What Bernie Sanders Believes

Bernie Sanders

Bernie Sanders has become the first to officially announce his plans to run against Hillary Clinton for the Democratic nomination. The conventional wisdom is that he has no chance to win (a type of prediction which I fear the media helps become true) but will move the conversation to the left. Unlike most politicians, Sanders’ views have remained quite consistent, making it a good bet that looking at his past statements will give a good idea of what he will be talking about while campaigning.

Common Dreams has a lengthy article on Sanders. This includes, “In December of last year, Sanders put forth what he called an Economic Agenda for America, a 12-point plan”

  1. Invest in our crumbling infrastructure with a major program to create jobs by rebuilding roads, bridges, water systems, waste water plants, airports, railroads and schools.
  2. Transform energy systems away from fossil fuels to create jobs while beginning to reverse global warming and make the planet habitable for future generations.
  3. Develop new economic models to support workers in the United States instead of giving tax breaks to corporations which ship jobs to low-wage countries overseas.
  4. Make it easier for workers to join unions and bargain for higher wages and benefits.
  5. Raise the federal minimum wage from $7.25 an hour so no one who works 40 hours a week will live in poverty.
  6. Provide equal pay for women workers who now make 78 percent of what male counterparts make.
  7. Reform trade policies that have shuttered more than 60,000 factories and cost more than 4.9 million decent-paying manufacturing jobs.
  8. Make college affordable and provide affordable child care to restore America’s competitive edge compared to other nations.
  9. Break up big banks. The six largest banks now have assets equivalent to 61 percent of our gross domestic product, over $9.8 trillion. They underwrite more than half the mortgages in the country and issue more than two-thirds of all credit cards.
  10. Join the rest of the industrialized world with a Medicare-for-all health care system that provides better care at less cost.
  11. Expand Social Security, Medicare, Medicaid and nutrition programs.
  12. Reform the tax code based on wage earners’ ability to pay and eliminate loopholes that let profitable corporations stash profits overseas and pay no U.S. federal income taxes.

PBS Newshour has this information on his views, including additional links:

Campaign finance: Limit corporate and interest-group spending in campaigns.

Sanders proposes a Constitutional amendment that would effectively reverse the Supreme Court’s Citizen United ruling and ban corporations and nonprofits from unlimited campaign expenditures. The independent senator would also require disclosure of any organizations spending $10,000 or more on an election-related campaign.

Climate change: Charge companies for carbon emissions

Considered to be a “climate change hawk” and use some of the money raised to boost renewable energy technology.

Education: Two years free tuition at state colleges. Reform student loans.

Sanders would provide $18 billion to state governments to allow them to cut tuition at state colleges by 55 percent. And he would allow anyone paying off a student loan currently to refinance at a lower rate.

Federal Reserve and banks: Break up big banks. Open up the Fed.

Sanders would divide large banks into smaller entities and charge a new fee for high-risk investment practices, including credit default swaps. In addition, he believes the Federal Reserve is an opaque organization which gives too much support to large corporations. His pushed for a 2011 audit of the Fed and he would use the Fed to force banks into loaning more money to small businesses. Finally, he would ban financial industry executives from serving on the 12 regional boards of directors.

Guns: A mixed approach. No federal handgun waiting period. Some protection for gun manufacturers. Ban assault weapons.

In the House of Representatives, Sanders voted against the pro-gun-control Brady Bill, writing that he believes states, not the federal government, can handle waiting periods for handguns. Soon after, he voted yes for the 1994 Violent Crime Control and Law Enforcement Act that included an assault weapons ban. He has voted to ban some lawsuits against gun manufacturers and for the Manchin-Toomey legislation expanding federal background checks.

Health care: Change to single-payer government-provided health care

Sanders voted for the Affordable Care Act, but believes that the new health care law did not go far enough. Instead, he espouses a single-payer system in which the federal and state governments would provide health care to all Americans. Participating states would be required to set up their own single-payer system and a national oversight board would establish an overall budget.

Immigration: Offer path to citizenship. Waive some deportations now.

Sanders generally agrees with President Obama that most of the undocumented immigrants in the country now should be given a path to citizenship. He voted for the senate immigration bill in 2013, which would have increased border security and issued a provisional immigrant status to millions of undocumented residents once some significant security metrics had been met. In addition, Sanders has supported President Obama’s use of executive orders to waive deportation for some groups of immigrants, including those who were brought to the United States as children.

Taxes: Raise some taxes on the wealthy. Cut taxes for middle class.

The current ranking minority member on the Senate Budget Committee, Sanders would nearly double taxes on capital gains and dividends for the wealthiest two percent of Americans. In addition, this year Sanders asked President Obama to use executive action to close six tax deductions benefitting corporations and hedge funds. The Vermont senator would use some of the revenue gained from higher taxes on the rich to lower taxes for middle and lower class Americans.

Iraq, Islamic State and Afghanistan: Opposed the Iraq war. Calls for troop withdrawal as soon as possible.

A longtime anti-war activist, Sanders voted against the Iraq war resolution in 2002. He has regularly called for the U.S. to withdraw troops from Afghanistan and Iraq as soon as possible. Regarding the Islamic State, Sanders has said the U.S. should not lead the fight. In general, he believes the U.S. should focus less on international conflict and more on the domestic needs of the middle class.

