On Everest, Traffic Isn’t Just Inconvenient. It Can Be Deadly. (NY Times)
Image: Project Possible, via Agence France-Presse — Getty Images
Friday, May 24, 2019
Thursday, May 23, 2019
Documenting the Train Wreck
Documenting the Train Wreck: Atmospheric CO2 Is Now Higher Than Ever in Human History, and Rising (Naked Capitalism).
Image: Peter Gleick (Twitter)
[ed. See also: An Even More Inconvenient Truth (ProPublica).]
The APA Meeting: A Photo-Essay
The first thing you notice at the American Psychiatric Association meeting is its size. By conservative estimates, a quarter of the psychiatrists in the United States are packed into a single giant San Francisco convention center, more than 15,000 people.
Being in a crowd of 15,000 psychiatrists is a weird experience. You realize that all psychiatrists look alike in an indefinable way. The men all look balding, yet dignified. The women all look maternal, yet stylish. Sometimes you will see a knot of foreign-looking people huddled together, their nametags announcing them as the delegation from the Nigerian Psychiatric Association or the Nepalese Psychiatric Association or somewhere else very far away. But however exotic, something about them remains ineffably psychiatrist.
The second thing you notice at the American Psychiatric Association meeting is that the staircase is shaming you for not knowing enough about Vraylar®.
Seems kind of weird. Maybe I’ll just take the escalator…
…no, the escalator is advertising Latuda®, the “number one branded atypical antipsychotic”. Aaaaaah! Maybe I should just sit down for a second and figure out what to do next…
AAAAH, CAN’T SIT DOWN, VRAYLAR® HAS GOTTEN TO THE BENCHES TOO! Surely there’s a non-Vraylar bench somewhere in this 15,000 person convention center!
Image: uncredited
[ed. Hilarious. And depressing.]
Wednesday, May 22, 2019
I Am Pilgrim
Neither its plot nor its provenance do much to recommend Terry Hayes’s “I Am Pilgrim.” So it’s all the more surprising that this first novel by a screenwriter of films not renowned for their dialogue turns out to be the most exciting desert island read of the season.
Yes, the 600 or so action-packed pages are headed toward a showdown between a brave and ultra-brilliant American secret agent and an equally fearless jihadi terrorist. But neither is written as a stereotype; the two don’t meet until the end of the story; and this book has the whole globe to trot around before that. There are more than enough subplots and flashbacks to keep readers riveted. The American agent’s wild array of past exploits could fill a book of their own.
Despite Mr. Hayes’s long history as a movie guy (his credits include “Mad Max 2: The Road Warrior” and “Mad Max Beyond Thunderdome” ), “I Am Pilgrim” is not a film treatment bloated into book form. It’s a big, breathless tale of nonstop suspense, and it has something rarely found in big-budget movies of the same genre: the voice of a single writer instead of the patchwork nonsense created by endless collaborators and fixers. Mr. Hayes delivers his share of far-fetched moments, and no doubt he’d like to see “I Am Pilgrim” filmed some day. But he’s his own worst enemy in that regard. His novel will be hard for any movie version to beat.
The screenwriter in Mr. Hayes mandates that “I Am Pilgrim” begin with a big, lurid crime scene. So our narrator, who goes by many fake names, is summoned to a hotel room in Lower Manhattan in the aftermath of Sept. 11. There, in the midst of the chaos, is a once-hot-looking woman who has been killed in a way that erases all signs of her identity. It’s almost as if the killer had followed guidelines described in the secret but worshipfully regarded forensics manual our guy wrote, under the fake name Jude Garrett, for a secret subsidiary of the C.I.A.
With lightning speed, and with logic best not examined too closely, Mr. Hayes greatly widens his book’s canvas after this New York scene. We find out about how, our main man, now 32, spent his early years on an estate in Greenwich, Conn.; was faking his identity, even as a boy; and has earned his reputation as a lethal spy but fears that he must give up a “a thing most people call love, I suppose.” As he puts it, “I wanted to walk along a beach with someone and not think about how far a sniper can fire.” Maybe that’s possible in a sequel, but he won’t be taking any slow, romantic strolls this time.
Cut to Saudi Arabia, where the mind of a teenage terrorist is being formed. Allowing for the fact that few mainstream Western writers have much insight into such characters, Mr. Hayes does what he can to breathe life into the ideas of hatred and vengeance as life-altering motivations. (He has also written screenplays for Mel Gibson.) So this boy, who will come to be known as the Saracen, has his fate determined by his father’s. “Only in a police state does a child pray for nothing more serious than a crippling accident to have befallen their parent,” Mr. Hayes writes. Grammarians who howl at popular fiction like Dan Brown’s books can find a lot to work with here, too.
After Mr. Hayes writes, more movingly than gruesomely, of how the boy is affected by his father’s public beheading (his crime: disparaging the royal family), he raises the rage level: The family’s widowed mother must now get a job, which somehow entails exposing her face and wearing Gucci sunglasses. That’s it: The son goes into exile, determined to learn how to wage war against America. A couple of decades later, having roamed from Bahrain to Afghanistan to Germany, he is ready and able.
The Saracen becomes a doctor and, after experimenting shockingly on human guinea pigs, perfects a new, improved strain of plague that is vaccine-proof. On a parallel track, our guy — who will ultimately be known as Pilgrim (no clue as to whether this is meant to evoke John Wayne) — is recruited at the highest level (enter the president of the United States) to ward off a terrible but mysterious threat to the nation, a threat that turns the last part of the book into a race against the clock.
Mr. Hayes aligns his characters very ingeniously for this final part of the story, to the point where even that initial New York murder has something to do with it, and all the loose ends begin to come together. By this point, the Saracen and Pilgrim are a couple so clearly made for each other that the reader can hardly wait for them to meet. The setting, like all this book’s settings, is too picturesque for words. Mr. Hayes seems to have done backbreaking travel to some of the world’s most beautiful places in the name of research for his peripatetic story.
by Janet Maslin, NY Times | Read more:
Image: Sonny Figueroa
[ed. I don't usually read mysteries/thrillers (like... never), but really enjoying this one. Can't put it down.]
Yes, the 600 or so action-packed pages are headed toward a showdown between a brave and ultra-brilliant American secret agent and an equally fearless jihadi terrorist. But neither is written as a stereotype; the two don’t meet until the end of the story; and this book has the whole globe to trot around before that. There are more than enough subplots and flashbacks to keep readers riveted. The American agent’s wild array of past exploits could fill a book of their own.
Despite Mr. Hayes’s long history as a movie guy (his credits include “Mad Max 2: The Road Warrior” and “Mad Max Beyond Thunderdome” ), “I Am Pilgrim” is not a film treatment bloated into book form. It’s a big, breathless tale of nonstop suspense, and it has something rarely found in big-budget movies of the same genre: the voice of a single writer instead of the patchwork nonsense created by endless collaborators and fixers. Mr. Hayes delivers his share of far-fetched moments, and no doubt he’d like to see “I Am Pilgrim” filmed some day. But he’s his own worst enemy in that regard. His novel will be hard for any movie version to beat.The screenwriter in Mr. Hayes mandates that “I Am Pilgrim” begin with a big, lurid crime scene. So our narrator, who goes by many fake names, is summoned to a hotel room in Lower Manhattan in the aftermath of Sept. 11. There, in the midst of the chaos, is a once-hot-looking woman who has been killed in a way that erases all signs of her identity. It’s almost as if the killer had followed guidelines described in the secret but worshipfully regarded forensics manual our guy wrote, under the fake name Jude Garrett, for a secret subsidiary of the C.I.A.
With lightning speed, and with logic best not examined too closely, Mr. Hayes greatly widens his book’s canvas after this New York scene. We find out about how, our main man, now 32, spent his early years on an estate in Greenwich, Conn.; was faking his identity, even as a boy; and has earned his reputation as a lethal spy but fears that he must give up a “a thing most people call love, I suppose.” As he puts it, “I wanted to walk along a beach with someone and not think about how far a sniper can fire.” Maybe that’s possible in a sequel, but he won’t be taking any slow, romantic strolls this time.
Cut to Saudi Arabia, where the mind of a teenage terrorist is being formed. Allowing for the fact that few mainstream Western writers have much insight into such characters, Mr. Hayes does what he can to breathe life into the ideas of hatred and vengeance as life-altering motivations. (He has also written screenplays for Mel Gibson.) So this boy, who will come to be known as the Saracen, has his fate determined by his father’s. “Only in a police state does a child pray for nothing more serious than a crippling accident to have befallen their parent,” Mr. Hayes writes. Grammarians who howl at popular fiction like Dan Brown’s books can find a lot to work with here, too.
After Mr. Hayes writes, more movingly than gruesomely, of how the boy is affected by his father’s public beheading (his crime: disparaging the royal family), he raises the rage level: The family’s widowed mother must now get a job, which somehow entails exposing her face and wearing Gucci sunglasses. That’s it: The son goes into exile, determined to learn how to wage war against America. A couple of decades later, having roamed from Bahrain to Afghanistan to Germany, he is ready and able.
The Saracen becomes a doctor and, after experimenting shockingly on human guinea pigs, perfects a new, improved strain of plague that is vaccine-proof. On a parallel track, our guy — who will ultimately be known as Pilgrim (no clue as to whether this is meant to evoke John Wayne) — is recruited at the highest level (enter the president of the United States) to ward off a terrible but mysterious threat to the nation, a threat that turns the last part of the book into a race against the clock.
Mr. Hayes aligns his characters very ingeniously for this final part of the story, to the point where even that initial New York murder has something to do with it, and all the loose ends begin to come together. By this point, the Saracen and Pilgrim are a couple so clearly made for each other that the reader can hardly wait for them to meet. The setting, like all this book’s settings, is too picturesque for words. Mr. Hayes seems to have done backbreaking travel to some of the world’s most beautiful places in the name of research for his peripatetic story.
by Janet Maslin, NY Times | Read more:
Image: Sonny Figueroa
[ed. I don't usually read mysteries/thrillers (like... never), but really enjoying this one. Can't put it down.]
Your Car Knows When You Gain Weight
Cars produced today are essentially smartphones with wheels. For drivers, this has meant many new features: automatic braking, turn-by-turn directions, infotainment. But for all the things we’re getting out of our connected vehicles, carmakers are getting much, much more: They’re constantly collecting data from our vehicles.
Today’s cars are equipped with telematics, in the form of an always-on wireless transmitter that constantly sends vehicle performance and maintenance data to the manufacturer. Modern cars collect as much as 25 gigabytes of data per hour, the consulting firm McKinsey estimates, and it’s about much more than performance and maintenance.
Cars not only know how much we weigh but also track how much weight we gain. They know how fast we drive, where we live, how many children we have — even financial information. Connect a phone to a car, and it knows who we call and who we text.
But who owns and, ultimately, controls that data? And what are carmakers doing with it?
The issue of ownership is murky. Drivers usually sign away their rights to data in a small-print clause buried in the ownership or lease agreement. It’s not unlike buying a smartphone. The difference is that most consumers have no idea vehicles collect data. (...)
Debates around privacy often focus on companies like Facebook. But today’s connected cars — and tomorrow’s autonomous vehicles — show how the commercial opportunities in collecting personal data are limitless. Your location data will allow companies to advertise to you based on where you live, work or frequently travel. Data gathered from voice-command technology could also be useful to advertisers.
