Sunday, May 26, 2019
The Austerity of Luxury
There is not enough seating here in Heathrow Airport’s Terminal 5, even though there is a lot of it. I keep bumping into people as I move around—it’s just an overcrowded space with too many bodies in it. The plastic seats are uncomfortable and hard, and about one in every 20 has a power outlet. (I was among the lucky few, but my outlet doesn’t work.) Even though Terminal 5 is in a bright, clean, modern building—the largest free-standing structure in the U.K., apparently—it feels cramped.
And yet, somehow, while the airport authorities have not managed to make space for passengers, they have managed to make space for a series of luxury storefronts. In Terminal 5 you can visit Prada, Burberry, Hermès, Rolex, Dior, Cartier, Chanel, Louis Vuitton, and Tiffany. If you want a £5000 handbag or a £200 bottle of cologne while you’re at the airport, Terminal 5 has you covered.
I find it a troubling sign of our age that to most people passing through the terminal, this doesn’t seem insane. I haven’t seen anyone in the Prada store since I’ve been here, but while there’s a sense that Terminal 5 is “upscale” nobody seems to think it’s profoundly dysfunctional and wrong. (...)
Thanks to expanding global inequality, we’re constantly seeing new bifurcations in the experience of rich people and ordinary people. At amusement parks, the rich can pay to go on rides sooner. They can hire people to stand in line for them. Their communities are gated, their schools are private, their airport lounges are roped off. All of this is going to continue to get worse: The number of everyday situations in which “we’re all in this together” will disappear. They will drive on traffic-free private toll roads and use members-only “public” parks. The things we hold in common will deteriorate, because they are no longer subsidized by the wealthy. Public schools are the most obvious example—instead of giving money that will be used to educate poor children, the rich simply retreat to their own segregated communities where the schools are magnificent. Meanwhile, the Detroit schools are literally falling apart. The airports will be the same: Economy class will be more and more uncomfortable, possibly even without seats, while first class will be ever more opulent.
I was struck by something else about Terminal 5, though, that you’ve probably noticed in your own journeys through Neoliberal Hellworld: It wasn’t even that luxurious for the rich. They get expensive things, to be sure, but they don’t really seem to get nice things. This was my experience the one time I was upgraded to first class. There was more legroom, which was good. But most of the other tweaks to the experience were things like calling me “Mr. Robinson,” and generating the feeling of superiority rather than the authentic experience of superior pleasure. You may have been struck, if you’ve ever entered a McMansion, by the fact that it isn’t actually a very comfortable house. All that money is buying status objects, but it’s often not buying the actual best things. The best house is not the largest house, because the largest house tends to be extremely inconvenient and makes you feel small and alone. (...)
Isn’t it a little strange? The rich are trapped just like we are, all they can do is choose which brand of bag or watch they want. Their airport, just like ours, has no trees or flowers, no fountains, no river running through it. Their time at the airport will not be much less depressing than yours, though they will spend it in a more comfortable chair. They live in expensive austerity, a world calculated to be maximally efficient in the delivery of pleasure that end up delivering a technologically sophisticated tedium.
I have bought expensive things now and then. I am for a “luxury leftism” that encourages people to have nice possessions, and I own a far-too-expensive dressing gown and a trio of beautiful suits. For these purchases to be pleasurable to me, however, they had to feel very special. If I had bought these treats at an airport because I was bored and had money, they would have meant very little. The people who make designer clothing and accessories work hard to make the experience “feel special,” but there is something absurd about putting these shops in an airport, like having a vending machine for precious gemstones. I do not believe that the rich are even getting the kind of experience that they are paying for when they are being sold designer handbags as a way of passing time, next to the racks of mystery novels and granola bars. It’s luxury without any of the feeling of special delight that should accompany indulgence.