Iran and Israel: Supports current talks with Iran. Critical of Israeli Prime Minister Benjamin Netanyahu.

In an interview with ABC News Sanders called the Clinton Foundation money, along with money from conservative sources, a very serious problem:

Sen. Bernie Sanders, I-Vermont, said he is concerned by the millions of dollars flowing into the Clinton Foundation at a time when he thinks money plays too strong a role in politics.

“It tells me what is a very serious problem,” Sanders said in an interview with ABC News’ Chief White House Correspondent Jonathan Karl. “It’s not just about Hillary Clinton or Bill Clinton. It is about a political system today that is dominated by big money. It’s about the Koch brothers being prepared to spend $900 million dollars in the coming election.

“So do I have concerns about the Clinton Foundation and that money? I do,” he added. “But I am concerned about Sheldon Adelson and his billions. I’m concerned about the Koch Brothers and their billions. We’re looking at a system where our democracy is being owned by a handful of billionaires.”

The issues in the above lists are primarily, but not exclusively, based on economic views. Sanders, as opposed to Clinton, also has a strong record of support for liberal positions on foreign policy and social issues. While it is inevitable that economic issues will dominate the campaign this year, I hope that during the course of the campaign more is said about both Clinton’s hawkish foreign policy views, along with her conservative cultural views.

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Marijuana, Needle Exchange Programs, And Clinton’s Cultural Conservatism

Clinton Marijuana

Following recent posts about Lincoln Chafee talking about running for the Democratic nomination I began looking to see if there are any other issues where the two have major differences besides Clinton’s support for the Iraq war, which he has been attacking Hillary Clinton on. which he has been attacking Hillary Clinton on. I was pleased to see that back in 2011 Chaffee called for a reclassification of medical marijuana from a Schedule I controlled substances, which puts states which have legalized medical marijuana at odds with federal laws.

Three years later, Martin O’Malley took this a step even further, signing a bill decriminalizing marijuana, while opposing outright legalization. Hillary Clinton, as would be expected from her overall cultural conservatism, has lagged behind the country, and the Democratic Party, on both legalization of marijuana and medical marijuana.

On a related issue, Clinton’s opposition to needle exchange programs, while certainly not a major issue, was also an early issue in the 2008 nomination battle which differentiated the political philosophies of Clinton from the more liberal Barack Obama. Martin O’Malley, who is also moving well to the left on economic issues, signed a bill allowing needle exchange in Maryland. Clinton and Obama also differed in 2008 on reforming sentencing for violation of drug laws. While Obama’s record on the drug war has certainly been mixed, I would hate to see a move further to the right under Clinton.

Clinton’s cultural conservatism and promotion of conservative causes has often been traced to her membership in The Fellowship while in the Senate. From Mother Jones in 2007:

Through all of her years in Washington, Clinton has been an active participant in conservative Bible study and prayer circles that are part of a secretive Capitol Hill group known as the Fellowship. Her collaborations with right-wingers such as Senator Sam Brownback (R-Kan.) and former Senator Rick Santorum (R-Pa.) grow in part from that connection…

That’s how it works: The Fellowship isn’t out to turn liberals into conservatives; rather, it convinces politicians they can transcend left and right with an ecumenical faith that rises above politics. Only the faith is always evangelical, and the politics always move rightward…These days, Clinton has graduated from the political wives’ group into what may be Coe’s most elite cell, the weekly Senate Prayer Breakfast. Though weighted Republican, the breakfast—regularly attended by about 40 members—is a bipartisan opportunity for politicians to burnish their reputations, giving Clinton the chance to profess her faith with men such as Brownback as well as the twin terrors of Oklahoma, James Inhofe and Tom Coburn, and, until recently, former Senator George Allen (R-Va.). Democrats in the group include Arkansas Senator Mark Pryor, who told us that the separation of church and state has gone too far; Joe Lieberman (I-Conn.) is also a regular.

Unlikely partnerships have become a Clinton trademark. Some are symbolic, such as her support for a ban on flag burning with Senator Bob Bennett (R-Utah) and funding for research on the dangers of video games with Brownback and Santorum. But Clinton has also joined the gop on legislation that redefines social justice issues in terms of conservative morality, such as an anti-human-trafficking law that withheld funding from groups working on the sex trade if they didn’t condemn prostitution in the proper terms. With Santorum, Clinton co-sponsored the Workplace Religious Freedom Act; she didn’t back off even after Republican senators such as Pennsylvania’s Arlen Specter pulled their names from the bill citing concerns that the measure would protect those refusing to perform key aspects of their jobs—say, pharmacists who won’t fill birth control prescriptions, or police officers who won’t guard abortion clinics.

Clinton has championed federal funding of faith-based social services, which she embraced years before George W. Bush did; Marci Hamilton, author of God vs. the Gavel, says that the Clintons’ approach to faith-based initiatives “set the stage for Bush.” Clinton has also long supported the Defense of Marriage Act, a measure that has become a purity test for any candidate wishing to avoid war with the Christian right…

The libertarian Cato Institute recently observed that Clinton is “adding the paternalistic agenda of the religious right to her old-fashioned liberal paternalism.” Clinton suggests as much herself in her 1996 book, It Takes a Village, where she writes approvingly of religious groups’ access to schools, lessons in Scripture, and “virtue” making a return to the classroom.

