Friday, November 06, 2020

RACIST AMERICA

Black patients with RA less likely to receive biologic, more likely to get glucocorticoids

AMERICAN COLLEGE OF RHEUMATOLOGY

ATLANTA -- A new study reveals that Black patients with rheumatoid arthritis (RA) were less likely to be prescribed a biologic treatment and more likely to use glucocorticoids, which carry a risk of serious long-term side effects. This study highlights ongoing racial disparities in the care of patients with rheumatic disease. Details of the study was shared at ACR Convergence, the ACR's annual meeting (RA is the most common type of autoimmune arthritis. It is caused when the immune system (the body's defense system) is not working properly. RA may cause pain and swelling in the joints as well as affect multiple organ systems such as the lung and eye. RA is treated with disease modifying anti rheumatic drugs, including biologics, to help stop joint pain and swelling, and also prevent joint damage. "

Racial disparities in access to care and effective treatment regimens are poorly understood in the RA population, but past research shows that non-white RA patients have a lower frequency of biologic use versus white patients, even when accounting for comparable disease activity and access to treatment. This new study looked at racial disparities in RA treatment and emergency department use in patients with RA at a single, tertiary academic center in Pennsylvania.

"With the explosion of effective therapies for rheumatoid arthritis, it is particularly important to make sure that we are treating patients in the best way possible," says the study's co-author, Michael George, MD, MSCE, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania. "Variability in practice, and disparities in treatment, suggest that there is room for significant improvement. We hope that this study will add to the existing literature about disparities in rheumatoid arthritis care-understanding why they exist and finding ways to address them are key to improving the health of patients with RA."

The study used electronic health record data from 1,831 patients with RA from 2010 to 2018. Patients had at least two RA diagnoses from a rheumatology outpatient encounter and at least one prescription of a disease-modifying antirheumatic drug (DMARD) during the follow-up period, or from their first to their last clinic visit. The researchers also measured patient demographic information, medication use and comorbidities at the baseline visit and at any point during the follow-up period.

The researchers then compared the differences in patient characteristics and visits between Black and white patients. Of the 1,831 patients in the study, 82% were female, 35% were Black, 54% were white and the mean age was 55. The average follow-up period for all patients was 6.97 years. Black patients were more likely to be older, have a higher body-mass index (BMI), were former or current smokers and had higher rates of cardiovascular disease and diabetes.

The researchers found racial disparities in how RA was treated with prednisone and conventional synthetic DMARD treatments used significantly more often in Black patients than whites: 79.3% of Black patients used prednisone compared to 69.1% of whites, and 96.7% of Black patients used a conventional DMARD compared to 93.5% of whites.

Additionally, white patients in the study were significantly more likely to use a biologic, a more advanced, expensive, and effective treatment for controlling RA disease activity and preventing joint damage. According to the data, 74% of whites and 67% of Blacks were prescribed a biologic drug. Black patients also had significantly more visits to the hospital emergency department (ED) over the eight-year period.

"This project supports prior work showing reduced use of biologics and a greater use of prednisone in patients who were Black - which could potentially mean worse outcomes or increased steroid side effects in this group," says Dr. George. "A key next step that many are working on is understanding the key drivers of these disparities - understanding why they exist (e.g., access to medications, insurance, patient-provider communication, health beliefs, etc.) is important so we know how to address these disparities."

ABSTRACT:

Characterization of Racial Disparities in Rheumatoid Arthritis Treatment Choice and Location of Care

Background/Purpose:

Racial disparities in access to care and treatment regimens exist but remain poorly characterized in the rheumatoid arthritis (RA) patient population. Previous studies using the Ethnic Minority RA Consortium (EMRAC) have demonstrated non-Caucasian RA patients have a lower frequency of biologic use versus Caucasian patients despite controlling for comparable disease activity and access to treatment. Here we explore longitudinal racial disparities in rheumatoid arthritis treatment and emergency department (ED) use in a single tertiary academic center.

Methods:

Structured de-identified data from 2010-2018 of patients who had at least two diagnoses of RA from a rheumatology outpatient encounter and at least one DMARD script during the follow-up period were extracted from the electronic health record of a single tertiary care center. Follow-up was measured from each patient's first visit to each patient's last visit within the 2010-2018 timeframe. Patient demographics were measured at the baseline visit, with medication use and comorbidities measured at baseline or at any point during follow-up. The average number of outpatient visits and ED visits per year (limited to ED visits within the health system) during follow-up were also measured. Differences in patient characteristics and visits were compared in patients who were Black versus white based on standard t-test and χ2 analysis.

Results:

A total of 1831 patients with rheumatoid arthritis were identified from 2010-2018. Baseline demographics were measured at each patient's first visit and include mean [SD] age, 55.05 [14.47] years; 1499 [81.87%] female; and 991 [54.12%] white. Average [SD] duration of follow-up for all patients was 6.97 [2.28] years. Comparing black (n=639) and white (n=991) patient demographics, significant findings include that black patients were more likely to be older, have higher BMI, former or current smoking status, and have higher rates of diabetes and cardiovascular disease (p< 0.0001). Prednisone and csDMARD use were significantly more frequent in black patients compared to white patients (79.3% vs 69.1% p< 0.0001; 96.7% vs 93.5%, p=0.005, respectively). Biologic use was significantly more common among white patients compared to black patients (white 74.3%, black 67.0% p=0.001). In terms of site of care delivery, black patients had significantly more ED visits, with a median 0.24 ED visits per patient per year versus 0.00 for white patients. A summary of the findings are shown in Table 1.

Conclusions:

Patients who were black were less likely to receive a biologic and more likely to use glucocorticoids. ED visit use was higher in black patients, which could be related to higher rates of comorbidities, although differences in geographic location could also influence whether patients visited an ED or saw non-rheumatology providers within or outside the health system. Further studies identifying drivers of racial disparities in access to care and outcomes are needed.

