Saturday, December 06, 2008
Thursday, December 04, 2008
Wednesday, December 03, 2008
Governors Against State Bailouts: Hard to believe, but not everyone in politics wants a free lunch. By Rick Perry and Mark Sanford
DECEMBER 2, 2008
As governors and citizens, we've grown increasingly concerned over the past weeks as Washington has thrown bailout after bailout at the national economy with little to show for it.
In the process, the federal government is not only burying future generations under mountains of debt. It is also taking our country in a very dangerous direction -- toward a "bailout mentality" where we look to government rather than ourselves for solutions. We're asking other governors from both sides of the political aisle to join with us in opposing further federal bailout intervention for three reasons.
First, we're crossing the Rubicon with regard to debt.
One fact that's been continually glossed over in the bailout debate is that Washington doesn't have money in hand for any of these proposals. Every penny would be borrowed. Estimates for what the government is willing to spend on bailouts and stimulus efforts for this year reach as much as $7.7 trillion according to Bloomberg.com -- a full half of the United States' yearly economic output.
With all the zeroes in the numbers, it's no wonder Washington politicians have lost track.
That trillion-dollar figure is the tip of the iceberg when it comes to checks written by the federal government that it can't cash. Former U.S. Comptroller General David Walker puts our nation's total debt and unpaid promises, like Social Security, at roughly $52 trillion -- an invisible mortgage of $450,000 on every American household. Borrowing money to "solve" a problem created by too much debt seems odd. And as fiscally conservative Republicans, we take no pleasure in pointing out that many in our own party have been just as complicit in running up the tab as those on the political left.
Second, the bailout mentality threatens Americans' sense of personal responsibility.
In a free-market system, competition and one's own personal stake motivate people to do their best. In this process, the winners create wealth, jobs and new investment, while others go back to the drawing board better prepared to try again.
To an unprecedented degree, government is currently picking winners and losers in the private marketplace, and throwing good money after bad. A prudent investor takes money from low-yield investments and puts them in those that yield better returns. Recent government intervention is doing the opposite -- taking capital generated from productive activities and throwing it at enterprises that in many cases need to reorganize their business model.
Take for example the proposed Big Three auto-maker bailout. We think it's very telling that each of the three CEO's flew on their own private jets to Washington to ask for a taxpayer handout. No amount of taxpayer largess could fix a business culture so fundamentally flawed.
Third, we'd ask the federal government to stop believing it has all the answers.
Our Founding Fathers were clear and deliberate in setting up a system whereby the federal government would only step in for that which states cannot do themselves. An expansionist federal government of the last century has moved us light-years away from that model, but it doesn't mean that Congress can't learn from states that are coming up with solutions that work.
In Texas and South Carolina, we've focused on improving "soil conditions" for businesses by cutting taxes, reforming our legal system and our workers' compensation system. We'd humbly suggest that Congress take a page from those playbooks by focusing on targeted tax relief paid for by cutting spending, not by borrowing.
In the rush to do "something" to help, federal leaders would be wise to take a line from the Hippocratic Oath, and pledge to do no (more) harm to our country's finances. We can weather this storm if we commit to fiscal prudence and hold true to the values of individual freedom and responsibility that made our nation great.
Mr. Perry, a Republican, is the governor of Texas. Mr. Sanford, a Republican, is the governor of South Carolina.
Posted by Joyce Kavitsky at 12/03/2008 11:25:00 AM
Friday, September 26, 2008; A23
I am worried for our country -- not so much because of the tumult in the financial markets but because of the federal government's response and its implications.
It seems that each new crisis is met with a new answer from the government. After Hurricane Katrina, the federal government assumed roles traditionally handled by state and local governments. After the Sept. 11, 2001, attacks, the government federalized 25,000 workers through the Transportation Security Administration. The example of security-focused countries such as Israel, which elects to have that function handled by the private sector, did not matter. Now, our federal government is likely to commit three-quarters of a trillion dollars -- more than last year's Pentagon budget -- to a bailout based on what happened in the credit markets last week.
