High prices for foreign tourists
gives them a flawed message

Dear A.M. Costa Rica:

There is something in Costa Rica tourism that really gets under my skin, and that is charging tourists "non-nationals" two or three times as much as Ticos for entrance into a tourist destination!  The message, IMHO, is very clear:  Welcome to Costa Rica . . . now we are going to rip you off!"

The solution:  Charge a single price, a balance between the current ripoff and the Tico price, and on the literature and entry signage, in small print below, offer a specified discount to all holders of a Costa Rican cédula.  Seems pretty logical (I know, I know, I forgot where I am!).

Costa Rica is a major tourist destination.  To show tourists, in print, that they are being excessively charged, compared to a national, sends a very flawed message!


There is a better way to find
the beginnings of breast cancer

Dear A.M. Costa Rica:

I have been reading about the lack of usefulness and dangers of mammograms for at least five years.

Dr. Joseph Mercola, among others, has written several articles exposing the near zero positive results and the radiation danger, pain plus unnecessary biopsies with mammograms.

Since physical exams are just about as good, adding ultrasound which will find some more should be better than mammograms with no danger.

When my wife got the EBAIS to specify an ultrasound, the attending technician insisted she had to have a mammogram also even though it was not specified. Next time we will make sure that the order for exam does not permit the mammogram.

There is a much better technology available in the USA, but not in Costa Rica that I have heard of. It is called thermography and involves taking infrared photos which measure the extra heat of a forming cancer. It has been available in the U.S.A. since about 1970. Photos are digital and can be emailed to diagnosis experts for high level accuracy. The technology is well developed now. I would expect it to be a little less expensive as no silver containing paper is needed nor chemicals nor envelopes nor storage bins for results. Just a hard or flash drive. In Jpg format it is easy to compare previous photos. The best part is that it detects much smaller cancers 5 to 10 years earlier at a much higher accuracy.

Its biggest deterrent is that those with investments in mammogram equipment don’t like it due to the competition. Medicine is a competitive business. Sometimes when found early, cancer will respond to lifestyle changes and treatment can be avoided altogether.  The Caja Costarricense de Seguro Social should like that.


Awareness is most important
in personal health maintenance

Dear A.M. Costa Rica:

Your article on the benefits of mammograms versus physical breast exams distorts the truth in a way that the media virtually always does. Neither method saves lives -- both methods only prolong lives, and that only on average.

Epidemiological studies of competing risks help to clarify claims about prolonging lifespan. For example, comparisons of death by coronary failure versus cancer show that if either were entirely cured, average lifespan would be increased less than half a year. Why? Because people die of the other. (The key is the word "average.")

In the case of breast cancer, both manual exams by trained health professionals and mammograms can be used. Self examination after training can discover more tumors, whether benign or malignant, than either, if enough people do it.

And men are not immune. A friend, a male physician working at a cancer registry in the States, died of breast cancer because he didn't respond to obvious symptoms. So awareness is the most important tool in health maintenance.

More unrest in Venezuela
predicted but not a coup


Nearly one year after the death of Venezuelan President Hugo Chávez, violent protests have erupted against his hand-picked successor, President Nicolás Maduro. The unrest is fed by deteriorating economic conditions and rampant lawlessness that cast fresh doubts on the viability of the socialist experiment Chávez launched in Venezuela more than 15 years ago.

Growing numbers of Venezuelans are taking to the streets and confronting riot police.
 
One protester said, “We Venezuelans do not have food. There are no jobs, no education. There is insecurity. We don't want this anymore."

The unrest comes as no surprise to Latin America expert Michael Shifter. “Economic conditions have never been worse in Venezuela. Crime is off the charts, completely uncontrolled. Inflation is the highest in the world, there are shortages of basic goods. And there is widespread frustration and discontent with the government,” he said.

Maduro has mobilized his backers, including petroleum workers like Jose Hernandez. “The oil industry stands with President Maduro, with his economic measures, in order to counter everything the oligarchy is doing.”

The “oligarchy” is a reference to Venezuela’s political opposition, whose leader, Leopoldo López, has been arrested.

“We have to take up protests in the streets. It is a moral duty, a patriotic duty. If not now, then when?” asked Lopez.

Lopez stands accused of inciting violence. Maduro also accuses the United States of engineering unrest, and has expelled three American diplomats. White House spokesman Jay Carney rebuts the charge.

“We have seen many times that the Venezuelan government tries to distract from its own actions by blaming the U.S. or other members of the international community for events inside Venezuela," said Carney.

Meanwhile, Maduro is making thinly-veiled threats about any effort to remove him from office.

“If one day you receive news that the oligarchy succeeded in toppling a government, a scenario that will not happen, then perhaps this peaceful, democratic revolution will take on another character, an armed one, deeply revolutionary. The world should know this. We are willing to do everything necessary,” said Maduro.

In his quest to boost the fortunes of Venezuela’s poor, former President Chávez concentrated political power and depleted Venezuela’s substantial oil revenues for massive social welfare programs. He is proving a tough act to follow, according to analyst Shifter.

“Chávez really had the charisma. He had tremendous political skills, and he had money. He rode a boom in Venezuela. And his successor does not have charisma, does not have political skills, and is really strapped on the fiscal front,” said Shifter.

Shifter does not believe a coup is likely, but thinks conditions in Venezuela could deteriorate further, leading to far deeper, more widespread unrest and pressure for new elections on an accelerated timeline.