It does not take much, I had injury that resulted in a prescription and once it's no longer hitting just the pain receptors (I don't really understand how this all works or claim to) and you feel the "calming" effect you can pretty quickly see why it can become so addictive and scary. Even being educated, happy, well-off, and aware you can fall to these type of addictions, I can't imagine how hard it must be for many others.
i am a foreigner trying to understand this issue: why don't they just stop prescribing opium based pain killers to the general public and limit them to cancer patients - like they do in the rest of the world, wouldn't that scale down the crisis? How did the problem get this large? Even Imperial China went to war when Britain started pushing Opium to the public, why wasn't this whole thing stopped much earlier?
Opium-based pain killers are the most reliable way to ease pain without causing organ damage in the near term.
Drugs like Advil and Tylenol cause organ damage even at small doses and are thus unusable for extreme pain.
Opiates are used the world over for pain relief, not just for cancer patients. If we had a way to ease pain with something non-addictive that didn’t cause immediate organ damage that would be great.
The key difference is the easy availability in the US. It seems to me that the GPs are eager to prescribe you some opiates, whereas here in the Czech Republic they would have to go through quite a lot red tape to do that. Which, given the potential harm, seems like a good idea. (Even though we do have some problems with opiates not being used often enough. But compared to the US situation that’s a great problem to have.)
Much has been written on the Sackler family this year, including the article below, but rest assured they are embedded deep in politics and popular culture behind the scenes. Not so easy to simply sue them out of business.
Few people actually have the resources to pursue legal remedies and given the demographics of those affected by opioid addiction, I'm completely unsurprised.
I'm not sure how you'd identify participants. Medical privacy rules would prevent you from taking the typical "this consumer product causes warts so we'll find everyone on record of having bought one" approach.
I guess as someone who doesn't own a TV I've not been exposed to much of that, but I do wonder whether the success rate of such an initiative would be lower among opioid addicts. "Please step forward, admit to the world you're addicted, and in 10-15 years you might get a coupon for free drugs."
Also, what are we really looking for? Do addicts really know whether they were overprescribed? Is being addicted sufficient cause for a lawsuit?
Anyway, I'm not saying it's unsolvable, but I can imagine some tougher hurdles than the class action suits I've been privy to.
That isn't the sole reason, but if you compare the "shadowy financier" tone of many stories about right-of-center families to the stories about opioids, you'll see that the "shadowiness" component of the reporting suddenly disappears.
The only part of the above link that would speak to this says:
[Living in Texas] in a modern hilltop mansion on the outskirts of the city, in an area favored by tech entrepreneurs. According to tax disclosures from his personal foundation, he has continued giving money to Yale, but his largest donation in 2015 was a hundred-thousand-dollar gift to a neoconservative think tank, the Foundation for Defense of Democracies.
It's not all democrats. Rep. Tom Marino, the main force behind the bill limited the DEA's ability to fight against these companies is a republican. Also Trumps nominee to become the next drug czar.
It's false, but fair to say the family is involved in both political parties. They seem to lean more towards the Democrat side, but that's to be expected given Obama's two terms.
The reason it matters is that political clout and general goodwill helps shield them from legislative action and judicial inquiry.
When the truth of one issue goes against a person's political leanings, that person will generally say whatever they can to avoid feeling guilt or shame.
Heroin is a Schedule I (in the US) which means no medical benefit, and its a 20 year felony for distributing it. There is also the Federal Analogue Act, 21 U.S.C. § 813, which is supposed to group similar drugs in the same category. So, how do these companies get away with selling analogs of heroin? Shouldn't the people who work there and make money off these opioid drugs be arrested? Why haven't they?
If that is a serious question its because the drug analog act explicitly excludes certain drugs from being defined as a drug analog including drugs approved by the FDA.
> (C) Such term does not include -
(i) a controlled substance;
(ii) any substance for which there is an approved new drug application;
(iii) with respect to a particular person any substance, if an exemption is in effect for investigational use, for that person, under section 355 of this title to the extent conduct with respect to such substance is pursuant to such exemption; or
(iv) any substance to the extent not intended for human consumption before such an exemption takes effect with respect to that substance.
MDMA is Schedule I also even though it's proven to be a breakthrough treatment for PTSD at dosages that are completely harmless to the body. "No medical benefit" is a complete clown.
If I recall correctly Germany offers diamorphine opoid maintenance programs. Get daily injections of heroin under medical supervision. Sounds heavenly honestly.
Because what they sell isnt on the schedual and does have medical use. Hate opiods addiction and overprescription, but dont forget that these things have a place.
Absolutely yes. We don't want to go back to a world without drugs for chronic and severe pain.
For all the hoopla around the addiction problem, we must never forget there are real people who need these things. With some of the treatment options, as I understand it, it's even possible to be an addict and a functioning member of society.
I start worrying in public discussions when people ascribe too much good or evil to inanimate objects. Drugs are tools, like a lot of other things. They can do great good or evil. It's how we use them that makes the difference. Education will get us a lot further in helping folks than prohibition ever will.
> With some of the treatment options, as I understand it, it's even possible to be an addict and a functioning member of society.
Absolutely. Unfortunately it's often very hard to get good treatment options. A close friend of mine has to travel 45 minutes each way, each day, to get to a clinic where she pays $20 each day.
...and she's fortunate that she was able to get a spot there after spending months buying suboxone from other addicts because she couldn't get a doctor to prescribe it because doctors are constrained on how many prescriptions they can write.
When you're poor and have no reliable transportation, that's a brutal way to live. Falling into addiction is easy, and often you never truly escape.
That word, need, the the heart of the pain issue. Often they don't need it in the sense that they will not die if they don't get it. Pain itself rarely kills. Conversely, the stats are now pointing to patients living shorter lives on opioid than not. So an argument comes that they really have no medical need. But nobody wants to live in a world with so many people in chronic but treatable pain. That's just mean. I have no medical need for lidocaine but it sure makes having my tooth drilled less horrific. Balances need to be struck. Balance is not an easy word when dealing with addictive substances.
This one is interesting because it deals with a young short seller, Chris Drose, that caused a lot of share price decline in a stock I once held, likewise by writing an article for SeekingAlpha.
This is the other stock he did that to, but his article was retracted... of course, only after the stock tanked huge, and continued to tank more afterwards. He must have made a fortune.
