Saturday, June 19, 2004

Liberals Promote Abstinence-Only Education!

Michigan Liberals Promote Abstinence-Only Education

JUNE 19, 2004
LANSING (MI) -- At the Capitol today, leading House Democrats held a press conference to explain the many virtues of their new abstinence-only education campaign.  Republicans complained that "they are stealing our thunder." 

Undeterred by this criticism, House minority leader Dianne Byrum (D-Onandaga) pointed out the main points of the program.

"Complete abstinence is the only method proven to be 100% effective.  When it comes to violence, the only way to be absolutely certain that you don't shoot someone, is to never pull the trigger."  To elaborate, she went on, "The critics of this program argue that 'kids will do it anyway, so there is no point in trying to stop them.'  This does not square well with the values we want Michigan kids to have." 

"Some people argue that an occasional punch in the nose does no real harm, and it builds character.  The only character it builds is the kind of character that beats his wife." 

House Republicans counter by pointing out that most of them were picked on as children, and it helped them to be better politicians.  "That's how I learned that the only way to be successful, is to always win at any cost," said Speaker of the Hose, Alexander de Large (R-Isle Royale). 

"In order to survive in the rough-and-tumble world of Lansing politics, you've gotta know a good one-two punch."  He adds, "the only good compromise is a dead compromise."  Asked to explain why he thinks Democrats are stealing the Republican's idea, he stated: "Now, the Democrats are stealing a page from our playbook.  The abstience-only concept has proven to be successful with sex education.  The teen pregnancy rate in Michigan has dropped to zero, at least in the New Charter schools.  But whereas abstinence from sex is a good thing, abstinence from violence only breeds a bunch of weaklings.  A little of the old ultra-violence helps build ambition.  It is a valuable as the good old ultra-work." 

Mr. de Large was referring to the recent study conducted among certain Michigan Charter schools, known as "New Charter Schools," that show a complete absence of teen pregnancy.  These schools have children work 60 hours per week to pay for their education.  Some pundits have argued that the insistence on productive work has added to the value of the children. 

After the press conference, Mr. de Large stopped by the Magdalene Laundry to pick up his dry cleaning.  The laundry, run by the girls-only New Charter School, provides dry-cleaning and other desired services to Michigan politicians at low cost.  As he walked in to the cleaners, he noted with approval that the girls all work behind chest-high "modesty panels" so that no signs of sexual maturation would be visible to the public...

Notes: There are many snarky  little twists in this satire, but one or two may require a bit of explanation in order for this to make any sense at all.  The Magdalene Laundries  were sort of like "reform" schools, mainly for teenage girls who got pregnant without first getting married.  The history of the Magdalene Laundries is one of the darker chapters in the history of humankind.  Of course, throughout history, various societies have had ways of pretending that teenagers are not sexually active.  One common method was to send the unfortunate girls to some kind of institution, far from their hometown.  Often, it was said that they were off caring for an elderly aunt, or some such pretext.   Some of the institutions were built with windows that were chest-high, so that passers-by could not see that the girls were pregnant. 

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Notes on Herbal Remedies
Natural ≠ Safe

A recent article in the LA Times reports on hazards associated with herbal sex aids.  This brings to mind a couple of reasons to be concerned about herbal products and dietary supplements. 

Potential dangers may be hiding in herbal sex aids
Timothy Gower
June 14, 2004

[...] Canadian researchers underscored these concerns in May with an alarming report. An analysis of herbal preparations touted as sexual enhancers found that some contained drugs prescribed to treat erectile dysfunction.

Dr. Neil Fleshner of Toronto's Princess Margaret Hospital came up with the idea for the probe when lab analyses by two groups in the United States showed that batches of PC-Spes — an herbal product used by men with prostate cancer that was taken off the market in 2002 — contained synthetic drugs used to fight cancer. (Officials at the company that made PC-Spes said they didn't know how the adulteration occurred.)

