Using Telemedicine to Treat Opioid Addiction

Covid-19 has made life much harder for people with opioid addiction. But the response to the virus has also revealed a way forward that could radically expand effective treatment and reduce overdose deaths.

Until now, getting effective treatment depended on where you lived. Forty percent of American counties — much of Appalachia, for example — have no providers licensed to prescribe buprenorphine, the most successful treatment so far.

But the pandemic has made it possible to see a licensed provider from home, and that could make buprenorphine treatment available anywhere.

Michelle (she asked me to not use her family name) is 57, lives near Wilkes-Barre, Pa., and works from home as a customer service representative. Her computer allows her to live a good life — after eight years on heroin that followed many years on other drugs.

Over the internet, she sees a psychiatric nurse practitioner, Roseanna Melle, who offers light counseling and prescribes the widely used drug Suboxone — a combination of buprenorphine and the overdose reversal drug naloxone. It blocks her cravings and prevents withdrawal symptoms, but doesn’t get her high. She feels … normal.

Before starting telemedicine in April, Michelle got Suboxone at a local addiction medicine clinic. “It was a revolving door — sometimes standing room only,” she said. “Who wouldn’t want to just do your appointment in the comfort and privacy of your own home?”

Robert, 30, another of Ms. Melle’s patients, from nearby Scranton, said: “Home treatment lessens the shame for me. I don’t have to worry what doctors around here think. My Suboxone — it’s just a medication. I don’t think about it. I just take it and go about my day.”

Ms. Melle is one of two — soon to be four — providers at a new telemedicine company in Pennsylvania called Ophelia. It’s one of several companies started in the last few years that prescribe Suboxone: Bicycle Health, Bright Heart Health, Workit Health, PursueCare, Boulder Care. Each is slightly different and they operate in different states.

The science is unequivocal: The only effective treatment for opioid use disorder is what is called “medication-assisted treatment.” Medication makes patients far more successful in treatment and less likely to overdose.

But at least 80 percent of people who could benefit from it don’t receive it. Some are deterred by the stigma still attached to taking Suboxone. But likely more important is the shortage of local providers. In 2016, the Obama administration increased the number of providers and allowed them to treat more patients. It’s still far from enough.

So people buy Suboxone from their drug dealer. “I bought it on the black market — a lot of people do,” Michelle said. “They sometimes try it because they can’t get their drug of choice. Or they’re thinking about getting clean, and they don’t have insurance and don’t want to go through the red tape.”

Ophelia’s medical director, Arthur Robin Williams, an addiction psychiatrist and assistant professor at Columbia University said, “It is easier for people to get the dangerous drugs than to get the treatment for addiction.”

Some clinics have been using telemedicine for the last few years, but patients still faced many barriers to treatment. The first visit had to be in person — which meant that access to treatment still depended on where you lived. Doctors were paid a pittance for telehealth appointments, so few doctors offered them. A patient could get only a week’s supply of buprenorphine at a time.

Advocates for treatment have campaigned to remove these barriers — unsuccessfully until Covid-19.

The pandemic has led to regulatory changes: Treatment can now be entirely virtual, including the first appointment. Medicare now pays providers the same for a video appointment as a conventional one — many insurers and Medicaid programs have followed. Patients can get a month’s prescription for buprenorphine instead of just a week’s.

These changes are temporary, but everyone I talked to wanted them made permanent.

“This has just catapulted through this crisis,” said Allegra Schorr, a Manhattan doctor and the president of Compa, a New York State coalition of medication-assisted treatment providers and advocates. “Now everybody’s doing it,” she said. “Within this environment, it certainly seems to be working.”

Prevention Point Philadelphia is among the largest harm reduction centers in the country. It offers syringe exchange, medical care, social services — and now, food. The majority of its patients are without homes, and most suffer from multiple mental and physical illnesses.

Prevention Point has offered medication-assisted treatment for 12 years and now treats 268 patients — many out of a mobile van. “We try to wipe out any barriers,” said Silvana Mazzella, associate executive director.

In mid-March, Prevention Point started prescribing Suboxone through telemedicine. But many of its patients can’t do the “tele” part. They don’t have phones or have no-data phones and can’t afford the airtime for an appointment. Prevention Point has given patients some donated phones with data and minutes of usage included, and is seeking more.

Ms. Mazzella said telemedicine has helped the patients who can use it. “It’s a reduction of the hassle, wait times, anxiety and fear of withdrawal in a waiting room,” she said. But the switch has also changed the foundations of treatment,” she added. “We have moved to more of a harm reduction model. We have taken away drug screens and things that feel punitive, things patients must do to prove they’re a good patient. We’ve removed the stigma and the power dynamic that typically exists in a clinic. We are putting the same level of trust in patients as you would with diabetes or hypertension.”

She said telemedicine patients have proven more likely to fill their prescriptions than patients who had appeared in person in the past.

by Tina Rosenberg, NY Times | Read more:
Image: Sabina Louise Pierce for The New York Times

via:

Bird's Eye Gallery: Amusement Parks (ArchDaily)

via:

Ghosting The News

Earlier this month, the McClatchy Company, publisher of 30 daily newspapers, including the Miami Herald, The Kansas City Star and the Charlotte Observer, was sold in a bankruptcy auction to the Chatham Management Group, a New Jersey hedge fund. Hedge fund ownership of other papers has led to sharp budget cuts and reduced local coverage. Due to competition from the Internet and other pressures, more than 2,000 American newspapers have gone out of business since 2004. Financial stresses from the coronavirus pandemic have only made things worse.

Our guest, veteran journalist Margaret Sullivan, believes the decline of local news coverage is a crisis every bit as serious as the spread of disinformation on the Internet. In a new book, Sullivan argues that when local news fails, citizens lack critical information to make good decisions, and democracy is weakened. (...)

DAVIES: The decline of traditional media organizations, especially daily newspapers, is not a new story. Why did you want to sound the alarm about it now?

