Public health and politics

 Most people would agree that West Virginia is pretty close to being Ground Zero for the opioid crisis after being virtually cluster bombed for years by pharmaceutical companies dumping highly addictive drugs around the state. 

As the supply of pills declined, more people switched to injecting opioids, which of necessity involves needles...and which has become a political hot button issue in places like Charleston, WV. In 2018, the city shut down the needle exchange program operated by the Kanawha Charleston Health Department.

Of course, people with substance use disorder don't stop using when the supply of clean needles goes away, which can lead to all kinds of horror stories, including an underground market in used needles. It's a classic example of what economists call inelastic demand. 

What could possibly go wrong with that scenario? 

A grassroots group called Solutions Oriented Addiction Response (SOAR) took up the slack, which until recently offered sterile syringes, Naloxone, condoms, snacks, HIV testing, conversation and such until they came under fire from city officials. They're still around, although they've stopped syringe distribution.

This excellent report by WV Public Broadcasting shows what can happen when public health is politicized. And you may learn more about reusing needles than you ever expected to.

Pandemics and prison overcrowding are a recipe for disaster

 Gov. Jim Justice in a news conference regarding the latest spike in COVID-19 cases, now famously said, “I don’t know what else I can do.”

To give credit where credit is due, starting in March Justice has shown a willingness to listen to public health experts and take proactive measures to prevent the spread of the virus.

However, for the thousands of people who are incarcerated or who work in state correctional facilities — all of whom are at elevated risk of sickness and death from COVID-19 — there are many responses that have not yet been taken by the governor and state officials that would help prevent more outbreaks.

Incarcerated people are infected by COVID-19 at a rate more than five times higher than the nation’s overall rate, due largely to the fact that social distancing necessary to prevent the spread of the virus is virtually impossible in overcrowded facilities.

As of this writing, according to the West Virginia Department of Health and Human Resources COVID-19 website, there are 254 positive cases of COVID-19 in the Stevens Correctional Facility in McDowell County, which means 64% of the prison inmates have contracted the virus. Statewide, there are 58 employees of Division of Corrections and Rehabilitation who are currently positive for COVID-19.

Our state’s regional jails are 35% over capacity, and what’s worse is that nearly half of those incarcerated are pre-trial, meaning they have not been convicted of any crime but, more likely than not, are too poor to come up with the bail money to purchase their freedom as they await trial. This has dire and potentially fatal consequences for these individuals and their families.

To put this problem in perspective, and also as cautionary tale, a recent report by the University of Texas at Austin found that 80% of those who had died from COVID-19 in Texas jails had not been convicted of a crime but were incarcerated pre-trial.

According to public health and safety experts in their October report, “Decarcerating Correctional Facilities During COVID-19,” commissioned by the National Academies of Sciences, Engineering and Medicine, state officials can prevent outbreaks and deaths if they take action to reduce incarceration.

The first recommendation is to reduce “churn” in regional jails by law enforcement officials using their discretion to divert individuals from incarceration through citations in lieu of arrests.

Additionally they recommend judges and prosecutors adhere to “strong presumption against pretrial detention” through issuance of personal recognizance bonds.

Prior to the pandemic in early March, the state Legislature, wanting to reduce county jail bills, passed House Bill 2419, which instructs magistrates to grant personal recognizance bonds for low-level felony and misdemeanor charges “unless for good cause shown.” To date, even with correctional facilities and their surrounding communities becoming COVID-19 hot spots, there is little indication the new law is being applied.

The report also stresses the need to expedite release for people who are nearing the end of their sentence or are medically vulnerable, and who pose no threat to public safety.

According to data from the West Virginia State Parole Board, between March 3 and May 2, 389 people were granted parole, while 438 were either denied or deferred parole, meaning that the majority of people who were parole eligible were not released.

One way to expedite more releases would be the governor empowering the DOCR commissioner to work with staff to identify individuals who are parole eligible or within a year of parole eligibility, who are deemed low risk for reoffending, and see to their release.

The report also recommends that probation and parole policies be revised to “greatly limit revocation for technical violations,” and instead direct that only when a new crime is committed should parole or probation be revoked.

Last but not least, the report underscores the importance of reentry support to ensure people’s safety and well-being after release. Even in non-pandemic times, reentry is tremendously challenging for those who don’t have resources for housing, transportation and food.

Pile on lack of employment opportunities during a global pandemic while saddled with a criminal conviction, and one can imagine how crucial it is we invest in reentry, especially transitional housing.

As inspiration, other states have safely reduced their prison and jail populations. Most recently in New Jersey, Gov. Phil Murphy and the state legislature worked together on legislation that allowed for the release of over 2,000 adults and juveniles with qualifying offenses who had a year or less left on their sentence.

Why not here?

When leaders of our state realize the urgency to reduce incarceration during this pandemic, lives will be saved.

Then beyond this pandemic, if we take bold steps for criminal legal reform and reinvest the $250 million we spend annually on adult and juvenile incarceration, we will see lives restored and families reunited.

