Health Innovation Policy for the People: Undercutting profit motive for better outcomes

For at least the last 25 years, Rhode Island has relied on the medical-industrial complex to serve as an economic engine.

The quest for patentable, scalable cures for the diseases of industrialism has taken up a huge amount of the energy and resources devoted to economic development in RI.

There are deep-seated problems with this strategy, the resultant neglect of public health measures, and the role this innovation-based economy plays in making the cost of healthcare astronomical – as well as its role in the gentrification of our communities and the increase in homelessness that follows from this strategy.

What may be among the biggest indictments against centering attention on the patentable medical-industrial complex is that, despite the miracle cures and information that flows from this system, life expectancy in the United States has increased much more over the last 100 years due to the provisioning of clean water and sewage treatment than from all of the miracle cures for industrial diseases.

But, of course, no one gets traction telling the folks focused on innovation and economic development that public health measures do more good than their innovations and that measures to reduce the harms of industrialism work better than cures after the fact.

What profit is there in the old idea that an ounce of prevention is worth a pound of cure? It has been a lonely and frustrating fight for an outsider, but recently something happened that gives me a bit of hope.

I read “Health Policy Innovation for the People,” by Dr. Shobita Parthasarathy, PhD, of the University of Michigan Gerald R. Ford School of Public Policy, where she is director of the Science, Technology and Public Policy Program.

By the time I had finished the introduction, I realized this was one of the most important articles I had ever read on the medical-industrial complex, and I started sending it out to everyone I know who works on these issues.

Dr. Parthasarathy reported on many of the problematic aspects of the innovation system, including the U.S. Patent and Trademark Office and the entire system built up around patents, the flow of research dollars, the panels of [mostly] old white men and representatives of drug companies deciding what research is acceptable, the monopoly basis of the big research universities, the disdain for the research on women’s health and public health measures, and how the system appears to funnel money to keep the big players happy.

The National Institutes of Health spends 500 times as much money on genetic research as it does on the effects of structural racism on health, despite the vast disparity in lifespan between white people and people of color in the US.

I cannot really do justice to the article in a synopsis, so I strongly recommend you read the 20 pages, but let me offer up a few examples of how the current patent-protected system has really failed our communities, especially communities of color, and the public’s health.

An egregious example

One of the most egregious examples of the current system floundering is the pulse oximeter, a device that clamps onto the end of a finger and measures blood oxygen levels. First produced by Hewlett Packard, the device is a critical tool in the struggle with COVID, as low blood oxygen levels serve as a definitive sign that more care is needed.

It turns out the original pulse oximeters did not read properly on dark-colored skin, something that Hewlett-Packard eventually figured out and rectified. But the current manufacturer is allegedly producing pulse oximeters with the original flaw and apparently shows no signs of rectifying this problem.

As a direct result of this flaw, many African Americans and others with dark skin did not receive prompt treatment for COVID-19 – and may have died in disproportionate numbers from the disease.

Thousands of people who could have received early intervention and been saved were not, allegedly due to protections by the patent system. The US Food and Drug Administration apparently considered this type of racial bias to be outside of what it could regulate.

In breast cancer research and treatments

The focus on patentable and scalable treatments instead of public health has also shown up in breast cancer research and treatments. Here is a rather lengthy quote from the article by Dr. Parthasarathy. Read it and weep:

“U.S. biotechnology company Myriad Genetics announced that it had identified two genes linked to these cancers, BRCA1 and BRCA2, and then applied for U.S. and European patents and began offering tests [Parthasarathy, 2007].

Citing these pending patent rights, Myriad then systematically shut down all other providers in the United States and tried to do the same in Europe. It offered its own “gold standard” test to U.S. consumers, which sequenced the DNA of both genes for approximately $2,500 and provided customers with information about whether they had mutations that might cause disease.

But European scientists and public health officials challenged the company’s proprietary position and continued to conduct research and offer BRCA testing through their health systems.

Soon afterward, French researchers announced that they had found a major flaw in Myriad’s approach: it missed large deletions and rearrangements in the genes that increase susceptibility to disease. [Myriad Genetics had halted similar research in the United States.]”

Upbraided and cajoled

The NIH had to be severely upbraided and cajoled to put women and breast cancer patients onto the panels that made recommendations as to what research to fund, and while it eventually created a program to fund research into the environmental issues around breast cancer, it has since shut down that program.

Providence has a major problem with asthma. South Providence neighborhoods have some of the highest rates in the country. The patent system has meant that many lower-income people may have no way to afford inhalers, and, of course, most of the research spending is on patentable medicines rather than the environmental triggers for asthma.