SULLIVAN: Well, it's - it is an alarming situation but one that, most members of the public don't seem to be very tuned into. In fact there's research that's been done that shows that, you know, some 70% of Americans think that local news organizations are doing pretty well financially. That's not the case, especially when it comes to newspapers. And after spending most of my career at a regional newspaper in Buffalo, I know how important that is to the community and to - sort of as an underpinning of our democracy.

And I thought it would be important to show people the connection between the decline of local news and what's happening in our society at large. And it's - it means less political engagement, less voting across party lines, the possibility of more corruption at the local government level and, I think, the weakening of community ties in which we all kind of relate to each other based on a shared, you know, group of facts that we may want to do different things with - interpret in different ways. But we all can sort of agree on what's happening. So I see it as a real crisis. And I wanted to let people know what the price of it is before it's entirely too late.

DAVIES: One medium-sized newspaper that you write about is the Youngstown, Ohio, Vindicator. Just tell us briefly its story and what it meant to the community and what happened.

SULLIVAN: So last summer, there was a surprise announcement that The Vindicator in Youngstown, Ohio, which is a substantial city, was going to close its doors the next month. The announcement was in July. They would - their last day of publication would be in August. And it was a shocker to the community. The paper had been around for over 150 years, mostly family-owned during that time and still family-owned. And people just couldn't believe it.

So I actually went off to Youngstown and spent quite a bit of time chatting with people and trying to - spending time in the newsroom there and trying to understand what had happened and what the cost of it would be. It's a very disturbing story because it would leave a pretty decent-sized city without its own newspaper anymore and one that had been a real part of the community. Everybody called it The Vindy. Everybody had, you know, had a story about delivering it. Or your mom's obit had been in it. Or they covered my sports event - whatever it was. This was going to go away.

I attended a community meeting, and people were in tears about it. But a - one of the editors who I spoke with later said, well, that was very poignant, but I wonder if we had had a show of hands about who among the crying audience had actually been seven-day-a-week subscribers - I wonder what that would have been. And his theory was that not very many. Circulation had gone way, way down.

DAVIES: So what was the impact when The Vindicator went under in Youngstown?

SULLIVAN: Well, since The Vindicator closed, of course, there's a loss to the community. And there's no doubt about that. And people are feeling it. But there have been some things that have kind of come in to help to fill the gap a little bit. There is a new digital-only organization that McClatchy and Google are involved in called Mahoning Matters, with - the Mahoning Valley is the larger area around Youngstown. I think they have four reporters and a couple editors. So that's, you know, maybe six people. That's a far cry from the 44-member Vindicator newsroom but still a good thing.

A neighboring news chain has started to put out an addition in Youngstown that, again, isn't really a fully Youngstown paper, but it does something. They do still - and they took on The Vindicator name. So there is still something called the Youngstown Vindicator. It just isn't what it once was. And ProPublica, the great, you know, and much-esteemed digital-only investigative journalism organization, has put a reporter in Youngstown at one of the TV stations to you know help do some of this enterprise or investigative coverage. So, you know, I think it's a great, little laboratory. There was a big loss. And people feel it, and the community feels it. And yet there are some bright spots, too.

DAVIES: You cite an example of the impact of the decline of many small newspapers in the case of a congressman from western New York, Chris Collins, who was indicted for fraud as he was running for reelection. And this gave his opponent, seemingly, a huge advantage, a guy named Nate McMurray. What did McMurray find when he sought to raise this as a campaign issue?

SULLIVAN: Well, McMurray, who was a Democrat running in a very red district - in fact, it's New York state's most Republican district and one that spreads across eight counties - found that when he went out to some of the more rural parts of the district, where there was less local news coverage and where newspapers had gone under, that - you know, he told me that when he would start to talk to people about Chris Collins's indictment on insider trading charges, that some of them said, what are you talking about? We - you know, they did not know about it. And when he tried to inform them about it, they would, you know, sort of shout back that this was fake news.

And, in fact, Chris Collins was fundraising from the reports of his indictment that The Buffalo News, my old paper, had been writing about a lot. So in the parts of the district that had more local news and were more sort of immersed in local news coverage, a lot of people crossed the aisle to vote for the challenger, people who normally would, we can say, I think, confidently would have voted Republican. But in the parts of the district that had far less local news, one of which is termed a news desert, that didn't happen nearly as much. And McMurray said that, you know, he was really surprised. But he could understand it because he thought that people were getting a lot of their information from less dependable sources - social media, talk radio and just what he called rumors.

So there - you know, it's impossible to say exactly what would have happened if there'd been a great local newspaper in those parts of the district. But the sort of anecdotal evidence suggests that it really did have an effect.

DAVIES: Right. So McMurray, the challenger, lost the primary. The congressman ultimately resigned, right?

SULLIVAN: That's right. McMurray lost by just a whisker, one half of 1%, which was far, far less than what would normally have happened. And, you know, he would say that if there'd been great local news coverage in the further out parts of the district, including this news desert area, he believes he would have won. And then, ultimately, Chris Collins - the case went to trial. And he was sentenced to a jail term.

DAVIES: You know, another point you make is that the loss of local news coverage isn't just about watchdog reporting and investigations into local government officials, as important as that is. There was also a way in which they knitted communities together. So what's the impact when the paper closes?

SULLIVAN: Well, I mean, this is something that I feel so strongly about because part of - a big chunk of my time at the Buffalo News was as the features editor. So the people who I was dealing with every day and supervising and whose work I was lucky enough to edit were, for example, the book critic, the movie critic, the pop music critic, people who wrote feature stories about local people. And, you know, this was in a daily section called Life and Arts.

And when that section and when those jobs go away, which they have in Buffalo, I think that we lose something. We lose that connection. That has nothing to do with corrupt local officials. It has to do with how we relate to each other as members of a community. Our arts and our culture and, you know, sort of our society as a community, I think, becomes less knitted together and weakened.

by Dave Davies, NPR |  Read more:

Image: Mark Lennihan / Associated Press

‘This Push to Open Schools Is Guaranteed to Fail’

In March, we were all living in 15-day increments. Working from home and distance learning, for those who had the terrible luxury of such things, would be a weeks-long affair, surreal but temporary. Fifteen days to flatten the curve. Fifteen days to slow the spread.

