When Winter Never Ends

DAY 1: FEB. 4, 2018

"There is timing in the whole life of the warrior, in his thriving and declining, in his harmony and discord."
--Musashi Miyamoto (circa 1584-1645), samurai and artist

Ichiro Suzuki steps out of the cold into the small restaurant that serves him dinner most nights. It's winter in Kobe, Japan, where he once played professional baseball and where he comes during the offseason to train. His wife, Yumiko, is back home in Seattle. He is here alone, free from the untidy bits of domestic life that might break his focus. Every day, he works out in a professional stadium he rents, and then he usually comes to this restaurant, which feels like a country inn transported to the city. It's tucked away on the fifth floor of a downtown building and accessible by a tiny elevator. Someone on the staff meets Ichiro at the back door so he can slip in unseen. Someone else rushes to take his coat, and Ichiro sits at a small bar with his back to the rest of the diners. Two friends join him. Inside the warm and glowing room, the chef slips on his traditional coat as he greets Ichiro in mock surprise.

"Thanks for coming again," says the chef, wearing Miami Marlins shorts.

"You guys made me wait outside," Ichiro jokes.

Ichiro is a meticulous man, held in orbit by patterns and attention to detail. This place specializes in beef tongue, slicing it thin by hand and serving it raw alongside hot cast-iron skillets. They do one thing perfectly, which appeals to Ichiro. Tonight he's got dark jeans rolled up to the calf, each leg even, and a gray T-shirt under a white button-down with a skinny tie. His hair looks darker than in some recent photos, maybe the lighting, maybe a dye job. Either way, not even a 44-year-old future Hall of Famer is immune from the insecurities and diminishments that come with time. This winter is the most insecure and diminished he's been.

He doesn't have a professional baseball contract in America or Japan. His agent, John Boggs, has called, texted and emailed teams so often that one MLB general manager now calls Boggs "the elephant hunter," because he's stalking his prey. Boggs recently sent an email to all 30 teams. Only one wrote back to decline. Ichiro hasn't spoken to Boggs once this offseason, locked in on what he and his aging body can control.

The restaurant fills up. Customers take off their shoes. At every table, signs warn that no pictures can be taken. Ichiro waves at an older couple. A producer type brings two young women over to meet him, and Ichiro makes small talk before they bow and recede. He makes some jokes about aging and turns a wine bottle in his hand to read the label. The waiters, wearing sandals and blue bandannas, sling plates of raw tongue and mugs of cold beer with ice flecks in them. The chef installs a fresh gas can and sets down a cast-iron grill in front of Ichiro.

"This is really delicious," Ichiro says.

He and his companions discuss the future, debating philosophies of business, a new world opening up. Later they turn nostalgic and talk about the past. He started training every day in the third grade and has never stopped. Once during his career he took a vacation, a trip to Milan that he hated. This past October, Marlins infielder Dee Gordon came to get something at the clubhouse after the season. He heard the crack of a bat in the cages and found Ichiro there, getting in his daily swings. "I really just hope he keeps playing," Gordon says with a chuckle, "because I don't want him to die. I believe he might die if he doesn't keep playing. What is Ichiro gonna do if he doesn't play baseball?"

Former teammates all have favorite Ichiro stories, about how he carries his bats in a custom humidor case to keep out moisture, how in the minors he'd swing the bat for 10 minutes every night before going to sleep, or wake up some mornings to swing alone in the dark from 1 to 4 a.m. All the stories make the same point: He has methodically stripped away everything from his life except baseball. Former first baseman Mike Sweeney, who got close to Ichiro in Seattle, tells one about getting a call from an old teammate who'd had an off-day in New York. You're not gonna believe this, the guy began. He'd brought along his wife and they walked through Central Park, thrilled to be together in such a serene place. Far off in the distance, at a sandlot field with an old backstop that looked leftover from the 1940s, they saw a guy playing long toss. The big leaguer did the quick math and figured the distant stranger was throwing 300 feet on the fly. Curious, he walked closer. The guy hit balls into the backstop, the powerful shotgun blast of real contact familiar to any serious player. He became impressed, so he got even closer, close enough to see.

The man working out alone in Central Park was Ichiro.

His agent and those close to him think he'll sign with a Japanese team if no offer comes from the major leagues. Television crews floated around the Ginza district in Tokyo the night before asking people what they think about Ichiro's future. Ichiro, as usual, is saying nothing. He's a cipher, keeping himself hidden, yet his yearning has never been more visible. His old team, the Orix Buffaloes, wants him back desperately -- but Japanese spring training started three days ago and Ichiro remains in Kobe. For a private man, these three days speak loudly about his need for another season in America. Over the years, he's talked about playing until he's 50 but also of his desire to "vanish" once his career ends. Those two desires exist in opposition, and if America never calls, he holds the power to make either of them real. He can sign with Orix, or he can fade away. The choice is his.

These are the things working in his life at dinner, a cold Sunday night between the Rokko mountains and Osaka Bay. Ichiro finally stands to leave. Two customers step into the aisle and bow, not the perfunctory half-bow of business associates and hotel bellmen, but a full to-the-waist bow of deep respect. Is this what the end of a great career looks like up close? Ichiro hates not playing baseball, but he might hate playing poorly even more. When he's slumping, his wife has said, she will wake up and find him crying in his sleep. The first time he went on the disabled list as a major leaguer was because of a bleeding stomach ulcer. That year, he'd led Japan to a victory in the 2009 World Baseball Classic, winning the final game with a base hit in extra innings. The stress ate a hole in his stomach. Weeks later, a Mariners team doctor told him he couldn't play on Opening Day. Ichiro refused to listen, his teammate Sweeney says. Before the team ultimately forced him to sit, the doctor tried to explain that a bleeding ulcer was a serious condition that could actually kill him.

Ichiro listened, unmoved.

"I'll take my chances," he said.

DAY 2: FEB. 5, 2018

The next morning at 11:46, Ichiro moves quickly through the Hotel Okura lobby. A hood covers his head. This 35-story waterfront tower is where he always stays, an understated gold and black lacquer palace that looks designed by the prop department from "You Only Live Twice." His green Mercedes G-Class SUV is parked directly in front of the hotel and he climbs inside. The ballpark he rents, literally an entire stadium, is over the mountains, and he takes a right onto Highway 2, then an exit onto Fusehatake. He uses his blinker to change lanes.

The temperature is 38 degrees and falling.

A waterfall in front of the hotel is frozen mid-cascade.

On the drive toward the stadium, it begins to flurry.

At the field, he changes into shorts and steps out onto the field. A hard wind blows. Passing clouds drop the mercury even more. Ichiro isn't here in spite of the brutal cold but because of it. Japanese culture in general -- and Ichiro in particular -- remains influenced by remnants of bushido, the code of honor and ethics governing the samurai warrior class. Suffering reveals the way to greatness. When the nation opened up to the Western world in 1868, the language didn't even have a word to call games played for fun. Baseball got filtered through the prism of martial arts, and it remains a crucible rather than an escape. Japanese home run king Sadaharu Oh wrote in his memoir: "Baseball in America is a game that is born in spring and dies in autumn. In Japan it is bound to winter as the heart is to the body." (...)

DAY 3: FEB. 6, 2018

Ichiro walks through the hotel lobby at exactly the same time as the day before, 11:46 a.m., repeating his routine to the minute. He's a funny self-deprecating guy who often makes light of his own compulsive behaviors, which extend far beyond his baseball-related rituals. He said in a Japanese interview that he once listened to the same song for a month or more. There's enlightenment in obsession, he says, because focus opens perception to many things. It boils life down.

"I'm not normal," he admitted.

He gets stuck in patterns. In the minors, sometimes his 10-minute bedtime swinging ritual stretched to two hours or more. His mind wouldn't let him stop. For years, he only ate his wife's curry before games, day after day. According to a Japanese reporter who's covered him for years, Ichiro now eats udon noodles or toasted bread. He likes the first slice toasted for 2 minutes, 30 seconds, and the second slice toasted for 1 minute, 30 seconds. (He calculates the leftover heat in the toaster.) For a while on the road he ate only cheese pizzas from California Pizza Kitchen. He prefers Jojoen barbecue sauce for his beef. Once Yumiko ran out and mixed the remaining amount with Sankoen brand sauce -- which is basically identical -- and Ichiro immediately noticed. These stories are endless and extend far beyond food. This past September, a Japanese newspaper described how he still organizes his life in five-minute blocks. Deviations can untether him. Retirement remains the biggest deviation of all. Last year, a Miami newspaperman asked what he planned on doing after baseball.

"I think I'll just die," Ichiro said.

