Update on the effort to rebalance the mission of Albuquerque's public hospital:
Urban Indian advocates re-establish some equity in the hospital

So, for the past two years, our coalition has been negotiating with the CEO of our public hospital to change some heinous policies and reinstill a sense of mission in the institution. our efforts have focused mostly on homeless, immigrant and uninsured populations. turns out that parallel to us, urban indian advocates and IHS (Indian Health Service) administrators were doing the same thing. few facts. Albuquerque has about 30-45 thousand urban indians who theoretically have health care coverage thru the IHS. reality check is that all the money goes to the tribes of origin so these folks would then need to travel back to their reservations to receive the benefit. up until a few years ago things were sort of balanced because the pueblo tribes near albuquerque put a significant chunk of their money into the albuquerque IHS clinic which was able to serve these people with primary care and urgent care. a few years ago many tribes took advantage of a new law called "638" to take all their money back to their tribes. this has bankrupted albuquerque ihs clinic.

in the face of this the public hospital, which gets almost $200,000,000 in subsidy and tax breaks, began applying for a $250,000,000 mortgage from the feds. in order to do this the hospital had to negotiate with the indian governors to ensure that the land (which was donated by indians to establish this hospital 50 years ago) was not in any legal conflict should the hospital be unable to pay this new huge loan.

now it gets interesting. the governors have watched their equity in the hospital dwindle over the past fifty years from an initial treaty agreement to provide 100 hospital beds to a mere 8 beds held in reserve. one of the few perks that still exist is that indian patients are billed to IHS at cost, instead of inflated charges. so the governors decided to make a stand. they put together a list of 8 negotiation points that had to be agreed upon by the hospital before they would sign onto the new lease agreement. the thorniest of which is that the hospital has always been the "payer of last resort." this means that money must be collected from any other source before the hospital will give a cent. makes sense for medicare and medicaid patients so we don't tap the $200,000,000 for these patients when the federal and state governments are willing to pay.

but the governors stated that IHS now needed to be the payer of last resort for urban indians since IHS is bankrupt. the justice issue here is one of racism. an urban indian is a person who lives, works and pays taxes in a city. he or she is a citizen. the whole notion of forcing people to go back to their reservations for health care when they are entitled as any other resident to services where they live is discrimination. the hopsital had no qualms in seeking the assistance of Senator Dominici from NM to try to force the IHS to stop their complaining and accept a bad deal. rumors were flying about how expensive it would be for the hospital to shoulder the burden. lies were stated about how IHS wanted the hospital to pay for care for all indians in the state (12% of the population).

here are a few more details. the new lease is for the next 50 years, so a bad decision made today is gonna last a long long time. the second fact is that the cost of urban indian care at UNMH is roughly 1.1 million per year. a drop in the bucket.

with a little help from our coalition and a lot of backbone and courage and work from IHS officials and urban Indian activists, this stupidity was put to a stop and the CEO was forced to honor the initial treaty that created the hospital and share some equity with Urban Indians. of course, what's on paper is just a place to start. now the harder work begins to ensure that people get their due. we already know the financial aid system is set up to exclude indians and immigrants and homeless people. it's not policy, it's process. this is where the efforts of the community coalition in alliance with urban indians, will work to monitor and hold the hospital accountable to their mission.

the added benefit from this recent conflict is that the CEO is pissed. :> he's not happy when he is forced to share public tax dollars with the public. now that urban indian activists and the coaltion activists are allies in the open, he's got more to worry about. the usual tactics of divide and conquer aren't going to work anymore. a cold hard truth is that those tactics have worked. too many immigrants believe that indians have all the healthcare they need and too many Indians believe that immigrants get free health care. the truth is so much more complex and disastrous than that. as long as we fight each other, we'll never unveil the truths and lies of oppression and achieve a just society.

On Transforming the Culture of Medicine: Global Health Equity, and a new Residency Program

Paul Farmer and friends have a piece in this week's Lancet, on the need for looking at medicine globally and teaching it globally, including the huge global disparities that exist and what role physicians can play. WOW. Imagine if physicians were empowered to have an active role in community, national, and global policymaking? I decided to past the whole piece below (under fair use policy) because it's so damn good. And they're starting up a Global Health Equity Residency Program in Internal Medicine up in Boston -- how's THAT for transforming the culture of residency?