The data on your driving habits — how fast you drive, how hard you brake, whether you always use your seatbelt — could be valuable to insurance companies. You may or may not choose to share your data with these services. But while you can turn off location data on your cellphone, there’s no opt-out feature for your car.
Carmakers use data to alert us when something needs repair or when our cars need to be taken in for service. What they don’t tell us is that by controlling our data, they can limit where we get that repair or service done. For almost a century, car and truck owners have been able to take their vehicles to whichever shop they choose and trust for maintenance and repair. That may be changing.
Because of the increasing complexity of cars and the Internet of Things, data is critical to repair and service. When carmakers control the data, they can choose which service centers receive our information. They’re more likely to share our data exclusively with their branded dealerships than with independent repair shops, which could have the edge in price and convenience. However, independent repair shops currently make 70 percent of outside warranty repairs throughout the country.
This is a different facet of the privacy conversation. Our anxiety about data typically focuses on what happens when information is shared with those we don’t want to see it. But what about when information is withheld from those we do want to see it?
Imagine visiting a medical specialist and learning he can’t get access to the medical history that your doctor maintains, or having a financial adviser acknowledge that neither of you can see your accounts unless you pay a fee. It’s alarmingly easy to imagine carmakers’ charging fees to independent repair shops that need access to vehicle data to service a vehicle purchased for tens of thousands of dollars. That fee will lead to vehicle owners’ paying higher repair prices just so that technicians can obtain the data.
There are more than 180,000 independent repair shops across the country; most have all the tools needed to work on today’s connected and complex cars, and most of today’s highly trained service technicians can perform anything from basic tuneups to sophisticated electronic diagnostics. But without access to car data, they’re working blindfolded, unable to see the diagnostic information they need.
Today’s cars are equipped with telematics, in the form of an always-on wireless transmitter that constantly sends vehicle performance and maintenance data to the manufacturer. Modern cars collect as much as 25 gigabytes of data per hour, the consulting firm McKinsey estimates, and it’s about much more than performance and maintenance.
Cars not only know how much we weigh but also track how much weight we gain. They know how fast we drive, where we live, how many children we have — even financial information. Connect a phone to a car, and it knows who we call and who we text.But who owns and, ultimately, controls that data? And what are carmakers doing with it?
The issue of ownership is murky. Drivers usually sign away their rights to data in a small-print clause buried in the ownership or lease agreement. It’s not unlike buying a smartphone. The difference is that most consumers have no idea vehicles collect data. (...)
Debates around privacy often focus on companies like Facebook. But today’s connected cars — and tomorrow’s autonomous vehicles — show how the commercial opportunities in collecting personal data are limitless. Your location data will allow companies to advertise to you based on where you live, work or frequently travel. Data gathered from voice-command technology could also be useful to advertisers.
The data on your driving habits — how fast you drive, how hard you brake, whether you always use your seatbelt — could be valuable to insurance companies. You may or may not choose to share your data with these services. But while you can turn off location data on your cellphone, there’s no opt-out feature for your car.
Carmakers use data to alert us when something needs repair or when our cars need to be taken in for service. What they don’t tell us is that by controlling our data, they can limit where we get that repair or service done. For almost a century, car and truck owners have been able to take their vehicles to whichever shop they choose and trust for maintenance and repair. That may be changing.
Because of the increasing complexity of cars and the Internet of Things, data is critical to repair and service. When carmakers control the data, they can choose which service centers receive our information. They’re more likely to share our data exclusively with their branded dealerships than with independent repair shops, which could have the edge in price and convenience. However, independent repair shops currently make 70 percent of outside warranty repairs throughout the country.
This is a different facet of the privacy conversation. Our anxiety about data typically focuses on what happens when information is shared with those we don’t want to see it. But what about when information is withheld from those we do want to see it?
Imagine visiting a medical specialist and learning he can’t get access to the medical history that your doctor maintains, or having a financial adviser acknowledge that neither of you can see your accounts unless you pay a fee. It’s alarmingly easy to imagine carmakers’ charging fees to independent repair shops that need access to vehicle data to service a vehicle purchased for tens of thousands of dollars. That fee will lead to vehicle owners’ paying higher repair prices just so that technicians can obtain the data.
There are more than 180,000 independent repair shops across the country; most have all the tools needed to work on today’s connected and complex cars, and most of today’s highly trained service technicians can perform anything from basic tuneups to sophisticated electronic diagnostics. But without access to car data, they’re working blindfolded, unable to see the diagnostic information they need.
by Bill Hanvey, NY Times | Read more:
Image: Claire Merchlinsky
[ed. See also: Elizabeth Warren's Right-to-Repair proposal (Boing Boing), which should really be expanded to include all consumer products. And, on a slightly different topic but still relevant to much needed digital legislation: The Internet Security Apocalypse You Probably Missed (NY Times).]
Tuesday, May 21, 2019
Don't Punish Pain: The Unseen Victims of the Opioid Crisis
April Grove Doyle, a 40-year-old single mom with metastatic breast cancer, pulled her car to the side of the road. Her face was flushed and her eyes puffy from crying, but she looked into the phone mounted on her dashboard and pressed the record button.
“So, I’m just leaving my pharmacy,” she said, taking a breath to steady herself. “I’m not, I’m not—I’m frustrated, and that’s why I’m crying. I get pain pills, maybe every two, three months, OK? I can make one monthly prescription of pain pills last two or three months because I don’t really take it unless I absolutely need it. And when you have metastatic cancer in your bones, you need it. Because sometimes the pain is so much you can’t even function. And I just want to function.”
After another deep breath, Doyle explained: The pharmacist at her local Rite Aid pharmacy in Visalia, California, had berated her for her history of opioid prescriptions, then told her to come back later. She left without the refill, feeling that she was being treated like a criminal.
Like millions of other chronic pain patients around the country, Doyle is the collateral damage of the opioid abuse epidemic. About 17,000 people die each year in the US from a prescription opioid overdose. Fifty million Americans suffer from chronic pain—one-fifth of the adult population—including 20 million who have what’s called high-impact chronic pain, or pain that frequently limits their daily life.
The campaign to keep opioids away from people who abuse them has ended up punishing the people who use them legitimately—even torturing them to the point of suicide. Now they are pushing back, mobilizing as best they can into a burgeoning movement. “Don’t Punish Pain” rallies are taking place in cities nationwide on May 22, and pain patients are organizing a protest at the Centers for Disease Control and Prevention in Atlanta on June 21.
Doyle posted her video to her Facebook page, The C Life, and by the time she got back to her office after her lunch break, her phone began to bing with notifications. The video has since been viewed about 330,000 times; many of the 1,400 comments came from people with similar experiences. After her post went viral, Rite Aid filled her prescription—and apologized.
“This is not right,” Doyle says. “These medications were created for the very problems we’re having, and yet we’re not being allowed access to them.” (...)
Perhaps the most powerful support comes from pain experts. In March, a group called Health Professionals for Patients in Pain wrote to the Centers for Disease Control and Prevention, urging the agency to respond to the “widespread misapplication” of its 2016 Guideline for Prescribing Opioids for Chronic Pain. Patients were being forced to taper off opioids and were subjected to unnecessary suffering, they said. The letter was signed by more than 300 health professionals, including three former US drug czars.
On April 9, the Food and Drug Administration warned that suddenly decreasing dosage or halting opioids in patients who are dependent on them could lead to “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.” The next day, the CDC director clarified that the agency’s guideline, which recommends against high doses of opioids, applies to the initiation of opioid treatment and not to patients who have been stable in long-term treatment. (...)
Yet chronic pain patients say many doctors have already stopped prescribing opioids. They fear scrutiny from the Drug Enforcement Administration, state medical boards, or even their own health institutions. Authorities want to shut down “pill mills” that fuel the overdose crisis by providing opioids inappropriately, but those same enforcement efforts can affect doctors who prescribe high doses to chronic pain patients. Oregon, for example, wanted to shift patients from opioids to alternative pain treatment, such as acupuncture, massage, and cognitive behavioral therapy. In 2016, the state required Medicaid patients with back and spine conditions to taper off of opioids.
Sean Mackey, chief of the Division of Pain Medicine at Stanford University, was initially reluctant to enter the fray over opioids. “I prefer to avoid this space because there is so much emotional rhetoric and anger and attacks flying both ways,” he says. “I just want to focus on pain, the research and clinical care of people in pain.” But he felt compelled to speak out against what he calls “a social experiment on a large part of the most vulnerable population.”
Mackey wrote a letter warning that forced tapering poses significant harm without any evidence of safety or effectiveness. It was co-signed by more than 100 pain and addiction experts and patient advocates. “People of good conscience need to step up and say ‘No, this is wrong,’” he says.
by Michele Cohen Marill, Wired | Read more:
Image: Godong/UIG/Getty Images
[ed. Thanks to the CDC, FDA, DEA, grandstanding politicians (TOUGH on drugs!), imbecilic media, chickenshit hospitals, physicians, pharmacies, insurance companies, and everyone else who's complicit in making this epidemic worse than it needs to be, here's the face of normal patients just trying to live a normal life without being treated like addicts.]
Opioid Steering Committee Part 15 Hearing 1/30/18: Our next presenter is Dr. Richard Lawhern.