Scientists warned us even then that a return to normalcy would take longer, but the telescoped timeline had obvious appeal. You can put up with almost anything for just 15 days.

Acting on the chance to get it right was essential, but we now know it was not temporary. We’ve seen the failures—in testing, in containment, in federal and state leadership—compound in catastrophic ways. And as our pandemic summer has stretched on, many of us have let go, one by one, of experiences from the world we used to inhabit. We bid goodbye to sleepaway camp, to live music, to distant travel, to boisterous weddings, and to spontaneity in general. Today, a new realization is dawning, and as the debate over schools reopening rages, we must acknowledge it plainly: We aren’t going back to how it was. And we shouldn’t.

“This push to open schools is guaranteed to fail,” says Peter Hotez, a pediatrician and molecular virologist, and the dean for the National School of Tropical Medicine at Baylor College of Medicine. I’ve been corresponding with Hotez, and with several epidemiologists, over the course of the pandemic, and have noticed a starkness in their views in recent weeks. “The social-distancing expectations and mask requirements for the lower grades are unrealistic,” Hotez told me. “In communities with high transmission, it’s inevitable that COVID-19 will enter the schools. Within two weeks of opening schools in communities with high virus transmission, teachers will become ill. All it will take is for a single teacher to become hospitalized with COVID and everything will shut down.”

Hotez has good reason to be pessimistic. There were 68,605 new cases in the United States yesterday, according to data from the Centers for Disease Control and Prevention. The seven-day average has stayed above 60,000 new cases per day since July 13. Reaching 100,000 cases per day, once seen as an apocalyptic, worst-case-scenario warning from Anthony Fauci, is no longer difficult to imagine. Indeed, my conversations with epidemiologists in recent days were all strikingly dark. They agreed: Schools should not risk reopening, probably not even for the youngest children, in the coming weeks. “We can’t pretend like everything’s fine,” said Gary Simon, the director of the infectious diseases division at George Washington University. “If I had a school-age kid, I wouldn’t want to send him to school.”

The evidence is all around us. There is the summer camp in Georgia where hundreds of kids and counselors—nearly half the camp—got infected after only a few days together. Then there’s the school in Indiana where, just hours after reopening last week, a student tested positive for the coronavirus. (“We knew it was a when, not if,” the superintendent told The New York Times, but officials were “very shocked it was on Day 1.”)

There’s also the JAMA Pediatrics study that suggests that babies and young children can carry extremely high viral loads of SARS-CoV-2. The study’s authors found at least as much viral material in the throats and airways of young children as in infected adults, and sometimes 100 times as much as in adults. We’ve long known that kids older than age 10 can efficiently transmit the virus, but this new research suggests that younger kids pose a risk of transmission to the people around them, just as older children do. The more we learn, the more likely it seems that children are highly effective vectors for transmission. Springtime school closures took place before the virus seized the nation. A return to the classroom now—even with thoughtful precautions—would create excellent conditions to test just how quickly COVID-19 can saturate a community. School was deemed unsafe for children, teachers, and staffers back in March. The pandemic is worse in the United States now than it was then, with multiple epicenters burning across the country. So why would schools reopen now?

“The problem is the White House and the task force could never organize themselves to lead a federal response and bring virus transmission down to containment levels,” said Hotez, who has argued for the necessity of a federal containment plan that, if executed effectively, might allow the nation to reopen comprehensively as soon as October. “Instead they took a lazy and careless route, claiming schools are important, as we all know, and the teachers and principals need to figure it out. What they did was deliberately set up the teachers, staff, and parents to fail. It’s one of the most careless, incompetent, and heartless actions I’ve ever seen promoted by the executive branch of the federal government.”

There is another cause for concern, this one about what the virus might do to children themselves. Although the rate of morbidity in young children is relatively low, young children are also among the least-tested cohort in America. Fauci has stressed repeatedly in recent weeks that we know relatively little about children and the virus. For example, we still don’t know how frequently children get infected, or what percentage of children are symptomatic, or how underlying conditions may exacerbate or even alleviate the severity of the infection. The results of one six-month National Institutes of Health study, which enrolled thousands of families from 11 U.S. cities, are expected in December.

But “we don’t need additional information to make decisions,” Hotez insisted. Right now, he said, there are at least 40 states in which schools simply should not open. “Remember, schools are not hermetically sealed ... We need to reach containment first. It’s that simple.”

One of the strangest things about living through a pandemic is the lag in understanding of how bad things are, an awful mirror of the lag in deaths that come like clockwork after a surge in coronavirus cases. All along, this disaster has been simultaneously wholly shared and wholly individualized, a weird dissonance in a collective tragedy that each person, each family, has to navigate with intricate specificity to their circumstances. The despair that has seemed to crest in recent days represents another kind of lag—a lag of realization—and the inevitable end of hopefulness about what life might be like in September.

by Adrienne LaFrance, The Atlantic | Read more:
Image: Olivia Authur/Magnum
[ed. I wonder if we might see a wave of early retirements, too. See also: Why Can’t We Just Have Class Outside? (Atlantic)]

Max Richter

Here's What's Going to Happen

We thought the pandemic would be over by now but it's not. So, we're back to making predictions and dreaming about the future. (...)

Indoor dining will fully shut down again. We expected some sort of indoor dining rollback, but we didn’t expect last week’s announcement that indoor dining will soon be limited to members of the same household, sitting at the same table. 🤔 What about eating out with a partner who lives in another apartment? Or with a child who lives with another family member? Won’t people just lie? This Tinder-Dates-on-the-Patio-Only Rule will apparently be enforced by “restaurants—say, a host or hostess—ask[ing] customers if they are in the same household,” says the governor’s deputy communications director. “Verification is not required.” Oookay. This isn’t going to work. Expect a full rollback of indoor dining if we can’t get coronavirus to calm down. And then expect a wave of closures. What a mess. —C.B. (...)

