Saturday, August 22, 2009

Obama Update

by Richard Crews

It has been 214 days since Obama's inauguration. How's he doing?

The financial meltdown seems to have been averted; the Second Great Depression seems to have bottomed out. Moreover, he used those economic crises to launch revolutionary initiatives in infrastructure repair, green energy, and revitalized education. He has reintroduced international diplomacy and initiated a rebirth of civil rights and of scientism and intelligent, open discourse in public affairs.

Some libertarians object that he has moved too slowly on restoring civil liberties.

Some naturalists object that he has moved too slowly on green matters--on counteracting pollution and on restoring the protection of our parks and wild places, and of endangered species.

His most aggressive and impressive initiative has been toward cleaning up and rebuilding our health-care system.

His most striking failure has been in the lack of bipartisan cooperation. The Republican (conservative) philosophy has some potentially useful perspectives: that changes should be careful and gradual, and spending should be limited. Unfortunately no sensible Republican leadership has emerged (please, if you know of any, name them); moreover the catastrophic effects of deregulation and the historical failure of trickle-down economic stimulation have become evident. The Republicans have reduced themselves to obstructionism--including distortion and deceit. They have simply read themselves out of the governing equation.

I believe Obama has gotten off to a strong start on--
(1) building his team(s) based on brains and pragmatism
(2) initial rescue from inherited economic and diplomatic debacles
(3) laying foundations for infrastructure and education reconstruction
(4) expending his honeymoon gloss to break the health-care log jam

I believe he has honed his Washington political-manipulation skills (having carefully studied Lincoln's, Teddy Roosevelt's, FDR's, Reagan's, and Clinton's strengths and errors). He has added to his community-organizing and rhetorical skills--plus his experience as a Constitutional scholar and then a struggling worker-bee-drone in the Senate--toward development of a Washington leadership style--
(1) get the best academic and scientific advice available
(2) make a show of consulting all stake-holding power brokers--early and loudly
(3) but--and he has only just learned this through getting burned a bit on the health-care thing--design and shepherd specific legislative initiatives through Congress (almost LBJ-like, but hopefully never that savage)

The philosophic visions that have become evident are wonderful--
(1) grabbing the technology tiger by the tail (Twitter- and nano-power)
(2) rebuilding social conscience--widespread (though we see it mainly domestically) and popular (though we see it initially in the bourgeoisie)
(3) green-ness, wisely tempered by scientism and political pragmatism
(4) Constitutional and civil-libertarian values
(5) good, old fashioned international diplomacy, frustrating and reptilian as it may be

And his sense of pace is inspiring--
(1) economic salvage work must be done immediately, but developing effective re-regulation of the financial industries will take years
(2) one can chip away at wealth redistribution--taxes on the superwealthy, curbing exorbitant pay and bonuses, etc.--but this, too, is a change in the social structure that must evolve over many years
(3) reconstruction of infrastructure, education, energy, internationalism (political and economic), green-ness, etc. will take decades, but one must get the first shovel into the ground.

Thursday, August 20, 2009

Healthcare--Some Ideas

by Richard Crews

The U.S. healthcare system is a vast and complicated patchwork of ideas and principles; of individual careers and social patterns; of clinics, hospitals, pharmacies, educational programs, service and philanthropic groups--of schemes and dreams--that has grown up over many decades. It is expansive and expensive--it involves nearly one-sixth of the national economy. It is painfully personal and epically tragic--it interacts with our deepest emotional aches and existential fears.

And it is not particularly efficient nor effective. Several First-World countries provide their citizens better healthcare--by every measure from longevity and chronic disease statistics to waiting-room annoyances--than the U.S. does, and with less cost and social discontent.

Some say the U.S. healthcare system is in need of reform because of this fragmentation, socio-cultural dissonance, and disparity with other First-World systems. Alternatively, some say we need to fix it because science and medicine are progressing so fast that--like Lewis Carrol's famous metaphor--we have to run as hard as we can just to stay in the same place. But all knowledgeable analysts agree that healthcare costs are increasing, over a period of years and decades, faster than inflation and the growth of the U.S. economy (of GDP); in other words, if we do nothing but sit back and watch, healthcare costs will bankrupt our country--and hence our civilization and our way of life--over the next couple of decades.

That being said, we can set aside the political dilemma that has paralyzed healthcare reform up to now. Yes, there are entrenched interests--resistances from big business, from religion, from social and political powers. Yes, there is tremendous inertia--the healthcare system has been pieced together from bits and pieces that worked and didn't work over many decades. Yes, there is a disparity of views--for every good idea about what should be done, there are strong, reasonable counter-views as to why that particular idea should not be implemented. But we can set all this aside in our considerations, not because it is easy to overcome, but because--given the economic and historic handwriting on the wall--it MUST be overcome.

So here are some ideas--some of them "good ideas"--about what can, and must, be done in overhauling the U.S. healthcare system. (I plan to expand, with specifics, each of these broad "idea" areas.)

(1) Waste, inefficiencies, and economic inequities must be weeded out of the system.

(2) Greed and absurd proprietary profits must yield to proper competition and regulation.

(3) A strong thrust of education, disease prevention, and personal responsibility for health must be built into our lifestyle patterns.