Investors that investigate companies, identify hidden problems and report on them to the public help enable more accurate price discovery. This wouldn't happen at all if they couldn't trade against it.
For instance, I recall a story where a hedge fund sent PIs to determine that a factory reported running was actually closed down. They can't just trade against that info - it also has to be made public for them to realize gains. I can't imagine how you'd consider activity like this "getting away with it", when the alternative is companies performing unscrupulous acts in secret.
I wasn't criticizing the act of short selling itself. I was criticizing the concept of an individual writing what amounts to a hit piece that was later retracted, and yet profiting off it despite the fact.
Or, in the first case, alleging that a company led to the death of an individual, when later the charge of murder was dropped.
It piqued my interest that in both cases, the meat of his allegations are at least highly ambiguous.
As someone whose job is not nearly as difficult as working with opioid addicts, it would be difficult to condemn such people without damning evidence.
That a person having respiratory issues might not be thought of as requiring hospitalization to me seems like something that could happen without negligence on the part of a rehab facility.
And the idea that rehab facilities are inherently motivated by greed when compared to cheaper outpatient programs based around prescriptions seems to infer malice when the obvious conclusion is that some people really believe that approach is superior. This claim is the type of thing that a competitor might believe but nobody else should.
> That a person having respiratory issues might not be thought of as requiring hospitalization to me seems like something that could happen without negligence on the part of a rehab facility.
That a person having respiratory issues might not be thought of as requiring his oxygen tank refilled strikes me as pretty clearly passing the "reasonable person" test for negligence, on the grounds that if I - with no first aid training to draw on - happened upon someone in such a strait, that would be among the first things I thought to check, once it was evident the person's airway was patent. It seems like an obvious enough concern, after all.
On the other hand, I do carry glucose tablets in my satchel against the possibility of happening on another person with diabetes in severe need of a blood sugar boost, so perhaps I am simply not in all respects a reasonable person.
They charged the company with murder, which is a first for the legal system. That concept barely makes sense. Who at the company was at fault, and why? The company itself is a legal fiction.
And now you have false allegations mounted against Kratom for the purpose of banning it. People were using Kratom to get themself off the heavy drugs with minimal side-effects. But we can't let all that money go to waste, instead they want only publicly available addiction remedy to go to expensive treatments and expensive drugs.
I cannot understand why the Government is not acting against the pharmas profiting from this crisis. And why people are not revolting. There is a clear nexus between pharmas and doctors. Something should be done.
Between 2006 and 2015, Purdue and other painkiller producers, along with their associated nonprofits, spent nearly nine hundred million dollars on lobbying and political contributions—eight times what the gun lobby spent during that period.
And the revolving door:
He had also enlisted Rudolph Giuliani, the former mayor of New York, and his associate Bernard Kerik to preëmpt any government crackdown.
Not exactly. If money speaks than the cannabis would be generally accessible in every state because it brings in huge amount of tax to government and income for companies.
Money did speak... 90 years ago when interested (and wealthy) parties saw to it that weed be made illegal. It has been banned ever since and so there hasn't been almost any opportunity for the money in the marijuana business to do any speaking. That is the real reason that pharma businesses lobby against legalization of it. Not just because it would hurt their business directly (lost sales) but because weed businesses would be able to legally lobby against pharama's interests.
Indeed. I work at a local clinic and see the fallout of the opioid crisis on a daily basis.
I'm always surprised how the Opium Wars seldom comes up in these discussions.
Opioids are quite effective at coaxing a population into complacency. Unless the government intervenes, I don't see the problem slowing down anytime soon.
As someone else pointed out, the lobbyists are very influential...
I cannot understand why people are not revolting against the health care system in general.
This crisis is not about pharma in particular, it's about the entire system. In fact, the opioid crisis illuminates a lot of the problems with the system at once.
Pharma benefits because it creates a market for their drugs.
Physicians benefit twice, because the initial prescribers get the seekers and then the "addiction specialists" get to profit when someone tries to come clean and are required to go to them to do so.
There's no oversight because the foxes are in charge of the henhouse. I.e., we say "physicians are the only ones who are really positioned to understand and regulate the system."
The criminal justice system benefits because they get to treat everyone as a criminal. Cause that's the right way to approach the drugs, right? Oh, and cracking down on drugs has really improved society in the US and elsewhere right?
The FDA is revealed to be useless because it's banning harmless drugs like cannabis and kratom while allowing harmful drugs to be used under the assumption that the monopolies they're granting (to pharma, physicians) are selfless, competent experts who only have the patients' well-being in mind.
And I'm sure all this is being charged and reimbursed appropriately?
The US healthcare system is a protection racket enabled by the government.
Why would people revolt? I had a surgery last year and in pre-op room as anesthesiologists questioned patients about what they were taking, I heard two guys explain why they were on fentanyl patches. They defended their use of them.
So many older men are on opioids for chronic pain. They're not going to revolt when their alternative is no solution to their problems.
When they become heavily addicted and it's too late, an American sentiment of personal responsibility kicks in.
I agree. This is a human rights issue happening right under our eyes, but we're so wrapped up in opiophobia and supposed benevolent paternalism to see it.
The people who use them for dealing with chronic pain have been devastated by this war against them and their medicine. Many are committing suicide rather than face the pain without their medicine, and yes the medicine is being taken away, with "stopping the opioid epidemic" given as justification. It is truly sick what we're doing out of ignorance as a society. I've seen very few profiles of people in the media (beyond the Pain News Network), so most non-pain patients have no idea about this world and what they are doing to their neighbors.
can put things into perspective. I know it's hard for people who have never experienced chronic severe pain to not understand why these medications are needed. the same as I look at normal people and can't remember what it's like to not be in pain.
I can't help but feel that these medications are being vastly over prescribed by doctors.
Why is this not a problem in other countries? Either the number of people suffering from chronic pain in the U.S is way higher (percentage wise) than in other countries (why?) or the doctors are prescribing extremely dangerous medicine as if it were candy.
From my experience there are two factors I can see:
Due to end user advertising the US a lot of people are tuned into taking drugs. It's just a part of life. I am 50 and people seem to be baffled when I tell them I don't any prescription drugs unless I have something acute. I see tons of people taking antibiotics and pain killers immediately when they have a problem. That starts from childhood on.
