December 30, 2008

The Newest Deal - bigger government

Larry Summers outlines his ideas for righting some wrongs;
Investments in an array of areas -- including energy, education, infrastructure and health care -- offer the potential of extraordinarily high social returns while allowing our country to address some long-standing national challenges and put our economy on a solid footing for years to come.
Its all about semantics;
The Obama plan represents not new public works but, rather, investments that will work for the American public.
Looks like a bailout, sounds like a bailout...
..his economic team is crafting a broad proposal, the American Recovery and Reinvestment Plan, to support the jobs and incomes essential for recovery while also making a down payment on our nation's long-term financial health.
You can forget about allowing the taxpayer to spend his own money;
Some argue that instead of attempting to both create jobs and invest in our long-run growth, we should focus exclusively on short-term policies that generate consumer spending. But that approach led to some of the challenges we face today -- and it is that approach that we must reject if we are going to strengthen our middle class and our economy over the long run.


Larry Summers served as Treasury secretary in the Clinton administration and will head the White House National Economic Council in the Obama administration.

Quantiferon in prisons

Following an outbreak of MDR-TB in a prison in Germany a contact investigation was conducted using both TST and QFT; the results were not so unusual
With the TST 29.5% of the inmates were tested positive, whereas with the IGRA the positive rate was 18.1%. For 7 inmates there was a positive IGRA despite a negative TST.
In a high risk environment false negative results are simply unacceptable

December 29, 2008

Quantiferon successful in aggressive zero tolerance TB program

From the latest issue of PMDA News, (Pennsylvania’s Association for Long-Term Care Medicine) comes this gem; Conestoga View Nursing & Rehabilitation started using QFT and were then faced with the following dilemma -
• An individual with a history of residence in a country of high prevalence of TB
• Positive PPD
• Positive chest x-ray
• Negative CT scan of the chest

Conestoga View went the extra mile for a definitive answer. Requiring further evaluation ended in a success story for the employee and employer. The results—a negative QFT-G and happy ending (or perhaps happy beginning) for everyone.

The QFT-G proved advantageous in expediting the employee’s ability to work.

Conclusion
Conestoga View’s commitment to infection control involves zero tolerance of TB bacteria. CV supports ongoing research to support and implement comprehensive practices to achieve this end.

Short term gain for long term pain?

Economist Tyler Cowen reviews the bailout of hedge fund Long Term Capital in 1998 and sees a pattern;
At the time, it may have seemed that regulators did the right thing. The bailout did not require upfront money from the government, and the world avoided an even bigger financial crisis. Today, however, that ad hoc intervention by the government no longer looks so wise. With the Long-Term Capital bailout as a precedent, creditors came to believe that their loans to unsound financial institutions would be made good by the Fed — as long as the collapse of those institutions would threaten the global credit system. Bolstered by this sense of security, bad loans mushroomed.

December 28, 2008

Biotech bailout blues

Forbes cover the downturn in the biotech sector
Big drug companies are benefiting from small-company woes, as early-stage products suddenly go on sale. “It is an opportunity,” says GlaxoSmithkline Senior Vice President Adrian Rawcliffe. In October his company agreed to buy Genelabs Technologies, which is working on hepatitis drugs, for $57 million, or $1.30 per share.

In November Roche inked a deal to buy Memory Pharmaceuticals, which invented two Alzheimer’s drugs Roche is testing, for $50 million, a mere 61 cents a share. That’s a nice gain over the 15-cent quote on the shares the day before but quite a comedown from the $7 new-issue price in 2004. Biotech companies’ fundraising woes means “we will see more biotech companies looking for an acquisition,” says Daniel L. Zabrowski, Roche’s global head of drug deals.

How India Avoided A Crisis

is the title of this piece in the NYT. Joe Nocera takes a look at India's world of finance
… two years ago, the Indian real estate market — commercial and residential alike — was every bit as frothy as the American market. High-rises were being slapped up on spec. Housing developments were sprouting up everywhere. And there was plenty of money flowing into India, mainly from private equity and hedge funds, to fuel the commercial real estate bubble in particular. Goldman Sachs, Carlyle, Blackstone, Citibank — they were all here, throwing money at developers.

So why did the Indian banks stay on the sidelines and avoid most of the pain that has been suffered by the big American banks?
Rana Kapoor from Yes Bank
“What has taken a number of us by surprise is the lack of adequate supervision and regulation,
..“This was despite the fact that Enron had happened and you passed Sarbanes-Oxley. We don’t understand it. Maybe it’s because we sit in a more controlled economy but ...
and Deepak Parekh, the chief executive of HDFC
We don’t do interest-only or subprime loans. When the bubble was going on, we did not change any of our policies. We did not change any of our systems. We did not change our thought process. We never gave more money to a borrower because the value of the house had gone up. Citibank has a few home equity loans, but most banks in India don’t make those kinds of loans. Our nonperforming loans are less than 1 percent.”
Of course it is easy to say that any comparison between India and the US is trite; India has a well earned reputation as a land of starving millions.
The Global Hunger Index reported last week that more than 200 million Indians live in hunger and that 47 per cent of Indian children are malnourished. Conditions in parts of Madhya Pradesh, the report said, are as bad as Ethiopia and Chad and our infant mortality rate is worse than war-ravaged Eritrea. Despite our economy growing at 8 per cent annually since 2002, three-quarters of our population lives on Rs 25 a day.
India has a centrally controlled economy that is slowly relaxing its grip, a recent survey by the Heritage Foundation found that India's economy is 54% free
India could improve in several areas, including business freedom, trade freedom, financial freedom, investment freedom, and freedom from corruption. The average tariff rate is high, and the government imposes severe non-tariff barriers. Foreign investment is overly regulated, and the judicial system is erratic and clogged by a significant backlog of cases. Though the country has a large financial sector, the government interferes extensively with foreign capital.

India still has some way to go before they are in a position to lead by example.



December 27, 2008

CDC promotes 2nd IGRA conference

Published on their National Prevention Information Network here; note that Dr Lee Reichmann is to handle the abstracts and travel awards

The Economic News Isn't All Bleak

WSJ gives reason as to why things may not be as bad as they say;
The last months of 2008 will go down as one of the most severe economic reversals to date, and on a global scale. But it is foolish to assume that this period provides a viable guide to what lies ahead.

The rush to declare the future bleak has obscured the fact that no one knows the outcome of an unprecedented event. No one. The worst course in the face of uncertainty is blind faith in conventional wisdom and past patterns. The best is to stay humble in the face of the unknown, creative and unideological about solutions, and open to the possibility that as quickly as things turned sour they can reverse.

Unions reneg on deal

You can file this under "so what's new?", the UAW are saying that they will fight any concessions on wages and benefits;
“This (deal) is putting an undue tax on the workers themselves,” Gettelfinger said in an interview with FOX Business.

This comes after the UAW said Friday it was against the terms set by the White House for the $17.4 billion in loans for General Motors (GM: 3.63, 0.41, 12.73%) and Chrysler. The UAW said it would work to renegotiate better terms once President-elect Barack Obama is inaugurated in January
Adding to the UAWs ambit claim is Dem Rep. Barney Frank who said
it is unreasonable to require workers' wages to come into line with the wages of the workers at the U.S. plants of foreign automakers.
What isnt fair is the added burden placed on the taxpayer, the Big 3 are bleeding $6B a month and their business is unsustainable.

Over to you Obama.

December 23, 2008

Why markets are down.

WSJ say that its because generally, investors are pulling out of stocks;
Since 2006, investors have been pulling money out of US stock funds at a rate of about $40 billion a year

When you look at monthly withdrawals things look grim
Citing data from the Investment Company Institute, a mutual fund trade group, the Wall Street Journal report stated that investors pulled out a record $72 billion from stock funds in October alone.

Barrons conducted a survey amongst analysts and found
a little good news: Wall Street's top strategists believe -- or hope -- that the U.S. stock market has already absorbed the worst of the selling pressure this year, and will start to recover in 2009.

