Doing the Opioid Crisis Rag

Heard a talk from a former New Hampshire House of Representatives Rep, a physician, about the opioid crisis and about all those deaths from Fentanyl in New Hampshire which earned us a shout out from President Swamp Boy about New Hampshire being a "drug infested den."

He showed a slide which showed that New Hampshire, second in the nation in drug deaths, is 49th in spending on drug rehab programs, the suggestion being that if we only weren't so cheap, and valued the lives of these people who are using opioids, we could save them. 

He did not have a slide which showed the expenditures of the other states on the X axis and drug deaths on the Y axis: In other words he did not know if the states which spent the most money on drug rehab programs had fewer deaths, and if this correlation exists is this because there are fewer drug deaths in richer states because when people are rich and have a lot to live for, they don't take drugs?

Of course, there are lots of stories of affluent white kids dying of drug overdoses, but the reasons for that are not well examined, as far as I can see.

A little defensive, are we?

The National Institutes of Health has a National Drug Abuse Institute and on this site they attempt to answer a Frequently Asked Question: Do drug rehab programs actually work?  Intelligently, the authors say, well it depends on what you mean by a program "working." They feature a graph showing that during the actual treatment program, those enrolled in drug rehab programs have fewer drug overdoses, but afterwards a sizable number return to drug use, in about the same proportions as people who are hospitalized for asthma continue to need treatment for asthma and people hospitalized for type 1 diabetes need ongoing treatment.
Oh, that's reassuring. 
Really, what they are saying is like alcoholism, heroin addiction is for life and you need constant attention.

This answer stinks strongly of self interest, the bias of a group of practitioners whose salaries depend on the notion that what they are offering is effective.

Of course, every time the deaths of young people are presented to politicians, they run for cover and talk about the government programs, the spending they are directing at the problem.  This is a shield for the politicians, but as far as I can see, there is precious little evidence these programs or expenditures actually prevent drug deaths in the medium to long run. 
It reminds me of the point in the diabetes lecture when the guy says, well, of course, you have to refer your patients to a registered dietitian and everyone in the audience is thinking--oh, good, now I can wash my hands of that obligation. But, of course, the nutritionists have nothing effective to offer: Well, count your carbs and eat what is pictured on this poster and you will notice absolutely no benefit at all. 

It may be dated, and it is focused on the inner city drug culture, but "The Wire" presents a detailed discussion and depiction, which if people actually watched the 5 seasons, would convince most of them what we are doing and calling "drug rehab" is insanity.

There was an old cynical jibe at the cancer hospitals: More people make a living off cancer than actually die of it.  When I listened to the programs mentioned tonight, involving certification of Drug Rehabilitation Coaches and in patient facilities and outpatient clinics, that came to mind. Lots of people cashing in on the efforts to treat drug addiction and drug deaths are benefiting. The patients, not so much.

Portugal has taken an radically different approach to drug deaths and drug disability: It decriminalized drug use and drug possession and treats addicts as patients.
They still prosecute drug dealers, oddly enough. Not sure how they do this.
But deaths from drug use related HIV, subacute bacterial endocarditis and hep C diagnoses have plummeted in Portugal. 
Until we actually want to face the uncomfortable truths in America about what drug use means, and how we should regard drug abusers, we likely will spend money foolishly, and we'll pat ourselves and our politicians on the back and ignore the real problems and their solutions and the deaths and associated diseases will continue.

Until liberal politicians take a hard look at reality, engage in tough minded analysis of what we call "drug rescue programs" they will continue to look like opportunists who always have an easy answer, and no credibility.

Justice Scalia and A Well Regulated Militia

If ever you need a good laugh, or if ever you need a good cry, or if ever you need something to get your blood boiling and your brain exploding, just to reassure yourself you are actually still alive and capable of outrage, or if you simply want to reassure yourself that mental masturbation was alive and well among the justices of the Supreme Court in June, 2008, go on line and read Justice Scalia's opinion which reversed centuries of Supreme Court precedent and delivered the right of any half witted citizen the right to buy, possess and use firearms in the comfort of his own home. Not just firearms, but specifically hand guns.

The case is "Heller v District of Columbia," and, to Scalia's credit, he begins with the "prefatory phrase" which he agrees is "unique" in the Constitution, in that it is the only place in either the Amendments (Bill of Rights) or the articles where the founders (of whom Scalia is enamored to the point of ancestor worship) actually explain why they are granting and defining a "right."

