Another Day, Another Misinformed Article on Obama’s Addiction Treatment Record

Writing about President Obama’s record on drug addiction treatment without mentioning the passage of the Affordable Care Act and the development of the regulations for the Mental Health Parity and Addiction Equity Act (MHPAEA) is analogous to writing about LBJ’s record on health care without mentioning Medicare and Medicaid. But alas, Christopher Ingraham of the Washington Post is the latest journalist to do so. The transformative impact of the ACA and MHPAEA on addiction treatment is not a hard-to-uncover secret. It has been written about extensively in the scholarly literature (see for example here and here) and in the mass media (see for example here and here). But like a number of other journalists, Ingraham critiqued the Obama Administration’s alleged lack of commitment to drug treatment without even mentioning either landmark piece of legislation.

To Ingraham’s credit, he did at least look at some data, which was the budget for federal drug control spending across agencies:

So on the one hand, yes – it’s true that more federal dollars are going toward drug treatment. On the other hand, treatment and prevention account for less than half of federal drug spending, most of which still goes toward law enforcement efforts.

This conclusion rest on the false assumption that an administration’s financial commitment to addiction treatment is equal to federal spending on addiction treatment. But the ACA and MHPAEA are major federal actions that drive private dollars into addiction treatment by improving coverage for over 100 million people with private insurance. Analyzing what an administration has done in any health care policy area without looking at its laws and regulations for private insurance is generally misleading, and is certainly so in this case where none of the private investment is captured in federal drug control budget data.

Health care policy analysts generally see the Obama Administration’s addiction treatment record as the most praiseworthy in at least 40 years, and some journalists (e.g., Jesse Singal) have done a fine job reporting that fact. That does not however make it less disappointing to see yet another misinformed article written as if the ACA and MHPAEA never happened.

Mining the ocean

Codfish from the waters off New England was once the cheapest protein in the world; salted, it went everywhere in the Mediterranean and Caribbean, where poor people figured out how to make it palatable and invented all the bacalhau/bacalao/merluzzo dishes that now appear as gourmet specials on menus.  Now, not so much.

A 1951 seafood restaurant menu looked like this:



Seen finan haddie on any menus lately? Real Gulf red snapper? Any other good-tasting fish except salmon? There was no bluefish at Legal Seafoods this summer, but there’s always farmed tilapia; it tastes like sticking your tongue out the window, but you can pour all sorts of spicy sauces on it and it is technically fish. We’re pretty well down the yummy scale in the ocean, to orange roughy, for example, and “Chilean Seabass”, tasteless, coarse creaturse you can try to save with seasoning.  But we’ve cleaned even those out to the point that they’re both in trouble (this page just brings me to tears, as a planet resident and a diner both.

When I worked in the Massachusetts Environmental Affairs Office, the state and the feds were trying to get the Gloucester fishermen to understand what was happening to them.  It was tough, and quite heartbreaking: “  There will always be fish in the sea, what we need is low-interest loans to buy bigger boats with better electronics, and to stop making rules about how many days we can fish, and stop sending these pointy-head professors who don’t know a purse seine from a sow’s ear to lecture us. Look, my grandfather was a fisherman, and my father and all three uncles, and my two brothers and I: all fishermen, it’s what we do, it’s who we are.”  The  devastation of the sea floor occasioned by dragging a bottom trawl across it is invisible, while a culture and tradition of generations commits unintentional suicide, and on the high seas, it’s just business.

You don’t expect Exxon to leave oil in the ground, do you?


I now tweet.

Having just returned from the American Political Science Association’s annual meeting, in which arson at the main hotel in the middle of the night effected a mass slumber party of political scientists on the lawn and in the hotel ballroom, I was so entertained by reading on the web the hashtags #APSAonfire and #APSAsuspects that I was provoked into signing up for twitter.

I won’t promise—or threaten—to tweet incessantly. But if you want quick notices of my blog posts, and the occasional one-liner, you can now find me @andysabl


Quote of the day

The flame of conception seems to flare and go out, leaving man shaken, and at once happy and afraid. There’s plenty of precedent of course. Everyone knows about Newton’s apple. Charles Darwin said his Origin of Species flashed complete in one second, and he spent the rest of his life backing it up; and the theory of relativity occurred to Einstein in the time it takes to clap your hands. This is the greatest mystery of the human mind — the inductive leap. Everything falls into place, irrelevancies relate, dissonance becomes harmony, and nonsense wears a crown of meaning. But the clarifying leap springs from the rich soil of confusion, and the leaper is not unfamiliar with pain.

