Evil Infests Augusta

John Brunner said it exactly right in The Shockwave Rider:  “If there is such a phenomenon as absolute evil it consists in treating another human being as a thing.”

With that in mind, let me give you the latest from Maine’s governor, the utterly odious Paul LePage:

Gov. Paul LePage vetoed a bill Wednesday that would allow pharmacists to dispense an anti-overdose drug without a prescription, saying that allowing addicts to keep naloxone on hand “serves only to perpetuate the cycle of addiction.” [via Kerry Eleved at GOS]

That’s nonsense on its own terms, as the deeply valuable Maia Szalavitz — herself a former addict — has argued over and over again:

As with needle exchange, opposition to Naloxone distribution has mainly come from those who fear that reducing drug-related harm will lead to increased drug use.   Fortunately, also similarly to the data on needle exchange, the research doesn’t find this occurring.

But don’t let any actual experience bother you, LePage!

“Naloxone does not truly save lives; it merely extends them until the next overdose,” LePage wrote, repeating a contention that has caused controversy before. “Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

It’s a strong word to use, I know.  But this is evil.

Rembrandt_Harmensz._van_Rijn_-_Christ_with_the_Sick_around_Him,_Receiving_Little_Children_(The_'Hundred_Guilder_Print')_-_Google_Art_Project

In LePage’s telling the addict isn’t a person.  He or she is rather just the worthless meat sack that locally reverses entropy between one overdose and the next.  He’s rather let those suffering an overdose die than live because, as he frames it here, the state of addiction robs the user of all other human attributes.

This is how a monster thinks.

I won’t say that this is the view that infects all of your modern Republican party, because on this issue it’s not. But it remains a perfectly mainstream one for the GOP — and this is a case of words (and inactions) that kill.

If you needed any more reason to go all yellow-dog Democrat on every line of your ballot, Governor (sic!) Paul LePage is exhibit (n)*

Last, to help wash the taste of tiny-minded misery out of your mouth, here’s Szalavitz again:

…one of the biggest misunderstandings we have about addiction is that tough love—is that being kind will fail and tough love will work. What really helps and why harm reduction, which is this idea that we will meet you where you’re at and we’ll help you whether you’re ready to stop or not—why that works is because when you have addiction, you tend to be very marginalized, self-hating. You might be homeless. You feel like a criminal. Nobody has any respect for you. And when somebody just hands you a clean needle or gives you access to naloxone and says, “I believe you deserve to live, regardless of whether you do what I want,” that’s a really powerful message of kindness.

And here a plug (full disclosure: she’s a friend) — here’s Maia’s new book on addiction.

*Where n is an arbitrary large number.

Image: Rembrandt van Rijn, Christ Preaching (The Hundred Guilder Print) c. 1649.



Winning, tieing and losing

Who won Wyoming’s Democratic caucus’s this weekend?

  • Bernie Sanders
  • Neither as it was a tie
  • Hillary Clinton

All of those answers can be true depending exactly on what question is being asked and what is being used as the baseline.

The Green Papers has the data.
Wyoming
Sanders received more votes and won by about 12%. That is the simplest way of answering that question and it is true.

However, it is an incomplete answer as popular vote margins are not the relevant unit of measure in the nominating race. The popular vote is not the decisive unit of measure in the Presidential elections. Popular vote in both cases tends to correlate fairly well with the relevant unit of measure, delegates and electoral votes, but not perfectly.

And that is how we get to a tie. It was an even delegate split, each candidate received seven pledge delegates.

However the Wyoming race is not happening in isolation. Within the context of the greater Democratic primary where some states favor Sanders based on the fundamentals, and some states favor Clinton on the fundamentals and there is a 215+ delegate lead, a tie is a win for Clinton as it takes another fourteen delegates off the board while giving up no net ground. It is the political equivalent of two football teams exchanging punts after successive three and outs. For the team that is ahead by nineteen with twelve minutes left in regulation, that is a win.

Why am I going over this? Will this get a good pie fight going on in the comment section? Most likely.

More importantly, it is an excellent illustration about asking the precisely right question as three very different answers can emerge from the same data set as the initial question and related context differs slightly.  Data in and of itself is not informative.  Analysis of that data is, but once we start analyzing data, we layer lots of assumptions and questions about that analysis.  We, people who seek to be informed about policy and the empirical world around us, need to be aware of exactly what question is being asked of the data and what assumptions are behind that question and answer.

