Wednesday, February 4, 2009

Relationships with the Drug Industry: Build Trust Based on Good Science

Relationships with the Drug Industry: Build Trust Based on Good Science. By Scott Gottlieb, M.D.
AEI, Wednesday, February 4, 2009

How do the current tensions in the relationship between the pharmaceutical industry, physicians, and patients affect individual health? Dr. Scott Gottlieb explores the possible causes for the breakdown in communication between these groups and charts a strategy to improve the productivity of their interactions and leverage these relationships in order to advance public health.

Medical treatments are becoming increasingly more individual, with respect to both disease and patient. They are also becoming more complex, and precise diagnoses and close monitoring are needed to optimise their use. In this environment, consumers and doctors need to work more closely with product developers. Yet increasing regulation of the drug industry is restricting its ability to disseminate the results of its clinical studies. This risks shrinking the opportunities patients have to improve their health. In the face of regulatory steps to restrain their scientific speech, drug makers need to take new steps in their relationship with doctors and patients and establish transparent guidelines for those interactions. They should also focus more squarely on matters of advancing science, monitoring for safety, and improving health education.


Science not marketing

A large part of the industry’s current problems stems from the way its relationship with academic physicians and medical institutions has evolved over the past few decades. Formerly, the industry depended on academic doctors to conduct basic and clinical research. Now more of that work is done in house.[1] As a consequence, the relationships forged with the academic medical community are often based on marketing related activities. This feeds the regrettable perception that drug makers ally themselves with medical thought leaders to advance marketing goals, not science, and that information they generate cannot be trusted.

Relationships should be predicated on genuine scientific work. This doesn’t mean that drug makers should stop engaging leading physicians to help companies generate and share information about new advances, but that they need to engage with doctors who had a role in discovering those advances rather than those with no or little link to the underlying science. The latter creates the unfortunate appearance that opinions are being rented; the former is unassailable, as a scientist is the most appropriate champion for his work.


Overcoming mistrust

As patients are taking an increasingly active role in treatment decisions drug companies need to take new steps to improve health literacy and patient education while they continue to invest in better ways to monitor the performance and safety of their products. Unfortunately, the existing mistrust means that policy makers continue to create restrictions that impede the ability of drug companies to speak to patients. This creates information asymmetry and denies patients the opportunity to receive truthful, non-misleading information about new products, thus hurting health outcomes.[2] [3] It also leads to a regulatory edifice that makes it harder for drug companies to monitor the performance of their drugs by talking directly with patients and makes it harder for them to provide targeted information to patients on proper use of prescription drugs. The bottom line remains that the drug firms remain one of the few actors in this marketplace with the financing and incentives to share and collect information. Under proper regulation, public health imperatives should compel us to make better use of these resources on behalf of patients.

Scott Gottlieb, M.D., is a resident fellow at AEI.


Notes

1. Bodenheimer T. Uneasy alliance--clinical investigators and the pharmaceutical industry. N Engl J Med 2000;342:1539-44.
2. Sentell TL, Halpin HA. Importance of adult literacy in understanding health disparities. J Gen Intern Med 2006;21:862-6.
3. Schillinger D, Grumbach K, Piette J, Wang F, Osmond D, Daher C, et al. Association of health literacy with diabetes outcomes. JAMA 2002;288:475-82.

Full text w/links in the references here

Cheney warns of new attacks

Cheney warns of new attacks. By John F Harris, Mike Allen and Jim VandeheiPolitico, Feb 04, 2009
http://www.politico.com/news/stories/0209/18390.html

Former Vice President Dick Cheney warned that there is a “high probability” that terrorists will attempt a catastrophic nuclear or biological attack in coming years, and said he fears the Obama administration’s policies will make it more likely the attempt will succeed.

In an interview Tuesday with Politico, Cheney unyieldingly defended the Bush administration’s support for the Guantanamo Bay prison and coercive interrogation of terrorism suspects.

And he asserted that President Obama will either backtrack on his stated intentions to end those policies or put the country at risk in ways more severe than most Americans—and, he charged, many members of Obama’s own team—understand.

“When we get people who are more concerned about reading the rights to an Al Qaeda terrorist than they are with protecting the United States against people who are absolutely committed to do anything they can to kill Americans, then I worry,” Cheney said.

Protecting the country’s security is “a tough, mean, dirty, nasty business,” he said. “These are evil people. And we’re not going to win this fight by turning the other cheek.”

Citing intelligence reports, Cheney said at least 61 of the inmates who were released from Guantanamo during the Bush administration—“that’s about 11 or 12 percent”—have “gone back into the business of being terrorists.”

The 200 or so inmates still there, he claimed, are “the hard core” whose “recidivism rate would be much higher.” He called Guantanamo a “first-class program,” and “a necessary facility” that is operated legally and with better food and treatment than the jails in inmates native countries.

But he said he worried that “instead of sitting down and carefully evaluating the policies,” Obama officials are unwisely following “campaign rhetoric” and preparing to release terrorism suspects or afford them legal protections granted to more conventional defendants in crime cases.

The choice, he alleged, reflects a naïve mindset among the new team in Washington: “The United States needs to be not so much loved as it needs to be respected. Sometimes, that requires us to take actions that generate controversy. I’m not at all sure that that’s what the Obama adminstration believes.”

The dire portrait Cheney painted of the country’s security situation was made even grimmer by his comments agreeing with analysts who this recession may be a once-in-a-century disaster.

“It’s unlike anything I’ve ever seen,” Cheney said. “The combination of the financial crisis that started last year, coupled now with, obviously, a major recession, I think we’re a long way from having solved these problems.”

The interview, less than two weeks after the Bush administration ceded power to Obama, found the man who is arguably the most controversial—and almost surely the most influential—vice president in U.S. history in a self-vindicating mood.

He expressed confidence that files will some day be publicly accessible offering specific evidence that waterboarding and other policies he promoted—over sharp internal dissent from colleagues and harsh public criticism—were directly responsible for averting new September 11-style attacks.

Not content to wait for a historical verdict, Cheney said he is set to plunge into his own memoirs, feeling liberated to describe behind-the-scenes roles over several decades in government now that the “statute of limitations has expired” on many of the most sensitive episodes.

His comments made unmistakable that Cheney—likely more than former President Bush, who has not yet given post-White House interviews—-is willing and even eager to spar with the new administration and its supporters over the issues he cares most about.

His standing in this public debate is beset by contradictions. Cheney for years has had intimate access to the sort of highly classified national security intelligence that Obama and his teams are only recently seeing.

But many of the top Democratic legal and national security players have long viewed Cheney as a man who became unhinged by his fears, responsible for major misjudgments in Iraq and Afghanistan, willing to bend or break legal precedents and constitutional principles to advance his aims. Polls show he is one of the most unpopular people in national life.

In the interview, Cheney revealed no doubts about his own course—and many about the new administration’s.

“If it hadn’t been for what we did—with respect to the terrorist surveillance program, or enhanced interrogation techniques for high-value detainees, the Patriot Act, and so forth—then we would have been attacked again,” he said. “Those policies we put in place, in my opinion, were absolutely crucial to getting us through the last seven-plus years without a major-casualty attack on the U.S.”

Cheney said “the ultimate threat to the country” is “a 9/11-type event where the terrorists are armed with something much more dangerous than an airline ticket and a box cutter – a nuclear weapon or a biological agent of some kind” that is deployed in the middle of an American city.

“That’s the one that would involve the deaths of perhaps hundreds of thousands of people, and the one you have to spend a hell of a lot of time guarding against,” he said.

“I think there’s a high probability of such an attempt. Whether or not they can pull it off depends whether or not we keep in place policies that have allowed us to defeat all further attempts, since 9/11, to launch mass-casualty attacks against the United States.”

If Cheney’s language was dramatic, the setting for the comments was almost bizarrely pedestrian. His office is in a non-descript suburban office building in McLean, in a suite that could just as easily house a dental clinic. The office is across the hall from a quick-copy store. The door is marked by nothing except a paper sign, held up by tape, saying the unit is occupied by the General Services Administration.

At several points, Cheney resisted singling out Obama personally for criticism, at one saying he wants to give him a break after just two weeks in office. He said he admires Obama’s choice to keep Defense Secretary Robert Gates on the job.

But if he treated Obama gingerly, Cheney was eager to engage in the broader philosophical debate he was with Democrats and even many in his own party about the right way to navigate a dangerous planet. He said he fears the people populating Obama’s ranks put too much faith in negotiation, persuasion, and good intentions.

“I think there are some who probably actually believe that if we just go talk nice to these folks, everything’s going to be okay,” he said.

He said his own experience tempers his belief in diplomacy.

“I think they’re optimistic. All new administrations are optimistic. We were,” he said.

“They may be able, in some cases, to make progress diplomatically that we weren’t,” Cheney said. “But, on the other hand, I think they’re likely to find—just as we did—that lots of times the diplomacy deosn’t work. Or diplomacy doesn’t work without there being an implied threat of something more serious if it fails.”

As examples of the dangerous world he sees—and one he predicted Obama and aides would find “sobering”—were Russia’s backsliding into authoritarianism and away from democracy, and the ongoing showdowns over the nuclear intentions of Iran and North Korea.

But it was the choice over Guantanamo that most dominated Cheney’s comments.

“If you release the hard-core al Qaeda terrorists that are held at Guantanamo, I think they go back into the business of trying to kill more Americans and mount further mass-casualty attacks,” he said. “If you turn ’em loose and they go kill more Americans, who’s responsible for that?”

