Joe Lieberman -- for what seems like the umpteenth time -- says he'll join Blanche Lincoln and filibuster health care reform if it includes a public option:

Transcript:

SEN. LIEBERMAN:  Well, I voted last night, as 59 others did, to go ahead with the debate because I, I want us to begin not only debating healthcare reform, but doing something about healthcare reform.  But I don't think anybody feels this bill, as Senator Reid put it down, though he made a lot of progress in blending bills together, I don't think anybody thinks that this bill will pass as it is.

MR. GREGORY:  As written.  It's got a public option; you said you would not vote for it as a matter of conscience, that you would even filibuster it if that stays in there.  Still the case?

SEN. LIEBERMAN:  That's right.  Just to explain, once the bill is on the floor the, the only alternative--amendments will be offered, but essentially every amendment is subject to a filibuster and will take 60 votes to pass.  My only resort, and, and every other senator--and there'll be others who feel exactly the way I do about the public option.  If the public option is still in there, the only resort we have is to say no at the end to reporting the bill off the floor.

He's with us on everything except everything else, which explains why Olympia Snowe and Susan Collins are back on the radar screen. Those who are working the Snowe/Collins angle should keep in mind the results of NY23 and the poll showing Snowe would be trounced in a GOP primary. Snowe would be crazy if she weren't considering pulling a Specter and coming over to the Democratic Party, but she'd be even crazier if she thinks she could do that after filibustering health care reform.

Anne Tergesen at The Wall Street Journal reports:

According to the U.S. Equal Employment Opportunity Commission, age-discrimination allegations against current, former and prospective employers have hit a high -- up 29% to 24,582 in fiscal year 2008, from 19,103 in 2007.

Behind the trend are the recession and the graying of the American work force. As of June, almost 20% of the labor force was 55 or older, up from 13% in 1999. When combined with widespread layoffs, "it's not surprising that a greater number of older people are alleging discrimination," says David Grinberg, a spokesman for the EEOC.

But there's a hang-up. It's last June's dreadful 5-4 Supreme Court ruling in Gross v. FBL Financial Services Inc. In short, by requiring those who allege age discrimination to prove that this was essentially the only cause for their being fired, or demoted or not promoted, getting a favorable ruling has become immensely more difficult.

Previously, workers could win a claim of age bias if they could prove it was a simply a part of the reason for the decision to fire, demote or not promote them. In the past in these "mixed motives" cases, it was up to employers to show they had a legitimate reason for their action. Given that layoffs tend to fall disproportionately on older workers who usually make more money than younger ones, the employer was required to show that that they would have dealt with the situation the same way no matter how old the worker was.

No more thanks to the court. The damage is likely to be widespread. Especially during a long recession like the current one, with industries doing major restructuring of their workforces, employees not expecting to retire for a decade or so can find themselves literally on the street with little recourse.

Over the past decade, anyone with their eyes open has seen many hard-working fiftysomethings ushered out the door. While buy-outs, both generous and stingy, have prompted some to take early retirement, others who had no thought of leaving because it would put them in an economic bind have wound up out of work anyway. Even in a fairly robust economy, finding a new job at comparable pay when you're 56 or so is tough. Experience counts, but employers don't like the salary needs of someone who has been on the job for 30+ years. Thus do many in that age bracket end up working for two-thirds or half or even less what they made previously. And frequently in jobs for which they are vastly over-qualified.

Morever, since it's the rare person over 50 who doesn't have a pre-existing medical condition, employers who might otherwise be willing to pay the higher salary such experienced people deserve, they are loath to hire in that age bracket because it's likely to increase their group medical rates. Somebody 20 years younger and cheaper with a clean medical record is likely to get the job.

So, the best thing to do if you're 50 or so is hang onto that job with all your might. Age discrimination legislation was meant to make that task a little easier. Five members of the Supreme Court have succeeded in making far more difficult.

Steve Benen does some cataloguing:

In June, Lieberman said, "I don't favor a public option because I think there's plenty of competition in the private insurance market." That didn't make sense, and it was quickly dropped from his talking points.

In July, Lieberman said he opposes a public option because "the public is going to end up paying for it." No one could figure out exactly what that meant, and the senator moved onto other arguments.

In August, he said we'd have to wait "until the economy's out of recession," which is incoherent, since a public option, even if passed this year, still wouldn't kick in for quite a while.

In September, Lieberman said he opposes a public option because "the public doesn't support it." A wide variety of credible polling proved otherwise.

In October, Lieberman said the public option would mean "trouble ... for the national debt," by creating "a whole new government entitlement program." Soon after, Jon Chait explained that this "literally makes no sense whatsoever."

Well, it's November. And guess what? We're onto the sixth rationale in six months. I actually like the new one.

"This is a radical departure from the way we've responded to the market in America in the past," Lieberman said Sunday on NBC's "Meet The Press." "We rely first on competition in our market economy. When the competition fails then what do we do? We regulate or we litigate.... We have never before said, in a given business, we don't trust the companies in it, so we're going to have the government go into that business.."

The "we've never done it before" approach doesn't quite square with America's view of itself as innovative, creative and dynamic, but what the heck. Lieberman's clearly rifling through a lending library of excuses anyway, and as Benen notes with an eye on the calendar, December's approaching quickly and surely a new excuse to obstruct health care reform will be broadcast shortly.

From the GREAT STATE OF MAINE...

Slugger Swings for the Senate

When the Pittsburgh Pirates are on the road, the club will open PNC Park to various groups, and last summer the Netroots Nation attendees got a chance to walk onto the field (it's the first time I've been in actual awe of grass), toss the ball around, and try their hand at bat. As my partner Michael and I were hiking to it, we were joined by Jonathan Tasini, who is running against Kirsten Gillibrand in next year's U.S. Senate primary in New York. The moment we walked through the service entrance and into the ballpark, Jonathan made a beeline for the field, hoisted a bat on his shoulder, tossed a ball up and---Whack!!!---knocked that sucker into the outfield. And then he did it again. And again. And again. The politician, author (his latest is The Audacity of Greed), activist, labor organizer and long-time Kossack was something else that night: a kid.

This morning Jonathan risks his reputation---and by that I, of course, mean risks elevating it beyond his wildest dreams---by agreeing to sit in the beanbag chair for the latest installment of our C&J interview series, Yes, We're All Staring At YOU!

Cheers and Jeers: How long have you been blogging and what originally brought you to Daily Kos?
Jonathan Tasini: I started a blog called Working Life in 2004, which gave me a daily outlet to write about labor and unions, which the traditional media did not, and does not, write about on any regular, knowledgeable basis. But, my initial audience was primarily drawn from labor and I have always been interested in creating movements built on broad audiences. That was the reason I came to Daily Kos (User ID 39124).

You're taking on Kirsten Gillibrand in next year's special election in New York. What are the biggest differences between where she stands on the issues and where you stand?
This election will be about one issue: change can’t wait. There is a deep well of desire to change our country---which led to the election of Barack Obama. At the same time, change can be unsettling and scary to people. To embrace change, I believe the voters across the political spectrum want someone whose principles and values they can trust to bring about real changes in the rules of the economy and the direction of our global policies. I believe my opponent will be the weakest candidate for our party in the general election because the voters will simply not trust the appointed Senator, who has been an avowed advocate of the National Rifle Association, someone who has been anti-immigrant, an aggressive defender of Big Tobacco and, now, wants voters to believe she holds a whole set of new principles and values.

But, I believe the appointed Senator is not the issue. In these troubled times, I still believe that the values of our country embodied in our Constitution---equal justice under the law, promoting the general welfare, securing liberty, and providing for the common defense---are the right ideals upon which we build a decent society. But, to fulfill those ideals, we---people of all political backgrounds---need individuals who speak for the people, not insiders who come from a dysfunctional political system and speak for the Wall Street financiers, banks, and pharmaceutical companies. If voters are able to hear the voice of our campaign (very subtle hint for people to invest in our campaign in whatever way they can afford), I think we will win the race. If voters believe that change can’t wait, the choice will be clear.