Fleshner and his colleagues purchased seven products on the Internet, which they found by plugging the phrase "herbal Viagra" into a search engine. A lab analysis revealed that one contained real Viagra, while a second was laced with Cialis, another erectile dysfunction drug.

The potential danger from this adulteration is obvious: Viagra and Cialis can be toxic and even fatal if taken with certain other common drugs. In particular, men who use nitrates to relieve chest pain caused by angina could suffer a deadly drop in blood pressure. [...]

The full article (free registration required) has some valuable safety information about herbal products in general.  However, the author of this article missed two very important points, which I elucidate here. 

One, herbal products are highly variable in their contents.  Since they are regulated only loosely by the FDA, they may or may not contain what the marketer claims they contain; the amount of what they contain is likely to vary from batch to batch; and they may contain ingredients that are not listed.  The findings of the Canadian researchers are not unusual. There have been many cases of so-called herbal products containing synthetic drugs that ordinarily require a prescription.  There also have been cases of herbal products that contain nonpharmaceutical contaminants that are dangerous. 

Two, some herbal sex aids contain yohimbine.  Yohimbine is a naturally-occurring compound that acts on the alpha-2 receptor.  α2 receptors are (presynaptic) autoreceptors that regulate the release of norepinepherine.  Yohimbine blocks these receptors, causing nerve cells to release more norepinepherine.  This raises blood pressure, and can cause extreme anxiety.  A pharmaceutical form is available; it contains a precisely measured amount of active drug.  Herbal preparations generally are not standardized, so it is impossible for the consumer to tell how much active drug is present. 

Note that some manufacturers  do  employ various methods to standardize their herbal products.  The Corpus Callosum recommends that, if herbal remedies are used, standardized preparations should be chosen. 

Herbal products containing aristolochic acid were recalled  because they are carcinogenic and nephrotoxic.  In April of this year, products containing ephedra were banned in the USA.  Ephedra is a naturally-occurring substance found in several plants.  It is chemically similar to epinephrine (adrenaline) and can cause high blood pressure, heart attacks, strokes, and seizures. 

A dietary supplement, L-tryptophan, was taken off the market after there were 27 deaths caused by eosinophilic myositis (eosinophilia-myalgia syndrome, or EMS).  L-tryptophan, a precursor of serotonin, had been found to have a slight antidepressant effect.  It also acted as a nonaddictive sleep aid.  Being a "natural" product, it became fairly popular.  Some psychiatrists started to use it to boost the effect of prescription antidepressants.  This practice was ended quickly  when the association between EMS and L-tryptophan was discovered. 

There are many instances of interactions  between herbal products, prescription drugs, and over-the-counter drugs.  Pharmaceutical products re not tested routinely for interactions with herbal products.  The Corpus Callosum recommends that anyone who takes a medication, and who is considering use of an herbal product, check with their pharmacist about the potential for interactions. 

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Wednesday, June 16, 2004

Antidepressant Rx: Careful Monitoring Needed

On WebMD, there is a decent article  with recommendations for monitoring antidepressant treatment, especially for children and adolescents.  While I agree with much of the article, there are a few things I disagree with:

Therapy helps people understand the roots of their depression, change negative thought patterns, and learn better coping skills, Fassler explains.

This notion -- that therapy helps people understand the roots of their depression -- is a common misunderstanding, in my view.  The statement implies that it is possible to know what the "roots" of the depression are.  Sometimes it is obvious; usually it is not obvious; and when it is not obvious, it probably is not possible to know what the roots are; at least with our current level of technology.  This is not to impugn the value of psychotherapy.  On the contrary, psychotherapy can be enormously beneficial.  I am skeptical, though, of any claim that we know how or why it works. 

As a philosophical aside, I think it is important to recognize therapy for what it is: an attempt to solve problems.  When first confronted with a problem, a natural response is to approach the problem by trying to figure out what caused the problem.  Sometimes that leads to a solution, but not always.  In fact, in the course of psychotherapy, it often is more helpful to understand what perpetuates  a problem, as opposed to what caused  it in the first place. 

