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Archive for April 2nd, 2018

Study links marijuana legalization to fewer opioid prescriptions

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Jessie Hellmann reports in The Hill?

States that have legalized marijuana for medical or recreational purposes have seen fewer opioid prescriptions for Medicaid patients, according to a study published in the Journal of the American Medical Association.

States with medical marijuana laws had a 5.8 percent lower rate of Medicaid-covered prescriptions for opioids, the study found.

When states with existing medical marijuana laws began allowing recreational use of the drug, prescriptions for opioids dropped an additional 6.38 percent.

“Overprescribing of opioids is considered a major driving force behind the opioid epidemic in the United States,” wrote the authors of the study, Hefei Wen and Jason Hockenberry.

“Marijuana is one of the potential non-opioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose.”

Among the eight states that began implementing medical marijuana laws between 2011 and 2016, four had significantly lower opioid prescribing rates: Delaware, Massachusetts, Minnesota and New Hampshire.

Of the four states studied that have legalized marijuana for recreational use, three had significantly lower opioid prescribing rates during that same time period, the study found.  . .

Continue reading.

Also in the report:

Another study published in the journal Monday found that in states where medical marijuana is legal, there was an 8.5 percent reduction in the number of daily opioid doses filled under Medicare Part D.

Written by LeisureGuy

2 April 2018 at 2:25 pm

How to Serve a Deranged Tyrant, Stoically

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Ryan Holiday, the author of “The Daily Stoic” and the editor of, writes in the NY Times:

In January 2017, I was offered a potential position inside the newly forming Trump administration: a job as communications director for a cabinet member. I had not supported Mr. Trump and so the offer was a surprise, and I surprised myself by even considering it.

While I didn’t pursue the opportunity very seriously and it did not come to pass, even the possibility of having worked in the Trump administration has colored my read on the news this past turbulent year. While others follow each new scandal and the dizzying parade of White House hirings and firings with glee or horror, I pause to consider a dangerous near miss. It has also given me a different perspective on a side of philosophy that is often ignored — its interaction and interplay with politics.

In the ancient world, as is true today, navigating political chaos was a pressing dilemma. Philosophers were forced to decide whether to participate in, resist or simply endure the political rulers of their time. Socrates, the incorrigible free spirit, was a soldier in the Peloponnesian War and a citizen who lived through Athens of the Thirty Tyrants. Aristotle, who wrote brilliant works on justice, happiness and government, worked for Alexander the Great, a murderous warmonger.

Or consider the case of Seneca, a man whose political life mirrors much of the chaos of the Trump administration. In A.D. 49, the well-known writer and Stoic philosopher was recalled from exile to tutor the successor of the emperor Claudius, a promising teenager named Nero. Like many people today, Seneca entered public service with ideals mitigated by a pragmatic understanding of the reality of the politics of his time.

Although just a few generations earlier, the Stoics had been ardent defenders of the republican ideals (Cato, Seneca’s hero, famously disemboweled himself rather than live under Julius Caesar), by Seneca’s time most of these objections had become futile. As Emily Wilson, a translator and biographer of Seneca, writes: “Cicero hoped that he really could bring down Caesar and Mark Antony. Seneca, by contrast, had no hope that he could achieve anything by direct opposition to any of the emperors under whom he lived. His best hope was to moderate some of Nero’s worst tendencies and to maximize his own sense of autonomy.”

We can imagine, too, that he saw the inexperienced Nero as an opportunity to advance his own interests and influence. Only time would reveal that fusing his fate to Nero was a Faustian bargain.

Though Nero had good qualities, he was obsessed with fame and had an endless need for validation. He was also unstable and paranoid, and began to eliminate his rivals — including murdering his own mother. Was Seneca personally involved in these decisions? We don’t know. But he helped legitimize the regime with his presence, and profited from it as well, becoming one of Rome’s richest men through his 13 years of service.

Seneca was torn. To the Stoics, contributing to public affairs was a critical duty of the philosopher. Could Seneca decline to serve because he disagreed with the emperor? Could he leave a deranged Nero unsupervised? In time, Seneca would also come to the conclusion that when “the state is so rotten as to be past helping, if evil has entire dominion over it, the wise man will not labor in vain or waste his strength in unprofitable efforts.”