Today Ichiro walks onto the field in Kobe, right on time, and everyone is waiting. It's uncanny. They bow when he reaches the dugout. It's a Tuesday, even colder than the day before, but the routine doesn't change: the four jogging laps across the outfield, the baserunning, the 50 soft-toss pitches, exactly 50. Except for the cold these aren't hard workouts, more like a ritualized ceremony among friends. He could choose the best players in Japan to help him but he doesn't. He doesn't need to get better at swinging a bat. What he needs, and what he seems to find in this rented stadium, is the comfort of the familiar, a place where he knows who he is supposed to be.

He is equally precise during the season, to the amusement of teammates. Dee Gordon says Ichiro even lint-rolls the floor of his locker. He cleans and polishes his glove and keeps wipes in the dugout to give his shoes a once-over before taking the field. The Yankees clubhouse manager tells a story about Ichiro's arrival to the team in 2012. Ichiro came to him with a serious matter to discuss: Someone had been in his locker. The clubhouse guy was worried something had gone missing, like jewelry or a watch, and he rushed to check.

Ichiro pointed at his bat.

Then he pointed at a spot maybe 8 inches away.

His bat had moved.

The clubhouse manager sighed in relief and told Ichiro that he'd accidentally bumped the bat while putting a clean uniform or spikes or something back into Ichiro's locker, which is one of the main roles of clubhouse attendants.

"That can't happen," Ichiro said, smiling but serious.

From that day forward, the Yankees staff didn't replace anything in his locker like they did for every other player on the team. They waited until he arrived and handed him whatever he needed for the day.

These stories are funny individually, but they feel different when taken as a whole. Like nearly all obsessive people, Ichiro finds some sort of safety in his patterns. He goes up to the plate with a goal in mind, and if he accomplishes that goal, then he is at peace for a few innings. Since his minor league days in Japan, he has devised an achievable, specific goal every day, to get a boost of validation upon completion. That's probably why he hates vacations. In the most public of occupations, he is clearly engaged in a private act of self-preservation. He's winnowed his life to only the cocoon baseball provides. His days allow for little beyond his routine, like leaving his hotel room at 11:45, or walking through the lobby a minute later, or going to the stadium day after day in the offseason -- perhaps his final offseason. Here in the freezing cold, with a 27-degree wind chill, the hooks ping off the flagpoles. The bat in his hand is 33.46 inches long. He steps into the cage and sees 78 pitches. He swings 75 times.

Up close, he looks a lot like a prisoner.

by Wright Thompson, ESPN | Read more:
Image: Kevork Djansezian/Getty

Małgorzata Sajur, Mirror mirror
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The Arithmetic of Risk

A month ago, I noted that prevailing valuation extremes implied negative total returns for the S&P 500 on 10-12 year horizon, and losses on the order of two-thirds of the market’s value over the completion of the current market cycle. With our measures of market internals constructive, on balance, we had maintained a rather neutral near-term outlook for months, despite the most extreme “overvalued, overbought, overbullish” syndromes in U.S. history. Still, I noted, “I believe that it’s essential to carry a significant safety net at present, and I’m also partial to tail-risk hedges that kick-in automatically as the market declines, rather than requiring the execution of sell orders. My impression is that the first leg down will be extremely steep, and that a subsequent bounce will encourage investors to believe the worst is over.”

On February 2nd, our measures of market internals clearly deteriorated, shifting market conditions to a combination of extreme valuations and unfavorable market internals, coming off of the most extremely overextended conditions we’ve ever observed in the historical data. At present, I view the market as a “broken parabola” – much the same as we observed for the Nikkei in 1990, the Nasdaq in 2000, or for those wishing a more recent example, Bitcoin since January.

Two features of the initial break from speculative bubbles are worth noting. First, the collapse of major bubbles is often preceded by the collapse of smaller bubbles representing “fringe” speculations. Those early wipeouts are canaries in the coalmine. For example, in July 2000, the Wall Street Journal ran an article titled (in the print version) “What were we THINKING?” – reflecting on the “arrogance, greed, and optimism” that had already been followed by the collapse of dot-com stocks. My favorite line: “Now we know better. Why didn’t they see it coming?” Unfortunately, that article was published at a point where the Nasdaq still had an 80% loss (not a typo) ahead of it.

Similarly, in July 2007, two Bear Stearns hedge funds heavily invested in sub-prime loans suddenly became nearly worthless. Yet that was nearly three months before the S&P 500 peaked in October, followed by a collapse that would take it down by more than 55%. (...)

As I’ve emphasized in prior market comments, valuations are the primary driver of investment returns over a 10-12 year horizon, and of prospective losses over the completion of any market cycle, but they are rather useless indications of near-term returns. What drives near-term outcomes is the psychological inclination of investors toward speculation or risk-aversion. We infer that preference from the uniformity or divergence of market internals across a broad range of securities, sectors, industries, and security-types, because when investors are inclined to speculate, they tend to be indiscriminate about it. This has been true even in the advancing half-cycle since 2009.

The only difference in recent years was that, unlike other cycles where extreme “overvalued, overbought, overbullish” features of market action reliably warned that speculation had gone too far, these syndromes proved useless in the face of zero interest rates. Evidently, once interest rates hit zero, so did the collective IQ of Wall Street. We adapted incrementally, by placing priority on the condition of market internals, over and above those overextended syndromes. Ultimately, we allowed no exceptions.

The proper valuation of long-term discounted cash flows requires the understanding that if interest rates are low because growth rates are also low, no valuation premium is “justified” by the low interest rates at all. It requires consideration of how the structural drivers of GDP growth (labor force growth and productivity) have changed over time.

Careful, value-conscious, historically-informed analysis can serve investors well over the complete market cycle, but that analysis must also include investor psychology (which we infer from market internals). In a speculative market, it’s not the understanding of valuation, or economics, or a century of market cycles that gets you into trouble. It’s the assumption that anyone cares.

The important point is this: Extreme valuations are born not of careful calculation, thoughtful estimation of long-term discounted cash flows, or evidence-based reasoning. They are born of investor psychology, self-reinforcing speculation, and verbal arguments that need not, and often do not, hold up under the weight of historical data. Once investor preferences shift from speculation toward risk-aversion, extreme valuations should not be ignored, and can suddenly matter to their full extent. It appears that the financial markets may have reached that point.

A second feature of the initial break from a speculative bubble, which I observed last month, is that the first leg down tends to be extremely steep, and a subsequent bounce encourages investors to believe that the worst is over. That feature is clearly evident when we examine prior financial bubbles across history. Dr. Jean-Paul Rodrigue describes an idealized bubble as a series of phases, including that sort of recovery from the initial break, which he describes as a “bull trap.”

I continue to expect the S&P 500 to lose about two-thirds of its value over the completion of the current market cycle. With market internals now unfavorable, following the most offensive “overvalued, overbought, overbullish” combination of market conditions on record, our market outlook has shifted to hard-negative. Rather than forecasting how long present conditions may persist, I believe it’s enough to align ourselves with prevailing market conditions, and shift our outlook as those conditions shift. That leaves us open to the possibility that market action will again recruit the kind of uniformity that would signal that investors have adopted a fresh willingness to speculate. We’ll respond to those changes as they arrive (ideally following a material retreat in valuations). For now, buckle up.

by John P. Hussman, Ph.D. Hussman Funds |  Read more:

Image: Dr. Jean-Paul Rodrigue

Ralph Goings, Still Life With Spoons
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Socialism as a Set of Principles

Nearly half of millennials describe themselves as sympathetic to “socialism” and not terribly fond of “capitalism.” Yet if you asked each of them to explain the mechanics of how a socialist economy would function, I doubt many would have especially detailed answers. Jacobin magazine’s ABCs of Socialism consists of answers to skeptical questions about socialism (e.g. “Don’t the rich deserve their money?” “Is socialism pacifist?” “Will socialism be boring?”) but notably “How will socialism actually work?” is not among them. With twelve million Democratic primary voters having cast ballots for a self-described “socialist,” isn’t it concerning that nobody has explained in detail how socialism will “work”? Embracing a new economic system without having a blueprint seems like it could only ever lead to something like Venezuela’s collapse.

I think this criticism seems very powerful, and comes from an understandable instinct. But it has a mistaken view of what socialism actually means to the people who use the label. In the 21st century, for many of its adherents socialism is not describing a particular set of economic rules and government policies, some clearly-defined “system” that must be implemented according to a plan. Instead, it describes a set of principles that we want the economic and political system to conform to. Bringing the world into harmony with these principles will require experimentation, but that lack of rigidity is an asset. Because 20th century “socialist” states attempted vast social engineering projects, there is a tendency to think of “a socialist economy” in engineering terms. Capitalism is an engine, with its parts all working together to produce an effect. Socialists come along and say that the engine should be designed entirely differently, with a totally different set of rules in order to produce better effects. If this is what we’re talking about when we’re talking about “capitalism versus socialism,” then it’s completely right to ask for an explanation of how the proposed alternative works. We’d be very suspicious of someone who said they had reinvented the combustion engine but refused to tell us how the alternative would work and insisted that before trying it we destroy all of our combustion engines.