Every decade or so, it seems, there is a major shake-up in medical education. The current one revolves around topics with which many medical educators are unfamiliar or uncomfortable: health as a human right and the growing disparities of outcome between well-to-do and poor patients.

The burden of disease is growing disproportionately in precisely those regions most commonly afflicted by "the brain drain". From Africa and the poorer regions of Asia and Latin America, doctors and nurses who cannot make living wages flee rural areas for cities, then make their way to industrialised countries. A decade ago, there were more Haitian psychiatrists in the city of Montreal, Canada, than in all of Haiti.1 A more recent survey in a Kenyan teaching hospital showed that most trainees were contemplating quitting their jobs; many met clinical criteria for major depression.2

Here is the irony: more and more trainees in affluent nations seek to dedicate at least part of their working lives to benefit the world's destitute sick,3 while the brain drain draws culturally and linguistically competent clinicians away from their home countries. What is our pedagogic plan? How can medical schools and teaching hospitals respond, with conscience and pragmatism, to the goodwill of trainees from rich countries desiring to serve in the settings that endure the exodus of their own health professionals?

Growing inequalities are at the heart of this irony. Medicine is developing evidence, but has no equity plan: we lack a rights-based approach to its distribution. Medicine and public health goods are still parochial, limited to a few beneficiaries. We have developed no compelling strategy for medicine to exert the same global reach as, say, finance.

According to economists such as James Galbraith, there has been a sharp upturn in global inequality since about 1980.4 Regardless of their origins, social and economic inequalities are reflected epidemiologically: disparities of outcome in and between countries are now major challenges in medicine and public health. If health is ever to be construed as a human right, such disparities must be seen as the chief challenge for medical education.

What matters most, for those training the next generation of health workers, is not improved curricula in international health or tropical or geographical medicine. None of these terms captures the dilemma so well as does "global health equity".5 Too much conventional international health education shrinks from acknowledging the social roots of grotesque inequalities. Too many in medicine are unwilling or unable to confront the complexities by which, for example, financial institutions exhort poor countries to cap spending on health and education. Above all, too many of us are slow to incorporate rights into our health and teaching practices.

As medical educators, we can turn away from these complexities, shrug them off, delegate them to economists or policy-makers. However, more and more students and trainees are now eager to span the worlds of the rich and poor--which also means reducing the divide between clinical medicine and public health. Thus, we are launching, at Boston's Brigham and Women's Hospital, a global health equity residency. It will enable residents in internal medicine to train in public health and work to address inequalities of access and outcome. It will be underpinned by a rights-based approach to responding to growing inequalities in health. We close with a question: why only internal medicine? The same inequalities exist in surgery, psychiatry, obstetrics and gynaecology, radiology, and paediatrics. What branch of medicine or public health is not forced to confront the growing outcome gap that promises to shield the privileged, while the world's bottom billion continue to die from readily preventable or treatable disease?

How about $12,437?

Nobody's ever charged that for a prescription before... new Tom Toles cartoon.

Should docs be punished for accepting gifts from Big Pharma?

In the U.S., when pharmaceutical companies are tried for bribing physicians (the latest trial settled was about Pfizer bribing docs to prescribe Neurontin for off-label uses), physicians are usually not put to blame. The same happened recently with the drug Lupron -- urologists involved in accepting gifts or bribes were not implicated or punished in any way. However, in Italy, a few thousand doctors ARE going on trial for similar acts:

"One of the biggest inquiries into marketing practices in the drugs industry ended yesterday with Italian police asking for almost 5,000 people to be put on trial, including more than 4,000 doctors and at least 273 employees of the British pharmaceuticals giant, GlaxoSmithKline. Some face up to five years in jail if tried and convicted...

"The most serious accusations have been leveled at doctors, pharmacists and sales representatives alleged to have been involved in a programme intended to promote Hycamtin, a drug mainly used in the treatment of lung and ovarian cancers. In some cases, it is claimed, specialists received a pro rata cash payment based on the number of patients treated with the drug."

