The Cannabis Question I Full Documentary

Psilocybin microdosers display mental health improvement during 1 month period compared to non-microdosers

I’m game.  Patricia Y. Sanchez writes in PsyPost:

Psilocybin, the active compound in “magic mushrooms,” has been shown to be a promising treatment for various mental health issues. New research published in Scientific Reports found that people who microdose psychedelics displayed greater improvements in mental health and mood over the span of 1 month compared to non-microdosers.

Most of the research on psilocybin treatment has focused on doses that are large enough to contribute to a substantial alteration of one’s consciousness. However, “microdosing,”or taking a small enough dose of psilocybin to not impair cognitive functioning, has become increasingly popular.

“Improvements in mood, emotional well-being and cognition have been reported among the top motivations for microdosing, and several cross-sectional studies have identified associations between microdosing and perceived improvements in mood and cognitive functioning, reductions in stress, depression, and anxiety,” wrote study author Joseph M. Rootman and colleagues.

Relatively fewer studies have investigated the effects of microdosing and these studies have not included a non-microdosing control group, which is essential in evaluating any causal effects of microdosing. To address this gap, researchers collected data from respondents participating in a larger study of psychedelic microdosing.

“The study consisted of . . .

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After Marijuana Legalization Did Opioid Overdoses Go Up, Stay the Same, or Go Down?

Dr. Michael Greger has an interesting blog post on the outcomes of marijuana legalization. The whole post is worth reading; here’s the bulleted summary:

• More than 200 million opioid painkiller prescriptions are written annually despite the diagnosis of millions in the United States with an opioid use disorder and more than 80 Americans dying every day from opioid overdose.
• Might cannabis act as a gateway to harder drugs, like opioids, or might it reduce opioid addiction by offering a substitute painkiller to prescription pills?
• The American Medical Association’s official position is that marijuana “has no scientifically proven, currently accepted medical use for preventing or treating any disease,” but studies have found that cannabis compounds produce pain relief “equivalent to moderate doses of codeine,” an opioid used to treat mild to moderate pain.
• At the end of life, cannabis may allow patients to reduce opiate doses without compromising pain relief such that they may not be in such a drug-induced stupor that they cannot say goodbye.
• Most New Englanders taking opioids claimed they reduced their opioid use after starting medical cannabis, and some also reduced use of alcohol, antidepressants, sleeping pills, and anti-anxiety and migraine medications. Cannabis may also reduce use of crack cocaine.
• After medical marijuana laws were passed, opioid overdoses went down, about a 25 percent lower rate of opioid overdose deaths, and fewer people were filling prescriptions—not only for painkillers, but also for anti-anxiety drugs, antidepressants, anti-nausea drugs, antipsychotics, anti-seizure drugs, and sleeping pills.
• About half a billion dollars would be saved annually if medical marijuana laws were adopted across the United States, but the half-billion taxpayers would save is the half-billion drug companies would lose.

At the end of the blog post is a list of links to more information:

• The Institute of Medicine Report on the Health Effects of Marijuana
• Researching the Health Effects of Marijuana
• Is Marijuana Addictive?
• Does Marijuana Cause Health Problems? 
• Does Marijuana Cause Lung Cancer?
• Does Marijuana Cause Schizophrenia?
• Does Marijuana Cause Permanent Brain Damage in Teens?
• Does Marijuana Cause Permanent Brain Damage in Adults?
• Pesticides in Marijuana
• Effects of Smoking Marijuana on the Lungs
• The Effects of Marijuana on Fertility and Pregnancy
• Will Cannabis Turn into Big Tobacco?
• Smoking Marijuana vs. Using a Cannabis Vaporizer
• Can Cannabis Cure Cancer?
• Are Cannabis Edibles Safe?

The Next Big Addiction Treatment

Brendan Borrell has an interesting — and important — article (gift link, no paywall) in the NY Times, which includes an audio of the article. The article begins:

In recent years there has been a spate of research suggesting psychedelic drugs can help people manage mental health conditions like depression, anxiety, chronic pain or even eating disorders. But a growing body of data points to one as the leading contender to treat the intractable disease of substance abuse. Psilocybin, the active ingredient in psychedelic mushrooms, has shown promise in limited early studies, not only in alcohol and harder drugs, but also nicotine — all of which resist long term treatment.

“The old rule of thumb is that one-third of people get better, one-third stay the same, and one-third continue to get worse,” said Dr. Michael Bogenschutz, a psychiatrist at New York University’s Grossman School of Medicine studying psilocybin-assisted therapy as a treatment for alcohol abuse. “What’s fascinating to me about this whole process is how many different kinds of experiences people can have, which ultimately help them make these profound changes in their behavior.”

Take Aimée Jamison, who several years ago wanted to kick her cigarette habit before her 50th birthday. Statistically speaking, Ms. Jamison’s chance of success wasn’t great. According to the Centers for Disease Control and Prevention, 55 percent of adult smokers tried to quit in 2018, but only 8 percent were successful.

Ms. Jamison, an investor who lives part-time in Boston, had heard about psychedelic therapies, but the drug is largely illegal for personal use. So, in the fall of 2018, she flew to Baltimore to participate in a clinical trial at the Johns Hopkins Center for Psychedelic & Consciousness Research. When she had to abstain from nicotine for a day before a brain scan, she could barely sleep and called it “the most hellish 24 hours I’ve experienced.”

After three talk therapy sessions at the Hopkins clinic, she was given a single pill containing 30 milligrams of psilocybin, a relatively high dose. After swallowing the pill, she put on an eye-mask, lay on a couch and went on a psychedelic trip with two therapists nearby for the next five hours.

When her trip ended, she sat up and looked at the therapists. “Now, I understand why I smoked,” she said, “and I don’t need to do that anymore.”

Over the next couple months Ms. Jamison attended several more therapy sessions, but took no additional psilocybin. She hasn’t touched a cigarette in the years since. An early version of that study (in which participants had two or three psilocybin sessions), published in 2014, reported an 80 percent success rate in 15 smokers, compared with 35 percent typically observed in patients taking the leading conventional antismoking drug Chantix.

Buoyed by such positive outcomes, the Hopkins study has expanded to include more participants, and, last year, the team received a $4 million grant from the National Institutes of Health.

It’s still uncertain how effective using psilocybin to treat addiction is in the long-term and whether some individuals are more likely to benefit than others. Some study participants have had . . .

Continue reading. (gift link, no paywall)

The Red Wedding for Rural Pharmacies

Matt Stoller writes in BIG:

Biden just tried to regulate CVS, United Health, and Cigna. Cigna struck back, and is now trying to wipe out independent pharmacies and harm patients. Plus, antitrust enforcers are getting real.

First some good news. Last week, I reported on how a bad judge dismissed an important antitrust suit against Amazon. Well the state Attorney General involved, Karl Racine, just said he will be filing a motion for reconsideration, which is basically an appeal. Yay!

Ok, onward. Today I’m writing about what happens when a monopolist gets mad. In this case, it’s health giant Cigna taking revenge on rural pharmacies and patients after the Biden administration tried to slightly reduce the firm’s profits from Medicare prescription drug benefits.

I’ll also show how antitrust enforcers have stopped being polite and are starting to get real. The FTC’s Lina Khan is going after TurboTax maker Intuit for false and deceptive practices, and the Antitrust Division’s Jonathan Kanter blocked a big but obscure merger of port crane producers.

And now…

series Game of Thrones was The Rains of Castamere, otherwise known as the ‘Red Wedding.’ The Red Wedding is perhaps the ugliest and most disproportionate sense of revenge ever aired on TV. In it, a regional warlord named Robb Stark attends a wedding of one of his vassals that is supposed to help patch up a minor dispute with a fellow warlord, Walder Frey. The wedding is at Frey’s castle, and Frey invites Stark, his family, and his soldiers to feast. For a time, everyone makes merry, but towards the end of the evening, Frey has his troops ambush Stark and his now-drunk band. Frey has everyone massacred, and even has one of his soldiers stab Stark’s pregnant wife in the belly to ensure he kills the unborn child.

The message from Frey to all future rivals was crystal clear. Don’t mess with me. Though fictional, Game of Thrones draws from medieval history, and such tales of vengeance are not unusual. English history, French history, and many empires of conquest pursued such a strategy of brutalizing subjects so viciously they wouldn’t consider fighting back in the future. These strategies are common because they work. For instance, Mongol empire had many cities surrender without a fight, due to fear that the Mongols would massacre everyone inside should they put up an inch of resistance.

The point of these stories isn’t just about geopolitics, but what happens when humans have too much power over other humans. Which brings me to the problem of monopolies, and what some of them do when they are even slightly challenged. A few months ago, the Biden administration put out a rule to regulate the pharmacy benefits management business, an opaque but massive part in the pharmaceutical drug supply chain. PBMs handle the drug benefit piece of insurance plans. They maintain a list of drugs for insurance companies, they negotiate drug prices, and they manage reimbursements to pharmacies.

The original idea behind PBMs is they would be able to get enough bargaining power by representing multiple insurance companies that they could negotiate to bring down drug prices. And accumulate bargaining power they did, merging until three PBMs control 80% of the insurance market. They are also vertically integrated with insurance companies and drug store chains. The top three PBMs are owned by CVS, United Health, and Cigna.

Unfortunately, because of an exemption from anti-kickback laws, PBMs don’t use their bargaining power to reduce consumer prices. Instead, they force pharmaceutical firms to compete over who will give the PBM the biggest kickback, which in the industry is known as a rebate. Take insulin. In 2013, Sanofi gave a 2-4% kickback to PBMs to prefer their product to customers. In 2018, that number went up to 56%. In other words, more than half of the price of insulin is going to a middleman who does nothing more than push around paper.

The many bad practices of PBMs are legendary. PBMs often force customers to buy more expensive drugs over their generic counterparts, likely because they get kickbacks when customers do so. This ends up making this obscure group of firms a lot money. The combined revenue of the top three firms, who comprise just a small part of the U.S. health system, is larger than the entire amount France spends on all medical care for its entire population.

