it is “all but impossible” to get OSHA to make significant changes.

“Risk assessment drives the entire process of regulation,” he said, and “courts almost always defer” to the agency’s assessments.

But critics say the additional step does nothing to protect workers.

“This rule is being pushed through by an administration that, for the last seven and a half years, has failed to set any new OSHA health rules to protect workers, except for one issued pursuant to a court order,” said Margaret M. Seminario, director of occupational safety and health for the A.F.L.-C.I.O.

Now, Ms. Seminario said, “the administration is rushing to lock in place requirements that would make it more difficult for the next administration to protect workers.”

She said the proposal could add two years to a rule-making process that often took eight years or more.

Representative George Miller, a California Democrat who is chairman of the House Committee on Education and Labor, said the proposal would “weaken future workplace safety regulations and slow their adoption.”

The proposal says that risk assessments should include industry-by-industry data on exposure to workplace substances. Administration officials acknowledged that such data did not always exist.

In their letter, Mr. Obama and other lawmakers said the Labor Department, instead of tinkering with risk-assessment procedures, should issue standards to protect workers against known hazards like silica and beryllium. The government has been working on a silica standard since 1997 and has listed it as a priority since 2002.

The timing of the proposal appears to violate a memorandum issued in early May by Joshua B. Bolten, the White House chief of staff.

“Except in extraordinary circumstances,” Mr. Bolten wrote, “regulations to be finalized in this administration should be proposed no later than June 1, 2008, and final regulations should be issued no later than Nov. 1, 2008.”

The Labor Department has not cited any extraordinary circumstances for its proposal, which was published in the Federal Register on Aug. 29. Administration officials confirmed last week that the proposal was still on their regulatory agenda.

The Labor Department said the proposal affected “only internal agency procedures” for developing health standards. It cited one source of authority for the proposal: a general “housekeeping statute” that allows the head of a department to prescribe rules for the performance of its business.

The statute is derived from a law passed in 1789 to help George Washington get the government up and running.

The Labor Department rule is among many that federal agencies are poised to issue before Mr. Bush turns over the White House to Mr. Obama.

One rule would allow coal companies to dump rock and dirt from mountaintop mining operations into nearby streams and valleys. Another, issued last week by the Health and Human Services Department, gives states sweeping authority to charge higher co-payments for doctor’s visits, hospital care and prescription drugs provided to low-income people under Medicaid. The department is working on another rule to protect health care workers who refuse to perform abortions or other procedures on religious or moral grounds.

 

Deadly Effects of Racism and Lack of Healthcare on Latin American Immigrant Workers November 28, 2008

Posted by rogerhollander in Immigration, Latin America, Mexico.
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from: San Francisco Gray Panthers

Immigration, Health Care Highlighted in UC Report

Contra Costa Times, October 23, 2008

Sarah Terry-Cobo

BERKELEY — Immigrants, particularly those of Latin American origin, significantly contribute to the work force but are harmed by the lack of health care coverage, according to a UC Berkeley report released Monday. The study was based on US Census data.

“What this report is showing, unfortunately, is that immigrants and those who come from Mexico and Latin American countries are absorbing the most difficult jobs and are facing the highest job-related deaths,” said Xochitl Castaneda, director of the Health Initiative of the Americas, a program of the UC Office of the President.

Mexican immigrants make up nearly one-third of U.S. population, but because they are usually employed in dangerous occupations, such as farming and construction, they account for 44 percent of immigrant workers who die on the job or as a result of an on-the-job injury, the report states.

Professor Steven Wallace, associate director of the UCLA Center for Health Policy Research, School of Public Health, described some of the findings.

“Despite taking the large number of dangerous jobs in the country, (immigrants) are not offered the basic necessities such as health insurance, where they are literally putting their life on the line,” he said.

The research for “Migration, Health and Work: The Facts Behind the Myths,” was conducted by the UCLA and UC Berkeley schools of public health, the UC Office of the President and the Health Initiative of the Americas.

In particular, Mexican immigrants often work at low-wage jobs that provide little or no insurance. Nationwide, about one-fifth of Mexican immigrants in sectors such as construction, agriculture and service industries have insurance, the report states.

In addition, the report notes that Latin American immigrants are in better overall health than most non-Latino whites, but their health declines the longer they reside in the United States This is most likely because of inadequate access to services and lack of funds to pay for prevention and treatment.

Immigrants arrive healthy, Wallace said. “There needs to be a concern with adequate levels of health care services so they can maintain the level of health,” that they had when they entered the country.

“The report is an instrument for those who want to make informed decisions,” said Castaneda. “It provides facts behind the myths for those who really want to construct a better world, who should be more informed.”

The release of the report coincides with the Binational Health Week and the Binational Policy Forum on Migration and Health held in Los Angeles.

By the numbers

# One in four workers in California are Latino immigrants.

# One in five employed men in California ages 18-64 are Mexican immigrants.

# Eight in 10 agricultural workers in California are Mexican immigrants.

# 94 percent of Mexican immigrant men in the United States are actively employed.

# One in four Mexican immigrant adults live in families that are below the federal poverty level.

# “Mexican immigrants report fewer chronic conditions overall, spend fewer days in bed because of illness and have lower mortality rates than U.S.-born non-Latino whites.”

Source: “Migration, Health and Work: Facts behind the Myths”

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