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From the Los Angeles Times

LAPD Officer Deon Joseph tries to persuade a church group from South Los Angeles not to distribute food to the homeless on skid row.

Not all welcome skid row charity Authorities are wary of groups that hand out food and clothing, claiming they may leave a mess behind or fuel drug sales. By Alexandra Zavis, Los Angeles Times September 12, 2010 Los Angeles police officer Deon Joseph followed a trail of discarded paper plates and half-eaten macaroni down 6th Street and around the corner into San Pedro Street. There he found his targets: members of a church group, heads bowed in prayer after serving lunch to a long line of homeless people. Dozens of groups from across the Southland converge on downtown Los Angeles every week to hand out food and clothing in skid row, which has been called the homeless capital of the nation.

American jailed in Iran can leave, for a price

Sarah Shourd's lawyer says the Swiss Embassy in Tehran will arrange for her $500,000 bail. Her two hiking companions will remain in custody.

By Borzou Daragahi

Los Angeles Times Staff Writer

September 12, 2010

Reporting from Istanbul, Turkey —

In the latest twist to the seesawing fortunes of three Americans held in an Iranian prison, a prosecutor now says one of them can leave jail -- provided she puts up half a million dollars bail.

Tehran prosecutor Abbas Jaffar Dowlatabadi told reporters Sunday that bail had been set at the equivalent of $500,000 for Sarah E. Shourd, according to the semi-official Iranian Labor News Agency.

The 32-year-old woman was arrested last year along with Americans Joshua Fattal and Shane Bauer along the Iran-Iraq border during what relatives of the detainees call an ill-fated hiking trip. None have been formally charged, though Iranian officials have accused them of espionage.

But Dowlatabadi said an "indictment of charges against the three accused has been issued and their cases are ready to be submitted to the court."

He also said the "order of arrest for the other two American nationals … has been extended."

The lawyer for the three Americans, Massoud Shafiqi, said he was upbeat about Shourd's release. He said he had contacted his client's family and informed the Swiss embassy, which hosts the U.S. interests section in Iran in the absence of formal relations between Washington and Tehran, "so that they can take the necessary measures," according to the Iranian Students News Agency.

Iranian officials under the authority of President Mahmoud Ahmadinejad had days earlier said Shourd would be released Saturday morning but, in a stark illustration of Iran's domestic political infighting, backtracked after the powerful judiciary said the investigation of her case had not been completed.

Dowlatabadi did not say whether Shourd, who has reportedly complained of medical problems to her family, would be allowed to leave the country if she's freed. He referred to the case of Clotilde Reiss, the French lecturer arrested in Iran last year and accused of espionage who was eventually released from Evin but barred from leaving the country for months.

The hikers' continued detention has further strained relations between Iran and the U.S., which accuses Tehran of pursuing a nuclear weapons program and undermining peace efforts in the Middle East.

http://www.latimes.com/news/nationworld/world/la-fgw-iran-hikers-20100913,0,6832062,print.story

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Angry tones mix with somber at Sept. 11 memorials

Protests and quarreling over a proposed mosque near the former World Trade Center site in New York strike a divisive chord amid the ritual expressions of mourning.

By Geraldine Baum, Tina Susman and Bob Drogin, Los Angeles Times

September 12, 2010

Reporting from New York and Washington

Nine years after the terrorist attacks of Sept. 11, 2001, Americans came together Saturday to honor the victims with now-familiar rites of remembrance and prayer.

But this Sept. 11 was dramatically different from those in the past. For the first time, in Lower Manhattan where the twin towers fell, the ground that had long served to unify the nation began to divide it instead.

Angry protests erupted over a proposed Islamic center and mosque two blocks from the former World Trade Center site. No violence or arrests were reported, but the bitter passions over religious tolerance and cultural diversity threatened to overshadow an anniversary that previously was marked chiefly by mourning and sober reflection.

With national polls showing anti-Muslim sentiment on the rise, President Obama appealed for Americans to "rekindle the spirit of unity" that swept the stunned nation after nearly 3,000 people died in the horrors of that sun-dappled morning nine years ago.

"This is a time of difficulty for our country," Obama said in his weekly radio address. "And it is often in such moments that some try to stoke bitterness — to divide us based on our differences, to blind us to what we have in common."

The worst fears for the day did not materialize. An anti-Muslim pastor from a tiny church in Florida said he had "totally cancelled" his plan to burn copies of the Koran, but not before sparking outrage around the globe and anti-U.S. protests in several Muslim countries, including Afghanistan.

As in previous years, solemn ceremonies were held at the places where the four jetliners hijacked by Al Qaeda militants crashed.

Obama placed a wreath at the Pentagon, Vice President Joe Biden spoke at the former World Trade Center site, and First Lady Michelle Obama and former First Lady Laura Bush appeared at a Sept. 11 national park under construction in Shanksville, Pa.

But along with weeping and prayers, there was discord.

Police estimated that more than 2,000 protesters converged near the abandoned coat factory where the 13-story Islamic cultural center is proposed.

Shouting matches and angry placards filled the air as people argued over whether the planned house of worship would represent a triumph of religious freedom or an affront to those who perished and their families. Police used barricades to keep rival groups apart, but there were scattered scuffles.