On the issue page where you address the economy, you write: "What happened to the idea that some day every one of us could reach an age when we could sit back, fish, play a little golf, take up a new hobby, maybe watch our children and grandchildren play or just simply relax and watch the grass grow---without worrying about whether we had money for food and rent?"  My answer is that it's completely possible...assuming Americans start living to 250. What's your answer?
It’s a question of choices.  Our society can only work well when we treat people fairly, particularly in their retirement years. We got away from that. We’ve been told that the "new economy" means people change jobs a lot more which means business doesn’t have any responsibility to its workers. But that new mobility is not out of choice---the "new economy" has meant "let’s save money by showing less loyalty to workers." I favor a national pension system, funded largely by the businesses that choose not to offer their own pensions.

What kind of music makes you feel invincible to the GOP horde?
Rock and Roll, Neil Young, Bob Marley. I challenge your readers to name a better list of four consecutive songs on one album than Live Rust’s Powderfinger, Cortez The Killer, Cinnamon Girl and Like A Hurricane. I could put those on one loop and be happy.

You're a huge supporter of organized labor. What are the Top 3 priorities we need to achieve to swing the pendulum back so that workers can reassert their collective power?
Fairness: anyone who puts in a fair day at work should get a fair day’s pay and be treated with dignity and respect. It does not mean the rich get richer, a few Wall Street insiders and bankers cash huge paychecks after wrecking the economy for the rest of us while the rest of us get poorer, get foreclosed upon, have our 401ks made worthless, and where a hard-working American can’t earn a fair wage and share in the wealth of the country, and, instead, has to live on credit cards and home equity loans. That may seem obvious---and it was a basic idea in America for a very long time---but we got away from that.

Justice: if you want a union, you should be allowed to choose one without fear of being fired. Rather than focusing on foolish drug laws, let’s impose harsh penalties where they matter to more people. I am for mandatory jail time for the top executive whose company breaks a labor law or safety and health rule---you know how quick union-busting would stop and how rapidly workplaces would be safer if executives lost their personal freedom?

Common sense: to be strongly pro-labor means to be strongly pro-business. We should want businesses to grow because they provide jobs. My standard is simple: I want rules in the economy that start from the first question: "How do we build a sustainable society that benefits the people, and how do businesses, then, fill that role?"

You're in favor of full marriage rights for same-sex couples. (Thank you.) What do you see as the future of marriage equality in New York?
I have been for full marriage rights for a very long time (and, unlike my opponent, I have been quite clear and vocal on the topic) and have been an advocate for LGBT rights for two decades, going back to 1992 when I played a leading role in a winning campaign within the United Auto Workers---of which I am a proud member---to add "sexual orientation" in the UAW Constitution’s non-discrimination clause.

To your specific question about New York: short-term---I worry because of the particular dysfunction of our state legislature. Long-term (I don’t know what that time frame is)---I think we will win but it will require large-scale mobilization.

What's the one book every Kossack must read?
The Grapes of Wrath. It’s always been one of my top five books of all time. Pick it up now and read it in the context of the current financial crisis---we have modern-day Joads who are struggling to make ends meet in a world shaped by reckless modern-day bankers.

You support decriminalization of marijuana. Isn’t that just you bowing to the powerful ice cream, pastry and snack-chip lobby?
Got the munchies just thinking about it, huh? Actually, I think I am bowing down to logic and sanity---the drug wars and drug laws have been a disaster for the country, a colossal waste of money that only benefits the burgeoning for-profit prison industry. But, be forewarned---I believe that the same laws that apply to drunk driving should apply to pot: you want to smoke? Fine. But, don’t get behind the wheel.

No waffling here: dogs or cats?
Sorry---both. And it’s not a waffle, rather a choice because I am not a believer in cooping up dogs in NY apartments hence my personal pet choice since moving to Manhattan has been on the feline side.

What are the best and worst things you see in the healthcare reform bills now being debated on capitol Hill?
Worst: That my party has now decided to throw women’s rights overboard with an astonishingly atrocious rollback thanks to the Stupak amendment. That the bill allows the insurance industry to exist, guaranteeing the inefficiencies imposed on every American by the insurance industry, all of which is a colossal waste of both money and doctors’ time---all to the detriment of the people. Best: That my future colleague Joe Lieberman is unhappy with the current legislation.

Finish this sentence: In the kitchen I make a mean...
Braised Tofu with Eggplant with Shiitake Mushrooms---the thing that makes this even better is the Chili Sauce. I think eggplant is one of the great foods on the planet and I will cook and eat it in any form. Truth in advertising: I’m not a vegetarian and I like cooking everything from chicken, fish and a steak but I love this dish from Mark Bittman’s How To Cook Everything Vegetarian.

I have one question left, but the kitty appears to be playing in my box of dynamite again. Please ask and answer the final question yourself...

How can a nice guy like you be a Yankees season-ticket holder?
This may lose me more votes than any other issue but blame it on my pre-Steinbrenner childhood neighbor who taught me baseball---he was a fanatic and it stuck so hard that I now go to spring training in Tampa. But, since one of my life goals is to go to a game in every stadium in the country---I’m more than half way there---I can feel good about cheering on spectacular play for others.

Cheers and Jeers starts in There's Moreville... [Swoosh!!] RIGHTNOW! [Gong!!]

Monday punditry, so let's dive in on conservatism, health care and the economy.

Ross Douthat:

For now, no Republican leader projects a similar level of seriousness. Late in the Bush years, it was easy to dismiss conservatism as brain-dead. Among policy thinkers, that isn’t true anymore: the advent of Obama seems to have provided just the jolt that right-of-center wonks needed. But innovative proposals are useless without politicians willing to champion them.

Really? Cut taxes and reduce spending are now considered innovative? I love the New York Times, but c'mon...

Rich Lowry: I have nothing intelligent to say about health care, so here's another column to fill the void. Consider this "conservatism as brain-dead".

EJ Dionne:

Something truly momentous happened in the United States Senate last night, and almost all of the accounts today involve carping. Typical is the Politico headline: "How health care reform could fall apart."

Indeed.

David Orentlicher, Professor, co-dir., Center for Law and Health, Ind. University Schools of Law and Medicine ::

Last night's vote gives health care legislation another first down across midfield, but we can expect the opposition to stiffen as the bill moves closer to the goal line. There will be many concessions before final passage--the big question is, how many? It's difficult to see any version of the public option surviving; it's also difficult to see how Congress avoids the tough abortion provision in the House bill. Will the cancer screening controversy doom a meaningful Medicare commission to encourage cost containment? How generous will be the subsidies to help offset the costs of insurance for moderate-income families? What percentage of the uninsured will be covered eventually?

Dean Baker:

Harry Reid, President Obama and the Democrats deserve a lot of credit on this one. They had a lot of obstacles to overcome, but they managed to get there. There are still more hurdles to get through before President Obama has a bill on his desk to sign, but getting a bill to the floor of the Senate was an impressive feat and an essential step on this path.

Paul Krugman:

What happened? To be sure, "centrists" in the Senate have hobbled efforts to rescue the economy. But the evidence suggests that in addition to facing political opposition, President Obama and his inner circle have been intimidated by scare stories from Wall Street.

NY Times Room for Debate:

As they deal with tighter budgets, what should public universities do to balance fiscal responsibility and equal opportunity?

Philip Brasher at the Des Moines Register reports:

• • • • • • •

Green Diary Rescues appear on Wednesdays, Fridays and Saturdays. The diary rescue begins below and continues in the jump. Inclusion of a particular diary does not necessarily indicate my agreement with it.

