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California Mobilizes for War Against Trump

by BessieHatley Posted on January 13, 2017

Mother Jones

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Here in America’s most populous state, the wealthy pay the nation’s highest income tax rate, the minimum wage will soon rise to $15 an hour statewide, more than a quarter of the population is foreign born, and the economy is booming. California, the world’s sixth-largest economy and a bastion of progressivism, is now being hailed as a kind of great blue firewall—Democrats’ most important bulwark against the retrograde policies of Donald Trump.

“If you want to take on a forward-leaning state that is prepared to defend its rights and interests, then come at us,” Xavier Becerra, the state’s incoming attorney general, taunted the president-elect in December.

“One thing that should be made very clear is that one election won’t change the values of the state of California,” Kevin de León, the Senate president pro tempore, told Mother Jones. “What we would say to the incoming Trump administration is that we hope you find value in what we do in California—by growing the economy, creating real jobs that can be verified, reducing our carbon footprint, respecting immigrants for who they are, and recognizing that diversity, a rich mosaic of different hues, is actually a strength, not a weakness.”

Soon after Trump announced Cabinet nominees that “confirmed our worst fears about what a Trump presidency would look like,” says de León, he and his colleagues in the Statehouse retained former US Attorney General Eric Holder to advise on potential legal challenges from the next White House. “He brings a lot of legal firepower to do everything within our power to protect the policies, people, and progressive values of California.”

In a state where Democrats control all statewide elected offices and a supermajority of the Legislature, the economy grew 4.1 percent in 2015—the fastest in the country and nearly double the national average. Since 2011, when Democrat Jerry Brown replaced Republican Arnold Schwarzenegger as governor, the state has turned a $26 billion budget deficit into a surplus that is projected to include upward of $8 billion for a rainy-day fund by the end of 2017. California has leveraged its booming economy to expand social services; since 2014, it has increased its budget for child care and preschool for low-income children by 24 percent, to $3.7 billion.

Trump’s bigoted rhetoric and alignment with far-right extremists during the presidential campaign alienated many people in California, which boasts an economy that in many ways is defined by immigrant labor, global free trade, and a progressive regulatory regime. A push to deport undocumented farmworkers could hurt the state’s agricultural sector. The green-energy sector fears a loss of subsidies and more drilling, maybe even in pristine federally protected waters just off the coast. Silicon Valley is suspicious of Trump on cybersecurity, trade protectionism, and the import of highly skilled tech workers. And then there is Hollywood: Meryl Streep’s condemnation of Trump at the Golden Globes this month underscored a deep antipathy for the president-elect among celebrities, many of whom have declined to perform at his inauguration.

But California’s leaders aren’t just engaging in a rhetorical war on Trump. Here’s what the Golden State is already doing to counter the president-elect on a range of major issues and defend its progressive achievements.

Climate Change

Trump famously suggested global warming is a Chinese hoax and has vowed to “cancel” the Paris Accord committing nearly every nation to curb emissions. His pick to lead the Environmental Protection Agency, Oklahoma Attorney General Scott Pruitt, is a climate change denier best known for suing the EPA in an effort to overturn its clean-energy policies. A darling of oil and coal interests, Pruitt has vowed as EPA chief to fight “unnecessary regulations” and promote “freedom for American business.”

But even if the Trump administration works to pull America back toward its carbon-spewing past, it will have little impact in California, which last year enacted a bill requiring the state to slash greenhouse gas emissions to 40 percent below 1990 levels by 2030. Recently, Gov. Brown and other state leaders said they would bypass Trump and work directly with other nations and states to reduce emissions; California already trades emissions credits with Quebec, and in 2013 the state inked a pact with China committing to joint efforts to combat climate change and support clean energy—the only such agreement China has signed with a subnational government.

California plays a unique role in setting national energy policy: Section 209 of the Clean Air Act allows California, but not other states, to set its own stricter-than-federal emissions standards for automobiles if they address “compelling and extraordinary conditions.” Other states are then allowed to adopt those regulations. To date, 10 other states, representing 40 percent of the US population, have signed on to California’s tighter efficiency and emissions rules for cars, appliances, and automobiles. “The California standard actually governs in many cases rather than the federal standard,” notes Hal Harvey, president of Energy Innovation, a policy research group in San Francisco, “because nobody wants to make two product lines.”

California plays a less decisive role in directly supporting environmental sciences and energy research, which depend heavily on federal support, but Brown has signaled a desire to step in if Trump pulls the plug. “We’ve got the scientists, we’ve got the lawyers, and we’re ready to fight,” Brown said at the American Geophysical Union Conference in San Francisco. He even suggested that if Trump follows through on some advisers’ ambitions to end NASA’s role in climate science, California could step in and “launch its own damn satellite.”

Immigration

Though Trump campaigned on the idea of deporting America’s estimated 11 million undocumented immigrants, he has more recently said he will focus first on deporting 2 million to 3 million immigrants with criminal records—a number that would presumably include many people who’ve committed minor infractions. (Only about 820,000 undocumented immigrants have been convicted of crimes, according to the nonpartisan Migration Policy Institute.) But pursuing mass deportations in California won’t be easy. A 2014 law bans state authorities from holding immigrants convicted of minor crimes for any longer than required by criminal law, thereby protecting them from being turned over to federal authorities for deportation. Many California cities have even broader “sanctuary city” policies.

Last month, state legislators introduced a package of bills that would go even further: Legislation authored by de León would bar state and local authorities from enforcing immigration laws, limit records sharing with federal immigration officials, and create “safe zones” at schools, hospitals, and courthouses where immigration enforcement would be prohibited. “To the millions of undocumented residents pursuing and contributing to the California Dream, the state of California will be your wall of justice should the incoming administration adopt an inhumane and overreaching mass-deportation policy,” de León said last month.