And yet, somehow, while the airport authorities have not managed to make space for passengers, they have managed to make space for a series of luxury storefronts. In Terminal 5 you can visit Prada, Burberry, Hermès, Rolex, Dior, Cartier, Chanel, Louis Vuitton, and Tiffany. If you want a £5000 handbag or a £200 bottle of cologne while you’re at the airport, Terminal 5 has you covered.
I find it a troubling sign of our age that to most people passing through the terminal, this doesn’t seem insane. I haven’t seen anyone in the Prada store since I’ve been here, but while there’s a sense that Terminal 5 is “upscale” nobody seems to think it’s profoundly dysfunctional and wrong. (...)Thanks to expanding global inequality, we’re constantly seeing new bifurcations in the experience of rich people and ordinary people. At amusement parks, the rich can pay to go on rides sooner. They can hire people to stand in line for them. Their communities are gated, their schools are private, their airport lounges are roped off. All of this is going to continue to get worse: The number of everyday situations in which “we’re all in this together” will disappear. They will drive on traffic-free private toll roads and use members-only “public” parks. The things we hold in common will deteriorate, because they are no longer subsidized by the wealthy. Public schools are the most obvious example—instead of giving money that will be used to educate poor children, the rich simply retreat to their own segregated communities where the schools are magnificent. Meanwhile, the Detroit schools are literally falling apart. The airports will be the same: Economy class will be more and more uncomfortable, possibly even without seats, while first class will be ever more opulent.
I was struck by something else about Terminal 5, though, that you’ve probably noticed in your own journeys through Neoliberal Hellworld: It wasn’t even that luxurious for the rich. They get expensive things, to be sure, but they don’t really seem to get nice things. This was my experience the one time I was upgraded to first class. There was more legroom, which was good. But most of the other tweaks to the experience were things like calling me “Mr. Robinson,” and generating the feeling of superiority rather than the authentic experience of superior pleasure. You may have been struck, if you’ve ever entered a McMansion, by the fact that it isn’t actually a very comfortable house. All that money is buying status objects, but it’s often not buying the actual best things. The best house is not the largest house, because the largest house tends to be extremely inconvenient and makes you feel small and alone. (...)
Isn’t it a little strange? The rich are trapped just like we are, all they can do is choose which brand of bag or watch they want. Their airport, just like ours, has no trees or flowers, no fountains, no river running through it. Their time at the airport will not be much less depressing than yours, though they will spend it in a more comfortable chair. They live in expensive austerity, a world calculated to be maximally efficient in the delivery of pleasure that end up delivering a technologically sophisticated tedium.
I have bought expensive things now and then. I am for a “luxury leftism” that encourages people to have nice possessions, and I own a far-too-expensive dressing gown and a trio of beautiful suits. For these purchases to be pleasurable to me, however, they had to feel very special. If I had bought these treats at an airport because I was bored and had money, they would have meant very little. The people who make designer clothing and accessories work hard to make the experience “feel special,” but there is something absurd about putting these shops in an airport, like having a vending machine for precious gemstones. I do not believe that the rich are even getting the kind of experience that they are paying for when they are being sold designer handbags as a way of passing time, next to the racks of mystery novels and granola bars. It’s luxury without any of the feeling of special delight that should accompany indulgence.
by Nathan J. Robinson, Current Affairs | Read more:
Image: uncredited
First Do No Harm
Democrats who've made "Medicare for All" a top health care priority are running up against their toughest opponent yet: their own neighborhood hospitals.
The multibillion-dollar industry has emerged as the most formidable foe of single-payer health care. It’s helped assemble a coalition of health care lobbies that has launched social media campaigns attacking Medicare for All and its most high-profile proponent, Sen. Bernie Sanders (I-Vt.), while fighting narrower Democratic proposals to expand federal health coverage over concerns any change would slash hospital revenue.
That’s created a dilemma for Medicare for All champions who cast themselves as crusaders against a broken health care system full of greedy insurers and drug companies, yet remain wary of taking on hospitals that rank as top employers in many congressional districts and are seen by the public as life-saving institutions.
