Wednesday, July 23, 2014
Every now and again I pick out what I think are the best pix and graphics from my various blogs and compile them into "galleries". I have just got around to doing the gallery for July to December, 2013, which can be accessed HERE or HERE or HERE. Some fun stuff there.
Israel's War of Restraint Continues
Secretary of State John Kerry has been dispatched to Egypt as the latest world diplomat to call on Hamas to accept an Egyptian cease-fire proposal in the Gaza conflict – a pact backed by both the United States and Israel, provided Hamas complies, which they won’t. State Department spokeswoman Jen Psaki said the Obama administration is “deeply concerned about the risk of further escalation, and the loss of more innocent life.” Meanwhile, Kerry called on Hamas to “step up and show a level of reasonableness, and … accept the offer of a cease-fire.” Does he know who he’s talking to?
In two weeks of fighting, Gaza officials claim the Palestinian death toll exceeds 500 as Israel retaliates for indiscriminate rocket attacks coming from Hamas strongholds. Conversely, 20 Israelis have been killed by Hamas strikes (including two Americans fighting in the Israeli army). The low number is mainly thanks to the success of Israel’s “Iron Dome” defensive infrastructure designed to repel the frequent Hamas rocket attacks.
While Israel sent in ground troops, the high Palestinian death toll is not from an overly aggressive Israeli offensive. Hamas doesn’t “give a whit about the Palestinians,” scolded Israeli Prime Minister Benjamin Netanyahu. “All they want is more and more civilian deaths.” He also noted, “Here’s the difference between us: We’re using missile defense to protect our civilians, and they’re using their civilians to protect their missiles.”
Indeed, a common practice of Hamas leadership is to place weapons, supply dumps and command-and-control sites amid civilians (hospitals, schools, markets, etc.) to maximize casualties from any Israeli attack – in effect holding their own people hostage. The Israeli government warns occupants of targeted areas in advance of their bombings, yet Hamas leaders ask their civilians not to seek safety. The end result is the high Palestinian death toll, and a victory for Hamas in the propaganda war as numbers are gobbled up by an anti-Semitic populace worldwide.
Unbelievably, the UN discovered some of those rockets in a Gaza school and promptly handed them to the government in Gaza, i.e., Hamas. The stupidity is stunning.
Speaking of stupidity, John Kerry was caught on a hot mic disparaging Israel’s efforts at limiting civilian casualties with pinpoint strikes. “It’s a hell of a pinpoint operation,” Kerry sarcastically blustered. It isn’t the first time Kerry has criticized Israel. In April, he warned of an apartheid state if Israel didn’t make changes.
This Israeli offensive is intended to clean out a network of tunnels and other shelters used by Hamas to store and transport weapons and give cover to leadership. It’s also clearly self-defense. “If it’s left up to Hamas, thousands of Israelis would be dead,” said Sen. Lindsay Graham (R-NC). So a fed-up Israel is fighting back after months of fruitless negotiations and ever-increasing attacks.
Predictably, the prospect of a peaceful two-state solution – which Israel helped to boost a decade ago by clearing out its own unwilling settlers and providing 3,000 greenhouses to jumpstart an economy they hoped would be based on a thriving Gaza export industry – isn’t working out in favor of either party. “This is a world in which the U.N. ignores humanity’s worst war criminals,” writes columnist Charles Krauthammer, “while incessantly condemning Israel, a state warred upon for 66 years which nonetheless goes to extraordinary lengths to avoid harming the very innocents its enemies use as shields.” When the choices are vigilance or extinction, sometimes blows have to be exchanged.
The Statin religion: British doctors are bitterly divided over calls for half of all adults to be put on pills to cut cholesterol
Having reached the age of 72, Professor Klim McPherson was prepared to accept some deterioration in his physical capabilities. But when, earlier this year, he found he was struggling to bend over to tie up his shoelaces, he decided enough was enough.
And so it was that little more than a month ago, the Oxford don stopped taking the little orange tablets his doctor had prescribed him and which he had been swallowing before bedtime every night for the past three years.