Other proposed bills would subsidize immigrant legal services by training public defenders in immigration law and setting up a fund to cover legal bills for immigrants caught up in deportation proceedings. Studies have shown that immigrants with a lawyer are far more likely to succeed in challenging deportation proceedings. Los Angeles last month announced a $10 million immigrant legal fund; the San Francisco Public Defender’s Office has proposed a similar $5 million fund.

More than a quarter of immigrants in the United States illegally live in California. In 1994, voters approved Proposition 187, a ballot measure making undocumented immigrants ineligible for public benefits. But since then, the state has moved sharply in the other direction. In 2011, Brown signed the California DREAM Act, allowing Californians who came to the country illegally when they were children to apply for financial aid from state colleges. In 2013, California allowed undocumented immigrants to obtain driver’s licenses, qualify for in-state tuition, and obtain law and other professional licenses. Last year, the state expanded its California-only Medicaid (Medi-Cal) program to undocumented children.

Anticipating that the Trump administration could use records collected through such programs to identify and round up undocumented immigrants, the American Civil Liberties Union is pushing for further safeguards here. “We’re concerned about ensuring that information is protected and can remain confidential,” says Jennie Pasquarella, the director of immigrant rights for the ACLU of California. “It is critical that California first show a model for the rest of the country—our values as a state that is filled with immigrants.” California’s Kamala Harris announced earlier this month that her first act as a US senator would be to co-sponsor legislation to protect the nation’s 744,000 “DREAMers” from deportation.

Health Care

Republicans and Trump have vowed to repeal the Affordable Care Act—but in California the law is overwhelmingly popular and successful. The law has provided $20 billion for the Medi-Cal program and for insurance subsidies for 1.2 million Californians, helping to cut the state’s uninsured rate by half, from 6.5 million people in 2012 to 3.3 million in 2015. Patient advocacy groups don’t want to give up those gains. In December, the California Endowment announced that it would spend $25 million over three years to defend against federal cuts to Obamacare and other social programs. “California has made great progress both economically and on the health front over the past several years,” says Daniel Zingale, senior vice president of the Endowment’s Healthy California program. “We think it is important to defend that from threats in Washington.”

Several California leaders are even pushing Trump to replace Obamacare with “Medicare for All,” a.k.a. single-payer health care. “The one I am counting on the most to push nationalized health care is Trump,” RoseAnn DeMoro, the head of the Oakland-based National Nurses United union, told Politico, citing Trump’s “international perspective” as a businessman and the fact that his wife comes from Slovenia, which has a single-payer system. Another major backer of “Medicare for All” is California Lt. Governor Gavin Newsom, who as mayor of San Francisco in 2007 launched Healthy San Francisco, a health care plan available to all city residents regardless of their immigration status, employment, or preexisting conditions.

Marijuana

Trump’s pick for attorney general, Alabama Sen. Jeff Sessions, last year killed a bipartisan bill that would have reduced prison sentences for some lower-level drug offenders. He said last April that “good people don’t smoke marijuana” and that “we need grown-ups in charge in Washington to say marijuana is not the kind of thing that ought to be legalized.”

Though Sessions moderated that rhetoric during his confirmation hearing this week, his nomination is staunchly opposed by California’s $3 billion legal marijuana industry and its representatives in Washington. “Sessions has a long history of opposing marijuana reform, and nothing he said at the hearing suggests he has changed his mind,” Bill Piper, senior director of the Drug Policy Alliance’s Office of National Affairs, said in a press release. The DPA was a major backer of November’s successful California Proposition 64, which legalizes recreational marijuana.

In an echo of the Proposition 64 campaign, drug policy reform groups have partnered with civil rights groups such as the NAACP and LatinoJustice to oppose Sessions on the grounds that the war on drugs has fueled mass incarcerations of people of color for nonviolent offenses. They want to make sure Trump stands by his 2015 statement to the Washington Post that marijuana legalization “should be a state issue.”

Marijuana industry leaders expect California to vigorously defend Proposition 64 from any federal court challenges. “We would expect a very, very strong pushback from the state, because the reality is it’s a public safety issue,” Nate Bradley, executive director of the California Cannabis Industry Association, told the Los Angeles Times. “They have decriminalized a product, so if you don’t allow any sort of regulation in place for people to access that product, the underground market is only going to grow.”

Guns

Enthusiastically endorsed by the National Rifle Association, Trump has vowed to diminish federal gun regulations, including eliminating gun-free zones at schools and on military bases, and he supports a national right-to-carry law for concealed guns. During the presidential campaign he also suggested he would appoint an explicitly anti-gun-control justice to the US Supreme Court.

But California this year further strengthened its gun laws, which were already among the toughest in the nation. In July, Brown signed off on legislation that outlawed the possession of ammunition magazines that hold more than 10 bullets, required background checks for the purchase of ammunition, and banned the sale of certain types of semi-automatic assault rifles. Proposition 63, approved by voters in November, added requirements for owners to report lost and stolen guns and created a system for confiscating guns from felons.

“The United States is a federal republic, not a monarchy, and California plays an outsized role in our nation’s success,” Lt. Governor Newsom, the architect of Proposition 63, said in a statement to Mother Jones. “The reduction of our state’s gun violence rate is a model for the nation and we’re resilient, flexible, and well prepared for any effort by the NRA and the President-elect to make California a Wild West again.”

One place where California hasn’t pushed back much against Trump since the election is Silicon Valley. A few rank-and-file tech workers have held meetings with civil rights groups, but tech CEOs have quietly sidled up to the president-elect. A few weeks ago, a handful of top tech names climbed Trump Tower for an awkward photo op with Trump and his children. “We definitely gave up a little stature now for possible benefit later,” one source told Recode’s Kara Swisher at the time. “It’s better to be quiet now and speak up later if we have to, and save our powder.”

