Tag: health

Blaming Republicans Again

I know you thought that the current Ebola outbreak was the result of dysfunctional countries with horrendous health care systems. Or maybe you thought it was the fault of organizations like the WHO to respond quickly enough. Or maybe you think it’s no one’s fault and that disease outbreaks are going to happen.

But you’re wrong. The current Ebola outbreak is the fault of …. Republicans:

“Republican Cuts Kill” is the message coming from The Agenda Project, a 501(c)4 organization that is placing ads in various battleground states. According to an email signed by the group’s founder Erica Payne and titled “If you die, blame them,” the group is starting a

a multi-pronged blitzkrieg attack that lays blame for the Ebola crisis exactly where it belongs– at the feet of the Republican lawmakers. Like rabid dogs in a butcher shop, Republicans have indiscriminately shredded everything in their path, including critical programs that could have dealt with the Ebola crisis before it reached our country.

The supposed proximate cause is “deep draconian cuts” in the budgets of the NIH and the CDC which hindered their disease response. Never mind that the US still spends a total of $8 billion on global health. Never mind that the CDC and NIH have nearly $40 billion in funding between them. Never mind that cuts to CDC/NIH and specifically cuts for disease control were included in the budget proposal of Barack Obama who, last time I checked, was not a Republican. Never mind that according to Daily Kos’s own graph, the steep budget cuts in PHEP started in 2006, when the Democrats controlled Congress. Never mind that the Republican increased CDC funding over the President’s budget.

Conservatives, dammit!

This was partially stimulated by the head of the NIH saying that we would have an Ebola vaccine if not for budget cuts. Numerous people have responded by finding silliness in the NIH budget — such as $666,000 grant to find out why people like watching Seinfeld reruns — that they did have money for. I’m a bit loathe to play that game because often projects that sound stupid aren’t or are, at least, massively misrepresented.

But I will take issue with the NIH’s claim that we’d have an Ebola vaccine if it weren’t for budget cuts (a claim they are slowly backing away from). Vaccine research is hard. We’ve been spoiled because most of the vaccines we’re used to — like measles — are cheap, effective and have minimal side effects. Such vaccines have wiped out smallpox and brought polio to the brink of extinction. But not all vaccines are that easy. We’ve been working on an AIDS vaccine for thirty years. Enormous effort has gone into finding a vaccine for malaria — which kills hundreds of thousands of people a year — with no success. Even some of the vaccines we do have are hideously expensive, come with significant side effects or have limited effectiveness. NIH might have an Ebola vaccine if they had more money. They might also have nothing.

I’m a big fan of science funding, obviously. I like NIH to be well-funded. Public health is one of the few things we can all agree government should invest in. And I think basic science funding falls under Adam Smith’s description of something “which it can never be for the interest of any individual, or small number of individuals, to erect and maintain” but that benefits the public generally. But Ebola is not the reason to fund the NIH. They should be funded because of the outstanding research they do on everything else, especially the chronic common diseases that affect all of us. I especially want them to be working on antibiotic-resistant diseases, which, to my mind, pose the greatest healthcare menace for the 21st century. They should research Ebola as well. With a $30 billion budget, there’s plenty to go around. But Ebola research is only a tiny fraction of what they do. And I’d prefer they not try to pretend otherwise.

As for the CDC, a bit less money on public health issues and a bit more money on infectious disease would be a good idea. And that, my friends, is squarely on the President and the man he appointed to head that agency.

As a general rule, however, I would prefer that we keep Ebola and politics apart. This isn’t an excuse to grind your favorite political axe, be it immigration, budget cuts or single-payer healthcare. This is a time to calmly but decisively react to a potential health crisis. The main effort should be stomp this out in West Africa before it really does rage out of control. Because if this blows up to hundreds of thousands of people, if this spreads to South Africa or India or China, we will have a global epidemic on our hands.

The Bill Comes Due

Remember all that talk about how Obamacare was going to save us all this money? Evil uncaring heretics like me pointed out that this was impossible. You can not insure more people and you can not outlaw cheap insurance without increasing healthcare costs. Romneycare saw costs soar after implementation because … funny story … when people have insurance they see the doctor more often. Even the dreaded ER visits went up.

But no, we just didn’t understand. We were letting our hatred of poor people cloud our vision. Why the cost curve bent down in 2009-2013, which was proof that Obamacare was keeping costs down even before it was implemented!