Bring on the tuition riots. The whole college thing has been a racket for many years. Students are forced to pay way too much for even a standard college degree. And student debt in the US has become obscene. And now colleges want students to continue paying all of this money and carrying all of this debt for classes online? This is an explosive situation. When millions of college students return to their online classes this fall, expect, on day one, sparks to fly from a fuse that is not very long. —C.M.

Teens will spend their gap year(s) pursuing TikTok careers. Maybe there’s only one sustainable career path as the unemployment rate nears 20 percent in major U.S. cities, AKA double what it was in the 2008 Great Recession: Tik Tok.

The Chinese video-sharing app is highly addicting, is potentially spyware, and is hot and getting hotter. The company (which is expected to add 10,000 U.S. jobs) just announced a $200 million fund for stateside creators to spur more original content. COVID-19 is far from over. We should be gearing up for the second wave (or the end of the first wave?) but instead we decided to spit into the face of God and open up bars and restaurants. As we inevitably close down again, many teens' go-to first jobs—waiting tables, schlepping coffee, working at Cinerama—will go up in flames. Maybe those Tik Tok dances they've been learning throughout high school were a Plan B. While companies fail and the service industry goes kaput, live-streaming sites like Twitch and content hubs like Tik Tok will become the most dependable paychecks. —N.G. (...)

We'll pay for Twitter. Eventually. It’s inevitable. After destroying blogs, Twitter will end up behind its own paywall. Digital advertising is not working for Twitter. (It’s not working for anyone—except Google and Facebook.) Twitter’s user growth is soaring, but its revenue is plummeting. Its stock bounced when it was discovered that the company was hiring for a subscription platform under the code name “Gryphon,” and last week CEO Jack Dorsey announced that the company is looking at multiple subscription models. Will people pay for it? Will it make the product better? Will the platform’s cult of contrarians complain that this is censorship? We’ll see—I bet within the next year. —C.B. (...)

Virtual fans will become the norm at major events. Last week, FOX announced that they will digitally insert virtual fans into empty stadiums during their Major League Baseball broadcasts to make the games "look natural." The National Basketball Association is using Microsoft Teams' Together Mode to invite fans to the game by using AI to segment their face and shoulders, virtually putting them together on 17-foot tall LED screens that wrap around the court. The fans can react in real-time and players can see and hear those reactions.

Sports lovers are, admittedly, not in love with the technology as it's still a lil bit freaky to see virtual bodies where real ones should be. But as we push further into a socially distant society with a "need" for big in-person events like political conventions, concerts, game shows, award ceremonies, and other sporting events, I believe virtual crowds will become the norm. Especially as they open up a new advertising revenue stream for channels and organizations that desperately need it.

And not to be all Black Mirror, but this development immediately reminded me of their "Fifteen Million Merits" episode, where singing competition contestants sang in front of a crowd of virtual avatars. Maybe we're not too far from that future after all. —J.K.

Baseball is gonna be canceled. I’m sorry! But the games started five days ago and we’ve already got COVID outbreaks! Why did anyone think a 60-game season across 30 stadiums during a blooming pandemic was going to work! The hubris! —C.B.

With a looming wave of evictions and economic crisis, I suspect we’ll see a lot more petty crimes of desperation—stealing a loaf of bread to feed a family, breaking into a construction site to sleep out of the rain. The uniquely American lack of a safety net, such as those enjoyed by more developed nations, is going to be bad enough for everyone involved; and I think the rich are going to react not with compassion but with insular self-interest. They’ll retreat into ever more fortified enclaves, terrified of the surge in crime, and gated communities will start to have the same military-grade gear as suburban police departments. Within a year, I suspect the wealthy will have their own militias patrolling their McMansions. That alarming couple who brandished guns at protestors are just a taste of what’s to come — how long do you think it’ll be before those militias start eyeing each other with suspicion, or pondering a pre-emptive attack on perceived threats? —M.B.

This crisis is going to last years, not months. What if the timeline on this disease is less like SARS and more like HIV? The coronavirus is not as deadly as HIV, but it is transmitted more easily, and scientists say they are finding "eerie parallels with HIV," including depletion of T cells. Chinese researchers said in May that the coronavirus "emulates the HIV strategy to remove marker molecules on the surface of an infected cell that are used to identify invaders, in a manner to evade attack from the human immune system," leading them to the speculation that this disease "may be around for some time." —C.F.

Americans will give up. Since the first recorded COVID-19 death in the US (February 6, 2020), nearly 150,000 Americans have been killed by the virus. Today, we can expect 1,000 Americans to exit the world by way of the pandemic. And if Trump is re-elected, we will be forced to live with crowded hospitals, traumatized health professionals, and the daily destruction of thousands upon thousands of Americans for the next four years. This is what the presidential election of 2020 has come down to: necro-America or no necro-America. And 40 percent of voters still support Trump. Who are these people? Are they even people? 40 percent means 60,000,000 Americans are fine with living in a country that, by the spring of 2021, will likely be dumping surplus bodies into massive graves.

As we near Election Day, and the possibility of a necro-America increases, the strain will be too much for a good number of heads. In this depressing condition, many Americans will be too exhausted to fight for their lives. They will not correct a car that has unexpectedly veered toward a ditch or a tree, or just give up while drowning, or not care if a lump appears on their stomach. These people are not exactly suicidal; they would happily live (and fight to live) in a world where the forces of death, of necro-economics, are not in so much power.

That said, here is a passage I love from Marcel Proust's Remembrance of Things Past. —C.M.

[The] next day, [Charlus had to] begin afresh his attempt to find out what Odette had been doing, must use all his influence to contrive to see her. This compulsion to an activity without respite, without variety, without result, was so cruel a scourge that one day, noticing a swelling over his stomach, he felt an actual joy in the idea that he had, perhaps, a tumour which would prove fatal, that he need not concern himself with anything further, that it was his malady which was going to govern his life, to make a plaything of him, until the not-distant end. If indeed, at this period, it often happened that, though without admitting it even to himself, he longed for death, it was in order to escape not so much from the keenness of his sufferings as from the monotony of his struggle. (...)

