Monday, November 30, 2009

Direct democracy in action

Switzerland held a number of referenda on November 29th. The better-known (indeed, fairly notorious) referendum was the one that proposed forbidding the construction of minarets... This one has reverberated around Europe and the world, and was passed by the Swiss with 57.47 per cent voting for the ban. Only four cantons had a majority against the ban - three of the Suisse Romande cantons (Geneve, Vaud, and Neuchatel) and Basel-City...

A referendum that created much fewer waves was the one that proposed prohibiting the export of arms, and it was defeated by a wide margin (see map of results below).

This blog entry will not be discussing the factors that caused the results, the ramifications of the outcomes of the votes, etc., but will very briefly look at some of the posters used in favor of, and against, the proposition (see below). Clearly the 'anti-minaret' forces won the 'battle of the posters.' The "pro-ban" posters had much more powerful imagery; the "anti-ban" posters were reduced to ridiculing and denigrating those who favored the ban (casting them as delirious or as xenophobes...). This is not to say that the posters caused the outcome, that is entirely the responsibility of those who cast their votes in favor of the referendum. However, from the marketing standpoint the 'anti-minaret' forces clearly carried the day.

posters in favor of the ban:

posters against the ban:
The second referendum, this one a proposal to ban the export of arms, was voted down by 68.2 per cent, with no cantons voting in favor. The posters used in favor of this ban implicitly acknowledged, by their use of very similar imagery, the 'strength' of the anti-minaret visual message (see below).

It is true that any initiative that contains or banks on anti-foreigner sentiment starts off with close to a solid forty percent or more of support, and one can generally count on Swiss parochialism in this matter .. who can forget the "For more security" posters that were used the last time a referendum to restrict the numbers of foreigners failed to pass (but not by all that much), see below:

Saturday, November 28, 2009


While in Illinois, visiting during Thanksgiving, this blogger happened to notice an editorial by Bill O'Reilly in The Pantagraph... In it he approvingly cited something called the "Manhattan Declaration," saying "It took a while—we're talking decades—but finally, some American religious leaders say they are fed up. A few days ago, a faith-based group including New York Archbishop Timothy Dolan issued a scathing indictment of.... secularism."

Ah yes, that scourge of civilization, secularism, responsible for most of the ills in our society. such as climate change, the degradation of the environment, etc., etc. (held so by no less an august personality than the 'Bishop of Rome, Vicar of Jesus Christ, Successor of the Prince of the Apostles, Supreme Pontiff of the Universal Church, Primate of Italy, Archbishop and Metropolitan of the Roman province, Sovereign of the State of the Vatican City, Servant of the Servants of God' i.e. the Pope, see here and here.) Well, this blogger had to find out what excited Bill O'Reilly's approbation, so looked up "The Manhattan Doctrine: A Call of Christian Conscience" It turns out to be a document recently published by a group of Orthodox, Catholic, and Protestant leaders, which reaffirms the principles of sanctity of life, the definition of marriage, and freedom of worship, all of which they feel are under attack.

This blog entry is not going to discuss these weighty issue. However, a few comments on the preamble, excerpted below, are in order:

The preamble starts, "Christians are heirs of a 2,000-year tradition of proclaiming God’s word, seeking justice in our societies, resisting tyranny, and reaching out with compassion to the poor, oppressed and suffering. While fully acknowledging the imperfections and shortcomings of Christian institutions and communities in all ages, we claim the heritage of those Christians who defended innocent life by rescuing discarded babies from trash heaps in Roman cities and publicly denouncing the Empire’s sanctioning of infanticide. We remember with reverence those believers who sacrificed their lives by remaining in Roman cities to tend the sick and dying during the plagues, and who died bravely in the coliseums rather than deny their Lord. After the barbarian tribes overran Europe, Christian monasteries preserved not only the Bible but also the literature and art of Western culture. It was Christians who combated the evil of slavery: Papal edicts in the 16th and 17th centuries decried the practice of slavery and first excommunicated anyone involved in the slave trade; evangelical Christians in England, led by John Wesley and William Wilberforce, put an end to the slave trade in that country. Christians under Wilberforce’s leadership also formed hundreds of societies for helping the poor, the imprisoned, and child laborers chained to machines. In Europe, Christians challenged the divine claims of kings and successfully fought to establish the rule of law and balance of governmental powers, which made modern democracy possible. And in America, Christian women stood at the vanguard of the suffrage movement. The great civil rights crusades of the 1950s and 60s were led by Christians claiming the Scriptures and asserting the glory of the image of God in every human being regardless of race, religion, age or class. This same devotion to human dignity has led Christians in the last decade to work to end the dehumanizing scourge of human trafficking and sexual slavery, bring compassionate care to AIDS sufferers in Africa, and assist in a myriad of other human rights causes – from providing clean water in developing nations to providing homes for tens of thousands of children orphaned by war, disease and gender discrimination. Like those who have gone before us in the faith, Christians today are called to proclaim the Gospel of costly grace, to protect the intrinsic dignity of the human person and to stand for the common good. In being true to its own calling, the call to discipleship, the church through service to others can make a profound contribution to the public good."