Doctors in the US are really quick prescribing hardcore drugs. I have had several occasions when I had an injury like a bruised and got a Cocktail of vicodine and muscle relaxers. They make you feel real good quickly and I can totally see how people can get addicted. In addition people who have withdrawal symptoms get cut off cold turkey and get no help. I guess that's even more so in low income populations that barely get any healthcare.
The NewYorker article mentioned above explains some of the reasons, ranging from misleading marketing to more nefarious tactics. The article is worth reading.
Keep in mind, as you watch this, 60 Minutes never asks "Why wasn't the lack of receiving data a red flag?" Sure the DEA is supposed to get various things submitted to it. But does it have to be so trusting? (Hint: No not at all.)
This is true. The mechanism is decentralized, and so very powerful. In capitalism speech is proportional to money, so those with money speak more loudly and more often than others. The Adam Smith ideal is that successful capitalists use their soapbox to ideologically reproduce. However, the soapbox is used to mislead, weakening society at large to enrich oneself. Each individual is weakened only slightly, but in aggregate the benefit to the attacker is enormous.
Doves want drugs. A smart business wolf constructs a sophisticated machine (business) that in order to sell drugs, hires genius level lawyers and chemists (techie wolves) to do an end-run around the law, strengthen legal and technical barriers-to-entry, and perhaps make a good side-business with private law-enforcement in several ways (make new addicts, fund recovery programs, sell recovery drugs, and also sell private prison services, which is the most lucrative of all).
It's thoroughly, blatantly evil. The law is clearly insufficient to control the wolves - it may even be that US democracy is insufficient to control the wolves, since doves can't even be counted on to vote in their own interest, thanks in no small part to being mentally disabled by the wolves.
"what federal officials Thursday called the “largest ever health care fraud enforcement action” by the Medicare Fraud Strike Force, 412 individuals, including 115 doctors, nurses and other licensed medical professionals, were arrested in a nationwide operation that involved more than 1,000 law enforcement agents in at least 30 states."
I have a lot of friends in the treatment business and some of the stories I’ve heard of unethical providers are absolutely shocking.
Ignoring the urine testing schemes, in the worse areas people will sometimes pay clients to relapse after they leave a program so that they can reenroll and they can bill insurance all over again.
Google AdWords for treatment became such a problem that Google stopped allowing them because unethical centers were basically killing people.
Don’t even get me started on the altnernative “treatments” out there. In a town near me there is a place that will give you amino acid injections and claim that’s all one needs to get clean.
It’s obscene that this happens and unfortunately as a consumer it can be hard to separate the good from the bad if you are desperate for help.
I had a similar experience though the treatment providers were actually trying to work in the patient's best interest.
I had a family member who was in and out of treatment for a disorder and discharge was largely dictated by the insurance company against the recommendation of everyone else involved.
Without saying as much, the treatment providers strongly implied a quick relapse and return to the facility would ultimately be the best thing because it would reset the clock with insurance.
I just don't see this issue the way others do. "Capitalism" or profit motive certainly is interacting problematically with the issue. But profiteers are not, per se, why we have an opiod epidemic to begin with. The roots of that look pretty complicated.
One of the roots is hopelessness. We need to pass universal basic healthcare and solve the affordable housing crisis to make headway on that.
Another is, frankly, the success of modern medicine. You can live for decades these days with debilitating conditions that would have just killed you decades ago. And this often means living with a lot of pain.
Figuring out how to not just improve lifespan but also quality of life is the answer to that. And it is no small ask. It is quite the tall order.
I comment on this fairly often, so I saw no reason to do a long write up and lots of reasons not to. If you are curious as to my thinking on the matter, you can just ask rather than taking swipes at me.
There's nothing to support your assertions on the first page of your current threads page [0], so could you explain your reasoning?
It seems like a real pain to put the argument in words here, so is there an opinion piece somewhere which argues more or less what you argue? You write professionally, so have you recorded your position somewhere?
But I don't know that it will seem pertinent to you. So let me try to give you a nutshell version:
Average size of new homes in the US has more than doubled since the 1950s. Meanwhile, average number of occupants has dropped.
We tore down up to 80 percent of SROs, a low cost form of housing that used to be common, but now has to be explained because people don't know what they are, so here is a link in case you don't know: https://en.m.wikipedia.org/wiki/Single_room_occupancy
Healthcare in the US accounts for a crazy high percentage of expenses and this disproportionately impacts the poor.
If 20 percent or more of your income is eaten by healthcare and 50 percent or more is eaten by housing costs, life will be pretty damn bleak and UBI won't solve it. This likely is a large factor in things like the opioid crisis and rising suicide rates.
Poverty in the US should not routinely mean homelessness or being unable to afford essential healthcare. It should mean you live in a tiny speck of an apartment and you can't afford a fancy wardrobe.
The way we abandon our own people in a very rich country is monstrous and certainly promotes depression for a lot of people. I spent years homeless and asking for help to figure out how to make money online from people who make money online. The way I was treated was pretty psychologically scarring.
I'm a tough cookie and have more support than is apparent from my general lack of sufficient income. If I had less education or less social support or whatever, I would not have overcome all that. I would have been destroyed by it.
So I infer that's an issue for many Americans.
You aren't required to agree. That's just what I think.
> If 20 percent or more of your income is eaten by healthcare and 50 percent or more is eaten by housing costs, life will be pretty damn bleak and UBI won't solve it. This likely is a large factor in things like the opioid crisis and rising suicide rates.
Figures do seem to indicate an increase between 2001 and 2009 in health care spending as a percentage of income, but isn't most of this a difference in real after-tax income? It's hard to make heads or tails of post-2010 data because of the PPACA. As for SRO, do you have some idea of why these properties have been disappearing? Has it become a bad deal for aesthetic/cultural reasons, or is it a matter of excess liability for the landlords? The Wikipedia article for them seems to suggest that they just don't make sense anymore for landlords in San Francisco at least. It seems to me like a simple matter of places becoming more financially valued, and therefore no longer viable places to rent for anyone below the naturally matching income bracket. If you want affordable housing, you'll have to travel a few kilometres in any other direction (this of course being especially hard for coastal cities, where you're typically restricted to 170 or fewer degrees of sprawl which may or may not offer attractive employment.
I'm not sure what your point is about healthcare costs. People at the bottom are being pinched. As it gets gradually worse, it forces more people into dire straits.
