RoguePundit

Random Nature #219

Not Bulletproof:  It's no mystery that many teens engage in a range of risky behaviors.  People keep looking for reasons why.  

Borowsky and colleagues analyzed data collected by the National Longitudinal Study of Adolescent Health, a nationally representative sample of more than 20,000 youth in grades 7 through 12 during three separate study years. In the first set of interviews, nearly 15 percent of adolescents predicted they had a 50/50 chance or less of living to age 35. Those who engaged in risky behaviors such as illicit drug use, suicide attempts, fighting, or unsafe sexual activity in the first year were more likely in subsequent years to believe they would die at a young age. Vice versa, those who predicted that they'd die young during the first interview were more likely in later years to begin engaging in these same risky behaviors and have poor health outcomes. Notably, these teens were significantly more likely to be diagnosed with HIV/AIDS just six years later, regardless of their sexual preference.

"While conventional wisdom says that teens engage in risky behaviors because they feel invulnerable to harm, this study suggests that in some cases, teens take risks because they overestimate their vulnerability, specifically their risk of dying," Borowsky said. "These youth may take risks because they feel hopeless and figure that not much is at stake."

I thought we already knew that with--for instance--gang activity.  Anyway...

Nearly 25 percent of youth living in households that receive public assistance and more than 29 percent of American-Indian, 26 percent of African-American, 21 percent of Hispanic, and 15 percent of Asian youth reported believing they would die young—compared to just 10 percent of their Caucasian peers.

So, hope is about income?

"Our findings reinforce the importance of instilling a sense of hope and optimism in youth," Borowsky said. "Strong connections with parents, families, and schools, as well as positive media messages, are likely important factors in developing an optimistic outlook for young people."

Sounds nice, but that's way easier to claim than to prove. 

Consequences:  Plenty of research shows that alcohol consumption increases the risk of cancer (example here).  Men still drink more than women, but the gap is closing.  From this link...

Research from Canada's own Centre for Addiction and Mental Health (CAMH) featured in this week's edition of the Lancet shows that worldwide, 1 in 25 deaths are directly attributable to alcohol consumption. This rise since 2000 is mainly due to increases in the number of women drinking.

CAMH's Dr Jürgen Rehm and his colleagues found that alcohol-attributable disorders are among the most disabling disease categories within the global burden of disease, especially for men. And in contrast to other traditional risk factors for disease, the burden attributable to alcohol lies more with younger people than with the older population.

There is research that attributes 3.5% of all cancer deaths worldwide to alcohol drinking.  But how often does an autopsy or death certificate for a cancer victim note that the cause of death was alcohol consumption?  In other words, part of this study was based upon estimates rather than hard data. 

The study showed that Europe had a high proportion of deaths related to alcohol, with 1 in 10 deaths directly attributable (up to 15% in the former Soviet Union). Average alcohol consumption in Europe in the adult population is somewhat higher than in North America: 13 standard drinks per person per week (1 standard drink = 13.6 grams of pure ethanol and corresponds to a can of beer, one glass or wine and one shot of spirits) compared to North America's 10 to 11 standard drinks. The recent Canadian consumption rate is equivalent of almost 9 standard drinks per person per week age 15 plus, and has been going up, as has high risk drinking. Globally, the average is around 7 standard drinks per person per week (despite the fact that most of the adult population worldwide actually abstains from drinking alcohol).

Most of the deaths caused by alcohol were through injuries, cancer, cardiovascular disease, and liver cirrhosis.

...

"Globally, the effect of alcohol on burden of disease is about the same size as that of smoking in 2000, but it is relatively greatest in emerging economies. Global consumption is increasing, especially in the most populous countries of India and China."

Most of the alcohol related injury and disease burden occurs in people under 45 years of age.  The global statistic is 72.4%, but in the Americas it is 82.1%.  Unfortunately, the data is rather broad...the four categories are ages 0-14, 15-44, 45-69, and 70 & older.  As one would expect, the big numbers are in the 15-44 category.

Slow-Motion Prohibition:  When our nicotine addict-in-chief signed the bill giving the FDA authority to regulate tobacco, a couple of tobacco researchers jumped on the bandwagon and offered some advice for reducing smoking rates over the next 50 years.

