Anger at the so-called Monsanto Protection Act — a biotech rider that protects genetically modified seeds from litigation in the face of health risks — has been directed at numerous parties in Congress and the White House for allowing the provision to be voted and signed into law. But the party responsible for anonymously introducing the rider into the broad, unrelated spending bill had not been identified until now.
As Mother Jones’ Tom Philpott notes, the senator responsible is Missouri Republican Roy Blunt — famed friend of Big Agrigulture on Capitol Hill. Blunt even told Politico’s David Rogers that he “worked with” Monsanto to craft the rider (rendering the moniker “Monsanto Protection Act” all the more appropriate). Philpott notes:
The admission shines a light on Blunt’s ties to Monsanto, whose office is located in the senator’s home state. According to OpenSecrets, Monsanto first started contributing to Blunt back in 2008, when it handed him $10,000. At that point, Blunt was serving in the House of Representatives. In 2010, when Blunt successfully ran for the Senate, Monsanto upped its contribution to $44,250. And in 2012, the GMO seed/pesticide giant enriched Blunt’s campaign war chest by $64,250.
… The senator’s blunt, so to speak, admission that he stuck a rider into an unrelated bill at the behest of a major campaign donor is consistent with the tenor of his political career. While serving as House whip under the famously lobbyist-friendly former House Majority leader Tom DeLay (R-Texas) during the Bush II administration, Blunt built a formidable political machine by transforming lobbying cash into industry-accomodating legislation. In a blistering 2006 report, Public Citizen declared Blunt “a legislative leader who not only has surrendered his office to the imperative of moneyed interests, but who has also done so with disturbing zeal and efficiency.”
By: Natasha Lennard, Salon, April 5, 2013
On December 14, a 20-year-old Connecticut man shot and killed his mother in the home they shared. Then, armed with 3 of his mother’s guns, he shot his way into a nearby school, where he killed 6 additional adults and 20 first-grade children. Most of those who died were shot repeatedly at close range. Soon thereafter, the killer shot himself. This ended the carnage but greatly diminished the prospects that anyone will ever know why he chose to commit such horrible acts.
In body count, this incident in Newtown ranks second among US mass shootings. It follows recent mass shootings in a shopping mall in Oregon, a movie theater in Colorado, a Sikh temple in Wisconsin, and a business in Minnesota. These join a growing list of mass killings in such varied places as a high school, a college campus, a congressional constituent meeting, a day trader’s offices, and a military base. But because this time the killer’s target was an elementary school, and many of his victims were young children, this incident shook a nation some thought was inured to gun violence.
As shock and grief give way to anger, the urge to act is powerful. But beyond helping the survivors deal with their grief and consequences of this horror, what can the medical and public health community do? What actions can the nation take to prevent more such acts from happening, or at least limit their severity? More broadly, what can be done to reduce the number of US residents who die each year from firearms, currently more than 31 000 annually?1
The answers are undoubtedly complex and at this point, only partly known. For gun violence, particularly mass killings such as that in Newtown, to occur, intent and means must converge at a particular time and place. Decades of research have been devoted to understanding the factors that lead some people to commit violence against themselves or others. Substantially less has been done to understand how easy access to firearms mitigates or amplifies both the likelihood and consequences of these acts.
For example, background checks have an effect on inappropriate procurement of guns from licensed dealers, but private gun sales require no background check. Laws mandating a minimum age for gun ownership reduce gun fatalities, but firearms still pass easily from legal owners to juveniles and other legally proscribed individuals, such as felons or persons with mental illness. Because ready access to guns in the home increases, rather than reduces, a family’s risk of homicide in the home, safe storage of guns might save lives.2 Nevertheless, many gun owners, including gun-owning parents, still keep at least one firearm loaded and readily available for self-defense.3
The nation might be in a better position to act if medical and public health researchers had continued to study these issues as diligently as some of us did between 1985 and 1997. But in 1996, pro-gun members of Congress mounted an all-out effort to eliminate the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC). Although they failed to defund the center, the House of Representatives removed $2.6 million from the CDC’s budget—precisely the amount the agency had spent on firearm injury research the previous year. Funding was restored in joint conference committee, but the money was earmarked for traumatic brain injury. The effect was sharply reduced support for firearm injury research.
To ensure that the CDC and its grantees got the message, the following language was added to the final appropriation: “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”4
Precisely what was or was not permitted under the clause was unclear. But no federal employee was willing to risk his or her career or the agency’s funding to find out. Extramural support for firearm injury prevention research quickly dried up. Even today, 17 years after this legislative action, the CDC’s website lacks specific links to information about preventing firearm-related violence.
