[eggplant43]

October 1, 2002

Drug Industry Is Told to Stop Gifts to Doctors

By ROBERT PEAR


WASHINGTON, Sept. 30 — The government warned pharmaceutical companies today that they must not offer any financial incentives to doctors, pharmacists or other health care professionals to prescribe or recommend particular drugs, or to switch patients from one medicine to another.

The government informed the industry that many practices commonly used in the marketing and sale of prescription drugs could run afoul of federal fraud and abuse laws.

Specifically, the government said that drug makers could not offer incentive payments or other "tangible benefits" to encourage or reward the prescribing or purchase of particular drugs by doctors, health plans or companies that manage drug benefits for employers and insurers.

The new standards, the first of their kind, were issued by Janet Rehnquist, inspector general of the Department of Health and Human Services, as guidance to the pharmaceutical industry.

Aggressive marketing is the norm in the industry. For years, drug makers have treated doctors to free Broadway plays, weekend trips, expensive meals and other lavish perks. Many companies have rewarded middlemen, or pharmacy benefit managers, for putting their products on lists of recommended drugs, known as formularies. Some companies have also rewarded doctors and drugstores for switching patients from one medication to another.

Similarly, doctors in a position to influence the prescribing of drugs for large numbers of patients have been retained as advisers and consultants to drug manufacturers.

While the new standards do not have the force of law, drug makers that flout them are more likely to be investigated and prosecuted for violations of federal fraud and kickback statutes.

"In today's environment of increased scrutiny of corporate conduct and increasingly large expenditures for prescription drugs," Ms. Rehnquist said, "it is imperative for pharmaceutical manufacturers to establish and maintain effective compliance programs."

The public will have 60 days to comment on the standards. The government may revise them in the light of those comments.

The government said it was concerned about the industry's marketing practices because they could improperly drive up costs for Medicare and Medicaid, the federal health programs for 75 million people who are elderly, disabled or poor. The federal government spends $400 billion a year on the two programs combined, and the cost is expected to double in 10 years.

The new standards say "switching arrangements," under which drug companies offer financial incentives to shift patients from one drug to another, "are suspect under the anti-kickback statute."

Similar arrangements, under which companies pay drugstores or pharmacy benefit managers to contact patients or doctors to encourage them to change from one drug to another, are also suspect, the government said. It warned companies that they would run afoul of the law if they rewarded pharmacies and pharmacy benefit managers for "moving market share" from one product to another.

The inspector general said that payments to consultants, advisers and researchers "pose a substantial risk of fraud and abuse" if the payments exceed "fair market value for the services rendered."

The new guidelines say that drug makers can violate the kickback statute when they offer entertainment, recreation, travel, meals or similar benefits; when they sponsor "educational conferences"; and when they offer research grants, gifts, gratuities and "other business courtesies" to doctors, hospitals and other health care providers who influence the prescribing of drugs.

The standards also apply to financial incentives given to purchasing coalitions that buy drugs and medical devices for hospitals. The buying groups are sometimes paid by manufacturers whose products they are supposed to evaluate objectively.

Ms. Rehnquist said that every drug company should appoint a compliance officer, establish a hotline to receive complaints of fraud and abuse and consider paying rewards to employees who report misconduct.

Under the new standards, companies are responsible not only for their own employees, but also for sales agents and contractors who "engage in improper marketing and promotional activities" on their behalf.

In April, the Pharmaceutical Research and Manufacturers of America, a trade group for brand-name drug companies, adopted a voluntary marketing code setting out what sales representatives may do in dealings with doctors and other health care professionals.

The code says, for example, that a drug maker cannot give golf balls emblazoned with the company's name to doctors, because the products do not provide a benefit to patients.

The inspector general said that compliance with the industry code was desirable, but "will not necessarily protect a manufacturer from prosecution or liability for illegal conduct."

Employers and health plans hire pharmacy benefit managers to review and pay claims for prescription drugs, to help control costs and to coordinate care for patients.

Barrett Toan, chairman of Express Scripts, a pharmacy benefit manager in St. Louis, said drug makers paid rebates to pharmacy benefit managers "to make their products more attractive — to improve their position on the formulary," increasing the likelihood that their drugs will be prescribed, in preference to products made by other companies.

John M. Rector, senior vice president of the National Community Pharmacists Association, said, "Pharmacy benefit managers increasingly take payments from drug makers, with the result that patients are switched from a product that might be the best prescription drug for them to a more expensive brand-name product."

The new standards say that drug companies may be subject to civil and criminal penalties if they report inaccurate or incomplete data on the prices or sales of their products. The government uses such information to compute reimbursement under Medicare and Medicaid, and the inspector general said the reported prices should reflect any discounts or rebates offered to buyers.

Ms. Rehnquist said that if drug makers found "credible evidence" of violations of federal law or regulations, they should notify the government within 60 days, or sooner if beneficiaries could be harmed.

In recent years, the government has issued guidance to other segments of the health care industry on how to prevent fraud and abuse. Those guidelines were addressed to doctors, hospitals, nursing homes, laboratories, home care agencies and suppliers of medical equipment.

[Tipacanoe]

American media keep the liberals invisible
There's little media time for critics of U.S. culture

By Antonia Zerbisias

Michael Moore's writing and filmmaking is largely ignored by American media. Sunday night, way up in the nosebleed section of the digital dial on MSNBC, I was thrilled to land on a rerun of the news conference that Michael Moore (Roger & Me, Stupid White Men) gave at the Toronto International Film Festival to promote his newest documentary Bowling For Columbine, which borrows its title from the horrible high school massacre in Colorado in 1999.

(No, MSNBC wasn't actually running the news conference. Rogers, which had taped it during the fest for telecast on its "community" Channel 10, was merely subbing regular MSNBC programming with the newser in order to fulfill its CanCon commitments for carrying the channel in Canada. But that's another column.)

Moore, who seems to be more at home here than in his native U.S.A., was defending his polemical film about guns and the American psyche, a film that won a special jury prize at Cannes — here it also earned a sustained 13-minute ovation from the audience.

Moore complained that American critics had not given Bowling For Columbine the attention it deserves, that nobody had reported that the country's largest theatre chain, which is based in Colorado, has refused to exhibit the film when it opens later this month.

Big surprise. Moore's anti-corporate, left-liberal films, TV shows and books tend not to play well with the corporate, conservative media. For example, his Stupid White Men, which was almost shredded by the publisher last fall for being patriotically incorrect, has been on all the bestseller lists for nearly a year — but has yet to be reviewed by The New York Times and other major papers. His last TV series, The Awful Truth, was made in Canada, by the Halifax-based Salter Street Films, which also co-financed Columbine.

I can count on one hand the number of times I have seen him onscreen on U.S. TV since Stupid White Men became a hit. And yet, Ann Coulter, his polar opposite both physically and politically, is seen all over the dial screeching the same half-truths she wrote in her best-selling screed Slander: Liberal Lies About The American Right.