– John Steinbeck, Sweet Thursday

While the language police are having donuts

As anyone learning it as a second language will tell you, English could use some tidying up. The orthography alone is a mess: a “Spelling Bee” would be completely silly in most other languages, where letters are used with some relationship to phonetics. Never mind Chinese. Then we have all those idiomatic traps (in front of, but behind);  illogicalities, real and seeming: loosen = unloosen, raveled = unraveled, inflammable=flammable; and all the words whose negating barnacles can no longer be pried off:

 It had been a rough day, so when I walked into the party I was very chalant, despite my efforts to appear gruntled and consolate. I was furling my wieldy umbrella for the coat check when I saw her standing alone in a corner. She was a descript person, a woman in a state of total array. Her hair was kempt, her clothing shevelled, and she moved in a gainly way. I wanted desperately to meet her, but I knew I’d have to make bones about it, since I was travelling cognito. Beknownst to me, the hostess, whom I could see both hide and hair of, was very proper, so it would be skin off my nose if anything bad happened….

What we don’t have, and could use, is the wonderful Italian kit of modifying suffixes .  I know, when you have two words for everything from Latin and German, plus colonial uploads like bungalow, yada yada…  But wouldn’t you like to be able to stick -accio/a on something to tersely express disdain in the middle of a noncommittal sentence (Tea Partaccia), or signal affection by just saying “Spotuccio!” when your dog brings your unchewed slippers?

They stack, too: “Spotinuccio” for the little pug. This needs care, however, as they can trip over each others’ feet, so if you try this, heed the following, what happens when rough and untrained hands are allowed to meddle with machinery.

The violin was christened a “small viol” (violino). It isn’t really a viol (square shoulders, tuned in fifths, etc.), but violino/violin it is, OK.  A double bass is a great big one, violone, and it really is exactly that.  The tenor of the violin family was named a “small big viol”, or violoncello (its official name, also in English, and note the second o) even though it’s more properly a violinone (skipping the viola, but see below) and not any kind of viol.  Worse, the pieces got disconnected, and we absurdly call this second-largest of  the strings a cello, literally “a small”. By curdled analogy, the tenor, larger mandolin (mandolino = small mandola, OK so far) is a mandocello.

The Germans got off this derailing train with Geige, Bratsche , and Bass-Geige, but even they passed up Kleine Bass-Geige for violoncello. Bratsche is its own mystery, supposedly an attempt to bring   viola da braccia, “arm viol”, across the Alps. But (i) how can that word not denote a horn? and (ii) how could it not have been called violaccia from the start?

Pub Quiz: Labor Day

Happy Labor Day! Google not and see how well you can do on this quiz about labor. As ever, please post scores and comments/critiques at the end.

1. The Industrial Workers of the World are more commonly known by what nickname?

2. In what U.S. city did the first Labor Day parade take place?

3. In the U.S., Labor Day is held on the first Monday in September, but in much of the world it falls on May 1 to memorialize the protesting workers who died in a bombing and riot in what city?

4. In what decade was the U.S. Department of Labor created?

5-7. Name the country of birth of these three labor activists: Mother Jones, Samuel L. Gompers and Walter P. Reuther.

8. Historically, Labor Day was the last day of the year that fashionable men could wear what kind of suit?

9. In 1936, British labor activists protesting mass unemployment marched almost 300 miles to Parliament from what Northeastern English city?

10. What was the middle name of American Federation of Labor president Samuel L. Gompers?

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Weekend Film Recommendation: In the Name of the Father

By 1993, Daniel Day-Lewis had cemented his reputation as one of the foremost young British talents in cinema. The method acting for which he had acquired the interest of the critics (and the consternation of the film crew) in Jim Sheridan’s My Left Foot was deployed yet again in their collaboration on the film adaptation of Gerry Conlon’s autobiography Proved Innocent: The Story of Gerry Conlon of the Guildford Four. The film that resulted, In the Name of the Father (1993), is this week’s recommendation.

Screen shot 2014-08-26 at 15.13.05

The film front loads the explosive action: in the opening scenes we watch the bombing of a pub in Guildford that we later learn kills five and wounds many more; back in Belfast a few days earlier, an upstart young Gerry (played by Day-Lewis) accidentally ignites an overblown military response by the British Armed Forces in his Belfast neighborhood after he’s caught stripping roof materials with his friend Paul. To secure Gerry’s safety, his father Giuseppe (played by Pete Postlethwaite) sends Conlon the lesser to London, whereupon Gerry and Paul waste no time getting into mischief.

