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Javier E

Portugal's drug decriminalization faces opposition as addiction multiplies - The Washin... - 0 views

www.washingtonpost.com/...decriminalization-heroin-crack

drug liberalisation portugal

shared by Javier E on 08 Jul 23 - No Cached
  • Cocaine production is at global highs. Seizures of amphetamine and methamphetamine have exploded. The multiyear pandemic deepened personal burdens and fomented an increase in use.
  • In the United States alone, overdose deaths, fueled by opioids and deadly synthetic fentanyl, topped 100,000 in both 2021 and 2022 — or double what it was in 2015.
  • Across the Atlantic in Europe, tiny Portugal appeared to harbor an answer. In 2001, it threw out years of punishment-driven policies in favor of harm reduction by decriminalizing consumption of all drugs for personal use, including the purchase and possession of 10-day supplies.
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  • Consumption remains technically against the law, but instead of jail, people who misuse drugs are registered by police and referred to “dissuasion commissions.” For the most troubled people, authorities can impose sanctions including fines and recommend treatment. The decision to attend is voluntary.
  • Other countries have moved to channel drug offenses out of the penal system too. But none in Europe institutionalized that route more than Portugal. Within a few years, HIV transmission rates via syringes — one the biggest arguments for decriminalization — had plummeted. From 2000 to 2008, prison populations fell by 16.5 percent. Overdose rates dropped as public funds flowed from jails to rehabilitation. There was no evidence of a feared surge in use.
  • None of the parade of horrors that decriminalization opponents in Portugal predicted, and that decriminalization opponents around the world typically invoke, has come to pass,” a landmark Cato Institute report stated in 2009.
  • But in the first substantial way since decriminalization passed, some Portuguese voices are now calling for a rethink of a policy that was long a proud point of national consensus. Urban visibility of the drug problem, police say, is at its worst point in decades and the state-funded nongovernmental organizations that have largely taken over responding to the people with addiction seem less concerned with treatment than affirming that lifetime drug use should be seen as a human right.
  • “At the end of the day, the police have their hands tied,” said António Leitão da Silva, chief of Municipal Police of Porto, adding the situation now is comparable to the years before decriminalization was implemented.
  • the percent of adults who have used illicit drugs increased to 12.8 percent in 2022, up from 7.8 in 2001, though still below European averages
  • Overdose rates have hit 12-year highs and almost doubled in Lisbon from 2019 to 2023. Sewage samples in Lisbon show cocaine and ketamine detection is now among the highest in Europe, with elevated weekend rates suggesting party-heavy usage
  • even proponents of decriminalization here admit that something is going wrong.
  • In Porto, the collection of drug-related debris from city streets surged 24 percent between 2021 and 2022, with this year on track to far outpace the last.
  • Crime — including robbery in public spaces — spiked 14 percent from 2021 to 2022, a rise police blame partly on increased drug use
  • When crack pipes are available, the social workers give them out. There’s no judgment, few questions, and no pressure to embrace change.
  • Summing up the philosophy, Luísa Neves, SAOM’s president, said: “You have to respect the user. If they want to use, it is their right.”
  • Police deployed in force to the area three months ago to crack down on dealers, who can be and are being arrested. Patrol cars are now stationed in the neighborhood 24 hours a day, scattering people using drug
  • overdoses this year in Portland, the state’s largest city, have surged 46 percent.
  • “When you first back off enforcement, there are not many people walking over the line that you’ve removed. And the public think it’s working really well,
  • “Then word gets out that there’s an open market, limits to penalties, and you start drawing in more drug users. Then you’ve got a more stable drug culture, and, frankly, it doesn’t look as good anymore.”
  • An eight-minute walk uphill from Porto’s safe drug-use center, in a neighborhood of elegant two-story homes with hedgerows of roses and hibiscus, neighbors talk of an “invasion” of people using drugs since the pandemic
  • In Oregon — where the policy took effect in early 2021 openly citing Portugal as a model — attempts to funnel people with addiction from jail to rehabilitation have had a rough start. Police have shown little interest in handing out toothless citations for drug use, grants for treatment have lagged, and extremely few people are seeking voluntary rehabilitation
  • We have to do something with the law. We know they can’t stay here forever. What happens when the police leave?”
  • Porto’s mayor and other critics, including neighborhood activist groups, are not calling for a wholesale repeal of decriminalization — but rather, a limited re-criminalization in urban areas and near schools and hospitals to address rising numbers of people misusing drugs.
  • In a country where the drug policy is seen as sacred, even that has generated pushback — with nearly 200 experts signing an opposition letter after Porto’s city commission in January passed a resolution seeking national-level changes.
  • ave today no longer serves as an example to anyone.” Rather than fault the policy, however, he blames a lack of funding.
  • After years of economic crisis, Portugal decentralized its drug oversight operation in 2012. A funding drop from 76 million euros ($82.7 million) to 16 million euros ($17.4 million) forced Portugal’s main institution to outsource work previously done by the state to nonprofit groups, including the street teams that engage with people who use drugs. The country is now moving to create a new institute aimed at reinvigorating its drug prevention programs.
  • Twenty years ago, “we were quite successful in dealing with the big problem, the epidemic of heroin use and all the related effects,” Goulão said in an interview with The Washington Post. “But we have had a kind of disinvestment, a freezing in our response … and we lost some efficacy.”
  • Of two dozen street people who use drugs and were asked by The Post, not one said they’d ever appeared before one of Portugal’s Dissuasion Commissions, envisioned as conduits to funnel people with addiction into rehab
  • “Why?”
  • “Because we know most of them. We’ve registered them before. Nothing changes if we take them in.”
Javier E

Rebecca Solnit: Apologies to Mexico - Guernica / A Magazine of Art & Politics - 0 views

www.guernicamag.com/...cca-solnit-apologies-to-mexico

drugs Mexico Latin America pain economics US cultural values

shared by Javier E on 23 Jul 12 - No Cached
  • drugs, when used consistently, constantly, destructively, are all anesthesia from pain. The Mexican drug cartels crave money, but they make that money from the way Yankees across the border crave numbness. They sell unfeeling. We buy it. We spend tens of billions of dollars a year doing so, and by some estimates about a third to a half of that money goes back to Mexico.
  • We want not to feel what’s happening to us, and then we do stuff that makes worse things happen–to us and others. We pay for it, too, in a million ways, from outright drug-overdose deaths (which now exceed traffic fatalities, and of which the United States has the highest rate of any nation except tiny Iceland, amounting to more than thirty-seven thousand deaths here in 2009 alone) to the violence of drug-dealing on the street, the violence of people on some of those drugs, and the violence inflicted on children who are neglected, abandoned, and abused because of them–and that’s just for starters.  The stuff people do for money when they’re desperate for drugs generates more violence and more crazy greed
  • Then there’s our futile “war on drugs” that has created so much pain of its own.
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  • No border divides the pain caused by drugs from the pain brought about in Latin America by the drug business and the narcotraficantes.  It’s one big continent of pain–and in the last several years the narcos have begun selling drugs in earnest in their own countries, creating new cultures of addiction and misery.  
  • Many talk about legalizing drugs, and there’s something to be said for changing the economic arrangements. But what about reducing their use by developing and promoting more interesting and productive ways of dealing with suffering? Or even getting directly at the causes of that suffering?
  • Here in the United States, there’s no room for sadness, but there are plenty of drugs for it, and now when people feel sad, even many doctors think they should take drugs. We undergo losses and ordeals and live in circumstances that would make any sane person sad, and then we say: the fault was yours and if you feel sad, you’re crazy or sick and should be medicated. Of course, now ever more Americans are addicted to prescription drugs, and there’s always the old anesthetic of choice, alcohol, but there is one difference: the economics of those substances are not causing mass decapitations in Mexico.
  • We give you money and guns, lots and lots of money. You give us drugs. The guns destroy. The money destroys. The drugs destroy. The pain migrates, a phantom presence crossing the border the other way from the crossings we hear so much about.The drugs are supposed to numb people out, but that momentary numbing effect causes so much pain elsewhere. There’s a pain economy, a suffering economy, a fear economy, and drugs fuel all of them rather than making them go away.
  • We’ve had movements to get people to stop buying clothes and shoes made in sweatshops, grapes picked by exploited farmworkers, fish species that are endangered, but no one’s thought to start a similar movement to get people to stop consuming the drugs that cause so much destruction abroad.
  • I have been trying to imagine the export economy of pain. What does it look like? I think it might look like air-conditioning. This is how an air conditioner works: it sucks the heat out of the room and pumps it into the air outside. You could say that air-conditioners don’t really cool things down so much as they relocate the heat. The way the transnational drug economy works is a little like that: people in the U.S. are not reducing the amount of pain in the world; they’re exporting it to Mexico and the rest of Latin America as surely as those places are exporting drugs to us.
  • Mexico, I am sorry.  I want to see it all change, for your sake and ours. I want to call pain by name and numbness by name and fear by name. I want people to connect the dots from the junk in their brain to the bullet holes in others’ heads. I want people to find better strategies for responding to pain and sadness. I want them to rebel against those parts of their unhappiness that are political, not metaphysical, and not run in fear from the metaphysical parts either.
  • A hundred years ago, your dictatorial president Porfiro Díaz supposedly remarked, “Poor Mexico, so far from God and so close to the United States,” which nowadays could be revised to, “Painful Mexico, so far from peace and so close to the numbness of the United States.”
runlai_jiang

Trump actually thinks executing drug dealers would help. That's the problem. - The Wash... - 0 views

www.washingtonpost.com/...s-would-help-thats-the-problem

drugpolicy Trump

shared by runlai_jiang on 04 Mar 18 - No Cached
  • President Trump has been talking up a new strategy in the nation’s struggle against the opioid epidemic: imposing the death penalty on drug dealers, just as they do in Singapore and Rodrigo Duterte’s Philippines.
  • “You have to have strength, and you have to have toughness — the drug dealers, the drug pushers are, they’re really doing damage, they’re really doing damage,
  • Some countries have a very, very tough penalty — the ultimate penalty — and by the way, they have much less of a drug problem than we do.
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  • he country has already tried an aggressive enforcement approach to drug crimes — the four-decade-plus war on drugs — and among experts and law enforcement officers , it is almost universally acknowledged as a massive failure in economic and practical terms
  • Even more concerning, the war on drugs has been disproportionately waged against black and brown people . Escalating the possible sentence for drug crimes to death would just amplify the many injustices already present in a broken system.
  • He doesn’t recognize that most of our opioid deaths result from drugs that are made in the United States or shipped in from China 
  • And that self-centered self-assuredness is the slender framework supporting his enthusiasm for adopting the bloodthirsty edicts of a genuine despot and a notoriously repressive quasi-police state
  • hese policy proposals (such as they are) are terrible ideas considered on their own. But it’s something of an accomplishment to have them combine quite as gruesomely as “more firearms in schools” and “shoot all drug dealers” might — at least Singapore’s tougher gun-control laws prevent the kind of “good guy with a gun” vigilantism that Trump regularly invokes
  • the government has got to teach children that they’ll die if they take drugs and they’ve got to make drug dealers fear for their lives.”
  • runlai_jiang on 04 Mar 18
     
