Via Naked Capitalism and Lambert Strether:

And now abideth faith, hope, charity, these three; but the greatest of these is charity. –Corinthians 13:13

I posted this letter in Links, but I found I could expand on it. Spectrum Health Care’s letter to Hedda Martin speaks for itself, and for what our health care system has become under neoliberalism:

View image on Twitter

(The provenance: I started with AOC, who hat-tipped @DanRiffle, who linked to the original poster, @DanRadzikowski, quoted above. From Radzikowski’s thread, Hedda Martin: “This is me”; Martin’s GoFundMe, which was successful.) In this post, I’ll focus on two things: the intriguing backstory of Spectrum Health, the institution that denied Martin care until she could raise $10,000; and the weaknesses of GoFundMe as a solution. Before I get to the main part of the post, however, I’ll point out that Hedda Martin’s example is not exception…

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A little history:

In 1980, the Porter and Jick letter to the editor of the New England Journal of Medicine by the Boston Collaborative Drug Surveillance Program stated:

“the risk of addiction was low when opioids such as oxycodone were prescribed for chronic pain.”

It was a brief statement by the doctors conducting the study, taken out of context, and cited many times afterwards as justification for the use of oxycodone.

In a June 1, 2017 letter to the NEJM editor, the authors reported on the broad and undocumented assumptions made as a result of the 1980 Letter on the Risk of Opioid Addiction.. Using bibliometric analysis of the impact of this letter to the editor, the citations of the 1980 letter were reviewed to determine the citation’s portrayal of the letter’s conclusions.

Identified in the bar chart are the number (608) of citations of the 1980 letter over a period of time from 1981 to 2017.

“72.2% (439) of the citations, quoted the letter or used it as evidence addiction was rare in patients when treated with opioids such as oxycodone. 80.8% or 491 of the citations failed to note the patients described in the letter were hospitalized at the time they received the prescription.”

There was a sizable increase of citations after the introduction of OxyContin (extended release oxycodone) in 1995. As the analysis noted “affirmational citations of the letter have become less common in recent years in contrast to the 439 (72.2%) positive and supporting citations of the 1980 correspondence in earlier years. The frequency of citation of this 1980 letter stands out as being unusual when compared to other published and cited letters. Eleven other published, stand-alone, and more recent letters on different topics published by the NEJM were cited at a median statistic of 11 times each.

Citations of the 1980 standalone letter on “addiction being rare” from the use of opioids such as oxycodone failed to mention, the patients administered to were in a hospital setting as noted in the Porter and Jick letter. Overlooked, a mistake, intentional misquote by the people citing this letter?

In 2007 in the pharmaceutical industry, “the manufacturer of OxyContin and three senior executives of Purdue Pharma plead guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with OxyContin.”

This year, law makers questioned Miami-Luken and H.D. Smith wanting to know why millions of hydrocodone and oxycodone pills were sent (2006 to 2016) to five pharmacies in four tiny West Virginia towns having a total population of about 22,000. Ten million pills were shipped to two small pharmacies in Williamson, West Virginia. The number of deaths increased along with the company and wholesaler profits.

60% of all drug-poisoning deaths in 2013 involved prescription opioids and/or heroin. Among individuals aged 25 to 64 years, deaths from a drug overdose—the majority of which were opioid-related—exceeded motor vehicle collisions as the leading cause of accidental death in 2013. Four in five new heroin users started out misusing prescription painkillers.

The information is out there as to why the abuse of opioids and related drugs is increasing. It is being ignored or argued against as limiting a patients rights to have unhindered access to opioids by doctors and patients alike. Sound familiar, similar to the gun lobby?

Today

AMA Delegates Back Physician Freedom in Opioid Prescribing At best, 20% of all doctors are members and the percentage has been declining. From the meeting; “The CDC’s guidelines on the use of opioids for pain management are well-intentioned, but some insurers and pharmacists have used them to restrict providing and need to be discouraged from doing so, members of the American Medical Association (AMA) House of Delegates said Tuesday.”

And the CDC response as told by one doctor. “a member of a pain management task force being convened by the Department of Health and Human Services. “Draft comments will be coming out in a couple of weeks and will very specifically address the misinterpretation of the CDC guidelines,” he noted. “This is really timely because the comments from the AMA will be extremely important in weighing in [on the issue].”