An ounce of prevention is worth a pound of cure, but the profit seems to be the motivational factor, despite the massive societal costs of asthma.

Here again, I offer up a couple of quotes from Dr. Parthasarathy’s article, because I could not explain it any better:

• The story of asthma, a disease that disproportionately affects Black children, is similar. [Alexander and Currie, 2017] In recent years, the cost of albuterol inhalers, which help to control the disease, have also increased considerably due to patent-based monopolies.

Albuterol has been available as a generic tablet for use in inhalers for decades, but in the 2010s, the tablet was altered slightly after federal regulators required the redesign of inhalers so that they did not emit environmentally dangerous chlorofluorocarbons.

The inhaler and tablets were re-patented. Likely as a result, the market price for albuterol tablets increased over 4,000 percent and triggered a decline in use, presumably due to insurer questions and limits and uninsured patients simply unable to afford it. [Kenner, 2018; Rosenthal, 2013]

• “Let’s consider again the example of asthma. Its cause is unclear and there is no cure, but many of its triggers are external and specifically environmental, including air pollution, chemical fumes, and dust. It is also strongly associated with poverty. [Kravitz-Wirtz et al., 2018]

More and more people are being diagnosed with the disease, but its prevalence is increasing much more rapidly among historically disadvantaged communities of color.

These communities are also likely to experience worse disease outcomes, including hospitalization and death.

In response, governments have increased research funding, but this work has focused primarily on genetic and biological mechanisms rather than on how to transform environmental and socioeconomic conditions necessary to prevent and mitigate disease. [Whitmarsh, 2008]

This approach fits with both the dominant concerns and approaches of scientists in this field as well as the private sector.

How to turn the system around

Parthasarathy then goes on to offer up a number of recommendations as to how best to turn this system around. These include having community members as experts on the panels determining what research should be funded, and making sure that the research money is spread around better. [Harvard, for instance, receives more funding than all of the Historically Black Colleges and Universities put together.]

And, by focusing much more attention and research on social and environmental determinants of health. Parthasarathy goes on to ask for serious reform of the patent system, which seems to be focused on profits rather than health.

Giving voice to my concerns

I have long voiced my concerns with a medical-industrial complex that delivers the most expensive [by far] healthcare in the world, but that ranks no better than 37th in the delivery of healthcare, systematically excludes vast swathes of the population from the latest advances and ignores the environmental hazards in the community because it would mean taking on powerful economic and political interests.

Dr. Parthasarathy has done us all a service by exposing it so clearly. I want to expand her thesis a bit by pointing out what I see as the problems of using the medical-industrial complex as a tool of economic development in Rhode Island – and what I believe is an exaggerated focus on the innovation system as a major focus of the entire economic development strategy in the state.

Rhode Island spends a considerable amount of money each year to promote and develop the innovation economy. The main supporter of this work is the Commerce Corporation of RI.

The economic development investments by CommerceRI appear to be looking for the next big thing, with a focus on patentable and scalable innovations. While they may have invested in a few programs that are focused on economic development in the neighborhoods, that is not their primary focus. They are looking for gazelles and unicorns.

Predictable results

In my experience, when you attempt to talk with CommerceRI and discuss ideas such as the ridiculousness of giving tax breaks to the rich or eliminating environmental regulations, they seem to be unwilling to listen, despite the overwhelming weight of the evidence pointing out that their approach does not work and that it promotes greater inequality.

So, the results are entirely predictable: growing inequality, gentrification [when you keep putting more money in the hands of the already wealthy, it always drives up housing costs and displaces lower-income community members], unaffordable healthcare, decreased longevity, failing public services and an obsession with real estate development.

The real estate obsession, in my opinion, is among the most troubling aspects of the agency’s investment strategy, as it is ownership, rather than wages, that drives most of the rapidly growing inequality in our communities.

The data is very clear that lower taxes on the rich and tax breaks for the rich do not contribute to general prosperity, and that strong environmental regulation is correlated with healthier economies.

This last point is important as stronger environmental regulations are correlated strongly with healthier populations, meaning people can be more productive and less money is spent on healthcare so it can be spent elsewhere in the economy.

Some day Rhode Island will understand that economic development works best as a bottom-up process, not a top-down trickle.

Investment could be funneled toward communities that need the jobs the most, creating jobs for the people who already live here and matching the skills of Rhode Islanders, focusing on whole systems rather than after-the-fact cures, and putting the new climate economy at the center of our work.

But until that day, the results will be the same as always, with growing economic inequality and division and a decline in life expectancy.