When other agencies funded high-quality research, similar action was taken. In 2009, Branas et al5 published the results of a case-control study that examined whether carrying a gun increases or decreases the risk of firearm assault. In contrast to earlier research, this particular study was funded by the National Institute on Alcohol Abuse and Alcoholism. Two years later, Congress extended the restrictive language it had previously applied to the CDC to all Department of Health and Human Services agencies, including the National Institutes of Health.6
These are not the only efforts to keep important health information from the public and patients. For example, in 1997, Cummings et al7 used state-level data from Washington to study the association between purchase of a handgun and the subsequent risk of homicide or suicide. Similar studies could not be conducted today because Washington State’s firearm registration files are no longer accessible.8
In 2011, Florida’s legislature passed and Governor Scott signed HB 155, which subjects the state’s health care practitioners to possible sanctions, including loss of license, if they discuss or record information about firearm safety that a medical board later determines was not “relevant” or was “unnecessarily harassing.” A US district judge has since issued a preliminary injunction to block enforcement of this law, but the matter is still in litigation. Similar bills have been proposed in 7 other states.
The US military is grappling with an increase in suicides within its ranks. Earlier this month, an article by 2 retired generals—a former chief and a vice chief of staff of the US Army— asked Congress to lift a little-noticed provision in the 2011 National Defense Authorization Act that prevents military commanders and noncommissioned officers from being able to talk to service members about their private weapons, even in cases in which a leader believes that a service member may be suicidal.9
Health researchers are ethically bound to conduct, analyze, and report studies as objectively as possible and communicate the findings in a transparent manner. Policy makers, health care practitioners, and the public have the final decision regarding whether they will accept, much less act on, those data. Criticizing research is fair game; suppressing research by targeting its sources of funding is not.
Efforts to place legal restrictions on what physicians and other health care practitioners can and cannot say to their patients crosses an even more important line. Yet this is precisely what Florida and some other states are seeking to do. Physicians may disagree on many issues, including the pros and cons of gun control, but are united in opposing government efforts to undermine the sanctity of the patient-physician relationship, as defined by the Hippocratic oath. While it is reasonable to acknowledge and accept the Supreme Court’s recent decision regarding the meaning of the Second Amendment, it is just as important to uphold physicians’ First Amendment rights.
Injury prevention research can have real and lasting effects. Over the last 20 years, the number of Americans dying in motor vehicle crashes has decreased by 31%.1 Deaths from fires and drowning have been reduced even more, by 38% and 52%, respectively.1 This progress was achieved without banning automobiles, swimming pools, or matches. Instead, it came from translating research findings into effective interventions.
Given the chance, could researchers achieve similar progress with firearm violence? It will not be possible to find out unless Congress rescinds its moratorium on firearm injury prevention research. Since Congress took this action in 1997, at least 427 000 people have died of gunshot wounds in the United States, including more than 165 000 who were victims of homicide.1 To put these numbers in context, during the same time period, 4586 Americans lost their lives in combat in Iraq and Afghanistan.10
The United States has long relied on public health science to improve the safety, health, and lives of its citizens. Perhaps the same straightforward, problem-solving approach that worked well in other circumstances can help the nation meet the challenge of firearm violence. Otherwise, the heartache that the nation and perhaps the world is feeling over the senseless gun violence in Newtown will likely be repeated, again and again.
By: Arthur L. Kellerman, MD, MPH and Frederick P. Rivara, MD, MPH, The Journal of The American Medical Association, December 21, 2012
In oral arguments before the Supreme Court in March, lawyer Paul Clement made the case that the simplest way to dispense with the 2010 health-care-reform law would be to overturn it entirely: If the Court finds that the individual mandate is unconstitutional, it should strike down the whole thing. “The better answer might be to say, ‘We’ve struck the heart of this act; let’s just give Congress a clean slate,’” said Clement, representing the National Federation of Independent Business and the 26 states that oppose the law.
On its face, Clement’s logic seems simple: If you’re going to monkey with a giant piece of legislation that restructures nearly one-fifth of the U.S. economy, it’s best not to get into the weeds. Just let Congress start from scratch. But this argument misunderstands what would happen if the sprawling law is suddenly moot. Unlike partial revocations, which would give Congress time to fix potential glitches, a complete invalidation would start several policy fires that would require immediate congressional action. And members of Congress have not spent much time planning for this scenario.
