Thursday, May 26, 2016

What makes America great? Free, online courses for a start -- May 26, 2016 column


Enough nostalgia for America of an earlier era.  

Take the country back to the 1950s or 1960s? You’ve got to be kidding. Make America great again? Please. It’s already great.

And not just because we have sushi happy hour, Uber and Fitbit. America is great because anyone with internet access can enroll in courses from the nation’s best universities online for free. It’s great because America connects people worldwide who share the desire to learn.   

The 21st century has delivered to our laptops and mobile devices access to thousands of free and low-cost courses that can enhance our technical and business skills or help us live more creatively and fully.   

Want to sweat through a mathematical biostatistics boot camp? Johns Hopkins has you covered. Listen and learn about Handel’s Messiah and Baroque Oratorio? Harvard has a class. Need logic? Stanford University is on it. 
The first massive open online courses -- MOOCs -- started at Stanford in 2011. More than 600 colleges and universities around the world have developed 4,200 online courses, and more than 35 million people worldwide have signed up for one, according to data compiled by Class Central.

You can learn about aerodynamics from the Massachusetts Institute of Technology, dog emotion and cognition from Duke University and subjects in between. Beginning Mandarin? Peking University offers it. Chicken behavior? The University of Edinburgh.

After reading about MOOCs for years, I finally signed up for one. Well, three. I started Tibetan Buddhist Meditation from the University of Virginia and then Positive Psychology from the University of North Carolina at Chapel Hill. They weren’t for me, though, and I dropped out with a click.

Something like only about 5 percent of people who start a MOOC finish it, Online Course Report said in its State of the MOOC 2016 study. The quit rate worries academics, but to me it also shows learners exercising their freedom to explore. The course completion rate is far higher in corporate-sponsored classes.

For me, the third course was the charm. I’ve spent the last 10 weeks studying Greek and Roman mythology through the University of Pennsylvania. My classmates in America and all over the world -- including Bangladesh, Canada, Denmark, Germany, Italy, Portugal, Morocco, Mexico, South Africa, Spain, Taiwan and the United Kingdom -- interacted on community discussion boards.

The mythology course “took,” even though in every session Professor Peter Struck, wearing a white shirt, looked at the camera and lectured. That sounds deadly, but his enthusiasm for his subject was contagious and his insights fascinating.

The class was offered through Coursera, a for-profit company started by two Stanford professors. Two other big providers of MOOCs are for-profit Udacity, with computer science classes developed by Google, Facebook and other companies, and edX, a nonprofit founded by Harvard and MIT.

Many people take MOOCs to enhance their resumes with tech and business skills. More than 75,000 people, for example, have taken Applied Cryptology on Udacity, taught by University of Virginia computer science professor David Evans. Information Week ranked it the #1 class to pump up IT careers.

I was looking for something to take me away from work, and a trip to ancient Greece and Rome was just the ticket. As with many other courses, you could earn a certificate for $79 or take the course free without a certificate. I didn’t need a certificate, but business learners often do.

The MOOC model is changing, though. The trend is toward more fees and fewer free courses. Humanities courses were 19 percent of offerings in 2013, but only 9 percent last year. Computer science and programming made up 17 percent of classes last year, the same percentage as business and management, according to Online Course Report.

The next new thing in MOOCs is virtual reality. Harvard’s most popular course, both on campus and on edX, with more than 1 million enrollees, is CS50, an introduction to computer science. This fall, Harvard will film the course in virtual reality. Using a cardboard viewer and the screen of a smartphone, a learner anywhere will be able to experience the class almost as if he or she were there in person.

It’s enough to make you believe in America’s greatness again.

©2016 Marsha Mercer. All rights reserved.


Thursday, May 19, 2016

Tis the season for pomp, circumstance and politics -- May 19, 2016 column


President Barack Obama isn’t on the ballot, but he is on the campaign trail. His harshest attack yet on Donald J. Trump previewed the president’s role in the fall campaign.   