Doctors do no want interference with decision- making when it comes to patients. At the same time, little has been done to rein in addiction due to prescription opioids which lead to other addictions because prescriptions are expensive or are limited in access. Here is Janet from stopnow blog and who writes about addicted babies due to mothers taking opioids:

More overdose deaths last year than the entire Viet Nam War. The FDA approves sufentanyl 10 times stronger than fentanyl. Yesterday the AMA President was quoted using the same verbiage as Big PhRMA- undertreatment of pain. And now a campaign to undo the CDC guidelines which until they were released doctor education was coming from the drug companies. We need full disclosure – is this funded by Big PhRMA.

Here is a counter argument from a pharmacist where he misapplies the stats to suit his argument:

“it depends what numbers of overdose deaths you are referring to because it is certainly not more deaths due to opioid pain medications. There were 72,000 overdose deaths which includes ALL overdoses from ALL classes of medications. Overdoses from opioids were 49,000 and within that group only 19,354 were from opioid pain relievers. Deaths from fentanyl (illicit) totaled over 29,000, heroin almost 16,000, and cocaine 14,500. (One death could be counted in more than one category, numbers from NIH.) Vietnam war deaths totaled 58,220 versus 19,354 deaths from opioid pain medications. By the way, there were 10,684 deaths due to benzodiazepines, should the CDC mandate doses and days of therapy for those also?

I have no connections with or any payments/gifts from any drug manufacturer. My only concern is that in the national noise of the ‘opioid epidemic’ the focus is on those who abuse opioids and I want to make sure that we still hear the cry of the patient who needs pain relief and who does NOT abuse the medications.”

Yes the pharmacist is correct when he says of the 72,000 deaths only 19,354 can be attributed to opioid pain relievers in 2018. Janet cited the 20 years of Vietnam deaths. The pharmacist conveniently sidesteps the time periods involved here. In three years and if the numbers stay the same (they have been increasing YOY), the numbers of opioid deaths will be slightly less than 20 years of Vietnam if it were to remain at 19,000/year. Four in five new heroin users started out misusing prescription painkillers. Of recently cited 150,000 accidental deaths, 72,000 (a record high) can be attributed to drug overdose deaths, a record high.

And this is ok?

“60% of opioid deaths occur in those who were given a prescription by a physician. The other 40% of deaths are caused by people who obtained opioids by “doctor shopping,” and receive multiple scripts at once. The perceived safety and easy accessibility of these drugs have presented the highest risk for most users, even if they eventually seek out illicit opioids or “street drugs.” In 2014, only 22.1% of non-medical users obtained opioids through a doctor, meaning that the diversion rate of these drugs is very concerning. Many people are getting these medications illegally or without doctor supervision.”

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Four states had the Medicaid Expansion on the ballot this last election and another is still fumbling around with expanding it..

The Good

Idaho: Idahoans approved Idaho Proposition 2, an initiative requiring the state to submit an amendment to the Centers for Medicare and Medicaid Services (CMS) in order to implement the Medicaid expansion no later than 90 days after the approval of the act. The Idaho Department of Health and Welfare is required and authorized to take all actions necessary to implement the provisions of this section as soon as practicable and outgoing Governor Butch Otter endorsed the ballot initiative less than a week before the election and Republican Governor-elect Brad Little has said he will implement the initiative.

Nebraska: Nebraskans voted in favor of Initiative 427 requiring the state to submit an amendment/documents seeking waiver approval from CMS on or before April 1, 2019 to expand Medicaid. As directed by the initiative, the state Department of Human Services to “take all actions necessary to maximize federal financial participation in funding medical assistance pursuant to this section”. Although newly reelected Governor Pete Ricketts has been a vocal opponent of expansion, he has stated he would let the voters decide if it made it onto the ballot.

Utah: Voters approved Utah Proposition 3 calling for the state to expand Medicaid coverage beginning April 1, 2019. The initiative also prohibits future changes to Medicaid and CHIP that would reduce coverage, benefits, and payment rates below policies in place on January 1, 2017. The proposition calls for a 0.15% increase to 4.85% from 4.7% the state sales tax (except for groceries) to finance the expansion or Medicaid and CHIP more broadly.

The Bad

Montana: Montanans voted down Montana I-185 after spending on campaigns for and against the initiative made it the most expensive ballot measure race in Montana history. The measure proposed raising taxes on all tobacco products and e-cigarettes and vaping products to dedicate a percentage of increased tax revenues for Montana’s current Medicaid program and veteran’s services; smoking prevention and cessation programs; and long-term care services for seniors and people with disabilities. The initiative also would have eliminated the sunset date for the Medicaid expansion of June 30, 2019. Republican controlled Montana State Legislature could still take action to continue the expansion program beyond June 2019. Tobacco companies had spent more than $17 million on advertising and other efforts to oppose the ballot measure, most of which came from cigarette maker Altria (Philip Morris).