Black patients with lupus have three times higher risk of stroke

AMERICAN COLLEGE OF RHEUMATOLOGY

Research News

ATLANTA -- New research reveals that, in the U.S., Black patients with lupus have a threefold higher risk of stroke and a 24-fold higher risk of ischemic heart disease. The study also found several lupus-specific symptoms that predict stroke and IHD in these patients. Details of the study was presented at ACR Convergence, the American College Rheumatology's annual meeting (ABSTRACT #0433).

Systemic lupus erythematosus, also called lupus or SLE, is a chronic disease that causes systemic inflammation affecting multiple organs, such as the skin, joints, kidneys, the tissue lining the lungs (pleura), heart (pericardium) and brain. Many patients experience fatigue, weight loss and fever. The disease is more common among Black, Asian, and Native American people and tends to be worse in these groups.

Black people with lupus have a 19-fold higher occurrence of cardiovascular disease compared to other groups and have a disproportionately higher number of stroke-related events around the time of lupus diagnosis. Researchers wanted to know more about the specific risks and predictors of stroke and ischemic heart disease in Black people with lupus.

"The risk for developing cardiovascular disease is up to 52 times higher in patients with lupus, compared to patients without lupus. Black populations have three times higher risk to develop lupus, develop it at a significantly younger age and have more severe disease. However, most prior lupus and cardiovascular disease (CVD) studies were conducted in predominantly white cohorts, limiting the generalizability of the findings," says the study's co-author, Shivani Garg, MD, MS, Assistant Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. "It's important to quantify the risk, predictors and timing of stroke and ischemic heart disease in Black people with lupus in order to guide early CVD diagnosis and preventive interventions in this at-risk population." The study highlights the need for aggressive heart disease preventive care to reduce these racial disparities and improve lupus outcomes, particularly in recently diagnosed patients, she adds.

The researchers collected data from the Georgia Lupus Registry of lupus patients from Atlanta. They identified patients from 2002 to 2004 who met four or more of the ACR's SLE criteria or three criteria with a final lupus diagnosis by their own rheumatologist. They matched the patients to the Georgia Hospital Discharge Database and National Death Index from 2000 to 2013. Stroke and ischemic heart disease-related hospitalizations and deaths were based on hospital admission and death medical codes. Transient ischemic attacks were included in the stroke data, and myocardial infarction (heart attack) and angina were included in ischemic heart disease data. The researchers also examined symptoms that predicted strokes and ischemic heart disease. Of the 336 lupus patients included in the final study, 87% were female, 75% were Black, and the mean age at diagnosis was 40.

They found 38 stroke-related and 25 ischemic heart disease -related health events or deaths that occurred from two years before to 14 years after a lupus diagnosis. In the 11% of patients who had strokes, the mean age at first stroke was 48, and 78% of the strokes occurred in females. Ninety percent of the strokes occurred in Black patients. The peak number of strokes happened in the second year after lupus diagnosis. The study also showed that 8% of the patients had ischemic heart disease, and their mean age at diagnosis was 52. All the ischemic heart disease cases occurred in females, 96% occurred in Black patients and the peak number of cases occurred in the 14th year after diagnosis with lupus. All in all, the data showed that Black patients with lupus have a threefold higher stroke risk and a 24-fold higher ischemic heart disease risk than other groups.

What about potential predictors of stroke or ischemic heart disease? Discoid rash at the time of lupus diagnosis predicted a five-fold higher risk of stroke, while renal disorder at the time of lupus diagnosis predicted a two-fold higher stroke risk. Neither discoid rash nor renal disorder predicted ischemic heart disease, however. Strong predictors of ischemic heart disease were neurologic disorders (prior psychosis or seizure) and immunologic disorders (anti-DNA, anti-Sm, or antiphospholipid antibodies), but these did not predict strokes.

These findings highlight significant racial disparities in both stroke and ischemic heart disease among patients with lupus, says Dr. Garg.

"Our study increases awareness of higher risk, the timing of accelerated risk and disease presentations that contribute to higher risk of stroke and ischemic heart disease among Black patients with lupus. Such knowledge can help patients and providers look for and diagnose CVD events earlier and discuss starting preventive care to reduce their risk," says Dr. Garg. "Timely interventions could help reduce cardiovascular disparities in lupus and reduce CVD-related morbidity and mortality in young lupus patients, who are at relatively higher risk of premature CVD."

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About ACR Convergence

ACR Convergence, the ACR's annual meeting, is where rheumatology meets to collaborate, celebrate, congregate, and learn. Join ACR for an all-encompassing experience designed for the entire rheumatology community. ACR Convergence is not just another meeting - it's where inspiration and opportunity unite to create an unmatched educational experience. For more information about the meeting, visit https://www.rheumatology.org/Annual-Meeting, or join the conversation on Twitter by following the official hashtag (#ACR20).

About the American College of Rheumatology

The American College of Rheumatology (ACR) is an international medical society representing over 7,700 rheumatologists and rheumatology health professionals with a mission to empower rheumatology professionals to excel in their specialty. In doing so, the ACR offers education, research, advocacy and practice management support to help its members continue their innovative work and provide quality patient care. Rheumatologists are experts in the diagnosis, management and treatment of more than 100 different types of arthritis and rheumatic diseases.

ABSTRACT:

Racial Disparities and New SLE-Specific Predictors of Stroke and Ischemic Heart Disease in Patients with Lupus

Background/Purpose:

In the US, cardiovascular disease (CVD) is the leading cause of disparities in life expectancy between black and white populations. We recently reported a 19-fold higher occurrence of CVD in blacks with SLE compared to non-blacks and noted disproportionately high stroke-related events around the time of SLE diagnosis. This study measured the risk and predictors of stroke and ischemic heart disease (IHD) in a predominantly black, population-based, incident cohort.

Methods:

The Georgia Lupus Registry (GLR) is a population-based registry of SLE patients from Atlanta, Georgia. Incident patients in 2002-04 met ?4 ACR SLE criteria or 3 criteria with a final diagnosis of SLE by their board-certified rheumatologist. Patients were matched to the Georgia Hospital Discharge Database and National Death Index from 2000-13. Stroke- and IHD-related hospitalizations and deaths were classified by the first three admission or cause of death codes. Stroke also included transient ischemic attack, and IHD included myocardial infarction and angina. Predictors of strokes and IHD were examined using Cox proportional hazards models.