As noted in the above excerpt, Clinton’s affiliation with the religious right was seen in her support for the Workplace Religious Freedom Act , a bill introduced by Rick Santorum and opposed by the American Civil Liberties Union for promoting discrimination and reducing access to health care, along with her promotion of restrictions on video games and her introduction of a bill making flag burning a felony. Her social conservatism is also seen in her weak record on abortion rights, such as supporting parental notification laws and stigmatizing women who have abortions with the manner in which she calls for abortion to be “safe, legal and rare.”

(Links to additional material added on April 19)

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John Oliver Exposes Pharmaceutical Marketing

John Oliver and Last Week Tonight returned on HBO last weekend with a biting expose of the pharmaceutical industry (video above). Like Jon Stewart, Oliver’s comedy version of the news is far more revealing than what is seen on most actual news reports. Last Week Tonight also has the advantage of spending more time on a single story than either Jon Stewart or actual news shows.

Oliver pointed how how Americans are addicted to prescription drugs, spending almost $330 billion on them. He suggested that Walter White of Breaking Bad could have made a lot more money cooking up drugs for rheumatoid arthritis instead of meth. He lampooned the efforts of pharmaceutical companies to influence the prescribing habits of physicians, describing their ethics with this comparison:  “Drug companies are a bit like high school boyfriends; they are much more concerned with getting inside you than being effective once they are in there.”

Oliver concluded with a warning about doctors who take large amounts of money from the pharmaceutical industry with a mock public service commercial, Ask Your Doctor:

Here’s how it works. Money combines with the cash receptors in your doctor’s wallet to create fast-acting financial relief, so your doctor can rest easy and enjoy life.

Common side effects of doctors taking money may include chronic overprescription, unusually heavy cash flow, dependency on free samples, inflammation of confidence, affluenza and an increased tendency to suggest off-label prescriptions, which in turn can cause heart attack, stroke, loss of feeling in arms and legs, seizures, blurred vision, grinding of the teeth, temporary deafness, total blindness, numbness, sudden bursts of rage, angry erections lasting over 17 hours, and death.

Ask your doctor today if he’s taking pharmaceutical company money. Then ask your doctor what the money is for. Ask your doctor if he’s taken any money from the companies that make the drugs he’s just prescribed for you. Then ask yourself if you’re satisfied with that answer.

The story was quite accurate. If this was a documentary as opposed to a comedy show my only complaint is that it concentrates on one side of the story in portraying doctors who take money and are susceptible to pharmaceutical sales pitches. Many doctors actually are quite aware of the problem and many do not take any meaningful amount of money from pharmaceutical companies.

For example, Oliver quoted a drug rep as being disturbed when a doctor asked her for advice on treating a patient as she is just a poli-sci major. I often feel the opposite, when pharmaceutical reps act as if they are qualified to give me advice (invariably involving greater use of their drug), knowing how little pharmaceutical or medical background most of them have. While I do accept samples in order to help out patients, which requires me to have some contact with drug reps, I am certainly not going to consider anything they say to be anything other than advertising. One time I even had a drug rep run out of my office crying when I didn’t play long with her sales pitch. We also have not been too welcoming to the rare drug rep who attempts to get back into our sample room in order to put his drugs in front and hide the samples form the competition.

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Rand Paul’s Past May Catch Up With Him

Rand Paul

Paul Waldman reminds us of some of the nutty things Rand Paul has said in the past, such as his belief in the NAFTA Superhighway conspiracy theory and past statements on the Civil Rights Act. He got in trouble again this week, along with some other Republicans, when discussing measles vaccination. It is not surprising that Paul, as is the case with the many in the Tea Party faction of the Republican Party (along with some mainstream Republicans) has a history of association with anti-vaccine groups. Paul has gone further than most other Republicans in the past in both questioning the science of vaccines and questioning the right of the state to mandate vaccinations.

Waldman has a good suggestion as to why Paul has made it to the Senate despite a history of holding views which would have prevented others from winning such a position:

But that’s not the path Rand Paul followed. Whatever his talents, he’s a United States senator because he’s Ron Paul’s son. Over his time in Congress, Ron Paul developed a small but fervent national constituency, made up of some ordinary libertarians and a whole lot of outright wackos. That constituency was greatly expanded by his 2008 presidential campaign. Despite the fact that Paul had plenty of interesting and reasonable things to say, it’s also the case that if you were building a bunker to prepare for the coming world financial crash and ensuring societal breakdown (and possible zombie apocalypse), there was only one presidential candidate for you. When Rand Paul decided to run for Senate in 2010, having never run for anything before, the Ron Paul Army mobilized for him, showering him with money and volunteers. He also had the good fortune to be running in a year when Republicans everywhere were looking for outsider, tea party candidates, so he easily beat the choice of the Kentucky GOP establishment in the primary.

You may remember that early on, and unseasoned Rand Paul got in trouble for his ideas about things like the Civil Rights Act. But he quickly discerned what was acceptable and what wasn’t, and he set about moderating his views, sanding down the rough edges of libertarianism to find something that would fit more neatly within the Republican Party while also finding issues where he could say something distinctive. It’s been very effective, but you can’t erase the past.

