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Published: Thu, 26 Apr 2018 00:00:00 -0400

Last Build Date: Thu, 26 Apr 2018 11:13:24 -0400


FDA Investigation of Adolescent Juuling Could Endanger Adult Smokers

Wed, 25 Apr 2018 14:00:00 -0400

Juul, a discreet, streamlined e-cigarette developed by the innovative vaporizer company Pax Labs, is pretty cool. That's a problem for Juul Labs, which spun off from from Pax last year, because teenagers like cool things. Yesterday the Food and Drug Administration, responding to anecdotal reports of students who juul during school, announced that it is investigating whether the company is marketing its products to minors. New York Times reporter Kate Zernike already seems to have made up her mind. She says the FDA wants to "get manufacturers to stop marketing e-cigarettes to young people," which implies that manufacturers are in fact doing that. With respect to Juul, that charge seems pretty implausible. The company's website, which asks visitors to affirm that they are at least 21 (the minimum purchase age for e-cigarettes in some jurisdictions), emphasizes that the rectangular vaping devices, which resemble elongated flash drives and can be charged via USB ports, are "for design," delivering nicotine doses similar to those from conventional cigarettes. "JUUL was created to be a satisfying alternative to cigarettes," the website says. "JUUL was founded by former smokers...with the goal of improving the lives of the one billion adults smokers. We envision a world where fewer people use cigarettes, and where people who smoke cigarettes have the tools to reduce or eliminate their consumption entirely, should they so desire." Juul is clearly positioning its e-cigarettes as harm-reducing alternatives for grownups who smoke, which the FDA itself has recognized as a potential boon for public health. The models on Juul's website are all in their 20s or older, and so are the consumers featured in the video testimonials. The selling points touted by Juul—"simple," "clean," "satisfying"—are consistent with the market the company says it is trying to reach. There is nothing about Juul's pitch that seems geared to adolescents or even adult nonsmokers. "Our ecommerce platform utilizes unique ID match and age verification technology to make sure minors are not able to access and purchase our products online," Juul says. Some of the retailers selling Juul vaporizers have been less punctilious. The FDA says it is conducting "a large-scale, undercover nationwide blitz to crack down on the sale of e-cigarettes—specifically JUUL products—to minors at both brick-and-mortar and online retailers." So far the agency has sent 40 warning letters to retailers, including convenience stores across the country, for selling e-cigarettes to customers younger than 18, the minimum age under FDA regulations. In her Times story, Zernike erroneously reports that the retailers "violated the law preventing sales of vaping devices to anyone under 21." There is no such federal law, although a few states and cities, including California and New York City, have enacted that rule. In most places the minimum purchase age is 18. FDA Commissioner Scott Gottlieb worries that "e-cigarettes have become wildly popular with kids." Whether that is true depends on your definition of "wildly popular." In 2016, the most recent year for which data from the National Youth Tobacco Survey are available, 11 percent of high school students reported using e-cigarettes during the previous month, down from 16 percent in 2015. Less than 3 percent of high school students use e-cigarettes "frequently," meaning they report use on 20 or more of the previous 30 days. If e-cigarettes did not exist, teenagers would not be using them. In that sense, companies such as Juul are absolutely responsible for underage vaping. (Then again, teenagers who vape might otherwise be smoking, which would expose them to much bigger hazards.) Juul likewise can fairly be charged with making sleek, convenient electronic gadgets that appeal to teenagers as well as adults. The same goes for the flavors of its e-liquid pods. "Juul comes in kid-friendly flavors like mango and crème brûlée," Zernike says. But these are also adult-friendly flavors, as demonstrated by surveys in which grownups [...]