The not-so-great news: Any progress might be limited
OK, but guess what they all agreed on
No surprise: health care is the new year's most crowded trade, with the sector beloved by 10 of 12 strategists.
2008 - hasta la vista

December 22, 2008

Spending bogged down in red tape

Greg Mankiiw gets a letter from a government stimulus skeptic;
I work for the DoD and when the Department of Homeland Security was established,we helped them with many things, not the least of which was contracting. To make a long story short, you cannot juice up a government agency's budget by tens of billions (or in the case of the stimulus package, hundreds of billions) and expect them to be able to process the paperwork to contract it out, much less oversee the projects or even choose them with any kind of hope for success. It's like trying to feed a Pomeranian a 25 lb turkey. It's madness.

..Stop looking at models and equations and theoretical constructs for a while and look at the practical considerations of the stimulus package. I've been doing this sort of thing for quite a while and I'm convinced it's doomed from the start. If they feel the need to blast a trillion dollars into confetti, then tax cuts would make the most sense. Even if the public used the money to pay down debt, that would be a good thing as it would transfer the debt burden from the consumer to the government making the consumer feel a little bit like spending again.

John Taylor, undersecretary of Treasury for international affairs 2001-2005, senior fellow at the Hoover Institution and a Professor of economics at Stanford University proves that short-term fiscal policies fail to promote long-term growth
After years of study and debate, theories based on the permanent-income model led many economists to conclude that discretionary fiscal policy actions, such as temporary rebates, are not a good policy tool. Rather, fiscal policy should focus on the "automatic stabilizers" (the tendency for tax revenues to decline in a recession and transfer payments such as unemployment compensation to increase in a recession), which are built into the tax-and-transfer system, and on more permanent fiscal changes that will positively affect the long-term growth of the economy.

..The theory that a short-run government spending stimulus will jump-start the economy is based on old-fashioned, largely static Keynesian theories. These approaches do not adequately account for the complex dynamics of a modern international economy, or for expectations of the future that are now built into decisions in virtually every market.




Tax cuts unfairly blamed

The NYT claims that a change to capital gains tax may have helped the housing bubble;

“Tonight, I propose a new tax cut for homeownership that says to every middle-income working family in this country, if you sell your home, you will not have to pay a capital gains tax on it ever — not ever.”

— President Bill Clinton, at the 1996 Democratic National Convention

many economists say that the law had a noticeable impact, allowing home sales to become tax-free windfalls. A recent study of the provision by an economist at the Federal Reserve suggests that the number of homes sold was almost 17 percent higher over the last decade than it would have been without the law.

Vernon L. Smith, a Nobel laureate and economics professor at George Mason University, has said the tax law change was responsible for “fueling the mother of all housing bubbles.

To support their case the NYT use the Shiller graph (from Robert Shiller of Yale University who, in 2005, warned of the impending collapse in house prices)






Their case, that Event B caused Trend A, falls down on logic



Census data also indicates more "irrational exuberance" by Keynesian tax eaters;

"Excessive exuberance" - maybe

Alan Greenspan argues that for banks to function properly capital must be restored and
the most credible source is a partial restoration of the $30 trillion of global stockmarket value wiped out this year, which would enable banks to raise the needed equity. Markets are being suppressed by a degree of fear not experienced since the early 20th century (1907 and 1932 come to mind). Human nature being what it is, we can count on a market reversal, hopefully, within six months to a year.
Alan Greenspan has been severely criticised for his actions in what is now known as the Global Financial Crisis (GFC) however in his defence he points out that his function was constrained by the obligations of office;
the overall view that I take, of regulation, is that I took a pledge when -- I took an oath of office when I became Federal Reserve Chairman. And I recognized that you do with that -- what I did is I said that I'm here to uphold the laws of the land, passed by the Congress, not my own predilections.
To be fair, it was the Government that created the Federal Reserve System to which Alan Greenspan was obligated to
The Federal Reserve System is considered to be an independent central bank because its decisions do not have to be ratified by the President or anyone else in the executive branch of government. The System is, however, subject to oversight by the U.S. Congress. The Federal Reserve System must work within the framework of the overall objectives of economic and financial policy established by the government; therefore, the description of the System as “independent within the government” is more accurate.
The scope and range of activities of the Federal Reserve Bank is directed by Congress via the Federal Reserve Act and is subject to the decisions of the Federal Open Market Committee so it is unreasonable to blame just one man for the collective actions of many.

In testimony to the House Oversight and Government Reform Committee Alan Greenpan stated that he had found a
flaw in the model that I perceived as the critical functioning structure that defines how the world works, so to speak
..that's precisely the reason I was shocked, because I had been going for 40 years or more with very considerable evidence that it was working exceptionally well
In another house testimony Alan Greenspan advises that as a result of the failure to properly price risky assets
I see no choice but to require that all securitizers retain a meaningful part of the securities they issue. This will offset in part market deficiencies stemming from the failures of counterparty surveillance.

...The financial landscape that will greet the end of the crisis will be far different from the one that entered it little more than a year ago. Investors, chastened, will be exceptionally cautious.

...This crisis will pass, and America will reemerge with a far sounder financial system.

December 20, 2008

Documented failure of TST guides Government policy

From Spain is this study regarding the prevention of TB in patients being treated with TNF inhibitors; Slovakia has already stopped the use of TST referencing this study as evidence;
Following March 2002, a total of 5,198 patients treated with a TNF antagonist were registered in BIOBADASER. Fifteen ATB cases were noted (rate 172 per 100,000 patient-years, 95% CI 103-285). Recommendations were fully followed in 2,655 treatments. The probability of developing ATB was 7 times higher when recommendations were not followed (incidence rate ratio 7.09, 95% CI 1.60-64.69). Two-step tuberculosis skin test for LTBI was the major failure in complying with recommendations.

Quantiferon and anti-TNF therapy, a success story

Since July 1st 2006, all patients indicated for the anti TNF therapy underwent the Quantiferon TB Gold Test.

..Our results demonstrate a low incidence of tuberculosis activation during anti-TNF treatment in patients with inflammatory rheumatic diseases in the Slovak Republic and confirm the high effectiveness ours specified complex screening measures

Source

The Effectiveness for Prevention of Tuberculosis in Patients with Inflammatory Rheumatic Diseases Treated with TNF Inhibitors.


BACKGROUND: New biologic therapies blocking TNF undoubtly constitute a considerable advancement in the management mentioned diseases, but are also associated with higher risk of activation of tuberculosis.

METHODS: An assessment of tuberculosis activation rate in the group of patients with rheumatoid arthritis, juvenile idiopatic arthritis, ankylosing spondylitis and psoriatic arthritis threated by anti-TNF inhibitors since January 1st 2001 to June 30th 2007 in Slovakia and went in for special anti-tuberculosis screening before start of therapy.

RESULTS: A total 537 rheumatic patients received the anti-TNF therapy. There were 346 rheumatoid arthritis patients, 68 juvenile idiopatic arthritis patients, 71 patients suffered from ankylosing spondylitis and 52 from psoriatic arthritis. Duration of anti-TNF therapy was 843 of patient-years. Infliximab took 203 patients with duration of therapy 348 patient-years, etanercept 201 patients with duration of therapy 331 patient-years and adalimumab 133 patients with duration of therapy 164 patient-years. The activation of tuberculosis reached the incidence 0.37% (2 cases for 537 patients) representing 0.237 cases for 100 patient-years. Both patients had extrapulmonary forms of tuberculosis which was in one patient disseminated, but they fully recovered after the anti-TNF drugs were stopped and chemotherapy was completed.

CONCLUSION: Our results demonstrate a low incidence of tuberculosis activation during anti-TNF treatment in patients with inflammatory rheumatic diseases in the Slovak Republic and confirm the high effectiveness ours specified complex screening measures

December 19, 2008

Shipping News - update

Whilst November saw reports of merchant shipping running aground December sees an improvement, albeit ftom a very low base.