And we can look back and know West Virginia was on the right side of history, as we put our country’s failure of mass incarceration behind us once and for all.

(This ran as an op-ed by AFSC's Lida Shepherd in the Sunday Gazette-Mail.)

Mask or ventilator?

It kind of baffles me that so many people seem to pop their clogs when asked to wear masks to protect themselves and others from the coronavirus.

If I wanted to get Freudian about it, which is kind of fun sometimes, I might speculate that they see this as some kind of symbolic neutering imposed on them by authorities unconsciously associated with father figures.

Holy Oedipus complex, Batman!

(There’s nothing like a little recreational psychoanalysis every now and then.)

However, I’m not wedded to that idea. After all, Freud supposedly said that, sometimes, a cigar is just a cigar.

Sometimes, I think some people see it as an attack on their sense of whiteness and/or masculinity. I haven’t done an exhaustive statistical demographic analysis, but I suspect that kind of reaction does seem to be most common among those who might strongly self-identify in one or both of those categories.

Whatever the case, I’d urgently like to say that, if you think masks are bad, just try a ventilator sometime.

I found that out the hard way more than 15 years ago. I’d been doing a lot of endurance events, including the Charleston Distance Run and an Olympic-distance triathlon, but I kept getting slower and slower.

Then, I started getting a weird pain in the right shoulder. Usually, I could push past things like that but, this time, it shut me down.

At the time, I thought it might be a shoulder injury sustained after I tried to do a judo throw on a guy built like a pyramid. I went to a physical therapist, who is now one of the most conservative members of the state Senate. He urged me to get a stress test.

I thought it was a crazy idea but went along with it, which might have been one of the few times we agreed on something. I say that with all respect and gratitude. That advice saved my life.

It turned out my major arteries were totally blocked. The term “widowmaker” was used. My capillaries were apparently keeping me alive, so all that running, however slow, paid off.

I got scheduled right away for a quadruple bypass.

I expected that to be a drag. In the days before minimally invasive surgery, this meant my sternum getting sawed in half and cracked open like a clam shell. There were other cuts and tubes to be endured.

What I didn’t know and wish someone would have told me was what waking up on a ventilator would be like.

I came to with a weird sensation in my throat. Some ginormous-seeming object was there that, in retrospect, reminds me of the space creature in the first “Alien” movie that latched on to that poor guy’s face before its baby popped out of his chest.

I wanted to gag, but that wasn’t an option. Then there was the fact that it was uncomfortable, to put it mildly.

Then there was the breathing. At first, I didn’t think it was happening but, eventually, I figured out that, since I wasn’t dead, the alien was breathing for me. But let’s just say it’s nothing like the real thing.

I think my reaction to all that, ironically, wound up keeping me on it longer than might have otherwise been the case.

Maybe things have changed since then. Maybe being intubated these days is like taking a ride on a magical unicorn. But that would surprise me.

Here’s the thing: I was on that for just a few hours. Some COVID-19 patients have been on one for days or weeks. Fortunately, those who are ventilated are generally put into a medically induced coma, so they don’t experience that kind of distress.

But still, the real or imagined indignity, discomfort or inconvenience of wearing a mask is pretty small stuff, considering other possibilities.

That person with a mask just might be keeping you from getting a tube down the throat. It might be nice to return the favor.

(This ran as an op-ed in the Charleston Gazette-Mail.)

Protecting vulnerable workers

When it comes to amateur epidemiology these days, I think there are two kinds of people: those who know they’re not experts and those who don’t.

I’m in the former category.

Like millions of Americans and people around the world, I’d like for things to get back to some kind of normal, preferably a better normal than we had before. I miss seeing people face to face, going to libraries, social and family gatherings, visiting Taylor Books in search of the ever-elusive no-bake cookie, eating out, contact sports and all that.

But I don’t want a rushed return to “normal” if it means another spike in COVID-19 infections and fatalities, which is inevitable if restrictions are lifted too soon.

In Georgia, for example, moves to reopen led to a more than 40% spike in the coronavirus incidence rate, which represents the number of infections per 100,000 people, between April 21 and May 2. For some, that will mean death.

The Texas Tribune reported on May 14 the largest daily increase in COVID-19 infections and fatalities since the outbreak began, with 1,448 infections and 58 deaths. That state began the reopening process on April 17.

A reopening spike would hit West Virginia particularly hard. As has been widely reported, the Kaiser Family Fund found that we have the highest share of adults at risk of serious illness if infected, at the rate of 51% compared to a national average of 41%. That includes around 32% of people between ages 18 and 64, the prime working years.

One area that demands a careful approach is dealing with unemployment insurance. As of this writing, 143,149 West Virginians have filed for unemployment insurance since the outbreak. Some of those who are unemployed have compromised immune systems or live with someone who does. As things now stand, when their employers open, they will have to choose between risking health and life or losing unemployment benefits. Many of those who would have to make that decision are low-wage workers, with a disproportionate representation of women and African Americans.