On a clear, crisp morning, much like the one nine years ago, bagpipes skirled, drums beat a mournful tattoo and the familiar ritual began beside the gaping hole where the twin towers long had stood — chiming bells, moments of silence, and the slow reading aloud of each victim's name, 2,752 in all.

A huge U.S. flag found in the rubble and stitched back together was unfurled on the stage. Police and firefighters in dress uniforms stood at attention while men and women clutched one another, tears streaming down their faces. For many families, it was a reunion of shared grief and searing loss.

None of the speakers mentioned the planned mosque, but the troublesome issue formed an undercurrent through conversations in the crowd.

"This was really the first time I thought of not coming because of all the controversy around this Muslim place," said Marty Lesser, 59, who fled down 30 flights of stairs to escape one of the burning towers. "I come here to get quiet, and this year the noise is everywhere."

Rosaria Reneo, whose 25-year-old sister, Daniela Notaro, died in the collapsing towers, said she was bothered by the cranes and heavy equipment that will construct a Sept. 11 memorial at the site by next year, as well as the planned Islamic center nearby.

"A lot of people were not found, including my sister," she said. "It's also really a cemetery."

The site of the towers was not visible from two blocks away, where the Islamic center would rise. Standing on the corner, Matt Sky, a 26-year-old Web designer, waved a placard reading, "Honor 9-11, honor the freedom of religion." He was immediately challenged by a slew of angry opponents.

"This is not a religious issue," said Rose Van Guilder, 62. "It's an issue of sensitivity."

"If you had a child who was raped, would you want the family of the people who did it to move right next to you?" demanded Christopher Olivaria, a sanitation manager.

"The people who want this center didn't do anything wrong," Sky responded. "They just want to practice their religion as they always have in this area."

As the crowd grew, and the argument heated up, police moved the group behind a metal barricade to get them off the street. The shouting soon calmed down, but other debates and quarrels erupted nearby.

The family of Brooke Jackman, who was 23 when she died on Sept. 11, ignored the quarreling as well as a man who railed against Muslims in front of TV cameras. As in past years, the family attended the ceremony, waited for Jackman's name to be read aloud, then left flowers and photographs behind.

"This is a day of remembrance — nothing more," said the victim's sister, Erin. "We're doing what we always do on this day."

Two other women, the widow and sister of a victim, didn't argue. But they didn't agree either on whether the proposed Islamic center should be built. The widow called it a "typical Muslim victory" monument for lives lost and families shattered. But the sister quietly cited the right to worship anywhere in America. They declined to give their names.

By midafternoon, the area began to resemble a raucous street fair of competing religious, social and civic groups, all vying for attention.

One group passed out leaflets protesting homosexuality. Another held up huge antiabortion signs. Down the street, women in bonnets and long, flowered dresses handed out Mennonite literature. An old man with a long gray beard played "Amazing Grace" on a flute.

Pro-mosque groups gathered by City Hall, and activists waved signs reading, "Down with anti-Muslim bigotry" and "Christians for religious freedom in America." Leaders from more than 50 groups, including ministers, rabbis, imams and union leaders, took turns at the megaphone.

One speaker, from a mosque in Albany, N.Y., complained that Muslim Americans were treated "like the bogeyman — marginalized, demonized."

Several blocks away, however, opponents toted signs that read, "It stops here" and "Never forgive, never forget, no WTC mosque." Some chanted "USA" and "No mosque here."

One opponent held a sign reading, "The Quran is a lie and hate." When a passerby challenged him, another woman responded sharply. "Not every Muslim is a terrorist, but every terrorist happens to be Muslim," she said.

"Haven't you heard of Timothy McVeigh?" an onlooker shouted back.

McVeigh, a white American militia movement sympathizer, was convicted and executed for carrying out the 1995 Oklahoma City bombing, which killed 168 people. It was the deadliest act of terrorism on U.S. soil prior to Sept. 11.

http://www.latimes.com/news/nationworld/nation/la-na-9-11-anniversary-20100912,0,3922981,print.story

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Obama honors Sept. 11 victims, condemns terrorists

'It was not a religion that attacked us that September day, it was Al Qaeda, a sorry band of men which perverts religion,' the president says during a memorial at the Pentagon.

By Christi Parsons, Tribune Washington Bureau

September 12, 2010

Reporting from Washington

Observing the Sept. 11 anniversary Saturday at the Pentagon, President Obama asked Americans to honor the tragedy's victims by renewing a "sense of common purpose" and refusing to let terrorists tear down the nation's ideals.

The highest honor that Americans can pay to those killed that day nine years ago is to do what adversaries fear most, Obama said.

"We define the character of our country," Obama said, "and we will not let the acts of some small band of murderers who slaughter the innocent and cower in caves distort who we are."

Obama spoke not far from a prayer room opened by the military weeks after the attack so that service members of all faiths could pray, read their holy books and join clerics, including an imam once a week, for services.

As the furor continues over the possibility that an Islamic center and mosque will open blocks from the World Trade Center site in New York, Obama promised to champion the rights of every American to worship as they choose, "as service members and civilians from many faiths do just steps from here, at the very spot where the terrorists struck this building."