Um … oops:

As I reported earlier this month, there were already signs of growing health care spending in the fourth quarter of 2013, when it jumped 5.6 percent, which had been the fastest clip since 2004.

But the 9.9 percent jump (on an annualized basis) came in the quarter from January through March, which was the first three months in which individuals who gaining coverage through the law were able to use it. That was the fastest rate recorded since health care spending grew at a 10 percent rate in the third quarter of 1980.

The data released on Wednesday, as part of the government’s report on gross domestic product, is preliminary and subject to revision in the coming months.

Note that first quarter GDP growth came in at 0.1%, so the non-healthcare section of the economy shrank by 1% last quarter.

So … are the Obamacare supporters admitting that they were wrong? Uh, not exactly:

But let’s be very clear about what’s happening here: an improving economy is allowing Americans to now spend more on health care, while people who have previously been uninsured are finally getting insurance and are using their care. In the meantime, health care prices are still continuing to grow at low rates, reducing Americans’ health costs.

ThinkRegress goes on to say that, in the long run, healthcare costs will come down because the IPAB will force changes in healthcare reimbursement. Therefore we should be celebrating because the first half of the CBO’s prediction — healthcare costs will rise — has come true!

There are many many problems with this. The biggest is history. IPAB is not the first effort by the government to reign in healthcare spending. There is a whole alphabet soup of programs — RBRVS, GRH, SGR, etc. — that have completely failed in this regard. And that leads to the bigger point. Those of you who have followed the budget debates for the last twenty years know how this plays out: we get spending increases today with the promise of spending cuts tomorrow to balance them out. And those spending cuts never happen. Because tomorrow we are told that spending needs to go up because of the economy, the uninsured, the homeless or Venus being in Taurus.

So what will the Democrats and their apologists say when health care costs continue to rise? Well, besides blaming Republicans, I expect they will claim that this “proves” how much we need single-payer. To prepare for that, read McArdle today. Over the last twenty years, uber-controlled monopsony single-payer healthcare systems have restrained their spending growth to … about what we’ve had in the United States. The big growth in US healthcare spending occurred forty years ago and is now baked into the system. So … no, Virginia, socialized medicine will not cure what ails us.

Buckle your seat belts, friends. The ride’s only going to get bumpier.

Chasing Libertarianism Into A Corner

One of the problems I have with my libertarianism — indeed, a big reason I often describe myself as a conservative-libertarian — is the tendency of some libertarians to chase the philosophy into intellectual cul-de-sacs. All political philosophies have a tendency to favor ever “purer” strains. But because libertarians define our philosophy as one of personal liberty, we have a tendency to think that the only acceptable policies are those with maximum personal liberty. Any practical objections tend to be swept under the rug with a few unconnected words about “free markets”.

I’m not explaining this well. Let me illustrate with an unrelated example.

When I was in college, I took a philosophy class with a feminist professor. When we got to the portion on feminism, we were discussing third wavers who thought that women in an oppressive society fundamentally could not consent to sex, that all sex was therefore rape and therefore women should not have sex. My response was that any philosophy that countenanced, at least in theory, the potential extinction of the human race was fundamentally immoral. I said that these were the deranged ramblings of someone who had drunk too deeply of the feminist well. They had taken good ideas (women shouldn’t be second class citizens) and purified them to a bizarre extreme.

A more germane example: a number of libertarians oppose environmental regulation on the grounds that if my neighbor is polluting my land, he is violating my property rights and this should settled in the courts. That sounds good if you only consider the ideology. But as a practical matter, it is a recipe for disaster. First, it’s not always clear that pollution has happened. The residents of Love Canal had no idea why they were getting so many birth defects and miscarriages. By the time they did figure it out, there had been immense suffering already. Second, it’s not always clear who is responsible for ills caused by pollution. In the Woburn Massachusetts case, it wasn’t clear who poured chemicals into the river that sickened the children. The jury was asked to decide the lawsuit based on a series of bewildering technical questions. Third, even in cases where the culprit is clear, you are frequently talking about powerful businesses with armies of lawyers who can drag a case on for decades. The Exxon Valdez lawsuits dragged on for twenty years. You can imagine how bad it is when the polluter is the government itself or when you’re dealing with the decade-old pollution of a business that no longer exists. Fourth, the ability of such a system to prevent pollution is dubious since it’s not always clear that Substance X will produce Harm Y for a long time. Finally, it seems absolutely appalling to countenance reparations for birth defects, miscarriages, severe illnesses and deaths rather than just preventing them in the first place in the name of free markets.

