Does cannabis availability help prevent opioid overdoses?

There’s been lots of chatter about the cannabis-opioid substitution question.

Newsweek headlines, “Can Legal Marijuana Solve the Opioid Crisis?”  while Dr. Jeff Sessions opines that cannabis is “only slightly less awful” than heroin.

People whose background is medical research tend to distrust anything that’s not a randomized controlled trial. They point to the positive correlation between cannabis use and opioid use at the individual level, and the fact that opioid deaths continue to rise even where cannabis is most freely available. Their position is, “We don’t know anything about this. Let’s due the clinical studies before taking action.”

But “not taking action” now means continuing to criminalize even the possession of cannabis. If cannabis substitutes for opioids, those laws cost lives: lives that can’t be regained ten years from now, after the clinical-trial results are in.

Moreover, the relevant clinical trials can’t actually be done in the U.S. Continue reading “Does cannabis availability help prevent opioid overdoses?”

How to walk: the RBC guide

Two easy tips for better walking.

We all learnt to walk very young, normally in the second year of life. It’s completely automatic. Severely neglected babies in orphanages ( update – assuming they are physically normal, see comments /update) get up on their feet and walk (Bowlby, 1952, page 20) just as soon as the adored princelings of modern parents, who cheer on every step with praise and console with hugs after every fall. As with any self-taught skill, our methods are approximate, and we stick with what works.

Skills acquired like this can often be improved. Here is a tip sheet from British sports scientist and walking guru, Joanna Hall.

Ms Hall has a system to sell. If you can’t be bothered to wade through it all, here is the RBC tl;dr condensed version in two bullet points. Continue reading “How to walk: the RBC guide”

My Favorite Roger Bannister Story

I grieve the loss of Sir Roger Bannister, whom I never got to repay for his kindness to me. But at least let me relate my favorite story about the great man.

Many people don’t realize that his achievements didn’t end after his famous athletic feat. He went on to become a prominent and respected neurologist who mentored a number of my London-based colleagues. One of them was training in internal medicine and Sir Roger was teaching a mini-rotation on neurology. She was struggling and he had to give her some feedback.

He: “You simply spend too long with each patient. You will never have as much time in everyday practice as you spent with that head injury case this morning. Just make an quick initial assessment and refer the patient on to neurology if you suspect serious damage.”

She: “I needed the 30 minutes to be sure.”

He: “In practice, you will have to do at least 15 of these screenings in an hour.”

She (getting irritated): “I can’t do a neurological screening in just 4 minutes!”

He (with a kind smile): “You might be surprised what you can accomplish in 4 minutes.”

At the moment, gun control matters more

Of course the gun nuts, their lobby, and the elected officials who have traded their souls for the money trot out the platitude that mass shootings demonstrate the need for better mental health care, not gun control.

On Saturday morning, a young man with a background full of warning signs walked into the public library in Winchester, Massachusetts, armed with a large knife, and fatally stabbed a young woman who was reading at a table. Bystanders, including a 77-year-old man, rushed to help and were able to keep the man at bay until the police arrived. One is dead, another injured.

It’s awful. But it’s not another 17 dead bodies. Jeffrey Yao lived in Massachusetts where it’s a lot harder to get a gun and there is much less “rah rah, we love guns” in the culture. When the madness seized him, he had only a knife.

Certainly we need a better system for dealing with mentally ill people who behave like Jeffrey Yao and Nikolas Cruz. Perhaps we could ask the psych experts instead of the police and courts to work on a system that protects the public and the individual. That will be a hard task. Gun control is not a hard task. Get it done.

Slaughter of the innocents

Rick Snyder, the Republican governor of Michigan, set the Flint water crisis in motion by implementing his deeply-felt beliefs (I infer from his behavior, always the best evidence) that spending tax money, or exercising government regulatory power, for the benefit of poor people–especially poor black people who probably vote wrong if you let them grow up–is a moral offense.

He is also a very strong (not the strongest/rape-and-incest) abortion opponent, and we don’t have to infer, because he’s on the record about that. It turns out he and his gang of vicious, reckless, subordinates committed the biggest mass abortion episode in US history; lead in Flint’s water not only damaged thousands of little kids for life, but killed hundreds in utero.

Nice, Rick.

Universal coverage is the proper Democratic rallying cry moving forward

Democrats from Joe Manchin to Bernie Sanders are doing a great job uniting in defense of the Affordable Care Act. Moving forward, there is a risk we will form a circular firing squad around support or opposition to single-payer health care. A better approach is to unite around universal coverage, and around various forms of the public option, so that consumers can buy into Medicare or Medicaid if they so choose.

More from me here, in a tome at Democracy Journal.

A missed opportunity to report on the rural opioid crisis

Columnist Salena Zito wasn’t very candid with me in a recent Twitter exchange. That’s annoying. More important, she’s missed a real opportunity to contribute genuine reporting on the rural opioid crisis.

Twitter generally conveys the emotional warmth of a contentious economics seminar without the intellectual rigor. Still, I’ve come to value my Twitter engagements with kindred spirits and others with whom I deeply disagree whose insights I value.