Is it just because she has better legs than Moore that she gets all this exposure, including a substitute hosting gig on CNN's Crossfire? Or is it because, contrary to her contention and that of many readers who have e-complained about my "left-wing ravings" and The Star's "commie" slant, the liberal media ain't so liberal?

Sure, there are islands in the market-might-is-right media ocean. On the magazine racks, you'll find Harper's and The Nation, to name two of the few. The Internet is blessedly filled with alternative sites. In Canada, we can count on CBC and TVO not to always run everything through the is-this-good-for-the-market filter. But, in the U.S., aside from NPR (National Public Radio), there's not much, not even PBS.

That's right: Not even PBS.

Consider how, last month, even the much respected Jim Lehrer gave Defense Secretary Donald Rumsfeld a free pass, never challenging him when he repeatedly fudged the facts. For example, Rumsfeld reiterated the Bushist propaganda about how Saddam Hussein "threw the (U.N. weapons) inspectors out" — when, in fact, they were pulled out.

Last spring PBS ran a superb six-hour documentary titled Commanding Heights: The Battle For The World Economy, based on the book by Daniel Yergin and Joseph Stanislaw. It's an unabashed appreciation of the free market, a tribute to Margaret Thatcher, Ronald Reagan, Milton Friedman and their inspiration, Nobel Prize-winning economist Friedrich von Hayek. So one-sided is it that The Wall Street Journal headlined its review of it "PBS Likes Capitalism More Than the Commercial Networks Do," calling it a "paean to private enterprise." This series was not only originally co-funded by Enron, it ran just as the markets were imploding and CEOs were getting busted for being too free of regulation.

Meanwhile, I can list dozens of provocative and prize-winning films PBS will not run, including Danny Schechter's Counting On Democracy, about the scandalous 2000 vote in Florida. Schechter, an Emmy-winning TV journalist, author and weblogger (http://www.mediachannel.org), says PBS rejected it because it is "biased." Instead, it will air Who Counts? — a political special starring Saturday Night Live alumnus Darrell Hammond doing his Al Gore impersonation.

One PBS show that does get behind the news is Now With Bill Moyers. To watch it, I tape it Sundays at dawn — off KCTS in Seattle. That's because, like many other PBS stations, WNED in Buffalo doesn't air it.

So much for the liberal media. Which is why I root for Michael Moore even when he goes over the top and/or edge.

Maybe his next film should take on CNN.

[mole]

George F. Will: Innocents abroad


Published 2:15 a.m. PDT Tuesday, October 1, 2002

WASHINGTON -- Hitler found "Lord Haw Haw" -- William Joyce, who broadcast German propaganda to Britain during the Second World War -- in the dregs of British extremism. But Saddam Hussein finds American collaborators among senior congressional Democrats.

Not since Jane Fonda posed for photographers at a Hanoi antiaircraft gun has there been anything like Rep. Jim McDermott, speaking to ABC's "This Week" from Baghdad, saying Americans should take Saddam Hussein at his word, but should not take President Bush at his. McDermott, in his seventh term representing Seattle, said Iraqi officials promised him and his traveling companion, Rep. David Bonior, a 13-term Michigan Democrat, that weapons inspectors would be "allowed to look anywhere."

Bonior, until recently second-ranking in the House Democratic leadership, said sources no less reliable than Saddam's minions told them that inspectors will have an "unrestricted ability to go where they want." McDermott said: "I think you have to take the Iraqis on their value -- at their face value." And: "I think the president would mislead the American people."

McDermott and Bonior are two specimens of what Lenin, referring to Westerners who denied the existence of Lenin's police-state terror, called "useful idiots." Perhaps Iraqi officials, knowing fathomless gullibility when they see it -- they have dealt with U.N. Secretary-General Kofi Annan -- actually said such things. Or perhaps McDermott and Bonior heard what they wished to hear. Either way, these innocents abroad should have known that Iraq's proclaimed policy is:

The only permissible inspections would be those permitted by the 1998 agreement Saddam reached with his servant, Annan, who was last seen doing his Neville Chamberlain impersonation, waving a piece of paper (Iraq's recent letter promising weapons inspections "without conditions") that he said meant peace in our time. Under the 1998 agreement, various inspections are forbidden, such as any at eight "presidential sites" -- about 12 square miles of facilities, with thousands of buildings.

McDermott sided with Saddam in opposing what McDermott calls the "coercive stuff" -- inspections backed by force, which are the only kind that have even a remote chance of being productive. Parroting Saddam's line to perfection, he said "Iraq did not drive the inspectors out, we" -- actually, the U.N. -- "took them out. So they should be given a chance." His implication is that America, not Iraq, foiled inspections.

Bonior's contribution from Baghdad was to charge that "a horrendous, barbaric, horrific" number of cases of childhood leukemia and lymphomas have been caused by "uranium that has been part of our weapons system that was dropped here during the last war." These weapons "are coated with uranium that atomize and cause these serious health problems."

This familiar accusation, which struck Bonior as new, concerns the use of depleted uranium as a heavy metal (also used in the armor plating of U.S. tanks) to increase the armor-penetrating ability of anti-tank munitions. The radiation involved is much less than that occurring naturally in the Iraqi soil where tank battles occurred in 1991. At least a dozen U.S., U.N., and European studies, including one involving U.S. soldiers who still have depleted uranium in their bodies resulting from "friendly fire" accidents, show no grounds for believing in the health effects Baghdad and Bonior claim.

McDermott's accusation that the president -- presumably with Cheney, Powell, Rumsfeld, Rice and others as accomplices -- would use deceit to satisfy his craving to send young Americans into an unnecessary war is a slander licensed six days earlier by Al Gore. With transparent Nixonian trickiness -- being transparent, it tricks no one -- Gore all but said the president is orchestrating war policy for political gain in November.

Gore and many other Democrats who supported the 1998 Iraq Liberation Act, with which the Clinton administration endorsed regime change, are now engaged in moral infantilism -- willing the end but refusing to will any realistic means to that end. Such evasions define today's Democrats, even in domestic policy, as when Tom Daschle and others say Bush's tax cuts are calamitous, but flinch from saying the cuts should be rescinded.

McDermott's and Bonior's espousal of Saddam's line, and of Gore's subtext (and Barbra Streisand's libretto), signals the recrudescence of the dogmatic distrust of U.S. power that virtually disqualified the Democratic Party from presidential politics for a generation. It gives the benefits of all doubts to America's enemies and reduces policy debates to accusations about the motives of Americans who would project U.S. power in the world.

Conservative isolationism -- America is too good for the world -- is long dead. Liberal isolationism -- the world is too good for America -- is flourishing.
--------------------------------------------------------------------------------

[Mulderator]

I love the Clinton/Lieberman "Lauer" questions!