To his great surprise, within seven days, the aches and pains that had so restricted his movements had almost entirely disappeared.
'I'd been finding it difficult getting down the stairs and had to negotiate them step by step,' says Professor McPherson, one of the country's most eminent public health experts.
'As for reaching my laces, that was painful and uncomfortable. But now I can once again do all the things I couldn't do before.'
The medication that Professor McPherson has chosen to go without is a statin called Simvastatin.
Like the seven million or so other Britons who take statins on a daily basis, the professor had been prescribed the drug to lower his cholesterol levels and so reduce the risk of heart attacks or strokes.
In this way, the NHS estimates the drugs, which can cost as little as £16 for a 12-month course, save 7,000 lives a year.
And so it is against this background that last week, the National Institute for Health and Care Excellence (Nice), the NHS watchdog, issued guidance that the drugs should in future be prescribed even more widely - in fact, to almost half of all adults.
'Cardiovascular disease (CVD) maims and kills people through coronary heart disease, peripheral arterial disease and stroke,' explained NICE's Professor Mark Baker. 'Together, these kill one in three of us. Our proposals are intended to prevent many lives being destroyed.'
A worthy aim, undoubtedly. However, to say that not everyone agrees with the role statins have to play in the future health of the nation would be something of an understatement.
NICE's proposals have caused an unprecedented outbreak of warfare among the medical and scientific community.
On one side are those who wholeheartedly support the ever-widening use of statins. On the other are those who believe their side-effects have been massively underestimated.
This, some claim, is due to an over‑reliance on research funded by the pharmaceutical industry, for whom statins have proved to be the single most profitable class of drug ever manufactured.
They argue that depression, cataracts, an increased risk of diabetes and the sort of muscle pains experienced by Professor McPherson could affect anywhere between 10 and 40 per cent of statin users.
And, while they do not deny the benefits statins can bring to those at a high risk of heart disease, they warn against putting millions of healthy patients on pills for the rest of their lives.
At the centre of this battle is the patient, confused and unsure what to believe. It is a worrying state of affairs and one that some fear could have terrible consequences.
'There are some real concerns people will come off statins because of this and then a fatal heart attack will occur,' says Jules Payne, CEO of the charity HEART UK, which provides support, guidance and education services to healthcare professionals and people with concerns about cholesterol.
'We will lose people when the whole point of this is to keep people alive.'
Statins work by lowering levels of cholesterol, the fatty substance in the blood that clogs up arteries. They block the action of a certain enzyme in the liver which makes 'bad' cholesterol, called low-density lipoprotein.
While statins are routinely given to patients who have had heart attacks, angina or bypass surgery, they are also given to patients at risk of CVD. GPs calculate the level of risk by looking at factors such as smoking history, cholesterol levels, blood pressure and body mass index.
Doctors in this country used to prescribe statins only to those with a 30 per cent risk of a heart attack within the next decade, but this was cut to a 20 per cent risk in 2005.
As a result, Britain has become not just the statins 'capital' of Europe, but the second highest prescriber of the drug in the Western world, after Australia.
Under the new NICE guidance, the threshold would be lowered further still so that those who have a 10 per cent risk will be offered statins.
NICE estimates that between five and ten million adults are currently taking the drugs, although 12.5 million are eligible. But under the new guidelines, another 4.5 million would qualify. This means that 17 million adults - nearly half of the 37 million adults in Britain - would either be on statins or offered them.
Part of the reason for this change is that many statins are now out of patent, meaning that they can cost just a few pence a day. Preventing a heart attack in this way is obviously much cheaper for the NHS than treating someone who has suffered one.
But some doctors are concerned. They warn that while the drugs themselves may be cheap, once the cost of extra GP appointments to prescribe and monitor patients is added in, the annual cost to the NHS could run into billions of pounds.
They also claim that by targeting a relatively low-risk section of the population, the plan could make minimal difference to the number of heart attacks and strokes while exposing millions more people to possible side-effects.
While some studies have shown that these affect just one in 10,000, some doctors and academics believe the problems they cause are much more widespread.