Of one alternative—moving prisoners to the U.S. prisons—Cheney said he has heard from few members of Congress eager for Guantanamo transfers to their home-state prisons, and asked: “Is that really a good idea to take hardened al Qaeda terrorists who’ve already killed thousands of Americans and put ’em in San Quentin or some other prison facility where they can spread their venom even more widely than it already is?”

While Cheney’s words were dire, his own mood was relaxed, even loquacious. He was not on crutches—much less the wheelchair he rode to Obama’s inauguration—from an injury while moving a box of books into his new home.

Suddenly a man of leisure, Cheney has a Kindle, Amazon’s wireless reading device, and said he used it recently to read James M. McPherson’s new “Tried by War: Abraham Lincoln as Commander in Chief.” About a week ago, he had a phone conversation with former President George W. Bush, the first time the two had talked since they appeared together at a rally at Andrews Air Force Base just after Obama’s swearing-in.

“He’s fine,” Cheney said. “We had a pleasant chat on the phone. It was a private, personal conversation – not about policy. We’re both citizens – civilians.”


Other highlights of the 90-minute interview:

*What Cheney called “the trillion-dollar so-called stimulus bill”: “It looks to me like there’s a lot of stuff in there that has nothing to do with stimulus – it’s a sort of a wish list of a lot of my congressional Democratic friends,” he said.

*The potential consequences of $1 trillion in deficit stimulus spending: “It’s huge, obviously – potentially huge. You worry about what ultimately happens to inflation. You worry about what’s going to happen to the ability of the government to borrow money. … I’m nervous.”

*Whether the Bush administration should have done more about the economy: “We did worry about it, to some extent. … I don’t think anybody actually foresaw something of this size and dimension occurring. It’s also global. We only control part of the world economy – a very important part.”

*On the chance of progress in the Israeli-Palestinian peace process in the foreseeable future: “I think it’s unlikely.”

After leaving office, Cheney and his wife, Lynne, went first to his home in Wyoming, then returned to Washington to enjoy their grandchildren. He’s working on a book about his career, which has included stints as a House member, White House chief of staff and secretary of Defense.

His daughter, Liz Cheney, the former principal Deputy Assistant Secretary of State for Near Eastern Affair, supervised the interview and at one point was looking for a tape recorder.

“I’m not a very good press aide,” she joshed.

Cheney found one on his own. “See, you don’t need staff,” she said.

John Kyl: "President Bush's Lasting Legacy: Missile Defense"

President Bush's Lasting Legacy: Missile Defense. By John Kyl
The Bush-Cheney Alumni Association, Feb 03, 2009

When the history of the Bush administration's national security achievements is written, one of the most significant accomplishments will be the building of a national missile defense system.
The idea of a national ballistic missile defense system to supplement the nuclear deterrent was born 25 years ago by our 40th president, Ronald Reagan, who said, "I've become more and more deeply convinced that the human spirit must be capable of rising above dealing with other nations and human beings by threatening their existence."

But, something stood in President Reagan's way: the 1972 Anti-Ballistic Missile (ABM) Treaty. This treaty was a classic example of arms control promising much more than it was ever able to deliver.

The theory was that by ensuring mutual vulnerability to nuclear missile attack, the incentive to build increasing numbers of offensive forces would be removed. History proved that theory wrong. And, in fact, strategic nuclear forces expanded not just quantitatively, but also qualitatively.

The ABM treaty also stood in the way of developing defenses against rogue regimes that were - and are - developing ballistic missiles. Deterrence is simply inadequate in dealing with rogue dictators. To depend only on nuclear deterrence - that is, rational decision making - with the Iranian and North Korean regimes would be irresponsible. And so, President Bush officially withdrew the United States the ABM treaty in June 2002.

Four years later, in 2006, the wisdom of President Bush's action was demonstrated when North Korea tested its Tae Po Dong 2 missile and detonated a nuclear device. Had it been necessary, the Missile Defense Agency was able to provide the president a real missile defense capability to combat the threat posed to the American people by a rogue regime armed with ballistic missiles and weapons of mass destruction.

The United States missile defense system is now composed of 26 Ground-Based Interceptors in California and Alaska; 18 Aegis ballistic missile defense warships, complete with 65 interceptors on board; an advanced system of command and control; and surveillance and targeting radars. This is a significant capability, but it represents only the beginning of what's needed to protect the American people.

It is now President Obama's responsibility to ensure the safety of the American people against all threats, including the ballistic missile threat. The available evidence suggests this will not be easy. In recent years, Democrats in the House and Senate have made significant cuts to the missile defense budget, including restricting the development of defenses against future threats we know our adversaries are developing.

Our new president should also welcome Congress' recent decision to reverse an ill-conceived decision that it and President Clinton made in 1993 to abandon the study of space-based interceptors for missile defense. As a result of this reversal, the Department of Defense can now move forward on a study that could provide a roadmap for both a future defense of the United States from ballistic missile attack and a defense of our critical national security space systems. Opponents of this decision are already at work to stop the positive momentum created by Congress' decision to fund this study. They will not only attempt to cancel it, they will attempt to permanently shackle the defensive capability of the United States with a "space weapons ban" treaty, which could not work and would effectively amount to nothing more than feel good arms control.

President Bush left office having provided the American people, and his successor, a significant new defense capability. History will not be able to ignore this legacy. President Obama's opportunity to follow this good example has just begun. May history prove his judgment to be as good as his predecessor.

Sen. Kyl serves on the Senate Finance and Judiciary committees and as the Senate Minority Whip. Visit his website at www.kyl.senate.gov.

The news of Daschle's withdrawal shocked his Democratic colleagues

Obama on Daschle: I take responsibility. By Josh Gerstein
Politico, Feb 03, 2009

Excerpts:

[...]

The news of Daschle's withdrawal shocked his Democratic colleagues, many of whom had vowed to fight for his nomination.

"It's a big loss for the country," said Sen. Kent Conrad (D-ND.).

Conrad called Daschle "one of the most honest men" he had ever known, but said it was a case where "the story never caught up with headlines."

"I think it"s a tragedy," said a visibly irate Conrad.

"I wish Tom Daschle had not decided to withdraw his nomination," Sen. John Kerry (D-Mass.) said in a statement. "While Tom’s decision is a reminder of his loyalty to President Obama and his determination not to be a distraction, this was no ordinary appointment and today is not a good day for the cause of health care reform."

Obama told NBC Tuesday afternoon that the twin withdrawals made him "angry and disappointed and it's something I have to take responsibility for. I appointed these folks."

The distraction Daschle referred to was the mounting furor over his tax problems - a controversy that threatened to become a permanent blot on Obama's promise to clean up Washington's ethical quagmire. The White House appeared to have the votes to confirm Daschle in the Senate- but seems to have made the judgment that there were larger forces at play, forces that could bring long-term harm to the young administration.

Baucus said Daschle's withdrawal was "surprising" and "unfortunate."

"I just learned of it 15, 20 minutes ago," Baucus said. "I was a little surprised. I thought he was going to get confirmed. He's a good man. I thought he'd be confirmed."

[...]

The issue for Obama was one of credibility. The new president ran and won as a reform candidate, promising a new brand of politics. The day after being sworn in, he immediately put in place what he touted as far-reaching ethical reforms. But Obama quickly granted exceptions to his purportedly hard-line ban on lobbyists serving in his administration and is now offering explanations as to why it is acceptable for two of his top cabinet officers to serve despite failing to pay taxes.

These issues threaten to divert Obama from his focus on rejuvenating the economy and are prompting questions from otherwise political allies on his commitment to changing the political culture of the capital. Obama is not just getting flak from predictable political opponents: the Daschle nomination was savaged Tuesday morning by the New York Times editorial page and has also been criticized by the Nation magazine, a touchstone of Democratic liberalism.

On MSNBC, Andrea Mitchell said she had just spoken with Daschle - who said that when he read the New York Times this morning, he realized he could never pass health care reform if he was such a distraction.

Killefer's decision to step down also seemed a result of the mounting drumbeat of criticism of the new Obama team. “Said a Senate source of Killefer: "She has nanny tax problems that may not have been insurmountable on their own, but given the Geithner and Daschle cumulative effect, she had to withdraw.”

Gibbs said Daschle and Killefer came to the realization that their mistakes would be seen as tarnishing Obama’s mandate for change. “I think they both recognize that you can’t set a standard of responsibility but set a different example in who serves,” he said.

Obama ignored a shouted question Monday morning from CNN’s Ed Henry after a White House ceremony announcing the selection of Sen. Judd Gregg as Commerce Secretary as to why so many administration appointees are having tax troubles.

John Bresnahan, Carol E. Lee, Jonathan Martin and Manu Raju contributed to this story.

Howard Dean for HHS or Health Czar

Howard Dean for HHS or Health Czar. By Cenk Uygur
HuffingtonPost, Feb 04, 2009

Remember Tom Daschle was selected for two different positions in the Obama administration. The Secretary of Health and Human Services and Health Czar. These can be and are meant to be two distinct jobs (otherwise, why bother having a health czar).

At this point, if Howard Dean is not selected for at least one of these positions, it is a clear snub. But not just to Dean, but to all like-minded progressives. There's no way that Rahm Emanuel's animosity toward Dean can be explained away if they pass over him again, especially given his tremendous success at the DNC. That success is not a claim he holds over the Democratic Party, it is a testament to his ability to get things done.