An ever-expanding scope of federal commitment and power is not what made this country great. Expanded power in one place comes at a cost in other places. American cornerstones such as individual initiative and an entrepreneurial spirit -- born in free and open societies with private property rights and the rule of law -- have never fit particularly well within the context of an ever-growing federal government.
For 200 years, the "business model" in our country has rested on a simple fact: that while one may reap rewards from taking risks, one should also be prepared to face the consequences of those risks. Some of the proposed actions with regard to the credit market turn that business model on its head -- absolving those who took too much risk, or bought too much house, from the weight of their own choices. If Congress passes the proposed bailout, we will be destined to have far greater problems in time, leaving those who are prudent in their finances to foot the bill for those who are not.
I am not writing to criticize Treasury Secretary Henry Paulson. I respect his business judgment greatly, and his unenviable task is to find a short-term solution to problems grown by government over the long term. Whether his proposals are right or wrong is less the issue than the question of where we are, as a society, in terms of having government in the business of protecting people from their own financial decisions.
Last week's events were rooted in distressed mortgage securities whose optimistic values were facilitated by quasi-governmental entities Fannie Mae and Freddie Mac. The investment banking capital write-downs were turbocharged by the Sarbanes-Oxley Act, which did what too many laws do -- it fixed yesterday's problem. The amazing expansion of credit was fueled by a Federal Reserve offering an easy-money policy that led us right into a credit bubble. All this was made worse by the government enabling some people's tendency to want more house than they can afford.
With that bubble popped, we will now go through a major financial de-leveraging. It will be painful. Yet to preserve what has made this country great, we need to be on guard against Washington offering endless cures to our ills.
Many of the "cures" that are soon to be offered will have one thing in common -- telling us what others did wrong. Instead of listening to these, each of us as taxpayers must admonish those in Washington to get their own financial house in order. Washington is the master of creative and unsustainable finance, with $50 trillion in unfunded promises.
We will be told of bailouts that "won't cost anything." We should caution policymakers that this has never been the history of bailouts, and remind them of Milton Friedman's suggestion that the capitalist system never works without loss. Investment titans recently featured in Vanity Fair trading $60 million beach homes should never be sheltered from this old-fashioned concept.
We will be told of "temporary" funds and programs. We should remind our leaders of Ronald Reagan's words that the closest thing to eternal life is a government program.
We will be told "trust us" on pricing assets, and we should not -- because no matter how pure one's intentions, no one watches your money like you do. This makes transparency and open bidding incredibly important.
If we do these things right, we will weather the very rough patch ahead and be better for it as a country. If we do not, there will be more parallels between our nation and Edward Gibbon's "The Decline and Fall of the Roman Empire" than we would like to imagine. The difference lies in each of our hands.
Mark Sanford, a Republican, is governor of South Carolina. He represented South Carolina for three terms in the U.S. House and was formerly employed by Goldman Sachs.
Posted by Joyce Kavitsky at 12/03/2008 11:20:00 AM
Tuesday, December 02, 2008
November 07, 2008
Why didn't they say this in their magazine BEFORE the election?
Yesterday I shared with you the audio of Tom Brokaw being interviewed by Charlie Rose where both men admit they don't know who Obama really is or what he intends to do in office. Now, a post election admission from Jon Meacham and Evan Thomas of Newsweek; also interviewed by Charlie Rose. Audio is provided with commentary by Rush Limbaugh (transcript):
MEACHAM: You know, they don't let him out. And have you ever seen a victory speech where there was no one else on stage?
MEACHAM: No adoring wife, no cute kid. He is the messenger.
THOMAS: There is a slightly creepy cult of personality about all this. I mean, he's such an admirable --
ROSE: Slightly. Creepy. Cult of personality.