The country is not at war with Islam, the president said.

"It was not a religion that attacked us that September day, it was Al Qaeda, a sorry band of men which perverts religion," he said.

"And just as we condemn intolerance and extremism abroad, so will we stay true to our traditions here at home as a diverse and tolerant nation."

http://www.latimes.com/news/nationworld/nation/la-na-obama-remembrance-20100913,0,6618075,print.story

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From the New York Times

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American Doctors Held in Zimbabwe

JOHANNESBURG — Five Americans — two doctors, two nurses and an organizer — who carried donated AIDS drugs to Zimbabwe for distribution to the poor were arrested Thursday and remained jailed in Harare on Saturday on a charge of dispensing the medicine without the supervision of a pharmacist or proper licenses, their lawyer said.

The Americans, who are being held in smelly, poorly ventilated cells at Harare Central police station, were to have appeared in court on Saturday for a bail hearing, but the police said they had not finished the paperwork, said the lawyer, Jonathan Samukange. The Americans are expected to appear before a magistrate on Monday.

A Zimbabwean doctor working with them was also arrested on related charges.

The state-run newspaper, The Herald, on Saturday quoted a spokesman for the criminal investigations department, Detective Inspector Augustin Zimbili, confirming the arrests and the charges.

The Americans belong to the Allen Temple Baptist Church AIDS Ministry in Oakland, Calif. The church serves a predominantly African-American congregation. Three or four times a year since 2000, members have paid their own way to Zimbabwe to give antiretroviral medicine, vitamins, clothing and food baskets to impoverished people with AIDS.

The epidemic is severe throughout Zimbabwe and the country's broken health system fails to treat most people in need.

On this trip, the team had brought a four-month supply of antiretroviral drugs for about 800 people with AIDS, some of them orphaned children, in Harare and Mutoko, a rural district.

Arnold Perkins, the retired public health director in Alameda County, Calif., said in a telephone interview from California that he had made the trip six times and saw skeletal AIDS patients restored to health by the medicine. The arrest of the team there “breaks my heart,” he said.

“If this work stops, it's a human tragedy,” he said. “People will die. That's a fact.”

But the police spokesman defended the arrests. “It is our duty to ensure that all clinics and medical institutions are registered for easy monitoring,” The Herald quoted Detective Inspector Zimbili as saying. “There is a risk of dispensation of expired drugs. When premises are not licensed, it is difficult to check if the act is being complied with.”

The lawyer for the Americans, Mr. Samukange, denied the charges. He said the doctors who dispensed the medicine, Dr. Andrew Reid, an American resident of Zimbabwe, and Dr. Tembinhosi Ncomanzi, a Zimbabwean, were licensed to practice there.

In addition to the two doctors, according to the Oakland ministry, the others in custody include two nurses, David Greenberg and Gregory Miller, and the head of the AIDS ministry, Gloria Cox-Crowell. “They're all in good spirits,” Mr. Samukange said.

Kenric Bailey, a member of the AIDS ministry, said a soured relationship with a Zimbabwe charity was at the root of the arrests.

“It's very unsettling,” said Mr. Bailey, who has paid his way to Zimbabwe eight times.

Mr. Samukange said he expected that the American medical team would be released on bail on Monday and subjected at most to a fine.

http://www.nytimes.com/2010/09/12/world/africa/12zimbabwe.html?_r=1&ref=world&pagewanted=print

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Still on Duty at Ground Zero, the Indomitable Nurse Reggi

ALL attempts to keep Mary Regina Shane from working exactly where she wants to have failed, thank you very little.

Terrorists did not manage to kill Ms. Shane in 1993, and they failed to kill her again in 2001. When she wanted to go back, her mother tried an appeal to common sense: Regina, have you lost your mind? That did not work, either. And so Ms. Shane, a cheerful daughter of Staten Island better known as Nurse Reggi, reports to work every morning at what can honestly be called her favorite place in town: the World Trade Center site.

“I have a guardian angel, for sure,” she said in the small trailer marked “First Aid” below what will someday be a 1,776-foot-tall tower.

Having twice survived attacks on the World Trade Center, Ms. Shane returns to the site every morning as part of a medical team to mend the cuts and bruises and burns of construction workers rebuilding it.

“I love this place; I really do,” said Ms. Shane, 63, a plug of an Irish-Italian mother of two and grandmother of four, who was wearing a hard hat as she stood in the middle of the site recently.

In 1993, Ms. Shane was working as a nurse in the employee health unit of the Port Authority of New York and New Jersey , on the 63rd floor of the South Tower. “I was very lucky,” she said, as if talking about landing such a job instead of surviving it on Feb. 26 that year. She was in the lobby when the bomb went off. It was lunchtime. A picture of her pushing a woman out of the building on a coffee cart ran later in USA Today.

“I felt like a rescuer,” she said. “I didn't feel like my life was in danger. We never, ever thought the buildings could ever come down.”

Ms. Shane changed jobs after that, working in New Jersey and eventually landing at Verizon in its human resources department, employed in the workers' compensation office. When Verizon moved her to its office on the ninth floor of the South Tower in the late 1990s, she was happy to be back.