• • • • • • •

In her Dawn Chorus Birdblog, lineatus took us to meet some hawks. If I can just make an editorial comment here and say that this is one of the most spectacular bird photos ever.

meepdog had a problem with the Interior Secretary in Salazar the Slaughter Czar: Sky Protest Over Denver: "Secretary Salazar to Relocate Broncos?
While the Denver Broncos continue their fight for a division title against the San Diego Chargers, Secretary Salazar continues his quest to cleanse the West of their namesakes, as well as many other wild animals including Wolves, and Bison. Secretary Salazar has proposed a plan to remove most of the Wild Horses from the West, despite the House having recently passed the ‘Restore Our American Mustangs Act’ (ROAM Act), which would direct the BLM to restore the wild horses to the wild and onto 20 million acres of rangeland.  The same amount of BLM lands that a GAO Report admits has been taken from them. As Congressman Raul Grijalva stated regarding the ROAM Act, ’We must not lose these majestic icons of the West.’"

• • • • • • •

Interceptor7 has posted the Overnight News Digest.

Tonight's rescue brought to you by BentLiberal, jlms qkw, mem from somerville, srkp23, and vcmvo2, with srkp23 editing.

• Summoning beauty and clarity, Stuart Heady delivers a perfect mix of Western "straight line" thinking and Native American "circles" of understanding in weaving the subtly masterful Day After Thanksgiving Observance, the Native American Heritage Day signed into being by President Obama. (BentLiberal)
• Barth recalls a day when everything changed, and asks us to be aware and to recommit on this November 22. (mem from somerville)
• litho transitions from football to the Pacific in The Thanksgiving pig? (jlms qkw)
• In Prehistoric Weekly - Of crocodiles, sand, and time, Username4242 describes boars, ducks, and dog crocs, oh my! (vcmvo2)
• They don't want a war, they just want a meal: lineatus gives us the up-close-and-personal way to Dawn Chorus Birdblog: Meet some hawks. (jlms qkw)
• wide eyed lib brings us this penultimate diary in the series until spring: Free Food: Foraging Beneath the Snow. (vcmvo2)
• AKMask reports a very intriguing scientific advance in Weekend Science: Diabetic? Get a tattoo. (vcmvo2)
• Tom Taaffe enumerates the issues and then makes The Case for a New WPA Project. (mem from somerville)
• Orinoco finishes the study of long division in Fundamental Understanding of Mathematics XL. (jlms qkw)
• Vetwife declares I am more important than Sarah Palin! (jlms qkw)

jotter serves up the Week's High Impact Diaries: November 14-20, 2009 and yesterday's High Impact Diaries: November 21, 2009.

sardonyx brings Top Comments: Slow Weekend Edition.

Enjoy and please promote your own favorite diaries in this open thread.

Normally, the New York Post is a publication known for tabloid-style stories with a right-wing slant. However, in January 2009, they published a short but fascinating inauguration story on something that has the feel of a whispered legend... but it's entirely real. The story was about the "football":

The nuclear "football" was handed off yesterday without a fumble.

The metal briefcase with the power to launch Armageddon arrived at the Capitol yesterday behind George W. Bush and left trailing President Obama.

Moments after Obama was sworn in, a military aide in full dress uniform holding the black container, which holds the keys to a nuclear strike, crossed the platform to stand closer to the new commander in chief.

The Federation of American Scientists website has more details on "the football", and what the briefcase generally contains.

If you think that the Post's language regarding Armageddon is hyperbolic, think again.

The briefing that Obama got -- and that his counterpart, President Dmitri Medvedev must have gotten -- would include information regarding their respective nuclear arsenals, which are indeed vast, as you can see here:

US, Russian nuclear inventory details.

Image credit: Hans Kristensen, Federation of American Scientists. Click to enlarge.

The number, and manner of deployment, of these nuclear weapons has decreased and shifted gradually over the years:

The US and Russia still have huge inventories of nuclear warheads.

Image credit: Hans Kristensen, Federation of American Scientists.

Several years after the end of the Cold War, in 1991, George H. W. Bush and Mikhail Gorbachev got together and signed a treaty to limit strategic nuclear weapons:

Presidents Bush and Gorbachev sign[ed] the "Treaty on the Reduction and Limitation of Strategic Offensive Arms" (START I), which calls for the United States and the Soviet Union to reduce their strategic nuclear forces over seven years to 1,600 SNDVs and 6,000 "accountable" warheads, of which no more than 4,900 may be on ballistic missiles. This will result in a cut in strategic warheads of 25 to 35 percent.

As you can imagine, the details of the START I treaty are anything but simple; the path the arms reductions have taken over the years is also not without bumps, but overall, it's obvious that both of our countries have managed to significantly reduce our respective arsenals.

This past summer, Presidents Obama and Medvedev met in Moscow to discuss a new START agreement, because the old one will expire on December 5, 2009. Their Joint Statement was broad but decisive; an excerpt:

Presidents Obama and Medvedev in Moscow, July 7, 2009. Official White House photo by Pete Souza.

The United States of America and the Russian Federation confirm their commitment to strengthening their cooperation to prevent the proliferation of nuclear weapons and stop acts of nuclear terrorism. We bear special responsibility for security of nuclear weapons.  While we reconfirm that security at nuclear facilities in the United States and Russia meets current requirements, we stress that nuclear security requirements need continuous upgrading.  We will continue cooperating on effective export controls that make it possible to prevent nuclear materials, equipment and technologies from falling into the hands of actors unauthorized by the state as well as prevent their use in any manner contrary to obligations under the Nuclear Non-Proliferation Treaty (NPT).

Negotiators have been working tirelessly and continuously behind the scenes to meet the treaty deadline. Obama and Medvedev met in Singapore during Obama's recent trip to Asia. Though the leaders downplayed any problems with the negotiations on "New START", it has become clear that a new treaty probably won't happen until after the December 5 deadline.

Kingston Reif is Deputy Director of Nuclear Non-Proliferation at the Center for Arms Control and Non-Proliferation. The other day, we chatted about New START and how there won't be a treaty by the deadline. Reif has previously written about possible obstacles that the US and Russia are encountering, which include verification issues, missile defense, advanced conventional weapons systems, and upload capacity (which is our ability to quickly put nuclear warheads that are in reserves back on delivery vehicles).

In our conversation, Reif explained that since the treaty involves only strategic forces, missile defense will not be mentioned in it, except perhaps in the treaty preamble. However:

In recent weeks we’ve seen a lot of stories and reports on some of the verification issues that have yet to be resolved.  For example, the Russians no longer want to extend us the right to have monitors at their mobile missile production facility at Votkinsk. I think that's an issue. That's obviously something we would like to retain, and the Russians are telling us that "well, we don't have any comparable ability to do that in the US because you are no longer producing new missiles, you stopped doing that, so it would be one-sided if we were to allow you to monitor what's going on at our facility."

Another issue that has arisen with regard to verification is that the Russians have a road/mobile version of their SS-27 missile, which is also known as the Topol-M, and they're resisting efforts on the part of the US to try and monitor and verify the movements of that particular missile. So I think that's also still a sticking point.

Regarding upload capacity, Reif said:

The US basically wants to maintain more delivery vehicles and fewer warheads, whereas the Russians have been reducing their forces by getting rid of delivery vehicles but still maintaining a relatively steady number of warheads.

This relates to the Moscow Treaty, which -- the limits in the Moscow Treaty [SORT] for warheads were 1,700 to 2,200. Basically, we've tried to get down to that limit by taking warheads off of delivery vehicles and just putting them into our reserve. So the Russians are worried that we could just quickly take those warheads and put them back on our missiles and bombers.

But it’s important to keep this in perspective -- obviously, there are stumbling blocks, but the two sides should be able to get around them. I think they'll be able to do so this year, maybe early January at the latest, but I still think there's an excellent chance for an agreement this year.