We still want to get things done, right? We don't just want to bargain with the Republicans all day long and walk away without real change, do we? Are we playing a political game of who can appear to be more bi-partisan or are we really going to bring the change that was promised?

You know who promised change and then really delivered? Howard Dean. No one believed that he could change the mindset at the DNC and have the kind of success he did with the 50 state strategy. But he got it done. It would be unconscionable to ignore that. If they don't tap Dean for at least one of these positions, there is something seriously wrong with the way this administration is going about its business. This would bring things to the point where I would begin to question if they actually want to affect change or not.

By the way, why is there always room for another Republican in this team of rivals cabinet, but never room for one strong progressive voice we all trust like Howard Dean?

PPI: "US and China: Grappling Over Economic Rescue -- Part II"

US and China: Grappling Over Economic Rescue -- Part II. By Edward Gresser
The two nations must first coordinate stimulus plans, then engage in currency diplomacy
PPI Online, February 2, 2009

WASHINGTON: As the United States bails out banks and shoe-factories close their doors in China, should the two governments worry about exchange rates?

The question arose after Timothy Geithner, new US treasury secretary, suggested in a congressional hearing that China is "manipulating" the value of its currency. China then fired back, echoed by a chorus of financial-gallery alarm over potential trade conflicts. But a reading of Geithner's full comment should dispel fear of a looming trade war over exchange rates: What the US seeks is a coordinated approach to save both economies from sinking.

Geithner's argument was that Chinese currency rates are a topic that both governments need to address, but not the immediate issue. Noting

"We look forward to a productive economic dialogue with the Chinese government on a number of short- and long-tem issues. The Yuan is certainly an important piece of that discussion, but given the crisis the immediate focus needs to be on the broader issue of stabilizing domestic demand in China and the US.... Because China accounts for such a large fraction of the world economy, a further slowdown in China would lead to a substantial fall in world growth (and demand for US exports) and delay recovery from the crisis. Therefore, the immediate goal should be for us to convince China to adopt a more aggressive stimulus package as we do our part to try to pass a stimulus package here at home."

This is the right context. The world needs more balanced growth in the next decade. Change in Chinese currency policy is part of this. But the immediate problem is accelerating economic collapse, which confrontation between America and China could easily worsen. Meanwhile, the immediate reason for currency diplomacy -- the imbalances that can arise from currency misalignments -- is at least for the moment fading as America's imports and deficits shrink. So, though both countries need to address the causes of their illness, they can afford to wait until both patients feel better.

Why, an observer might ask, are currency rates relevant at all?

Fundamentally, currency rates are a way to moderate swings in global growth and trade flows. A high currency value makes exports expensive, imports cheap and can slow growth when inflation threatens. A low currency value helps countries escape from economic slumps through cheaper exports. The currencies of most big economies -- the dollar, the euro, yen and pound -- swing back and forth in this way, traded at rates of $3 trillion per day. China's yuan is the exception, set in a band by government policy.

This is not inherently unworkable. But if the setting does not change with economic conditions, it can lead to big surpluses, deficits and risks. Here, we have one source of the crisis.

Leaving office, Geithner's predecessor Henry Paulson pointed to international imbalances as one of the crisis' causes. He meant that Americans were borrowing and spending too much, and Asia -- China in particular -- was saving too much and spending too little.

This is not a new phenomenon. Americans shop a lot and save little, relying on the worth of home ownership to build wealth. They save 5 or 6 percent of GDP in normal times; Asians by contrast save 20 to 40 percent of GDP, and spend less time in malls. The result is an imbalance, with Americans buying more of what everyone makes and Asians selling more than buying.

These habits have fairly deep roots: Americans have run deficits with Asia not only since the 1970s, but throughout the 19th century and the first half of the 20th century. But the imbalances of this decade grew larger and faster than those of earlier periods. US government policy, through steady tax cuts and low interest rates, drove American savings rates to just above 1 percent of GDP, the lowest figures recorded since 1934. Chinese hyper-savings and low consumption, meanwhile, helped create an anomalously high pool of capital and a steadily growing trade surplus. By 2006, America maintained a current-account deficit -- the balance between spending and receiving trade revenue, investment income, charitable donations and foreign aid -- equivalent to almost 6 percent of American GDP -- an all-time record, and double the deficit of 2001. China's surplus, meanwhile, rose from rough balance in 2003 to a 10 percent of GDP surplus in 2007, with a mirroring increase in American manufacturing-trade deficits. A fixed currency rate for the Chinese RMB, at 8.28 to the dollar from 1994 to 2005, meant currency did not respond to these changing conditions.

Geithner is therefore right to say that the yuan level is an important issue. Nor is he alone -- in the high-growth period of 2004 to 2007, economists at the International Monetary Fund and universities politely protested both Chinese currency policy and America's low savings and tax-cut mania. Nobody in a position to do something did much because solving imbalances is painful. Americans would have to save more, shop less and live modestly. Chinese would need to export less, sell more at home and shift employment from apparently reliable export factories to new sources of prosperity and create domestic demand. Chinese currency did appreciate after 2005, and America's imbalance did begin to shrink, but only by a modest amount and China's surplus continued to grow.

At some point, which nobody can quite predict, a rising imbalance becomes a risk. Both countries are seeing the consequences -- trembling banks in America, shuttering factories in coastal China, and rising unemployment in both countries.

Over time, governments need to set their recovery on a more solid foundation than the one of 2003-2006. This will require a more flexible currency in China that can moderate any returning boom, as well as better regulation and more savings in America.

But as Geithner pointed out, timing is everything. For the moment, imbalances are not the world's big problem. Markets reduce them by force, as demand collapses. With unemployment up, American families no longer go to the mall each Saturday for clothes and TVs. Imports are therefore plunging, from $229 billion in July to $183 billion by November; imports from China fell from about $33 billion to $28 billion. This is the fastest US import drop since the Second World War. As imports fall, America's trade gap shrinks, from an annualized $720 billion in early 2008 to $530 billion by the winter. Across the Pacific, Chinese migrant workers from the coastal industrial zone head home as export orders dry up. China's surplus may accordingly drop.

This collapse in demand is now the big evil governments must meet. Rising imports and imbalances may return, but are not the problem today. A confrontation over these matters would do little to solve the day's big evils, but could make them worse.

Therefore, as Geithner pointed out, currency should not be the immediate concern. Instead the US and Chinese governments need to cooperate, coordinating stimulus policies to give maximum support to demand.

As they restore growth, though, they must find ways to make it balanced growth. Yes, as ordinary people worry about jobs and growth, governments should think about the foreign-exchange markets. But they should act at the right time. Geithner's comment about currency, taken in its full context, implies that the Obama team is thinking along these lines. If so, they suggest the intention to restore health first, then place the prosperity of the 2010s on a stronger foundation than this decade's expansion -- not a bad goal at all.

Edward Gresser is director of the Trade & Global Markets Project with the Progressive Policy Institute.

Tuesday, February 3, 2009

On the CCSP revised Global Climate Change Impacts in the US report

Here We Go Again, More Cherry Picking by the CCSP. By Roger Pielke, Jr
Prometheus, February 2nd, 2009

Excerpts:

The CCSP revised and re-released Synthesis Report is out. I have not had a chance to look at thoroughly, but my first look does not leave me impressed. In fact, I am once again amazed at the brazen and willful misrepresentation of an area of climate change that I have some expertise in. The selective presentation of research on disasters and climate change by various assessment bodies leaves me convinced that such selectivity is a matter of choice and not simply incompetence. Such behavior damages the credibility of the entire climate science enterprise. Read on for the details of this latest and now common misrepresentation of the state of science on disasters and climate change.

[...]

But wait there is more. The CCSP itself reported no climatological basis for increasing economic losses in the United States in its report on extremes.

The bottom line is that the CCSP report refuses to acknowledge the range of legitimate scientific discussion on the subject of disasters and climate change. It selectively cites research that supports conclusions that it would like to reach, and dismisses and ignores that which is inconvenient. This is not how assessments should be done. How can anyone trust the climate science community as long as such shenanigans are allowed to take place?

Cuba Plans New Offshore Drilling in Search for Big Oil Finds in the Gulf of Mexico

Cuba Plans New Offshore Drilling in Search for Big Oil Finds in the Gulf of Mexico. By Thomas Omestad
US News & World Report, February 3, 2009

HAVANA—Cuban officials say that exploratory drilling to assess the potential for oil reserves in the Gulf of Mexico is likely to resume in the second quarter of this year, a sign that lower world oil prices have not derailed efforts by the Cuban government and its foreign corporate partners to keep moving toward offshore oil production.

Cuba believes it has major oil reserves in its waters. But the prospect of exploratory drilling—followed by likely future commercial drilling—in the Florida Straits has fired controversy in the United States, with the expectation that someday, foreign oil firms could be drilling as close as about 50 miles from parts of Florida.

The exploratory drilling will take place about 20 miles north of Havana and will be conducted by a consortium led by the Spanish oil firm Repsol, working with India's state-run Oil & Natural Gas Co. and Norway's StatoilHydro. Other exploratory drilling in the portion of the Gulf under Cuba's economic control is anticipated in 2010 and 2011.

"Cuba has high potential from an exploratory point of view," said Rafael Tenreyro Perez, exploration manager for Cubapetroleo (Cupet), the Cuban state oil company, in an interview. Seismic tests suggesting possible oil deposits over the past two years in Gulf waters were "very encouraging," he said.