And I’m guessing there’s more in Paul’s past that will be of interest now that we’re getting into the 2016 campaign. I don’t mean scandalous behavior, I mean scandalous notions. I wouldn’t be at all surprised if there are a dozen more videos like this one out there, in which the now-respectable senator says some alarming things to groups of people who revere his father in all the elder Paul’s eccentric glory. I could be wrong, of course—the NAFTA superhighway and vaccines causing autism may be the only conspiracy theories Rand Paul has ever entertained. But we’re going to find out.

Rand Paul is not Ron Paul and we cannot attribute all of Ron Paul’s nuttier views and actions to Rand without evidence. I do bet that plenty more will come out if he has to face the scrutiny of a presidential campaign, and his Republican opponents for the nomination won’t hesitate to begin the opposition research.

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A Bigger Computer Fiasco For The Obama Administration Than Healthcare.gov

The fiasco with the initial opening of the exchanges at healthcare.gov has become a well-known IT glitch from the Obama administration, but that might not turn out to be their biggest mistake regarding computers and health care. As it primarily involves physicians and hospitals, as opposed to the general public, far fewer people are aware with the ongoing problems regarding implementation of Meaningful Use Stage 2 requirements for electronic medical records.

The original stimulus package after Barack Obama took office included a program to provide funds to medical practices to be used for conversion to electronic medical records. In order to qualify for the incentive payments, physicians and hospitals have to follow a set of Meaningful Use requirements which have increased requirements for each stage. Initially there would be incentive payments (which turned out to be far less than the costs of conversion to electronic medical records), and subsequently there are penalties for failing to comply. The first stage was successful in terms of getting large numbers of doctors to adopt electronic medical records, but it is more questionable as to whether this is really resulting in the desired cost savings.

Stage 2 was initially required by October 2014. This would have greatly increased the use of electronic medical records, possibly resulting in more medical cost savings, but the requirements were unrealistic. The law originally required that physicians comply with the requirements of Stage 2 for a 90 day period in 2014, which essentially meant that we could wait until October 1 to implement them. When it was apparent that most physicians could not comply with this, the government postponed this until January 2015.

It was quickly apparent that this was no solution, partially as the new requirements required a full twelve months of compliance with the Stage 2 rules. By requiring compliance by this January, this only gave an additional three months. The same problems which prevented compliance with the rules by October 2014 are still present this January.

The biggest obstacle is that the rules require communication between systems which do not exist in the present software. Before making such requirements, the government should have set up a secure system for communication between computer systems rather than hoping that each individual vendor would offer a solution. Another problem is that the requirements include factors which are outside of a medical office’s control. For example, a medical office could set up a patient portal as required in order for patients to assess medical information. However, there are requirements not only to establish this, but for five percent of patients to utilize it. Many physicians, such as those with primarily elderly patients are especially concerned that not enough will even be interested in using such computerized tools. Fortunately this requirement was at least reduced from ten percent in the original regulations to five percent.

Compliance with the rules is further complicated by it being all or nothing. A medical office might follow 90 percent of the rules but will get zero incentive money and pay the full penalties for non-compliance. There are some exclusions and some flexibility in some areas, but this still creates far too great a burden on physician practices.

When the government first changed the rules last fall delaying the requirements for Stage 2 until January, some members of Congress did realize that this was not long enough to have any impact. There was a bipartisan bill introduced to reduce the requirements for a 90 day period in 2015, essentially giving physicians until October instead of January. This was not introduced until shortly before Congress went on recess prior to the election, and died before the end of the last session. Earlier this month Renee Ellmers (R-N.C.) and Ron Kind (D- Wis.) introduced The Flexibility in Health IT Reporting (Flex-IT) Act of 2015 to restore the 90 day requirement. The bill also has the support of organizations including the American Academy of Family Physicians, American Hospital Association, American Medical Association, College of Healthcare Information Management Executives and Medical Group Management Association.

Even this only postpones the problem and we don’t know if the technology will be any better this fall than it is now. A recent survey of physicians found that 55 percent do not plan to attest to Stage 2, despite the financial penalties.

This failure in the implementation of computerized medical records could be a far worse fiasco than the initial roll out of the exchanges under the Affordable Care Act. The manner in which the Obama administration quickly fixed that problem turned out to be a tremendous success, and this problem is also fixable. A real fix will take more than just postponing requirements.

The government must rethink the logic behind the requirements. Most industries have computerized on their own without being forced to by the government. Some government assistance in conversion to electronic medical records would be helpful, such as establishing standards for communication between systems. Physicians must also be given flexibility to determine for ourselves which aspects of computerization are really of value for caring for our patients and which are not, rather than being forced to follow a long set of rules and only receive credit for 100 percent compliance, or being dependent on factors beyond our control.

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PolitiFact Lie of The Year: Exaggerations about Ebola

Conservatives used Ebola as one means of spreading fear, helping them in the 2014 midterm elections. PoltiFact has now made exaggerations about Ebola their 2014 Lie of the Year. This includes both conservative hysteria which greatly exaggerated the threat faced in a developed nation such as the United States and many of the right wing conspiracy theories. I have already discussed many of these false claims, often in the context of debunking right wing attempts to restrict civil liberties while ignoring the science. From PoltiFact:

Thomas Eric Duncan left Monrovia, Liberia, on Sept. 19, for Dallas. Eleven days later, doctors diagnosed Duncan with Ebola.

Eight days after that, he was dead.