ROSE: What's slightly creepy about it?
THOMAS: It -- it -- it just makes me a little uneasy that he's so singular. He's clearly managing his own spectacle. He's a deeply manipulative guy.
RUSH: Now, let me tell you what they're saying that they're not saying. We've seen this before. We have seen this creepy cult of personality. We have seen this singular, managing his own spectacle. We've seen this deeply manipulative guy. We saw this before. They are scared. They are not saying that, but I hear fear. Here's the next bite. Charlie Rose continues here with a question.
ROSE: Watching him last night in that speech, he finishes --RUSH: Ahhhh. Charlie Rose, light goes on, ahhhh. Self-aware enough to know that this creature he's designed isn't necessarily a real person. That is fear. These guys are looking at Obama and they've seen him the exact way we have, all of this time. They only now after they think they got him into office are now starting to talk about their fears about how nobody knows anything about him, his resume is thin, he's only written two books, and they're autobiographies, we don't know what other books he's read. Yes, we do. We don't know anything about him. It's creepy, never seen a victory speech with nobody on stage -- what is this making fun of Biden, by the way? Locking Biden in the bar so he doesn't come out? Look at all they hid. Look at all that they refused to report. They had plenty of chances to write editorials at Newsweek magazine, and they didn't write one reflective of what they really saw and know and fear about Obama.
ROSE: -- and he sort of -- it's almost like he then ascends to look at the circumstance.
MEACHAM: He watches us watching him.
THOMAS: Watching him!
THOMAS: He does --
MEACHAM: It's amazing.
ROSE: It is amazing.
THOMAS: He writes about this metaphor being a screen upon which Americans will project. He said they want of Barack Obama; I'm not sure I am Barack Obama.
THOMAS: He had -- he has the self-awareness to know that this creature he's designed isn't necessarily a real person, and he's self-aware enough --
At what point will Meacham and Thomas, along with Brokaw and so many others face the fact that they committed journalistic malpractice by hiding the character concerns they are only now sharing about Obama? Were they just tooooo busy digging dirt on Sarah Palin's children and Joe the Plumber to tell the American people what a "creepy," "manipulative," "creature" Obama is?
Posted by Joyce Kavitsky at 12/02/2008 03:26:00 PM
By INVESTOR'S BUSINESS DAILY | Posted Monday, December 01, 2008 4:20 PM PT
Housing Crisis: A new report from the Associated Press claims that the mortgage meltdown is due largely to President Bush's failure to act in 2005. Sounds plausible — until you actually look at the facts.
IBD Exclusive Series: What Caused The Loan Crisis?
"Under pressure, U.S. eased lending rules," reads the AP special report's headline. But "U.S." is really a misnomer. The news service really means "Bush."
"The Bush administration backed off proposed crackdowns on no-money-down, interest-only mortgages years before the economy collapsed, buckling to pressure from some of the same banks that have now failed," the report asserts.
The report goes on to catalog what it says are Bush's crimes. Namely, that his administration bowed to "aggressive lobbying" by banks and delayed doing anything for a year. This, says the AP, is "emblematic of a philosophy that trusted market forces and discounted the need for government intervention in the economy."
All utterly wrong.
Here at IBD, we've done more than a dozen pieces — most recently, in yesterday's paper — detailing how rewrites of the Community Reinvestment Act in 1995 under President Clinton, along with major regulatory changes pushed by the White House in the late 1990s, created the boom in subprime lending, the surge in exotic and highly risky mortgage-backed securities, and the housing boom whose government-fed excesses led to inevitable collapse.
Despite this clear record, we're now besieged by enterprising journalists blaming Republican "deregulation" or the president's failure to recognize the seriousness of the problem or act. But these claims fall apart, as a partial history of the last decade shows.
Bush's first budget, written in 2001 — seven years ago — called runaway subprime lending by the government-sponsored enterprises Fannie Mae and Freddie Mac "a potential problem" and warned of "strong repercussions in financial markets."
