Bezos Reveals His Ugly Vision For The World He’s Trying To Rule

“Guess what the best planet is in this solar system?” asked Amazon CEO Jeff Bezos at a recent media event on his Blue Origin space program.

“It’s easy to know the answer to that question,” he continued. “We’ve sent robotic probes like this one to all of the planets in our solar system. Now, some of them have been fly-bys, but we’ve examined them all. Earth is the best planet. It is not close. This one is really good.”

Bezos then went on to discuss his plan to ship humans off of the best planet in the solar system and send them to live in floating cylinders in space.

Bezos claimed that the growing human population and growing energy consumption will force us to make a choice between “stasis and rationing” and “dynamism and growth”, and claimed that the latter item in his dichotomy is possible only by moving humans off the planet.

“If we’re out in the solar system, we can have a trillion humans in the solar system, which means we’d have a thousand Mozarts and a thousand Einsteins,” Bezos said. “This would be an incredible civilization. What would this future look like? Where would a trillion humans live? Well it’s very interesting, someone named Gerry O’Neill, a physics professor, looked at this question very carefully and he asked a very precise question that nobody had ever asked before, and it was, ‘Is a planetary surface the best place for humans to expand into the solar system?’ And he and his students set to work on answering that question, and they came to a very surprising–for them–counterintuitive answer: No.”

Bezos went on to describe how the limited surface areas, distance, and gravitational forces of the other planets in our solar system make settling on those planets impractical and cost-prohibitive, while constructing giant space cylinders closer to Earth which can hold a million people is far more practical. These cylinders would spin to replicate Earth’s gravitational pull with centrifugal force.

Here are some illustrations Bezos used in his presentation to show us what these “O’Neill colonies” might look like:

“These are really pleasant places to live,” Bezos said. “Some of these O’Neill colonies might choose to replicate Earth cities. They might pick historical cities and mimic them in some way. There’d be whole new types of architecture. These are ideal climates. These are short-sleeve environments. This is Maui on its best day, no rain, no storms, no earthquakes.”

No rain? No weather? Just big, spinning cylinders floating monotonously in space? A trillion divided by a million is one million, which means that the best idea the richest man in the world can come up with for the future of our species is to fill our solar system with a million of these floating homogenized space malls.

“If we build this vision, these O’Neill colonies, where does it take us? What does it mean for Earth?” Bezos asked. “Earth ends up zoned, residential, and light industry. It’ll be a beautiful place to live, it’ll be a beautiful place to visit, it’ll be a beautiful place to go to college, and to do some light industry. But heavy industry, polluting industry, all the things that are damaging our planet, those will be done off Earth. We get to have both. We get to keep this unique gem of a planet, which is completely irreplaceable–there is no Plan B. We have to save this planet. And we shouldn’t give up a future of our grandchildren’s grandchildren of dynamism and growth. We can have both.”

Now, if you look at the behavior of Jeff Bezos, who exploits his employees and destroys his competitors, and who some experts say is trying to take over the underlying infrastructure of our entire economy, you can feel reasonably confident that this man has no intention of leaving “this unique gem of a planet”, nor of having the heirs to his empire leave either. When you see this Pentagon advisory board member and CIA contractor planning to ship humans off the Earth’s surface so the planet can thrive, you may be certain that he’s talking about other humans. The unworthy ones. The ones who weren’t sociopathic enough to climb the capitalist ladder by stepping on the backs of everyone else.

And make no mistake, when Bezos talks about saving the planet for “our grandchildren’s grandchildren”, he’s not just talking about his heirs, he’s talking about himself. Bezos has invested large amounts of wealth in biotech aimed at reversing the aging process and cracking the secret of immortality.

This is the sort of guiding wisdom that is controlling the fate of our species, everyone. The world’s most ambitious plutocrat envisions a world in which, rather than evolving beyond our destructive tendencies and learning to live in collaboration with each other and our environment, we are simply shipped off into space so that he can stretch out and enjoy our beautiful planet. That’s his best idea.

Our plutocratic overlords aren’t just sociopaths. They’re morons.

Bezos’ incredibly shallow vision for humanity reminds me of something Julian Assange said at a 2017 London festival via video link about the way Silicon Valley plutocrats are trying to become immortal by finding a way to upload their brains onto computers.