Somewhat recently I visited a webpage that referenced Gabor Maté's work, In the Realm of Hungry Ghosts: Close Encounters with Addiction [0] - my local library had a copy. Dr. Maté spent decades working with the most hopeless of the residents of "the drug ghetto of Vancouver's Downtown Eastside".
Part I has some anecdotes from patients - virtually 100% of Dr. Maté's patients suffered from childhood trauma. Part II goes into the science of addiction. "'It may be said without hesitation that for man the most important stressors are emotional', wrote the pioneering Canadian stress researcher and physician Hans Selye."
I went to the science library to look up the reference - Dr. Selye discussed how he came to appreciate the general syndrome of being sick, and claimed to have originated the term 'stress' into the medical lexicon. I have to wonder why good science gets ignored, while garbage science [1] persists for decades?
This theory of addiction basically matches my observations of my girlfriend's predicament. She had some childhood stress (won't get into here). After six months of my influence she was doing fine, then she got sucked into the mental health system. Her current drug treatment program costs $10,000/month, and is mostly a scam. They try real hard to be helpful, though - I think they want an 'A for Effort'.
Helping people to feel safe is most important intervention of all [2].
[2] https://news.ycombinator.com/item?id=15024780 - my comment from 134 days ago about the importance of helping people feel safe, and how drug rehab helps people feel like failures.
(minor edits)
Edit2: Dr. Maté's book tells of how one of his patients described heroin as 'a hug in a needle'... "Chapter 14: Through a Needle, a Warm, Soft Hug" [3]
The thrust of this is that opiod manufacturers should be sanctioned, charged with crimes, etc. But don't we do that already with cocaine, meth, heroin, etc.? Why should going after the suppliers work for opiods when it failed for every other drug?
The "lucrative" aspect of many of these businesses results because they register themselves as 501c3 orgs; yet they clearly operate for-profit enterprises, with active solicitation at jails and courtrooms.
The first story of the series about how a short-selling investor was able to uncover a potential murder case against a rehab company and profit from it is an interesting anecdote on how the same market incentives that we tend to blame so much on can also be a force for good.
I've been reading Dreamland by Sam Quinones, which goes into detail and background of the past ~50 years or so about how we got into this situation. A large part of the WHY you're referring to I'll summarize as
1. Pain being identified as a vital sign and hospitals/institutions new-found focus on tracking and treating pain
2. Deceptive pharmaceutical marketing that painkillers are a be-all solution to pain and also non-addictive (Purdue/Sackler seem to be worst offenders here)
This lead to doctors prescribing opioid painkillers to many of middle-class americans who would likely have otherwise not come in contact with drug addiction. The book so far has been a really good read and also goes into detail around how heroin started spreading through the rust belt as well (feeding on the existing prescription addiction). I highly recommend it (about 65% through it right now).
> Then, the new insurance laws in 2008 and 2010 transformed what had largely been a government-funded and charitable-minded field into an enticing for-profit business.
That's freaking discussing and yet another reason I refuse to pay for insurance. I'll take the fines.
It doesn't intentionally do it, because capitalism isn't a person, but when everything is monetized by our creative entrepreneurs, it grows; our problems being no exception.
Once someone makes money, they want more of it. Capitalism demands more of it. And we stretch every line of the law, even cross it, just to get more from where that came from.
Unfortunately one person suppressing their unethical behavior is inconsequential. If an opportunity exists, eventually someone will use it.
Actually the opposite. Government regulations outlaw cheap non-dangerous alternatives (like cannabis) and create a monopoly by granting patents to a single entity.
The solution is to make cannabis legal for everybody in every state for medical use and since it cannot be patented there will be many suppliers who compete with the quality and price just like it happens with almost everything that is not under very strict government regulation.
> Actually the opposite. Government regulations...
I'm from the Netherlands so you won't hear me disagree with the argument that criminalizing cannabis and drugs is not the solution[0].
Having said that, the typical undertone on HN of "regulation is bad by definition" really irks me. I can imagine that if the only perspective one has is a dysfunctional government, one might think that, but please take a look abroad and see how things work over there. Government regulations are a tool that can be used for good and bad.
[0] Also, in the US these laws are historically very much set up to target poor and black people (and I wish I had a clear picture of how things are in my own country regarding that, actually; I'm sure there's a few laws sneakily screwing over migrant workers or something), but I digress.
I think there is a lot of reason to believe that we have a uniquely ineffectual government. Excluding defense expenditures, and counting all levels of government, Canada spends less public money per capita, while having cheaper healthcare, education, better transit, etc. For example, we spend more per capita on education than any OECD country except Switzerland, and get worse results. Our federal system (where states aren’t mere administrative bodies taking direction from the central government) makes things particularly difficult. Which means the aspects of government closest to the people (roads, schools, housing, transit) are often the worst managed.
In at least one case, we have problems in part due to insufficient regulation, rather than excessive regulation. Pharmaceutical companies spend over $5 billion per year on direct-to-consumer advertising in the US; this practice is effectively illegal in Canada, although the regulations surrounding it are poorly enforced.
That $5 billion advertising spend is going to get paid for elsewhere in the health industry ecosystem, and probably several times over once all of the associated costs are considered.
I wonder some days just how much economic damage will have to be done, just how many millions of lives will need to be ruined, before the American public starts to accept that unregulated capitalism is dangerous in almost every market.
I think you are on to something looking at state governments but I don't find the answer completely satisfying because a lot of US States are similarly sized to European countries. Why should we expect the State of NY (~20M people) to have a worse government than the Netherlands (~17M people)? I don't have a great answer to this question.
Perhaps it's just the separation of government in general. People can only pay attention to so much and the attraction of national politics pulls attention away from state politics. That's just not something that happens in many other places.
I never fully realized it until now, but the US, with it's federated structure is putting itself at a competitive disadvantage to other countries.
It's the worst of both worlds, where states have a flaccid independence (they can legislate but not control their borders, thus cannot avoid the free-rider problem). Nation-wide standards that don't fall under the commerce clause have to be bribed into half-ass existence, and then only for a political season.
We're structurally incapable of benefiting from economies of scale or standardization in government.
And what to do about it? Most conservatives want smaller federal government, which reduces the aggregate size and expenditure for government, but exacerbates fragmentation. On the other hand, progressives want larger federal government, which introduces standardizing layers, but spends way more on aggregate government.
I find both of these positions frustratingly vague, and I'm eager to blame them for making the problem appear intractable. They're perfectly intuitive enough to make people have a gut-feeling for what it means without actually thinking about what it means, and in that sense avoid actually debating that, which would be productive.