In 2003, Bush's Treasury secretary, John Snow, proposed what the New York Times called "the most significant regulatory overhaul in the housing finance industry since the savings and loan crisis a decade ago." Did Democrats in Congress welcome it? Hardly.
"I do not think we are facing any kind of a crisis," declared Rep. Barney Frank, D-Mass., in a response typical of those who viewed Fannie and Freddie as a party patronage machine that the GOP was trying to dismantle. "If it ain't broke, don't fix it," added Sen. Thomas Carper, D-Del.
Unfortunately, it was broke.
In November 2003, just two months after Frank's remarks, Bush's top economist, Gregory Mankiw, warned: "The enormous size of the mortgage-backed securities market means that any problems at the GSEs matter for the financial system as a whole." He too proposed reforms, and they too went nowhere.
In the next two years, a parade of White House officials traipsed to Capitol Hill, calling repeatedly for GSE reform. They were ignored. Even after several multibillion-dollar accounting errors by Fannie and Freddie, Congress put off reforms.
In 2005, Fed chief Alan Greenspan sounded the most serious warning of all: "We are placing the total financial system of the future at a substantial risk" by doing nothing, he said. When a bill later that year emerged from the Senate Banking Committee, it looked like something might finally be done.
Unfortunately, as economist Kevin Hassett of the American Enterprise Institute has noted, "the bill didn't become law, for a simple reason: Democrats opposed it on a party-line vote in the committee, signaling that this would be a partisan issue. Republicans, tied in knots by the tight Democratic opposition, couldn't even get the Senate to vote on the matter."
Had they done so, it's likely the mortgage meltdown wouldn't have occurred, or would have been of far less intensity. President Bush and the Republican Congress might be blamed for many things, but this isn't one of them. It was a Democratic debacle, from start to finish.
Posted by Joyce Kavitsky at 12/02/2008 12:37:00 PM
By INVESTOR'S BUSINESS DAILY | Posted Friday, November 28, 2008 4:20 PM PT
Regulation: The Community Reinvestment Act is to blame for the financial crisis, but it so powerfully serves Democrats' interests that they'll do anything to protect it including revising history.
Read More: Business & Regulation
The CRA coerces banks into making loans based on political correctness, and little else, to people who can't afford them. Enforced like never before by the Clinton administration, the regulation destroyed credit standards across the mortgage industry, created the subprime market, and caused the housing bubble that has now burst and left us with the worst housing and banking crises since the Great Depression.
The CRA should be abolished, along with the government-sponsored enterprises that fueled the secondary market for subprimes under pressure from Clinton, who ordered HUD to set quotas for "affirmative action" lending at Fannie Mae and Freddie Mac.
But powerful Democrats in Washington want to protect the act along with Fannie and Freddie and spin the subprime scandal as the result of too little regulation, not too much.
"Repealing or weakening the CRA would be a mistake," warns Senate Banking Committee Chairman Chris Dodd, D-Conn., who argues that the CRA should be strengthened.
Dodd, the top recipient of Fannie donations and himself a beneficiary of a sweetheart mortgage brokered by a subprime lender, recently invited one of Clinton's top enforcers of the CRA to testify.
"The notion that CRA has caused this problem is a pernicious thought," said former Comptroller of the Currency Gene Ludwig. "These are not truthful statements. The CRA has helped to create a better and sounder world for finance, not the opposite."
Dead wrong. But the mainstream media believe it, and have attacked those, including this paper, who dare to tell the truth about the crisis. Already the debacle has erased $13 trillion in wealth, while putting taxpayers on the hook for up to $8 trillion in bailouts.
"The latest salvo from conservatives began via a Sept. 15 editorial in Investor's Business Daily, titled 'The Real Culprits In This Meltdown,' " grumbled a column distributed by Scripps Howard News Service. "Its editorial blamed President Clinton for today's mess."
