Monthly Archives: March 2016

What is the real Marijuana question?

Leave a reply

I think it’s time I tackled the subject of marijuana. In the mixed bag that is the dialogue about cannabis, why is marijuana treated as a controlled substance in the United States, and how does it differ from other legal drugs?

How dangerous is marijuana when compared to drugs, like alcohol and tobacco, which are not outlawed by federal statue? Significantly less dangerous. According to the National Institute on Drug Abuse, an NIH agency, the major cannabis risks are breathing problems (if smoked), increased heart rate for 3 hours after use, and problems of child development during pregnancy. Hardly the evil drug that would warrant such rigid federal drug policy. There are also concerns about long-term use, but what drug – legal or otherwise – doesn’t have adverse effects in the long term with overuse? I’m not advocating aggressively for pot, but I’m unconvinced that marijuana EVER warranted the effort that has been exerted to keep it out of the mainstream.

More evidence of this is found in further comparison to the effects of our legalized drugs. Unlike alcohol users, marijuana users’ driving abilities do not deteriorate appreciably. Government-funded studies have proved this. Marijuana users are also very unlikely to exhibit violent behavior after use, which can’t be said for alcohol consumers. Tobacco use, while not noticeably altering user behaviors, is an immense burden on the country’s health system due to the drug’s well-known effects on the lungs, heart and circulatory system, and is responsible for more than 700,000 deaths dues to cancer and other smoking-induced disorders. Marijuana health complications are insignificant in comparison.

It’s always struck Random Spotter as hypocritical that we continue to allow deadly recreational drugs while our official position on a far more benign drug continues to drive policies that fill our jails and cost taxpayers billions. Pot has been legalized by voter initiative in 4 state and DC thus far. Four more states will have similar initiatives on the ballot in November. And, Vermont is the first state set to consider the issue through legislation in coming months. So, clearly, the state tides have turned. I think it’s time to stop the endless failure that is our federal policy on marijuana, create a sensible tax and distribution program, and call game over on the topic.

Meet the “Good” Lab-Created Mosquito

Leave a reply

Random Spotter stumbled upon an interesting article, and it prompted me to learn more about the subject. Here it is: A company called Oxitec, owned by US synthetic biology company Intrexon, has developed a mosquito strain whose males engender offspring that die before adulthood, thus before being able to reproduce.

The positive implications are astounding, as the company claims it can reduce Aedes aegypti mosquito populations by up to 90%. Theoretically, it could be possible to nearly wipe out the threat of dengue fever, malaria, yellow fever and Zika through insect control.

Most mosquito species used to exist primarily in Africa and tropical Asia just 30 years ago, and many can now be found in almost every corner of the globe. The Asian Tiger mosquito, now resident in at least 6 continents, is believed to be capable of spreading up to 25 known viruses, and outbreaks of little-known diseases, with names like chikungunya and St. Louis encephalitis, are now a common occurrence. So, the risks are not only real; they appear to be growing in frequency and severity.

The Food & Drug Administration agreed recently that an environmental assessment provided by Oxitec shows minimal environmental impact. This nod from the FDA could move Oxitec’s proposal to conduct a field trial in the Florida Keys forward. Mosquitoes are particularly numerous in the southern region of Florida, and success there could signal greater commercial appeal for Oxitec products.

I’m very concerned about the introduction of any genetically modified organism into the environment. But considering the growing risk of disease spread by mosquitoes, in the absence of reliable data to the contrary, Random Spotter thinks the benefits of the genetically modified mosquito outweigh the environmental concerns.

Caring for Aging Parents: It’s hard alright

Leave a reply

There’s no doubt that caring for aging parents is a burden. Most of us understand that, as their minds and bodies decline, they will require more of our time and financial resources, even if their retirement savings are adequate. I suppose that most of us ignore the eventuality of this until we are faced with the reality that our parents can no longer maintain real independence. Once the fear wears off, we must begin the task of discerning how to be good to our parents while still meeting our own family and professional obligations.

Random Spotter has been reflecting on these challenges as my own parents have come to need this level of support. Although it’s a painful experience, there are positives. For one, it is good to know that my parents are not neglected. For another, I am happy to report that I am mostly the person I thought myself to be. More on that in a minute.