Results:

Among 336 incident SLE patients, 87% were female, 75% were black patient with a mean age at SLE diagnosis of 40 ± 17 years. There were 38 stroke-related and 25 IHD-related events or deaths, from the period 2 years before through 14 years after SLE diagnosis.

In the 11% with strokes, the mean age at first stroke was 48 years, with 78% occurring in females and 90% in blacks. The peak number of strokes occurred during the 2nd year after SLE diagnosis. We noted 8% had IHD, the mean age at first IHD was 52 years, with all occurring in females and 96% in blacks. The peak number of IHD occurred in the 14th year after SLE diagnosis.

Blacks had a 3-fold higher risk for stroke (HR 3.4, 95% CI 1.2-10, p 0.03) and a 24-fold higher risk for IHD (HR 24, 95% CI 3-206, p 0.004) (Table 1 & 2). Discoid rash at SLE diagnosis predicted a 5-fold (HR 4.6, 95% CI 1.7-13, p 0.003) and renal disorder predicted a 2-fold higher risk for stroke (HR 2.4, 95% CI 1.1-2.5, p 0.04) (Table 1). Neither impacted IHD (Table 2). Neurologic (HR 4.0, 95% CI 1.3-13, p 0.02) and immunologic disorder (HR 4.7, 95% CI 1.3-18, p 0.02) (Table 2) were strong predictors of IHD but not stroke.

Race stratified Cox proportional hazard models showed significantly accelerated stroke and IHD events in black compared to non-black patients (p ? 0.001) (Figure 1A & B).

Conclusions:

We found a 3-fold higher risk of stroke and 24-fold higher risk of IHD in blacks with SLE. We found different SLE-specific predictors of stroke and IHD: discoid rash and renal disorder predicted stroke, and neurologic and immunologic disorder strongly predicted IHD. This study provides unique insights on significantly different SLE-disease related predictors, timing and racial disparities in stroke compared to IHD in SLE. Hence, we highlight the need to consider different preventive strategies for stroke and IHD in SLE

About ACR Convergence

About the American College of Rheumatology

U.S. Peace Activists Castigate Those Vilifying China

China Daily

Editor Li Jiayao

Nov 2 2020 - Anti-war organizations in the US are calling on politicians to end what they say is aggression toward China that "feeds anti-Asian attacks at home and a cold war abroad".

"The US is waging a cold war against China that could lead us to a real war resulting in unbelievable harm to the people in both countries and the world," said Julie Tang, co-founder of Pivot to Peace, an organization dedicated to advocating US-China peace.

Despite the "futility of the trade war which harmed Americans more than China", the US administration continues "information warfare as a tool to manufacture consent from the public for a full cold war against China", Tang told the audience at a webinar hosted by Code Pink, a grassroots organization working to end what it says is US militarism.

The anti-China tactics of the US administration include employing tools of economics and the law, diplomatic maneuvers, a military buildup in the South China Sea, support for "color revolutions" in Hong Kong and Xinjiang and attacks on Chinese students and scholars in the United States, she said.

"This kind of confrontation has an equally dangerous and harmful effect on America and Americans, and especially on Chinese Americans," said Tang, a retired judge of the San Francisco Superior Court. "We have seen a level of racism that has not been seen in the last 50 years."

From about 2018 US mainstream media started running articles that painted China "in an extremely negative light", she said.

"What they said about China is a very different China that I know and personally experience." When the pandemic started and US President Donald Trump used the term "China virus", the US public was "sufficiently prepped to blame China and impliedly consented to a cold war with China", she said.

To help end the conflict with China, Code Pink is petitioning the Democratic vice-presidential nominee Kamala Harris, a California senator, to stand with Asian communities throughout the US and push the Joe Biden team to recognize that "China is not our enemy".

The document garnered more than 1,200 signatures, mostly non-Chinese names, in just two days.

"It is clear people don't want racism in the United States," said Jodie Evans, co-founder of Code Pink, adding that Americans should "do better on knowing who the Chinese are before we start to hate them".

The organization has also partnered with groups such as Pivot to Peace and Veterans For Peace to launch a webinar series called "China Is Not Our Enemy" with the aim of "dismantling the US White House led anti-China rhetoric".

Not overextending

China is a civilization that simply maintained itself within its natural limits and it did not overextend itself by world-conquering campaigns as other empires did, said Michael Wong, vice-president of Veterans For Peace's Chapter 69 in San Francisco.

"World conquests would eventually lead to its downfall. And the dilemma that the United States finds itself in, trying to extend power all around the world, demonstrates the wisdom of the Chinese strategy."

China "has really set a standard "in dealing with the COVID-19 pandemic, Tang said. "Our COVID-19 cases are surging every day, while the economy is still in a standstill. Meanwhile, China's economy is surging ahead of other major economies … Furthermore, the United States is still reliant on government stimulus to save the economy; China's economy rebounds on a strong foundation of industrial production and retail sales."

Especially in the area of developing COVID-19 vaccines, Americans should demand that the government start to work with China, Tang said.

"China is very advanced in biomedicine and advanced in all kinds of technologies, so exchanges between the two countries in those areas can greatly benefit both countries."

Book Review: Jodi Dean's 'Comrade'

Photo: The Young Communist League, 1929. (Afro American Newspapers / Gado / Getty Images)

By Corey Robin

The Nation

...In Ernst Lubitsch’s 1939 film Ninotchka, three Soviet officials are sent to Paris on a mission. But instead of doing the work, they’re bewitched and bourgeoised by the City of Lights. They drink, they dance, they stay out late. Moscow dispatches an envoy to set the rogues straight. They anxiously await the envoy’s arrival at the train station. When they discover the envoy is a striking woman nicknamed Ninotchka (played by Greta Garbo), they’re enchanted. A “lady comrade!” one exclaims. But Ninotchka is not amused. “Don’t make an issue of my womanhood,” she tells them. “We’re here for work, all of us.”