Substantial increases in federal and state tobacco excise taxes.

A national clean-indoor air law.

Elimination of nicotine from tobacco products.

Funds for an aggressive mass media campaign to counter the tide of tobacco industry ads and sponsorships.

A ban on tobacco advertising, promotion and sponsorship.

Evidence-based counseling and medication for every smoker who wants to quit.

Protecting young people, particularly those 17 and younger, from starting to smoke. Research shows that a major genetic risk for lifelong nicotine dependence can be suppressed if young people avoid daily smoking prior to age 17.

That suggestion to eliminate nicotine from tobacco products didn't do much for their credibility.  And how much more anti-smoking advertising do we need before they consider it an aggressive campaign?  But, the point about genetic risk is certainly interesting.

One of the things the researchers emphasized is that adult smoking rates have been steadily decreasing for 40 years.  Switching to another piece of research published this past week...

In 2005, 32 percent of active-duty personnel and 22 percent of veterans were smokers; rates among active-duty personnel have recently increased, possibly because of growing tobacco use by deployed troops.

Not good...but why didn't they ask the age the troops took-up smoking?  For instance, perhaps as the standards for new recruits have been relaxed, an increasing percentage of smokers has been accepted into the military.  

Not Self-Sufficient:  Many of those who make it to old age aren't financially prepared to take care of themselves.  The U.S., like most industrialized nations is dependent upon population growth to fund pay-as-you-go benefits.  This is one of several reasons that politicians tend to be more enthusiastic about immigration than the people they serve.  

Spain has been studying this issue.  From an press release on research entitled (in Spanish) "The effect of immigration on the long-term sustainability of the pension system in Spain."

Researchers from the University of Valladolid have constructed a demographic and economic simulation model called 'Carrión', which projects the costs of pensions, Social Security contributions and GDP up until 2060. The model also includes detailed scenarios about the behaviour of people migrating to Spain currently and in the future, in relation to the length of time they stay, their fertility, salaries and employment rate.

The new study ... evaluates the stability of the Spanish pensions system and carries out a detailed analysis of the effect of immigration on the accounts of the Social Security system.

One of the most striking results is that by 2055 the contributions/pensions ratio of immigrants "will have a net value in excess of that of native-born people", Jiménez-Ridruejo tells SINC. The researcher says that, through this demographic and economic simulation model, his team has provided the first projection of the contribution made by migrants to the Spanish pensions system, both in terms of contributions and pensions expenditure.

In 2008, foreign-born individuals comprised roughly 12% of the Spanish population.  From 1996-2008, the number of immigrants--both legal and otherwise--rose from about 500,000 to 5,220,000.  The biggest sources of legal immigrants are Romania and Morocco.  The majority of the immigrants are from Latin America--especially Ecuador, Bolivia, and Colombia.  And we can't forget the sun-deprived British; the official number is 350,000, though it may be as high as 1 million.

The study also shows a more pronounced increase in the fertility rate, which will reach almost two children per woman, and that the pension load will start to decline after 2020. This will primarily be due to the rejuvenation of the population, implying reduced increases in the dependency rate, an indicator that "could even start to decline by 2055".

Spain's fertility rate is currently well-below replacement--just 1.37.  Of note though is that it's been climbing since the late 90s...along with immigration.  However, expecting the number to rise to almost 2.0 sure seems optimistic.  But then, optimism is a key component of pension math.

When our politicians claim they're pro-environment, ask them how they're going to pay for social security long-term without a continuing increase in the population--which isn't good for the environment. 

More on Those Falsified Results

Sorry for the quiet the last couple of days...am still fighting off some sort of bug.

Dr. Timothy Kuklo has kept a low profile since all of the publicity earlier this year over the retraction of his favorable study on Medtronic's Infuse bone graft product.  The Army found that he'd falsified data and forged the signatures of his supposed co-authors (previous blog here).  Dr. Kuklo--who retired from the Army in March of 2007--hasn't spoken publicly on the subject and has taken a leave of absence from Washington University in St. Louis, where he is now a professor of orthopedic surgery.  The University won't discuss whether it's investigating him. 