The Ugly

Maine: Maine. Medicaid expansion was adopted in Maine through a ballot initiative in November 2017. Governor Paul LePage resisted the implementation of it and then complied with it after the Maine SC ordered him to submit an expansion state plan amendment (SPA) to CMS. He did submit the plan along with a asking CMS to reject the SPA. The newly elected Democratic governor, Janet Mills, has supported Medicaid expansion and is likely to move quickly to implement. Democrats also control the Maine legislature.

The ACA has shown up more in this last election even though it is pretty much a done deal and near impossible to repeal. Still Republicans repeat the same old “lies” even though they have been shot down repeatedly. One often repeated lie is the Democrats and the ACA stole $800 billion from Medicare to fund it. This lie was used by Mike Bishop in Michigan and our President also. Quite the opposite occurred with the Medicare TF being extended for a few more years and excess payments to Advantage plans reduced to match what Medicare pays out.

More to be read here: What Does the Outcome of the Midterm Elections Mean for Medicaid Expansion?

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Tom MacArthur a multimillionaire former insurance broker who negotiated the House legislation to repeal the ACA taken to the wood shed by a constituent. Tom MacArthur met with his constituents in a Town Hall meeting and he listened to them and took the abuse he rightfully deserved. Mike Bishop consistently refused to meet with his constituents face to face in a high density, Gerrymandered Republican District. People were angry and we needed the right candidate to emerge and lead. Elissa Slotkin won!

It did not have to be this way. It could have been different. MacArthur like Mike Bishop chose his political party over country and constituents. Tom MacArthur and Mike Bishop lost.

The eleven minutes to hear this rebuttal are worth hearing.

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I made a mistake. And it’s a good thing.

Following up on my Running on Empty post, I wanted to give a more finely-grained analysis of climate costs relative to GDP growth, so I returned to my sources to see who their sources were and how they did their calculations. Watson et al., compiled their estimate from National Centers for Environmental Information, “U.S. Billion Dollar Weather and Climate Disasters” and Paulina Jaramillo and Nicholas Muller, “Air pollution emissions and damages from energy production in the U.S. 2002-2011.”

Jacobson, Delucchi et al. presented their estimates in two tables, broken down by country. I had taken what I thought was 15% of their global climate cost estimate but it turns out that my number was roughly double theirs. I may have taken their high estimate instead of the mean. Anyway their actual estimate was around $4 trillion in 2013 dollars. But that is not the mistake I am concerned with here.

The mistake came to light after I had all the carefully checked numbers, recalculated in 2012 dollars and I compared annual GDP growth to annual health and climate costs. Climate costs exceeded growth in 13 of the 28 years from 1990 to 2017. Over the entire period those costs offset 95% of reported real GDP growth. Or so the numbers claimed.

Then I tried a different tack. I subtracted estimated annual climate costs from GDP and then calculated annual growth. To my surprise the resulting annual growth was only somewhat lower. O.K., I thought, I’m starting from a much lower total in the base year and the year-to-year number reflects only the the annual increase in climate costs and not the annual cost.

So which calculation, then, is the “right” one? Year-to-year growth minus annual cost or Year-to-year growth of (GDP minus climate cost)? Neither! Both calculations rely on double counting of the sort that Irving Fisher warned about 112 years ago.

The problem is also illustrated by the relationship between GDP and Net Domestic Product. Annual growth of Net Domestic Product and Gross Domestic Product track each other pretty closely:

Meanwhile, look at what has happened to depreciation. It has nearly doubled as a percentage of GDP, from around 9% in the late 1940s to almost 17% in recent years.

Something that doesn’t show up too well in the graph above is that most of the growth in depreciation relative to GDP has occurred in the last 48 years. So, doubling every half century we could have an economy in 125 years that runs entirely on depreciation! But that would be O.K. because GDP would be so much BIGGER then. Isn’t that right, Professor Nordhaus? Professor Solow? Professor Krugman?

I don’t have the solution to this computational problem, other than to point out that it is the inevitable consequence of a poorly-conceived metaphor for the “measurement” of heterogeneous good and services. The monetary yardstick is made of a highly elastic material and correction for changes in the cost of a basket of consumer goods (CPI) does not begin to address the real issue. GDP and GDP growth has become the increasingly opaque lens through which we view society and “the economy.” It is a cracked, scratched, smudged, distorting lens that may not even enable us to tell whether what we view through it is upside up or upside down.

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A little over a year ago, Robert Watson, former chair of the IPCC, and two co-authors published a report titled “The Economic Case for Climate Action in the United States.” Based on trends over the past few decades, the authors estimated the current total annual cost in the U.S. of losses from weather events intensified by climate change and health damage from fossil fuel pollution to be $240 billion, which they described as “about 40 percent of current economic growth of the United States economy.”