It gets worse. PBMs all own mail-order pharmacies, and they are increasingly mandating that patients use those mail-order pharmacies instead of the local pharmacy around the corner. Moreover, PBMs now have so much power they are able to claw back money randomly from pharmacies months after a drug was dispensed, using something called a Direct and Indirect Remuneration fee. (DIR fees are only used for Medicare plans, but that is still 37% of the market.) For independent pharmacies, DIR fees are impossible to plan for, they are opaque, and they end up raising prices for consumers.

PBMs are particularly bad for independent pharmacies, who are a critical lifeline in many underserved parts of America. 77% of independent pharmacies serve communities with fewer than 50,000 people. In these places, the independent pharmacist often is the health care infrastructure. Seven in ten do free home delivery, a service which is virtually non-existent with chains. The amount that PBMs have been reimbursing these pharmacists has been going down for years, to the point that many are losing money depending on the medicine they are filling for customers. To put it differently, it’s the equivalent of Amazon raising fees on third party sellers, or Tyson cutting the amount they pay to cattle ranchers.

A few months ago, the Biden administration proposed eliminating most DIR fees, which would get rid of a good, but not critical, profit center for giant PBMs. It looked like a nice win for the anti-monopolists, patients, and independent pharmacies. Last week, however, a contact passed me a new contract from Express Scripts, the giant PBM owned by Cigna.

Cigna has about a quarter of the PBM market, which means that one out of every four people who goes to a pharmacy to get drugs is using Cigna insurance. There’s regional variation, so in some places Cigna won’t have much market share, while in states like Georgia, something like 50% of the Medicare drug plans are Cigna plans. As one pharmacist put it to me, “If you don’t sign these contracts, then a third of patients won’t come to me because they won’t be able to get their services through their insurance benefits.” In other words, pharmacists can’t turn away a third of the people who come into the store, so they tend accept whatever terms Cigna offers.

And as it turns out, Cigna’s offer to pharmacists just got a lot worse. PBM pricing is insanely weird and complex, so I’ll try to explain it to you. The short story is . . .

Continue reading.

Being a bad manager (and a bully) can be dangerous

Fascinating story, particularly to me, who lived in Santa Cruz for 8 years and then just around to the other side of Monterey Bay in Monterey for 25 more years. Scott Eden has an absorbing (and fairly long) account of a conflict between a Silicon Valley ambition and mindset and the realities of others’ lives. It begins:

HE NEIGHBORHOOD OF Pleasure Point stands on cliffs overlooking one of the more famous surf breaks in California, a menacing swell that locals call Sewers. Some four miles from the Santa Cruz boardwalk, the break takes its name from an old underwater pipe that once disgorged the town’s sewage into Monterey Bay. Today, the Sewers can draw a rugged crowd, and woe betide the newcomer who does not pay the proper deference to those locals, for the surfers of Santa Cruz have earned a reputation for being as hostile as they are skilled.

A stretch of opulent oceanfront villas also looks out over the surf at Pleasure Point. Ever since San Francisco first got rich–more than 170 years ago, from the California gold rush–the city’s elite has treated Santa Cruz as its favored beach resort. But in the past two decades, there has been a wealth invasion unlike any before. Just on the other side of the Santa Cruz Mountains, an easy commuter’s drive away, sprawls Silicon Valley. From there, the tech titans have come. When Reed Hastings and (rumor has it) Mark Zuckerburg bought glamorous pads in the Santa Cruz area, their hirelings at Netflix and Facebook began snapping up nearby properties in aspirational emulation. The pattern repeated with other tech barons, and other hirelings, until today the median price for a single-family home in Santa Cruz is $1.3 million.

The villa at 3034 Pleasure Point Drive has a multilevel deck that’s built out over the cliffs. The view from there is a panorama of changeable seas and histrionic sunsets, with the Monterey Peninsula hovering on the horizon like a blue-green mystery. On the night of September 30, 2019, the owner of the home slept alone in his master suite. There and throughout the house, the ocean’s waves were soporifically audible, rumbling against the rocks and sliding back again in their lunar rhythms.

Two months earlier, the villa’s owner, Tushar Atre, had turned 50, though he looked decades younger. He had a beaming, youthful smile and an infectious vitality that charmed almost everyone he met. A keen surfer, mountain biker, and wild-edibles forager, he was in top physical condition. He was also rich. He’d grown up in affluent Westchester County, New York, the son of Indian immigrants, had studied at NYU, and had come west in 1996 in pursuit of the dot-com dream.

This, by all appearances, he had unconditionally achieved. The founder of AtreNet, an early corporate web-design firm, Atre, who had never married or had children, was now at the charismatic center of a circle of prosperous friends, many of them Silicon Valley entrepreneurs and executives. The group had become practitioners of a kind of heady lifestyle discipline, a philosophy of hyperfocus, first popularized by the late Hungarian American psychologist Mihaly Csikszentmihalyi, called “the flow.” For Atre and his circle, this often meant intense sessions of early-morning surfing, when they would strive to work their minds and bodies into a kind of adrenal rapture. “There was this voracious appetite for work and danger,” says a family friend. After surfing, perhaps after meditation, the flow state would be achieved. Then they would retire to their desks and go to work, focused, relentless–hour after hour, without pause–applying their energies to their various business ideas.

For his part, Atre had recently shifted his primary focus from AtreNet and turned his ambition toward a fresh field, one he believed held immense potential. One he felt was ripe for disruption. One whose growth opportunities in recent years had lured myriad entrepreneurs to stake their claim–with more than 38,000 U.S. licenses issued, per cannabis data firm Whitney Economics. By the fall of 2019, he’d spent more than a million of his own dollars on the new business and had raised millions more from investors. Atre was building a cannabis startup.

At 2:48 on the morning of October 1, 2019, according to the time stamp on surveillance footage captured by a camera on a neighboring home, three men entered the house at Pleasure Point Drive. They appeared to be wearing gloves, baseball caps, and N95-style facemasks. One carried an assault rifle. There were no signs of forced entry; Atre had either let them inside or they knew the passcode. But there was a struggle. At one point, the entrepreneur escaped. The same footage shows a figure running down Pleasure Point Drive, a normally quiet lane ensconced in the force field of its own affluence, his wrists apparently cuffed behind his back. In the video, a man gives chase and brings the figure violently to the ground. An SUV then pulls up beside them, and two men quickly bundle their victim into the passenger seat. Then the vehicle speeds off, disappearing into the night.

THE CITY OF SANTA CRUZ lies not just on the Pacific, but also in the shadow of the Santa Cruz Mountains, a ­secluded hinterland of redwood forest and fern canyons, unpaved switchbacks, and remote homesteads. The mountains harbor a swath of rural isolation right at the edge of the Bay Area megalopolis, and it was here that California’s counter­culture found one of its first bucolic, dharma-bum milieus. Ken Kesey kept a writing cabin in the Santa Cruz Mountains in the ’60s, where he threw his wild hallucinogenic parties and incubated the Merry Pranksters. With Kesey’s crowd providing the initial demand, some of the earliest commercial (and, at the time, illegal) cannabis crops in the U.S. were planted nearby. Major, now globally famous strains of marijuana–Haze, Blue Dream–were, at least according to legend, first bred by experimental growers on the south-facing slopes of the Santa Cruz Mountains above 800 feet, where the marine-layer fogs halt their ascent and ideal growing conditions exist. An outlaw pot-ag culture took hold, hillbilly hippies with dreadlock beards burying safes in the woods containing hundreds of thousands of dollars in cash. It was here too, in the 1980s, that the cannabis legalization movement began. Some of the earliest efforts in the nation to create an exemption for the use of marijuana to ease the pain of the chronically and terminally ill were spearheaded by Santa Cruz grower Valerie Leveroni Corral. Her work helped lead to the 1996 passage of Proposition 215, which made California the first state in the country to legalize medical marijuana. This, in turn, led to Proposition 64 and the legalization of recreational cannabis in California, which went into effect on January 1, 2018, and seemed to mark the beginning of a new cannabis boom.

For Tushar Atre, Santa Cruz and its environs represented the . . .

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Blast from the past: President Nixon’s National Commission on Marihuana and Drug Abuse

A Facebook discussion on various problems in government services — for example, in BC we currently have a shortage of medical professions (doctors, nurses, nurse practitioners, et al.), but one can see various problems in various government services — started with the question of how to fix the problem.

I offered this thought:

Solutions are found when the problem is fully understood, and that requires some committed research by knowledgeable people — a team, or a (good) commission that will do some serious investigation. And I believe that there are two problems: one is the problem of nurses, nurse practitioners, physicians in various specialities, therapists, and so on leaving the health profession prematurely. So one question is to look at the reasons for the losses. For example, I recently learned that ER physicians get no sick leave. That might in some cases be the straw the broke the camel”s back, but we need a full inventory of reasons to understand and prioritize the fixes needed. (The fix in this case is simple: ER physicians should get 2 weeks paid sick leave per year, at a minimum, especially since they are routinely exposed to infectious diseases.)

So loss is one problem. Supply is another. How can the province increase the supply? (And that amounts to finding out why people are not choosing the profession.)

I would say there are two ways: one is to make the working conditions more attractive; the other is to lower barriers to entry, which could be done by subsidizing educational and training costs (in return for a commitment to practice in BC for a decade, or some such).

I think both avenues of investigation would prove fruitful, and the more transparent the investigation is — that is, the more the public is informed of the work in progress — the better. People really need to know a) that something is being done to address the problem and b) what that something is. Right now it seems almost as though work on the problem (if any) is done in secret for fear the public will learn what is being found.

One commenter derided my suggestion:

   the govt? In charge of investigating?  
Bless your 

I responded:

Governments (legislatures and executive branches) will often appoint an independent commission of persons outside the government who have relevant expertise to do the investigation and make a report and recommendations. This is not at all uncommon, and it’s done specifically to avoid (as you say) the government investigating itself. Of course, the government doesn’t always agree with findings nor follow the recommendations of the expert commission.

For example, President Nixon’s National Commission on Marihuana and Drug Abuse recommended that “marihuana” be legalized and regulated. Nixon, based on his own (lack of) expertise decided to reject that in favor of a War on Drugs, which cost billions of dollars and hundreds of thousands of lives and failed utterly. You can read the report that Nixon ignored.

And the report is pretty interesting. Here it is.