MR. LAWHERN: Good morning. I'm Richard Lawhern, sometimes called Red. I am cofounder of the Alliance for the Treatment of Intractable Pain. We're an organization of about 200 medical professionals knowledgeable with chronic pain patients and caregivers, healthcare providers, and others. We get a daily reach of about 80,000 viewings from social media. We're here to represent the concerns and interests of three million chronic pain patients who are under regular treatment with opioid analgesics. Organizing a late minute session, I wanted you to have the takeaway points up front and these are going to be a little surprising to some in the audience. First of all, FDA is chasing the wrong opioid crisis. Second, the REMS in its present form will harm hundreds of thousands of patients to no good outcome, and help almost none. And I'll expand on these points in the presentation. Second we implore the FDA, and by the way, the DEA, to stand down from further regulation. Take a breath before you do even more harm than the CDC guidelines already have.We focus on the recall and revision of the CDC opioid guidelines, which right now have a wide level of critics among medical professionals on the grounds that I'm stating here. Those guidelines are dangerously incomplete, they are dangerous to public health, and they should be withdrawn and rewritten on a priority basis. Now here is a chart which in a strange way speaks to the very thing I've just remarked upon. Pill counting and supply restriction are not working and the statistics of the CDC itself demonstrate that. The number of prescriptions peaked in 2011 and began to fall. Since the mandated reformulation of OxyContin, prescriptions of that prescription opioid have dropped by two-thirds, but opioid prescriptions being at a low, overdose deaths due to all sources have continued to ramp up. That should be an immediate indicator that what you're doing isn't working, and I'll speak to that in some greater detail as we go. Now I mentioned that I think you're chasing the wrong opioid crisis. We now know from the CDC statistics that opioid deaths are dominated by street drugs, particularly these four. Prescription drugs are a distant fifth in this mortality rate. We have heard the message parroted over and over that 75% or more of addicts start with prescription drugs, and by the way, and alcohol, but most of these drugs are diverted. They're not prescribed by a doctor to a patient who overdoses on them. Massachusetts did a review and tracked their overdose deaths for a year back to their PMP. They found that fewer than 8% of those who died had a current opioid prescription. Likewise, the typical new addict and the typical pain patient are different people.The demographics don’t work.The typical addict, or if you will, a person with addiction-I don’t want to be disrespectful to any of them-is an adolescent or early 20s male with a chronic history of unemployment, family trauma, and perhaps mental health issues. That population is medically underserved. They come from depressed areas of the US, but the typical pain patient is a woman in her 40s or older who has a history of accident trauma, failed surgery, fibromyalgia, and other diseases that produce chronic pain as a symptom, and older women whose lives are stable enough to see a doctor for a prescription are very rarely addicts. You can't make the trail of bread crumbs between these two demographics. It doesn’t exist. Now there are eight questions in the FDAREMS. I will speak briefly to each as we go. First, should the FDA specify a drug amount threshold for additional risk benefit, review? If you'll pardon my venturing slightly in the vernacular, our answer to this is not only no, but hell no. And there's for good reason. Because the CDC guidelines have already specified such a special and that specification has resulted in doctors leaving the practice and in hundreds of suicides. It is literally of that magnitude or larger. Patients are regularly being deserted, discharged, or coerced into tapering down to subtherapeutic levels of opioids.That's got to get fixed. The guidelines have also created a very hostile regulatory environment. Hospitals are actually refusing to treat palliative care patients with opioids in a few cases.There is no one-size-fits-all patient or treatment plan. Each patient must be treated as an individual and we have seen ample evidence that those limitations and rigid pill counting directly harm patients by forcing them into subtherapeutic levels of therapy. Likewise, we should add that the state regulations which mandate for increased visits and shorter visit times for people coming back for prescription are also helping very few and harming great numbers. Prescriptions being denied at pharmacies is endemic and it's being denied on an abundance of care because these people are afraid of being persecuted out of business by the DEA, and I do mean the term persecuted. Extralegal measures are being used to condemn without a trial people who are being forced out of practice for no good cause. Likewise, the second point in REMS. If you want to ensure compliance, you're going to have to put portals in every doctor's office and in every pharmacy in the country. And the problem we have here is the pain patients themselves are a small minority of all people with addiction. You're going after 100% of a cohort of three million people in order to help solve a problem among maybe eight to ten percent of them. Whatever happened to first do no harm? That certainly isn't a good example. We should also remark that very few doctors who are in normal practice are casual about prescribing. You've been successful in getting their attention and very few patients quickly become addicted. There's something not in my presentation I want to add here. There's a study that I recommend to each of the members on this commission. It was published in this month's British Medical Journal. It examines over 560,000 post-surgical patients prescribed opioids and it finds after following them for an average of two-and-a-half years, that 0.6% reported with a diagnosis of an opioid misuse disorder, 0.6. That means that 99.4% of all patients treated in the short term for largely acute pain do not become addicted. That's a direct contradiction to the CDC nonsense and it is that. It's nonsense. MS. TOIGO: Dr. Lawhern, I don’t want to interrupt, but your, your time is up. DR. LAWHERN: Oh, I beg your pardon. MS. TOIGO: You want to wrap up --DR. LAWHERN: I will --MS. TOIGO: Thank you. DR. LAWHERN: Let's go back to the bottom line and the rest of this you can catch on the update, if you will.The FDA is now chasing the wrong crisis. Overregulation is going to make the real crisis worse by driving patients into the street. It's already happening. You will drive more patients into disability and death if you do not realize the regulation is not the answer. The guidelines must be suspended and the VA Page must be directed to remove and rewrite their practice standard which mandates the elimination of opioids from practice. That is not optional. It is a moral and ethical imperative.]
[ed. See also: this, this and this.]
“So, I’m just leaving my pharmacy,” she said, taking a breath to steady herself. “I’m not, I’m not—I’m frustrated, and that’s why I’m crying. I get pain pills, maybe every two, three months, OK? I can make one monthly prescription of pain pills last two or three months because I don’t really take it unless I absolutely need it. And when you have metastatic cancer in your bones, you need it. Because sometimes the pain is so much you can’t even function. And I just want to function.”
After another deep breath, Doyle explained: The pharmacist at her local Rite Aid pharmacy in Visalia, California, had berated her for her history of opioid prescriptions, then told her to come back later. She left without the refill, feeling that she was being treated like a criminal.
The campaign to keep opioids away from people who abuse them has ended up punishing the people who use them legitimately—even torturing them to the point of suicide. Now they are pushing back, mobilizing as best they can into a burgeoning movement. “Don’t Punish Pain” rallies are taking place in cities nationwide on May 22, and pain patients are organizing a protest at the Centers for Disease Control and Prevention in Atlanta on June 21.
Doyle posted her video to her Facebook page, The C Life, and by the time she got back to her office after her lunch break, her phone began to bing with notifications. The video has since been viewed about 330,000 times; many of the 1,400 comments came from people with similar experiences. After her post went viral, Rite Aid filled her prescription—and apologized.
“This is not right,” Doyle says. “These medications were created for the very problems we’re having, and yet we’re not being allowed access to them.” (...)
Perhaps the most powerful support comes from pain experts. In March, a group called Health Professionals for Patients in Pain wrote to the Centers for Disease Control and Prevention, urging the agency to respond to the “widespread misapplication” of its 2016 Guideline for Prescribing Opioids for Chronic Pain. Patients were being forced to taper off opioids and were subjected to unnecessary suffering, they said. The letter was signed by more than 300 health professionals, including three former US drug czars.
On April 9, the Food and Drug Administration warned that suddenly decreasing dosage or halting opioids in patients who are dependent on them could lead to “serious withdrawal symptoms, uncontrolled pain, psychological distress, and suicide.” The next day, the CDC director clarified that the agency’s guideline, which recommends against high doses of opioids, applies to the initiation of opioid treatment and not to patients who have been stable in long-term treatment. (...)
Yet chronic pain patients say many doctors have already stopped prescribing opioids. They fear scrutiny from the Drug Enforcement Administration, state medical boards, or even their own health institutions. Authorities want to shut down “pill mills” that fuel the overdose crisis by providing opioids inappropriately, but those same enforcement efforts can affect doctors who prescribe high doses to chronic pain patients. Oregon, for example, wanted to shift patients from opioids to alternative pain treatment, such as acupuncture, massage, and cognitive behavioral therapy. In 2016, the state required Medicaid patients with back and spine conditions to taper off of opioids.
Sean Mackey, chief of the Division of Pain Medicine at Stanford University, was initially reluctant to enter the fray over opioids. “I prefer to avoid this space because there is so much emotional rhetoric and anger and attacks flying both ways,” he says. “I just want to focus on pain, the research and clinical care of people in pain.” But he felt compelled to speak out against what he calls “a social experiment on a large part of the most vulnerable population.”
Mackey wrote a letter warning that forced tapering poses significant harm without any evidence of safety or effectiveness. It was co-signed by more than 100 pain and addiction experts and patient advocates. “People of good conscience need to step up and say ‘No, this is wrong,’” he says.
by Michele Cohen Marill, Wired | Read more:
Image: Godong/UIG/Getty Images
[ed. Thanks to the CDC, FDA, DEA, grandstanding politicians (TOUGH on drugs!), imbecilic media, chickenshit hospitals, physicians, pharmacies, insurance companies, and everyone else who's complicit in making this epidemic worse than it needs to be, here's the face of normal patients just trying to live a normal life without being treated like addicts.]
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[Addendum.] See also: transcripts of FDA public hearings on the topic. They were definitely warned but chose to ignore it. See: here (heartbreaking) and here (pdfs). Opioid Steering Committee Part 15 Hearing 1/30/18: Our next presenter is Dr. Richard Lawhern.
MR. LAWHERN: Good morning. I'm Richard Lawhern, sometimes called Red. I am cofounder of the Alliance for the Treatment of Intractable Pain. We're an organization of about 200 medical professionals knowledgeable with chronic pain patients and caregivers, healthcare providers, and others. We get a daily reach of about 80,000 viewings from social media. We're here to represent the concerns and interests of three million chronic pain patients who are under regular treatment with opioid analgesics. Organizing a late minute session, I wanted you to have the takeaway points up front and these are going to be a little surprising to some in the audience. First of all, FDA is chasing the wrong opioid crisis. Second, the REMS in its present form will harm hundreds of thousands of patients to no good outcome, and help almost none. And I'll expand on these points in the presentation. Second we implore the FDA, and by the way, the DEA, to stand down from further regulation. Take a breath before you do even more harm than the CDC guidelines already have.We focus on the recall and revision of the CDC opioid guidelines, which right now have a wide level of critics among medical professionals on the grounds that I'm stating here. Those guidelines are dangerously incomplete, they are dangerous to public health, and they should be withdrawn and rewritten on a priority basis. Now here is a chart which in a strange way speaks to the very thing I've just remarked upon. Pill counting and supply restriction are not working and the statistics of the CDC itself demonstrate that. The number of prescriptions peaked in 2011 and began to fall. Since the mandated reformulation of OxyContin, prescriptions of that prescription opioid have dropped by two-thirds, but opioid prescriptions being at a low, overdose deaths due to all sources have continued to ramp up. That should be an immediate indicator that what you're doing isn't working, and I'll speak to that in some greater detail as we go. Now I mentioned that I think you're chasing the wrong opioid crisis. We now know from the CDC statistics that opioid deaths are dominated by street drugs, particularly these four. Prescription drugs are a distant fifth in this mortality rate. We have heard the message parroted over and over that 75% or more of addicts start with prescription drugs, and by the way, and alcohol, but most of these drugs are diverted. They're not prescribed by a doctor to a patient who overdoses on them. Massachusetts did a review and tracked their overdose deaths for a year back to their PMP. They found that fewer than 8% of those who died had a current opioid prescription. Likewise, the typical new addict and the typical pain patient are different people.The demographics don’t work.The typical addict, or if you will, a person with addiction-I don’t want to be disrespectful to any of them-is an adolescent or early 20s male with a chronic history of unemployment, family trauma, and perhaps mental health issues. That population is medically underserved. They come from depressed areas of the US, but the typical pain patient is a woman in her 40s or older who has a history of accident trauma, failed surgery, fibromyalgia, and other diseases that produce chronic pain as a symptom, and older women whose lives are stable enough to see a doctor for a prescription are very rarely addicts. You can't make the trail of bread crumbs between these two demographics. It doesn’t exist. Now there are eight questions in the FDAREMS. I will speak briefly to each as we go. First, should the FDA specify a drug amount threshold for additional risk benefit, review? If you'll pardon my venturing slightly in the vernacular, our answer to this is not only no, but hell no. And there's for good reason. Because the CDC guidelines have already specified such a special and that specification has resulted in doctors leaving the practice and in hundreds of suicides. It is literally of that magnitude or larger. Patients are regularly being deserted, discharged, or coerced into tapering down to subtherapeutic levels of opioids.That's got to get fixed. The guidelines have also created a very hostile regulatory environment. Hospitals are actually refusing to treat palliative care patients with opioids in a few cases.There is no one-size-fits-all patient or treatment plan. Each patient must be treated as an individual and we have seen ample evidence that those limitations and rigid pill counting directly harm patients by forcing them into subtherapeutic levels of therapy. Likewise, we should add that the state regulations which mandate for increased visits and shorter visit times for people coming back for prescription are also helping very few and harming great numbers. Prescriptions being denied at pharmacies is endemic and it's being denied on an abundance of care because these people are afraid of being persecuted out of business by the DEA, and I do mean the term persecuted. Extralegal measures are being used to condemn without a trial people who are being forced out of practice for no good cause. Likewise, the second point in REMS. If you want to ensure compliance, you're going to have to put portals in every doctor's office and in every pharmacy in the country. And the problem we have here is the pain patients themselves are a small minority of all people with addiction. You're going after 100% of a cohort of three million people in order to help solve a problem among maybe eight to ten percent of them. Whatever happened to first do no harm? That certainly isn't a good example. We should also remark that very few doctors who are in normal practice are casual about prescribing. You've been successful in getting their attention and very few patients quickly become addicted. There's something not in my presentation I want to add here. There's a study that I recommend to each of the members on this commission. It was published in this month's British Medical Journal. It examines over 560,000 post-surgical patients prescribed opioids and it finds after following them for an average of two-and-a-half years, that 0.6% reported with a diagnosis of an opioid misuse disorder, 0.6. That means that 99.4% of all patients treated in the short term for largely acute pain do not become addicted. That's a direct contradiction to the CDC nonsense and it is that. It's nonsense. MS. TOIGO: Dr. Lawhern, I don’t want to interrupt, but your, your time is up. DR. LAWHERN: Oh, I beg your pardon. MS. TOIGO: You want to wrap up --DR. LAWHERN: I will --MS. TOIGO: Thank you. DR. LAWHERN: Let's go back to the bottom line and the rest of this you can catch on the update, if you will.The FDA is now chasing the wrong crisis. Overregulation is going to make the real crisis worse by driving patients into the street. It's already happening. You will drive more patients into disability and death if you do not realize the regulation is not the answer. The guidelines must be suspended and the VA Page must be directed to remove and rewrite their practice standard which mandates the elimination of opioids from practice. That is not optional. It is a moral and ethical imperative.]
