Later On

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Archive for November 19th, 2019

Inside Purdue Pharma’s Media Playbook: How It Planted the Opioid “Anti-Story”

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David Armstrong reports in ProPublica about how wealthy drug dealers get away with it.

In 2004, Purdue Pharma was facing a threat to sales of its blockbuster opioid painkiller OxyContin, which were approaching $2 billion a year. With abuse of the drug on the rise, prosecutors were bringing criminal charges against some doctors for prescribing massive amounts of OxyContin.

That October, an essay ran across the top of The New York Times’ health section under the headline “Doctors Behind Bars: Treating Pain is Now Risky Business.” Its author, Sally Satel, a psychiatrist, argued that law enforcement was overzealous, and that some patients needed large doses of opioids to relieve pain. She described an unnamed colleague who had run a pain service at a university medical center and had a patient who could only get out of bed by taking “staggering” levels of oxycodone, the active ingredient in OxyContin. She also cited a study published in a medical journal showing that OxyContin is rarely the only drug found in autopsies of oxycodone-related deaths.

“When you scratch the surface of someone who is addicted to painkillers, you usually find a seasoned drug abuser with a previous habit involving pills, alcohol, heroin or cocaine,” Satel wrote. “Contrary to media portrayals, the typical OxyContin addict does not start out as a pain patient who fell unwittingly into a drug habit.”

The Times identified Satel as “a resident scholar at the American Enterprise Institute and an unpaid advisory board member for the Substance Abuse and Mental Health Services Administration.” But readers weren’t told about her involvement, and the American Enterprise Institute’s, with Purdue.

Among the connections revealed by emails and documents obtained by ProPublica: Purdue donated $50,000 annually to the institute, which is commonly known as AEI, from 2003 through this year, plus contributions for special events, for a total of more than $800,000. The unnamed doctor in Satel’s article was an employee of Purdue, according to an unpublished draft of the story. The study Satel cited was funded by Purdue and written by Purdue employees and consultants. And, a month before the piece was published, Satel sent a draft to Burt Rosen, Purdue’s Washington lobbyist and vice president of federal policy and legislative affairs, asking him if it “seems imbalanced.”

On the day of publication, Jason Bertsch, AEI’s vice president of development, alerted Rosen to “Sally’s very good piece.”

“Great piece,” Rosen responded.

Purdue’s hidden relationships with Satel and AEI illustrate how the company and its public relations consultants aggressively countered criticism that its prized painkiller helped cause the opioid epidemic. Since 1999, more than 200,000 people have died from overdoses related to prescription opioids. For almost two decades, and continuing as recently as a piece published last year in Slate, Satel has pushed back against restrictions on opioid prescribing in more than a dozen articles and radio and television appearances, without disclosing any connections to Purdue, according to a ProPublica review. Over the same period, Purdue was represented by Dezenhall Resources, a PR firm known for its pugnacious defense of beleaguered corporations. Purdue was paying Dezenhall this summer, and still owes it money, according to bankruptcy filings.

Purdue funded think tanks tapped by the media for expert commentary, facilitated publication of sympathetic articles in leading outlets where its role wasn’t disclosed, and deterred or challenged negative coverage, according to the documents and emails. Its efforts to influence public perception of the opioid crisis provide an inside look at how corporations blunt criticism of alleged wrongdoing. Purdue’s tactics are reminiscent of the oil and gas industry, which has been accused of promoting misleading science that downplays its impact on climate change, and of big tobacco, which sought to undermine evidence that nicotine is addictive and secondhand smoke is dangerous.

Media spinning was just one prong of Purdue’s strategy to fend off limits on opioid prescribing. It contested hundreds of lawsuits, winning dismissals or settling the cases with a provision that documents remain secret. The company paid leading doctors in the pain field to assure patients that OxyContin was safe. It also funded groups, like the American Pain Foundation, that described themselves as advocates for pain patients. Several of those groups minimized the risk of addiction and fought against efforts to curb opioid use for chronic pain patients.

Purdue’s campaign may have helped thwart more vigorous regulation of opioid prescribing, especially in the decade after the first widespread reports of OxyContin abuse and addiction began appearing in 2001. It may also have succeeded in delaying the eventual reckoning for Purdue and the billionaire Sackler family that owns the company. Although Purdue pleaded guilty in 2007 to a federal charge of understating the risk of addiction, and agreed to pay $600 million in fines and penalties, the Sacklers’ role in the opioid epidemic didn’t receive widespread coverage for another decade. As backlash against the family swelled, the company filed for Chapter 11 bankruptcy in September.