Health Departments Continue to Sabotage Home Cooks Across the Country

Sat, 07 Apr 2018 08:30:00 -0400

Shelli Eng lives in Erie, Illinois, a village about 100 miles due west of Chicago. For years, Eng, known as the "Bread Lady," has sold baked goods at a local farmers market and two other locations. But then county regulators, red tape in hand, came calling. Now her business is in jeopardy. But it really shouldn't be, because Illinois has a law that's meant to protect folks like Eng. Adopted in 2011, and later expanded, the state's "cottage food" law allows home cooks to make and sell low-risk foods without using a commercial kitchen. These laws lower the barriers to entry for countless home cooks. As I noted in 2013, they "help budding culinary entrepreneurs escape often crushing regulations faced by restaurants and other food sellers." But the true potential of these laws haven't been realized, as I write in my recent book, Biting the Hands that Feed Us: How Fewer, Smarter Laws Would Make Our Food System More Sustainable. That's largely due to the fact many cottage food laws kinda stink (or, as I put it in more delicately my book, are "still too strict"). And state and local health departments are often to blame. That brings us back to Eng. To placate the state's health department, which opposed the cottage food law, Illinois lawmakers forced Eng and others to rely on the benevolence of their local health inspectors. These local lords have veto power over whether their respective jurisdictions will adopt the law. Unfortunately for Eng, she sells her baked goods in Whiteside County, where the local health inspector vehemently opposes cottage food entrepreneurs like her. According to, the county health department administrator, Beth Fiorini, "does not want a cupcake law in her county[.]" Fiorini cites a litany of food-safety concerns. But such claims haven't held up, as I told The Economist in 2015. The county's stance has left Eng "crustfallen," notes. She's circulating a petition she hopes will push her county to change its law. But Eng is hardly alone in dealing with a cottage food law that promises much more than it delivers. As I lamented in a 2011 Hit & Run post, "in spite of the good intentions behind [cottage food] laws, they sometimes merely create a parallel system of numbingly stupid regulations." Forty-nine states currently feature cottage food laws. (New Jersey, among countless other demerits, is the only state that doesn't have such a law. That earned the state a big fat lawsuit to overturn the ban, which the Institute for Justice filed last month.) North Dakota adopted a more permissive type of cottage food law, dubbed a "food freedom act," last year. That was spectacular news. But the state has so far botched implementing the law. First, the state health department announced public hearings on rules to implement the law. Then supporters of the law said they were disappointed with the rules the health department had proposed. Facing a backlash over the rules, the health department cancelled the remaining public hearings and said they'd go back to the drawing board. One North Dakota cottage food supporter said she was "delighted" that the health department had pulled the proposed rules, arguing they "'flew in the face' of what the Legislature had intended." Other cottage food reforms are underway in states across the country. In Alaska, a bill currently making the rounds would expand that state's cottage food law. Maryland also appears likely to loosen its restrictive cottage food laws this legislative session. But the Maryland reforms would only go so far. For example, the current bill still wouldn't allow for retail food sales. California's cottage food law is a pretty good one. A 2013 report on cottage food laws notes California's law allows sales to restaurants, retail establishments, and farmers markets. But it's not good enough. For one, while many states allow the sale of all "non-potentially hazardous foods" under their laws, California's regulations enumerate specific foods a cottage food entrepreneur may sell. If it's not on the list—as, s[...]

No, Starbucks Coffee Won't Give You Cancer

Thu, 05 Apr 2018 10:40:00 -0400

At a glance, warning people about substances that can cause cancer seems like a sensible way to protect the public health. California's Proposition 65 requires companies to inform their employees and consumers if their products expose them to "chemicals that cause cancer, birth defects or other reproductive harm." But as so many regulations do, the 1986 ballot initiative wound up leading to some really stupid labeling requirements and predatory lawsuits. The latest example is a ruling by Los Angeles County Superior Court Judge Elihu M. Berle requiring coffee roasters in the state to label their products as potentially carcinogenic due to the presence of a naturally occurring chemical called acrylamide. Acrylamide forms upon heating in many foods, particularly starchy ones like french fries and potato chips, but also coffee, chocolate, certain breads, certain teas, black olives, and prunes. It won't hurt you, because humans seldom consume any carcinogenic foodstuff in the massive quantities that induce cancer activity in rats. I repeat, you should not be worried about coffee cancer, no matter what California requires Starbucks to print on your cup. As The Washington Post reports, rodents can develop cancer from acrylamide, but only when fed "rates 1,000 to 10,000 times higher than what humans consume in food." And coffee is not even the chief culprit! That would be potato chips, in which "the highest acrylamide concentrations were measured in thousands of parts per billion, much lower than the levels that cause cancer in lab animals." There are other chemicals on California's Prop. 65 list that you probably shouldn't worry too much about. Pyridine was added in 2002, yet the U.K. Health Protection Agency reported in 2010 that there is no evidence it causes cancer in humans, and In the Pipeline's Derek Lowe was unable to find any evidence supporting its toxicity as recently as 2017. The Prop. 65 list also contains, uh, "wood dust." What does that mean, exactly? Where do you affix the label—to the offramp sign at the state visitor center? You should worry if you're a California business, because Prop. 65 lawsuits tend to look a lot like shakedowns. The Starbucks lawsuit closely resembles a 2002 suit filed against McDonald's and Burger King. After six years, McDonald's and Burger King settled, agreeing to warn consumers about acrylamide in their french fries, as well as to pay civil penalties to the group that brought the suit. And attorney's fees. Lots of attorney's fees. Both suits were brought by the Council for Education and Research on Toxics (CERT), which is organized as a nonprofit. Except I can't find any information about CERT on Charity Navigator or Guidestar. According to attorney Nathan Schachtman, the nonprofit at one time shared an address and contact information with the Metzger Law Group, the law firm that filed both the McDonald's suit and the more recent Starbucks suit. In other words, one could be forgiven for suspecting that CERT was set up by trial attorneys in order to create a plaintiff that could bring Prop. 65 lawsuits against California companies. "Californians are so inured to Proposition 65 warnings that the ubiquitous signage has become meaningless," former Burger King CEO Jeffrey Campbell wrote in 2016. "The rate of cancer in the state is no different than any other, suggesting that the warnings have no impact. In 2015 alone, companies paid more than $26 million in Proposition 65 settlements and suits. But the trial lawyers are the real winners. They take home about 70 percent of all money paid by businesses." Google "prop 65 lawsuit" for a glimpse of a gross ecosystem of legal eagles who specialize in suing business owners who presumably haven't spent enough money on compliance officers. Wells Fargo even offers Prop 65 insurance, and helpfully notes in its brochure that "[i]ndividual plaintiff awards are one-fourth of the civil penalty paid by the defendant"—meaning the rest goes to the suing law firm. All that said, your odds of getting[...]