Tse Chi Lop, The Company Man

Stephen Marche writes in Toronto Life:

Tse Chi Lop doesn’t look like the biggest drug lord in history. He looks like a bedraggled, exhausted, late-middle-aged trader in commodities, which is exactly what he is. Tse’s commodities just happen to be high-margin, addictive, illegal drugs—heroin, ketamine and methamphetamine. Tse runs a drug syndicate known to law enforcement as “Sam Gor,” Cantonese for “Third Brother,” and to its members simply as the Company. The United Nations Office on Drugs and Crime estimates that Sam Gor’s annual revenue could be as high as $21 billion, the same as Citibank’s.

Practically every newspaper in the West has described Tse Chi Lop as Asia’s El Chapo. The comparison could hardly be less accurate. Joaquín “El Chapo” Guzmán, the leader of Mexico’s Sinaloa Cartel, has claimed personal responsibility for up to 3,000 murders in a drug war that took some 300,000 lives. That is not Tse’s way. He achieved the size of Sam Gor not by murder and torture, but by industrializing his business, reducing the cost per unit, providing an excellent product at a fair price, and establishing well-maintained networks of key partnerships. There’s also the question of scale. El Chapo’s cartel was worth, at its peak, $3 billion—a fraction of Sam Gor’s value.

Toronto taught Tse his business. The seeds for what would become the world’s largest drug empire were planted during his days surviving what police still remember as the “wild wild west” of the heroin glut in the late ’80s and early ’90s. Insofar as a man as cosmopolitan and as mobile as Tse Chi Lop has a home, Toronto is his.

Tse’s career reflects the changing nature of crime, and of the methods of synthetic drug manufacture that are rendering traditional police practices null, but it also reflects the changing nature of business in general. Traditional organized crime was a 20th-century affair. Sam Gor is pure 21st-century innovation. Its success comes down to technological innovation, relentless focus on customer experience, and mastery of globalized logistics. Tse Chi Lop is much more effective—and dangerous—than El Chapo. He is the Jeff Bezos of the drug trade.

From early in his career, Tse Chi Lop was an innovator. He was born in 1963 and grew up in Guangzhou in Guangdong province, the mainland neighbour to Hong Kong. When he was 25, he moved to Canada, part of the wave of emigration before Hong Kong’s transfer of sovereignty. Tse brought his fiancée with him, and his parents soon followed. He and his wife had children in Toronto, first a daughter, then a son. He also got decent jobs, working for Fujifilm and Kodak.

Back then, Toronto was a cauldron of competing Asian criminal organizations, including a group of Vietnamese gangsters supported by Born to Kill from New York City, and the Boston-backed Fukienese, all fighting for territory. Maclean’s called the shocking violence of the time “Terror in the Streets.” In 1990, Peter Yuen, now a deputy chief of the Toronto Police Service, was a detective constable working undercover during the height of the violence. “You had gun battles, 15 rounds at the corner of Dundas and Spadina on a Saturday afternoon,” Yuen says. One night, he snuck into an illegal gaming house. Four gang members burst in, taking customers’ jewellery and wallets along with the house’s money. They found Yuen’s police badge on him, so they beat him until his shirt was soaked in blood. One thief put a .45-calibre automatic in his mouth, another put a .357 magnum to his head. He heard the click of a hammer, and the guys fled. A forensic test revealed the gun had misfired. It is pure fluke that Yuen is alive today. “It was like watching a triad movie,” he says. “And the cops were just like dogs, too. We wanted to tell them, ‘We own these streets.’ ”

At that time, Tse belonged to the Big Circle Boys, if belonging is the right word. He was a mid-level player, but with outsized ambitions, on the way up. The BCB were a collective of international apex criminals who’d emerged out of Guangzhou in the 1960s. Triads or the mafia or biker gangs or Japanese yakuza share certain traits. They have formal hierarchies with membership; they wear uniforms; they undergo initiation rituals; they control territories and they control the use of their names. Some Chinese triads have been known to require 36 separate oaths. Mafia families do not allow non-members to use their name without permission; if you call yourself a member of the Gambino crime family, you’d better be one. None of this applies to the BCB. They’re basically just colleagues—there’s no strict hierarchy, no codified set of rules. They’re criminals and they’re organized, but they’re not organized crime.

David Au, a former sergeant in the RCMP specializing in Asian organized crime, explains that traditional gangs, like the Hells Angels, are like marbles in a glass jar, with every marble in its own position. “That jar is in the middle of the table, and around the table are the police investigators, and they can study the jar of marbles. And by studying this jar of marbles, you see where every marble sits.” In Au’s metaphor, the BCB is the jar turned over, with all the marbles bouncing around, constantly in motion. Anyone on the street can call themselves a Big Circle Boy. As a police officer, how do you know you’ve got who you think you’ve got? When you’ve broken up a cell, what have you broken up? How do you infiltrate an organization that breaks up and reforms for every project?

These radical criminal businessmen began as Communist partisans and Red Guards during the Cultural Revolution, and were sent to Guangdong province in southeast China for re-education in the 1960s and ’70s. Some later fled to Hong Kong, either across the mountains or by swimming 12 kilometres across Deep Bay, with many drowning en route.

Unlike local Hong Kong gangs, the BCB had paramilitary training, and . . .

Continue reading.

This helps account for the epidemic of homelessness and mental illness: A new kind of cheap meth

I think this article may be outside the paywall. It’s by Sam Quinones in the Atlantic, titled “‘i Don’t Know That I Would Even Call It Meth Anymore,’” and it’s definitely worth reading. The article is adapted from Sam Quinones’s new book, The Least of Us: True Tales of America and Hope in the Time of Fentanyl and Meth. Two snippets from the article:

. . . One night in 2009, in Temecula, California, partway between San Diego and L.A., a longtime user of crystal meth named Eric Barrera felt the dope change.

Barrera is a stocky ex-Marine who’d grown up in the L.A. area. The meth he had been using for several years by then made him talkative and euphoric, made his scalp tingle. But that night, he was gripped with paranoia. His girlfriend, he was sure, had a man in her apartment. No one was in the apartment, she insisted. Barrera took a kitchen knife and began stabbing a sofa, certain the man was hiding there. Then he stabbed a mattress to tatters, and finally he began stabbing the walls, looking for this man he imagined was hiding inside. “That had never happened before,” he told me when I met him years later. Barrera was hardly alone in noting a change. Gang-member friends from his old neighborhood took to calling the meth that had begun to circulate in the area around that time “weirdo dope.”

Read: A former meth addict talks about his experience with drug court

Barrera had graduated from high school in 1998 and joined the Marine Corps. He was sent to Camp Lejeune, in North Carolina, where he was among the few nonwhite Marines in the platoon. The racism, he felt, was threatening and brazen. He asked for a transfer to Camp Pendleton, in San Diego County, and was denied. Over the next year and a half, he said, it got worse. Two years into his service, he was honorably discharged.

After the September 11, 2001, terrorist attacks, Barrera was filled with remorse that he hadn’t stuck it out in the Corps. He was home now, without the heroic story he’d imagined for himself when he joined the Marines. The way he tells it, he drank and used meth to relieve his depression.

He’d sometimes stay up on meth for four or five days, and he had to make excuses for missing work. But until that point, he’d held his life together. He worked as a loan processor, then for an insurance company. He had an apartment, a souped-up Acura Integra, a lot of friends.

But as the meth changed around 2009, so did Barrera’s life. His cravings for meth continued, but paranoia and delusions began to fill his days. “Those feelings of being chatty and wanting to talk go away,” he told me. “All of a sudden you’re stuck and you’re in your head and you’re there for hours.” He said strange things to people. He couldn’t hold a job. No one tolerated him for long. His girlfriend, then his mother, then his father kicked him out, followed by a string of friends who had welcomed him because he always had drugs. When he described his hallucinations, “my friends were like, ‘I don’t care how much dope you got, you can’t stay here.’ ”

By 2012, massive quantities of meth were flowing into Southern California. That same year, 96 percent of the meth samples tested by DEA chemists were made using the P2P method. And, for the first time in more than a decade of meth use, Barrera was homeless. He slept in his car and, for a while, in abandoned houses in Bakersfield. He was hearing voices. A Veterans Affairs psychologist diagnosed him with depression and symptoms of schizophrenia.

Even many years later, when I spoke with him, Barrera didn’t know how the drug he was using had changed and spread, or why. But as a resident of Southern California, he was among the first to be affected by it. Over the next half-dozen years or so, the flood of P2P meth would spread east, immersing much of the rest of the country, too.

And, later in the article,

.. . The Louisville, Kentucky, area is one example. For years, Louisville had a paltry meth market. A pound of it sold for $14,000. Then Wiley Greenhill went to prison. Greenhill was a minor drug dealer in Detroit who had come to Louisville in 1999, attracted by Kentucky’s vibrant street market for pain pills, which were fetching five times what they sold for in Detroit.

He eventually landed at the Roederer Correctional Complex, north of Louisville, where he struck up a friendship with an inmate from California. The inmate’s father, a businessman from Southern California named Jose Prieto, had gotten into debt with the wrong people from Sinaloa. The Sinaloans told Prieto that to settle his debt, he had to sell their meth. Greenhill was given the opportunity to buy it.

By 2016 Greenhill was out of prison, and the meth began to flow. At first Prieto sent small quantities through the mail. Soon the loads reached 50 to 100 pounds a month, driven east by women Greenhill hired.

Prieto proved eager to get his product out. He fronted Greenhill hundreds of thousands of dollars’ worth of meth on the promise that he would be repaid. Tim Fritz, a DEA agent who investigated the Prieto-Greenhill ring, told me, “Jose Prieto would say, ‘Whatever you need, we got it. Whatever you buy, I’ll double it. You want 10 pounds, I’ll give you 20—pay me later.’ ”

As months passed, the Louisville meth market expanded beyond anything the region had seen before. The trade spread to southern Indiana and nearby counties in Kentucky as the number of customers grew. Other local traffickers began to import meth as well. The price of a pound of meth fell to about $1,200, less than a tenth of what it had been just a few years earlier.