-------------------------------------------------------------------------------
Larry Elder

September 26, 2002

How Matt Lauer patronized Charlton Heston

Is it me, or does "Today Show's" Matt Lauer condescendingly give Republicans/conservatives the old "look-me-in-the-eye" treatment when asking questions?

In an interview with President George W. Bush, for example, Lauer questioned the president about the environment. "So you can look me in the eye and say that you are a president committed to cleaning up the environment?" he asked. "Look me in the eye and say that you are ... committed to cleaning up the environment"!

How about his recent interview with NRA President Charlton Heston? Lauer condescendingly asked Heston whether shootings or crime involving guns ever made Heston rethink his position on the Second Amendment.

Lauer: "Have you ever gotten up one morning, read the newspaper or seen the news about a particularly horrific crime or event that involved a shooting and thought, even for a second, 'I may be on the wrong side of this issue?'"

Heston: "No, I never felt that."

Lauer: "Never wavered?"

Heston: "No. Again, I'm on the side of the -- the men who invented the country. They believed in the Second Amendment, and I believe in it, too."

Does Lauer give "gun control advocates," like Sarah Brady, the same treatment? Imagine the following:

Lauer: Ms. Brady, 38 states now allow citizens to carry concealed weapons. Violent crime in those states declined. It turns out that few gun permit holders violate the terms of their permits by engaging in crime. In fact, gun permit holders, as a class, commit fewer crimes than the non-permit-holding general public. Does this cause you to rethink, even for a second, your position on gun control?

Lauer: And to follow up, in Professor John Lott's book, "More Guns, Less Crime," he suggests that 2.5 million Americans use guns every year for defensive purposes. Of that number, 400,000 claim but for their access to a handgun, they feel that they would have been dead. Twenty thousand Americans a year die because of guns, with nearly half of those committing suicide. So, in looking at 10,000 dead vs. 400,000 still alive, do you ever think, even for a second, that 'I may be on the wrong side of the issue'?

Or how about something like this?

Lauer: Sen. Clinton, early in your husband's first term, he appointed you to create a national health-care system patterned after the Canadian so-called single-payer scheme. But according to Kerri Houston in Investor's Business Daily, "Looking to Canada's system of universal health care as a model for anything besides what not to do is lunacy of the highest order. ... Canada's health care is so bad that even the most liberal of politicians there are now calling the system a failure, screaming for complete overhaul and even proposing -- gasp! -- private-sector solutions." Increasing numbers of Canadians travel to the states for treatment with, say, MRI equipment, long available in America under its more free-market-oriented system. Does this cause you, even for a second, to rethink your attempted takeover of our nation's health-care system?

Or how about the following?

Lauer: Sen. Lieberman, you recently urged the repeal of the George W. Bush $1.35 trillion tax cut and oppose making any such tax cut permanent. However, let me play for you a tape of former President John F. Kennedy making the opposite argument about taxes. In this clip, he suggests that lowering taxes actually increases revenues:

(Begin tape)

Kennedy: "The final and best means of strengthening demand among consumers and business is to reduce the burden on private income and the deterrence to private initiative which are imposed by our present tax system. ... It is a paradoxical truth that tax rates are too high today and tax revenues are too low -- and the soundest way to raise revenues in the long run is to cut rates now. The experience of a number of European countries has borne this out. This country's own experience with tax reductions in 1954 has borne this out, and the reason is that only full employment can balance the budget -- and tax reduction can pave the way to full employment. The purpose of cutting taxes now is not to incur a budgetary deficit, but to achieve the more prosperous expanding economy, which will bring a budgetary surplus."

(End tape)

Lauer: Sen. Lieberman, hearing that, does that cause you to perhaps, even for a second, rethink your opposition to tax cuts?

Expect someday soon for Lauer to give liberals the same treatment he gives conservatives. Naa-aah.

In ex-CBS reporter Bernard Goldberg's book, "Bias," he notes that the mainstream media cannot even grasp the notion that otherwise rational, sane people might see the world differently. Goldberg quotes the late New Yorker film critic Pauline Kael, who after George McGovern's 1972 crushing defeat at the hands of Richard Nixon, lamented, "Nobody I know voted for Nixon."

But maybe it's me.
----------------------------------------------------------------------------------

Two-faced liberals!

[Tipacanoe]

Bush looks for buddies in bad times

By ERIC MARGOLIS -- Contributing Foreign Editor

President George Bush blasted Democrats last week for "not being interested in the security of the American people." Democrats, it seems, were not jumping fast enough on Bush's invade-Iraq bandwagon.

Senate Majority Leader Tom Daschle, a Democrat and war veteran, furiously demanded Bush apologize for this slander. Bush spokesmen claimed the president was quoted out of context, but the Democrats remained enraged.

Many senior Democrats are decorated war veterans.

Let's see what all those Republican "chickenhawks" clamouring for war against Iraq did during America's last major conflict, Vietnam (with thanks to the muckraking New Hampshire Gazette).

# President George Bush - a cushy slot near home engineered by dad in the Texas Air National Guard; apparently went AWOL for an entire year; service records never revealed.

# Vice President Dick Cheney - no military service.

# Chief Pentagon hawks Richard Perle and Paul Wolfowitz - no military service.

# Grand Inquisitor John Ashcroft - no military service.

# Newt Gingrich and Trent Lott, no military service.

Media neo-cons baying for war against Iraq: William Kristol, Michael Ledeen, Bill O'Reilly, Charles Krauthammer, George Will, Ken Adelman, Chris Mathews, and Rush Limbaugh - no military service during Vietnam.

These men are all around my age. During that time, I enlisted in the U.S. Army. Where were they when so many men were going into battle and to their deaths?

Now, these bellicose crusaders want to send more young Americans into another unnecessary war.

Bush should be ashamed of insulting Democrat war vets like hero Senator Dan Inouye, Al Gore, Richard Gephardt, David Bonior, Tom Daschle, John Kerry and even Teddy Kennedy, who all served their nation in uniform.

Yes, Bill Clinton was a draft dodger, but Bush's war record was not much better. The only senior member of the Bush administration with an honourable military record is Gen. Colin Powell, and he is least in favour of the coming war.

This whole ugly business came right after Bush had turned his fire on Germany's just re-elected Chancellor Gerhard Schroder for refusing to join the anti-Iraq mob.

Hitler comparison

Bush was sizzling mad - and rightly so - after one of Schroder's running mates stupidly compared Bush's tactics over Iraq to Hitler's. But this came after the White House and U.S. ambassador clumsily interfered in Germany's election by openly backing the conservative candidate, Edmund Stoiber, something close allies do not do.

Schroder won an uphill election campaign, largely by refusing to join Bush's jihad against Iraq, a position supported by two-thirds of German voters. Bush furiously accused Schroder of "playing politics" over Iraq.