    I think this is a reasonable policy though, we need to let the drug dealers feel afraid to deal drugs.
Javier E

Ozempic or Bust - The Atlantic - 0 views

www.theatlantic.com/...678211

obesity treatment culture history policy health

shared by Javier E on 09 May 24 - No Cached
  • June 2024 Issue
  • Explore
  • it is impossible to know, in the first few years of any novel intervention, whether its success will last.
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  • The ordinary fixes—the kind that draw on people’s will, and require eating less and moving more—rarely have a large or lasting effect. Indeed, America itself has suffered through a long, maddening history of failed attempts to change its habits on a national scale: a yo-yo diet of well-intentioned treatments, policies, and other social interventions that only ever lead us back to where we started
  • Through it all, obesity rates keep going up; the diabetes epidemic keeps worsening.
  • The most recent miracle, for Barb as well as for the nation, has come in the form of injectable drugs. In early 2021, the Danish pharmaceutical company Novo Nordisk published a clinical trial showing remarkable results for semaglutide, now sold under the trade names Wegovy and Ozempic.
  • Patients in the study who’d had injections of the drug lost, on average, close to 15 percent of their body weight—more than had ever been achieved with any other drug in a study of that size. Wadden knew immediately that this would be “an incredible revolution in the treatment of obesity.”
  • Many more drugs are now racing through development: survodutide, pemvidutide, retatrutide. (Among specialists, that last one has produced the most excitement: An early trial found an average weight loss of 24 percent in one group of participants.
  • In the United States, an estimated 189 million adults are classified as having obesity or being overweight
  • The drugs don’t work for everyone. Their major side effects—nausea, vomiting, and diarrhea—can be too intense for many patients. Others don’t end up losing any weight
  • For the time being, just 25 percent of private insurers offer the relevant coverage, and the cost of treatment—about $1,000 a month—has been prohibitive for many Americans.
  • The drugs have already been approved not just for people with diabetes or obesity, but for anyone who has a BMI of more than 27 and an associated health condition, such as high blood pressure or cholesterol. By those criteria, more than 140 million American adults already qualify
  • if this story goes the way it’s gone for other “risk factor” drugs such as statins and antihypertensives, then the threshold for prescriptions will be lowered over time, inching further toward the weight range we now describe as “normal.”
  • How you view that prospect will depend on your attitudes about obesity, and your tolerance for risk
  • The first GLP-1 drug to receive FDA approval, exenatide, has been used as a diabetes treatment for more than 20 years. No long-term harms have been identified—but then again, that drug’s long-term effects have been studied carefully only across a span of seven years
  • the data so far look very good. “These are now being used, literally, in hundreds of thousands of people across the world,” she told me, and although some studies have suggested that GLP-1 drugs may cause inflammation of the pancreas, or even tumor growth, these concerns have not borne out.
  • adolescents are injecting newer versions of these drugs, and may continue to do so every week for 50 years or more. What might happen over all that time?
  • “All of us, in the back of our minds, always wonder, Will something show up?  ” Although no serious problems have yet emerged, she said, “you wonder, and you worry.”
  • in light of what we’ve been through, it’s hard to see what other choices still remain. For 40 years, we’ve tried to curb the spread of obesity and its related ailments, and for 40 years, we’ve failed. We don’t know how to fix the problem. We don’t even understand what’s really causing it. Now, again, we have a new approach. This time around, the fix had better work.
  • The fen-phen revolution arrived at a crucial turning point for Wadden’s field, and indeed for his career. By then he’d spent almost 15 years at the leading edge of research into dietary interventions, seeing how much weight a person might lose through careful cutting of their calories.
  • But that sort of diet science—and the diet culture that it helped support—had lately come into a state of ruin. Americans were fatter than they’d ever been, and they were giving up on losing weight. According to one industry group, the total number of dieters in the country declined by more than 25 percent from 1986 to 1991.
  • Rejecting diet culture became something of a feminist cause. “A growing number of women are joining in an anti-diet movement,” The New York Times reported in 1992. “They are forming support groups and ceasing to diet with a resolve similar to that of secretaries who 20 years ago stopped getting coffee for their bosses.
  • Now Wadden and other obesity researchers were reaching a consensus that behavioral interventions might produce in the very best scenario an average lasting weight loss of just 5 to 10 percent
  • National surveys completed in 1994 showed that the adult obesity rate had surged by more than half since 1980, while the proportion of children classified as overweight had doubled. The need for weight control in America had never seemed so great, even as the chances of achieving it were never perceived to be so small.
  • Wadden wasn’t terribly concerned, because no one in his study had reported any heart symptoms. But ultrasounds revealed that nearly one-third of them had some degree of leakage in their heart valves. His “cure for obesity” was in fact a source of harm.
  • In December 1994, the Times ran an editorial on what was understood to be a pivotal discovery: A genetic basis for obesity had finally been found. Researchers at Rockefeller University were investigating a molecule, later named leptin, that gets secreted from fat cells and travels to the brain, and that causes feelings of satiety. Lab mice with mutations in the leptin gene—importantly, a gene also found in humans—overeat until they’re three times the size of other mice. “The finding holds out the dazzling hope,”
  • In April 1996, the doctors recommended yes: Dexfenfluramine was approved—and became an instant blockbuster. Patients received prescriptions by the hundreds of thousands every month. Sketchy wellness clinics—call toll-free, 1-888-4FEN-FEN—helped meet demand. Then, as now, experts voiced concerns about access. Then, as now, they worried that people who didn’t really need the drugs were lining up to take them. By the end of the year, sales of “fen” alone had surpassed $300 million.
  • It was nothing less than an awakening, for doctors and their patients alike. Now a patient could be treated for excess weight in the same way they might be treated for diabetes or hypertension—with a drug they’d have to take for the rest of their life.
  • the article heralded a “new understanding of obesity as a chronic disease rather than a failure of willpower.”
  • News had just come out that, at the Mayo Clinic in Minnesota, two dozen women taking fen-phen—including six who were, like Barb, in their 30s—had developed cardiac conditions. A few had needed surgery, and on the operating table, doctors discovered that their heart valves were covered with a waxy plaque.
  • Americans had been prescribed regular fenfluramine since 1973, and the newer drug, dexfenfluramine, had been available in France since 1985. Experts took comfort in this history. Using language that is familiar from today’s assurances regarding semaglutide and other GLP-1 drugs, they pointed out that millions were already on the medication. “It is highly unlikely that there is anything significant in toxicity to the drug that hasn’t been picked up with this kind of experience,” an FDA official named James Bilstad would later say in a Time cover story headlined “The Hot New Diet Pill.
  • “I know I can’t get any more,” she told Williams. “I have to use up what I have. And then I don’t know what I’m going to do after that. That’s the problem—and that is what scares me to death.” Telling people to lose weight the “natural way,” she told another guest, who was suggesting that people with obesity need only go on low-carb diets, is like “asking a person with a thyroid condition to just stop their medication.”
  • She’d gone off the fen-phen and had rapidly regained weight. “The voices returned and came back in a furor I’d never heard before,” Barb later wrote on her blog. “It was as if they were so angry at being silenced for so long, they were going to tell me 19 months’ worth of what they wanted me to hear. I was forced to listen. And I ate. And I ate. And ate.”
  • For Barb, rapid weight loss has brought on a different metaphysical confusion. When she looks in the mirror, she sometimes sees her shape as it was two years ago. In certain corners of the internet, this is known as “phantom fat syndrome,” but Barb dislikes that term. She thinks it should be called “body integration syndrome,” stemming from a disconnect between your “larger-body memory” and “smaller-body reality.
  • In 2003, the U.S. surgeon general declared obesity “the terror within, a threat that is every bit as real to America as the weapons of mass destruction”; a few months later, Eric Finkelstein, an economist who studies the social costs of obesity, put out an influential paper finding that excess weight was associated with up to $79 billion in health-care spending in 1998, of which roughly half was paid by Medicare and Medicaid. (Later he’d conclude that the number had nearly doubled in a decade.
  • In 2004, Finkelstein attended an Action on Obesity summit hosted by the Mayo Clinic, at which numerous social interventions were proposed, including calorie labeling in workplace cafeterias and mandatory gym class for children of all grades.
  • he message at their core, that soda was a form of poison like tobacco, spread. In San Francisco and New York, public-service campaigns showed images of soda bottles pouring out a stream of glistening, blood-streaked fat. Michelle Obama led an effort to depict water—plain old water—as something “cool” to drink.
  • Soon, the federal government took up many of the ideas that Brownell had helped popularize. Barack Obama had promised while campaigning for president that if America’s obesity trends could be reversed, the Medicare system alone would save “a trillion dollars.” By fighting fat, he implied, his ambitious plan for health-care reform would pay for itself. Once he was in office, his administration pulled every policy lever it could.
  • Michelle Obama helped guide these efforts, working with marketing experts to develop ways of nudging kids toward better diets and pledging to eliminate “food deserts,” or neighborhoods that lacked convenient access to healthy, affordable food. She was relentless in her public messaging; she planted an organic garden at the White House and promoted her signature “Let’s Move!” campaign around the country.
  • An all-out war on soda would come to stand in for these broad efforts. Nutrition studies found that half of all Americans were drinking sugar-sweetened beverages every day, and that consumption of these accounted for one-third of the added sugar in adults’ diets. Studies turned up links between people’s soft-drink consumption and their risks for type 2 diabetes and obesity. A new strand of research hinted that “liquid calories” in particular were dangerous to health.
  • when their field lost faith in low-calorie diets as a source of lasting weight loss, the two friends went in opposite directions. Wadden looked for ways to fix a person’s chemistry, so he turned to pharmaceuticals. Brownell had come to see obesity as a product of our toxic food environment: He meant to fix the world to which a person’s chemistry responded, so he started getting into policy.
  • The social engineering worked. Slowly but surely, Americans’ lamented lifestyle began to shift. From 2001 to 2018, added-sugar intake dropped by about one-fifth among children, teens, and young adults. From the late 1970s through the early 2000s, the obesity rate among American children had roughly tripled; then, suddenly, it flattened out.