As Nero worsened, Seneca attempted to leave. Joining Nero’s administration was easy, but an exit was not. Nero could not afford to lose his most influential adviser, or allow the perception that someone as well known as Seneca was cutting ties with him. Seneca was granted a quiet sabbatical at Nero’s whim — the modern equivalent of a jointly issued news release.

Seneca had finally come to experience the truth of the words of the Roman poet Horace, whose work had greatly influenced him: “To have a great man for a friend seems pleasant to those who have never tried it; those who have, fear it.”

In a larger sense, Seneca’s struggle has echoes into our time, especially in politics. Last year, Senator Marco Rubio, a Republican who has both criticized Donald Trump and supported many of his policies, tweeted a quote from Seneca about tyranny, prompting some to ask if he was subtweeting the president. Ken Kurson, the former editor in chief of The New York Observer and an informal adviser to Mr. Trump and Jared Kushner during the election, told me that the Stoics were an inspiration to him as he dealt with the ethical and personal challenges of his position.

My own early career involved some questionable service to businesspeople. . .

Continue reading. There’s more.

Written by LeisureGuy

2 April 2018 at 1:22 pm

Posted in Daily life, Politics

Five Democratic arguments that might resonate in the suburbs

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Jennifer Rubin’s on a roll. She writes in the Washington Post:

Freed from their obsessive interest in President Trump’s core base (Should we have said “Merry Christmas” more often? Maybe we should have pretended that NAFTA cost jobs?) and the temptation to shun reality in search of the secret sauce for attracting fact-free Fox News viewers, Democrats seem to be coming to the realization that their traditional base — single women, minorities, young voters, college-educated voters, urban dwellers — is perfectly compatible with other demographic cross-sections of America (e.g. married women, suburbanites, #NeverTrump Republicans). Moreover, occasional voters (e.g. millennials) can become spirited activists and off-year voters if given enough reason to turn out. There is no shortage of issues that can bring together all these voters. We’ll start with just five that might resonate in the suburbs, with college-educated women and with disaffected Republicans — and also, in some cases, might help turn out traditional Democratic constituents:

1. Accountability: So long as Republicans retain House and Senate majorities, Trump and his band of ethically challenged advisers pay no price for their conflicts of interest, misuse of taxpayer monies, nepotism and lack of transparency. If voters think that this president and every future one should reveal his tax returns and eschew monies coming from foreign entities, they will need to jettison Republican majorities, who have been absolutely clear that they take no interest in the president’s financial self-dealing and conflicts. Real congressional oversight is possible only with Democratic-led committees.

2. Economic self-sabotage: Trump likes to take credit for the economy that he inherited, but he is doing a bang-up job undercutting the economic recovery now in its ninth year. Trump’s trade war is well underway. The Post reports:

The Chinese government plans to immediately impose tariffs on 128 U.S. products, including pork and certain fruits, a direct response to President Trump’s recent moves to pursue numerous trade restrictions against Beijing.

If U.S. goods become more expensive in China, Chinese buyers could opt to purchase products from Europe, South America or elsewhere, though White House officials have routinely discounted the likelihood of this.

Beijing’s move could force Trump to decide whether to follow through on expansive trade restrictions he had hoped would crack down on China even if Beijing is now threatening to harm U.S. companies that rely on Asian markets for buyers. . . . In addition to pork, the new tariffs from the Chinese government will include U.S. exports of apples, oranges, almonds, pineapples, grapes, watermelons, cranberries, strawberries, raspberries, cherries, and a host of other items.

Meanwhile, Trump’s anti-immigrant raving is costing the United States high-skilled workers. As Axios recently reported: “Tech companies in and around Toronto have seen a surge in international job applications over the last year, by far mostly from the U.S., according to a new survey. The number doubled and tripled in some of the companies, the result of a deliberate Canadian campaign to attract tech workers from the U.S. and around the world. … The spike in applications and hiring adds to the evidence suggesting that President Trump’s immigration crackdown is resulting in a loss of tech workers to Canada.”