Hmm, so Christians have fought for justice and for the poor and oppressed for over 2,000 years, and are responsible (among other things) for: saving life; protecting education and knowledge during the "dark ages;" ending slavery; challenging the doctrine of the divine right of kings; woman's suffrage; the U.S. civil rights successes; and so on... Good to know. True, over those 2,000 years there were a few not so bright spots, (the inquisition, etc.) but these can be easily glossed over in just three words - "imperfections and shortcomings" - while "claiming the heritage" of all the positive actions. Yes, the church did support slavery, the divine right of kings, the second class status of women, etc. for a long time, but I guess that it would be churlish to point that out given that they eventually ended up on the right side of those issues. Finally, doubtless the worthy signatories of the declaration also believe that no atheists, agnostics, or secularists were involved in any of the advances for which they take full credit... Cherry-picking anyone?

"The Manhattan Declaration: A Call of Christian Conscience"

Saturday, November 21, 2009

Great quotes...

“I’m proud to have asked for it. I’m proud to have fought for it, and I will continue to. That is not the reason I’m moving to the debate” - Senator Landrieu (D-LA) She was speaking of reports that an "inducement" had been slipped into the health care bill, a section increasing federal Medicaid subsidies for “certain states recovering from a major disaster” carefully crafted to ensure funds went to Louisiana, to "buy" her vote... Landrieu insisted that the funds had not influenced her vote, while at the same time saying it really was $300 million...

Random charts

Graphs showing: 1) The percentage of Afghans who say they have either been imprisoned, tortured, or injured, or that this has happened to a family member, 2) The percentage of Afghans who say they have been internally or externally displaced by violence, and, 3) The reasons for which Afghans believe their country to be in conflict... Source: The Cost of War: Afghan Experiences of Conflict 1978 to 2009

Friday, November 20, 2009

Health care re-form XV (RIP CER)

The August 15th blog entry, 'Health care re-form (Effectiveness)', poured some cold water on the notion that implementation of comparative effectiveness research would have the predicted ability "to bend the cost curve downward." Not because of any inherent problem with the notion of comparative effectiveness per se, but because the parties coming out on the short end (whether real or perceived; whether financially or health-wise, etc.) would agitate against implementation of the recommendations, and (based on the historical evidence) they would find some politician all too eager to take up their cause... This because most politicians often legislate "by sob story," and usually stampede to pass legislation "so that no other family will have to go through this pain..." (Note: by its nature comparative effectiveness research would say that it does not make sense to spend the money until it effects X families, X being a larger number. However, for most of our legislators X can be just one of their constituents, especially if it is a child, or other photogenic person, etc.)

The obstacles to change become even more insurmountable when the results of research goes contrary to the received wisdom of the day, because then resistance to the new suggestions will arise among many additional parties e.g. the physicians, "activists' of various stripes, and/or the public... An excellent example of this is the kerfuffle about the utility of mammograms, which kicked off this week.