  • although the obesity rate among adults was still increasing, its climb seemed slower than before. Americans’ long-standing tendency to eat ever-bigger portions also seemed to be abating.
  • sugary drinks—liquid candy, pretty much—were always going to be a soft target for the nanny state. Fixing the food environment in deeper ways proved much harder. “The tobacco playbook pretty much only works for soda, because that’s the closest analogy we have as a food item,
  • that tobacco playbook doesn’t work to increase consumption of fruits and vegetables, he said. It doesn’t work to increase consumption of beans. It doesn’t work to make people eat more nuts or seeds or extra-virgin olive oil.
  • Careful research in the past decade has shown that many of the Obama-era social fixes did little to alter behavior or improve our health. Putting calorie labels on menus seemed to prompt at most a small decline in the amount of food people ate. Employer-based wellness programs (which are still offered by 80 percent of large companies) were shown to have zero tangible effects. Health-care spending, in general, kept going up.
  • From the mid-1990s to the mid-2000s, the proportion of adults who said they’d experienced discrimination on account of their height or weight increased by two-thirds, going up to 12 percent. Puhl and others started citing evidence that this form of discrimination wasn’t merely a source of psychic harm, but also of obesity itself. Studies found that the experience of weight discrimination is associated with overeating, and with the risk of weight gain over time.
  • obesity rates resumed their ascent. Today, 20 percent of American children have obesity. For all the policy nudges and the sensible revisions to nutrition standards, food companies remain as unfettered as they were in the 1990s, Kelly Brownell told me. “Is there anything the industry can’t do now that it was doing then?” he asked. “The answer really is no. And so we have a very predictable set of outcomes.”
  • she started to rebound. The openings into her gastric pouch—the section of her stomach that wasn’t bypassed—stretched back to something like their former size. And Barb found ways to “eat around” the surgery, as doctors say, by taking food throughout the day in smaller portions
  • Bariatric surgeries can be highly effective for some people and nearly useless for others. Long-term studies have found that 30 percent of those who receive the same procedure Barb did regain at least one-quarter of what they lost within two years of reaching their weight nadir; more than half regain that much within five years.
  • if the effects of Barb’s surgery were quickly wearing off, its side effects were not: She now had iron, calcium, and B12 deficiencies resulting from the changes to her gut. She looked into getting a revision of the surgery—a redo, more or less—but insurance wouldn’t cover it
  • She found that every health concern she brought to doctors might be taken as a referendum, in some way, on her body size. “If I stubbed my toe or whatever, they’d just say ‘Lose weight.’ ” She began to notice all the times she’d be in a waiting room and find that every chair had arms. She realized that if she was having a surgical procedure, she’d need to buy herself a plus-size gown—or else submit to being covered with a bedsheet when the nurses realized that nothing else would fit.
  • Barb grew angrier and more direct about her needs—You’ll have to find me a different chair, she started saying to receptionists. Many others shared her rage. Activists had long decried the cruel treatment of people with obesity: The National Association to Advance Fat Acceptance had existed, for example, in one form or another, since 1969; the Council on Size & Weight Discrimination had been incorporated in 1991. But in the early 2000s, the ideas behind this movement began to wend their way deeper into academia, and they soon gained some purchase with the public.
  • “Our public-health efforts to address obesity have failed,” Eric Finkelstein, the economist, told me.
  • Others attacked the very premise of a “healthy weight”: People do not have any fundamental need, they argued, morally or medically, to strive for smaller bodies as an end in itself. They called for resistance to the ideology of anti-fatness, with its profit-making arms in health care and consumer goods. The Association for Size Diversity and Health formed in 2003; a year later, dozens of scholars working on weight-related topics joined together to create the academic field of fat studies.
  • As the size-diversity movement grew, its values were taken up—or co-opted—by Big Business. Dove had recently launched its “Campaign for Real Beauty,” which included plus-size women. (Ad Age later named it the best ad campaign of the 21st century.) People started talking about “fat shaming” as something to avoid
  • By 2001, Bacon, who uses they/them pronouns, had received their Ph.D. and finished a rough draft of a book, Health at Every Size, which drew inspiration from a broader movement by that name among health-care practitioners
  • But something shifted in the ensuing years. In 2007, Bacon got a different response, and the book was published. Health at Every Size became a point of entry for a generation of young activists and, for a time, helped shape Americans’ understanding of obesity.
  • Some experts were rethinking their advice on food and diet. At UC Davis, a physiologist named Lindo Bacon who had struggled to overcome an eating disorder had been studying the effects of “intuitive eating,” which aims to promote healthy, sustainable behavior without fixating on what you weigh or how you look
  • The heightened sensitivity started showing up in survey data, too. In 2010, fewer than half of U.S. adults expressed support for giving people with obesity the same legal protections from discrimination offered to people with disabilities. In 2015, that rate had risen to three-quarters.
  • In Bacon’s view, the 2000s and 2010s were glory years. “People came together and they realized that they’re not alone, and they can start to be critical of the ideas that they’ve been taught,” Bacon told me. “We were on this marvelous path of gaining more credibility for the whole Health at Every Size movement, and more awareness.”
  • that sense of unity proved short-lived; the movement soon began to splinter. Black women have the highest rates of obesity, and disproportionately high rates of associated health conditions. Yet according to Fatima Cody Stanford, an obesity-medicine physician at Harvard Medical School, Black patients with obesity get lower-quality care than white patients with obesity.
  • That system was exactly what Bacon and the Health at Every Size movement had set out to reform. The problem, as they saw it, was not so much that Black people lacked access to obesity medicine, but that, as Bacon and the Black sociologist Sabrina Strings argued in a 2020 article, Black women have been “specifically targeted” for weight loss, which Bacon and Strings saw as a form of racism
  • But members of the fat-acceptance movement pointed out that their own most visible leaders, including Bacon, were overwhelmingly white. “White female dietitians have helped steal and monetize the body positive movement,” Marquisele Mercedes, a Black activist and public-health Ph.D. student, wrote in September 2020. “And I’m sick of it.”
  • Tensions over who had the standing to speak, and on which topics, boiled over. In 2022, following allegations that Bacon had been exploitative and condescending toward Black colleagues, the Association for Size Diversity and Health expelled them from its ranks and barred them from attending its events.
  • As the movement succumbed to in-fighting, its momentum with the public stalled. If attitudes about fatness among the general public had changed during the 2000s and 2010s, it was only to a point. The idea that some people can indeed be “fit but fat,” though backed up by research, has always been a tough sell.
  • Although Americans had become less inclined to say they valued thinness, measures of their implicit attitudes seemed fairly stable. Outside of a few cities such as San Francisco and Madison, Wisconsin, new body-size-discrimination laws were never passed.
  • In the meantime, thinness was coming back into fashion
  • In the spring of 2022, Kim Kardashian—whose “curvy” physique has been a media and popular obsession—boasted about crash-dieting in advance of the Met Gala. A year later, the model and influencer Felicity Hayward warned Vogue Business that “plus-size representation has gone backwards.” In March of this year, the singer Lizzo, whose body pride has long been central to her public persona, told The New York Times that she’s been trying to lose weight. “I’m not going to lie and say I love my body every day,” she said.
  • Among the many other dramatic effects of the GLP-1 drugs, they may well have released a store of pent-up social pressure to lose weight.
  • If ever there was a time to debate that impulse, and to question its origins and effects, it would be now. But Puhl told me that no one can even agree on which words are inoffensive. The medical field still uses obesity, as a description of a diagnosable disease. But many activists despise that phrase—some spell it with an asterisk in place of the e—and propose instead to reclaim fat.
  • Everyone seems to agree on the most important, central fact: that we should be doing everything we can to limit weight stigma. But that hasn’t been enough to stop the arguing.
  • Things feel surreal these days to just about anyone who has spent years thinking about obesity. At 71, after more than four decades in the field, Thomas Wadden now works part-time, seeing patients just a few days a week. But the arrival of the GLP-1 drugs has kept him hanging on for a few more years, he said. “It’s too much of an exciting period to leave obesity research right now.”
  • When everyone is on semaglutide or tirzepatide, will the soft-drink companies—Brownell’s nemeses for so many years—feel as if a burden has been lifted? “My guess is the food industry is probably really happy to see these drugs come along,” he said. They’ll find a way to reach the people who are taking GLP‑1s, with foods and beverages in smaller portions, maybe. At the same time, the pressures to cut back on where and how they sell their products will abate.
  • the triumph in obesity treatment only highlights the abiding mystery of why Americans are still getting fatter, even now
  • Perhaps one can lay the blame on “ultraprocessed” foods, he said. Maybe it’s a related problem with our microbiomes. Or it could be that obesity, once it takes hold within a population, tends to reproduce itself through interactions between a mother and a fetus. Others have pointed to increasing screen time, how much sleep we get, which chemicals are in the products that we use, and which pills we happen to take for our many other maladies.
  • “The GLP-1s are just a perfect example of how poorly we understand obesity,” Mozaffarian told me. “Any explanation of why they cause weight loss is all post-hoc hand-waving now, because we have no idea. We have no idea why they really work and people are losing weight.”
  • The new drugs—and the “new understanding of obesity” that they have supposedly occasioned—could end up changing people’s attitudes toward body size. But in what ways
  • When the American Medical Association declared obesity a disease in 2013, Rebecca Puhl told me, some thought “it might reduce stigma, because it was putting more emphasis on the uncontrollable factors that contribute to obesity.” Others guessed that it would do the opposite, because no one likes to be “diseased.”
  • why wasn’t there another kind of nagging voice that wouldn’t stop—a sense of worry over what the future holds? And if she wasn’t worried for herself, then what about for Meghann or for Tristan, who are barely in their 40s? Wouldn’t they be on these drugs for another 40 years, or even longer? But Barb said she wasn’t worried—not at all. “The technology is so much better now.” If any problems come up, the scientists will find solutions.
Javier E

