Saturday, September 20, 2014

WE CAN IMPROVE HEALTH WHERE IT BEGINS





By Rishi Manchanda

For over a decade as a doctor, I've cared for homeless veterans, for working-class families. I've cared for people who live and work in conditions that can be hard, if not harsh, and that work has led me to believe that we need a fundamentally different way of looking at healthcare. We simply need a healthcare system that moves beyond just looking at the symptoms that bring people into clinics, but instead actually is able to look and improve health where it begins. And where health begins is not in the four walls of a doctor's office, but where we live and where we work, where we eat, sleep, learn and play, where we spend the majority of our lives.

So what does this different approach to healthcare look like, an approach that can improve health where it begins? To illustrate this, I'll tell you about Veronica. Veronica was the 17th patient out of my 26-patient day at that clinic in South Central Los Angeles. She came into our clinic with a chronic headache. This headache had been going on for a number of years, and this particular episode was very, very troubling. In fact, three weeks before she came to visit us for the first time, she went to an emergency room in Los Angeles. The emergency room doctors said, "We've run some tests, Veronica. The results are normal, so here's some pain medication, and follow up with a primary care doctor, but if the pain persists or if it worsens, then come on back."

Veronica followed those standard instructions and she went back. She went back not just once, but twice more. In the three weeks before Veronica met us, she went to the emergency room three times. She went back and forth, in and out of hospitals and clinics, just like she had done in years past, trying to seek relief but still coming up short. Veronica came to our clinic, and despite all these encounters with healthcare professionals, Veronica was still sick.

When she came to our clinic, though, we tried a different approach. Our approach started with our medical assistant, someone who had a GED-level training but knew the community. Our medical assistant asked some routine questions. She asked, "What's your chief complaint?" "Headache." "Let's get your vital signs" — measure your blood pressure and your heart rate, but let's also ask something equally as vital to Veronica and a lot of patients like her in South Los Angeles. "Veronica, can you tell me about where you live? Specifically, about your housing conditions? Do you have mold? Do you have water leaks? Do you have roaches in your home?" Turns out, Veronica said yes to three of those things: roaches, water leaks, mold. I received that chart in hand, reviewed it, and I turned the handle on the door and I entered the room.

You should understand that Veronica, like a lot of patients that I have the privilege of caring for, is a dignified person, a formidable presence, a personality that's larger than life, but here she was doubled over in pain sitting on my exam table. Her head, clearly throbbing, was resting in her hands. She lifted her head up, and I saw her face, said hello, and then I immediately noticed something across the bridge of her nose, a crease in her skin. In medicine, we call that crease the allergic salute. It's usually seen among children who have chronic allergies. It comes from chronically rubbing one's nose up and down, trying to get rid of those allergy symptoms, and yet, here was Veronica, a grown woman, with the same telltale sign of allergies. A few minutes later, in asking Veronica some questions, and examining her and listening to her, I said, "Veronica, I think I know what you have. I think you have chronic allergies, and I think you have migraine headaches and some sinus congestion, and I think all of those are related to where you live." She looked a little bit relieved, because for the first time, she had a diagnosis, but I said, "Veronica, now let's talk about your treatment. We're going to order some medications for your symptoms, but I also want to refer you to a specialist, if that's okay."

Now, specialists are a little hard to find in South Central Los Angeles, so she gave me this look, like, "Really?" And I said, "Veronica, actually, the specialist I'm talking about is someone I call a community health worker, someone who, if it's okay with you, can come to your home and try to understand what's going on with those water leaks and that mold, trying to help you manage those conditions in your housing that I think are causing your symptoms, and if required, that specialist might refer you to another specialist that we call a public interest lawyer, because it might be that your landlord isn't making the fixes he's required to make."

Veronica came back in a few months later. She agreed to all of those treatment plans. She told us that her symptoms had improved by 90 percent. She was spending more time at work and with her family and less time shuttling back and forth between the emergency rooms of Los Angeles. Veronica had improved remarkably. Her sons, one of whom had asthma, were no longer as sick as they used to be. She had gotten better, and not coincidentally, Veronica's home was better too.

What was it about this different approach we tried that led to better care, fewer visits to the E.R., better health? Well, quite simply, it started with that question: "Veronica, where do you live?" But more importantly, it was that we put in place a system that allowed us to routinely ask questions to Veronica and hundreds more like her about the conditions that mattered in her community, about where health, and unfortunately sometimes illness, do begin in places like South L.A. In that community, substandard housing and food insecurity are the major conditions that we as a clinic had to be aware of, but in other communities it could be transportation barriers, obesity, access to parks, gun violence.

The important thing is, we put in place a system that worked, and it's an approach that I call an upstream approach. It's a term many of you are familiar with. It comes from a parable that's very common in the public health community. This is a parable of three friends. Imagine that you're one of these three friends who come to a river. It's a beautiful scene, but it's shattered by the cries of a child, and actually several children, in need of rescue in the water. So you do hopefully what everybody would do. You jump right in along with your friends. The first friend says, I'm going to rescue those who are about to drown, those at most risk of falling over the waterfall. The second friends says, I'm going to build a raft. I'm going to make sure that fewer people need to end up at the waterfall's edge. Let's usher more people to safety by building this raft, coordinating those branches together. Over time, they're successful, but not really, as much as they want to be. More people slip through, and they finally look up and they see that their third friend is nowhere to be seen. They finally spot her. She's in the water. She's swimming away from them upstream, rescuing children as she goes, and they shout to her, "Where are you going? There are children here to save." And she says back, "I'm going to find out who or what is throwing these children in the water." In healthcare, we have that first friend — we have the specialist, we have the trauma surgeon, the ICU nurse, the E.R. doctors. We have those people that are vital rescuers, people you want to be there when you're in dire straits. We also know that we have the second friend — we have that raft-builder. That's the primary care clinician, people on the care team who are there to manage your chronic conditions, your diabetes, your hypertension, there to give you your annual checkups, there to make sure your vaccines are up to date, but also there to make sure that you have a raft to sit on and usher yourself to safety. But while that's also vital and very necessary, what we're missing is that third friend. We don't have enough of that upstreamist. The upstreamists are the health care professionals who know that health does begin where we live and work and play, but beyond that awareness, is able to mobilize the resources to create the system in their clinics and in their hospitals that really does start to approach that, to connect people to the resources they need outside the four walls of the clinic.