At the MORE Center, a Louisville clinic set up to treat pain-pill and heroin addicts, patients started coming in on meth. Before the Prieto-Greenhill connection, only two of counselor Jennifer Grzesik’s patients were using meth. Within three years, almost 90 percent of new patients coming to the clinic had meth in their drug screen. “I don’t remember having any homeless people in my caseload before 2016,” she told me. But 20 percent of her clients now are homeless.

Greenhill and Prieto were arrested in 2018 and 2019, respectively, and are now serving lengthy federal-prison terms. They left behind a transformed market. Primed by the new supply, meth demand has exploded, in turn drawing more dealers who have found their own supply connections. The price of a pound of meth remains low. To compete, some Louisville meth dealers now offer free delivery; others offer syringes already loaded with liquid meth so users can immediately shoot up. Similar partnerships, arrangements, and retail innovations have transformed regional drug markets across the U.S. . . .

And also:

Over the past year and a half, I’ve talked with meth addicts, counselors, and cops around the country. The people I spoke with told me stories nearly identical to Eric Barrera’s: P2P-meth use was quickly causing steep deterioration in mental health. The symptoms were always similar: violent paranoia, hallucinations, conspiracy theories, isolation, massive memory loss, jumbled speech. Methamphetamine is a neurotoxin—it damages the brain no matter how it is derived. But P2P meth seems to create a higher order of cerebral catastrophe. “I don’t know that I would even call it meth anymore,” Ken Vick, the director of a drug-treatment center in Kansas City, Missouri, told me. Schizophrenia and bipolar disorder are afflictions that begin in the young. Now people in their 30s and 40s with no prior history of mental illness seemed to be going mad.

How do you spell “conflict of interest”? McKinsey knows. McKinsey Never Told the FDA It Was Working for Opioid Makers While Also Working for the Agency

Ian MacDougall reports in ProPublica:

Since 2008, McKinsey & Company has regularly advised the Food and Drug Administration’s drug-regulation division, according to agency records. The consulting giant has had its hand in a range of important FDA projects, from revamping drug-approval processes to implementing new tools for monitoring the pharmaceutical industry.

During that same decade-plus span, as emerged in 2019, McKinsey counted among its clients many of the country’s biggest drug companies — not least those responsible for making, distributing and selling the opioids that have ravaged communities across the United States, such as Purdue Pharma and Johnson & Johnson. At times, McKinsey consultants helped those drugmaker clients fend off costly FDA oversight — even as McKinsey colleagues assigned to the FDA were working to bolster the agency’s regulation of the pharmaceutical market. In one instance, for example, McKinsey consultants helped Purdue and other opioid producers push the FDA to water down a proposed opioid-safety program. The opioid producer ultimately succeeded in weakening the program, even as overdose deaths mounted nationwide.

Yet McKinsey, which is famously secretive about its clientele, never disclosed its pharmaceutical company clients to the FDA, according to the agency. This year ProPublica submitted a Freedom of Information Act request to the FDA seeking records showing that McKinsey had disclosed possible conflicts of interest to the agency’s drug-regulation division as part of contracts spanning more than a decade and worth tens of millions of dollars. The agency responded recently that “after a diligent search of our files, we were unable to locate any records responsive to your request.”

Federal procurement rules require U.S. government agencies to determine whether a contractor has any conflicts of interest. If serious enough, a conflict can disqualify the contractor from working on a given project. McKinsey’s contracts with the FDA, which ProPublica obtained after filing a FOIA lawsuit, contained a standard provision obligating the firm to disclose to agency officials any possible organizational conflicts. One passage reads: “the Contractor agrees it shall make an immediate and full disclosure, in writing, to the Contracting Officer of any potential or actual organizational conflict of interest or the existence of any facts that may cause a reasonably prudent person to question the contractor’s impartiality because of the appearance or existence of bias.”

Agency officials rely on disclosure to ensure that they have the information they need to consider whether a contractor’s other business relationships risk slanting its judgment. “Contractors have the obligation to disclose potential conflicts, and then the government has an obligation to figure out how to deal with it,” said Jessica Tillipman, an assistant dean and government procurement law expert at George Washington University Law School.

Asked for comment, McKinsey did not assert that it disclosed potential conflicts to the FDA. But a spokesperson for the firm, Neil Grace, nonetheless maintained that . . .

Continue reading.

What role did the CIA play in the drug trade in the 1980s?

As I mentioned in an earlier post, the Venn-diagram intersection of the circle of what the CIA does and the circle of what criminal organizations do is much larger than is comfortable (or seemly). Watch this video for an example

This is what billionaire “justice” looks like

Patrick Radden Keefe, author of Empire of Pain: The Secret History of the Sackler Dynasty, writes in the NY Times:

In 2016, a small-time drug dealer in Leesburg, Va., named Darnell Washington sold a customer a batch of what he thought was heroin. It turned out to be fentanyl. The customer shared it with a friend, and the friend died from an overdose.

To combat the opioid crisis, prosecutors have begun treating overdose deaths not as accidents but as crimes, using tough statutes to charge the dealers who sold the drugs. Washington had never met the person who overdosed. But, facing a mandatory minimum prison sentence of 20 years for “distribution resulting in death,” he pleaded guilty to the lesser charge of distribution and is now serving a 15-year sentence in federal prison.

I thought about this the other day when it became clear that members of the billionaire Sackler family will most likely soon receive a sweeping grant of immunity from all litigation relating to their role in helping to precipitate the opioid crisis. Through their control of Purdue Pharma, the families of Raymond and Mortimer Sackler made a vast fortune selling OxyContin, a powerful prescription opioid painkiller that, like fentanyl, is a chemical cousin of heroin.

Though they are widely reviled for profiting from a public health crisis that has resulted in the death of half a million Americans, they have used their money and influence to play our system like a harp. It is hardly news that our society treats people like Darnell Washington with sledgehammer vengeance, and people like the Sacklers with velvet gloves.

But it’s worth asking: How did they pull this off?

For a long time, the families of Raymond and Mortimer Sackler simply evaded scrutiny, pruning their public image so that people knew about the philanthropic contributions like the Sackler Library at Oxford, but not about the source of their wealth. After the press started writing stories, in 2001, about how OxyContin had given rise to a wave of addiction, high-price spin doctors labored to keep the Sackler name out of the controversy.

As the death toll associated with OxyContin grew, Purdue continued to argue in its marketing campaign that the drug was rarely addictive. When journalists raised tough questions, the company sent its lawyers to intervene with their editors.

This “can I see your manager” approach works even with law enforcement. In 2006, federal prosecutors in Virginia were preparing to charge Purdue with felonies. They focused on three senior lieutenants who worked for the company, expecting them to flip on the Sacklers — the ultimate target, according to the lead prosecutor — when faced with potential prison time. But Purdue had enlisted two former U.S. attorneys, Rudy Giuliani and Mary Jo White. Ms. White telephoned Paul McNulty, who was then the deputy attorney general: “It’s Mary Jo White,” Mr. McNulty recalled recently. “It’s somebody who thought of herself as having access.”

The Justice Department informed the federal prosecutors in Virginia that they could not charge the executives with felonies, robbing them of their most significant point of leverage: the threat of jail. The executives did not cooperate with efforts to implicate the Sacklers; instead, they pleaded guilty to misdemeanors while maintaining that they had done nothing wrong. The company pleaded guilty to felony “misbranding” and paid a $600 million fine.

You would not be alone in detecting a whiff of La Cosa Nostra. In an expert report filed in a recent lawsuit, John C. Coffee Jr., who directs the Center on Corporate Governance at Columbia Law School, concluded that “there is little to distinguish the control the Sacklers exercised over Purdue from the control that the Godfather held over his Mafia family.” After the executives took the fall, the Sacklers voted to pay one of them $3 million. Another got $5 million. Impunity will cost you. According to court documents, a single law firm billed Purdue more than $50 million for the case.

Yet the Sacklers were unchastened. Last year, Purdue pleaded guilty to a new set of felony charges related to the marketing of OxyContin. Once again, none of the Sacklers were charged criminally; instead, they agreed to pay a relatively meager $225 million to settle a civil investigation, without any admission of wrongdoing. Astonishingly, prosecutors appear to have settled with the Sacklers without ever bothering to interview them. Asked in a deposition whether any of the Sacklers had “direct contact with the D.O.J. in connection with the investigation,” David Sackler, who served on Purdue’s board from 2012 to August 2018, replied, “I do not believe that any of them have.”

This time, no individual executives were charged even with misdemeanors. Instead, the Justice Department informed the prosecutors on the case that they wanted to deal with Purdue quickly. In October, administration officials announced that Purdue had reached an $8 billion settlement with the government. This sounded impressive — except that the company didn’t have $8 billion, because by then it had filed for bankruptcy.

How could a corporation with a product that has generated an estimated $35 billion in revenue end up filing for bankruptcy? One answer is that by the time Purdue filed for Chapter 11, in 2019, it was being sued by practically every state in the country and thousands of other claimants. But there is another, more relevant explanation.

By 2007, the Sacklers seems to have realized, as David Sackler noted, that eventually one lawsuit might “get through to the family.” They started pulling money out of Purdue and securing it in their own accounts, many of them overseas. According to an audit report, between 2008 and 2017 they took out over $10 billion. (Family members have said the transfers were proper.) Then, in 2019, with Purdue engulfed by lawsuits, the company sought protection in bankruptcy court.

It is difficult to overstate the fiendish brilliance of this move. Now, the company would be shielded from all those lawsuits while restructuring its debts. Of course, at this point some of the lawsuits had indeed broken through: More than two dozen states had filed suit against individual Sackler board members. But the Sacklers and Purdue now requested that the bankruptcy judge freeze any lawsuits against family members — even though the family had not declared bankruptcy.

American corporations can pick the jurisdiction where they file for bankruptcy and, thus, often the judge who determines their fate. Even though Purdue has never had any real business presence in White Plains, N.Y., that is where it filed its bankruptcy case. Purdue has maintained that this choice was driven by proximity to the company’s headquarters in Stamford, Conn. But it may also have been relevant that only one federal bankruptcy judge presides in White Plains — Robert Drain. In the past, Judge Drain had indicated a willingness to shield from litigation certain parties who had not even filed for bankruptcy in his court. He promptly granted the request, temporarily protecting the Sacklers from those suits.