This past week, Medtronic disclosed that it had paid Dr. Kuklo nearly $800,000 for his consulting work between August 2006 and May 2009.  August 2006 is also when he joined the faculty of the Washington University Medical School.  It's also eight months before he retired from the Army...I still can't figure out that timing.  Medtronic also picked up $42,295 in expenses from 2001-2005 related to Dr. Kuklo speaking at various conferences.  That's okay, provided he made the proper financial disclosures.  Medtronic claims that none of its payments were related to the study in question. 

From the most recent link... 

Last November the Department of Justice subpoenaed documents from Medtronic as part of a probe into whether the company encouraged doctors to use the Infuse spinal graft for unapproved purposes. Grassley is conducting a similar inquiry.

Senators Grassley (R-IA) and Kohl (D-WI) are pushing the proposed Physician Payment Sunshine Act (S-301), which would force the disclosure of payments (over $100) from the medical industry to doctors.  In February, Medtronic joined several other companies in stating that it would begin voluntarily making disclosures...but not until 2010.    

Falsified Results

Dr. Timothy R. Kuklo is a surgeon who is also a West Point grad and has a law degree from Georgetown.  He retired from the Army in 2007 and is now--at age 48--an associate professor at the prestigious Washington University medical school in St. Louis.  He is also a Medtronic consultant.   

Infuse was approved by the F.D.A. in 2002 for use in the lower spine and in 2004 for fractures of the shinbone. The studies on which the F.D.A. approved shin-bone treatment involved patients injured in accidents like car crashes and falls.

But because doctors are free to use any product approved by the F.D.A. for whatever purposes they see fit, surgeons at Walter Reed used the product to see if it could help soldiers with far more severe, combat-related injuries.

During his time at Walter Reed Dr. Kuklo was extensively involved in research and writing about various Medtronic products, including editing two books published by the company and conducting three studies that were approved by his Army superiors, according to his list of publications and an Army report.

However, one of his later studies while with the Army hasn't stood up to scrutiny. 

The results reported by Dr. Kuklo in his Infuse study “suggested a much higher efficacy of the product being researched in the article than is supported by the experience of the purported co-authors,” according to the Army’s investigation.

Colonel Coots said Tuesday that the total number of patients Dr. Kuklo reported as having been treated for extensive lower leg wounds at Walter Reed during the study period — 138 soldiers — was greater than the number for which the hospital could find records.

...

Army investigators found that Dr. Kuklo forged the signatures of four Walter Reed doctors on the article before submitting it last year to a British medical journal, falsely claiming them as co-authors. He also did not obtain the Army’s required permission to conduct the study.

Let's hope that other doctors weren't influenced by his so-called research to use Infuse when another product or procedure might have worked better. 

So far, Dr. Kuklo doesn't seem to be suffering particularly major consequences for his dangerous ethical breach. 

Army officials said that Colonel Coots sent the results of their investigation late last year to Medtronic’s chief executive and to the dean of the Washington University School of Medicine. A university official declined to say whether it was investigating Dr. Kuklo but added that he remained on the faculty.

Colonel Coots said he decided to handle the matter by notifying the journal, university and Medtronic, as well as several orthopedics professional groups, rather than recalling Dr. Kuklo from retirement to face possible Army discipline.

A goal of the back surgery I had in '01 was to buy me 6-8 years before a probable spinal fusion.  Between exercising & physical therapy, avoiding certain activities, pain management, etc., I've been trying to put off that next surgery for as long as possible...and so far, so good.  If I'd had a fusion back then, it would have involved bone harvesting from the hip and some cadaverous material.  The Infuse bone graft is supposed to be a significant improvement.  Hopefully there are even better technologies available by the time I go back under the knife. 

Impotent Peace Activists

The American Friends Service Committee...

...is a practical expression of the faith of the Religious Society of Friends (Quakers). Committed to the principles of nonviolence and justice, it seeks in its work and witness to draw on the transforming power of love, human and divine.

 And this is the best that they can come up with?

Testifying before the Portland City Council this morning, members of several area peace groups called for passage of a resolution that would declare the city a sanctuary for AWOL service members.

The idea would be for the council to tell police not to honor federal arrest warrants if the subject of a traffic stop or other infraction happened to be wanted by the military for desertion. Such a stance, the activists argue, is in line with the council's previously stated opposition to the Iraq War.