FDA’s Low-Nicotine Cigarette Scheme Is an Invitation to Black Market Vendors

Mon, 26 Mar 2018 00:00:00 -0400

Technically, the Food and Drug Administration's new proposal "to lower nicotine in cigarettes to minimally or non-addictive levels" isn't an exercise in prohibition. Cigarettes would still remain available—but they wouldn't be the product that smokers had in mind. Instead, they'd be a substitute foisted on them by their self-identified betters. This sort of not-quite prohibition isn't new, and it's guaranteed to have very familiar consequences. In a statement linked to the FDA's advanced notice of proposed rulemaking, Commissioner Scott Gottlieb asks "What unintended consequences—such as the potential for illicit trade or for addicted smokers to compensate for lower nicotine by smoking more—might occur as a result?" I'm glad he asked. Low-nicotine cigarettes sound an awful lot like the 3.2 percent beer that plagued much of the country after Prohibition. Nobody was happy with the diluted swill, and they tolerated it only if they couldn't smuggle in something better. Most places have since dumped it, indicating that a taste for the unadulterated product remained strong even after years of restrictions. "Colorado has already changed their liquor laws and will permit stronger beer to be sold in grocery stores beginning in 2019, leaving only three states (Utah, Kansas and Minnesota) with laws mandating these low alcohol 'baby beers' that even the majors have less interest in brewing for them," reports American Craft Beer. There's no particular reason to think that smokers will be happier with denatured tobacco than drinkers have been with weak beer. Gottlieb has said "the FDA has a science-based obligation that supersedes popular trends and relies on evidence." Such stiff-necked sincerity is swell, but it can't make people like having their choices constrained by professional scolds. We've seen clear consequences of efforts to constrain choices in states where marijuana is newly legalized. It turns out that when you try to replace illegal markets with overtaxed and highly regulated legal ones, you throw a lifeline to underground dealers. "Pot black market still thrives after Colorado legalization," PBS reported in 2014 after the state introduced a hobbled form of legalization. "An ounce of pot on the black market can cost as little as 180 dollars," according to correspondent Rick Karr. "At the store Andy Williams owns, you have to pay around 240 dollars for an ounce. That's partly because the price includes a 15 percent excise tax, a 10 percent marijuana tax, the state sales tax, and Denver's marijuana sales tax." California officials are seeing similar results in their overregulated and overtaxed new non-medical marijuana market. Three months into a very tepid legalization, sales from legal vendors remain slow as "high taxes, complicated regulations and a thriving black market are having deleterious effects," according to the Sacramento Bee. Federal policies making it dangerous for financial institutions to transact with newly legal (at the state level) marijuana dealers also work to keep black markets alive. "[S]tate marijuana commerce will stay as black a market as bootlegged rum during Prohibition until banks find ways to operate under restrictive financial laws stemming from the Controlled Substances Act," the Alaska Journal of Commerce noted. Tobacco isn't all that different a product than alcohol or marijuana, and the burdensome taxes and regulations under which the stuff is sold have already created healthy opportunities for smugglers and bootleggers. "Excessive tax rates on cigarettes approach de facto prohibition in some states, inducing black and gray market movement of tobacco products into high-tax states from low-tax states or foreign sources," says Scott Drenkard of the Tax Foundation which, with the Mackinac Center for Public Policy, tracks cigarette smuggling on an ongoing basis. Under existing rules, an estimated 56.8 percent of cigarettes consumed in New York come from illegal sources. Enforcement efforts are as brutal i[...]