How false hope spread about hydroxychloroquine to treat covid-19 - and the consequences... - 0 views

www.washingtonpost.com/...xychloroquine-its-consequences

Covid-19 treatment response trump

shared by Javier E on 13 Apr 20 - No Cached
  • President Trump has repeatedly touted the anti-malarial medications hydroxychloroquine and chloroquine as that much-needed solution.
  • Scientists have since pointed to major flaws in those original studies and say there is a lack of reliable data on the drugs. Experts warn about the dangerous consequences of over-promoting a drug with unknown efficacy: Shortages of hydroxychloroquine have already occurred, depriving lupus and rheumatoid arthritis patients of access to it. Doctors say some patients could die of side effects. Other potential treatments for covid-19 could get overlooked with so much concentration on one option.
  • Raoult’s findings helped bring the theory to the United States. However, scientists have since discredited the trial, pointing to major flaws in the way it was conducted. The journal that published the study announced on April 3 that it did not meet its standards.
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  • A large portion of activity online at the end of February and early March appeared in French and centered on a study published by French researcher and doctor Didier Raoult.
  • Anecdotal evidence refers to people’s personal stories about taking the drugs and has no basis in scientific data. It’s akin to a Yelp review.
  • The faulty research then appeared in the Gateway Pundit, Breitbart and the Blaze. It ultimately made its way to Fox News, first appearing on Laura Ingraham’s program on March 16. Fox News shows hosted by Sean Hannity and Tucker Carlson went on to promote the drugs and continue to do so.
  • On March 19, Trump first mentioned hydroxychloroquine at a White House news briefing. DiResta’s analysis showed that the following week, the claim started to spike in the United States, with 101,844 posts on Facebook. Starbird reports Trump’s first mention set off a surge in attention, seeing tens of thousands of tweets per hour in late March.
  • Trump again spoke about the drugs at news conferences on April 3, 4 and 5. Mentions on Twitter skyrocketed on April 6.
  • scientists say there is only “anecdotal evidence” on the drugs. To a layperson, that may not sound bad, but it’s actually an insult in the scientific community.
  • Yet before the record could be set straight, the hypothesis spread widely on U.S. social media.
  • t there’s very little evidence that we actually have that this has a clinical benefit, which is kind of bad for something that’s being very heavily promoted. We should probably have some data and some science behind it.”
  • Asked whether chloroquine was a possible cure for covid-19, Janet Diaz of WHO told reporters on Feb. 20 that the organization was prioritizing other therapeutics: “For chloroquine, there is no proof that that is an effective treatment at this time. We recommend that therapeutics be tested under ethically approved clinical trials to show efficacy and safety.” A few weeks later, both chloroquine and hydroxychloroquine were included in a mega-trial WHO launched.
  • The Food and Drug Administration granted an emergency use approval to distribute millions of doses of the drugs to hospitals across the country on March 29.
  • Luciana Borio, the former head of medical and biodefense preparedness at the National Security Council, criticized the FDA’s EUA announcement and has called for a randomized clinical trial of the drugs.
  • “I think that it was a misuse of emergency authorizations of the authority that the FDA has. Because it gives this credence that the government is actually backing, and it’s so common for people to equate that with an approval,” Borio said.
  • When asked whether any of the completed studies have provided substantial evidence that the benefits of the drugs outweigh the risks, Borio responded, “Not at all. No study was done in a way that would allow that conclusion.”
  • Over the course of only a few weeks, posts online, the media and politicians turned chloroquine from an unknown drug to a “100% coronavirus cure,” misleading the public on its effectiveness and engendering unintended but negative consequences.
  • Hydroxychloroquine and chloroquine as treatments for covid-19 are not yet backed by reliable scientific evidence. In a pandemic, it’s important for everyone to follow the lead of scientists. Rumors on the Internet are the least reliable source of information. And politicians are not qualified to provide scientific advice, despite even the best intentions.
  • In particular, Trump’s incorrect comments on the drugs and his role in advocating for their use, based on minimal and flimsy evidence, sets a bad example. His advocacy for this unproven treatment provides potentially false hope and has led to shortages for people who rely on the drugs. The president earns Four Pinocchios.
aleija

F.D.A. Approves Alzheimer's Drug Despite Fierce Debate Over Whether It Works - The New ... - 0 views

www.nytimes.com/...-approves-alzheimers-drug.html

US disease history

shared by aleija on 07 Jun 21 - No Cached
  • The Food and Drug Administration on Monday approved the first new medication for Alzheimer’s disease in nearly two decades, a contentious decision, made despite opposition from the agency’s independent advisory committee and some Alzheimer’s experts who said there was not enough evidence that the drug can help patients.
  • The drug, aducanumab, which go by the brand name Aduhelm, is a monthly intravenous infusion intended to slow cognitive decline in people in the early stages of the disease, with mild memory and thinking problems. It is the first approved treatment to attack the disease process of Alzheimer’s instead of just addressing dementia symptoms.
  • During the several years it could take for that trial to be concluded, the drug will be available to patients, the agency said. If the post-market study, called a Phase 4 trial, fails to show the drug is effective, the F.D.A. can — but is not required to — rescind its approval.
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  • But the F.D.A. advisory committee, along with an independent think tank and several prominent experts — including some Alzheimer’s doctors who worked on the aducanumab clinical trials — said the evidence raised significant doubts about whether the drug is effective.
  • The F.D.A. authorized the drug under a program called accelerated approval, which has been applied to therapies for some cancers and other serious diseases for which there are few, if any, treatments.
  • The risks with aducanumab involve brain swelling or bleeding experienced by about 40 percent of Phase 3 trial participants receiving the high dose. Most were either asymptomatic or had headaches, dizziness or nausea. But such effects prompted 6 percent of high-dose recipients to discontinue. No Phase 3 participants died from the effects, but one safety trial participant did.
  • About two million Americans may fit the description of the patients the drug was tested on: people in the early stages of Alzheimer’s or the stage just before that, Alzheimer’s-related mild cognitive impairment. About six million people in the United States and roughly 30 million globally have Alzheimer’s, a number expected to double by 2050. Currently, five medications approved in the United States can delay cognitive decline for several months in various Alzheimer’s stages.
  • The crux of the controversy over aducanumab involved two Phase 3 trials with results that contradicted each other: One suggested the drug slightly slowed cognitive decline while the other trial showed no benefit. The trials were stopped early by a data monitoring committee that found aducanumab didn’t appear to be showing any benefit. Consequently, over a third of the 3,285 participants in those trials were never able to complete them.
  • Aducanumab, a monoclonal antibody, targets a protein, amyloid, that clumps into plaques in the brains of Alzheimer’s patients and is considered a biomarker of the disease. One thing both critics and supporters of approval agree on is that the drug substantially reduces levels of amyloid, and the F.D.A. said that the drug’s effect on a biomarker qualified it for the accelerated approval program.
  • He estimates 25 to 40 percent of the clinic’s roughly 3,000 patients might be eligible, but it doesn’t have enough neurologists.
Javier E

What Cookies and Meth Have in Common - The New York Times - 0 views

www.nytimes.com/...s-and-meth-have-in-common.html

food addiction drug stress plasticity reward environment psychology research brain science

shared by Javier E on 03 Jul 17 - No Cached
  • Why would anyone continue to use recreational drugs despite the medical consequences and social condemnation? What makes someone eat more and more in the face of poor health?
  • modern humans have designed the perfect environment to create both of these addictions.
  • the myth has persisted that addiction is either a moral failure or a hard-wired behavior — that addicts are either completely in command or literally out of their minds
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  • Now we have a body of research that makes the connection between stress and addiction definitive. More surprising, it shows that we can change the path to addiction by changing our environment.
  • Neuroscientists have found that food and recreational drugs have a common target in the “reward circuit” of the brain, and that the brains of humans and other animals who are stressed undergo biological changes that can make them more susceptible to addiction.
  • In a 2010 study, Diana Martinez and colleagues at Columbia scanned the brains of a group of healthy controls and found that lower social status and a lower degree of perceived social support — both presumed to be proxies for stress — were correlated with fewer dopamine receptors, called D2s, in the brain’s reward circuit
  • The reward circuit evolved to help us survive by driving us to locate food or sex in our environment
  • Today, the more D2 receptors you have, the higher your natural level of stimulation and pleasure — and the less likely you are to seek out recreational drugs or comfort food to compensate
  • people addicted to cocaine, heroin, alcohol and methamphetamines experience a significant reduction in their D2 receptor levels that persists long after drug use has stopped. These people are far less sensitive to rewards, are less motivated and may find the world dull, once again making them prone to seek a chemical means to enhance their everyday life.
  • Drug exposure also contributes to a loss of self-control. Dr. Volkow found that low D2 was linked with lower activity in the prefrontal cortex, which would impair one’s ability to think critically and exercise restraint
  • Food, like drugs, stimulates the brain’s reward circuit. Chronic exposure to high-fat and sugary foods is similarly linked with lower D2 levels, and people with lower D2 levels are also more likely to crave such foods. It’s a vicious cycle in which more exposure begets more craving.
  • At this point you may be wondering: What controls the reward circuit in the first place? Some of it is genetic. We know that certain gene variations elevate the risk of addiction to various drugs. But studies of monkeys suggest that our environment can trump genetics and rewire the brain.
  • simply by changing the environment, you can increase or decrease the likelihood of an animal becoming a drug addict.
  • The same appears true for humans. Even people who are not hard-wired for addiction can be made dependent on drugs if they are stressed
  • Is it any wonder, then, that the economically frightening situation that so many Americans experience could make them into addicts? You will literally have a different brain depending on your ZIP code, social circumstances and stress level.
  • In 1990, no state in our country had an adult obesity rate above 15 percent; by 2015, 44 states had obesity rates of 25 percent or higher. What changed?
  • What happened is that cheap, calorie-dense foods that are highly rewarding to your brain are now ubiquitous.
  • Nothing in our evolution has prepared us for the double whammy of caloric modern food and potent recreational drugs. Their power to activate our reward circuit, rewire our brain and nudge us in the direction of compulsive consumption is unprecedented.
  • The processed food industry has transformed our food into a quasi-drug, while the drug industry has synthesized ever more powerful drugs that have been diverted for recreational use.
  • Fortunately, our brains are remarkably plastic and sensitive to experience. Although it’s far easier said than done, just limiting exposure to high-calorie foods and recreational drugs would naturally reset our brains to find pleasure in healthier foods and life without drugs.
anonymous