But this is a poor way of thinking about what is being advocated by socialists. Books are a better analogy. We have, in our hands, a badly-written manuscript and are trying to edit it into a well-written manuscript. But there’s no blueprint for the well-written manuscript. We create it through a process. Delete a passage here, insert one there, move this around, move that around. And in doing this, we follow a set of principles: we want it to flow well, we want the reader not to get confused, we want all our sentences to be forceful and precise. Those principles aren’t handed down from on high, and there are lots of different ways we could write the book that would produce something satisfactory. But asking at the beginning of the process “Well, what will the finished product look like?” makes no sense. If we could present a blueprint for the finished book, we wouldn’t need a blueprint because we would already have finished the book.

Socialism can be conceived of similarly: socialists are trying to make society better, so that its operations meet a particular set of ideal criteria. Here, I want to quote Leszek Kołakowski, the Polish scholar of Marxism, who was a vicious opponent of communist governments but drew an important distinction between socialism as a system and an ideal:

[It would be] a pity if the collapse of communist socialism resulted in the demise of the socialist tradition as a whole and the triumph of Social Darwinism as the dominant ideology….Fraternity under compulsion is the most malignant idea devised in modern times… This is no reason, however, to scrap the idea of human fraternity. If it is not something that can be effectively achieved by means of social engineering, it is useful as a statement of goals. The socialist idea is dead as a project for an ‘alternative society.’ But as a statement of solidarity with the underdog and the oppressed, as a motivation to oppose Social Darwinism, as a light that keeps before our eyes something higher than competition and greed—for all these reasons, socialism—the ideal, not the system—still has its uses.

By his last years, Kołakowski was bitterly disenchanted by the left to an extreme I find off-putting. But even he offered high praise for the great socialists of early 20th century Europe, and the ideals they embodied. They “wanted not only equal, universal and obligatory education, a social health service, progressive taxation and religious tolerance, but also secular education, the abolition of national and racial discrimination, the equality of women, freedom of the press and of assembly, the legal regulation of labour conditions, and a social security system. They fought against militarism and chauvinism [and] embodied what was best in European political life.”

Here we begin to see what socialist principles actually involve. How can they best be summarized? Kołakowski suggests it’s “fraternity,” but that seems too limited and too squishy. It does start there, though: with a feeling of connectedness and compassion for other human beings. “We are here to help each other through this thing, whatever it is,” as Kurt Vonnegut said. Many socialists begin with that feeling of “solidarity” with people whose lives are needlessly hard and painful, and a sense that we are all in this together. (...)

This is what leads socialists toward the idea about “collective ownership of the means of production,” which is often cited as the core tenet of socialism. The reason socialists talk about “ownership” so much is that “ownership” refers to decision-making power. If I own a book, it means I am the one who gets to decide what happens to it. I can write in it, sell it, or throw it away. The instinct that “people should be able to shape their own destinies” leads socialists to endorse what I think is the core meaning of “democracy,” namely the idea that people should have decision-making power over those things that affect them. If we think people’s choices should be valued, then they should be included in decision-making that affects them. (...)

There are plenty of different ideas for how to make the world more democratic, to ensure that people’s lives aren’t being controlled by mysterious private or state forces that they have no control over. Socialists have a variety of proposals for economic democracy, such as the Universal Basic Income, worker cooperatives, and mandating profit-sharing. But the democratic principle isn’t just about economics. It’s also what turns socialists into feminists and anti-racists. Sexism and racism are outside forces that are acting on people against their will, making their lives more difficult on account of demographic characteristics that they cannot choose. The principle “everyone should have the most fulfilling possible life” means that women shouldn’t be harassed at work, transgender teens shouldn’t be bullied, and people of color shouldn’t face unique structural disadvantages.

One may think that by identifying ideas like “giving everyone a maximally fulfilling life” as core principles, I am draining socialism of meaning. After all, who doesn’t want people to have fulfilling lives? If socialism just means “things should be good,” everyone is a socialist. But that’s part of the point: socialism tries to apply values that are essentially universal. What differentiates the socialist and the non-socialist is the “apply” part. Everyone talks about democracy and freedom and fulfillment, but socialists are concerned to figure out what those things would really entail, and ensure that they are meaningful components of everybody’s lives, rather than only existing for some. The United States is “democratic,” and people are “free.” But when the public’s views don’t affect the government’s policies, and when people can’t get vacation time to go and take advantage of their freedom, these concepts are not being fully realized. (...)

The millennial embrace of socialism, then, does not mean that millennials are trying to implement some complicated new economic system that they do not understand. It means that they measure any economic system by the degree to which it is humane and democratic, and they are angered by the degree to which our current one fails people. It means that they reject selfishness and believe in solidarity. And it means that they are determined to help each other build something better, whatever that may be.

by Nathan J. Robinson, Current Affairs |  Read more:

Image: uncredited

Busting the Myth of ‘Welfare Makes People Lazy’

“Welfare makes people lazy.” The notion is buried so deep within mainstream political thought that it can often be stated without evidence. It was explicit during the Great Depression, when Franklin D. Roosevelt’s WPA (Works Progress Administration) was nicknamed “We Piddle Around” by his detractors. It was implicit in Bill Clinton’s pledge to “end welfare as we know it.” Even today, it is an intellectual pillar of conservative economic theory, which recommends slashing programs like Medicaid and cash assistance, partly out of a fear that self-reliance atrophies in the face of government assistance.

Many economists have for decades argued that this orthodoxy is simply wrong—that wisely designed anti-poverty programs, like the Earned Income Tax Credit, actually increase labor participation. And now, across the world, a fleet of studies are converging on the consensus that even radical welfare programs—including basic-income programs and what are called conditional cash transfers—don’t make people any less productive.

Most notably, a 2015 meta-study of cash programs in poor countries found “no systematic evidence that cash transfer programs discourage work” in seven different countries: Mexico, Nicaragua, Honduras, the Philippines, Indonesia, or Morocco. Other studies of cash-grant experiments in Uganda and Nigeria have found that such programs can increase working hours and earnings, particularly when the beneficiaries are required to attend classes that teach specific trades or general business skills.

Welfare isn’t just a moral imperative to raise the living standards of the poor. It’s also a critical investment in the health and future careers of low-income kids.

Take, for example, the striking finding from a new paper from researchers at Georgetown University and the University of Chicago. They analyzed a Mexican program called Prospera, the world’s first conditional cash-transfer system, which provides money to poor families on the condition that they send their children to school and stay up to date on vaccinations and doctors’ visits. In 2016, Prospera offered cash assistance to nearly 7 million Mexican households.

In the paper, researchers matched up data from Prospera with data about households’ incomes to analyze for the first time the program’s effect on children several decades after they started receiving benefits. The researchers found that the typical young person exposed to the program for seven years ultimately completed three more years of education and was 37 percent more likely to be employed. That’s not all: Young Prospera beneficiaries grew up to become adults who worked, on average, nine more hours each week than similarly poor children who weren’t enrolled in the program. They also earned higher hourly wages.

This finding has direct implications for the United States, where a core mission of the Republican Party is to reduce government aid to the poor, on the assumption that it makes them lazy. This attitude is supported by many conservative economists, who argue that government benefits implicitly reward poverty and thus encourage families to remain poor—the idea being that some adults might reject certain jobs or longer work hours because doing so would eliminate their eligibility for programs like Medicaid.

But this concern has little basis in reality. One of the latest studies on the subjectfound that Medicaid has “little if any” impact on employment or work hours. In research based in Canada and the U.S., the economist Ioana Marinescu at the University of Pennsylvania has found that even when basic-income programs do reduce working hours, adults don’t typically stay home to, say, play video games; instead, they often use the extra cash to go back to school or hold out for a more desirable job.

But the standard conservative critique of Medicaid and other welfare programs is wrong on another plane entirely. It fails to account for the conclusion of the Prospera research: Anti-poverty programs can work wonders for their youngest beneficiaries. It’s true north of the border, as well. American adults whose families had access to prenatal coverage under Medicaid have lower rates of obesity, higher rates of high-school graduation, and higher incomes as adults than those from similar households in states without Medicaid, according to a 2015 paper from the economists Sarah Miller and Laura R. Wherry. Another paper found that children covered by Medicaid expansions went on to earn higher wages and require less welfare assistance as adults.