According to Bloomberg, customs data showed that China, the biggest steelmaker, imported 32.5 million tonnes of iron ore last month, up from 30.6 million tonnes in October.

The news agency also stated that the markets were moving now on the iron-ore front, quoting Philippe van den Abeele, London-based managing director of Castalia Fund Management (UK) Ltd.

“There’s demand beyond Christmas, and requirements for January are coming into the market so it seems more sustainable than the end of the year. It’s a good development but the jury is still out when it comes to longer-term prospects,” said van den Abeele.




News of the increase spread around the ports
a revival of the ailing capsize market drove the Baltic dry market ahead during the past week, with the Baltic Capsize Index moving at fast paces, quickly leaving the 1,000 points mark and closing the week at 1,331 points. The BCI managed to post a whopping 52% increase, translated at 460 points. This development brought the whole BDI up, by more than 100 points in a week or 15% with more than half of that increase coming at the end of the week.

Macquarie Research forecast that Prospects bright for Pacific Basin and CSD

..the Baltic dry index would average 1,200 in the first quarter next year. The investment house said: "In our view the keys to long-term profitability in dry bulk shipping will be a reacceleration in Chinese steel production and the failure of the order book to materialise as actual deliveries."

Turning to the general economic outlook, Macquarie analysts led by the firm’s Tim Rocks said: “Asia must save Asia” next year with governments embarking on aggressive fiscal stimulus measures to offset the collapse in external demand in the first half of next year.

Even so half of Asia, including Japan, Hong Kong, Singapore, South Korea and Taiwan, will either move into recession or the downturn will intensify. By comparison, China, India and Indonesia are expected to record the strongest expansion next year.
Overall, Macquarie analysts expected the “clouds to clear from the second quarter” next year as inventories are rebuilt and government spending programmes kick-in in earnest.

December 18, 2008

The macroeconomic implications of financial ‘deleveraging'

Treasury has released this paper, here is the abstract;

Financial ‘deleveraging’ is inimical to the health of the world economy. This article examines the theoretical and practical mechanics of deleveraging, surveys the historical record of prior deleveraging phases and describes the circumstances that distinguish the current episode. The macroeconomic implications of deleveraging are then considered.

The conclusion is that the first stage of the deleveraging process, which is driven by the decline in both asset values and lending to borrowers at the riskier end of the spectrum, is currently well advanced. The second phase, where the decline in credit availability begat by the initial phase hurts the value of more prosaic asset classes, and less marginal borrowers, is significantly less advanced. This dynamic will place significant stress on the world economy in 2009. For emerging markets the impact will differ depending upon a number of factors, with the single most important among them being pre-crisis external financing arrangements.

On an optimistic note, policy makers are well aware that the magnitude of the challenge presented demands a forthright global response from the public sphere. The multi-dimensional global policy response provides needed insurance against downside risks to growth next year, and lays the foundation for recovery in the period beyond.

DELHI JOURNAL OF MEDICINE

Notwithstanding a few spelling errors, Rajiv Singla is on the right track;
The IFN release and the T -cell-based assay may well supplant the TST in diagnosing LTBI in much of the world.
Source: Delhi Journal of Medicine


Current Prespectives in Diagnosis of Tuberculosis

December 17, 2008

Taking On Dr. Doom: Warren Buffett's 'Buy and Hold' Strategy Is Alive and Well

Source: CNBC Buffett watch

Posted By:Alex Crippen

Monday, 1 Dec 2008

Don't make travel plans just yet for the funeral of Warren Buffett-style 'buy and hold' stock strategy. One well-known value investor says it's more important right now than ever.

The combination in recent months of a steep decline for stock prices and a dramatic increase in volatility have prompted some early death notices for the strategy of buying a good stock at a good price and holding it for a long period of time.

This morning on CNBC's Asia television programming, the investor known as Dr. Doom was kicking the 'corpse.'

Marc Faber, editor and publisher of The Gloom, Boom & Doom Report, delivered this autopsy report:
"We've moved into an environment of very high volatility where you will have up and down moves of, like, 20 percent all the time and that is a traders' market... The Warren Buffett approach is dead and it's been dead for ten years and it's going to be dead for another ten years ... We can have huge rebounds and then huge downturns again and I think the best for the average investor is to play it relatively in small amounts and not gear up and take big risks."

Value investor Whitney Tilson has been doing a lot of Buffett-defending recently on CNBC's Fast Money and in the New York Times, so I emailed him for his response:
"It is, in fact, precisely during times of high volatility that the long-term-oriented approach of Warren Buffett, rooted in the ageless concepts of intrinsic value and margin of safety, work best. No-one can possibly predict the short-term moves of this crazy market, but it's actually fairly easy to find good companies with stocks that are deeply undervalued if one looks out a few years -- and has the courage and conviction to weather the near-term volatility."

Berkshire Hathaway is not only one of those stocks, says Tilson, it is his "favorite" right now and undervalued by at least 25 percent. "We believe the company is well positioned to weather -- and even take advantage of -- the storm."

Current Berkshire stock prices: $3321.01

AMA president confirms ignorance

As reported by Fairfax Australian Medical Association (AMA) SA president Peter Ford has defended the decision by an Adelaide Hospital to allow a doctor to continue to work after having tested positive for TB.

"This is a managed risk situation ... and it seems to me that everything that should have been done, was done."

"..I would argue that there would be people in that hospital and every hospital who would have a positive (skin) test, so you can't remove them from society or hospitals on the basis of an unreliable test."

Clearly Mr Ford is unaware of the risk of transmission in a neo natal ward and the consequences of transmission and is also unaware of the full range of options available to him.

On the first point, there have been recorded incidences of positive skin tests later infecting infants;
Evaluating young children recently exposed to airborne Mycobacterium tuberculosis is a public health priority. If infected, children aged <2>. .....Among those who were tested, four infants had positive tuberculin skin test (TST) results, likely attributable to recent transmission of M. tuberculosis. The findings emphasize the difficulty of conducting contact investigations in certain settings and the importance of effective LTBI testing and treatment programs for health-care workers (HCWs) to prevent TB disease and subsequent health-care associated transmission.

Yes Mr Ford, it is a public health priority.

On the second point, why continue to use an unreliable test when there is a more reliable one? In all countries, excepting Australia, Quantiferon is acknowledged as being more sensitive and specific that the skin test.

Overall, because of its high specificity and other potential advantages, IGRAs are likely to replace the TST in low-incidence, high income settings where crossreactivity due to BCG might adversely impact the interpretation and utility of the TST.
World Health Organisation and FIND


The issue now has moved on from public relations to ones of medical negligence and liability.

December 16, 2008

Dead parrot lives on

Some years ago researchers from Belgium thought that they were on a winner with this so called new TB antigen known as heparin-binding hemagglutinin (HBHA). HBHA is obtained by purifying Mycobacterium bovis BCG and was first indentified late last century.

Subsequent to the discovery a patent for methylated HBHA was applied for by Kevin Pethe, Franco Menozzi and Camille Locht from the Pasteur Institute and French Health Department.

In a later test conducted at a Brussels hospital they ran HBHA alongside QFT-GIT and were so pleased with the results that they happily announced;
The use of ESAT-6- and CFP-10-based IGRAs may underestimate the incidence of LTBI, whereas the use of HBHA may combine the operational advantages of IGRAs with high sensitivity and specificity for latent infections.

The researchers hypothesise that QFT-GIT can only diagnose recent infections and that QFT HBHA would be able to diagnose recent and past infections. They then set out to prove their hypothesis.

Unfortunately to prove their hypothesis they had to shift the goal posts;
  • Despite previously stating that there is no gold standard (1) they then used the TST as the gold standard (2)
  • They did not fully follow the procedure (3) for QFT as specified by Cellestis
  • They used separated blood for the HBHA (4)
  • They used a version of HBHA that is not commercially available (5)
  • By extending incubation periods they would have picked up memory T cells (6)
  • Selection criteria for LTBI was of IFNy negative by TST (7)
  • Selection criteria excluded those with possible immune supprresion (8)
  • HBHA was cultured for 4 days in white cells (9)

In short, they have used a complex, labour intensive and no doubt costly procedure using a generally unprocurable antigen to (falsely) diagnose an infection in a select group in which infection may have already been eradicated.