Opinion | Trump Health Care Policies That Biden Should Consider Keeping - The New York ... - 0 views

www.nytimes.com/...biden-trump-health-care.html

Politics

shared by anonymous on 12 Mar 21 - No Cached
  • But as the current administration works to reverse the actions of its predecessor, it should recognize that former President Donald Trump introduced some policies on medical care and drug price transparency that are worth preserving.
  • o be clear, the Trump administration, generally, put the health care of many Americans in jeopardy: It spent four years trying to overturn the Affordable Care Act, despite that law’s undeniable successes, and when repeal proved impossible, kneecapped the program in countless ways. As a result of those policies, more than two million people lost health insurance during Mr. Trump’s first three years. And that’s before millions more people lost their jobs and accompanying insurance during the early days of the Covid-19 pandemic.
  • These master price lists span hundreds of pages and are hard to decipher. Nonetheless, they give consumers a basis to fight back against outrageous charges in a system where a knee replacement can cost $15,000 or $75,000 even at the same hospital.
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  • ast summer hospitals said it was too hard to comply with the new rule while they were dealing with the pandemic. They still managed to continue the appeal of their lawsuit against the measure, which failed in December. The rule took effect, but the penalty for not complying is just $300 a day — a pittance for hospitals — and there is no meaningful mechanism for active enforcement. The hospitals have asked the Biden administration to revise the requirement.
  • In September his health secretary, Alex Azar, certified that importing prescription medicine from Canada “poses no additional risk to the public’s health and safety” and would result in “a significant reduction in the cost.” This statement, which previous health secretaries had declined to make, formally opened the door to importing medication. Millions of Americans, meanwhile, now illegally purchase prescription drugs from abroad because they cannot afford to buy them at home.
  • The Trump administration’s attempted market-based interventions shined some light on dark corners of the health market and opened the door to some workarounds. They are not meaningful substitutes for larger and much-needed health reform. But as Americans await the type of more fundamental changes the Democrats have promised, they need every bit of help they can get.
  • Finally, shortly before the election, Mr. Trump issued an executive order paving the way for a “most favored nation” system that would ensure that the prices for certain drugs purchased by Medicare did not exceed the lowest price available in other developed countries. The industry responded with furious pushback, and a court quickly ruled against the measure.
  • Biden may want to continue the previous administration’s efforts to lower drug prices and make medical costs transparent.
  • But the Trump administration did attempt to rein in some of the most egregious pricing in the health care industry. For example, it required most hospitals to post lists of their standard prices for supplies, drugs, tests and procedures. Providers had long resisted calls for such pricing transparency, arguing that this was a burden, and that since insurers negotiated and paid far lower rates anyway, those list prices didn’t really matter.
  • ut the drug lobby will no doubt prove a big obstacle: The Pharmaceutical Research and Manufacturers of America, an industry trade group, filed suit in federal court in November to stop the drug-purchasing initiatives. The industry has long argued that importation from even Canada would risk American lives.
katyshannon

Justice Department set to free 6,000 prisoners, largest one-time release - The Washingt... - 0 views

www.washingtonpost.com/...5-aa5b-f78a98956699_story.html

justice department release prisoners

shared by katyshannon on 07 Oct 15 - No Cached
  • The Justice Department is set to release about 6,000 inmates early from prison — the largest one-time release of federal prisoners — in an effort to reduce overcrowding and provide relief to drug offenders who received harsh sentences over the past three decades, according to U.S. officials.
  • inmates from federal prisons nationwide will be set free by the department’s Bureau of Prisons between Oct. 30 and Nov. 2. About two-thirds of them will go to halfway houses and home confinement before being put on supervised release. About one-third are foreign citizens who will be quickly deported, officials said.
  • The commission’s action is separate from an effort by President Obama to grant clemency to certain nonviolent drug offenders, an initiative that has resulted in the early release of 89 inmates.
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  • The panel estimated that its change in sentencing guidelines eventually could result in 46,000 of the nation’s approximately 100,000 drug offenders in federal prison qualifying for early release. The 6,000 figure, which has not been reported previously, is the first tranche in that process.
  • an additional 8,550 inmates would be eligible for release between this Nov. 1 and Nov. 1, 2016.
  • The releases are part of a shift in the nation’s approach to criminal justice and drug sentencing that has been driven by a bipartisan consensus that mass incarceration has failed and should be reversed.
  • Along with the commission’s action, the Justice Department has instructed its prosecutors not to charge low-level, nonviolent drug offenders who have no connection to gangs or large-scale drug organizations with offenses that carry severe mandatory sentences.
  • The U.S. Sentencing Commission voted unanimously for the reduction last year after holding two public hearings in which members heard testimony from then-Attorney General Eric H. Holder Jr., federal judges, federal public defenders, state and local law enforcement officials, and sentencing advocates. The panel also received more than 80,000 public comment letters, with the overwhelming majority favoring the change.
  • The policy change is referred to as “Drugs Minus Two.” Federal sentencing guidelines rely on a numeric system based on different factors, including the defendant’s criminal history, the type of crime, whether a gun was involved and whether the defendant was a leader in a drug group.
  • An average of about two years is being shaved off eligible prisoners’ sentences under the change. Although some of the inmates who will be released have served decades, on average they will have served 8  1/2 years instead of 10  1/2 , according to a Justice Department official.
  • “Even with the Sentencing Commission’s reductions, drug offenders will have served substantial prison sentences,” Deputy Attorney General Sally Yates said. “Moreover, these reductions are not automatic. Under the commission’s directive, federal judges are required to carefully consider public safety in deciding whether to reduce an inmate’s sentence.”
  • katyshannon on 07 Oct 15
     
    Justice Department is set to free 6,000 prisoners this year.
Javier E

Opinion | Ozempic Is Repairing a Hole in Our Diets Created by Processed Foods - The New... - 0 views

www.nytimes.com/...ozempic-weight-loss-drugs.html

satiety food industry UPFs morality hunger appetite

shared by Javier E on 08 May 24 - No Cached
  • In the United States (where I now split my time), over 70 percent of people are overweight or obese, and according to one poll, 47 percent of respondents said they were willing to pay to take the new weight-loss drugs.
  • They cause users to lose an average of 10 to 20 percent of their body weight, and clinical trials suggest that the next generation of drugs (probably available soon) leads to a 24 percent loss, on average
  • I was born in 1979, and by the time I was 21, obesity rates in the United States had more than doubled. They have skyrocketed since. The obvious question is, why? And how do these new weight-loss drugs work?
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  • The answer to both lies in one word: satiety. It’s a concept that we don’t use much in everyday life but that we’ve all experienced at some point. It describes the sensation of having had enough and not wanting any more.
  • The primary reason we have gained weight at a pace unprecedented in human history is that our diets have radically changed in ways that have deeply undermined our ability to feel sated
  • The evidence is clear that the kind of food my father grew up eating quickly makes you feel full. But the kind of food I grew up eating, much of which is made in factories, often with artificial chemicals, left me feeling empty and as if I had a hole in my stomach
  • In a recent study of what American children eat, ultraprocessed food was found to make up 67 percent of their daily diet. This kind of food makes you want to eat more and more. Satiety comes late, if at all.
  • After he moved in 2000 to the United States in his 20s, he gained 30 pounds in two years. He began to wonder if the American diet has some kind of strange effect on our brains and our cravings, so he designed an experiment to test it.
  • He and his colleague Paul Johnson raised a group of rats in a cage and gave them an abundant supply of healthy, balanced rat chow made out of the kind of food rats had been eating for a very long time. The rats would eat it when they were hungry, and then they seemed to feel sated and stopped. They did not become fat.
  • then Dr. Kenny and his colleague exposed the rats to an American diet: fried bacon, Snickers bars, cheesecake and other treats. They went crazy for it. The rats would hurl themselves into the cheesecake, gorge themselves and emerge with their faces and whiskers totally slicked with it. They quickly lost almost all interest in the healthy food, and the restraint they used to show around healthy food disappeared. Within six weeks, their obesity rates soared.
  • They took all the processed food away and gave the rats their old healthy diet. Dr. Kenny was confident that they would eat more of it, proving that processed food had expanded their appetites. But something stranger happened. It was as though the rats no longer recognized healthy food as food at all, and they barely ate it. Only when they were starving did they reluctantly start to consume it again.
  • Drugs like Ozempic work precisely by making us feel full.
  • processed and ultraprocessed food create a raging hole of hunger, and these treatments can repair that hole
  • the drugs are “an artificial solution to an artificial problem.”
  • Yet we have reacted to this crisis largely caused by the food industry as if it were caused only by individual moral dereliction
  • Why do we turn our anger inward and not outward at the main cause of the crisis? And by extension, why do we seek to shame people taking Ozempic but not those who, say, take drugs to lower their blood pressure?
  • The first is the belief that obesity is a sin.
  • The second idea is that we are all in a competition when it comes to weight. Ours is a society full of people fighting against the forces in our food that are making us fatter.
  • Looked at in this way, people on Ozempic can resemble cyclists like Lance Armstrong who used performance-enhancing drugs.
  • We can’t find our way to a sane, nontoxic conversation about obesity or Ozempic until we bring these rarely spoken thoughts into the open and reckon with them
  • remember the competition isn’t between you and your neighbor who’s on weight-loss drugs. It’s between you and a food industry constantly designing new ways to undermine your satiety.
  • Reducing or reversing obesity hugely boosts health, on average: We know from years of studying bariatric surgery that it slashes the risks of cancer, heart disease and diabetes-related death. Early indications are that the new anti-obesity drugs are moving people in a similar radically healthier direction,
  • But these drugs may increase the risk for thyroid cancer.
  • Do we want these weight loss drugs to be another opportunity to tear one another down? Or do we want to realize that the food industry has profoundly altered the appetites of us all — leaving us trapped in the same cage, scrambling to find a way out?
Javier E

Opinion | Who Killed the Knapp Family? - The New York Times - 0 views

www.nytimes.com/...deaths-despair-poverty.html

American dream despair working class culture crisis jobs responsibility welfare state drugs