Most importantly, to those who would say that this is some sort of "failure", Reif pointed out that:

It's important to take into account that the two sides only began negotiating earlier this year, in large part because, as we all know, the Bush administration was not interested in a new arms control agreement to replace START I. They knew that the expiration of START was on the horizon, and they simply weren't interested in doing much about it. The Obama administration's negotiating team entered this in a pretty tight spot, so it was always going to be a challenge to get an agreement negotiated before December 5, to say nothing about actually getting an agreement negotiated, signed, and then ratified by the US Senate by December 5.

Reif feels that there is a good chance that New START will be ratified by the US Senate and the Russian Duma sometime this Spring, and that it will be a far less contentious battle than that we'll see regarding ratification of the Comprehensive Test Ban Treaty.

Between the time we have a treaty and the time that both sides ratify it, there will be a significant gap. Reif said:

Earlier this month, Sen. Lugar introduced a bill that would give the President the authority to continue to grant privileges and immunities to Russian inspectors to carry out START I’s inspection provisions until June 2010.  Once START I expires, Russian inspectors will have no legal authority to remain in the U.S.  But at this point this bill is more or less a half measure.  It’s not clear that the Russians would reciprocate.  

U.S. officials have stated that they are negotiating a bridging agreement in parallel to the actual treaty to cover the gap but they’ve remained pretty tight-lipped about the details of it.  START I includes provisions for data exchanges, 12 types of inspections, as well as continuous monitoring at certain mobile missile production sites (see Votkinsk).  What’s going to happen to these verification provisions once START I expires?  Neither side simply wants to extend all of them.  Some of them will need to be amended and some new provisions will have to be negotiated.  So the most likely outcome is that the two sides will agree to abide by New START’s provisions on a provisional basis until the treaty is ratified.  What these procedures will be remains to be seen.  We may not get them until the treaty is negotiated.

Finally, Reif left me with a quote by Linton Brooks, who negotiated START I:

To reiterate, there still are issues that need to be resolved. There's no question about that, but I still think we’re very likely to get an agreement by the end of this year.  As Linton Brooks [the US negotiator for START] I put it, "Arms control’s gotta be a little bit painful; otherwise, why do you do it?"

And another reason why I'm optimistic is that both sides don't want to live in a world in which there are no legally-binding limits on or the means of verifying their respective nuclear arsenals.  The further they stray from December 5, the longer they may have to live in such a world.

Let's hope that we do get a New START treaty by the end of the year, and that Senate ratification happens with minimal fuss, with as few Republicans as possible taking the hard-line approach that we saw during the Bush years, and that still surfaces again from time to time.

A Page From History, And The Atomic Rulebook

IAEA Board of Governors meeting. Photo Credit: Dean Calma/IAEA Imagebank

On December 8, 1953, US President Dwight D. Eisenhower proposed that there should be an international, independent, nuclear watchdog agency, an organization to monitor "the dread secret and the fearful engines of atomic might...". Thus, in 1957, the International Atomic Energy Agency, or IAEA was born. It has evolved and expanded over the years to include 150 member states, a large staff, and a multifaceted mission.

Among other things, the IAEA:

... verifies through its inspection system that States comply with their commitments, under the Non-Proliferation Treaty and other non-proliferation agreements, to use nuclear material and facilities only for peaceful purposes.

The Treaty on the Non-Proliferation of Nuclear Weapons (NPT) states, in part, that [pdf]:

Each Non-nuclear-weapon State Party to the Treaty undertakes to accept safeguards... for the exclusive purpose of verification of the fulfilment of its obligations assumed under this Treaty with a view to preventing diversion of nuclear energy from peaceful uses to nuclear weapons or other nuclear explosive devices... The safeguards required by this Article shall be applied on all source or special fissionable material in all peaceful nuclear activities within the territory of such State, under its jurisdiction, or carried out under its control anywhere.

This means that member states absolutely must comply with their safeguard agreements -- in other words, if they're going to be a member of the club, they have to play by the rules. As stated by the IAEA [pdf]:

Safeguards are a set of activities by which the IAEA seeks to verify that a State is living up to its international undertakings not to use nuclear programmes for nuclear weapons purposes. The safeguards system is based on assessment of the correctness and completeness of the State’s declarations to the IAEA concerning nuclear material and nuclear-related activities. To date, 145 States have entered into such agreements with the IAEA, submitting nuclear materials, facilities and activities to the scrutiny of IAEA’s safeguards inspectors.

Back in 1968, Iran signed the NPT and officially became a member of this special nuclear club. Their membership has been anything but uneventful, especially in recent years.

This Fall has been no exception.

January 2009 satellite image of the Qom nuclear facility in Iran. Click to enlarge. Image Credit: DigitalGlobe-ISIS.

Not Playing By The Rules

In late September 2009, Iran sent a letter to the IAEA, notifying the watchdog that they had been building a clandestine uranium enrichment facility at Fordow, close to the holy city of Qom. Iran's hand was forced, in part, by knowledge that intelligence officials from France, the UK, and the US were on the verge of disclosing the facility.

Since then, a lot has happened. There has been quite a bit of detailed analysis of what might or might not be going on at the Qom site; regardless, rules are rules, and as the IAEA's Director-General, Mohamed ElBaradei said at the end of September:

Iran broke international law by not disclosing sooner its recently revealed uranium enrichment site, the head of the United Nation's nuclear watchdog agency said.

[snip]

"Iran has been on the wrong side of the law in so far as to inform the agency at an earlier date," ElBaradei told CNN's sister station in India, CNN-IBN. "Iran was supposed to inform us on the day it was decided to construct the facility. They have not done that."

His words are reinforced by the latest IAEA Safeguards Report on Iran, which has been sent to the IAEA Board of Governors. The report [pdf] is fairly detailed, and shows that the Qom facility (a.k.a. the Fordow Fuel Enrichment Plant, or FFEP) is "at an advanced stage of construction", though no centrifuges have yet been installed; Iran's other fuel enrichment facility, at Natanz, continues to operate and produced low-enriched uranium.

According to the report, Iran's explanation for the existence of the FFEP is that it was planned as a "contingency enrichment plant" because they felt that Natanz was a military target, and that if it was hit, they could continue uranium enrichment at the FFEP. They also claim that they started construction on the Fordow site "in the second half of 2007", and have therefore not violated any safeguard agreements (see the discussion of "modified code 3.1" here and here).

However, that is not true. The IAEA report states:

During the meetings, the Agency [IAEA] informed Iran that it had acquired commercially available satellite imagery of the site indicating that there had been construction at the site between 2002 and 2004, and that construction activities were resumed in 2006 and had continued to date. The Agency also referred to the extensive information given to the Agency by a number of Member States detailing the design of the facility, which was consistent with the design as verified by the Agency during the DIV. The Agency also informed Iran that these Member States alleged that design work on the facility had started in 2006.

Several analysts at the nonpartisan, nongovernmental Arms Control Association (ACA) put it this way:

... the [IAEA] has rejected a possible loophole Iran pursued where it could construct a nuclear facility in secret and claim, in case that secret is revealed, that Tehran was simply not yet obligated to inform the Agency about such construction," said Peter Crail, nonproliferation analyst with ACA.

"Iran not only tried this tactic when the Fordow enrichment facility near Qom was revealed by Western governments in September, it made similar claims when its original secret nuclear facilities were made public in 2002," added Crail.

Another analyst at the ACA said:

"Rather than cooperating with the Agency only under pressure, Tehran should agree to expanding IAEA access under the terms of the Additional Protocol to ensure that it is not pursuing any other significant nuclear activities in secret," added Thielmann.

"Securing such additional transparency from Iran should be the priority for the P5+1 in their negotiations with Tehran," [Greg] Thielmann concluded.

In other words, this is an opportunity for Iran to establish greater transparency about the purpose of their nuclear program. Deception is breeding distrust, and understandably so. Why are they being secretive? What is the point, if their nuclear program is for peaceful purposes?