What does "large" and "small" even mean? Governments are complex social/cultural/legal systems, no matter what the "size". I'm pretty sure waterbed theory applies here[0].
(This is not a critique of your post, but about the US discourse surrounding this in general. At least how it comes across to me as a European)
[0] "the observation, ascribed to Larry Wall, that some systems, such as human and computer languages, contain a minimum amount of complexity, and that attempting to "push down" the complexity of such a system in one place will invariably cause complexity to "pop up" elsewhere.",
I think we're saying the same thing. Small Federal Government either means larger state governments or a whole bunch of undesirable problems like increased pollution, job discrimination, etc, and those issues are not uniformly distributed because of the states.
There is little privatization in the U.S. in the areas I mentioned. For example, less than 10% of Americans go to private or charter schools. In Denmark, Japan, Spain, Korea, and the Netherlands, that number ranges from 20-65%. Few American roads are privately-operated (mostly some turnpikes). In contrast, all of the French autoroute (highway) system is private. Much of Japan's highway and transit system is private too.
Transit is almost entirely publicly owned and operated in the U.S. For example, Amtrak is both owned and operated by the government. In contrast, Deutsche Bahn and Eurostar are are private companies (though subsidized by the government). SNCF, though owned by the government, is run like a private company. E.g. in contrast to Amtrak, where only a single route produces an operating profit, 80% of SNCF's routes produce an operating profit. Japan's key railroads are privatized, and the biggest one (JR East) receives no public subsidy.
Anti-development housing policies that drive up prices are all done by the government (compare to Japan's lax zoning laws).
Healthcare is really the only thing that's more privatized in the U.S. versus other OECD countries, though it's less than you might think. About 50% of healthcare spending in the U.S. comes from direct public money, comparable to Korea, versus 70% in Canada or Spain, and 75-85% in Italy, Germany, France, and the U.K. However, if you account for indirect expenditures (public subsidies for health insurance), the total comes to about 65%, not much less than in Canada or Spain: http://www.pnhp.org/news/2016/january/government-funds-nearl....
And are hardly solely responsible for the opioid crisis as StreamBright suggests. Of course government could have done something to avoid this, however, they'd likely be criticized for putting forth regulations that stifle innovation and hurt businesses. StreamBright's definitely not wrong though that the prohibition of weed has exacerbated the problem.
> Having said that, the typical undertone on HN of "regulation is bad by definition" really irks me.
I think you just notice that undertone more because of your predisposition. I notice just as many pro regulation as anti regulation comments, and I think of myself as a capitalism moderate (since there are negative externalities that do not get included in the price, regulations act as corrective measures to move markets slightly in the direction they would be if those were included correctly, at least when done well).
The empirical evidence speaks in your favor, since I fully expected my remark to be downed, but instead now see a lot of supportive votes.
Mea culpa, I blame negativity bias[0]. US-centric thinking annoys me in a "don't be short-sighted" way (Eurocentric thinking too, but I have more blind spots there), and as a European, the "neutral" position for regulation is probably far more on the regulation side of things (just like how the "neutral" political leaning being very left compared to the US, for that matter).
I also suspect that hathawsh comment elsewhere is right about discourse taking more extreme positions in general, although I doubt the polarization in the US is the lone cause. Stronger opinions are always more vocal, so it is the nature of the internet, and public discourse in general to show apparent extremities within public opinion[1].
> typical undertone on HN of "regulation is bad by definition"
This is pure ancap, "Austrian school" ideology. They define regulation as bad by definition, because supposedly it goes against "freedom". This works as a clutch so that if you say anything bad against capitalism they will retort "it is regulation", even thought nobody ever saw (and never will see) an economic system without laws and regulations.
Well, you can't just blame capitalism for problems happening with government granted monopolies. You must at a minimum get some evidence that it isn't the monopoly causing the problem.
And because modern economies are to a large part composed of government granted monopolies, with almost all problems being in that part¹, nearly all "capitalism is bad" commentary is simply bullshit.
1 - Both governments tend to grant monopolies on problematic areas, and anything that a government grant a monopoly on becomes problematic. So, it can hardly be different.
The BS of this argument is to believe the governments would grant monopolies to random people for no reason. The reason there are monopolies is that capitalists have paid for this privilege, therefore they arise as a result of capital trying to starve competition, as it normally does by several means. The government in this case is simply another tool used by capitalists to keep their privileged position in the markets, not the "source of all evil" as ancaps want naive people to believe. Capitalism and monopolies are just facets of the same thing.
Not really typical, we are very diverse people with very different opinions. What is your argument? Who said government regulations cannot be good and bad? Anything about the subject?
You were responding to someone arguing that this is a byproduct of giving capitalism free, uninhibited reign (paraphrasing). You are arguing that the cause is government regulation, and that this is the opposite.
Apologies for misinterpreting if this was not your intent, but based on what I just wrote, I don't think it's a stretch to interpret that message as implying that regulation is bad in general.
What irks me is how people on the one hand believe that you can't trust companies like Google or Facebook over moderate things, and say "we need federated, decentralized alternatives," and yet when it comes to government (apart from their own pet issues) we magically trust powerful bodies with even less accountability with more important things.
you may be recalling a Hacker News from another era...at this point it is mostly aging software developers bemoaning change and harumphing most everything.
there might be a forum for legitimate hackers who are genuinely stymied by government regulation, but HN isn't it, at least not anymore
YC itself isn't much of a change agent anymore either, it has devolved into a private club for people who won in Silicon Valley
I don't know, dude. If you are talking of using camnnabis for medical use, I'm gonna want a dosage guideline and strength/purity promises.
I'm pretty sure for medical use, it will more closely resemble ibuprofen or cough medicine if it is without prescription. With prescription it'll be more like generics. It might still be a monopoly, since these drugs have to go through all the FDA testing. Heck, if you want fluoride in your toothpaste you have to go through animal testing - same for menthol in cough drops. I don't know why folks think it should be different for medical cannabis, though some folks will just use their own supply instead.
Outside of medical use, I'll guess it'll be regulated much like alcohol or tobacco. These aren't exactly lightly regulated either, though it is a much easier market to break into.
Besides, there is lots to patent. Hybrid plants, GMO plants, extraction methods for pills. Brands will be a thing, I'd think. And it doesn't mean all the other stuff won't be necessary - pot isn't a cure all, though should be an option in the arsenal. Folks will still make their money, I think.