shared by Javier E on 12 Jan 20 - No Cached
  • there is a cancer gnawing at the nation that predates Trump and is larger than him.
  • Suicides are at their highest rate since World War II; one child in seven is living with a parent suffering from substance abuse; a baby is born every 15 minutes after prenatal exposure to opioids; America is slipping as a great power.
  • We have deep structural problems that have been a half century in the making, under both political parties, and that are often transmitted from generation to generation.
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  • Deaton and the economist Anne Case, who is also his wife, coined the term “deaths of despair” to describe the surge of mortality from alcohol, drugs and suicide.
  • “The meaningfulness of the working-class life seems to have evaporated,” Angus Deaton, the Nobel Prize-winning economist, told us. “The economy just seems to have stopped delivering for these people.”
  • Only in America has life expectancy now fallen three years in a row, for the first time in a century, because of “deaths of despair.”
  • “I’m a capitalist, and even I think capitalism is broken,” says Ray Dalio, the founder of Bridgewater, the world’s largest hedge fund.
  • The suffering was invisible to affluent Americans, but the consequences are now evident to all: The survivors mostly voted for Trump, some in hopes that he would rescue them
  • The stock market is near record highs, but working-class Americans (often defined as those without college degrees) continue to struggle. If you’re only a high school graduate, or worse, a dropout, work no longer pays.
  • If the federal minimum wage in 1968 had kept up with inflation and productivity, it would now be $22 an hour. Instead, it’s $7.25.
  • we would return to the Kristof family farm in Yamhill and see a humanitarian crisis unfolding in a community we loved — and a similar unraveling was happening in towns across the country. This was not one town’s problem, but a crisis in the American system.
  • Even in this presidential campaign, the unraveling of working-class communities receives little attention. There is talk about the middle class, but very little about the working class
  • One consequence is that the bottom end of America’s labor force is not very productive, in ways that reduce our country’s competitiveness
  • we discuss college access but not the one in seven children who don’t graduate from high school.
  • “We have to stop being obsessed over impeachment and start actually digging in and solving the problems that got Donald Trump elected in the first place,”
  • We have to treat America’s cancer.
  • the situation is worsening, because families have imploded under the pressure of drug and alcohol abuse, and children are growing up in desperate circumstances
  • In the 1970s and ’80s it was common to hear derogatory suggestions that the forces ripping apart African-American communities were rooted in “black culture.” The idea was that “deadbeat dads,” self-destructive drug abuse and family breakdown were the fundamental causes, and that all people needed to do was show “personal responsibility.
  • A Harvard sociologist, William Julius Wilson, countered that the true underlying problem was lost jobs, and he turned out to be right. When good jobs left white towns like Yamhill a couple of decades later because of globalization and automation, the same pathologies unfolded there.
  • Men in particular felt the loss not only of income but also of dignity that accompanied a good job. Lonely and troubled, they self-medicated with alcohol or drugs, and they accumulated criminal records that left them less employable and less marriageable.
  • Family structure collapsed.
  • The problems are also rooted in disastrous policy choices over 50 years
  • The United States wrested power from labor and gave it to business, and it suppressed wages and cut taxes rather than invest in human capital, as our peer countries did.
  • The kids on the No. 6 bus rode into a cataclysm as working-class communities disintegrated across America because of lost jobs, broken families, gloom — and failed policies.
  • Americans also bought into a misconceived “personal responsibility” narrative that blamed people for being poor.
  • It’s true, of course, that personal responsibility matters: People we spoke to often acknowledged engaging in self-destructive behaviors.
  • But when you can predict wretched outcomes based on the ZIP code where a child is born, the problem is not bad choices the infant is making.
  • If we’re going to obsess about personal responsibility, let’s also have a conversation about social responsibility.
  • Why did deaths of despair claim Farlan, Zealan, Nathan, Rogena and so many others?
  • First, well-paying jobs disappeared
  • Second, there was an explosion of drugs
  • Third, the war on drugs sent fathers and mothers to jail, shattering families.
  • Both political parties embraced mass incarceration and the war on drugs, which was particularly devastating for black Americans, and ignored an education system that often consigned the poor — especially children of color — to failing schools
  • Since 1988, American schools have become increasingly segregated by race, and kids in poor districts perform on average four grade levels behind those in rich districts.
  • Yet it’s not hopeless. America is polarized with ferocious arguments about social issues, but we should be able to agree on what doesn’t work: neglect and underinvestment in children. Here’s what does work.
  • ob training and retraining give people dignity as well as an economic lifeline. Such jobs programs are common in other countries.
  • For instance, autoworkers were laid off during the 2008-9 economic crisis both in Detroit and across the Canadian border in nearby Windsor, Ontario. As the scholar Victor Tan Chen has showed, the two countries responded differently
  • The United States focused on money, providing extended unemployment benefits. Canada emphasized job retraining, rapidly steering workers into new jobs in fields like health care, and Canadian workers also did not have to worry about losing health insurance.
  • The focus on job placement meant that Canadian workers were ushered more quickly back into workaday society and thus today seem less entangled in drugs and family breakdown.
  • Another successful strategy is investing not just in prisons but also in human capital to keep people out of prisons.
  • We attended a thrilling graduation in Tulsa, Okla., for 17 women completing an impressive local drug treatment program called Women in Recovery.
  • The graduates had an average of 15 years of addiction each, and all were on probation after committing crimes. Yet they had quit drugs and started jobs
  • Women in Recovery has a recidivism rate after three years of only 4 percent, and consequently has saved Oklahoma $70 million in prison spending,
  • Bravo for philanthropy, but the United States would never build interstate highways through volunteers and donations, and we can’t build a national preschool program or a national drug recovery program with private money.
  • For individuals trying to break an addiction, a first step is to face up to the problem — and that’s what America should do as well
lucieperloff

Democrats Drop Prescription Drug Prices From Spending Bill | Time - 0 views

time.com/...rices-spending-bill-big-pharma

economics politics policy government

shared by lucieperloff on 29 Oct 21 - No Cached
  • Democrats had hoped to give the federal government the power to negotiate with pharmaceutical companies over drug prices
  • a promise to deliver lower drug prices this year.
  • Big Pharma employs roughly 1,500 lobbyists on Capitol Hill and spent more than $177 million on lobbying and campaign donations in 2021 alone.
  • ...11 more annotations...
  • spent $7.44 million on lobbying during the third quarter alone, a nearly 25% increase from the same period last year.
  • But a small cadre of Democratic holdouts appear to be enough to have stopped the proposal in its tracks.
  • Most were among the top recipients of money from the pharmaceutical industry.
  • But it’s also “very good at knowing exactly how many votes they need to kill pieces of legislation, and figuring out a way to get those votes.”
  • Senate Finance Committee Chair Ron Wyden also said he was continuing to have conversations on the drug pricing issue
  • It would allow Medicare to negotiate prices—but only for medications used in outpatient services, and only after the drugs’ patents expire.
  • It stands in sharp contrast to the more sweeping plan favored by Sen. Bernie Sanders and other Democrats that would allow the government to negotiate in Medicare Part D, which covers far more drugs.
  • On Thursday, he called the omission of the drug pricing provision in Biden’s framework a “major problem.”
  • He argued that just because the prescription drug pricing provision has been popular among voters doesn’t make it the right policy.
  • If Democrats end up passing any proposal, even a modest one, that gives the government the power to negotiate drug prices, it would mark a historic shift.
  • If Democratic lawmakers end up with no drug pricing proposal in this wide-ranging spending bill, they not only leave millions of Americans struggling to afford their medicines, they also miss the best chance they’ve had in decades.
peterconnelly

Canada Decriminalizes Opioids and Other Drugs in British Columbia - The New York Times - 0 views

www.nytimes.com/...mbia-decriminalizes-drugs.html

new york times canada drugs

shared by peterconnelly on 03 Jun 22 - No Cached
  • Facing soaring levels of opioid deaths since the pandemic began in 2020, the Canadian government announced Tuesday that it would temporarily decriminalize the possession of small amounts of illegal drugs, including cocaine and methamphetamines, in the western province of British Columbia that has been ground zero for the country’s overdoses.
  • The announcement was applauded by families of deceased opioid users and by peer support workers
  • British Columbia declared drug-related deaths a public health emergency in 2016.
  • ...7 more annotations...
  • “For too many years, the ideological opposition to harm reduction has cost lives,” said Dr. Carolyn Bennett, the federal minister of mental health and addictions, at a news conference on Tuesday.
  • British Columbia has been a leader in Canada’s harm reduction movement.
  • Decriminalization will allow police to focus on organized crime and drug traffickers, instead of individual users, said Sheila Malcolmson, the provincial minister of mental health and addictions. “We will take this year ahead to ready our justice and health systems,” she added.
  • The exemption will go into effect on Jan. 31, 2023, and will expire after three years.
  • “I think making drug use easier for them is kind of like palliative care,” said Mr. Doucette, who spent 35 years working for the Royal Canadian Mounted Police before retiring, most of which he spent in drug enforcement. “It’s just condemning them to a slow death because of drugs, whereas if you get them off drugs, get them a life back, they can enjoy life.”
  • British Columbia has one of the highest per capita rates of drug death across North America, at 42.8 deaths per 100,000 people in 2021, according to provincial data.
  • In the U.S., the 10 states with the highest level of drug overdose, have rates ranging between 39.1 deaths per 100,000 in Connecticut, to 81.4 deaths per 100,000 in West Virginia, according to the latest mortality data, for 2020, by the Centers for Disease Control.
Javier E

Why Medicine Is Cheaper in Germany - Olga Khazan - The Atlantic - 0 views

www.theatlantic.com/...371418

Germany health-care medicine market economics

shared by Javier E on 25 May 14 - No Cached
  • Germany's process has worked pretty well ever since Otto Von Bismarck set it in motion in 1889. But by 2009, the system started to break down. Drug manufacturers were introducing new drugs—knowing they'd be reimbursed by the sickness funds—but the new drugs weren't necessarily any better than the earlier ones. The result: Drug prices spiraled.
  • nter 2010's Pharmaceutical Market Restructuring Act, or Arzneimittelmarkt-Neuordnungsgesetz, abbreviated in German as AMNOG. As in "AMNOGonna pay drug companies for new meds that are more expensive but not any better than the old ones."
  • s soon as a new drug enters the market, manufacturers must submit a series of studies that prove it heals patients better than whatever was previously available. If the new drugs don't seem any better than their predecessors, the sickness funds will only pay for the price of the earlier version. Patients can still buy the newer medicine, but it's up to them to make up the price difference out of pocket.
  • ...3 more annotations...
  • the new regulation so far hasn't had a chilling effect on medical innovation: "Even though the Federal Joint Committee ruled 27 prescription drugs to have no added benefit, only five of these drugs have left the German market as a result."
  • Bahr's approach to pharmaceutical price regulation is market-driven, if you think about it. Why not force drug makers to compete with each other to prove they're providing added bang for patients' buck? Evzio, meet invisible hand.
  • The American style of drug pricing, meanwhile, is like shopping for clothes with a blindfold on, as Princeton economics professor Uwe Reinhardt put it. "In a truly competitive market, both the prices and the inherent qualities of the goods or services being traded are known to all parties ahead of any trade," he wrote in the Times' Economix blog. "By contrast, in the American healthcare market, both the price and the quality of health care have been kept studiously hidden from patients."
Javier E

Why Pfizer didn't report that its rheumatoid arthritis medication might prevent Alzheim... - 0 views

www.washingtonpost.com/...9-8bb7-0fc796cf2ec0_story.html

medication alzheimer Research ethics medical

shared by Javier E on 05 Jun 19 - No Cached
  • “I’m frustrated myself really by the whole thing,’’ said Clive Holmes, a professor of biological psychiatry at the University of Southampton in Great Britain who has received past support from Pfizer for Enbrel research in Alzheimer’s, a separate 2015 trial in 41 patients that proved inconclusive.
  • He said Pfizer and other companies do not want to invest heavily in further research only to have their markets undermined by generic competition. “Someone can pop up and say, ‘Look, I’ve got a me-too drug here,’ ’’ Holmes said, referring to the advent of generic versions of Enbrel. “I think that is what this is all about.’’
  • Drug companies often are criticized for extending the patent life of a drug — and winning new profits — by merely tweaking a drug’s molecule or changing the method of delivery into the body. But it is a “heavy lift’’ for a company to win regulatory approval to use a drug for a completely different disease, said Robert I. Field, a professor of law and health care management at Drexel University.
  • ...6 more annotations...
  • “Our patent laws do not provide the appropriate incentives,’’ Field said. Drug therapy for early Alzheimer’s “would be a godsend for American patients, so we should be doing everything we can as a country to encourage development of treatments. It’s frustrating that there may be a missed opportunity.’’
  • Wagering money on a clinical trial of Enbrel for an entirely different disease, especially when Pfizer had doubts about the validity of its internal analysis, made little business sense, said a former Pfizer executive who was aware of the internal debate and spoke on the condition of anonymity to discuss internal Pfizer matters.
  • “It probably was high risk, very costly, very long term drug development that was off-strategy,’’ the former executive said.
  • “I think the financial case is they won’t be making any money off of it,’’ the second former executive said.
  • Drug companies frequently have been pilloried for not fully disclosing negative side effects of their drugs. What happens when the opposite is the case? What obligation does a company have to spread potentially beneficial information about a drug, especially when the benefits in question could improve the outlook for treating Alzheimer’s, a disease that afflicts at least 500,000 new patients per year?
  • A medical ethics expert argued that Pfizer has a responsibility to publicize positive findings, although it is not as strong as an imperative to disclose negative findings.
kaylynfreeman