Currently, immunocompromised people can be exempt from this dilemma with a doctor’s excuse. However, that could be a problem for people who are self-quarantining for health reasons — and for the estimated 60,000 West Virginians who have lost health insurance during the crisis or the more than 120,000 who didn’t have health coverage to start with.

According to federal Department of Labor guidelines, “Federal law would permit a state to determine whether the separation [from employment due to the outbreak] here is a quit or a discharge and whether the circumstances are allowable under the state’s good cause/just cause provisions. If permitted under the state’s good cause/just cause provision, states should consider how they will adjudicate the reasonableness of an individual’s separation for reasonable risk of exposure. One such factor could be considering if the individual is in a population that is particularly susceptible to COVID-19.”

In general, I think the Justice administration has done a good job of dealing with the outbreak. But I respectfully suggest that giving this matter more consideration isn’t a matter of playing politics or keeping people on unemployment forever. It’s about looking out for the lives of West Virginia’s working families.

(This ran as an op-ed in last week's Charleston Gazette-Mail.)

A time (and place) to test

 One of the populations most at risk of COVID-19 infection are people held in jails, prisons, and juvenile detention centers and those who work there. In such institutions, social distancing is impossible.

In addition to working with allies to reduce the number of West Virginians in confinement, AFSC in WV signed on to a letter to state officials urging that universal testing for the virus be made available to all detainees and workers in the system. This is particularly urgent because a significant percentage of those with the virus show no symptoms--and since outbreaks in one setting can easily spread to the community at large.

Please feel free to share the contents of the letter and to urge state officials to take appropriate action. Here's the letter:

Monday, April 27, 2020 

Dear Governor Justice, Commissioner Jividen, and Secretary Crouch:

As the COVID-19 crisis continues in West Virginia, so does our concern regarding its impact on those behind bars or otherwise detained in congregate settings across the state. Many West Virginians are extremely worried about loved ones of all ages who are incarcerated in jails, prisons, juvenile detention facilities and other out of home placements, where following social distancing guidelines is nearly impossible. The same is true of those who work in these facilities, their families and communities. We, the undersigned, share their concerns.  In fact, we would go even further to stress that what occurs in those settings can impact all West Virginians.  It is clear to all by now that prisons, just like nursing homes, schools, colleges and other locations that you have worked hard to address are at heightened risk, which then can adversely impact the general population.
  
We highly commend state leaders such as yourselves for taking effective measures to stop the spread of the disease. However, the recent news that a correction officer has tested positive raises disturbing possibilities.  Given the very high risk for this population and for the thousands of West Virginians connected to it in one way or another, we are writing to request that the state make universal testing available to all people detained or employed in these facilities as testing supplies become more available. Since studies indicate that many people who have and can spread the virus are asymptomatic, this is the surest way to identify cases of infection and to allow authorities to take appropriate measures in the interest of all West Virginians.

This would be consistent with federal guidance for the use of the CARES Act, which states that funds can be used for "costs of providing COVID-19 testing, including serological testing" as well as "COVID-19-related expenses of maintaining state prisons and county jails, including as relates to sanitation and improvement of social distancing measures, to enable compliance with COVID-19 public health precautions.”

Further, because of the vulnerability of this population, it is imperative that West Virginia provide robust transparency with regards to COVID-19 testing occurring in our corrections system. Other states like Florida, North Carolina, Ohio, Oklahoma, Texas, and Virginia publicly
report not only the number of positive cases in correctional facilities, but also the total number of tests performed as well. We’re asking that this information be made publicly accessible.

Ongoing forthrightness about COVID-19 testing and results within the prison system will maintain the public trust in our health and law enforcement officials. Transparency will similarly put incarcerated individuals and their families at greater ease.

Limiting the spread of COVID-19 in high-risk environments like our prison system is imperative for the health of incarcerated individuals, correctional staff, and our communities as a whole. The more incarcerated individuals and correctional staff that need treatment at local hospitals, the greater the strain will be on our health care system’s capacity.

The organizations listed below represent a diverse cross section of West Virginians supporting this request. We thank you and those who work with you for your service in this difficult time and look forward to your response.

Sincerely,

Americans for Prosperity
American Friends Service Committee
 WV Council of Churches
WV Access to Justice Commission
Catholic Diocese of WV
 American Civil Liberties Union-WV
Our Future WV
WV Center on Budget and Policy
Appalachian Prison Book Project
Mountain State Justice
NAACP – Jefferson County

Thoughts on getting through these days

Albert Camus (1913-1960)

Stephen King…what can I say? I grew up reading his books and watching the movies.

I sometimes go years without going there. Other times, I binge on book after book. By King’s own admission, some are more gripping and substantial than others.

One that stuck with me over the years is The Stand. In case you missed it, the book starts with a super flu epidemic nicknamed Captain Trips that wipes out most of the human race.

Then things really get bad.