As we said, Clinton beefed up the CRA and used it to force banks to subsidize poor communities with close to $1 trillion in high-risk loans and other commitments that flouted underwriting rules.
Yet, somehow, these media-driven myths keep getting in the way of actual facts, such as:
Fact: The 1977 law was only lightly enforced until Clinton added teeth to it in 1994 and launched an anti-redlining campaign against banks, led by Ludwig, Housing Secretary Henry Cisneros (and later Andrew Cuomo) and Attorney General Janet Reno that lasted into this decade.
Minority homeownership rates, which had been flat, began a steep rise in 1995, and home prices soon followed, stoked by easier lending. Numerous bank officials complain that they still feel pressured by CRA regulators to make inner-city loans they know are at great risk of defaulting.
Myth: The CRA could not have led to financial Armageddon, because the overwhelming share of subprime mortgages came from lenders that were not banks and not regulated by the CRA.
Fact: Nearly 4 in 10 subprime loans between 2004 and 2007 were made by CRA-covered banks such as Washington Mutual and IndyMac. And that doesn't include loans made by subprime lenders owned by banks, which were in effect covered by the CRA.
Last year, when the bubble burst, bank subprime loans totaled $142 billion, dwarfing those made by lenders.
What's more, the biggest subprime lender, Countrywide, while not subject to the law, still came under federal pressure to make risky loans in minority communities.
Clinton created a separate department at HUD to police "fair lending" at Fannie and Freddie and also at lenders like Countrywide, which became Fannie's biggest client. In 1994, Countrywide became the nation's first mortgage lender to sign with HUD a "Declaration of Fair Lending Principles and Practices."
As a result, Countrywide made more loans to minorities than any other lender and not surprisingly, was one of the first lenders swamped by loan defaults.
Other lenders felt the heat from Reno's Justice Department, which prosecuted them for failing to operate enough branches in black neighborhoods. Reno put the entire banking industry on notice about the CRA and her enforcement program.
Myth: The CRA did not force anyone to do subprime loans or take excessive risks.
Fact: Subprime loans were the vehicle banks used to satisfy CRA compliance, and Clinton and his regulators encouraged their use. Before Clinton took office, subprimes were virtually unheard of. By the time he left, they made up more than 9% of the market for mortgage originations. Today they're 20%.
"It's instructive to go back to the early stages of the subprime market, which has essentially emerged out of the CRA," ex-Fed chief Alan Greenspan said in recent testimony on the roots of the crisis.
Clinton pushed banks to grant mortgages to minorities with poor credit by using "flexible" underwriting standards or risk being branded racist. Rules were weakened to the point where welfare and unemployment checks were accepted as qualifying income.
Myth: Greedy investment bankers, who securitized and sold subprime mortgages, drove us to the credit crisis, not government.
Fact: Clinton's regulatory policies led to the creation of this new risk on Wall Street. His CRA amendments created the subprime market, and only after he pressured Fannie and Freddie to socialize the risk and guarantee the profit from the subprime loans did Wall Street get involved in a big way.
The exotic securitizations that have gotten so much of the blame were a symptom, not the cause, of the crisis.
The architects of the crisis want to divert attention from their own culpability by blaming the markets rather than their own regulations mandating that banks make high-risk loans based on race.
In fact, regulations had almost everything to do with this mess. And instead of strengthening them to atone for the alleged "sins of capitalism," we should be abolishing them.
Two bills in the House would be a good place to start. HR 7264, which has nine co-sponsors, would repeal the CRA. And HR 7094, with 17 co-sponsors, would dissolve Fannie Mae and Freddie Mac.
During the last severe slump, President Reagan deregulated the economy, saying: "Government is not the solution to the problem; government is the problem." He's as right today as he was then.