“Welfare helps people work” may sound like a strange and counterintuitive claim to some. But it is perfectly obvious when the word people in that sentence refers to low-income children in poor households. Poverty and lack of access to health care is a physical, psychological, and vocational burden for children. Poverty is a slow-motion trauma, and impoverished children are more likely than their middle-class peers to suffer from chronic physiological stress and exhibit antisocial behavior. It’s axiomatic that relieving children of an ambient trauma improves their lives and, indeed, relieved of these burdens, children from poorer households are more likely to follow the path from high-school graduation to college and then full-time employment.

by Derek Thompson, The Atlantic |  Read more:

Image: Kai Pfaffenbach / Reuters

Giving Up the Ghost

When it comes to quitting smoking, you’re on your own

I had expected an austere, sanatorium-like atmosphere, with staff in crisp lab coats, the walls plastered with rules and bumper sticker–type slogans: Rehab is for quitters, maybe. Instead, the place skews toward homey, or at least as homey as a medical facility can be, with nary a motivational poster to be seen. My room features a Murphy bed, a small desk, a wall-mounted TV, and an inoffensive print; brown and beige are the dominant colours. The space is reminiscent of an upscale dorm or a highway motel, except for the syringe disposal receptacle in the bathroom.

But matters of decor are not top of mind on this Friday in January, as I stand outside the entrance of the building. Instead, I’m focused on cigarettes—or, more precisely, smoking as many of them as possible in the time left before 4:30 p.m., when nine other people and I will hand over our packs and lighters, and put our faith in the Mayo Clinic’s Nicotine Dependence Center.

A half-century ago, I lit up for the first time. It was 1964, the same year that United States surgeon general Luther Terry released a depth-charge report unequivocally drawing a direct link between cigarettes and lung cancer, chronic bronchitis, emphysema, and coronary heart disease. Or, as the New York Times headline succinctly put it, “Cigarettes Peril Health.” Being fourteen at the time, I didn’t read the Times, but the news filtered into my hometown of Guelph, Ontario—the site of an Imperial Tobacco factory, where, it was said, workers got free cartons. My friends and I mordantly joked that every cigarette we smoked would shorten our lives by ten minutes. Because we were immortal, this didn’t seem like a big deal.

At school, I belonged to the science club and entered fairs with projects like “The Miracle of Rayon.” I was an A student in home economics; my pocket money came from babysitting. In short, I was something of a nerd, and desperately wished for an edgier image, which I believed smoking bestowed.

At the time, nearly half of Canadian adults were smokers, and in that Mad Men era you could light up just about anywhere—planes, banks, movie theatres, even doctors’ offices and hospital rooms. To object to someone smoking was rather like being the cranky neighbour yelling at kids for playing hockey in the street. These days, though, the 16 percent of us who still smoke daily are the ones beyond the pale—which is to say a car’s length or two from building entrances, if we’re obeying the omnipresent signs.

I could claim that an extremely belated road-to-Damascus experience led me to rehab, but the fact is, for years now, you have had to be either terminally dense or a Big Tobacco executive (not mutually exclusive categories) to deny the health risks. It wasn’t even the pariah status, the death-ray glares of disapproval that lighting up automatically incurs. True, that contempt—and its flip side, a self-image hovering below zero—was one of the reasons I’d quit numerous times over the past five decades. I had stopped for as little as a week and as long as seven years, the latter an interregnum that went up in flames during an evening that featured a lot of fun and too much wine; suddenly, cadging a cig seemed like a good idea. Within a week, I was back to a pack and a half a day.

This time, there were two things that influenced me to kick the habit. One was my kid, twenty-three years old and a smoker since he was fifteen. I know he’s not immortal, even if he doesn’t, and my guilt about being a noxious role model is intense. The second, at the risk of seeming to have skewed priorities, was the money. I was smoking two large packs a day—fifty cigarettes, about thirty more than what’s currently defined as heavy smoking—which translated to a ludicrous $8,750 a year. On the cusp of retirement, with its decreased income, I realized I couldn’t afford to keep smoking if I still wanted to live indoors. (...)

The truth is that we don’t fund cigarette rehab because we don’t consider smoking a true addiction. Today, people are said to be hooked on everything from Facebook to Oreos, but being an Internet fanatic or cookie monster is not the same as experiencing the panicky tightening in the gut, the I’d-do-anything-for-a-hit feeling, that strikes when you’re running short of fill-in-the-blank—smack, booze, Oxys, cocaine, cigs. Unlike those other substances, though, cigarettes are both legal and, when used as intended, apt to kill their consumers. It’s impossible to contemplate these dissonant facts without engaging in some conspiracy theorizing. Might there be a connection between cigarettes’ still-lawful status, despite their indisputably lethal nature, and the $7.3 billion in tobacco-related tax revenue the federal and provincial governments reaped last year? After all, if everyone actually quit, that’s a lot of dough forgone.

Behind these counterintuitive policies is the big lie that smoking is merely a bad habit. As the industry’s disingenuous slogan of the 1980s and 1990s had it, “My pleasure, my choice.” But it’s not just Big Tobacco that advances this perspective. Last February, Globe and Mail columnist Margaret Wente articulated a common outlook: “If addiction is a disease, it’s a peculiar one.” Her point was that, unlike those with so-called real diseases, addicts get themselves into trouble and can jolly well get themselves out. “The disease model of addiction implies that the victim is helpless,” she wrote. “It denies the role of personal agency, which is probably the most important force of all when facing down your demons.”

This is reminiscent of how wartime post-traumatic stress disorder was once chalked up to lmf—lack of moral fibre. It’s the attitude of those who unhelpfully recount how they just got up one day and pitched their cigs, the implication being that you could do the same if you weren’t such a gormless loser. And it’s a point of view that even permeates anti-tobacco campaigns, which over the decades have morphed from concern for the addict—“Smoking kills”—to stigma-driven shock and shame. Think of that American Cancer Society poster featuring the ravaged older woman, puffing away, with the slogan, “Smoking is very glamorous.” Cruise the Internet a bit, and you’ll find images that are even more jolting. One substitutes a cigarette filter for a woman’s nipple (i.e., smoking is bad for breastfeeding babies); another, aimed at teenagers, equates smoking with being forced to perform oral sex. In these ads, there is no acknowledgement of cigarettes’ extraordinary addictive power. We don’t expect drug users to just kick the habit, but that idea permeates cigarette discourse. The message is as clear as a No Smoking sign: when it comes to quitting, you’re on your own.

In the minutes before Friday’s 4:30 p.m. relinquishing of our cigs and lighters, everyone chain-smokes furiously outside the Colonial Building. We aren’t acquainted yet, but there’s lots of nervous banter as we mainline our nicotine, huddled in twos and threes. Do any of us really believe the butts we’ve just ground out will be our last? Still, once inside, we all participate in the disposal ritual—everything’s tossed into an ordinary plastic bag, which doesn’t strike me as sufficiently ceremonious—and then we have our initial group therapy session. Besides me, there are six men and three women, two of whom are also Canadian.

A decade ago, I realized I was drinking too much—more than a bottle of wine a night—and tottered off to Alcoholics Anonymous. There, we called them drunkalogs—tales of humiliating things done while under the influence of booze. At the exotic end of the spectrum were exploits like attempting to steal a plane or losing a rental car; more common were heartbreaking accounts of domestic upheaval, workplace flame-outs, sordid affairs. In smokers’ rehab, our versions are more quotidian. Illicit puffs in airport washrooms figure prominently, with a couple of the guys trading stories about their favourite spots at Chicago O’Hare. An entertainment entrepreneur spins a hilarious story about smoking up a hotel room and simply leaving the several-hundred-dollar fine in cash when he checked out. The parents of younger children describe John le Carré–level diversionary tactics to prevent their kids from learning their secret. I recount having missed a plane in Dublin a few years ago because I was indulging my addiction rather than lining up for the security check, a dumb-ass move that cost me $500 in rebooking fees; it’s too painful to confess to the group that I missed the moment of my mother’s death because I’d nipped out for a hit. None of these anecdotes addresses the matter of compromised health, but they don’t really have to, since one of us, a fellow in his late fifties, has barely finished chemo for lung cancer.