Managed care companies now recognize the need for mental health treatment, Feinberg tells WebMD. "The number of visits may be limited, but I think managed care has done a good job in increasing access to treatment."

I don't know who this Feinberg is, or what planet he is on, but on Earth, managed care has been a disaster for mental health treatment.  (Actually, I do know who Feinberg  is, and he has a good reputation.)  The hospital I work for terminated its contact with Blue Care Network, because they kept imposing unrealistic limits on coverage for mental health treatment.  One of the clinics I work at refused to renew its contract with Care Choices, for similar reasons.  I personally refuse to do business with Health Alliance Plan, because they impose such ridiculous bureaucratic obstacles to everything.  Years ago, I worked at an eating disorders program.  We had to close the program because of tightening insurance restrictions.  To be fair, managed care is not the only culprit, but I really don't see how Dr. Feinberg can say what he said.  Apparently, he had second thoughts himself, because his next statement was:

However, there may be some difficulty getting coverage for a psychiatrist's care, he adds. Patients may have to pay out of pocket, or sign up for a preferred provider (PPO) plan, to get coverage for a psychiatrist's care.

This is followed by:

Access to treatment for clinical depression has improved in recent years, Feinberg tells WebMD. "If you need therapy, you will get therapy."

Another perplexing statement.  Most therapists won't accept Medicaid, because it literally does not even cover the overhead in most clinics.  Washtenaw County Community Mental Health rarely provides psychotherapy to clients.  Another vexing aspect to insurance coverage is that most plans will authorize only a certain number of sessions, AND the number they authorize has to be split between the therapist and the psychiatrist.  So the more the patient sees the therapist, the less they can see the psychiatrist.  One could argue that this rarely poses a problem for patients with uncomplicated problems.  But the patients with uncomplicated problems usually don't see a psychiatrist: they get their prescriptions from their primary care provider. 

The title of the article -- Antidepressant Rx: Careful Monitoring Needed -- is good advice.  Careful monitoring is needed, for sure.  But the very structure of modern health insurance either makes that impossible, for many people, or makes it so difficult as to be impractical. 

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Sunday, June 13, 2004

Abuse of Medical Records at Guantanamo;
No Question About the Medical Ethics Involved

The WaPo published an article on the abuse of medical records at Guantanamo. 

Detainees' Medical Files Shared
Guantanamo Interrogators' Access Criticized

By Peter Slevin and Joe Stephens
Washington Post Staff Writers
Thursday, June 10, 2004; Page A01

Military interrogators at the U.S. detention facility at Guantanamo Bay, Cuba, have been given access to the medical records of individual prisoners, a breach of patient confidentiality that ethicists describe as a violation of international medical standards designed to protect captives from inhumane treatment.

The files, which contain individual medical histories and other personal information about prisoners, have been made available to interrogators despite continued objections from the International Committee of the Red Cross, according to interviews and documents obtained by The Washington Post. After discovering the practice in mid-2003, the Red Cross refused to send medical monitoring teams to the facility for more than six months, sources said. [...]

This was commented upon by few bloggers.  Bete, at  Self-Indulgent Record of Idle Time,  copied the article to her blog without comment.  Based upon the context (the themes of adjacent posts) it appears that she is bothered by the report.  In contrast, Dr. Cori Dauber, on Rantingprofs, is troubled by the fact that some people are offended by the report.  Similarly, Greg, on Gregnews,  states:

If these doctors get their way they may, one day, have many patients to see in the form of victims of another horrendous terror attack. Far be it for anyone to counter this sacrosanct opinion of these quoted doctors but I bet we could find some in the medical community, say those related to 9-11 victims or those not with their head up their arse, who would say this is “okay.”

Which view is "correct" ?  