The San Francisco-based Electronic Frontier Foundation, which defends free speech and privacy on the internet, took out a full-page advertisement in Wired magazine in December, warning the technology community, “Your threat model has changed.” The ad calls upon tech companies to secure their networks against an incoming Trump administration by encrypting user data, scrubbing data logs, and disclosing government data requests while fighting them in court.

“For California, Trump is creating a lot of fronts where organizations and government are going to be fighting battles,” says Dave Maass, an investigative researcher at EFF. “We are focused on civil liberties and privacy, and we believe they are fundamental to whatever kind of activism battle that you want to fight. If you don’t have free speech and don’t have the ability to organize, then you can’t do anything.” He anticipates that California lawmakers will be generating a flurry of new bills, and that no small number of them “are going to be direct responses to Trump.”

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California Mobilizes for War Against Trump

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Republican Congresswoman Discovers Her Followers Love Obamacare

by SallySteele079 Posted on January 4, 2017

Mother Jones

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With Republicans convinced they need to repeal Obamacare ASAP but unsure of how they want to replace it, Rep. Marsha Blackburn issued a public plea for help on Tuesday. The Tennessee Republican—and member of President-elect Donald Trump’s transition team—asked the Twitter masses to take a poll on whether they like the law. Turns out Blackburn’s followers are pretty big fans of the Affordable Care Act, with 84 percent of the 7,968 votes opposing a repeal of Obamacare.

Online polls are hardly scientific. But the GOP’s hopes to make Obamacare magically disappear without having to offer a replacement took a serious hit on Tuesday, when the American Medical Association—the country’s largest organization of doctors—wrote a letter to congressional leaders demanding that any tweaks to the health care law ensure that the 20 million people who gained insurance under Obamacare don’t lose coverage. That request would be impossible to meet under the various proposals floated by Republican politicians so far.

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Republican Congresswoman Discovers Her Followers Love Obamacare

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Even After Health Care, Per Capita Income Keeps on Rising

by VonnieIronside Posted on December 30, 2016

Mother Jones

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Here’s another chart. I don’t know why I did this one. I was looking at some other stuff, and then one thing led to another. But it seemed kind of interesting. Even after you account for ever-rising health care expenditures, personal income has been steadily rising for 60 years.

This does not show medians, so don’t make too much of it. Especially over the past couple of decades, it’s skewed by the massive income increases of the top 1 percent. A more interesting measure, I suppose, would be median disposable income after median out-of-pocket health care expenditures. Maybe I’ll root around one of these days and see if I can find that.

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Even After Health Care, Per Capita Income Keeps on Rising

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California Set a Bunch of Drug Offenders Free—and Then Left Them Hanging

by BurtonBrookshir Posted on December 16, 2016

Mother Jones

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California’s experiment with releasing thousands of drug offenders from its prisons—a major step in the fight against mass incarceration—has run up against a big problem: Once they’re out, there aren’t enough social service programs to help these offenders overcome addictions and restart their lives.

At least 13,500 inmates have been freed in California since 2014, when voters passed a measure called Proposition 47 that reclassified simple drug possession as a misdemeanor rather than a felony. But the state has not yet invested enough money in treatment programs, according to a seven-month investigation by journalists at the Desert Sun, the Ventura County Star, the Record Searchlight, and the Salinas Californian. The end result: Thousands of addicts and mentally ill people have gone from incarceration to the streets, without a safety net to help them deal with substance abuse.

“Prop 47 was not a cure-all. It’s not a panacea,” Michael Romano, a Stanford law expert who helped draft the proposition, told the reporters. It succeeded in getting drug offenders out of overcrowded prisons and jails, he says, but that’s just “one piece in an extraordinarily complicated puzzle.”

It costs about $20,000 to send someone through inpatient drug treatment, which typically lasts six months to a year. It costs three times more to keep him in jail or prison for a year. Under Prop 47, the millions of dollars saved in prison costs were supposed to be earmarked for rehabilitation programs to help inmates restart their lives. The reporters—who filed 65 records requests, pored over thousands of pages of public documents, and interviewed dozens of policymakers, police officers, and former felons for their investigation—found that not a single cent had been spent yet on these programs. An agency has been working to allocate the money for a year and a half, but it just started accepting bids last month to give out its grants. During this fiscal year, which started in October, the state plans to spend $34 million of its $67 million Prop 47 fund on programs to help the mentally ill, addicts, and youth offenders.

In the meantime, drug treatment programs are struggling with long waiting lists. “People die waiting to get treatment,” David Ramage, an administrator at Impact Drug and Alcohol Treatment Center in Pasadena, which has a 90-day wait list, told the reporters.

At the same time, when new offenders land in drug court, where they have a choice of either going through probation or rehab, fewer choose rehab now—because a misdemeanor offense may be a quicker ordeal and less restrictive. The longest-running drug court program in Los Angeles has seen its enrollment drop from 80 people to just 4, the reporters found. For more, check out the full investigation here.

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California Set a Bunch of Drug Offenders Free—and Then Left Them Hanging

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The Price Is Wrong

by EduardoShultz Posted on December 15, 2016

Mother Jones

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The American Medical Association, the country’s largest professional group of doctors, wasted no time in throwing its support behind Rep. Tom Price (R-Ga.) after he was announced on November 29 as President-elect Donald Trump’s pick to be secretary of health and human services. “His service as a physician, state legislator and member of the U.S. Congress provides a depth of experience to lead HHS,” the AMA said in a press release that same day. “Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs.”

