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Politics : Formerly About Advanced Micro Devices -- Ignore unavailable to you. Want to Upgrade?


To: TimF who wrote (337341)5/12/2007 7:20:37 AM
From: Road Walker  Respond to of 1584452
 
re: The Problem With DRM Is The Name?

He should get a job in the Bush admin where an escalation is a "surge".



To: TimF who wrote (337341)5/12/2007 8:56:05 AM
From: Road Walker  Respond to of 1584452
 
Bad Medicine, Sneaking In
By ATUL GAWANDE
As I read about the melamine-tainted pet food, and about the hundreds in Panama killed by phony glycerin from China, I remembered a patient I once saw. She was a dancer in her 40s who had hobbled into the emergency room one October night with a painful, bulging mass in her groin. I gently put my fingers to it. It was beet-sized and firm. When I placed my stethoscope on it, I heard gurgling. This was, I told her, a strangulating hernia — a rent in her abdominal wall had trapped a loop of intestine. The swelling was the knot of bowel; the gurgling, the fluid inside.

She was at risk of gangrene and agreed to an emergency hernia operation. It’s not a complicated procedure. But there are still plenty of ways it can go wrong. Inside her, I found the hernia defect — a one-inch gap in her muscle wall — and, protruding through it, a choked-off, purple, six-inch length of bowel. I opened the gap wider, pushed the bowel back in, and thankfully it pinked back to life. We’d gotten there in time. I closed the hernia with a polypropylene mesh cut to size. It was like sewing a patch onto a torn couch cushion. The next day, she went home. I saw her two weeks later. No infection. No troubles. She’d done beautifully.

Then I got an e-mail notice. The mesh manufacturer, Johnson & Johnson, was reporting that the mesh I’d put in was counterfeit. It was fake.

Someone had infiltrated the supply chain somewhere between Sherman, Tex., where the authentic mesh was manufactured, and Boston, where I’d operated on the patient. Apparently, mesh can travel through many hands. The original lot had gone to a Memphis warehouse, and then through at least two hospital goods distributors, which sell and trade medical supplies on what turns out to be a worldwide market, like oil. Somewhere along the way a counterfeiter replaced the lot with fake mesh packaged exactly like Johnson & Johnson’s, right down to the lot number. It is believed this happened someplace in Asia. But no one really knows.

The material looked like ordinary mesh to me. But according to the alert from the Food and Drug Administration, it wasn’t sterile. And although it seemed to be polypropylene, the fibers and weave were different from the manufacturer’s. It wasn’t clear what should be done. I called the patient to come see me.

I also began to wonder how I could trust anything I use. My sterile gloves come from the Philippines, surgical sponges from China, devices and instruments from Taiwan to Texas. The ingredients for medications come from all over the world.

This is how it is now. That’s not bad, I know. But it’s not all good, either. In the effort to get the best possible results for people, it seems hard enough make sure one’s decisions are right. I’d never considered that I had to worry about my supplies, too.

So what to do?

In the name of safety and simplicity, we could try to restrict medical manufacturing and distribution networks to our borders. This is, for example, the argument for blocking the sale of medications from Canada. It’s folly, though. Medicine’s success and affordability already critically depend on materials and distribution from around the globe. Yet market forces aren’t weeding out the shady operators, either.

So we’re left only with vigilance — police work. Put enough F.D.A. inspectors on the ground and tracing technology on the goods and we actually could block those who would put an industrial solvent in children’s cough medicine and fake, unsterile material in our surgical supplies.

This we don’t do, though. The number of F.D.A. inspectors has actually been cut — partly because of small-government ideology and partly because of tight budgets. And still they’re finding more cases than ever. (In recent years, they’ve found counterfeit Lipitor, Viagra, Botox, Zyprexa and birth control pills, among others.) We need many times more inspectors. But nothing like it has been considered. That is no longer acceptable.

I saw my patient and told her about the fake mesh. She was stunned. We then considered what to do. It wasn’t clear the mesh would hold; and in many other patients, it became infected and had to be removed. But she’d done all right so far, and redoing the repair is major surgery. So she decided to wait and see what happened.

Given the alternative, doing nothing and hoping for the best was a wise choice for her. But it’s a bad choice for the rest of us.

Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and a New Yorker staff writer, is the author of the new book “Better.” He is a guest columnist this month.



To: TimF who wrote (337341)5/12/2007 12:21:58 PM
From: Road Walker  Read Replies (2) | Respond to of 1584452
 
The interesting part is towards the end...

A Contrarian on Retirement Says Wait
By DAMON DARLIN
Come retirement, it will finally be time to get back the money that has been extracted from your paycheck your entire working life.