The only way a second lockdown will not happen is if Trump is re-elected. And if history is kind to us, we can expect not only a second lockdown but one that will be more thorough and better managed than the first. Such a regime will require the imposition of strict controls on every home. In the second lockdown, movement in and out of the house will be rationed (one person is permitted exit and entry per day). Here is where ice cream trucks might be handy. The owners of these vans could transform them into necessary businesses that carry coffee, cigarettes, carbonated water, booze, eggs, and pickles. Picture this: The van makes its way down your street at around 8 in the morning. You order what you need by an app; the van operator drops your goods at your doorstep.

The flying sushi boat scene in The Fifth Element will give some idea of converted ice cream van of the future. —C.M.

by Staff, The Stranger |  Read more:

Image: Sasha Suzi/Getty

Living Tree Bridges In A Land Of Clouds

PHOTOS: Living Tree Bridges In A Land Of Clouds (NPR)

Images: Prasenjeet Yadav

"When I think back to my own arduous trek across this hillscape, I begin to comprehend how much the geography of this place is characterized by isolation and disconnectedness. Even today, most of these villages do not have road access. A trip to the closest town might require climbing down into valleys and crossing flooding rivers to reach another village.

But crossing these rivers isn't possible without a bridge.

It's hardly surprising, then, that it was the need for connectedness that provided the first guiding impulse for these ancient experiments in bioengineering. Tree bridges are structures that are literally rooted in the terrain and that thrive under the relentless pressures of the wettest land in the world."

         ~ Prasenjeet Yadav

via: lost

via:

America's Most Racist Town?

[ed. Harrison, Ark. Lovely place. Hope they don't rely on tourism much.]

Do We Believe in U.F.O.s? That’s the Wrong Question

We were part of The New York Times’s team (with the Washington correspondent Helene Cooper) that broke the story of the Pentagon’s long-secret unit investigating unidentified flying objects, the Advanced Aerospace Threat Identification Program, in December 2017.

Since then, we have reported on Navy pilots’ close encounters with U.F.O.s, and last week, on the current revamped program, the Unidentified Aerial Phenomenon Task Force and its official briefings — ongoing for more than a decade — for intelligence officials, aerospace executives and Congressional staff on reported U.F.O. crashes and retrieved materials.

We’re often asked by well-meaning associates and readers, “Do you believe in U.F.O.s?” The question sets us aback as being inappropriately personal. Times reporters are particularly averse to revealing opinions that could imply possible reporting bias.

But in this case we have no problem responding, “No, we don’t believe in U.F.O.s.”

As we see it, their existence, or nonexistence, is not a matter of belief.

We admire what the great anthropologist Margaret Mead said when asked long ago whether she believed in U.F.O.s. She called it “a silly question,” writing in Redbook in 1974:

“Belief has to do with matters of faith; it has nothing to do with the kind of knowledge that is based on scientific inquiry. … Do people believe in the sun or the moon, or the changing seasons, or the chairs they’re sitting on? When we want to understand something strange, something previously unknown to anyone, we have to begin with an entirely different set of questions. What is it? How does it work?”

That’s what the Pentagon U.F.O. program has been focusing on, making it eminently newsworthy. And to be clear: U.F.O.s don’t mean aliens. Unidentified means we don’t know what they are, only that they demonstrate capabilities that do not appear to be possible through currently available technology.

In our reporting, we’ve focused on how the Department of Defense, the Office of Naval Intelligence and members of two Senate committees are engaged with this topic. Current officials are now concerned about the potential threat represented by the very real, advanced technological objects: how close they can come to our fighter jets, sometimes causing a near miss, and the risk that our adversaries may acquire the technology demonstrated by the objects before we do.

So if U.F.O.s are no longer a matter of belief, what are they and how do they do what they do?

And if technology has been retrieved from downed objects, what better way to try to understand how they work?

Our previous stories were relatively easy to document with Department of Defense videos of U.F.O.s and pilot eyewitness accounts backed up by Navy hazard reports of close encounters with small speeding objects.

But our latest article provided a more daunting set of challenges, since we dealt with the possible existence of retrieved materials from U.F.O.s. Going from data on a distant object in the sky to the possession of a retrieved one on the ground makes a leap that many find hard to accept and that clearly demands extraordinary evidence.

Numerous associates of the Pentagon program, with high security clearances and decades of involvement with official U.F.O. investigations, told us they were convinced such crashes have occurred, based on their access to classified information. But the retrieved materials themselves, and any data about them, are completely off-limits to anyone without clearances and a need to know.

by Ralph Blumenthal and Leslie Kean, NY Times |  Read more:

Image: NYT/US Navy

[ed. See: No Longer in Shadows, Pentagon’s U.F.O. Unit Will Make Some Findings Public (NYT).]

Mitch McConnell Could Rescue Millions. He's Going On Vacation

The worst economic news on Thursday was not the official announcement that the American economy shrank at an annualized rate of 32.9 percent in the second quarter of 2020 — a grim quantification of the pain caused by the coronavirus pandemic.

No, the really bad news was the lack of action on Capitol Hill.

Congress needs to extend the emergency aid programs that were created in March to help Americans endure a broad suspension of economic activity. Instead, even as the pandemic rages on, Congress is allowing those aid programs to expire.

People who lost jobs during the pandemic have received $600 a week from the federal government on top of standard unemployment benefits. For many, the money is all that has kept them from going hungry and has allowed them to stay in their homes. It has prevented a significant increase in the share of Americans living in poverty. But those payments end this week, even as unemployment remains at a level last experienced during the Great Depression.

The federal government also is ending a moratorium on evictions, as well as a program that provides aid to small businesses.

Among those pleading for aid that hasn’t come: state and local governments starved of tax revenue. School districts that need money for safety equipment. Hospitals caring for the victims of the pandemic. Elections officials bracing for November.

The abject failure to act is not the fault of Congress in a collective sense. House Democrats passed a serviceable aid bill more than two months ago. Responsibility for the current debacle rests specifically and squarely on the shoulders of the Senate majority leader, Mitch McConnell, Republican of Kentucky, and the other 52 Senate Republicans.