“I know from our sources deep inside those Silicon Valley institutions, they genuinely believe that they are going to produce artificial intelligences that are so powerful, relatively soon, that people will have their brains digitized, uploaded on these artificial intelligences, and live forever in a simulation, therefore will have eternal life,” Assange said. “It’s a religion for atheists. They’ll have eternal life, and given that you’re in a simulation, why not program the simulation to have endless drug and sex orgy parties all around you. It’s like the 72 virgins, but it’s like the Silicon Valley equivalent.”

I mean, damn. First of all, how stupid do you have to be to overlook the fact that science has virtually no understanding of consciousness and doesn’t even really know what it is? Even if these idiots find a way to upload their neurological patternings onto some AI’s virtual simulation, it’s not like they’d be there to experience it. It would just be a bunch of data running in a computer somewhere, mimicking the personality of a dead person and experienced by no one. People who believe that all there is to them is their dopey mental patterns have not spent any time whatsoever exploring what they are, and have no idea what it is to be human. The fact that anyone would think they could become immortal by digitizing their churning, repetitive personality patterns is crazy, and the fact that they’d want to is even crazier.

People who think this way should shut up and learn about life, not rule the world in a plutocratic system where money translates directly to political influence. People who think that humans can be happily unplugged from the ecosystemic context in which they evolved, the ecosystemic context of which they are an inseparable part, and people who think they can become immortal by uploading their wanky personalities onto a computer should shut the fuck up, spend some time alone with themselves, maybe try some psilocybin mushrooms, and learn a bit about what it means to be human. They certainly shouldn’t be calling the shots.

Earth is our home. It’s what we’re made for. The earth went through a lot to give you life. Sparks had to catch, oceans had to freeze, billions of cells had to survive endless disease, all of these amazing things had to happen just right to give you life. You belong here. You are as much a creation of the earth as the air you breathe. You may feel like a singular organism but you’re actually as much a singular organism as one of the many billions of organisms that make up your body. You and earth are one. And because you evolved on earth, you are perfectly adapted to earth and it is perfectly adapted to you. It yearns for your breath as you yearn for its breeze on your face.

by Caitlin Johnstone, CatlinJohnstone.com |  Read more:

Images: Jeff Bezos

In Your Hands, My Dissatisfied Countrymen: The Jaquess-Gilmore Mission

“I worked night and day for twelve years to prevent the war, but I could not. The North was mad and blind, would not let us govern ourselves, and so the war came.” —Jefferson Davis, July 1864

By the time Sherman’s armies had scorched and bow-tied their way to the sea, by the time Halleck had followed Grant’s orders to “eat out Virginia clean and clear as far as they go, so that crows flying over it for the balance of the season will have to carry their own provender with them,” and by the time Winfield Scott’s Anaconda Plan was finished squeezing every drop of life out of the Confederacy, there had to be those who wondered what possible logic would lead intelligent men like Jefferson Davis to make such a catastrophic choice.

Yet, the South almost won the gamble. With secession, they had challenged the core of the American Experiment, the democratic principle of equal rights, general (male) suffrage, government by a majority, and a peaceful transition of power when that majority so indicated. They also posed an existential question for the North: Was adherence to a principle, even a cherished one like the Union, worth lives and property?

The Civil War is fascinating on so many levels, but what made it fundamentally different than any other conflict that preceded it was that, for the first time, two peoples with the ability to exercise electoral oversight engaged in a protracted armed conflict. This implied something new. The simplest mechanisms of civic beliefs: the right to disagree publicly, to organize, to place elected leadership on notice that their jobs could be at risk, would all play an unexpectedly crucial role in the manner in which the war began and was ultimately prosecuted.

There is no question that the issue was ripe. The Jefferson Davis quote, self-serving though it may be, reflects the reality of a political war that had been going on for more than a decade. The South (or at least the Fire-Eaters, who were more influential than their numbers would imply) had talked themselves into eternal dissatisfaction. They had also convinced themselves that the North would lack backbone when pushed. Threatening to leave if Lincoln were to win the election wasn’t just bluster. The South saw him as a real threat, and secession mutterings progressed to secession organizing. Several Southern States did legislative groundwork in anticipation of a Lincoln win, and they swung into action immediately thereafter. Between December 20,1860 and February 1, 1861, South Carolina, Mississippi, Alabama, Florida, Georgia, Louisiana, and finally Texas seceded, all before Lincoln could even take the Oath of Office.