WOW. I think physicians should be held to much higher standards in taking bribes (gifts) than pharmaceutical companies should be in proposing bribes, and I think it's quite fascinating to see Italy putting docs on trial for this.

On a related note -- a new article in the Medical Journal of Australia is worth reading -- "The Ethics of Pharmaceutical Industry Relationships with Medical Students" -- AMSA's Pharmfree Pledge and 4 step program to stop the drug-company-gift addiction are spelled out in the article! Makes me proud. I'm going to keep a copy of this article in my white coat during my 4th year med school rotations. Most medical students and attendings on my rotations don't believe that there's any harm to eating free drug company lunches and taking textbooks and other gifts. They look at me funny when I bring my own lunch or buy lunch in the cafeteria -- as if I must have a "holier than thou" attitude. Perhaps I can start a productive discussion with this article.

Election 2004: President Idol?

Virginia Heffernan's got the right idea about our presidential elections -- make them more like American Idol:

"November's general elections need a "results show" like the big bash "American Idol" staged on Fox last night. Instead of distracted anchormen calling tallies from boring desks, the hyperhappy host, Ryan Seacrest, could crow in a tieless tux about how fabulous voter turnout was. Past failed candidates - Carol Moseley Braun, Bob Dole and Howard Dean, certainly - could reprise old stump speeches, all smiles now. Finally, following a sax rendition of "The Star-Spangled Banner" by a former idol, Bill Clinton, George W. Bush and John Kerry could stand up, holding hands, trembling but beaming encouragement to each other, as Ryan announced our next American president."

I wasn't sure if America's youth was ready for an African-American idol this year, especially when La Toya London was booted off a few weeks ago. It was good to see that Heffernan thought the same. But all was well when Fantasia Barrino's win brought back my hope. At the end of the piece, Heffernan pointed out "the twist" in American Democracy by allowing voters to vote as many times as they wanted to, and took back her case for moving towards American Idol type elections. It's good to know though that there's increasing demand for paper trails in places where electronic voting machines are going to be determining our next president. Doug Chapin gets my vote for weirdest metaphor on electronic voting and paper trails:

"You can either build a fence around a cliff or put an ambulance in the valley," he said. "The paper trail is the ambulance in the valley. Certifying the machines and testing them in the first place to make sure they are secure is the fence around the cliff."

Sex in the Box - TV's portrayal of things sexual

Cool show on Monday night on TV -- I'll hopefully be watching it to distract myself from studying for step 2 of the medical boards. Thanks to the kaiser network daily news for this:

The Bravo television series "TV Revolution" -- which examines "groundbreaking moments in television history" -- on Monday in the third of its five episodes examines TV programs' depictions of sexual issues, including abortion and teenage sexuality, according to a Bravo release. TV programs "always" have been cautious of depictions of sex, and sexual revolutions "often" have been "at odds" with TV images, according to the release. The episode -- titled "Sex in the Box" -- discusses CBS' decision to write actress Lucille Ball's real-life pregnancy into the "I Love Lucy" script but to always use the term "expecting" instead of "pregnant"; the depiction on the soap opera "All My Children" of the first legal abortion for a TV character; a conversation among characters on the show "30 Something" about whether to use contraception; and television shows that have depicted sexually active teenagers, such as "Beverly Hills, 90210" and "Buffy the Vampire Slayer" (Bravo release, 5/21). "TV Revolution" airs May 23 to May 30 at 9 p.m. ET.

Any Republican leaders up for an inspiring history read?

"Thirty years ago, a Republican president, facing impeachment by the House of Representatives and conviction by the Senate, was forced to resign because of unprecedented crimes he and his aides committed against the Constitution and people of the United States. Ultimately, Richard Nixon left office voluntarily because courageous leaders of the Republican Party put principle above party and acted with heroism in defense of the Constitution and rule of law."

Apparently Barry Goldwater, a Republican Senator during President Nixon's term, gathered influential republican leaders together to firmly advised Nixon to resign. They placed "principle over politics" and dissociated the Republican Party from Nixon's presidential politics. And in 1968, Democratic leaders (including Eugene McCarthy, George McGovern, Robert Kennedy) advised then-president Lyndon Johnson to not run for a second term due to his botched Vietnam War policies.