Dr. Dauber's post is entitled "HERE'S WHERE I JUMP OFF THE BANDWAGON."  Excerpt follows:

Another stunning revelation in the on-going prisoner abuse scandal: medical personnel treating detainees at Guantanamo Bay have made detainee files available to interrogators.

Well apparently this just has all kind of very fine people very upset.

Are you kidding me? They're being held in detention because they're al Queda members and they're supposed to have the same privacy restrictions on their medical files as, oh, I don't know, people who don't blow people up as a career choice?

Cry me a damn river. I'm not kidding, I just don't care. Show the interrogators every scrap of information we get on these people.

We don't want them beaten? Excellent. I'm all in. But that means it's a psychological game between the interrogators and the detainees, and every single bit of information the US side -- anyone on the US side -- has available to bring to bear helps construct a strategy for that game. So long as they aren't actually denied appropriate medical care, and there's no evidence at all that's the case, go for it.

Apparently, she does not agree with these statements, from the WaPo article:

There is no universally established international law governing medical confidentiality. But ethics experts said international medical standards bar sharing such information with interrogators to ensure it is not used to pressure prisoners to talk by withholding medicine or by using personal information to torment a detainee.

"I don't think any American medical worker, doctor, nurse should go along with this," said Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania. "The role of health care workers in any facility should be solely looking after the health of patients; anybody who is not involved in that should not have access to medical records."

[...] specialists in international humanitarian law said that by making the files available to nonmedical personnel, U.S. authorities crossed a line that separates the medical needs of prisoners from the government's interest in interrogating them.

"That is a violation of ethical standards that are quite old and accepted," said Leonard S. Rubenstein, executive director of Physicians for Human Rights, a Boston-based advocacy organization. "I don't think you would find any medical person who would say this is okay."

Steven H. Miles, a professor of bioethics at the University of Minnesota, said that using the information in interrogations of detainees would be a "clear-cut violation" of the Geneva Conventions.

"This is an enormously serious breach," said Miles, past president of the American Association of Bioethics. "You just can't do that."

Ok, there are three experts in medical ethics who agree that the disclosure of medical records -- for the purpose of interrogation -- is unethical.  And one professor of Communication Studies, plus one nearly-anonymous blogger,  who think it is OK.  Dr. Dauber is entitled to her opinion, as is Greg.  I hasten to add that Dr. Dauber includes some things in her post that I agree with.  But she is wrong to state that interrogators should have access to medical records.  The fact that there is no established international law governing medical confidentiality is immaterial.  (Our Administration has nothing but contempt for international law; so even if there were such a law, it would be no deterrent.)  The problem with giving interrogators access to medical records has to do with medical ethics, most of which are traditional, not legal. 

In daily practice, it is common for me to get requests for medical information, and I refuse to give it.  When I do so, I invariably get a ream of paper over the fax machine that points out that the request is legal.  I invariably send a note back to the insurance company/employer/attorney, saying something like "OK, maybe it's legal, but it also is unethical." 

For a medical professional to turn over records, to the detriment of the patient, can be permissible under narrowly defined circumstances.  The circumstances vary, but in all cases, there is a due process involved.  This often involves judicial oversight, duly constituted administrative oversight, or at least a carefully worded bit of legislation that clarifies the exact circumstances in which disclosure is necessary.  For example, if a patient tells a medical professional of a credible plan to kill or seriously harm an identified third party, the doctrine of duty to warn  is invoked.  I've done this myself a few times, and I agree that it is a valid legal principle. 

One might argue that, in wartime, it is OK to bend the rules:  If it is permissible to warn someone based upon the content of certain privileged information, perhaps we could extend that a little bit, and use privileged information to find out if a danger exists.  This, obviously, would be analogous to abandoning the doctrine of probable cause.  The principle of probable cause is one thing that keeps us from being a totalitarian state.  Giving this up would be extremely dangerous.  The US government is more powerful than any terrorist organization, and it needs to be constrained.  Moreover, and more to the point, medical knowledge is dangerous, and generally should be limited to benevolent purposes.  If there are to be exceptions, as with the duty to warn, these exceptions should be delineated in a democratic forum. 