Now you might ask, and it's a very obvious question that a lot of colleagues in medicine ask: "Doctors and nurses thinking about transportation and housing? Shouldn't we just provide pills and procedures and just make sure we focus on the task at hand?" Certainly, rescuing people at the water's edge is important enough work. Who has the time? I would argue, though, that if we were to use science as our guide, that we would find an upstream approach is absolutely necessary. Scientists now know that the living and working conditions that we all are part of have more than twice the impact on our health than does our genetic code, and living and working conditions, the structures of our environments, the ways in which our social fabric is woven together, and the impact those have on our behaviors, all together, those have more than five times the impact on our health than do all the pills and procedures administered by doctors and hospitals combined. All together, living and working conditions account for 60 percent of preventable death.

Let me give you an example of what this feels like. Let's say there was a company, a tech startup that came to you and said, "We have a great product. It's going to lower your risk of death from heart disease." Now, you might be likely to invest if that product was a drug or a device, but what if that product was a park? A study in the U.K., a landmark study that reviewed the records of over 40 million residents in the U.K., looked at several variables, controlled for a lot of factors, and found that when trying to adjust the risk of heart disease, one's exposure to green space was a powerful influence. The closer you were to green space, to parks and trees, the lower your chance of heart disease, and that stayed true for rich and for poor. That study illustrates what my friends in public health often say these days: that one's zip code matters more than your genetic code. We're also learning that zip code is actually shaping our genetic code. The science of epigenetics looks at those molecular mechanisms, those intricate ways in which our DNA is literally shaped, genes turned on and off based on the exposures to the environment, to where we live and to where we work. So it's clear that these factors, these upstream issues, do matter. They matter to our health, and therefore our healthcare professionals should do something about it. And yet, Veronica asked me perhaps the most compelling question I've been asked in a long time. In that follow-up visit, she said, "Why did none of my doctors ask about my home before? In those visits to the emergency room, I had two CAT scans, I had a needle placed in the lower part of my back to collect spinal fluid, I had nearly a dozen blood tests. I went back and forth, I saw all sorts of people in healthcare, and no one asked about my home."

The honest answer is that in healthcare, we often treat symptoms without addressing the conditions that make you sick in the first place. And there are many reasons for that, but the big three are first, we don't pay for that. In healthcare, we often pay for volume and not value. We pay doctors and hospitals usually for the number of services they provide, but not necessarily on how healthy they make you. That leads to a second phenomenon that I call the "don't ask, don't tell" approach to upstream issues in healthcare. We don't ask about where you live and where you work, because if there's a problem there, we don't know what to tell you. It's not that doctors don't know these are important issues. In a recent survey done in the U.S. among physicians, over 1,000 physicians, 80 percent of them actually said that they know that their patients' upstream problems are as important as their health issues, as their medical problems, and yet despite that widespread awareness of the importance of upstream issues, only one in five doctors said they had any sense of confidence to address those issues, to improve health where it begins. There's this gap between knowing that patients' lives, the context of where they live and work, matters, and the ability to do something about it in the systems in which we work.

This is a huge problem right now, because it leads them to this next question, which is, whose responsibility is it? And that brings me to that third point, that third answer to Veronica's compelling question. Part of the reason that we have this conundrum is because there are not nearly enough upstreamists in the healthcare system. There are not nearly enough of that third friend, that person who is going to find out who or what is throwing those kids in the water. Now, there are many upstreamists, and I've had the privilege of meeting many of them, in Los Angeles and in other parts of the country and around the world, and it's important to note that upstreamists sometimes are doctors, but they need not be. They can be nurses, other clinicians, care managers, social workers. It's not so important what specific degree upstreamists have at the end of their name. What's more important is that they all seem to share the same ability to implement a process that transforms their assistance, transforms the way they practice medicine. That process is a quite simple process. It's one, two and three. First, they sit down and they say, let's identify the clinical problem among a certain set of patients. Let's say, for instance, let's try to help children who are bouncing in and out of the hospital with asthma. After identifying the problem, they then move on to that second step, and they say, let's identify the root cause. Now, a root cause analysis, in healthcare, usually says, well, let's look at your genes, let's look at how you're behaving. Maybe you're not eating healthy enough. Eat healthier. It's a pretty simplistic approach to root cause analyses. It turns out, it doesn't really work when we just limit ourselves that worldview. The root cause analysis that an upstreamist brings to the table is to say, let's look at the living and the working conditions in your life. Perhaps, for children with asthma, it's what's happening in their home, or perhaps they live close to a freeway with major air pollution that triggers their asthma. And perhaps that's what we should mobilize our resources to address, because that third element, that third part of the process, is that next critical part of what upstreamists do. They mobilize the resources to create a solution, both within the clinical system, and then by bringing in people from public health, from other sectors, lawyers, whoever is willing to play ball, let's bring in to create a solution that makes sense, to take those patients who actually have clinical problems and address their root causes together by linking them to the resources you need. It's clear to me that there are so many stories of upstreamists who are doing remarkable things. The problem is that there's just not nearly enough of them out there. By some estimates, we need one upstreamist for every 20 to 30 clinicians in the healthcare system. In the U.S., for instance, that would mean that we need 25,000 upstreamists by the year 2020. But we only have a few thousand upstreamists out there right now, by all accounts, and that's why, a few years ago, my colleagues and I said, you know what, we need to train and make more upstreamists.