On a more literary level, one of my favorite novels is The Plague by Albert Camus, which I’ve often mentioned. It’s about an epidemic in Oran, Algeria around 1940, when the country was still under French control. And the disease is a metaphor for life in Nazi-occupied Europe.

The plague takes over the lives of everyone. People are separated from loved ones and feel totally confined and cut off from the rest of the world. Everything changes, including the sense of time.

In both books, the epidemic requires people to make moral decisions. In The Stand, it’s a pretty stark choice between good and evil. In The Plague, it’s interesting to see the different ways people respond to the situation. Some respond with quiet heroism, while others seem to profit or thrive from the epidemic.

For obvious reasons, those books have been on my mind lately. First though, let me say that the current situation is nowhere near these literary extremes and I don’t think we’re going to get anywhere close to them.

But I think the situation does require a response from us. Probably the worst things we can do now are either to politicize the Coronavirus outbreak (as in “Fake news. SAD”) or spread hysteria…which may entail taking a deep breath or two and stepping away from the TV every now and then.

So how should individuals and communities respond to the latest developments? And what can we learn from it? I have a few ideas:

*take reasonable, evidence-based steps to protect ourselves and pay attention to the latest recommendations and cooperate with the reasonable directions of health authorities, even if it can be a pain in the rear;

*if necessary, do what you can to nudge public officials to step up and do all they can to respond and prepare for the future if the virus spreads. Also, encourage them to take steps to ease the economic impact. We've already had some success with this in WV;

*take Mr. Rogers advice and “look for the helpers.”

*put things in perspective: it’s not like we were immortal before Coronavirus came around. We don’t know how bad the hit is going to be, but it’s not the only threat out there. According to the Centers for Disease Control and Prevention, between Oct. 1 2019 and Feb. 29 2020, there have been an estimated 20,000 to 52,000 deaths from “regular” flu in the US. Worldwide, somewhere between 291,000 and 646,000 die annually from seasonal flu.

In a normal year, 40,000 Americans die from auto accidents. It’s been estimated that sugary drinks kill over 180,000 people per year in the US. According to the DHHR website, 300,000 deaths per year are related to obesity. The CDC reports that 480,000 Americans die each year due to cigarette smoking. Worldwide, tobacco kills around seven million people per year.

We don’t notice what we get used to.

*let’s not recreate past mistakes. Sometimes events like this make people search for someone to blame or some vulnerable group to target. During the Black Death of the mid 1300s, Christians blamed the plague on Jews, who were accused of poisoning wells. This unleashed horrific persecution throughout Europe. The “enemy” is a virus, not other people.

*this could be a reminder of how interconnected people are all over the world. Sometimes I think that very wealthy people, for example, think they can insulate themselves and their children from the effects of their actions on others, whether it’s the damage done by extreme inequality or climate change.

Sticking with the literature of epidemics, that was a theme of Edgar Allan Poe’s story “The Masque of the Red Death,” in which Prince Prospero and his aristocratic friends party in apparent safety while an epidemic raged outside their walls. It didn’t work out very well for them. 

There may be a lesson in that. As Bob Marley sang, “When the rain falls, it don’t fall on one man’s house.”

*this could also be a reminder of how important things like paid sick days, universal health care, universal basic income and out of school food programs for children are. We have a lot of unfinished business.

*but the main one is, after taking all reasonable precautions, not to stop living or being human or showing compassion to others out of fear. Shakespeare’s Henry V observed that “we owe God a death,” but let’s not die while we’re still breathing.

That’s the message of a Buddhist parable about a man chased by a tiger. When he comes to the edge of a cliff, he climbs down a vine. The tiger is waiting. At the bottom of the cliff, there’s another tiger. Meanwhile, two mice just out of reach start gnawing at the vine. Then he notices a ripe strawberry. He plucked it and took a bite. It tasted great. The end.

That’s pretty much the human condition.

I’m not suggesting that people should crank up the song “Don’t Fear the Reaper.”

But if you do, enjoy the cowbell.

(This is an updated version of an op-ed in the Charleston Gazette-Mail last week.)

WV groups urge state action on COVID-19

Around 15 WV organizations, including AFSC have signed on to this letter to WV Governor Jim Justice. It ran as an op-ed in the Charleston Gazette-Mail Saturday. Thanks to the WV Center on Budget and Policy for taking the lead on this:

As of publication, no cases of COVID-19 have been identified in West Virginia, but it is very likely only a matter of time until our state’s residents are affected.

While the Governor’s Office and state agencies are taking this issue very seriously, this pandemic has revealed serious holes in our state’s and nation’s health system, safety net and economic infrastructure. Fortunately, there are immediate measures that we, the undersigned, call on state officials to implement to address the situation.

In the short-term:

Begin holding daily press availability of staff of the Governor’s Office and the Bureau for Public Health. A key to preventing panic and keeping the public well-informed is the free flow of information and timely updates.