Does this mean the government isn’t over-zealous in fighting pollution? It frequently is and often chases its own ideology into banning minimally dangerous substances. Does this mean government always makes the right decisions? Of course not; the aforementioned Love Canal community was built on land the local government was warned was dangerous. Does it sometimes carve out exemptions for big polluters while hurting little guys? Absolutely; see what happened after the lead toy debacle. But at some point, we have to accept these limitations rather than get seduced by the seductive appeal of bottomless liberty.

(Another good example, on the Civil Rights Act, is illustrated here by James Joyner.)

I bring up this subject because there is a debate going on at Reason between Ronald Bailey and Jeffrey Singer over mandated vaccinations. Singer’s op-ed, which you can find here, crosses as me the rambling of someone drunk on libertarian ideals. It’s a series of libertarian statement strung together in the hope that it makes an argument. And it winds up saying bizarre things like this:

The phenomenon of herd immunity allows many unvaccinated people to avoid disease because they free ride off the significant portion of the population that is immunized and doesn’t, therefore, spread a given disease. Economists point out that free riding is an unavoidable fact of life: people free ride when they purchase a new, improved, and cheaper product that was “pre-tested” on more affluent people who wanted to be the first to own it; people free ride when they use word-of-mouth reviews to buy goods or services, or to see a film; those who choose not to carry concealed weapons free ride a degree of personal safety off the small percentage of the public that carries concealed weapons. So long as a person being free-ridden is getting a desired value for an acceptable price, and is not being harmed by the free riding, it really shouldn’t matter to that person. Achieving a society without free riders is not only unnecessary, it is impossible.

Well, duh. But we should try our best to limit the free riders to people who can not be vaccinated — people who are immunocompromised, for example. And while we can’t force 100% compliance, we can do as much as we can to get the immunization numbers into the 90-95+% numbers necessary to establish the herd immunity that protects the millions who have no choice but to free ride. Or people for whom the vaccine didn’t take.

On this subject, I find myself agreeing with Bailey: your freedom to swing your fists ends where someone else’s nose begins. I find it very difficult to countenance any version of a “free society” that includes the freedom to run around potentially spreading dangerous and deadly diseases. Most people are smarter than their government. But you don’t need a large percentage to be dumber to have, as we now do, huge outbreaks of entirely preventable diseases that are leaving dead and hurt children in their wake. Are those children to be human sacrifices to our idealized notion of freedom?

If we were talking about sexual transmitted diseases, I would agree with Singer. But these are diseases that can be spread by casual contact. They can be spread by people who are already vaccinated. They can be spread by people who never catch the disease themselves. This isn’t the moral equivalent of seat-belt law; this is the moral equivalent of laws against drunk driving.

Vaccinations are one of the greatest achievements in human history. They have destroyed smallpox and put hepatitis A and B, rotavirus, diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, varicella and some forms of meningitis on the run. These diseases used to kill and maim millions. Their eradication is far too great an achievement to trust to the ideology-addled hope that people will act in their own enlightened self-interest.

Because too many people don’t.

New York, New York

The Left is jumping up and down over a report that insurance rates will fall by 50% or more in New York thanks to Obamacare. So is this a huge triumph?

Um, not really. Sarah Kliff throws a little bit of cold water on that:

A headline about the health care law driving down premiums, by this level of magnitude, is a rarity. But it shouldn’t be shocking: New York has, for two decades now, had the highest individual market premiums in the country. A lot of it seems to trace back to a law passed in 1993, which required insurance plans to accept all applicants, regardless of how sick or healthy they were. That law did not, however, require everyone to sign up, as the Affordable Care Act does.

New York has, for 20 years now, been a long-running experiment in what happens to universal coverage without an individual mandate. It’s the type of law the country would have if House Republicans succeeded in delaying the individual mandate, as they will vote to do this afternoon. The result: a small insurance market with very high insurance premiums.