Lucky for Americans Bush wasn't playing politics over Iraq. With mid-term U.S. elections only five weeks away, no decent person would dare accuse Bush of trying to whip up war fever to distract American voters from the looming U.S. $157 billion deficit he created, collapsing stocks, or serial Wall Street scandals and a possible second recession.

Bush refused to even congratulate Schroder on his victory and had Defence Secretary Donald Rumsfeld accuse the Chancellor of "poisoning" U.S.-German relations. What ever happened to Powell, who is supposed to deal with diplomatic affairs?

The Germans, in the White House view, are not being sufficiently warlike. So what if the Germans had 4.2 million dead in two world wars (America lost 418,000), that's no reason for them to be such Euro-wimps.

Germans and Americans seem to have switched stereotypes: it's now Germans who are peace-loving, while Bush's recently declared America Uber Alles strategy reeks of old, aggressive Teutonic geopolitics.

Delusions of grandeur

Washington has long urged Europe to act like a true partner. But whenever Europeans dare disagree with U.S. policy, they get blasted by the U.S. government and media for insubordination and accused of delusions of grandeur.

In reality, Europe, in the words of master strategist Zib Brzezinski, "remains largely an American protectorate, with its allied states reminiscent of ancient vassal and tributaries." Now, for the first time since WWII, Germany has openly defied Washington, to the delight of most Europeans. Schroder did this to save his political hide, but the effect is still highly significant: a cannon shot that could announce Europe's coming of age. Germany has been forced to accept the role of a paroled criminal ever since 1945. It's now time for Germany, tightly bound to France, and within the framework of the EU, to begin asserting its rights as a sovereign nation that has fully paid its debt for WWII.

Bush calls for democracy around the globe, but his spiteful criticism of Germany is just another example of the occasional anti-democratic tendencies that course through his administration. German voters have spoken. Bush's clumsy efforts to punish Germans for opposing a war seen around the globe as unjust and unnecessary have further inflamed European opinion against his government and damaged America's strategic interests and reputation in Europe.

[Tipacanoe]

On Becoming a Wal-mart Greeter

By Sean Gonsalves

Charles Leach describes himself as a 62-year-old, silver-haired, overweight, wing tip shoe-wearing president of a small company that manufactures textile screen printing inks - "not exactly the 'neo-hippie anarchist' the media picks out as the typical WTO protester."

It's not that Leach was in the streets of Seattle protesting the WTO in 1999. He lives in Lynchburg, Ohio and, as he puts it, "instead of doing something productive, like attempting to shut down a WTO meeting, I have been wasting my time pushing a 'Human Standards Import Fee'."

In the name of Calvin "The business of America is business" Coolidge, what is Leach talking about?

Leach knows what many of the "experts" now concede - globalization is no panacea. In fact, it has some severe consequences for ordinary people.

Sounding like a "know-nothing" protestor, Leach sees globalization, as it is now being championed, as essentially "a race to the bottom" - an international system in which there is "a transfer of wealth from the world's poorest people to world's richest." Hence, his idea: the "Human Standards Import Fee."

But before, we get to that concept, let me share with you why Leach identifies with the "senseless" protestors.

"My little company will probably close this year due to the domino effect of globalization. For over three decades I have been involved in the textile screen printing industry. The industry has had its ups and downs, but has historically been a magnet for creative entrepreneurs with more passion than cash," he says.

Recall with me the words of President Bush. No. 43 said he wanted to "encourage entrepreneurship - the path to prosperity taken by so many....Across America, more than 1 in 5 jobs is created by a business that didn't exist a decade ago...The entrepreneurs of America create jobs, take risks and make their profits with honor."

But "prosperity is not a given," the Prez said, "and governments don't create it. Wealth is created by Americans - by creativity and enterprise risk-taking...The role of government is to create an environment where businesses and entrepreneurs and families can dream and flourish."

And here comes the kicker. "We'll be prosperous," he said, "if we embrace free trade. I'll work to end tarriffs and break down barriers everywhere, en-tirely, so the whole world trades in freedom."

Ah, yes globalization, "free-trade," and the flourishing of entrepreneurs.

Leach continues: "T-shirt printing shops were typically family operations, and often started when the bread winner was laid off. Any creative person with a few thousand dollars, who was willing to work, could keep food on the family table, a roof over the family's head, and send the kids to college."

"Family owned t-shirt shops sprang up in cities and towns across the country and companies such as mine sprang up to supply them with the materials they required."

"As demand for printed apparel grew, big companies moved in to supply big retail chains. Wal-Mart did not buy from mom and pop operations. With bigger companies, and automation, supply soon started to exceed demand and giant retailers could soon set prices.

"To remain profitable, most companies put in higher speed equipment, thus exacerbating the situation. Soon they started moving their operations to Mexico, where low labor costs and freedom from environmental concerns allowed even lower prices.

"With prices for printed apparel plunging, mom and pop operations across the country closed, as did the local distributors set up to serve them. As the race to the bottom continues, companies are moving out of Mexico and into countries where even lower wages can be paid."

"Mills across the once booming 'textile belt' in the Carolinas, having moved there from New England to lower labor costs, were also moving to Mexico and then on to even more poverty-stricken countries. The companies that supply them have been forced to follow their customers or close down."

Sounding like one of the pesky protestors, Leach points out: "Executives of companies that move often remain in the United States, where tey won't have to cope with Third World living conditions, and put their ever increasing salaries in off-shore banks so they can avoid paying taxes. The latest scam is to leave corporate headquarters in the United States, but incorporate in Bermuda to avoid paying corporate taxes, thus shifting even more of the burden of paying for government services to the middle class."

Now, back to Leach's idea of a "Human Standards Import Fee." The concept is pretty simply, he explained to me last week. "An import duty, amounting to, say, 66 to 75 percent of the savings accrued by manufacturing a product in a Third World country, where people are not paid enough to afford decent food, shelter, and health care, and where the environment can be destroyed without penalties; would be applied to a product when it enters the (U.S.).

"The money would be held in escrow for a period of one to two years. If, within that time, the country or corporation of origin presents a plan to use the money to improve the workers standard of living and protect their environment, and said plan is approved, the money would be released for the expressed purpose. If a plan is not presented and approved in the allotted time the money would be used to pay health care costs and so forth of displaced workers," he said.

Leach says the prospects for his company are not too bright. "I will probably soon join the growing ranks of people who have helped build a once vibrant industry, and who have then been displaced by globalization.

"I plan to become a greeter at Wal-Mart, giving people carts that they can fill with merchandise made in China. That is OK for old codgers like me but where do younger people, displaced from jobs that paid a decent wage go? Where is the new haven for creative hard working entrepreneurs with a few thousand dollars?"

Although Leach considers himself a Barry Goldwater conservative, he's not convinced by Bush's speech writers. He voted for Nader and said he might have voted for McCain if he had won the GOP nomination.