So we decided to start an organization called Health Begins, and Health Begins simply does that: We train upstreamists. And there are a lot of measures that we use for our success, but the main thing that we're interested in is making sure that we're changing the sense of confidence, that "don't ask, don't tell" metric among clinicians. We're trying to make sure that clinicians, and therefore their systems that they work in have the ability, the confidence to address the problems in the living and working conditions in our lives. We're seeing nearly a tripling of that confidence in our work.

It's remarkable, but I'll tell you the most compelling part of what it means to be working with upstreamists to gather them together. What is most compelling is that every day, every week, I hear stories just like Veronica's. There are stories out there of Veronica and many more like her, people who are coming to the healthcare system and getting a glimpse of what it feels like to be part of something that works, a health care system that stops bouncing you back and forth but actually improves your health, listens to you who you are, addresses the context of your life, whether you're rich or poor or middle class.

These stories are compelling because not only do they tell us that we're this close to getting the healthcare system that we want, but that there's something that we can all do to get there. Doctors and nurses can get better at asking about the context of patients' lives, not simply because it's better bedside manner, but frankly, because it's a better standard of care. Healthcare systems and payers can start to bring in public health agencies and departments and say, let's look at our data together. Let's see if we can discover some patterns in our data about our patients' lives and see if we can identify an upstream cause, and then, as importantly, can we align the resources to be able to address them? Medical schools, nursing schools, all sorts of health professional education programs can help by training the next generation of upstreamists. We can also make sure that these schools certify a backbone of the upstream approach, and that's the community health worker. We need many more of them in the healthcare system if we're truly going to have it be effective, to move from a sickcare system to a healthcare system. But finally, and perhaps most importantly, what do we do? What do we do as patients? We can start by simply going to our doctors and our nurses, to our clinics, and asking, "Is there something in where I live and where I work that I should be aware of?" Are there barriers to health that I'm just not aware of, and more importantly, if there are barriers that I'm surfacing, if I'm coming to you and I'm saying I think have a problem with my apartment or at my workplace or I don't have access to transportation, or there's a park that's way too far, so sorry doctor, I can't take your advice to go and jog, if those problems exist, then doctor, are you willing to listen? And what can we do together to improve my health where it begins?

If we're all able to do this work, doctors and healthcare systems, payers, and all of us together, we'll realize something about health. Health is not just a personal responsibility or phenomenon. Health is a common good. It comes from our personal investment in knowing that our lives matter, the context of where we live and where we work, eat, and sleep, matter, and that what we do for ourselves, we also should do for those whose living and working conditions again, can be hard, if not harsh. We can all invest in making sure that we improve the allocation of resources upstream, but at the same time work together and show that we can move healthcare upstream. We can improve health where it begins. 

MAGIC OF THE AMAZON RIVER









By Antonio Donato Nobre

Usually, talking about science is like exercising in a dry place. However, I've had the pleasure of being invited to post here about water. The words "water" and "dry" do not match, right? It is even better to talk about water in the Amazon, which is the splendid cradle of life. Fresh life. So this is what inspired me.

That's why I post here, although I'm carrying my head over here. I am trying, or will try to convey this inspiration. I hope this story will inspire you and that you'll spread the word. We know that there is controversy. The Amazon is the "lung of the world," because of its massive power to have vital gases exchanged between the forest and the atmosphere. We also hear about the storehouse of biodiversity.

While many believe it, few know it. If you go out there, in this marsh, you'll be amazed at the — You can barely see the animals. The Indians say, "The forest has more eyes than leaves." That is true, and I will try to show you something. But today, I'm going to use a different approach, one that is inspired by these two initiatives here, a harmonic one and a philosophical one.

I'll try to use an approach that's slightly materialistic, but it also attempts to convey that, in nature, there is extraordinary philosophy and harmony. There'll be no music in my post, but I hope you'll all notice the music of the reality I'm going to show you. I'm going to talk about physiology — not about lungs, but other analogies with human physiology, especially the heart. We'll start by thinking that water is like blood. The circulation in our body distributes fresh blood, which feeds, nurtures and supports us, and brings the used blood back to be renewed.

In the Amazon, things happen similarly. We'll start by talking about the power of all these processes. This is an image of rain in motion. What you see there is the years passing in seconds. Rains all over the world. What do you see? The equatorial region, in general, and the Amazon specifically, is extremely important for the world's climate. It's a powerful engine. There is a frantic evaporation taking place here.

If we take a look at this other image, which shows the water vapor flow, you have dry air in black, moist air in gray, and clouds in white. What you see there is an extraordinary resurgence in the Amazon. What phenomenon — if it's not a desert, what phenomenon makes water gush from the ground into the atmosphere with such power that it can be seen from space? What phenomenon is this? It could be a geyser. A geyser is underground water heated by magma, exploding into the atmosphere and transferring this water into the atmosphere.