Indeed, requesting your Social Security benefits might seem like the first order of business as soon as the going-away party is over. But you might be a lot better off waiting a bit longer, until age 66 or even 70 before tapping into the government retirement fund. Relying at first on other savings like individual retirement accounts or the 401(k) from work could raise your living standard in retirement as much as 10 percent, according to calculations made by Laurence J. Kotlikoff, an economics professor at Boston University.

This is unconventional advice as Mr. Kotlikoff is the first to acknowledge. But Mr. Kotlikoff, 56, who has been studying savings his entire career, thinks that much of what passes for financial advice is merely conventional wisdom.

As noted here, he has annoyed the financial planning industry with his research that suggests that the calculators used to forecast retirement needs overstate the amount that must be saved.

He also says that the elderly should be investing more heavily in equities rather than bonds, as most planners advise. “There is almost nothing that you can tell me about conventional financial advice that makes any sense,” he said.

There are many skeptics.

Margaret H. Smith, an assistant economics professor at Pomona College in Claremont, Calif., and a financial planner, thinks that a decision about when to take Social Security should not be coupled with other retirement funds. “It all depends on how long you live,” she said. As with many planners, she thinks tax-advantaged accounts, like 401(k)s or Roth I.R.A.s should be left to accumulate as long as possible.

“If they can afford to take it at a later date because they have other sources of income, that’s good, but the lion’s share of people need every penny they can get,” said Chad Terry, the director for retirement solutions at the Principal Financial Group, a financial services company based in Des Moines.

But there are some compelling financial reasons to at least hear Mr. Kotlikoff out. The average retirement age is now 62, not 65. Indeed, only 27 percent of Americans retire at age 65 or later, according to the Employee Benefit Research Institute.

The early retirement might be a direct result of the early availability of the payments. But delaying retirement can make a big difference financially. The Fidelity Research Institute did a study (www.fidelityresearchinstitute.com/pdf/Beyond_Conventional_Wisdom.pdf) last year showing how advantageous a delayed retirement is. It used an example of a 55-year-old making $75,000. Upon retirement at 62, he would get $15,888 in Social Security. If retirement was postponed until 66, the amount would rise to $21,768. A further delay to age 70 would yield an annual benefit of $29, 436.

There is a similar effect for those who choose to stop working at 62, but don’t tap Social Security until later. Instead of payments of $15,888, the retiree who waits until 66 receives $21,181 a year in benefits and one who delays until 70 receives a $28,821 annual stipend, or 81 percent more, the Fidelity Research Institute said. There is no additional financial benefit to delaying past 70.

So why don’t more people delay taking their Social Security? Some may not know how benefits accrue. It is also possible that they figure they will die in only a few years. If that is the case, grabbing benefits early makes sense, but study after study shows Americans tend to underestimate their longevity — one reason financial planners urge people to save more.

A foreboding that Social Security will not be around may be another reason Americans act early. Research by Hugo A. Benítez-Silva, Debra Sabatini Dwyer and Warren C. Sanderson at the State University of New York at Stony Brook found that the fear among Americans that future benefits might not be there drives many retirees to take benefits as soon as they are available. Researchers at the RAND Corporation are studying this issue to find ways to encourage Americans to consider delaying retirement or deferring benefit payments.

Mr. Kotlikoff points out that because Social Security accounts increase at the rate of 7 percent a year from age 62 to 66 and then at 8 percent a year until age 70, retirees get a better return there than they might get on the bonds inside their I.R.A.s. “That’s a safe real return of 7 percent or 8 percent,” he said. “You can’t get anything close to that in the market.”

The tax implications of raiding Social Security first does not matter much for the wealthy, but for everyone else it might. Social Security income is tax- free for an individual with a total income of less than $25,000 ($32,000 for a couple filing jointly). As income rises, the share of benefits subject to tax rises to 50 percent and then 85 percent.

Here is the troublesome part and it will sound familiar to anyone who has been hit with the federal alternative minimum tax on their income: the tax on Social Security benefits is not indexed for inflation. As with the alternative tax, an increasing number of people will be subject to the benefits tax and pay more to the government than they need to. “There are a lot of taxes on Social Security benefits, if you don’t do this correctly,” Mr. Kotlikoff said.

His advice does not mean that everyone should start delaying their Social Security payments. It may very well make sense for many to take them immediately, depending on what other assets they are counting on to tide them over in retirement. An adviser can help.

Mr. Kotlikoff relies on financial planning software he has been developing called ESPlanner. It has been used by a number of economists and academics who are studying retirement savings. Mr. Kotlikoff used it recently to reach the startling conclusion that over a lifetime a plumber has a higher standard of living than a physician with a general practice because the doctor starts earning later, pays higher taxes and high malpractice insurance premiums.

Ms. Smith, the financial planner-economics professor, is a bit wary of the software for financial planning. It comes back to death. “His software assumes an end date,” she said. It misses “income uncertainty and life expectancy uncertainties, two very large unknowns in the planning process,” she said.

