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Sunday Snark

Sunday Morning “New Yorker

WASHINGTON (The Borowitz Report)—Millions of Americans do not want Donald J. Trump to text them that there is an emergency, but “very strongly” want Robert Mueller to text them when this current emergency is over, a new poll shows.

FEMA’s about-to-be-launched “Presidential alert” system drew a sharply negative reaction in the poll, with a majority of Americans saying that they would burn, smash, or otherwise pulverize their phones in advance of the first text that Trump attempts to send them.

By contrast, and by a wide margin, Americans said that they wanted an alert system that would enable Mueller to text them “the second he knows this shit show is over,” the poll indicates.
Poll respondents were amenable to a broad array of methods by which Mueller might deliver such news, including the one-word text “FINITO,” the phrase “ORANGE CRUSHED,” and emojis depicting a thumbs-up or smiley face.

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Fighting Opioid and Painkiller Addiction

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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Dutch Police React to Knife Attacker

‘A suspect has been shot after a stabbing incident at Amsterdam Central Station,’ Dutch police said on Twitter.”

Briefly:

– Two people stabbed by an attacker.
– Three shots fired by Police.
– Two victims stabbed taken to the hospital.
– Wounded attacker taken to the hospital.

Attacker did not have a bullet-spewing-weapon. No 30 rounds sprayed about by police. No one dead.

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Reskilling America

Conversable Economist Tim Taylor presents a chart representing spending over a life time on Education and Skills in America.

“Figure 4 (depicted) is from a report by the White House Council of Economic Advisers, titled “Addressing America’s Reskilling Challenge” (July 2018). The blue area shows public education spending, which is high during K-12 years, but the average spending per person drops off during college years. After all, many people don’t attend college, and of those who do many don’t attend a public college. Private education spending shown by the red area takes off during college years, and then trails off through the 20s and 30s of an average person. By about age 40, public and private spending on education and skills training is very low. Spending on formal training by employers, shown by the gray area, does continue through most of the work-life.

The figure focuses on explicit spending, not on informal learning on the job. As the report notes: “Some estimates suggest that the value of these informal training opportunities is more than twice that of formal training.” Nonetheless, it is striking that the spending on skills and human capital is so front-loaded in life. The report cites estimates that over a working lifetime from ages 25-64, the average employer spending per person on formal training totals about $40,000.”

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Monopoly Politics

“The national landscape in 2018 tilts in favor of Republicans with Republicans sitting on 208 safe seats, 10 seats away from a majority, and 22 additional and not projected seats leaning Republican(too close to call).” It would take Democrats casting 55% of the votes in a national two-party election to tip the House majority the other way. It is possible as it did happen in 2008 when there was a 57% turnout.

What makes the following projections disturbing is the accuracy of Fair Vote projections does not take into consideration polls, demographic characteristics of the districts, incumbent’s voting record, any scandals, or money spent. The basis for these projections are the presidential election results (both in the district and nationally) from 2016, and an incumbent’s performance in prior elections. The only changes incorporated are when incumbents announce they will not seek re-election or when a state redraws congressional district lines. The methodology in the report is in detail with the only overwhelmingly important factor being a district’s partisanship measured only by the relative presidential vote in that district.

I have advocated for much smaller congressional districts along the lines of what is in Article 1 Section 2 of the Constitution which would remove much of the ability to gerrymander, give greater representation to people, and make Congressional representations responsive to the interests of the district rather than a select group in power. Fair Vote advocates another way worth taking into consideration. Read more of the site for a explanation. The following is how they view the 2018 House election outcome

Rather than follow 538 or Princeton Consortium both of who made a mess out of the 2016 election, I picked up on Fair Vote Organization. With 435 House Seats being elected every two years, one could believe there would be a small number of incumbents reelected each cycle. It is safe to say, the percentage returning to office is projected at 86% by the Fair Vote Org. or 374 seats secured by incumbents. So much for a Blue Wave? Incumbents can feel relatively secure in returning to office regardless of the opponent, how much is spent, or type of partisan wave occurring. The following chart represents 2018 Projections including Toss-Ups.

Supporting their bold projections is a legacy of accuracy in 2012, 2014 and 2016 for 1,062 House races and missing only once (1). 99.9% correct is a good accuracy rate to have. The 2018 report shows the most ossified electoral landscape yet, being the first year we have projected more than 370 seats at this degree of confidence. Fair Vote does have a map on site showing each congressional seat as an equal area and which ones are in play (yellow seats). The purple seats are all safe enough to be projected with high confidence.