References:

(1) in the absence of a gold standard, the most widely used diagnostic test for LTBI remains the tuberculin skin test

(2) LTBI subjects were defined by documented TST conversion (increase in induration size of≥10 mm compared to the previous year) at the Occupational Medicine Department (n = 31) or by a diameter of induration of the TST≥10 mm for household contacts of active TB case patients (n = 21) or by the clinical data and/or TST result at the time of employment as a health care worker, as assessed by the Occupational Medicine Department (n = 13).

(3) we have chosen to incubate the PBMC for 96 h, rather than for 24 h, as recommended for the commercial QFT-IT

(4) the QFT-G In-Tube (QFT-IT) assay was performed on whole blood, in contrast to the in-house IGRAs

(5) HBHA is a methylated antigen, and that the methylation is important for the HBHA-specific T-cell responses [21]. When recombinant, non-methylated HBHA is used instead of native, methylated HBHA, the sensitivity of the IGRA for the detection of LTBI decreases to 69.44% with a 88.46% specificity (data not shown). HBHA is thus not yet commercially available

(6) prolonged incubation with antigen has recently been shown to increase the sensitivity of T cell tests for the detection of LTBI [23], probably because short in vitro incubation times in the presence of antigen preferentially result in the detection of effector T cells, whereas longer incubation times favor the detection of both effector and memory T cells

(7) LTBI subjects were defined by documented TST conversion

(8) All participants were sero-negative for HIV, and none had neoplasia, malign hemopathies or had undergone immunosuppressive treatment or solid organ transplantation, nor were any of the women pregnant during the study period.

(9) The IFN-γ concentrations were measured in 4-day cell culture supernatants by ELISA as previously described

Drug-resistant tuberculosis rife in China

I wonder if the AMA know about this?

--------------------------

Public release date: 10-Dec-2008

Levels of drug-resistant tuberculosis (TB) in China are nearly twice the global average. Nationwide research published in the open access journal BMC Infectious Diseases has shown that almost 10% of Chinese TB cases are resistant to the most effective first-line drugs.

Susan van den Hof, from the KNCV Tuberculosis Foundation in The Netherlands is one of the authors on a Chinese study into the prevalence of multi-drug resistant tuberculosis (MDR-TB). She said, "In order to obtain insight into the prevalence and distribution of resistance, China has joined the global project on anti-tuberculosis drug resistance surveillance, and investigated drug resistance in ten provinces between 1996 and 2004."

China has the second largest number of TB cases in the world, and is one of the countries with high levels of drug-resistant TB. According to the authors, "The prevalence of drug resistance varied greatly between the provinces, but on average was worryingly high, with a weighted mean for MDR-TB of 9.3% among all cases; 5.4% among new cases and 25.6% among previously treated cases. The global MDR-TB estimates are 4.8% for all cases, 3.1% for new cases and 19.3% for previously treated cases."

Treatment of MDR-TB requires use of costly, toxic and less effective second-line drugs and infected patients are less likely to survive treatment. In a well-functioning TB control program with low levels of defaulting from treatment, high resistance levels are expected among previously treated cases. This is consistent with the authors' observations in China. If a good TB control program is in place, the proportion of previously treated patients among all TB patients should also be low. In China the proportion of previously treated patients varied between the provinces but on average was about 20%, compared to a global average of 11%.

The authors said, "Many possible explanations for the development of drug resistance in China exist, and different explanations may prevail in different areas of this vast country. These include the inadequate use of anti-TB drugs in public hospitals, lack of supervision of treatment, poor drug-management and absence of infection control measures in hospitals. Also, availability of anti-TB drugs without a prescription in some areas of China in the past may have contributed to the development of drug resistance."

At this moment, programmatic treatment of MDR-TB cases with second-line drugs is being piloted in some areas of China. MDR-TB treatment will then be expanded within China to prevent further spread of MDR-TB and help to bring MDR-TB rates down.

###
Notes to Editors

1. Prevalence of tuberculosis drug resistance in 10 provinces of China Guang Xue He, Yan Lin Zhao, Guang Lu Jiang, Yu Hong Liu, Hui Xia, Sheng Fen Wang, Li Xia Wang, Martien W Borgdorff, Marieke J van der Werf and Susan van den Hof BMC Infectious Diseases (in press)

During embargo, article available here. After the embargo, article available at the journal website.

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

Article citation and URL available on request at press@biomedcentral.com on the day of publication.

2. BMC Infectious Diseases is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of infectious and sexually transmitted diseases in humans, as well as related molecular genetics, pathophysiology, and epidemiology. BMC Infectious Diseases (ISSN 1471-2334) is indexed/tracked/covered by PubMed, MEDLINE, CAS, Scopus, EMBASE, Thomson Scientific (ISI) and Google Scholar.

3. BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Science+Business Media, a leading global publisher in the STM sector.

Medical journals haunted by ghost writers

Wyeth’s Use of Medical Ghostwriters Questioned

Source:NYT

LinkBy DUFF WILSON

Wyeth, the pharmaceutical company, paid ghostwriters to produce medical journal articles favorable to its hormone replacement therapy Prempro, according to Congressional letters seeking more information about the company’s involvement in medical ghostwriting. At least one article was published even after a federal study found the drug raised the risk of breast cancer.

The letters, sent electronically Friday by Senator Charles E. Grassley, ask Wyeth and DesignWrite, a medical writing company, to disclose payments related to the preparation of journal articles and the activities of doctors who were recruited to put their names on them for publication.

The letters are part of a continuing investigation by Mr. Grassley, a member of the Senate Finance Committee, into drug industry influence on doctors.

“Any attempt to manipulate the scientific literature, that can in turn mislead doctors to prescribe drugs that may not work and/or cause harm to their patients, is very troubling,” Mr. Grassley, an Iowa Republican, wrote Friday to Wyeth’s chairman and chief executive, Bernard J. Poussot.

Doug Petkus, a Wyeth spokesman, said Friday that Mr. Grassley was recycling old arguments.

“The authors of the articles in question, none of whom were paid, exercised substantive editorial control over the content of the articles and had the final say, in all respects, over the content,” Mr. Petkus said.

Officials for DesignWrite, a Princeton, N.J., firm, and its parent company, JMI, a medical information company in New York, did not return multiple phone calls and e-mail messages requesting comment.

Mr. Grassley’s staff on the Senate Finance Committee released dozens of pages of internal corporate documents gathered from lawsuits showing the central, previously undisclosed role of Wyeth and DesignWrite in creating articles promoting hormone therapy for menopausal women as far back as 1997.

One article was published as an “Editors’ Choice” feature in May 2003 in The American Journal of Obstetrics and Gynecology, more than a year after a big federal study called the Women’s Health Initiative linked Wyeth’s Prempro, a combination of estrogen and progestin, to breast cancer. The May 2003 article said there was “no definitive evidence” that progestin caused breast cancer and added that hormone users had a better chance of surviving cancer.

At the peak of hormone therapy, in 2001, more than 126 million prescriptions for such drugs were written for women in the United States. Sales that year, primarily by Wyeth, were $3 billion. But after the federal finding, sales of the hormone drugs plummeted.

The drugs, which contain cancer warnings on the label, are still approved to treat severe symptoms of menopause, but their use is advised at only the lowest possible doses.

The documents show company executives came up with ideas for medical journal articles, titled them, drafted outlines, paid writers to draft the manuscripts, recruited academic authors and identified publications to run the articles — all without disclosing the companies’ roles to journal editors or readers.

The issue of ghostwriting for medical journals has been raised in the past, involving various companies and drugs, including the Merck painkiller Vioxx, which was withdrawn in 2004 after it was linked to heart problems, and Wyeth’s diet pills, Redux and Pondimin, withdrawn in 1997 after being linked to heart and lung problems.