What's Next?

The P5+1 are the five permanent members of the UN Security Council, plus Germany (France, the UK, the US, China, Russia, and Germany). Last month, they met with Iranian nuclear negotiators to try to hammer out a deal to refuel the Tehran Research Reactor, which makes medical isotopes. The deal put forth was basically that approximately 70% of Iran's low-enriched uranium would be removed from the country, sent to Russia for enrichment to nearly 20%, and then fabricated into fuel assemblies by France. Iran agreed "in principle" to the deal, but the deal has since crumbled, especially with Supreme Leader Ayatollah Khamenei's implicit rejection of it as being part of "naive and perverted" diplomacy with the United States.

The IAEA Board of Governors will meet next week, on November 26, where they will discuss the latest safeguards report.

Joshua Pollack is a frequent contributor to the Bulletin of the Atomic Scientists as well as the much-respected website, ArmsControlWonk.com. I asked him what part the (nearly failed) Tehran Research Reactor deal plays in the big picture, specifically with respect to the latest safeguards report. He said:

I think that if [the Tehran Research Reactor deal is not resolved before] the Board of Governors meeting, the nicest possible thing you could say about it is that the game is in overtime. I think that will seriously complicate things, because the Board of Governors is quite likely to send Iran to the Security Council again, with a violation of safeguards, over the Qom facility, and that means that the momentum is going to be very negative, after the Board of Governors meeting, because we'll all be back in punishment mode, and the Iranians will be back in defiance mode, and it's going to be very hard -- if it's hard to get a deal done now, it'll be a lot harder to get one done then, because the atmospherics will shift quite starkly.

And similarly, if we can get it done before then, it would change the atmospherics in the Board of Governors enough that the referral to the Security Council, which I assume would still happen, would be much gentler in tone, and would not basically come with the promise of sanctions on it, because there's a substantial overlap between getting a two-thirds vote on the Board of Governors and getting a sanctions vote in the Security Council. It's not a slam dunk. You have to deal with the Russian and Chinese vetoes. But, if they get a referral, they will pass a Security Council resolution, and I doubt it will be totally toothless. I'm not predicting what will be in it, but, you know, going into the Board of Governors meeting without making a deal is going to create a very dark and ugly atmosphere, and that is going to lead to a pretty tough referral.

Unless there's a miracle, and Iran suddenly decides to go with the original terms of the nuclear deal offered by the P5+1, things look like they will be very difficult for them indeed, going into the Board of Governors meeting.

Conclusion And A Cautionary Note

A world without rules would be very chaotic indeed. A world without rules regarding dual-use technology, like nuclear fission and its related technologies, would be a nightmare.

When an independent, international watchdog agency like the IAEA has concerns about illicit activity involving nuclear materials, they have those concerns for a reason. Picking and choosing which of their findings one is going to believe (or not believe) because it doesn't fit one's worldview is not the way to approach their conclusions. The rules laid out by the IAEA and by the terms of the Nuclear Non-Proliferation treaty are absolutely clear, and they are absolutely to be followed to the letter.

It is my opinion that it would be a happier world if all states, whether or not they have signed the NPT, could somehow pledge to only use nuclear technology for peaceful purposes, and never for weapons.

Unfortunately, the world is not ideal.

I'll end with something that Josh Pollack said to me. We were talking about how invariably, someone will mention "this means we're going to bomb Iran" whenever news like the current safeguards report comes up.

This is about diplomacy. It's not about war. This is just the opening move...

The diplomatic ball is in Iran's court now. What are they going to do with it?

Most of us know that politics doesn't only go from left to right. But there's a lot of disagreement about which other axes are most important for understanding political difference or politics more generally. Pragmatist vs. idealist? Grassroots vs. establishment?

When we get into arguing strategy, terms like those often fly fast and loose (and I don't exempt myself from that). If we stop and think, though, pragmatist vs. idealist serves no purpose other than to insult everyone involved in a conversation. Does the person proclaiming themself a pragmatist mean to say "I have no ideals"? Does the person identifying as an idealist mean to say "I don't care about getting things done"? These terms don't work to describe people, only motives -- for instance, my pragmatic streak may be at work but it will always be in consultation with my ideals.

What, then? I've suggested in the past that in arguing about politics, it's easy to confuse strategy and ideology. The Fifty-State Strategy, for instance, isn't inherently progressive. It's a strategy: to work in the long term to strengthen a party in every state, to refuse regionalism or investing only in places where the party can win this cycle. But it could be used to promote ideologically conservative positions or candidates as easily as progressive ones. (We could add tactics to this, too: How specifically do you implement your strategy?)

Let's say two people both want to see the House moved as far to the left as possible. One thinks the Fifty-State Strategy is the best way to achieve that, that spreading available resources as widely as possible will yield the most possible chances now and that strengthening local parties will produce good candidates and create chances a few cycles down the road; the other thinks that turning every available resource to races that are winnable now is better, figuring that victory today will create chances further down the road. Same goal, yet if these two people get into an argument with each other, their very different strategies might lead them to believe they want substantially different things.

And of course, it is actually more complicated than wanting the same electoral or legislative outcome. A strategy that hands power to the already powerful will tend to be effectively conservative (in the classic sense of resisting change as opposed to in the radical wingnut sense); the already powerful have every incentive not to change things too much.

Which brings us to party and movement. As the battles over the Fifty State Strategy and other strategic questions of how the party will go about obtaining power show, and of course as the contrast between the Democratic and Republican parties show, parties can be more or less controlled by the powerful and/or responsive to the grassroots. (This contrast is shown still more by parties in other countries, as our Democratic party may be among the most conservative and certainly among the most pro-corporate "left" major parties in the democratic world.) But parties and movements are always different.

Parties, bluntly, exist to win elections -- and that usually means the next election. They form as parties around ideologies or policies, but the impulse to win elections is always primary. Movements, on the other hand, come together around issues, and, to be maximally effective, have to always remember that their interests are not identical to those of parties.

The Democratic party is much more friendly to women than the Republican party, but that doesn't mean that feminist groups or pro-choice groups can sit back and say "the Democratic party is taking care of our interests." They have to always be pushing the party apparatus to put the principles of fair pay and choice above the temptations of corporate donations, chiding bishops, and Village wisdom. Because the party can hold the right position and still decide that selling that position out is in its own interest.

To take the main issue we're facing these days: The DSCC cares more about electing Democrats to the Senate than about passing a strong health care bill. The DCCC cares more about electing Democrats to the House than about passing a strong health care bill. And the DNC -- and components thereof, like OFA -- cares more about reelecting Barack Obama than it does about passing a strong health care bill.

That's definitional. Exactly to the extent that the party committees think that victory requires a public option, they will push for it. To the extent they think they can pass a weaker version of reform that will piss off marginally fewer Republicans without depressing their own Democratic base, they'll do it.

Questions raised about the efforts of the party committees to pass health care reform are less about their competence at achieving their goals and more about whether their goals are identical with those of the uninsured, the underinsured, those who might be vulnerable to losing their insurance.

Would we be better off with Republicans in power? Hell, no. No one here is saying that. But should we sit back and expect that Democrats in Congress and the administration will fight for the best possible policies without pressure from the grassroots? Equally, no. And an arm of the party is never a part of the grassroots. No matter how effectively OFA engages grassroots activists, for instance, its priorities and strategies are defined by Barack Obama's legislative priorities and by the need to maximize Democratic support (ie voting), and it is an arm of the DNC.

We fight to elect Democrats, but when they are in office, we have to take a page from generations of social movements and fight the party's fear of losing elections, the money they're tempted with by lobbyists and corporate PACs, their desire to be respectable in the Village. Fighting to get them to pass the legislation the people of this country need is not betrayal of the party. It's a healthy recognition that the goals of a broader progressive movement are not identical with the goals of the Democratic party. That the party will, in the long term, be stronger for having its base keeping up the pressure to do the right thing.