I think the more difficult lessons of this experience have to do with siblings and relatives. I’ve read that it’s not unusual for one person to assume a greater responsibility for aging parents. This seems reasonable since one sibling may live far away, another may have limited financial resources, or there may be other restrictions that impede a person’s ability to help. Understanding this encourages the necessary flexibility that allows everyone to participate in this delicate partnership. But, this passage exposes a lot about us, and we can learn things about one another that we wished never to discover.

What has this revealed to the Random Spotter? Mostly, two things.

  • Lesson #1: I’m not that bad, and I do correct past mistakes. When this all first began, I allowed a sibling to carry the load because I live in a different state. But, I felt a discomfort that I interpreted as an important cue: I could do more. So, I made changes. And, I committed to do more to relieve my over-burdened sibling because, when one individual takes on a majority of these duties, it is a wearisome sacrifice. The cost to the primary caregiver is too significant, even if it is accepted willingly. I see that very clearly now, and I’m glad that my conscience invited me to act differently.
  • Lesson #2: We don’t know our family like we think we do. Another revelation from this process has been that, regardless of our shared upbringing, the adults we become can be very different from our shared history. While some of us may see duty and need clearly, and step up to do more, others will not. (To be clear, I am not exclusively referencing financial assistance but things like covering evenings and weekends for one another.) And, even after the most gut-wrenchingly honest discussions about sharing responsibility for the care of those who gave us life and the opportunities of our youth, not everyone has been moved to action. It’s been a very sad insight to Random Spotter that I barely recognize my siblings. I’m sure it’s odd to them, too, that I would expect so much when their desire to act is limited. I was naïve to feel that we were still the same people who lived under the same roof decades ago.

The true sadness now is that I feel very estranged from my siblings, so much so that it feels like the only things we have in common are the aging parents about whose support we don’t agree.

This is a difficult topic for all of us, and it’s nearly devastating when there is a lack of agreement about the sacrifices of time (and money) that must be made for our parents. Random Spotter is coping and solving his way through it, and this post helps. Hopefully, there’s some value for others in these words, too.

Coming Soon to Medicare: Drug Reimbursements linked to Patient Outcomes

Leave a reply

“Proposing sweeping changes to Medicare Part B drug reimbursement without thoughtful consideration and stakeholder input is not the right approach and puts Medicare patients who rely on these medicines at risk.” – Pharmaceutical Research and Manufacturers of America spokeswoman Allyson Funk.

Ms. Funk was responding to an announcement by the Obama administration indicating that it would pursue “value-based” pricing strategies for certain drugs covered by Medicare. This strategy would, in effect, reward manufacturers whose drugs produce better patient outcomes. The strategy has already seen some success with large pharmacy benefit managers who negotiate with drug makers for the pharmacy plans they administer, and it’s expected to expand as payers evaluate drugs competing for limited space in health plan drug formularies.

How will this be a better strategy than the status quo? Well, for much of the past century, drugs have been marketed through providers, with prescriptions driving growth. In this way, it was quite possible for new drugs that might be ineffective – or no more effective than already available medicines – to gain market share and distribution, in spite of higher costs. In the Random Spotter’s opinion, evidence-based pricing strategies in this area are long overdue.

Ms. Funk’s comments in representation of the industry sound like more of what we’ve been hearing for a long time from drug makers.  The industry bemoans the high costs of regulation and research that somehow justify astronomical prices for new drugs, even those that may not be most effective. They spend hundreds of millions of dollars annually to lobby government regulators. And, when all else fails, they frighten Grandma with threats that the medication she relies on will no longer be available to her. Theirs is a well-rehearsed playbook whose success is irrefutable.

And, yet, this is a difficult issue for the Random Spotter. I’m not one who supports a Robin Hood approach, in spite of the immense profitability of this segment. The fact that drugs are profitable is not necessarily a reason to interfere here. I am, after all, a believer in free markets and a staunch supporter of limited government regulation and capitalist principles. So, who am I to question the profit-maximizing behaviors of organizations that answer to their profit-seeking shareholders?

The answer is that I am a flawed, principled individual. I try to examine myself, my actions, and my values frequently. And, I think that’s the right way to live. I also don’t whine about my woeful circumstances while secretly benefiting handsomely from the illusion I help to sustain. That’s pharma, and that sickens me. I’m not saying that my values rule here. I’m only saying that, in the long run, people should matter more than profits, and truth should trump lies.