“We’re not cutting out hospitals, we are keeping the existing hospital system,” said Rep. Pramila Jayapal (D-Wash.), a leader of Democrats’ Medicare for All caucus and fierce critic of corporate influence, adding “they’re very much going to be a partner at that table.”
The bill would all but end private insurance and regulate hospitals in a vastly different way, dramatically changing operators’ business model and costing community hospitals as much as $151 billion a year, according to one estimate published in JAMA.
The industry's stand against Medicare for All comes amid lobbying on separate and intensifying bipartisan efforts to address "surprise" medical bills, with hospitals fighting other parts of the health care industry to ensure they’re not the ones who have to swallow the bulk of the patient’s tab.
Hospitals now drive a significant share of the nation's health care spending, though the public doesn't see it because insurers wind up paying much of the bill. And hospitals make up for the relatively lower payments they get for Medicare and Medicaid patients by shifting some of the expense to patients with private insurance, which pays more than double Medicare rates, according to a new study that’s put the hospital industry on the defensive.
The calculus would change dramatically under Medicare for All, which would free millions more patients to seek no-cost medical care while slashing hospitals’ pay rates and putting up to 1.5 million jobs at stake.
"Every congressman has got a major hospital in their district, and that hospital is a major employer,” said Kevin Schulman, a professor of medicine at Stanford, who co-authored the JAMA article. “And so how hard we can push on hospitals given that is an open question.” (...)
For-profit hospital trade group Federation of American Hospitals led the formation of The Partnership for America’s Health Care Future — a coalition spanning the provider, insurer and drug lobbies formed solely to oppose major efforts to expand government coverage. Its 30 members include hospitals’ other lobbying juggernaut, the American Hospital Association, and a slew of big operators including Ascension — the nation’s largest Catholic health system — and Texas hospital management giant Tenet Healthcare.
The Partnership has spent more than $68,000 attacking Medicare for All on Facebook and Twitter this year, and plans to spend at least six figures targeting voters and Washington policymakers, according to a person familiar with its strategy. Its frequent email blasts deride Medicare for All as a costly government takeover that would destabilize the health system and cut access to care.
In recent weeks, The Partnership launched a series of broadsides at Sanders, a 2020 presidential contender, reflecting a conscious decision to directly challenge the top-tier Democratic candidate over his health care rhetoric, the person familiar with the strategy said.
Sanders’ campaign manager, Faiz Shakir, responded by calling the group “a partnership to protect America’s health industry profits” and a front for profiteering corporations.
by Adam Cancryn and Rachel Roubein, Politico | Read more:
Image: via
[ed. See also: It’s time to disrupt the existing hospital business model (Brookings).]
The multibillion-dollar industry has emerged as the most formidable foe of single-payer health care. It’s helped assemble a coalition of health care lobbies that has launched social media campaigns attacking Medicare for All and its most high-profile proponent, Sen. Bernie Sanders (I-Vt.), while fighting narrower Democratic proposals to expand federal health coverage over concerns any change would slash hospital revenue.
That’s created a dilemma for Medicare for All champions who cast themselves as crusaders against a broken health care system full of greedy insurers and drug companies, yet remain wary of taking on hospitals that rank as top employers in many congressional districts and are seen by the public as life-saving institutions.“We’re not cutting out hospitals, we are keeping the existing hospital system,” said Rep. Pramila Jayapal (D-Wash.), a leader of Democrats’ Medicare for All caucus and fierce critic of corporate influence, adding “they’re very much going to be a partner at that table.”
The bill would all but end private insurance and regulate hospitals in a vastly different way, dramatically changing operators’ business model and costing community hospitals as much as $151 billion a year, according to one estimate published in JAMA.
The industry's stand against Medicare for All comes amid lobbying on separate and intensifying bipartisan efforts to address "surprise" medical bills, with hospitals fighting other parts of the health care industry to ensure they’re not the ones who have to swallow the bulk of the patient’s tab.