The absence of the titillating or outlandish in our stories perhaps explains the dearth of motivational books or movies for the would-be non-smoker. Prior to my trip to the Mayo, a diligent search for butting-out memoirs, something along the lines of Mary Karr’s Lit, or Augusten Burroughs’s Dry, turned up just one. Lighting Up features an overexcited subtitle—How I Stopped Smoking, Drinking, and Everything Else I Loved in Life Except Sex—that fails to suggest the mix of chaos and catharsis that makes a good taking-the-cure account. On the flick front, finding nothing about tobacco at all, I thought I’d screen some of the booze-and-drugs rehab movies I’d watched when I decided to quit drinking—28 Days; Clean and Sober; My Name Is Bill W. What I hadn’t noticed ten years ago was that everyone in these movies smokes all the time. In fact, being a nicotine fiend is kind of a thing among reformed drinkers. Bill Wilson of AA fame apparently smoked like a chimney. Caroline Knapp, the author of the acclaimed memoir Drinking: A Love Story, died of lung cancer at forty-two. As Burroughs observed, “Everybody in recovery smokes.” You can see the problem. Popular culture basically doesn’t acknowledge smoking as a dangerous addiction, nor does it lend it the patina of romantic dissolution that might garner users more sympathy—or better treatment options.

I used to wonder why I am the only member of my family with addiction issues. Then I realized a strong vein of clinical depression runs through our history, and addiction is often a co-occurring condition. My father struggled through many dark days; one of my sisters committed suicide; my cousins knock back antidepressants, and so do I. I saw my first psychiatrist at eighteen, when even taking a shower began to seem too hard. I can’t recall when my drinking shifted from recreational to alcoholic, but it spiked during a period of high drama: My kid (step-grandson, actually)—who, tragically, has fetal alcohol syndrome—was a rebel without a cause by the time he was thirteen. My husband had his own alcohol issues. There was also my then-undiagnosed bipolar disorder, which co-occurs with alcoholism up to 50 percent of the time. At the Mayo, we don’t spend a lot of time comparing our psychological profiles, but I quickly realize that I’m not alone. Three of the others are addicts-turned-teetotallers; another takes a pharmacopoeia of medications that rivals my own.

Scientists trying to understand people like us have found that the brain of the zebrafish, a freshwater member of the minnow family, is a good substitute for the human organ when it comes to studying addiction. The Center for Tobacco-Free Living, a public-information space at the Mayo, features a big tank labelled Zebrafish, in recognition of their key role in research. But the tank’s occupants are imposters—the real zebrafish were so small they kept getting sucked into the filter. It’s not hard to see a metaphor here, with the doomed creatures representing smokers trapped and enslaved by Big Tobacco. This interpretation, embraced by the Mayo program, is comforting: it’s not my fault.

Still, I have to acknowledge that being a cigarette addict isn’t all tubercular coughing and grimy ashtrays. Smoking doesn’t come with the perils associated with other types of dependence—jail time, homelessness, personal chaos. Plus, there’s that first-puff-of-the-morning kapow, the immediate rush of nicotine to the brain, a high that doesn’t fade no matter how long you’ve smoked—no chasing the dragon, trying to recapture the sensation of your initial hit. It makes for great anecdotes, like the time I realized the only other occupant of a New York theatre’s gritty little smoking area (except for a bodyguard) was Pierre Trudeau, then on his second stint as prime minister. And then there’s the camaraderie of smokers at events, puffing away alfresco and joking that we are the most interesting people there. (...)

But these golden moments account for just a fraction of the half-million-odd cigarettes I’ve consumed in my life. According to Dr. Richard Hurt, the founder of the Mayo program, I’ve mostly lit up because the numerous nicotine receptors in my brain have been calling out for another hit. Why some people can smoke and not get hooked is what those zebrafish are helping to illuminate. Clearly, I’m not addiction-proof, and neither are the members of my Mayo posse.

by Lynn Cunningham, The Walrus |  Read more:

Image: Alena Skarina

Off the Green and into the Blue

Alex Weber takes a deep breath through her snorkel and dives to the bottom of Carmel Bay, a calm coastal cove several kilometers south of Monterey, California. Just meters away, atop the small cliffs that drop into the waves, golfers tread on the emerald greens of Pebble Beach Golf Links. It’s early December—the sky’s blue, the weather T-shirt warm. The golfers swing their way from hole to hole on the famed golf course. Unfortunately, their aim is rarely perfect.

Weber surfaces 45 seconds later and drops nearly a dozen golf balls into a yellow mesh bag held open by her father, Mike, who is also in a wetsuit and snorkeling gear. The pair have been in the water for several hours and have collected more than 1,500 golf balls—the fallout of a sport that has unseen, and probably significant, consequences for the ocean.

About 1.2 billion golf balls are manufactured every year, according to a 2017 report in Chemical & Engineering News, and more than half may be lost in the environment. A New York Times story in 2010 reported that an estimated 300 million disappear each year in the United States alone. With many of the planet’s approximately 32,000 golf courses located beside the ocean, countless golf balls find their way into the water, where they sink and accumulate more rapidly than anyone is cleaning them up.

Weber, a grade 12 student, is doing her best, but is barely putting a dent in the collection of drowned balls. Just two weeks earlier, Weber and her father spent several hours snorkeling in the same cove and cleared the seafloor of about 2,000 balls.

Now, the ocean bottom is again awash with golf balls.

“Big waves come through and uncover them,” says Weber, who started collecting golf balls here in 2016. “It can sometimes make what we’re doing feel futile.”

Her effort began as a simple volunteer cleanup job but has morphed into a novel research project in which the golf balls are data and Weber is a groundbreaking scientist. To date, she and her helpers have collected more than 20,000 golf balls. Weber keeps the stash at home in buckets and barrels, where the balls are sorted by collection site and graded by level of wear. Number ones, she explains, appear new, still shiny and covered with dimples. Fours are as smooth as ping-pong balls, their outer layers of plastic polished away. The fives are so old their shells have worn away entirely, allowing spaghetti-like rubber to erupt out the sides.

To better understand the problem, Weber is collaborating with ecologist Matthew Savoca, a California Sea Grant State Fellow who earned his PhD studying the effects of plastic and marine debris on the ocean. Together, they are writing a paper they hope to have published before the end of the year. Their research, Weber says, is intended to set a baseline understanding of the problem while exploring why the balls gather in certain areas, how long it takes for them to break down, and what it all means for marine life—all topics that nobody else, it seems, has closely explored. Some of this subject matter may be explored in more depth in subsequent studies, Weber says.

“But in this first paper,” she explains, “we’re basically just saying there are golf balls in the ocean.”

According to a former golf pro at Pebble Beach, that course alone hosts about 62,000 rounds of golf per year, and Weber says caddies working the course have told her that three or four balls are lost per round. Even a conservative estimate would suggest that tens—and perhaps hundreds—of thousands of them reach the ocean.

In his 2012 book Sandy Parr at the 19th Hole, author Mohamed Noorani reported that one billion golf balls—almost 46 million kilograms, much of it plastic—disappear every year. Some of this material is recovered. A cottage industry, in fact, is based upon collecting and selling lost golf balls. Todd Baker, an Indiana golfer who manufactures wooden Eco Golf Balls that float in water and biodegrade, says entrepreneurial collectors retrieve millions of golf balls from ponds, lakes, and rivers each year and sell them to vendors.

“But golf balls that go into the ocean are pretty much goners,” he says.

They don’t just sit inertly on the seafloor, either. As Weber has documented, they corrode. A standard golf ball weighs about 46 grams, but those she has recovered have lost as much as a third of their mass. That means for every 1,000 submerged golf balls, several kilograms of microplastic are shed into the ocean. Such debris may enter the food chain through creatures such as copepods and anchovies. Plastic tends to attach to a variety of contaminants that may be present in the water, including PCBs, and research has shown these particles can bioaccumulate in aquatic organisms, disrupting behavior and cellular functions.

University of Toronto scientist Chelsea Rochman studies microplastics, one of the planet’s most concerning but least understood forms of pollution. “It’s ubiquitous now,” she says. “We find microplastic virtually everywhere we sample. It affects wildlife, and it’s in our seafood.”

Although a leader in her research field, Rochman has not studied golf ball toxicity, nor has she ever found a golf ball in a trawl-net trash survey—probably, she guesses, because she has not surveyed areas near golf courses.

Rochman notes that much microplastic is so degraded that it cannot be traced back to its source. “So it’s really important that people are focusing on the bigger material, because that can influence policy change,” she explains.

There’s no question how the golf balls landed in Carmel Bay. “They’re different from other types of plastic pollution in that way—you’ve got a very clear point source,” Savoca says.

Still, prompting policy changes takes time and effort. When Richard Steiner, a retired professor of marine conservation at the University of Alaska, demanded in 2016 that authorities investigate a resort in Fairbanks, Alaska, that challenges its guests to hit golf balls across the Chena River, the Alaska Department of Environmental Conservation took little meaningful action. Steiner said the practice, promoted by Pike’s Waterfront Lodge for many years, has created a stream of golf balls flowing downriver to the Bering Sea, creating a potential threat to marine life. While there was a temporary shutdown of the driving range in 2016, in a September 2017 letter to Steiner, the Department of Environmental Conservation’s water division director Michelle Hale said the “limited environmental risks posed by golf balls” that enter waterways merited no enforcement action. Steiner also made the US Environmental Protection Agency aware of the matter, but the agency has said it is not pursuing an investigation. The resort’s owner, Jay Ramras, did not respond to requests for an interview.