Other firms that have, to varying degrees, partnered with the Cuban oil company in the hunt for oil either on or offshore hail from Venezuela, Malaysia, Vietnam, China, Canada, and Brazil. U.S. companies are barred from participating under regulations flowing from the 48-year-old American embargo of Cuba's economy. That widely criticized policy was intended to pressure Cuba's communist government to move toward democracy, but other countries oppose the U.S. isolation strategy toward Cuba and do business anyway.

Foreign firms have signed exploration and production agreements for 21 of the 59 blocks Cuba has created for its Gulf waters, where the biggest oil finds are believed to be located. An additional 23 blocks are said to be the subject of discussions with foreign companies.
Cupet has estimated that there are 20 billion barrels of recoverable offshore oil in Cuban waters. If that bears out, Cuba, with 11 million people, would have reserves that come into the same range as those of the United States.

The U.S. Geological Survey, though, has issued more conservative estimates: under 5 billion barrels in Cuba's offshore fields. Furthermore, most of the oil is believed to lie under deep water, where extraction is difficult and expensive.

Some see the advent of Cuban offshore oil drilling as raising the costs of maintaining the embargo policy, with other countries taking a piece of the Cuban action that might otherwise fall to some American firms. Some Capitol Hill lawmakers have urged that an exception be made in the embargo to permit energy cooperation. Overall Cuba policy is now under review by the Obama administration.

Others are worried that a future oil spill, given Gulf currents, could spoil Florida beaches and shore areas. Tenreyro says that any drilling operations will follow "the highest" international environmental standards.

Some Cuba watchers argue that environmental coordination with Cuba ought to be one of the early results of any policy changes developed by the Obama administration.

ACSH: Counterfeit Drugs Continue to Present a Growing Threat to Global Health

Counterfeit Drugs Continue to Present a Growing Threat to Global Health, Says New Report.
"estimated to be about 10% of the global drug supply"
American Council on Science and Health, Monday, February 2, 2009

New York, NY -- Counterfeit drugs remain a real and growing threat to global health, jeopardizing the security of the American drug supply, according to an updated report by the American Council on Science and Health (ACSH).

The 2009 edition of the booklet Counterfeit Drugs: Coming to a Pharmacy Near You was released today, following peer review by a panel of top experts in the field. It documents how increasingly sophisticated counterfeiting rings, some with connections to organized crime and even terrorist groups, have improved upon their methods of evading international police and investigative forces, slipping potentially dangerous counterfeit, substandard and adulterated drugs into legitimate drug supplies, including that of the United States.

Counterfeit drugs, a term that includes fake, substandard, adulterated, and mislabeled pharmaceuticals, were estimated by the World Health Organization to be about 10% of the global drug supply, and a much higher percentage in developing countries. For years, counterfeits have wreaked havoc in developing countries and have contributed to the increasing drug-resistance of diseases such as malaria, HIV/AIDS and tuberculosis. Hundreds of thousands of these counterfeits have been shipped to pharmacies and dispensed to unwitting American consumers.

•As recently as this past year, the first episode of fatalities from tainted drugs in the United States came to light when almost 100 people died from contaminated heparin, imported from China. Of course, this number pales in comparison to the toll of counterfeit drugs in the less developed world.
•The risk of fake, adulterated medicine is even greater when drugs are purchased from unregulated online sites. Some of these, ostensibly "Canadian," have been found to actually be located in China and other poorly-regulated regions.




The FDA has no ability to control the safety of drugs purchased through these channels, and studies have found that as much as 88% of drugs being imported into the United States violate FDA safety standards and are potentially dangerous. Such importation is illegal under current law, but the FDA lacks the resources to stop the practice.

•ACSH president Dr. Elizabeth Whelan warns that the legalization of drug importation, advocated by many in Congress as an easy way to obtain cheap drugs, "represents an unjustifiable breaching of our domestic drug supply that has the potential to erase even the minimal gains we have made in the fight against counterfeit drugs."
•Efforts to address the counterfeit problem through drug pedigrees, new anti-counterfeiting technology, and increased licensing of wholesalers hold promise but must be combined with aggressive enforcement.


What can individuals do to protect themselves? According to ACSH's report, "the American consumer must be aware of the dangers posed by counterfeit drugs and be vigilant." Consumers should pay attention to the appearance and packaging of their prescription drugs for any unusual changes in shape, size or color, or sudden changes in the effectiveness of a medicine.

The ACSH report advises: "Despite certain safety issues, prescription drugs bought from state-licensed pharmacies remain by far the safest choice available to consumers. Consumers should avoid imported drugs and those purchased from unregulated online drug stores, as these have a high risk of being substandard or counterfeit and could endanger your health."

Read the updated ACSH report on Counterfeit Drugs here

State Dept: "Zimbabwe: Unity Government"

Zimbabwe: Unity Government. By Robert Wood
US State Dept, Acting Department Spokesman, Public Affairs
Washington, DC, Feb 03, 2009

The Movement for Democratic Change (MDC) has agreed to join a unity government with Robert Mugabe under the conditions called for in the Southern African Development Community (SADC) January 27 Communiqué. The success or failure of such a government will depend on credible and inclusive power sharing by Robert Mugabe and his ZANU-PF party. The international community must remain engaged and continue to scrutinize actions by Mr. Mugabe to ensure adherence to the letter and spirit of this agreement, including respect for human rights and the rule of law. We urge SADC to fulfill its obligation to guarantee that Mr. Mugabe proceeds on a new path toward reconciliation and genuine partnership with the MDC.

The U.S. will only consider new development assistance and easing of targeted sanctions when we have seen evidence of true power sharing as well as inclusive and effective governance. We will continue to provide humanitarian assistance to the Zimbabwean people in their time of suffering.

PRN: 2009/098

Today's Message to Young Entrepreneurs: Get a Nice, Safe Government Job Instead

Today's Message to Young Entrepreneurs: Get a Nice, Safe Government Job Instead. By Newt Gingrich
Feb 03, 2009

Imagine you are a young Bill Gates. You’re smart. You’re ambitious. You’re thinking about starting a business to put your talents to their best use for you and for society.

Then you turn on the television and see President Obama say that “now is not the time” for entrepreneurs to make profits and get bonuses.

You hear Vice President Joe Biden say of corporate CEOs: “I’d like to throw these guys in the brig.”

You pick up the newspaper and read about a bill sponsored by Sen. Claire McCaskill (D-Mo.) to cap the salaries of top executives (“idiots” in her words) of firms that accept government bailout money.

And you read about another bill speeding through Congress that will allow judges to alter the terms of mortgage contracts after the fact; to unilaterally reduce the amount of principal borrowers agreed to pay back when they signed their mortgage contracts.


The Vice President is Threatening to Throw Businessmen in the Brig. Why Take the Chance?

What lessons does a young entrepreneur learn from listening carefully to the voices advocating more and more government regulation and intervention in our economy?

He learns that the President has more faith in government to save the economy than free enterprise. So why not get a nice, safe government job instead?

She learns that starting a business and creating jobs may put her in the cross hairs of the Vice President. Maybe he means that part about throwing her in the brig, maybe he doesn’t. Why take the chance?

He learns that when politicians like Claire McCaskill get involved in economic enterprises, politics -- not economics -- rules. Why risk everything to have your future controlled by Washington?

And she learns that contracts aren’t worth the paper they’re written on. When judges can unilaterally re-write contracts, lenders will charge more to lend. So why even try to get that small business loan?


Biden and McCaskill Should Be Outraged With Themselves

Vice President Biden, Sen. McCaskill and others who are advocating greater and greater government intervention into private business are rightly outraged at reports of corporate CEOs receiving billions in taxpayer bailout dollars and then turning around and awarding themselves and their cronies lavish corporate bonuses.

This outrage is entirely justified. Politicians are understandably looking for someone to blame for this breach of the public’s trust.

But they should be looking at themselves. Vice President Biden and Sen. McCaskill should be outraged with themselves.

The reason is simple: If there had been no big government bailout of these companies, their CEOs would have no fiduciary duty to the taxpayers. It wouldn’t be any of Sen. McCaskill’s business how they compensate themselves.

But government offered the money, and private companies took it. So now government is in charge.


The Rules for Spending Taxpayers Money Don’t Work in the Private Market

The great management guru Peter Drucker taught us that there is a set of rules for spending the taxpayers’ money that is antithetical to the proper functioning of a private business.

For instance, when taxpayers are footing the bill, it’s perfectly legitimate for the people, through their representatives in government, to set limits on compensation.

In the free market, however, if government sets arbitrary limits on compensation, the best minds and greatest talents will go to where there are no limits. Politicians will have set these companies up to fail.

And if government decides some contracts are no longer politically tolerable, they erode the value of all contracts. And in the case of home mortgage contracts, government abrogation only makes future mortgages more expensive.


Rent Seeking Capitalism: The Growth of “Fusion Enterprise”

The danger is not simply that government will hobble private enterprise with regulation once it has become a stakeholder.

The greater danger is that the act of going into business in America will come to mean simultaneously going into the government lobbying business. Future “entrepreneurs” will compete, not just for private capital, but for government investment to give them the edge over their competitors.

Former American Enterprise Institute President Chris DeMuth calls this “fusion enterprise” and warns that it’s catching on:

Already, the government-appointed chief executive of AIG is boasting to his
customers and others that his firm is much better capitalized (that is, by
Washington) than the mere private firms it competes with. Several of those
rivals see the point and are lining up for their shares. We have no economic
theory, and only fragmentary casual examples, to resist this halfway house
between comprehensive socialism on the one hand and conventional regulation on
the other …


“He Who Does Not Work Does Not Eat”

Since the earliest American settlers at Jamestown in 1607 adopted Captain John Smith’s rule, “He who does not work does not eat,” America has thrived in a system of private enterprise and incentives for hard work and risk-taking.