Duncan’s case is just one of two Ebola-related fatalities in the United States, and since Duncan traveled to Dallas, more Americans — at least nine, and likely many more — have died from the flu.

Yet fear of the disease stretched to every corner of America this fall, stoked by exaggerated claims from politicians and pundits. They said Ebola was easy to catch, that illegal immigrants may be carrying the virus across the southern border, that it was all part of a government or corporate conspiracy.

The claims — all wrong — distorted the debate about a serious public health issue. Together, they earn our Lie of the Year for 2014…

Fox News analyst George Will claimed Ebola could be spread into the general population through a sneeze or a cough, saying the conventional wisdom that Ebola spreads only through direct contact with bodily fluids was wrong.

“The problem is the original assumption, said with great certitude if not certainty, was that you need to have direct contact, meaning with bodily fluids from someone, because it’s not airborne,” Will said. “There are doctors who are saying that in a sneeze or some cough, some of the airborne particles can be infectious.” False.

U.S. Sen. Rand Paul, R-Ky., described Ebola as “incredibly contagious,” “very transmissible” and “easy to catch.” Mostly False.

Internet conspirators claimed President Obama intended to detain people who had signs of illness. Pants on Fire. Bloggers also said the outbreak was started in a bioweapons lab funded by George Soros and Bill Gates. Pants on Fire.

A Georgia congressman claimed there were reports of people carrying diseases including Ebola across the southern border. Pants on Fire. Sen. John McCain, R-Ariz., said Americans were told the country would be Ebola-free. False.

When combined, the claims edged the nation toward panic. Governors fought Washington over the federal response. The Centers for Disease Control and Prevention stumbled to explain details about transmission of the virus and its own prevention measures. American universities turned away people from Africa, whether they were near the outbreak or not.

The post went on to discuss the actual medical facts.

Not surprisingly the misinformation came from many of the usual subjects such as Fox and Republicans such as John McCain and Rand Paul. Their conspiracies theories also involved the usual subjects of right wing attacks like Barack Obama and George Soros.

At least one good thing did come about from the Ebola hysteria. Republicans, with the help of the NRA, had blocked the appointment of Vivek Murthy for Surgeon General for months. The Ebola outbreak placed increased attention on this vacancy and he was finally confirmed by the Senate today.

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Court Rules Against Quarantine Of Hickox Representing A Victory For Science And Civil Liberties

A judge in Maine has ruled against the quarantine of Kaci Hickox which the governor of Maine has attempted to impose, agreeing with the medical evidence that Hickox “currently does not show symptoms of Ebola and is therefore not infectious.” This is a victory for Hickox personally, along with a victory for both science and civil liberties.

The politicization of Ebola has demonstrated the usual divisions between left and right in this country. As on so many other issues, the right wing has rejected scientific findings, distorted scientific information which conflicted with their political goals, and ignored the rights of the individual. This also provides another example of the emptiness of Republican claims of wanting to keep government out of health care decisions.

While the media has concentrated on a small number of people who have returned from West Africa, Médecins Sans Frontières (Doctors Without Borders) has had a staff of over 3300. Of these 3300 MSF staffers, only 23 have contracted Ebola. The staff includes over 700 who came to West Africa from other nations with only one developing symptoms of Ebola after he returned home.The one doctor who did return to New York subsequently followed protocols for continued monitoring and was hospitalized prior to spreading the infection to anyone else.

With these odds, there is no justification in assuming that Hickox, or any other medical worker, is infected with Ebola merely due to having worked in the affected nations. People who are infected have a very low viral load early and do not spread the disease until after they exhibit symptoms, which Hickox has not done. It is becoming increasingly unlikely that she will. While a twenty-one incubation period is commonly cited by the media, and should be used as a precaution, in reality the vast majority of patients exhibit symptoms in six to twelve days. Monitoring for twenty-one days provides an ample additional margin of safety to the public.

While some Republicans have played politics with the issue and, as happens far too often, some Democrats such as Andrew Cuomo initially acquiesced in fear, the guidelines from the CDC and precautions already in effect are sufficient to protect the public and, to err on the side of safety, call for greater restrictions than are necessary based upon the science. There is no need for politicians to go beyond these precautions and unjustly restrict the civil liberties of Americans. The monitoring protocols already in place from Doctors Without Borders can be seen here.

In response to the controversy engendered by those who have been ignoring the science, the American Nurses Association released this statement on October 29:

The American Nurses Association (ANA) opposes the mandatory quarantine of health care professionals who return to the United States from West African nations where Ebola is widespread. ANA supports registered nurse Kaci Hickox, who recently returned to the United States after treating Ebola patients in Sierra Leone, in her challenge of a 21-day quarantine imposed by state officials in Maine, her home state. Hickox arrived at Newark airport on Oct. 24 and was immediately quarantined in a hospital tent by New Jersey state officials, who eventually allowed her to travel to Maine via private transport on Oct. 27. After testing negative twice for Ebola, nurse Hickox, who continues to be symptom free, poses no public threat yet is restricted to her home.

ANA, along with the American Hospital Association and American Medical Association, supports the Centers for Disease Control and Prevention’s (CDC) guidance based on the best available scientific evidence. The CDC guidance would not require a mandatory 21-day quarantine of Hickox given risk levels outlined by the CDC in her particular case. ANA urges authorities to refrain from imposing more restrictive conditions than indicated in the CDC guidelines, which will only raise the level of fear and misinformation that currently exists.