Even if golf balls entering the Chena River never reach the ocean, those used in the Bering Sea Ice Classic Golf Tournament, an annual event held in western Alaska, almost certainly do. Participants play on the frozen surface of the sea, and an online bulletin promoting the event says golf balls used in the competition “have a tendency to roll into cracks in the ice or get lost in snow drifts.”

This marine region, Steiner points out, is a summer feeding zone for gray whales. “They scoop up their food from the seafloor,” he says.

In fact, golf balls have been found in the stomachs of at least two gray whales found dead in Washington State—one in 2010, the other in 2012—though the balls were not identified as the cause of either death. Golf balls also appear in bird stomachs on occasion—something Steiner says he has seen scores of times while inspecting decayed albatross carcasses in the northwestern Hawai‘ian Islands. Golf balls may even find their way into birds’ reproductive tracts—in one documented case, a golf ball encased in shell was laid by a Canada goose.

by Alastair Bland , Hakai Magazine | Read more:
Image:Silver Parrot Studio/Getty

Why We Pretend to Clean Up Oil Spills

In many respects, society’s theatrical response to catastrophic oil spills resembles the way medical professionals respond to aggressive cancer in an elderly patient. Because surgery is available, it is often used. Surgery also creates the impression that the health care system is doing something even though it can’t change or reverse the patient’s ultimate condition. In an oil-based society, the cleanup delusion is also irresistible. Just as it is difficult for us to acknowledge the limits of medical intervention, society struggles to acknowledge the limits of technologies or the consequences of energy habits. And that’s where the state of marine oil spill response sits today: it creates little more than an illusion of a cleanup. Scientists—outside the oil industry—call it “prime-time theater” or “response theater.”

The hard scientific reality is this: a big spill is almost impossible to contain because it is physically impossible to mobilize the labor needed and current cleanup technologies in a timely fashion. When the city of Vancouver released a study in 2015 on the effectiveness of responses to large tanker or pipeline spills along the southern coast of British Columbia, the conclusion was blunt: “collecting and removing oil from the sea surface is a challenging, time-sensitive, and often ineffective process,” even in calm water.

Scientists have recognized this reality for a long time. During the 1970s when the oil industry was poised to invade the Beaufort Sea, the Canadian government employed more than 100 researchers to gauge the impacts of an oil spill on Arctic ice. The researchers doused sea ducks and ring seals with oil and set pools of oil on fire under a variety of ice conditions. They also created sizable oil spills (one was almost 60,000 liters, a medium-sized spill) in the Beaufort Sea and tried to contain them with booms and skimmers. They prodded polar bears into a man-made oil slick only to discover that bears, like birds, will lick oil off their matted fur and later die of kidney failure. In the end, the Beaufort Sea Project concluded that “oil spill countermeasures, techniques, and equipment” would have “limited effectiveness” on ice-covered waters. The reports, however, failed to stop Arctic drilling.

Part of the illusion has been created by ineffective technologies adopted and billed by industry as “world class.” Ever since the 1970s, the oil and gas industry has trotted out four basic ways to deal with ocean spills: booms to contain the oil; skimmers to remove the oil; fire to burn the oil; and chemical dispersants, such as Corexit, to break the oil into smaller pieces. For small spills these technologies can sometimes make a difference, but only in sheltered waters. None has ever been effective in containing large spills.

Conventional containment booms, for example, don’t work in icy water, or where waves run amok. Burning oil merely transforms one grave problem—water pollution—into sooty greenhouse gases and creates air pollution. Dispersants only hide the oil by scattering small droplets into the water column, yet they often don’t even do that since conditions have to be just right for dispersants to work. Darryl McMahon, a director of RESTCo, a firm pursuing more effective cleanup technologies, has written extensively about the problem, and his opinion remains: “Sadly, even after over 40 years experience, the outcomes are not acceptable. In many cases, the strategy is still to ignore spills on open water, only addressing them when the slicks reach shore.”

The issue partly boils down to scale, explains Jeffrey Short, a retired National Oceanic and Atmospheric Administration research chemist who studied the aftermath of the 2010 BP disaster as well as the Exxon Valdez spill in Prince William Sound, which grew at the alarming rate of half a football field per second over two days. “Go try and control something like that,” says Short. Yet almost 30 years after the Exxon Valdez contaminated much of Prince William Sound, the cleanup technology has changed little.

“What I find the most disturbing is the tendency for responsible authorities and industry to adopt technologies mainly because of their optics and with scant regard for their efficacy,” says Short. In addition, chaos rules in the aftermath of a spill. The enormous political pressure to do something routinely sacrifices any duty to properly evaluate what kind of response might actually work over time, says Short. “Industry says ‘we just want to clean it up,’ yet their demonstrative ability to clean it up sucks.”

Consider, for a moment, the industry’s dismal record on oil recovery. Average citizens may think that a successful marine oil spill cleanup actually involves recovering what has been spilled. They may also expect the amount of oil recovered would increase over time as industry learns and adopts better technologies. But there has been little improvement since the 1960s.

During the BP disaster, the majority of the oil evaporated, dropped to the ocean bottom, smothered beaches, dissolved, or remained on or just below the water’s surface as sheen or tar balls. Some oil-chewing bacteria offered assistance by biodegrading the oil after it had been dispersed. Rough estimates indicate that, out of the total amount of oil it spilled, BP recovered 3 percent through skimming, 17 percent from siphoning at the wellhead, and 5 percent from burning. Even so, that’s not much better than the Exxon Valdez spill in 1989 when industry recovered an estimated 14 percent of the oil. Transport Canada admits that it expects only 10 to 15 percent of a marine oil spill to ever be recovered from open water. “Even informed people are taken aback by these numbers,” says Short.

by Andrew Nikiforuk, Smithsonian | Read more:
Image:RGB Ventures/SuperStock/Alamy Stock Photo

Paul Westerberg

The Myth of What’s Driving the Opioid Crisis

Doctor-prescribed painkillers are not the biggest threat.

As an addiction psychiatrist, I have watched with serious concern as the opioid crisis has escalated in the United States over the past several years, and overdose deaths have skyrocketed. The latest numbers from the Centers for Disease Control and Prevention show fatalities spiraling up to about 42,000 in 2016, almost double the casualties in 2010 and more than five times the 1999 figures. The White House Council of Economic Advisers recently estimated that the opioid crisis cost the nation half a trillion dollars in 2015, based on deaths, criminal justice expenses and productivity losses. Meanwhile, foster care systems are overflowing with children whose parents can’t care for them, coroners’ offices are overwhelmed with bodies and ambulance services are straining small-town budgets. American carnage, indeed.

I have also watched a false narrative about this crisis blossom into conventional wisdom: The myth that the epidemic is driven by patients becoming addicted to doctor-prescribed opioids, or painkillers like hydrocodone (e.g., Vicodin) and oxycodone (e.g., Percocet). One oft-quoted physician refers to opioid medication as “heroin pills.” This myth is now a media staple and a plank in nationwide litigation against drugmakers. It has also prompted legislation, introduced last spring by Senators John McCain and Kirsten Gillibrand—the Opioid Addiction Prevention Act, which would impose prescriber limits because, as a news release stated, “Opioid addiction and abuse is commonly happening to those being treated for acute pain, such as a broken bone or wisdom tooth extraction.”

But this narrative misconstrues the facts. The number of prescription opioids in circulation in the United States did increase markedly from the mid-1990s to 2011, and some people became addicted through those prescriptions. But I have studied multiple surveys and reviews of the data, which show that only a minority of people who are prescribed opioids for pain become addicted to them, and those who do become addicted and who die from painkiller overdoses tend to obtain these medications from sources other than their own physicians. Within the past several years, overdose deaths are overwhelmingly attributable not to prescription opioids but to illicit fentanyl and heroin. These “street opioids” have become the engine of the opioid crisis in its current, most lethal form.

If we are to devise sound solutions to this overdose epidemic, we must understand and acknowledge this truth about its nature.