For years New York has had one of the most heavily regulated insurance markets in the country. The 1993 reforms not only required insurers to accept all customers; they also mandated that insurers charge everyone the exact same price. Young or old, healthy or sick, it doesn’t matter in New York: Everyone gets the same deal.

This is great for someone who is sick and old who, in other states, might get charged a sky high rate or rejected altogether. It’s not great though for the young and healthy, who end up footing a bigger chunk of the bill for all those more expensive beneficiaries.

Basically, the New York insurance market — which, incidentally was the test ground for a lot of what went into Romneycare and what later went into Obamacare — was so screwed up that almost anything was an improvement. New York had the coverage mandate without the purchase mandate. It didn’t have any of the quasi-market instruments — the insurance exchanges — that are supposed to bring down prices. It was a perfectly crafted piece of wishful thinking crap. The state government just told the insurance companies to cover everyone and didn’t imagine that it would crash and burn the way anyone with two brain cells to rub together knew it would.

As Avik Roy points out, New York basically destroyed the individual insurance market. At present, only 17,000 people in the entire state have individual policies. It is expected that Obamacare will force several hundred thousand uninsured people into the markets — mostly young healthy people. So the total amount spent on insurance will actually go up. It’s just that it will be spread out among more people. And we have yet to see what this will do to the group plans that most people are covered by.

I think this story is yet another illustration of how bad the situation is for Obamacare. They are taking one of the smallest and worst markets in the country — individual policies in New York — a market was thrashed and destroyed by the precursor of Obamacare — and proclaiming a triumph because it won’t be as bad.

Another case of settled science goes “poof”

In this case its the meme that less salt is important to good health. I suspected this was bullshit a long time ago, and I am glad to see my suspicions vindicated. Two things that are critical to balanced brain chemistry and to avoid depression are salt and sunlight. We have been told for decades to consume less salt and stay out of the sun because of dubious claims that one causes heart problems and the other cancer. I called bullshit on both decades ago. Heart problems and cancer are both genetic, and from what the medical field is discovering now, possibly even caused by viruses.

I have never had any form of depression because I do not hide from the sun nor avoid salt. I know a ton of people that avoid the sun like they are vampires and will not touch salt because of their fear of heart damage. Practically every one of them is a basket case, always battling depression, and quite a few are even suicidal. Once even took her own life. Fuck that. Eat salt, like with everything else in moderation, and be happy. Give them a few more years and they will actually tell us salt is essential.

Remember the whole egg fiasco and how that played out? I do. Eggs are good. Eggs are going to kill you! Eggs might not be so bad. Eggs are awesome for you! The beauty of real science is that if you make a claim and the facts do not bere out, we get to toss your idiotic claim out of the window. Real science that is. Not that consensus shit.

Bloomberg was not available for comments.

Piling On

Apropos to Alex’s post below, the huge news in the last day is a study from Oregon that looked at the effects of expanding Medicaid. As McCardle points out, the study was done under near ideal circumstances. Oregon could not expand Medicaid to everyone who wanted it, so they created a lottery. Sociologists swooped in and recruited. The result was a study of 6000 people with Medicaid and almost 6000 without. One of the authors was an Obamacare architect. This is the kind of diverse randomly-selected sample that sociologists dream about.

The result is …. not much:

Utilization went up, out-of-pocket expenditure went down, and the freqency of depression diagnoses was lower. But on the three important health measures they checked that we can measure objectively–glycated hemoglobin, a measure of blood sugar levels [and diabetes indicator]; blood pressure; and cholesterol levels–there was no significant improvement.

It’s one of two major RCTs that have ever been done on insurance. And like the first one, it doesn’t show a signficiant effect. That is huge news. Not good news–obviously, it’s much nicer if giving people money to pay for health care makes them obviously much healthier. But big.

And it’s actually bigger, and more important than Obamacare. We should all be revising our priors about how much health insurance–or at least Medicaid–really promotes health. What this really tells us is how little we know about health care, and making people healthy–and how often data can confound even our most powerful intuitions.

In other words, insuring people resulted in more spending by the government, but not necessarily improved health. Gee, I think I’ve heard that before.

As you can imagine, the liberals are spinning as fast as they can. And, to be fair, they have a point. The study covers only of a couple of years and it might take a while for long-term effects to show up. But you know that if the study showed even the slightest improvement in health, they would be shouting it from the rooftops. They have, after all, spent years citing dubious studies that claim that the lack of universal healthcare kills, if I remember the Obamcare rhetoric correctly, at least 17.4 billion Americans every year. And, in fact, when the first Oregon study came out and showed that people weren’t healthier, per se, but felt better, the liberals crowed about it.