It’s not surprising that the organization, which has battled against various health care regulations, would be eager to see Price appointed. The former orthopedic surgeon has long complained that doctors face, as the AMA put it, “excessive regulatory burdens,” and his proposals would lead to increased pay for doctors. But they would also reverse reforms that have kept health care spending in check during Barack Obama’s presidency and could send costs skyrocketing once again.

For all of the controversy over health care under Obama, there has been general agreement on one area of success: Growth in health care spending has slowed. The Affordable Care Act, popularly known as Obamacare, created new schemes for paying doctors and hospitals that helped sharply reduce the annual increase in national health care spending and keep it below pre-recession levels. Both Republicans and Democrats have supported these provisions, which have centered on charging for the overall quality of care rather than for each service performed. But now Price, a longtime booster of freeing doctors from government restrictions, appears eager and able to undo them.

David Cutler, a Harvard professor who served as Obama’s senior health adviser during the 2008 campaign and helped craft the ACA, is worried that the progress on slowing health spending would stall or reverse under Price. “Price has expressed skepticism about many of the payment changes that have been ongoing and have bipartisan support,” he says. “This is quite scary, as they are starting to pay off. He seems to want to go back to the days when price was based on the volume of services provided, not the value. I don’t know if it’s a product of being an orthopedic surgeon, where that is how one earned a lot of money. In any case, I don’t think it bodes well for the vast changes in the health care landscape that are taking place.”

Much of the attention paid to Price’s plans for dismantling the ACA has focused on his proposal to undo the expansion of health insurance coverage. In short, Price would wipe away the Medicaid expansion that has given millions of poor people access to health insurance. The effect, as Sarah Kliff explains in Vox, would be to make the individual market more expensive for people who have been sick.

But the ACA wasn’t just an effort to expand health insurance. Until the 2008 recession slowed it, the cost of health care was rising at an alarming rate, accounting for an increasing share of the country’s total spending, and the trend lines projected unsustainable spending levels in the future. The ACA introduced a host of reforms and pilot programs for different schemes to reward doctors based on health outcomes in order to keep spending under control. The exact mechanisms were complex, but the basic idea was simple: The fees charged by US doctors and medical facilities were far higher than worldwide norms, and the best way to slow the growth of health care spending was to keep those pay rates in check.

Despite the hoopla this fall over rising premiums in the ACA marketplaces, the growth in health care spending slowed immensely during the Obama years, before a recent uptick. That growth peaked in 2002, at an 9.6 percent annual rate. During the recession, the rate dropped sharply, to 4.5 percent in 2008. But even as the economy rebounded, health care spending growth continued to decline, dipping to 2.9 percent in 2013—the lowest growth rate in more than half a century. It inched back up again in 2014, and earlier this month the Centers for Medicare & Medicaid Services announced a 5.8 percent growth rate for health spending in 2015—still below pre-recession levels, even though the ACA expanded insurance coverage to 20 million more Americans. A study from the Urban Institute earlier this year found that the amount the United States spent on health care under the ACA was far lower than anticipated—$2.6 trillion lower over five years.

Price has never been shy about his advocacy on behalf on doctors. When he first ran for Congress in 2004, he complained that people who lacked a background in the medical field were setting regulations and policy. Health professionals are by far the largest group funding his congressional career, having donated $3.6 million to his campaigns. The insurance industry is second, with more than $800,000 in donations.

Easing the restrictions doctors face when accepting patients with government-funded health insurance has been a central part of his health care policy proposals. When he reintroduced his Obamacare replacement plan earlier this year, he described it as “one that empowers patients and ensures they and their doctor have the freedom to make health care decisions without bureaucratic interference or influence.”

One of his key pushes over his time in Congress has been “private contracting” that would give Medicare patients access to doctors who don’t normally accept Medicare because of the lower rates it pays. But there’s a catch: The patients must pay extra fees to the doctor, on top of the rate Medicare pays the doctor. That gives doctors a perverse incentive to abandon Medicare so that they receive more from those patients than they’d get under Medicare alone. The consequence would be a reduction in Medicare participation among doctors, which would in turn reduce the government’s bargaining power in negotiating prices.

Price’s background as an orthopedic surgeon might be part of the reason he’s disinclined to support payment reforms, says Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University. Nichols notes that specialists who see patients only for specific problems have different incentives from doctors who see patients repeatedly. “They are almost perfectly tailored for fee-for-service, episodic, fix your knee, they make sure it works, goodbye,” Nichols says. “Because of that, as a class they tend to be rather skeptical of all this bundling, payment reform, incentive stuff, because they look at it like: I have a price for your knee, I fix your knee, then I’m done with you, you’re done with me.”

Price has been harshly critical of the Center for Medicare & Medicaid Innovation, an office created by the ACA to conduct experiments in new ways of compensating doctors that can, if successful, be expanded without congressional approval. Price spearheaded a letter from Republican members of Congress in September demanding that CMMI stop all of its mandatory payment reforms. “CMMI has overstepped its authority and there are real-life implications—both medical and constitutional,” Price said at the time. “That’s why we’re demanding CMMI cease all current and future mandatory models.”

Price did join the majority of both Democrats and Republicans in the House voting in favor of the Medicare Access and CHIP Reauthorization Act of 2015, which will eventually require doctors to bill Medicare patients based on quality, rather than quantity, of care. But he’s since sounded a more skeptical note, objecting earlier this year to the Obama administration’s rulemaking language on the bill because it would move doctors away from a fee-for-service model.

“He was a founding member of the tea party caucus,” Nichols says. “Skepticism of government is in his veins. If you have a natural, professional distaste, disinclination, distrust of these payment reform things, and you couple that with they’re coming from government, then it’s a double whammy.”