“Efforts to reverse the epidemic have had to counter widespread narratives that opioids are generally safe and that it is people who abuse them that are the problem,” said Caleb Alexander, co-director of the Center for Drug Safety and Effectiveness at the Johns Hopkins Bloomberg School of Public Health, who has served as a paid expert witness in litigation alleging that Purdue’s marketing of OxyContin misled doctors and the public. “These are very important narratives, and they have become the lens through which people view and understand the epidemic. They have proven to be potent means of hampering interventions to reduce the continued oversupply of opioids.”

Satel, in an email to ProPublica, said that she reached her conclusions independently. “I do not accept payment from industry for my work (articles, presentations, etc),” she wrote. “And I am open to meeting with anyone if they have a potentially interesting topic to tell me about. If I decide I am intrigued, I do my own research.”

As for Purdue’s funding of AEI, Satel said in an interview that she “had no idea” that the company was paying her employer and that she walls herself off from information regarding institute funders. “I never want to know,” she said. She didn’t disclose that the study she referred to was also funded by Purdue, she said, because “I cite peer-reviewed papers by title as they appear in the journal of publication.”

The sharing of drafts before publication with subjects of stories or other interested parties is prohibited or discouraged by many media outlets. Satel said she didn’t remember sharing the draft with Rosen and it was not her usual practice. “That’s very atypical,” she said. However, Satel shared a draft of another story with Purdue officials in 2016, according to emails she sent. In that case, Satel said, she was checking facts.

Satel said she didn’t remember why the doctor with a patient on high doses of painkillers wasn’t named in the Times story. The draft she sent to Purdue identified him as Sidney Schnoll, then the company’s executive medical director, who defended OxyContin at public meetings and in media stories. In an interview, Schnoll described Satel as an old friend and said her description of his patient was accurate. He left Purdue in 2005 and now works for a consulting company that has Purdue as a client, he said.

Purdue, in a statement, said it has . .

Continue reading.

Written by LeisureGuy

19 November 2019 at 4:45 pm

114,000 Students in N.Y.C. Are Homeless. These Two Let Us Into Their Lives.

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The US has abandoned greatest-nation status because of how it treats children, minorities, the poor, and the vulnerable. And don’t forget the immigrant children — children! — taken from their parents and then lost, with the Trump administration having no clue as to where they are now.

Eliza Shapiro reports in the NY Times, with photos by Brittainy Newman:

The number of school-age children in New York City who live in shelters or “doubled up” in apartments with family or friends has swelled by 70 percent over the past decade — a crisis without precedent in the city’s history.

By day, New York’s 114,085 homeless students live in plain sight: They study on the subway and sprint through playgrounds. At night, these children sometimes sleep in squalid, unsafe rooms, often for just a few months until they move again. School is the only stable place they know.

The New York Times followed Darnell and Sandivel for one day, from sunrise to sunset, to capture how much effort, help and luck it takes for homeless children to have a shot at a decent education.

Sandivel gets up just before 6 a.m. She shares a bed with her mother, Maria, and youngest brother, Jonni; three other brothers sleep on a thin mattress on the ground. With no space for a nightstand, the cellphone that doubles as an alarm clock is stashed in the bed.

Sandivel gets up just before 6 a.m. She shares a bed with her mother, Maria, and youngest brother, Jonni; three other brothers sleep on a thin mattress on the ground. With no space for a nightstand, the cellphone that doubles as an alarm clock is stashed in the bed.

They have tried to make their space cheerful. The walls, which are painted to look like the sky on a summer day, are plastered with posters of Barack Obama and the Virgin Mary.

Two at a time, the children brush their teeth. Staggering is essential — the family shares the bathroom and the kitchen of the two-bedroom apartment with another family of four.

“I have a lot of people with me, but they comfort me,” says Sandivel, who goes by Sandy.

Sandy has a collection of hair bows lined up on a wall in the bedroom. She picks a different one each morning on her way out.

Maria packs Sandy’s lunch: a bag of cheese puffs, from a huge tub in the kitchen she bought on a recent Costco run. The children make the sign of the cross and head out the door. Ahead of them is an hour commute from Bensonhurst, Brooklyn, to the Lower East Side of Manhattan.

Sandy is one of over 73,000 homeless students who lived “doubled up” last year. In one place Sandy’s family used to live, a roommate tried to kill a neighbor. In another apartment, the family was barred from using the kitchen by their housemates and had to eat in the bedroom.

Her mother is supporting the family on meager savings and spends each day looking for a steady job, but she is running out of money. Rent for her room is about $700 a month.