But it’s out of the frying pan and into the fire, as Conlon actually has a rather unhappy knack for stepping into sensitive and highly threatening situations. The wider political climate, fraught with tension as the Troubles were reaching (one of) their peak(s), has just seen the passage of the Prevention of Terrorism Act that permits – among other things – the detention of terrorist suspects for up to seven days. Conlon becomes a suspect in the Guildford bombing and is tortured by the cops for days until they extract a fabricated confession from him that incriminates himself, his travel buddy Paul, and two other friends. In a wretched turn of events, even Gerry’s father and aunt are included in the conspiracy.

From that point forward, the drama shifts gears to a crusade for the exoneration of those convicted for the Guildford bombing – a crusade prosecuted by the resolute Giuseppe and the lawyer Gareth Pierce (played by Emma Thompson). Giuseppe and Peirce hope to recruit Gerry to the cause by rousing him from apathy before it’s too late. In a film dominated by male spaces, all of which lack either determination, a sense of justice, or competence, Peirce brings a refreshing blend of all three.

Although the physically demanding preparatory rituals Day-Lewis used in My Left Foot weren’t required for In the Name of the Father, he was no less obsessive in getting into character. He stayed awake for days and starved himself before permitting filming to proceed in the interrogation scenes, and his desperation shows through. Even the weariness of being in prison for fifteen years comes across in his appearance, right down to the facial features. It’s not Linklater’s Boyhood, but Day-Lewis looks like he’s visibly aged by the end of the film.

Screen shot 2014-08-26 at 15.11.41

While there’s no question that Postlethwaite is outstanding as Conlon the elder, the added value of his character to the overall plot (beyond simply providing added grist to the suffering mill at the heart of the miscarriage of justice trope) becomes clear only as we approach the film’s conclusion. The father-son dynamic sharpens the sadness in the beginning of the film, but Giuseppe’s most significant contribution is as a foil for Gerry’s character development. At various points, Gerry spurns all three of the film’s elder male leads (Gerry’s father, the righteous Giuseppe; Gerry’s one-time idol, the self-confident IRA soldier McAndrew; and Gerry’s nemesis, the crooked cop Dixon). Eventually, Gerry has to pick what direction his embitterment will turn him toward, and it’s this complexity – combined with the impressive performances – that elevates In the Name of the Father above your garden variety miscarriage of justice movie.

Indeed, throughout the film there are fragments of more subtle imagery and nuance than the traditional ‘wrongful conviction’ genre would suggest: in prison, Conlon dulls his nerves to the indignity of his incarceration by taking acid smuggled in on pieces of a jigsaw puzzle of, you guessed it, the British Empire. As Conlon’s undeserved time in prison ticks by, the fabric of the Empire itself is gradually chipped away. The religious allegory one expects from the film’s title is mercifully never over-played, even as the themes of redemption and forgiveness permeate the story.

Watch it, and you’ll get a sense of how good a film has to be to make a soundtrack that includes Bono’s music tolerable.

Google translates peak Chinese coal

Sometimes Google Translate is good enough. A news item in Chinese from the blog of Polaris Power, a Chinese energy trade site (via Lauri Myllyvirta’s blog at Greenpeace East Asia, picked up by others). Reproduced without a cleanup I’m not competent to do.

Polaris-fired power news

This year, the national coal market oversupply problems have become increasingly prominent, inventory remains high, prices have fallen sharply, economic sectors continued to decline, to further expand the scale of loss, coal economic operation situation is more severe.

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Mismatch between patient preferences and what Medicare covers

I have a new paper with Duke and NIH colleagues out this week (early online) in the Journal of Clinical Oncology (full pdf:JCO-2014-Taylor) that demonstrates gaps between the stated preferences of Medicare beneficiaries with cancer and their caregivers about what Medicare should cover, and what the benefit package actually covers. The gaps we highlight show beneficiaries and caregivers allocating finite resources toward now-uncovered benefits that broadly speaking are designed to maximize quality of life:

  • unrestricted cash  (some level chosen by 46%)
  • home based long term care (52% choose a level far beyond what home health would cover)
  • concurrent palliative care (45% chose a level beyond the current hospice benefit; such care without having to unelect curative treatments)

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