3. DACA (the Deferred Action for Childhood Arrivals) program: Aside from the economic ramifications of his anti-immigrant stance, Trump’s approach to the “dreamers” — highlighted in his Easter Sunday tirade — is a moral disgrace and nightmare for local police (who understand the danger to public safety when a significant number of residents refuse to report crimes or assist police for fear of being deported). Upwards of 80 percent of voters want dreamers legalized; if deportations pick up, that number may soar. This is not just an issue for Hispanic voters. Bloomberg reports:

A sizable majority of Americans, especially Democrats and independents, support giving legal status to Dreamers, opinion polls have shown. The topic resonates especially in California, Arizona, Texas, Florida and Nevada — states with large Hispanic populations where Democrats are seeking to chip away at the Republican majorities in the House and Senate.

“We’re discussing it in our race every single day,” said Jacky Rosen, a U.S. representative who’s the likely Democratic nominee to face Republican incumbent Senator Dean Heller in Nevada. “Dean Heller is doing whatever the president wants — he’s opposing the Dream Act and he voted against two bipartisan DACA deals.” . . . . “To young voters, DACA isn’t an abstraction — it’s their friend, their neighbor, the classmate they’ve grown up with, who the Republican Party was willing to deport,” said Jesse Ferguson, a Democratic consultant.

4. Unfit nominees: The GOP Senate rubber-stamped a slew of incompetent, unqualified and/or ethically deficient nominees who predictably washed out (former secretaries Rex Tillerson, Tom Price, David Shulkin) or remain mired in scandal (the Environmental Protection Agency’s Scott Pruitt, Housing and Urban Development’s Ben Carson, Treasury’s Steven Mnuchin, Interior’s Ryan Zinke). It would be far better for the country, and for Trump frankly, if the Senate would exercise some quality control. It should have been apparent at Education Secretary Betsy DeVos’s confirmation hearing (guns in classrooms to shoot bears?!?) and from Attorney General Jeff Sessions’s repeated untruths to the Senate Judiciary Committee about his Russia contacts that they would stumble in office. Nevertheless, the GOP-led Senate waved them through. If voters want to stop the parade of extremists, cranks, incompetents and ethical malefactors, they will need to dump the Senate majority.

5. War: . . .

Continue reading.

Written by LeisureGuy

2 April 2018 at 1:12 pm

Trump’s incoherence on immigration ought to embarrass his supporters

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So far as I can tell, Trump’s supporters (like Trump himself) are incapable of embarrassment. Jennifer Rubin writes in the Washington Post:

