TheMillerCircle.org

One thing the government is not getting right in the Gulf oil spill, is the protection of workers who are exposed to toxic chemicals, while working as members of the cleanup crews. It’s in BP’s interest to minimize the health risks that cleanup workers must confront. The National Academy of Sciences has reported that forty percent of the oil that comes to the surface evaporates and within that evaporated mix are toxic chemicals, including benzene, a known carcinogen, once commonly used as a solvent,  which has long been implicated as a causative link to leukemia.  Several weeks ago, the Coast Guard called the commercial ships involved in the cleanup operation into port, when seven crew members became ill and were hospitalized with nausea, headache, dizziness and chest pains.  Amy Goodman on Democracy Now interviewed Clint Guidry, president of the Louisiana Shrimp Association, who turned out to have a lot of experience with oil cleanup methods, having worked in the oil industry in similar operations for many years, cleaning up shut-down oil refineries. However, the toxic environment to which workers get exposed is not through oil evaporation alone, but is also created by Corexit, the chemical dispersant used in the cleanup, which contains another toxin, 2-butoxyethanol (up to 60%: the exact formula for Corexit is kept secret as a proprietary formula by its manufacturer–Nalco)–so one thing the government needs to do is force Nalco (which is at least partially owned by BP) to reveal the chemical composition of Corexit, so we know exactly what the hazards of this set of reagents might be. Britain has banned the use of Corexit for cleanup purposes in that country, so why is it still being used in the United States? What is it we don’t know about this dispersant that the Brits know? According to some experts, the purpose of the dispersant, now widely used in the gulf, is to break-up and sink the oil, so no one can point to a “corpse.” The dispersant does not eliminate the oil, but breaks it up into small droplets that help hide the corpse beneath the surface (sort of like if you don’t have a body you can’t charge someone with murder). When the dispersant treated oil occupies mid-regions of the ocean, or sinks to the ocean floor, it can then more easily enter into the life cycle of other forms of ocean fauna, such as fish and bottom-dwelling organisms. The tuna that occupy the western side of the Atlantic breed in the Gulf and are now going through the cycle in which the eggs are hatching and fry are feeding.  The dispersed oil makes it more likely that two toxic components, the oil and the dispersant, will get ingested by the fish swimming and breeding in the region. Apparently, BP is spraying Corexit broadly in the air over water regions, but close to some residential areas near the Gulf shore, raising the possibility of toxic air pollution for residents in the region. The fisherman who have lost their ability to fish are now working for BP for $3,000/day and, at the risk of losing the only employment they have, they are not going to speak out about the working conditions. Since Exxon Valdez, the routine of exposing cleanup workers to toxic chemicals, and forbidding the use of protective devices such as respirators, knowing that those employed for the cleanup operation will never expose the company for the poor working conditions, has become part of the gold standard for how an oil company responds to an oil spill, the first duty of which is to protect the company against long-term liability.

BP has denied there are any health hazards to which cleanup workers get exposed and claims to have taken measurements of the air quality to prove it. But, but those measurements have yet to appear in public. Mr Guidry, knowledgeable about air quality issues, brought respirators to the commercial fisherman who were employed by BP for the cleanup, but they were all informed that BP would fire anyone caught using a respirator. Guidry claims that this experience goes all the way back to the Exxon Valdez oil spill, when respirators were not allowed to be used so that the company limited its liability; the use of respirators is an indication that the oil company believes there is an environmental problem with air quality and, as such, exposes them to the liability for respiratory ailments, a situation that could lead to long-term legal problems for the company. BP has stated that nothing is wrong with the air quality in the cleanup areas. If so, what made the workers ill a few weeks ago? Guidry claims it was exposure to toxins in the air. As it turns out, EPA (Environmental Protection Agency), the Federal agency responsible for monitoring air quality has no jurisdiction for air quality over the water, but would have jurisdiction once the air moves onto land. It appears that the Coast Guard and MMS have jurisdiction over air quality issues in the water and so far these organizations have not made any decisions about air quality or cleanup worker safety. Measurements of air quality seem to be limited to those provided by BP. Mr Guidry reported that when he did work in cleaning up oil refineries, all workers had protective clothing and boots, as well as respirators as part of the normal routine worker protection. He has claimed that the lack of such protection exists solely so that BP limits its liability.