• The cult leader of wackadoodleism plans to co-opt the 47th anniversary of Martin Luther King's "I have a dream" speech on August 28, 2010, to promote a dream of his own.

  BECK: I’ve done a lot of reading on history in the last few years and I was amazed to find that what we’re experiencing now is really a ticking time bomb that they designed about 100 years ago, beginning in the progressive movement. And they thought, "you know what, if we just do this and this and this and this, over time if we do it in both the Republican and Democratic parties, we will have our socialist utopia." Well, I say again, two can play at that game. I am drafting plans now to bring us back to an America that our founders would understand. ... We need to start thinking like the Chinese. I’m developing a 100-year plan for America. A 100-year plan. We will plant this idea and it will sprout roots.

• How come this never gets mentioned when we're talking about deficit spending?

  When the Bush tax cuts sunset at the end of 2010, the previous administration will have left the government holding the bag for well over $2 trillion in lost revenue.

• Alyssa Rosenberg laments the consequences as Twilight says goodbye to decades of strong, empowered, adventurous heroines in girls' fantasy novels.
• James Ridgeway explains How We Pay for Big Pharma's Malpractice.
• In case you missed it Friday, and, sadly most Americans did, Bill Moyers Journal on PBS was an amazing hour of real journalism every American, including President Obama, should see. Here's a key segment. (In another bit of sadness, Bill Moyers Journal will be retired in April.)
• Retailers cross their fingers on holiday shopping:

  When the U.S. holiday shopping season kicks off on the day after Thanksgiving, retailers can expect to see millions of less frightened, but even more bargain-hungry customers cross their thresholds.

  Industry experts expect a strong turnout on Black Friday, which falls on Nov. 27 this year, as deep discounts lure shoppers after more than a year of subdued spending. But they caution it will not mean a bumper holiday season in the weeks leading up to Christmas since consumers still remain cautious.

• Roman Catholic Bishop Thomas Tobin has banned Patrick Kennedy from receiving communion.
• Iran has started an air defense exercise:

  Iran has begun five days of large-scale war games to simulate attacks on its nuclear sites, officials said, warning it will retaliate if provoked.

  The head of Iran's air defence said the aim of the exercises was to thwart aerial reconnaissance and air attacks.

• 15 Signs American Society Is Coming Apart at the Seams.
• At The New York Review of Books, Hussein Agha and Robert Malley ask Israel & Palestine: Can They Start Over?
• David L. Ostendorf urges us to give a thought to the people who process turkeys this Thanksgiving:

  Reflecting the racial structure of the nation’s entire food system, turkey processing relies largely on the hard labor of low-wage workers of color. On plant floors across the country, a predominantly black, Latino and Asian work force kills, guts, cleans, processes and packages the Thanksgiving centerpiece along fast-moving production lines.

  Injuries are commonplace. Thousands of individual repetitive motions every shift raise the probability of chronic pain for line workers.

• Greenland's ice loss behind a sixth of sea-level rise.

Odds are good that at some point in your life you are going to experience some puzzling symptoms. Twisting intestinal pain that never goes completely away, dry mouth, a painful recurrent eye problem, or stabbing back and neck pain that ranges from annoying to excruciating with no rhyme or reason. In most cases it will be misdiagnosed, perhaps for years, before you're finally driven to seek a specialist and the correct evaluation is made: a chronic autoimmune condition. If so you're not alone, millions of Americans deal with these disorders. Thanks to a full blown, classic case of Ankylosing spondylitis, I'm one of them.

Most layman might imagine the brain and central nervous system are the most complex and least understood networks in the human body. But our immune system gives neurophysiology a run for its money. Actually, it's more like immune systems, since there are so many interlocking, overlapping, and at times even conflicting components. Some immune cells are like the blob, they engulf and digest their prey. Others simply stick to invaders like velcro and wrap them up tighter than a mummy. Others sniff around and chemically paint a suspect so that its buddies can glide in on that beacon like laser guided bombs into an enemy bunker. In complex animals like humans, there are even parts of our immune system that have grown so sophisticated they can rewire themselves on the fly. Once they're exposed to a particular germ, assuming they successfully fight it off, they 'remember' that bug and are forever on guard for it.

An autoimmune disorder occurs when one or more components in that vast array gets a little trigger happy and starts going after healthy tissue instead of dangerous microbes or diseased cells. That can happen easier than you might think, and the culprit is good ole evolution.

All kinds of white blood cells and antibodies are ready to lay down their tiny lives for you at the first sign or marauding microbes or misbehaving cells. To do that effectively, they have to be able to distinguish between good cells and bad cells. If they're too easy going, the bad cells might get an upper hand and suddenly you're sick as a dog. If they're too overzealous, they attack good cells and you have an autoimmune disease. So naturally, any enterprising bad guy has a powerful advantage if it can disguise itself as one of the good guys. Viruses and bacteria that can get past some portion of the immune system in this way are more likely to succeed and leave descendants. But the real masters of disguise are malignant (Cancer) cells: they completely fake out the bodies defenses with chemical disguises that tell the immune cells "Nothing here but us healthy cells doing our job, move along," while deep inside they've gone into business for themselves replicating like mad, co-opting, invading, and eventually devouring nearby tissue and organs. There are constant evolutionary skirmishes going on between immune components and bad guys looking to fake them out. The immune system forever walks a fine line between ineffective and overactive.

When humans abandoned hunter gatherer societies and began living in horrifically unsanitary conditions in close quarters with hordes or other people and domesticated animals, those skirmishes turned into a full fledged war. Suddenly it paid and paid well to have an overactive immune system that shoots first and never asks questions. It might mean that the incidence of other problems caused by enhanced immune components in that population increases dramatically, but as long as some members live long enough to reproduce, in the face of endemic diseases, that trait will become ubiquitous in the population over time.

We all descend from those survivors. Diseases that would have torn through a stone age tribe like a tornado don't even give us the sniffles. The price? Sickle cell anemia for one, and possibly higher numbers of peole suffering lupus, irritable bowel syndrome, and a host of other hard won adaptations that can misfire and cause serious problems, any one of which a research physician could study for a lifetime.

The good news is the outlook for patients has never been better. Moderate symptoms usually respond well to simple aspirin or ibuprofen. As the disease progresses, cortical steroids and narcotic painkillers are effective. In severe cases, immuno-suppressants like Cyclosporin can quell the immune system. In the last decade, a number of new drugs from the family of biologics have been developed that have proven extremely useful. It happens that many of these new drugs are made by biotech companies like Genentech. Scientifically, Genentech has a hell of an interesting science story behind it. Legislatively, that would be the same Genentech that sent an army of Borg lobbyists into DC to assimilate the HCR bill and enslave it in service to their own insatiably greedy corporate culture. Congressional resistance is apparently futile or non existent.

Which brings me back to my own condition. It happens that in AS, there's a genetic precursor called HLA-B27. Over 90% of those suffering from AS are positive for the gene. It's just one small example of numerous disorders with a big genetic component -- some of which can be lethal -- and more are being discovered all the time. I have the AS gene and symptoms, mystery solved, biologic treatment started.

That brings up an interesting point: in a sane world, babies would be checked for all those genes from the moment they come wiggling out of the womb. And parents, teachers, and PCPs would take the necessary precautions and be on the lookout for symptoms, so that any autoimmune or other diseases could be controlled before they flare into a gruesome, bone eating, organ destroying, lifetime orgy of agonizing pain. But in our crazy-ass healthcare system, that's a risk. Because, if a health insurance company finds out that you knew your kid has a genetic marker for a costly disorder, that policy might be null and void on everything they can tie that preexisting condition to, which in the case of some autoimmune diseases and with the judicious assistance of talented lawyers happens to include just about everything you can think of and then some.