“In politics and in life, ignorance is not a virtue,” Obama said May 15 in his commencement address at Rutgers University. “It’s not cool to not know what you’re talking about. That’s not keeping it real or telling it like it is. That’s not challenging political correctness. That’s just not knowing what you’re talking about.”

The partisan campaign pitch by a president is unusual – what isn’t this election cycle? -- but Obama isn’t the first to take center stage at graduation exercises and throw down a political or policy gauntlet.

As war raged in Europe in 1940, President Franklin D. Roosevelt used a commencement address at the University of Virginia, where his son, Franklin Jr., was graduating from the law school, to warn the United States could no longer be “a lone island in a world dominated by the philosophy of force.”

Italy had declared war on France and Great Britain just that morning, and FDR said: 

“On this tenth day of June 1940, the hand that held the dagger has struck it into the back of its neighbor.

“On this tenth day of June 1940, in this university founded by the first great American teacher of democracy, we send forth our prayers and our hopes to those beyond the seas who are maintaining with magnificent valor their battle for freedom,” he said.

The speech, received with cheers and rebel yells in Charlottesville, presaged the United States’ eventual entry into World War II. With the election only months away and Roosevelt was running for a third term, though, some Democrats worried FDR would alienate voters.

In a commencement address at the University of Michigan in May 1964, President Lyndon B. Johnson set the theme for his presidential campaign and his domestic agenda when he outlined his goals for a Great Society. His ambitious plan called for no less than rebuilding cities, cleaning up the environment and transforming education.

Twenty-seven years later, President George H. W. Bush chose commencement in Ann Arbor to open his reelection bid, saying Johnson’s social agenda had not only failed but backfired.

“Programs designed to ensure racial harmony generated animosity. Programs intended to help people out of poverty invited dependency,” Bush said in May 1991.

“We don’t need another Great Society with huge and ambitious programs administered by the incumbent few. We need a Good Society built upon the deeds of the many, a society that promotes service, selflessness and action,” Bush said.

Obama renewed the debate about the scope of government and the level of political discourse in a commencement speech at the University of Michigan in 2011.

“What troubles me is when I hear people say that all of government is inherently bad,” he said.

“We’ve got politicians calling each other all sorts of unflattering names. Pundits and talking heads shout at each other. The media tends to play up every hint of conflict because it makes for a sexier story – which means anyone interested in getting coverage feels compelled to make their arguments as outrageous and as incendiary as possible,” Obama said.

Trash-talking about government has only gotten worse, and Trump’s candidacy five years later makes Obama seem prescient. Trumpians endorse the isolationist tendencies FDR rued so long ago.

In his Rutgers speech, Obama said, “If the past two decades have taught us anything, it’s that the biggest challenges we face cannot be solved in isolation.”

He scorned the ideas of building a wall to keep out Mexicans and banning Muslims from entering the country as “not just a betrayal of our values” but as actions that “would alienate the very communities at home and abroad who are our most important partners in the fight against violent extremism.”

In reply, Trump typically fired a quick, personal hit. 

“`In politics, and in life, ignorance is not a virtue.’ This is a primary reason that President Obama is the worst president in U.S. history,” he tweeted.

Obama will have many chances over the next six months to use the bully pulpit to assail Trump. His final commencement address as president is June 2 at the U.S. Air Force Academy, where he likely will focus on the United States’ role in the world.
©2016 Marsha Mercer. All rights reserved.

Thursday, May 12, 2016

From STATELINE -- TB persists in the United States

Is Tuberculosis Making a Comeback?