Scalia has a real problem here and over the next 10 pages or so he tries to wriggle out of his dilemma with allusions to what the country was like in those days when gods in powdered wigs roamed the land and wrote the Constitution, which, next to the Bible, is the holiest book on earth, handed down engraved originalist parchments, which may or may not have been in gold plates, buried and then rediscovered--I'm not sure, I may be mixing up the Bible with the Constitution or the Book of Mormon.

The problem, of course, is that the founding fathers did not always write with the precision and clarity of Madison, but sometimes more in the ornate and blurry style of Hamilton, who may have written like he was running out of time, which is to say, voluminously, but who often could have done us all a favor if he had taken time to edit.  But, in the case of the Second Amendment, they took care to say, okay, this might sound a little crazy, but since we have no standing army and the only way we have of defending our new nation is these local militias made up of men who have a flintlock above their mantle places, we have to assure that no government, like the King's government we knew in the early part of the 18th century, will come by and demand citizens hand over their guns.

After all, we need those militias, as long as they are "well regulated."  The founding fathers, note, did not shrink from that idea of "regulations."  (Donald Trump would not have done well as a founding father. )

Of course, for Justice Scalia, it's always a question of "What would Jesus do?"  or, in the secular case of the Constitution, "What would Jefferson and Madison have said?"

So he gets to arguing with Justices Stewart and Ginsburg over the meaning of to "keep and bear"  arms.  He digs out his 1773 edition of Samuel Johnson's dictionary (you cannot make this stuff up) and after several wearisome paragraphs he grapples with Justice Stevens' observation that James Madison, in his original draft of the Second Amendment adds a conscientious objector clause "but no person religiously scrupulous of bearing arms, shall be compelled to render military service in person."

Well, this is a problem for Justice Scalia because it reveals quite clearly what the founding fathers really were talking about--they were talking about arms as a part of an armed service, a regulated militia, not some nutcase who is stocking up his own arsenal hoping to arm all the Indians in a revolt against a whiskey tax.

But Scalia quickly dismisses all this evidence with a breezy well, this was a rough draft, and we can't be imputing motives or causes to rough drafts.

But the deed was done--this was all about military arms, military service not guns for personal use.

Scalia then entertains the folks with the observation that Catholics convicted of not attending service in the Church of England were penalized by losing their "rights to keep arms in their houses."  Scalia is never one to miss the opportunity to talk about Catholics or their history. 

The real question is, of course, do we want to live with what we regard as a living Constitution or with a secular Bible--if we prefer Bible, then we are in pursuit of knowing the mind of God, or in the case of the Constitution, the minds of gods.

It's entertaining, no doubt, for Scalia to skulk around looking for copies of a 1773 dictionary and to speculate about what Madison was really thinking, but the outcome of Scalia's prejudged decision, that he was determined to find a way to allow anyone who likes guns to own and use them, no matter what, is that we are left with a nation in which mass shootings by lunatics are visited upon people at concerts, movie theater goers, elementary school children, people on streets, people in churches and any place of congregation, all because we have some overstuffed Justice of the United States Supreme Court, who doesn't give a damn.

I suspect that when Roger Taney wrote his opinion in the Dred Scott case, he started, as Justice Scalia, with the end point, where he wanted to go--no slave can sue in the Supreme Court for his freedom--and he got there by similar exercises of thought contortion--oh, he cannot sue because animals cannot sue in the Supreme Court, nor can vegetables, only human beings, only men (and, on a generous day, perhaps women) may sue in the Supreme Court. This is called "standing." Slaves, dogs and pigs have no standing to sue in the Court.  Given that pretext, all the rest follows.

And now, given the faces on the current Court, that is where we remain.

A Well Regulated Militia

A well regulated militia being necessary to the security of a Free State, the right of the people to keep and bear arms shall not be infringed.

These guys look like what Mr. Madison and Jefferson had in mind.


But these guys are what the Supreme Court had in mind:

Nobody cares much about these guys.

Swamp Boy Strikes Again.

Swamp boy says the mayor of Puerto Rico is disrespecting him, but the problem really is the Puerto Ricans won't help themselves. 

Their electric grid is third world and they aren't real Americans. All they do is vote and serve in the military.

Some of them don't even respect the flag.

If the Dotard had a golf course down there, he'd have crews out there cleaning up right now.

There'd be so much winning.