Carl Bernstein, co-author of All the President's Men and one of the investigative journalists who blew open the Watergate scandal, writes that Republican leaders are not holding President Bush accountable for his presidency. Check it out, it's a quick read. Makes me wonder which Republican congresspeople or party leaders would ever come out and hold Bush accountable, and uplift the respect of the party.

ADBUSTERS and 163 interventions

Man, the people at Adbusters are always blowing my mind, with their striking combination of art and commentary, which has sometimes seemed over the top to some of my friends, but has given me some clarity in our world of consumerism, globalization, capitalism, and daily life struggles. The magazine is an experience, and I've often found myself saying repeatedly "WOW, i've never heard it put that way."

Check out the Adbusters site for some amazing features and campaigns, including True Cost Economics, Media Carta, Corporate Spotlight, TV Turnoff Day, etc. But for a must-read -- the latest issue of the magazine, the May/June issue (issue no. 53), is dedicated to the history of the United States, the core values we were founded upon and how they've been manipulated through the times, and numerous military interventions that we've started. I'm still reading it, so I'll share more as I read more.

Thankfully, there's a great summary of our history of military interventions on a flash link off of the adbusters site. It's a great read, though it only starts at 1801, which is after where the magazine starts. For example, the magazine starts off with our first military intervention -- Columbus and the settlers' domination of Native Americans and the crazy things we did to wipe them out (some of this is from Howard Zinn's "A Peoples' History of the United States," in which our first biological weapon was used -- that of blankets infected with smallpox and distributed to Native Americans, back in the Columbus days).

Sometimes I really wish we were educated about these horrid facts back when we were learning about Columbus in elementary school. My kids are going to come home from kindergarten and first grade praising Columbus and if I'm successful, they'll get a re-education and they'll re-educate their teachers...if I'm not successful, they'll stop communicating with "crazy mommy."

Palme d'Or for Moore -- Fahrenheit 9/11

Well, friends, he did it. Michael Moore won the Cannes Film Festival's most prestigious award, the Palme d'Or, for his film Fahrenheit 9/11 (an award not given out since 1956, for a movie that Jacques Costeau did). I almost got emotional about it myself (without having yet watched it) from reading a well-written Frank Rich piece in the NY Times, which describes what some of the scenes capture. Not only does it address the Bush/Bin Laden family link, but it explores SO much more. I am especially grateful that the documentary explores the lives of actual soldiers suffering from the consequences of war, including those suffering from physical and emotional damage, and actual footage of soldiers injured and maimed on the battlefield. Some may call Mr. Moore a sensationalist, but I honestly think that's crap. I'm thankful that he's doing work like this. When our country's administration won't even let parents see their dead sons and daughters coming home from battle (let alone allowing the public to see these images), we need this voice to bring the message and images to the people.

In the May/June 2004 issue of Adbusters magazine (get yourself a copy if you can!), there's a neat graph showing an inverse relationship between distance from target (whether enemy combatant or civilian) and emotional feeling about the target. The same holds true for those of us watching the war happen on TV -- we can shut it off, we can distance ourselves from the target -- as long as we don't repeatedly see images of our injured soldiers' and Iraqi civilians' bodies. And that's just dangerous. SO, THANK YOU Michael Moore.

I hear this documentary may actually be out in theaters across the U.S. over July 4th weekend. My fingers are crossed. THIS may be the straw that breaks the camel's back and allows us to unseat our current regime leader.

And in related news, the Associated Press is carrying a story about Michael Moore and the Cannes Festival, and raises an interesting point. "Some critics speculated that if "Fahrenheit 9/11" won the top prize, it would be more for the film's politics than its cinematic value." I don't know what I think about this (I'm going to mull over it some). How much does a film's politics contribute to its cinematic value?

Back to the Garden State! I'm home again!