  • May 12, 2016
  • By Marsha Mercer
Letter from health authorities© The Associated Press
A woman shows a letter she received from health authorities saying her son was exposed to tuberculosis in a hospital in El Paso, Texas. State and local health departments are the front line of defense against a disease that may be on the upswing.
A year ago, Laura Hall felt tired all the time, was losing weight and had a bad cough.
The 41-year-old Spanish teacher from Shelburne, Vermont, went to doctors for three months before they finally nailed the diagnosis: active tuberculosis.
“I was scared. I was horrified. Oh my gosh, how did I get this? Where did I get it?” Hall said in a video about TB survivors’ experiences. “I didn’t think that I could get TB, ever.”
While Hall underwent treatment — isolation at home and a demanding regimen of antibiotics and other drugs — the Vermont Department of Health tested about 500 students and co-workers who might have been exposed to her. Nineteen children and two adults tested positive for latent TB. (People with latent TB aren’t sick or contagious, but they carry a greater lifetime risk of developing active TB.)
Hall’s was one of seven active cases in Vermont last year, up from two the year before. Twenty-nine states and the District of Columbia also reported more active TB cases last year than in 2014, the Centers for Disease Control and Prevention reported in March.
After two decades of steady decline, the number of active tuberculosis cases in the U.S. inched up last year. Hall’s was one of 9,563 TB cases reported last year, up from 9,406 cases the year before. The CDC is still trying to determine the reason for the uptick.
The goal set by the CDC, in 1989, of eliminating TB by 2010 — defined as less than one case in a million people — remains elusive. Even if the trend of declining cases had continued, the United States would not have eliminated TB by the end of this century, the CDC said.
“We are not yet certain why TB incidence has leveled off, but we do know it indicates the need for a new, expanded approach to TB elimination,” said Dr. Philip LoBue, director of the CDC’s Division of Tuberculosis Elimination, in an email.
A dual approach is needed: continue to find and treat cases of disease and evaluate their contacts as well as identify and evaluate other high-risk persons for latent TB infection, he said.
In Vermont, health officials aren’t sure whether last year’s increase was just a statistical anomaly or the beginning of a trend. In case it is the latter, the state Health Department is considering contracting with an outside firm to help it test contacts for exposure. Last year, the shorthanded department brought in health staff from around the state as well as volunteers from the Vermont Medical Reserve Corps to test contacts for exposure.
“We were lucky it wasn’t worse,” said Laura Ann Nicolai, deputy state epidemiologist and head of the tuberculosis control program.

Airborne Bacteria

TB is an airborne infectious disease caused by bacteria that spreads through the air, person to person, when someone coughs or sneezes. One in three people worldwide have latent TB, according to the World Health Organization. In the United States, up to 13 million people have been exposed to TB and could develop the disease.
Every year, tuberculosis claims 1.5 million lives worldwide and 500 to 600 in this country.
In the United States, Asians have the most cases and the highest rate of disease — 17.9 out of 100,000 persons. The top five countries of origin for foreign-born TB patients are Mexico, the Philippines, Vietnam, India and China.
Immigrants and refugees are screened for TB and treated before entering the United States. Tourists, students and temporary workers are not screened. The CDC does not recommend across-the-board screening for everyone entering the United States, the CDC’s LoBue said.
Because TB hits some ethnic and racial groups harder than others, TB patients can face discrimination and social isolation. Public health officials worry about finding ways to target high-risk populations with TB education and treatment without stigmatizing those groups.
“Given the stigmatization of TB, our ability to do targeted interactions is limited,” said Dr. Jeffrey Starke, a pediatric tuberculosis physician at Texas Children’s Hospital in Houston. Starke is a member of the federal Advisory Council for the Elimination of Tuberculosis, which makes policy recommendations. “We’ve got to find a nonpejorative way to do it so others don’t perceive discrimination,” he said.