And, oh yes, he hasn't forgotten how to fire people. 
Tom Price, who says he has always put the public first, who cares more about patients and other people than he cares about his own comfort was pushed out for flying in Gulf Stream luxury jets at taxpayer expense, $400,000 worth.

Got to give the Dotard credit, he acted fast. 

Betsy DeVos flies her own private airplanes. She is in no danger. She's going to make public schools private. Now that's real initiative. So much winning!

Swamp boy wants to play quarterback for the Redskins this Sunday. There'll be so much winning, Redskins fans will get bored.

But that name. Really a failing franchise name. New name:  Rednecks. Go with a winner. 
Hail to the Rednecks. 
Hail Victory.
Drain that old Swamp!
Fight for old D.C!
Run or pass and score. 
Return to burning coal once more!
Beat 'em Swamp 'em.
Touchdown! Let the points soar!
Hail to the Rednecks
Hail Victory.
Klan on the Rise Now!
Fight for Fantasy!


Here's an alternative fight song, from Randy Newman:
https://www.youtube.com/watch?v=j5mue4uDHNQ

I feel so much better.

Trump Tax Cut: Oh, Happy Day!

Watched President Trump this morning giving a pep talk about his new tax plan which he says will bail out the middle class. It's going to be wonderful. The best tax plan ever. You can fill out your taxes on the back of a post card.

And here's the best part:  He told a little tale about two people in the audience who are married and their combined income is $90,000 and this new plan will save this middle class couple $1000 over the year. Wow! Isn't that wonderful? 

That comes out to $2.70 a day!  That ought to cover a cup of McDonald's coffee for each of them with 70 cents left over to invest in the stock market.

Here's something to warm the hearts of struggling middle class families everywhere: The Trump Tax would save the 400 richest families in the nation about 5 million dollars a year and it would eliminate the "death tax" aka the "estate tax" which have more than $5 million estates which is 0.2% of the nation. So, to say this plan has something for everyone is an understatement--it's taking care of everyone, even the 400 richest families and the 0.2%. Like Trump care, this is just fabulous, you're-gonna-love-it great.

Hey, you got $2.70 more every day. You can afford those smokes now.

I also learned  from the Tripe the NFL is failing, big declines in attendance and TV ratings are way down.  TV ratings are going South, the President exulted. 

Ever notice how whenever Trump faces criticism from a news paper or a magazine or any organization, his response is not to the substance of the criticism but to the status of the critic.  Well, don't believe them, because their ratings are down. Why believe a bunch of losers?

So it's the failing New York Times, the failing NBA and now the failing NFL.

According to the NFL, TV ratings are down because people are watching the games on other devices, on tablets, smart phones etc., but viewership, such as you can measure that, is actually up.

Stadiums for every team, are over 95%, most above 97% and some above 100%.

I have to admit, I'm ambivalent about football now. It was my favorite game growing up, but the head injury thing is pretty significant and the power of this generation of players is stunning.

And then there is the case of Aaron Hernandez.  Why would a guy who is making millions in the NFL shoot some punk drug dealer and then hang himself?  Well, on autopsy, his brain is riddled with traumatic lesions.
Do you think the two might be connected?

Sorry, Mr. Lincoln, but the Time Has Come

Abraham Lincoln looked at the warring nations of Europe and drew the conclusion that the North American continent had to avoid that fate and so when the Southern states attempted to leave the union, he refused to grant them a divorce.

Better a bad marriage than no marriage, Lincoln thought.

The twentieth century proved the felicity of Lincoln's concept--were it not for an enormous country of unified  states capable of producing 10,000 airplanes a month, the Third Reich might not have been defeated and one needs only watch "The High Castle" to imagine the consequences.

But now, in the twenty first century, the truths of the 19th and 20th centuries may have to give way to a new truth. The new truth is that the time may have arrived when we should arrange for as amicable divorce as we can arrive at and go our separate ways.  Let the red states in the South and the middle of the country live happily in their own way and allow the blue states on the coasts with selected mid section friends form another country.

As Michelle Goldberg enumerates in her inaugural article in today's New York Times, there are such genuine and irreconcilable differences built into our union that we can no longer hope for even a more perfect union. That a citizen of Wyoming should have 67 times the power of a citizen of California, that 40% of the country should have 80% of the power in the Senate and even in "the people's chamber," the House, is simply an unworkable sort of politics.