For starters, among people who are prescribed opioids by doctors, the rate of addiction is low. According to a 2016 national survey conducted by the Substance Abuse and Mental Health Services Administration, 87.1 million U.S. adults used a prescription opioid—whether prescribed directly by a physician or obtained illegally—sometime during the previous year. Only 1.6 million of them, or about 2 percent, developed a “pain reliever use disorder,” which includes behaviors ranging from overuse to overt addiction. Among patients with intractable, noncancer pain—for example, neurological disorders or musculoskeletal or inflammatory conditions—a review of international medical research by the Cochrane Library, a highly regarded database of systemic clinical reviews, found that treatment with long-term, high-dose opioids produced addiction rates of less than 1 percent. Another team found that abuse and addiction rates within 18 months after the start of treatment ranged from 0.12 percent to 6.1 percent in a database of half a million patients. A 2016 report in the New England Journal of Medicine concluded that in multiple published studies, rates of “carefully diagnosed” addiction to opioid medication averaged less than 8 percent. In a study several years ago, a research team purposely excluded chronic-pain patients with prior drug abuse and addiction from their data, and found that only 0.19 percent of the patients developed abuse and addiction to opioids.

Indeed, when patients do become addicted during the course of pain treatment with prescribed opioids, often they simultaneously face other medical problems such as depression, anxiety, other mental health conditions, or current or prior problems with drugs or alcohol. According to SAMHSA’s 2014 National Survey on Drug Use and Health, more than three-fourths of those who misuse pain medication already had used other drugs, including benzodiazepines and inhalants, before they ever misused painkillers. And according to CDC data, at least half of all prescription opioid-related deaths are associated with other drugs, such as benzodiazepines, alcohol and cocaine; combinations that are often deadlier than the component drugs on their own. The physical and mental health issues that drive people to become addicted to drugs in the first place are very much part of America’s opioid crisis and should not be discounted, but it is important to acknowledge the influence of other medical problems and other drugs.

Just because opioids in the medical context don’t produce high rates of addiction doesn’t mean doctors aren’t overprescribing and doing serious harm. The amount of opioids prescribed per person in 2016, though a bit lower than the previous year, was still considered high by the CDC—more than three times the amount of opioids dispensed in 1999. Some doctors routinely give a month’s supply of opioids for short-term discomfort when only a few days’ worth or even none at all is needed. Research suggests that patients given post-operation opioids don’t end up needing to use most of their prescribed dose.

In turn, millions of unused pills end up being scavenged from medicine chests, sold or given away by patients themselves, accumulated by dealers and then sold to new users for about $1 per milligram. As more prescribed pills are diverted, opportunities arise for nonpatients to obtain them, abuse them, get addicted to them and die. According to SAMHSA, among people who misused prescription pain relievers in 2013 and 2014, about half said that they obtained those pain relievers from a friend or relative, while only 22 percent said they received the drugs from their doctor. The rest either stole or bought pills from someone they knew, bought from a dealer or “doctor-shopped” (i.e., obtained multiple prescriptions from multiple doctors). So diversion is a serious problem, and most people who abuse or become addicted to opioid pain relievers are not the unwitting pain patients to whom they were prescribed.

While reining in excessive opioid prescriptions should help limit diversion and, in theory, suppress abuse and addiction among those who consume the diverted supply, it will not be enough to reduce opioid deaths today. In the first decade of the 2000s, the opioid crisis almost seemed to make sense: The volume of prescribed opioids rose in parallel with both prescription overdose deaths and treatment admissions for addiction to prescription opioids. Furthermore, 75 percent of heroin users applying to treatment programs initiated their opioid addiction with pills, so painkillers were seen as the “gateway” to cheap, abundant heroin after their doctors finally cut them off. (“Ask your doctor how prescription pills can lead to heroin abuse,” blared massive billboards from the Partnership for a Drug-Free New Jersey.) If physicians were more restrained in their prescribing, the logic went, fewer of their patients would become addicted, and the pipeline to painkiller addiction and ultimately to heroin would run dry.

It’s not turning out that way. While the volume of prescriptions has trended down since 2011, total opioid-related deaths have risen. The drivers for the past few years are heroin and, mostly, fentanyl, a synthetic opioid that is 50 times as potent as heroin. Fentanyl has legitimate medical use, but there is also illicit fentanyl, trafficked mostly from China, often via the Dark Web. Fentanyl and heroin (which itself is usually tainted to some extent with the fentanyl) together were present in more than two-thirds of all opioid-related deaths in 2016, according to CDC data. Painkillers were present in a little more than one-third of opioid-related deaths, but a third of those painkiller deaths also included heroin or fentanyl. While deaths from prescription opioids have basically leveled off, when you look at deaths in which prescription opioids plus heroin and fentanyl were present, then the recorded deaths attributed to prescription opioids continue to climb, too. (An especially pernicious element in the mix is counterfeiters with pill presses who sell illicit fentanyl in pill form deceptively labeled as OxyContin and other opioid pain relievers or benzodiazepines.)

Notably, more current heroin users these days seem to be initiating their opioid trajectory with heroin itself—an estimated 33 percent as of 2015—rather than with opioid painkillers. In the first decade of the 2000s, about 75 to 80 percent of heroin users started using opioids with pills (though not necessarily pain medication prescribed by a doctor for that particular person). It seems that, far more than prescribed opioids, the unpredictability of heroin and the turbocharged lethality of fentanyl have been a prescription for an overdose disaster.

***

Intense efforts to curb prescribing are underway. Pharmacy benefit managers, such as CVS, insurers and health care systems have set limits or reduction goals. State-based prescription drug monitoring programs help doctors and pharmacists identify patients who doctor-shop, ER hop or commit insurance fraud. As of July, 23 states had enacted legislation with some type of limit, guidance or requirement related to opioid prescribing. McCain and Gillibrand’s federal initiative goes even further, to impose a blanket ban on refills of the seven-day allotment for acute pain. And watchdog entities such as the National Committee for Quality Assurance have endorsed a system that compares the number of patients receiving over a certain dose of opioids with the performance rating for a physician.

A climate of precaution is appropriate, but not if it becomes so chilly that doctors fear prescribing. This summer, a 66-year-old retired orthopedic surgeon who practiced in Northern California—I’ll call her Dr. R—contacted me. For more than 30 years, she had been on methadone, a legitimate opioid pain medication, for an excruciating inflammatory bladder condition called interstitial cystitis. With the methadone, she could function as a surgeon. “It gave me a life. I would not be here today without it,” she told me. But one day in July, her doctor said the methadone had to stop. “She seemed to be worried that she was doing something illegal,” Dr. R told me.

Dr. R was fortunate. She found another doctor to prescribe methadone. But her experience of nonconsensual withdrawal of opioids is not isolated. Last year, the nonprofit Pain News Network conducted an online survey among 3,100 chronic pain patients who had found relief with opioids and had discussed this in online forums. While not necessarily a representative sample of all individuals with chronic pain who are on opioids, the survey was informative: 71 percent of respondents said they are no longer prescribed opioid medication by a doctor or are getting a lower dose; 8 out of 10 said their pain and quality of life are worse; and more than 40 percent said they considered suicide as a way to end their pain. The survey was purposely conducted a few months after the CDC released guidelines that many doctors, as well as insurance carriers and state legislatures, have erroneously interpreted as a government mandate to discontinue opioids. In other accounts, patients complain of being interrogated by pharmacists about their doses; sometimes they are even turned away.

The most tragic consequence is suicide. Thomas F. Kline, an internist in Raleigh, North Carolina, has chronicled 23 of them. His count is surely a harbinger of further patient abandonment to come. Meanwhile, so-called pain refugees—chronic pain patients whose doctors have dropped them—search out physicians to treat them, sometimes traveling more than a hundred miles or relocating. And in a recent Medscape survey, half the doctors who were polled expressed fear of violent reactions if patients were refused the prescription.

Knowing all this, what should we do about the opioid crisis? First, we must be realistic about who is getting in trouble with opioid pain medications. Contrary to popular belief, it is rarely the people for whom they are prescribed. Most lives do not come undone, let alone end in overdose, after analgesia for a broken leg or a trip to the dentist. There is a subset of patients who are vulnerable to abusing their medication—those with substance use histories or with mental health problems. Ideally, they should inform physicians of their history, and, in turn, their doctors should elicit such information from them.

Still, given that diverted pills, not prescribed medication taken by patients for pain, are the greater culprit, we cannot rely on doctors or pill control policies alone to be able to fix the opioid crisis. What we need is a demand-side policy. Interventions that seek to reduce the desire to use drugs, be they painkillers or illicit opioids, deserve vastly more political will and federal funding than they have received. Two of the most necessary steps, in my view, are making better use of anti-addiction medications and building a better addiction treatment infrastructure.

by Sally Satel, M.D., Politico | Read more:
Image: John Moore/Getty Images
[ed. There isn't a single aspect of America's War on Drugs that makes sense or has been effective: enforcement, scheduling, criminalization, rehabilitation, research. Nothing. See also: Opioid crisis: overdoses increased by a third across US in 14 months, says CDC and America Is Giving Away the $30 Billion Medical Marijuana Industry]

Dimmed Stars With Fuel to Burn

Ichiro Suzuki went 0 for 4 the day Felix Hernandez made his debut for the Seattle Mariners in 2005. But that is not how Hernandez remembers it. To him, Suzuki might as well have batted 1.000.