Judge Drain is known for prizing deal making and efficiency and has tried to seal off the proceedings from the messy imperatives of justice and accountability. As an army of lawyers haggled over the carcass of Purdue, the Sacklers advocated a “global resolution,” a single, sweeping deal that would address all of the claims against the company and the family. Their offer: $4.5 billion, with no admission of wrongdoing by the family and permanent immunity from any future civil liability related to the opioid crisis.

That may seem like a lot of money, but billionaire math can be deceptive. The Sacklers proposed to pay the $4.5 billion out over nine years. Their current fortune is estimated to be at least $11 billion. Conservatively, with interest and investments, this means they can expect a 5 percent annualized rate of return on that fortune. If that’s the case, they’ll be able to pay the fine without even touching their principal. When they’re done paying in 2030, they will probably be richer than they are today.

For months, a coalition of “nonconsenting” states held out for a better deal. But Judge Drain indicated that he was inclined to permanently enjoin the states from pursuing their cases against the Sacklers. This would be essential, the judge observed, to achieve “true peace.”

On July 7, with their leverage diminishing, 15 of the nonconsenting states indicated that they would sign off on the Sacklers’ proposed deal. At a news conference, New York’s attorney general, Letitia James, said, “The battle is not over.” But clearly, it is. The company will be wound down. The Sacklers will be barred from the opioid business. They will admit no wrongdoing. They — along with their scores of lawyers, consultants and public relations advisers — will be granted permanent immunity. (In principle, they could still be criminally prosecuted, but this seems unlikely; through their representatives, members of the family have maintained that they acted “ethically and legally.”)

There is one small consolation. . .

Continue reading. There’s more, and no paywall on this article.

Keeping People Out of Jail [for minor crimes] Keeps People Out of Jail [by curtailing major crimes]

David Byrne (of Talking Heads fame, and also founder of the site) writes in Reasons to Be Cheerful:

Both sides of the political fence in the U.S. agree that mass incarceration isn’t working. It is expensive, discriminatory and has serious societal consequences. Crime has, in general, been trending down for decades (even in 2020, despite public perception) while prisons just keep filling up.

Credit: NYU Brennan Center

 The partisans may disagree on the best way to lower the prison population, but the good news is they agree it has to happen. The present system is unsustainable.

One way of reducing mass incarceration is to simply start ignoring certain laws. Some 80 percent of cases filed nationally are for misdemeanors. These are the types of crimes that are often victimless, but that can mess up the life of the person prosecuted for them. A few places have addressed this in the most straightforward way possible: by not automatically prosecuting these crimes. What has happened as a result? Studies have shown that these places reduced their prison populations without putting the public at risk. Crime did not go up. In fact, in many cases, it went down. And, surprisingly, often not just for misdemeanors. 

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A seemingly radical idea

The consequences not just for the individual but for society and the economy begin well before someone is actually incarcerated. Simply being prosecuted, having a record, becomes a disadvantage for life. It can make it harder to get a job, to vote, to get a loan for an education or a mortgage for a home. Minor nonviolent infractions can leave one disadvantaged forever. They can effectively ruin a life. 

Rachael Rollins, the district attorney of Suffolk County, which includes Boston, was well aware of this when she did something that seemed radical upon being elected in 2018. The county stopped automatically prosecuting people for small crimes: minor drug possession, shoplifting, disorderly conduct and other nonviolent offenses. A study released a year later showed that this change prevented a large number of folks who were charged with these offenses from being funneled into the criminal justice system. But it also had a broader effect: violent offenses in Suffolk County went down by 64 percent, and even traffic offenses decreased by 63 percent. 

Why would declining to prosecute people for low-level crimes also reduce other types of crimes? The study, by the National Bureau of Economic Research, found that the key is keeping folks out of the criminal justice system. Doing so reduced the odds by 58 percent that these folks would engage with that system in the future. So, to be clear, this doesn’t suddenly empty out the prisons — it’s not retroactive — but it dramatically slows the flow of folks being incarcerated, which, in turn, reduces the chances that those people will commit future crimes. As the presently incarcerated end their sentences and leave, there won’t be the same flow of new prisoners coming in to replace them. It seems to me this is incredibly good news — both sides of the political divide should be happy.

I decided to call up the three authors of this study to see what they felt were the implications of their research on this policy. It turns out they were as pleasantly surprised by the results as I was. 

The authors of the study are Amanda Agan (Rutgers University), Anna Harvey (New York University) and Jennifer Doleac (Texas A&M University).

DB: Can you summarize your results for our readers?

AA: Our study found that, at least for certain defendants [mostly first time offenders], non-prosecution — not moving forward with charging an individual defendant — actually reduces the probability that that individual ends up back in the criminal justice system, and so reduces recidivism and reduces future criminal justice contact. 

We wanted to study this because there’s a potential tension: if we’re going to choose to not prosecute somebody, is this going to embolden them to go on to commit more crimes? Or is it going to kind of put them on a better path and allow them that second chance to potentially reduce their criminal justice involvement?  And we’ve found it’s the latter, that this is reducing recidivism in the future.

DB: What presently happens when these minor offenses are prosecuted?

AH: This is really important for your readers to understand: in most jurisdictions, when you’re arrested for a crime, that goes on to what is potentially a lifetime permanent criminal record maintained by the state criminal record agency, that potentially, depending on the state statutes, can show up to employers when they conduct a background check, and it can show up to law enforcement, police officers and prosecutors in the future. 

There’s really good evidence to suggest that [being prosecuted] changes people, the way you’re treated down the road, potentially, for a lifetime. What we’re studying are nonviolent misdemeanor arrests, which are, in most of the cases we study, later dismissed. What we’re finding is that defendants whose cases in which the prosecutors don’t prosecute them, they don’t receive a criminal record. And that seems to have a really beneficial effect.

DB: How did you, as the authors of the study, know for sure that it was leniency in prosecuting that had this effect? 

AA: What we were doing was a little different. We were taking advantage of the fact that in Suffolk County, the person who decides whether to charge you with a crime or not is basically randomly assigned to your case. You have no control over whether me, Jen or Anna is going to be the one that’s going to end up making a decision about whether to charge you or not. 

[For example], it turns out Jen is really lay-down-the-law. She’s really going to want to prosecute people. And Anna, Anna is super lenient, she really likes to give second chances, just kind of by nature. 

And so we’re using that luck of the draw, that some offenders happen to get Anna and others happen to get Jen. We try to understand what happens when you get Anna and you don’t get that criminal record. What is the effect on your future recidivism versus if you got that harsher prosecutor? 

DB: What kinds of offenses are we talking about?

AA: They’re all nonviolent misdemeanors like disturbing the peace, trespassing, some low-level kinds of theft or shoplifting, minor drug possession. There are also some more serious kinds of traffic or moving violations that move into the realm of criminality, rather than just citations or traffic tickets, that are going to kind of make up a majority of these nonviolent crimes that we’re talking about. 

AH: Misdemeanors are often things like driving with an expired registration, or driving with an expired license, driving with expired insurance — basically, driving without the right paperwork. Who doesn’t forget to renew stuff? 

AA:In a sense [this is] criminalizing poverty.  [Low-income folks] don’t have the time or resources to go and handle some of these problems.

As these researchers point out, once you’ve engaged with the criminal justice system it can be a slippery slope, so keeping folks out of it in the first place can have a huge knock-on effect. It prevents future crime.

AH: One of the things that we’re finding is that even though the cases that we’re studying are only these nonviolent misdemeanor offenses, when you prosecute a first-time nonviolent misdemeanor, offender, person, individual, they’re more likely to come back — not just on another non-violent misdemeanor offense, they’re more likely to come back on a violent offense and a felony offense. 

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Charm City lives up to its name

In March 2020 in Baltimore, State’s Attorney Marilyn Mosby tried a similar experiment initially prompted by the increased risk of Covid spreading in prisons. Her office would no longer prosecute a host of minor nonviolent charges: limited drug possession, prostitution, minor traffic infractions, misdemeanors and trespassing. This doesn’t mean all these things became legal, but it does mean that if you get arrested for them, you probably won’t be locked up. 

What happened? Well, no surprise, crime rates dropped suddenly. Which doesn’t mean folks stopped doing these things — only that they weren’t being prosecuted for them. But what’s interesting is that it wasn’t just those nonviolent crime rates that dropped. Violent crime dropped 20 percent too, and property crime dropped 36 percent. 39 percent fewer people overall got caught up in the criminal justice system, which is what you’d expect if some charges are not prosecuted. But, as in Suffolk County, it seems the reduction extended well beyond those nonviolent crimes. This also helps reduce discrimination, as it is mostly people of color who get caught up in the system. 

This past March, after the experiment proved to be successful, it was made permanent. When police realized these offenses were not being prosecuted they stopped arresting folks for them — for instance, there were 80 percent fewer arrests for drug possession. That allowed prosecutors to focus on violent crimes instead of these misdemeanors, which, according to some research, results in an increase in public safety. 

The cops were skeptical at first. The police commissioner expected crime to rise, but it continued to go down — even when it rose in many other big cities during the pandemic. Johns Hopkins University in Baltimore did a follow up study and found that of 1,431 folks who had charges dropped in this experiment only five ended up being arrested again, which is considered pretty incredible. 

Baltimore is now also following the example of the CAHOOTS program in Eugene, Oregon, previously written about here, by directing some calls about nonviolent incidents to the Baltimore Crisis Response, Inc., a behavioral health organization, rather than to the police. People in crisis get help from trained social workers instead of dealing with the police and risking the possibility of getting locked up. The police commissioner there has since come out in support of police not being expected to be social workers. 

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It’s catching on

From NBC News: . . .

Continue reading. There’s more.

Why Joe Biden Punched Big Pharma in the Nose Over Covid Vaccines

Matt Stoller has a very interesting column today:

Today I’m writing about Joe Biden’s attack on vaccine monopolists. What happened is a bit technical and involves a bunch of weird international agreements on patents and IP, but the short story is that what Biden just did could be as significant as Reagan firing the air traffic controllers in 1981, or Teddy Roosevelt taking on JP Morgan in 1904 over a giant railroad combination. It’s a signal that the American order is changing.