It is ridiculous to say that exceptions are appropriate just because we are in a War on Terrorism.  It is disingenuous to imply that bending the rules is OK because we are in an exceptional circumstance.  Terrorism will never go away.  Thus, any "exceptions" will not really be exceptions; they will be the new standard operating procedure.  If we want to change our standard procedure, well, let's do that; but let's do it with a clear understanding that it is not because of an exceptional circumstance. 

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Should We Go Ahead With Nuclear Power?

There has been a fair amount of blogbuzz lately, about the subject of nuclear power: not the type of power that comes from having really big bombs, but the type of power that is used to generate electricity.  There are posts on the subject at Crooked Timber, Tapped, Mark A. R. Kleinman, Washington Monthly, and Brad DeLong's Semi-Daily Journal.  These posts generated a lot of comments, but not a lot of technical information is present in the original posts or in the comments.  Several comments included requests for more information.  On the weblog Too Many Worlds, William Kaminsky (a PhD student in the Physics Department of MIT) responds to some of the requests for more information on the subject. 

As it happens, I used to work at a nuclear research reactor.  This alone does not make me qualified to provide technical information, but the experience did make me a little more receptive to the idea of nuclear power.  At least I don't dismiss the idea automatically.

In this post, I provide links to some additional sources of information about nuclear power, add my own thoughts on the subject, and attempt to sharpen the focus of public discussion. 

It is important to recognize the fact that there are two main areas of discussion: the technical aspects of nuclear power, and the public policy aspects. 

Regarding the technology, a good set of links to technical information is at IDEA Nuclear Science Information.  The journal, Nature, has a good review  of the latest technical developments; unfortunately, a subscription is required to view it.  Much of the information in the Nature paper can be found elsewhere.  The key phrase to search for is "Generation IV International Forum" known by the acronym, GIF.  Generation IV is the fourth generation of nuclear power plant designs.  The GIF is a consortium of ten countries that has been meeting to reach consensus on the most promising new designs.  An understandable summary of these designs can be found here.  Some may find the design details to be boring, but people who like reading about technology will be interested.   For reference, there is a concise explanation of some key concepts is here

The basic idea is that future plants will have to operate at high temperatures in order to increase efficiency.  The increased efficiency is necessary to reduce waste generation and to decrease the cost of the energy produced.  Note that, as a side benefit, some of the designs produce heat that could be used in industrial processes; and some could be adapted to produce hydrogen.  They also can be used for desalination of ocean water.  All of the new designs include planning for management of the nuclear fuel and radioactive waste. 

The last point mentioned is a critical one.  It seems to me that in the early history of nuclear power generation, there was not sufficient planning for the production, transportation, and disposal of radioactive fuel.  Most of the Generation IV designs have incorporated a capacity for recycling of fuel.  This helps minimize the need for transportation of radioactive material.  Whether it would be cost-effective depends upon the price and availability of uranium ore, as well as the cost of disposing of spent fuel.  

The ability to produce hydrogen could turn out to be an important benefit.  The themochemical reaction made possible by high-temperature operation produces hydrogen and oxygen, without producing carbon dioxide.  SInce the hydrogen is a good energy source, the production of hydrogen results in an increase in the net efficiency of the operation.  It also avoids the environmental problems associated with producing hydrogen from fossil fuels. 

Turning now from the technical to the policy issues, there is a short, freely-available review of the public policy issues pertaining to nuclear power is a paper that is on-line at the Belfer Center for Science and International Affairs.  The author states that he is not advocating for or against nuclear power; rather, his intent is to clarify the reasons for nuclear power to be a significant issue, and to highlight some important safety issues. 