But the documents Mr. Grassley released Friday provide a detailed look at the practice — from the conception of ideas for journal articles through the distribution of reprints.

The documents released Friday include a “publication plan tracking report” by Wyeth showing 10 articles in which manuscripts were completed by the company before they were sent to the putative author for review. Any revisions were subject to final approval from the company, according to the tracking report.

Such activities would seem to run afoul of medical journal guidelines. The World Association of Medical Editors, for example, says ghost authorship — which it defines as a substantial contribution not mentioned in the manuscript — is “dishonest and unacceptable.”

Congressional investigators were given the documents about a month ago by James F. Szaller, a personal injury lawyer in Cleveland who has sued drug makers. Mr. Szaller collected the documents from court filings and made reference to some in an article he wrote last year for a law magazine, Trial.

“For the last three years, I’ve looked at ghostwriting at Wyeth,” Mr. Szaller said in a telephone interview. “There is a mammoth amount of material. The problem is that almost all of it is still under seal.”

In Friday’s letter, Mr. Grassley asked Wyeth to list all scientific reports prepared for the company by DesignWrite since Jan. 1, 1995, to describe the named authors’ “extent of involvement” and to disclose fees paid to DesignWrite, authors and others.

The May 2003 article supporting Prempro was signed by Dr. John Eden, an associate professor at the University of New South Wales and director of the Sydney Menopause Center in Australia. Wyeth executives suggested that Dr. Eden write such a paper in 2000, according to the documents, and had the outline and draft manuscript written for him. It was published in The American Journal of Obstetrics and Gynecology — with no mention of Wyeth or DesignWrite connections.

Thomas Reller, the director of corporate relations for Elsevier, which owns the obstetrics journal, said he had not had time yet to review the specific article cited by Mr. Grassley, but Elsevier follows strict industry standards. Dr. Eden did not return e-mail messages or calls to his listed telephone number in Sydney.

In another case, documents show, Dr. Lila E. Nachtigall, a New York University professor and director of its Women’s Wellness Center, was recruited by Wyeth as author of a 1999 journal article extolling hormone treatment after the manuscript had already been drafted.

Dr. Nachtigall, reached by telephone Friday afternoon, said she had written all of the approximately 1,000 articles and three books she has had published. Asked about the Wyeth documents, she said, “If they came up with the idea or gave me an outline or something, I don’t remember that at all.” Dr. Nachtigall added: “It kind of makes me laugh that with what goes on in the Senate, the senator’s worried that something’s ghostwritten. I mean, give me a break.”

December 14, 2008

St Loius Fed President Jim Bullard: Severe Recession Is Unlikely

Dec. 4 — In an interview with Bloomberg News this week, St. Louis Fed President Jim Bullard discussed a wide range of economic topics, from the current recession to the nuances of quantitative easing and additional Fed tools to fix the economy. Asked whether he stood by an earlier prediction that the U.S. economy might get by with a less severe 1990-91 style recession rather than a 1981-82 style recession, Bullard said he thought this outlook was still sound, even in light of recent economic data. “Right now, we’re looking for a pretty sharp decline in the fourth quarter, little less sharp in the first quarter, and then, hopefully, things will improve after that,” he said, adding that this scenario would be similar to 1990-91. “I don’t see a prolonged outcome materializing." (Watch the video on Bloomberg's YouTube channel.)

Source

December 13, 2008

Mr Magoo, you've done it again


At the American College of Rheumatology (ACR) 2008 Annual Scientific Meeting the presentation titled Risks and Adverse Events Associated With Biologic Agents for Rheumatoid Arthritis was made by Dr Marc Levesque. This presentation covered the risk of TB in RA patients and QFT's role in diagnosing latent TB.

There were a total of 5 presentations dealing with Quantiferon made at the conference, they being from Israel, Ireland, Italy, Romania and India.

Dr Levesque makes note of several of the abstracts presented at the meeting and acknowledges that, on the evidence provided, QFT-G may be more sensitive and specific for LTBI than TST in patients with RA. However he concludes that due to the lack of a gold standard
larger, similar studies will need to be done to confirm and expand these findings...the best approach to diagnosing LTBI in patients with RA remains unclear"
This muddled thinking must be unhelpful for those having to deal with immune suppression - by confining himself only to the studies presented Dr Levesque is in no position to give an informed opinion.

A quick search on Google scholar reveals 357 studies on quantiferon and arthritis, including the large study undertaken in the UK, the Newcastle (UK) experience
The QTG test has been employed by the Rheumatology department at The Freeman Hospital, Newcastle-upon-Tyne, UK, since March 2004 as part of the TB screening programme for just such a patient group. We have audited its use amongst 101 consecutive RA patients, recruited over a 2 year period, who fulfilled published criteria permitting use of a biologic drug
They were not so easily put off by any lack of gold standard
...the absence of any cases of MTB, whether reactivation or de novo, over a relatively long period of follow-up, points to a favourable, albeit unquantifiable, test sensitivity.

We conclude that use of the QTG test as a screening tool amongst RA patients due to start anti-TNF- treatment is feasible, that its informativeness appears unaffected by any impaired immunocompetence of our patient group, and that it is a useful and potentially cost-effective adjunct to existing protocols.
Dr Levesque could have just as easily referred to the Cellestis site where some 37 studies specifically dealing with immune suppression are listed. The Jordan study presented at the conference was of 63 patients over 2 years, studies on the Cellestis site include one from Peru where 101 RA patients and 93 controls were assessed with a finding that
In a TB-endemic population, the QuantiFERON®-TB Gold In-Tube assay seemed to be a more accurate test for detection of LTBI in RA patients compared with the TST
Had Dr Levesque followed the procedure adopted by the Swiss medical community his vision may have further improved;
A group of experts in rheumatology, gastroenterology and pneumology met in Berne on 19 September 2006 to evaluate the current arguments in favour of IGRA and their incorporation into recommendations for tuberculosis screening before prescription of anti- TNF-a therapy, and decided to issue Swiss recommendations based on current knowledge and literature and their own experience of using IGRA tests in this setting.

Screening for latent tuberculosis infection is indicated prior to the administration of anti- TNF-y therapy. Due to the better sensitivity and specificity of IGRA tests, their incorporation into current recommendations should serve to detect more cases at risk for reactivation of latent tuberculosis infection and to prevent unnecessary prophylaxis with its potentially adverse effects in patients with false-positive TTS.

December 12, 2008

Tax cuts -vs- Government spending

Greg Mankiw considers the evidence that Government spending of $1 lifts GDP by $1 whereas a tax cut of $1 lifts GDP by $3 and concludes;
My advice to Team Obama: Do not be intellectually bound by the textbook Keynesian model. Be prepared to recognize that the world is vastly more complicated than the one we describe in ec 10. In particular, empirical studies that do not impose the restrictions of Keynesian theory suggest that you might get more bang for the buck with tax cuts than spending hikes.

Whether Obama can convince his supporters to forgo a bailout is another matter, he owes some of his success to union support.

LANSING, Mich. - The United Auto Workers international executive board has endorsed Democrat Barack Obama for president.

UAW President Ron Gettelfinger said in a news release that Obama has given the country a positive vision for a better America and concrete plans to achieve it.

..The Obama campaign said the endorsement means that two Michigan superdelegates, UAW Secretary-Treasurer Elizabeth Bunn and retired UAW Vice President Richard Shoemaker, now are Obama superdelegates. They had remained uncommitted until the union endorsement.

Shoemaker confirmed he was endorsing Obama. A message seeking comment was left Tuesday with Bunn.