In addition to 374 high-confidence projections, Fair Vote also projects favorites for the other 61 seats with a lower level of confidence. 40 of the 61 seats favor one party over the other, not enough to warrant a projection, and leaves only 21 true “toss up” seats leaning slightly lean to one party.

Previous projections for all 435 seats in 2016 were remarkably accurate including those made for the lower confidence seats. Of the 56 seats Fair Vote did not project; but which favored one of the parties, Fair Vote was right in 50 picks or 89.3% correct. Of the 18 seats identified as “toss ups” with a slight lean to one of the parties; Fair Vote was right in 12 or 66.7% correct. In 2016 Fair Votes full projections were correct in 423 of 435 districts or 97.2% correct. The clincher was the projections were made more than two years before the 2016 elections. The following chart represents current projections, favored, and a breakdown of tossups.

Our ’18 House Projections: Monopoly Politics Remains in Place, Fair Vote Organization

Fair Vote Organization

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Cuomo: America ‘was never that great’

Gov. Andrew Cuomo at an event, where he signed anti sex-trafficking bills into law. “We’re not gonna make America great again. It was never that great. We have not reached greatness and we will reach greatness when every American is fully engaged.

We will reach greatness when discrimination and stereotyping against women, 51 percent of our population, is gone and every woman’s full potential is realized and unleashed. When every woman is making her full contribution . . . when that happens, this nation is going to be taken even higher.”

A Republican response? “America, with its imperfections, has always been great, our people, our principles, and our promises have been a beacon light to the world for 242 years and counting.”

Wow, reflections of Ronald Reagan.

“Governor Mario Cuomo (father) challenged President Reagan’s shining city metaphor and offered one of his own. He asserted that America is more a ‘Tale of Two Cities’ than it is a ‘Shining City on a Hill,’ and Republican policies such as trickle down economics ‘divide the nation into the lucky and the left-out.’”

The Hill, America Was Never that Great

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States Fight non-ObamaCare Health Plans

The Trump administration’s new policy of expanding the sale of “short-term” insurance plans as a cheaper alternative to ObamaCare is quickly running into opposition from state regulators.

The Department of Health and Human Services is urging states to cooperate with the federal government, but instead, insurance commissioners are panning the new plans as “junk” insurance and state legislatures are putting restrictions on their sales.

State insurance officials argue that, despite being less expensive than ObamaCare plans, the short-term plans are bad for consumers and aren’t an adequate substitute for comprehensive insurance.

“These policies are substandard, don’t cover essential health benefits, and consumers at a minimum don’t understand [what they’re buying], and at worse are misled,” California Insurance Commissioner Dave Jones (D) said.

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Mid Week Clips

Sleepers in Hong Kong McDonalds

I have eaten at the McDonalds in Hong Kong over the years. Just smaller portions and only after I grew tired of fish and veggies. I think I told the story of coming off The Wall, making my way down a road with my Chinese associates towards a Chinese restaurant, and turning the corner to eat at a KFC (their choice). It back upped to The Wall. They loved it.

According to a survey, in just five years there has been a six-fold increase in so-called McRefugees in Hong Kong or residents who spend their nights sleeping in the 24-hour McDonald’s outlets across the city.

People Keep Shooting Up the Emmet Till Sign

Hate and bigotry dies hard in some places.

Shot-up Emmett Till Memorial

Kroger To Stop Accepting Visa

A California subsidiary of Kroger will stop accepting Visa credit cards next month in a dispute over swipe fees.

“Foods Co. Supermarkets said it would no longer take Visa credit cards beginning Aug. 14. The ban will cover 21 stores and five fueling centers in central and northern California. Shoppers will still be able to use Visa debit cards, as well as cards from other networks such as Mastercard, Discover and American Express.”

The cost of swiping using a debit card and computerized systems are getting out of hand. In 2014, Walmart filed suit against Visa alleging it cost $350 million in fees from 2004 to 2012.

Trump Admits to Meeting

“President Trump said on Sunday that a Trump Tower meeting between top campaign aides and a Kremlin-connected lawyer was designed to “get information on an opponent” — the starkest acknowledgment yet that a statement he dictated last year about the encounter was misleading.”

Too Little Too Late’: Bankruptcy Booms Among Older Americans

For a growing number of older Americans, traditional ideas about life in retirement are being upended by a dismal reality . . . bankruptcy.
The signs of potential trouble such as vanishing pensions, soaring medical expenses, inadequate savings have been building for years. Now, new research sheds light on the scope of the problem. The study found the rate of people 65 and older filing for bankruptcy is three times what it was in 1991 and the same group accounts for a far greater share of all filers.