On Sept. 11, 2001, Ms. Shane heard an explosion and saw flaming debris streaming down from the North Tower. “The floor shook; the lights flickered,” she said. “Someone ran in and said this was a commercial airliner that hit the building.”

“We ran out,” she recalled. “We were very lucky.”

In the lobby, someone told her group that it would be safe inside. Ignoring that, she and a co-worker ran toward Century 21. She did not look back when the buildings fell.

“I had terrible guilt about not trying to stay and rescue more people, but I honestly was in fear of my life,” she said. “Honest to God, I was going to jump in the river if one more thing blew up.”

Her mother, in Midland Beach, on the eastern edge of Staten Island, feared the worst until Ms. Shane finally called after landing safely home in Stuyvesant Town, where she still lives.

Her mother, Santa Maria Shane, born in 1927, was the Italian half of the family and a woman of many opinions. Among other things, she frowned at the nickname Nurse Reggi.

“My mother would never call me that — ‘I didn't name you that,' ” Ms. Shane said. “She was a corker.”

All joking ceased after the attacks. “September 12th, I said, ‘I'm coming back,' ” Ms. Shane recalled. “My mother said, ‘I'm not speaking to you anymore.' ”

Afraid she was serious, the daughter stood down, reporting to work at a Verizon office on 38th Street to outfit workers with air masks before they repaired telephone lines near ground zero. No more talk of a move downtown. “It wasn't even discussed,” she said.

Ms. Shane's father died in 2005. Her mother, who had scleroderma for years, died in 2006, at age 79.

A week or two later, Ms. Shane was reading a newspaper and came across a small classified ad at the bottom of a page. “This big,” she said, holding a pinky sideways. The ad was seeking someone in occupational health to work in Lower Manhattan. She called, and a man with Concentra Health Solutions asked, “Have you heard of the Freedom Tower?”

“It was like kismet,” she said. “I'm sure it was my mom saying, ‘O.K., have it your way. You can go back to work there.' ”

The clinic, staffed by three full-time and two part-time emergency medical technicians, two consulting physicians as well as Ms. Shane, is open around the clock six days a week and most of Sunday. In between treating injuries, she provides safety programs for the construction workers.

Ms. Shane has been back on the site for three years, and on any given day she must be the happiest-looking person anywhere in the area, which is filled with toiling workers and populated, of late, by angry opponents of a planned Islamic cultural center. Ms. Shane's take: Other people's religion is not her business.

The other day, she gave a short tour, color-commentating to the visitor about a faraway worker's safety precautions — “Tie off, brother. Let me see you tie off ... good job” — and exchanging greetings with guys who have visited her trailer.

She speaks with uncommon expertise about the stages of the various projects, including the subway lines below, the memorial plaza and the lifts that take workers to the top of the growing tower. “People are so friendly, and they tell me things,” she said.

Ms. Shane treats about five workers on a busy day, for welding burns or turned ankles where the footing is unsure, or dust and dirt in the eye. She also takes every opportunity to check blood pressure and give little lectures about tetanus shots and how to prevent infection and eat better. “People liken it to working in a school,” she said, “but having big kids.”

Ms. Shane takes her meals from a food truck like everybody else, and her biggest complaint seems to be the discomfort of having put down her cigarettes almost three weeks ago. She is proud of the workers and the way they look out for one another.

“Enough people have died here,” she said.

http://www.nytimes.com/2010/09/12/nyregion/12NURSE.html?pagewanted=print

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Number of Families in Shelters Rises

PROVIDENCE, R.I. — For a few hours at the mall here this month, Nick Griffith, his wife, Lacey Lennon, and their two young children got to feel like a regular family again.

Never mind that they were just killing time away from the homeless shelter where they are staying, or that they had to take two city buses to get to the shopping center because they pawned one car earlier this year and had another repossessed, or that the debit card Ms. Lennon inserted into the A.T.M. was courtesy of the state's welfare program.

They ate lunch at the food court, browsed for clothes and just strolled, blending in with everyone else out on a scorching hot summer day. “It's exactly why we come here,” Ms. Lennon said. “It reminds us of our old life.”

For millions who have lost jobs or faced eviction in the economic downturn, homelessness is perhaps the darkest fear of all. In the end, though, for all the devastation wrought by the recession, a vast majority of people who have faced the possibility have somehow managed to avoid it.

Nevertheless, from 2007 through 2009, the number of families in homeless shelters — households with at least one adult and one minor child — leapt to 170,000 from 131,000, according to the Department of Housing and Urban Development .

With long-term unemployment ballooning, those numbers could easily climb this year. Late in 2009, however, states began distributing $1.5 billion that has been made available over three years by the federal government as part of the stimulus package for the Homeless Prevention and Rapid Re-Housing Program , which provides financial assistance to keep people in their homes or get them back in one quickly if they lose them.

More than 550,000 people have received aid, including more than 1,800 in Rhode Island, with just over a quarter of the money for the program spent so far nationally, state and federal officials said.

Even so, it remains to be seen whether the program is keeping pace with the continuing economic hardship.