Price has also proposed some more extreme health care reform ideas, such as privatizing Medicare and turning Medicaid into a block grant program—in effect reducing the amount of money spent on poor people’s health coverage over time. But these large-scale changes would require acts of Congress. Many of the programs for cost control experiments and pilot programs, by contrast, are at the direction of HHS—leaving the prospective secretary in broad control of the way doctors and hospitals are paid.

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The Price Is Wrong

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Science Says Magic Mushrooms Can Help Ease the Horror of Late-Stage Cancer

by WilhelmRUAW Posted on December 1, 2016

Mother Jones

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Cancer doesn’t just ravage bodies. People stricken with life-threatening cancers are also prone to depression and anxiety, which can in turn make them more vulnerable to succumbing to the disease. So any treatment that can ease the psychological toll of cancer not only reduces suffering; it can also prolong lives. Two separate research teams—one at New York University, one at Johns Hopkins—published studies Thursday identifying such a remedy: a single magic-mushroom trip, experienced under controlled conditions with a therapist.

Even though these results are promising, they likely won’t lead to a treatment your doctor can prescribe anytime soon. In a June episode of Bite podcast, author Michael Pollan gave us a brilliant rundown on the history and science of hallucinogenic compounds like LSD and magic mushrooms (which contain psilocybin). Pollan explains how their ability to generate altered mental states has shrouded them in taboo—and made us turn away from their potential as medicines. As the NYU team notes, hallucinogens—including psilocybin—have shown promise for treating cancer stress for decades. But research on them halted in the mid-1970s, after the passage of Controlled Substance Act, which deemed LSD and magic mushrooms illegal substances.

As Pollan explained in a 2015 New Yorker piece, the gradual easing of the federal government’s “war on drugs” has opened space for a small renaissance of research. These two new studies are some of the earliest fruit of that effort. Both the NYU and the Johns Hopkins study focused on a group of cancer patients suffering from anxiety and depression, and used the “double-blind” method, meaning neither the subjects nor their therapists knew who got the real drug and who got the placebo.

The NYU team divided 29 patients into two groups, half of whom got a “single moderate dose” of psilocybin, the compound that brings the magic to psychedelic mushrooms; the other half got a dose of niacin, a common B vitamin. After seven weeks, the groups crossed over—the psilocybin-dosed patients got niacin, and vice-versa. Both also received psychotherapy.

The results were stark: A single dose of psilocybin “produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual well-being, and increased quality of life.” After about six months, these benefits persisted for most of the participants.

The Johns Hopkins study also involved two groups of cancer patients. Instead of niacin, half of them initially got a tiny, “placebo-like” dose of psilocybin, while the other half got doses similar to the ones in the NYU study. After five weeks, they crossed over. “Drug sessions were conducted in an aesthetic living-room-like environment with two monitors present,” the researchers write. They continue:

For most of the time during the session, participants were encouraged to lie down on the couch, use an eye mask to block external visual distraction, and use headphones through which a music program was played. The same music program was played for all participants in both sessions. Participants were encouraged to focus their attention on their inner experiences throughout the session.

And the results were similar to those of the NYU study: After getting a dose of magic mushrooms, patients quickly showed “large decreases” in depression and anxiety, “along with increases in quality of life, life meaning, and optimism, and decreases in death anxiety,” effects that persisted for a majority of the patients six months later.

The decidedly positive results are a big deal, because as the NYU team notes in its study, cancer patients are often treated with conventional pharmaceuticals to treat depression and anxiety, but these drugs don’t take effect very rapidly or last very long, and carry “significant side effects” that make them unpleasant to use. By contrast, a single dose of psilocybin usually produced what might be described in layman’s terms as a “good trip”—what the authors call a “psilocybin-induced mystical experience.” As for unpleasant side effects, the NYU researchers found none. Some of the Johns Hopkins patients did experience elements of what might be called bad trips after their dose—15 percent endured nausea or vomiting, for example, and 32 percent reported some form of “psychological discomfort”—but none of these adverse episodes were deemed serious.

And there were positive side effects. In a press release, Anthony Bossis, one of the NYU researchers, noted study participants reported “going out more, greater energy, getting along better with family members, and doing well at work,” as well as “unusual peacefulness and increased feelings of altruism.” Bossis stressed, though, that no one, including cancer patients, should take psilocybin on their own or “without supervision by a physician and a trained counselor.”

Of course, bringing psilocybin to market as an approved pharmaceutical will likely require years of research and regulatory maneuvering. As Pollan argued on Bite, the paranoia psychedelics can generate is not confined to people on a bad trip. “They’re very threatening substances to institutional power, whether it’s religious institutions or the state,” Pollan said.

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Science Says Magic Mushrooms Can Help Ease the Horror of Late-Stage Cancer

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Pharma Reps Pitched Doctors on Addictive Painkillers by Spelling Out “OxyContin" in Doughnuts

by AngieCharette Posted on September 23, 2016

Mother Jones

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In the late ’90s, sales reps from pharmaceutical giant Abbott Laboratories faced a conundrum: They wanted to sell the recently introduced painkiller OxyContin to an orthopedic surgeon, but the usual sales tactics weren’t working. They visited the office a couple times, but got the cold shoulder. They pitched him on the drug over lunch‚ but he didn’t seem interested.

When they learned the doctor had a weakness for sweets, they came up with a new plan: deliver a box of with donuts and other treats carefully arranged to spell out the word “OxyContin.” The surprise gift won over the doctor, who began prescribing OxyContin. “We are pleased that we have such a sweet start in developing a relationship with this ‘no-see’ physician,” the sales reps later wrote, “and we’re looking forward to sweet success with OxyContin!”