Going in the Wrong Direction

State and local health departments are the front line of defense for a disease that many think has already been eradicated. In the late 1800s and early 1900s, TB was a leading cause of death in this country and Europe. With no cure for the disease, patients were urged to “go west.”
More people flocked to Colorado as TB patients looking for dry air and sun than stormed the state as prospectors during the gold rush. Among them: Doc Holliday, friends with gunslinger Wyatt Earp and a participant in the shootout at the O.K. Corral.
“Colorado historically has been on the forefront of TB work,” said Dr. Robert Belknap, director of the Denver Metro TB program. “At the turn of the century, one-third of the state was here because of TB — seeking care for themselves or family members,” he said.
Some of Colorado’s first hospitals were TB sanatoriums, later closed and repurposed. Local and state support for TB prevention and control remains strong in Colorado, said Belknap, president of the National Tuberculosis Controllers Association.
Today four states — California, New York, Texas and Florida — have more than half the nation’s active TB cases, though they have only a third of the country’s population. The four states have the highest numbers of foreign-born residents. The number of cases in Texas rose 5 percent to 1,334 last year.
“We’re clearly going in the wrong direction,” Starke said.
He pointed out that TB is “a social disease with medical implications” because living conditions put someone at risk. TB is associated with poverty, overcrowding and being born outside the United States.
California, with 2,137 cases in 2015, has more than one in five of the new U.S. cases each year and a TB rate nearly twice the national average. Its TB prevention and control program is the nation’s largest — a $17.2 million annual budget split roughly in half between federal and state general funds, and a 40-person central office staff that works with TB contacts in the state’s 61 local health jurisdictions.
In addition to state TB control efforts in California, local health department programs in the counties of Los Angeles, San Diego and San Francisco also receive federal TB control grants from the CDC. Those grants total $7.7 million this year.
About 2.5 million people are infected with TB in California, but most don’t know it, said Dr. Jennifer Flood, chief of California’s TB control program.
While California has several programs aimed at latent TB, she said, “Smaller states are often challenged to test and treat latent TB” because they lack the resources.

Labor Intensive Treatment

Treating TB patients is labor intensive. To ensure that TB patients complete the course of drugs that lasts six months or longer, Directly Observed Therapy programs require a health care worker — not a family member — to watch patients with active TB swallow every dose. If a patient cannot get to a clinic, a health care worker goes to the person’s home. The worker monitors patients for side effects and other problems.
Care also involves communication and cultural challenges. In Michigan, where the number of active TB cases rose from 105 in 2014 to 130 last year, the health department reaches out to Detroit’s large Arab and Bangladeshi populations. In other parts of the state, Burmese immigrants have different needs, said Peter Davidson, Michigan TB control manager.
“Some local health departments have strong partnerships with translation services. Some rely on a less formal mechanism — a private physician or someone on staff at the hospital who speaks the language,” Davidson said.
The cost of treating an active TB case that is susceptible or responsive to drugs averages $17,000, according to the CDC. Care of patients with drug-resistant TB, which can result from taking antibiotics prescribed before TB was properly diagnosed, costs many times more: $134,000 for a multidrug-resistant patient and $430,000 for an extensively drug-resistant one.
Advocates say TB suffers from a lack of urgency and funding.
“TB isn’t as exciting a topic because it’s been around so long. It doesn’t get as much attention as Ebola and Zika, and its advocates aren’t as active as those for HIV/AIDS,” said Belknap. “We’re jealous.”
The federal Tuberculosis Elimination Act, the chief federal funding for TB programs, is authorized at $243 million a year but has received an appropriation of far less for the last several years — $142 million this year, for example.
Most of the money goes to the 50 states, the District of Columbia, 10 major cities and eight territories in grants under a formula based on the number of cases, their severity and other factors. The grants are used to pay salaries for nurses, doctors and epidemiologists, as well as for education and outreach services. Treatment costs are paid by insurance, Medicaid and state and local governments.
Funding at the authorized level could support research on a vaccine and better drugs and treatment of more cases of latent TB, advocates say. For now, no TB vaccine is approved for use in the United States. The medicines that cure TB and brought down the disease rate were developed in the mid-20th century. They require months of treatment and can have serious side effects, including hearing loss. A promising new drug may be able to prevent TB with only 12 doses over three months.
“The tools we have are inadequate,” Belknap said. “It’s a federal and a global problem.”