There are no geysers in the Amazon, unless I am wrong. I don't know of any. But we have something that plays the same role, with much more elegance though: the trees, our good old friends that, like geysers, can transfer an enormous amount of water from the ground into the atmosphere. There are 600 billion trees in the Amazon forest, 600 billion geysers.

That is done with an extraordinary sophistication. They don't need the heat of magma. They use sunlight to do this process. So, in a typical sunny day in the Amazon, a big tree manages to transfer 1,000 liters of water through its transpiration — 1,000 liters. If we take all the Amazon, which is a very large area, and add it up to all that water that is released by transpiration, which is the sweat of the forest, we'll get to an incredible number: 20 billion metric tons of water. In one day. Do you know how much that is? The Amazon River, the largest river on Earth, one fifth of all the fresh water that leaves the continents of the whole world and ends up in the oceans, dumps 17 billion metric tons of water a day in the Atlantic Ocean.

This river of vapor that comes up from the forest and goes into the atmosphere is greater than the Amazon River. Just to give you an idea. If we could take a gigantic kettle, the kind you could plug into a power socket, an electric one, and put those 20 billion metric tons of water in it, how much power would you need to have this water evaporated? Any idea? A really big kettle. A gigantic kettle, right? 50 thousand Itaipus. Itaipu is still the largest hydroelectric plant in the world. and Brazil is very proud of it because it provides more than 30 percent of the power that is consumed in Brazil. And the Amazon is here, doing this for free.

It's a vivid and extremely powerful plant, providing environmental services. Related to this subject, we are going to talk about what I call the paradox of chance, which is curious. If you look at the world map — it's easy to see this — you'll see that there are forests in the equatorial zone, and deserts are organized at 30 degrees north latitude, 30 degrees south latitude, aligned. Look over there, in the southern hemisphere, the Atacama; Namibia and Kalahari in Africa; the Australian desert. In the northern hemisphere, the Sahara, Sonoran, etc. There is an exception, and it's curious: It's the quadrangle that ranges from Cuiabá to Buenos Aires, and from São Paulo to the Andes. This quadrangle was supposed to be a desert. It's on the line of deserts. Why isn't it? That's why I call it the paradox of chance.

What do we have in South America that is different? If we could use the analogy of the blood circulating in our bodies, like the water circulating in the landscape, we see that rivers are veins, they drain the landscape, they drain the tissue of nature. Where are the arteries? Any guess? What takes — How does water get to irrigate the tissues of nature and bring everything back through rivers? There is a new type of river, which originates in the blue sea, which flows through the green ocean — it not only flows, but it is also pumped by the green ocean — and then it falls on our land.

All our economy, that quadrangle, 70 percent of South America's GDP comes from that area. It depends on this river. This river flows invisibly above us. We are floating here on this floating hotel, on one of the largest rivers on Earth, the Negro River. It's a bit dry and rough, but we are floating here, and there is this invisible river running above us. This river has a pulse. Here it is, pulsing. That's why we also talk about the heart. You can see the different seasons there.

There's the rainy season. In the Amazon, we used to have two seasons, the humid season and the even more humid season. Now we have a dry season. You can see the river covering that region which, otherwise, would be a desert. And it is not. We, scientists — You see that I'm struggling here to move my head from one side to the other. Scientists study how it works, why, etc. and these studies are generating a series of discoveries, which are absolutely fabulous, to raise our awareness of the wealth, the complexity, and the wonder that we have, the symphony we have in this process. One of them is: How is rain formed? Above the Amazon, there is clean air, as there is clean air above the ocean. The blue sea has clean air above it and forms pretty few clouds; there's almost no rain there.

The green ocean has the same clean air, but forms a lot of rain. What is happening here that is different? The forest emits smells, and these smells are condensation nuclei, which form drops in the atmosphere. Then, clouds are formed and there is torrential rain. The sprinkler of the Garden of Eden. This relation between a living thing, which is the forest, and a nonliving thing, which is the atmosphere, is ingenious in the Amazon, because the forest provides water and seeds, and the atmosphere forms the rain and gives water back, guaranteeing the forest's survival.

There are other factors as well. We've talked a little about the heart, and let's now talk about another function: the liver! When humid air, high humidity and radiation are combined with these organic compounds, which I call exogenous vitamin C, generous vitamin C in the form of gas, the plants release antioxidants which react with pollutants. You can rest assured that you are breathing the purest air on Earth, here in the Amazon, because the plants take care of this characteristic as well.

This benefits the very way plants work, which is another ingenious cycle. Speaking of fractals, and their relation with the way we work, we can establish other comparisons. As in the upper airways of our lungs, the air in the Amazon gets cleaned up from the excess of dust. The dust in the air that we breathe is cleaned by our airways. This keeps the excess of dust from affecting the rainfall. When there are fires in the Amazon, the smoke stops the rain, it stops raining, the forest dries up and catches fire.

There is another fractal analogy. Like in the veins and arteries, the rain water is a feedback. It returns to the atmosphere. Like endocrinal glands and hormones, there are those gases which I told you about before, that are formed and released into the atmosphere, like hormones, which help in the formation of rain. Like the liver and the kidneys, as I've said, cleaning the air. And, finally, like the heart: pumping water from outside, from the sea, into the forest. We call it the biotic moisture pump, a new theory that is explained in a very simple way.

If there is a desert in the continent with a nearby sea, evaporation's greater on the sea, and it sucks the air above the desert. The desert is trapped in this condition. It will always be dry. If you have the opposite situation, a forest, the evaporation, as we showed, is much greater, because of the trees, and this relation is reversed. The air above the sea is sucked into the continent and humidity is imported.