For the same reasons we want tobacco regulated, alcohol regulated, some food regulated, and drugs regulated. The fact is that it isn't parsley, nor does it have similar effect on our body. While consuming too much might not kill you, getting to work and finding that your supposedly non-high-bringing cannabis-based pain reliever certainly made you high isn't the sort of thing one wants to find. Alternatively for recreational use, I want what the thing says on the package and would be horribly angry if I wound up with the other dude's non-high-bringing smoke. I want my "weaker" strain to be just that, just like I'd not appreciate finding out my beer/wine/whiskey is stronger than is on the package.
Cannabis in the UK is a class B drug. Possession with intent to supply carries a posible 14 year prison sentence. Possession alone has a maximum 5 year sentence, although for an uncomplicated first offence the fine would be a band B fine (100% of weekly income).
When you say "government", I hear "of the people, by the people, for the people".
When you say "regulation", I hear "market protections", eg property rights, fair & impartial courts, rule of law. In other words, no regulation means no market.
My sole notion (so far) for a more fair society is some sort of balance of power, modeled after our constitution (executive vs legislative vs courts), where regulations somehow have a third pillar. So instead of just us vs them, like government vs business, there's a third seat at the table. Like maybe producers, consumers & regulators, where the consumers have equal voice.
The correct response to bad regulation isn't no regulation but GOOD REGULATION.
There have been similar circumstances as concern snake oil, opium, cocaine, radium, asbestos, lead, safety belts, air bags, ABS, screw and nut sizes, fire exits (and suppression equipment, and risk mitigation, and alarms -- look up the Triangle Shirtwaist Factory some time), and Jim Crow, and poll taxes, and "separate but equal", and CFCs, and C02, and ....
"Capitalism" is a label that's come to mean numerous different things to numerous different entities.
But some mix of laissez-fair, small-government, complete reliance on decisionmaking at the individual level (except where corporations can impose their preferences over individuals, communities, regions, states, nations, or globally), very strong defences of some kinds of property rights, and an exceptionally high level of un-accounted externalties, seems to capture much the flavour.
That's the scary question. Legal opioids would flood the street with cheap, safe (comparatively speaking), legal morphine.
What's worse? Morphine flooding a our society as a recreational drug? Think how easily highschoolers can get beer and cigarettes, but with opioids...
But our current approach has lead to the widespread adoption of the cheapest, most concentrated, and most dangerous opioid imaginable: Fentanyl. This which has rapidly become the continent's foremost public health plague as it kills a terrifying number of people every year.
Would freely available morphine or heroin be better?
Drug and free market seems like a nasty bet IMO; too much money, too much immaturity and decrease of rationality. My bet is that most 80% of the time it will degenerate into gangs and cartels.
Legalization eliminates the gangs and cartels. The problem is that it makes abuse and misuse into a public health crisis. There are no more gangs of liquor runners - instead we have InBev. People don't go blind from bad bathtub brews anymore, but they kill themselves with overconsumption or even kill others with driving drunk.
So legal opioids would presumably mean the same: more abuse, more misuse, but safer and without the cartels.
Yes. I think a better term here might be corporate personhood, where corporations have some of the rights that people have while shielding their owners from liability.
That first definition is actually not the definition in political science circles; there, it refers to the view of society as a collection of associations ("bodies", corpora), which form the metaphorical organs of the "body" that is society. This is a term created by advocates to promote it, and so does not denote necessarily a system that undermines the public interest; the first definition I see of it is the Catholic Church's one in the late 19th century as a "system of social organization that has at its base the grouping of men according to the community of their natural interests and social functions, and as true and proper organs of the state they direct and coordinate labor and capital in matters of common interest".
If this sounds kind of creepy and dictatorial to you, you've got a good head on your shoulders.
This semantic distinction is important because a lot of modern leftist rhetoric about fascism is based on a misinterpretation of the term as used in current academic literature and in Fascist ideology of the 1920s and 30s. A defining feature of fascism is corporatism, but this does not mean the unbridled power of big business corporations and certainly is not a good description of current American society. Rather, it refers to the way that undemocratic systems co-opt the organized associations that represent interest groups ("civil society" in current political science literature). See for example the way that the Chinese Communist party traditionally ran the only trade unions, women's rights organizations, etc. in the country; or the way that the Hitler Youth and the League of German Girls replaced the Scouts and Wandervögel in Nazi Germany; or the way the Italian Fascist regime ran the economy through a council of hand-picked, compliant representatives of employers and workers. In essence, civil society is transformed from a way for groups to band together and advance their interests, into a transmission belt for the state to control those groups.
Yeah, I was thinking about that but I think corporatism is an effect of corporate personhood. If we're talking about root causes, I think it's the rights we attach to corporations.
> Unfortunately one person suppressing their unethical behavior is inconsequential. If an opportunity exists, eventually someone will use it.
This isn't solely a feature of capitalism. Any system is going to devolve into the strong eating the weak unless the strong identify with and have solidarity with the weak.
I have recently become much more willing to listen to ethno-nationalists of all ethnoses based on this realization: stripped of any imperialistic impulse it may be the best way to generate cross class identity in a given political unit. I tend to think size/scale matters as well, perhaps more so, so that the strong are forced into closer quarters with the weak and so that social interactions are iterated, leading to a better stable state.
Don't listen to the ethno-nationalists. There are other ways of building consensus than based on something as slippery as ethnicity. Nationalism per se may not be a bad thing (stripped of imperialism, as you say), but tying it to ethnicity IS bad. Tying it to culture is better, as it is something that can be taught and acquired and shared (even better is building a metaculture of sharing and appreciating other cultures in a positive-sum, which is, I think, one of the core positive attributes of the American Experiment). Don't let the ethno-nationalists (racists) own nationalism/patriotism/etc.
(Indeed, the ironically-pan-nationalist ethno-nationalism of today is largely foreign to America and is opposed to the consensus of American nationalism developed during and after WW2 and on into the civil rights era... Of course this is a thing that hasn't been entirely resolved.)
I don't believe there is strong evidence that a metaculture (really, multiculturalism) will survive and not devolve into squabbling ethnoses, particularly on the scale of the north american continent.