"I haven't changed my views since Goldwater but now I'm considered a flaming liberal," he said, adding, "we're still the number one market in the world. If we can unilaterally bomb another country, we ought to be able to unilaterally establish a Human Standards Import Fee or something like it."

[pyritechips]

Thought this is a good read for anybody that used a computer!

~Jim

California takes junk e-mailer to court

Last Updated Tue, 01 Oct 2002 11:07:33

SAN FRANCISCO - The state of California has filed a lawsuit against a marketing company over its use of e-mail to advertise. It's believed to be the first time a state has launched such an action.
The Attorney General's office says PW Marketing violated the state's statute banning spam and participated in deceptive advertising and unfair business competition.
Twenty-six states in the U.S. have laws against junk e-mail but none has taken companies to court. The California case could set a precedent.
Attorney General Bill Lockyer called spam the "scourge of the Information Age." Lockyer says PW Marketing sent millions of unsolicited e-mails that advertised books, software and lists of e-mail addresses, as a way to make money.
The e-mails violated state law by failing to include a toll-free phone number or valid e-mail address for people to stop future e-mails. The e-mail also did not contain the letters "ADV" in its subject line to indicate it was an ad.
PW Marketing faces up to $2,500 for each violation if convicted.
Consumer advocates are cheering the move. They say lawsuits seem to be the only way to combat spam.
Linda Sherry of Consumer Action says spammers are ignoring state laws and routing e-mails through different Internet service providers to hide their locations.
"(The problem) is out of control," says Sherry, who complains that companies should not send marketing e-mails unless the individual requests it.
"I do think additional lawsuits will enhance the deterrence effect," said Megan Auchincloss, who represents law firm Morrison & Foerster. The company filed a lawsuit against a marketer for sending spam to its employees, after being asked not to.
"We were getting thousands and thousands of these e-mails. With employees going through and deleting them on a daily basis it was costly to the firm," said Auchincloss.
New research says one-third of all e-mails at businesses are unsolicited and workers are spending more time dealing with it.
According to spam filtering company, Brightmail, the amount of junk e-mail quintupled between July 2001 and July 2002.
The California Attorney General's office is now asking people to send their samples of spam.
Consumer groups in North America have been lobbying for anti-spam legislation. They want national legislation in Canada and the United States to spell out clear rules for spammers:
spam marketers should be forced to identify themselves properly
marketers must make their pitches honestly
they must honour a request to be removed from their contact lists
Written by CBC News Online staff <http://cbc.ca/bios.html>

[eggplant43]

Bill Bennett knows if you've been bad or good
Will Al Gore be the latest addition to his list of un-Americans?

- - - - - - - - - - - -
By Keith Olbermann



Oct. 2, 2002 | Last June, Al Gore was pulled aside for random security screening at the gate at Reagan National Airport in Washington. Remarkably, the next day, at Mitchell International in Milwaukee, the same thing happened again: his carry-on bag opened up and searched, a politician's dirty laundry literally open to public viewing.

At the time, the obvious joke was that Gore had encountered either the two dumbest airport screeners in the country, or ones so paranoid that they had concluded that because the former vice president had lost the presidential election to George Bush, Gore had gone over to al-Qaida.

Now, however, in the light of something called AVOT, we can revise that joke. Gore might have been pulled out of the boarding lines not because of the risk he posed by having lost to Bush, but rather because of the risk he posed by having opposed him.

AVOT is the most recent acronym selected by the most recent group of Americans who have anointed themselves responsible for deciding what kind of freedoms we should have in this country, and who gets their approval to have them. Where were you, and what were you doing, when you first heard these great hits of yesteryear: HUAC; McCarthy Committee; Alien and Sedition Acts; Truman Loyalty Oath; Woodrow Wilson Plays "Stop That Newspaper"?

"Americans for Victory Over Terrorism" is the brainchild of the former education secretary and omnipresent scold, William Bennett. Unveiled in March in an open letter, AVOT signaled its vigilance against threats "both external and internal," and Bennett went on to explain that the internal threats included "ideologues who are attempting to use this opportunity to promulgate their agenda of 'blame America first.'"

In a series of public statements, Bennett identified some of these "internal" threats. There is no evidence that Gore has yet made the list -- although after the former vice president's speech on Iraq last week, Bennett pretty much ran him out of American politics, calling the Gore address "an act of political self-immolation" in the pages of the Wall Street Journal. But the Bennett list definitely includes Rep. Maxine Waters of Southern California, novelist John Edgar Wideman, Harper's magazine editor Lewis Lapham and former President Jimmy Carter. Their threatening behavior? Each had listened to President Bush's pronouncements about terrorism and not stood up straight enough nor cheered loudly enough.

To quote Mel Brooks as Gov. William J. LePetomane: "I didn't get a harrumph out of that guy."

Most recently, Bennett has swung AVOT against critics of Bush's Gulf War II plans. In a wonderful display of bipartisanship, mentioned in his most recent dispatch from AVOT World Headquarters are Tom Daschle and Dick Durbin, and Brent Scowcroft, the national security advisor to the previous President Bush. (You'll remember him from the current chief executive's recent 'Saddam Hussein tried to kill my father' speech.) They presumably join the "internal threats list," while the former Democratic senator Bob Kerrey, whom Bennett cites for having written a Wall Street Journal Op-Ed headlined "Finish the War -- Liberate Iraq," is probably, even as we speak, being mailed a gold star he can stick on his forehead.

While Bennett and AVOT basically portray the war of good and evil as a war of right vs. left, it should be remembered that shouting "J'Accuse" in a crowded country has hardly been the exclusive prerogative of conservatives. Harry Truman happily imposed loyalty oaths and Woodrow Wilson did indeed try to suppress newspapers critical of his war policies. The America Firsters -- most prominently Charles Lindbergh and CBS commentator Boake Carter -- may have been unwittingly aiding the original Axis, but they were nonetheless silenced rather than out-argued by a mostly Democratic majority. And it is instructive that both editions of the House Unamerican Activities Committee flourished under Democratic administrations -- the first of them, FDR's.

The AVOT story is neither new, nor tied to a political party or group. It's the first step of a well-worn path to American hell. The branding, the demonizing, the demand that we always speak with only one voice -- and its inevitable consequences -- should inspire Bill Bennett to make his list of "internal threats," check it twice, and add AVOT to it.

There is one element of corner-cutting that elevates, or perhaps lowers, AVOT to a different echelon among the would-be silencers of our history. A visitor to its Web site is greeted by the words of two presidents, one set of which has been trimmed to 45 words to make it seem somehow related to the 40 in the other. The shorter excerpt is from George W. Bush's 2002 State of the Union address. The other is a truncated version of FDR's "Four Freedoms":

"We look forward to a world founded on four essential freedoms.

"The first is freedom of speech and expression.

"The second is freedom of every person to worship God in his own way.