It's not a common little river that flows into a canal. It's a mighty river that irrigates South America, among other things. This image shows those paths, all the hurricanes that have been recorded. You can see that, in the red square, there hardly are any hurricanes. That is no accident. This pump that sucks the moisture into the continent also speeds up the air above the sea, and this prevents hurricane formations.

To close this part and sum up, I'd like to talk about something a little different. I have several colleagues who worked in the development of these theories. They think, and so do I, that we can save planet Earth. I'm not talking only about the Amazon. The Amazon teaches us a lesson on how pristine nature works. We didn't understand these processes before because the rest of the world is messed up.

We could understand it here, though. These colleagues propose that, yes, we can save other areas, including deserts. If we could establish forests in those other areas, we can reverse climate change, including global warming. I have a dear colleague in India, whose name is Suprabha Seshan, and she has a motto. Her motto is, "Gardening back the biosphere," "Reajardinando a biosfera" in Portuguese. She does a wonderful job rebuilding ecosystems. We need to do this.

Having closed this quick introduction, we see the reality that we have out here, which is drought, this climate change, things that we already knew. I'd like to tell you a short story. Once, about four years ago, I attended a declamation, of a text by Davi Kopenawa, a wise representative of the Yanomami people, and it went more or less like this: "Doesn't the white man know that, if he destroys the forest, there will be no more rain? And that, if there's no more rain, there'll be nothing to drink, or to eat?" I heard that, and my eyes welled up and I went, "Oh, my! I've been studying this for 20 years, with a super computer, dozens, thousands of scientists, and we are starting to get to this conclusion, which he already knows!"

A critical point is the Yanomami have never deforested. How could they know the rain would end? This bugged me and I was befuddled. How could he know that? Some months later, I met him at another event and said, "Davi, how did you know that if the forest was destroyed, there'd be no more rain?" He replied: "The spirit of the forest told us." For me, this was a game changer, a radical change. I said, "Gosh! Why am I doing all this science to get to a conclusion that he already knows?" Then, something absolutely critical hit me, which is, seeing is believing. Out of sight, out of mind. This is a need the previous speaker pointed out: We need to see things — I mean, we, Western society, which is becoming global, civilized — we need to see. If we don't see, we don't register the information.

We live in ignorance. So, I propose the following — of course, the astronomers wouldn't like the idea — but let's turn the Hubble telescope upside down. And let's make it look down here, rather than to the far reaches of the universe. The universe is wonderful, but we have a practical reality, which is we live in an unknown cosmos, and we're ignorant about it.

We're trampling on this wonderful cosmos that shelters us and houses us. Talk to any astrophysicist. The Earth is a statistical improbability. The stability and comfort that we enjoy, despite the droughts of the Negro River, and all the heat and cold and typhoons, etc., there is nothing like it in the universe, that we know of. Then, let's turn Hubble in our direction, and let's look at the Earth. Let's start with the Amazon! Let's dive, let's reach out the reality we live in every day, and look carefully at it, since that's what we need.

Davi Kopenawa doesn't need this. He has something already that I think I missed. I was educated by television. I think that I missed this, an ancestral record, a valuation of what I don't know, what I haven't seen. He is not a doubting Thomas. He believes, with veneration and reverence, in what his ancestors and the spirits taught him. We can't do it, so let's look into the forest. Even with Hubble up there — this is a bird's-eye view, right? Even when this happens, we also see something that we don't know. The Spanish called it the green inferno. If you go out there into the bushes and get lost, and, let's say, if you head west, it's 900 kilometers to Colombia, and another 1,000 to somewhere else.

So, you can figure out why they called it the green inferno. But go and look at what is in there. It is a live carpet. Each color you see is a tree species. Each tree, each tree top, has up to 10,000 species of insects in it, let alone the millions of species of fungi, bacteria, etc. All invisible. All of it is an even stranger cosmos to us than the galaxies billions of light years away from the Earth, which Hubble brings to our newspapers everyday. I'm going to end my talk here — I have a few seconds left — by showing you this wonderful being.

When we see the morpho butterfly in the forest, we feel like someone's left open the door to heaven, and this creature escaped from there, because it's so beautiful. However, I cannot finish without showing you a tech side. We are tech-arrogant. We deprive nature of its technology. A robotic hand is technological, mine is biological, and we don't think about it anymore. Let's then look at the morpho butterfly, an example of an invisible technological competence of life, which is at the very heart of our possibility of surviving on this planet, and let's zoom in on it. Again, Hubble is there.

Let's get into the butterfly's wings. Scholars have tried to explain: Why is it blue? Let's zoom in on it. What you see is that the architecture of the invisible humiliates the best architects in the world. All of this on a tiny scale. Besides its beauty and functioning, there is another side to it. In nature, all that is organized in extraordinary structures has a function. This function of the morpho butterfly — it is not blue; it does not have blue pigments. It has photonic crystals on its surface, according to people who studied it, which are extremely sophisticated crystals. Our technology had nothing like that at the time. Hitachi has now made a monitor that uses this technology, and it is used in optical fibers to transmit — Janine Benyus, who's been here several times, talks about it: biomimetics.

I'll wrap it up with what is at the base of this capacity, of this competence of biodiversity, producing all these wonderful services: the living cell. It is a structure with a few microns, which is an internal wonder. I won't talk much longer, but each person in this room, including myself, has 100 trillion of these micromachines in their body, so that we can enjoy well-being. Imagine what is out there in the Amazon forest: 100 trillion. This is greater than the number of stars in the sky. And we are not aware of it.