[ed. See also: this, this and this.]
Why Every Cyclist Needs a Pool Noodle
It’s late March and my friend Erik and I are on the first leg of our 2,000-mile bicycle trip from Los Angeles to Denver. After sweating my way up a hill in Southern California, I bask in a glorious downhill. To protect myself from stumbling off the edge and make myself more visible to cars, I do what I normally do on long, steep downhills: take up the full lane. Through my eyeglass-mounted mirror, I watch cars inevitably pile up behind me. When the terrain flattens out and I move back to the shoulder, a stream of cars pass me.
A woman in one of the passing cars rolls down the window, and instead of the typical words of encouragement, her shriek nearly scares me off my bike as she yells at the top of her lungs, “SELFISH BITCH!”
The hard truth is that bicycles are still largely seen as a nuisance on the road. We’re on the margins—literally. Cyclists are reminded of this every time we get skimmed by a car. According to the World Health Organization, over half of international traffic deaths involve vulnerable road users such as cyclists. And because Americans are among the least avid cyclists in the world, they’re among the most likely to get killed by a car.
But I’ve discovered a life-saving device that allows cyclists to protect themselves and take back the road: the pool noodle.
Find one for about $2 anywhere: dollar stores, shopping malls, even the supermarket. Choose from the array of fun colors and use a bungee cord to strap this light, flexible toy to your bike rack so that it sticks out to the left side (or the right side, if you’re in a country where cars drive on the left). Start pedaling and watch as car after car moves over to the other lane.
The pool noodle may look silly, but since strapping it on our loads, it has made our lives safer every day. (Plus, it’s a fun conversation starter at pitstops, and it also reminds us not to take life too seriously.) On roads with zero road shoulder, the pool noodle becomes our shoulder. It makes us more visible to passing cars and the 18-wheelers that used to skim us constantly.
by Annalisa van den Bergh, Quartz | Read more:
Image: Annalisa van den Bergh
A woman in one of the passing cars rolls down the window, and instead of the typical words of encouragement, her shriek nearly scares me off my bike as she yells at the top of her lungs, “SELFISH BITCH!”
The hard truth is that bicycles are still largely seen as a nuisance on the road. We’re on the margins—literally. Cyclists are reminded of this every time we get skimmed by a car. According to the World Health Organization, over half of international traffic deaths involve vulnerable road users such as cyclists. And because Americans are among the least avid cyclists in the world, they’re among the most likely to get killed by a car.But I’ve discovered a life-saving device that allows cyclists to protect themselves and take back the road: the pool noodle.
Find one for about $2 anywhere: dollar stores, shopping malls, even the supermarket. Choose from the array of fun colors and use a bungee cord to strap this light, flexible toy to your bike rack so that it sticks out to the left side (or the right side, if you’re in a country where cars drive on the left). Start pedaling and watch as car after car moves over to the other lane.
The pool noodle may look silly, but since strapping it on our loads, it has made our lives safer every day. (Plus, it’s a fun conversation starter at pitstops, and it also reminds us not to take life too seriously.) On roads with zero road shoulder, the pool noodle becomes our shoulder. It makes us more visible to passing cars and the 18-wheelers that used to skim us constantly.
by Annalisa van den Bergh, Quartz | Read more:
Image: Annalisa van den Bergh
Netflix Has 175 Days Left To Pull Off A Miracle... Or It's All Over
Last year, half of Americans aged 22 to 45 watched zero hours of cable TV. And almost 35 million households have quit cable in the past decade.
All these people are moving to streaming services like Netflix (NFLX). Today, more than half of American households subscribe to a streaming service.
The media calls this “cord cutting.”
This trend is far more disruptive than most people understand. The downfall of cable is releasing billions in stock market wealth.
Combined, America’s five biggest cable companies are worth over $750 billion. And most investors assume Netflix will claim the bulk of profits that cable leaves behind.
So far, they’ve been right. Have you seen Netflix’s stock price? Holy cow. It has rocketed 8,300% since 2009, leaving even Amazon in the dust:
But don’t let its past success fool you.
Because Netflix is not the future of TV. Let me say that one more time… Netflix is not the future of TV.
The Only Thing That Matters
Netflix changed how we watch TV, but it didn’t really change what we watch…
Netflix has achieved its incredible growth by taking distribution away from cable companies. Instead of watching The Office on cable, people now watch The Office on Netflix.
This edge isn’t sustainable.
In a world where you can watch practically anything whenever you want, dominance in distribution is very fragile.
Because the internet has opened up a whole world of choice, featuring great exclusive content is now far more important than anything else.
For example, about 20 million people tuned in to watch the first episode of the latest season of hit show Game of Thrones.
It was one of the most-watched non-sporting events in TV history.
Netflix management knows content is king. The company spent $12 billion developing original shows last year. It released 88% more original programming in 2018 than it did the previous year.
And spending on original shows and movies is expected to hit $15 billion this year.
It now invests more in content than any other American TV network.
To fund its new shows, Netflix is borrowing huge sums of debt. It currently owes creditors $10.4 billion, which is 59% more than it owed this time last year.
The problem is that no matter how much Netflix spends, it has no chance to catch up with its biggest rival…
Disney Enters the Race
The Walt Disney Company (DIS) is one of America’s most iconic companies. (...)
More than a third of Disney’s revenue comes from its cable business. As you may know, Disney owns leading sports network ESPN and ABC News.
It makes money delivering this content to millions of Americans through cable providers like AT&T. As you can imagine, cord cutting has hit this business hard.
Disney’s cable business has stagnated over the past seven years. But in about 175 days, Disney is set to launch its own streaming service called Disney+.
It’s going to charge $6.99/month—around $6 cheaper than Netflix.
And it’s pulling all its content off of Netflix.
This is a big deal.
by Stephen McBride, Forbes | Read more:
Image: RiskHedge
All these people are moving to streaming services like Netflix (NFLX). Today, more than half of American households subscribe to a streaming service.
The media calls this “cord cutting.”
This trend is far more disruptive than most people understand. The downfall of cable is releasing billions in stock market wealth.
Combined, America’s five biggest cable companies are worth over $750 billion. And most investors assume Netflix will claim the bulk of profits that cable leaves behind.So far, they’ve been right. Have you seen Netflix’s stock price? Holy cow. It has rocketed 8,300% since 2009, leaving even Amazon in the dust:
But don’t let its past success fool you.
Because Netflix is not the future of TV. Let me say that one more time… Netflix is not the future of TV.
The Only Thing That Matters
Netflix changed how we watch TV, but it didn’t really change what we watch…
Netflix has achieved its incredible growth by taking distribution away from cable companies. Instead of watching The Office on cable, people now watch The Office on Netflix.
This edge isn’t sustainable.
In a world where you can watch practically anything whenever you want, dominance in distribution is very fragile.
Because the internet has opened up a whole world of choice, featuring great exclusive content is now far more important than anything else.
For example, about 20 million people tuned in to watch the first episode of the latest season of hit show Game of Thrones.
It was one of the most-watched non-sporting events in TV history.
Netflix management knows content is king. The company spent $12 billion developing original shows last year. It released 88% more original programming in 2018 than it did the previous year.
And spending on original shows and movies is expected to hit $15 billion this year.
It now invests more in content than any other American TV network.
To fund its new shows, Netflix is borrowing huge sums of debt. It currently owes creditors $10.4 billion, which is 59% more than it owed this time last year.
The problem is that no matter how much Netflix spends, it has no chance to catch up with its biggest rival…
Disney Enters the Race
The Walt Disney Company (DIS) is one of America’s most iconic companies. (...)
More than a third of Disney’s revenue comes from its cable business. As you may know, Disney owns leading sports network ESPN and ABC News.
It makes money delivering this content to millions of Americans through cable providers like AT&T. As you can imagine, cord cutting has hit this business hard.
Disney’s cable business has stagnated over the past seven years. But in about 175 days, Disney is set to launch its own streaming service called Disney+.
It’s going to charge $6.99/month—around $6 cheaper than Netflix.
And it’s pulling all its content off of Netflix.
This is a big deal.
by Stephen McBride, Forbes | Read more:
Image: RiskHedge
Monday, May 20, 2019
Insurance Covers Mental Health, But Good Luck Using It
The U.S. is in the midst of a mental health crisis. In 2017, 47,000 Americans died by suicide and 70,000 from drug overdoses. And 17.3 million adults suffered at least one major depressive episode. The Mental Health Parity and Addiction Equity Act, a landmark law passed more than a decade ago, requires insurers to provide comparable coverage for mental health and medical treatments. Even so, insurers are denying claims, limiting coverage, and finding other ways to avoid complying with the law.
Americans are taking to the courts to address what they see as an intrinsic unfairness. DeeDee Tillitt joined one lawsuit in 2016, months after she lost her son Max. He’d been an inpatient for three weeks at a treatment center to recover from a heroin addiction and seemed to be making progress. His addiction specialist wanted him to stay. United Behavioral Health, a unit of UnitedHealth Group, the nation’s largest insurer, declined to cover a longer stay for Max. Reluctantly, his family brought him home. Ten weeks later, Max was dead of an overdose. He was 21.
