Why Even Good Hospitals And Doctors Are An Obstacle To Better, Cheaper Healthcare

As we noted in the context of antibiotics, it's well recognized that financial incentives cause the pharmaceutical industry to engage in research that tends to maximize profits rather than maximizing the health of the public. But a widely-circulated article in the Washington Post reveals another kind of bias that may stop us from adopting better ways of keeping people healthy that would also reduce healthcare costs. 

On Techdirt.

TTIP's "Science-based" Assault on Democracy Begins

Last month I predicted that one of the main tropes that would be used in the TAFTA/TTIP negotiations would by that of "science-based" policy. As I pointed out then, this is a trick, since the "science" actually consists of work by scientists working for big companies that want to push their products with minimal health and safety oversight by independent laboratories.

A great article from Public Citizen shows that this line of attack has already been deployed in a series of submissions hammering home the idea to both the US and EU delegations:

Food Safety

• “Science-based risk assessment, as the foundation for regulatory decisions, must not be overruled by an incorrect (and politically driven) application of the precautionary principle, as currently applied by the EU” (Croplife America, a lobbying group of U.S. pesticide corporations that includes genetically-modified-organism (GMO) giant Monsanto)
• “Finally, the EU’s political approach in regulating crops enhanced with traits achieved through modern biotechnology procedures is a concern to U.S. wheat producers. The EU biotechnology approval process is slow and often influenced more by politics than science, creating uncertainty and deterring new investment in wheat research… Science and market preferences, not politics, should be the determinants.” (U.S. Wheat Associates)
• “The current 'asynchronous approval' situation is caused by many factors, including risk assessment guidelines that are not aligned and increasing politically-motivated delays in product approvals.” (National Grain & Feed Association and North American Export Grain Association, lobbying groups comprised of the largest U.S. agribusinesses, such as Cargill and Archer Daniels Midland)
• “International trade rules fully support trade in products of biotechnology for planting, processing and marketing, subject to science-based regulation… Politically motivated bans or moratoria by WTO member states are not consistent with members’ WTO obligations.” (National Corn Growers Association)
• “The implementation of production standards based on politics or popular thought instead of science will do nothing more than eliminate family operations and drive up costs to consumers.” (National Cattlemen's Beef Association, a factory-farm-supporting lobbying group for the beef industry)
• “What is deeply concerning about the EU’s overall approach to SPS [sanitary and phytosanitary] issues, however, is that its political body is frequently given the ability to override the EU’s own scientific authority’s findings to instead establish restrictions on products based typically on animal welfare or consumer preferences.” (National Milk Producers Federation & U.S. Dairy Export Council)

 Product Safety

• “Significant barriers to further alignment, namely politics and differences in regulatory approach, remain on both sides of the Atlantic. Our experience has also shown that politics and differences in regulatory philosophy are fundamentally the root causes for differences in toy safety standards… Frequently, standards that are stricter than their international counterparts are promulgated due to political influence or the (often unstated) desire to erect technical barriers to trade, and not predicated by science or risk factors.” (Toy Industry Association and Toy Industries of Europe)
• “We would like to highlight the fact that these regulatory differences are often politically motivated… We regret that the differences in regulations in the EU and US are often caused by the result of politics rather than a different approach to ensuring safety.” (Toy Industries of Europe)
• “Such discussions need to take place between technical, not political or administrative, entities and need to make business sense for the organizations involved.” (ASME, a lobbying group for engineers -- the first U.S. "non-profit" entity convicted for violating antitrust laws)

Some of the statements there are truly incredible - for example, the idea that animal  welfare or consumer preferences have no place in a country's trade policy, or that standards "stricter than their international counterparts" are somehow bad, and should be forbidden (isn't that what we should be striving for - doing better than the average?)  The latter also confirms what I've noted elsewhere: that the only way TTIP can "succeed" on its own terms is if all health and safety standards are levelled *downwards*, to the detriment of the public.

But the most significant point that emerges from the above is the false opposition between that "science-based" method and the "politically-motivated" approach.  As rightly pointed out by Public Citizen:

the "political" bodies the corporations fear are the democratically elected representatives of the people.  

Without realising it, the corporations are revealing their profound contempt for democracy, and for the right of citizens to choose the laws that govern them.  Instead, the huge multi-nationals are asserting the primacy of profit - and of their right to over-rule local laws.  I've warned about this previously, specifically in the case of Monsanto, but it's still frightening to see the naked expression by companies of their desire to see law trumped by lucre.

Why has Monsanto "Quit" Europe? The Answer is ISDS in TAFTA/TTIP

The battle to bring GM food to Europe has been fiercely fought for years.  Most assumed it would be continue to rage for many more. Which makes this recent announcement extremely surprising:

The world's largest producer of seeds, Monsanto, has apparently given up on attempts to spread its genetically modified plant varieties in Europe. A German media report said the firm would end all lobbying for approval.

The German newspaper "taz" reported Friday that US agriculture behemoth Monsanto had dropped any plans to have farmers grow its genetically modified (GM) plant varieties in Europe.

Monsanto Europe spokesman Brandon Mitchener was quoted as saying the company would no longer engage in any lobbying fur such plants on the continent, adding that at the moment the firm was unwilling to apply for approval of any GM plants.

This is very curious.  Monsanto may be many things, but it is not a company that  gives up.  However, there is a clue in the last sentence of the above quotation: "at the moment the firm was unwilling to apply for approval of any GM plants". That suggests this is only a temporary halt, and that it will be back.

So why might it do that? Is there anything happening that might have triggered this move?

Why, yes: TAFTA/TTIP.  In fact, the issue of GM crops is likely to be one of the biggest sticking points.  The US side is insisting that "Sanitary and Phytosanitary" (SPS) measures must address GM foodstuffs, with the European side adamant that it won't drop its precautionary principle.