THE MOST CORRUPT POLITICAL MAFIA ON EARTH NEEDS A COUP DE GRACE



Pasok, a socialist political mafia, sowed the seeds of future problems by building a bloated public sector based on patronage and political corruption. Myriad sinecures were created in state companies and then given to Pasok members, a system that continued under New Kleptocracy. 


TÜRKOGLU SAVED PAPANDREOU FROM LIFE IN PRISON

The notion of meritocracy was pushed aside as senior positions in universities and local councils became party appointees. Public construction licenses were always decided on the basis of political support, with Pasokleptocrats lining their pockets through bribes and kickbacks. Political corruption blossomed.  Andreas Papandreou went on trial in 1991 accused of embezzlement.  Papandreou ordered state corporations to transfer their holdings to the Bank of Crete, where the interest was skimmed off to benefit Pasok and  Pasokleptocrats.  He was narrowly acquitted, thanks to lawyer Türkoğlu, now president of Pasok.  If it weren’t for Türkoğlu, Papandreou would have been imprisoned for life.

The collapse of Pasok has gone hand-in-hand with the decline of the Greece it created. And with it has fallen the once omnipotent Papandreou dynasty, as George senior, Andreas, and George junior were all premiers of Greece. Nepotism has long had a grip on Greek politics.

Pasok is now a party without a heartbeat, a real zombie, now motivated by just an instinct of self-preservation. Pasok tries to survive for just another day. Turkoglu has been largely discredited over many scandals. His attempts to claw back respectability has not resonated with hoi polloi who are as mad as hell, and they cannot take it from Pasok anymore.

Pasok is going belly up, overwhelmed by debts of 200 million euros. The debts of Pasok far exceeds the state funding. Parties that receive more votes get more funding. Relying on past good results, Pasok has pledged future state funding as collateral for bank loans. But in the 2012 election, its support collapsed, leaving Pasok with big loans and facing much smaller incomes.

This is all about the exchange of favors. Pasok cannot pay the debt so it's a vicious circle in which Pasok comes to depend on the banks. It creates an interdependence of Pasokleptocrats and banks. At the 2012 election Pasok saw its share of the vote plunge from 43 percent to 12 percent.  Pasok owes ATE 130 million euros. ATE had to be rescued from collapse, taken over by Piraeus Bank.

Greece provides public funding for political parties and their election campaigns. Last year the state handed out a total of 54 million euros. Each year parties receive funding equal to 0.13 percent of annual state revenue. Greece hands out more than three times the amount spent by Germany on political parties. Per valid vote cast, Athens spends an average ten euros versus Germany's three euros.

Greece has all the right conditions for corruption: plenty of bureaucracy, no functioning justice system, laws with numerous loopholes, and economic pressure.  Regarding bribes and robbing the Greek Treasury, Premier Andreas Papandreou, founder of Pasok, famously advised Pasokleptocrats: We all agree, of course, that we are allowed to give ourselves a little present from time to time, but please don't make it too large!







PAPANDREOU DYNASTY

The Papandreou dynasty created a bloated kleptocracy of cronyism that cannot change without the intervention of the Greek army. Georgios Papandreou, George Papandreou's grandfather, founded the family's political dynasty, serving as prime minister. After the 1967-1974 military dictatorship, Georgios' son Andreas Papandreou created the socialist party Pasok. In the 1980s, he gave so much to his cronies and supporters that the country's debt ballooned.

The last four decades have seen the Papadreou dynasty establish a kleptocracy. It squandered 300 billion euros the government didn't actually have and showered kith and kin with sinecures and prosperity that were all based on credit. These kleptocrats bloated Greece's government so that everyone could have a piece of corruption, and created a bureaucratic hydra, which devoured many great institutions, such as the Bank of Crete. The Papandreou brothers who were not ministers of the government were sitting in the boards of directors of the largest Greek corporations milking the country.

Papandreou dynasty's dealings were always more about favors than policies.  Anyone with access to public funds used them to buy friends and voters, who were then beholden to the mafia. The result for Greece has been a feudal kleptocracy, where the generations come and go but Papandreous always remain in politics. The new Pasok cannot survive, because it chose Türkoğlu, the founder of kleptocratic impunity, as its leader, it continues political corruption as usual, and it shelters most freakish blogbusters.

Pasok is a socialist mafia, a den of thieves, member of the Socialist International, the Party of European Socialists, and the Progressive Alliance of Socialists and Democrats. Pasokleptocrats span the gamut of political corruption. Bribe is the gift bestowed to influence the recipient's conduct. Kickback is a payment to a person in a position of power or influence for having made an income possible. Embezzlement is outright theft of entrusted funds. Patronage is favoring supporters. Nepotism is favoring kin. Cronyism is favoring kith. Graft is an unscrupulous use of a politician's authority for personal gain. 

During Andreas Papandreou's leadership, wages were substantially boosted and income was heavily taxed. At the very beginning, the members and the leadership of the mafia were very critical of NATO and the European Economic Community, but this attitude was soon abandoned when they realized they could make more kickbacks and bribes. Andreas Papandreou and Akis Tsochatzopoulos wished to create a socialistic world where kleptocrats would dominate.


CROWN PRINCE TSOCHATZOPOULOS

Tsochatzopoulos, a distinguished leader and cofounder of Pasok, served in cabinets between 1981 and 2004.  He was elected to the Greek Parliament for the first time in 1981 and remained in seat until 2007.  He was the second most important person of Pasok, the crown prince of Pasok, but fate was not nice to him, ending up in prison for what all Pasokleptocrats did anyhow, political corruption beyond imagination!  But while the other Pasokleptocrats knew how to cover their ass, Tsochatzopoulos lived like a king, inviting scrutiny and jealousy.