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The anecdote, which comes from the internal Abbott bulletin above, is part of a trove of recently unsealed court documents detailed in an investigation by health news site STAT. As the story explains, after Purdue Pharma introduced OxyContin in 1996, the company embarked on a massive sales campaign to convince doctors and patients alike on the benefits of treating pain with opioids. Since then, the opioid overdose rate has soared; many experts trace the origins of the epidemic back to Purdue Pharma’s campaign. In 2007, the company and its executives paid a $600 million fine for misleading patients, doctors, and policymakers about the drug’s addictive effects.

But the STAT investigation shows that Purdue was far from alone: Abbott Laboratories had signed on to a partnership with Purdue to promote OxyConton through a series of aggressive, often questionable sales tactics. Under the terms of the partnership, which started in 1996, at least 300 Abbott sales reps launched what they called a “crusade” to sell OxyContin. In return, Abbott received up to 30 percent of net sales. Critically, the deal specified that Abbott would be indemnified from legal costs involved in selling the drug—a move that would later save Abbott millions of dollars and lots of bad press. By 2006, Purdue Pharma claimed $400 in legal fees involving OxyContin. Meanwhile, Abbott had made $374 million in OxyContin commissions by 2002.

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In the “crusade” to sell OxyContin, Abbott sales reps were referred to as “crusaders” and “knights” and sales director Jerry Eichorn was called the “King of Pain.” (Eichorn, who signed memos as “King,” is now the national director of sales for Abbott spinoff AbbVie, which sells Vicodin.) Sales reps were instructed to highlight how the drug has “less abuse/addiction potential” than other painkillers; similar statements would later cost Purdue millions of dollars.

The court documents detailed all sorts of questionable sales strategies: Sales reps paid for take-out lunch at restaurants the doctors liked, giving their pitch in the few minutes it took to pick up the food—a move called the “Dine and Dash.” They gave surgeons bookstore coupons, and pitched the drug while waiting to pay. Top-performing reps—like the doughnut arrangers—were rewarded with prizes, from travel coupons to lottery tickets.

As the internal Abbott bulletin would put it: “All hail the Knights of the Round Table in the Royal Court of OxyContin!”

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Pharma Reps Pitched Doctors on Addictive Painkillers by Spelling Out “OxyContin" in Doughnuts

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Scientists Just Took a Big Step Toward Ending the Opioid Epidemic

by well Posted on August 29, 2016

Mother Jones

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Scientists are one step closer to designing a drug that relieves pain but doesn’t have the harmful side effects of today’s opioid painkillers.

The need is clear: In 2014, 14,000 Americans died from overdoses involving prescription opioids like oxycodone or hydrocodone (known by brand names OxyContin and Vicodin). The death toll from prescription opioid overdoses has roughly quadrupled since 1999. The drugs, prescribed for chronic pain, frequently lead to addiction; as many as one in four people prescribed opioids for long-term pain struggles with addiction, according to the Centers for Disease Control. When ingested in high doses, the drugs slow down breathing and can be fatal.

A team of researchers, whose work was published earlier this month in Nature, designed a compound named PZM21 that is producing promising results. Multiple experiments on mice appear to reduce pain without slowing down breathing or being addictive. When the rodents treated with the compound were placed on a hot plate, for example, they appeared to experience as much pain relief as those treated with morphine. Mice showed no preference between being in a chamber where they received PMZ21 and another where they received a saline solution.

Rather than tweaking an existing drug, as most drugs are created, the research team used a combination of computational modeling and synthetic drug generation to design a compound from scratch that would bind well with the known structure of the brain’s opioid receptors. Doing so was a four-year effort, involving researchers from Stanford University, the University of North Carolina at Chapel Hill, the University of California-San Francisco, and Friedrich-Alexander University in Germany.

Of course, there’s a long way between mice studies and a drug on the market for human use; the authors estimate it will be one to two years until the compound makes its way to the Food and Drug Administration for testing. Still, when it comes to developing a drug that could help mitigate today’s opioid crisis, Aashish Manglik, a Stanford physiologist and the study’s lead author, says he is “cautiously optimistic.”

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Scientists Just Took a Big Step Toward Ending the Opioid Epidemic

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The Black Man Whose Killing Sparked Milwaukee Riots Had Bipolar Disorder

by MarcellaEstell Posted on August 23, 2016

Mother Jones

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Sylville Smith, the 23-year-old black man whose shooting by police sparked riots in Milwaukee earlier this month, suffered from bipolar disorder and attention deficit disorder, according to his mother, Mildred Haynes. Smith had chosen not to take medication, Haynes told me, because he thought that admitting to mental illness would impede his ability to get a concealed-carry license. “He didn’t want to be disabled because he wanted a gun,” she told me. Her son had been shot twice in the past, and robbed four times, Haynes said. He wanted the weapon to protect himself.

Wisconsin is a concealed-carry state. Applicants who have been committed for treatment for mental illness or drug dependency are barred from receiving a permit, but people are not required to undergo a mental health evaluation when they apply. Haynes earlier told the Milwaukee Journal Sentinel that her son had, in fact, obtained a permit. Police officials have said the gun in Smith’s possession at the time of his death was stolen from a home in a nearby town.

In our interview, Haynes also told me that Smith had an Individualized Education Program (IEP) in elementary and high school, a specialized plan for students with learning disabilities, mental health issues, or other impairments. He had problems with comprehension and understanding, she said, and he spent time in special-education classes from elementary school onward. He also was suspended from school for behavior related to his condition.

Smith was shot by a Milwaukee police officer earlier this month while fleeing from a traffic stop. According to the official account, the officer chased Smith, who turned toward the cop holding a gun. Milwaukee Mayor Tom Barrett said body camera footage of the incident, which has not been released, confirms the police account. The department has not publicly identified the officer, but Milwaukee residents have been spreading his name and, in some cases, home address on social media—the Milwaukee Journal Sentinel says it has confirmed that this officer was the shooter.