Plus, beef prices are at record highs, so why are cattle producers going bankrupt? And why did we face meat shortages during the pandemic? I talked to South Dakota ranching advocate Bill Bullard about why our national food systems are collapsing.

Biden: We Must Vaccinate Everyone in the World

Three days ago, United States Trade Representative Katherine Tai announced that the United States supports a global waiver on intellectual property protections for Covid vaccines. There are two excellent vaccines. The first is produced by a partnership between industry giant Pfizer and the German company BioNTech, the second by multi-billion dollar start-up success story Moderna in a partnership with the National Institute of Health. Biden took the first step in a legal process to force these firms, among others, to share their technology.

The announcement sent shock waves throughout the world. French President Emanuel Macron jumped on board, director of the World Health Organization Tedros Adhanom Ghebreyesus called it a “monumental moment in the fight against Covid,” the FT’s Edward Luce said Biden had made “a brilliant move,” and political leaders globally began putting pressure on their own governments to follow suit. “Thank you, President Biden and USTR Katherine Tai,” said Lori Wallach of Global Trade Watch, a key leader in the campaign.

The pharmaceutical industry reacted with shock and anger. “In the midst of a deadly pandemic, the Biden Administration has taken an unprecedented step that will undermine our global response to the pandemic and compromise safety,” read a statement from the trade association group PhRMA. The US Biotechnology Innovation Organization pronounced “extreme disappointment” and the European Federation of Pharmaceutical Industries and Associations warned this move will lead to counterfeit vaccines.

What just happened? And what does it actually mean?

There are multiple layers to this story. I’m going to offer an explanation of how this waiver affects the global attempt to address the pandemic, the politics behind the decision, and what it means going forward. The short story is that this is an unexpected and major defeat for the pharmaceutical industry, all the more bizarre that it comes from Joe Biden, who in his career generally deferred to big business. As one Washington lobbyist told the Financial Times, “Nobody really thought Biden was going to take on the pharmaceutical lobby, [they thought] that he would be too scared. But before the financial crisis, everybody thought the financial services industry was untouchable, then that changed. This week showed that pharma companies are the new banks.”

To understand what happened, we have to start with the development of the vaccines themselves.

The Vaccine Success Story

The development of Covid vaccines is the single most successful U.S. government program since the elimination of polio. Vaccines have traditionally taken more than a decade to develop. Yet, in this case, less than a year after the virus was first genetically sequenced by Chinese scientists and posted to the web, trucks began rolling out of factories with safe and effective vaccines ready for deployment. Today, more than a billion doses have been injected into arms, and wealthier countries are seeing the pandemic recede.

In part, the global spread of pharmaceutical technology is one reason for this success. China, Russia, Europe, and the U.S. all have put out vaccines that work. Yet the best new vaccines come from the U.S. or Europe, and use a new technology called mRNA. The old way of making vaccines consisted of growing a weakened or deactivated germ, which would create an immune response by getting your body to respond to something that looked like a deadly virus. But making these kinds of viruses was cumbersome because they have to be grown, and they don’t always work well. Flu vaccines are grown in chicken eggs, for instance, and that takes a long time.

The mRNA vaccine by contrast is not a weakened germ, it is a set of instructions to your body to produce a custom-designed protein shaped like a part of the Covid virus, which your immune system then responds to. In doing so, you acquire immunity. The mRNA vaccine is programmable, meaning that it’s easy to update the vaccine to address new diseases or new variants, and because it is chemical, production scales quickly. Think of the difference between the old way of doing vaccines and mRNA as similar to printing books by woodblocks, each of which has to be carved by hand, versus using moveable type printing presses.

The mRNA technology comes from Katalin Kariko, a Hungarian immigrant who perfected the technology with fellow scientist Drew Weissman at the University of Pennsylvania. The two licensed mRNA to two small firms, BioNTech in Germany and Moderna in the United States. BioNTech spent years perfecting the technology and eventually got German government support. Meanwhile, Moderna received U.S. government funding in the 2010s from the Defense Advanced Research Projects Agency (DARPA), the same unit that helped create packet-switching technology in the 1970s.

When the pandemic hit, three things happened. First, Pfizer and BioNTech quickly agreed to work together to scale and develop their mRNA vaccine. Second, government scientists at the National Institute of Health designed a spike protein molecule and sent it to Moderna, which used it as the basis for its mRNA vaccine. Third, the U.S. government, through what was called Operation Warp Speed, created a market for vaccines, signing guaranteed-purchase agreements with a number of firms, including Pfizer/BioNTech and Moderna, to secure hundreds of millions of vaccine doses for the U.S. population.

This process worked remarkably well. The first country to have more than 50% of its population vaccinated, Israel, basically has no Covid anymore, and Covid is dropping rapidly everywhere these vaccines have been widely deployed. If we could deploy vaccines worldwide, we could effectively eradicate Covid, or at the very least, make the outbreak of new variants that can evade vaccines much less likely.

Where there’s great success, there’s great money. Pfizer is projecting it will make $26 billion in 2021 from its vaccine, and Moderna will make $18.4 billion. That’s a good thing. These firms should make large sums of money from a fantastically useful vaccine, even though the technology was publicly financed.

Still, despite this success, there’s a significant vaccine shortage. The world will need 10-12 billion to be fully vaccinated, and Moderna and Pfizer/BioNTech won’t produce that much. Pfizer/BioNTech, for instance, forecast production of 2 billion doses in 2021, and Moderna will make something on the order of a billion doses. That’s a lot, it’s just not nearly enough. Indeed, at this rate, some countries aren’t going to start significant vaccination campaigns until 2023. That’s quite dangerous, because if the pandemic keeps raging, it’s more likely that a vaccine-resistant Covid variant emerges. If that happens, such a variant will spread across the already vaccinated areas of the world.

So making sure we have a global vaccination campaign looks like a logistical challenge, but also a necessary one. That said, there’s a fly in the ointment, a ghoulish incentive at work for Pfizer, BioNTech, and Moderna.

Pfizer and the “Durability of the Franchise”

On an investor call last month, the CEO of Pfizer, Frank D’Amelio, discussed what would happen to revenue from his vaccine product as the Covid pandemic ends, what he called the “durability of the franchise.” He told analysts not to worry. People in rich countries will need annual booster shots, and that is where Pfizer will make real money.

For these annual treatments, Pfizer will be able to charge much more than it does now. The current price for a covid vaccine, D’Amelio noted, is $19.50 per dose. He told analysts of his hope Pfizer could get to a more normal price, “$150, $175 per dose,” instead of what he called “pandemic pricing.”

The ghoulish part, however, is why there will need to be annual boosters. It’s not because the vaccine strength wanes over time, though that might happen. It’s because, as D’Amelio told Wall Street, there will be new variants emerging from abroad that can evade the vaccine. And how will variants emerge abroad? Well as outbreaks occur in non-vaccinated parts of the world, new strains will naturally occur as the virus mutates. If the rest of the world gets vaccinated, however, new variants won’t arise.

What D’Amelia really wants is to be able to charge $150 for a vaccine he is now charging $19.50 for. But D’Amelio is also assuming that there won’t be a global effective vaccination campaign. And, in a narrow sense, while Pfizer’s main goal is to keep prices high, it is actually against Pfizer’s financial interest to have the rest of the world vaccinated. If the world gets vaccinated, Pfizer won’t necessarily be able to sell expensive booster shots in rich countries who can afford them. Yikes.

The corporate world, sans Pfizer, has a very strong reason not to want a vaccine-resistant variant. A new variant of Covid could force the world back into lockdown, which is expensive. The International Chamber of Commerce, hardly a bastion of lefties, put out a study asserting that not sufficiently vaccinating poor countries will cost $9.2 trillion (with wealthy countries like the U.S. bearing half the cost). Covid isn’t good business for most firms, but it’s great for Pfizer and Moderna.

So what is the holdup for global vaccination? One argument is that there isn’t . . .

Continue reading. There’s much more.

Later in the column, he discusses why beef prices are rising as cattle prices are dropping. That begins:

Beef Is Expensive. So Why Are Cattle Ranchers Going Bankrupt?: During the Covid pandemic, Americans went to the supermarket and found something that hadn’t happened for decades – a meat shortage. There was plenty of cattle, but the beef wasn’t getting to the supermarket shelves.

What happened and why?

To answer this question, I asked Bill Bullard, a former cattle rancher and the current CEO of R-CALF, a cattle producer-only membership organization focused on the viability of the U.S. cattle ranching industry. “We have so skeletonized the entire live cattle and beef supply chains that it is no longer capable of withstanding a shock,” he said, “whether it be the covid pandemic or a climatic circumstance.” This shortage was a wake-up call. “The industry is incapable of meeting our national food security needs.”

Bullard is an ardent anti-monopolist, a viewpoint developed through hard-won experience dealing with a consolidated meatpacking industry. He noticed problems with our cattle markets becoming more severe in 2014. That’s when beef prices and cattle prices started to diverge. . .

Read the whole thing.

The Future of Weed: 12 Bold Predictions for the Next Decade of Consumer Cannabis

As more states legalize marijuana, the Federal government must at some point reconsider its classification as a Schedule 1 drug:

Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples of Schedule I drugs are:

heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone, and peyote

LSD, ecstasy, and peyote all have potential use in psychotherapy, and marijuana clearly has medical use and not nearly so high a potential for abuse as alcohol, which is not on the schedule at all despite its clear and obvious dangers associated with addiction and death. (See, for example, this report from today: “Bowling Green student dies after drinking ‘copious’ alcohol at a frat event under investigation for hazing.”) There are no recorded deaths from marijuana.

In Inside Hook Eli London takes a look at where the cannabis business might go:

So what’s the deal with weed?

It’s sort of legal, but also not really. It’s a plant … or at least a flower that’s derived from one. Back when it mostly grew out of the ground, it was demonized by Nixon’s DEA as a gateway drug; now that it’s taxable and grown in hulking, byzantine greenhouses, it’s seen as a path to redemption from the opioid epidemic and a road to riches for investors and entrepreneurs.