Posted by Joyce Kavitsky at 12/02/2008 12:34:00 PM
Monday, December 01, 2008
Obama Fomenting A Constitutional Crisis: Constitutional Lawyer Discusses Ramifications Of Controversy By John P. Connolly
Controversy continues to surround President-elect Barack Obama's eligibility to serve as president, and a case involving his birth certificate waits for its day before the U.S. Supreme Court. A constitutional lawyer said were it to be discovered that Mr. Obama is not a natural-born U.S. citizen, it would have grave consequences for the nation.
According to the Constitution, a president must be a natural born citizen of the U.S. Mr. Obama's critics have failed to force him legally to produce his original birth certificate, and Mr. Obama has resisted any attempt to make him do so. Currently, only Hawaii Department of Health officials have access to Mr. Obama's original records.
Some of Mr. Obama's critics have said he was born in Kenya and have claimed he is a citizen of Kenya, Indonesia, or even a British subject.
Edwin Vieira, a constitutional lawyer who has practiced for 30 years and holds four degrees from Harvard, said if it were to be discovered Mr. Obama were not eligible for the presidency, it would cause many problems. They would be compounded if his ineligibility were discovered after he had been in office for a period of time.
"Let's assume he wasn't born in the U.S.," Mr. Vieira told The Bulletin. "What's the consequence? He will not be eligible. That means he cannot be elected validly. The people and the Electoral College cannot overcome this and the House of Representatives can't make him president. So what's the next step? He takes the oath of office, and assuming he's aware he's not a citizen, then it's a perjured oath."
Any appointments made by an ineligible president would have to be recalled, and their decisions would be invalidated.
"He may have nominated people to different positions; he may have nominated people to the judicial branch, who may have been confirmed, they may have gone out on xecutive duty and done various things," said Mr. Vieira. "The people that he's put into the judicial branch may have decided cases, and all of that needs to be unzipped."
Mr. Vieira said Obama supporters should be the ones concerned about the case, because Mr. Obama's platform would be discredited it he were forced to step down from the presidency later due to his ineligibility, were it to be discovered.
"Let's say we go a year into this process, and it all turns out to be a flim-flam," said Mr. Vieira. "What's the nation's reaction to that? What's going to be the reaction in the next U.S. election? God knows. It has almost revolutionary consequences, if you think about it."
Mr. Vieira said Mr. Obama's continued silence and avoidance in the release of his birth certificate is an ethical issue because of the dire consequences that could be caused by a possible constitutional crisis.
"If he were my client and this question came up in civil litigation, if there was some reason that his birth status was relevant and the other side wanted him to produce the thing and he said 'no,' I would tell him, 'you have about 15 minutes to produce it or sign the papers necessary to produce the document, or I'm resigning as your attorney," said Mr. Vieira. "I don't think any ethical attorney would go ahead on the basis that his client could produce an objective document in civil litigation [and refused to do so]."
Further, Mr. Vieira cited a fraud ruling in a 1977 case called U.S. v. Prudden, which he feels applies in this case.
"Silence can only be equated with fraud when there is a legal and moral duty to speak or when an inquiry left unanswered would be intentionally misleading," the ruling reads. "We cannot condone this shocking conduct ... If that is the case we hope our message is clear. This sort of deception will not be tolerated and if this is routine it should be corrected immediately."
Mr. Vieira said such an ethical question of representing a client who refused to produce such a basic document is important, even in a small civil case. The current question is concerning the man who potentially could have his finger next to the nuclear button.
"[The birth certificate], in theory, should be there," said Mr. Vieira. "What if it isn't? Who knows, aside from Mr. Obama? Does Russian intelligence know it isn't there? Does Chinese intelligence know it isn't there? Does the CIA know that it isn't there? Who is in a position to blackmail this fellow?"
Mr. Vieira explained all laws have to be submitted to the president. In the event that there is no valid president, then no laws passed by Congress in that administration would be legally null and void. Because of that, this case will probably not go away, even after Mr. Obama takes the oath of office.