Other recent shootings by police have involved subjects with a mental illness. Korryn Gaines, killed by Baltimore County police officers during a standoff earlier this month, had “developmental and behavioral injuries,” depression, and mood swings due to childhood lead poisoning, according to a lawsuit filed against her former landlord. In July, a health worker was inexplicably shot in North Miami after an officer took aim at an autistic patient the victim cared for. The officer, according to the police, mistook the toy car the patient was holding for a gun.

A report by the Treatment Advocacy Center last December found that 1 in 4 police encounters involve a person with mental illness, and that people with mental health problems are 16 times more likely to be killed by police than are people who lack such problems.

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The Black Man Whose Killing Sparked Milwaukee Riots Had Bipolar Disorder

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One Megadonor Is Crippling the Pro-Life Movement—and No One Knows Who It Is

by HalinaMackersey Posted on July 14, 2016

Mother Jones

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Back in January, as the Supreme Court was preparing for its most important abortion case in a generation, some four dozen social scientists submitted a brief explaining why they believed key portions of Texas law HB 2 should be struck down. The brief was a 58-page compendium of research on everything from the relative dangers of abortion versus childbirth to the correlation between abortion barriers and postpartum depression. “In this politically challenged area, it is particularly important that assertions about health and safety are evaluated using reliable scientific evidence,” the researchers declared.

Six months later, the material they submitted clearly helped shape Justice Stephen Breyer’s majority opinion in Whole Women’s Health v Hellerstedt, which found critical elements of HB 2 unconstitutional. This decision also handed a resounding though less noticed victory to private donors who’ve spent more than a decade quietly pouring at least $200 million dollars into the scientists’ work, creating an influential abortion-research complex that has left abortion opponents in the dust.

The research initiative dates back at least to the early 2000s and became more urgent after the high court held in 2007 that in cases of “medical and scientific uncertainty,” legislatures could have “wide discretion” to pass laws restricting abortion. Since then, a primary objective of abortion rights supporters has been to establish a high level of medical certainty—both about the safety of the procedure and about what happens when a woman’s reproductive options are drastically curtailed or eliminated.

There’s little or no publicly funded research on this controversial subject in the United States, so for years basic information was lacking—from how often patients have complications to what happens to women who want abortions but can’t obtain them.

Into this breach stepped the Susan Thompson Buffett Foundation, named for the late wife of one of the richest men in the world. Established in the 1960s, the philanthropic behemoth (which ranked fourth among family foundations in 2014 in terms of giving) is known for its focus on abortion access, training, and, more recently, prevention. It’s also known for its secrecy, often appearing under grant acknowledgements only as “an anonymous donor.”

The Buffett Foundation helped finance the development of the abortion drug RU-486 back in the 1990s. From 2001 to 2014, it contributed more than $1.5 billion to abortion causes—including at least $427 million to Planned Parenthood worldwide, $168 million to the National Abortion Federation—a track record that led one abortion foe to call Warren Buffett the “sugar daddy of the entire pro-abortion movement.” In the past 15 years, it has also made research a core part of its strategic efforts, funding such organizations as the Guttmacher Institute, a policy think tank and advocacy group that tracks demographic and legislative trends ($40 million), and Gynuity Health Projects, which focuses on medication abortion ($29 million) and work by academics abroad. Other foundations supporting research on a smaller scale have included the William and Flora Hewlett Foundation, the David and Lucile Packard Foundation, the John Merck Fund, and the Educational Foundation of America. (Hewlett is also a funder of ProPublica.)

Buffett’s main academic partner (receiving at least $88 million from 2001 to 2014) has been the University of California-San Francisco, a medical research institution with a strong reproductive health infrastructure. (Abortion opponents’ perspective is a bit different: “America’s abortion training academy,” one National Right to Life official recently called it). Historically, “it’s very unusual for foundations to fund research,” Tracy Weitz, former director of the UCSF’s Advancing New Standards in Reproductive Health project (ANSIRH, pronounced “answer’), told ProPublica in 2013. But over the last 10 or 12 years, “there’s been recognition in the philanthropic community that in order to make progress, either culturally or politically or in the service-delivery arena, there are research questions that we need to answer.”

Located in the state with the strongest record on reproductive rights, UCSF has been able to do pioneering studies without the kind of political interference that might be expected elsewhere. Indeed, California lawmakers have granted special protections for people who work in the reproductive health field, while state health agencies worked behind the scenes to facilitate a potentially controversial project that involved training non-doctors to perform abortions (see sidebar). The ANSIRH program was established in 2002 as part of UCSF’s Bixby Center for Global Reproductive Health and lists more than two dozen separate abortion-related initiatives on its website on everything from mandatory ultrasound-viewing laws to abortion in movies and TV to reproductive health access for women in the military. The funder and recipient have been closely intertwined; Weitz left UCSF to become the Buffett Foundation’s director of US programs in 2014.

Well before the Texas case, foundation-backed researchers had already begun to churn out studies aimed at debunking some of the most common justifications for new abortion restrictions: that clinics were teeming with incompetent and unscrupulous doctors; that injured, abandoned patients were flooding emergency rooms; that the psychological damage caused by grief and regret after abortions often persists for years and ruins women’s lives.

Over the past three years, their findings have influenced a string of policy changes—prompting the Food and Drug Administration to revise its labeling guidelines for abortion drugs, persuading the Iowa Supreme Court to uphold a telemedicine program for medication abortion, and convincing the California Legislature to allow health care professionals besides doctors to perform first-trimester abortions.