"The message from the Obama campaign was not to just sit and wait for change to come," said Kelly Campbell, peace director for the American Friends Service Committee in Portland. "We should consider what vision we bring and what changes we can make to our country."

The activists have framed the issue as one of supporting veterans of the current wars in Iraq and Afghanistan who, since signing up for military service, object to the fighting as a matter of conscience.

Deserters aren't necessarily conscientious objectors...some are homesick, or running from crimes, or having trouble coping, on and on.  Plus, a military member isn't officially a conscientious objector until he or she has proven to the military that there's been a geniune change of heart since volunteering to serve.  Rather than helping the deserters deal with their situations, these so-called peace activists would rather help keep the deserters hidden.  That doesn't contribute to making the world a more peaceful place...that doesn't help anything at all.

So far, the group has had little luck getting any of the council members to champion the cause, so they wanted to make a public show of it. They said they got a warm reception from Mayor Tom Potter, the only member of the council to meet with them, and have had conversations with staff members of the others.

Three activists from different groups testified briefly. The council did not discuss the issue, as is customary when citizens sign up to speak under the public communications part of the weekly meeting.

Still, they agreed that council members are tepid, if not outright opposed to the idea. Commissioner Randy Leonard has said he thinks its inappropriate while deferring to the Obama administration to deal with the war in Iraq.

I'd never make a good politician, because I don't suffer fools gladly.

Higher Suicide Rate Amongst Veterans

Last fall, CBS reported on what it called an epidemic of suicides amongst veterans.  Today, it had a follow-up story that focuses upon Oregon's suicide data.

The state health report, “Violent Deaths in Oregon: 2005” found 18 to 24-year-old male veterans had the highest rate of suicide among all males in the state from 2000 to 2005 – almost 5 times higher than non-veteran males the same age.

...

Data for the report was collected from local medical examiners, police reports and death certificates. In 2005, veterans accounted for 28 percent of all suicides in Oregon. The majority of the veteran suicides (97 percent) were committed by males. And overall, in the years 2000 to 2005, male veterans died of self-inflicted wounds in Oregon at more than double the rate of male non-veterans.

Switching to a paragraph from the report...

The reasons for higher rates of suicide among veterans are not clear.  There are many unexplored possible contributors.  For example, the difference could be due to baseline differences predisposing to suicide between those who choose to enter the armed services and those who do not, or could be due to exposure to traumatic events during combat, or a high prevalence of gun availability and familiarity among veterans.  Regardless of the cause, these results argue strongly for suicide prevention efforts targeted to veterans.   Two facts should prompt officials to make suicide prevention a prominent focus among older veterans: First, the high rate of suicide among veterans older than 65 and that approximately 70 percent of older males are veterans (2000 census).

For military members, conversations with military (or contracted) mental health professionals are not privileged.  What you say can come back to bite you career-wise.  It's somewhat safer to talk to a chaplain.  Nevertheless, I've often wondered whether that stigma makes vets less prone to seek help or be open with those trying to help them. 

Back to the article...

Researchers with Oregon's Violent Death Reporting System are now digging deeper into the issue of veteran suicides as a result of their recent findings. According to Millet, they plan to team up with the Oregon National Guard and the Portland Department of Veterans Affairs to gain more information about the individuals who died of suicide. Millet says "we need to see what can be done to reduce the problem."

They need to talk to friends and family as well.

Slowly But Surely

The destruction continues.

The U.S. Army Chemical Materials Agency announced Tuesday that half the nation's 30,000-ton stockpile of chemical agent used in weapons has been destroyed.

More than 3 percent of that stockpile has been destroyed at Oregon's Umatilla Chemical Depot since September 2004. There, an original stockpile of 3,719 tons has been reduced by 1,069 tons, or 29 percent, so far.

...

Umatilla is one of the five remaining sites and is home to about 12 percent of the country's original chemical agent stockpile. The depot finished destroying sarin-filled munitions July 8.

Since late October it has been processing its inventory of VX nerve agent, an oily, clear liquid that can cause seizures, paralysis and suffocation. It is found in rockets, spray tanks, artillery shells and land mines.