ANA supports a policy of appropriate monitoring for health care workers who have cared for or been in contact with patients with Ebola. Those who are not exhibiting symptoms of illness consistent with Ebola do not require quarantine. Monitoring should follow recommendations outlined by the CDC based on risk levels and the presence or absence of symptoms, including regular monitoring of body temperature and oversight by a public health agency. If symptoms do occur, the appropriate next step is isolation and transport to a medical facility for further evaluation. ANA seeks to balance protection of public health and safety with individual liberties. Policies to protect the public from the transmission of Ebola must be based on evidence and science, not fear.

Mandatory quarantine for individuals who do not have symptoms or risk factors is not backed by science. Such actions undermine efforts to recruit sufficient numbers of volunteer nurses and other health care professionals, who are essential to help contain the spread of the disease in West Africa.

ANA’s position emphasizing evidence and science as the foundation for decision-making extends to proposals to ban travel to the United States from West African nations affected by the Ebola outbreak. There is no evidence to suggest that a travel ban would be effective; public health experts oppose it. In fact, a ban could be counterproductive, encouraging individuals to try to circumvent reporting and other systems. ANA supports the current requirement that those traveling to the U.S. from affected nations in West Africa, including health care professionals who have provided care to Ebola patients, once they have passed initial screening, engage in monitoring according to CDC guidelines and reporting to their respective public health agencies.”

Multiple other medical organizations have issued statements in opposition to imposing quarantines including the American Medical Association, the Infectious Diseases Society of America, and the Association for Professionals in Infection Control and Epidemiology.

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Ebola Hysteria Leads To Lousiana Interfering With Medical Conference

The hysteria continues regarding Ebola. We still don’t know how things will turn out with Kaci Hickox’s fight against the unconstitutional restrictions on her civil liberties when she returned from West Africa, and I’ve heard a doctor who is returning from West Africa also plans to resist the unscientific quarantine requirements.  We continue to face a variety of right wing conspiracy theories.

NPR reports on yet another counterproductive action arising from the current hysteria–preventing scientists from participating in a conference, which could interfere with the development of a disease or cure for Ebola:

Louisiana health officials say that anyone who’s been in an Ebola-affected country over the last three weeks will be quarantined in their hotel rooms.

The American Society of Tropical Medicine and Hygiene is telling researchers who’ve recently traveled to Ebola-affected parts of West Africa that they can’t come to the society’s annual meeting. That wasn’t the medical group’s idea.

The convention opens this weekend at the New Orleans Sheraton, but the specialists with the most current experience with Ebola in the field aren’t expected to be there.

The Louisiana Department of Health and Hospitals just ruled that anyone who’s been in Sierra Leone, Liberia or Guinea in the past three weeks “should NOT travel to New Orleans to attend the conference.” (That big “NOT” is in the original letter.)

“While the state of Louisiana’s policies are outside of the scientific understanding of Ebola transmission — and acknowledged by the state health officials’ own admission — we recognize that the state has determined its policy in this matter,” the society said in a statement. “ASTMH does not agree with the policy as outlined by the Louisiana DHH…

Dr. Piero Olliaro had big plans for the conference.

“This is the place to be,” says Olliaro, a researcher at Oxford University who specializes in setting up clinical trials to test drugs in the developing world. “It’s once a year. This is where you get to meet all the others.”

Olliaro was going to present several papers on his recent work involving treatments for malaria and river blindness. But two weeks ago he was in Guinea for the World Health Organization scouting a site to test an experimental Ebola medication.

Yesterday Olliaro got a letter from the Louisiana health department saying that anyone who’d been in Sierra Leone, Liberia or Guinea in the past 21 days would be quarantined…

Olliaro, who’s in England, says the decision is unfair, unwarranted and not based on medical science. But he’ll abide by it…

Olliaro says the problem is much larger than just this one convention. The world’s leading tropical disease researchers often fly back and forth from Africa to their labs in the United States.

The new patchwork of Ebola-related travel bans and quarantine policies, he says, make it unclear whether they’ll be able to continue to do that. And that could ultimately undermine research into a vaccine or cure for this terrifying viral disease.

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Kaci Hickox Is A Hero–Now On Two Counts

Kaci Hickox is a hero. First for volunteering to help treat Ebola patients, as eradicating Ebola in West Africa is the only way to handle this disease. She became a hero again for standing up to unjust restrictions upon her civil liberties upon returning home and supporting the concept of making political decisions based upon science and reason as opposed to giving in to public hysteria.

It was Hickox’s protests which forced Governors Christie and Cuomo to back away from guidelines policies which were both unnecessary and counterproductive. Some state governments are still going beyond the extremely cautious CDC guidelines with policies such as home quarantine of individuals who show no sign of the disease for twenty-one days. We know that this is unnecessary based both upon our knowledge of how the Ebola virus is transmitted and based upon our experience to date.  Ebola is not contagious early in the disease and is not transmitted by casual contact. While highly contagious when people are having symptoms such as projectile vomiting and uncontrolled diarrhea, those who do not have symptoms are not contagious. People with Ebola do not yet pose a danger of spreading the disease when they initially reach the CDC’s threshold of a fever of 101.4 degrees, and they certainly are not contagious before reaching this point.