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Red Knot Shorebird

Perhaps we need another century or two to understand the species of the world and their inter-dependencies before we make judgments about who should go and who should stay: say goodbye to one and you may have to do the same for a seemingly diverse group of animals for reasons that are highly counter-intuitive. It’s foolish of course to even suggest that we are in a position to make decisions about species survival, because we aren’t knowingly making those judgments, even though events, such as species extinction, are very likely occurring on a regular basis as a result of human interventionism. But, species extinctions are taking place without our knowledge of the cause or even, in most cases, an understanding of the species involved. We keep track of big animals, like lions, tigers, elephants and other large mammals and, though  the future for them is not looking particularly bright, we are completely ignorant about animals a step or two below on the evolutionary ladder–like the now extinct, Gastric-Brooding Frog. Who said goodbye to that species? But, here’s one to ponder for the short-term: are you kidding me?–shorebirds and horseshoe crabs? This survival dynamic may play itself out over the next few years.

The interconnectedness of nature almost dictates that you don’t lose single species, that in in losing one, some other species or fauna will also be put into harm’s way:  the loss of one species may precipitate the loss of one or more others, largely because we are unaware of the biological forces that unite them. I don’t know who else we lost or which other species might have been changed when the Gastric-Brooding Frog disappeared, but it didn’t disappear without impacting other species. Of that we can be certain. But, what connection for example does the continued vitality of the horseshoe crab, Limulus polyphemus, an ancient marine arthropod, have with survival of the Red Knot bird, a migratory shore bird that makes an annual stopover in the region in which the horseshoe crab breeds? The Limulus is virtually unchanged since it first appeared in the Paleozoic, 570-248 million years ago. Though most people have barely heard of the Limulus, anyone who studies vision is well versed with this species, as its compound eye was first used by H.K. Hartline to reveal fundamental mechanisms of visual physiology, for which he went on to win a Nobel Prize in 1967 for his pioneering work. Horseshoe crabs are abundant on the shoreline of Woods Hole Massachusetts, where Hartline did much of his early work. One of Hartline’s students, Robert Barlow, went on to show that the male Limulus uses its eyes to search aggressively for females and looks for the outlines of the carapace as a visual cue for finding a suitable female, at a time when the animals come into the shoreline for laying and fertilizing their eggs, an activity that usually takes place at night. But, who would ever have thought that the seasonal breeding of this ancient marine species, which takes place big time in Delaware Bay on the East coast, would have a dramatic impact on the survival of the Red Knot bird, a migratory shorebird that flies 20,000 miles each year, from South America to the Arctic, where it breeds, and then flies back again. Surely the biologists got this one wrong!

The Red Knot arrives in Delaware Bay just at the time the Limulus has come near the shore for breeding and egg laying. Eggs are laid by the female in the sand and then fertilized externally by the male or males that surround her. It is the nourishment derived from feeding on the newly released Limulus eggs that provides a critically needed source of food for the Red Knot to regain its stamina and prepare for resuming its long journey North.  Once the Red Knots arrive at the Delaware shore, they only have about two weeks to get sufficient nourishment, rebuild their wing muscles and store fat for the flight ahead to their Arctic breeding grounds, where they lay their own eggs and raise their young over the short summer of the region. If  insufficient Limulus eggs are available, the Red Knot does not seem to have a plan B and may be ill-equipped to finish the long journey to the Arctic. In some regions where Red Knots used to breed in the Arctic, they have not been seen in recent years and insufficient Limulus egg nourishment has been regarded as the main deficiency in their failed migratory outcome. In preparation for the long flight from South America (Tierra del Fuego, in Chile/Argentina) the bird’s digestive system shuts down, such that the intermediate stop, to feed on Limulus eggs, provides the bird with a very digestible meal, rich in proteins–apparently the ideal food for building up muscle and fat for an animal with a reduced capacity digestive system. Despite the aggressive feeding of the Red Knot on Limulus eggs, the horseshoe crab population in the region was stable into the 1990s, when fishing with Limulus bait became popular.

