August 1, 2012

Posted by orrinj at 5:43 AM


Islam, Democracy and the Long View of History : The U.S. had no trouble living with the Arab autocrats. It did so, as George W. Bush once put it in a memorable speech, for six long decades. (FOUAD AJAMI, 7/31/12, WSJ)

Defense Secretary Leon Panetta arrived in Cairo Tuesday to meet Egypt's new Islamist president, the Muslim Brotherhood's Mohammed Morsi, and the country's top general, Field Marshal Mohammed Hussein Tantawi. After the meeting, the secretary told reporters, "It's clear that Egypt, following the revolution, is committed to putting into place a democratic government."

Such patience and reassurance is wise in the wake of an Arab Spring that brought forth democratic elections for the first time in generations. It should be remembered that the U.S. had no trouble living with the Arab autocrats. It did so, as George W. Bush once put it in a memorable speech to the National Endowment for Democracy in 2003, for six long decades--all in the name of stability. The terrible band of jihadists who struck America on 9/11 shattered that compact with the autocrats.

We are now called upon to figure out the terms of a new accommodation, and suddenly many of us are without historical patience. The Islamists in Egypt, Tunisia, Morocco have stepped forth. They didn't make that Arab Awakening of 2011 but had become its beneficiaries. Their leaders had not been on the Rolodex of Goldman Sachs, they were not clients of Washington lobbying firms. They had no favors to dispense. Suddenly history broke their way.

That would be History.
Posted by orrinj at 5:27 AM


In Mammogram Debate, Politics Trounces Science (Handel Reynolds, Jul 31, 2012, Bloomberg)

 In a moment of unprecedented candor for an official of the normally message- disciplined American Cancer Society, Otis Brawley, its chief medical officer, made a startling admission. In a New York Times interview, he said, "I'm admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated." He went on to say that even though mammography can save lives, "if a woman says, 'I don't want it,' I would not think badly of her, but I'd like her to get it."

Brawley was responding to an article that had just been published in the Journal of the American Medical Association, in which researchers argued that 20 years of widespread breast and prostate cancer screening had failed to deliver the promised health benefits. In both cases, screening had led to a huge increase in the incidence of early-stage disease, with only a very slight decrease in late-stage disease. This is significant because the basic rationale for screening has always been that identifying and treating more early-stage cancers will lower the number of late-stage cancers. That this has not happened suggests that screening detects many nonaggressive cancers that would not have progressed if left undetected. The practical result of large-scale screening, in other words, was overdiagnosis and overtreatment.

Posted by orrinj at 5:22 AM


More Treatment, More Mistakes (SANJAY GUPTA, July 31, 2012, NY Times)

It is a given that American doctors perform a staggering number of tests and procedures, far more than in other industrialized nations, and far more than we used to. Since 1996, the percentage of doctor visits leading to at least five drugs' being prescribed has nearly tripled, and the number of M.R.I. scans quadrupled.

Certainly many procedures, tests and prescriptions are based on legitimate need. But many are not. In a recent anonymous survey, orthopedic surgeons said 24 percent of the tests they ordered were medically unnecessary. This kind of treatment is a form of defensive medicine, meant less to protect the patient than to protect the doctor or hospital against potential lawsuits.

Herein lies a stunning irony. Defensive medicine is rooted in the goal of avoiding mistakes. But each additional procedure or test, no matter how cautiously performed, injects a fresh possibility of error. CT and M.R.I. scans can lead to false positives and unnecessary operations, which carry the risk of complications like infections and bleeding. The more medications patients are prescribed, the more likely they are to accidentally overdose or suffer an allergic reaction. Even routine operations like gallbladder removals require anesthesia, which can increase the risk of heart attack and stroke.

So what do we do to be safer? Many smart people have tackled this question. Peter Pronovost at Johns Hopkins developed a checklist shown to bring hospital-acquired infections down to close to zero. There are rules against disturbing nurses while they dispense medications and software that warns doctors when patients' prescriptions will interact badly. There are policies designed to empower nurses to confront doctors if they see something wrong, even if a senior doctor is at fault.

What may be even more important is remembering the limits of our power. More -- more procedures, more testing, more treatment -- is not always better. In 1979, Stephen Bergman, under the pen name Dr. Samuel Shem, published rules for hospitals in his caustically humorous novel, "The House of God." Rule No. 13 reads: "The delivery of medical care is to do as much nothing as possible." First, do no harm.

Posted by orrinj at 4:50 AM


Electronic Arts to Make Key Game Free (SHARA TIBKEN, 7/31/12, WSJ)

Electronic Arts Inc. said it will make a key videogame free for players following struggles to gain traction with a subscription model.

The company announced the pricing switch on "Star Wars: The Old Republic"

Posted by orrinj at 4:47 AM


UK experts to help Iraq destroy chemical residues (BUSHRA JUHI, 7/30/12,  Associated Press)

Britain will help the Iraqi government dispose of what's left of deposed Iraqi dictator Saddam Hussein's chemical weapons, still stored in two bunkers in north of Baghdad, the British embassy in Baghdad announced Monday.

The British Defense Ministry will start training Iraqi technical and medical workers this year, an embassy statement said. The teams will work to safely destroy remnants of munitions and chemical warfare agents left over from Saddam's regime. He was overthrown in 2003 following an American-led invasion.

Saddam stored the chemical weapons near population centers so that he could access them quickly, despite the danger to his civilian population.