First up: Medicare. The Affordable Care Act changed the formulas that Medicare uses to pay providers from top to bottom. It shifted growth rates, boosted some providers’ pay, and baked in financial incentives for doctors and hospitals that achieve quality benchmarks. It also codified many of the Medicare payment adjustments that it passes every year. (After all, when you have one big health bill moving, why not throw in everything?) Since 2010, regulators have acted on those changes, and the Centers for Medicare and Medicaid Services pays out 100 million medical bills each month according to the new pay scale.
If the law is overturned, no one is sure what figures the system would use. Should CMS continue to pay providers at the rates set by the law? Or should it go back to 2009 levels? Both Donald Berwick, who ran CMS under President Obama before he joined the Center for American Progress last year, and Gail Wilensky, who held a similar post during the presidency of George H.W. Bush and is now at Project HOPE, said they don’t know the answer. The House Ways and Means and Senate Finance committees would need to move fast to establish a clear legal authority for CMS to pay providers.
Furthermore, CMS operates using an antique IT system that makes it difficult to enact quick changes. Last year, when Congress looked like it might not pass routine legislation to forestall a big cut to physician pay rates, CMS Deputy Administrator Jonathan Blum told reporters that the system could hold claims for only 10 days before the computers crashed. Congressional staffers say they would probably need to freeze the current rates for weeks or months to give CMS time to switch back to the old pay scale.
Sen. Tom Coburn, R-Okla., a physician and a member of the Senate Finance Committee, which has jurisdiction over Medicare, opposes the law. But, he says, “there’s going to be a lot of chaos.” Although “there are discussions going on all the time,” Coburn says, few decisions have been made. On the House side, a Republican aide says that staffers are making preparations, but members are not concerned about a real emergency if the law is struck down. “I don’t think, overnight, there’s going to be this immediate panic,” the aide said.
The health-care law also reauthorized several long-standing federal programs, including the Indian Health Service, the principal care provider for nearly 2 million American Indians and Alaska natives. And it dedicates billions of dollars to expand community health centers and the health care workforce. If it disappears, the legal authority for those programs or their funding would disappear with it. If Congress doesn’t want these programs to shut their doors and shed workers, it will need to reauthorize them quickly. Many of these programs have enjoyed broad bipartisan support for decades, and it’s unlikely that even Republicans clamoring for repeal of the health care law would want to see them eradicated.
A complete erasure of the health care law could also spell trouble for the Centers for Disease Control and Prevention. The law’s Public Health and Prevention Fund, despite recent reductions, is set to dole out about $10 billion for community health ventures over 10 years. But because of recent appropriations cuts, the agency is using $825 million of that sum to pay for bioterrorism response-planning, lead-poisoning prevention, immunization programs, and many other core functions this year. Without new appropriations, these public-health programs will face instant, dramatic cuts. Sen. Robert Casey, D-Pa., a member of the Health, Education, Labor, and Pensions Committee, says he has not talked to his Democratic colleagues about contingency plans, and he is not optimistic that much would pass in this Congress. “The last time we did this, it took 30 years,” he says.
Since the Court is not especially likely to overturn the entire law, few lawmakers — including party leaders — have planned for it. “You asked whether there have been discussions,” said Senate Minority Whip Jon Kyl, R-Ariz., who is a member of the Finance Committee. “The answer is yes. But there have been no conclusions reached yet.” In this Congress, though, even if both chambers ready blueprints in time, it’s hardly clear that anything could become law.
By: Margo Sanger-Katz and Meghan McCarthy, The Atlantic, June 25, 2012
Public health and women’s autonomy collided with religion last week. Elders in the Catholic Church were incensed as the regulations implementing the federal healthcare law would have required institutions affiliated with the Church (but not the Church itself) to provide health plans covering contraception. The rules (part of the normal regulation-writing process that comes after a sweeping law is enacted) would not have forced the Church or its clergymen to hand out birth control; they only would have required Catholic-affiliated schools, hospitals, and universities to play by the rules everyone else has to follow, and provide for full healthcare coverage for women.
The Obama administration, under fire as the health issue turned into a political issue, offered a compromise: health insurance companies would have to provide the free birth control to the female employees (some of whom are not even Catholic), but the religious-affiliated institutions would not have to pay for it.