Tillitt soon discovered that Max’s death wasn’t an isolated tragedy. Across the country, people who need mental health and addiction treatment encounter roadblocks to care that could save their lives. United Behavioral Health was already the target of a class action alleging that it improperly denied coverage for such treatment. UnitedHealth’s headquarters is in the Minneapolis suburbs, not far from where Tillitt lived. She says she spent hours on the phone getting passed from one rep to another in her quest to find Max care the insurer would cover. “I felt like, God, could I just drive down to the lobby and scream at them?’ ” she says.
Tillitt became part of the suit against the company in February 2016. In March of this year, a judge found United Behavioral Health liable for breaching fiduciary duty and denying benefits, saying the insurer considered its bottom line “as much or more” than the well-being of its members in developing coverage guidelines. United Behavioral Health says it’s changed its guidelines and that “our policies have and will continue to meet all regulations.” In May the company asked the court to decertify the class, which would mean only the named plaintiffs would be eligible for remedies.
Failures of the mental health system contributed to trends that have lowered U.S. life expectancy over the past three years. From 2008, when Congress passed the parity act, to 2016, the rate at which Americans died by suicide increased 16%. The rate of fatal overdoses jumped 66% in the same period. “The health insurers are not following the federal law requiring parity in the reimbursement for mental health and addiction,” President Trump’s commission on the opioid crisis wrote in its report in November 2017. “They must be held responsible.”
The Lawmaker
Patrick Kennedy, a former Rhode Island congressman, was the force behind the parity law. In the early hours of May 4, 2006, he crashed his car on Capitol Hill. In a press conference the next day, Kennedy disclosed lifelong trouble with depression and addiction and announced he was going to rehab. Two years later he helped push through legislation to strengthen access to mental health care.
The law was problematic from the start. Passed in the midst of the 2008 financial crisis, the parity act was tacked onto the emergency bill that bailed out the U.S.’s failing banks. “We didn’t pass the mental health parity legislation because there was this big public outcry, because we had this great march on the mall and we had 100,000 people show up,” Kennedy says. “The good news is that we got it passed. The bad news is no one knew that we got it passed because the underlying bill was secondary to the fact that we were facing a potential Great Depression.” Kennedy now works on several initiatives to improve compliance with the law.
In 2010 the Affordable Care Act became law, mandating that commercial health insurance plans offer mental health benefits. Combined with the parity act, federal law appeared to guarantee that Americans would have access to mental health services like never before. And there are signs the laws have helped. A federal report published in February 2019 concluded that the law increased the use of outpatient addiction treatment services and, for those already getting mental health care, the frequency of their visits.
Ghost Networks
Insurers fought the requirements from the start. The industry formed a group called the Coalition for Parity that sued to block the regulations to implement the law, saying they would be unduly burdensome. A judge dismissed the challenge.
In the years since, health insurance companies have eliminated many of the explicit policies that violate the law. Benefit plans can no longer set higher out-of-pocket limits on mental health care than on medical care, for example. But patients and their families say insurers use more subtle methods to stint on treatment. Their directories of providers are padded with clinicians who don’t take new patients or are no longer in an insurer’s coverage network. They request piles of paperwork before approving treatment. They pay mental health clinicians less than other medical professionals for similar services.
Patients frequently complain of “ghost networks”—insurance directories full of clinicians listed as in-network who aren’t contracted with the plan. Brian Dixon, a Fort Worth child psychiatrist, no longer accepts insurance. But Blue Cross and Blue Shield of Texas’ directory indicates he’s still part of the network. He says he regularly has to tell patients who call his office that he won’t take their coverage. “It’ll look like they have all these psychiatrists,” Dixon says of the network, “but they actually don’t.” The insurer says it updates its directory based on information received from physicians.
Some practitioners who want to join networks are turned away. Melissa Davies, a psychologist in Defiance County, Ohio, was part of Anthem’s network for years when she worked in a larger medical group. But the insurer refused to contract with her after she started a solo practice in 2012, saying the area was saturated, even though Davies is one of only three psychologists in the county. When Davies examined Anthem’s directory, “I found a great number of their providers were no longer practicing, or were dead,” she says. Anthem says it works to ensure its network can meet members’ needs and is dedicated to adding behavioral health providers.
It all adds up to a wall between people and the help they need, the kind of barrier that would never be tolerated if the illness were diabetes or leukemia. “You have parity coverage on paper,” says Angela Kimball, acting chief executive officer of the National Alliance on Mental Illness. “But if you can’t find an in-network provider in your coverage, it can become meaningless for you if you can’t afford care or find it.”
by Cynthia Koons and John Tozzi, Bloomberg | Read more:
Image: DeeDee Tillitt
Americans are taking to the courts to address what they see as an intrinsic unfairness. DeeDee Tillitt joined one lawsuit in 2016, months after she lost her son Max. He’d been an inpatient for three weeks at a treatment center to recover from a heroin addiction and seemed to be making progress. His addiction specialist wanted him to stay. United Behavioral Health, a unit of UnitedHealth Group, the nation’s largest insurer, declined to cover a longer stay for Max. Reluctantly, his family brought him home. Ten weeks later, Max was dead of an overdose. He was 21.
Tillitt soon discovered that Max’s death wasn’t an isolated tragedy. Across the country, people who need mental health and addiction treatment encounter roadblocks to care that could save their lives. United Behavioral Health was already the target of a class action alleging that it improperly denied coverage for such treatment. UnitedHealth’s headquarters is in the Minneapolis suburbs, not far from where Tillitt lived. She says she spent hours on the phone getting passed from one rep to another in her quest to find Max care the insurer would cover. “I felt like, God, could I just drive down to the lobby and scream at them?’ ” she says.Tillitt became part of the suit against the company in February 2016. In March of this year, a judge found United Behavioral Health liable for breaching fiduciary duty and denying benefits, saying the insurer considered its bottom line “as much or more” than the well-being of its members in developing coverage guidelines. United Behavioral Health says it’s changed its guidelines and that “our policies have and will continue to meet all regulations.” In May the company asked the court to decertify the class, which would mean only the named plaintiffs would be eligible for remedies.
Failures of the mental health system contributed to trends that have lowered U.S. life expectancy over the past three years. From 2008, when Congress passed the parity act, to 2016, the rate at which Americans died by suicide increased 16%. The rate of fatal overdoses jumped 66% in the same period. “The health insurers are not following the federal law requiring parity in the reimbursement for mental health and addiction,” President Trump’s commission on the opioid crisis wrote in its report in November 2017. “They must be held responsible.”
The Lawmaker
Patrick Kennedy, a former Rhode Island congressman, was the force behind the parity law. In the early hours of May 4, 2006, he crashed his car on Capitol Hill. In a press conference the next day, Kennedy disclosed lifelong trouble with depression and addiction and announced he was going to rehab. Two years later he helped push through legislation to strengthen access to mental health care.
The law was problematic from the start. Passed in the midst of the 2008 financial crisis, the parity act was tacked onto the emergency bill that bailed out the U.S.’s failing banks. “We didn’t pass the mental health parity legislation because there was this big public outcry, because we had this great march on the mall and we had 100,000 people show up,” Kennedy says. “The good news is that we got it passed. The bad news is no one knew that we got it passed because the underlying bill was secondary to the fact that we were facing a potential Great Depression.” Kennedy now works on several initiatives to improve compliance with the law.
In 2010 the Affordable Care Act became law, mandating that commercial health insurance plans offer mental health benefits. Combined with the parity act, federal law appeared to guarantee that Americans would have access to mental health services like never before. And there are signs the laws have helped. A federal report published in February 2019 concluded that the law increased the use of outpatient addiction treatment services and, for those already getting mental health care, the frequency of their visits.
Ghost Networks
Insurers fought the requirements from the start. The industry formed a group called the Coalition for Parity that sued to block the regulations to implement the law, saying they would be unduly burdensome. A judge dismissed the challenge.
In the years since, health insurance companies have eliminated many of the explicit policies that violate the law. Benefit plans can no longer set higher out-of-pocket limits on mental health care than on medical care, for example. But patients and their families say insurers use more subtle methods to stint on treatment. Their directories of providers are padded with clinicians who don’t take new patients or are no longer in an insurer’s coverage network. They request piles of paperwork before approving treatment. They pay mental health clinicians less than other medical professionals for similar services.
Patients frequently complain of “ghost networks”—insurance directories full of clinicians listed as in-network who aren’t contracted with the plan. Brian Dixon, a Fort Worth child psychiatrist, no longer accepts insurance. But Blue Cross and Blue Shield of Texas’ directory indicates he’s still part of the network. He says he regularly has to tell patients who call his office that he won’t take their coverage. “It’ll look like they have all these psychiatrists,” Dixon says of the network, “but they actually don’t.” The insurer says it updates its directory based on information received from physicians.
Some practitioners who want to join networks are turned away. Melissa Davies, a psychologist in Defiance County, Ohio, was part of Anthem’s network for years when she worked in a larger medical group. But the insurer refused to contract with her after she started a solo practice in 2012, saying the area was saturated, even though Davies is one of only three psychologists in the county. When Davies examined Anthem’s directory, “I found a great number of their providers were no longer practicing, or were dead,” she says. Anthem says it works to ensure its network can meet members’ needs and is dedicated to adding behavioral health providers.
It all adds up to a wall between people and the help they need, the kind of barrier that would never be tolerated if the illness were diabetes or leukemia. “You have parity coverage on paper,” says Angela Kimball, acting chief executive officer of the National Alliance on Mental Illness. “But if you can’t find an in-network provider in your coverage, it can become meaningless for you if you can’t afford care or find it.”
Image: DeeDee Tillitt
Snack Attack
There was a time, at an old job of mine, when the snack options were so plentiful they required their own room: a closet filled with plastic freshness-preserving bins, like the kind the rich people I nannied for as a teenager had, full of cereals and Goldfish and wasabi peas and peanut-butter-filled pretzels. We also had a fro-yo machine, complete with a toppings bar, and on the first Tuesday of every month, we had birthday treats for any and all employees with a birthday that month: cupcakes, or doughnuts, or giant, gooey cookies. While working there, I made enough money to eat as much as I needed, and then some, as did most (if not all) of my co-workers. And yet, when birthday treats were announced, or a new fro-yo flavor debuted, we rushed the kitchens and pantries like starving children.
I regularly get mad at my well-fed, spoiled dog for lunging at every discarded sidewalk chicken bone she sees, but I am no better when it comes to free office food, and neither, I suspect, are you. Though I now work at an office that doesn’t routinely provide free food, on those blessed occasions snacks do become available, I will be one of the first alerted as a member of a Slack channel called “snackers-of-nymag,” which has nearly 200 members.
What is it about the workplace that makes snacking so serious an enterprise? Why do so many of us rise like the reanimated dead from our desks anytime the presence of anything free and edible is made known? I know it’s not hunger. It’s not even usually genuine interest. I have eaten so many small, bad cupcakes just because they are there. I don’t need any of this stuff, so why, when it isn’t there, do I feel somehow deprived?