Enabling A Significant Future For Nuclear Power:
Avoiding Catastrophes, Developing New Technologies, Democratizing Decisions -- And Staying Away From Separated Plutonium
Matthew Bunn

For nuclear power to meet more than a few percent of the world's greenhouse-constrained energy needs in the 21st century would require a world of thousands of gigawatts of nuclear capacity, rather than hundreds. For such a broad expansion of fission-generated power to become broadly acceptable would require: (a) avoiding any further catastrophes, such as major reactor accidents or theft of weapons-usable nuclear material for use by proliferating states or terrorists; (b) development of new technologies that would address the complexity, cost, safety, waste management, and proliferation concerns that have so far limited utility, government, and public acceptance of nuclear power; and (c) profound transparency and democratization in nuclear decision-making, putting a better-informed public in a position to ensure that its concerns are fully addressed.

Dr. Bunn's paper was written in 1999, which, obviously, was before 9/11/2001.  Even so, terrorism and nuclear proliferation are prominent themes in his paper.  Indeed, all the the Generation IV designs include consideration of antiterorrist hardening.  That is, even though the paper is old (by standards of modern technology) the policy issues still are current.  Read the whole thing if you want, but his main point is that, in order to reduce the risk of nuclear proliferation, reprocessing of nuclear fuel should be avoided.  He advocates what he calls a "once-through" fuel cycle. 

Another point Bunn makes is this:

Unfortunately, as Fetter has pointed out,7 the structure of the nuclear debate has inhibited technical re-thinking in these areas. Nuclear supporters generally believe that these issues are political, not technical, as current reactors are already extremely safe, waste management poses negligible risks, proliferation risks are theoretical at best and countries will get nuclear weapons if they want them regardless of what fuel cycle technologies are pursued, and the high cost of nuclear power is driven by unjustified regulatory delays and requirements. Nuclear critics, by contrast, believe that nuclear power is so fundamentally flawed that no amount of R&D will fix it.

I believe that both of these views leave out critical parts of the picture.

The implication is that careful, unbiased study is needed prior to making any major policy decisions.  The Belfer Center has a more recent report, The Future of Nuclear Power, (dated July 2003) that is available as a PDF download.  The whole thing is over 29 Megabytes, though.  The summary (350Kb) is here.

IAEA flagThe authors share Dr. Bunn's view that a once-though fuel cycle is desirable.  They also suggest that limited government subsidies may be appropriate.  The notion of government subsidies is a point of contention used by antinuclear activists, and it is not popular with those who tend to advocate pure free-market economic policies.  They also recommend streamlining regulatory functions: sure to be popular with the industry; sure to meet with skepticism from the public.  They raise some important safety questions.  They advocate for an expanded role for the IAEA (website link), including giving them the authority to inspect all "suspect" sites. This could include inspections within the USA.    They favor the development of only one of the Generation IV designs: the very-high-temperature gas-cooled reactor (HTGR).  In short, everyone will find at least some recommendations that they dislike. 

The authors of The Future of Nuclear Power  do not necessarily advocate expansion of nuclear power generation:

At least for the next few decades, there are only a few realistic options for reducing carbon dioxide emissions from electricity generation:
  • increase efficiency in electricity generation and use;
  • expand use of renewable energy sources such as wind, solar, biomass, and geothermal;
  • capture carbon dioxide emissions at fossil-fueled (especially coal) electric generating plants and permanently sequester the carbon; and
  • increase use of nuclear power.
The goal of this interdisciplinary MIT study is not to predict which of these options will prevail or to argue for their comparative advantages. In our view, it is likely that we shall need all of these options and accordingly it would be a mistake at this time to exclude any of these four options from an overall carbon emissions management strategy. Rather we seek to explore and evaluate actions that could be taken to maintain nuclear power as one of the significant options for meeting future world energy needs at low cost and in an environmentally acceptable manner.