At around the same time, Mark Jacobson, Mark Delucchi and a carload of co-authors published an article in which they projected damages to health and property in the U.S. from climate change and pollution under “business as usual” to be around eight trillion dollars in 2050. A simple linear extrapolation between the two estimates suggests that the annual cost of climate change is increasing at around an 11 percent annual rate. Based on that extrapolation, the health and property damage cost of climate change can be projected to exceed annual GDP growth by 2026.

But wait. Watson’s 40 percent figure compares average annual damage with some of the better recent years of growth. Even excluding years of recession and stagnation, in which growth was less than $240 billion, the remaining eight of the last 12 years averaged only around $430 billion a year in real GDP growth. Counting the recession and stagnation years, it’s virtually break even.

But there’s more. Part of that economic growth simply reflects expansion of the population. Real economic growth per capita in the U.S. has been even more anemic in the 21st century. Of course this means the cost of damage can be spread more thinly as well but the crucial point is still what happens to per capita income relative to the damage.

The future is hard to predict, so I tried a number of scenarios. First, if per capita growth continues at the rate it has since 2009, the U.S. has already entered the red zone where the cost of climate change exceeds growth by an increasing amount each year. If real per capita growth accelerates to 1.5 percent per annum that fateful point won’t be reached until the year after next. A growth rate of 2 percent would postpone the day of reckoning until 2024, six years before the IPCC deadline for achieving net zero carbon emissions. To make it to 2030 without crossing permanently into the red would require a sustained rate of real per capita growth that hasn’t been achieved since 1960-1970.

One more thing. As Andreas Malm wrote, the global warming effects of fossil fuel consumption are “seriously backloaded” and “substantially deferred.” This year’s climate damage is a consequence of actions taken decades ago and the greenhouse gases emitted today will not have their full impact until decades from now. How does one estimate, then, the contribution to intermediate consumption of the deferred cost of current emissions? How much should GDP be deflated to account for the artificial inflation of nominal value added by waste gases whose cost is off the balance sheet?

Let’s assume that emissions in a given year contribute to 4 percent of climate change costs each year for the next 25 years. Why 25 years and why a constant percentage? Because it is better than attributing all of this year’s cost to this year’s emissions. Who knows? It probably makes more sense that choosing a “market-based” consumption discount rate of 4.3 percent. At any rate, considering the deferred nature of the climate costs moves the year in which GDP growth vanishes back. The 4 percent for 25 years scenario moves it back to 2007. The economy has literally been running on fumes for over a decade. Talk about “degrowth”!

It/s here. It’s not going away. It only gets worse. The question isn’t whether or not one “advocates” degrowth but whether or not one faces the stark reality and acknowledges the expiry of GDP growth and consequently the irrelevance — and, frankly, mischief — of the growth paradigm.

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Michigan 8th District Congressman Mike Bishop’s ad:

“Additionally, under the American Health Care Act (AHCA), insurance companies cannot deny coverage based on pre-existing conditions – yet Elissa Slotkin continues to lie about Mike Bishop’s record.

Sec. 137 of H.R. 1628 of the AHCA states:

“Nothing in this Act shall be construed as permitting health insurance issuers to limit access to health coverage for individuals with preexisting conditions.”

Under the bill, health status cannot affect premiums, unless a state asks for and receives a waiver — a condition of which is the state having other protections in place for those with pre-existing conditions. To obtain a waiver, states would have to establish programs to serve people with pre-existing conditions. No matter what, insurance companies cannot deny coverage based on pre-existing conditions.”

It is a tossup in Michigan and Mike Bishop and his campaign manager “Stu” are scrambling and slinging all the mud they can to sway many of the voters he ignored over the last two years when he was invited to meet in townhall meetings. He could care less and there was always an excuse not to be there and listen to the people talk about his priorities and what he is doing as their Congressional Representative. He will ignore many of his constituents again over the next two years if we return him to office.

Everyone can have access to buy anything they want to buy; but, can they afford it is the question? Charles Gaba at ACA Signups; “The AHCA did not protect pre-existing conditions” the same as the coverage under the Affordable Care Act (ACA). What the AHCA does do is allow states to strip away those protections via the waiver process.

Quickly, the ACA prevents insurance companies from: refusing to insure someone with pre-existing conditions, charging more for pre-existing conditions, denying coverage of the condition, not covering a minimum of 60% of enrollee medical costs, having an arbitrary maximum annual or lifetime claims cap, and capping maximum out-of-pocket costs for in-network healthcare expenses.