Today, we are on the verge of repudiating 400 years of free market principle.

And the irony is that the $900 billion big government, big bureaucracy, big politician stimulus package that is being passed in the name of speeding our economic recovery may make emerging from the economic downturn that much harder.


What Began as an Economic Crisis is Becoming a Cultural Crisis

This crisis, which began as an economic crisis, is becoming a cultural crisis. And the lessons being learned by young entrepreneurs are precisely the wrong ones.

We are teaching young Americans to ignore American history and look to government first.

We are teaching young Americans not to start businesses when small businesses are the engine of job creation.

We are teaching young Americans not to compete on the level playing field of the free market, but to seek to co-op government in the pursuit of profit.

In his inaugural speech, President Obama singled out the “the risk-takers, the doers, the makers of things” as the source of American greatness. Does President Obama mean what he says? Or is this one more example of his moderate rhetoric not matching his liberal deeds?

NATO in Afghanistan: Lazy Allies

Lazy Allies, by Ted Galen Carpenter
The National Interest, February 2, 2009

Media reports indicate that President Obama may abandon his plan to ask America’s NATO partners to provide more combat troops for the mission in Afghanistan. Given how militarily useless many of the existing European deployments have been, that may not prove to be a big loss. But the feckless conduct of some of the European members of NATO in Afghanistan is indicative of a larger problem. The reality is that Washington’s much-touted alliances now involve more symbolism and tokenism than any meaningful addition to America’s military power. Immediately following the terrorist attacks on 9/11, NATO governments invoked Article V—which states that an attack on one member is an attack on all—for the first time in the alliance’s history. American leaders welcomed the European pledges of support, and the U.S.-led military campaign in Afghanistan soon had a significant NATO component.

But early on, doubts arose about how serious the European allies were about their military commitments. Indeed, most of the NATO governments seemed to view their troop deployments as personnel for humanitarian relief and nation-building tasks rather than for combat operations. The military heavy lifting was by and large left to U.S. forces and those of a few other countries, primarily Canada, Britain and the Netherlands.

Most NATO members have placed various caveats on the use of their military personnel. Some are prohibited from night operations (which are inherently more dangerous). Others are prohibited from being deployed in certain areas of the country—specifically, those areas where significant combat is occurring and additional troops might actually prove useful.

Germany is one of the worst offenders in that regard. Berlin has restricted its troops to the northern regions of Afghanistan, where virtually no fighting is taking place. Despite Washington’s repeated requests, the German government has refused to lift that restriction. That might be just as well. A December 2008 German parliamentary report concluded that the country’s troops in Afghanistan spent most of their time lounging around and drinking beer, and that many were now too fat and out of condition to be of any use in combat operations.

The desire of U.S. allies to keep their troops out of harm’s way is not confined to the Afghanistan theater—or for that matter to the NATO allies. A similar pattern emerged with the deployments of both South Korean and Japanese forces in Iraq. Seoul insisted that its troops be stationed only in Iraqi Kurdistan, by far the safest area of the country. But the South Korean government was a profile in courage compared to the Japanese government. Although Tokyo sent units of its Self-Defense Force (SDF) to Iraq, it insisted that those forces must be confined to noncombat roles. Indeed, the SDF units had to be protected by the troops of other coalition countries. Thus, from a military standpoint, the Japanese contribution was not an asset to the occupation effort—it was a liability.

Such episodes indicate that many of America’s supposed military partners are more interested in engaging in tokenism and security symbolism than they are with playing a meaningful military role. The governments of those countries want to show that they are good allies and willing participants in U.S.-led missions, while incurring few, if any, battlefield risks. That sort of conduct may salve the consciences of political leaders in allied capitals, and it may appeal to U.S. policymakers for whom symbolism is more important than substance. It may even gull an otherwise suspicious American public. But it provides little useful addition to America’s own military power.

One wonders at times if U.S. leaders believe that this country should have allies for the sake of having allies, even if those military partners bring little of value to the table. Why else would American officials tolerate the tokenism evident with the allied contributions in both Iraq and Afghanistan? And why would those same officials be so enthusiastic about the addition of tiny, militarily insignificant members to the NATO alliance?

The last round of NATO expansion brought on board such military powerhouses as Estonia, Latvia, Lithuania and Slovenia. According to the 2008 edition of the widely respected publication The Military Balance, Estonia’s annual defense budget is $386 million, and the country fields 4,100 active-duty troops. The figures for Latvia are $471 million and 5,996 troops; Lithuania, $470 million and 13,850 troops; and Slovenia, $750 million and 5,973 troops. At NATO’s summit last year in Bucharest, alliance leaders gave the green light to membership for Croatia and Albania. Croatia’s accession would add $875 million and 17,660 troops, while Albania’s would add $208 million and 11,020 military personnel.

Collectively, such members spend less on their militaries in a year than the United States spends in Iraq in two weeks. How adding such military pygmies to NATO is supposed to enhance the security of the United States is a mystery. Indeed, since several of those countries have serious tensions with their neighbors, they are not just militarily irrelevant, but are outright security liabilities that could drag the United States into needless conflicts.

U.S. policymakers ought to be far more realistic about the utility of alliances. Allies are neither good nor bad, per se. But American officials should not pretend that allies are making meaningful military contributions when the evidence indicates otherwise. Security symbolism and tokenism is of little practical use, yet that is the level of assistance that has become all too common from America’s alliance partners.

Brookings' Rivlin on Budget Policy Challenges

Budget Policy Challenges, by Alice M. Rivlin, Senior Fellow, Metropolitan Policy Program, Economic Studies, Brookings Institution
House Committee on the Budget, Jan 27, 2009

Mr. Chairman and members of the Committee: It is a pleasure for me to be back at the House Budget Committee. I am especially gratified to follow my former colleague, Douglas Elmendorf, as he makes the first of many appearances before this Committee as Director of the Congressional Budget Office.

I will say a few words about the uncertainties of the economic outlook and then turn to the question of how to deal with the immediate and longer-run challenges of fiscal policy. The challenge of budget-making has never been greater. Indeed, I believe that the future viability of the United States economy depends very heavily on budget policy-makers’ ability to focus on two seemingly contradictory imperatives at the same time:

The immediate need to take actions which will mitigate the impact of the recession and help the economy recover—actions that necessarily require big increases in the budget deficit The equally urgent need to take actions that will restore fiscal responsibility and reassure our creditors that we are getting our fiscal house in order—actions to bring future deficits down.I stress two sets of actions because I do not believe it will be sufficient to pay lip service to the long run challenge, while acting only on deficit-increasing responses to the current financial and economic crisis. Congress and the Administration must work together on actual solutions to both problems at the same time.


The Economic Outlook

We meet at a time of extraordinary uncertainty about how deep the recession will be and how long it will last. Forecasters all admit that they have little confidence in their ability to predict how consumers, producers, and investors at home and abroad will react to the cataclysmic economic events that have occurred. But people in the forecasting business still have to produce forecasts, so they do the best they can. The Congressional Budget Office (CBO) forecasts that the recession will “last well into 2009” and that the economy will begin to recover, albeit slowly, in 2010. CBO expects unemployment to peak at about 9 percent. The CBO is a bit more pessimistic than the Blue Chip average of commercial forecasters, because the rules of CBO forecasting do not allow them to take account of likely congressional actions to stimulate the economy and enhance recovery.

Right now I think we should be skeptical of all forecasts and especially conscious of the risk that things may continue to go worse than expected. The current CBO forecast is much more pessimistic than the one released just last September, and the Blue Chip consensus has been going steadily south for many months. Additional revelations of weakness in the financial services sector could further impede credit flows and produce a continued slide in all forecasters’ expectations.

Indeed, uncertainty about the health of the financial sector compromises all current forecasting efforts. The economic models used by forecasters are based on the experience of the post World War II period, especially the last several decades. Not since the 1930’s, however, have we experienced a downturn caused by crisis in the financial sector. Despite aggressive efforts of the Treasury and the Federal Reserve to stabilize the financial sector, credit is not flowing normally, even to credit- worthy borrowers. Continued instability in the financial sector and credit tightness could deepen the recession and delay recovery.

Also adding to the uncertainty and increasing the chance that recovery will be unusually slow is the fact that is that returning to the pre-crisis economy is not desirable. Before the current crisis Americans were consuming and borrowing too much, while saving too little. We had become an over-mortgaged, over-leveraged society dependent on the inflow of foreign credit. If recovery from this recession is to be solid and sustainable, we must stop living beyond our means. We must transform ourselves into a society that consumes less, saves more and finances a larger fraction of its investment with domestic saving, rather than foreign borrowing. This transformation is necessary, but it will put recovery on a slower track.

Indeed, not since we were a developing country have we been so dependent on foreign creditors. We are lucky that, even though this world-wide financial crisis started in the United States, the response of world investors has been to flock to the safety of U.S. Treasuries, which makes it possible for our government to borrow short-term at astonishingly low rates. But we cannot count on these favorable borrowing conditions continuing forever. Especially if we fail to take serious steps to bring down future budget deficits, the United States Government could lose the confidence of its foreign creditors and be forced to pay much higher interest rates on to finance both public debt and private debt. Rapid increases in interest rates and a plummeting dollar could deepen the recession and slow recovery.