Smoking While Walking? That's a $50 Fine Under Proposed NYC Ordinance

Fri, 23 Mar 2018 13:05:00 -0400

(image) Smokers already have a tough time in New York City. They are prohibited from lighting up (or even vaping) in bars, restaurants, and several other enclosed spaces. Their cigarettes are some of the most highly taxed in the nation, running $13 a pack. And if you're one of the many New Yorkers who looks to live outside the law by purchasing untaxed cigarettes on the thriving black market, there's a chance the cops might murder your vendor.

So far, the city's smokers have taken these indignities in stride. A newly introduced ordinance would prevent them from doing even that, by banning smoking while walking.

Yesterday Councilmember Peter Koo introduced legislation that would ban anyone from smoking in motion on the city's 12,750 miles of public sidewalks. Also prohibited: puffing in parking lots and on pedestrian paths overseen by the Parks Department.

Non-stationary smokers would receive a $50 fine.

"You can smoke. You can walk. But don't do both together," Koo tells the local CBS affiliate, describing in vivid detail the harm transient tobacco users visited on both him and the children. "I'm walking behind someone who's smoking, and I'm suffering for five or 10 minutes. I see mothers with their strollers walking behind people who smoke, and they're exposing the baby to secondhand smoke."

Presumably, smokers standing in one place are producing just as much supposedly dangerous second-hand smoke as those lighting up on their way to and from their destination. Indeed, stationary smokers would appear to be the greater environmental hazard, concentrating their deadly fumes in one small area as opposed to spreading them across several city blocks.

And without a crystal-clear legal definition of walking, readily apparent to both citizens and police, Koo's bill will lend itself to haphazard enforcement and rank abuse.

Would lighting up, and then moving from one side of the pavement to the other—perhaps to avoid getting your smoke in someone else's face—constitute a violation? How about those quieting anxious jitters by smoking and pacing back and forth? Will they too be hit with a $50 fine?

This fuzzy definition makes it nearly impossible for law-abiding smokers to stay on the right side of the law. It also gives police officers endless opportunities to use the law as a pretext to stop and question someone.

Koo himself appears to have given remarkably little thought to how the specifics of his policy might actually play out, saying only that "if there's a law around, it's up to the police to enforce it. It should be discretionary."

Giving police broad authority to crack down on an incidental behavior, while at the same time just assuming they will use this authority in a wise, rational, and retrained manner, is sloppy legislating indeed.