Maria commutes with her children to and from school every day, which means she needs to find a job with predictable daytime hours.

On the subway, Sandy looks up from her book and notices an exhausted-looking child standing in front of her. She gives up her seat.

On the subway, Sandy looks up from her book and notices an exhausted-looking child standing in front of her. She gives up her seat. . .

Continue reading. Lots of photos. Much more.

Mahatma Gandhi: “The true measure of any society can be found in how it treats its most vulnerable members.” The US does poorly by this measure.

Written by LeisureGuy

19 November 2019 at 2:46 pm

Posted in Daily life

Lt. Col. Alexander Vindman’s powerful opening statement in the impeachment hearings

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Jen Kirby reports in Vox:

Lt. Col. Alexander Vindman testified Tuesday that he was concerned about President Donald Trump’s July 25 call with Ukrainian President Volodymyr Zelensky, calling it “improper for the president of the United States to demand a foreign government investigate a U.S. citizen and political opponent.”

That wasn’t a surprise: It’s what Vindman said in closed door-testimony last month.

But what really stood out in Vindman’s public testimony before the House Intelligence Committee was his moving conclusion, where he recounted his military service and own family’s journey to America as refugees from the former Soviet Union nearly 40 years ago.

“When my father was 47 years old, he left behind his entire life and the only home he had ever known to start over in the United States so that his three sons could have better, safer lives,” Vindman told the committee. “His courageous decision inspired a deep sense of gratitude in my brothers and myself and instilled in us a sense of duty and service. All three of us have served or are currently serving in the military. Our collective military service is a special part of our family’s story in America.”

As he prepared for hours of questioning Tuesday— including partisan attacks from Republican defenders of Trump — Vindman convincingly argued thathis presence before Congress was part of the American dream.

In Russia, Vindman said, his “act of expressing my concerns to the chain of command in an official and private channel would have severe personal and professional repercussions and offering public testimony involving the president would surely cost me my life.”

For that, he said, he was grateful for his father’s decision to come to the US, and giving him the privilege of being a public servant and United States citizen.

“Dad, my sitting here today, in the US Capitol talking to our elected officials is proof that you made the right decision forty years ago to leave the Soviet Union and come here to the United States of America in search of a better life for our family,” Vindman said in the closing moments of his statement.

“Do not worry. I will be fine for telling the truth.”

Read Vindman’s full opening statement here.

And, related: “Alexander Vindman’s Family Under 24-Hour Security Monitoring After Twitter Targeting By Trump.”

Trump supporters are a clear and present danger, and they seem to hate the truth.

Written by LeisureGuy

19 November 2019 at 2:11 pm

Nearly All Mass Shooters Since 1966 Have Had 4 Things in Common

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David Noriega and Tess Owen report in Vice:

The stereotype of a mass shooter is a white male with a history of mental illness or domestic violence. While that may be anecdotally true, the largest single study of mass shooters ever funded by the U.S. government has found that nearly all mass shooters have four specific things in common.

A new Department of Justice-funded study of all mass shootings — killings of four or more people in a public place — since 1966 found that the shooters typically have an experience with childhood trauma, a personal crisis or specific grievance, and a “script” or examples that validate their feelings or provide a roadmap. And then there’s the fourth thing: access to a firearm.

The root cause of mass shootings is an intensely partisan debate, with one side blaming mental health and the others blaming guns. Researchers hope that the findings in the study could usher in a more holistic and evidence-based approach to the issue — and provide opportunities for policy action.

“Data is data,” said Jillian Peterson, a psychologist at Hamline University and co-author of the study. “Data isn’t political. Our hope is that it pushes these conversations further.”

The study, compiled by the Violence Project, a nonpartisan think tank dedicated to reducing violence in society, was published Tuesday and is the most comprehensive and detailed database of mass shooters to date, coded to 100 different variables. Its release comes less than a week after a teenage boy killed two students at his high school in Santa Clarita, California, before fatally shooting himself in the head.

The researchers used the FBI’s definition of a “mass murder” — four or more people killed, excluding the perpetrator — and applied it to shootings in one public place. The dataset stretches back to August 1, 1966, when a former Marine opened fire from an observation deck at the University of Texas, killing 15 people. It wasn’t the first mass shooting in the U.S., but researchers chose it as a starting point because it was the first to be substantively covered on radio and TV.

The database delivers a number of arresting findings. Mass shootings are becoming much more frequent and deadly: Of the 167 incidents the researchers logged in that 53-year period, 20% have occurred in the last five years, and half since 2000.

They’re also increasingly motivated by racial, religious, or misogynist hatred, particularly the ones that occurred in the past five years.