An “Anti-Recession Package” and Investment in Future Growth

Despite the uncertainty of forecasts it is already clear that this recession is bad and that worse is yet to come. Recessions always increase budget deficits as revenues drop and recession-related spending increases. These automatic deficits help stabilize the economy. In addition, since an unusually severe downturn in the economy is threatening, the government should act quickly to mitigate the downslide with spending increases and revenue cuts that will stimulate consumer and investor spending, create jobs and protect the most vulnerable from the ravages of recession.

What we used to call “stimulus” (temporary spending or tax relief designed to jump-start the economy) has been merged into a broader concept of “recovery” and investment in future growth. However, I believe an important distinction should be made between a short-term “anti-recession package” (aka “stimulus”) and a more permanent shift of resources into public investment in future growth. We need both. The first priority is an “anti-recession package” that can be both enacted and spent quickly, will create and preserve jobs in the near-term, and not add significantly to long run deficits. It should include temporary aid to states in the form of an increased Medicaid match and block grants for education and other purposes. Aiding states will prevent them from taking actions to balance their budgets--cutting spending and raising taxes--that will make the recession worse. The package should also include temporary funding for state and local governments to enable them to move ahead quickly with genuinely “shovel ready” infrastructure projects (including repairs) that will employ workers soon and improve public facilities. Another important element of the anti-recession package should be substantial transfers to lower and middle income people, because they need the money and will spend it quickly. This objective would be served by increasing the Supplemental Nutrition Assistance Program (SNAP), unemployment compensation, and the Earned Income Tax Credit. Helping people who lose their jobs to keep their health insurance and aiding distressed homeowners also belong in this “anti-recession” package. On the tax side, my favorite vehicle would be a payroll tax holiday, because payroll tax is paid by all workers and is far more significant than the income tax for people in the lower half of the income distribution. Moreover, a payroll tax holiday would be relatively easy to reverse when tax relief was no longer appropriate. This anti-recession package should move forward quickly. Because its components would be temporary, there would be little reason for concern about its impact on the deficit three or four years down the road.

The anti recession package should be distinguished from longer-run investments needed to enhance the future growth and productivity of the economy. The distinction is not that these longer-run investments are less needed or less urgent. We have neglected our public infrastructure for far too long and invested too little in the skills of the future workforce. If our economy is to grow sustainably in the future we need to modernize our transportation system to make it more efficient and less reliant on fossil fuels. We need to assure access to modern communications across the country and invest in the information technology and data analysis needed to make medical care delivery more efficient and effective. We need a well thought-out program of investment in workforce skills, early childhood education, post-secondary education, science and technology. Such a long-term investment program should not be put together hastily and lumped in with the anti-recession package. The elements of the investment program must be carefully planned and will not create many jobs right away.

Since a sustained program of public investment in productivity-enhancing skills and infrastructure will add to federal spending for many years, it must be paid for and not simply added to already huge projected long-term deficits. That means either shifting spending from less productive uses or finding more revenue. Overtime, Congress could reduce commitments to defense programs and weapons systems that reflect outmoded thinking about threats to U.S. security, reduce agricultural subsidies, and eliminate many small programs that have outlived their original priorities. Reform of the tax system--including making the income tax simpler and fairer or increasing reliance on consumer taxation—could produce more revenue with less drag on economic growth. None of these policies would be easy, but the resources to pay for large permanent increases in federal spending must be shifted from somewhere else as the economy returns to full employment. Congress will only be able to accomplish this reallocation of resources if it reinstates some form of long run (say, ten year) PAYGO and caps on discretionary spending.

I understand the reasons for lumping together the anti-recession and investment packages into one big bill that can pass quickly in this emergency. A large combined package will get attention and help restore confidence that the federal government is taking action—even if part the money spends out slowly. But there are two kinds of risks in combining the two objectives. One is that money will be wasted because the investment elements were not carefully crafted. The other is that it will be harder to return to fiscal discipline as the economy recovers if the longer run spending is not offset by reductions or new revenues.


Immediate Action to Bring Down Future Deficits

As this Committee knows well, projections of the federal budget show rapidly rising spending over the next several decades attributable to three major entitlement programs; namely, Medicare, Medicaid and Social Security. Under current rules, Social Security spending will rise rapidly over the next two decades, but level off after the Baby Boom generation passes through the system. The health care entitlements are expected to rise even faster. Moreover, they are expected to keep on rising because they are dominated by continued increases in the spending for health care in both the public and private sectors. If policies are not changed Medicare and Medicaid—and to a lesser extent Social Security—will drive federal spending up considerably faster than the rate at which the economy is likely to grow. Unless Americans consent to tax burdens that rise as fast as spending, a widening gap will open up. We will not be able to finance these continuously growing deficits.

Because rapidly rising debt threaten our credibility as sound fiscal managers, we do not have the luxury of waiting until the economy recovers before taking actions to bring down projected future deficits. Congress and the Administration should take actual steps this year to reduce those deficits in order to demonstrate clearly that we are capable of putting our fiscal house in order. This can be done without endangering economic recovery.

The crisis may have made Social Security less of a political “third rail” and provided an opportunity to put the system on a sound fiscal basis for the foreseeable future. Fixing Social Security is a relatively easy technical problem. It will take some combination of several much-discussed marginal changes: raising the retirement age gradually in the future (and then indexing it to longevity), raising the cap on the payroll tax, fixing the COLA, and modifying the indexing of initial benefits so they grow more slowly for more affluent people. In view of the collapse of market values, no one is likely to argue seriously for diverting existing revenues to private accounts, so the opportunity to craft a compromise is much greater than it was a few years ago. Fixing Social Security would be a confidence building achievement for bi-partisan cooperation and would enhance our reputation for fiscal prudence.

Vigorous action should also be taken to make Medicare more cost effective and slow the rate of growth of Medicare spending, which contributes so much to projected deficits. While restraining health spending growth should be a major feature of comprehensive health reform, Medicare is an ideal place to start the effort. Medicare is the largest payer for health services and should play a leadership role in collecting information on the cost and effectiveness of alternative treatments and ways of delivering services, and designing reimbursement incentives to reward effectiveness and discourage waste. Congress has a history of allowing pressure from providers and suppliers (for example, suppliers of durable medical equipment or pharmaceutical companies) to thwart efforts to contain Medicare costs. The government has also not been adequately attentive to punishing and preventing Medicare fraud. The United States will not stand a chance of restoring fiscal responsibility at the federal level unless Congress develops the political will to hold health providers accountable—whether in the context of existing federal programs or comprehensive health reform--for delivering more cost effective care. A good place to start is Medicare.


Process Reform

This Committee does not need to be convinced that deficits matter and that the deficits looming in the federal budget--exacerbated by the rapid increases in debt associated with recession and financial bailout—must be dealt with sooner rather than later. You know that procrastination will make the hard choices harder and make us increasingly dependent on our foreign creditors and exposed to their policy priorities. The question is: should you take actual steps now to reduce future deficits or design process reforms that will force you to confront viable options and make choices in the future? My answer is: do both.

Fixing Social Security and taking aggressive steps to control the growth of Medicare costs would be visible evidence that Congress and the new Administration have the courage to rein in future deficits. But the Congress also needs to restore discipline to the budget process—not use recession or the financial meltdown as excuses for throwing fiscal responsibility to the winds just when we are going to need it more than ever. A large temporary anti-recession package is the right fiscal policy in the face of severe recession and should not be subject to offsets—that would defeat the purpose. But more permanent investments in future growth—also good policy—should be paid for and not allowed to add to future deficits. Caps on discretionary spending and PAYGO for revenues and mandatory spending should be reinstated and seriously enforced.

Moreover, PAYGO is not enough, because it only guarantees that congressional actions with respect to entitlements and revenues will not make projected deficits worse than they would be under current policies. But, we all know that deficits projected under current policy will rise at unsustainable rates. Spending required by Medicare, Medicaid and Social Security will rise substantially faster than revenues at any feasible set of tax rates. We will not be able to borrow that much money—even if we thought it desirable to do so.

The current budget process subjects a declining—discretionary spending—to annual scrutiny by leaves entitlement programs and revenues on automatic pilot outside the budget process. Fiscal responsibility requires that all long-term spending commitments be subject to periodic review along with taxes and tax expenditures. There is no compelling logic for applying caps and intense annual scrutiny to discretionary spending, while leaving huge spending commitments, such as Medicare or the home mortgage deduction entirely outside the budget process and not subject to review on a regular basis. I am a member of a bipartisan group called the Fiscal Seminar (sponsored by The Brookings Institution and the Heritage Foundation) that addressed this problem in a paper entitled, Taking back our Fiscal Future, in 2008. We may not have come up with the right solution, but we certainly identified a serious problem that stands in the way of getting the federal budget on a sustainable long run track.


Not a Partisan Matter

The challenges that face this Committee—mitigating the recession, enhancing future growth, restoring sustainable fiscal responsibility—cannot be solved by one political party, but require non partisan analysis and bipartisan cooperation. Many budget analysts with quite disparate views on particular policies share the conviction that Congress and the Administration must meet the double challenge of reviving the economy and restoring fiscal responsibility at the same time. I attach a memo to President Obama signed by twelve experienced budget analysts (including myself) that emphasizes these points.

Thank you, Mr. Chairman and members of the Committee.