Work to destroy them could finish in mid-2009, Henrickson said. Then work will begin to destroy bulk containers of mustard gas. All work could be finished by 2012, though such time frames aren't guaranteed.

Sarin is also a nerve agent...that's been used a few times in recent memory.  Saddam attacked the Kurds with sarin (and mustard gas) in the late '80s, and Japanese cultists used it in a couple of attacks, including on the Tokyo subway system in 1995.  It was the Germans who developed sarin as a pesticide in the late '30s.

It is hoped 90 percent of the country's stockpile of chemical agent will be destroyed by 2017. The remaining 10 percent will be destroyed at facilities being built in Colorado and Kentucky.

North Korea has a huge chemical munitions arsenal and delivery systems which allow it to attack from afar.  It's one of the few nations which has never joined the Chemical Weapons Convention. 

Maybe Vets' Data is Safe...Maybe

The following article starts out with some good news, but ends up leaving me wondering even more whether the VA can be trusted on this issue. 

The government has recovered the stolen laptop computer and hard drive with sensitive data on up to 26.5 million veterans and military personnel. The FBI said Thursday there is no evidence that anyone accessed Social Security numbers and other data on the equipment.

Veterans Affairs Secretary Jim Nicholson, in announcing the recovery of the computer, said there have been no reports of identity theft stemming from the May 3 burglary at a VA employee's Maryland home.

The FBI, in a statement from its Baltimore field office, said a preliminary review of the equipment by its computer forensic teams "has determined that the data base remains intact and has not been accessed since it was stolen." More tests were planned, however.

Nicholson said the laptop and hard drive were turned in Wednesday to the FBI by an unidentified person in response to the $50,000 reward offer. No suspects were in custody.

...

Michelle Crnkovich, a spokeswoman for the Baltimore FBI field office, said tipster who turned in the laptop in Baltimore has not been charged and likely was not the thief. She said the FBI still believes the laptop was taken in a routine burglary and that the VA data was not the target.

Let's hope the computer forensic folks are correct.  Can one presume this also means the data hasn't been copied?  Obviously this has started a debate over whether credit monitoring (previous blog here) is still needed.

And then there's the following regarding the data, which is certainly different from what the VA has been saying...

According to documents obtained by The Associated Press, the data analyst faulted for losing the personal data had the department's approval to access millions of Social Security numbers on a laptop from home. One document shows the analyst, whose name was being withheld, had approval as early as Sept. 5, 2002, to use special software at home that was designed to manipulate large amounts of data.

A separate agreement, dated Feb. 5, 2002, from the office of the assistant secretary for policy and planning, allowed the worker to access Social Security numbers for millions of veterans. A third document, also issued in 2002, gave the analyst permission to take a laptop computer and accessories for work outside of the VA building.

The department said last month it was in the process of firing the data analyst, who is now challenging the dismissal.

Under questioning, Nicholson said he was not personally aware of the agreements. Tim McClain, the VA's general counsel, told the committee that the Social Security authorization is standard for an employee doing data analysis work, and that the laptop authorization was for a computer different from the one that was stolen.

"I can't comment on a pending action because it is still pending," McClain said.

We'd previously been told that the data analyst was fired for violating procedures--taking the data home without permission.  Now we find out that not only isn't he gone, but he may have had permission to take the data home? 

Remember that it took three weeks for the VA to publicize that the data had been stolen.  First it was just vets that were victims, but then we're told that the data from most active duty and many guard and reserve personnel had been stolen as well.  Initially it was just names, SSNs, birth dates, and some disability codes that had been stolen, but then we're told that addresses and phone numbers were also included. 

The data analyst's boss (VA deputy assistant secretary Michael McLendon) has resigned, and another senior VA official is on administrative leave while the investigation proceeds.  But, it's no secret that the VA has had security issues for a fair while.  When do we start holding the leadership responsible for those problems?

VA Identity Theft and Free Credit Monitoring

The government hasn't done a good job of protecting my personal information.  In late '02, the military HMO that handled my back surgery and related treatment had some computers stolen which evidently included info on me.  Luckily (knock on wood), I haven't seen an impact from the identity theft.  Then last month came the theft of a VA computer containing the personal information (and disability ratings when applicable) on millions of vets and active duty military.  I'd already seen that I'd eventually be eligible for free credit monitoring.  But now I may have to wait longer because of a class action lawsuit to get us victims a better deal?