President Trump’s Easter tweets and rambling comments to reporters about immigration should remind us that he shows no desire to learn even rudimentary facts about the Deferred Action for Childhood Arrivals (DACA) program.
The Post reports: “In fiery Sunday morning tweets, sent an hour after he wished Americans a ‘HAPPY EASTER’ and minutes before he attended a church service here, Trump vowed, ‘NO MORE DACA DEAL.’ ”
Of course, he had a DACA deal sitting there — legalizing the “dreamers” in exchange for the wall — but he was talked out of it, presumably by anti-immigrant zealots such as Stephen Miller. Trump on Sunday also insisted that the Senate do away with the filibuster, something Senate Majority Leader Mitch McConnell (R-Ky.) has repeatedly rejected, so as to get his own version of immigration reform. (Ironically, a generous DACA fix got 54 votes in the Senate, so by Trump’s reasoning, we’d be on our way to a DACA deal if the White House had not urged Republicans to reject the bill and keep the total below 60 votes.) It’s not clear if the president didn’t remember this, didn’t understand it at the time or is just plain lying to members of his base, who are frustrated that Trump got rolled in the budget deal, winding up with no wall.
Frank Sharry, executive director of the pro-immigration group America’s Voice, remarked to me, “Trump is desperately trying to win back the Ann Coulter-Fox News crowd by talking tough and beating his chest, but all it does is reinforce how stupid he was during the DACA and budget negotiations and how thoroughly he got rolled by [Senate Minority Leader Charles E.] Schumer and [House Minority Leader Nancy] Pelosi in the spending package.”
Trump then suggested that new immigrants could take advantage of DACA. (They can’t.) “A lot of people are coming in because they want to take advantage of DACA,” he proclaimed. Only if they arrived via a time machine could they qualify for DACA, which he repealed and which required that the recipients have been in the United States since June 15, 2007.
Although he acknowledges that he needs Mexico’s help to patrol the border, Trump chose to threaten Mexico. “Mexico is doing very little, if not NOTHING, at stopping people from flowing into Mexico through their Southern Border, and then into the U.S. They laugh at our dumb immigration laws,” he tweeted. “They must stop the big drug and people flows, or I will stop their cash cow, NAFTA. NEED WALL!” And Trump falsely suggested that the “catch and release” policy (it was not a “law,” as he claimed) is still in place. (“Border Patrol Agents are not allowed to properly do their job at the Border because of ridiculous liberal (Democrat) laws like Catch & Release,” he tweeted. “Getting more dangerous. ‘Caravans’ coming. Republicans must go to Nuclear Option to pass tough laws NOW. NO MORE DACA DEAL!” (In fact, as U.S. News & World Report noted, “Trump signed an executive order five days into his presidency that called for a host of enhanced border protection efforts, including more border patrol agents and an end to the “catch-and-release” policy for handling immigrants apprehended while illegally crossing.”)
Too many talking heads on TV will try to keep a straight face and attempt to decipher Trump’s words, acting as though his remarks are the product of rational, informed thinking. Not enough reporters will refuse to accept the inevitable White House spin that Trump’s remarks somehow all make sense. Others will skip straight to process stories. (Maybe it’s clever politics! He’s reassuring his base! No, he means DACA figuratively, not literally!)
Let’s get real. Other than a visceral distaste for Hispanic immigrants (and others from “shithole” countries, in Trump’s words) and a need to feed material to the white-grievance racket (e.g. Fox News, Breitbart, FAIR, anti-immigrant bloggers, etc.), Trump doesn’t much care what the current law is or what current conditions exist for immigrants. All he knows is that he blew the deal for the wall and will get blamed for DACA (which he repealed). Trump and his spokesmen should not get a free pass, the presumption of rationality, when the president sounds this uninformed and divorced from reality.
Trump certainly is not entirely alone in his ignorance. How many other right-wing anti-immigrant (legal and illegal) provocateurs insist that immigrants are stealing jobs? The same people who are convinced that we are being overrun by murderers and drug dealers might want to consider what is going on in red America — where many members of Trump’s base actually live. Aside from having a very small percentage of immigrants, these areas have an acute labor shortage. The Wall Street Journal reports:

Manufacturers in northern Iowa are begging Terry Schumaker for freshly trained workers for their factories. The problem is he doesn’t have enough students to train.
“It’s not like we have the people beating down our door to apply,” said Mr. Schumaker, a dean at the North Iowa Area Community College in Mason City.

It is a problem playing out in many parts of the Midwest, a region with lower unemployment and higher job-opening rates than the rest of the country. Employers, especially in more rural areas, are finding that there are just too few workers. That upends a long-running view in Washington, D.C., and many state capitals, where policy makers often say the unemployed simply lack the skills to get hired.

Oh. Well, yes. In places with a declining and graying population, they need more young workers, at all levels. “The U.S. labor market is the tightest it has been in nearly two decades. The national unemployment rate held at a 17-year low of 4.1% for five straight months, and the number of job openings is at a record,” the Journal notes. “In the Midwest, the worker shortage is even more pronounced. If every unemployed person in the Midwest was placed into an open job, there would still be more than 180,000 unfilled positions, according to the most recent Labor Department data. The 12-state region is the only area of the country where job openings outnumber out-of-work job seekers.”
Ironically, the answer to their economic problems is staring them in the face: Start attracting more immigrants. (“The Midwest has seen an outflow of people. A net 1.3 million people living in the Midwest in 2010 had left by the middle of last year, according to census data. The area also attracts fewer immigrants than the rest of the country. As a result, Midwest employers are more dependent on filling jobs with workers who already live there.”) Where this has been tried — in Michigan, for example — it has been wildly successful.
No matter how many times you present the data that immigrants complement the existing workforce, expand the economy (as consumers, homeowners, entrepreneurs), provide a solution to an aging workforce (thereby paying for retiring baby boomers’ retirement), commit fewer crimes than native-born Americans and are more likelyto start businesses than native-born Americans, Trump and his anti-immigrant crowd insist that these people are a menace to the United States.
Listen. Trump said it himself. If immigrants . . .