Well, I made it! *phew* After exploring the country with nothing but sunglasses, sparring with anti-justice folk, building relationships and creative visions with like-minded folk, and doin' the Anju dance alot, I finally made the move from Reston, VA where I was living this past year, while working at the American Medical Student Association as the Jack Rutledge Fellow for Universal Health Care and Eliminating Health Disparities, to Nutley, New Jersey. (wow, long run-on sentence).

I'm starting up my 4th (and final) year of medical school, at UMDNJ-New Jersey Medical School in Newark, NJ. Did I mention that this will be my FINAL year of med school? finally. I'm supposed to be studying for Step 2 of the boards (yikes, after no clinical exposure in the past year except for playing "guess the pharmaceutical company that made this medicine" on long airplane rides -- though that information won't really help me), but it's a bit hard to transition from doing fun cool things around the country to studying for a standardized exam with questions like...oh nevermind. I'll be posting randomly to this site, as I adjust to my new life of studying (the BIG rocks in the jar, as a friend put it) and doing my other shit (producing music, djing, activism) as the little rocks that fill in the spaces). But i ain't kidding anyone, the big rocks are the latter, and i'm trying to fit in the little rocks of studying. Anyway, hopefully more frequent posting as I try to distract myself often from studying in the next month. :>

On Transforming Good Cucumbers into Sour Pickles

Philip Zimbardo, a social psychologist and lead scientist in the Stanford Prison experiment of the 1970's, in which students were broken into groups of prisoners and prison guards, and which had to be stopped a week ahead of its end date because of abuses being carried out, has some wise words about the Iraqi prisoner abuse that is seemingly more and more widespread:

In the current situation, we must not allow the politicians and pentagon to dismiss the seriousness of what happened with the usual dispositional analysis of a few bad apples in a good barrel. Bush said it should not reflect on the good nature of all Americans or our military.

Wrong. The situational analysis says the barrel of war is filled with vinegar that will transform good cucumbers into sour pickles and will always do it to make the majority of good people, men and women, into perpetrators of evil, where there is:
anonymity-deindividuation, dehumanization, secrecy, diffusion of responsibility, social modeling, big power differentials, frustration, feelings of revenge, obedience to authority, lack of supervision that conveys a sense of permissiveness.

A moment to mourn, A moment of peace

Kos has a wonderful post on "peace", along with a picture of the sculpture commemorating the peace accords in Guatemala after their long (3 decades long) and bloody civil war -- this picture is outside the Guatemalan national palace. Just yesterday I said bye (for one month) to my friend Barbara, who's spending a few weeks in Guatemala learning intensive Spanish and experiencing the country while living with a Guatemalan family. Perhaps we'll have a post or two from her experiences there.

Hard America = Good. Soft America = Bad.

I don't know why I read this George Will column but I did. Will reviews Michael Barone's new book about Hard America versus Soft America. Soft America is seen as the move towards progressive values (soft things like universal education, affirmative action, welfare, social programs, etc) and hard America is seen as capitalistic, rugged, individualistic (no "racial preferences", more profits, more prisons, less capital gains taxes, etc).

Unsurprisingly, "racial preferences" are equated with "affirmative action" and "soft America". Will states, "Racial preferences, which were born in the 1960s and '70s, fence some blacks off from Hard America, insulating them in 'a Soft America where lack of achievement will nonetheless be rewarded.'" Ouch. Now THAT's racist. A fact that's pointed out as a positive benefit of "hard America" and the ability to curb crime in our country is that in 1970 there were 200,000 people in prison, while in 2000 (JUST 30 years later) there were over 1.3 million people in prison. YIKES. That's seriously disturbing. Lock 'em all up, even the innocent ones, boys.

Over at Paperweight's Fair Shot, it's pointed out astutely that this debate is all about "framing the debate", with the following conclusions being derived from the column:

Republicans are tough pragmatic competent men of action, forged in the fires of a free market.
Democrats are mollycoddled and mollycoddling wimps sucking off the goverment teat.

Fair Shot has a GREAT analysis of the G.Will column, DEFINITELY worth checking out.

And myth-creation about the scary freeloading welfare program:
"In the Soft America of 1970, the tapestry of welfare benefits had a cash value greater than a minimum-wage job. In the Harder America of 1996, welfare reform repealed Aid to Families with Dependent Children, a lifetime entitlement to welfare. And in the 1990s, welfare dependency -- and crime -- were cut in half. A harder, self-disciplined America is a safer America."