This fundamental disagreement was highlighted in May when the British Medical Journal was forced to withdraw claims published in an article stating that statins cause side-effects in one in five patients.
Leading the attack on the BMJ was Oxford University's Professor Sir Rory Collins, who has led analysis of many statin trials, and who accused the paper's authors of overstating the risks 20-fold. In so doing, he warned that patients could be discouraged from taking statins and their lives put at risk.
But still, the controversy rolls on. Critics of the ever-widening roll-out have claimed that the data driving the new NICE guidelines was largely funded by the pharmaceutical companies and has not been sufficiently scrutinised by independent researchers.
And they have also attacked the independence of NICE itself, pointing out that at least half of its 12-strong advisory panel of experts have direct financial ties to the pharmaceutical companies that manufacture statins.
NICE has since stated that none of the panel members stand to gain financially from the guidance and that all of the links were formally declared to NICE and published online.
Among the most vocal critics of the new statin strategy is Dr Malcolm Kendrick, a GP from Macclesfield who is also a member of the British Medical Association's General Practitioner's sub-committee.
He says that the official research is contradicted by what he and fellow medics see on a daily basis.
'If just one in 10,000 patients were really suffering side-effects as we are told is the case, then in all my clinical work I might expect to have seen one or two people with these problems,' says Dr Kendrick.
'Two weeks ago on a Monday morning the first three people who came to see me were complaining about the adverse affects of statins. They were mainly suffering from muscle aches and pains and one had quite bad stomach problems.
'Over New Year, another female patient went into hospital with severe stomach pains and nearly had an operation. She came to see me and I said statins can cause stomach pains, and she stopped and the pain went away. If she hadn't, she would have had her abdomen opened up.
'These drugs are all damaging, and as you get older that damage gets all the more serious.
'You find that someone who can just about get out of a seat starts taking statins and then can't get out of his seat; someone who used to be able to walk down the shops now can't.
'I say that statins won't make you live 15 years longer - but they will make you feel 15 years older.'
Of course, real evidence is needed before an informed decision can be made. As a scientist, and in of spite his own personal experience, that is something that Professor McPherson acknowledges.
For this reason, he is among those calling for the existing data produced by the pharmaceutical companies to be tested independently before statins are offered more widely.
'I think NICE making these somewhat draconian rules on the basis of such an inadequate evidence basis is foolhardly,' he says.
Federal $25 Billion Drug Bust
Drug regulation and enforcement should be solely a State matter
Michael Botticelli, the federal “drug czar” and adviser to Barack Obama, wants to spend $25 billion next year to fight drugs. A report to Congress from the drug czar’s office said, “we must seek to avoid oversimplified debates between the idea of a war on drugs and the notion of legalization as a panacea.” The proposal to spend $25 billion came a day after Washington state allowed the sale of marijuana in the style of Colorado. California voters authorized medical marijuana in 1996.
As for oversimplification, how about the idea that a “war on drugs” declared by Richard Nixon in 1971 can solve the problem by spending $1 trillion? “What do we have to show for it?” asked Richard Branson on CNN. “The U.S. has the largest prison population in the world, with about 2.3 million behind bars. More than half a million of those people are incarcerated for a drug law violation. What a waste of young lives.”
Likewise, Allison Schrager notes in the Huffington Post that the United States spends more than $40 billion each year on drug prohibition, and that is only the explicit cost. Implicit costs include “increased violence, otherwise productive citizens in prison, and perpetual poverty, both at home and, especially, abroad.”
The federal Drug Enforcement Administration, launched by Richard Nixon, started with a budget of $65 million in 1972. In 2014 the budget approaches $3 billion, and DEA bosses want to keep the money coming. In Washington more money is the answer to everything. That’s why the war on drugs continues, despite massive costs, casualties, and collateral damage.
For more blog postings from me, see TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated) and Coral reef compendium. (Updated as news items come in). GUN WATCH is now mainly put together by Dean Weingarten.
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Posted by JR at 12:32 AM