And in an era when tightening gun laws, including background checks, is a national political issue, the study found that more than half of all mass shooters in the database obtained their guns legally.

But researchers said they were particularly struck by how many mass shooters displayed symptoms of being in some sort of crisis prior to the shooting. “Those are opportunities for prevention,” said Peterson.

5 profiles of mass shooters

Experts have long cautioned that there is no single profile for a mass shooter. But the Violence Project researchers found some personal characteristics often align with certain types of locations targeted by shooters, and created five general categories:

  • K-12 shooters: White males, typically students or former students of the school, with a history of trauma. Most are suicidal, plan their crime extensively, and make others aware of their plans at some point before the shooting. They use multiple guns that they typically steal from a family member.
  • College and university shooters: Non-white males who are current students of the university, are suicidal, and have a history of violence and childhood trauma. They typically use legally obtained handguns and leave behind some sort of manifesto.
  • Workplace shooters: Fortysomething males without a specific racial profile. Most are employees of their targeted location, often a blue-collar job site, and have some grievance against the workplace. They use legally purchased handguns and assault rifles.
  • Place of worship shooters: White males in their 40s, typically motivated by hate or domestic violence that spills out into public. Their crimes typically involve little planning.
  • Shooters at a commercial location (such as a store or restaurant): White men in their 30s with a violent history and criminal record. They typically have no connection to the targeted location and use a single, legally obtained firearm. About a third show evidence of a “thought disorder,” a term for a mental health condition, like schizophrenia, that results in disorganized thinking, paranoia, or delusions.

Hate on the rise

The study shows that the number of shooters who are motivated by racism, religious hate, and misogyny have increased since the 1960s — most dramatically in the last five years.

Since 2015, hate-fueled shootings targeting black churchgoers in Charleston, Jews at synagogues in Pittsburgh and Poway, women at a yoga studio in Tallahassee, and Latinos at a Walmart in El Paso, have dominated national headlines and added another layer of complexity to the problem of mass violence in America.

READ: A Marine used a neo-Nazi site to recruit for a “racial holy war.”

Between 1966 and 2000, there were 75 mass shootings. Of those, 9% were motivated by racism, 1% by religious hatred, and 7% by misogyny. Of the 32 mass shootings that have occurred in the U.S. just since 2015, 18% were motivated by racism, 15% by religious hatred, and 21% by misogyny.

The increase in ideologically motivated mass shootings has coincided with the emergence of a newly emboldened far right, who’ve forged national and even international alliances of hate online. The sharp rise in misogyny-inspired shootings also squares with the rise of the “Incels,” short for “involuntarily celibate,” an online subculture comprised of angry young men who deeply resent and blame women for their isolation.

Mental health is a factor — but rarely the cause

Two-thirds of the mass shooters in the database had a documented history of mental health problems. While this seems high, researchers point out that roughly 50% of Americans have experienced some kind of mental health problem at some point in their lives.

Moreover, the percentage of shooters whose crimes were directly motivated by the symptoms of a mental disorder (such as delusions or hallucinations caused by psychosis) is much smaller: roughly 16%. That is a smaller percentage than shooters motivated by hate, a workplace grievance, or an interpersonal conflict.

“If someone has a mental health history, I think we’ve gotten in the habit of blaming that for their actions,” said Peterson. “But someone can have, say, depression, and it’s not like everything they do is driven by that.”

READ: Trump blamed “mentally ill monsters” for Dayton and El Paso massacres.

That said, the study found strong links between suicidal motivations and mass shootings. Nearly 70% of shooters were suicidal before or during the shooting, and the numbers are even higher for school shooters.

These findings could have powerful implications for . . .

Continue reading. There’s more.

Written by LeisureGuy

19 November 2019 at 1:01 pm

How to Lower Your Sodium Intake

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I actually found it pretty easy to cut my sodium intake to an average of 1200mg/day (which is what I think enabled me to discontinue taking the medication for high blood pressure). Using Cronometer helped a lot in tracking it, particularly the Cronometer feature that displays a sorted list of the foods you consumed for any particular nutrient when you hover the mouse over that nutrient’s progress bar. That was what enabled me to discover how much sodium was being contributed by hot sauce, Worcestershire sauce, fish sauce, and the like. And after 4-5 days of food tasting flat, the tastes returned as my tongue recalibrated itself.