Ms. Zito is one person I hoped to learn from across the usual partisan and ideological lines. She is a conservative reporter and commentator who writes for the Washington Examiner, New York Post, CNN, and other outlets. Ms. Zito is most famous for her aphorism that “the press takes [President Trump] literally, but not seriously; his supporters take him seriously, but not literally.” This is a genuinely valuable insight into how political professionals underestimated Trump’s electoral appeal. (It is also a profound moral evasion, but that’s another matter.)
Continue reading “A missed opportunity to report on the rural opioid crisis”

BCRA and the disability community

I’ve been doing some writing for Slate these days. I wrote a long and profound piece on BCRA and disability here.

Just today, I did a podcast with Jordan Weissmann. I bloviated, but it was fun. I have to raise my podcast game.

The best part was schooling Jordan on BCRA by making analogy to Jay-Z and Rihanna’s relationship woes. Still not sure why he kept laughing when I was trying to make a serious point.

Another Modest Proposal on health insurance

Follow the logic of ACA repeal and ban employer health insurance (irony alert).

I am shocked, shocked to discover that no less than 155 million Americans are forced by employers to take a substantial part of their pay (or the family breadwinner’s pay) in the form of health insurance. Health insurance they have not chosen, but has been forced on them. Republicans cannot be content with the repeal of ACA and the cutting of Medicaid down to size. As Avik Roy points out, Medicare cannot be ignored for long. Nor should the cancer of employer health insurance. The same sound conservative logic points inexorably to its abolition.

The loss of freedom is on a positively Soviet scale. Consider these well-known facts.

  • Employer health insurance covers the healthy and the unhealthy alike, and at the same rates. That’s totally unjust. Why should a 25-year-old trainee who runs a mile every morning, never smokes or drinks, and shops entirely at the farmers’ market, hand over part of her hard-earned pay to subsidise the asthmatic 55-year-old chappie in Accounts who smokes, drinks, never takes any exercise and alternates between McDonalds, KFC and Dominos for his daily injection of cholesterol-, sugar-, and additive-laden food? It’s positively un-American, and removes the vital incentive to make good lifestyle choices.
  • Male employees have as much deducted from their pay as women, and the single as much as those who have children. Nothing wrong with children of course, but it’s a personal choice just like preferring a new car to a holiday in Tahiti, and people should assume the consequences of their actions. If a woman has a child without previously arranging for a husband, that is likewise her lookout.
  • Employer health insurance is a form of bondage that ties the employee to her employer independently of the mutual benefit of a free labour contract. The costs of losing a job include, as they do not in America’s competitors, the loss of health insurance. Many American workers are trapped in jobs they are not suited for, or have gone sour on, through this fear.
  • Employers are also faced with a heavy cost their competitors in other countries do not bear. In a world without employer health insurance, cash wages go up of course. But the employer would still gain on balance: from not keeping on the unhappy workers whose main motive for staying on is assured health cover, and the high administrative costs of running the scheme. Danish businesses don’t employ a team of people in Human Resources to look after employee health, what would be the point?
  • The public policy win comes from bringing back that vital “skin in the game” when individuals buy insurance for themselves. In employee health insurance, it’s not so much a principal-agent problem as the absence of an identifiable principal. Firms know little about health insurance. They buy it because it’s expected by new hires and valued long-serving core staff alike, and everybody else does. They will buy “good enough” and then stop looking. Unleashing the power of the free market to lower prices implies real competition in every sale. This means each individual or family unit must be an agent in a vigorously contested market.

Employer health insurance must go, with the massive tax break transferred to individuals. Some of my more radical libertarian friends think that’s far from enough. All insurance is morally flawed, as it removes the “skin in the game” by spreading risk across large pools. Insurance breeds carelessness. Beyond that, the whole concept of employer and employee is suspect. The Marxists are right, they say, in condemning the wage relationship as servile and alienating: you are not selling something you have made to another, but selling him your very will, accepting a temporary but still abject bondage under which your master controls what you do. In a truly free society, the only employees are women and children naturally subject to the authority of the male head of the family. Should slavery be reintroduced, an idea on which I offer no opinion, it would complete the salutary restoration of the Roman paterfamilias.

We must reluctantly postpone these fascinating debates to another day. For now, Republicans must use their possibly short-lived control in Congress to strike off the tentacles of employer health insurance slowly strangling American business and American freedom.

The “American Employee Freedom in Health Care Act” would be very short. It only needs two operative articles, leaving aside the changes to the tax code.

Article 1. With effect from 1 January 2019, it shall be prohibited for employers to provide health insurance to employees, under pain of a fine of $5,000 for each employee and year of service for which such insurance is provided.

Article 2. The date of entry into force laid down in Article 1 shall be brought forward to January 1 2018 where the employer is a media organization, registered lobbyist, think tank, political party, or other organization engaging in political advocacy or policy analysis as its principal activity, and the employee is a journalist, columnist, presenter, analyst, or regular commentator.

BCRA will probably kill thousands of Americans every year

…And it’s not alarmist or uncivil to say so.

The effects of insurance on mortality are inherently difficult to precisely forecast.
But we have many strong reasons to believe that uninsuring millions of Americans would cause thousands of them to needlessly die every year.

We can debate the magnitude of this effect and how we might measure it. But the burden of proof does not rest with liberals to defend this sensible proposition, nor to prove that the likely harms associated with BCRA will definitely come to pass. Rather, the burden resides with BCRA supporters to show why we can be confident that snatching coverage from low-income people will not bring serious harm. Bill supporters have not come close to meeting this standard.

At least that’s what I argue in my second piece for Slate.