In the address to the US Senate the head of the Auto Workers Union noted
If the federal government can provide this type of blank check to Wall Street, the UAW submits that Main Street is no less deserving of assistance
From the above testimony what is remarkable is how auto workers in the US have become totally dependent on the union
The truth is, wages for UAW members range from about $14 per hour for newly hired workers to $28 per hour for assemblers. The $73 an hour figure is outdated and inaccurate. It includes not only the costs of health care, pensions and other compensation for current workers, but also includes the costs of pensions and health care for all of the retired workers, spread out over the active workforce.
The US auto industry has become a defacto welfare industry with the union pulling the purse strings. Consider the situation in Asia;
The lack of a social safety net in much of Asia has also added to the propensity to save, forcing people to defer consumption and plan for the future. In China, where private demand is an astonishingly low one-third of GDP, people hoard cash to pay for education, healthcare and retirement benefits that their nominally Communist government entirely fails to provide.

Costs of screening immigrants

In commenting on the study Interferon-gamma release assays and TB screening in high-income countries: a cost-effectiveness analysis Cellestis makes the pertinent observation;
An immigrant screening program for LTBI has a cost to prevent TB outbreaks, it is not self funding

Policy makers have to determine if their priorities are to prevent disease from entering the country or saving money.

In another study Cost optimization of screening for latent tuberculosis in close contacts Cellestis commented that whilst QFT-GIT was 2/3 the cost of TST the cheapest method was to test first with TST then confirm TST positives with QFT.

The researchers confirmed that QFT reduced the costs of TST only by 43%

However, the researchers did not consider the costs of running two systems in tandem and possible additional organisation and resource in their analysis - presumably running one system has to be easier than running two.

Importantly the take home message is that not only is QFT more accurate than the TST it is cheaper.

December 11, 2008

Further review of published study

Cellestis have published a compendium of scientific studies dealing with Quantiferon, which can be found here.

The study titled Detection of Mycobacterium tuberculosis Infection in United States Navy Recruits Using the Tuberculin Skin Test or Whole-Blood Interferon-γ Release Assays prompted the following comments from Cellestis;

Key Findings
• Primarily a specificity study in a cohort of young US-born subjects at very low risk of TB infection, and without BCG vaccination. The specificity cohort was further selected by excluding any that had been TST positive previously, thus biasing the TST specificity estimate.
• Using a 10mm cut-off for the TST (that routinely used by the US military), the specificity of QFT (99.8%) was significantly higher than for the TST (98.4%).
• This paper relates to the liquid antigen version of QFT and also reports results for the original QFTTB test, which is no longer available.

Limitations
• The authors have inappropriately attempted to address sensitivity in a study primarily designed to estimate specificity.
• BCG vaccination status of the subjects was not adequately investigated.
• Potential influence of BCG vaccination on the TST was not addressed in statistical analysis. Many people with a very high probability (based on vaccination rates in their countries of birth) of being BCG vaccinated were deemed as unvaccinated for statistical the analysis.
• TST responses greater than 15mm were assumed by the authors to indicate highly probable TB infection and were not considered as likely due to BCG, NTM, or other factors.
• The paper has made the assumption that a 15mm TST response is indicative of MTBI, and has thus made the suggestion that the TST may be more sensitive. This is contrary to the scientific literature and was strongly argued against by the Cellestis author. This conclusion as it stands ignores the large body of evidence to the contrary that has emerged from studies conducted outside of the USA.

“Be Nice to the Countries That Lend You Money”

In his first interview since the world financial crisis, Gao Xiqing, the man who oversees $200 billion of China’s $2 trillion in dollar holdings, explains why he’s betting against the dollar, praises American pragmatism, and wonders about enormous Wall Street paychecks. And he has a friendly piece of advice.
by James Fallows

Source: The Atlantic

AMERICANS KNOW THAT China has financed much of their nation’s public and private debt. During the presidential campaign, Barack Obama and John McCain generally agreed on the peril of borrowing so heavily from this one foreign source. For instance, in their final debate, McCain warned about the “$10 trillion debt we’re giving to our kids, a half a trillion dollars we owe China,” and Obama said, “Nothing is more important than us no longer borrowing $700billion or more from China and sending it to Saudi Arabia.” Their numbers on the debt differed, and both were way low. One year ago, when I wrote about China’s U.S. dollar holdings, the article was called “The $1.4 trillion Question.” When Barack Obama takes office, the figure will be well over $2 trillion.

During the late stages of this year’s campaign, I had several chances to talk with the man who oversees many of China’s American holdings. He is Gao Xiqing, president of the China Investment Corporation, which manages “only” about $200billion of the country’s foreign assets but makes most of the high-visibility investments, like buying stakes in Blackstone and Morgan Stanley, as opposed to just holding Treasury notes.

Gao, whom I mentioned in my article, would fit no American’s preexisting idea of a Communist Chinese official. He speaks accented but fully colloquial and very high-speed English. He has a law degree from Duke, which he earned in the 1980s after working as a lawyer and professor in China, and he was an associate in Richard Nixon’s former Wall Street law firm. His office, in one of the more tasteful new glass-walled high-rises in Beijing, itself seems less Chinese than internationally “fusion”-minded in its aesthetic and furnishings. Bonsai trees in large pots, elegant Japanese-looking arrangements of individual smooth stones on display shelves, Chinese and Western financial textbooks behind the desk, with a photo of Martin Luther King Jr. perched among the books. Two very large, very thin desktop monitors read out financial data from around the world. As we spoke, Western classical music played softly from a good sound system.

Gao dressed and acted like a Silicon Valley moneyman rather than one from Wall Street—open-necked tattersall shirt, muted plaid jacket, dark slacks, scuffed walking shoes. Rimless glasses. His father was a Red Army officer who was on the Long March with Mao. As a teenager during the Cultural Revolution, Gao worked on a railroad-building gang and in an ammunition factory. He is 55, fit-looking, with crew-cut hair and a jokey demeanor rather than an air of sternness.

His comments below are from our one on-the-record discussion, two weeks before the U.S. elections. As I transcribed his words, I realized that many will look more astringent on the page than they sounded when coming from him. In person, he seemed to be relying on shared experience in the United States—that is, his and mine—to entitle him to criticize the country the way its own people might. The conversation was entirely in English. Because Gao’s answers tended to be long, I am not presenting them in straight Q&A form but instead grouping his comments about his main recurring themes.

Does America wonder who its new Chinese banking overlords might be? This is what one of the very most influential of them had to say about the world financial crisis, what is wrong with Wall Street, whether one still-poor country with tremendous internal needs could continue subsidizing a still-rich one, and how he thought America could adjust to its “realistic” place in the world. My point for the moment is to convey what it is like to hear from such a man, rather than to expand upon, challenge, or agree with his stated views.

.....

About the financial crisis of 2008, which eliminated hundreds of billions of dollars’ worth of savings that the Chinese government had extracted from its people, through deliberately suppressed consumption levels:

We are not quite at the bottom yet. Because we don’t really know what’s going to happen next. Everyone is saying, “Oh, look, the dollar is getting stronger!” [As it was when we spoke.] I say, that’s really temporary. It’s simply because a lot of people need to cash in, they need U.S. dollars in order to pay back their creditors. But after a short while, the dollar may be going down again. I’d like to bet on that!

The overall financial situation in the U.S. is changing, and that’s what we don’t know about. It’s going to be changed fundamentally in many ways.

Think about the way we’ve been living the past 30 years. Thirty years ago, the leverage of the investment banks was like 4-to-1, 5-to-1. Today, it’s 30-to-1. This is not just a change of numbers. This is a change of fundamental thinking.

People, especially Americans, started believing that they can live on other people’s money. And more and more so. First other people’s money in your own country. And then the savings rate comes down, and you start living on other people’s money from outside. At first it was the Japanese. Now the Chinese and the Middle Easterners.

We—the Chinese, the Middle Easterners, the Japanese—we can see this too. Okay, we’d love to support you guys—if it’s sustainable. But if it’s not, why should we be doing this? After we are gone, you cannot just go to the moon to get more money. So, forget it. Let’s change the way of living. [By which he meant: less debt, lower rewards for financial wizardry, more attention to the “real economy,” etc.]

.....