Commentary on US News and World Report on Vouchers

US News and World Report Gets it Wrong, by Andrew J. Coulson
Cato at Liberty, Feb 02, 2009

US News and World Report contributing editor Bonnie Erbe writes that “school vouchers… have already drained federal tax coffers of hundreds of millions of dollars.” With all due respect, this is not true.

There is only one federal school voucher program, in Washington, DC. That program is serving fewer than 2,000 children with an average voucher amount below $6,000, for an annual price tag under $12 million. It is in its fifth year of operation. Perhaps Ms. Erbe can explain to her readers how 5 * $12 million can be made to exceed $100 million?

Of course, even if the value of the vouchers to date did exceed $100 million, that wouldn’t mean it had “drained federal coffers” as Erbe claims. That’s because, as I wrote in the Washington Post and on this website, DC’s public schools spent $24,600 per pupil in 2007-08 — more than four times the average voucher cost. Much of the DC school system’s budget comes from the federal government, and the DC voucher program is saving taxpayers a great deal of money for every child it serves in place of the exorbitant district schools.

Ms. Erbe’s misrepresentation of the cost of federal vouchers calls into question the reliability of the US News and World Report. A correction is in order.

Who is the Indian Mujahideen?

Who is the Indian Mujahideen? Namrata Goswami
IDSA, Feb 3, 2009

In 2008, India faced multiple terror attacks on its cities across several states. These attacks resulted mostly in civilian deaths. The May 13, 2008 Jaipur bombings killed 80 civilians and injured more than 200, the Ahmedabad terrorist bombings of July 26, 2008, killed nearly 45 civilians and wounded 160, while the Bangalore bombs the previous day killed one person and wounded six. The Delhi bombings of September 13, 2008 killed 30 civilians and injured nearly 90 while the Guwahati blasts of October 30 the same year killed 83 civilians and injured nearly 300. In the Guwahati attacks, a group, identifying itself as Islamic Security Force (Indian Mujahideen), originally claimed responsibility via an email. Significantly, in all the other attacks, a hitherto unknown group calling itself the Indian Mujahideen (IM) claimed responsibility, thereby shifting the blame from more established terror groups like the Lashkar-e-Taiba (LeT) and the Hizbul Mujahideen (HM). In an email sent five minutes before the Ahmedabad bombings, the IM requested the LeT not to claim responsibility for the bombings. A deeper scrutiny into such behaviour by terrorist outfits reveal that newly established terror groups carry out attacks at short intervals not only to establish their deadly credibility in the world of terror networks but also to attract sponsors at home and abroad for their activities.
The IM’s frequent bomb blasts in Indian cities except perhaps Mumbai where the direct involvement of the LeT is established, begs answers to the question: who is the IM, what are their motives and where do they actually come from?


The Indian Mujahideen: Tracing the Roots and the Causes

According to Indian intelligence, the IM is not a well knit organization with a hierarchical structure like other more established groups like the LeT. Rather, it is a loose network of Islamic organizations which includes the Students’ Islamic Movement of India (SIMI), certain individuals from the state of Uttar Pradesh with alleged links with the Harkat ul-Jihad-e-Islami (HuJI), and the terror cartel of Aftab Ansari. Key SIMI members like Qayamuddin Kapadia, Usman Agarbattiwala and Sajid Mansuri started supporting the idea of the formation of the IM as early as December 2007 with 50 SIMI cadres participating in a jihadi training camp in Aluva, Kerala1. The plausible reason for men forming the IM could be many. First could be their personal experiences during the Gujarat riot of 2002. Other reasons could be the availability of funds for such activities in abundance in an underground network of terror financiers. Young men especially from UP also join these activities because of the availability of money in it vis-à-vis the absence of alternate employment opportunities. Terror activities also do not require too much of education or knowledge of the English language and yet the monetary benefit could be tremendous. Most of the arrested IM cadres were ill versed in English yet fluent in Hindi or Urdu.


Radical Ideology

Another important reason for young men taking up such subversive activities is the teaching of radical Islam which is easily available these days in the internet in any language. It is also a fact that the ideological roots of Islamic fundamentalism started in South Asia. History reveals that the founder of the Jamaat-e-Islami in Pakistan was Maulana Maududi (1903-1979), who in turn inspired men like Sayyid Qutb (1906-1966) of Egypt to further spread it. Maududi’s Islamic liberation theology was an anti-thesis to the West attracting several young alienated Muslims to take up arms. Maududi in fact called for a universal jihad by all Muslims to fight Western barbarism providing an ideological framework for many Sunni Islamic fundamentalist groups.2 The SIMI narratives also reveal the influence of Maududi’s teachings and can be very influential on younger people.

Anger at mainstream media biased reporting is also cited as one of the causes by most IM arrested cadres. It is argued that the mainstream media turns a blind eye to Hindu fundamentalist groups while mostly depicting the fundamental nature of Islam.

Politics is seen as another cause of the radicalization of communities along religious lines. Political parties deliberately play on the religious nerve of communities in order to garner votes. This results in social fragmentation and a polarized politics which in turn leads to young men and women from the minority community viewing the Indian state as been non-representative of all its communities. Experts like B. Raman also argue that “Over the last few years, [Indian Islamist terrorists] have expanded the ambit of their grievances from purely domestic issues to global issues like the U.S.-led war in Iraq”.


Leadership and Cadres

The leadership of the IM is mainly traced to a man from Mumbai named Abdul Subhan Usman Qureshi, code name “Kasim” or “al-arbi” who signed the email manifestos sent by the IM before and after the multiple blasts last year. Qureshi’s background however refutes the theory that most IM cadres come from a deprived background or was schooled in a radical Madrassa. Qureshi studied at the Antonio DeSouza High School ran by a Christian missionary in Byculla, Mumbai and came from an economically privileged background. Qureshi was studying at Bharatiya Vidyapeeth in Navi Mumbai in 1992 when the Mumbai riots took place followed by the demolition of the Babri Masjid. In 1995, he obtained a diploma in industrial electronics and in 1996, a specialised software maintenance qualification from the CMS Institute in Marol. After obtaining these degrees, he joined Radical Solutions, an independent computer firm operating out of the Fort area in south Mumbai in November, 1996. In 1999, he changed jobs and joined Datamatics, a major computer firm in Mumbai. However, somewhere in these years, Qureshi was also harbouring more radical ideologies and in 2001, he left his job at the firm stating in his resignation letter that “I have decided to devote one complete year to pursue religious and spiritual matters.”3

According to Mumbai police intelligence, by 1998, Qureshi was one of the most committed SIMI activists going on to edit one of SIMI’s house-magazines, Islamic Voice, from New Delhi. By then, SIMI’s growing links with global Islamic movements like the Egyptian Brotherhood and Hamas were clear. Links with Bangladesh based HuJI and Pakistan based LeT were also coming to the fore. The radicalization process of SIMI became clearer by its 1999 Aurangabad convention when SIMI activists Mohammad Amir Shakeel Ahmad stated that “Islam is our nation, not India”. Qureshi was one of the principal organisers of SIMI’s last public conference in 2001 in which 25, 000 young people participated. He also succeeded in training hundreds of SIMI-IM cadres since 2007 and was the mastermind of the Delhi blasts undertaken by Mohammad Bashir, Mohammad Fakruddin and Saif Ahmad in September 2008.4 The main assault members of the IM include Atif Amin, who belongs to UP, and responsible for the Ahmedabad bombings, and Aftab Ansari’s lieutenant, Riaz Bhatkal, who is mainly responsible for the IM’s finance coming mostly from West Asia.5 Recently, an arrest in Pune of Anwar Ali Bagwaan, a MBBS graduate who was practicing in Hyderabad, revealed that he trained IM members on how to administer sedatives on persons they were planning to kidnap. According to another UP based IM cadre, Sadiq Shaikh, hailing from Azamgarh district and who was arrested on September 23, 2008, IM modules exist in Uttar Pradesh, Karnataka, Pune and Mumbai. Shaikh is a software professional who lived in Central Mumbai. Most arrested IM cadres are computer professionals and bomb makers. Among those arrested are Pune-based Mohammed Mansoor Asgar Peerbhoy and Mubin Kadar Shaikh, who jointly designed the IM logo and hacked into unsecured Wi-fi connections.

Another significant intelligence input from the UP police indicates that UP based IM cadre Fahim Arshad Ansari who was arrested in UP in February 2008 was in direct contact with the LeT in masterminding the Mumbai attacks of November 2008. Ansari studied at the Malad Municipal Secondary School in Mumbai, from where he graduated in 1989 but later on went onto Dubai. In 2005, another Hyderabadi, Sami Ahmad who was arrested by the police in 2006 revealed that he agreed to put Ansari in touch with the LeT then. The narrative of Ansari is equally revealing. He got in touch with LeT in Dubai and reached Pakistan in 2005 itself. In the LeT’s Muzzafarabad base, Ansari was put under Muzammil, the LeT commander in charge of operations in India. Ansari revealed during interrogation that he went through a 21-day Daura Aam (basic combat course), followed by a rigorous three-month advanced Daura Khaas (specialized guerrilla tactics) as a precursor to the Fidayeen attack on Mumbai6. He also learnt the use of maps, compasses and Global Positioning Systems (GPS). Mumbai was traced in the Google Earth maps and chillingly, Mumbai stock exchange, the Taj Mahal Hotel, railway station and airport were identified as target areas. Ansari arrived in India in 2007 and from November 28 to December 10, 2007, he stayed at the Sunlight Guest House in Mumbai, photographing and mapping the targets he had been shown prominent amongst them being the Chattrapati Shivaji Terminus and the Taj Mahal Hotel.7


Game Plan

The game plan of the IM is rather obvious. Despite its obvious LeT connections and training in Pakistan in sophisticated weaponry and guerrilla warfare, the IM wants to establish itself as an Indian based terror outfit. This is done for three reasons.