We have seen one patient in Texas be released in error by an Emergency Room and return to the community. We have seen a nurse later revealed to be infected with Ebola fly with a low grade fever. We have had a doctor traveling around a city as densely populated as New York City just prior to meeting criteria for isolation. Not a single person has contracted Ebola due to contact with these individuals. That is the nature of the disease.

Kaci Hickox, well aware of the science, has stated she plans to fight the involuntary home quarantine being imposed:

“I will go to court to attain my freedom,” Hickox told “Good Morning America” today via Skype from her hometown of Fort Kent, Maine. “I have been completely asymptomatic since I’ve been here. I feel absolutely great.”

One of her attorney’s explained her legal position:

New York civil rights lawyer Norman Siegel, said she would contest any potential court order requiring her quarantine at home.

“The conditions that the state of Maine is now requiring Kaci to comply with are unconstitutional and illegal and there is no justification for the state of Maine to infringe on her liberty,” he said.

Hickox will abide by daily monitoring, as recommended the by updated guidelines released Monday by the federal Centers for Disease Control and Prevention, Hyman said. She has been in regular contact with state health officials, Siegel said.

U.S. CDC Director Tom Frieden called for isolation of people at the highest risk for Ebola infection but said most medical workers returning from the three African nations at the center of the epidemic — Sierra Leone, Liberia and Guinea — would require daily monitoring without isolation.

The new guidelines recommend considering isolation only for individuals exposed to Ebola who show symptoms. Those with no signs of illness should be monitored for 21 days after the last potential exposure, with symptom-free individuals at the highest risk subject to “restricted movement within the community” and no travel on public transportation, according to the guidelines…

“She understands the nature of the disease, she treated it,” Hyman said. “She understands the nature of the risk.”

The American Civil Liberties Union has posted an article on the over-reaction to Ebola coming from some politicians, in contrast to the more rational guidelines proposed by the Center for Disease Control and the Obama administration:

One over-reaction to the disease that has emerged is a proposal for a blanket travel ban from the affected countries in West Africa. Public health experts say that such bans are not necessary, would not be effective, and would be a poor use of resources. Worse still, experts say they would most likely make matters worse by further isolating the countries where the outbreak is taking place, worsening the situation in those countries and therefore the threat to the United States. Travel bans “hinder relief and response efforts risking further international spread,” as the World Health Organization warned. Experts say such bans would also inevitably drive travelers underground, making it difficult to retrace the path of a disease when a case does appear.

Proposals to close the border to all travelers from affected nations are not a scientifically and medically legitimate exercise of government power and therefore would be arbitrary and discriminatory whether applied to citizens or non-citizens.

Now, of course, we are also seeing the questionable use of quarantine powers in some states. Medical experts have opposed such steps given that Ebola is not transmissible until after a fever begins and is not a highly transmissible disease generally, and given that individuals have strong incentives to carefully monitor themselves. Doctors Without Borders, for example, has condemned these quarantines as a threat to its battle against the disease in Africa. It cites the effect the quarantines will have in deterring doctors and nurses from taking the already remarkably brave step of entering the fight against the disease—and in stigmatizing them when they do. In short such quarantines threaten to weaken the most effective weapon we have in stopping the disease at its source. (It’s also shameful to treat returning health care workers, who have put their own lives at risk to help others, as anything less than heroes.)

Where individuals cooperate with the authorities in allowing close monitoring of their health and other reasonable precautions, the imposition of quarantines on those without symptoms appears to be driven by politics rather than science, and therefore raises serious civil liberties concerns.

While some political leaders have acted out of fear, Obama Administration officials deserve praise for largely sticking to science and not caving in to some of the fear mongering that is swirling around them. The White House has prioritized medicine over politics. It has resisted calls for travel bans, tried to persuade the governors of New Jersey and New York to reconsider their quarantines, and has largely followed the advice of public health experts in the recommendations that they have made. The Administration has also taken helpful steps such as expediting emergency FDA authorization for the use of new machines for rapid detection of the Ebola virus—which could allow detection of the disease before symptoms appear.

In fact, the Obama Administration has a history of good policy on communicable diseases. As we described in a 2009 white paper on that year’s H1N1 flu scare, the Administration acted calmly and appropriately in response to that epidemic, and overall, President Obama has turned away from his predecessor’s military/law enforcement approach to fighting disease, which we criticized in detail in our 2008 report on pandemic preparedness.

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Arguing Against Counterproductive Hysteria Over Ebola

While the outbreak of Ebola began in West Africa about ten months ago, we have now had only nine patients with Ebola in this country. Most were brought in for treatment after contracting it elsewhere. One is currently undergoing treatment. One died. All the rest have recovered. There have been zero cases of transmission in the general population but two nurses have become infected while treating the patient who died.

There is a remarkable amount of hysteria in this country for a disease which has had so little actual impact. Some of this is natural fear, seeing how less developed nations have been affected, and some is due to hysteria being generated by Republican politicians for political gain. Unfortunately the proposals made by Republicans would be counterproductive, making it harder to treat Ebola at its source. Eliminating Ebola in West Africa is the only way to eliminate the problem and prevent further spread.

This is also turning out to be a learning experience, at least for those who respect science and are willing to consider the facts. In terms of treatment, hospitals around the country have learned from the mistakes made in Texas, and these are not likley to be repeated.