A federal judge temporarily has barred the government from publicizing its free credit monitoring offer to veterans whose personal data was stolen and wants to see if they might get a better federal offer.

Lawyers who have filed a class-action lawsuit on behalf of the 26.5 million veterans and active-duty troops affected contend that accepting the government's offer could jeopardize their chance of winning more money in the privacy suit.

U.S. District Judge William Bertelsman in Kentucky scheduled a hearing this Friday to determine whether the Veterans Affairs Department should revise its offer. His order on the credit monitoring was issued late last Friday.

The suit seeks free monitoring and other credit protection for an indefinite period as well as $1,000 in damages for each person - or up to $26.5 billion total - in what has become one of the nation's largest information security breaches.

Why exactly is identity theft from the government worth $1,000 per victim?  The free monitoring and credit protection for some length of time (not indefinitely) certainly makes sense.  And if some of us run into significant problems from the identity theft, I can certainly see the government bearing the burden of that cost (though proof could be tough to assess).  But, a check for $1,000 on top of that?  Maybe that's just the lawyers setting up a bargaining chip. 

Last week, the department announced its plan to offer free monitoring for a year to millions of veterans and nearly all active-duty military troops whose names, birthdates and Social Security numbers were stolen May 3 from a VA data analyst's home in suburban Maryland.

The department said it would send out letters to affected veterans and military personnel in early August - after it solicits bids from contractors - on how to sign up for the free service. It also posted information on the government's Web site.

But in court papers, lawyers for veterans said the VA's deal was "incomplete and misleading." The VA must make clear whether veterans who take the government deal will have to give up their rights in court to a potentially larger payout, lawyer Marc Mezibov wrote.

...

Last week, a Senate committee approved $160 million to pay for the credit monitoring for veterans. It is one of many expected payments as the government struggles with fallout from data breaches crossing at least six agencies.

The VA alone has spent more than $14 million so far to notify veterans by letter and set up a call center, and it is spending an additional $200,000 a day to maintain the call center.

By the time the VA gets around to sending out those letters, it will have been three months since the identity theft...unless the lawsuit causes a greater delay.  Is it reasonable to expect that the criminal(s) won't act on the information very quickly?  Guess that's why the government and others have been giving us advice on how we can help ourselves until the government gets around to it.  The $160 million the Senate approved for the credit monitoring is only about $6 per victim. 

Our socialized medicine is sure efficient.

Large TRICARE Fee Increase Proposed

The Veteran's Administration (VA) primarily serves disabled vets, only a small percentage of whom are military retirees.  Because of funding limitations, the VA (which isn't part of the Department of Defense) prioritizes access to care, giving preference to vets with purple hearts and higher service-connected disability percentages.  Thus, some disabled vets also pay for TRICARE, the military's HMO, to ensure they get care when they need it.

Who provides the promised health care for the typical military retiree?  The Department of Defense.  It used to be when military retirees and their family members hit the age of 65, the responsibility for providing their medical care shifted to the Department of Health and Human Services via Medicare.  That changed in 2001 when the TRICARE for Life program was established.  Since the military started offering such service to its senior citizens, its healthcare costs have been accelerating faster than normal. 

The DoD wants to free up more money to spend on current defense priorities, so its leaders will soon lobby Congress for approval to significantly increase enrollment fees, co-pays, and deductibles for retirees under the age of 65.  The theory is that these retirees are still of working age and are likely to have some medical coverage through their current employer, thus they can better afford the increase.

...Defense officials want annual enrollment fees for TRICARE Prime, the military’s managed care plan, to triple by October 2008 for working-age retired officers, from $230/$460 a year (individual/family coverage) up to $750/$1500, and to double, to $450/$900, for under-65 enlisted retirees.

Retirees who use TRICARE Standard, the military’s traditional fee-for-service health insurance, would see their annual deductible raised too. They also would pay for the first time an annual enrollment fee. Beyond 2008, all TRICARE fees and co-payments would be indexed to medical inflation.