It seems like smaller, more homogonous political units is the best way to avoid conflict, and I don't see why that has to be malicious. My main problem with most of the ethno-nationalists that I read is that they are really racialists or pan-europeanists, which strikes me as almost (almost) as useless for generating inter-class solidarity as appealing to universal humanism.
> I don't believe there is strong evidence that a metaculture (really, multiculturalism) will survive and not devolve into squabbling ethnoses, particularly on the scale of the north american continent.
Doesn't the empirical reality of large cosmopolitan cities provide evidence that multiculturalism will work just fine?
New York City, for instance, has 8.5 million people of every race, color, creed, citizenship, language, etc. crammed pretty tightly together. That's more than the population of about 3/4 of US states. It has cultural enclaves - there are places in the city where you'll look and feel out of place if you're not, say, an Orthodox Jew, or black, or of Chinese ancestry, or whatever. (Being none of these, I've been to these places and consciously felt, well, not that I wasn't welcome to visit, but that it was someone else's home and not mine.) But it doesn't have squabbling. There's definitely been ethnic violence in the city's history, but the city generally lives together and works together just fine; it's not more violent or more dangerous than you'd expect any city of its size to be. And places which have had violence (e.g., Crown Heights after the 1991 riot) have worked pretty successfully to find ways of living together that involve neither one cultural group leaving and ceding the area to another, nor any cultural group losing its particular identity.
I expect there to continue to be multi-ethnic cities and neighborhoods within cities, which is a fairly common occurrence throughout history, particular in capital cities of empires, which is what I would describe New York as. There is no doubt that some people (particularly smart people) highly value the diversity and cosmopolitanism that cities of this form provide. On the other hand, people who value high social trust and stronger social identity would probably prefer to living in more homogenous (and less urban) environments.
It seems to me like the american continent, anyway, is large enough to give everyone what they would like, without either interfering with one another politically.
I am getting the sense that you're saying that New York City is primarily a city of smart people who value cosmopolitanism and not of people who value high social trust and strong social identity. That might be the stereotype of certain parts of Manhattan (especially of people who - and I admit I'm one of them - have voluntarily moved to the city for work), but that's not the majority of New York City at all. Come and visit Harlem or Crown Heights or Flushing. Come and walk through the parts of Brooklyn with storefront signage in Hebrew and not English. Come and take a taxi and talk to the driver about social trust or social identity. Come and talk to people who have had family living here for generations.
The evidence, as far as I can tell, is that multiculturalism is a perfectly stable approach, and people who say that we need cultural isolation are only saying that because of belief and not evidence. Of course the continent is big enough to support giving people what they want, whether or not they're rational to want it. But to the original topic of how to prevent the strong from taking advantage of the weak, I don't think there's any reason to believe that dividing people by race to force an alliance of each race's strong and weak is going to be successful, or that avoiding multiculturalism is going to be necessary.
Well, the neighborhoods you are discussing, which do have higher social trust, do have a strong ethnic identity, so I think that this may reinforce my point rather than hurt it.
I must admit that I have a more pastoral and conflict-adverse personality, so the idea of New York as an ideal is difficult for me to comprehend. I'm OK with that: there are obviously many people to whom this idea is obvious as well. My long term conclusion is we should allow these types of folks to separate and establish different political units that satisfy these needs: some of these could be relatively ethnically homogeneous, some less so. I would expect, but am willing to admit this is speculation, that you would find higher trust and cross-class identity in the more homogeneous political units.
I appreciate you taking the time to thoughtfully reply to my comments.
> I must admit that I have a more pastoral and conflict-adverse personality, so the idea of New York as an ideal is difficult for me to comprehend.
I still don't get this. I don't think that NYC is a high-conflict place at all. I'm not sure I'd quite call it "pastoral," really, but the outer boroughs are much closer to medium-sized cities in the rest of the US than to Manhattan - houses with yards and garages, strip malls with large parking lots, etc. Sure, there are areas where you're surrounded by skyscrapers and enough bright lights to ensure the city never sleeps. But that's a pretty small part of the residential population of NYC.
Or in other words, I think you'd be perfectly happy living here, given the preferences you've expressed, as long as you didn't live in Manhattan (and not wanting to live in Manhattan far from unusual!). If you find that merely being in a subway car or in line at a store with someone of a different race/culture uncomfortable, maybe NYC isn't the place for you, but I have no reason to believe from your comments that you're that sort of person.
(And you might still prefer rural areas where there are acres of land between you and your closest neighbor - which is fine! I'm not saying that we should cover the world in New York Cities. I'm just saying that it's empirical evidence that multiculturalism is stable, and not just for people who voluntarily choose in adulthood to move to a dense cosmopolitan city.)
I think you're right that there is a lot more informal, self-directed ethnic/cultural affinity than I was selling. But none of that has any level of structure that gets anywhere close to ethno-nationalism, with independent political entities and representation and policy between the ethnic enclaves. There are things like Hatzolah, yes, but there is one NYPD for all neighborhoods. There's one housing policy (and one affordable housing lottery). There's one minimum wage. There's one policy on how much to cooperate with ICE. And so forth. And there's one set of elections for influencing those things. (I would actually argue that there isn't enough political autonomy for the boroughs, but for the reason that smaller political entities are less prone to corruption and more likely to give opportunities for meaningful representation, not because different boroughs have independent and distinct cultures that require different political goals. I don't think we should have, say, two different police departments in Crown Heights for the black and Jewish communities, but I do think the police department in Crown Heights should be a smaller entity - with a smaller budget and smaller political influence - than the NYPD as it is today, possibly a Brooklyn Police Department, possibly even smaller. So I'd agree with your point above regarding size/scale, but I don't think that division on cultural or ethnic grounds is required.)
I'd believe the argument that NYC doesn't offer evidence that people will voluntarily give up ethnic/cultural identities as a way of living day-to-day. But I think it does offer strong evidence that people with these separate identities can be happy, successful, and peaceful with a single government.
Nothing is certain to work on its own. So we have to work at it to make it function.
I don't think we should let the pendulum swing too far and say "squabbling ethnoses are the inevitable end-point." That is not certain, either. People actually had to work at (spend lots of time and money) making our recent national unity start to turn into squabbling ethnoses. I fail to see why I should make their job easier by granting the inevitability of that outcome.