"The third is freedom from want.

"The fourth is freedom from fear."

Of course, that wasn't what President Roosevelt said to Congress on Jan. 6, 1941. The actual "Four Freedoms" have a decidedly international meaning, and would seem to argue against both the aims of AVOT, and unilateral action against Iraq or anybody else. FDR's words are rarely quoted in full; perhaps this is an important time to cite them:

"In the future days, which we seek to make secure, we look forward to a world founded upon four essential human freedoms.

"The first is freedom of speech and expression -- everywhere in the world.

"The second is freedom of every person to worship God in his own way -- everywhere in the world.

"The third is freedom from want -- which, translated into world terms, means economic understandings which will secure to every nation a healthy peace time life for its inhabitants -- everywhere in the world.

"The fourth is freedom from fear -- which, translated into world terms, means a world-wide reduction of armaments to such a point and in such a thorough fashion that no nation will be in a position to commit an act of physical aggression against any neighbor -- anywhere in the world."

Thus, to be correct, to stand up to "ideologues who are attempting to use this opportunity to promulgate their agenda," Mr. Bennett needs to buy a few ellipses and identify the conveniently edited quote on his Web site as: "Contents May Have Settled During Shipping: Up To But Not Including Four Freedoms."

[mole]

By Charles Krauthammer
Friday, September 27, 2002; Page A23


A pudding with no theme but much poison. Such was the foreign policy speech Al Gore delivered in San Francisco on Monday. It was a disgrace -- a series of cheap shots strung together without logic or coherence. Most of all, it was brazen. It was delivered as if there had been no Clinton-Gore administration, no 1990s.

The tone of the speech is best reflected in Gore's contemptuous dismissal of the U.S. victory in Afghanistan as "defeating a fifth-rate military power." If the Taliban were a fifth-rate military power, why didn't the Clinton-Gore administration destroy it and spare us Sept. 11?

It is not as if, during Gore's term, al Qaeda had not declared itself or established its postal address. It declared war on the United States, blew up our embassies in Kenya and Tanzania and attacked the USS Cole. What did Gore's administration do? Fire a few missiles into the Afghan desert and a Sudanese pharmaceutical factory, then wash its hands and leave the problem to its successors.

Why didn't the Clinton-Gore administration go after this fifth-rate military power? This is a question that even Russian President Vladimir Putin has asked. In an interview with the German newspaper Bild shortly after Sept. 11, Putin recounted having talked to the Clinton administration about Osama bin Laden: "They wrung their hands so helplessly and said, 'The Taliban are not turning him over, what can one do?' I remember I was surprised: If they are not turning him over, one has to think and do something."

They did nothing. Gore now scorns the success of the man who did something. Considering the glass house he inhabits, Gore's attack on Bush is remarkably ad hominem. He implies, first, that the president is going after Iraq to distract attention from not finding Osama bin Laden. And second, that Bush is doing this for electoral purposes.

Interesting charges. On Aug. 17, 1998, Gore's president, the one he declared "will be regarded in the history books as one of our greatest presidents," made his Monica confession on national TV and then slinked away to Martha's Vineyard, Mass., for penance and isolation. Then, less than three days later, he returned from oblivion with that ostentatious commander-in-chief walk from Marine One to the Oval Office to announce his response to the African embassy bombings: his useless cruise missile salvo against Afghanistan and Sudan.

Then, that December, another bombing spasm, a three-day affair against Iraq that similarly achieved nothing. Operation Desert Fox occurred right in the midst of the House debate on impeachment. The timing was so wag-the-dog precise that it actually caused a postponement of the vote, with some Democrats suggesting that with the country now in crisis the impeachment proceedings should be canceled altogether and the whole mess left to the next Congress.

Gore should be careful about leveling charges about presidents getting combat-happy to distract attention from other problems. Yet what is most remarkable about Gore's speech is that for all its poison, it is profoundly unserious. Take Gore's repeated characterization of the Bush policy on postwar Afghanistan as "this doctrine of wash your hands and walk away."

Walk away? Our current policy is to secure Kabul, retrain the army, protect the new president and establish a small central government that can, over time, expand its political and geographic reach. This is a serious commitment. Our soldiers trying to fulfill it are being shot at regularly. Tell them they're walking away.

There is a serious question about how deeply involved in Afghanistan we ought to be. Are we more likely to bring stability by continuing Afghanistan's long history of decentralization and allowing warlords to act in their traditional areas of influence, or by sending an imperial army to go around imposing order in places where outsiders -- the British and the Soviets most notably -- have not had much luck imposing their own order?

One can argue either way, but the burden of proof is on those urging the more onerous and risky MacArthur regency. If Gore were a serious man he would make the case. But he doesn't. He doesn't even try to. He is too thin. And too cynical.

The New York Times reports that Gore wrote the speech "after consulting a fairly far-flung group of advisers that included Rob Reiner." Current U.S. foreign policy is the combined product of Donald Rumsfeld, Condoleezza Rice, Dick Cheney, Colin Powell, Paul Wolfowitz and the president. Meanwhile, the pretender is huddling with Meathead.

Had it not been for a few little old ladies baffled by the butterfly ballot in Palm Beach, Fla., American foreign policy today would be made by Gore-Reiner instead of the Bush brain trust. Who says God doesn't smile upon the United States of America?



© 2002 The Washington Post Company

[mole]

From wsj.com:

Democrats should get serious, Republicans should show some solemnity.


Peggy Noonan
Friday, September 27, 2002 12:01 a.m. EDT

The battle is joined, the debate begun in earnest. In the past 48 hours we have witnessed Bush vs. Daschle, Hitchens vs. Cockburn, Democrats vs. Republicans, The American Conservative vs. The Weekly Standard and National Review, paleocons vs. neocons, compassionate conservatives vs. the left. In New York we debate whether strong criticism of Israeli policy is prima facie evidence of anti-Semitism. In Washington it's two questions: Who owns conservatism, and is the modern left more than a collection of depressives, America-lasters and anti-Semites?

The background music to all this has underscored the drama of the moment: It is the plaintive wilderness fiddle of PBS's "The Civil War," repeated each night all week. You can walk the dog in the evening in the upscale neighborhoods of the East and hear the fiddle's lonely tune coming from the screened windows of neighbor after neighbor. It's what you hear as you walk along, wondering how the question of war will be resolved.

We wanted interesting lives, and we got them.





What is at issue as we discuss war on Iraq? The safety of America, of untold numbers of people, the position of our country in the Mideast and elsewhere--and that's just the beginning. The debate has already become personal. This one is "a repulsive character," that one is "another middle-aged porker of the right." Personal viciousness is probably inevitable, but this fight should be serious.
It should be epochal.

One question has already been settled. The war will be the great issue of the 2002 elections. Some Democrats says this is Karl Rove's plan to restrict the national conversation to foreign policy, where Republicans are traditionally strong, and away from the economy. Maybe that is Mr. Rove's plan, and if it is, it's not without logic--what is more important than war?