First, when the blame for terror attacks in India is pinned on the IM, then Indian security forces will have to concentrate their resources within India instead. This is done deliberately as Indian intelligence on the IM cellular networks is rather weak at present and most of the intelligence inputs are gathered from arrested IM cadres who might mislead the police.

Second, the LeT then can go blameless despite its obvious hand in training and providing weaponry. That will also offset any diplomatic pressure from India and the international community on Pakistan to act against the LeT in its territory.

Third, once its credibility is established, the IM can also easily target vulnerable minority youth base within India for direct recruitment into terror outfits in India and abroad.


Linkages

Though the IM cadres mostly come from India, their linkages with a global jihad are worrisome. Links to the LeT and the HuJi also portends the fact that cross border movement of cadres and arms appears rather easy with the help of false names and passports mostly of Pakistani origin. Ansari entered India in 2007 from Nepal with a false Pakistani passport no. BM 6809341, issued on November 1, 2007 in Pakistan with the pseudonym Hammad Hasan. The connection to HuJI is also alarming given the porous nature of India’s international border with Bangladesh. Hence, despite India increasing surveillance and border security at the Line of Control (LoC) with Pakistan in its Western border, motivated IM-LeT cadres like Qureshi or Ansari can easily enter India via Nepal and Bangladesh with the help of HuJI who is active in these areas. Insurgent groups from Assam like the United Liberation Front of Asom (ULFA) also run camps in Bangladesh with covert connections with HuJI and could end up transporting terror cells into India. This calls for very strict fencing of India’s eastern borders and steep increase in border patrolling.


Countering the IM

A review of India’s ground forces for law enforcement and intelligence gathering last year reveal that India's police strength comes to 126 officers per 100,000 people while the standard United Nations norm is 222.9 The Intelligence Bureau (IB) has only 3,500 field operatives to monitor a country of 1.1 billion. Thereby, a boost in India’s security forces is a must along with modernization of the police forces and speedy undertaking of vital security sector reforms. Terror activities can be deterred if specific intelligence can zero in on different actors within a terror network. According to two distinguished terror experts, Paul Davies and Brian Jenkins, terror groups comprise of “leaders, lieutenants, financiers, logisticians, and other facilitators, foot soldiers, supporting population segments, and religious and otherwise ideological figures”10. Hence, it’s a long drawn process of planning and coordination before the final act of terror is unleashed. Terror activity is a process rather than the single final act that we see in terms of violence. The 9/11 terror process started in 1996 when Muhammad Atta began planning for the attack in Hamburg.11 Keeping this insight in mind, the IM terror process can be easily deterred if the state forces concentrate on finding the financiers, usually the least motivated amongst the other actors.

A counter against the IM ideology can also be undertaken at the social level. In February, 2008, theologians from 6,000 religious schools met at the Darul-Uloom Deoband, an influential, 150-year-old Islamic school in UP, to denounce terrorism as an activity against Islam. Deoband’s cooperation in fighting terror is a very positive way of handling the spread of radical ideologies within India. Also, vulnerable areas like Azamgarh in UP must be closely monitored and the local civil society encouraged to talk against terror activities. India has to construct a counter-narrative against terror which should have cooperation from all the nation’s stakeholders if the fight against terror is to be a unified and successful effort.


References

1. Pravin Swami, “New Insights into Indian Mujahideen Network”, The Hindu, October 08, 2008 at http://www.hindu.com/2008/10/02/stories/2008100256021200.htm (Accessed on October 09, 2008).2. Saba Naqvi, “Delhi Blasts: Mind of Terror” at http://www.outlookindia.com/full.asp?fodname=20080929&fname=Cover+Story&sid=1&pn=2 (Accessed on October 17, 2008). 3. Pravin Swami, “The Hunt for the Indian Mujahideen’s al-arbi”, The Hindu, September 13, 2008 at http://www.hindu.com/2008/09/13/stories/2008091355761100.htm (Accessed on September 15, 2008). Also see Jeremy Page, “Abdul Subhan Qureshi, known as India’s Bin Laden named as bombing suspect” at http://www.timesonline.co.uk/tol/news/world/asia/article4759825.ece (Accessed on January 19, 2009).4. Namrata Goswami, “Averting Terror Attacks”, IDSA Strategic Comments, September 25, 2008 at http://www.idsa.in/publications/stratcomments/NamrataGoswami250908.htm (Accessed on September 29, 2008). 5. Pravin Swami, no.3. 6. Praveen Swami, “ Abortive Lashkar plot hold clues to Mumbai massacres”, The Hindu, December 08, 2008 at http://www.hindu.com/2008/12/08/stories/2008120859431000.htm (Accessed on December 10, 2008). 7. Ibid. 8. Tejinder Singh, “Lashkar-e-Taiba’s audacious siege of Mumbai” at http://www.neurope.eu/articles/90887.php (Accessed on December 29, 2008). 9. Madhur Singh, “India: The Terrorist Within”, July 27, 2008 at http://www.time.com/time/world/article/0,8599,1826950,00.html (Accessed on January 19, 2009).10. As quoted in Robert F. Trager, Dessislava P. Zagorcheva, “Deterring Terrorism: It Can be Done”, International Security, 30/3, Winter 2005-06, p. 9611. Ibid, pp. 87-123.

China Policy Change?

China Policy Change? By Dan Blumenthal
AEI, Tuesday, February 3, 2009

As the first U.S. president to come of age after the Cold War, Barack Obama has an opportunity to dispose of the Cold War baggage that has guided U.S.-Chinese relations for the past thirty years. He should pursue a renewed policy that places increased emphasis on reforming China's human rights record, trade practices, and military pursuits, while strengthening relationships with Asia's diverse democracies.

Regarding China policy, President Obama may really offer change we can believe in. Treasury Secretary Timothy Geithner's tough words about China's manipulation of its currency may be a harbinger of change in America's increasingly sclerotic approach to the People's Republic.

President Obama is not part of the generation that shaped our current China policy. He was graduating high school when Washington and Beijing finalized the terms of diplomatic normalization in 1979. Much of the deal had been worked out in secret, and set Washington on a 30-year path that would subordinate concerns about Taiwan, political reform in China, unfair trading practices and even China's military ambitions to diplomatic engagement at any cost. While the architects of China policy saw China through a Cold War prism, Mr. Obama is the first American president who came of age as the Cold War was receding. For many in Obama's generation, the massacre of Chinese protesters at Tiananmen Square is a more powerful symbol of Chinese leadership than President Nixon's breakthrough visit to Beijing.

It may have been reasonable for Cold Warriors to overlook Washington's many differences with Beijing when both countries were trying to contain the Soviet Union, but that rationale has obviously disappeared. Since the Soviet Union collapsed, the Sino-U.S. relationship has been a partnership in search of a purpose. Americans of Mr. Obama's generation wonder why Washington looks askance at China's poor human-rights record, intimidation of democratic Taiwan, irresponsible trade practices, and alarming military build-up.

Moreover, the president's experience in another Asian country, Indonesia, will undoubtedly help him understand that Asia is more than just China, and that Asians are quite capable of governing themselves under democratic rule. The young president will be less beholden to past legacies that define our China policy. He could start by questioning a policy that gives China a pass on its human-rights practices at home and irresponsible polices abroad. He can also puzzle over why China so often sets the policy agenda in a region made up of so many diverse and successful democratic countries.

A less Sino-centric Asia policy would be good for the United States, the rest of Asia and ultimately the Chinese people themselves. China is the only Asian power that is not a democracy. The United States benefits from deep and enduring cooperation with Australia, Japan, South Korea, India, Indonesia and Taiwan, precisely because these relationships are embedded in common values and interests.

China is more than capable of joining this club. Many Chinese people yearn for a more just and open system that acts responsibly on the world stage. If Mr. Obama changes America's "engagement at any price" policy, he will help the Chinese people fulfill their own aspirations at the same time as he advances American interests.

Obviously the president should not end America's engagement with China--that would be both imprudent and impossible. But he can change the way Washington engages. Mr. Obama can directly speak to the tech-savvy Chinese people--among whom he is very popular--about universal notions of liberty, justice and transparency.

At the same time, he can carry out America's official business with the Chinese Communist Party, urging a more balanced trade policy, cooperation on energy and the environment and cooperation on nonproliferation.

But he need not indulge in ritualized happy talk about a Sino-American relationship that is still fraught with problems. Neither should he repeat his predecessors' practice of overstating the relationship's modest successes. Speaking truthfully about a relationship characterized by economic interdependence on the one hand, and concerns about China's polices on the other, will set the relationship on a firmer course.

Meanwhile, Mr. Obama could strengthen relationships with Asia's diverse democracies from Jakarta to Taipei to Delhi. All of Washington's allies want to benefit from trade with China, but at the same time all are worried that an autocratic China will one day dominate Asia. In turn, as China sees Washington net together a web of Asia's democracies, China's many reformers could hold their government to the same standards of behavior as their democratic neighbors.

As our first president who came of age after the Cold War, Mr. Obama has an opportunity to dispose of the Cold War baggage that still guides our China policy. If Mr. Obama sides with the Chinese people pushing for a just and open society he will hear a billion more "yes we cans."