On Aug. 9, Mr. Griffith, 40, Ms. Lennon, 26, and their two children, Ava, 3, and Ethan, 16 months, staggered into Crossroads Rhode Island, a shelter that functions as a kind of processing and triage center for homeless families, after a three-day bus journey from Florida.

“It hit me when we got off the bus and walked up and saw the Crossroads building,” Ms. Lennon said. “We had all our stuff. We were tired. We'd already had enough, and it was just starting.”

The number of families who have sought help this year at Crossroads has already surpassed the total for all of 2009. Through July, 324 families had come needing shelter, compared with 278 all of last year.

National data on current shelter populations are not yet available, but checks with other major family shelters across the country found similar increases.

The Y.W.C.A. Family Center in Columbus, Ohio, one of the largest family shelters in the state, has seen an occupancy increase of more than 20 percent over the last three months compared with the same period last year. The UMOM New Day Center in Phoenix, the largest family shelter in Arizona, has had a more than 30 percent increase in families calling for shelter over the last few months.

Without national data, it is impossible to say for certain whether these are anomalies. Clearly, however, many families are still being sucked into the swirling financial drain that leads to homelessness.

The Griffith family moved from Rhode Island to Florida two years ago after Mr. Griffith, who was working as a waiter at an Applebee's restaurant, asked to be transferred to one opening in Spring Hill, an hour north of Tampa, where he figured the cost of living would be lower.

He did well at first, earning as much as $25 an hour, including tips. He also got a job as a line cook at another restaurant, where he made $12 an hour.

The family eventually moved into a three-bedroom condominium and lived the typical suburban life, with a sport-utility vehicle and a minivan to cart around their growing family.

In January, however, the restaurant where Mr. Griffith was cooking closed. Then his hours began drying up at Applebee's. The couple had savings, but squandered some of it figuring he would quickly find another job. When he did not, they were evicted from their condo.

They lived with Ms. Lennon's mother at first in her one-bedroom house in Port Richey, Fla., but she made it clear after two months that the arrangement was no longer feasible. The family moved to an R.V. park, paying $186 a week plus utilities. By late July, however, they had mostly run out of options.

They called some 100 shelters in Florida and found that most were full; others would not allow them to stay together.

They considered returning to Rhode Island. An Applebee's in Smithfield agreed to hire Mr. Griffith. They found Crossroads on the Internet and were assured of a spot. Using some emergency money they had left and $150 lent by relatives, they bought bus tickets to Providence.

Now, the family is crammed into a single room at Crossroads' 15-room family shelter, which used to be a funeral home. All four sleep on a pair of single beds pushed together. There is a crib for Ethan, but with all the turmoil, he can now fall asleep only when next to his parents. A lone framed photograph of the couple, dressed up for a night out, sits atop a shelf.

The living conditions are only part of the adjustment; there is also the shelter's long list of rules. No one can be in the living quarters from 10 a.m. to 4:30 p.m. The news is even off-limits as television programming in the common area. Residents were recently barred from congregating around the bench outside.

Infractions bring write-ups; three write-ups bring expulsion.

The changes have taken a toll on the family in small and large ways. Ethan has taken to screaming for no reason. Ava had been on the verge of being potty-trained, but is now back to diapers. Their nap schedules and diets are a mess. Their parents are squabbling more and have started smoking again.

Mr. Griffith found that he could work only limited hours at his new job because of the bus schedule. The family did qualify last week for transitional housing, but that usually takes a month to finalize. They are still pursuing rapid rehousing assistance.

Others at the shelter with no job prospects face a steeper climb meeting the requirements.

Every few days, new families arrive. A few hours after the Griffiths got back from the mall, a young woman pushing a stroller with a toddler rang the shelter doorbell, quietly weeping.

http://www.nytimes.com/2010/09/12/us/12shelter.html?ref=us&pagewanted=print

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Is Newer Better? Not Always

OPINION

The Congressional Budget Office estimates that an astonishing half or more of the increased spending for health care in recent decades is due to technological, surgical and clinical advances.

For the most part, such advances are a cause for celebration. But an expensive new drug is not always better than an older, cheaper drug, and sometimes a new technology or treatment that is highly effective for some patients is unnecessary or even dangerous for others.

The system almost seems designed to keep driving up costs.

To win approval, drugs and many devices must undergo tests for safety and effectiveness. For drugs, there is usually no comparison to products already approved. For both, there is no consideration of cost. Once drugs or devices are approved to treat one class of patients or illnesses, doctors can use them for virtually any ailment they please. Manufacturers eagerly promote their most expensive products to doctors and patients.

Patients have few ways to judge what is best for improving health or saving money. They must rely on doctors who may have insufficient information — or economic incentives to pick the costliest treatment.

The new health care reform law makes a start at figuring this out. It sets up a new system to evaluate the comparative effectiveness of drugs, treatments and medical devices. But, after all of the cynical demagoguing about “death panels,” it limits the extent to which the studies can be used to help hold down costs.

No one wants to bar patients from getting the treatment they need. But without curtailing the use of unnecessary, overly costly and even dangerous new technologies and surgical procedures, there is little hope of restraining the relentless rise in health care costs.