Greg Gerritt is the director of research at ProsperityForRI.com.

Letter to the Editor: Forest Losses

Global forest losses are one of the big drivers of climate change. RI needs to step up and stop deforestation as part of our climate policy.  And if solar is a part of our future energy strategy we need very good numbers on the trade offs of solar for forest.  I do not think solar wins, but where solar can provide multiple benefits is on buildings and parking lots. The benefits of shading parking lots can help reduce the heat island effect. Ground mounted solar makes it worse. And the list could go on and on.  

The report makes clear that DEM is constrained by a governor who still wants to make Wall St happy, but the only way to do that is growing inequality and climate catastrophe and these days, that leads to pandemics and people in the streets. Climate justice has to lead everything RI does in the next 20 years, or life is going to get very strange and dictators will roam the land.   

Letter to the Editor: COVID-19 and the Environment

These days it is hard to avoid thinking about the COVID-19 outbreak. I am mostly working on climate issues, and I am sure there are conspiracy theories about how they are linked. Conspiracies aside, there is one way that the virus and our climate are definitely linked, and that is through deforestation. Let me explain.

There have been a number of relatively recent disease outbreaks with novel diseases, diseases that western science had not seen before, and often diseases that the communities where the outbreaks originate had not experienced before. Most of these diseases are also originally transmitted to people from tropical wild animal populations, with bats and primates implicated in some of them. What is happening is that the deforestation process works in a variety of ways, driven by factors like new road construction and the development of plantations. As roads reach new areas, it increases both the cutting of trees and the shooting of wildlife for food.  Some of the wildlife is eaten locally and replaces food sources lost as deforestation progresses, some of the hunting takes advantage of the new roads and transports the food to urban markets where there is often a high demand for bush meat. With the hunting taking place in places where very few people have hunted previously that are now available for exploitation due to new roads, or places where hunters are no longer living isolated communities, hunters are running into novel diseases in the same way that a survey of biodiversity in places that have not been explored/exploited before find new species of geckos, salamanders, and monkeys. It makes perfect sense that if you are finding new species of animals and plants, you are running into new microorganisms, some of which will eventually be used to cure diseases, others that will cause new diseases, and most that have little direct effect on humans. 

The climate link is that the protection and maintenance of good health in the global forest, and especially tropical forests, is a critical part of our strategy to prevent the worst effects of climate change. We have to move toward zero carbon emissions rather quickly, but we also have to suck carbon dioxide out of the sky and trees and soils are the most natural and least energy intensive ways to do that. The best way to keep the trees and soils healthy is to protect tropical forests. We are already seeing reports how the carbon budget of the tropical forests is turning negative.  Deforestation is the big driver, but a decent amount of the loss of carbon in tropical forests is a cascade effect. As forest turn silent, as the animals are all hunted out even if it is prior to deforestation, the forest unravels. No animals are eating seeds that need to go through digestive systems to germinate. No animals are depositing seeds in their poop as they move from place to place. Very small pests run amok with predators gone. The ability of the forest to sequester and store carbon falls apart, requiring ever greater efforts to de carbonize to preserve the climate, and new ways of sequestering carbon dioxide already in the atmosphere. 

The conclusion is that the process that brings the new diseases to humans, deforestation and the bush meat trade is part and parcel of the climate crisis, and to better prevent future novel diseases, we need to do a lot better job of protecting the forests that help keep the climate intact. 

What’s Up, Earth?

It’s been quite a year for the environment. There’s been good … bad … and really bad… Check out our list of some of the top local, national and international environmental happenings of 2019.

Emissions and fossil fuel use continue to skyrocket, leading to ever greater disasters. Greta Thunberg, Sunrise, and Extinction Rebellion and the young continue to lead the resistance. Climate strikes and boycotts of polluters are sprouting up everywhere. Climate justice and a just transition is becoming the central theme of the resistance.

Deforestation continues everywhere, worsening in places with little democracy and a history of genocide against the Indigenous. The murder of forest protectors increases while all over the world people are coming to realize we must protect the forest and the people who live there.

The extinction catastrophe and insect apocalypse (400,000 species fact extinction) are becoming ever greater threats to our planet’s ecosystem.

There is more plastic in the oceans, but more and more places, including cities in Rhode Island, are banning more and more kinds of plastic.

In 2019, the governor and the Rhode Island General Assembly did absolutely nothing to improve the health of the environment and reduce greenhouse gas emissions. 

The people stopped Invenergy from building a fracked gas power plant in Burrillville. Solar Farms are destroying forests in RI, but solar and wind are providing greater amounts of energy, and new investment and new jobs in green energy exceed that of investment in fossil fuels.