Hospitals now drive a significant share of the nation's health care spending, though the public doesn't see it because insurers wind up paying much of the bill. And hospitals make up for the relatively lower payments they get for Medicare and Medicaid patients by shifting some of the expense to patients with private insurance, which pays more than double Medicare rates, according to a new study that’s put the hospital industry on the defensive.
The calculus would change dramatically under Medicare for All, which would free millions more patients to seek no-cost medical care while slashing hospitals’ pay rates and putting up to 1.5 million jobs at stake.
"Every congressman has got a major hospital in their district, and that hospital is a major employer,” said Kevin Schulman, a professor of medicine at Stanford, who co-authored the JAMA article. “And so how hard we can push on hospitals given that is an open question.” (...)
For-profit hospital trade group Federation of American Hospitals led the formation of The Partnership for America’s Health Care Future — a coalition spanning the provider, insurer and drug lobbies formed solely to oppose major efforts to expand government coverage. Its 30 members include hospitals’ other lobbying juggernaut, the American Hospital Association, and a slew of big operators including Ascension — the nation’s largest Catholic health system — and Texas hospital management giant Tenet Healthcare.
The Partnership has spent more than $68,000 attacking Medicare for All on Facebook and Twitter this year, and plans to spend at least six figures targeting voters and Washington policymakers, according to a person familiar with its strategy. Its frequent email blasts deride Medicare for All as a costly government takeover that would destabilize the health system and cut access to care.
In recent weeks, The Partnership launched a series of broadsides at Sanders, a 2020 presidential contender, reflecting a conscious decision to directly challenge the top-tier Democratic candidate over his health care rhetoric, the person familiar with the strategy said.
Sanders’ campaign manager, Faiz Shakir, responded by calling the group “a partnership to protect America’s health industry profits” and a front for profiteering corporations.
by Adam Cancryn and Rachel Roubein, Politico | Read more:
Image: via
[ed. See also: It’s time to disrupt the existing hospital business model (Brookings).]
Saturday, May 25, 2019
[ed. Harming its reputation?! With who... cockroaches?]
Comcast does so much lobbying that it says disclosing it all is too hard (Ars Technica)
Image: Cindy Ord/Getty
The Office Rookies Who Ask for the World
It can be an awkward standoff.
After only a year on the job, more young employees are approaching their managers for a promotion, asking, “All right, I’m ready. What’s next?” says Christopher Kalloo of New York, who heads college relations for a big retailer. New hires have little patience with entry-level tasks, he says. “They want to help with strategy. They want to help drive the business.”
Some managers say they’re taken aback, wondering, “Who do these rookies think they are?”
More than 75% of Gen Z members believe they should be promoted in their first year on the job, according to a recent survey of 1,000 participants ages 18 to 23 by InsideOut Development, a workplace-coaching company. Employers see similar patterns among younger millennials in their late 20s and early 30s.
The trend has managers scrambling to manage young employees’ expectations without driving them out the door. Many are finding new ways to respond, by carving out step-by-step career paths for restless new hires, or handing out new titles or small bonuses. A few hold “workversary” celebrations for employees passing the one-year mark to recognize their accomplishments on the job.
Young employees who push too hard risk derailing their careers by projecting a sense of entitlement. Alex Klein, a vice president and recruiter at VaynerMedia, an 800-employee global agency based in New York, says new recruits are constantly questioning him about promotion opportunities. Many also ask to be considered for a raise earlier than the agency’s customary timetable.
“Those are great questions to ask. I want to hire people who want to grow,” Mr. Klein says. “But you also need to leave the employer with the impression that you want to earn it.”
Their impatience can frustrate employers. Joseph Cacciola was dismayed when a talented recent college grad he’d hired grew restless after six months.
“She was having these crises of confidence, saying, ‘Well, you haven’t offered me a promotion, so I interviewed someplace else,’ ” says Mr. Cacciola, a senior vice president for an entertainment company in New York. He arranged for her to take programming courses at the company’s expense, but she still left for a higher-paying job because he couldn’t offer her as big a raise as she wanted.