Of course, that wasn’t the entire South—there was significant Unionist sentiment in many places, and slaveholding Border States actually remained loyal. Bear in mind as well that in no state, even in the Deep South, did slaveholders or even slaveholding families represent a majority. But, as William Freehling points out in The Reintegration of American History, a different type of political culture predominated, one that was far more hierarchical and patriarchal. It wasn’t just that the economic elites (often meaning the Planter Class) held power. It was the way they expressed that power: A plantation required a self-sacrificing leader making all the decisions and receiving in return obedience from inferiors—slaves, employees, tradesmen, wives, and people of a lower social standing. Apply that mind-set to politics, and you have the few choosing for the many.

As to the North, the picture was more complex, in part because divergent views had greater access to power. There were plenty of Southern sympathizers, not just Copperheads but also “Doughfaces” like outgoing President James Buchanan. There were bankers and business people who wanted access to Southern markets. There were also many rank and file Democrats who stuck, out of loyalty, with an increasingly Southern-dominated party. But, just as Southern anger burned, so did resentment in the North. The constantly escalating Southern demands, always couched in hyperbolic terms, grated. Lincoln himself had made this point powerfully at Cooper Union in 1859—the South demanded not just Northern obeisance, but also Northern complicity in what many thought of as a profound moral wrong.

Secession made it palpable, real, and now. It forced Northerners to decide whether the whole thing was worth it. Maybe another set of concessions would work, but, if not, why not just let the slavemongers go their own way, and be done with the problem altogether? The entire country held its breath.

It was at this point that the South (or, at least South Carolina) took a fateful step: They fired first, shelling Fort Sumter in Charleston Harbor on April 12, 1861. Northern public opinion moved sharply in the direction of intervention, but Lincoln’s call for 75,000 volunteers to respond also induced four Southern States, first Virginia, the big prize, then Arkansas, North Carolina, and Tennessee, to join the Confederacy.

Why did South Carolina do it? There was no strategic reason—Major Anderson lacked the supplies to sustain his command for any length of time. It’s reasonable to suspect that the aristocratic Southern leadership, steeped in the culture of honor and duels, and contemptuous of a presumed Northern lack of manly fiber, simply assumed it would be easy.

But if the firing on Fort Sumter misjudged the situation, a second Southern assumption was far better. No quick strike was going to end the rebellion. They could fight a largely defensive war—the North would have to come to them, and they felt they had superior military leadership, easier logistics, and far better knowledge of the topography. In short, the South could win just by not losing, and the longer the war went on, the greater the risk to Lincoln that public support would erode.

In the short run, this is exactly what occurred. Poor generalship and tactics led to Northern defeats on the battlefield and at the ballot box: In 1862, Democrats gained 27 seats in the then-184-seat House of Representatives. Northern fortunes picked up militarily in 1863 and early 1864 with the victory at Gettysburg and the capture of New Orleans, but by midsummer they were back to slogging it out again, with heavy loss of life.

Criticism of Lincoln intensified. Seemingly everyone from across the Northern political spectrum found something to dislike in his policies. Influential thought-leaders like William Cullen Bryant, Horace Greeley, and Theodore Tilton came to the conclusion that Lincoln was a failure and needed to be replaced. Others started a John C. Frémont movement, which would have seriously impacted Lincoln’s chances in the general election. At the Republican National Convention in Baltimore, whispers began for a Grant candidacy. Lincoln did secure re-nomination, but, right afterwards, hostilities broke out again with his own party after he pocket-vetoed the Wade-Davis Reconstruction Bill, which was far more punitive than he wanted and would have seized control of the process from the Executive Branch.

The disappointments mounted. In June 1864, Confederate General Jubal Early launched a surprise raid on Washington itself, and almost broke through. By August, against a backdrop of continued military frustrations and a revitalized Democratic Party about to nominate General George McClellan, Lincoln wrote his famous “Blind Memo” to his Cabinet: “This morning, as for some days past, it seems exceedingly probable that this Administration will not be re-elected. Then it will be my duty to so co-operate with the President elect, as to save the Union between the election and the inauguration; as he will have secured his election on such ground that he cannot possibly save it afterwards.” At the very time that memo was written, a serious attempt was made to have a second convention, in Cincinnati, on September 28, to replace Lincoln as the nominee.

Weariness with the war wasn’t confined to the North, although Davis was more secure as a result of his six-year term. The public wanted something done. This gave rise to an unusual number of peace talks, peace feelers, and ad hoc peace conferences. Lincoln even sent the ever-complaining Horace Greeley to one. But perhaps the most interesting is the only one that engaged Jefferson Davis directly, the ragtag Jaquess-Gilmore Mission.