It was a dodge of sorts, to be sure, but it gave the bishops the cover they needed to maintain the Catholic Church standard opposing contraception. Still, it was a generous compromise. And now the bishops are suggesting it is not enough, citing “serious moral concerns” about the compromise, particularly as it might apply to entities that self-insure.
That, on its own, is a bit of a stretch. The Church, after all, has given marriage annulments to politically-connected people who had not only been married for years, but have had children. If that’s not an inartful dodge around the Church rule forbidding divorce, nothing is. And while it’s probably not helpful to resurrect the painful episode of the decades of child sexual abuse by priests and the failure of the Church to stop them, it’s also true that the institution of the Church is still rebuilding its “moral” brand.
Picking a fight with the Obama administration does nothing to advance that goal. Nor does it improve the Church’s power over its own flock—98 percent of whom have used birth control. Government should indeed protect religious freedom, which is why no one’s asking priests to marry same-sex couples or forcing Catholic hospitals to perform abortions. But what the Church is dangerously close to doing is an equally invasive reverse: asking the government to try to enforce a rule the Church has been wildly unsuccessful in imposing on its own members.
There’s one clear reason why both the Church and the GOP presidential candidates have been raising the tired old accusations of the a war on Catholicism (an allegation that is extremely insulting to Catholics, to whom faith in God is sincere and unshakeable—certainly not threatened by a coworker getting free birth control pills). It’s an election year, so it’s prime time for making hyperbolic and incendiary accusations that have little basis in fact. Social issues have been largely absent from the campaign so far, and for a reason: the economy has been so bad that it was enough of an issue for GOP candidates to run on. But now that the unemployment rate is creeping slowly down and the stock market is stabilizing, the economy may retreat somewhat as an issue. And that leads candidates to insert wedge issues like the contraception debate.
Remarkably, opponents of the Obama administration rule, along with self-described liberal pundits, are convinced that the “Catholic vote” will rise up against Obama in the fall. That analysis assumes that all Catholics vote according to their Church’s dictates, which is absurd, especially in this case. If nearly all Catholics use birth control, why on earth would they vote against a president who tried to make access to birth control easier? Those who are that upset about contraception weren’t planning to vote for this president, anyway.
There will be more social issues raised during this election year, especially after the GOP nomination is sealed. But the contraception debate is a phony one.
By: Susan Milligan, U. S. News and World Report, February 13, 2012
There are disasters we can’t see coming, and then there are disasters we refuse to see coming. That an earthquake (and tsunami) of biblical proportions would crack open nuclear power plants along the coast of Japan is the sort of catastrophe that’s very difficult to predict. On the other hand, the consequences of a large increase in the volume of greenhouse gases in the atmosphere are not hard to predict. The precise effects of climate change may be uncertain — though that does not make them any less dire — but we know, in a rough way, what will happen: the earth will warm. In fact, it’s already warming. Has been for decades. You can see it clear as day on any graph of global temperatures. You can see it in the record books, too: Of the 10 hottest years on record, nine were in the Aughts, and the last was in 1998.
This is a disaster, however, that we refuse to see coming. On Monday, the House Energy and Commerce Committee marked up Republican-backed legislation to bar the Environmental Protection Agency from regulating greenhouse gases. Democrats proposed a series of amendments that simply admitted the reality of global warming — they didn’t require regulation or a carbon tax. Just an admission of the state of the science. Rep. Diana DeGette’s amendment was particularly careful in its language: “’The scientific evidence is compelling’ that elevated concentrations of greenhouse gases resulting from anthropogenic emissions ‘are the root cause of recently observed climate change,’” it read. Not one of the 31 Republicans on the committee voted for it, or any of the amendments. Not one. Confronted by one of the most significant threats our planet faces, the 31 House Republicans charged with coordinating America’s response refused to even admit the underlying facts. “I would say it’s not settled,” said Rep. Joe Barton.
So much of what goes wrong on the planet seems unjust. Humans are not to blame for the impersonal whims of tectonic plates, but they nevertheless suffer greatly for them. Global warming, however, is oddly fair: it is a consequence of actions we know that we’re taking, we have been warned of it long in advance and, if we are willing to cooperate among nations and marshal our resources and make some hard decisions, we have the tools at our disposal to mount a credible response. But it looks like we will refuse. Which actually is unfair, as those who will pay for our inaction will not be those who made the decision not to act. They’ll be our descendants, and disproportionately the residents of poorer nations that never emitted many greenhouse gases to begin with. For them, the question will be long-since settled. But it will also be much too late.
By: Ezra Klein, The Washington Post, March 16, 2011