Joe Paolino’s plan to kick bus riders and the poor out of Kennedy Plaza and the DOT’s efforts to steal money from bicycle and pedestrian infrastructure are incredibly stupid and short-sighted. Resistance to the misguided plans is powerful.

Letter to the Editor: Authoritarian Column

To the Editor,
On April 7 Theodore Gatchell’s column really showed his true colors: Authoritarian. His disparagements of the workers at Microsoft who do not wish to build weapons demonstrates a complete disregard for civil liberties and democracy. The people have a right to say no to the war machine, just as we have the right to say no to the fossil fuel dinosaurs. Telling people that they must contribute to the killing and have no right to tell their bosses that they will not contribute to such projects does not sound like the America I grew up in. The people have always had to rein in the elites who think empire is their right. Right now the people are saying the wars for oil and the wars against Islam are a big waste of humans and resources and are making the problems worse. Eighteen years of war tell us that very clearly. Microsoft is not going to fire all its workers who want peace. It would be left with an empty shell. It is time for the violence mongers in DC to learn the lesson.

Letter to the Editor: RI Economy

To the Editor,
The headline in the April 7 Providence Journal was “RI economy cools off in first quarter.”  It then quoted all the usual suspects as to why and how much. Inside the headline was  “Economy steady but not spectacular,” referring to the national economy. What the first article neglected to say was that despite all the phony stuff told us about how to make the economy grow faster in Rhode Island, the Rhode Island economy has a growth rate year in and year out of about 70% of the US growth rate. 71.4% over the last 5 years, and nearly every year, despite the gyrations of policy, very close to 70%. RI grows at 70% of the US growth rate because the national growth rate is skewed up by a system of measurement that calls resource depletion and pollution growth, without deductions for the harm the businesses are causing to communities. It is time for truth in journalism about what is really going on in the economy rather than continuing to quote those who ignore the larger context.
Greg Gerritt

Letter to the Editor: Trump Tax Cuts

To the Editor,
On Sunday, March 24, The Boston Globe published an op-ed by Paul Krugman titled  “Holy Voodoo Batman” in which he notes that the Trump tax cut boom has fizzled, and no one thinks that it had more than the most short-term effect on the American economy. Growth rates, for myriad reasons, are sliding down.
What I really liked was tht Krugman, a NYTimes columnist on economic issues, points out there has never been a clear demonstration that tax cuts for the wealthy or large corporations ever improve economic performance. I can provide three or four recent articles that affirm Krugman’s position and have the numbers to back it up.
So I repeat my question to those who make and implement economic development policy in Rhode Island: Why do you continue to rely on outdated policy that has been proven not to work as your economic development strategy? Is it because you do not have good information? Because it fits your ideological straitjacket? Or because powerful people with money to burn spend lots of money to push these failed policies simply because they think it benefits them and other wealthy folks and helps shut down democracy? It is time to get an economy for the 21st century in Rhode Island, and neoliberalism and business climate obsessions will never bring that to fruition.


Stop Digging: To get out of this hole, we have to stop building fossil fuel facilities

Climate change because of deforestation and the burning of fossil fuels is the existential crisis of our times. The amount of carbon dioxide in Earth’s atmosphere has gone from 280 parts per million to 410 parts per million since the beginning of the Industrial Revolution, and almost all of the buildup of CO2 in the atmosphere has taken place in the last 70 years.
Atmospheric scientists say the amount of CO2 in the atmosphere is the same as in various periods in the distant past that were significantly warmer than today and had sea levels as much as 20 meters higher than we do today. We have not yet hit some of the higher temperatures because CO2 in the atmosphere has an additive effect. It bounces infrared radiation back to Earth and bounces some of the rebounding radiation as well, which builds up through time with a greater percentage bounced back to Earth as the amount of CO2 in the atmosphere increases. In other words, there is more heating of the planet baked in with the pollution we have already spewed, and we’ll feel it down the road.
Every time we add additional fossil fuel facilities — power plants and pipelines, mostly — the amount of fossil fuels burned increases, making it less likely that we can stop the warming trend before it sets off civilization-breaking catastrophes.
A recent study done by Christopher J. Smith, Oiers M. Forster, Myles Allen, Jan Fuglesvedt, Richard J. Millar, Joeri Rogelj and Kirsten Zickfeld titled “Current fossil fuel infrastructure does not yet commit us to 1.5 degree celcius  warming” made it rather clear that the best climate models we have say that if we stop building any new fossil fuel facilities and wind down current fossil fuel facilities as we create more and more clean power, we have a 2/3 chance of avoiding the worst effects of climate change. If we continue to build new facilities, however, we have no chance to avoid out-of-control rising temperatures and the catastrophes that brings.
So we have to do something meaningful right now if the planet is to stay livable, and the most meaningful thing we can do is stop all expansion of the fossil fuel industries, stop mining new coal seams, stop drilling new oil fields and stop building pipelines and power plants. New England, in addition to many other places, has more than enough capacity with current fuel sources, to maintain our lifestyles — heat our houses, get us around the neighborhood and power the electric grid. Not building new facilities will not change our current lifestyles; it would take years before we noticed, and by then all the wind farms and solar arrays, the insulating and electrifying of buildings and the expansion of the electric car markets will mean that we can make a pretty seamless transition to clean power.
Yes it will be expensive, but billion dollar power plants that overheat the planet are pretty expensive, too. And construction jobs in renewable power, insulation and efficiency will keep the bottom from falling out of the economy just as well as dirty power plants can.
Why would anyone insist that we build more useless junk that will become white elephants as our society burns down? We can stop climate change in its tracks if we stop building new fossil fuel facilities, and we can do it in ways that help our communities become more prosperous and just. It is time.