TRICARE retail pharmacy co-payments also would be raised, which would be the only change to impact Medicare-eligible retirees too. The goal would be to discourage purchase of maintenance medicines through the more expensive retail network, by increasing the $3 co-payment for generic drugs to $5 while offering free generic drugs by mail. The current $9 co-pay for brand drugs would jump to $15 retail and $10 by mail order. Officials assume a 14 percent shift of TRICARE retail users to base pharmacies or into the mail order program

Many retirees are already blaming the military and/or Congress for not funding retiree healthcare adequately.  Most see it as a broken promise--a benefit that's eroding.  But, few folks are immune from sharing some of the burden of rising healthcare costs.  At least there hasn't been a TRICARE fee increase since 1995.  The low fees have motivated a growing number of new retirees to not take advantage of the health insurance offered by their new employers.

If the military is going to achieve a 14 percent shift to base pharmacies and the mail order program, most of it's going to have to come through mail order.  Many retirees have run into the situation where the overcrowded local base pharmacy (if there's one anywhere nearby--certainly an issue here in Oregon) doesn't always carry the medication they need.  And, military hospitals sometimes try to protect their local budgets by restricting access to some of the more expensive medications.      

One officer described a likely scenario, early in 2006, of the nation’s top military leaders sitting shoulder to shoulder before the armed services committees to testify that medical costs are now a critical readiness issue.

Higher TRICARE fees for younger retirees also will be endorsed in the Quadrennial Defense Review report which the service chiefs are completing to propose a realignment of military programs to meet future needs. The QDR recommendations are expected to be unveiled in early February when the Bush administration also sends its 2007 defense budget request to Congress.

The “24-star” endorsement, a reference to the six four-star officers who comprise the Joint Chiefs – the chairman, vice chairman, and top officer of the Army, Navy, Air Force and Marine Corps – is seen as necessary to persuade Congress to accept the first TRICARE fee increases in a decade and then to help insulate supportive lawmakers from the wrath of angry retirees.

In both older unions and the military, the goals of the workers and the retirees sometimes conflict.  In for instance the autoworkers, the retirees have more voting power than do the workers, which gives them the upper hand when it comes to maintaining their benefits, even when those costs financially endanger the corporation and thus the workers' jobs. 

Meanwhile with the military, the Congress controls the pursestrings, using multiple strategies to achieve its financial goals.  It can specifically legislate changes, and/or it can appropriate less money than necessary to satisfy a range of requirements, thus leaving it up to the military to make the hard choices.  When stuck choosing between supporting the current mission and the retirees, the top military leadership often works against the people they will join in retirement in the near future.   

TRICARE officials estimate that the higher fees and a decline in users will dampen projected health care costs by $12 billion within five years and $32 billion through fiscal 2015. But the numbers are viewed as optimistic, even by senior analysts, one source explained. They assume that 600,000 current beneficiaries, facing higher fees, will shift to employer-provided health insurance by 2011. 

The “flaw” behind that figure, the official explained, is it’s based on civilian HMO surveys of disenrollments when their fees are raised. Most HMO users, however, seek lower-cost alternatives. For TRICARE Prime users, even if the $460 enrollment fee for families is bumped to $1500 a year, as proposed for under-65 retired officers, TRICARE still will be a better deal.

If so, most of the projected cost savings will flow from the higher fees, which it might be argued is just a budget move to have younger military retirees and their families cover some of the cost of TRICARE for Life and senior pharmacy benefits for older retirees, their spouses and survivors.

...

Other than the cost of war and contingency operations, CBO says, the greatest budget risk facing the military is health care costs. The CBO report encourages an increase in fees, but suggests that a “transformational” set of higher fees and co-payments would boost out-of-pocket user costs to the level of civilian HMOs, and hit not only younger retirees and their families but Medicare-eligible beneficiaries and active duty family members too.

CBO is the Congressional Budget Office. 

Evidently, a lot of the leadership in DC figures that reducing military healthcare benefits won't have much of an impact on recruiting...and they might be right.  Folks generally don't think a lot about their future healthcare needs when they're young and healthy.  But, it may be more important when it comes to retention.  The retirees have to hope that Congress doesn't finally decide to show a bit of fiscal conservatism--at their expense. 

One thing we know for sure...military members won't strike to fight for this benefit. 