 



Doesn’t matter who staffs the bureaucracy: Safe access to abortion edition

The FDA released a new approved utilization regime for Mifepristone, a medication used to induce first trimester abortions:

Mifeprex is approved, in a regimen with misoprostol, to end a pregnancy through 70 days gestation (70 days or less since the first day of a woman’s last menstrual period).  The approved Mifeprex dosing regimen is:

  • On Day One: 200 mg of Mifeprex taken by mouth

  • 24 to 48 hours after taking Mifeprex: 800 mcg of misoprostol taken buccally (in the cheek pouch), at a location appropriate for the patient

  • About seven to fourteen days after taking Mifeprex: follow-up with the healthcare provider

 

From Medscape, a description of the previous FDA regime:

Numerous protocols have been studied and are in use, but only 1 has been approved by the FDA.( Table 3 and Table 4 ). The FDA-approved regimen can be initiated up to 49 days after the first day of the LMP and consists of mifepristone 600 mg orally on day 1, misoprostol 400 mcg orally provided at the doctor’s office on day 3, and a follow-up appointment on days 12-20. This protocol is 92% effective in inducing a complete abortion.[12,13] It is hoped that studies using different variations of the FDA-approved regimen will lead to expanded options that are safe and reduced costs.

There are a couple of major changes here.  The first is the dose for Mifeprex went down and the second round medication dosagage went up.  That may or may not be clinically important.  From a policy perspective there are three major changes.

The first is that the FDA allowed window to have a medical abortion goes from 7 weeks after the last day of the woman’s menstrual cycle to 10 weeks.  This gives women a lot more flexibility and decision time from the point where she knows she is pregnant to the point where the least invasive option can is no longer FDA approved.

Secondly, the window for the follow-up dosage expands; again this is flexibility which means compliance and follow-up is easier.

More importantly, the change in location for where that second dose is administered is critical.  Previously, that second dose was to be down at the doctor’s office.  Now it is as a location appropriate for the patient.  That is massively more flexible as it means an individual could take the second pill home with her.

Why is this important?  It is a counter-move to the proliferation of TRAP anti-abortion access laws as Think Progress explains:

anti-abortion lawmakers — who have mounted an incremental strategy based on chipping away at abortion from all angles — were quick to exploit the discrepancybetween the official FDA label and the real-world medical practice. States started passing laws requiring doctors to stick to the outdated FDA method of prescribing the abortion pill. It was easy for politicians to misleadingly argue that they were simply interested in keeping women safe and ensuring that abortion patients aren’t taking dangerous, unregulated drugs.

This reduces practical restrictions on pharmaceutical abortion access by reducing the number of trips needed while also expanding the time option space.  As a side note, it allows clinics a little more flexibility to cope with other TRAP laws as some of the current surgical abortions in restrictionist states can be transferred to pharmaceutical abortions which will free up staff and appointment slots to handle more misogynistic bullshit.

So staffing the federal bureaucracy matters.

Let’s keep that in mind for November!



One pie to rule them all

And it was put together by Charles Gaba at ACASignups.net:

2016_total_coverage_pie_chart

I am amazed at how much work Charles has put into becoming one of the two or three most informed people on the matter of health insurance enrollment. I could not even start figuring out where to ask the right questions to put together the pie graph that rules them all.

Bravo Zulu!

And now let’s use this as an early morning open thread.



Monday Evening Open Thread: Must Be Tourist Season

Per the local paper, the Washington Post:

A man with a gun was shot by police Monday afternoon at the Capitol Visitor Center at the U.S. Capitol Complex, according to two D.C. police officials. He was taken to MedStar Washington Hospital Center.

The report of gunfire in a city on heightened alert because of terrorist attacks in Europe sent dozens of emergency vehicles to the Capitol building and forced staff and visitors into lockdown. Road barricades went up, and police officers with automatic rifles were stationed on street corners.

The shooting occurred about 2:40 p.m. at the entrance to the visitors’ center, an underground complex east of the Capitol building. All visitors are screened through metal detectors as they enter the facility…

[U.S. Capitol Police Chief Matthew R.] Verderosa said the man is known to Capitol police from prior contacts, but he declined to elaborate. He said police “believe this is an act of a single person who has frequented the Capitol grounds before. There is no reason to believe this is anything more than a criminal act.”…

The Capitol will be open on Tuesday, the chief said.

Trevor Kussman, a textile executive visiting with his wife and children from Chicago, said his family was inside the visitors’ center watching an educational movie when an announcement was made about “shots being fired.” The movie continued to play, but some people got up to leave…

On the plus side, as the Post points out, the “Capitol Hill shooting today happened in a building built to protect the Capitol from shooters”.