From the moment Congress passed the last big coronavirus aid bill, in March, it has been a matter of public record that the aid was going to end in August.

For a time, there was reason to hope that the worst of the pandemic could be over by now, too. But it has been clear for weeks that the United States has failed to control the pandemic and that many Americans still would need economic aid beyond July. Yet Mr. McConnell and his caucus chose to spend the summer confirming federal judges rather than confronting the crisis.

Only in recent days have Republicans belatedly begun a frantic effort to devise a coherent response to the crisis. Like students who wait until the night before an assignment is due, they have pleaded for more time and asked if they could submit a part of the work. The nation will suffer the consequences.

Mr. McConnell put forward a proposal on Monday that included billions of dollars for new F-35 jet fighters, but not a penny in aid for state and local governments. In any event, it quickly became clear that many Senate Republicans were not exactly on board. “There’s no consensus on anything,” said Mr. McConnell’s deputy, Senator John Cornyn of Texas. Senator Josh Hawley, Republican of Missouri, called the proposal “a mess.”

Lawmaking is laborious and rarely proceeds in a straight line. If the calendar still said June, there would be less reason to worry about these convolutions.

But behaving in late July as if it were still June is a recipe for disaster.

Even with the infusion of trillions of dollars in federal aid since March, many Americans are struggling to ride out the crisis. Almost 40 million people do not expect to be able to make their next rent or mortgage payment. Almost 30 million Americans said they did not have enough to eat during the week ending July 21. Last week, for the 19th straight week, more than a million people filed fresh claims for unemployment benefits.

Grim as those numbers may be, the United States is on the verge of an even deeper crisis.

Ernie Tedeschi, an economist at Evercore ISI, a financial research firm, estimates that failing to resume the federal unemployment payments would cause a drop in consumer spending large enough to eliminate about 1.7 million jobs — roughly the magnitude of job losses during the recessions of the early 1990s and the early 2000s.

Britt Coundiff of Indianapolis is living on unemployment benefits after losing her job at an art-house cinema. Without the federal payments, she’ll be left with a weekly state payment of $193. She told Talmon Joseph Smith of The Times, “With two kids and rent and groceries, that is not enough for us to survive.”

On Thursday, Senate Republicans proposed an inadequate stopgap: a narrow extension of supplemental unemployment benefits. Instead of continuing the $600 weekly payments, however, Republicans proposed cutting the sum to $200 a week, through the end of the year. That would replace only a portion of the income of the average unemployed worker, which is reasonable in normal times; it encourages people to find jobs. But in the midst of a pandemic, with few jobs available, the benefit cut is an act of pointless cruelty.

Democrats refused to accept the proposal, and Republicans refused to do anything more.

The result: More than 20 million unemployed Americans are about to lose $600 a week. They need the money. They can’t find jobs. And the Senate is leaving for vacation.

by Editorial Board, NY Times |  Read more:

Image: Michael Houtz; photograph by Alamy

via:
[ed. See also: Screwing Up Is What We Do (LARB) |  Read more:

via:

They Will Kill The Post Office If They Can Get Away With It

Conservatives have always been very blunt about their opposition to the United States Postal Service. Milton Friedman said plainly: privatize it. On the Wall Street Journal op-ed page, a McKinsey partner says the agency is “obsolete” and must be “phased out,” that its popularity is solely due to “nostalgia.” The Trump administration has not tried to disguise its intentions. Its “Delivering Government Solutions in the 2st Century” document announces plainly that the administration wants to privatize the service, turning it into a “private postal operator that delivers mail fewer days per week and to more central locations (not door delivery).” The administration says:

A private entity would also have greater ability to adjust product pricing in response to changes in demand or operating costs. Freeing USPS to more fully negotiate pay and benefits rather than prescribing participation in costly Federal personnel benefit programs, and allowing it to follow private sector practices in compensation and labor relations, could further reduce costs.

So: a post office that operated (1) to serve investor profits rather than the public good, (2) has higher prices (3) pays lower wages and cuts workers’ benefits and (4) delivers a few days a week, and not door-to-door but to “central locations” that you have to shlep your packages from. This is the dream!

It sounds awful, yes. But conservatives are always going to be committed to privatizing the post office, no matter what. This is because they hold firmly to an ideological conviction that government is incapable of working as well as private, for profit-companies. They believe, as a matter of religious faith rather than evidence, that the public sector is necessarily ineffective, even when the USPS is ranked the most efficient postal service in the world, beating out many privatized postal services.

If a government agency were to function well, it would threaten right-wing ideology in a very serious way. When public services work well, they make it difficult to convince people of the argument that strong public institutions are the “road to serfdom” and that the welfare state is a form of slavery. Look at the National Health Service in Britain: despite the right-wing myths in America about its uselessness, the NHS is so popular among Britons that a Conservative prime minister like Boris Johnson has to praise it highly and pay tribute to its greatness. Once people have experienced good free-at-point-of-use public services, they like them, and they don’t want to get rid of them.

This creates an incentive for conservatives in government to make the user experience of government as dreadful as possible. If people absolutely hate every interaction they have with public airports or schools or the DMV, they will certainly be more receptive to the argument that government cannot succeed and must be turned over to for-profit corporations. Nevermind that in other countries, public schools and public airports function perfectly well, thus disproving the idea that the problem is that ours are public rather than that ours are poorly-run. Americans are rarely told about what other countries are like, so we do not get to see that you can eliminate private schools almost entirely and still have an excellent education system.

Donald Trump has insisted that he wants the USPS to raise prices on packages, possibly “by up to four times,” and threatened to withhold coronavirus aid to the agency if they did not increase prices. USPS packages are already not cheap and go up constantly, and Trump’s idea would make the USPS more expensive than FedEx and UPS. The postal service is the most popular government agency, with over 90% of Americans wanting it to receive renewed financial assistance from the U.S. government. A good way to try to destroy that public goodwill is to do what Trump wants to do: jack up prices and to delay mail deliveries.

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

Image: uncredited
[ed. For an example of the "inefficiency" set-up, see also: USPS workers sound alarm about new policies that may affect 2020 mail-in voting CNN.]