Cut the Scrap!: The 2019 Compost Conference highlights the triumphs and hopes of the industry

ECRILogoI have been composting since 1981, when I first started cleaning sheep barns for a cut of the manure. I fed sheep manure compost to my garden every year for 15 years and watched the clumpy clay and rock soil turn into black earth that could grow anything. Then I moved to Providence and after helping Southside Community Land Trust convince the City of Providence to make it a policy to put community gardens in city parks in partnership with communities, we realized that in order for all of these gardens to thrive, and for the gardens to reduce food insecurity in our communities, we needed good sources of compost in the city.
In RI, 250,000 pounds of food scrap is sent to the RI Resource Recovery Corporation’s Central Landfill in Johnston each day. A good composter, with a comparable collection of leaves from the neighborhood, could turn that into about 40,000 pounds of compost each day, enough compost to put a 2-inch layer on hundreds of garden beds.
Food scrap is the heaviest and wettest part of what is thrown away in RI, stinks up the neighborhood while it is sitting around waiting to be collected, and when it ends up in the landfill it generates methane, which smells bad and does worse things to your body and the atmosphere — it’s 20 times more potent a greenhouse gas than carbon dioxide. If we could find a smart and almost odor-free way to turn this food scrap into soil amendments right in our neighborhoods, it would be a source of jobs, entrepreneurial opportunities, food security, cooler neighborhoods with expanded green spaces and reduced greenhouse gas emissions.
In 2010, I organized the First Rhode Island Compost Conference. And have organized one each year since. This year, to commemorate 10 years of compost conferences, we are going to have five people who have been in the compost field for most of this time period discuss the changes they have seen. The perspectives of regulators, farmers, composters, educators and journalists in short takes should be entertaining and informative. There have been changes in the laws that now mandate composting by the largest generators of food scrap, changes in regulations that now provide a streamlined permitting process for small-scale compost facilities that serve small neighborhoods and changes in the tip fees at the central landfill. There’s now a much wider understanding among the community of the importance of removing food scrap from the waste stream and turning it into a community asset and a number of businesses are starting up to collect and process food scrap and restaurants are taking advantage of these services. There is room for action at almost any scale, from bicycle collection routes going to community gardens to solid waste treatment plants accepting food scrap and capturing methane from anaerobic digestion to power the plant and neighborhood.
The breakout workshops will be more relevant than ever.  The breakthroughs in Providence and Aquidneck Island will be highlighted and we shall have workshops on creating large and small scale facilities, a bit of compost philosophy, and how the collection business is changing.
Like all good endeavors in the community, education is a critical component as Rhode Island develops systems that help people manage food scrap so that it ends up benefiting the community rather than as a problem to be hidden away. And we all know parents learn from their kids when this type of innovation is called for, so we end the four-day event with a panel on what is going on in RI Schools organized by Foodscape.
Registration is available online at environmentcouncilri.org/2019-compost-conference-trade-show
Discounts to youth groups and schools are available.

Letter to the Editor: Recreational Marijuana and Security Clearances

Recently, executives at Electric Boat complained that if Rhode Island legalizes recreational marijuana, it will make it hard to find workers who can get security clearances. Electric Boat makes things designed to kill people, which is why its workers need security clearances. I think it is better for people to smoke marijuana than build new and better ways to kill. If Electric Boat stopped building things to kill people, it could find plenty of workers in the modern world.

Greg Gerritt