I understand where you're coming from, but the empirical history of America (at least) brings up two problems. The first is that the definition of race/ethnicity tends to shift based on what's politically expedient for the powerful: consider whether Irish people, Eastern Europeans, Arabs, and Jews count as "white" at various points across American history. Race just isn't a solid enough concept to be a reliable way to ensure a share of power for anyone who doesn't already have a unrelated strong grasp of power.
The second is that in practice this just causes the weak to identify with and have solidarity with the strong, which isn't the direction you want. There's a lot history of public policy in America that's been targeted at getting lower-class "white" people (for whatever the current definition of "white" is) to believe that their self-interest is more aligned with the success of the white race than with the success of the lower class regardless of race. You can see this clearly in the history of things like Bacon's Rebellion, and the establishment of slavery in the US as a racial-superiority thing as a way to avoid a combined revolt by white indentured servants and black slaves against the upper class. But I think you can see the same thing happening in the present day.
As I said in a sibling comment, I view race as too broad a concept to usefully generate social identity, and the fluidity of the concept makes it slippery to deal with. Your second point is a good one, I will think more about it. That said, it seems to me that in the long run relatively homogenous populations (really, many smaller politically independent homogeneous populations, as well as politically independent hetrogeneous populations for the smarter folks) is the best way to maximize social identity and minimize conflict.
By the way, I appreciate you taking the time to thoughtfully respond to my comment. It is difficult to say what I think may be the truth (with, I hope, no maliciousness) in todays environment, so thank you.
Nothing about capitalism demands an ugly lack of proper legislation, regulation, and enforcement. I would not like to write off capitalism on the basis of a rigged system that just uses the name for ideological purposes.
Indeed, rule of law is essential. As is some level of regulation because history has shown that some people are bad actors. The challenge of regulation is how to control the tendency of its bureaucracies to grow and become burdensome.
Balance is key, and difficult, and will always tend to fall out of balance under external influences. All too often though I feel that the problem is framed as "too hard" you know? It is not too hard, if more people were on board and made it a priority. Sadly history seems to indicate that it will take a lot for that to happen, if it does. Without popular support and voter oversight, government becomes toxic, but without government support and oversight, things fall apart.
Puritanical drug policy in response to the anti-war and hippie movements on the 1960s has a lot to answer for and is a huge contributing factor to this current crisis.
- Under Nixon, the Controlled Substances Act of 1970 inexplicably made cannabis a Schedule 1 drug. Cocaine, by comparison, is Schedule 2.
- Cannabis became harder to get and more expensive than both cocaine and opiate based drugs.
- In 2016, a bill sailed through Congress and was signed into law by Obama with little discussion or concern. It was the result of pharma lobbyists. The bill made it nigh-on-impossible for the DEA to investigate and penalize drug companies of suspicious shipments of drugs [1].
An example of this is shipping NINE MILLION hydrocodone pills over a two year period to a single pharmacy in Kermit, WV with a population of 392 [2].
- A large number of people get onto heroin after becoming addicted to prescription opiates [3], which seem to be dispensed far more frequently in the US than in other developed nations [4].
- Not only does cannabis seem to reduce the rate of opiate addiction, it seems like it might help treat opiate addiction too [5].
I choose to be an optimist here. I see Trumpism as a desperate last gasp for a declining but increasingly militant religious conservative minority in the United States. As much as these short-term policy decisions hurt, I look forward to the day when Puritan ideals will no longer blindly dictate policy with no basis in fact whatsoever.
I personally think the combination of the (legal, or at least government approved) prescription opioid crisis, combined with the relatively successful decriminalization at various levels of cannabis in several states, has really changed the tone of conversation on pharmaceutical compounds, recreational or otherwise.
Old paradigms (particularly ones that are not 100% based on factual / scientific analysis, as drug law tended to be) die hard, and it will take some time to change laws as a result. But the moral panic over "illegal drugs" is way less these days than it was in, say, the 1980s.
> Millions of people have fallen victim to drugs, painkiller abuse, alcoholism, the rise of meth and the revival of heroin.
Through all this carnage somehow the left still fights for the legalization of the gateway drug marijuana. Of course not all weed users move towards harder drugs, but it opens the door to more lethal drugs once susceptible individuals become accustomed to the highs. I have personally seen friends from college smoke weed for a couple of years and then move to coke for the better highs. Less drugs, not more would be a good step
EDIT: Its extremely well documented that marijuana usage leads to increased vulnerability for addiction to other substances. One of many research links:
This is a myth, and not even a good one. Alcohol has a far stronger correlation with negative outcomes than marijuana does, and having "personally seen friends" doesn't change that.
As for the childish "less drugs, not more" solution you've come up with, weed has been illegal for almost a century. It hasn't helped yet -- what do you propose? We start killing weed dealers?
Your opinion is archaic and not supported by facts. It is the distilled ignorance of decades of drug war propaganda propped up by some anecdotes with dubious conclusions.
Slightly off topic, but I do sometimes experience a pleasant and relaxing, but short-lived (5-15 minute) “high” from caffeine comparable to a mild Adderrall high without the motivation drive. People I’ve spoken to about this have generally been dismissive of it as placebo or saying it is atypical - am I alone in experiencing this?
This is totally not true, and it was proven by many countries where marijuana had been legal for years without any significant changes in hard-drugs abuse. Just google for it, this is the 1st result: https://www.drugabuse.gov/publications/research-reports/mari...
Even if I were to accept marijuana is a gateway drug anymore than alcohol or your doctor, the war on drugs has cost the US an estimated 51 billion dollars a year. Prohibition is not effective and given how dubious the “gateway” claims are I would not consider that a strong basis for continuing to waste trillions in tax payer dollars.
These findings are consistent with the idea of marijuana as a "gateway drug." However, the majority of people who use marijuana do not go on to use other, "harder" substances. Also, cross-sensitization is not unique to marijuana. Alcohol and nicotine also prime the brain for a heightened response to other drugs52 and are, like marijuana, also typically used before a person progresses to other, more harmful substances.
It is important to note that other factors besides biological mechanisms, such as a person’s social environment, are also critical in a person’s risk for drug use. An alternative to the gateway-drug hypothesis is that people who are more vulnerable to drug-taking are simply more likely to start with readily available substances such as marijuana, tobacco, or alcohol, and their subsequent social interactions with others who use drugs increases their chances of trying other drugs. Further research is needed to explore this question.
It's not the fault of liberals that you believe quantifiably incorrect things, but it's a convenient idealogical scapegoat to get out of learning anything helpful.