That is a truth that American politicians and taxpayers cannot afford to ignore for much longer.

•

The good news on medical advancements is undeniable. Doctors can now keep patients alive with improved dialysis treatments while they await a kidney transplant, replace disintegrating hips and knees with artificial joints, and spot internal growths with high-tech imaging devices that avoid the need for exploratory surgery.

Even costly therapies can end up saving money as well as lives. Studies by respected economists have shown that spending on new cardiac treatments, neonatal care for low-birth-weight infants, and mental health drugs have more than paid for themselves.

This is not always the case. Consider the prostate-specific antigen test, which is widely used to screen men for possible prostate cancer. In an Op-Ed piece in The Times in March, Richard J. Ablin, the doctor who discovered prostate-specific antigen, described the test as “hardly more effective than a coin toss” at distinguishing who is at risk, and lamented that the test's popularity has led to “a hugely expensive public health disaster.”

Each year some 30 million American men undergo the test at a cost of at least $3 billion, and many go on to have surgery, intensive radiation or other damaging treatments that may not have been necessary.

Or consider complex fusion surgery to relieve lower back pain. An article and an editorial in the April 7 issue of The Journal of the American Medical Association deplored the rapidly rising use of this surgery, which fuses multiple disks in the spine, in patients who would have done better, and faced fewer risks, with simpler surgery that eases pressure on the nerves without fusion.

The explanation for the boom was likely economic. Surgeons were paid 10 times as much for the complex surgery, hospitals were paid three and a half times as much, and manufacturers reaped a bonanza selling $50,000 worth of implants for the complex surgery, compared with little or no profit from the simpler surgery.

•

Research that systematically compares the effectiveness of different treatments and drugs is clearly needed.

The Obama administration started the process, committing $1.1 billion from stimulus funds to finance comparative studies. The new reform law will move that ahead, setting up a nonprofit, independent institute to organize the work. The comptroller general will appoint a governing board of 19 members, representing patients, doctors, manufacturers and others, including two designated federal health officials.

If the institute works the way it is supposed to, patients, doctors and the government will have better information about what works and what does not, what may be worth the extra cost and what does not make sense. Even then, the legislative language is so convoluted there is no guarantee that even the most credible findings will help ensure that patients get the best and most cost-effective treatment.

With critics wrongly charging that these studies would insert government bureaucrats between patients and their doctors and end up denying access to essential care, reformers pulled their punches.

The institute is supposed to make regular reports of its findings but is carefully restricted as to what it can say. It cannot make recommendations to Medicare or private insurers about what they should or should not cover. It cannot tell doctors what treatments to use, or recommend how much doctors and hospitals should be paid for any services.

Depending on how the White House decides to proceed, the effort could begin to change things. The law says the secretary of health and human services cannot deny Medicare coverage of services “solely” on the basis of comparative effectiveness research, but it does not prevent the use of such findings in conjunction with other factors in making coverage decisions. Those decisions generally influence what private insurers cover as well.

The secretary needs to press the panel to get the research going and then begin including the findings in Medicare coverage and reimbursement decisions. Critics will howl. If the panel does its job right — and politicians have the courage to make the case — both patients and taxpayers will benefit.

http://www.nytimes.com/2010/09/12/opinion/12sun1.html?ref=opinion&pagewanted=print

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We're No. 1(1)!

I want to share a couple of articles I recently came across that, I believe, speak to the core of what ails America today but is too little discussed. The first was in Newsweek under the ironic headline “We're No. 11!” The piece, by Michael Hirsh, went on to say: “Has the United States lost its oomph as a superpower? Even President Obama isn't immune from the gloom. ‘Americans won't settle for No. 2!' Obama shouted at one political rally in early August. How about No. 11? That's where the U.S.A. ranks in Newsweek's list of the 100 best countries in the world, not even in the top 10.”

The second piece, which could have been called “Why We're No. 11,” was by the Washington Post economics columnist Robert Samuelson. Why, he asked, have we spent so much money on school reform in America and have so little to show for it in terms of scalable solutions that produce better student test scores? Maybe, he answered, it is not just because of bad teachers, weak principals or selfish unions.

“The larger cause of failure is almost unmentionable: shrunken student motivation,” wrote Samuelson. “Students, after all, have to do the work. If they aren't motivated, even capable teachers may fail. Motivation comes from many sources: curiosity and ambition; parental expectations; the desire to get into a ‘good' college; inspiring or intimidating teachers; peer pressure. The unstated assumption of much school ‘reform' is that if students aren't motivated, it's mainly the fault of schools and teachers.” Wrong, he said. “Motivation is weak because more students (of all races and economic classes, let it be added) don't like school, don't work hard and don't do well. In a 2008 survey of public high school teachers, 21 percent judged student absenteeism a serious problem; 29 percent cited ‘student apathy.' ”

There is a lot to Samuelson's point — and it is a microcosm of a larger problem we have not faced honestly as we have dug out of this recession: We had a values breakdown — a national epidemic of get-rich-quickism and something-for-nothingism. Wall Street may have been dealing the dope, but our lawmakers encouraged it. And far too many of us were happy to buy the dot-com and subprime crack for quick prosperity highs.