The shortage of Limulus eggs seems to reflect an overly aggressive harvesting of animals, particularly gravid females used by fisherman as bait for catching eels and conch (marine snails): this has led to a significant decline in the number of Limulus eggs laid on the shoreline, down to perhaps 2/3 of previous estimates and the magnitude of this decline has been implicated in the reduced numbers of Red Knot birds making it to their Arctic breeding grounds. Indeed, it was the alarmingly fast reduction in the Red Knot population, by about 70%, that led to the discovery of their dependence on Limulus eggs in Delaware Bay.  The decline in Limulus breeding and egg-laying seems to be the tipping point that could wipe out the Red Knot and could do so very quickly if a better balance isn’t restored.   There is now a two-year moratorium on using Limulus for fishing bait in the region and researchers are busy trying to find artificial bait substitutes that could be used in place of the real thing. An excellent video about this species interdependency was shown recently on PBS and can be seen here.

How long this interconnectedness between a marine animal that is roughly 350 million years old and a bird, whose evolutionary record goes back 150 million years, is not a matter that can be resolved through the fossil record. At some point, the Red Knot’s migratory flight to Delaware Bay was initiated to be well-timed to the breeding season of the Limulus.  This synchrony could be seriously interrupted further by global climate change which might affect one or the other of these tightly timed mechanisms. Some biologists believe the Red Knot could be extinct within five years. At some point, you reach a bird density wherein birds can’t find one another to mate.

Limulus polyphemus

The fishing industry is not the only survival challenge that Limulus faces. The blood of  Limulus has been used for many years because of its unusual properties. Limulus blood is blue because it uses a copper protein as an oxygen carrier. But, of more importance is the fact that Limulus blood clots whenever it comes into contact with endotoxins. Extracts of Limulus blood have been used for decades to test for bacterial contamination. One quart of Limulus blood is valued at about $15,000. Currently, the FDA insists that all intravenously administered drugs should be exposed to a Limulus blood amebocyte lysate as a test for endotoxins. This is a significant improvement over the prior process of injecting a rabbit with the substance and then waiting to see if the animal gets sick and develops a fever!  The discovery of Limulus amebocyte lysate also took place at Woods Hole, through the observations of scientist Fred Bang. This insight and its technological development has reduced the endotoxin analysis test from days to about 45 minutes. Instead of killing the horseshoe crabs and then bleeding them, the pharmaceutical industry harvests blood from live animals, who are then returned to their native habitat. Thus, some former fisherman, who used them for bait, now collect them for blood letting in a laboratory environment and then release them to the same location. Last year, 300,000 horseshoe crabs were bled and then released; about 13% do not survive this blood-letting procedure, which extracts about 2/3 of their blood.

The counter-intuitive interconnectedness of the Red Knot and the horseshoe crab could only be revealed by extensive field studies that involved capturing, tagging and measuring birds along the pathway of their extensive, almost incomprehensible, migratory flight pattern. These are dedicated scientists who share a passion for this bird and its preservation. Why a bird would exist under the harsh conditions of the Tierra del Fuego, near the Strait of Magellan, then fly to the even harsher climate of the Arctic for breeding and the early rearing of their young, before flying off again on another 10,000 mile trip, is well beyond our capacity to comprehend. Perhaps it got started before tectonic plates rearranged the land masses. The migratory pattern of North America by non-indigenous Homo sapiens was primarily East to West, which is a little easier to understand. In contrast to the rational, the Red Knot flight plan is not one that any of us would recommend to serve as the basis for a committed, routine lifestyle, unless it was one we recommended to our Republican friends. I can imagine Rush Limbaugh feeding on Limulus eggs in search of a new high. Let us hope that the Red Knot survives and the current iteration of the Republican Party goes the way of the Dodo bird as its major flight plan glides it  into extinction. There are many signs that such a glide pattern is already underway. We will undoubtedly hear more about each species in the coming years.