Waive copays and coinsurance for coronavirus testing and related visits. While the Public Employees Insurance Agency has announced this policy, West Virginia should require all insurers regulated by the state to cover coronavirus testing and related treatment at 100%, without coinsurance, copays or deductibles. This is critical to ensuring that cost concerns do not become a barrier to testing or treatment. People who go without testing because of cost concerns could spread COVID-19 to their communities.

Promote telehealth. West Virginia should require insurers to conduct outreach to consumers to make sure they are aware of telehealth benefits available to them to increase testing and decrease the spread of COVID 19. Telehealth services around COVID 19 diagnoses also should be covered at 100%, without coinsurance, deductibles or copays.

Bar utility shutoffs and evictions via executive action. Individuals and families who are financially affected by COVID-19 and the resulting economic downturn and layoffs must not have their utilities shut off. In particular, water is a critical need, as is electricity for people who rely on medical devices.
Temporarily suspend re-determination of eligibility for federal assistance programs, as allowed. This will ensure that there is no interruption of critical medical, food or other needs and that interruptions in the state’s workforce and ability to process applications will not disrupt benefits.

Provide good-cause exemptions for the Supplemental Nutritional Assistance Program, or SNAP, work requirements and time limits. SNAP work requirements and time limits should be waived entirely but, in the absence of the ability to do that, West Virginia should provide good-cause exemptions to all adults known as “ABAWDs,” Able-Bodied Adults Without Dependents, ensuring access to food during this crisis. Outreach and education also should be conducted to let those who have previously been denied know they are eligible for benefits during this time.

Utilize contingency funds to provide outreach, education and testing to people who are most likely to be affected by COVID-19, including those in homeless shelters and West Virginians who visit food pantries and senior centers. Those who are most likely to be affected by community spread need to have access to health and food benefits and testing.

Waive the one-week waiting period for unemployment insurance benefits and “noncharge” benefits to protect employers. Suspending the waiting period will help ensure financial security among unemployed or temporarily separated workers as a result of COVID-19, while “noncharging” benefits will protect employers from bearing the brunt of the increased uptake in unemployment insurance.

Waive state policies that terminate a child’s eligibility for Child Care and Development Fund child care subsidies based on a specific number of absent days. This will allow parents to make the decision to keep sick or exposed children home, curtailing the spread of virus without jeopardizing their longer-term eligibility for child care assistance.

Adjust payment policies to child care providers so that they are based on enrollment of children rather than attendance. This is critical in allowing sick children and parents to stay home without disrupting revenue for providers.

Suspend charging those in our state’s prisons and jails money for phone calls. During this time while visitation is curbed, those in our prisons and jails must not be charged for staying in touch with loved ones.

In the longer term:

Pass paid-sick-days policies.
Protect and expand Medicaid.
Restore funding to public health.
Implement paid family and medical leave for public and private employees.

Just thinking

There's nothing like a good outbreak of some kind to make you think about things. Here are some things I'm thinking about these days:

*WV attorney general Patrick Morrisey joined the lawsuit to repeal the Affordable Care Act. How's that going down with the coronavirus outbreak?

*The US Supreme Court has taken up the case to repeal the Affordable Care Act. It would be...interesting if they did that with all this going on.

*Whatever happens, this highlights the importance of things like paid sick days for all workers, universal health care, investing in public health (and science education), and things like plans for feeding kids when they're out of school for whatever reason. We've got a lot of unfinished business.

Surprise, surprise

Golly, who could have seen this coming? After the city of Charleston WV suspended its needle exchange program in March 2018, cases up hepatitis C shot up from 458 in 2017 to 1114 in 2018.
The program was suspended under pressure from then mayor Danny Jones and then police chief Steve Cooper.

Gazette-Mail reporter Amelia Ferrell Knisely did the math, and it looks like that means a new case every 8 hours. While most cases are due to needle sharing, the outbreak isn't likely to remain confined to people using intravenous drugs.

This is what happens when political interference  trumps evidence-based public health practices.

Harm reduction done right

In case you missed it, there was an interesting NY Times article about how Dayton Ohio and its county of Montgomery dramatically reduced opioid overdose deaths from last year to this.

Lots of things seemed to come together to make this possible. The most obvious of these was Gov. Kasich's decision to expand Medicaid under the Affordable Care Act. Dayton mayor Nan Whaley claimed it was the basis for everything they've been able to accomplish, saying

“If you’re a state that does not have Medicaid expansion, you can’t build a system for addressing this disease.”

That's sad but really true. Some of the states that need it most haven't done it year, although that number is fortunately diminishing.

Other factors were harm reduction programs, support groups, a strong program to distribute Naloxone to reverse the effects of overdoses, and, importantly, the growing cooperation between Dayton police and public health workers.

Unfortunately, Charleston WV has been going in the opposite direction, as this WV Public Broadcasting story relates. 

The Times article quotes Sam Quinones, author of “Dreamland: The True Tale of America’s Opiate Epidemic,”who told a congressional hearing that "the more cops and public health nurses go out for a beer, bridge that cultural chasm between them," the better the US will be able to deal with the problem.