“Every time he came up to the plate was a hit,” Hernandez said by his locker on Tuesday at the Peoria Sports Complex. “It was exciting. He could do a lot of things on the field.”

Suzuki, 44, will soon return officially to the Mariners’ clubhouse, where he already has a locker stall, a stack of mail and his old No. 51 jersey waiting for him. The Mariners have not announced their contract agreement, but it is an open secret that Suzuki, a former American League most valuable player who took his physical in Seattle on Monday, is coming back.

About 10 miles down Bell Road, at the Texas Rangers’ complex in Surprise, another former superstar has also found a home. Tim Lincecum, a two-time Cy Young Award winner for the San Francisco Giants, worked out with the Rangers on Tuesday after agreeing to a contract.

The Rangers were awaiting the results of a physical exam before officially clearing a roster space for Lincecum, who attended the funeral of his older brother, Sean, last weekend. The Rangers plan to use Lincecum, 33, as a reliever, but they do not know exactly what they have. (...)

In their primes, Suzuki and Lincecum were undersized marvels: Both 5 feet 11 inches and less than 180 pounds, their bodies seemingly made of elastic. Suzuki slashed and dashed in one motion as he bolted from the batter’s box. Lincecum twisted and whirled and launched his body at hitters, an impossibly long stride helping generate extraordinary power.

Suzuki’s M.V.P. rookie season in 2001 coincided with the last playoff appearance by the Mariners, whose postseason drought is now the longest of any team in baseball, the N.F.L., the N.B.A. or the N.H.L.

Seattle traded Suzuki to the Yankees in 2012, and in the last five seasons he has hit just .263. This version of Suzuki may not help much, but the nostalgia is palpable.

“Everywhere you go, people love him,” second baseman Robinson Cano said, who played with Suzuki on the Yankees. “He’s the man here. The things that he did here, it was something I don’t think anybody’s ever done.”

The résumé is remarkable, indeed: In each season from 2001 through 2010, Suzuki collected at least 200 hits while batting above .300, winning a Gold Glove and being named an All-Star. He has 3,080 hits in the majors and 1,278 in Japan.

“Last year, in the second half, he hit pretty good,” Hernandez said, referring to Suzuki’s .299 average for Miami after the All-Star break. “I tell you, man, he’s not gonna come over here and not produce. He’s gonna hit.”

by Tyler Kepner, NY Times |  Read more:

Image: uncredited

[ed. Ichiro is back with the Mariners!]

Andreas Gursky, Les Mées, 2016

via:

What Is Amazon Key?

With online shopping and home deliveries becoming more and more popular, porch theft is also on the rise. To protect the packages on your doorstep from getting into the wrong hands, Amazon created Amazon Key, a high-tech package delivery system that allows delivery personnel to enter your home and drop off packages rather than leaving them out in the open for thieves to potentially steal. While it seems some people are hesitant about the idea of letting strangers into their homes, there are many potential benefits to Amazon Key. If you’re ok with a delivery person putting your package inside your front door rather than outside, Amazon Key might be a good fit for you. Here’s everything you need to know about Amazon Key.

Who Can Use It?

Amazon Key is available to Amazon Prime members. Amazon Prime costs $99 for a year, or $13 a month if you select the month-to-month payment plan.

However, Amazon Key is not available all across the United States. You can enter your location here to find out if your zip code is eligible for the Amazon Key service.

How Do I Set Up Amazon Key?

To set up Amazon Key, you’ll need to get your home ready with the necessary devices. First, you’ll need to buy and install Amazon’s Cloud Cam home security camera near your front door. You’ll also need to add a compatible smart lock to your door and sync it up with the rest of your smart home. Amazon has an Amazon Key Home Kit that includes the Cloud Cam and a Yale smart lock available for $250. But, you don’t necessarily have to have this particular lock to access Amazon Key — other smart lock brands such as Kwikset are also compatible. Get more information here.

How Does It Work?

You’ll need to install the Cloud Cam within 25 feet of your smart lock and facing your front door. You’ll then need to download the Amazon Key app on your phone and follow the instructions for setup, including inputing your home address. After that, you should be ready to get started.

On delivery day, you’ll receive a notification in the morning with a 4-hour window for when the driver will arrive at your home. Right before the driver arrives, you will receive a notification and watch the delivery happening live if you want (or later, as it’s stored for 24 hours). The driver will knock first and then request to unlock your door with their handheld scanner. Amazon then verifies that the package belongs to the address and the driver is near the door, turns on Amazon Cloud Cam, and unlocks your door. The driver doesn’t get any codes to open the door. The delivery person then leaves the package just inside the house, closes the door, then leaves. The smart lock automatically locks once the delivery person has closed the door and left.

Got an existing security system? Amazon Key won’t be able to work in conjunction with that, so if you have an alarm that goes off anytime the door opens that requires a code to turn off, you’ll need to disarm that before the delivery happens.

How Do I Request a Key Delivery?

Once you’ve gotten an Amazon Prime subscription and your Amazon Key setup is installed, Amazon will automatically select a Key delivery request at checkout. But before you get excited about all the bulky items you’ll now be able to order with white-glove delivery service, keep one thing in mind. Amazon only allows Key delivery for 10 million goods across the site, and these products are all things that one person would be able to carry alone. That’s why appliances, large electronic items, and bulky furniture are not currently part of the service.

by Gia Liu, Digital Trends |  Read more:

Image: uncredited

[ed. Just kill me now.]

The Exhilarating Art of Landing Planes in Crazy Crosswinds

The next time you feel like complaining about flying, (so, the next time you fly) a report this morning from a pilot landing at Dulles International Airport in Washington, DC, should put things into perspective:

“Very bump on descent. Pretty much every one on the plane threw up. Pilots were on the verge of throwing up.”

The members of the cleaning crew assigned to that wretched and retched-upon Bombardier regional jet were among the many victims of the Nor’easter currently slamming the East Coast. Winds as fierce as 70 mph have downed enough power lines to leave 450,000 in the dark, forced officials to suspend rail service and close bridges, and thrown planes about like a baby whacking the mobile above its crib.

This kind of storm is no fun for anyone, except, maybe, the pilots. “It’s kind of fun,” says Doug Moss, a commercial pilot and aviation consultant, even if the people outside the cockpit don’t think so. “I’m sure it scares the living daylights out of a lot of them.”

When they’re cruising, pilots can avoid most turbulence with a slight change to the flight plan. But the runway is where the runway is, and there’s only one path from the air to the ground. Which can mean having to land in crosswinds that can push planes to and fro.

That may look scary, Moss says. But for a competent pilot, it’s just a matter of crabbing and slipping. When the winds are calm, coming in to land is a matter of lining up with the runway as you gradually slow down and lose altitude, and lifting the nose (that’s called flaring) at the last moment to reduce your vertical speed and soften the impact. A heavy crosswind, however, will push the plane off course as it makes its approach.

When you crab, as you approach, you point the nose of the plane to the left or the right, angling into the wind. The plane is flying sideways, in a sense—the way a crab walks—but doing so keeps it on course. As you shed altitude and speed, you’ll turn further into the wind, using a mix of experience and trial and error to find the right angle.

When you’re just 50 or 100 feet above the ground, about to lift the nose and put rubber to runway, you switch techniques, from the crab to the slip. That means using the rudder pedals to swing the plane so the fuselage is parallel to the runway, the way it would have been from the beginning in calmer winds. Now, to counteract the crosswind, you use the ailerons (those hinged bits near the tip of the wing) to bank the aircraft, tipping the wings into the wind. Because the plane isn’t quite level, you may put one set of wheels on the ground before the other. That’s why different planes are certified for landing at different crosswind speeds—aircraft differ in what structural forces they can handle when landing in suboptimal optimal conditions.

“It’s a real finesse maneuver,” Moss says. The art of flying is doing all of that smoothly enough to keep your passengers safe and their barf bags untouched. And while modern autopilot systems can do a lot of this, they only work up to a certain wind speed. The most galling of gales call for a human touch.

by Alex Davies, Wired |  Read more:

Image: via

[ed. Slips are useful not just for crosswinds but for dumping a lot of altitude over a short distance. Hard rudder one way, ailerons cranked the other, drop like a rock. It feels slighty unnerving when you're first learning it, but really kind of fun after that.]

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