That struggle—between an identity based on gender (or nation, race, or class) and the solidarity of doing the work—is at the heart of Jodi Dean’s Comrade. One of the most innovative and imaginative political theorists on the contemporary scene, Dean uses this scene in Ninotchka and a thoughtfully curated library of other texts, from the writings of the Soviet avant-garde to oral histories of the Black Belt, to argue for a communism that is stringent yet pleasurable, joyous yet disciplined. Like Ninotchka, Dean’s here for the work. Like Lubitsch, she makes it fun.

Comrade is part of a trilogy of texts Dean has written over the past decade on the political theory of communism. In The Communist Horizon, she identified the transcendence of capitalism as the ambit of the left’s actions. In Crowds and Party, she located those actions in the party form. In Comrade, she examines the relation between members of the party. That relation creates two force fields. The first lies between members of the party, where a regulative ideal of being a “good comrade” not only governs the actions of each but also binds the actions of all. That binding creates a massive amount of power, which then projects a second force field—against the agents and institutions of capitalism that comrades seek to overthrow. The attraction of the first force field is necessary for the repulsion of the second. Seasoned union organizers know the truth of these force fields all too well; as Dean shows, so did anti-communists like George Orwell. Yet it is a truth many on the left ignore or evade. “If the left is as committed to radical change as we claim,” Dean insists, “we have to be comrades.”

All politics require a space—a place where people can assemble, deliberate, and if necessary, move—and domains of action, which may include the economy, religion, sexuality, health, and more. What makes comrades unique is that it is the relationship among them that creates both types of space: where they assemble and what they assemble for. The word “comrade,” Dean explains, “derives from camera, the Latin word for room, chamber, and vault.” (Much like “cadre,” from the Latin quadrum, or square.) Rooms and vaults can be identical and easily reproducible. They provide cover or shelter. They differentiate those within from those without. Comrades create all of these effects by their affect, “a closeness, an intensity of feeling and expectation of solidarity,” and by their activity. Whereas work in a capitalist society is sustained by the coercion of the market, the work of comrades is powered by their commitment to one another, which derives from their close quarters (psychically speaking) and their commitment to the task at hand. The two commitments are mutually reinforcing. “One wants to do political work,” Dean writes, because of one’s attachment to one’s comrades, and one is attached to one’s comrades because one wants to do the work.

Yet comradeship exceeds those affects and attachments. It must, for our sympathies are momentary, our purposes inchoate. Sometimes we fly to the assemblies, ready to do the work of the collective; other times, we laze about at home, succumbing to other desires or hesitation about our aims. Comradeship turns longing into intention and sustains that intention after the originating rush has dissipated. Comradeship extends the life of the crowd. It fulfills the function that labor historians have ascribed to the best union bureaucracies, which prolong solidarity after the strike, and that Arendt ascribed to constitutions, which institutionalize the aims and ambitions of the revolutionary moment after that moment has ceased. Comradeship does that work without the law or the state. It is instead an “ego ideal,” to use Dean’s Freudian language, maintained by the comrades themselves.

That attempt to create a political space without relying on the law or the state is where we find the most intense unity of the ancients in all their outwardness and the moderns in all their inwardness. It is also where communism—and left politics in general—is most vulnerable to criticism and complaint.

The effort of comrades to create and sustain a public space entirely through the psychic mechanisms of the ego ideal puts tremendous, almost inhuman pressure on them and their work. Without the customary supports of public life—whether the institutions of the state (after communism comes into power is a different story) or familiar sources of identity and attachment—comrades must ensure that each and every waking hour of their lives is dedicated to the common work of comrades. It is a demanding and unforgiving ideal, for much is at stake in any one person’s withdrawal from it. Yes, the work is performed in common with comrades, and the force field between them is mighty in its effects. Yet the force field is vulnerable to the competing energy of other forms of identification and attachment.

Our other identities and attachments don’t simply disappear because the comrade declares them gone. They constantly clamor for our attention. Conversely, if those identities and attachments don’t sap the comrade of her energy and commitment, they may become all too tempting substitutes for the true work of comradeship. How many communists and leftists have taken this shortcut, forsaking political argument for simpleminded appeals to a worker’s identity or to national citizenship or gender or ethnic affiliation as the basis for action? How many activists have spoken those words of promise and threat—“You’re one of us”—that are so resonant in families yet so dangerous to politics? Tribalism comes in many varieties, and it would be foolish to think the comrade is not immune to its calls.

That moment of Ninotchka’s arrival in the Paris train station offers Dean another instructive mise-en-scène. As the three Soviets scan the platform, wondering who the comrade from Moscow might be, they spy a passenger who fits their expectations. They’re just about to extend a welcome when the passenger greets someone else, with a salute of “Heil Hitler.” The Soviets freeze. “That’s not him,” one of them says. Their mistake is productive for Dean. They’re assuming the comrade is a specifiable type—a gender, a face, a look—but comrades are “generic”; they don’t look like anyone or anything. They don’t have a specific identity. Comrades can be anybody, though not, Dean adds wryly, with a nod to that fascist, everybody. Anybody can do the work, and anyone who does the work will enjoy the solidarity of comrades. “We don’t even need to know each other’s names,” an activist tells her. “We’re comrades.”

The solidarity of political work is not a subject well examined in the canonical literature of politics—Weber, one of the few theorists to think about politics as work, focused almost exclusively on charismatic leaders, not collectives—but it is a concern of vital interest to the left. Socialists of varying stripes have often looked to the workplace (or warfare) as laboratories of solidarity. So taken by the coordinated nature of modern work were the Saint-Simonians, for example, that they designed vests with buttons in the back so that no one could dress without the cooperation of others. In the physicality of concerted labor, many a socialist has caught a glimpse of a more solidaristic future.