Cancel Culture: A Taxonomy of Fear

We live in a time of personal timorousness and collective mercilessness.

There might seem to be a contradiction between being fearful and fearless, between weighing every word you say and attacking others with abandon. But as more and more topics become too risky to discuss outside of the prevailing orthodoxies, it makes sense to constantly self-censor, feeling unbound only when part of a denunciatory pack.

Institutions that are supposed to be guardians of free expression—academia and journalism in particular—are becoming enforcers of conformity. Campuses have bureaucracies that routinely undermine free speech and due process. Now, these practices are breaching the ivy wall. They are coming to a high school or corporate HR office near you.

The cultural rules around hot button issues are ever-expanding. It’s as if a daily script went out describing what’s acceptable, and those who flub a line—or don’t even know a script exists—are rarely given the benefit of the doubt, no matter how benign their intent. Naturally, people are deciding the best course is to shut up. It makes sense to be part of the silenced majority when the price you pay for an errant tweet or remark can be the end of your livelihood.

Do these problems really matter so long as we have a president who daily tramples on rights, civil discourse, and the rule of law? They do. Of course, we must keep our focus on the danger this administration presents. But it is also our moral and strategic obligation to vigorously defend the principles of a free society. Upholding these values will help us defeat Trumpism.

The process by which sinners are punished and apostates expelled can seem random. But there are rules and patterns to the ways in which speech is being silenced. Analyzing and understanding these can help us stand up to the illiberalism of this moment, whether it comes from the left or the right.

To that end, here is my taxonomy of fear.

The Perils of Safety (...)

Confronted with words, ideas, or decisions they dislike, a growing number of people are asserting that they are in danger of suffering psychological or even bodily harm. But when one party asserts that a debate threatens their very well-being, it is hard to deliberate on policy—or topics such as race and gender. The result is a narrowing of the space for public discussion and an inability to teach ever more ideas and books.

Contamination by Association (...)

VanDerWerff’s note certainly illustrates safetyism. Going one step further, it also assumes the truth of a principle of “contamination by association.” People, the logic goes, cannot only be made unsafe by the beliefs or statements of their colleagues but also by those with whom their colleagues associate.

Intent Is Irrelevant (...)

Whether or not the accused had an intent to commit wrong-doing is a central question in many criminal prosecutions. Though it might be less obvious, understanding someone’s intent is just as crucial to our social functioning. If we decline to understand why others acted the way they did, or to take into account whether they intended any harm, we multiply the number of violations we perceive—and often end up treating benign people as moral wrongdoers.

Report to the Authorities (...)

Of course, some things do need to be reported. But when you live in a society in which people are primed to disclose all discomfort to authority figures, trust and goodwill quickly erode. It also means being aware that you yourself might end up as the subject of a complaint. As Lukianoff and Haidt write, “life in call-out culture requires constant vigilance, fear, and self-censorship.” But shaming someone, especially when done publicly as part of a group, “can award status.”

One of the most disturbing examples of this trend is that high school students are now being encouraged to excavate each other’s social media, looking for instances of racial insensitivity and making them public. “Many students believe the only consequence their peers will take seriously is having their college admissions letter rescinded,” reports the New York Times. As a sixteen-year-old administrator of a social media account exposing the alleged racism of her classmates explained, “people who go to college end up becoming racist lawyers and doctors. I don’t want people like that to keep getting jobs.” (...)

To be sure, being shunned by your peers or having your admission to college rescinded is not the same as going to jail. But in the age of the internet, social censure can, much like a criminal record, mark someone for life. Do we really want a world in which someone’s educational and professional prospects are diminished because of something they said—genuinely stupid or offensive though it may have been—when they were fifteen?

A Chilling Effect

Some on the left still claim cancel culture doesn’t exist. Mass firings, they say, are not taking place. Only a few people—who probably deserved it!—have lost their jobs.

But it doesn’t require mass dismissals to put many people in a genuine state of unease and intimidation. A few chilling examples are enough to spread the fear to a lot of people that an inadvertent error can destroy your life. As New York Times columnist Ross Douthat writes, “the goal isn’t to punish everyone, or even very many someones; it’s to shame or scare just enough people to make the rest conform.” (...)

Many people ask why any of this should matter in the age of Donald Trump—a president who attacks free speech, stokes bigotry and division, and believes he is above the law. It matters because we have seen what happened when his enablers on the right failed to stand up to the worst impulses of their leader. These enablers are now morally responsible for the tragic consequences of their inaction.

We better make sure that we don’t end up committing the same sin. For as Thomas Chatterton Williams writes, “ a generation unable or disinclined to engage with ideas and interlocutors that make them uncomfortable … open[s] the door—accessible from both the left and the right—to various forms of authoritarianism.”

by Emily Yoffe, Persuasion |  Read more:

Image: uncredited
[ed. Of course, social media plays a massive role in making this phenomenon worse, but that's just stating the obvious. It's also possible to point to mass media's herding tendencies (and the economic incentives that support it), and general balkanization of information as consumers rely on niche sources for news.]

How Social Isolation Affects the Brain

Daisy Fancourt was at her home in Surrey in southeast England when the UK government formally announced a nationwide lockdown. Speaking in a televised address on March 23, UK Prime Minister Boris Johnson laid out a suite of measures designed to curb the spread of COVID-19, including closing public spaces and requiring people to stay home except for exercise and essential tasks. For Fancourt, an epidemiologist at University College London (UCL), the announcement meant more than just a change to her daily life. It was the starting gun for a huge study, weeks in the planning, that would investigate the effects of enforced isolation and other pandemic-associated changes on the British public.

In more normal times, Fancourt and her colleagues study how social factors such as isolation influence mental and physical health. Before Johnson’s late-March announcement, the team had been watching as Italy, and subsequently other countries in Europe, began closing down public spaces and enforcing restrictions on people’s movements. They realized it wouldn’t be long before the UK followed suit. “We felt we had to start immediately collecting data,” Fancourt says. She and her colleagues rapidly laid the groundwork for a study that would track some of the effects of lockdown in real time. Between March 24 and the middle of June, the study had recruited more than 70,000 participants to fill out weekly online surveys, and in some cases answer questions in telephone interviews, about wellbeing, mental health, and coping strategies.