Oregon Becomes First U.S. State To Decriminalize Drug Possession | HuffPost - 0 views

www.huffpost.com/...110_n_5fa18176c5b686950032bf5f

politics US

shared by kaylynfreeman on 04 Nov 20 - No Cached
  • Oregon became the first U.S. state to decriminalize possession of all illegal drugs after voters passed a ballot initiative in Tuesday’s election.
  • Oregonians can no longer be criminally charged for possessing small amounts of illegal drugs, including heroin, methamphetamine and cocaine. The punishment for these felony and misdemeanor drug possession offenses will now be a simple $100 fine. The initiative also redirects some taxes raised through sales of legal marijuana to finance a new voluntary treatment system for drug users.
  • his marks the nation’s most significant development toward ending the 50-year war on drugs launched by President Richard Nixon.
  • ...3 more annotations...
  • Oregon’s initiative had broad support from groups like the NAACP Portland, local Black Lives Matter chapters, physicians groups and AFSCME, t
  • Supporters of drug decriminalization said they hope the passage of Oregon’s Measure 110 encourages other states to pass similar ballot initiatives or legislation that will ease the war on drugs.
  • The state legalized marijuana in 2014 and reduced many drug penalties from felonies to misdemeanors in 2017.
Javier E

He Was a Science Star. Then He Promoted a Questionable Cure for Covid-19. - The New Yor... - 0 views

www.nytimes.com/...raoult-hydroxychloroquine.html

science research france star scientist Covid-19

shared by Javier E on 25 May 20 - No Cached
  • In the 1990s, in an early repurposing experiment, he tested the effect of hydroxychloroquine on a frequently fatal condition known as Q fever, which is caused by an intracellular bacterium. Like viruses, intracellular bacteria multiply within the cells of their hosts; Raoult found that hydroxychloroquine, by reducing acidity within the host cells, slowed bacterial growth
  • He began treating Q fever with a combination of hydroxychloroquine and doxycycline and later used the same drugs for Whipple’s disease, another fatal condition caused by an intracellular bacterium. The combination is now considered to be a standard treatment for both diseases.
  • Chinese reports, however, appeared to confirm Raoult’s longstanding hopes for chloroquine. A deadly virus for which no treatment existed could evidently be stopped by an inexpensive, widely studied, pre-existing molecule, and one that Raoult knew well. A more heedful scientist might have surveyed the Chinese data and begun preparations for tests of his own. Raoult did this, but he also posted a brief, jubilant video on YouTube, under the title “Coronavirus: Game Over!”
  • ...44 more annotations...
  • Chloroquine had produced what he called “spectacular improvements” in the Chinese patients. “It’s excellent news — this is probably the easiest respiratory infection to treat of all,” Raoult said. “The only thing I’ll tell you is, be careful: Soon the pharmacies won’t have any chloroquine left!”
  • Raoult wrote his first research paper, in 1979, on a tick-borne infection sometimes known as Marseille fever. The disease was also called “benign summer fever,” and more than 50 years of science said it was nonlethal. And yet one of the 41 patients in his data set had died.
  • Before submitting the paper, Raoult, who was then a young resident, gave it to a supervising professor for review. “And he takes it,” Raoult told me, “he doesn’t show it to me again, and he publishes it — and he’d taken out the death. Because he didn’t know how to make sense of the death.”
  • Raoult was disgusted, and the incident shaped his philosophy of scientific inquiry. “I learned that the people who wanted to follow the familiar path were prepared to cheat in order to do it,” he said.
  • In Raoult’s view, French science was a duchy of appearances, connections and self-reverence. “It was people saying” — he mimed the drone of an aristocrat — “ ‘Oh, him, yes, he’s very good.’ And this reputation, you don’t know what it’s based on, but it’s not the truth.”
  • “He was a ‘follower,’” Raoult said of the professor. “And these ‘followers’ are all cheaters. That’s what I thought. And it’s still what I think.”
  • He is, fundamentally, a contrarian. In Raoult’s view, little of consequence has been accomplished by researchers who endorse the habitual tools and theories of their age.
  • “I’ve spent my life being ‘against,’” he told me. “I tell young scientists: ‘You know, you don’t need a brain to agree. All you need is a spinal cord.’” He is thrilled by conflict. It is a matter both of philosophy — the influence, no doubt, of the thinker he refers to admiringly as “master Nietzsche” — and of temperament.
  • His peers shake their heads at this behavior but grant him a grudging respect. “You can’t knock him down,” said Mark Pallen, a professor of microbial genomics at the University of East Anglia. “In terms of his place in the canon, the sainthood of science, he’s pretty secure there.”
  • In 1985 and 1986, Raoult worked at the Naval Medical Research Institute in Bethesda, Md., where he discovered the Science Citation Index. The index, a tool that can be used to measure a scientist’s influence on the basis of his or her publication history, was relatively unknown in France. Raoult looked up the researchers reputed to be the best in Marseille. “It was really the emperor wears no clothes,” he said. “These people didn’t publish. There was one who hadn’t written a paper in 10 years.”
  • In subsequent work, he demonstrated that Marseille fever was indeed fatal in almost precisely one in every 41 cases.
  • Raoult’s name sits atop several thousand; in each of the past eight years, he has produced more than 100. In 2020, he has already published at least 54.
  • Like many doctors, Molina viewed Raoult’s study with skepticism, but he was also curious to see if his proposed treatment regimen might in fact work. He tested hydroxychloroquine and azithromycin in 11 of his own patients. “We had severe patients, and we wanted to try something,” Molina told me. Within five days, one had died, and two others had been transferred out of his service to intensive care. In another patient, the treatment was suspended after the onset of cardiac issues, a known side effect of the drugs. Eight of the 10 surviving patients still tested positive for SARS-CoV-2 at the conclusion of the study period
  • Raoult is reputed to be an indefatigable worker, but he also achieves his extreme rate of publication by attaching his name to nearly every paper that comes out of his institute.
  • In recent years, Raoult has amused himself, it seems, by staking out tendentious scientific claims, sometimes in territories that are well beyond the scope of his expertise.
  • He is skeptical, for instance, of the utility of mathematical modeling in the realm of epidemiology.
  • The same logic has led him to conclude that climate modelers are no more than “soothsayers” for our “scientistic era” and that their dire predictions are mostly just an attempt to expiate our intense but irrational feelings of guilt.
  • Raoult’s most recent book, “Epidemics: Real Dangers and False Alerts,” was published in late March, by which time the W.H.O. had reported more than 330,000 confirmed cases of Covid-19 worldwide and more than 14,500 deaths. “This anguish over epidemics,” he writes, “is completely untethered from the reality of deaths from infectious diseases.”
  • Testing had been scheduled to run for two weeks per patient, but after only six days, the results were so favorable that Raoult decided to end the trial and publish
  • Others might have proceeded with more caution or perhaps waited to confirm these results with a larger, more rigorous trial. Raoult likes to think of himself as a doctor first, however, with a moral obligation to treat his patients that supersedes any desire to produce reliable data.
  • For decades, Raoult has boasted of his prodigious rates of publication and citation, which, as objective statistics, he considers to be the best measure of his worth as a researcher.
  • This observation has come to be known as the parachute paradigm: We tend to accept the claim that parachutes reduce injury among people who leap from airplanes, but this effect has never been proved in a randomized study that compares an experimental parachute group to an unlucky parachuteless control.
  • “If you don’t have something that’s visible in 10 patients, or 30, it’s useless. It’s not of any consequence.” An effective treatment for a potentially lethal infectious disease will be visible to the naked eye.
  • There is much about Raoult that might make him, and by extension his proposed treatment, appealing to a man like Trump. He is an iconoclast with funny hair; he thinks almost everyone else is stupid, especially those who are typically regarded as smart; he is beloved by the angry and conspiracy-minded; his self-congratulation is more or less unceasing.
  • Raoult classified Trump’s psychology as that of an “entrepreneur,” by way of contrast with that of a “politician.” “Entrepreneurs are people who know how to decide, who know how to take risks,” he said. “And at a certain point, to decide is to take a risk. Every decision is a risk.”
  • The French waited far too long, in his estimation, to approve the use of hydroxychloroquine in Covid-19 patients. The authorization came only after Raoult announced in the press that he would continue, “in accordance with the Hippocratic oath” and effectively in defiance of the government, to treat patients with his combination therapy. “I’m convinced that in the end, everyone will be using this treatment,” Raoult told Le Parisien. “It’s just a matter of time before people agree to eat their hats.”
  • Raoult had already begun assembling data for a larger study, but he dismissed the need for anything particularly vast or lengthy. Like other critics of the R.C.T., he likes to point out that a number of self-evidently useful developments in the realm of human health have never been validated by such rigorous tests.
  • Raoult’s study had measured only viral load. It offered no data on clinical outcomes, and it was not clear if the patients’ actual symptoms had improved or indeed whether the patients lived or died. At the outset, 26 patients were assigned to receive hydroxychloroquine, six more than the 20 who appeared in the final results.
  • The six additional patients had been “lost in follow-up,” the authors wrote, “because of early cessation of treatment.” The reasons given were concerning. One patient stopped taking the drug after developing nausea. Three patients had to be transferred out of the institute to intensive care. One patient died. (Another patient elected to leave the hospital before the end of the treatment cycle.)
  • “So four of the 26 treated patients were actually not recovering at all,” noted Elisabeth Bik, a scientific consultant who wrote a widely circulated blog post on Raoult’s study. She paraphrased the sarcasm circulating on Twitter: “My results always look amazing if I leave out the patients who died.”
  • The report was also riddled with discrepancies and apparent errors.
  • This apparent sloppiness was unsurprising to many of those who have tracked Raoult’s work in the past. A prominent French microbiologist told me that, in terms of publication, Raoult’s reputation among scientists has been “long gone” for some time.
  • Beyond its apparent errors and omissions, the study’s design — its small size, its flawed control, the unrandomized assignment of patients to the treatment and control groups — was widely viewed to render its results meaningless. Fauci repeatedly called its results “anecdotal”;
  • Large, well-controlled randomized trials are by no means the only way to arrive at useful scientific insights. Their utility is that they enhance statistical signals such that, amid the noise of human variability and random chance, even the faint effect of some new treatment can be detected.
  • The results of his initial trial have yet to be replicated. “I think what he secretly hopes is that no one will ever be able to show anything,”
  • The prime statistical hurdle that any proposed treatment for Covid-19 will have to overcome — one that is delicate for even Raoult’s critics to make note of, amid the sorrow and fear of this pandemic — is that the signal is likely to be very faint, because the disease is, in the end, rarely fatal. Nearly everyone survives; an effective treatment will save the life of the one or so patients in every hundred who would not have lived without it.
  • “Alzheimer’s drugs, obesity drugs, cardiovascular drugs, osteoporosis drugs: Over and over, there have been what looked like positive results that evaporated on closer inspection. After you’ve experienced this a few times, you take the lesson to heart that the only way to be sure about these things is to run sufficiently powered controlled trials. No shortcuts, no gut feelings — just data.”
  • “I’ve invented 10 or so treatments in my life,” Raoult told me. “Half of them are prescribed all over the world. I’ve never done a double-blind study in my life, never. Never! Never done anything randomized, either.”
  • “When you tell the story, it’s extremely straightforward, no? It’s subject, verb, complement: You detect a disease; there’s a drug that’s cheap, whose safety we know all about because there’s two billion people who take it; we prescribe it, and it changes what it changes. It might not be a miracle product, but it’s better than doing nothing, no?”
  • Raoult had by then begun to lose his composure. He accused Lacombe of being a shill for the pharmaceutical industry; his fans sent her death threats. On Twitter, he called Bik, the consultant who wrote critically about the first study, a “witch hunter” and called a study that she tweeted — one of several published in April and May that seemed to suggest that Raoult’s treatment regimen was ineffectual or even harmful — “fake news.” The authors of another such study were accused of “scientific fraud.” “My detractors are children!” Raoult told an interviewer.
  • It is possible that hydroxychloroquine and azithromycin are an effective treatment for Covid-19. But Raoult’s study showed, at best, that 20 people who would almost certainly have survived without any treatment at all also survived for six days while taking the drugs Raoult prescribed.
  • In recent weeks, Raoult has in fact tempered his claims about the virtues of his treatment regimen. The published, peer-reviewed version of the final study noted that another two patients had died, bringing the total to 10. Where the earlier version called the drugs “safe and efficient,” they were now described merely as “safe.”
  • He has shown flickers of what appears to be doubt.
  • “I don’t trust popularity,” he told the interviewer. “When too many people think you’re wonderful, you should start to wonder.” His initial YouTube video, “Coronavirus: Game Over!” has also been renamed. The new language is more measured, and in place of the exclamation point there now stands a question mark.
Javier E