"Everyone would know we were crazy"

"Imagine if the government chased sick people with diabetes, put a tax on insulin and drove it into the black market, told doctors they couldn't treat them then sent them to jail. If we did that, everyone would know we were crazy. Yet we do practically the same thing every day in the week to sick people hooked on drugs. The jails are full and the problem is getting worse every day"--Billie Holiday 1915-1959.

Harm reduction

A hot topic in WV's capitol city these days is the needle exchange program offered by the Kanawha-Charleston Health Department. Charleston's city council earlier this week essentially voted to delay a vote on eliminating the program.

Charleston's mayor Danny Jones, many of the city's law enforcement officers and others support ending the program because they believe it leaves a lot of dirty needles in public places in its wake.

As I understand it, however, the evidence suggests that ending the program won't end the problem. It could, however increase the number of people using dirty needles. Further, the Centers for Disease Control reports that addicted people who used needle exchange programs are five times more likely to eventually seek treatment than those who don't.

Obviously, it would be great to make the opioid crisis go away. And people are working on that. One huge step forward has been WV's Medicaid expansion as authorized by then Governor Tomblin back in 2013. But while we're working on a long term solution, there's no substitute for harm reduction measures like these programs.

Taking on the new tobacco

Given West Virginia's budget crisis and dismal state of public health, it's a good thing that a campaign is in the process of being launched that aims to increase the tax on sugary drinks. Already some cities have experienced success at this. This NY Times article shows the early results of a major university (and employer) that banned them from the campus.

Of course, the outcome of that campaign might be affected by Tuesday's outcome. As will many other things...

Sugar is the new tobacco

This op-ed of mine ran in yesterday's Charleston Gazette-Mail:

When legislators start scrambling to fill West Virginia’s budget gap next year, they would do well to consider raising the tax on sugary drinks. And maybe finishing the job on the tobacco tax.

There are plenty of reasons to consider this option, but here’s one to start with: sugar is the new tobacco. In more ways than one. And tobacco is the old sugar.

But, let’s start with the old one. According to the Centers for Disease Control and Prevention, cigarette smoking is responsible for more than 480,000 U.S. deaths per year.

For comparison, consider this: that’s more than twice the number of Union and Confederate soldiers killed or mortally wounded in battle in the whole Civil War (around 110,000 and 94,000, respectively).


The CDC estimates economic costs to be more than $300 billion per year, including $170 in direct medical costs and $156 billion in lost productivity.

That’s over 70 times the size of West Virginia’s general fund budget of $4.2 billion in 2015.

That’s bad enough, but many Americans may have forgotten how the tobacco industry knew about the danger of smoking but suppressed the information to protect profits and delay regulation.

As James Surowiecki wrote in The New Yorker, industry researchers “had demonstrated the addictive qualities of nicotine and the health hazards of smoking years before these things became public knowledge, and that tobacco companies had nonetheless embarked on a public campaign to deny what they knew to be true, from their own research, and to cast doubt on the dangers of cigarettes.”

It has recently come to light that the sugar industry was up to the same tricks for years.

According to a recent article in the Journal of the American Medical Association Internal Medicine, more than 50 years ago, sugar industry interest groups became concerned about research on the dietary causes of coronary heart disease, especially those that linked illness and early deaths to sugar intake.

Over a period of decades, the industry dumped a few million dollars on P.R. and “research,” including funding for Harvard scientists who minimized the role of sugar and cast fat as the villain. The scientists didn’t disclose any possible conflicts of interest.

As far back as the 1950s, one influential industry leader argued that “sugar is what keeps every human being alive and with energy to face our daily problems.” In effect, the industry paid for research to back up their claims.

You get what you pay for. Or the industry did anyhow. As the authors of the JAMA article note, “by the 1980s, few scientists believed that added sugars played a significant role in CHD, and the first 1980 Dietary Guidelines for Americans focused on reducing total fat, saturated fat, and dietary cholesterol for CHD prevention.”

As Surowiecki put it, the Harvard researchers “discounted studies suggesting that reducing sugar consumption could help with coronary heart disease, while overstating the evidence blaming saturated fats.”

If you’re old enough to read this, you probably remember the “low-fat” marketing craze that really took off in the ’90s and hasn’t entirely gone away.


This isn’t to say that fat is a new health food, but it’s hard to deny that the low-fat craze helped lead to the high-carb diets that have contributed to the nation’s — and especially West Virginia’s — obesity crisis, which is taking its own toll, in terms of health and financial costs.

Back in 2008, health care policy expert Ken Thorpe was commissioned to advise the Legislature on how to improve the state’s physical (and ultimately fiscal) health. At the time, he noted that we spent 13 percent more per person on health care than the national average.

He also noted that “Data from the U.S. Centers for Disease Control and Prevention indicate that West Virginia has among the highest rates of childhood and adult obesity in the country. These high rates of obesity are associated with high and rising rates of diabetes, hypertension, hyperlipidemia, heart disease, pulmonary disorders and co-morbid depression.”