Dean’s model derives from neither the workplace nor warfare but from the political work and testimony of communists themselves, which yields an eclectic blend of voices—part republican, part romantic. On the basis of that testimony, she concludes that comradeship enables us to take on the perspective of others, to see our actions “through their eyes,” which “remakes the place from which one sees.” That enlarged perspective has been the calling card of thinkers ranging from Rousseau and Kant to Arendt and Habermas. Whereas these thinkers often find that perspective in the legislative institutions of the state or the organs of public opinion or the heroic moments of civic action, Dean locates it, as does Gornick, in the slow boring of hard boards, in the work of politics that escapes the limelight but where comrades dedicate themselves to a task and hold themselves accountable to its completion.

Through that work, comrades can come to experience the joy of collective action and the enjoyment of one another. The joy is so intense that it spills onto other entities. Drawing on the work of artists and writers from the early Soviet avant-garde, which she compares to the poetry of Whitman, Dean describes an extension of ecstasy to “comrade objects” and “comrade things.” When the “love and respect” among comrades is “so great that it can’t be contained in human relations,” it “spans to include insects and galaxies (bees and stars).”

Up to the 1990s, Dean’s commitment to the generic nature of the comrade would have raised the hackles of those in the liberal center and on the right, who would have seen it as a threat to the individual. Today, it will press buttons for some on the left, who will see it as a challenge to the claims of certain forms of identity. The comrade, Dean insists, seeks to equalize relationships across race, class, nation, religion, ethnicity, and gender. It creates a sameness, the sameness of those who are doing the work.

The only difference that remains salient is between those who are on one side of the struggle and those who are on the opposite side. The mobility of that metaphor—of being on one side or the other—allows Dean to insist on forms of affiliation and attachment that are neither identitarian nor exclusive. Anyone can be a comrade; all one has to do is move to the other side. Though this quote from a Washington Post report on the Bernie Sanders campaign arrived too late for Dean to use, it offers a helpful instantiation of her claim: “Sanders is a candidate who presents himself less as a personality than a conduit for a movement. And in the Bernie bubble, [Alexandria] Ocasio-Cortez is seen as the future of the movement embodied. What makes her so effective as a surrogate, beyond her star power, is that if you campaign on electing a movement rather [than] a person, there’s no difference between hearing the message from the 78-year-old white male candidate or his 30-year-old Latina supporter.”

The comrade, Dean makes clear, is not a description but an ideal. Comrades do not eliminate gender or race or conflicts. But what they can do is name a common horizon; they can state a destination to which they are collectively heading, an aim toward which they are working. Comradeship is the announcement of another way of being: not one in which difference is eliminated but in which it becomes the stuff of political art, of mediating conflicts in order to do the work for which all have come. Though it is anarchists who are best known for emphasizing the prefigurative elements of radical politics—arguing that how we do the work now will shape the society to come—Dean’s analysis also has a prefigurative element, with Lenin as its seer. The discipline of comrades, he said, “is a victory over our own conservatism, indiscipline, petty-bourgeois egoism, a victory over the habits left as a heritage to the worker and peasant by accursed capitalism.” The comrade contains within herself the defeat of the old regime.

The left has good reason to be wary of the stern antinomies of the comrade. The freedom that goes by the name of discipline, the suppression of difference in the name of solidarity, the words of emancipation as window dressing for authoritarian constraint—we’ve been down this road before. Read More

Automation and the Future of Work

by Aaron Benanav

A consensus-shattering account of automation technologies and their effect on workplaces and the labor market

Silicon Valley titans, politicians, techno-futurists and social critics have united in arguing that we are living on the cusp of an era of rapid technological automation, heralding the end of work as we know it. But does the much-discussed “rise of the robots” really explain the jobs crisis that awaits us on the other side of the coronavirus?

In Automation and the Future of Work, Aaron Benanav uncovers the structural economic trends that will shape our working lives far into the future. What social movements, he asks, are required to propel us into post-scarcity, if technological innovation alone can’t deliver it? In response to calls for a universal basic income that would maintain a growing army of redundant workers, he offers a counter-proposal.

Reviews

“A powerful and persuasive explanation of why capitalism can’t create jobs or generate incomes for a majority of humanity.”

– Mike Davis, author of Set the Night on Fire

“An excellent, insightful account of the contours of our present labor crisis. Benanav articulately makes the case for a post-scarcity future.”

– Robert Skidelsky, biographer of John Maynard Keynes

“A highly quantitative analysis of the nature of contemporary unemployment flowers into something quite different and unexpected: a qualitative argument for the invention of new collective capacities in a world where work is no longer central to social life.”

– Kristin Ross, author of Communal Luxury

“A rare book that manages to soberly assess the contemporary landscape while keeping a clear eye on our utopian horizons. This is an important intervention into current discussions around technology and work—and a must-read for anyone who believes capitalist decay is not the only future.”

– Nick Srnicek, author of Platform Capitalism

“Benanav dissects and disproves the idea that automation is eradicating work … We don’t need to wait for robots to do all the work; we can collectively decide what we need, then plan the economy to achieve it.”

– Paris Marx, Passage

Tom Hazeldine

05 November 2020

Automation and the Future of Work: a letter from the Editor

"Among the books that will help us ascend from what Marx termed the realm of necessity to the realm of freedom, this is a pivotal contribution." – Tom Hazeldine, Verso Editor, on the publication of Automation and the Future of Work.

Justin Sullivan / Getty

It’s actually a rare thing for a writer to be fully at home in both speculative social theory and number-crunching economics, but Aaron Benanav of Humboldt University fits that bill. To adapt a phrase, he combines practicality of the intelligence with optimism of the will. As he argues, ‘our present reality is better described by near-future science fiction dystopias than by standard economic analysis’, and it’s become a matter of urgency for us ‘to slip out of this timeline and into another’. We won’t achieve that, however, Benanav demonstrates, without a proper grasp of the dynamics of actual material production.