As Lincoln noted in his second Inaugural address, when facing such disagreements, we all, on both sides,hope for a results less fundamental and astounding.  But the seeds of this dissolution were sown into the soil of the Constitution. The first cause for disunion was the unresolved issued of slavery, left intact by the Constitution which recognized "three fifths of all other persons," who were universally understood to be the colored slaves. "Indians" were mentioned as Indians, but slaves were not even called slaves, just, "three fifths of all other Persons." 

If slavery was the first fault line, then disproportionate representation was the second.  California has more people than 11 other states combined, which have a total of 22 Senators to California's 2.  The fact is, empty land, mountain ranges, deserts have been given more weight than human beings in the representation in Congress. 

The fact is, when I watched the Senate hearing on the Graham-Cassidy bill this morning, and saw arrayed on one side Senators from Nevada, Louisiana, Georgia, South Dakota, I loathed every last one of them. On the other side, the Democrats from California, New York, Washington were people I could smile about. They represented what I thought of as reasonable legislators.

It is true there were loathsome Republicans from Pennsylvania and Ohio. But overall, if you kept the Middle Atlantic states, New England, Illinois and Minnesota and the West Coast, you'd have, not a homogeneous collection of soul mates, but you'd have a workable grouping of liberal folks who believe in government, not as the ultimate solution to every problem, but as a bedrock resource for the common good. 

The red state Republicans talked about "one size fits all" medical care as if that was an anathema, oblivious to the biggest one size fits all medical program: Medicare, as if they would love to deny that to every American.  These tough minded, independent Republicans from tough minded independent states want to forge a country where no citizen asks help from any other, and certainly not from the government, because, don't you know, nobody deserves government help and nobody ought to think they do. Oh, just be sure no bureaucrat from Washington, D.C. comes between you and your doctor, or has anything to do with supporting you in your old age.

Private enterprise is the only moral mechanism for achieving the common good, and prosperity for all, according to the Republicans. Competition and the profit motive will solve all problems in medical care, in everything for that matter.  Tree huggers who worry about climate change, bleeding heart liberals who want to invite immigrants into this country, godless atheists who want to allow gays to marry, who want to allow for intermarriage of the races are what's wrong with this country!

Well, all this would be wrong in their country, for sure.

For generations, really from the late 19th century through the middle of the 20th century, the South, that bastion of the Ku Klu Klan and other more genteel versions of the Klan, managed to control the Congress and only when the Supreme Court and the Presidency intervened did segregation, racist laws and repression of civil rights of every stripe from those affecting women to homosexuals finally begin to wane.

But we are now swinging back into a repressive, racist society because of manipulations of the mechanisms of power, the Electoral College, gerrymandering, a Constitutional guarantee allowing for small states to wield disproportionate power, as if land mass were more important than people.

This is a structural flaw, built into our Constitution and nothing can change it because the power to change it has been rigged from the inception of the nation, intentionally, to prevent that change.

At this juncture, it might make more sense to smile, shake the hands of the folks in the South, the Far West and possibly many in the Midwest, and say, "Good luck and best wishes. You are on your own. We are heading our own way."

Nothing New Here

Today a woman told me, "I can't get my insurance to pay for my husband's medications and they're giving away methadone free to drug addicts!"


She was more than resentful. She was spitting mad.


I said, "Well, maybe you should go ask for some methadone."

Her husband's last full time job was drIving a truck from their home in Essex County, Massachusetts, to Wolfboro, New Hamsphire, where he picked up bottled water to bring back to a distribution plant in Massachusetts. But he required insulin for his diabetes and that meant he could not qualify for a commercial driver's license, because the government regulators didn't want him driving off the mountain road or Route 95 in a hypoglycemic swoon.
That was their complaint about the government then.


Now, it is methadone for undeserving drug addicts.


After thirty years, renting a house, the landlord decided he could make more money by refurbishing it and raising the rent. That was a bitter ending. There is no government run rent control, no government regulation to prevent that in Essex County.

Now he drives a van, delivering car parts to dealer ships locally, but he only gets three days of work weekly.

Life is spiraling down hill for this couple in their late 60's.


They got married out of high school and he has been able to cobble together enough money to get by but now they see their options drying up. He's never done anything wrong, far as he can tell. He went to work after high school. Never looked to get trained for higher paying jobs. Never had much ambition. But that's no crime, is it?
They were satisfied to rent a house for 30 years but then they discovered why people buy houses, when they got kicked out. They are not angry at the government for not providing for a health care system; they are angry about the government providing free health care for some no good, undeserving addicts.

I didn't ask, but I'm betting they voted to make America great again.
They are still waiting.