This started when the U.S. Preventive Services Task Force (USPSTF) reviewed and revised its 2002 recommendations re breast screening (see graphic above, and see here)... What is the USPSTF and who sits on it ? From the USPTSTF fact sheet here, "The U.S. Preventive Services Task Force (USPSTF), first convened by the U.S. Public Health Service in 1984, and since 1998 sponsored by the Agency for Healthcare Research and Quality (AHRQ), is the leading independent panel of private-sector experts in prevention and primary care. The USPSTF conducts rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications. Its recommendations are considered the "gold standard" for clinical preventive services. The mission of the USPSTF is to evaluate the benefits of individual services based on age, gender, and risk factors for disease; make recommendations about which preventive services should be incorporated routinely into primary medical care and for which populations; and identify a research agenda for clinical preventive care." The panel's members may also be seen at the link, which also has information regarding the background, mission, and work of the panel...

The outcry was immediate. Perhaps "primed" by the current debate over health care reform, people rushed to express their viewpoints, usually without bothering to review the process, research, or the science on which these new recommendations were based! Health care reform opponents (or at least the version proposed by the Democrats) rushed to label this as government cost-cutting, e.g. see here. The implication is that the task force members are government stooges, while in actuality they are "... 10 members, who bring expertise from the principal primary care specialties--family medicine, internal medicine, obstetrics and gynecology, and pediatrics-- and from the analytic sciences..." and "... the work of the Task Force is supported by scientific staff at the Office of Disease Prevention and Health Promotion in Washington, DC, and by a network of experts on preventive medicine and specific clinical topics throughout academia, the Federal Government, and the medical practice community." Beyond the 'anti-reform' folks, the "activists' also weighed in, rushing to join current adversaries in denunciations of the panel and its recommendations.

Politicians of all stripes and from both parties sounded off. The administration rushed to insulate itself from any adverse fallout, with HHS Secretary Kathleen Sebelius issuing a statement emphasizing that this came from "an outside, independent panel," and that much more research is required on the subject... The spokeswoman of America's Health Insurance Plans (AHIP, the lobbying group for the insurance industry) said that coverage would not change, and in a survey of 600 physicians 78% said that they did not agree with the new guidelines (one wonders based on what) and that they would not change the advice they give to their patients...

The bottom line: when research results bump up against peoples' hopes, fears, feelings about something as intimate as their health, most often the research will lose, at least in the short term. This is especially true if the research goes in the direction of reducing the availability of treatments. Not a good augury for the future success of comparative effectiveness research...

Mammogram Cutbacks – Make No Mistake, Rationing For Women Has Begun
Secretary Sebelius Statement on New Breast Cancer Recommendations
Majority of Doctors Do Not Agree With New Government Recommendations for Mammograms

Monday, November 16, 2009

Mental health break

Two trees in the side yard, one turns bright yellow and the other bright red. Unfortunately this year the second tree's foliage did not change color until after the first had completely dropped its leaves:

A year ago, the same, they also 'turned' at different times. However, two years ago they changed simultaneously, for a riot of color:

Saturday, November 14, 2009

Thursday, November 12, 2009

Great quotes...

"They are people who have that intrinsic fiber of really caring about people..." - Joe Grano. Grano was the keynote speaker at the 'Deloitte Cincinnati 100 Luncheon' this week, where he expounded on the nature of leadership, explaining "Truly great leaders are born."

OK, let's put aside this DNA determinism, and get back to the first quote... Leaders care about people, indeed he says it is a part of their "intrinsic fiber." Too bad, then, that according to Grano two exemplars of leaders (remember, "really caring about people") are Jack Welch and Dick Grasso! Indeed, these two are legendary for their compassion for their fellow human beings... not!

Mental health break

Patex Philippe Heavenly Celestial

Cuervos y Sobrinos Torpedo Historiador Semanal

Bovet Orbis Mundi

Ulysse Nardin Moonstruck

Wednesday, November 11, 2009

Speaking of Berlin...

On the Berlin trip along with some friends (1994), stopped at a small cafe around 2 a.m. in the morning (in what had previously been East Berlin) One of our party who had gone off to find the bathrooms came running back to get us... If you went out the back there was a courtyard surrounded by buildings still in shambles since WW II and what can only be described as a "Mad Max" style tableau. Very spooky in the early a.m., these photos taken the next day. Somewhere near Oranienburgerstrasse, if memory serves...

Five years ago...