A Story of Success

In many ways, though, the story of TB prevention and treatment in the United States is one of success.
“We often say we’re our own worst enemy,” said Donna Wegener, executive director of the National TB Controllers Association. “We had such success in reducing TB after the resurgence in the 1990s that people think we don’t need additional dollars.”
Patients with diabetes, cancer and especially HIV infection are more likely to contract active TB because their immune systems are less able to fight off TB germs. During the HIV/AIDs epidemic, from the mid-1980s to the early 1990s, the number of TB cases jumped by 19 percent. From 1992 to 2014, the number of cases dropped 65 percent.
There were nearly as many cases of Lyme disease in Pennsylvania in 2014 (7,457) as there were TB cases in the United States (9,406).
But, Wegener said, “If we were reporting 10,000 new cases of polio a year in the U.S., that would be unacceptable. It’s criminal that we are OK with 10,000 cases of TB.”
Among those infected in the early 1990s was a young physician who volunteered to treat TB patients at a clinic in New York City. He tested positive for exposure but his latent TB did not progress to active disease. Tom Frieden now is director of the CDC, leading the fight against TB.

'Healthy' and 'natural' with a side of skepticism -- May 12, 2016 column


After hiking in a beautiful Virginia state park last weekend, friends gathered around a picnic table. As we unpacked our lunches -- virtuous sandwiches on whole wheat and righteous chips of kale and quinoa -- Doug pulled out a bag of trail mix.

“Healthy,” the bag proclaimed in big print. Doug read the small print and frowned.

“How can this be healthy?” he demanded. “It’s got chocolate in it.”

No worries, his pals said. Chocolate is now OK – dark chocolate, anyway. Doug was unconvinced.

“Anybody want chocolate?” he asked.

We’ve all had that moment of feeling misled upon reading the fine print on an ingredient label. What we grabbed off the store shelf, lured by the promise of “healthy” or “natural,” turned out to be loaded with sugar or additives.

The Food and Drug Administration announced Tuesday it will review the definition of “healthy”; it’s already examining what it means to be “natural.”

The process of formulating new rules takes years. So we consumers need to accept the things we cannot change. Think of claims on packaged foods as puffery. Period.

The criteria the FDA uses to judge what’s “healthy” are antiquated. Under guidelines first adopted in the 1990s, canned soups, fat-free puddings and sugary cereals qualify, but not plain almonds, avocado and salmon.

This craziness happened because back then fat was Public Enemy No. 1. 

To be "healthy," a food could have 1 gram or less of saturated fat per serving and no more than 15 percent of calories from saturated fat. It also had to meet criteria in sodium, cholesterol and nutrients such as calcium and vitamin C. Sugar wasn’t even considered. Food science has moved on, and we now know there are good fats, like those in nuts and salmon.

In March 2015, the FDA sent Kind LLC a warning letter, saying it had to stop using the word “healthy” on four of its popular fruit-and-nut bars because the products had too much fat.

Kind fought back, filing a citizen petition with FDA, arguing that the agency should have rules that are consistent with current nutrition science as set forth in the 2010 Dietary Guidelines. Last month, FDA agreed and said Kind could use “healthy and tasty” on its packages as the agency reviews the definition.
The kerfuffle was great publicity for Kind, which had to change none of its ingredients. CEO and founder Daniel Lubetzky praised FDA for being “very, very open to listening” and for beginning the conversation to update the rules.

Here’s how Marion Nestle, New York University food science and nutrition professor and author of “Food Politics: How the Food Industry Influences Nutrition and Health,” assessed the situation on her Food Politics blog:

 “The terms `healthy’ and `natural’ help to sell food products. They are about marketing, not health. This makes life difficult for the FDA, which has the unenviable job of defining what the terms mean on food labels.”

Until the 1980s, companies were prohibited from touting foods as a possible way to reduce disease. In 1984, the Kellogg Company, maker of All-Bran cereal, and the National Cancer Institute began spreading the word that a low-fat, high-fiber diet could help reduce the risk of colon cancer. The FDA did not object because the statement was true, Clare M. Haskel wrote in the Journal of Nutrition.

Soon, though, unsubstantiated health claims flooded the market, and in 1989 Business Week magazine ran a cover story, “Health Claims for Foods are Becoming Ridiculous.” Congress passed the Nutrition Labeling and Nutrition Act of 1990, which allows health claims only with FDA approval.

FDA created a system for evaluating foods and has tried to keep consumers informed, but the messages are often confusing.