Colonel James Jaquess was a Methodist preacher and soldier from Illinois, James Gilmore a businessman from New York with contacts in the South. Jaquess had long had an obsession with bringing peace to both sides, and requested leave to travel South to meet with like-minded people. Finally, in June of 1864, Lincoln gave a pass to the two to travel to Richmond and attempt to connect with the Confederate President. They were given no formal status or negotiating authority, but were made generally aware of Lincoln’s bottom line—a reconstituted Union, the end of hostilities, and emancipation.

After a preliminary meeting with Judah P. Benjamin, then the Confederacy’s Secretary of State, they were granted an audience with Davis himself on July 17, 1864. What followed was an extraordinary back and forth that may give us as clear a roadmap to Davis’s thinking as we could possibly find. Jeffries later published an account of the meeting, and, making allowances for period language and perhaps a little puffery, it is worth reading in its entirety.

What first strikes you is how absolutely clear Davis was: The war could only end with the North withdrawing. The blame was entirely on them (“At your door lies all the misery and the crime of this war—and it is a fearful, fearful account.”). The North, by insisting on Union, “would deny to us what you exact for yourselves—the right of self-government.” When Jaquess suggested that he had many Southern friends who wished reconciliation, Davis disagreed: “They are mistaken… They do not understand Southern sentiment.”

Jaquess was a determined man, and he pressed his case. Surely peace was desirable? Davis was unmoved: “I desire peace as much as you do. I deplore bloodshed as much as you do; but I feel that not one drop of the blood shed in this war is on my hands; and I look up to my God and say this. I tried all in my power to avert this war. I saw it coming, and for twelve years I worked night and day to prevent it, but I could not. The North was mad and blind; it would not let us govern ourselves; and so the war came, and now it must go on till the last men of this generation falls in his tracks, and his children seize his musket and fight his battles, unless you acknowledge our right to self-government. We are not fighting for Slavery. We are fighting for independence, and that or extermination we will have.”

Over and over Davis returns to his central themes. Independence is non-negotiable. The South hates the North and will never rejoin it, and the North has no right to demand it stay. Each State is only in the Union as a result of a consent that can be withdrawn at any time.

Jaquess then proposes something so far-fetched that it is incredible he could have possibly thought either Lincoln or Davis would ever agree to it: An armistice, followed by a national vote that would choose between two competing proposals—(1) Peace with Disunion, or (2) Peace with Union, emancipation, no confiscation, and universal amnesty.

Davis rejects it, first with the technical objection that one Southern State had no legal right to end slavery in another. But then, in just a few words, he defines why any vote would never be acceptable, no matter the terms: “We seceded to rid ourselves of the rule of the majority, and this would subject us to it again.”

With that, the substantive part of the discussion is over. Jaquess and Jeffries take their leave, and on the way out are met by Judge Robert Ould, who had helped arrange the meeting. Judge Ould inquired about the results: “Nothing but war—war to the knife,” said Jeffries. Jaquess, who had staked so much emotionally on his ability to broker peace, was clearly disappointed at Davis’ fixation on an impossible result. Quoting Hosea 4:17, he adds, “Ephraim is joined to his idols—let him alone.”

by Michael Liss, 3QD | Read more:
Image: uncredited

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Range: Why Generalists Triumph in a Specialized World

Let's start with a couple of stories. This first one, you probably know.

The boy's father could tell something was different. At six months old, the boy could balance on his father's palm as he walked through their home. At 10 months he could climb down from his high chair, trundle over to a golf club that had been cut down to size and imitate the swing he'd been watching in the garage. At two—an age when physical developmental milestones include "kicks a ball" and "stands on tiptoe"—he went on national television and used a shoulder-height club to drive a ball past an admiring Bob Hope. That same year he entered his first tournament and won the 10-and-under division.

At eight, the son beat his father for the first time. The father didn't mind, because he was convinced that his boy was singularly talented, and that he was uniquely equipped to help him. The boy was already famous by the time he reached Stanford, and soon his father opened up about his importance. His son would have a larger impact than Nelson Mandela, than Gandhi, than Buddha, he insisted. "He has a larger forum than any of them," he said. "I don't know yet exactly what form this will take. But he is the Chosen One."

This second story, you also probably know. You might not recognize it at first.

His mom was a coach, but she never coached him. He would kick a ball around with her when he learned to walk. As a boy, he played squash with his father on Sundays. He dabbled in skiing, wrestling, swimming and skateboarding. He played basketball, handball, tennis, table tennis, and soccer at school. "I was always very much more interested if a ball was involved," he would say.