I do spark up the food. Acid brightens the taste, so I will add lemon juice or a blended lemon or citric acid (white crystalline powder that works well in a salt shaker) or some sort of vinegar (balsamic, brown-rice, sherry, red wine, or apple cider). I use herbs and spices — straight, homemade mix, or store-bought mix (e.g., Ms. Dash — though with those check ingredients to be sure that it has no salt and no sugar). Also, potassium chloride is sold under various brand names  as a good salt substitute (and source of potassium). That is best used in cooking rather than on (say) tomatoes, and you should use it lightly. MSG, which I buy as Aji-no-moto, is a good way to boost umami (and it is harmless).

Dr. Michael Greger blogs:

Reduction of salt consumption by just 15 percent could save the lives of millions. If we cut our salt intake by half a teaspoon a day, which is achievable simply by avoiding salty foods and not adding salt to our food, we might prevent 22 percent of stroke deaths and 16 percent of fatal heart attacks—potentially helping more than if we were able to successfully treat people with blood pressure pills. As I discuss in my video Salt of the Earth: Sodium and Plant-Based Diets, an intervention in our kitchens may be more powerful than interventions in our pharmacies. One little dietary tweak could help more than billions of dollars worth of drugs.

What would that mean in the United States? Tens of thousands of lives saved every year. On a public-health scale, this simple step “could be as beneficial as interventions aimed at smoking cessation, weight reduction, and the use of drug therapy for people with hypertension or hypercholesterolemia,” that is, giving people medications to lower blood pressure and cholesterol. And, that’s not even getting people down to the target.

A study I profile in my video shows 3.8 grams per day as the recommended upper limit of salt intake for African-Americans, those with hypertension, and adults over 40. For all other adults the maximum is 5.8 daily grams, an upper limit that is exceeded by most Americans over the age of 3. Processed foods have so much added salt that even if we avoid the saltiest foods and don’t add our own salt, salt levels would go down yet still exceed the recommended upper limit. Even that change, however, might save up to nearly a hundred thousand American lives every year.

“Given that approximately 75% of dietary salt comes from processed foods, the individual approach is probably impractical.” So what is our best course of action? We need to get food companies to stop killing so many people. The good news is “several U.S. manufacturers are reducing the salt content of certain foods,” but the bad news is that “other manufacturers are increasing the salt levels in their products. For example, the addition of salt to poultry, meats, and fish appears to be occurring on a massive scale.”

The number-one source of sodium for kids and teens is pizza and, for adults over 51, bread. Between the ages of 20 and 50, however, the greatest contribution of sodium to the diet is not canned soups, pretzels, or potato chips, but chicken, due to all the salt and other additives that are injected into the meat.

This is one of the reasons that, in general, animal foods contain higher amounts of sodium than plant foods. Given the sources of sodium, complying with recommendations for salt reduction would in part “require large deviations from current eating behaviors.” More specifically, we’re talking about a sharp increase in vegetables, fruits, beans, and whole grains, and lower intakes of meats and refined grain products. Indeed, “[a]s might be expected, reducing the allowed amount of sodium led to a precipitous drop” in meat consumption for men and women of all ages. It’s no wonder why there’s so much industry pressure to confuse people about sodium.

The U.S. Dietary Guidelines recommend getting under 2,300 milligrams of sodium a day, while the American Heart Association recommends no more than 1,500 mg/day. How do vegetarians do compared with nonvegetarians? Well, nonvegetarians get nearly 3,500 mg/day, the equivalent of about a teaspoon and a half of table salt. Vegetarians did better, but, at around 3,000 mg/day, came in at double the American Heart Association limit.

In Europe, it looks like vegetarians do even better, slipping under the U.S. Dietary Guidelines’ 2,300 mg cut-off, but it appears the only dietary group that nails the American Heart Association recommendation are vegans—that is, those eating the most plant-based of diets. . .

Continue reading.

Written by LeisureGuy

19 November 2019 at 8:44 am

Posted in Daily life, Food, Health, Science

Whipped Dog silvertip, Plant Java Hive, and the DOC Yaqi

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I bought this little octagonal-handled silvertip from Whipped Dog years ago — about $30, as I recall. At the time, it seemed to be popular to set the knot deeper than the standard depth, which narrows its range and stiffens it somewhat. I prefer softer knots, so I went with the standard depth, and the brush has been eminently satisfactory.

This morning I chose the unusual honey + coffee fragrance of Phoenix Artisan’s Planet Java Hive, here in the CK-6 formulation. The lather from that formula is exceptional, and I love the fragrance.

Three passes with Yaqi‘s quite wonderful double-open-comb razor left my face perfectly smooth for a splash of the matching aftershave — a great beginning for a new day.

Written by LeisureGuy

19 November 2019 at 8:06 am

Posted in Shaving

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