Relevant and even prescient commentary on news, politics and the economy.

Pelosi Challenging Outdated Norms

From Washington Monthly Nancy LeTourneau

On Wednesday some young climate activists joined by newly elected Alexandria Ocasio Cortez held a demonstration at Nancy Pelosi’s office. While we can debate whether it is a smart move to hold such an event at the office of a leader who is on your side as opposed to the myriad of Republican leaders who are climate deniers, Pelosi welcomed them with open arms.

Pelosi Nov 13, 2018

Deeply inspired by the young activists & advocates leading the way on confronting climate change. The climate crisis threatens the futures of communities nationwide, and I strongly support reinstating the select committee to address the crisis.

We welcome the presence of these activists, and we strongly urge the Capitol Police to allow them to continue to organize and participate in our democracy.

These types of actions are what makes Pelosi a great leader and is a wonderful example of how Democrats embrace grassroots activism and organizing.

As it happened on the same day some House Democrats were organizing against the election of Pelosi as the next Speaker of the House, there are those who mistakenly conflate the two developments. But the group challenging Pelosi’s leadership is completely different.

As Paul Krugman noted on twitter, this is a group that is “still in the old cringe position, buying into GOP demonization (which happens to any strong Democrat) despite a huge midterm victory.” Cringing at the GOP’s demonization is a tactic that too many Democrats embraced in the past and is what sent so many of them on a journey rightward in search of validation. In other words, it is a losing strategy undermining liberal values. The really superb Democratic candidates in the 2018 midterms completely rejected the approach and it is clear that Nancy Pelosi joins them.

The theme demonstrated by Nancy Pelosi and well articulated by Nancy LeToureau at WM? In her leadership role, Pelosi is challenging some of the old vestiges of power and strengthening the small “d” democratic processes in overall party. It should come as no surprise that these changes are being resisted as power shifts from top-down to bottom-up. But it’s important for all of us to be clear about exactly what’s happening and weigh in accordingly.

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The AMA is Calling for a Relaxing of CMC Opioid Prescription Restrictions

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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Initial markers for a manufacturing slowdown now hit

Initial markers for a manufacturing slowdown now hit

I have a new article that hopefully will get posted by Seeking Alpha later today.  In the meantime …

Two weeks ago I wrote an article establishing a manufacturing baseline for my forecast of an economic slowdown by about the middle of next year. I concluded that by saying:

the first thing I am looking for is decelerating growth which will show up in a reading below 15 in the average of  Regional Fed reports, and below 60 in ISM new orders.

The ISM new orders index did fall below 60 to a new nearly 2 year low (but still positive!) at the beginning of this month.

This could of course all be noise, but I’ve made a forecast, I’ve laid down some markers, and the data is – at least on an initial basis – hitting those markers.

*(okay, technically not “below” 15, but close enough).

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Changes in labor bargaining power take up to a decade to be fully effective

Changes in labor bargaining power take up to a decade to be fully effective

Sorry for the recent lack of posting on economic matters. Partly it is ennui, and partly it is a near total dearth of data in between the employment report a week ago Friday and tomorrow’s CPI report.  Even a couple of quarterly series I usually report on have been inexplicably delayed.

In the meantime, here is a graph from Jared Bernstein that is worth some extended comment. It is the YoY% change in real wages, adjusted by the full CPI (blue) and CPI less energy (gold):

It is worthwhile to remember that, since 1980, YoY inflation has been decelerating on a secular basis:

 

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A Serious Centennial

A Serious Centennial

After failing to show up at a major American cemetery in France at least our president did not add to his shame by failing to show up for the big show with 60 or so other national leaders at the Arc de Triomphe for the official ceremony marking the centennial of the 11th hour on the 11th day of the 11th month of November, 1918, when the guns fell silent on the western front of World War I, officially ending it in the eyes of most historians, even though fighting would escalate in certain other important zones whose outcomes still shake the world, most notably between Greece and Turkey, with the dissolution of the Ottoman Empire coming out of that leading to many wars since, some of them gong on right now.  We get it that Trump was uncomfortable given that President Macron was lecturing against the sort of nationalism that led to WW I, with a three day forum to follow that Trump will run as fast as possible back to the US to avoid. And, hey, Macron did not even have tanks and missiles for the parade this time, which Trump really likes to see.