Steel Giants With Ties to Trump Officials Block Tariff Relief for Hundreds of Firms

“Charlotte-based Nucor, which financed a documentary film made by a top trade adviser to Mr. Trump and Pittsburgh-based United States Steel which has previously employed several top administration officials have both objected to the 1,600 exemption requests filed with the Commerce Department.

To date, their efforts have not failed and resulted in denials for companies based in the United States but rely on imported pipes, screws, wire and other foreign steel products for their supply chains.

The ability of a single industry to exert so much influence on the exclusion process is striking even in Mr. Trump’s business-friendly White House, given the high stakes for thousands of American companies that depend on foreign metals. The boundaries of trade policy are being tested by the scope of Mr. Trump’s multifront trade war with allies and adversaries alike, which includes tariffs on up to $200 billion worth of goods from China and possible tariffs on automobiles and auto parts.”

Commerce Department: 59% of the denials come in cases where United States Steel, Nucor, or a third large steel maker AK Steel Holding Corporation have filed an objection. Nearly all of the rest were in cases where the company applying for an exclusion erred in its submission.

Economy Adds 157,000 Jobs in July, Little Evidence of Pick-up in Wage Growth Mark Thoma cites Dean Baker’s Report

“In spite of the healthy pace of job growth and the low unemployment rate, there continues to be little evidence of accelerating wage growth. Over the last year, the average hourly wage has risen by 2.7 percent. There is a very small uptick to 2.87 percent if we annualize the rate of wage growth for the last three months (May, June, and July) compared with the prior three months (February, March, and April).

Interestingly, there was a modest fall in hours in July, which led to a decline in the index of aggregate weekly hours from 110.0 to 109.8. As a result, the average weekly wage actually declined slightly in July.

The leading sector for job gains in July was manufacturing, which added 37,000 jobs, all but 5,000 of which were in the durable goods sector. Employment in the sector is up by 327,000 over the last year, an increase of 2.6 percent.”

NDD has covered similar in his posts at Angry Bear.

Notes On A Butter Republic

Paul Krugman: Denmark, where tax receipts are 46 percent of GDP compared with 26 percent in the U.S., is arguably the most social-democratic country in the world. According to conservative doctrine, the combination of high taxes and aid to “takers” must really destroy incentives both to create jobs and to take them in any case. So, Denmark must suffer from mass unemployment, right?

Yep, Danish adults are more likely to be employed than their U.S. counterparts. They work somewhat shorter hours, although that may well be a welfare-improving choice. But what Denmark shows is that you can run a welfare state far more generous than we do – beyond the wildest dreams of U.S. progressives – and still have a highly successful economy.

Indeed, while GDP per capita in Denmark is lower than in the U.S. – basically because of shorter work hours – life satisfaction is notably higher.

Short Term Healthcare Policies

Good Discussion at Kaiser on Trump/Republican Compliant Short Term Policies and what they will and will not cover.

The Affordable Care Act (ACA) exempted short-term policies from market rules that apply to most major medical health insurance policies sold to individuals in the non-group market: rules that prohibit medical underwriting, pre-existing condition exclusions, and lifetime and annual limits, and that require minimum coverage standards. By contrast, short-term policies:

• are often underwritten with pre-existing medical conditions in mind. Applicants with health conditions can be turned down or charged higher premiums, without limit, based on health status, gender, “age,” and other factors;
• exclude coverage for people with pre-existing conditions – policyholders who get sick may be investigated by the insurer to determine whether the newly-diagnosed condition can be considered pre-existing and excluded from coverage;
• do not have to cover essential health benefits – typical short-term policies do not cover maternity care, prescription drugs, mental health care, preventive care, and other essential benefits, and may limit coverage in other ways;
• can impose lifetime and annual limits – for example, many policies cap covered benefits at $2 million or less;
• are not subject to cost sharing limits – some short term policies may require cost sharing in excess of $20,000 per person per policy period, compared to the ACA-required annual cap on cost sharing of $7,350 in 2018 ; and
• are not subject to other ACA market requirements – such as rate review or minimum medical loss ratios.

In comparison, an ACA Catastrophic plan covers all essential benefits, allows 3 PCP visits per year, and will cover certain preventative services at no cost for people under 30. If your income is that low for either Trump’s plan or the ACA plan, you are better off to get a Bronze or Silver plan as you will be eligible for a subsidy. The new version by Trump and Azar is a ripoff.

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