Sure, regulation sucks. I’d definitely rather see free forces address these problems. But, in the absence of values driven transformation, regulation will prevail. The sweeping changes cited by Ms. Funk are coming to Medicare Part B and the broader insurance marketplace because they are in the best interests of patients and payers. She and her colleagues would do well to limit their distorted posturing and to escalate their cooperation.

The Wisdom of Compromise according to Nancy Reagan

Leave a reply

An ABC report this morning reminded us of an interview of Nancy and Ronald Reagan in which, when asked the secret to keeping romance in their marriage, Nancy Reagan said “I think it used to be that one of you thought that it had to be, everything had to be your way. Or 50/50. And it isn’t always 50/50, sometimes it’s 90/10. And you have to be willing to give the 90. Or he has to be willing to give the 90…But it’s something you want to do.”

It’s easy for compromise to be perceived as a battle of wills that is only successful when each side loses and gains equally in the endeavor. Chalk it up to our competitive nature, our modern perceptions of acceptance, or the FOMO (fear of missing out) in our modern society that spurs us to reject delayed gratification. But, when we take stubborn stances in the name of fairness, we rarely recognize the losses these positions bring to our relationships.

Mrs. Reagan must have understood this well. She knew that compromise only worked when perceived over the long term. The very long term of a lifetime. Her support of her husband, indeed of his legacy after he had passed, demonstrated a deep commitment to her marriage. This was not a principled commitment, but a personal, loving devotion to a relationship formed by two imperfect people who recognized that perfection in love was achieved by compromising in unique ways and included ratios that might feel very different from 50/50.

Thank you, Nancy Reagan. Random Spotter is humbled by your wisdom and wishes more people felt the same way.

American Airlines: “Toxic” and “Misaligned”

Leave a reply

So much for the lovefest that was the new American Airlines. A statement today from the Allied Pilots Association (APA) accused American Airlines of not making good on promises delivered to pilots at the outset of the merger between AA and USAir. I wish I could say I’m surprised.

Airlines are in an ugly place since deregulation. They suffer hugely when the price of gas and labor goes up, and there are no protections (in the US) to mitigate the negatives. Fortunately, due to American’s position of not hedging future oil prices, the tank in oil prices made it one of the most profitable airlines in the world this past year.

So, put your money where your mouth is, AA. I already hate what you’ve done and threaten to continue to do to gut the value of my AAdvantage rewards. Just remember that, even if customer loyalty is only advertising-speak to you, disrespecting the loyalty of your pilots and employees will have a more immediate impact on your business if they decide to walk away from you.

Let’s not ignore what’s happening in Turkey

Leave a reply

Yesterday, the Turkish government raided the Zaman newspaper, a paper that had originally supported Turkish President Erdogan. Why does the Random Spotter care about a situation that is so far away and doesn’t have any urgent connection to us? Well, I hate seeing oppression, no matter where it occurs. I’m convinced that well-reasoned criticism is necessary for good and accountable government, but there are too many places in the world right now where honesty will earn you time in jail, if not worse.

Turkey is supposed to be a secular, constitutional republic. That’s its legacy in Europe, and it’s been a shining example of religious and political tolerance in the region. But, the civil rights violations of President Erdogan’s regime are getting worse, and that’s dangerous to Turkish citizens and US interests alike.

So far, there’s not much outcry from the West or the world. Too bad. Oppression starts there, but you can bet it’s on its way here. 

Today, the only thing sadder than lingering racism is the damage caused by racial lies.

Leave a reply

Random Spotter read today about the University of Albany students whose accusations of white racial bigotry on a university bus have instead spurred misdemeanor assault charges against the accusers. Their original claims are all but overshadowed by charges that the incident was fabricated or not a hate crime at all.

I would never consider myself an expert on racism or equality. But I was concerned about the damage that is done when overly zealous people misrepresent events to give voice to their complaints, no matter how authentic the cause. As an observer of human nature, I see how people feel when the truth is bent is such a manner, and it’s difficult not to turn away from the entire issue, even when examination is truly warranted. My only point here is that this is a factor that I recognize, and I wish African American leaders – who surely must also recognize this – would do a better job of encouraging truthful dialogue, free from inflammation and embellishment. Easy for me to say, I know.

Here’s the Random Spotter’s takeaway: If a cause is to be truly understood, it must be accepted as legitimate by those who don’t yet recognize its significance. Situations like the University of Albany case do the exact opposite and take this issue a step backward, if only for a short while. That’s the real shame of it.