This important day, the first Armistice Day, which we renamed Veterans Day in the US after the War to End All Wars’ unfortunate sequel (actually  in 1954 right after the end of the “forgotten” Korean War) and have since turned into one of those Monday holidays, has turned into a curiously sad one personally.  It involves another war, Vietnam.  My cousin, Bill Atwater, died yesterday, the day before this serious centennial and also the 243rd birthday of the U.S. Marines.  Yes, Bill was a Marine and was in Vietnam where he was exposed to Agent Orange that led him to have various cancers that basically led to his death, although it was an opportunistic pneumonia that finally actually did him in.  He will be cremated with his ashes spread over the cemetery at Arlington. I had not communicated with him directly for over 20 years (did through another cousin), but he told me at his mother’s funeral that he had been spat on when he returned to the U.S.  I have more recently seen stories that such reports were exaggerated, if not outright true.  As it is, I have no way of checking on Bill’s story now, but I know  that he was a multiply wounded man.

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Is It Not The Economy, Stupid?

Is It Not The Economy, Stupid?

On many Mondays I indulge in taking Robert J. Samuelson to task after his regular Washington Post column of the day.  Today he was almost right, or if you prefer, even mostly right.  This one was titled “It’s Not the Economy, Stupid” about the outcome of the midterm election, as well as a delayed comment on the 2016 presidential election (although, of course, HRC did win the popular vote by three million popular votes, if not the electoral college).  His main argument is that in both of these elections, but especially last week’s midterms, the state of the economy was relatively unimportant.  The argument is that here is Trump with GDP growth exceeding 3%, the unemployment rate under 4%, inflation largely under control, but this supposedly good performance did not help him out much with his party taking a pretty serious hit (the size of which still being counted).  He also sees something similar in 2016, although arguably the economy was not as strongly favorable, but still quite respectable while not obviously helping the incumbent party.  Indeed, in 2016 many saw the economy as hurting the Dems, especially in the Rust Belt.

There is a lot of truth to this, with a lot more attention on ethnic and cultural issues, although it should be kept in mind that the top issue for Dems, health care, is at least partly an economic issue.  Certainly one sign of the weakness of the economic issue is the matter of the big GOP tax cut.  They were quite convinced when they passed it last December that this was their ticket to a strong showing in the midterm election.  And indeed it is almost certain that at least some of the acceleration of GDp growth can be attributed to it even if it may be setting up the economy for slower growth down the road.  So according the usual views, it should have helped the GOP. But in the end it seems to have been an electoral flop.  It has consistently done poorly in the polls, and most GOPs running for reelection in the end barely mentioned it.

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The Death of Shame

The Death of Shame

In any society not in a state of civil war, shame is a powerful force, perhaps the most powerful.  Individuals or organizations caught cheating, lying or otherwise doing evil, when exposed and called out, are expected to be embarrassed.  They should repent their sins and promise to make amends.  Other than pure coercion, what else can disarm those who violate the norms of society?

Evolutionary biologists tell us shame is hardwired not only in humans but many other social animals.  (They may not experience shame the same way humans do, but the outward markers and consequences are the same.)  We seek group membership in good standing, and while there is an incentive to exploit others for personal gain, or just relax our commitment for a while, the punishment of group rejection is a more powerful force.  That’s what holds us together.

It is natural that shame is invoked as a political weapon.  Corrupt businessmen, politicians and public officials may be flying high, but if we can document the facts they are trying to hide, we can clean them out.  A video documenting otherwise hidden police abuse, an audio recording of the murder of civilians released by Wikileaks, the disclosure of evidence of law-breaking by justices or political leaders should accomplish this.  Also testimony from women abused by powerful men: if they come forward and tell the world what really happened, that should stop abuse in its tracks.

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