This project and others like it underway in Australia, the United States, and elsewhere aim to complement a broader literature on how changes in people’s interactions with those around them influence their biology. Even before COVID-19 began its global spread, millions of people were already what researchers consider to be socially isolated—separated from society, with few personal relationships and little communication with the outside world. According to European Union statistics, more than 7 percent of residents say they meet up with friends or relatives less than once a year. Surveys in the UK, meanwhile, show that half a million people over the age of 60 usually spend every day alone.

These figures are concerning to public health experts, because scientific research has revealed a link between social isolation—along with negative emotions such as loneliness that often accompany it—and poor health. “We are seeing a really growing body of evidence,” says Fancourt, “that’s showing how isolation and loneliness are linked in with incidence of different types of disease [and] with premature mortality.” Alongside myriad connections to poor physical health, including obesity and cardiovascular problems, a range of possible effects on the human brain have now been documented: Social isolation is associated with increased risk of cognitive decline and dementia, as well as mental health consequences such as depression and anxiety.

It’ll be years before researchers understand whether and how measures enacted during the pandemic play into any of these risks. The sort of isolation people are experiencing right now is unprecedented, and is compounded with other pressures, such as fear of disease and financial strain. But now more than ever, it’s important to study the effects of social isolation, and potential means to mitigate it, says Stephanie Cacioppo, a social neuroscientist and cognitive psychologist at the University of Chicago. “We’re a social species,” she says. “We really need others to survive.”

The cognitive effects of prolonged social isolation

In 1972, French adventurer and scientist Michel Siffre famously shut himself in a cave in Texas for more than six months—what still clocks in as one of the longest self-isolation experiments in history. Meticulously documenting the effects on his mind over those 205 days, Siffre wrote that he could “barely string thoughts” together after a couple months. By the five-month mark, he was reportedly so desperate for company that he tried (unsuccessfully) to befriend a mouse.

This kind of experiment, and less extreme isolation periods such as those experienced by spaceship crews or scientists working in remote Antarctic research stations, has offered glimpses of some of the cognitive and mental effects of sensory and social deprivation. People routinely report confusion, changes in personality, and episodes of anxiety and depression. A crueler version of those experiments is continually underway in prisons across the world. In the US alone, tens of thousands of incarcerated people are in long-term solitary confinement, with devastating and lasting effects on cognitive and mental health. (See “Extreme Isolation” below.)

For most of human society, however, social isolation acts in more insidious ways than these “experiments” capture, often disproportionately affecting vulnerable members of the population, such as the elderly, and with effects accumulating slowly such that they may go unnoticed for many years, if not decades. The effects of this subtler sort of social isolation, which some health researchers and psychologists have already described as a public health risk, are better observed in longer-term studies that look for links between a person’s social connections and how the mind functions.

Many studies have found that chronic social isolation is indeed associated with cognitive decline, and that isolation often precedes decline by several years. One 2013 study, for example, measured cognitive function at two time points in a cohort of more than 6,000 older individuals taking part in the English Longitudinal Study of Ageing (ELSA). People who reported having fewer social contacts and activities at the beginning of the study, researchers found, showed greater decline in cognitive function, as measured by verbal fluency and memory recall tasks, after four years.

by Catherine Offord, The Scientist |  Read more:

Image: Istock.com, Maria Zamchy

Julian Lage & Chris Eldridge

Google’s Top Search Result? Surprise! It’s Google

In Google’s early years, users would type in a query and get back a page of 10 “blue links” that led to different websites. “We want to get you out of Google and to the right place as fast as possible,” co-founder Larry Page said in 2004.

Today, Google often considers that “right place” to be Google, an investigation by The Markup has found.

We examined more than 15,000 recent popular queries and found that Google devoted 41 percent of the first page of search results on mobile devices to its own properties and what it calls “direct answers,” which are populated with information copied from other sources, sometimes without their knowledge or consent.

When we examined the top 15 percent of the page, the equivalent of the first screen on an iPhone X, that figure jumped to 63 percent. For one in five searches in our sample, links to external websites did not appear on the first screen at all.

A trending search in our data for “myocardial infarction” shows how Google has piled up its products at the top. It returned:

• Google’s dictionary definition.
• A “people also ask” box that expanded to answer related questions without leaving the search results page.
• A “knowledge panel,” which is an abridged encyclopedia entry with various links.
• And a “related conditions” carousel leading to various new Google searches for other diseases.

All of these appeared before search results by WebMD, Harvard University, and Medscape. In fact, a user would have to scroll nearly halfway down the page—about 42 percent—before reaching the first “organic” result in that search.

Google’s decision to place its products above competitors’ and to present “answers” on the search page has led to lawsuits and regulatory fines. A number of websites said it killed their revenues—and their companies. Founders of both innovative startups and companies that had been around for a decade or more told The Markup that once Google started placing its product first, they didn’t stand a chance.

Travel research firm Skift wrote in November that the entire online travel industry is suffering. “The fact that Google is leveraging its dominance as a search engine into taking market share away from travel competitors is no longer even debatable.”

The choice to highlight its own products has been deliberate: Internal emails unearthed by the European Commission in an antitrust investigation show Google staffers discussing the need to place its comparison-shopping product at the top of the search results to garner traffic. An email the following year noted traffic to the retooled product had more than doubled from four million to 10 million visits, and “most of this growth is from improved google.com integration.”

Sally Hubbard, an expert on antitrust and technology companies with the Open Markets Institute, said Google’s decisions in search have huge implications. “Imagine you go to the library, and the card catalog is picking and choosing what book to get based on what makes the library the most money.”

Google makes five times as much revenue through advertising on its own properties as it does selling ad space on third-party websites.

by Adrianne Jeffries and Leon Yin, The Markup | Read more:
Image: uncredited

[ed. See also: How We Analyzed Google’s Search Results (The Markup).]