The new study is much more difficult to twist abut that’s not stopping their attempts. One thing they have harped on is that the insurance is preventing people from being financially destroyed by a health crisis. But Avik Roy is all over that in a must-read response to liberal excuse making:

Medicaid reduced financial hardship for the poor, by protecting them against catastrophic health risks. Wonderful, but we could have achieved the same outcome for a fraction of the price, by adopting the plan proposed by Florida’s Will Weatherford and Richard Corcoran: Offering low-income Americans a subsidy with which to purchase catastrophic coverage on the open market. That plan was foiled by people—including Republicans—who insisted on expanding Medicaid instead.

Ross Douthat is on the same page:

But what if we lived in a world in which the Republican Party had fully embraced the views of many right-of-center health policy writers (and some G.O.P. politicians, including the John McCain of 2008) and supported an alternative to Medicaid expansion, which would change the tax treatment of health insurance to free up money to create a universal tax credit or voucher designed to spur the purchase of catastrophic health insurance plans? What if the choice, in other words, weren’t between the current health care law and a repeal-plus-nothing G.O.P., but between the current health care law and the best conservative thinking on the issue?

This is, in fact, what most libertarians have advocated for years, including me.

I remind you that this isn’t a trivial question. Obamacare gambles some $750 billion on the idea that Medicaid will improve health outcomes, boost the economy, reunite the surviving Beatles and help us all lose ten pounds with diet and exercise. If the gain from that huge investment is this marginal, it is not worth it. I’m sorry to be cruel, but it not worth $750 billion to save only a few lives.

I do want to repeat my earlier caution that it would be odd to conclude that health insurance has no health benefit. We may not know for a while. But I do think it’s becoming clear that Medicaid expansion is not going to be the miracle breakthrough that so much of the Left has claimed it would be. If lack of insurance really were killing as many people as the Left insists it is, the Oregon data would show it. You might even already see a difference in mortality rates.

I know it surprises some people, but improving our nation’s health is not as simple as simply throwing lots of money around.

The Efficiency of Fraud

Remember, friends: Medicare is the model for how we should reform healthcare. Medicare for all is what Van Jones Propaganda Party, among others, is demanding.

On Tuesday, a jury found Iruke, his wife and an employee who worked for the couple guilty of healthcare fraud and conspiracy to commit fraud in a scheme that involved more than $14 million in illegitimate Medicare claims.

Authorities said Iruke and associates often supplied power wheelchairs to Medicare patients perfectly capable of walking on their own —including one who did jumping jacks to show agents he never needed one. Also among the patients Iruke and his associates filed reimbursement claims for were two people who were deceased, according to court papers.

fter purchasing the wheelchairs at about $900 wholesale and paying for the prescriptions, he pocketed the remainder of about $6,000 in taxpayer money he received as Medicare reimbursements, according to court documents. The pastor operated four medical equipment supply companies between May 2002 and September 2009 as part of the scheme, according to authorities.

A few things to pull out of this. First, how easy it was for these guys to defraud Medicare. Their fraud was so simple and straight-forward but it took the government seven years to spot it. The Feds are boasting about finding $2.3 billion in Fraud with their new strike force. But it’s clearly this is the low-hanging fruit of a crime spree that amounts to tens of billions. Notice also how efficient Medicare is. Surgeons haven’t had price increase in 30 years. But Medicare is shelling out six times the going price for a wheelchair.

This is just another illustration of how dysfunctional the liberal model for healthcare is. As I have argued here and Reason argues here, Medicare isn’t efficient, even if you ignore the massive fraud they tolerate. When you include it, Medicare becomes a boondoggle of epic proportions.

Charity bleg – Tour de Cure 2011

Tour de Cure

Photo credit: Nessie Photography - http://flic.kr/p/9LMdNw

Some of you may have wondered why I haven’t “passed the hat” yet. Well, partly because I hate doing it, and mainly I knew I was going to post this soon. I’d rather the hat get passed for this.
I’m riding the Tour de Cure event in North Haven, CT this year. Hoping for the metric century (100K/62-ish miles, although the route they have mapped out is more like 73!). If you’d like to sponsor my ride to help fight diabetes,you can donate online here.