So how might that apparent contradiction be resolved?  A recent meeting on SPS gives a clue:

WTO members celebrated the 50th anniversary of 186-member Codex Alimentarius, which sets international standards for food safety, by calling, on 27–28 June 2013, for continued support for the body, and for trade measures to be based on science.

The calls came in a two-day meeting of the WTO’s Sanitary and Phytosanitary Measures (SPS) Committee, which consists of all 159 WTO members and deals with food safety and animal and plant health — measures having an increasing impact on trade. 

 Specifically:

“The increase in the number of SPS measures that are not based on international standards, guidelines and recommendations, or that lack scientific justification, is a point of concern that has often been raised by many members in the SPS Committee and other contexts,” Brazil observed.

The discussion of the six new specific trade concerns and the 10 previously raised and discussed in this meeting reflected that theme.

They covered; processed meat, genetically modified organisms (GMOs), restrictions related to the Japanese nuclear plant accident, orchid tissue culture plantlets in flasks, citrus fruits (a complaint by South Africa against the EU about black spot, which is the first dispute settlement case in the International Plant Protection Convention), offal, salmon, pesticide residues, sheepmeat, phthalates (materials added to plastics in food and drink containers) in wines and spirits, shrimp, mad cow disease (BSE), GMO pollen in honey, Indonesia’s port closures, and pine trees and other products.

As can be seen there, GMOs are mentioned twice.

Well, "trade measures to be based on science" sounds reasonable enough, doesn't it?  Except, as I've discussed at some length recently, the "science" actually means "scientists employed by companies"; that is, it is far from being independent or disinterested.  By redefining such company testing as "scientific", it can then be used to push through products that have never been tested by national food safety bodies.

This approach seems certain to crop up during the TAFTA/TTIP negotiations, and would offer Monsanto a fresh opportunity to push its GM products in the EU.  What it will be aiming for is that US "testing" must be accepted in the EU too - that's precisely what TAFTA/TTIP is all about - which would mean automatic approval for its products there.  Hence the recent pull-out - it won't even need to make applications in the future.

But it gets even better for Monsanto.  Another key area for TAFTA/TTIP is investor-state dispute settlement (ISDS).  Again, I've written extensively about this elsewhere. Here I just want to explore how Monsanto might use it to blackmail European governments into accepting GM crops.

Essentially, ISDS allows companies to sue entire countries or even regions like the EU for alleged loss of future profits (see this terrifying example from Canada.)  So once TAFTA/TTIP is signed with ISDS provisions, Monsanto will be able to threaten to sue the EU and its member states if they don't allow its GM products to be sold there.  

The logic would be that it invested money in Europe in the "reasonable" expectation - based on "science", of course - that it could sell its products as a result.  Since the EU authorities and national governments have proved so hostile to GM, it was unable to do that.  It would therefore claim that it could sue the EU for hundreds of millions - possibly billions - of  Euros for its "lost" profits.

This is not some mad fantasy: it is already playing out around the world, as governments find that they cannot apply laws designed to protect public health and safety, since they would have the knock-on effect of reducing some multinational's profits, and therefore makes them subject to ISDS claims.

I believe this is the main reason for Monsanto's temporary pull-out from the European approvals process: it feels confident that ISDS provisions will be included in TAFTA/TTIP - indeed, both the EU and US sides have said they want them - and equally confident that it will be able to sue the socks off the EU and national states if they don't simply wave through GM products in their markets, no further approval required....

The Healthiest Kind of Commons

Creating a commons is all about sharing, and there can be few areas where sharing is more mutually beneficial than health. After all, everyone aspires to good health, and the best way to get that is to pool what we know. Surprisingly, that doesn't happen as much as it could at the moment, because antiquated ways of looking at medical knowledge - shaped by pharmaceutical companies - try to enclose as much of the commons as possible.

Happily, others are fighting that tendency. Here's the latest manifestation, called the Health Commons, from the same bunch of idealistic nutters that brought you the Science Commons:

Health Commons is a coalition of parties interested in changing the way basic science is translated into the understanding and improvement of human health. Coalition members agree to share data, knowledge, and services under standardized terms and conditions by committing to a set of common technologies, digital information standards, research materials, contracts, workflows, and software. These commitments ensure that knowledge, data, materials and tools can move seamlessly from partner to partner across the entire drug discovery chain. They enable participants to offer standardized services, ranging from simple molecular assays to complex drug synthesis solutions, that others can discover in directories and integrate into their own processes to expedite development — or assemble like LEGO blocks to create new services.

The Health Commons is too complex for any one organization or company to create. It requires a coalition of partners across the spectrum. It is also too complex for public, private, or non-profit organizations alone - reinventing therapy development for the networked world requires, from the beginning, a commitment to public-private partnership. Only through a public-private partnership can the key infrastructure of the Commons be created: the investments in the public domain of information and materials will only be realized if that public domain is served by a private set of systems integrators and materials, tools and service providers motivated by profit. And in turn, the long-term success of the private sector depends on a growing, robust, and self-replenishing public domain of data, research tools, and open source software.

Good to see open source being mentioned explicitly here: it does, indeed, form the basis of all these commons efforts, because it provides a completely flexible infrastructure that is also completely free.

Google+Open Access = Health

Doctors in doubt about a patient's ailment could use Google to help them reach a diagnosis, researchers said today.

Two Australian doctors have found that entering the symptoms of a tricky case into the internet search engine often results in accurately diagnosing the illness.

This story has an interesting implication. One easy way to improve the quality of the results - and hence the quality of the diagnosis and subsequent therapy - would be to release more medical literature as open access. Then, by definition, it would be picked up by Google, which would feed through the results to the medics.

Open access: you know it makes sense.