(4) And perhaps most difficult and subtle, yet most important--religious views and idealized human rights notwithstanding--a shift to a sort of cultural realism regarding healing, maturation, aging, and death must find its way into and throughout our national self-image and cultural expectations.

Sunday, August 9, 2009

Goat's Milk vs. Cow's Milk

by Richard Crews, M.D.

There are two significant nutritional differences between goat's milk and cow's milk: (1) goat's milk tends to be less allergenic than cow's milk (discussed below), and (2) goat's milk is less generative of atherosclerosis (hardening of the arteries, high blood pressure) than cow's milk (also discussed below).

There are two false problems that worry some people: (3) goat's milk tends to be more expensive commercially than cow's milk (discussed below), and (4) goat's milk may have a bad taste compared with cow's milk (also discussed below).

In general, milk from goats is very similar to milk from cows. Culturally, goat's milk is used more widely around the world than cow's milk; and historically, goat's milk has been used many centuries longer and in more widely diverse environmental settings than cow's milk.

The high protein content and excellent nutritional value of goat's milk is closely comparable to cow's milk. They have similar caloric loads (which means the number of calories that must be ingested to get comparable protein, vitamin, and mineral nutritional value). Unfortunately, they also both have the milk-sugar "lactose" to which some people are intolerant (and get digestive upsets from).

(1) As to how and why goat's milk tends to be hypoallergenic (it almost never causes allergic reactions), there has been considerable scientific exploration and speculation about this phenomenon, but the final answer is not entirely understood. Apparently it is because the proteins of the two kinds of milk are different and the protein fragments of goat's milk after digestion seem to trigger human allergic reactions much less frequently than cow's milk. In a cultural setting where drinking cow's milk is the norm, goat's milk can provide a valuable, nutritionally equivalent alternative for people who develop an allergic reaction to cow's milk.

(2) With regard to goat's milk being less conducive than cow's milk to the absorption of cholesterol (which causes hardening of the arteries and high blood pressure), this has been well established. It is because the fats of goat's milk are significantly different from those of cow's milk. Basic biological fats are called "triglycerides"; they consist of long-chain carbon compounds (chemically, in the form of "fatty acids") attached to the three hydroxyl groups of glycerol (or "glycerin"). But with cow's milk, these tend to be longer carbon chains, especially myristic acid (14 carbons long), palmitic acid (16 carbons long) and stearic acid (18 carbons long). The dominant fatty acids of goat's milk are caproic acid (6 carbons long), capryllic acid (8 carbons long), and capric acid (10 carbons long). (It is interesting to notice that the three words "caproic," "capryllic," and "capric" are all derived from the Latin word "caper" meaning "goat.") Longer fatty acids facilitate the absorption and metabolic integration of cholesterol more than shorter fatty acids do. Cow's milk therefore contributes significantly more than goat's milk to the formation of cholesterol-based atherosclerotic plaques in arteries and, therefore, to high blood pressure.

The shorter fatty acids of goat's milk have another interesting effect: they make the fats of goat's milk mix more easily with the water phase of the milk. This is why goat's milk tends to be naturally "homogenized" and not require special processing to keep the fats (that is, the cream) from separating.

(3) The reason goat's milk tends to be more expensive than cow's milk is that commercial production of cow's milk is routinely done in a factory-like way with cows held by the hundreds in tiny stalls, unable to move about, standing throughout their lives in their own manure, fed grains and cheap bulk foods at one end and drained of milk at the other end. Goats simply will not tolerate this kind of inhumane treatment--they rebel, they have aberrant behavioral outbursts, and they die. They are more intelligent and emotionally sensitive than cows and cannot be "factory-ized." Hence they are more expensive to tend, to feed, and to milk.

In recent years as factory-like handling of cow-milk production has become the commercial norm, the term "organic" has come to apply to cows that are treated humanely--they are allowed to range around a bit, to graze, and generally to live more normal cow-like lives. They are also not loaded with antibiotics to counteract the infections that run rampant in crowded, manure-contaminated cage quarters; such infections do not occur much in a freer range environment, and when they do, they are handled by the animal's normal immune system. Furthermore, the milk production of "organic" cows is not boosted artificially by hormone injections as is done routinely with factory-handled cows. Both antibiotics and hormones can be carried through as contaminants in non-organic cow's milk.

(4) As to the reputation that goat's milk has that is tastes bad, this is due to two factors. First, although goats are fastidious and picky in what they are willing to eat, their digestive systems are more hardy and versitile than cows; goats can digest a wide variety of food sources, both fresh and foul. If goats are hungry, they can and will eat garbage, and the bad tastes and smells of the garbage they eat can be carried through to the milk they produce. Second, male goats (called "billies") emit a pungent, musty, goaty smell. If the males and females are allowed to hang around together (other than for a week or two once or twice a year so they can mate), the pungent, musty, goaty smell is carried through to the milk. To prevent this, billy goats are commonly kept in separate pastures and allowed access to the females only for mating purposes.

In summary, goat's milk is a healthy, delicious, hypoallergenic, non-atherosclerosis producing alternative to cow's milk. It is commonly more expensive than cow's milk because of the streamlined but inhumane, factory-style production methods to which cows are subjected, but since it has significant nutritional advantages to cow's milk, perhaps this is a price premium we should be willing to pay.