But as plans go it's not without danger. Opponents of the war will now gather their forces, their resources, their arguments and data. They'll be all over trying to make their case. They'll have no trouble being heard.

So far they've not done well. They have argued that there are grave risks to action, but this is not an argument. There are grave risks to inaction, too. They have argued that America will have a hard time establishing a new Iraqi government. Well, yes. That doesn't mean it must not or cannot be attempted.

More is needed from the opposition.

The Bush administration says Saddam Hussein is sinister and vicious. Let me, with confidence and admitted presumption, assert on behalf of the majority of Americans: We believe it. Saddam has used poison gas, has already invaded two neighboring countries, has murdered people in the coldest of blood. The administration says Saddam is gathering weapons of mass destruction, and again: We believe it. There is plenty of evidence, and there is also proof. They say he is pursuing nuclear arms. Again: We believe it. He would.

The opponents of war, it seems to me, must face the questions that flow from what we know.

If you know Saddam is wicked, know he's gathering weapons of mass murder, know madmen are likely to ultimately use the weapons they stockpile, and know, finally, that he wishes America ill, then why not move against him? And why not now? Wouldn't inaction be irresponsible?





But the administration still has questions to face, too. Among them: What has stopped Saddam from using the weapons he has, and has had for some time? Isn't it deterrence--the sure knowledge that if he launches missiles weighted with weapons of mass murder he can wave goodbye to Baghdad, to his own life and those of many, many of his countrymen? The era of Saddam the Great would end.
If we move against Saddam now, this inhibiting incentive is lessened or removed. What will stop Saddam from going out in a great blaze of "glory"? He can kill millions.

Why is deterrence no longer operable?

The Democrats on Capitol Hill have so far failed to mount a principled, coherent opposition. I am not shocked by this, are you? One senses they are looking at the whole question merely as a matter of popular positioning: Will they like me if I say take out Saddam? Will they get mad at me if we try to take him out and it's a disaster? Will they like me if I say there's no reason to go to war? Have I focus-grouped this? Such unseriousness is potentially deeply destructive. It is certainly irresponsible. And here's the funny thing: If some Democrat stood up and spoke thoughtfully and without regard for political consequences about what is right for us to do, he'd likely garner enhanced respect and heightened standing. He'd seem taller than his colleagues. At any rate, more than usual, I am missing Pat Moynihan and Sam Nunn.

Members of the administration, on the other hand, seem lately almost inebriated with a sense of mission. And maybe that's inevitable when the stakes are high and you're sure you're right. But in off-the-cuff remarks and unprepared moments the president and some of his men often seem to have missing within them a sense of the tragic. Which is odd because we're talking about war, after all. Leaders can't lead by moping, but a certain, well, solemnity, I suppose, might be well received by many of us.





At any rate, the battle is joined. It will be waged over the next six weeks. It is going to be hot. It is going to dominate public discourse. This is good. We need and deserve a debate that is worthy of the moment, and worthy of the people--the millions of them--who could be affected by America's decision one way or another.
And by the way, it is not bad for a critical world to see how a great democracy, the world's oldest, goes about resolving questions of the utmost gravity. This is a good time to remind them who, and what, we are.

[eggplant43]

Nice article by Peggy Noonan. Gives one perspective.

[Tipacanoe]

The Bush doctrine

He started casually enough by reminiscing about his patchy college career and granting amnesty to those who committed "minor conduct offences". But the joking stopped there when George W. Bush addressed the uniformed graduates of the US military academy at West Point this month.

Far from the summer tradition of unmemorable graduation speeches, Mr Bush marked a historic break with the cold war doctrines that have dominated half a century of US foreign and military policy. Declaring that "new threats also require new thinking", he outlined a new era of national security threats and an entirely fresh doctrine of pre-emptive action.

"Deterrence - the promise of massive retaliation against nations - means nothing against shadowy terrorist networks with no nation or citizens to defend. Containment is not possible when unbalanced dictators with weapons of mass destruction can deliver those weapons on missiles or secretly provide them to terrorist allies," he explained.

In line with that speech, Mr Bush`s national security staff is now drawing up the most radical overhaul of US foreign policy since the cold war. The plans are already causing rifts in Washington and some senior US officials and conservative foreign policy analysts are expressing substantive reservations about the emerging doctrine and its impact on US national security interests.

Officials who support the doctrine insist that pre-emptive strikes represent just one policy option among many in dealing with rogue states such as Iraq. They say the administration`s first national security strategy, due to be released this year, will paint a far bigger picture of the new era of geopolitics. After September 11, the great powers - from European allies to China and Russia - are now aligned against a common enemy: terrorism.

"Early action means more than just military action," says one senior administration official. "It means counter-proliferation, non-proliferation and co-operative security arrangements with the great powers. It should, most importantly, mean trying to prevent the kind of petri dishes for terrorism that have grown up like Afghanistan."

The doctrine of pre-emption has evolved steadily, in line with the president`s vision for transforming the US armed forces. As he campaigned for the presidency during 2000, Mr Bush repeatedly raised the spectre of "madmen and missiles and terror" to justify his desire for a more agile, more deadly US military.

But since the September 11 terrorist attacks, those fears have taken on a new sense of urgency, leading directly to the emergence of a pre-emptive strategy. In his State of the Union address in January, Mr Bush sketched out the need for prompt intervention. "I will not wait on events, while dangers gather," he said.

Just two days later, Donald Rumsfeld, US defence secretary, was the first official to make explicit the need for pre-emptive strikes, as he detailed his plans for overhauling US forces. "Defending against terrorism and other emerging 21st-century threats may well require that we take the war to the enemy," he told the National Defence University in Washington. "The best, and in some cases the only, defence is a good offence."

But in burying the cold war doctrines, Mr Bush and his national security team are running head first into the clearest foreign policy principles of the Reagan administration. As the Reagan cabinet pursued containment and deterrence against the Soviet Union, it definitively rejected pre-emption.

When the last pre-emptive military strike was launched to destroy Iraq`s nuclear ambitions, the US had no hesitation in condemning the Israelis for bombing the Osirak reactor in 1981. Jeane Kirkpatrick, then US representative to the United Nations, said: "I don`t think anybody in the whole cabinet believed in the use of pre-emptive force and that is why we condemned Israel."

For Ms Kirkpatrick, now a senior fellow at the American Enterprise Institute, a pre- emptive strike against Saddam Hussein`s regime in Iraq poses serious dangers for other non-Islamist regimes in the region. "This involves a real shift of course for American military strategy and tactics and I do have some questions about whether it is a prudent shift of tactics," she says. "The question is whether the consequences would be to win recruits for the most radical Islamists and create more problems for Hosni Mubarak in Egypt or Jordan`s King Abdullah. Iraq has been a secular government and I think we don`t want to participate in driving those secular governments into something more violent and Islamist."