Chocolate, for example, has been shown in some studies to have antioxidant potential and may lower cholesterol, but its high calorie, sugar and fat content can lead to tooth decay and obesity.

Hardly a day passes without new guidance about what to eat -- or avoid eating -- to stay healthy. The ever-changing advice is frustrating, but one thing is clear:

“When it comes to food labels, `healthy’ and `natural’ are marketing terms,” says Nestle. “Their purpose is to sell food products. Caveat emptor.” 

(c)2016 Marsha Mercer. All rights reserved.

Thursday, May 5, 2016

Hillary meets coal reality -- May 5, 2016 column


When Hillary Clinton went to coal country Monday, she ran smack into a wall of anger – and it wasn’t built by Donald J. Trump.

Clinton built it herself, word by word.

Like most politicians, Clinton tries to please everyone all the time, tuning her pitch to different audiences. Once in a while, though, real life intervenes, as it did in Williamson, West Virginia. 

While hundreds of protesters outside shouted “We want Trump” and “Go home, Hillary,” Clinton talked with local people, among them Bo Copley, a 39-year-old father of three who recently lost his job as a coal mine foreman and maintenance planner.

Copley handed Clinton a picture of his family and quietly asked:   

“How can you say you’re going to put a lot of coal miners out of jobs and then come in here and tell us how you’re going to be our friend? Because those people out there don’t see you as a friend.”

In March at a CNN town hall in Ohio, Clinton had said, “We’re going to put a lot of coal miners and coal companies out of business.” Understandably, many in coal country are still livid.

“What I said was totally out of context with what I meant,” Clinton said in Williamson, blaming herself for her “misstatement.”

Clinton’s views on coal and climate change matter because West Virginia’s primary is Tuesday.

Before he wrapped up the Republican nomination, Trump won many hearts with promises to end President Barack Obama’s “war on coal” and bring back the coal industry and coal jobs.

Politicians have been talking about helping Appalachia since John F. Kennedy traversed West Virginia in 1960, but the region still struggles. Clean energy may be America’s future, but, as Copley reminded Clinton, real people are suffering in the transition.

In 2008, Clinton sailed to victory over Obama in the West Virginia primary. Now, Bernie Sanders, who continues his uphill fight for the Democratic nomination, leads her 45 percent to 37 percent in the state, with 18 percent of voters undecided, a Public Policy Polling survey released Tuesday found.

Clinton was narrowly ahead among Democrats, but Sanders held a commanding advantage among independents. Independents – about 20 percent of the state’s electorate -- can vote in either primary.

How Clinton came to eat her words reflects a risk politicians face when trying to be all things to all people.

Asked in March to make her case to poor whites who vote Republican, Clinton said she was the only candidate with a plan to bring economic opportunity to coal country with clean renewable energy after coal miners and companies were out of business.

She talked about uniting the country but referred to miners as “those people.”

“We’re going to make it clear that we don’t want to forget those people. Those people labored in those mines for generations, losing their health, often losing their lives to turn out our lights and power our factories.

“Now we’ve got to move away from coal and all the other fossil fuels, but I don’t want to move away from the people who did the best they could to produce the energy that we relied on,” she said then.

Clinton wants to expand President Obama’s Clean Power Plan, tough new Environmental Protection Agency regulations aimed at curbing coal consumption. The Supreme Court has put the regs on hold, pending review.

Her $30 billion plan to revitalize coal country includes preserving miners’ pensions and benefits and spending more money for roads and bridges and economic development.

She even says she’ll bring her husband out of retirement and put him in charge of helping coal country. Bill Clinton won West Virginia in the 1992 and 1996 general elections – something no Democratic presidential nominee has done since.

But times have changed. The former president was booed and heckled May 1, in Logan, W.Va.

“I came here to tell you that I care about what you’re going through,” he said. “I get it.”

Tuesday’s vote will be a test of the old Clinton magic.

The Facebook page for the West Virginia for Bernie Sanders group invites Hillary Clinton’s supporters to join, saying: “We’ve been waiting for you.”

©2016 Marsha Mercer. All rights reserved.