November 11th, 2009 is the fifth anniversary of the death of Yasser Arafat... Back in a January 2002 entry (reprinted below), this blogger mused re the role Arafat should play, if any, going forward. Subsequently the Israeli government decided "to wait Arafat out", and kept him walled up in the ruins of the Mukhata for several years. On his passing they claimed that it would be a turning point for peace... Unfortunately it was not.

Fast forward to today... Reading the old entry makes one realize how little things have changed - the situation is no better (worse if you consider the Fatah-Hamas split); there is no Palestinian leader who can speak for all the people; the continued humiliation of the Palestinians by the GOI continues; and the facts on the ground are the same. Some of the players are the same, for example George Mitchell, the author of the 2001 Mitchell Report, has been resurrected by President Obama as his Special Envoy to the Middle East; and the U.S. continues to flail around in its attempts to improve the situation...

Five years after Arafat's death, a Palestinian state remains elusive

OPED 10 Arafat - the end of the road? (Reprinted from January 22nd, 2002)

A passage from the Mitchell report succinctly sums up the situation between Israel and the Palestinians:

"Despite their long history and close proximity, some Israelis and Palestinians seem not to fully appreciate each other's problems and concerns. Some Israelis appear not to comprehend the humiliation and frustration that Palestinians must endure every day as a result of living with the continuing effects of occupation, sustained by the presence of Israeli military forces and settlements in their midst, or the determination of the Palestinians to achieve independence and genuine self-determination. Some Palestinians appear not to comprehend the extent to which terrorism creates fear among the Israeli people and undermines their belief in the possibility of co-existence, or the determination of the GOI to do whatever is necessary to protect its people. Fear, hate, anger, and frustration have risen on both sides. The greatest danger of all is that the culture of peace, nurtured over the previous decade, is being shattered. In its place there is a growing sense of futility and despair, and a growing resort to violence."

A topic that is currently the subject of much discussion is the role, if any, that Yasser Arafat should have going forward. The Sharon government recently labeled Arafat as "irrelevant", and then, following the interception of the Karine-A, as a "bitter enemy" and "terrorist". Should Israel treat Arafat as a potential peace partner, as a terrorist, or should they even eliminate him? This is a question with no easy answers.

Prior to Oslo Israel controlled the entire West Bank and Gaza Strip. Following the start of the 'peace process' Israel ceded some territorial control to the Palestinian Authority. The government of Israel essentially made a bet that Arafat could/would do what they could not - that for a certain amount of land, an 'international' airport, trappings of state, etc. he would crack down on extremists and prevent attacks on Israel and Israeli settlements. The majority of the difficult questions (e.g. status of Jerusalem, the 'right of return', etc.) were left to be settled later. Thus an explicit choice was made to deal with Arafat... Though known to be corrupt, to enrich himself and his cronies at the expense of the common folk, to be responsible for the arrest, torture, and death of many of his own people, all this could be overlooked as long as he kept his side of the bargain and kept things quiet. Unfortunately, the bet failed and Arafat has failed to deliver. Whether this is because he is a glorious freedom-fighter fighting for his people (Palestinian version), or because he has always sought the complete destruction of the state of Israel (Israeli version), or because he feels that he wouldn't be long for this earth if he really attempted to crush the extremists on his side (the self-preservation version), is a judgement that people and history will have to make. So, what to do now? There are no good choices left.
  • Taking back control of all the PA-administered territory is not an attractive option. The last time Israel controlled the West Bank and Gaza Strip there was terrorism against them. One thing you can't say is that Israel is soft on terror. They assassinated Palestinian killers at their discretion, they curfewed and road-blocked where they felt necessary, they demolished, dug up, smashed where they felt it would help, but still the cost was so high that they felt that withdrawal was in their best interest. Retaking the entire area will simply restore an untenable situation.
  • Simply ignoring Arafat, or eliminating him is also not a great option. One of the unfortunate side results of the bet made is that there are no other 'moderate' Palestinian leaders to challenge the old guard, assuming that they would be willing to risk their lives by doing so... So there are no other significant leaders to deal with.
  • Dealing with Arafat is not an attractive option, given his ongoing support for terrorism and the blood on his hands. Additionally it is doubtful that he could stop all attacks on Israel even if he wanted to (and there is much evidence that he does not want the violence to end...)
Well aware that there are no clear courses of action Israel is temporizing, cracking down militarily but not going all the way while waiting for the situation to clarify itself. Born from frustration at the ongoing violence, Israel seems also to be taking every opportunity to humiliate the Palestinians by striking at every symbol of Palestinian sovereignty, in addition to the daily humiliations that the Palestinians have to endure. This tactic is a mistake and can have no positive outcome, but will only result in increased hostility and anger and the further radicalization of all Palestinians. As noted in the quote above this is something that does not seem to be understood by those carrying out these actions.