In a 2009 report titled “The Future Costs of Obesity,” Thorpe reported that obesity-related diseases cost West Virginia $668 million in 2008, a number he expected to rise to $2.4 billion by 2018 if nothing changed.

It’s hard to get up-to-the-minute data on this, and some progress has been made, but it’s clear the public health threat is still with us.

The death toll hasn’t reached Civil War levels, but damage has been done, and our children have been among the targets. In 2012, nearly one in four West Virginia fifth-graders already had high blood pressure, according to West Virginia University measurements of thousands of children. One in five kindergarteners were coming to school obese and were at risk of type 2 diabetes. Nearly one in three adults were obese. According to Try This West Virginia, a campaign to promote healthy lifestyles, seven out 10 health care dollars were spent on preventable diseases.

Let’s just say that if another country had done this to our kids, we’d be at war.

I’m no purist about this stuff. I’m a former smoker and I consume sugary drinks (although you have to be 21 or older to buy most of them), but let’s face some facts.

Budget crisis or not, imposing a tax on things that kill us might not be a bad idea. Part of the revenue could go to addressing the medical costs these things cause. And if, over time, we consume less of them and suffer less harmful effects ... well ... that would be a good problem to have.

What he said

I mentioned in earlier posts that Republican candidate for governor Bill Cole has proposed increasing mandatory minimums and possibly building more prisons to deal with the drug problem. My friend Pastor Matthew Watts had a great response in today's Charleston Gazette-Mail. I highly recommend taking a look at this critique of one of the biggest policy failures of the last few decades.

Meanwhile, one possible partial solution to WV's budget woes could also help address our public health problems related to obesity. The idea in question is upping the tax on sugary drinks.

Finally, under the it's-not-all-bad category, WV's unemployment rate is at its lowest point since 2008, in spite of the serious slump in the coalfields.

Sugar sugar

The latest Front Porch is about WV's obesity epidemic and what can be--and is being--done about it.

A man is made Providence to himself

The theme at Goat Rope these days, aside from occasional rants when things get on my last nerve, is the life and work of Ralph Waldo Emerson. At this point, I'm on his Harvard Divinity School Address, which managed to tick off even Unitarians.

As I've mentioned before, Emerson and Thoreau were both forerunners of American Buddhism. In this essay, Emerson expounds a subtle idea of karma whereby people become more like what they invest themselves in. Compassionate people get better at compassion. Greedy people get better at greed. He sees this as working like a law of nature:

See how this rapid intrinsic energy worketh everywhere, righting wrongs, correcting appearances, and bringing up facts to a harmony with thoughts. Its operation in life, though slow to the senses, is, at last, as sure as in the soul. By it, a man is made the Providence to himself, dispensing good to his goodness, and evil to his sin. Character is always known. Thefts never enrich; alms never impoverish; murder will speak out of stone walls. The least admixture of a lie--for example, the taint of vanity, the least attempt to make a good impression, a favorable appearance--will instantly vitiate the effect. But speak the truth, and all nature and all spirits help you with unexpected furtherance. Speak the truth, and all things alive or brute are vouchers, and the very roots of the grass underground there, do seem to stir and move to bear you witness. See again the perfection of the Law as it applies itself to the affections, and becomes the law of society. As we are, so we associate. The good, by affinity, seek the good; the vile, by affinity, the vile. Thus of their own violition, souls proceed into heaven, into hell.

To which I can only say, with Hamlet's friend Horatio, so have I heard and do in part believe it. Or I'd like to  anyway.

COAL COUNTIES AND DEATH RATES seem to go hand in hand.

PLEASE CHECK OUT THIS WEBSITE to learn more about Medicaid expansion, whether you can qualify for coverage, and how you can take steps to make sure it happens here.

I CAN HANDLE BATS EATING SPIDERS, but the thought of spiders eating bats kind of grosses me out. Maybe it's a mammalian solidarity thing.

GOAT ROPE ADVISORY LEVEL: ELEVATED

PUBLIC HEALTH

For many years, mortality rates in the developed world have dropped while life expectancy has increased. These changes probably have a lot more to do with improvements in public health--things like sanitation, clean water, sewers--than with advances in medicine, as important as the latter have been.

The differences between the public health and medical approach are pretty clear. With the medical model, you treat the person with the disease; with a public health approach, you try to remove conditions that cause the disease to spread. Obviously, we need both, but the promise of the public health is vast.

Aside from these two approaches, there is another one, which is pretty popular these days but totally useless. It's the moralistic approach, which condemns things as bad and tells people not to do them. You can find the moralistic approach across the political spectrum, from the religious right's abstinence only approach to sex education to peace activists who condemn violence and war without making any effort to understand the conditions that contribute to them.

It is El Cabrero's opinion that the public health approach promises the best way to understand and reduce violence, whether at the personal, collective or structural (economic) level.

More on that to come...

SPEAKING OF PUBLIC HEALTH, check out this fascinating NY Times Magazine article on suicide and its prevention.