Automation and the Future of Work began life as a two-part essay in New Left Review toward the end of 2019. The first instalment questioned whether the much-anticipated rise of the robots really explained the worsening crisis of under-employment in all corners of the globe. ‘There are many reasons to doubt the hype’, he insisted. The second essay, equally heterodox, re-examined the assumptions that led automation theorists to pin their colours on proposals for a Universal Basic Income. UBI was, he insisted, no ‘silver bullet’ for deep-lying socio-economic problems. Taken together, these interventions were highlights of NLR’s publishing year.

Work on expanding the essays into a Verso book continued through the pandemic crisis of the spring. Aaron wrote to me from Chicago, his previous academic posting, in mid-March: ‘How are things over there? Does Verso still exist? Is my March 22 deadline still meaningful?’. To answer each point in turn: pretty bad, yes, and definitely yes. Holed up at home as Chicago prepared to go into lockdown, his emails mixed updates on the manuscript with concern for my Covid symptoms. ‘Sorry to be an American about this, but don't take anti-inflammatories/ibuprofen/aspirin’, he counselled. ‘Take some daily zinc, if you have it, and vitamin D3. Please be careful and keep me updated.’ I hope he felt in safe hands with me; I certainly did with him.

Benanav’s iconoclastic reappraisal of world labour-market dynamics, his systematic critique of the received wisdom around the supposedly decisive effect of technological unemployment, is likely to define the terms of debate; so, too, his plotting of a different, more solidaristic route to post-scarcity economics. ‘Instead of presupposing a fully automated economy and imagining the possibilities for a better and freer world created out of it,’ he writes, ‘we could begin from a world of generalised human dignity, and then consider the technical changes needed to realise that world.’

Among the books that will help us ascend from what Marx termed the realm of necessity to the realm of freedom, this is a pivotal contribution.

Tom Hazeldine, Verso Editor.

London, 2020.

Automation and the Future of Work by Aaron Benanav is one of our November Book Club reads: a carefully curated selection of books that we think are essential and necessary reading. Find out more about our Book Club here.

Solidarity rallies for health-care workers bring out support in Calgary, Edmonton

Supporters gathered in front of the Foothills Medical Centre at 6:30 a.m. on Thursday.

Several rallies were held across Alberta on Thursday morning to show solidarity for health-care workers who walked off the job last week to protest the provincial government's announcement it would outsource thousands of jobs.

On Oct. 26, hundreds of health-care workers engaged in a wildcat strike after Alberta's Minister of Health Tyler Shandro announced that Alberta Health Services would lay off between 9,700 and 11,000 employees.

They were swiftly ordered back to work by the Alberta Labour Relations Board.

On Oct. 27, Finance Minister Travis Toews told reporters that nursing and support workers who participated in the strike could be fined, suspended or even fired from their jobs.

On Thursday, supporters gathered in front of the Foothills Medical Centre and the Sheldon M. Chumir Health Centre in Calgary, and Edmonton's University of Alberta Hospital, to show their support for the front-line workers.

"We [are here] to thank all of the brave members that walked out on Oct. 26," said Bobby-Joe Borodey, one of the vice-presidents of the Alberta Union of Provincial Employees (AUPE) — the union that represents the health-care workers — at the rally in front of the Foothills hospital.

"We did that to send a message to [Premier] Jason Kenney and the UCP government that this direction that they're heading in with privatization is awful, and it's something that Albertans don't want."
'Make no mistake, they're all front-line workers'

Unions representing Alberta's health-care workers told CBC Edmonton in mid-October that there would be major labour strife if the government follows through on the proposed restructuring plan underpinned by thousands of layoffs.

Most of those who will lose their jobs work in laboratory, linen, cleaning and in-patient food services with AHS, and their positions will be outsourced to private companies.

According to Borodey, there is no overstating the value of their work during COVID-19.

"Make no mistake, they're all front-line workers," Borodey said. "When this pandemic started, they were the heroes that were on the front-line — the first line of defence at keeping Albertans safe at hospitals and health centres across the province.

"And then, when we're in month eight, all of a sudden, they're zeroes. And they're overpaid and replaceable. So, they're feeling pretty deflated and frustrated."

'We're in the same risk as these guys. It's high-stress. It takes a lot of dedication, it takes a lot of courage to go to work every day. And then to have the employer treat you with such disregard, it's, you know, it's demoralizing,' Mike Mahar said.

Mike Mahar, the Canadian director of the Amalgamated Transit Union (ATU), said that as fellow essential workers, the ATU wanted to attend the rally at the Foothills show its support.

Mahar, who had strong words for the provincial government, said transit workers understand the intense pressure of working the front-lines during the pandemic.

"We're in the same risk as these guys. It's high-stress. It takes a lot of dedication, it takes a lot of courage to go to work every day. And then to have the employer treat you with such disregard, it's, you know, it's demoralizing," Mahar said.

"To have the carpet pulled out from under you like that, during a pandemic — it's actually reckless. I think it's criminal. Not just putting those people out of work, but doing it right now … it's going to cost people's lives, I bet."

NDP MLA David Shepherd, who also attended the rally at the Foothills, said he is receiving hundreds of emails from people who are tired of the attacks on health-care staff.

"[The UCP government] announced this as our province is entering into the second wave of COVID-19. It's absolutely unacceptable," Shepherd said.

CBC News asked the Alberta government for comment on the rallies but it has not yet responded.

However, in October, Shandro said the cuts are eventually expected to save up to $600 million annually, and there will be a "long-term and gradual" implementation of the plan.

San Francisco voters approve new taxes for wealthy CEOs and tech companies

Any company whose top executive earns 100 times or more than their average worker will pay a surcharge under new law

Associated Press

Thu 5 Nov 2020

‘The very wealthy are gaining more and more. They’ve gotten much richer during the pandemic, while everyone else has remained stagnant,’ says the author of the measure.

In an effort to address economic disparity laid bare by the coronavirus pandemic, San Francisco voters overwhelmingly approved several tax measures targeting property owners and big businesses with CEOs paid far higher than their average workers.