And in tangentially related news, the Secret Service responds to that Change.org petition by announcing that, Second Amendment lulz or not, the only guns at the Republican National Convention in Cleveland will be in the hands of “law enforcement personnel”. Of course, there’ll be lots of LEP in attendance…
***********
Apart from the predictable consequences of America’s national religion, what’s on the agenda for the evening?



The inanity, it burns

Two very dumb things are making the rounds today.  The first is from Tad Devine, Sander’s campaign manager:

 

This actually makes some sense if we are to assume that the Sanders campaign is fundamentally a message and viewpoint campaign. Those campaigns are a valued part of the American political process and most cycles will have a couple of single issue candidates run in order to air their ideas to a much wider audience and hopefully get their party’s front-runners to bend their positions more closely to the single issue priority. If we analyze the Sander’s campaign in this fashion, then the statement makes a lot of sense and the Sanders’ campaign has been successful.

Maximizing a message opportunity is a very different objective than maximizing the probability of winning sufficient delegates to be nominated.  Hillary Clinton is running on a delegate optimization mode as she is running to actually be nominated.  That was her theory of her campaign in the spring of 2015 (and spring of 2007).  She needs to campaign everywhere to get delegates, while Sanders needs to stay plausible enough to get a microphone so spending resources and losing minimizes the microphone opportunity.  Two very different beasts being run with very different optimization functions.

But saying this outloud while still proclaiming that Sanders is running an actual campaign to get the nomination is stupid.

And now the other piece of stupid from reactionary anti-health policy “wonk” Michael Cannon:

There is no sense in marking the ACA’s anniversary, however, because the ACA is no longer the law.

Realizing the law he signed was unconstitutional and unworkable, President Obama and the Supreme Court have since made a series of dramatic revisions that effectively replaced the ACA with something we now call “Obamacare.”

Unconstitutional does not mean what Mr. Cannon thinks it means.

Unconstitutional does not mean “I don’t like this” and “the embedding of liberterian doctrine into a document written at least three generations before the first liberterian thinkers has been obstructed”.  Unconstitutional does not mean that something is stupid or venial.

Unconstitutional means what five justices on the Supreme Court thinks that means. So far, there have been at least five justices who have said that PPACA is fundamentally allowed under our governing constraints.   Constitutionality does not in and of itself imply that an act is wise, good, desirable or prudent.  In this case, I think those descriptors are fair descriptors of the ACA, but those can be up for debate.

Constitutionality is not at this point.



Saturday Morning Open Thread: Cupcakes!

wa caucus cupcakes by dan savage

Via Dan Savage at The Stranger

Washington, Alaska, and Hawaii all hold their primary caucuses today; I know at least a couple of regular commentors are deputies in their precincts, so we should have some on-the-ground reports by tomorrow. Meanwhile, Seattle’s Dan Savage reports a charming local custom:

Terry Miller, our in-the-tank-for-Hillz cupcake correspondent, writes…

It’s 8AM and what am I doing?!! Participating in the #CupcakeCaucus! Go to @cupcakeroyale [today] and vote with your mouth! (Don’t worry! There are Bernie cupcakes too!) $1 from every cupcake sold goes to the DNC to help elect those important down-ticket candidates this November. A great way to show your support for your candidate, the DNC, and make your friend’s tummies happy!…

On the other side of the country, the Washington Post‘s Dana Milbank prepares for a less appetizing meal:

… Six months ago, I made a reckless vow. With Donald Trump dominating in polls, I said I’d eat a column — 18 column inches of toxic newsprint, wood-pulp, ink and all — if Trump won the Republican presidential nomination…

… With the help of one of the capital’s great chefs — and seeking the guidance of you, the reader — I am taking the prudent step of preparing to eat my words in case Trump secures the nomination…

So I called my friend Katherine Miller, head of the food-advocacy group Chef Action Network, who put me in touch with a chef who would help me eat my words in style: Chef Victor Albisu of Washington’s Del Campo restaurant, an acclaimed Latin steakhouse. I did not discuss politics with Chef Victor, but I doubt he’s a yuuuuuge Trump fan, based on his recipes. And I sensed he was being arch when he told me: “If you’re eating newspaper, man, the world opens up to you.”…

Chef Albisu’s proposals all sound delish, but Milbank is still taking suggestions on Facebook and Twitter…

***********
Apart from food (Easter prep for some of y’all, I’m guessing) and politics, what’s on the agenda for the day?