Except for preventing insurance companies from refusing to insure someone with pre-existing conditions, the AHCA Mike Bishop voted for allows states to opt out of all of the other protections of the ACA. If we were living in a state which sought to protect its citizens from predatory insurance companies and assist them in getting affordable healthcare and healthcare insurance, I would not worry as much as to what Michigan Republicans would do.

Since 1992 Michigan has been controlled by a majority Republican Senate, a Republican majority House 18 of 26 years, and a Republican governorship 20 of 28 years. During that time period, Republicans have favored business over its constituents. The Medicaid expansion barely passed in Michigan with Senator Joe Hune (Senate Insurance Committee Chair) proclaiming he was sick to his stomach with its passage. Lana Theis is running for his seat as well as Adan Dreher. Lana favors farming out the administration of Medicaid insurance to insurance companies such as what might be found in an Advantage Plan which produces no better results than Medicare and costs taxpayers and Medicare recipients 14% more. Adam Dreher is more in tune with the constituency.

In the end Elissa Slotkin is not lying about Mike Bishop and the AHCA as Congressman Mike Bishop’s AHCA which he voted for does not protect constituents with pre-existing conditions in Michigan in the same manner as the ACA. His vote for the ACHA allows states to wavie the ACA protections in favor of insurance companies who can charge more, limit coverage, or deny coverage.

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Last March, U.S. Senator Tammy Baldwin of Wisconsin sponsored a bill (Fair Care Act) to block President Trump’s plan to allow insurers to sell short term or what is frequently called junk plans. Senator Baldwin bill would reverse all of what the Republicans attempted to do with short term plans by reinstating protections for pre-exiting conditions, maintaining the community benefit costing of the plans, blocking life-time cost limits, etc.

Senator Tammy Baldwin:

“As someone who was branded as a child with the words, ‘pre-existing condition,’ I want to make sure that no parent, foster parent or grandparent has to choose between helping their child get better or going bankrupt,” said Senator Baldwin. “Republicans pushed repeal, but promised they would protect people with pre-existing conditions. The Fair Care Act is an opportunity for lawmakers to keep their word on guaranteed protections for pre-existing conditions.”

The bill is more symbolic than anything as it will not get past Senate Republicans. Senator Baldwin was using it as a way of emphasizing the hypocrisy of Republicans promising constituents at home support of healthcare-for-all regardless of pre-existing conditions and then not supporting pre-exiting condition as we know it to be in healthcare while in Congress. As an example, the Republican AHCA which failed by one vote (McCain) would have established subsidized Risk Pools and insurance companies could have charged higher premiums for pre-exising conditions.

More on this beyond the 13 minute Risk Pool Part YouTube clip by Charles Gaba at ACA Signups which is an update to Why Republican Short Term Healthcare Plans “Suck”. In this version, Charles explores in depth what will happen when the Mandate is eliminated and people either drop out on healthcare altogether or go to short term plans. Charles also ads a solution to subsidies stopping at 400% FPL.

I am hoping you took the 13 minutes to view Charles Gaba review of the impact of the mandate elimination and short term plans implementation plus his solution to the needed relief for those beyond 400% FPL. In the end, we are back to where we were at pre-ACA.

Moving on to Tammy Baldwin’s Fair Care Act and the vote. Under the purview of the Congressional Review Act, which gives Congress the ability to reverse federal regulations within a certain time window; Senator Baldwin was able to introduce a resolution to unwind the Trump administration’s expansion (Executive Order) of short-term insurance plans. Senator Baldwin had the 30 votes needed to force a vote reversing the Executive Order on short term plans. Normally this vote would have never seen the light of day; but this time, McConnell could not stop it.

October 10, 2018 the Senate voted on Senator Baldwin’s S.2494 – Fair Care Act. Forty-nine Democrats and one Republican voted for Baldwin’s resolution, while fifty Senate Republicans voted for an expansion of junk insurance plans that can deny coverage to people with pre-existing conditions and do not have to provide essential health services like prescription drugs, emergency room visits and maternity care. Senator Susan Collins was the lone Republican voting with Democrats. It failed in the Senate.

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Senator Grassley tweeting: “Five times now we hv granted extension for Dr Ford to decide if she wants to proceed w her desire stated one wk ago that she wants to tell senate her story Dr Ford if u changed ur mind say so so we can move on I want to hear ur testimony. Come to us or we to u,”

I like how tweeting brings out the intellect in people and especially our politicians. And Chuckie the tweeting senator does this on a public forum with Ford and Kavanaugh so everyone can read along with him.

In New Jersey’s 2019 ACA marketplace, fruits of reinsurance, individual mandate, and silver loading.