About stock market derivatives and their role as source of evil:

If you look at every one of these [derivative] products, they make sense. But in aggregate, they are bullshit. They are crap. They serve to cheat people.

I was predicting this many years ago. In 1999 or 2000, I gave a talk to the State Council [China’s main ruling body], with Premier Zhu Rongji. They wanted me to explain about capital markets and how they worked. These were all ministers and mostly not from a financial background. So I wondered, How do I explain derivatives?, and I used the model of mirrors.

First of all, you have this book to sell. [He picks up a leather-bound book.] This is worth something, because of all the labor and so on you put in it. But then someone says, “I don’t have to sell the book itself! I have a mirror, and I can sell the mirror image of the book!” Okay. That’s a stock certificate. And then someone else says, “I have another mirror—I can sell a mirror image of that mirror.” Derivatives. That’s fine too, for a while. Then you have 10,000 mirrors, and the image is almost perfect. People start to believe that these mirrors are almost the real thing. But at some point, the image is interrupted. And all the rest will go.

When I told the State Council about the mirrors, they all started laughing. “How can you sell a mirror image! Won’t there be distortion?” But this is what happened with the American economy, and it will be a long and painful process to come down.

I think we should do an overhaul and say, “Let’s get rid of 90 percent of the derivatives.” Of course, that’s going to be very unpopular, because many people will lose jobs.

.....

About Wall Street jobs, wealth, and the cultural distortion of America:

I have to say it: you have to do something about pay in the financial system. People in this field have way too much money. And this is not right.

When I graduated from Duke [in 1986], as a first-year lawyer, I got $60,000. I thought it was astronomical! I was making somewhere a bit more than $80,000 when I came back to China in 1988. And that first month’s salary I got in China, on a little slip of paper, was 59 yuan. A few dollars! With a few yuan deducted for my rent and my water bill. I laughed when I saw it: 59 yuan!

The thing is, we are working as hard as, if not harder than, those people. And we’re not stupid. Today those people fresh out of law school would get $130,000, or $150,000. It doesn’t sound right.

Individually, everyone needs to be compensated. But collectively, this directs the resources of the country. It distorts the talents of the country. The best and brightest minds go to lawyering, go to M.B.A.s. And that affects our country, too! Many of the brightest youngsters come to me and say, “Okay, I want to go to the U.S. and get into business school, or law school.” I say, “Why? Why not science and engineering?” They say, “Look at some of my primary-school classmates. Their IQ is half of mine, but they’re in finance and now they’re making all this money.” So you have all these clever people going into financial engineering, where they come up with all these complicated products to sell to people.

.....

About the $700 billion U.S. financial-rescue plan enacted in October:

Finally, after months and months of struggling with your own ideology, with your own pride, your self-right-eousness … finally [the U.S. applied] one of the great gifts of Americans, which is that you’re pragmatic. Now our people are joking that we look at the U.S. and see “socialism with American characteristics.” [The Chinese term for its mainly capitalist market-opening of the last 30 years is “socialism with Chinese characteristics.”]

It is joking, and many people are saying: “No, Americans still believe in free capitalism and they think this is just a hiccup.” This is like our great leader Deng Xiaoping, who said that it doesn’t matter if the cat is white or black, as long as it catches the mouse. It doesn’t matter what we call this. It’s pragmatic.

.....

With so much of China’s money at stake, did U.S. officials consult the Chinese about the rescue plan?

Not directly. We were talking to people there, and they were hoping that we would be supportive by not pulling out our money. We know that by pulling out money, we’re not serving anyone’s good. Including ourselves. [This is the famous modern “balance of financial terror.” If Chinese officials started pulling assets out of the U.S. and touched off a run on the dollar, their vast remaining dollar holdings would plummet in value.] So we’re trying to help, at least by not aggravating the problem.

But I think at the end of the day, the American government needs to talk with people and say: “Why don’t we get together and think about this? If China has $2 trillion, Japan has almost $2 trillion, and Russia has some, and all the others, then—let’s throw away the ideological differences and think about what’s good for everyone.” We can get all the relevant people together and think up what people are calling a second Bretton Woods system, like the first Bretton Woods convention did.

.....

On what might make the Chinese government start taking its dollars out of America (I began the question by saying that China would hurt itself by pulling out dollar assets—at which he interjected, “in the short term”—and then asked about the long-term view):

Today when we look at all the markets, the U.S. still is probably the most viable, the most predictable. I was trained as a lawyer, and predictability is always very important for me.

We have a PR department, which collects all the comments about us, from Chinese newspapers and the Web. Every night, I try to pick a time when I’m in a relatively good mood to read it, because most of the comments are very critical of us. Recently we increased our holdings in Blackstone a little bit. Now we’re increasing a little bit our holdings in Morgan Stanley, so as not to be diluted by the Japanese. People here hate it. They come out and say, “Why the hell are you trying to save those people? You are the representative of the poor people eating porridge, and you’re saving people eating shark fins!” It’s always that sort of thing.

.....

And how should Americans feel about the growing Chinese presence in their economy? Isn’t it natural for them to worry that China will keep increasing its stake in American debt and assets—or that China won’t, essentially cutting America off?

I can understand why Americans might feel that way. But, talking with my lawyer head once again, it’s not relevant to discuss how Americans “should” think. We should discuss how Americans might think.

This concern is not really about China itself. It could be any country. It could be Japan, or Germany. This generation of Americans is so used to your supremacy. Your being treated nicely by everyone. It hurts to think, Okay, now we have to be on equal footing to other people. “On equal footing” would necessarily mean that sometimes you have to stoop to appear to be humble to other people.

And you can’t think as a soldier. You put yourself at the enemy end of everyone. I grew up during the Cultural Revolution, when people really treated other people like enemies. I grew up in an environment where our friends, our relatives, people I called Uncle or Auntie, could turn around and put a nasty face to me as a small child. One time, Vladimir Lenin told Gorky, after reading Gorky’s autobiography, “Oh my god! You could have become a very nasty person!” Those are exactly the words one of my dear professors told me after hearing what I went through.

But over the years, I believe I learned to be humble. To treat other people nicely. I learned that, from a social point of view, no matter how lowly statured a person you are talking to, as a person, they are the same human being as you are. You have to respect them. You have to apologize if you inadvertently hurt them. And often you have to go out of your way to be nice to them, because they will not like you simply because of the difference in social structure.

Americans are not sensitive in that regard. I mean, as a whole. The simple truth today is that your economy is built on the global economy. And it’s built on the support, the gratuitous support, of a lot of countries. So why don’t you come over and … I won’t say kowtow [with a laugh], but at least, be nice to the countries that lend you money.

Talk to the Chinese! Talk to the Middle Easterners! And pull your troops back! Take the troops back, demobilize many of the troops, so that you can save some money rather than spending $2 billion every day on them. And then tell your people that you need to save, and come out with a long-term, sustainable financial policy.

.....

Although Gao has frequently mentioned Chairman Mao’s maxim—“Go with the Republicans. They’re predictable!”—he obviously was hoping for a “change” agenda under the Democrats:

The current conditions can’t go on. It is time for the new government, under Obama or even McCain, to really tell people: “Look, this is wartime, this is about the survival of our nation. It’s not about our supremacy in the world. Let’s not even talk about that any more. Let’s get down to the very basics of our livelihood.”

I have great admiration of American people. Creative, hard-working, trusting, and freedom-loving. But you have to have someone to tell you the truth. And then, start realizing it. And if you do it, just like what you did in the Second World War, then you’ll be great again!

If that happens, then of course—American power would still be there for at least as long as I am living. But many people are betting on the other side.

Bailouts - the why.not.me? principle

A Wisconsin politician wants the bailout of Chrysler to be contingent on reopening two paper mills;
Congressman Steve Kagen, M.D. says no taxpayer money should be given to Chrysler until after Wisconsin papermakers go back to work. Cerberus Capital Management, L.P., one of the largest private equity investment firms in the United States, owns many corporations including automaker Chrysler and NewPage Corporation, which recently closed two paper mills in Northeast Wisconsin putting over 750 people out of work.
So its a bailout of Cerberus too?
Cerberus Capital Management, L.P. is one of the world's leading private investment firms. Cerberus specializes in providing both financial resources and operational expertise to help transform undervalued companies into industry leaders for long-term success and value creation.