Mr. Kotlikoff has taken some other unusual stances for fixing three of the most intractable problems Congress faces: health care, taxes and Social Security.

He proposes an annual health care voucher from the government, with the amount to be determined by the health of the citizen. He sees it as helping the poor, because they tend to have more health problems than the rich.

His plan for tax reform is to substitute a federal sales tax for the corporate and individual income tax and payroll taxes like Social Security and Medicare. The government would rebate a portion of the tax to the poor.

His third proposal tackles Social Security. It would set up individual accounts financed with whatever has been accrued as of the date of reform. Individuals would be forced to put 8 percent of their income into the account each year and the government would match the contributions of the poor. It would be invested in a weighted global index fund, he said, to “keep Wall Street’s hands off of it.”

From age 57 to 67, a person’s accounts would be gradually converted into inflation-protected government bonds. If a person dies before 67, a portion of the proceeds can be bequeathed to others, a move, he said, that would help blacks and Hispanics who tend to die younger than whites and Asians.

Mr. Kotlikoff’s ideas are way out there, but he attracted the attention of one presidential candidate. He is serving as an economic adviser to Mike Gravel, the former Alaska senator who garnered much attention in the Democratic debate in South Carolina last month with his outspokenness.

Mr. Gravel’s popularity, it should also be noted, remains an asterisk in most polls.

E-mail: yourmoney@nytimes.com



To: TimF who wrote (337341)5/14/2007 6:41:25 AM
From: Road Walker  Respond to of 1584452
 
Divided Over Trade
By PAUL KRUGMAN
Nothing divides Democrats like international trade policy. That became clear last week, when the announcement of a deal on trade between Democratic leaders and the Bush administration caused many party activists to accuse the leadership of selling out.

The furor subsided a bit as details about the deal emerged: the Democrats got significant concessions from the Bushies, while effectively giving a go-ahead to only two minor free trade agreements (Peru and Panama). But the Democrats remain sharply divided between those who believe that globalization is driving down the wages of many U.S. workers, and those who believe that making and honoring international trade agreements is an essential part of governing responsibly.

What makes this divide so agonizing is that both sides are right.

Fears that low-wage competition is driving down U.S. wages have a real basis in both theory and fact. When we import labor-intensive manufactured goods from the third world instead of making them here, the result is reduced demand for less-educated American workers, which leads in turn to lower wages for these workers. And no, cheap consumer goods at Wal-Mart aren’t adequate compensation.

So imports from the third world, although they make the United States as a whole richer, make tens of millions of Americans poorer. How much poorer? In the mid-1990s a number of economists, myself included, crunched the numbers and concluded that the depressing effects of imports on the wages of less-educated Americans were modest, not more than a few percent.

But that may have changed. We’re buying a lot more from third-world countries today than we did a dozen years ago, and the largest increases have come in imports from Mexico, where wages are only about 11 percent of the U.S. level, and China, where wages are only 3 percent of the U.S. level. Trade still isn’t the main source of rising economic inequality, but it’s a bigger factor than it was.

So there is a dark side to globalization. The question, however, is what to do about it.

Should we go back to old-fashioned protectionism? That would have ugly consequences: if America started restricting imports from the third world, other wealthy countries would follow suit, closing off poor nations’ access to world markets.

Where would that leave Bangladesh, which is able to survive despite its desperate lack of resources only because it can export clothing and other labor-intensive products? Where would it leave India, where there is, at last, hope of an economic takeoff thanks to surging exports — exports that would be crippled if barriers to trade that have been dismantled over the past half century went back up?

And where would it leave Mexico? Whatever you think of Nafta, undoing the agreement could all too easily have disastrous economic and political consequences south of the border.

Because of these concerns, even trade skeptics tend to shy away from a return to outright protectionism, and to look for softer measures, which mainly come down to trying to push up foreign wages. The key element of the new trade deal is its inclusion of “labor standards”: countries that sign free trade agreements with the United States will have to allow union organizing, while abolishing child and slave labor.

The Bush administration, by the way, opposed labor standards, not because it wanted to keep imports cheap, but because it was afraid that America would end up being forced to improve its own labor policies. So the inclusion of these standards in the deal represents a real victory for workers.

Realistically, however, labor standards won’t do all that much for American workers. No matter how free third-world workers are to organize, they’re still going to be paid very little, and trade will continue to place pressure on U.S. wages.

So what’s the answer? I don’t think there is one, as long as the discussion is restricted to trade policy: all-out protectionism isn’t acceptable, and labor standards in trade agreements will help only a little.

By all means, let’s have strong labor standards in our pending trade agreements, and let’s approach proposals for new agreements with an appropriate degree of skepticism. But if Democrats really want to help American workers, they’ll have to do it with a pro-labor policy that relies on better tools than trade policy. Universal health care, paid for by taxing the economy’s winners, would be a good place to start.