After Andreas Papandreou's death, Costas Simitis defeated Tsochatzopoulos, and he was elected President of Pasok. Simitis moved to modernize the mafia, making it purely social democratic. Tight fiscal policies, privatization of state enterprises, and a broadening of the tax base were implemented. But due to huge political corruption, Pasok was defeated at the polls in the election of 2004. The Nea Democratia policies adopted by the new government, forced Pasok to turn left under the leadership of George Papandreou. Five years later, the Party triumphed in the 2009 elections.

After the 2009 electoral sweep, there were many revelations of huge political corruption. Moreover, the deficit that had run up in the years leading to 2010 was of an enormous unmanageable scope. Greece was faced with imminent bankruptcy, and the government received emergency funds from IMF and ECB. In exchange for further loans, Fourth Reich required austerity policies.

In Greece, the most corrupt country of Fourth Reich, trains run completely empty to nowhere!  Many trains bought from Germany do not fit the rails, but they were bought just to generate bribes!   In 2009, investigators of the Munich Prosecution Department uncovered a corruption affair, in which MAN has given huge bribes to Greek politicians to get large orders for overpriced trolleys.  A streetcar named desire!  These trolleys with huge markups are named bribes!  But Greek prosecutors have started investigating this scandal just in September of 2012!  

Pasok’s transformation from its original socialistic principles to kleptocratic principles disenchanted many Party members. The social disruption flowing from revelations of huge political corruption sparked major demonstrations against the government.  In the May 2012 elections that followed, the Party placed third.  Recent polls place Pasok sixth, the last party with only 5% of popular support. It used to be the first party, with 42% of popular support. In next elections, Pasok might get less than 3%, leaving it out of the Greek parliament. For all practical purposes, Pasok is now dead.  History will record it as a den of thieves.

Piggish Pasokleptocrats chose former Defense Minister Akis Tsochatzopoulos of Pasok as a scapegoat  for their sins, because his living style corresponds to the Royal House of Saudi Arabia.  This way, they hope Greeks could cool down and forget about the myriad briberies and scandals of Pasokleptocrats.  Obviously, Pasokleptocrats undervalue the intelligence of Greeks.  Greeks know very well, there is no just a single culprit, but at least four hundred culprits who stole billions of euros, safely deposited in their offshore accounts.

Scapegoating Tsochatzopoulos is a hostile social-psychological discrediting routine by which Pasokleptocrats move blame and responsibility away from themselves and towards Tsochatzopoulos. It is also a practice by which angry feelings and feelings of hostility are projected, via accusation, towards Tsochatzopoulos. Tsochatzopoulos feels singly persecuted and receives vilification, blame and criticism, even though four hundred Graecokleptocrats did similar things.  Tsochatzopoulos suffers rejection from Greeks who Pasokleptocrats seek to influence.

In scapegoating Tsochatzopoulos, feelings of guilt, aggression, blame and suffering are transferred away from Pasokleptocrats so as to fulfill an unconscious drive to resolve or avoid such bad feelings. This is done by the displacement of responsibility and blame to Tsochatzopoulos who serves as a target for blame both for Pasokleptocrats and Greeks.

The Pasokleptocrats’ drive to displace and transfer responsibility away from themselves may not be experienced with full consciousness as self-deception is a feature. Tsochatzopoulos experiences exclusion, ostracism, and expulsion. Scapegoating frees Pasokleptocrats from some self-dissatisfaction and provides some narcissistic gratification to them. It enables the self-righteous discharge of aggression.

Scapegoating Tsochatzopoulos also can be seen as the Pasokleptocrats’ defense mechanism against unacceptable emotions such as hostility and guilt. Scapegoating Tsochatzopoulos is an example of projective identification, with the primitive intent of splitting, separating the good from the bad.  Pasokleptocrats are also insecure people driven to raise their own status by lowering the status of Tsochatzopoulos.  


ODYSSEY OF LAGARDE LIST

The odyssey of Lagarde list proves the huge Greek political corruption continues up to this day.  It primarily illustrates how Graecokleptocrats cover their ass. In the autumn of 2010, Christine Lagarde, who was the French finance minister at the time, gave her Greek counterpart George Papaconstantinou a list of 2062 bank accounts with information on Greek customers at the HSBC Bank in Switzerland.  While the French state was using this list to help collect half a billion euros from its own taxdodgers, Papaconstantinou hid the list and deleted the names of his three relatives! 

Adding insult to injury, Papaconstantinou hoodwinks that he does not know what happened to the original version of Lagarde list!   Papaconstantinou was succeeded by Evangelos Türkoğlu, who is the leader of Pasok, and thus part of the governing coalition. Türkoğlu served as finance minister for nine months. He is infamous for introducing the impunity of Graecokleptocrats twenty years ago. 

Türkoğlu didn't instruct the Financial Crimes Squad (SDOE) to conduct inquiries, nor did he inform anyone of the existence of this information. Everyone else in the government thought that the list had disappeared. It was only when the current Finance Minister John Stournaras heard about the Lagarde list, and wanted to ask Paris for the original pure version, that Türkoğlu supposedly remembered the doctored Lagarde list in his drawer!

Do not forget that HSBC is just one offshore bank out of thousand offshore banks.  Greeks wonder how many billion euros in total are deposited in the offshore accounts of all kith and kin of all Graecokleptocrats, who pretend they are penniless.  Could that be a trillion euros?  We have now a Greek tragicomedy of penniless billionaires!  Graecokleptocrats have just created a new oxymoron, their only contribution to philosophy!