RFM

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The healthcare bill that was passed by both Houses and signed by President Obama last week will become law beginning this year, though it will not be fully implemented until 2014. Now, we are compellingly absorbed in finding out what it all means. Few people alive today understand the full dimensions of the healthcare bill, though we all have the impression that it will impact on each of us one way or another, either through an improved and less costly(?) healthcare plan and benefits, or higher taxes or both. We must also keep in mind that many parts of the bill will change as our experience with the plan grows and gets implemented, just as Medicare and Medicaid have changed substantially over the years.  The good news for this new quest of ours is that the Science Times section of the New York Times, published on Tuesday, March 30, has devoted almost the entire section to a discussion of the new healthcare bill and goes into many of its widely different features. Overall, the articles tend to emphasize that our medical care system will change for the better on almost every aspect of our currently deficient, odious healthcare system. If you want to talk about mean America, you could use healthcare as your gold standard for conversation. You need go no further, unless you want to add the comparison between our nightmare healthcare stories and the secure and lavish funding of the Department of Defense and its associated expenditures (which go way beyond the Pentagon’s annual budget). But, rather than send you off into a frightful rage about relative costs and a stack of horror stories, we’d better stick with healthcare and the Times Science Section.

On the front section of Times Science, an article by Tara Parker-Pope, describes “What you need to know in the first year” in which she points out that for starters 32 million, presently uninsured Americans, will eventually be covered under this law, such that 94% of legal residents not covered by Medicare will get insurance, up from what has been estimated at 83%. While only a gain of 11%, there are lots of people that will have to be brought in under this new plan. The extended coverage will not kick in until 2014. This bill cannot help but have an enormous social impact on our country, as we have been the harbingers of nothing less that a disastrous healthcare system–a true nightmare for far too many of our citizens. Shouldn’t that issue be part of our national security?  Some of the most important changes for individuals will kick in this June, while others will be delayed until the end of this year. Look for the nuts and bolts of these changes to be elaborated by the Health and Human Services at a website devoted to healthcare, but the Parker-Pope Q&A section handles some specific issues. In June of this year, denial of coverage by pre-existing conditions should be eliminated. If you currently lack insurance, there will be several different options, depending on your age, financial status and the duration during which you have not been insured.
The Times has gotten pretty slick at providing multimedia graphics to explain and help clarify the issue and with a healthcare bill that has more than 2000 pages, everyone will need a period of accommodation before the impact of the bill can be truly appreciated. If you go to the Times Science Website and click on the Multimedia section in the middle column, it will take you to a brief summary of the options available if you are currently  insured or uninsured. The site also explains what you can expect to pay in taxes, given your income level, when the plan is fully implemented.
One of the horror stories during the build-up to the healthcare legislation was that of a woman who had a previous Cesarean section for child delivery; she was subsequently told that C-section was a prior condition and that she couldn’t be insured unless she was “sterilized.” When she went public with her story, the use of the word “sterilized” served as a key motivating factor for rallying against the gender inequity rules of health insurance companies and some of you may be surprised about the extent of gender prejudice in our healthcare system. Denise Grady describes how the new healthcare bill will “lower the cost of being a woman.” Here, here!
I remember attending a meeting in Boston about a decade ago when I was invited to tell the sad story of the University of Minnesota Medical School under the banner of “How Not to Reform a Medical School, held under the auspices of the AAUP (American Association of University Professors). It was there that I listened to a physician in the Boston area describe an interaction with one of  his patients who had a headache and insisted on having an MRI exam. The physician suggested that she should have some other procedures done first and the patient retorted that he (the doctor) knew that she needed an MRI, but he wouldn’t give her what she needed because he worked for the insurance company and the money for the procedure would come out of his pocket.  It was at that moment that the physician realized his profession had been drafted into the wrong side of the healthcare war: the doctor, who sounded like a well-intentioned, selfless physician was now viewed by at least one of his patients as a corporate shill.