Legal Ecstasy (Updated Below)

Color me hopeful, but suspicious.

American soldiers traumatized by fighting in Iraq and Afghanistan are to be offered the drug ecstasy to help free them of flashbacks and recurring nightmares.

The US food and drug administration has given the go-ahead for the soldiers to be included in an experiment to see if MDMA, the active ingredient in ecstasy, can treat post-traumatic stress disorder.

Scientists behind the trial in South Carolina think the feelings of emotional closeness reported by those taking the drug could help the soldiers talk about their experiences to therapists. Several victims of rape and sexual abuse with post-traumatic stress disorder, for whom existing treatments are ineffective, have been given MDMA since the research began last year.

Michael Mithoefer, the psychiatrist leading the trial, said: "It's looking very promising. It's too early to draw any conclusions but in these treatment-resistant people so far the results are encouraging.

"People are able to connect more deeply on an emotional level with the fact they are safe now."

He is about to advertise for war veterans who fought in the last five years to join the study.

Most military members are suspicious of mental healthcare, as information gained can be used against the members in a career-threatening way.  For instance, we don't want somebody who's unstable to be working with a nuclear missile.  But if you're a missileer or maintainer who's having marital difficulties and would like to talk with somebody about them, a psychologist in a military hospital doesn't provide a safe environment for such discussion. 

Chaplains can keep much more information privileged, so they are usually the preferred option, whether the member is religious or not.  In other words, most military members only go to see a hospital psychologist when forced to.  Giving members a drug whose use would ordinarily cost them not just their security clearance but their career is sure to make them more suspicious. 

But if you've already been diagnosed with PTSD, that changes the equation a bit, especially if you're close to getting out or retiring.  I can't imagine too many troops hoping to continue their careers would like to have experimental ecstasy testing in their medical records,  And how is the VA going to address such usage when it comes to potential disability...besides slowly?

According to the US national centre for post-traumatic stress disorder, up to 30% of combat veterans suffer from the condition at some point in their lives.

Known as shell shock during the first world war and combat fatigue in the second, the condition is characterized by intrusive memories, panic attacks and the avoidance of situations which might force sufferers to relive their wartime experiences.

Dr Mithoefer said the MDMA helped people discuss traumatic situations without triggering anxiety.

"It appears to act as a catalyst to help people move through whatever's been blocking their success in therapy."

Let's hope so, and let's hope that the usage doesn't have lasting side-effects that adversely impact the patients.  The military doesn't have a brilliant track record when it comes to medical experimentation with troops.  It's probably good that it's a small test (20 total, 12 who get the drug), and that it's being conducted by the Medical University of South Carolina.

The FDA approved clinical ecstasy testing in 2001, and the state of South Carolina eventually followed suit.  However, it took until 2004 for the DEA to approve such testing, 20 years after doctors first started seeking permission.  Ecstasy was also approved for other types of testing, including on terminal cancer patients to see if it can "lessen their fears, quell thoughts of suicide and make it easier for them to deal with loved ones."  Gee, maybe one day evidence from this test will be used to overturn Oregon's assisted suicide law.  Let's hope not.

The existing drug-assisted therapy sessions last up to eight hours, during music is played. The patients swallow a capsule containing a placebo or 125mg of MDMA - about the same or a little more than a typical ecstasy tablet.

Psychologists assess the patients before and after the trial to judge whether the drug has helped.

The study has provoked controversy, because significant doubts remain about the long-term risks of ecstasy.

Animal studies suggest that it lowers levels of the brain chemical serotonin, and some politicians and anti-drug campaigners have argued that research into possible medical benefits of illegal drugs presents a falsely reassuring message.

The South Carolina study marks a resurgence of interest in the use of controlled psychedelic and hallucinogenic drugs. Several studies in the US are planned or are under way to investigate whether MDMA, LSD and psilocybin, the active ingredient in magic mushrooms, can treat conditions ranging from obsessive compulsive disorder to anxiety in terminal cancer patients.

Let's hope the ecstasy helps.  PTSD is miserable to endure.

Update:  Well, with the Supreme Court having agreed to hear the Assisted Suicide Law challenge Tuesday, the ecstasy testing won't be done in time to affect the decision, at least this time.