Cerberus is headquartered in New York City with affiliate and/or advisory offices in Atlanta, Chicago, Los Angeles, London, Baarn, Frankfurt, Hong Kong, Tokyo, Beijing, Osaka and Taipei.

Cerberus holds controlling or significant minority interests in companies around the world. In aggregate, these companies currently generate over $100 billion in annual revenues.

Is the US auto industry way out of tune?

A quick look at the timeline of pianos in the US shows that
During 1896, the five largest piano manufacturers in the world were American, and more than half the pianos in the world were made here.

..During 1909, 374,000 pianos were made in the United States by 300 manufacturers.
Obviously the piano business was profitable however business conditions later changed
There are currently nine piano producers in the United States. Two producers shut down manufacturing operations during 1994-98, continuing a long-term contraction in domestic piano sales. There has also been a decline in the number of retail dealers, as well as in the number of suppliers of parts and materials to the piano industry, with many crucial supplies now available only from single sources in the United States.
To put this into some perspective at one time the single most expensive item for a home, excluding the house purchase, was the piano. Grand pianos, uprights, piano rolls, honky tonks - they were used everywhere for entertainment and for teaching. And then events changed all that, the 1930 Depression stopped consumer spending and the motor car became the most expensive item for a home.

Nowadays we have ipods and music can be downloaded from cyberspace at coffee shops - clearly technology has altered the music industry. For those that want one there is still a piano industry however they are mostly imported with well known names as Steinway being made in China under licence.

At one time the US auto industry was not only the greatest in the world they developed a business that was more than just generous
The Big Three are also distinguished not just by their size and geography, but also by their business model. The majority of their operations are unionized (United Auto Workers and Canadian Auto Workers), resulting in higher labor costs than other multinational automakers, including those with plants in North America. The 2005 Harbour Report estimated that Toyota's lead in labour productivity amounted to a cost advantage of $350 US to $500 US per vehicle over North American manufacturers. The UAW agreed to a two-tier wage in recent 2007 negotiations, something which the CAW has so far refused. Delphi, which was spun off from GM in 1999, filed for Chapter 11 bankruptcy after the UAW refused to cut their wages and GM is expected to be liable for a $7 billion shortfall.
Despite their good intentions they have been unable to control their destiny; with GM and Toyota battling it out for global sales GM lost control of its finances
GM posts record loss of $38.7 billion for 2007
whilst the Toyota business model returned a handy profit
Toyota announces record $14 billion profit
Toyota have a business plan called The Toyota Way and this has been instrumental to their success;
  • Base your management decisions on a long-term philosophy, even at the expense of short-term goals
  • Create continuous process flow to bring problems to the surface
  • Use "pull" systems to avoid overproduction
  • Level out the workload
  • Build a culture of stopping to fix problems, to get quality right the first time
  • Standardized tasks are the foundation for continuous improvement and employee empowerment
  • Use visual control so no problems are hidden
  • Use only reliable, thoroughly tested technology that serves your people and processes
  • Grow leaders who thoroughly understand the work, live the philosophy, and teach it to others
  • Develop exceptional people and teams who follow your company’s philosophy
  • Respect your extended network of partners and suppliers by challenging them and helping them improve
  • Go and see for yourself to thoroughly understand the situation (genchi genbutsu)
  • Make decisions slowly by consensus, thoroughly considering all options; implement decisions rapidly
  • Become a learning organization through relentless reflection and continuous improvement
Clearly bailing out Detroit car makers makes about as much sense as bailing out the piano industry.

December 10, 2008

Power tends to corrupt; absolute power corrupts absolutely.

Absolute power may shorten the honeymoon period for the incoming President; now that the Democrats hold all the congressional power in the US are we to expect more of these shenanigans?
FBI agents this morning arrested Illinois Gov. Rod R. Blagojevich (D) and his chief of staff on conspiracy and bribery charges, including allegations that the governor was seeking to benefit financially from his appointment of a successor to the U.S. Senate seat that was vacated by President-elect Barack Obama.
The full criminal complaint can be read here, some lowlights;
Defendants ROD BLAGOJEVICH and JOHN HARRIS, together with others, offered to, and threatened to withhold from, the Tribune Company substantial state financial assistance in connection with Wrigley Field, which assistance ROD BLAGOJEVICH believed to be worth at least $100 million to the Tribune Company, for the private purpose of inducing the controlling shareholder of the Tribune Company to fire members of the editorial board of the Chicago Tribune, a newspaper owned by the Tribune Company, who were responsible for editorials critical of ROD BLAGOJEVICH.
The Tribune has issued a statement saying;
Tribune Company and its executives will fully cooperate with the government during its investigation of the governor.
It gets worse as Blagovejevich schemes to take the "financial stress" off his family, even to the point of approaching president elect Barack Obama
Among other things, ROD BLAGOJEVICH raised the issue of whether the President-elect could help get ROD BLAGOJEVICH’s wife on “paid corporate boards right now.” Advisor A responded that he “think[s] they could” and that a “President elect . . . can do almost anything he sets his mind to.” ROD BLAGOJEVICH states that he will appoint “[Senate Candidate 1] . . . but if they feel like they can do this and not fucking give me anything . . . then I’ll fucking go [Senate Candidate 5].”
This is not an isolated incident, as "pay to play" politics is endemic in Illinois we can expect political collateral damage to wide spread;
Obama may be packaged as something new among presidential contenders, but in this town where politics is played like a blood sport he fit right in.

“He knows how the game is played,” said Jay Stewart, executive director of Better Government Assn., a nonpartisan group that honored Obama for helping overhaul state ethics law. Stewart called Illinois politics “deeply troubled, if not corrupt” at its core.

“It is very difficult to come out of a system that is flawed and walk out unscathed. Sen. Obama has done better than most. But it’s not as if he is a babe in the woods,” Stewart said.

Immigation TB testing the weakest link

Further to the recent news that 300 babies in the Neo-natal Intensive Care Unit and the Special Care Baby Unit had come into "close and prolonged contact" with a doctor who has active TB we now find that the migrant had passed a health check performed in the country of origin
Immigration Department official Sandi Logan says the doctor had a medical examination and chest x-ray in India by an approved doctor before coming to Australia and the results were clear.

"The doctor was free from any signs of TB," he said.
This is a serious slip up by medical authorities, by accepting the assurance of a non medical authority in lieu of their own medical examination they have diminished their credibility.

Aside from the obvious procedural failure is the possibility that the doctor already had latent TB which then progressed to active TB whilst in Australia - there has been no advice given that he had been tested for latent TB whilst in India.

As many in India have been BCG vaccinated skin testing for TB is of debatable value however QFT has proven to be successful in testing HCWs
The tuberculin skin test, in which the skin is pricked with antigens from Mycobacterium tuberculosis, had stood alone for more than 100 years as the method for detecting latent TB infection.

However, many health professionals consider the skin test crude, said Pai, because it is unable to clearly distinguish between people who have received a vaccine against TB from those who have a true infection. Moreover, the skin test requires the patient to return three days after the skin prick so that a health worker can measure the resulting bump on the skin.

Having a test that allows health care officials to confirm a true TB infection is important because a positive test can lead to a six-month treatment of daily anti-TB drugs for the patient.

Using an X-ray to determine active TB is on its own an unreliable method, particularly when there are no symptoms
Sensitivity of chest X-ray for symptomatic recurrent cases was 92.3%, and that for non-symptomatic recurrent cases 60.0%,

..Sensitivity of chest X-ray for early diagnosis of recurrent pulmonary tuberculosis is not very high, and bacteriological examinations are more important irrespective of chest X-ray finding
Source: Japan 2005

Hospital authorities had better wake up.