In terms of the political reaction, there are many sources which are trying to counter the over-reaction with reason. As we have seen on so many issues, some will pay attention to the facts, and others won’t.

The New England Journal of Medicine has released their editorial for next week’s issue, which includes a repetition of how Ebola is transmitted and the dangers of over-reaction:

The governors of a number of states, including New York and New Jersey, recently imposed 21-day quarantines on health care workers returning to the United States from regions of the world where they may have cared for patients with Ebola virus disease. We understand their motivation for this policy — to protect the citizens of their states from contracting this often-fatal illness. This approach, however, is not scientifically based, is unfair and unwise, and will impede essential efforts to stop these awful outbreaks of Ebola disease at their source, which is the only satisfactory goal. The governors’ action is like driving a carpet tack with a sledgehammer: it gets the job done but overall is more destructive than beneficial.

Health care professionals treating patients with this illness have learned that transmission arises from contact with bodily fluids of a person who is symptomatic — that is, has a fever, vomiting, diarrhea, and malaise. We have very strong reason to believe that transmission occurs when the viral load in bodily fluids is high, on the order of millions of virions per microliter. This recognition has led to the dictum that an asymptomatic person is not contagious; field experience in West Africa has shown that conclusion to be valid. Therefore, an asymptomatic health care worker returning from treating patients with Ebola, even if he or she were infected, would not be contagious. Furthermore, we now know that fever precedes the contagious stage, allowing workers who are unknowingly infected to identify themselves before they become a threat to their community. This understanding is based on more than clinical observation: the sensitive blood polymerase-chain-reaction (PCR) test for Ebola is often negative on the day when fever or other symptoms begin and only becomes reliably positive 2 to 3 days after symptom onset. This point is supported by the fact that of the nurses caring for Thomas Eric Duncan, the man who died from Ebola virus disease in Texas in October, only those who cared for him at the end of his life, when the number of virions he was shedding was likely to be very high, became infected. Notably, Duncan’s family members who were living in the same household for days as he was at the start of his illness did not become infected…

The American College of Physicians has made the same argument:

The American College of Physicians is strongly concerned about the approach being taken by some state health departments to impose strict, mandatory quarantines for all physicians, nurses, and other health professionals returning from West Africa, regardless of whether they are showing symptoms of Ebola virus infection. ACP agrees that physicians and other health professionals must take the necessary precautions to ensure the safety of others and prevent the spread of infection. However, the College maintains that mandatory quarantines for asymptomatic physicians, nurses and other clinicians, who have been involved in the treatment of Ebola patients, whether in the United States or abroad, are not supported by accepted evidence on the most effective means to control spread of this infectious disease. Instead, such mandatory quarantines may do more harm than good by creating additional barriers to effective treatment of patients with Ebola and impede global efforts to contain and ultimately prevent further spread of the disease…

Some newspapers, such as The New York Times, have repeated these arguments for a larger audience:

The Dangers of Quarantines

Ebola Policies Made in Panic Cause More Damage

… two ambitious governors — Chris Christie of New Jersey and Andrew Cuomo of New York — fed panic by imposing a new policy of mandatory quarantines for all health care workers returning from the Ebola-stricken countries of West Africa through John F. Kennedy and Newark Liberty international airports. There is absolutely no public health justification for mandatory quarantines…

Lost in this grandstanding was one essential point. The danger to the public in New York in the case of Dr. Craig Spencer, who had worked in Guinea for Doctors Without Borders, was close to nonexistent. Health experts are virtually unanimous in declaring that people infected with the virus do not become contagious until after they develop a fever or other symptoms, such as diarrhea, vomiting, or severe headaches, at which time they need to be hospitalized and taken out of circulation.

Health care workers like Dr. Spencer know that it is in their interest to ensure that — if symptoms do arise — they get care quickly to improve their chances of survival and to reduce the risk of infecting their friends and families. Dr. Spencer reported his temperature promptly when it was a low-grade fever of a 100.3 degrees and was rushed to Bellevue Hospital Center for isolation and treatment while his fiancée and two friends were put into voluntary isolation…

The problem with a mandatory quarantine, even if done at home, is that it can discourage heath care workers from volunteering to fight the virus at its source in West Africa. Doctors Without Borders, the nongovernmental organization that has led the battle there, typically sends its workers on arduous four- to six-week assignments. The risk of being quarantined for another 21 days upon return has already prompted some people to reduce their length of time in the field and may discourage others from volunteering in the first place…

Fortunately the response has been more rational at the federal than state level, including the statement from Barack Obama earlier today, pointing out that “If we don’t have robust international response in West Africa, then we are actually endangering ourselves here back home.”

President Obama pledged support for health care and aid workers in West Africa Tuesday, saying new rules for monitoring them for Ebola once they return to the United States would be “sensible and based on science.”

Obama gave brief remarks on the federal response to the disease after speaking with U.S. aid workers on the front lines of battling Ebola in West Africa.

“They’re doing God’s work over there, and they’re doing that to keep us safe, and I want to make sure that every policy we put in place is supportive of their efforts. Because if they are successful, then we’re not going to have to worry about Ebola here at home.”

Besides being counterproductive, there are civil liberties concerns when the government forcibly quarantines people who do not have the disease or who are not contagious.

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