Eisner, Mr. Anti-Politics

Disney's chief Michael Eisner doesn't want to distribute (through Miramax) Michael Moore's new hard-hitting documentary, Fahrenheit 9/11 because Disney is a family oriented company and doesn't want to get too political in an election year. FAIR does a great job of exposing HOW very wrong Eisner's statement is, as Disney's stations host the ABSOLUTE VILENESS of Rush Limbaugh's show and the 700 Club show. Graham has a post on Rush's recent awful justification of Iraqi prisoners of war. Two examples of family oriented TV and radio (provided by FAIR):

* Almost all of Disney's major talk radio stations-- WABC in New York, WMAL in D.C., WLS in Chicago, WBAP in Dallas/Ft. Worth and KSFO in San Francisco-- broadcast Rush Limbaugh and Sean Hannity. Indeed, WABC is considered the home station for both of these shows, which promote an unremitting Republican political agenda. (Disney's KABC in L.A. carries Hannity, but has Bill O'Reilly instead of Limbaugh.) Disney's news/talk stations are dominated by a variety of other partisan Republican hosts, both local and national, including Laura Ingraham, Larry Elder and Matt Drudge.

* Disney's Family Channel carries Pat Robertson's 700 Club, which routinely equates Christianity with Republican causes. After the September 11 attacks, Robertson's guest Jerry Falwell (9/13/01) blamed the attacks on those who "make God mad": "the pagans and the abortionists and the feminists and the gays and the lesbians who are actively trying to make that an alternative lifestyle, the ACLU, People for the American Way, all of them who try to secularize America." Robertson's response was, "I totally concur." It's hard to imagine that anything in Moore's film will be more controversial than that.

Media coverage of the March for Women's Lives

I've got a ton of thoughts on this topic, but I'll be brief here, since I've got to get back to some work. Today I saw a FAIR (Fairness and Accuracy in Reporting) update about media coverage of the historic March on Women's Lives, and it revealed how the March received 3 times less attention than a much smaller march organized by the Promise Keepers (some info on the Promise Keepers -- Facts and Myths here) back in 1997. The Promise Keepers (500,000-750,000 people) had 26 media reports, and the March for Women's lives (1.15 million people) had a total of 8 reports from 3 major news networks.

Also, two days after the march, I was watching a news show on TV (was it Fox channel? I can't remember), where the interviewer showed footage from the March for Women's Lives, at which more than 50 different people spoke (possibly 100), and of all the footage, ONE spoken word artist's controversial language was talked about and shown TWICE ("we can't even un-mute this video clip; seems the marchers were mostly radical feminists"). Yup, all radical feminists. The more we're portrayed like that -- and we meaning average Americans who come together over a common belief, come together over something that's being taken away from us by this president's administration and secretly by others on a state level -- the LESS credible we seem.

In talking to a few acquaintances about the March, several responses to why they didn't go was because they're not the "marcher" type. Ah, yes, that type. The yelling screaming anarchist marcher type who likes to cause a raucous. Americans just don't like to protest, march, or hold our elected officials accountable. Why is it that this concept of marching, rallying, protesting, etc is so foreign to us (even our anti-war marches were sporadic and not as well attended compared to the anti-war sentiment), while in Spain there's a train bombing and two days later 1/4th of the country is marching on the streets?

Knowing and not punishing is condoning

The Daily Misleader today has compiled information that shows that the Bush Administration knew of the Iraqi POW abuse committed by US and British troops, as early as a few months ago. As of now, Donald Rumsfeld and Bush both have only read summaries of the report. Our nation has essentially condoned the actions by not having cared enough to read the reports and take swift action on this.

Will Kerry win...

...by a landslide? Chuck Todd, writing in the Washington Monthly, seems to think so, and backs up his reasoning with data that incumbent presidents running against others either won by a landslide or lost by a landslide. Not knowing enough about the details of the past presidential races, his thinking sounds credible. But then again, I'm optimistic about Bush's defeat...