THE FALL OF PASOK STARTED ON OCTOBER 18, 2010



Your government is your #1 enemy.  Brutal police and kangaroo courts are tools to enslave you to your government.  But badges and benches do not grant extra rights. It’s your duty as a citizen to become a popopaparazzo, recording police misconduct. Use your smartphone to unmask cops, kangaroos, marilizards, godzillas, and other bastards of kleptocracy. 


DOUBLE STANDARDS

EU practices double standards on civil rights.  It’s freakish for EU to interfere in the civil rights of foreigners, but condone the abuse of my civil rights, a citizen of EU!  EU should get its own house in order before lecturing others. EU should rein in Greece, the most corrupt country of Europe with prisoners of conscience, testilying police, malevolent prosecutors, perjurers, and stupidest jurists.   Basil Venitis, venitis@gmail.com, http://venitism.blogspot.com


Greece is an incivil nation with kangaroo justice, overcriminalization, brutal police, huge political corruption, persecution of dissident bloggers, huge bureaucracy, huge taxation, and 23% VAT.  Freakish Graecokleptocrats use the kangaroo justice as a political tool to gag political opponents. 


J'ACCUSE!

I accuse the government of Greece for:

·        Persecuting me for four years

·        Stealing my life

·        Stealing my computer and files

·        Spreading lies about me on all Greek media

·        Using the kangaroo justice as a political tool

·        Postponing my trial eight times

·        Locking me in jail without toilet and pillow for a night

·        Taking away my hypertension pills

·        Making me urinate in a bottle

·        Humiliating me with handcuffs, fingerprints, and mug shots


AN UNCONSCIONABLE SILENCE

The political philosopher Edmund Burke once remarked that all that is necessary for the triumph of evil is for good folks to do nothing. A glaring example is my persecution by the government of Greece, which grossly violates my civil rights.


THEN THEY CAME FOR ME!

Martin Niemöller said:  First they came for the Socialists, and I did not speak out, because I was not a Socialist.  Then they came for the Trade Unionists, and I did not speak out, because I was not a Trade Unionist.  Then they came for the Jews, and I did not speak out, because I was not a Jew. Then they came for me, and there was no one left to speak for me!


GOVERNMENT STOLE MY LIFE

It’s been now four years since the Pasok government of Greece stole my life, my computer, and my files.  Nobody cares, nobody gives a damn!  I have done absolutely nothing, and I am being persecuted by the Greek government without any real reason.  My ordeal is against all rules of civil society and treaties that Greece has signed.  Greece, a country without a functioning justice system, has gone bananas.  Graecokleptocrats use the kangaroo justice as a political tool to gag political opponents.   Graecokleptocrats think the laws exist to give them whatever they want!   Basil Venitis, venitis@gmail.com, http://venitism.blogspot.com


STOLEN LIVES

GEORGE ORWELL’S MINILUV AND MINITRUE
MINISTRY OF PUBLIC DISORDER AND CITIZEN HARASSMENT
MINILUV

POLICE STEALING COMPUTERS!

On October 18, 2010, a gang of six brutal cops of the violent Greek Cyber-Crime Unit (CCU), a real godzilla, supervised by a dishonest prosecutor, a disgusting liar, raided my home in Athens and stole my computer, software, files, documents, and personal data.


HUMILIATED

The policemen locked me in jail for a night, they humiliated me with handcuffs, fingerprints, mug shots, and lies, leaked false information to the media parrots, and the Greek government initiated sham ex-officio court proceedings for a stack of freakish trumped-up charges!


URINATING IN A BOTTLE!

There was neither pillow nor toilet facility in my jail cell. I had to urinate in a bottle!  I, a 69-years-old man with high blood pressure, was not allowed to keep my hypertension pills with me. There was neither toilet paper nor soap in the whole CCU jail.


MINISTRY OF INJUSTICE, OPACITY, AND HUMAN DEPRIVATIONS
MINITRUE

Greece, a country of infinite political corruption, perjury, injustice, and brutal police, must be revamped.  Ex-officio law suit, αυτεπαγγελτος, the most dreadful word in justice, means the state sues somebody without involvement of the accuser.  This terrible scheme has been used by the Greek government to persecute me. 


EX-OFFICIO TERROR

Mariliza Xenogiannakopoulou of Pasok, Alternate Minister of Foreign Affairs, sued me, and she wouldn’t show up in court, because the state took over her position! 


DISGUSTING KANGAROO JUSTICE


PSORIASIS OF DEMOCRACY


At the ex-officio law suit, the accuser just hits and runs!  This hit-and-run justice is the most disgusting kangaroo justice on Earth.  The accused must be in a position to face his accuser eyeball to eyeball. The right to confront and cross-examine one’s accuser is a sign of civility. The malicious accuser slings false accusations against you, the state takes over, the accuser disappears from the court, and the trial is postponed infinite times!  This is penalty of the presumed innocent.  This is penalty without trial.  This is kangaroo justice of Third World countries!  This is barbarity and brutality, pure and simple. Shame, shame, shame on Greece.


SHAME ON GREECE


TAKE ACTION


Please email appeals to



·        Calling for the immediate stop of the persecution of Basil Venitis.

·        Stating that you believe these trumped-up charges to be politically motivated and intended to prevent him exercising his right to freedom of expression against political corruption.

·        Seeking assurances that the civil rights of Basil Venitis will always be respected.