"If you don't produce it, you think it's going to go away," he said. "There are all these cases challenging Mr. Obama, and some challenging secretaries of state, and they run into this doctrine called standing."
Mr. Vieira explained although legal standing is difficult to get around in Federal courts, the document could be produced in any criminal cases stemming from legislation passed in the Obama administration.
"Let's assume that an Obama administration passes some of these controversial pieces of legislation he has been promising to go for, like the FOCA (Freedom of Choice) Act," said Mr. Vieira. "I would assume that some of those surely will have some severe civil or criminal penalties attached to them for violation. You are now the criminal defendant under this statute, which was passed by an Obama Congress and signed by President Obama. Your defense is that is not a statute because Mr. Obama is not the president. You now have a right and I have never heard this challenged, to subpoena in a criminal case, anyone who has relevant evidence relating to your defenses. And you can subpoena them duces tecum, meaning 'you shall bring with you the documents.' "
Such a criminal defense would enable the defendant to subpoena any person to testify in court and any person to bring evidence in their possession to the court.
Further, records could be subpoenaed directly, in the case of a birth certificate. Once the record could be subpoenaed, the birth certificate could be examined by forensic experts, who would then be able to testify to the document's veracity as expert witnesses. Any movement by the judges to make a special exception to the president in a criminal case would hurt the legitimacy of that presidential administration.
"I can't believe I'm the only lawyer who would think of this," said Mr. Vieira. "I think any criminal lawyer defending against one of these politically charged statutes is going to come up with this. That means it will never go away until that document is laid down on the table and people say, 'yes, there it is.' And therefore they're caught. If people keep challenging this and the judges out of fear keep saying 'no, go to jail, go to jail, go to jail' then that's the end of the Obama administration's legitimacy. On the other hand if they open the file and it's not there, then that's really the end of the administration's legitimacy."
Several court cases in the birth certificate controversy are waiting admission to the Supreme Court.
A gathering of judges will meet on Dec. 5 to decide whether or not to hear a case from New Jersey, and a decision is still pending on a case from a lawyer in Pennsylvania. Should four of the judges vote to hear the case in the Dec. 5 meeting, then it will be scheduled for hearings. Court cases from Connecticut and New York have also applied for hearings at the U.S. Supreme Court.
John P. Connolly can be reached at email@example.com
Posted by Joyce Kavitsky at 12/01/2008 06:12:00 PM
Sunday, November 30, 2008
Raynaud's disease and Raynaud's phenomenon are rare disorders that affect blood vessels. These disorders are marked by brief episodes of vasospasm (narrowing of the blood vessels). Vasospasm causes decreased blood flow to the fingers and toes, and rarely to the nose, ears, nipples, and lips. The fingers are the most commonly affected area, but the toes also are affected in 40 percent of people with Raynaud's.
When this disorder occurs without any known cause, it is called Raynaud's disease, or primary Raynaud's. When the condition occurs along with a likely cause, it is known as Raynaud's phenomenon, or secondary Raynaud's. Primary Raynaud's is more common and tends to be less severe than secondary Raynaud's.
When you have primary or secondary Raynaud's, cold temperatures or stressful emotions can trigger attacks. During these attacks, there is a brief lack of blood flow to the affected body part(s), and the skin can temporarily become white then bluish. As blood flow returns to the area, the skin turns red. The affected areas can throb or feel numb and tingly. With severe Raynaud's, prolonged or repeated episodes can cause sores or tissue death (gangrene).
It is normal for the body to keep its vital inner organs warm by limiting blood flow to the arms, legs, fingers, and toes. The body naturally does this in response to a long period of cold. This response can cause frostbite. In people with Raynaud's, the response to cold is quicker and stronger. The response can be triggered by mild or short-lived changes in temperature, such as:
- Taking something out of the freezer
- Temperatures that dip below 60 degrees Fahrenheit
In people with Raynaud's, blood flow is more strongly reduced in response to cold temperatures than in people without the disorder. When Raynaud's is severe (which is uncommon), exposure to cold for as little as 20 minutes can cause major tissue damage.