A look at a map of the West Bank and Gaza Strip on the left clearly shows that peace will never be possible as the situation currently stands. The Palestinians control scattered, unconnected, islets of territory, completely surrounded by areas under Israeli control. Israeli settlements vie for scare resources (e.g. water) and are spreading throughout the area. The difficult-to-answer question of whether Arafat should have a future role in the 'peace process' seems almost a moot point given the current situation on the ground. Yet, if perchance the situation is to be improved, this is a question that will have to be answered.

Tuesday, November 10, 2009

Random charts...

Charts showing the percentage of U.S. hospitals with negative margins, and the median annual change in hospital labor and non-labor expenses. Both show improvements (fewer hospitals with negative margins; decreases in labor expense). Source: Thompson Reuters' Hospitals Continue Financial Recovery. Results from the second quarter of 2009 show hospitals bouncing back!

Monday, November 9, 2009

20 years later...

Hard to believe it has been twenty years since the Berlin Wall cracked open, then came down, and now can hardly be found! The above is a pin this blogger bought on a trip to Berlin four years after that historic date. At the top, memorial crosses set up for some of those killed trying to get across the wall...

Newseum: The Berlin Wall
Retracing the Berlin Wall
Berlin Wall Online

Sunday, November 8, 2009

Hyperbolic trend?

The blog entry 'No surprise' discussed the situation in Honduras, while the 'UNSC Resolution 1887' entry covered the United Nations Security Council resolution on nuclear proliferation and nuclear disarmament... In both cases the Obama administration brought together parties with widely differing and/or contradictory perspectives, and then achieved 'success' in getting them to "agree" on a declaration, that was subsequently hailed as "historic," game-changing, etc., etc. However, in each of these cases a close reading of the text showed that a sufficient degree of ambiguity was included which allowed the various parties to 'agree' to the formulations, without actually having to change their positions to come to a commonality of understanding and purpose!

In the case of the "Teucigalpa / San Jose Agreement," subsequent events have demonstrated the true worth of the agreement (note, Honduras is not a case where one side violated the written agreement, it is a case of where the agreement turned out to be more aspirational than real), while with UNSC 1887 we have not yet come to a time when facts on the ground will show the strength or hollowness of the agreement...

OK, so two events do not a trend make... yet. However, in conjunction with other events such as the 'also hailed as historic' agreement with Iran over its enriched uranium (which is still up in the air), and the "unprecedented" Israeli settlement concessions (that turned out to be anything but, prompting SecState Clinton to spend the next several days 'walking back' her comment), there seems to be a slight whiff of "Wonderland" in the air...

The White Queen from Alice in Wonderland - Alice laughed: "There's no use trying," she said; "one can't believe impossible things." "I daresay you haven't had much practice," said the Queen. "When I was younger, I always did it for half an hour a day. Why, sometimes I've believed as many as six impossible things before breakfast."

Quick update...

The July 15th, 2008 blog entry, 'La nouvelle union,' commented on the inaugural meeting of the new UPM (Union Pour la Mediterranée), or Mediterranean Union. At the time this blogger wondered why the French felt that they would be able to 'run' the 43-member organization, and if the bizarre hand-shake between Sarkozy and Mubarak (see above) would end up being more of a 'bras de fer' between the two...

Fast forward approximately sixteen months and all is not so well... Egypt has caused the cancellation of next month's meeting in Istanbul of the Foreign Ministers from the 43 members, and an European Union diplomat has said, "We are risking the death of the Mediterranean Union just after being born. The Union is in complete shambles and no progress has been made since its launch, both on the structure of the organisation and its seat." Quelle surprise (not)!

Palestine Causes Mediterranean Disunion
Sarkozy Seething - Mediterranean Union Barely Breathing