New Jersey’s Dept. of Banking and Insurance has posted individual market health plan prices for 2019. Thanks to the state’s new reinsurance program, state-based individual mandate, and silver loading (actively encouraged by DOBI), unsubsidized enrollees will see price drops from 2018. For the subsidized, it looks pretty much like status quo ante — although network changes and plan design changes could alter that picture.

As was the case last year, AmeriHealth has sewn up all the lowest price points. AmeriHealth and Oscar are offering discounted silver plans off-exchange — presumably because of silver loading (Cost Sharing Reduction, available only with silver plans and only on-exchange, is not priced into off-exchange silver). Horizon is not offering any off-exchange discounts, but it has dropped prices about 7% from last year. A few salient year-to-year comparisons below. Quoted premiums are for a 46 year-old — where they’re a clean 1.5 times the base rate posted by DOBI. Andrew Sprung at xpostfactoid

More states should follow New Jersey’s lead.

Further evidence that the tax cuts have not led to widespread bonuses, wage or compensation growth. Economics Policy Institute.

Newly released Bureau of Labor Statistics’ Employer Costs for Employee Compensation data allow us to examine nonproduction bonuses in the first two quarters of 2018 to assess the trends in bonuses in absolute dollars and as a share of compensation. The bottom line is that there has been very little increase in private sector compensation or W-2 wages since the end of 2017. The $0.03 per hour (inflation-adjusted) bump in bonuses between the fourth quarter of 2018 and the second quarter of 2018 is very small and not necessarily attributable to the tax cuts rather than employer efforts to recruit workers in a continued low unemployment environment.

“Saving the Planet Doesn’t Mean Killing Economic Growth”

Noah Smith: Hickel cites analyses by the United Nations Environment Program and others showing that even big improvements in resource efficiency, encouraged by very high carbon taxes, will be unable to halt overall resource use or global carbon emissions. But this evidence doesn’t support Hickel’s conclusions, which rely on several misconceptions about the nature and the importance of growth.

Hickel doesn’t seem to grasp the fact of most economic growth happening in countries that are relatively poor. From 2010 to 2015 as determined by estimates by the IMF emerging markets, developing countries were responsible for about 70 percent of global output and consumption growth and advanced economies were responsible for the rest. World Bank’s forecasts for 2017-2019 are similar.

China’s contribution to global growth will be double the U.S. growth and India’s will be larger than the whole of the entire euro zone. The same is true of greenhouse gas emissions. Since about 1990, emissions from the U.S. and EU have fallen, while emissions from developing countries such as (and especially) China and India have exploded.

In 2017, the International Energy Agency estimated that the growth in energy-related carbon emissions in China and the rest of developing Asia was more than five times the growth in the European Union while U.S. emissions declined.

If Hickel and others succeed in stopping economic growth in developing countries, it will not be rich countries bearing the brunt of the change. It will be poor and middle-income countries such as India and China. The desperately poor African countries will not a chance at increased prosperity.

$600,000 in Debt and the Crisis is Worsening “The student loan default rate more than doubled between 2003 and 2011, and 40 percent of borrowers are expected to fall behind on their loans by 2023.”

There is a long history of Congress favoring financial institutions with laws and regulation blocking students from debt relief. Yet, our president can bankruptcy relief multiple times without any court or law blocking him. For him it is business as usual, getting a new loan to buy property and increase profits, pay the old loan with then new loan, and declaring bankruptcy when costs exceed cash inflow. Students do not have the luxury of gaming the system.

With the cost of an education in this country is only rising, borrowing is unlikely to slow. State funding for public colleges fell by $9 billion between 2008 and 2017, and the gap has been filled with tuition hikes. For the first time, half of all states relied more heavily on tuition last year than on government appropriations to fund higher public education. Americans now spend an approximate $30,000 per student a year to gain a college education or twice as much as the average developed country.

The IBR and Repaye programs put in place by well-meaning advocates has been a failure due to a lack of understanding in how to manage it yearly and with some servicers such as Naviente deliberating misleading students into multiple postponements of loans instead of into the income-driven repayment plans. The plans cap monthly payments at a percentage of the borrower’s income. It is not the first-time commercial interests have lied to students and taken a predatory approach on student loans. Naviente is being sued by five states and the CFPB.

Indian sailor Abhilash Tomy injured on disabled yacht.

A multinational rescue effort is underway to try to reach an injured sailor whose yacht is disabled in the South Indian Ocean.