Historically, physicians made it hard on themselves by aligning their position on healthcare largely through the policies of the AMA, who repeatedly fought against the attempts to bring a unified system of healthcare to American citizens. Physicians tend to be Republican, whereas you would have thought intuitively, they should all be Democrats and believe in public policies that make us, all of us, healthier with better access to doctors.  Of course, there are some good, radical physicians who have helped push the issue of a single payer plan and we must be grateful for their voice, just as we should  be grateful to the California Nurses Association for pushing the same agenda. Perhaps someday we will get there–health insurance without health insurance companies. But we have to get through the current bill first before launching the better healthcare system that remains within our sights. The trouble is, we have a history of finding a fix, and no matter how imperfect, sticking with it until the mud flaps come off.

There continues to be something of a sham within medical schools, which have “ethics” programs that you might think should consider our present system of healthcare to fall within their purview. But most “ethics” programs at medical schools deserve to be expressed in quotes because they were really put their to deal with issues like “animal rights activism,” “organ transplant” and  “organ donor” issues and “death and dying” procedures. Only recently have I heard a few ethics members speak out against our disastrous healthcare system and even then it seemed like they were coming late to the healthcare party. So, almost any description of change in our healthcare system would be incomplete without comments on whether this new bill can help heal the badly fractured relationship between a doctor and his/her patient. In that regard, physician Pauline Chen describes an experience she went through with an uninsured patient and how she herself hopes that the new healthcare bill will offer at least the possibility of repairing what has become “a crippled, even broken, relationship between patients and doctors.” I would say to Dr. Chen, don’t hold your breath. As long as we have insurance companies dictating the treatments and drugs that will be given to a patient under their insurance plan and as long as a profit margin must be squeezed out of patient service denial, the doctor will still appear to be the insurance company shill who is denying service and appearing to do so while enhancing his own profit margin. At one time, doctors were in a position of control over the course that a unified healthcare plan might take. But they turned down the opportunity to be the master and instead became the slave of the healthcare industry. Now they are lightly regarded as a source of unbiased expertise on the healthcare debate. Nurses are a much better source of information. After all, they have been underpaid from the get-go.

Yet, we all have hope. Many of us have good physicians, whose passion for medicine is admirably high. My doctor for example donated an extensive period of his time to go to Haiti and treat patients and organizations such as “Doctors Without Borders,” continue to inspire hope that medicine and humanity are really one and the same. But such a unified concept cannot exist when corporate forces are in the way and the money-mad CEO is making the decisions. Many physicians have found their journey hopeless. I have noted in the past,  that for many months, AMWAY, the sales company, had a converted MD as their “employee of the month.” A more decent healthcare delivery system might  slow the rate of such defections, but we must recognize that part of the gigantic profit levels of the for-profit insurance companies, come off the backs of doctors, some of whom labor with huge debts and modest incomes.

Finally, in the same section of the Times, Abigail Zuber, MD reviews a book written by Lionel Shriver entitled “So Much for That.” It’s a story about a middle-class family, whose bread-winner comes down with the dreaded malignant mesothelioma–the asbestos-related cancer of the lining of the lungs. The symptoms of the cancer are generally very subtle, so by the time the diagnosis can be made, treatment is almost entirely palliative. Ms. Shriver details how the treatment causes other symptoms and during the course of therapy, retirement dreams are shattered and financial resources are drained. Shep, the husband-father with the disease is forced to keep working despite his decaying health, to keep his insurance active. Other health-related entanglements in the story reveal what a disastrous health care system we have imposed on our citizens, all for the sake of corporate profit and the unfettered free market system whose chief objective is to create disastrous levels of poverty that society then has to worry about. How about a Superfund from corporate profits to compensate for the widespread poverty the system has created?

RFM

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