Seeking Academic Edge, Teenagers Abuse Stimulants - NYTimes.com - 0 views

www.nytimes.com/...eenagers-abuse-stimulants.html

adolescent abuse stimulants academic competition drugs

shared by Javier E on 17 Jun 12 - Cached
  • Adderall, an amphetamine prescribed for attention deficit hyperactivity disorder that the boy said he and his friends routinely shared to study late into the night, focus during tests and ultimately get the grades worthy of their prestigious high school in an affluent suburb of New York City. The drug did more than just jolt them awake for the 8 a.m. SAT; it gave them a tunnel focus tailor-made for the marathon of tests long known to make or break college applications.
  • “Everyone in school either has a prescription or has a friend who does,” the boy said.
  • Pills that have been a staple in some college and graduate school circles are going from rare to routine in many academically competitive high schools, where teenagers say they get them from friends, buy them from student dealers or fake symptoms to their parents and doctors to get prescriptions.
  • ...23 more annotations...
  • “It’s throughout all the private schools here,” said DeAnsin Parker, a New York psychologist who treats many adolescents from affluent neighborhoods like the Upper East Side. “It’s not as if there is one school where this is the culture. This is the culture.”
  • The D.E.A. lists prescription stimulants like Adderall and Vyvanse (amphetamines) and Ritalin and Focalin (methylphenidates) as Class 2 controlled substances — the same as cocaine and morphine — because they rank among the most addictive substances that have a medical use.
  • merely giving a friend an Adderall or Vyvanse pill is the same as selling it and can be prosecuted as a felony.
  • While these medicines tend to calm people with A.D.H.D., those without the disorder find that just one pill can jolt them with the energy and focus to push through all-night homework binges and stay awake during exams afterward. “It’s like it does your work for you,”
  • But abuse of prescription stimulants can lead to depression and mood swings (from sleep deprivation), heart irregularities and acute exhaustion or psychosis during withdrawal, doctors say. Little is known about the long-term effects of abuse of stimulants among the young
  • the pills eventually become an entry to the abuse of painkillers and sleep aids.
  • “Once you break the seal on using pills, or any of that stuff, it’s not scary anymore — especially when you’re getting A’s,” said the boy who snorted Adderall in the parking lot. He spoke from the couch of his drug counselor, detailing how he later became addicted to the painkiller Percocet and eventually heroin.
  • “Children have prefrontal cortexes that are not fully developed, and we’re changing the chemistry of the brain. That’s what these drugs do
  • The number of prescriptions for A.D.H.D. medications dispensed for young people ages 10 to 19 has risen 26 percent since 2007, to almost 21 million yearly, according to IMS Health, a health care information company — a number that experts estimate corresponds to more than two million individuals.
  • Doctors and teenagers from more than 15 schools across the nation with high academic standards estimated that the portion of students who do so ranges from 15 percent to 40 percent.
  • “They’re the A students, sometimes the B students, who are trying to get good grades,”
  • “They’re the quote-unquote good kids, basically.”
  • After 30 minutes, the buzz began, she said: laser focus, instant recall and the fortitude to crush any test in her path.
  • “It wasn’t that hard of a decision. Do I want only four hours of sleep and be a mess, and then underperform on the test and then in field hockey? Or make the teachers happy and the coach happy and get good grades, get into a good college and make my parents happy?”
  • Madeleine estimated that one-third of her classmates at her small school, most of whom she knew well, used stimulants without a prescription to boost their scholastic performance. Many students across the United States made similar estimates for their schools, all of them emphasizing that the drugs were used not to get high, but mostly by conscientious students to work harder and meet ever-rising academic expectations.
  • Every school identified in this article was contacted regarding statements by its students and stimulant abuse in general. Those that responded generally said that they were concerned about some teenagers turning to these drugs, but that their numbers were far smaller than the students said.
  • This is one of the more vexing problems with stimulants in high schools, experts said — the drugs enter the schools via students who get them legally, if not legitimately.
  • Newer long-lasting versions like Adderall XR and Vyvanse allow parents to give children a single dose in the morning, often unaware that the pills can go down a pants pocket as easily as the throat. Some students said they took their pills only during the week and gave their weekend pills to friends.
  • She said many parents could push as hard for prescriptions as their children did, telling her: “My child is not doing well in school. I understand there are meds he can take to make him smarter.”
  • “These are academic steroids. But usually, parents don’t get the steroids for you.”
  • Asked if the improper use of stimulants was cheating, students were split. Some considered that the extra studying hours and the heightened focus during exams amounted to an unfair advantage. Many countered that the drugs “don’t give you the answers” and defended their use as a personal choice for test preparation, akin to tutoring.
  • One consensus was clear: users were becoming more common, they said, and some students who would rather not take the drugs would be compelled to join them because of the competition over class rank and colleges’ interest.
  • “Junior and senior year is a whole new ballgame,” the boy said. “I promised myself I wouldn’t take it, but that can easily, easily change. I can be convinced.”
davisem

U.S. Halts Aid Package to Philippines Amid Drug Crackdown - The New York Times - 0 views

www.nytimes.com/...philippines-us.html

shared by davisem on 16 Dec 16 - No Cached
  • The United States said on Thursday that it had deferred giving economic aid to the Philippines because of concerns about the rule of law as the brutal campaign on drugs under President Rodrigo Duterte appears to show no signs of slowing down
  • The Millennium Challenge Corporation, set up by the United States government to reduce poverty around the world
  • The United States has been openly critical of the Philippines’ bloody crackdown on narcotics, in which over 2,000 people have been killed at the hands of the police since Mr. Duterte assumed office in June. An additional 3,500 killings remain unsolved, but about a third of those have been identified as drug-related
  • ...2 more annotations...
  • The initial grant, approved in 2010, helped modernize the internal revenue bureau, expanded programs under the social welfare department intended to alleviate poverty and rehabilitated a major road network
  • The president’s embrace of violence has shocked other countries and brought condemnation from human rights groups, but Mr. Duterte remains popular among a large segment of Filipinos weary of crime and enthusiastic about his pledge to rid the country of drug dealers
  • davisem on 16 Dec 16
     
    The United States normally send packages to the Philippines, but w halted economic aid because we are worried about the law about drugs
prendergastja

US unveils 1st plan of its kind to fight drugs in Caribbean - AP News 1/16/2015 8:00 PM - 0 views

townhall.com/...ht-drugs-in-caribbean-n1944390

shared by prendergastja on 17 Jan 15 - No Cached
  • he flow of cocaine from the Caribbean to the U.S. has more than doubled in the past three years.
  • t is the
  • first federal plan of its kind that outlines the steps federal authorities are taking and will take to crack down on drug trafficking specifically in both U.S. territories.
  • ...5 more annotations...
  • Some 100 tons (91 metric tons) of cocaine passed through the Caribbean in 2013,
  • at least 90 percent of the drugs that enter Puerto Rico end up in the U.S.
  • suspects relying on go-fast boats, ferries, yachts and even cruise ships to transport drugs.
  • Cash seizures at Puerto Rico's main international airport are at an all-time high, according to the plan.
  • Drugs are blamed for more than 80 percent of killings in Puerto Rico,
  • prendergastja on 17 Jan 15
     
    The U.S. is showing a new plan to fight drug trafficking made by the Obama administration. This plan will focus on the Dominican Republic and especially Puerto Rico. These countries have been used heavily to traffic cocaine into the U.S. The DEA is going to focus more on the vehicles coming in and out of these countries including go-fast boats, ferries, and planes.
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