The sales of legal cannabis are projected to reach somewhere in the realm of $35 billion within the next five years. The actual economic impact of that market could hit $130 billion in that same timeframe. Marijuana startups are cropping up like they were being founded in hydroponic soil and bathed in UV light. Dozens of cannabis companies (mostly based in Canada, since it’s not federally legal in the US) are already available for trading in American markets. Marijuana is fully legal in 15 states (as well as DC) and at least somewhat legal in all but three states.

The green wave is coming. My inbox flows over with PR pitches from upstart marijuana companies and thinkpieces about the industry every week. In my financial news consumption, I hear about cannabis stocks on a near daily basis. In my political reading, I’m constantly reminded of the state-vs.-federal debate that underpins policy and legalization. And in keeping up with social-justice issues, I’m constantly reminded of the ugly and devastating impact marijuana and the war on drugs has had on Black and brown communities across the country.

But rather than try to summarize all these things and write a dreadfully underqualified synopsis of where the industry is heading over the next decade, I figured it would be better to talk to experts – founders, investors, lobbyists, organizers and more – from across the cannabis landscape to get their thoughts directly. I asked them broad questions about what the next decade of consumer cannabis will look like, and from their answers, I was able to parse together 12 predictions for what the next 10 years hold.

This is not an exhaustive or definitive list; it is a compendium of common themes and predictions I saw from speaking with a sizable amount of industry professionals. It is by no means gospel, but it is — we hope — a document that will give you thoughtful insight into a nascent sector of the American economy that is only destined to keep growing. That’s what plants do, after all.

Getting Stoned Out of Your Gourd Will No Longer Be the Goal

“Microdosing cannabis will become the preferred performance, productivity and wellness tool across many professions, including pro sports. Microdoses of cannabis become commercially available in settings where consumers face triggers for stress or anxiety, e.g., airports and airplanes, dental offices, etc.” – David Cookson, Founder, Sula

“There’s a misconception about what a large swath of the market wants out of a cannabis experience. While there’s a legacy community of consumers who want to get very high or for whom a high THC percentage is simply the norm, there’s a much larger existing and nascent consumer demo that is looking for a more moderate and functional high. Just as not everyone wants to be drunk when they drink, not everyone wants to be blasted when they’re high.” – David Weiner, Co-Founder, Gossamer

“Microdosed products will not only become more popular, they will be the norm. Products with a mild dose of THC are the most appealing to mainstream consumers that are open to cannabis but have not tried or have not tried recently. It is these products, like our Cann Social Tonics with 2mg THC, that will bring in waves of new consumers to the industry. They care about feeling in control, having consistent experiences that are turnkey, energizing and social. Watch out for more and more microdose THC products across all product categories.” – Jake Bullock, Co-Founder, Cann

We Will Stop Thinking about Weed in Terms of Indica or Sativa

“As more research is funded, we see the supremacy of the Indica/Sativa dichotomy being challenged. Research suggests that looking at cannabis strictly through this framework might not serve our understanding in the way it is marketed to us.” – Max Spohler, Co-Founder, Artet  

“Classification of ‘strains’ as indica, sativa or hybrid as well as creatively named hybrids/strains will be largely replaced by a scientifically supported classification system that more accurately correlates to evidence-based ‘effects’ and indications for cannabis compounds.” – Cookson

THC and CBD Are Only Part of the Equation

“Consumers will continue to become more knowledgeable about the benefits of cannabis and its various compounds beyond just THC and CBD, including terpenes and cannabinoids like CBN and CBG. They will also understand how cannabis can fit into their daily routines along with other supplements and health products.” – Jim Baudino, Partner, Sands Lane Holdings

“[There will be an increase in] awareness of minor cannabinoids and terpenes. We’ve only scratched the surface of understanding this plant’s full potential. Right now many consumers only know THC and CBD, and many buy weed solely on how high the THC percentage is. However, terpenes impact the high more than many consumers realize, so I think those will be more in the spotlight in coming years.” – Kate Miller, Co-Founder and CEO, Miss Grass

“More conversations [will revolve] around the impact of various cannabinoids (outside of the THC and CBD conversations that currently dominate). The cannabis plant in so rich and versatile, and up until now we primarily focus on two, while there are well over 100 to consider. – Nidhi Lucky Handa, Founder, Leune . . .

Continue reading. There’s much more.

How One of the Reddest States Became the Nation’s Hottest Weed Market

Paul Demco has a lengthy and interesting article in Politico:

WELLSTON, Oklahoma—One day in the early fall of 2018, while scrutinizing the finances of his thriving Colorado garden supply business, Chip Baker noticed a curious development: transportation costs had spiked fivefold. The surge, he quickly determined, was due to huge shipments of cultivation supplies—potting soil, grow lights, dehumidifiers, fertilizer, water filters—to Oklahoma.

Baker, who has been growing weed since he was 13 in Georgia, has cultivated crops in some of the world’s most notorious marijuana hotspots, from the forests of Northern California’s Emerald Triangle to the lake region of Switzerland to the mountains of Colorado. Oklahoma was not exactly on his radar. So one weekend in October, Baker and his wife Jessica decided to take a drive to see where all their products were ending up.

Voters in the staunchly conservative state had just four months earlier authorized a medical marijuana program and sales were just beginning. The Bakers immediately saw the potential for the fledgling market. With no limits on marijuana business licenses, scant restrictions on who can obtain a medical card, and cheap land, energy and building materials, they believed Oklahoma could become a free-market weed utopia and they wanted in.

Within two weeks, they found a house to rent in Broken Bow and by February had secured a lease on an empty Oklahoma City strip mall. Eventually they purchased a 110-acre plot of land down a red dirt road about 40 miles northeast of Oklahoma City that had previously been a breeding ground for fighting cocks and started growing high-grade strains of cannabis with names like Purple Punch, Cookies and Cream and Miracle Alien.

“This is exactly like Humboldt County was in the late 90s,” Baker says, as a trio of workers chop down marijuana plants that survived a recent ice storm. “The effect this is going to have on the cannabis nation is going to be incredible.”

Oklahoma is now the biggest medical marijuana market in the country on a per capita basis. More than 360,000 Oklahomans—nearly 10 percent of the state’s population—have acquired medical marijuana cards over the last two years. By comparison, New Mexico has the country’s second most popular program, with about 5 percent of state residents obtaining medical cards. Last month, sales since 2018 surpassed $1 billion.

To meet that demand, Oklahoma has  . . .

Continue reading. There’s much, much more.

One thing that struck me was how elected representatives worked hard to frustrate and foil the will of the public they claim to represent. In fact, the attitude of officials seems to have been in many cases outright hostile to the public and to the public interest. From later in the article:

No one embodies the transformation of Oklahoma from drug war battlefield to marijuana mecca better than Robert Cox.

Cox opened the Friendly Market in downtown Norman in October 2014. The 67-year-old grandfather of seven was nearing retirement and wanted to upgrade the image of the stereotypical seedy head shop. Eight years earlier, Cox had rediscovered a love of marijuana after a 29-year hiatus from using the drug. “It was like a transformational awakening,” he says.

But from the outset, Cox was warned by the Norman police that if he sold anything that they deemed to be drug paraphernalia—including glass pipes—they would come after him. At first, he heeded their warnings and stopped selling smoking devices. But after seeking legal advice, Cox decided to fight.

In December 2015, barely three months after sales resumed, the police twice raided The Friendly Market. Cox and the store’s manager, Stephen Holman, a member of the Norman City Council, were each hit with 13 criminal charges, including one felony count of “obtaining proceeds of drug activity.” Two other workers were each charged with one misdemeanor count. In addition, the cops seized most of the shop’s merchandise, forcing The Friendly Market to shut down.

Cox refused to back down. Over the course of two years, they fought the charges, culminating in a six-day jury trial for Cox and Holman. Ultimately, the owner and employees prevailed every criminal charge.

But even after they triumphed in court, the local authorities refused to return The Friendly Market’s merchandise, continuing to claim it was illegal drug paraphernalia. The case went all the way to the Oklahoma Supreme Court, with Cox once again prevailing. The store’s seized merchandise was finally returned, and Cox reopened for business in October 2017.

“We all smiled for weeks,” Cox recalls. “We were ecstatic.”

A year later, medical marijuana sales began in Oklahoma. . .

Rigorous Study Backs A Psychedelic Treatment For Major Depression

Jon Hamilton has an intriguing article for NPR:

The substance that makes some mushrooms “magic” also appears to help people with major depressive disorder.

A study of 27 people found that a treatment featuring the hallucinogen psilocybin worked better than the usual antidepressant medications, a team reported Wednesday in the journal JAMA Psychiatry.

“The effect was more than four times greater,” says Alan Davis, an author of the study and a faculty member at both Johns Hopkins University and Ohio State University.

The study comes after earlier research offered hints that psilocybin might work against depression and after a study by researchers at Johns Hopkins found that it could ease depression and anxiety in patients who had life-threatening cancer.

The study of cancer patients “led us to consider whether or not this treatment might be effective for people in the general depression community,” Davis says.

In the new study, patients received two doses of psilocybin on different days and also received about 11 hours of psychotherapy. The drug was administered in a supervised yet homey setting designed to put participants at ease, Davis says.

“They have a blindfold on, they have headphones on, listening to music,” he says. “And we really encourage them to go inward and to kind of experience whatever is going to come up with the psilocybin.”

Half the participants began treatment immediately. The rest were put on a waitlist so they could serve as a comparison group until their own treatment began eight weeks later.

“There was a significant reduction in depression in the immediate-treatment group compared to those in the waitlist,” Davis says. And patients responded much faster than with typical antidepressants.

“The effect happened within one day after the first session and sustained at that reduced level through the second psilocybin session all the way up to the one-month follow-up,” he says.

The study is notable for its scientific rigor, says Dr. Charles F. Reynolds III, distinguished professor emeritus of psychiatry at the University of Pittsburgh’s School of Medicine and the author of an editorial that accompanied the research.

“It offers, I think, a good deal of promise as a feasible approach to treating particularly chronic forms of depression,” Reynolds says. Even so, the results still might be skewed because patients were told they were going to get the drug.

“Some of the rapid improvement that we saw could have been related to expectancy effects on the part of the participants,” he says.