I think there are a number of things going on here, psychologically. But let us first consider the human-resources angle: Snacks, actual studies show, can make employees happy. Or happier, anyway. In his book The Surprising Science of Meetings, Steven G. Rogelberg, an organizational psychologist and professor at the University of North Carolina in Charlotte, writes: “Snacks at meetings are a good predictor of positive feelings about meetings. Not only do people enjoy treats, snacks help build an upbeat mood state and foster camaraderie that can carry into the substance of the meeting itself.” It’s true: Who among us hasn’t taken refuge in the mediocre breakfast spread at an otherwise intolerably boring meeting? We know it’s bait, and we accept it willingly.
But what of snacks provided not at meetings — the snack drawers, or closets, ready to be picked over at anytime of day? Jessica Methot, a professor of human-resource management at Rutgers University, says this form of office snack is so prized because it enables us to take “micro-breaks” from work. “Snacking gives us a chance to step back from the work that we’re doing and recuperate,” she says. Most often, we seek these micro-breaks when we’re stressed, or frustrated, and we look to a packet of Cheez-Its to alleviate those feelings. According to Methot, and some academic research, this only works when the snack you select is “healthy.” From an organizational perspective, says Methot, leaders who want “healthy” employees are often motivated to “gamify” snacking by encouraging employees to snack publicly, in front of each other, where their co-workers will see what they choose to eat. “When we involve everyone in the act of eating, people tend to be healthier, but if we just leave a bunch of snacks out all day, and we leave it up to people to eat when they want, people eat a lot less healthy,” she says. To this I would say neither my employer nor yours knows more about what’s healthy for us than we do, and I’ll take a better health-care plan and 401(k) matching over a free seaweed packet any day. But I digress. (...)
Choosing a snack is one of relatively few moments of true freedom each workday — and with this tiny bit of agency, we go truly crazy. My wife is an office manager, and I have learned from her experience to see the other side of employees’ long-waged battle for free, diverse, and extravagant workplace snacks. Shortly after she was hired, she revamped the entire snack section, providing her co-workers with high-ticket items like Babybel cheese, Cheerios, fruit, and hot Cheetos. For this, her co-workers thanked her profusely. And then they started to ask for things.
“Hi!!” one co-worker Slacked. “i wondered if we could get more healthy snacks like fresh fruit, please? we also used to get babybel cheese, which i really loved… ” The same co-worker went on to request more options “that aren’t heavily processed.”
I have memorized this anecdote because my wife told me about it in a daily post-work recap, and I was so horrified that I transcribed the story in full to someone else. Do we all behave this way? Do I behave this way?
I asked other office managers/office snack providers to weigh in, and basically — yes. We are all like this, and not only that: we are demanding, but also inconsistent. “There’s one guy who always insists that we get salads and other ‘healthy options’ and then literally never eats them,” an events manager told me. Another (former) provider describe the reaction to his decision to replace his co-workers’ Hostess-brand snack selection with V8 juice and granola bars as an “absolute uprising.”
I regularly get mad at my well-fed, spoiled dog for lunging at every discarded sidewalk chicken bone she sees, but I am no better when it comes to free office food, and neither, I suspect, are you. Though I now work at an office that doesn’t routinely provide free food, on those blessed occasions snacks do become available, I will be one of the first alerted as a member of a Slack channel called “snackers-of-nymag,” which has nearly 200 members.
What is it about the workplace that makes snacking so serious an enterprise? Why do so many of us rise like the reanimated dead from our desks anytime the presence of anything free and edible is made known? I know it’s not hunger. It’s not even usually genuine interest. I have eaten so many small, bad cupcakes just because they are there. I don’t need any of this stuff, so why, when it isn’t there, do I feel somehow deprived?I think there are a number of things going on here, psychologically. But let us first consider the human-resources angle: Snacks, actual studies show, can make employees happy. Or happier, anyway. In his book The Surprising Science of Meetings, Steven G. Rogelberg, an organizational psychologist and professor at the University of North Carolina in Charlotte, writes: “Snacks at meetings are a good predictor of positive feelings about meetings. Not only do people enjoy treats, snacks help build an upbeat mood state and foster camaraderie that can carry into the substance of the meeting itself.” It’s true: Who among us hasn’t taken refuge in the mediocre breakfast spread at an otherwise intolerably boring meeting? We know it’s bait, and we accept it willingly.
But what of snacks provided not at meetings — the snack drawers, or closets, ready to be picked over at anytime of day? Jessica Methot, a professor of human-resource management at Rutgers University, says this form of office snack is so prized because it enables us to take “micro-breaks” from work. “Snacking gives us a chance to step back from the work that we’re doing and recuperate,” she says. Most often, we seek these micro-breaks when we’re stressed, or frustrated, and we look to a packet of Cheez-Its to alleviate those feelings. According to Methot, and some academic research, this only works when the snack you select is “healthy.” From an organizational perspective, says Methot, leaders who want “healthy” employees are often motivated to “gamify” snacking by encouraging employees to snack publicly, in front of each other, where their co-workers will see what they choose to eat. “When we involve everyone in the act of eating, people tend to be healthier, but if we just leave a bunch of snacks out all day, and we leave it up to people to eat when they want, people eat a lot less healthy,” she says. To this I would say neither my employer nor yours knows more about what’s healthy for us than we do, and I’ll take a better health-care plan and 401(k) matching over a free seaweed packet any day. But I digress. (...)
Choosing a snack is one of relatively few moments of true freedom each workday — and with this tiny bit of agency, we go truly crazy. My wife is an office manager, and I have learned from her experience to see the other side of employees’ long-waged battle for free, diverse, and extravagant workplace snacks. Shortly after she was hired, she revamped the entire snack section, providing her co-workers with high-ticket items like Babybel cheese, Cheerios, fruit, and hot Cheetos. For this, her co-workers thanked her profusely. And then they started to ask for things.
“Hi!!” one co-worker Slacked. “i wondered if we could get more healthy snacks like fresh fruit, please? we also used to get babybel cheese, which i really loved… ” The same co-worker went on to request more options “that aren’t heavily processed.”
I have memorized this anecdote because my wife told me about it in a daily post-work recap, and I was so horrified that I transcribed the story in full to someone else. Do we all behave this way? Do I behave this way?
I asked other office managers/office snack providers to weigh in, and basically — yes. We are all like this, and not only that: we are demanding, but also inconsistent. “There’s one guy who always insists that we get salads and other ‘healthy options’ and then literally never eats them,” an events manager told me. Another (former) provider describe the reaction to his decision to replace his co-workers’ Hostess-brand snack selection with V8 juice and granola bars as an “absolute uprising.”
by Katie Heaney, The Cut | Read more:
Image: Peter Dazeley/Getty Images
[ed. Cheetos were my weakness, but someone could have put out broken glass and it would've been gone within an hour.]
Wayne Shorter
[ed. Elvin Jones on drums, Herbie Hancock on piano, Ron Carter on Bass, Freddie Hubbard on trumpet. Doesn't get any better than that.]
Sunday, May 19, 2019
The Great Work: Ralph Nader On Taking Back Power From The Corporate State
Ralph Nader ran for president four times, but most people only remember when he ran against Al Gore and George W. Bush in 2000. As the Green Party nominee Nader got nearly 3 million votes, 97,421 of them in Florida — a pivotal state where, after a contentious recount and a Supreme Court decision, Bush beat Gore by 537 votes. Democrats excoriated Nader, calling him a spoiler. He lost many friends. Even Public Citizen, the advocacy group he founded in 1971, distanced itself from him. Nader has no regrets about running and has remained steadfast in his belief that democracy requires multiparty elections: it is not good enough to have people cast votes for the candidate they find less distasteful than the other one. (...)
It’s estimated that at least 3.5 million lives were saved between 1966 and 2014 because of Nader’s campaign against dangerous automobiles, and many more lives were saved or improved by his other investigations. He and the idealistic people who worked with him, called “Nader’s Raiders,” helped provide us with clean air and water; less-toxic foods; nutritional labels; cigarette warning labels; protective X-ray aprons; workplace-safety laws; toys that don’t choke kids; and medical devices that don’t electrocute patients. Nader is the country’s safety inspector, keeping an eye on the leaking roof, the cracked pipes, the seep of sewage into our daily lives.
A tall, solitary man with no wife or children (and apparently no car, cellphone, or romantic partners), Nader has founded more than fifty public-interest groups and watchdog agencies. Now eighty-five, he still resembles the somber, youthful David who battled Detroit’s mighty Goliath with a slingshot made of hard facts.
Barsamian: What’s your take on what’s going on in the country?
Nader: There’s a relentless increase in corporate control of our elections, of government, and of democratic institutions. I would say this is the high point of corporate control in a mature corporate state. The media are concentrated in a few hands. We have an uncontrollable military-industrial complex. Corporations are controlling people’s money through credit cards, debit cards, and online payment systems. Corporations have so much control in Washington, D.C., and state capitals that they can turn the government against its own people. And now they’re getting their favorites appointed to the courts.
Corporations strategically plan our lives. They plan the food we eat: junk food and junk drink, leading to huge obesity rates among children. They market directly to children, circumventing parental authority. They’re certainly trying to strategically plan our elections, our government policies, and our public budgets to produce more F-35s and nuclear weapons and fewer public works and public facilities. They don’t have to have a conspiracy to do this. If they had a conspiracy, it would mean there was some resistance that they had to conspire against.
Corporations are strategically planning a lot of our military and foreign policy. They’re strategically planning our education system. They’re commercializing education. They want all children to be computer-literate but not civics-literate.
And election campaigns are commercialized. That’s why even some of the best candidates rarely use phrases like “corporate welfare,” “corporate crime,” “corporate domination,” or “corporate control,” even though back in 2000 Business Week polled the American people and found that more than 70 percent of them thought corporations had too much control over people’s lives. People know who’s running the show, but they haven’t organized to take advantage of the huge asset called the Constitution, which starts with “We the people,” not “We the corporation” or “We the Congress.” We have all kinds of support on both the Left and the Right for Medicare for All, living wages, and cracking down on corporate crime. This idea of red state versus blue state doesn’t quite hold up when you go down to where people live, work, and raise their children. They want clean air; they want clean water; they want adequate health care; they want good public schools and public transportation.
Every major advance for justice in our country took no more than 1 percent of adults — around 2.5 million people — with public opinion behind them, mobilizing to change government policy. If you’ve got 2.5 million people, you can recover our country, recover our government, recover our hopes and dreams. Is that too much to ask, 1 percent?
Barsamian: The novelist Ursula K. Le Guin once said, “We live in capitalism. Its power seems inescapable. So did the divine right of kings.”
Nader: This isn’t really capitalism as we used to know it. My father and mother had a restaurant. That’s capitalism. What’s taken over now is big corporate capitalism. Corporations tie up small businesses in franchise agreements. The little guys are disadvantaged because the big guys get more tax breaks. Corporate capitalism is literally destroying traditional, small-scale capitalism. (...)
Barsamian: Do you think those corporations you were describing earlier feel good about Trump’s global economic policies and tariffs?
Nader: They’re nervous. So far he’s done things they like. He’s cut corporate taxes. He’s cut taxes for the rich. So they like that. Deregulation — they like that, too, even though most regulations are so out of date they have hardly any bite to them. They love the huge expansion of the military budget. Trump gave the Pentagon $80 billion it wasn’t even asking for, which delighted Lockheed Martin, Northrop Grumman, Raytheon, and General Dynamics.