Many experts argue that in order to be successful in any field, one must start early, focus intensely, and rack up as many hours of deliberate practice as possible. But what if the opposite is true? Some of the world’s best athletes, musicians, scientists, artists and inventors are actually generalists, not specialists, and they present a powerful argument for how to succeed in any field.

Though his mother taught tennis, she decided against working with him. "He would have just upset me anyway," she said. "He tried out every strange stroke and certainly never returned a ball normally. That is simply no fun for a mother." Rather than pushy, a Sports Illustrated writer would observe that his parents were "pully." Nearing his teens, the boy began to gravitate more toward tennis, and "if they nudged him at all, it was to stop taking tennis so seriously."

As a teenager, he became good enough to warrant an interview with the local newspaper. His mother was appalled to read that, when asked what he would buy with a hypothetical first paycheck from tennis, her son answered, "a Mercedes." She was relieved when the reporter let her listen to a recording of the interview. There'd been a mistake: The boy had said "mehr CDs," in Swiss German. He simply wanted "more CDs."

The boy was competitive, no doubt. But when his tennis instructors decided to move him up to a group with older players, he asked to move back so he could stay with his friends. After all, part of the fun was hanging around after his lessons.

By the time he finally gave up other sports to focus on tennis, other kids had long since been working with strength coaches, sports psychologists and nutritionists. But it didn't seem to hamper his development. In his mid-30s, an age by which even legendary players are typically retired, he would still be ranked No. 1 in the world.

In 2006, Tiger Woods and Roger Federer met for the first time, when both were at the apex of their powers, and they connected as only they could. "I've never spoken with anybody who was so familiar with the feeling of being invincible," Federer would describe it.

Still, the contrast was not lost on him. "[Tiger's] story is completely different from mine," he told a biographer in 2006. Woods's incredible upbringing has been at the heart of a batch of bestselling books on the development of expertise, one of which was a parenting manual written by his father, Earl. Tiger was not merely playing golf. He was engaging in "deliberate practice," the only kind that counts in the now-famous 10,000 hours rule to expertise. Reams of work on expertise development shows that elite athletes spend more time in highly technical, deliberate practice each week than those who plateau at lower levels. And Tiger has come to symbolize that idea of success—and its corollary, that the practice must start as early as possible.

But when scientists examine the entire developmental path of athletes, they find that the eventual elites typically devote less time early on to deliberate practice in the activity in which they will later become experts. Instead, they undergo what researchers call a "sampling period." They play a variety of sports, usually in an unstructured or lightly structured environment; they gain a range of physical proficiencies from which they can draw; they learn about their own abilities and proclivities; and only later do they focus in and ramp up technical practice in one area.

In 2014, I included some of the findings about late specialization in sports in the afterword of my first book, The Sports Gene. The following year I accepted an invitation to talk about that research from an unlikely audience—not athletes or coaches but military veterans brought together by the Pat Tillman Foundation. In preparation, I perused scientific journals for work on specialization and career-swerving outside the sports world. I was struck by what I found. One study showed that early career specializers jumped out to an earnings lead after college, but that later specializers made up for the head start by finding work that better fit their skills and personalities. I found a raft of studies that showed how technological inventors increased their creative impact by accumulating experience in different domains, compared to peers who drilled more deeply into one.

I also realized that some of the people whose work I deeply admired from afar—from Duke Ellington (who shunned music lessons to focus on drawing and baseball as a kid) to Maryam Mirzakhani (who dreamed of becoming a novelist and instead became the first woman to win math's most famous prize, the Fields Medal)—seemed to have more Roger than Tiger in their development stories. I encountered remarkable individuals who succeeded not in spite of their diverse experiences and interests, but because of them.

by David Epstein, SI |  Read more:

Images: CBS/Getty Images: Courtesy of the Federer Family

Bart Starr (1934-2019)

Legendary Packers quarterback Bart Starr dies at age 85 (Green Bay Press Gazette).

Image: via

[ed. A class act all the way, one of the greatest.]

The Faux Revolution of Mindfulness

According to its backers we’re in the midst of a “mindfulness revolution.” Jon Kabat-Zinn, recently dubbed the “father of mindfulness,” goes so far as to proclaim that we’re on the verge of a global renaissance, and that mindfulness “may actually be the only promise the species and the planet have for making it through the next couple hundred years.”