“If you try to do everything you can and it still doesn’t work, I’m kind of like, ‘Well, all right, so be it,’ ” he says.
Competing to advance comes naturally to many new hires. “This generation has been given permission by their parents and teachers and other authority figures to just go for it, go for the gold, ask for whatever you want,” says Julie Jansen, author of a career book, “I Don’t Know What I Want, But I Know It’s Not This.”
Years spent in school, with its year-by-year advancement schedules and frequent feedback, leave them ill-prepared for a workforce in which promotion rates vary widely by employer and industry, says Jill Tipograph, the New York-based co-founder of Early Stage Careers, which helps prepare college grads for the workforce and mentors them on their first job. “Young employees just think, ‘Oh, I’ve been here a year, so that means I’m getting promoted, right?’ ” she says. “Promoted to what?”
Sue Shellenbarger, WSJ | Read more:
Image: James Steinberg
After only a year on the job, more young employees are approaching their managers for a promotion, asking, “All right, I’m ready. What’s next?” says Christopher Kalloo of New York, who heads college relations for a big retailer. New hires have little patience with entry-level tasks, he says. “They want to help with strategy. They want to help drive the business.”
Some managers say they’re taken aback, wondering, “Who do these rookies think they are?”
More than 75% of Gen Z members believe they should be promoted in their first year on the job, according to a recent survey of 1,000 participants ages 18 to 23 by InsideOut Development, a workplace-coaching company. Employers see similar patterns among younger millennials in their late 20s and early 30s.The trend has managers scrambling to manage young employees’ expectations without driving them out the door. Many are finding new ways to respond, by carving out step-by-step career paths for restless new hires, or handing out new titles or small bonuses. A few hold “workversary” celebrations for employees passing the one-year mark to recognize their accomplishments on the job.
Young employees who push too hard risk derailing their careers by projecting a sense of entitlement. Alex Klein, a vice president and recruiter at VaynerMedia, an 800-employee global agency based in New York, says new recruits are constantly questioning him about promotion opportunities. Many also ask to be considered for a raise earlier than the agency’s customary timetable.
“Those are great questions to ask. I want to hire people who want to grow,” Mr. Klein says. “But you also need to leave the employer with the impression that you want to earn it.”
Their impatience can frustrate employers. Joseph Cacciola was dismayed when a talented recent college grad he’d hired grew restless after six months.
“She was having these crises of confidence, saying, ‘Well, you haven’t offered me a promotion, so I interviewed someplace else,’ ” says Mr. Cacciola, a senior vice president for an entertainment company in New York. He arranged for her to take programming courses at the company’s expense, but she still left for a higher-paying job because he couldn’t offer her as big a raise as she wanted.
“If you try to do everything you can and it still doesn’t work, I’m kind of like, ‘Well, all right, so be it,’ ” he says.
Competing to advance comes naturally to many new hires. “This generation has been given permission by their parents and teachers and other authority figures to just go for it, go for the gold, ask for whatever you want,” says Julie Jansen, author of a career book, “I Don’t Know What I Want, But I Know It’s Not This.”
Years spent in school, with its year-by-year advancement schedules and frequent feedback, leave them ill-prepared for a workforce in which promotion rates vary widely by employer and industry, says Jill Tipograph, the New York-based co-founder of Early Stage Careers, which helps prepare college grads for the workforce and mentors them on their first job. “Young employees just think, ‘Oh, I’ve been here a year, so that means I’m getting promoted, right?’ ” she says. “Promoted to what?”
Sue Shellenbarger, WSJ | Read more:
Image: James Steinberg
Friday, May 24, 2019
Mt. Everest Traffic Jam
On Everest, Traffic Isn’t Just Inconvenient. It Can Be Deadly. (NY Times)
Image: Project Possible, via Agence France-Presse — Getty Images
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.]
---
[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.]
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