So they like him so far. But he is unpredictable, and they don’t like unpredictable politicians. They don’t want to get into a war that will mess up the stock market and the banking system. They’re worried about his instability, and they’re worried about the warmongers around Trump, like National Security Adviser John Bolton and Secretary of State Mike Pompeo. (...)
Barsamian: Would you favor term limits for Supreme Court justices?
Nader: Yes, I favor twelve years and out. That’s enough. In fact, the appointment system has resulted in such corporatist judges that the court has repeatedly voted 5-4 to entrench the corporate state. The justices think corporations are people and have privileges and immunities real people don’t. I don’t think that would be the case if Supreme Court justices were elected.
Ask a tough question, will you?
It’s estimated that at least 3.5 million lives were saved between 1966 and 2014 because of Nader’s campaign against dangerous automobiles, and many more lives were saved or improved by his other investigations. He and the idealistic people who worked with him, called “Nader’s Raiders,” helped provide us with clean air and water; less-toxic foods; nutritional labels; cigarette warning labels; protective X-ray aprons; workplace-safety laws; toys that don’t choke kids; and medical devices that don’t electrocute patients. Nader is the country’s safety inspector, keeping an eye on the leaking roof, the cracked pipes, the seep of sewage into our daily lives.
A tall, solitary man with no wife or children (and apparently no car, cellphone, or romantic partners), Nader has founded more than fifty public-interest groups and watchdog agencies. Now eighty-five, he still resembles the somber, youthful David who battled Detroit’s mighty Goliath with a slingshot made of hard facts.
Barsamian: What’s your take on what’s going on in the country?
Nader: There’s a relentless increase in corporate control of our elections, of government, and of democratic institutions. I would say this is the high point of corporate control in a mature corporate state. The media are concentrated in a few hands. We have an uncontrollable military-industrial complex. Corporations are controlling people’s money through credit cards, debit cards, and online payment systems. Corporations have so much control in Washington, D.C., and state capitals that they can turn the government against its own people. And now they’re getting their favorites appointed to the courts.Corporations strategically plan our lives. They plan the food we eat: junk food and junk drink, leading to huge obesity rates among children. They market directly to children, circumventing parental authority. They’re certainly trying to strategically plan our elections, our government policies, and our public budgets to produce more F-35s and nuclear weapons and fewer public works and public facilities. They don’t have to have a conspiracy to do this. If they had a conspiracy, it would mean there was some resistance that they had to conspire against.
Corporations are strategically planning a lot of our military and foreign policy. They’re strategically planning our education system. They’re commercializing education. They want all children to be computer-literate but not civics-literate.
And election campaigns are commercialized. That’s why even some of the best candidates rarely use phrases like “corporate welfare,” “corporate crime,” “corporate domination,” or “corporate control,” even though back in 2000 Business Week polled the American people and found that more than 70 percent of them thought corporations had too much control over people’s lives. People know who’s running the show, but they haven’t organized to take advantage of the huge asset called the Constitution, which starts with “We the people,” not “We the corporation” or “We the Congress.” We have all kinds of support on both the Left and the Right for Medicare for All, living wages, and cracking down on corporate crime. This idea of red state versus blue state doesn’t quite hold up when you go down to where people live, work, and raise their children. They want clean air; they want clean water; they want adequate health care; they want good public schools and public transportation.
Every major advance for justice in our country took no more than 1 percent of adults — around 2.5 million people — with public opinion behind them, mobilizing to change government policy. If you’ve got 2.5 million people, you can recover our country, recover our government, recover our hopes and dreams. Is that too much to ask, 1 percent?
Barsamian: The novelist Ursula K. Le Guin once said, “We live in capitalism. Its power seems inescapable. So did the divine right of kings.”
Nader: This isn’t really capitalism as we used to know it. My father and mother had a restaurant. That’s capitalism. What’s taken over now is big corporate capitalism. Corporations tie up small businesses in franchise agreements. The little guys are disadvantaged because the big guys get more tax breaks. Corporate capitalism is literally destroying traditional, small-scale capitalism. (...)
Barsamian: Do you think those corporations you were describing earlier feel good about Trump’s global economic policies and tariffs?
Nader: They’re nervous. So far he’s done things they like. He’s cut corporate taxes. He’s cut taxes for the rich. So they like that. Deregulation — they like that, too, even though most regulations are so out of date they have hardly any bite to them. They love the huge expansion of the military budget. Trump gave the Pentagon $80 billion it wasn’t even asking for, which delighted Lockheed Martin, Northrop Grumman, Raytheon, and General Dynamics.
So they like him so far. But he is unpredictable, and they don’t like unpredictable politicians. They don’t want to get into a war that will mess up the stock market and the banking system. They’re worried about his instability, and they’re worried about the warmongers around Trump, like National Security Adviser John Bolton and Secretary of State Mike Pompeo. (...)
Barsamian: Would you favor term limits for Supreme Court justices?
Nader: Yes, I favor twelve years and out. That’s enough. In fact, the appointment system has resulted in such corporatist judges that the court has repeatedly voted 5-4 to entrench the corporate state. The justices think corporations are people and have privileges and immunities real people don’t. I don’t think that would be the case if Supreme Court justices were elected.
Ask a tough question, will you?
by David Barsamian, The Sun | Read more:
Image: Myrna Aguilar
The Quest to Make a Bot That Can Smell as Well as a Dog
The dogs still make Andreas Mershin angry. “I mean, I love dogs,” says the Greek-Russian scientist, in his office at MIT. “But the dogs are slapping me in the face.”
He pulls up a video to show me what he means. In it, a black dog named Lucy approaches a series of six stations, each separated by a small barrier. At every one, a glass cup of human urine with a screened lid sits at the level of the animal’s nose. Lucy takes a brief sniff of each sample, sometimes digging her snout in to get a better whiff. She is performing a kind of diagnostic test: searching for the telltale scent of prostate cancer, which, it turns out, leaves a volatile, discernible signature in a man’s pee. Discernible if you’re a dog, anyway. When Lucy finds what she’s looking for, she sits down and receives a treat.
Among humans—whose toolmaking prowess has given the world self-driving suitcases and reusable rocket boosters—prostate cancer is notoriously difficult to detect. The prevailing method is to check a patient’s blood for elevated levels of a protein called prostate-specific antigen. But the test has a miserable track record. The scientist who first discovered PSA has described the test as “hardly more effective than a coin toss.” A false positive can lead to a prostate biopsy, a harrowing procedure that involves inserting a large, hollow needle through the wall of the rectum to retrieve a tissue sample from the prostate itself.
Properly trained dogs, on the other hand, can detect prostate cancer with better than 90 percent accuracy, and with sleek, tail-wagging efficiency. In the video, Lucy works her way through six samples in just a couple of minutes. This drives Mershin up the wall. “We have $100 million worth of equipment downstairs. And the dog can beat me?” he says. “That is pissing me off.” (...)
Mershin’s lab, where he keeps that $100 million worth of equipment, sits a few floors down from his office at MIT. In one room, researchers are trying to invent new colors; in another, to create the lightest, strongest materials on earth. But I’m here because this facility is doing some of the most important research in the world toward developing AO—artificial olfaction.
Plenty of robots these days can see, hear, speak, and (crudely) think. But good luck finding one that can smell. In part, that’s simply because olfaction has always been deeply underrated by humans—a species of cerebral, hypervisual snobs. Kant dismissed smell as the “most dispensable” of our five senses. One 2011 poll found that 53 percent of people ages 16 to 22 would rather give up their sense of smell than give up their smartphones and computers.
But in the past several years, it has become increasingly clear that smell, in the right snout, can be a kind of superpower. For millennia, humans have prized dogs for their tracking abilities; police and armed forces have long used them to sniff out bombs, drugs, and bodies. But since about the early 2000s, an avalanche of findings has dramatically expanded our sense of what dogs can do with their noses. It started when researchers realized that canines can smell the early onset of melanoma. Then it turned out they can do the same for breast cancer, lung cancer, colorectal cancer, and ovarian cancer. They can smell the time of day in the movement of air around a room; sense diabetic episodes hours in advance; and detect human emotional states in the absence of visual cues. And it’s not just dogs. Tipped off by a Scottish nurse with a highly attuned nose, scientists have recently learned that people with Parkinson’s disease begin emitting a distinct “woody, musky odor” years before they show symptoms.
All this adds up to a revelation not just about dogs but about the physical world itself. Events and diseases and mental states leave reports in the air—ones that are intelligible to highly attuned olfactory systems but otherwise illegible to science. Smell, it appears, is sometimes the best way of detecting and discriminating between otherwise hidden things out in the world. And often, the next-best method of detecting that same thing is expensive (gas chromatography/mass spectrometry) or excruciating (tissue biopsies) or impossible (mind reading).
Unfortunately, the other reason we don’t have robots that can smell is that olfaction remains a stubborn biological enigma. Scientists are still piecing together the basics of how we sense all those volatile compounds and how our brains classify that information. “There are more unknowns than knowns,” says Hiroaki Matsunami, a researcher at Duke University.
Mershin, however, believes that we don’t really have to understand how mammals smell to build an artificial nose. He’s betting that things will work the other way around: To understand the nose, we have to build one first. In his efforts with a brilliant mentor named Shuguang Zhang, Mershin has built a device that can just begin to give dogs—his panting adversaries—a run for their money.
by Sara Harrison, Wired | Read more:
Image: Bobby Doherty
He pulls up a video to show me what he means. In it, a black dog named Lucy approaches a series of six stations, each separated by a small barrier. At every one, a glass cup of human urine with a screened lid sits at the level of the animal’s nose. Lucy takes a brief sniff of each sample, sometimes digging her snout in to get a better whiff. She is performing a kind of diagnostic test: searching for the telltale scent of prostate cancer, which, it turns out, leaves a volatile, discernible signature in a man’s pee. Discernible if you’re a dog, anyway. When Lucy finds what she’s looking for, she sits down and receives a treat.
Among humans—whose toolmaking prowess has given the world self-driving suitcases and reusable rocket boosters—prostate cancer is notoriously difficult to detect. The prevailing method is to check a patient’s blood for elevated levels of a protein called prostate-specific antigen. But the test has a miserable track record. The scientist who first discovered PSA has described the test as “hardly more effective than a coin toss.” A false positive can lead to a prostate biopsy, a harrowing procedure that involves inserting a large, hollow needle through the wall of the rectum to retrieve a tissue sample from the prostate itself.Properly trained dogs, on the other hand, can detect prostate cancer with better than 90 percent accuracy, and with sleek, tail-wagging efficiency. In the video, Lucy works her way through six samples in just a couple of minutes. This drives Mershin up the wall. “We have $100 million worth of equipment downstairs. And the dog can beat me?” he says. “That is pissing me off.” (...)
Mershin’s lab, where he keeps that $100 million worth of equipment, sits a few floors down from his office at MIT. In one room, researchers are trying to invent new colors; in another, to create the lightest, strongest materials on earth. But I’m here because this facility is doing some of the most important research in the world toward developing AO—artificial olfaction.
Plenty of robots these days can see, hear, speak, and (crudely) think. But good luck finding one that can smell. In part, that’s simply because olfaction has always been deeply underrated by humans—a species of cerebral, hypervisual snobs. Kant dismissed smell as the “most dispensable” of our five senses. One 2011 poll found that 53 percent of people ages 16 to 22 would rather give up their sense of smell than give up their smartphones and computers.