Under the new law, any company whose top executive earns 100 times more than their average worker will pay an extra 0.1% surcharge on its annual business tax payment. If a CEO makes 200 times more than the average employee, the surcharge increases to 0.2%; 300 times gets a 0.3% surcharge and so on.

Voters also agreed to sweeping business tax changes that will lead to a higher tax rate for many tech companies, and a higher transfer tax on property sales valued between $10m and $25m.

“We’re not gonna shed any tears if penthouse dwellers have to cough up,” the San Francisco League of Pissed Off Voters wrote in its voter guide.

The results “show that San Franciscans are concerned about growing economic inequality”, city Supervisor Matt Haney, the author of the measure titled the Overpaid Executive Tax, said on Wednesday. “The very wealthy are gaining more and more. They’ve gotten much richer during the pandemic, while everyone else has remained stagnant.

“We need the wealth that has been generated in the city to be shared more broadly with workers and residents,” he said.

Critics call the surcharge a blatant attempt at redistribution of wealth and criticized raising business taxes in the middle of a recession.

Since March, Covid-19 restrictions have shut down critical elements of San Francisco’s economy. Tourists are scarce, and legions of workers in tech and in the city’s main business and financial districts have left, able to work remotely from anywhere. Office vacancy rates went up while rents in the prohibitively expensive city dropped to their lowest in years.
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“The middle of pandemic-fueled shutdown is the wrong time to raise taxes,“ said Jim Wunderman, president and CEO of the business advocacy group Bay Area Council. “The drip, drip, drip of new general taxes is going to erode the already shaky foundations of local economies decimated by the worst downturn in generations.”

The CEO tax is expected to generate between $60m and $140m per year, and Haney said he wants most of the money directed towards health services. He dismisses fears that the surcharge will drive companies out of the city, saying the tax was modest in comparison to the cost of moving a business. He said he hoped the tax would drive companies to re-examine their compensation structure and will ultimately be adopted on a national level.

The tax is somewhat similar to an executive-pay surcharge passed by the city council in Portland, Oregon, nearly four years ago. San Francisco city leaders considered the idea several years ago, and a 2014 state proposal to lower taxes for companies whose executives were paid less than 100 times the median worker did not pass in the California legislature.

“The idea didn’t get a lot of traction because people in San Francisco didn’t feel it made sense to tax CEOs,“ political consultant Jim Ross said. “But now you’re seeing a big segregation between the have and have-nots as executives get absurdly paid while others are struggling.”

Patients reported international hydroxychloroquine shortages due to
COVID-19

AMERICAN COLLEGE OF RHEUMATOLOGY

Research News

ATLANTA -- A new study shows that patients with rheumatic diseases across Africa, Southeast Asia, the Americas and Europe had trouble filling their prescriptions of antimalarial drugs, including hydroxychloroquine, during the 2020 global coronavirus pandemic, when antimalarials were touted as a possible COVID-19 treatment. Patients who could not access their antimalarial drugs faced worse physical and mental health outcomes as a result. Details of the research was presented at ACR Convergence, the American College of Rheumatology's annual meeting (ABSTRACT #0007).

Systemic lupus erythematosus, also called lupus or SLE, is a chronic (long-term) disease that causes systemic inflammation which can affect multiple organs: the skin, joints, kidneys, the tissue lining the lungs (pleura), heart (pericardium) and brain. Many patients experience fatigue, weight loss and fever. Antimalarial drugs are taken regularly by most people with lupus, as well as many with rheumatoid arthritis (RA) and other rheumatic diseases.

In the early weeks of the global SARS-CoV-2 (COVID-19) pandemic, two antimalarial drugs often used to treat lupus and RA, hydroxychloroquine and chloroquine, were touted to potentially prevent or treat COVID-19 infections. Both drugs were suddenly repurposed as COVID-19 treatments despite a lack of data to support this use, leading to worldwide shortages of both. A team of international researchers launched this study to assess the effects of antimalarials on COVID-19 infection and the impact of drug shortages on people with rheumatic disease.

"The COVID-19 Global Rheumatology Alliance's Patient Experience Survey was launched in April 2020 during the early days of the pandemic, when the scientific and research communities were under extraordinary pressure to identify safe and effective treatments for SARS-CoV-2. Since hydroxychloroquine is an essential treatment for RA and lupus, reported drug shortages of antimalarials became a major concern," says the study's lead author, Emily Sirotich, a doctoral student at McMaster Centre for Transfusion Research in Hamilton, Ontario. and Patient Engagement Lead of the COVID-19 Global Rheumatology Alliance. "The aims of this study were to assess the prevalence and impact of drug shortages during the COVID-19 pandemic, and whether the use of antimalarials in patients with rheumatic disease was associated with a lower risk of COVID-19 infection."

Data for the new study was collected using the COVID-19 Global Rheumatology Alliance Patient Experience Survey. The survey was distributed online through patient support organizations and social media. Both patients with rheumatic diseases and parents of pediatric patients anonymously completed the surveys with information on their rheumatic disease diagnosis, medications they take, COVID-19 status and any disease outcomes. The researchers evaluated the impact of antimalarial drug shortages on patients' disease activity, as well as their mental health and physical health.

Of the 9,393 people who responded to the survey, 3,872 were taking antimalarial drugs and 230 said they were unable to continue taking their medications because of a lack of supply at their pharmacy. Antimalarial shortages were worse for people in Africa and Southeast Asia: 26.7% of respondents in Africa and 21.4% of respondents in Southeast Asia reported inadequate supplies at local pharmacies. Patients in the Americas (6.8%) and Europe (2.1%) also reported being unable to fill their prescriptions at their pharmacy due to lack of supply.

The study found that patients on antimalarials and those who did not take these drugs had similar rates of COVID-19 infection. A total of 28 patients with COVID-19, who were also taking antimalarials, were hospitalized. Of 519 patients diagnosed with COVID-19 in the survey, 68 reported that they were prescribed an antimalarial for their coronavirus infection. Patients who could not fill their antimalarial prescriptions experienced higher levels of disease activity and also experienced worse mental and physical health symptoms, the study found.