The blood vessels of people with Raynaud's also physically overreact to stressful emotions. It is normal during times of psychological stress for the body to release hormones that narrow its blood vessels. But for people with Raynaud's, this squeezing of blood vessels is stronger. This results in less blood reaching fingers, toes, and sometimes other extremities.
For most people, primary Raynaud's is more of a bother than a serious illness and it can usually be managed with minor lifestyle changes. Secondary Raynaud's can be more difficult to manage, but several treatments may help prevent or relieve symptoms. Among the most important treatments for secondary Raynaud's is treating of the underlying condition.
How Is Raynaud's Disease Treated?
There is no cure for primary or secondary Raynaud's, but many measures can reduce the number or intensity of attacks, including:
- Lifestyle changes
- Treatments for the disease or condition that may help cause secondary Raynaud's
- Surgery for the tissue damage that some people with secondary Raynaud's develop
In most people with primary Raynaud's, the disorder is successfully managed with lifestyle adjustments. Patients with secondary Raynaud's may need medicines in addition to lifestyle changes, and in rare cases, they may need surgery. Anyone with Raynaud's who develops sores on their fingers or toes or elsewhere on their body should see a doctor right away to prevent tissue loss.
Most of the lifestyle changes that help people with Raynaud's aim to avoid the triggers of attacks. These triggers include cold, emotional stress, and certain medicines, chemicals, or actions. To protect the body from cold, people can:
- Wear a hat, gloves, scarf, and a coat with snug cuffs during cold weather.
- Wear gloves or mittens when taking food out of the refrigerator or freezer.
- Turn down air conditioning, or dress warmly while in an air conditioned space.
- Warm up the car before driving in cold weather.
To avoid emotional triggers, people can steer clear of stressful situations if possible. Relaxation techniques also can be helpful under stress.
To avoid workplace or recreational triggers, people can:
- Limit use of vibrating tools.
- Wear proper protective gear if they work with industrial chemicals.
- Limit frequent and repeated actions of the hands, such as typing or playing the piano.
A number of medicines can trigger attacks. People with Raynaud's should avoid:
- Beta blockers
- Over-the-counter cold or allergy remedies or diet aids that narrow blood vessels
- Birth control pills, which affect blood flow
- Headache medicines that contain ergotamine
Other helpful lifestyle changes for people with Raynaud's are those that boost blood flow in the body. These include exercising regularly and quitting smoking.
When attacks do occur, people with Raynaud's can take several steps to limit the length and strength of the attacks. These steps include:
- Moving to a warmer spot, such as indoors during cold weather.
- Warming the hands or feet. Hands can be placed under the armpits, and feet or hands can be soaked in warm water.
- Wiggling or massaging the fingers and toes.
- Moving the arms in circles or shaking arms or feet.
- Relaxing and getting out of stressful situations that trigger the attacks.
Medicines and Surgery
Most of the medicines used to treat people with Raynaud's are given to improve blood flow to the extremities. These medicines include calcium channel-blockers, such as:
Calcium channel-blockers help limit the number and severity of attacks in about 2 out of 3 patients with Raynaud's.
Also helpful are alpha-blockers, such as prazosin and doxazosin. In addition, skin creams that dilate blood vessels, such as nitroglycerine paste, can help heal skin sores.
The rare patient who develops sores or tissue death (gangrene) needs more aggressive treatment. Such treatment includes antibiotics and surgery to cut out damaged tissue. People with severe, worsening Raynaud's may have surgery or shots to block the action of nerves in the hands and feet that control blood flow in the skin. This surgery often gets rid of symptoms for 12 years. Patients may need shots more than once.
Posted by Joyce Kavitsky at 11/30/2008 02:37:00 PM