The study comes less than two years after the Food and Drug Administration approved the anesthetic and party drug ketamine for depression. And the emergence of treatments like ketamine and psilocybin may signal a new era in treatment, Reynolds says.

“Certainly that’s  . . .

Continue reading.

Hidden criteria that cause an approach that works to be rejected: Drug treatment division

Abby Goodnough reports in the NY Times:

Steven Kelty had been addicted to crack cocaine for 32 years when he tried a different kind of treatment last year, one so basic in concept that he was skeptical.

He would come to a clinic twice a week to provide a urine sample, and if it was free of drugs, he would get to draw a slip of paper out of a fishbowl. Half contained encouraging messages — typically, “Good job!” — but the other half were vouchers for prizes worth between $1 and $100.

“I’ve been to a lot of rehabs, and there were no incentives except for the idea of being clean after you finished,” said Mr. Kelty, 61, of Winfield, Pa. “Some of us need something to motivate us — even if it’s a small thing — to live a better life.”

The treatment is called contingency management, because the rewards are contingent on staying abstinent. A number of clinical trials have found it highly effective in getting people addicted to stimulants like cocaine and methamphetamine to stay in treatment and to stop using the drugs. But outside the research arena and the Department of Veterans Affairs, where Mr. Kelty is a patient, it is nearly impossible to find programs that offer such treatment — even as overdose deaths involving meth, in particular, have soared. There were more than 16,500 such deaths last year, according to preliminary data, more than twice as many as in 2016.

Early data suggests that overdoses have increased even more during the coronavirus pandemic, which has forced most treatment programs to move online.

Researchers say that one of the biggest obstacles to contingency management is a moral objection to the idea of rewarding someone for staying off drugs. That is one reason publicly funded programs like Medicaid, which provides health coverage for the poor, do not cover the treatment.

Some treatment providers are also wary of giving prizes that they say patients could sell or trade for drugs. Greg Delaney, a pastor and the outreach coordinator at Woodhaven, a residential treatment center in Ohio, said, “Until you’re at the point where you can say, ‘I can make a good decision with this $50,’ it’s counterproductive.”

Two medications used to treat opioid addiction, methadone and buprenorphine, have often been viewed with similar suspicion because they are opioids themselves, even though there is abundant research showing they substantially reduce the risk of death and help people stay in treatment. But the federal government has started aggressively promoting such treatment for opioid addiction, and has heavily invested in expanding access to it.

As of yet, there are no medicines proven to suppress the intense cravings that come with addiction to meth and cocaine. Instead, there are a raft of behavioral interventions, some of which have very little evidence of effectiveness.

“The most common treatment is to do whatever the hell you feel like,” said Michael McDonell, an associate professor at Washington State University who has conducted a number of studies on contingency management. “We had two statewide meetings about meth recently, and at one, a colleague said, ‘Why aren’t we just doing contingency management? Why would we spend all this money on interventions that won’t work?’”

The fact that no public or private insurer will pay for contingency management, except in a few pilot programs, is a major challenge to expanding it; the biggest obstacle is that offering motivational rewards to patients has been interpreted as violating the federal anti-kickback statute. A group of treatment experts recently asked the Department of Health and Human Services to waive the statute for two years as it pertains to contingency management, but the agency refused, saying programs that provide rewards need to be evaluated on a case-by-case basis.

Congress recently told states that they could start spending federal “opioid response” grants on treatment for stimulant addiction, but the agency that distributes the grants allows only $75 per patient, per year to be spent on contingency management — far less than what research has found effective.

“The biggest question is . . .

Continue reading.

The refusal to support a program that works because one has moral objections (to things that work?) seems to me to be itself morally objectionable (not to mention short-sighted if not outright stupid).

What if a Pill Can Change Your Politics or Religious Beliefs?

I’ve been interested in trying psilocybin for years, but properly supervised. Maybe I’ll get the chance yet. Eddie Jacobs writes in Scientific American:

How would you feel about a new therapy for your chronic pain, which—although far more effective than any available alternative—might also change your religious beliefs? Or a treatment for lymphoma that brings one in three patients into remission, but also made them more likely to vote for your least preferred political party?

These seem like idle hypothetical questions about impossible side effects. After all, this is not how medicine works. But a new mental health treatment, set to be licensed next year, poses just this sort of problem. Psychotherapy assisted by psilocybin, the psychedelic compound in “magic mushrooms,” seems to be remarkably effective in treating a wide range of psychopathologies, but also causes a raft of unusual nonclinical changes not seen elsewhere in medicine.

Although its precise therapeutic mechanisms remain unclear, clinically relevant doses of psilocybin can induce powerful mystical experiences more commonly associated with extended periods of fasting, prayer or meditation. Arguably, then, it is unsurprising that it can generate long-lasting changes in patients: studies report increased prosociality and aesthetic appreciation, plus robust shifts in personality, values and attitudes to life, even leading some atheists to find God. What’s more, these experiences appear to be a feature, rather than a bug, of psilocybin-assisted psychotherapy, with the intensity of the mystical experience correlating with the extent of clinical benefit.

These are undoubtedly interesting findings, but should any of it matter? However unusual a treatment’s consequences, shouldn’t we prioritize the preferences of an informed, consenting patient? Yes, I understand that this might change me in strange ways. But my depression is debilitating. I will roll that dice. Putting aside the matter of how well-informed one could really be about such radical transformations, political realities make things more complicated, with the case of psilocybin— currently a Schedule 1, highly illicit drug—showing vividly how values, politics and social narratives can influence the development of biomedical science.

The taboo of the illicit is not an insuperable obstacle. The Multidisciplinary Association for Psychedelic Studies (MAPS), an organization that advocates for “careful uses” of psychedelics, has gone an impressive way in rehabilitating MDMA (i.e., ecstasy) into a legitimate medicine. MAPS’s masterstroke was to focus on demonstrating its potential for treating PTSD. By articulating how MDMA-assisted therapy could help veterans, support for whom enjoys a rare level of bipartisan agreement, MAPS have attracted supporters from across the political spectrum, receiving positive coverage from MSNBC and Fox News alike.

Advocates of psilocybin-assisted therapy tout it as the solution to the burgeoning mental health crisis. But, like MDMA, psilocybin is far from a culturally neutral drug, carrying both the shame of Schedule 1 status and a checkered social history. It too may need to build the kind of politically heterogeneous coalition of supporters that MDMA-assisted therapy enjoys.

But to generate a breadth of appeal, one challenge stands out: psilocybin seems to make people more liberal. Scientific reports associating psychedelic use and liberal values stretch back as far as 1971, and although these findings have been replicated more recently, a noncausal explanation is readily available. Those with conservative attitudes tend to look more disapprovingly on illicit drug use, making them less likely than liberals to try a psychedelic drug in the first place.

However, emerging evidence suggests the relationship could be causal, with clinically administered psilocybin actively shifting political values, just as it shifts many other nonclinical characteristics. Notably, one study of psilocybin for treatment-resistant depression reported that the treatment decreased authoritarian political views in patients. That clinical trial also detected another effect that had previously been reported in healthy participants: psilocybin use leads to increases in the personality domain of openness, itself a predictor of liberal values. . . .

Perhaps psilocybin removes learned stereotypes and allows the mind to see reality for what it is, and reality has a well-known liberal aspect (one reasons conservatives are so strongly opposed to education).

Continue reading.

An example of systemic racism

Spencer Critchley posted on Facebook:

The end of Breonna Taylor’s life is a perfect example of how systemic racism works.

I don’t know if any of the police officers involved is a racist — and because of systemic racism, that’s almost beside the point.

And although I disagree, I can see how the case might be made, under the existing laws, that her shooting was a legally justified accident — and because of systemic racism, that too is almost beside the point.

Systemic racism means the racism is in the way systems are designed. It’s there because of our history of racism, or because of assumptions that are the living legacy of that history.

Systemic racism means that it’s almost impossible that what happened to Breonna Taylor would ever happen to someone like me. This remains true even if you assume the worst about her — remembering that assuming the worst about her is at the heart of the problem — and if you transfer those worst assumptions to me.

If someone close to me were suspected of dealing drugs, the police would not break down my door in the middle of the night. If *I* were suspected of dealing drugs, the police would not break down my door in the middle of the night. And if somehow they did, and I fired at them, I would get the benefit of the doubt.

Systemic racism starts with assumptions about how and why we pass and enforce drug laws. If people of my race and class use drugs, it’s just harmless recreation — “Hey, let’s celebrate 4/20!” Or it’s a minor vice — “Yeah, we may have done a little blow.” Or at worst, it’s a health problem — “Good for him, he got himself into rehab.” And whatever legal trouble someone like me gets into can be made a lot less serious by an expensive lawyer.

Take class out of it, and the difference remains. Look at how the meth epidemic in rural America is seen as cause for concern, while drug abuse in inner cities is seen as moral failure.

Look at those two phrases: a “meth epidemic” is a disease afflicting a community. “Drug abuse” is your own damn fault.

Think of how often you hear about “black on black crime.” You know what? By far most white crime is white on white. It’s because criminals prey on their own communities. And our communities, after all this time, are segregated.

Even with perfectly unbiased police, prosecutors, and judges, systemic racism would remain. It would remain embedded in the laws we expect those people to enforce. It would remain embedded in the economic choices that produce so much poverty, which is the surest predictor of crime and other social problems, independent of any racial or individual characteristics. And it would remain embedded in our failure to support alternatives to enforcement. I’ve never met a police officer who wanted to be sent to deal with domestic strife or mental health crises. But we keep sending them.

We don’t have to believe all law enforcement officers are racist (or any more racist than anyone else is) to see that there is systemic racism in the way our society enforces law.
Through my work I’ve gotten to know cops who are among the least racist people I’ve ever met. I don’t know many other people who would unhesitatingly risk their lives for strangers with whom they may have nothing in common. These cops do that all the time.

Some cops fall far short of that standard. But this isn’t a “bad apples” problem. Our real problem is not caused, and will not be solved, by individual police officers.

It will be solved, or not, by all of us. And that starts with something that couldn’t be more simple, although for some reason we find it hard: seeing that every one of us is a human being, and precious.

To be handled with care.

I will add that his Facebook posts are well worth reading. Minor personal note: He lives in Monterey, where I lived until a few years ago.