A common exercise in any intro statistic class is to split the students into two groups, one group flips a coin 100 times and records the results, another just makes 100 entries up off the top of their heads. The teacher then comes back, looks at the two lists, and usually identifies which is which with hardly a glance. How? The trick is the teacher knows that on the real list, there will be several sequences of four or five in a row of all heads or all tails, whereas on the other list students will tend to stick with a more heads-tails-heads-tails alternating approach.

Now, everyone knew what I meant just now when I wrote trick, right? Nothing deceitful, simply the method used to get an answer to a math problem. With that in mind, let's look at this 1999 email purporting to be evidence of fraud among some climate scientists:

"I've just completed Mike's Nature trick of adding in the real temps to each series for the last 20 years (i.e., from 1981 onwards) and from 1961 for Keith's to hide the decline."

The email is one of thousands sent over a period of ten years by climate researchers and other scientists, journalists, lobbyists, and the occasional flake, stolen from a university network a few days ago. DeSmogBlog has more on the theft. Obviously, emails don't change the observed reality of human assisted climate change in the cryosphere and elsewhere. Nevertheless, climate change denialists have combed through them looking for anything they can pull out of context and pass off as evidence of a global conspiracy. They're getting some media mileage out of it. Even though, so far, the best they've been able to come up with is examples like the above.

The "Mike" is Michael Mann, "hide" means to account for (See also this comment), and the trick referred to is how to resolve a question involving two sets of data. One set is the "real" actual temperature readings, the other is by proxy, tree-rings, corals, ice cores and the like. When reconstructing the temperature record going back a thousand years or more, proxies are all you get -- there were no super accurate thermometers handily placed around the globe during medieval times! But proxies only give an approximation, hence the large variance in the now familiar reconstruction graph affectionately known as the Hockey Stick represented below as shading around the blue and red lines.

But as time rolls by, and proxy data become more plentiful, the error bars (i.e. the variable shading) shrink. Eventually, thanks to the invention of modern thermometers and ships to carry them, precise temperature readings from all over the world become more widely available and increasingly reliable, and there is a relatively short interval where both the proxy reconstruction (blue) and the instrumental record (red) are used. The proxy record ends (1980), but the instrumental record continues through 1999. That was the issue being discussed in the emails: why end the plot in 1980 when there's instrumental data through the 90s? In the original 1998 paper published in Nature, Mann et al showed the instrumental data through the 1990s to complete the plot. The emailer was following suit in his own work. That's "Mike's Nature trick". It really is that simple.

Moreover, both instrumental and proxy records were clearly labeled and delineated in the original papers and many since, so there was no opportunity for any ambiguity as to what was being shown. It makes sense that "Mike" Mann would be mentioned, he has worked extensively with both kinds of data, actual and proxy, and was one of the original paleo-climatologist who developed the Hockey Stick using them. The email is just a tiny snippet of several colleagues in the midst of discussing these points and others.

How hard was it to figure this out? Anyone could have done it, assuming they wanted to. Just like any competent reporter, I asked the people involved, including Prof. Mann:

SA: What was the Mike's "trick"?
MM: All he (apparently) meant by "Mike's Nature trick" was us, in our original '98 Nature article, showing the instrumental record after the proxy record ends (1980). ... Full Text

But consider; it's taken me several grafs, and you a few minutes of reading, just to get a glimmer of what that one email was all about. The same effort would be required to untangle other stolen, out of context emails now brandished by skeptics as evidence of some kind of shadowy conspiracy. That's how easy it is to pluck something out of context and make it sounds ominous, if your goal is to misinform, prostitute yourself to the energy industry, and -- pardon the pun -- trick your readers.  

There's no way this complex issue can be covered in one post, but thankfully there have been some really thoughtful pieces written by others that we can pull from. For example, my own comments led to this headline on the AtlanticWire: Politics Beats Science in Cancer Screening Debate, featuring a terrific piece by Kevin Sack in the NY Times (Screening Debate Reveals Culture Clash in Medicine), comments by Ezra Klein (WaPo), Arthur Caplan (MSNBC), and David Dayen (Firedoglake). The author of the AtlanticWire piece jumps to the heart of the issue and writes:

According to the panel, the timing of the new pap smear guidelines is entirely coincidental. But politicians — already taking steps to distance themselves from the obviously unpopular mammography guidelines — seemed wary Friday. The anger from women, doctors, and advocacy groups over the relaxed screening guidelines is revealing, pundits say. They argue that it reveals a divide between the hard science of cancer screening and the explosive, personal politics of health.

Kevin Sack's piece adds something to the debate in the form of a graphic showing that mammogram utilization has fallen recently in other age groups, and that a steady bit more than 60% of women 40-49 get yearly mammograms (for those interested, a state by state table is here.)

Presumably for the 40% that don't get yearly mammograms, this represents no change. But the recommendations have been presented to younger women as if something important is being taken away from them, rather than what the panel actually said: that the experts suggest that they cannot determine whether yearly mammograms in that age group for low risk women are helpful or harmful and that the best thing to do is discuss it with your own doctor.

The balance of benefits and potential harms, therefore, grows more favorable as women age. The precise age at which the potential benefits of mammography justify the possible harms is a subjective choice. The USPSTF did not find sufficient evidence to specify the optimal screening interval for women aged 40-49.

That, of course, assumes you have a doctor, and that's where the interface between health reform and this topic is most obvious.

As to what the risk is from breast cancer, and why the recommendations were changed away from "just do them", this St. Louis Post-Dispatch piece notes:

The British Medical Journal published an article to help people understand the risk in simple terms.

It means that if 1,000 women don't get mammograms, we can expect four of them to end up dying of breast cancer. If all 1,000 women do get regular mammograms, three will still die of breast cancer.

No matter the odds, many doctors and patients say any life saved is worth everyone getting the mammograms.

"We're all in agreement that this is not the best tool, but does that mean we should take the next step and not screen at all?" said Dr. Burton Needles, medical director of the cancer center at St. John's Mercy Medical Center in St. Louis. "Most of us who treat patients with cancer feel that the benefits still outweigh the risks of screening."

For more details, Kossack charliehall (biostatistician) wrote this more detailed diary on studies available through the Cochrane database, and noted the same result as above: women in the screening group were just as likely to die as women in the no-screening group.

Given that kind of information, the panel suggested individualized care over rote screening for everyone. And on the topic of relying on routine breast self-exam, which was another recommendation from the panel, Orac (pseudonym of a practicing surgeon from ScienceBlog's Respectful Insolence) notes:

The USPSTF's recommendation not to teach breast self-examination (BSE) is another point of controversy. Despite a lot of enthusiasm for the practice, Cochrane Reviews and other evidence have failed to find convincing evidence that routine regular BSE saves lives. I wish it were otherwise, but it appears not to be, even though there are compelling anecdotes out there of women who did find a lump on BSE and it turned out to be cancer. Unfortunately, overall, the evidence to support BSE is weak. On the other hand, even the Cochrane Collaboration, which I have in the past sometimes accused of methodolatry and "nihilism" with respect to screening concluded:

Some women will continue with breast self-examination or will wish to be taught the technique. We suggest that the lack of supporting evidence from the two major studies should be discussed with these women to enable them to make an informed decision. Women should, however, be aware of any breast changes. It is possible that increased breast awareness may have contributed to the decrease in mortality from breast cancer that has been noted in some countries. Women should, therefore, be encouraged to seek medical advice if they detect any change in their breasts that may be breast cancer.

Indeed, on a purely practical level, I see nothing wrong with women being taught to be aware of how their breasts normally feel and to bring to a physician's attention any changes that concern them and still encourage that, but there really is no good evidence to support BSE.