Continue reading.

Written by LeisureGuy

2 April 2018 at 12:25 pm

Here’s the real reason teachers are revolting in red states

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Augustina S. Paglayan writes in the Washington Post:

Teachers are revolting — striking for better pay and improved school funding. Last month, the nation watched an unprecedented nine-day statewide strike in West Virginia, which ended only when the legislature passed — and the governor signed — a 5 percent raise for all teachers.
Last week, threatened with a similar strike, the Oklahoma legislature offered a raise and increased school funding — but not enough to stop teachers from striking. Arizona and Kentucky teachers have organized sickouts and rallied at their state capitols, with similar demands. Teachers in these red states are among the worst-paid in the country.
Why the low pay and unrest among public school teachers across conservative states?
Some observers believe weak labor rights are why teachers in these states are among the lowest-paid. These states don’t require local school districts to bargain collectively with teacher unions — and weaker labor rights leave teachers worse off. If only these states mandated bargaining with the unions, this argument goes, teacher salaries would be higher and there would be fewer reasons to strike.
But that’s a myth. My new research shows collective bargaining rarely leads to higher teacher salaries and more education spending. Teachers in red states are striking because of their low pay — but that is not because their labor rights are weak. The problem is they teach in states that have historically spent little on education.
Before the 1960s, virtually all U.S. states prohibited collective bargaining for teachers and other public employees. Beginning with Wisconsin in 1959, 33 states in total over the next 20 years — mostly outside the South — and the District of Columbia repealed this prohibition and required districts to bargain with teacher unions. In the remaining states, 10 states allowed but did not require bargaining with unions, and seven states, mainly in the South, prohibited it.
That pattern remained stable until 2011, when Republicans in Wisconsin and 10 other states passed laws that cut back teachers’ collective bargaining rights, promising this would help reduce public deficits.
Since collective bargaining rights for teachers did not emerge until the 1960s, we can look at the difference between those states that did and did not mandate collective bargaining to see whether these rights affected teacher salaries, employment and education spending.
To quantify the effect of mandatory collective bargaining with teachers, I tracked teacher salaries, the number of teachers hired, public spending on education, and spending on non-wage things such as pensions and health benefits across all 50 states from 1919 to the present.
Here are three things I found, and one implication for policymakers.
1. Teachers got collective bargaining rights in states that already paid teachers well.
By 1990, teacher salaries were 19 percent higher in states with mandatory collective bargaining than in states without. But that is not because of mandatory collective bargaining. The states that adopted these labor laws were historically wealthier and more liberal. They already spent more on education, even before mandating collective bargaining.

The gap in teacher salaries and education spending that we see today between states with and without mandatory bargaining already existed in 1919 — long before the rise of teacher unions.

2. Mandatory collective bargaining didn’t increase teacher pay or education spending.
After states passed these bargaining laws during the 1960s and 1970s, there was a sharp rise in the share of teachers covered by collective bargaining agreements, in teacher union membership, and in teachers’ political engagement.
What didn’t increase more were teacher salaries, the number of teachers hired, or public spending on education.
As you can see in the figure below, after some states mandated collective bargaining and others didn’t, the teacher salary gap between those two groups of states stayed more or less the same. Between 1959 and 2000, teacher salaries increased by 43 percent in states that introduced mandatory bargaining and by 47 percent in states that did not. The same thing goes for education spending and the number of teachers per student.
It is not the requirement to bargain with unions that makes the difference in how much governments spend on education and teachers. . .

Continue reading. More at the link.

Written by LeisureGuy

2 April 2018 at 12:11 pm

NIH rejected a study of alcohol advertising while pursuing alcohol industry funding for other research

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I wish the US had a good Congress that could put a stop to this sort of corruption. Sharon Begley reports in StatNews:

It’s rare for officials at the National Institutes of Health to summon university scientists from hundreds of miles away. So when Dr. Michael Siegel of Boston University and a colleague got the call to meet with the director of NIH’s Institute on Alcohol Abuse and Alcoholism, he said, “I knew we were in trouble.”