JOBS DECLINE. Here's economist Dean Baker on the job scene. On the bright side, Congress finally extended unemployment benefits, something some of us have been advocating for months.

CARVED IN STONE. An ancient tablet is sparking debates on Christian origins.

A PESSIMISTIC MOOD pervades the country, according to this AP piece.

GOAT ROPE ADVISORY LEVEL: ELEVATED

CHILDREN OF THE NIGHT...

"I never drink...wine." Speak for yourself, dude. Image courtesy of wikipedia.

When El Cabrero was a little kid, as yet innocent in the ways of goats or the larger world, Channel 8 used to show 1930s horror movies on Fridays at 5:00. I thought this was The Coolest Thing Ever.

I may have been predisposed to this since my old man read me Edgar Allen Poe at a very early age.

They showed Frankenstein, Dracula, Wolf Man, and the various combinations thereof in good old black and white. I liked them all but Dracula was a favorite. Before I could make out the big words, I conned the Maternal Unit into reading Bram Stoker's book aloud.

Ever since then, I've waited patiently for someone to make a Dracula movie that was actually like the Book. The 1990s flick Bram Stoker's Dracula was probably the closest I've found, but it was really Francis Ford Coppola's Dracula...But I digress.

The book is one I've gone back to for entertainment through the years over and over to clear the palate. It certainly doesn't rise to the peaks of literary greatness, but it is kind of diverting.

It was much later that I learned about the real Dracula, who was a lot scarier than Stoker's vampire.

More of that to come this week. Stay tuned...

NEW DEAL REMEMBERED. Here's a review of American-Made: The Enduring Legacy of the WPA, When FDR Put the Nation to Work. The book surveys the history and accomplishments of the Depression-era jobs program which among other things built a lot of the infrastructure of El Cabrero's beloved state of West Virginia.

AT LEAST THESE GUYS ARE DOING OK. The economy is lousy for most Americans, but businesses in the foreclosure "industry" are thriving.

WHERE'S THE BEEF? Here's Krugman on the Bush administration's approach to the credit crisis.

LOSING IT. Here's a review of current research on the subject of self control.

YOU DON'T NEED A WEATHERMAN. Here's an op-ed by yours truly on the opportunities of a well designed climate change policy.

COAL AND COMMUNITY HEALTH. Here's the latest news on public reactions (or the lack thereof) to a recent report by a WVU researcher on the health of coal communities.

GOAT ROPE ADVISORY LEVEL: ELEVATED

MYTH MAKING

Gustave Dore's illustration of Little Red Riding Hood, courtesy of wikipedia.

The nature of myth is the theme at Goat Rope these days, although you'll also find links and comments about current events. If this is your first visit, please click on earlier posts.

Maybe you've noticed that many myths and folktales follow a sort of pattern. In a typical Appalachian Jack tale, the eponymous hero leaves home to seek his fortune. He finds out about or runs right smack dab into some problem. Along the way, he is tested by a stranger and does the right thing. The stranger then gives Jack some help along the way. He then beats the haint (or king or giant or dragon or witch or whatever), gets the girl and then goes home.

Lots of tales are different but there is usually a pattern.

The Russian scholar Vladimir Propp (1895-1970) collected and traced the patterns in Russian folktales. He found that most were built around a quest pattern and contained certain elements or functions--31 to be exact--and a certain number of stock characters (he came up with seven, including typically the good guy, the bad guy, and the girl). What makes tales vary from each other is more the sequence of elements or functions than differences about characters.

A similar schema could easily explain most of the movies I've seen...

One approach to myth that sees people as basically wired to come up with patterns and narratives is called structuralism. The best known structuralist theorist was Claude Levi-Strauss, who aside from some fieldwork in Brazil was mostly an armchair anthropologist.

Levi-Strauss is as far as I can tell almost impossible to read, but here's the Goat Rope version: people are wired to classify things, often into binary pairs of opposites like night/day, raw/cooked, living/dead, etc. Every society does it, although each does it differently.

The elements of such a system only make sense in the context of the system itself, like a letter only makes sense as part of the alphabet or a playing card only makes sense as part of a full deck or a pawn as part of a chess set. The parts are only understandable as pieces of the whole. One function of myth is to mediate between the pairs of binary oppositions.

Note: I'm probably not getting that right, but what do you expect from a goat herder?

Of all the theories of myth discussed in this series, I find structuralism to be among the most intriguing, although it's as impossible to prove as it is to read. I do think we're wired to think in binary terms even when we shouldn't and we seem pre-packaged for story and metaphor as well.

MORE ON IRAQ. Here's more on the cost, human and financial. Here's a local op-ed on the Iraq mess by Carli Mareneck. And here's coverage on the unraveling of the surge.

NEW PROGRESSIVE BLOG. Check out The Wonk Room.

COAL AND HEALTH. Here's more on the WVU study of health in coal counties.

YES, VIRGINIA, there is a runner's high.

GOAT ROPE ADVISORY LEVEL: ELEVATED