Ask yourself: What made our Greatest Generation great? First, the problems they faced were huge, merciless and inescapable: the Depression, Nazism and Soviet Communism. Second, the Greatest Generation's leaders were never afraid to ask Americans to sacrifice. Third, that generation was ready to sacrifice, and pull together, for the good of the country. And fourth, because they were ready to do hard things, they earned global leadership the only way you can, by saying: “Follow me.”

Contrast that with the Baby Boomer Generation. Our big problems are unfolding incrementally — the decline in U.S. education, competitiveness and infrastructure, as well as oil addiction and climate change. Our generation's leaders never dare utter the word “sacrifice.” All solutions must be painless. Which drug would you like? A stimulus from Democrats or a tax cut from Republicans? A national energy policy? Too hard. For a decade we sent our best minds not to make computer chips in Silicon Valley but to make poker chips on Wall Street, while telling ourselves we could have the American dream — a home — without saving and investing, for nothing down and nothing to pay for two years. Our leadership message to the world (except for our brave soldiers): “After you.”

So much of today's debate between the two parties, notes David Rothkopf, a Carnegie Endowment visiting scholar, “is about assigning blame rather than assuming responsibility. It's a contest to see who can give away more at precisely the time they should be asking more of the American people.”

Rothkopf and I agreed that we would get excited about U.S. politics when our national debate is between Democrats and Republicans who start by acknowledging that we can't cut deficits without both tax increases and spending cuts — and then debate which ones and when — who acknowledge that we can't compete unless we demand more of our students — and then debate longer school days versus school years — who acknowledge that bad parents who don't read to their kids and do indulge them with video games are as responsible for poor test scores as bad teachers — and debate what to do about that .

Who will tell the people? China and India have been catching up to America not only via cheap labor and currencies. They are catching us because they now have free markets like we do, education like we do, access to capital and technology like we do, but, most importantly, values like our Greatest Generation had. That is, a willingness to postpone gratification, invest for the future, work harder than the next guy and hold their kids to the highest expectations.

In a flat world where everyone has access to everything, values matter more than ever. Right now the Hindus and Confucians have more Protestant ethics than we do, and as long as that is the case we'll be No. 11!

http://www.nytimes.com/2010/09/12/opinion/12friedman.html?ref=opinion&pagewanted=print

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Is This America?

For a glimpse of how venomous and debased the discourse about Islam has become, consider a blog post in The New Republic this month. Written by Martin Peretz, the magazine's editor in chief, it asserted: “Frankly, Muslim life is cheap, most notably to Muslims.”

Mr. Peretz added: “I wonder whether I need honor these people and pretend that they are worthy of the privileges of the First Amendment, which I have in my gut the sense that they will abuse.”

Thus a prominent American commentator, in a magazine long associated with tolerance, ponders whether Muslims should be afforded constitutional freedoms. Is it possible to imagine the same kind of casual slur tossed off about blacks or Jews? How do America's nearly seven million American Muslims feel when their faith is denounced as barbaric?

This is one of those times that test our values, a bit like the shameful interning of Japanese-Americans during World War II, or the disgraceful refusal to accept Jewish refugees from Nazi Europe.

It would have been natural for this test to have come right after 9/11, but it was forestalled because President George W. Bush pushed back at his conservative ranks and repeatedly warned Americans not to confuse Al Qaeda with Islam.

Now that Mr. Bush is no longer in the White House, nativists are back on the warpath. Some opponents of President Obama are circulating bald-faced lies about him that are also scurrilous attacks on Islam itself. One e-mail bouncing around falsely accuses Mr. Obama of lying and adds, “His Muslim faith says it's okay to lie.”

Or there's the e-mail I received the other day from a relative, declaring: “President Obama has directed the United States Postal Service to remember and honor the Eid Muslim holiday season with a new commemorative 44 cent first class holiday postage stamp.” In fact, it was President Bush's administration that first issued the Eid stamp in 2001 and that issued new versions after that.

Astonishingly, a Newsweek poll finds that 52 percent of Republicans believe that it is “definitely true” or “probably true” that “Barack Obama sympathizes with the goals of Islamic fundamentalists who want to impose Islamic law around the world.” So a majority of Republicans think that our president wants to impose Islamic law worldwide.

That kind of extremism undermines our democracy, risks violence and empowers jihadis.

Newsweek quoted a Taliban operative, Zabihullah, about opposition to the mosque near ground zero: “By preventing this mosque from being built, America is doing us a big favor. It's providing us with more recruits, donations and popular support.” Mr. Zabihullah added, “The more mosques you stop, the more jihadis we will get.”

In America, bigoted comments about Islam often seem to come from people who have never visited a mosque and know few if any Muslims. In their ignorance, they mirror the anti-Semitism that I hear in Muslim countries from people who have never met a Jew.

One American university professor wrote to me that “every Muslim in the world” believes that the proposed Manhattan Islamic center would symbolize triumph over America. That reminded me of Pakistanis who used to tell me that “every Jew” knew of 9/11 in advance, so that none died in the World Trade Center.