He never imagined, however, that at the 2015 meeting the director, George Koob, would leap out of his seat and scream at the scientists after their PowerPoint presentation on research the agency had eagerly funded on the association between alcohol marketing and underage drinking. “I don’t f***ing care!” Koob yelled, referring to alcohol advertising, according to the scientists.

Koob also made clear that NIAAA would pull back from such research, recalled Siegel and his colleague, David Jernigan of Johns Hopkins University, who described the previously undisclosed meeting in Bethesda, Md., in separate interviews with STAT. Shocked by the encounter, they retreated to an NIH cafeteria, asking each other what had just happened — and why.

It would take them three years to figure it out:In 2014 and 2015, Koob’s agency was quietly wooing the alcoholic beverage industry to contribute tens of millions of dollars for a study on whether drinking “moderate” amounts of alcohol was good for the heart. Those efforts were brought to light by recent reports in Wired and the New York Times.

Now STAT has found that the ties between Koob, his agency, and the alcohol industry were deeper than previously known — and that he told an industry official he would quash “this kind of work,” to which the industry objected. Doing so would be a radical departure from the NIH mission, in which decisions about what research to fund are supposed to be based on scientific merit and public need.

Koob, in a previously undisclosed email sent six months before the contentious 2015 meeting and provided to STAT, had assured the alcohol industry’s leading trade group that research like Jernigan’s and Siegel’s on alcohol advertising, which was published in respected journals, would never again be funded.

“Sam: For the record. This will NOT happen again,” Koob wrote in a 2014 email to Samir Zakhari, senior vice president for science at the Distilled Spirits Council of the United States, the lobbying group for alcoholic beverage producers.

In a written response to STAT, Koob said the email “was to convey that I had no intention of supporting research that was not of the highest scientific quality. NIAAA funds a vast amount of research on underage drinking, which is among the Institute’s top research priorities.” An NIAAA spokesman said Koob, 70, and other officials were not available for interviews, and NIAAA officials said they could not speak to a reporter without clearance by NIH’s communications office.

At the time of the 2015 meeting, no outsider was aware of NIAAA’s efforts to get industry funding for the very costly study of moderate drinking. With those revelations, Siegel said, “things finally made sense. If they’re soliciting money from industry, they wouldn’t want to do anything that would affect their chance of getting that money. Of course that will bias them toward intimidating researchers who study things [the industry doesn’t] like.”

In fact, Koob was true to his word. Jernigan applied for another NIAAA grant later in 2015, and . . .

Continue reading. There’s a lot more.

Written by LeisureGuy

2 April 2018 at 11:11 am

Breast cancer page scrubbed from women’s health website

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The Trump administration continues to act against the interests of the American public. Rebecca Savransky reports in The Hill:

A webpage that focused on breast cancer was reportedly scrubbed from the website of the Department of Health and Human Services’s (HHS) Office on Women’s Health (OWH).

The changes on — which include the removal of material on insurance for low-income people — were detailed in a new report from the Sunlight Foundation’s Web Integrity Project and reported by ThinkProgress.

A spokesperson for HHS told ThinkProgress the page was removed Dec. 6, 2017 “because content was not mobile-friendly and very rarely used.”

“Before we update any of the information … we engage in a comprehensive audit and use analysis process that includes reviewing other federal consumer health websites to ensure we are not duplicating efforts or presenting redundant information,” the spokesperson said.

According to the report, content about mammogram breast cancer screening remains on the site.

But “informational pages and factsheets about the disease, including symptoms, treatment, risk factors, and public no- or low-cost cancer screening programs, have been entirely removed and are no longer found elsewhere on the OWH site,” the report said.

“Among the material removed is information about provisions of the Affordable Care Act that require coverage of no-cost breast cancer screenings for certain women, as well as links to a free cancer screening program administered by the Centers for Disease Control and Prevention (CDC),” the report said. . .

Continue reading.

Written by LeisureGuy

2 April 2018 at 10:03 am

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