Really? A revolution? A global renaissance? What exactly has been overturned or radically transformed to garner such grand status?

The last time I watched the news, Wall Street and corporations were still conducting business-as-usual, special interests and political corruption were still unchecked, and public schools were still suffering from massive underfunding and neglect. The concentration of wealth and inequality is now at record levels. Mass incarceration and prison overcrowding have become a new social plague, while the indiscriminate shooting of African Americans by police and the demonizing of the poor remains commonplace. America’s militaristic imperialism continues to spread, and the impending disasters of global warming are already rearing their ugly heads.

Against this background, the hubris and political naiveté of the cheerleaders of the mindfulness ‘revolution’ is stunning. They seem so enamored of doing good and saving the world that these true believers, no matter how sincere, suffer from an enormous blindspot. They seem mindless of the fact that all too often, mindfulness has been reduced to a commodified and instrumental self-help technique that unwittingly reinforces neoliberal imperatives.

For Kabat-Zinn and his followers, it is mindless and maladapted individuals who are to blame for the problems of a dysfunctional society, not the political and economic frameworks within which they are forced to act. By shifting the burden of responsibility to individuals for managing their own wellbeing, and by privatizing and pathologizing stress, the neoliberal order has been a boon to the 1.1 billion dollar mindfulness industry.

In response, mindfulness has arisen as a new religion of the self, unencumbered by the public sphere. The revolution it proclaims occurs not out in the streets or through collective struggle and political protests or nonviolent demonstrations, but in the heads of atomized individuals. A recurrent message is that our failure to pay attention to the present moment - our getting lost in mental ruminations and mind-wandering - is the underlying cause of our dissatisfaction and distress.

Kabat-Zinn takes this one step further. He claims that our “entire society is suffering from attention disorder-big time.” Apparently, stress and social suffering are not the result of massive inequalities, nefarious corporate business practices or political corruption, but of a crisis inside our heads, what he calls a “thinking disease.”

In other words, capitalism itself is not inherently problematic; rather, the problem is the failure of individuals to be mindful and resilient in a precarious and uncertain economy. And not surprisingly, the mindfulness merchants have just the goods we need to be contented mindful capitalists.

Mindfulness, positive psychology and the happiness industry share a common core in terms of the de-politicization of stress. The ubiquity of individualistic stress rhetoric - with its underlying cultural message that stress is a given - should make us suspicious. As Mark Fisher points out in his book Capitalist Realism, the privatization of stress has led to an “almost total destruction of the concept of the public.”

Stress, we are told by the mindfulness apologists, is a noxious influence that ravages our minds and bodies, and it is up to us as individuals to ‘mindful up.’ It’s a seductive proposition that has potent truth effects. First, we are conditioned to accept the fact that there is a stress epidemic and that it is simply an inevitability of the modern age. Second, since stress is supposedly omnipresent, it’s our responsibility as stressed-out subjects to manage it, get it under control, and adapt mindfully and vigilantly to the thralls of a capitalist economy. Mindfulness targets this vulnerability, and, at least on the surface, appears as a benign technique for self-empowerment.

But in her book One Nation Under Stress: The Trouble with Stress as an Idea, Dana Becker points out that the stress concept obscures and conceals “social problems by individualizing them in ways that most disadvantage those who have the least to gain from the status quo.” In fact, Becker has coined the term stressism to describe “the current belief that the tensions of contemporary life are primarily individual lifestyle problems to be solved through managing stress, as opposed to the belief that these tensions are linked to social forces and need to be resolved primarily through social and political means.”

by Ronald Purser, Open Democracy |  Read more:

Image: Thai Ronald McDonald. Flickr/Daniel Grosvenor. CC BY-NC-ND 2.0

Celeste Dupuy-Spencer, “Little Smoke, Mt Washington”, 2016

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Alan Spazzali, Twin sisters, 2014
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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.

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).]

Comcast may be harming its reputation by failing to reveal all of its lobbying activities, including its involvement in trade associations and lobbying at the state level, a group of shareholders says in a proposal that asks for more lobbying disclosures.

[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

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

Jean-Pierre Lourdeau - Un petit dernier pour la route, 2019
via:

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!

…whatever, close enough.

by Scott Alexander, Slate Star Codex |  Read more:

Image: uncredited

[ed. Hilarious. And depressing.]

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.]

Pro Co RAT
via:
[ed. A true classic.]

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.

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).]

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.]

---

[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.]