To add to that, Our Bodies Ourselves (Boston Women’s Health Book Collective) wrote that the case against screening is not new:

New government guidelines recommending that women start screening for breast cancer at age 50 instead of 40 set off a round of criticism this week and caused much confusion for women who for years have been told that early detection saves lives.

But a number of women’s health organizations, including Our Bodies Ourselves, the National Women’s Health Network and Breast Cancer Action, for years have warned that regular mammograms do not necessarily decrease a women’s risk of death. Premenopausal women in particular are urged to consider the risks and benefits.

In fact, the NWHN issued a position paper in 1993 recommending against screening mammography for pre-menopausal women. It was a very controversial position at the time — even more so than now. The breast cancer advocacy movement was in its infancy and efforts were focused on getting Medicare and insurance companies to cover mammograms. What the NWHN found — and other groups have since concurred — is that the potential harm from screening can outweigh the benefits for premenopausal women.

The above statement is important for several reasons. This is not a male view of the world superimposed on women. It's also not a view suddenly brought into the discussion by those wanting to focus on cost and cost alone. it predates this health bill, and it predates cost control discussions in the House and Senate, and in the Obama administration. More from Our Bodies Ourselves:

I don’t believe the new guidelines are politically motivated, nor are they "patronizing" to women simply because they call into question the stress related to biopsies and false positive results. Rather, the guidelines provide a useful framework for helping each of us to decide when is the best time to begin screenings and the intervals at which they should be repeated.

Personal health remains just that: personal. Note what the World Health Organization has to add on BSE:  

There is no evidence on the effect of screening through breast self-examination (BSE). However, the practice of BSE has been seen to empower women, taking responsibility for their own health. Therefore, BSE is recommend for raising awareness among women at risk rather than as a screening method.

++++++

So what do you do when you feel you are sitting on data that contradicts the status quo? How do you convey that information to the public? It's not like there's nothing written on the topic. Recognizing the political and social impact of the guidelines is a must, and failure to do so is a mistake, one that science and government types seem to make a lot. These particular guidelines won't be implemented immediately in any case. Physicians and the public still need to read and accept them. The likelihood of any such thing happening, or participatory and reasoned dialog occurring with the public with the current political atmosphere, is nil (now, those are odds we can all understand.) But if the recommendations make sense, further supporting data will present itself and the discussion will go on.

Note that none of the above has anything to do with insurance companies. That's a side issue, more likely to be settled in the health reform debate than with these recommendations. But if Republicans want to make an issue of this (and they will), they are going to have to make an issue of evidence-based medicine.

Evidence-based medicine (EBM) aims to apply the best available evidence gained from the scientific method to medical decision making. It seeks to assess the quality of evidence of the risks and benefits of treatments (including lack of treatment).

EBM recognizes that many aspects of medical care depend on individual factors such as quality- and value-of-life judgments, which are only partially subject to scientific methods. EBM, however, seeks to clarify those parts of medical practice that are in principle subject to scientific methods and to apply these methods to ensure the best prediction of outcomes in medical treatment, even as debate continues about which outcomes are desirable.

Our own Christopher Hughes recently wrote a diary on evidence-based vs anecdotal medicine.

"Experience," or anecdote, is sometimes helpful in medicine, but often harmful, because we physicians often internalize our experience into hard rules about treating patients. This often leads us down dangerous paths.

Evidence based medicine is long overdue counterweight to this kind of medical practice. EBM, when evidence is available, makes us think hard about our practices: Are we doing this because that's the way we've always done it, or because we have scientific research to back up our decisions?

That is the future of medicine. These guidelines will stand or fall on their merit, but given the fact that the US is 19th of 19 in preventable deaths, the way we do things is going to have to change. And that may mean recognizing when cancer screening is helpful and useful (colonoscopy) and when it's not (Pap smears before age 21.) And it may also mean allowing ourselves to debate the issue without accusing each other of trying to kill women. Personally speaking, I really haven't tried to kill any women all this week, and I don't intend to start this weekend. But if we don't discuss this, we won't make any progress on preventable deaths. And that, my friends, is progress that has to happen.

For the meantime, I am sorely tempted to suggest that if you want people to get mammograms, tell them they can't, and if you want to get people not to get flu shots, tell them they have to.

Sunday punditry. Read it early, talk about it late.

Frank Rich on Sarah Palin:

But no matter how much Palin tries to pass for "center-right," she’s unlikely to fool that vast pool of voters left, right and center who have already written her off as unqualified for the White House. The G.O.P. establishment knows this, and is frightened. The demographic that Palin attracts is in decline; there’s no way the math of her fan base adds up to an Electoral College victory.

Yet among Republicans she still ties Mitt Romney in the latest USA Today/Gallup survey, with 65 percent giving her serious presidential consideration, just behind the 71 for her evangelical rival, Mike Huckabee.

Maureen Dowd:

Yet Democrats would be foolish to write off her visceral power.

As Judith Doctor, a 69-year-old spiritual therapist, told The Washington Post’s Jason Horowitz at Palin’s book signing in Grand Rapids, Mich., "She’s alive inside, and that radiates energy, and people who are not psychologically alive inside are fascinated by that."

No one should confuse winning the GOP nomination (which she can do) with winning the election (when 60% think you are not qualified, you can't.) Maureen goes to to say Obama's too intellectual, blah, blah, blah.

Ron Brownstein via Ezra:

"I'm sort of a known skeptic on this stuff," [MIT health economist Jonathan] Gruber told me. "My summary is it's really hard to figure out how to bend the cost curve, but I can't think of a thing to try that they didn't try. They really make the best effort anyone has ever made. Everything is in here....I can't think of anything I'd do that they are not doing in the bill. You couldn't have done better than they are doing."

Gruber may be especially effusive. But the Senate blueprint, which faces its first votes tonight, also is winning praise from other leading health reformers like Mark McClellan, the former director of the Center for Medicare and Medicaid Services under George W. Bush and Len Nichols, health policy director at the centrist New America Foundation. "The bottom line," Nichols says, "is the legislation is sending a signal that business as usual [in the medical system] is going to end."

More of same from Center on Budget and Policy Priorities:

The health reform bill that Senate leaders unveiled yesterday meets two rigorous fiscal tests: it reduces deficits over the next decade and beyond, and it puts long-term downward pressure on health care costs.

There are, however, still issues with affordability:

The health reform bill that Senate leaders unveiled on November 18 makes health coverage more affordable for millions of households of modest means, as compared to the bill that the Senate Finance Committee approved last month. The amounts that many families and individuals would pay for coverage would be less than under the Finance Committee proposal.

For people between 134 percent and 154 percent of the poverty line, however — people with incomes around $25,000 to $28,000 for a family of three — premiums would actually be higher than the already significant amounts they would have to pay under the Finance Committee bill. Modifications are needed at some point as the legislation moves forward to ensure that near-poor families and individuals do not face insurance premiums and cost-sharing charges that many of them could have difficulty affording.

David Broder does his own rigorous analysis, Beltway style: he asks "every expert" that agrees with him what they think of the new health care bill and ignores the CBO and the ones that don't.

Via Jay Rosen on twitter, this:

The job cuts at the Washington Post on Friday have produced a round of comments, broadly summed up by Steve Yelvington earlier today. They certainly begged the question that occurred to me as a former employee of both the Post and WPNI, its soon-to-be merged online operation: "What explains this kind of decision?"

They've decided the dead tree paper is more important than the web site.

CIDRAP:

Health officials in Wales today announced the identification of a cluster of patients in a Cardiff hospital who are infected with oseltamivir-resistant pandemic H1N1 influenza.

Also today, Duke University Medical Center in Durham, N.C., reported that oseltamivir-resistant H1N1 viruses were found in four very sick patients hospitalized there over the past 6 weeks. A Duke press release said all four patients had been in the same hospital unit, but it did not specify how many were there at the same time.

This is what we dread. Small numbers, but keep an eye on this.