While I share the belief of many that large charity organizations are at best top-heavy, the main goal of the American Diabetic Association is to inform & educate people with diabetes and pre-diabetic conditions. This is the kind of mission that can only be done by a large group with good name recognition. I only have four charities that I truly care about, and this is one of them.

As you may know, as we age the risk for getting Type II diabetes increases dramatically even when we do everything right, and our population as a whole is trending older and older each year. But, did you also know that one of the largest growing segments of Type II diabetes patients is now children? Type II used to be called “Adult Onset” diabetes. Now that so many more children are getting this disease each year, the medical community has dropped that name. So many kids get what was an adult disease, doctors have dropped the “adult” part. The American Diabetic Association can do a lot of good by educating children and parents as to how they can fight off Type II diabetes, and that’s why I am supporting them. I’m asking for your help as well.

The North Haven Tour de Cure is June 12th. You can donate anytime, but I need to raise $150 by the 11th or they won’t let me ride. It’s a good cause. One that can actually reduce health costs to society in the aggregate if they can spread the message of education. On top of that, we’re all likely to at least flirt with Type II diabetes if we live long enough. In my opinion, it actually benefits us all to support this particular organization…and what’s a better motivation than self-interest?

The demonization of food

Note: I posted this on a food & diet website I frequent. Thought it might be interesting to share here as well.

I’ve seen this happen in virtually every aspect of food and/or dieting. Today there was a brief flurry of stuff in my friends list about cheeseburgers and OMG HOW AWFUL

But why?

If you go to a fast food joint and get the greasy, salt-laden, saturated-fat megaburger, yeah. That’s not great. I suspect that is what people mean when they say “cheeseburger.” The Dairy Queen, In-and-Out, Burger King, Mickey D’s, Wendy’s idea of a cheeseburger, with the white, fluffy bun that is 93.5% chemicals and the rest is air. The word has sort of become a shorthand way of saying “fast food burger that is going to kill us all.”

The demonization of food


Mmm...bacon cheeseburger

But…why can’t we think – and talk – rationally about cheeseburgers?

I make ‘em sometimes. With ground bison if it’s on sale, or 93-95% lean beef if that’s on sale. I get whole grain buns made without High Fructose Corn Syrup. I use 2% cheese so I get some fat and good flavor. If you use things like fresh veg, an olive oil-based mayo and go easy on the bacon, there is nothing nutritionally wrong with a cheeseburger.

Just don’t eat nine of them. And you know what? Once in a blue moon – for me it means once a month or less – eating Mickey D’s ain’t gonna kill you any faster than the diseases we’re all gonna get if we live long enough anyway.

Yesterday I got my copy of the ADA Times. Multi-page article about a woman struggling with the fact that her husband was basically sabotaging her attempts to get healthy. First of all, her husband seems like an insecure douchebag. But…the point of the article was to help us understand client issues and recognize that their relationships can have an affect on success. Which is a good thing of which to remind us. But…the article started out with a giant photo and a passage demonizing pizza.

Why? Pizza, handled correctly, can remain in anyone’s diet. Just the other day I was craving pizza. So instead of ordering one, my wife and I went and got some healthy, protein-and-veg-heavy foods for dinner but on the way home, we picked up slices. She had two, I had one (I had a massive pile of chicken breast so I didn’t get two slices). Those slices were 1/4 of the amount we would have eaten had we ordered a whole pizza, but they hit the spot and satisfied the mental craving for something “naughty.”

Pizza can even be made to be healthy. Make the crust yourself, do it with whole grains, use 2% cheese, leave off salty sauces, use a lot of vegetables as toppings, use processed meats sparingly as accent flavors, not the main topping and you’ll be eating a reasonably healthy meal. Man cannot live on bread alone, but I’ll bet my life he could live on pizza if you made it right.

Success on a lifelong diet plan cannot be based on total restriction. You will break. EVERYONE will break. Modifying your behavior and making smart decisions can delay the breaking. And if you do it well, you may find that the small rewards of a slice every month or two is all the break you need to stay on track most of the time.

Barring some specific exceptions (like HFCS), foods are not the enemy. How we act around and about them – in otherwords us, ourselves – that’s the enemy, and that is the beast which must be tamed.