Moreover, if the policies of containment and deterrence worked so well against the Soviet Union`s totalitarian dictators, what is different about the current generation of dictators armed with weapons of mass destruction?

US officials who defend pre-emption point to two main distinctions. First, they suspect - but have released no evidence to suggest - that rogue states including Iraq have either co-operated with the al-Qaeda terrorist network, or are likely to do so in the near future.

Second, they argue that the Soviet Union was nothing like as unpredictable and unbalanced as dictators such as Mr Saddam. "You have to recognise that they don`t have the same kind of stake in the international system," says one senior administration official. "Their entire purpose is to destroy the capability of the US to help defend order in the international system. In that sense they are very different from the Soviet Union."

Other factors have also changed the debate about pre-emptive action in the US. Five decades ago, as the White House first shaped its doctrines of deterrence and containment, the National Security Council rejected the notion of a "preventive" war as "repugnant to many Americans". Moreover, the NSC concluded, international opposition to such action would undermine the world order. "Victory in such a war would have brought us little if at all closer to victory in the fundamental ideological conflict," it said.

Such repugnance among Americans is no longer a factor in US policymaking, at least in relation to Mr Saddam`s Iraq. According to an NBC News poll in April, 57 per cent believe that the US should take military action against Iraq.

That strong public support has emboldened many US officials to cite Iraq as a special case deserving of pre-emptive action. "Iraq was essentially put on notice by the international community and it has violated the terms of its parole," says a senior US official.

But if Iraq poses the most obvious case for pre-emptive strikes, it also highlights the practical problems. Given the administration`s desire to have a change of regime in Iraq, any build-up of US forces in the region is likely to prompt a first strike by Iraq - possibly using the very weapons of mass destruction that the US seeks to destroy.

Pre-emptive strikes would therefore need to be overwhelming and accurate. That requires impeccable intelligence - something that White House officials concede may be impossible in the case of biological weapons, which are easy to hide.

Even officials who support pre-emptive action say the bigger impact of such a strategy may be to shift the rules of the world order against US interests. If other nations, such as India and Pakistan, adopted pre-emption, the risk of nuclear war would rise sharply - at a time when the US ability to use its moral persuasion would be diminished in forcing both sides to back down.

"International relations is not a world of pure Hobbesian struggle," says one senior administration official. "One of the reasons there is not a constant state of war is that we all expect certain rules. We just have to be careful that if we create exceptions to those rules, the exceptions justify it - lest we establish precedents that others will emulate."

[eggplant43]

You didn't reference the article. I was just wondering who wrote it, and where it was published.

[eggplant43]

"Beware the leader who bangs the drums of war
in order to whip the citizenry into a patriotic fervor,
for patriotism is indeed a double-edged sword.
It both emboldens the blood, just as it narrows the mind.

And when the drums of war have reached a fever pitch and the blood boils with hate and the mind has closed, the leader will have no
need in seizing the rights of the citizenry. Rather, the citizenry,
infused with fear and blinded with patriotism, will offer up all of
their rights unto the leader, and gladly so.

How do I know?

For this is what I have done.

And I am Caesar."


Quoted by Barbra Streisand. Author unknown.

[eggplant43]

Self Exam Questioned


— Breast self-examination is commonly taught as a way for women to detect breast cancer, but new research says cancer detection may be best taken out of their hands - because the exams don't help, and may even hurt.
A study appearing Wednesday in the Journal of the National Cancer Institute finds no reduction in breast-cancer mortality for women who perform breast self-exams.

The study examined more than 266,000 women from Shanghai, China, who were randomly assigned to a group taught breast self-examination, or BSE, in which women learn to feel for suspicious changes in their breasts, or to a control group with no such instruction.

"The women in the instruction group did not find their tumors when they were any smaller or at a less-advanced stage than women in the control group that did not get the intensive breast self-exam instructions," lead author Dr. David Thomas of the Fred Hutchinson Cancer Center in Seattle told ABCNEWS' Jackie Judd.

Not only was there no reduction in overall mortality in the instruction group after 10 to 11 years of follow-up, but there was the suggestion that women who routinely check their breasts are at greater risk of undergoing more biopsies. More biopsies mean increased potential for false positive results, which can result in increased anxiety and excessive interventions, the study said.

This is not the first study failing to find benefits of BSE.

"It really fits many of our biases, which is that routine BSE has never been shown to effectively reduce mortality, even in retrospective studies. It does not surprise me that BSE is not very helpful at all," said Dr. Daniel Hayes, clinical director of the breast oncology program at the University of Michigan Comprehensive Cancer Center in Ann Arbor.

If It Ain’t Broke …

So does this mean that women should stop their self-exams, or at the very least, stop feeling guilty if they haven't been doing them?

For some experts, the answer is yes. Dr. Susan Love, author of Doctor Susan Love's Breast Book, has always doubted the value of self-detection. She says this report is long overdue.

"Instead of having advice and suggestions based on wishful thinking, we're actually having them based on science," Love said. "And for that, we should all be cheering."

But other experts, while applauding the study design and its results, say the findings will likely have little impact on the recommendations they make to their patients.

"It won't change the way I tell women how to examine and notice changes in their breasts," said Dr. Jay Brooks, chairman of hematology and oncology at the Ochsner Clinic in Baton Rouge, La. "I think that breast self-exams should be taught to women because it gives them empowerment over their own health and lives."

The self-exam is part of an array of possible detection tools, which include clinical exams like mammography and ultrasound. While BSE in and of itself may not be proven to reduce cancer mortality, it may have the effect of increasing overall awareness of the importance of evaluating breast-health using additional tools whose effectiveness has been clinically proven.

Furthermore, with the breast-cancer death rate on the decline overall, experts are loathe to do away with any part of that detection equation.

"The fact is that American women are dying at a lower rate than they were 10 years ago from breast cancer," said Dr. Clifford Hudis, chief of the breast cancer medicine service at Memorial Sloan-Kettering Cancer Center in New York City. "So until you are absolutely sure you know that something is useless, I would not stop it."

Maintaining Awareness

The bottom line, experts said, is that women should be aware that breast self-examination may increase the possibility of having benign biopsies, which does have consequences. But doing away with it altogether may be equally consequential.

"There is the harm of false positive results and excess interventions, but there could be harm the other way," said Hudis. "If you say to people from a public health point of view, you don't have to worry about this, everybody may pay a little less attention to themselves."

An editorial on the study suggests that awareness need not disappear along with routine breast self-examination should clinical practice change and women stop doing them. Physical examination of the breast, when conducted by a clinician, has been shown in some research to be as effective as mammography in reducing breast-cancer deaths.

"Routinely teaching BSE may be dead, but giving women information — and continuing research on the effectiveness of excellent physical examination — should live on," the editorial said.