[...] To preserve the nuclear option for the future requires overcoming the four challenges described above -- costs, safety, proliferation, and wastes. These challenges will escalate if a significant number of new nuclear generating plants are built in a growing number of countries. The effort to overcome these challenges, however, is justified only if nuclear power can potentially contribute significantly to reducing global warming, which entails major expansion of nuclear power. In effect, preserving the nuclear option for the future means planning for growth, as well as for a future in which nuclear energy is a competitive, safer, and more secure source of power.

To explore these issues, our study postulates a global growth scenario  that by mid-century would see 1000 to 1500 reactors of 1000 megawatt-electric (Mwe) capacity each deployed worldwide, compared to a capacity equivalent to 366 such reactors now in service. Nuclear power expansion on this scale requires U.S. Leadership, continued commitment by Japan, Korea, and Taiwan, a renewal of European activity, and wider deployment of nuclear power around the world.

Adding 1000 nuclear power plants would require a massive effort and equally massive investment.  The need for this many reactors is based upon the premise that one of the goals is to reduce CO2 emissions.  The authors of the report think that we should try to preserve the option of using nuclear power, specifically because of the importance of carbon dioxide in the genesis of climate change:

Today, nuclear power is not an economically competitive choice. Moreover, unlike other energy technologies, nuclear power requires significant government involvement because of safety, proliferation, and waste concerns. If in the future carbon dioxide emissions carry a significant “price,” however, nuclear energy could be an important -- indeed vital -- option for generating electricity. We do not know whether this will occur. But we believe the nuclear option should be retained, precisely because it is an important carbon-free source of power that can potentially make a significant contribution to future electricity supply.

In my view, this raises an important question, one that they do not address: is it already too late for us to make good use of nuclear power?  It is my opinion that the nuclear power industry, in the last half of the twentieth century, was overly complacent about the ability to technological advances to solve serious problems with nuclear power.  They raced ahead to build power plants even though there had not been adequate research into materials science and fuel cycle technology.  They assumed that any problems that emerged could be solved later.  They found out -- after many reactors already were in operation -- that some of the materials they were using could not withstand the torturous environment of a nuclear reactor.  They also found out that there are enormous political and technical problems with short-term and long-term waste storage.  In retrospect, they would have been better advised to go at a slower pace. 

If a slow pace is necessary for safety reasons, how feasible is it going to be to build 1,000 nuclear power plants by mid-century?  A smaller number will not have sufficient effect on climate change.  Yet, the worth of the entire endeavor is predicated upon the potential for nuclear power to reduce the risk of climate change. 

The implication of this argument is that it may already be too late for us to make good use of nuclear energy.  If climate change is not a concern, then nuclear energy is not economically viable.  If it is a concern, then we need to build a lot of reactors quickly in order to make a difference.  But if we build a lot of reactors quickly, we may run into serious safety problems.

I will accept their main recommendation at face value: we should try to preserve the option of nuclear power.  They state that this would entail increased R&D spending of about $400 million per year for the next five years, and $460 million per year for five years after that.  The Nature  article indicates that actual construction of a Generation IV facility would be about one billion dollars.  This would mean spending $4.3 billion on R&D, then another billion to build the first reactor. 

USS Ronald ReaganTo put that into perspective, we have already spent that much on the construction and operation of our newest aircraft carrier -- the USS Ronald Reagan (CVN 76).  The benefits of nuclear power R&D would be much greater than the benefit of a new aircraft carrier.  Just decreasing the risk of nuclear proliferation will do more to ensure our safety than one of those boats ever will. 

Keep in mind that other countries, especially China and France, are going ahead with nuclear power regardless of what US policymakers have to say.  Even if we never build our share of those 1,000 reactors, other countries are going to build theirs.  This being the case, it is in our interest to be sure that there is adequate research into the various safety issues.

I think, though, to get the most out of the R&D effort, it should be conducted in a way that maximizes the likelihood of finding new materials and new technologies that could have uses outside of the nuclear industry.  Furthermore, the research efforts should be designed to increase international cooperation and provide mutual benefit to all countries that participate. 

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