It is perfectly reasonable for critics to point to the shortcomings of Islam or any other religion. There should be more outrage, for example, about the mistreatment of women in many Islamic countries, or the oppression of religious minorities like Christians and Ahmadis in Pakistan.

Europe is alarmed that Muslim immigrants have not assimilated well, resulting in tolerance of intolerance, and pockets of wife-beating, forced marriage, homophobia and female genital mutilation. Those are legitimate concerns , but sweeping denunciations of any religious group constitute dangerous bigotry.

If this is a testing time, then some have passed with flying colors. Hats off to a rabbinical student in Massachusetts, Rachel Barenblat, who raised money to replace prayer rugs that a drunken intruder had urinated on at a mosque. She told me that she quickly raised more than $1,100 from Jews and Christians alike.

Above all, bravo to those Christian, Jewish and Muslim leaders who jointly denounced what they called “the anti-Muslim frenzy.”

“We know what it is like when people have attacked us physically, have attacked us verbally, and others have remained silent,” said Rabbi David Saperstein. “It cannot happen here in America in 2010.”

Cardinal Theodore McCarrick put it this way: “This is not America. America was not built on hate.”

“Shame on you,” the Rev. Richard Cizik, a leading evangelical Christian, said to those castigating Islam. “You bring dishonor to the name of Jesus Christ. You directly disobey his commandment to love your neighbor.”

Amen.

http://www.nytimes.com/2010/09/12/opinion/12kristof.html?ref=opinion&pagewanted=print

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From the Chicago Sun Times

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Crisis 'hollowing out' middle-class work force

ECONOMY | Careers in health care, management -- and fast-food restaurants jobs -- are booming

United Airways ground crew worker Anthony Sepe took a 30 percent pay cut, saw his home in Lombard lose as much as $85,000 in value, and watched in horror as his retirement savings "took a beating."

But among the millions of middle-class Chicago area residents who've lost out in the recession, the 38-year-old father of two is relatively lucky.

Unlike hundreds of his former co-workers at O'Hare, Sepe kept his job. His wife, Karen, took on extra shifts at the restaurant where she works. They bought their home a decade ago, before the housing bubble inflated. And now Sepe's close to joining one of the handful of rank-and-file professions that thrived despite the surrounding economic gloom, by retraining as a nurse.

"The last two years have been rough," said Sepe. "I'm looking for security."

The Sepes are typical of the new normal, post-recession Chicago area family -- which is more likely to be employed in the booming health-care industry, management or the restaurant business, and less likely to work in traditional union jobs like Anthony's airport gig, or in lower-level white-collar jobs in sales or administration, an analysis of Bureau of Labor Statistics data shows.

Even as the region's unemployment level doubled to more than 10 percent, 10,000 extra nurses found work in the Chicago area over the last five years, making an average of $68,000, 13 percent more after inflation than they did in 2005.

Infuriatingly for 40,000 laid-off office workers, 16,000 new management positions were created, with managers' wages up 10 percent over the same period. Scientists and environmentalists did well, but truck drivers, factory workers and sales reps all took huge hits in their pay and job prospects.

"What we're seeing is a hollowing out of the middle," said Professor Bob Bruno of the University of Illinois' School of Labor and Employment Relations. "Managers and executives in the corporate suites are still doing well, and there's more cheap jobs at the bottom in areas like fast food. But many businesses that cut back those middle-class jobs aren't rehiring."

Health care, the energy sector and finance and accounting are the hottest areas for jobs, according to John Challenger of employment experts Challenger, Gray and Christmas. Though government data doesn't yet reflect recent layoffs for teachers, education also remains a relatively secure profession, Challenger said, if only because "there's always going to be children to educate."

But workers in the housing industry face a longer wait to rebound, he said. The average Chicago area real estate broker has taken a 43 percent pay cut and now earns less than government program eligibility interviewers, whose pay they easily doubled five years ago; real estate appraisers are down 26 percent, and construction workers make 27 percent less.

In spite of the recession, the average Chicago area worker who managed to hold on to his or her job saw an after-inflation pay hike of 3.5 percent to just under $37,000 over the last five years. Those in work now are "probably safe; the huge layoffs we saw in 2009 have stopped," Challenger said. "But if you're looking for a job, the door is barely open."

All the same, fears over job security mean the average Chicago area borrower cut their credit card debt by $700, to $5,036, over the last two years, according to credit rating agency TransUnion.

"The overall debt load is so big -- the only way people make progress with that is to slowly pay it off, month by month, and it's going to take some time," Challenger said.

And small pay raises paled next to the $65,000 plunge in the value of the average Chicago area home -- now less than $200,000, according to the National Realtors Association -- and yo-yoing retirement funds worth less now than they were four years ago.

"Income rises aren't so important if your two biggest assets have been eviscerated," Bruno said.

Ironically, no profession did worse over the last five years than college-level economics teachers, who saw their wages plummet by 46 percent to an average of less than $35,000.

"They probably deserve it," Bruno said. "They've done a terrible job predicting what would happen."

http://www.suntimes.com/news/metro/2697828,CST-NWS-NewNorm12.article

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