Abhilash Tomy, a 39-year-old Indian naval commander, was competing in the 2018 Golden Globe Race. The race is a nonstop, 30,000-mile solo yachting competition that bars the use of modern technology. To me, this sounds like a lot of fun and a lot of work. I always like to sail as the quiet of the water is soothing.

Abhilash Tomy boat the “Thuriya,” hit a storm in the South Indian Ocean. The 36-foot boat was one of several hit by 80 mph winds and 46-foot seas midway across the South Indian Ocean on Friday, day 82 days of the race. Thuriya’s mast was broken about 1,900 miles southwest of Perth, Australia and “at the extreme limit of immediate rescue range,” according to media statements.

Organizers became concerned after Tomy sent a text message reading: “ROLLED. DISMASTED. SEVERE BACK INJURY. CANNOT GET UP,” and then was unheard from for nearly 15 hours. In a later satellite text message, the sailor gave his location and wrote: “ACTIVATED EPIRB (Emergency Position Indicating Radio Beacon). CANT WALK. MIGHT NEED STRETCHER.”

What is the White House Deflecting from Now?

It is no secret one of the strategies used by the White House is to deflect attacks on their agenda by creating another emer . . . spectacle . . . gency when the news and the opposition gets close to defeating their plans. The attack on Rosenstein as led by the NYT is just too easy, convenient, and laughable (almost). The deflections have happened too many times already. Trump holds Fire

Continuing on this path; “Kavanaugh Accuser Agrees to Testify” I am sure Grassley and other members of the Senate, Hatch, Cornyn, Cruz, Hannity, and the tier two Senators such as Flake, etc. will make this debacle into another shameful attack on Ford, women, and the truth. What, no women on the Repub side? I am sure the 4 women on the Dem side can support Ford and strike back.

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Some History

In 1980, a letter to the editor of the New England Journal of Medicine by the Boston Collaborative Drug Surveillance Program stated “the risk of addiction was low when opioids such as oxycodone were prescribed for chronic pain.” It was a brief statement by the doctors conducting the study which was cited many times afterwards as justification for the use of oxycodone.

In a June 1, 2017 letter to the NEJM editor, the authors reported on the broad and undocumented assumptions made as a result of the 1980 Letter on the Risk of Opioid Addiction. Using bibliometric analysis of the impact of this letter to the editor, the citations of the 1980 letter were reviewed to determine the citation’s portrayal of the letter’s conclusions.

Identified in the bar chart are the number (608) of citations of the 1980 letter over a period of time from 1981 to 2017.

“72.2% (439) of the citations, quoted the letter or used it as evidence addiction was rare in patients when treated with opioids such as oxycodone. 80.8% or 491 of the citations failed to note the patients described in the letter were hospitalized at the time they received the prescription.”

There was a sizable increase of citations after the introduction of OxyContin (extended release oxycodone) in 1995. As the analysis noted “affirmational citations of the letter have become less common in recent years in contrast to the 439 (72.2%) positive and supporting citations of the 1980 correspondence in earlier years. The frequency of citation of this 1980 letter stands out as being unusual when compared to other published and cited letters. Eleven other published, stand-alone, and more recent letters on different topics published by the NEJM were cited at a median statistic of 11 times each.

Citations of the 1980 stand alone letter on “addiction being rare” from the use of opioids such as oxycodone failed to mention, the patients administered to were in a hospital setting as noted in the letter by Porter and Jick. Overlooked, a mistake by the people citing this letter? “In 2007, the manufacturer of OxyContin and three senior executives of Purdue Pharma plead guilty to federal criminal charges that they misled regulators, doctors, and patients about the risk of addiction associated with OxyContin.”

Organization: “An early manifestation of the opioid abuse, addiction, and overdose problem occurred largely in the rural regions of Kentucky and other parts of Appalachia after the introduction of Oxycontin. A brand name for oxycodone, OxyContin was introduced in 1996 by Purdue Pharma and aggressively sold to doctors. Sold as a less-addictive alternative to other painkillers as it was made in a time-release formulation, allowing for a slow onset of the drug, and not a hit all at once which is more likely to lead to abuse. When used as prescribed, Oxycontin was safe. When ground up, it’s slow release characteristics were marginalized.

The aggressive sales pitch led to a spike in prescriptions for OxyContin of which many were for things not requiring a strong painkiller. In 1998, an OxyContin marketing video called “I Got My Life Back,” targeted doctors. In the promotional, a doctor explains opioid painkillers such as OxyContin as being the best pain medicine available, have few if any side effects, and less than 1% of people using them become addicted.

Shortly after 1996, Porter and Jick’s letter citations doubled and continued to be cited in a positive fashion with few negative citations and a failure to mention the hospital setting where the drugs were administered.