Read about the four ways that research changed the abortion debate. Looker_Studio/Shutterstock

The proliferation of so-called Targeted Regulation of Abortion Provider laws, or TRAP laws, like HB2—which purport to protect women’s safety and health by imposing tough rules on clinics and doctors—provided the research effort with its greatest test, yet also an opportunity to put its findings to potent effect.

Buffett Foundation money underwrote the Texas Policy Evaluation Project, the small band of demographers, doctors, and public health specialists based at the University of Texas-Austin who came together in 2011, when lawmakers slashed family-planning funding, kicked Planned Parenthood out of the Medicaid women’s health program, and required sonograms 24 hours before an abortion. “We realized that this was going to have devastating impact on the reproductive health and safety network in the state,” said Daniel Grossman, an investigator for the project who also teaches at UCSF and replaced Weitz as ANSIRH’s director last year.

Then, in 2013, the legislature passed HB 2, an omnibus bill that required abortion clinics to upgrade their facilities to surgical-center standards, mandated doctors to have admitting privileges at local hospitals, imposed new restrictions on medication abortion, and banned abortion after 20 weeks. The TRAP provisions shuttered almost half of the state’s 41 clinics practically overnight, with stark consequences, the project found. The abortion rate dropped by 13 percent and medication abortions by 70 percent. Travel distances and costs soared and wait times sometimes stretched for weeks, leading to a 27 percent increase in more dangerous (and more expensive) second-trimester procedures. Some women considered self-inducing. Some unhappily carried their pregnancies to term. Meanwhile, part of HB 2 was on hold pending the Supreme Court ruling; if it went into effect, another 8 to 10 clinics would shut and the few clinics that remained would be inundated. “They didn’t really seem to have the capacity to increase their services,” Grossman said. “It was really concerning.”

The 5-to-3 majority ruling in Hellerstedt read like a 38-page recitation of the researchers’ findings, declaring the Texas laws served no real medical purpose and created an undue burden on women’s constitutional rights. Within days, TRAP laws also toppled in Mississippi, Wisconsin, and Alabama, and abortion rights groups announced plans to challenge other types of laws—for example, 72-hour waiting periods and bans on abortions after 20 weeks. “Abortion restrictions cannot rely on junk science,” said Stephanie Toti, an attorney with the Center for Reproductive Rights (which has received more than $20 million in Buffett funding since 2001). “There has to be credible scientific evidence to support the law, and there has to be a determination that the benefits of the law outweigh the harm.”

Some abortion opponents have been quick to argue that the research is not credible, in some cases because the people who do it are biased. Justice Samuel Alito insisted the Texas Policy Evaluation Project’s analysis of clinic closures and capacity was unconvincing. “Research is fine when it illuminates an issue,” Randall O’Bannon, education and research director for National Right to Life, told a reporter for his organization’s news site. But the findings were “crafted to protect the interests of the abortion industry with scant attention to the legitimate health and safety issues of Texas women, let alone unborn babies.”

The anti-abortion movement has recently attempted to launch its own research initiative. The Charlotte Lozier Institute was established in 2011 as a policy think tank alternative to Guttmacher. The American Association of Pro-Life Obstetricians and Gynecologists holds annual conferences at which researchers who oppose abortion discuss research they’ve done on links between abortion and breast cancer, depression, and drug abuse, in addition to holding workshops on how to serve as expert witnesses. But those operations are minuscule compared with those of Buffett and ANSIRH. “The pro-choice research seems to have almost unlimited funds,” Bowling Green State University’s Priscilla Coleman lamented at this winter’s AAPLOG conference. So far, researchers funded by abortion opponents lack the infrastructure to conduct the kind of data collection and analysis that academic institutions have done. “Picking the right groups to compare, following them for a long period of time, so that you can really see what the outcomes are— it’s long and it’s hard and it’s costly,” UCSF’s Rana Barar said.

Abortion opponents have often seen data and scientific evidence as almost beside the point, acknowledged Lozier’s president, Chuck Donovan. “For most people on the pro-life side of the debate, abortion is primarily an ethical, moral, for some a religious challenge.” As a result, “a statistical base, an analytical base has gone a little bit undernourished.” Individual researchers have been stymied by mainstream medical hostility, Steven Aden, senior counsel at the conservative legal powerhouse Alliance Defending Freedom, said this spring. “It is extraordinarily difficult to get even a solid study peer-reviewed and published.” And when it does happen, “because the politics are against them, they are subjected to a beat-down campaign, sometimes even when what they’re arguing is fairly straightforward.” Often the best those efforts could hope to achieve was to “generate uncertainty,” as Mary Ziegler, a law professor at Florida State University and author of After Roe: The Lost History of the Abortion Debate, put it. Before Hellerstedt, that was often seen as enough: “The idea was if there’s uncertainty, the tie-breaker goes to the lawmakers,” Ziegler said.

Even before the Texas decision, abortion foes had begun to shift away from women’s health and safety, instead expanding restrictions (such as longer mandatory waiting periods and tougher parental consent laws) and renewing the focus on protecting fetuses: “The science of fetal development is a burgeoning area,” Aden said.

Researchers funded by the Buffett Foundation and others, meanwhile, have mounted projects that look at the impact of abortion restrictions in Georgia, Utah, Ohio, and Tennessee.

“The role of research and the nature of relevant research will be different in different contexts,” CRR’s Toti said. “But what the court made clear is that abortion restrictions are going to be evaluated on an evidence-based standard. States can no longer rely on speculation about the potential benefits of a law.” The question now, she said, is “what actual benefit does a regulation provide and how does that compare with the extent of the burden the law is going to impose on women.”

ProPublica’s Sarah Smith contributed research help.

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