"The findings from this study highlight the harmful consequences of repurposing antimalarials, without adequate evidence for benefit, on patients who rely on access to their hydroxychloroquine or chloroquine prescriptions for their rheumatic diseases," says Ms. Sirotich. "It is necessary to maintain scientific rigor even in the context of a pandemic and recognize the potential impacts of drug shortages. It is also important to address regional disparities in access to medications, to ensure all people, particularly those living in developing countries, receive fair and equitable access to their essential medications."

###

About ACR Convergence

About the American College of Rheumatology

ABSTRACT:

Antimalarial Drug Shortages During the COVID-19 Pandemic: Results from the Global Rheumatology Alliance Patient Experience Survey

Background/Purpose:

Early in the COVID-19 pandemic, hydroxychloroquine and chloroquine were empirically promoted and used for treatment and prevention of SARS-CoV-2 infection. The repurposing of these drugs before robust efficacy data were available led to potentially harmful shortages for people with rheumatic diseases. The aims of this study were to assess (1) whether the use of antimalarials in patients with rheumatic disease was associated with a lower risk of COVID-19 infection, and (2) the prevalence and impact of drug shortages during the COVID-19 pandemic.

Methods:

The COVID-19 Global Rheumatology Alliance (C19-GRA) Patient Experience Survey was distributed online through patient support organizations and on social media. Patients with rheumatic diseases (or the parents of pediatric patients) anonymously entered data including their rheumatic disease diagnosis, medications, COVID-19 status, and disease outcomes. Impact of drug shortages was evaluated for the effect on patient disease activity, mental health and physical health states by comparing mean values with two-sided independent t-tests to identify significant differences.

Results:

From 9,393 respondents (mean age 46.1 (SD 12.8) years, 90.0% female), 3,872 (41.2%) were taking antimalarials (Table 1). Of these, 230 (6.2%) were unable to continue taking antimalarials because of a lack of supply at their pharmacy. 21.4% of patients in South-East Asia and 26.7% in African regions reported an inadequate supply of antimalarials in pharmacies, in contrast to 6.8% of patients in the Americas and 2.1% in European regions. There were similar rates of COVID-19 infection among patients on antimalarials as compared to patients not on these drugs (6.7% vs. 4.7%). A total of 28 patients (10.8%) with COVID-19 who were taking antimalarials were hospitalized. Of 519 patients diagnosed with COVID-19, 68 (13.1%) indicated they were prescribed antimalarials as a treatment for their COVID-19 infection.

Patients who were unable to obtain antimalarials from their pharmacies compared to those who did not experience medication shortages experienced higher levels of rheumatic disease activity (5.1 > 4.3, t(244) = 4.44, p < 0.001) (Figure 1) and poorer mental (5.8 < 6.3, t(252) = 3.82, p < 0.001) and physical health (5.6 < 6.4, t(254) = 5.97, p < 0.001) (Figure 2).

Conclusions:

Patients in African and South-East Asian regions reported greater difficulty obtaining antimalarial drugs to treat their rheumatic disease in contrast to patients in the Americas and European regions. Patients who experienced antimalarial drug shortages reported worse mental and physical health outcomes than those able to obtain their medications. Antimalarials did not protect patients with rheumatic disease from COVID-19 or from hospitalization as a result of COVID-19. The unintended harmful consequences of repurposing antimalarials, without adequate evidence for benefit, highlights the importance of maintaining scientific rigor even in the context of a pandemic. Regional disparities of access to medications should be addressed to ensure all people, particularly those living in developing countries, receive fair and equitable access to these essential medications.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releas

Court orders FDA to assess environmental impact of GM salmon

NEW YORK — A federal court judge ordered the U.S. Food and Drug Administration on Thursday to conduct an environmental assessment of genetically modified salmon that he said was required for the agency’s approval of the fish.

© Provided by The Canadian Press

But the judge did not vacate the FDA’s approval of the salmon for human consumption in the meantime, because he said the risk for near-term environmental harm is low.

“The FDA has to go back to the drawing board and do its homework,” said George Kimbrell, legal director for the Center for Food Safety, one of the groups that filed suit challenging the agency's approval of the genetically modified salmon.

The ruling by U.S. District Court Judge Vince Chhabria in San Francisco centres on AquaBounty’s salmon, which are genetically modified to grow faster than normal salmon. In 2015, the fish became the first genetically modified animal approved for human consumption in the U.S. After clearing other regulatory hurdles. AquaBounty began growing the fish in indoor tanks at an Indiana plant last year.

In an email Thursday, a representative for AquaBounty noted that the ruling covered the potential environmental impact of the fish, and not the health and safety of eating them. The company said the salmon are not yet being sold in the U.S.; it had previously said the fish could be in the market by late this year.

The FDA said in a statement that its approval of the salmon remains in place but did not address the judges ruling on the adequacy of its environmental assessment.

To ensure the fish do not escape and breed with wild fish, Massachusetts-based AquaBounty says its salmon are raised in tanks and bred to be female and sterile.

But advocacy groups maintain the company’s own tests have shown it’s not 100% certain the fish would be sterile, and that the risk of fish escaping into waters could grow if the company were to expand operations.

In his ruling, Judge Chhabria noted that the FDA determined the probability of the salmon escaping and surviving in the wild to be quite low. But he said the company's production could expand, and that “with every new facility built, the possibility of exposure grows.” And even if it’s unlikely the fish could get into the wild, he said the FDA was still required to assess the consequences of the possibility.

AquaBounty fish are Atlantic salmon injected with DNA from other fish species that makes them grow faster. The salmon already has been sold in limited quantities in Canada, where it doesn’t have to be labeled as genetically modified, the company has said.

___

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education. The AP is solely responsible for all content.

Candice Choi, The Associated Press

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Friday, November 06, 2020

Black patients with lupus have three times higher risk of stroke

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Automation and the Future of Work: a letter from the Editor

Patients reported international hydroxychloroquine shortages due to
COVID-19

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