More Recent

By 2015 over a six-year period, more than 183,000 deaths from prescription opioids were reported in the United States. Today, millions of Americans are now addicted to opioids.” In part much of this was the result of doctors being told there was a low risk to opioid addiction.

Figure 2 shows each year being progressively worse and reaching a record high of 71,568 deaths (2017) in the US due to all drug overdoses as reported by the Centers for Disease Control (CDC) in their “Provisional* estimates on U.S. drug overdose. According to the CDC this is a record and represents a 6.6% national increase in overdose deaths over 2016.

At the end of the 12-month period of January 2018, the reported deaths was 69,703. The final and predicted number of deaths is expected to be as high as 71,568. 0.18 of 1% of the reports are pending the completion of investigation (numeric within chart). *Underreported due to incomplete data.

*Provisional counts of all drug overdose deaths are underestimated relative to final counts. The degree of underestimation is determined primarily by the percentage of records with the manner of death reported as “pending investigation” and tends to vary by reporting jurisdiction, year, and month of death. Specifically, the number of drug overdose deaths will be underestimated to a larger extent in jurisdictions with higher percentages of records reported as “pending investigation,” and this percentage tends to be higher in more recent months”.

In 2018 law makers questioned Miami-Luken and H.D. Smith wanting to know why millions of hydrocodone and oxycodone pills were sent (2006 to 2016) to five pharmacies in four tiny West Virginia towns having a total population of about 22,000. Ten million pills were shipped to two small pharmacies in Williamson, West Virginia. The number of deaths increased along with the company and wholesaler profits.

For context, the nearly 72,000 drug overdose deaths (spurred by the ongoing opioid painkiller addiction epidemic, including the increased use of more potent synthetic opioids [fentanyl]) outpaced fatalities from suicide, or from influenza and pneumonia, which claimed about 44,000 and 57,000 lives in 2016. It nearly rivaled the approximately 79,500 people who die from diabetes-related complications each year in the U.S. (the 7th leading cause of death).

Nearly 150,000 Americans die each year from accidents such as car crashes, injuries, or accidental overdoses. If the CDC’s latest figures are accurate, drug overdoses could account for nearly half of accidental deaths.

As tends to happen with public health epidemics, overdoses have an outsize effect in certain regions. For instance, the biggest spike in fatalities by percentage occurred in Nebraska, North Carolina, New Jersey, Indiana, and West Virginia (33.3%, 22.5%, 21.1%, 15.1%, and 11.2% rises, respectively). But areas like Wyoming, Utah, and Oklahoma experienced declines of 9.2% to 33%.

With the clamp down on opioid prescriptions by doctors due to the abuse, addiction, and overdoses, those addicted to opioids turned elsewhere. Again Recall Report;

“In 2015 heroin overdose deaths in the U.S. surpassed the number of deaths by gun homicide for the first time ever. In addiction treatment facilities around the country, heroin addiction is becoming the most common reason to enter treatment, surpassing even alcohol addiction.

In combatting the prescription painkiller addiction epidemic, public officials may have unwittingly contributed to the heroin epidemic. As prescription opioids became more difficult to obtain and more expensive, addicts turned to a cheaper similar high: “heroin.” Mexican drug cartels were more than willing to supply the demand and much of the cheap heroin in use in the country now comes through Mexico.”

The ease of accidentally overdosing can be a tragic consequence resulting from the abuse of opioids and heroin. Both drugs act upon areas of the brain controlling breathing and depress it. Too much opioid drug can cause a person to stop breathing and their subsequent death. Add alcohol or a sedative and the risk increases. To combat the impact of overdosing on opioids or heroin, Narcon in an injection or a nasal spray format acts as an antagonist reversing the effects of opioids and the overdose.

Stopping the abuse of opioids is an important measure in gaining control of the growing number of people becoming addicted to opioids and dying from its abuse. Once addicted, treatment is essential with detox and withdrawal the first painful step back to a normal life. Without supervised treatment and/or residing in a residential treatment center, the return to opioid usage and addiction is easy as the cravings for using it again are powerful. As a resident in a treatment center, therapy, support, and medical treatment with drugs is possible.

The abuse of opioids and subsequent addiction will remain a problem for years to come until the supply of it is brought under control.

Prescription Painkiller Addiction: A Gateway to Heroin Addiction, Recall Report Organization

A 1980 Letter on the Risk of Opioid Addiction, NEJM, June 1, 2017

Supplementary Appendix NEJM, June 1, 2017; Copy of Porter and Jick’s letter to NEJM in 1980.

Provisional Drug Overdose Death Counts CDC, National Center for Health Statistics, August 5, 2018

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