But in the past several years, it has become increasingly clear that smell, in the right snout, can be a kind of superpower. For millennia, humans have prized dogs for their tracking abilities; police and armed forces have long used them to sniff out bombs, drugs, and bodies. But since about the early 2000s, an avalanche of findings has dramatically expanded our sense of what dogs can do with their noses. It started when researchers realized that canines can smell the early onset of melanoma. Then it turned out they can do the same for breast cancer, lung cancer, colorectal cancer, and ovarian cancer. They can smell the time of day in the movement of air around a room; sense diabetic episodes hours in advance; and detect human emotional states in the absence of visual cues. And it’s not just dogs. Tipped off by a Scottish nurse with a highly attuned nose, scientists have recently learned that people with Parkinson’s disease begin emitting a distinct “woody, musky odor” years before they show symptoms.
All this adds up to a revelation not just about dogs but about the physical world itself. Events and diseases and mental states leave reports in the air—ones that are intelligible to highly attuned olfactory systems but otherwise illegible to science. Smell, it appears, is sometimes the best way of detecting and discriminating between otherwise hidden things out in the world. And often, the next-best method of detecting that same thing is expensive (gas chromatography/mass spectrometry) or excruciating (tissue biopsies) or impossible (mind reading).
Unfortunately, the other reason we don’t have robots that can smell is that olfaction remains a stubborn biological enigma. Scientists are still piecing together the basics of how we sense all those volatile compounds and how our brains classify that information. “There are more unknowns than knowns,” says Hiroaki Matsunami, a researcher at Duke University.
Mershin, however, believes that we don’t really have to understand how mammals smell to build an artificial nose. He’s betting that things will work the other way around: To understand the nose, we have to build one first. In his efforts with a brilliant mentor named Shuguang Zhang, Mershin has built a device that can just begin to give dogs—his panting adversaries—a run for their money.
by Sara Harrison, Wired | Read more:
Image: Bobby Doherty
When He Was Gone
Paul goes away for business a lot, and I try not to think about how OK I am with it. I’m OK, you’re OK. We’re OK, I tell people.
I neatly fold that thought up and put it in a drawer, along with the single hair on my chin and the TV show they just canceled that I was heavily relying on to get me through the next few years maybe. But I’m OK. If the place I order takeout from most nights ever closes, I’ll confront all these feelings in one drunken argument that will end with me telling Paul I like it better on my own anyway. But for now we’re OK. What we are is what that little word, OK, is for.
Friends think it must be exciting when he comes back from a trip. They mean the sex. They’re projecting their fantasies onto us, and we mostly let them. We’ve always been that couple: The writer and the computer guy. Living the dream, if the dream is having separate lives and being OK with it. In reality, when Paul comes back from a trip, I’m usually asleep on the couch with my laptop open to whatever I’m supposed to be writing, food spilled on my lap, a cat from the neighborhood that climbed in the window eating the food from my lap and making me have weird almost-sex dreams, which Paul interrupts. Maybe I left some kitchen appliance on, so there’s a burning smell. This is how we live, in this IKEA-induced fugue. But it’s OK.
Friends picture him coming home to New York like a soldier in uniform, even though his uniform is hoodies and obscure foreign sneakers he’s not cool enough to wear. He wishes he could ride a skateboard to work, because that’s the closest thing to his childhood hoverboard fantasy. I know the boy who lives inside him, you see. I chose that boy from all the boys. I chose this life. They picture him bursting in and carrying me off to bed, like he’s been away at war or at sea, when really he’s just been hanging out in Japan under the guise of business. Business, business, business — say it enough and it might mean something.
Paul was in high spirits when he left. He was going to Japan, motherfuckers, which is how I imagine his boss gave him the news. As he packed, he told me what he’d be doing while he was away, like not recognizing anything he ate and barely bathing, which pretty much described what I do all the time. I was busy trying to write an e-mail to a grumpy editor about some changes he had made that I did not think needed to be made, so I was only half listening, one foot in, one foot out of our life, always somewhere else but never sure quite where.
He tried to tickle me at one point, and I shouted, I’m trying to do important business! and he thought that was hilarious because he knew how I felt about business.
From what he can make out, my business is lying horizontally in different places around the apartment, not writing, mostly watching cooking shows or reading what other people have written and thinking, Well, I don’t need to write that now. To me his business is just standing vertically in different exotic locations, looking at the latest video games. The biggest misconception about his job is that he sits around and plays video games all day. It’s all virtual reality now, so he actually stands a lot, golfing, skiing, boxing, killing zombies, or whatever people do virtually that they could do quite as easily — or more easily, even — in the real world. He always tries to get me to go to those 3-D movies that are almost theme-park rides, the ones that have surround sound and smells and wind, and I just roll my eyes and say, Or we could go outside. I made him go to a park once, and a pigeon shat on him, and I said, See, you don’t get that at the movies. I told him it was a sign of good luck as he frantically dabbed at his shirt.
You write articles online, he said, to remind me I’m just as far gone from reality as he is. He doesn’t know all the secret ways I try to write off-line, keep one foot in the world still. Like at Whole Foods there’s a suggestion book where you can leave a comment, and some days I write things in it like Where’s the black garlic? or How do I make bread? or Thank you for existing. I always write in different handwriting so they don’t think I’m crazy. I’d love to just be crazy.
Paul doesn’t know who I am when he’s away, and I don’t know who he is when he’s away, but when we’re together, we’re Paul and Julia again. We are who we’re supposed to be, and the rest isn’t real. I assume it’s like that for everyone.
When he said he was going away this time, I immediately thought of it as an opportunity to sleep more and wash less, but after he left, I felt like I should get up and bathe, and I ended up making a bigger effort than usual, and then I felt obliged to go out and take advantage of not looking like a teenage boy for once. There are some impeccably groomed and dressed writers, but I avoid them at all costs. When Paul called to say he’d gotten there safely, I had to pretend I was on the couch in my pajamas and not in a bar day-drinking. It was confusing. He wanted me out there in the world, but I felt I was supposed to pretend I was a little sad he was gone — at least, for the first few days. I told him I missed him, because I did. I’m not a complete monster.
Once, when he was away, I told him I had sniffed his shirt, because I’d seen someone do that in a movie. I don’t think people really do that though, or I hope they don’t. But then, people are gross, so they might.
I was trying not to think about how much I liked having my own space, though it was technically our space, and day-drinking helped me forget. Paul was doing what he needed to do, and I was doing what I needed to do, which just happened to be day-drinking and then going home and eating family-size bags of chips and watching all the TV. I was listening to my body. That’s what we’re supposed to do now, right?
I neatly fold that thought up and put it in a drawer, along with the single hair on my chin and the TV show they just canceled that I was heavily relying on to get me through the next few years maybe. But I’m OK. If the place I order takeout from most nights ever closes, I’ll confront all these feelings in one drunken argument that will end with me telling Paul I like it better on my own anyway. But for now we’re OK. What we are is what that little word, OK, is for.
Friends think it must be exciting when he comes back from a trip. They mean the sex. They’re projecting their fantasies onto us, and we mostly let them. We’ve always been that couple: The writer and the computer guy. Living the dream, if the dream is having separate lives and being OK with it. In reality, when Paul comes back from a trip, I’m usually asleep on the couch with my laptop open to whatever I’m supposed to be writing, food spilled on my lap, a cat from the neighborhood that climbed in the window eating the food from my lap and making me have weird almost-sex dreams, which Paul interrupts. Maybe I left some kitchen appliance on, so there’s a burning smell. This is how we live, in this IKEA-induced fugue. But it’s OK.Friends picture him coming home to New York like a soldier in uniform, even though his uniform is hoodies and obscure foreign sneakers he’s not cool enough to wear. He wishes he could ride a skateboard to work, because that’s the closest thing to his childhood hoverboard fantasy. I know the boy who lives inside him, you see. I chose that boy from all the boys. I chose this life. They picture him bursting in and carrying me off to bed, like he’s been away at war or at sea, when really he’s just been hanging out in Japan under the guise of business. Business, business, business — say it enough and it might mean something.
Paul was in high spirits when he left. He was going to Japan, motherfuckers, which is how I imagine his boss gave him the news. As he packed, he told me what he’d be doing while he was away, like not recognizing anything he ate and barely bathing, which pretty much described what I do all the time. I was busy trying to write an e-mail to a grumpy editor about some changes he had made that I did not think needed to be made, so I was only half listening, one foot in, one foot out of our life, always somewhere else but never sure quite where.
He tried to tickle me at one point, and I shouted, I’m trying to do important business! and he thought that was hilarious because he knew how I felt about business.
From what he can make out, my business is lying horizontally in different places around the apartment, not writing, mostly watching cooking shows or reading what other people have written and thinking, Well, I don’t need to write that now. To me his business is just standing vertically in different exotic locations, looking at the latest video games. The biggest misconception about his job is that he sits around and plays video games all day. It’s all virtual reality now, so he actually stands a lot, golfing, skiing, boxing, killing zombies, or whatever people do virtually that they could do quite as easily — or more easily, even — in the real world. He always tries to get me to go to those 3-D movies that are almost theme-park rides, the ones that have surround sound and smells and wind, and I just roll my eyes and say, Or we could go outside. I made him go to a park once, and a pigeon shat on him, and I said, See, you don’t get that at the movies. I told him it was a sign of good luck as he frantically dabbed at his shirt.
You write articles online, he said, to remind me I’m just as far gone from reality as he is. He doesn’t know all the secret ways I try to write off-line, keep one foot in the world still. Like at Whole Foods there’s a suggestion book where you can leave a comment, and some days I write things in it like Where’s the black garlic? or How do I make bread? or Thank you for existing. I always write in different handwriting so they don’t think I’m crazy. I’d love to just be crazy.
Paul doesn’t know who I am when he’s away, and I don’t know who he is when he’s away, but when we’re together, we’re Paul and Julia again. We are who we’re supposed to be, and the rest isn’t real. I assume it’s like that for everyone.
When he said he was going away this time, I immediately thought of it as an opportunity to sleep more and wash less, but after he left, I felt like I should get up and bathe, and I ended up making a bigger effort than usual, and then I felt obliged to go out and take advantage of not looking like a teenage boy for once. There are some impeccably groomed and dressed writers, but I avoid them at all costs. When Paul called to say he’d gotten there safely, I had to pretend I was on the couch in my pajamas and not in a bar day-drinking. It was confusing. He wanted me out there in the world, but I felt I was supposed to pretend I was a little sad he was gone — at least, for the first few days. I told him I missed him, because I did. I’m not a complete monster.
Once, when he was away, I told him I had sniffed his shirt, because I’d seen someone do that in a movie. I don’t think people really do that though, or I hope they don’t. But then, people are gross, so they might.
I was trying not to think about how much I liked having my own space, though it was technically our space, and day-drinking helped me forget. Paul was doing what he needed to do, and I was doing what I needed to do, which just happened to be day-drinking and then going home and eating family-size bags of chips and watching all the TV. I was listening to my body. That’s what we’re supposed to do now, right?
by Lucie Britsch, The Sun | Read more:
Image: Jon Kral
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