Free Yourself From the Soft Tyranny of Nutrition Studies

Wed, 07 Mar 2018 15:30:00 -0500

"Fish oil or omega-3 supplements won't help people with heart disease," writes nutritionist Alice Callahan in Lifehacker. Her source is a recent JAMA Cardiology meta-study that looked at 10 trials with a total of 77, 917 participants and found that "supplementation with marine-derived omega-3 fatty acids for a mean of 4.4 years had no significant association with reductions in fatal or nonfatal coronary heart disease or any major vascular events." American consumers were told to supplement with omega-3 (and to eat more fish) based on studies of Inuit people in Greenland who eat a lot of omega-3-rich animals and have exceptionally healthy hearts. You should read Callahan's piece at Lifehacker for the full story (turns out, Inuit genes may be different than yours and mine), then check out the JAMA Cardiology paper if you want more. The post you're reading right now, however, is about nutrition studies and why you shouldn't think about them too much. Nutrition studies are confusing and mostly useless for regular people. I do not say that just because a leading nutrition researcher has been exposed for manipulating data for years and years. I say it because most nutrition studies test the validity of small claims that just don't matter in the larger scheme of living a life you love, and because the problems that ail us at the population level cannot be fixed with a bandolier of colloidal silver bullets. There is no "supplement" that can cure heart disease, or melt away obesity, or reverse the effects of inhaling a carcinogen all day, every day, for decades. Take curcumin. For years and years, people have sworn by the yellowing agent in turmeric as an exceptionally potent natural remedy for almost everything. But as Derek Lowe noted last year, "no curcumin trial has ever reported any convincing positive results." Turmeric is a great ingredient. Put it on everything if you like—but because it tastes good, not because it'll change your genetic predisposition to disease or undo the decades you spent treating yourself like garbage. And if you live up north or are worried about bone health, there's no harm in taking the daily recommended amount of vitamin D in supplement form. Just don't expect it to cure your cancer. Our desire for incontestable and universally true claims about nutrition reflects our fear of death and our inability to navigate the Age of Abundance, which I posit began in 1863 with the publication of William Banting's Letter on Corpulence, Addressed to the Public, and extends through today, when you can choose from 13 different types of Cheerios. A wealth of options and of competing health claims, coupled with our ability to consume media everywhere, all the time, seems to have given many of us the impression that living a good life requires reviewing all of that information, deciding whether to believe it, and integrating new products into our lives on a revolving basis. Never mind that most of us aren't capable of critically reviewing the studies that produce these claims (nor are most journalists), or, that many such products are forgettable fads. Remember the pomegranate craze? How about the insanity over echinacea in the late 1990s and early 2000s? We'll probably be talking about coconut oil the same way a few years from now. There is a simpler method for stocking your medicine cabinet and your fridge, and that is to opt out of the micro-efficacy debate entirely. Enjoy things you like in moderation, eat more things you generally resisted as a child (broccoli; I'm talking about broccoli), and don't throw money at the next big thing. Even if it is mildly carcinogenic, bacon alone probably will not kill you, any more than curcumin alone will allow you to live forever, even if is revealed to be mildly anti-inflammatory. For most Americans, there are bigger and more important questions to tackle: Am I getting enough sleep? How can I eat more perishable (read: fresh) foods? S[...]

The 2010s Have Been a Banner Decade for Unintended Consequences

Tue, 06 Mar 2018 11:35:00 -0500

The 2010s are proving to be a banner decade for unintended consequences in America's war on drugs. By now, readers are likely familiar with the policies that bolstered the markets for heroin and then illicit fentanyl: Law enforcement cracked down on doctors who prescribed large amount of painkillers, pharmacists were required to report opioid prescriptions to government databases, and regulators asked the pharmaceutical industry to make pills harder to manipulate. Unable to access snortable or injectable pills, users turned to the black market. As a result, prescription overdose deaths have declined in many states, but fentanyl- and heroin-related overdose deaths have skyrocketed. The New York Times reports that two other substances are also having a moment. "Overshadowed by the Opioid Crisis: A Comeback by Cocaine," reads a Times headline from Monday morning. "Meth, the Forgotten Killer, Is Back. And It's Everywhere," the Grey Lady declared in February. Neither drug really went away—only Quaaludes have ever done that—but they are cheaper and more plentiful than they have been in years, thanks to supply reduction policies enacted by the United States and its allies. The Times tells us, for example, that a study by RAND found that cocaine consumption fell 50 percent between 2006 and 2010. But in the past few years, the cocaine supply from Colombia has climbed to a record high in part because of a peace settlement that includes payments to farmers who stop growing coca. To be in a position to qualify for those payments in the future, many farmers started growing it. As a result...cocaine prices have fallen, leading to an increase in cocaine use in the United States and some European countries. The Economist says farmers in Colombia knew for years before the peace settlement was completed that the government would eventually pay them to stop growing coca, which is a very good reason to not grow anything else until the checks start coming in. Stateside, cocaine is cheap and, in many places, contaminated. Last week, Harm Reduction Ohio reported that cocaine samples across the state tested positive for illicit fentanyl and its analogs, meaning cocaine users with no opioid preference (or tolerance) are playing Russian roulette every time they put schnozz to mirror. People who intentionally mix heroin and cocaine, meanwhile, are increasingly likely to shoot those two plus fentanyl. The result is more dead cocaine users. Back in December, the pseudonymous blogger Jubal Harshaw emailed me with some data from the Centers for Disease Control showing that cocaine overdose deaths involving fentanyl had increased from 23 percent of cocaine deaths in 2015 to 40 percent in 2016. In Maryland, the number of opioid-cocaine deaths has increased dramatically: A large number of overdose deaths have always involved more than one drug. Classically deadly combinations include opioids plus alcohol and opioids plus benzodiazepines. Mainstream reporting seldom covers the crisis with that much nuance, but now's as good a time as any to split hairs, per a recent Vice dispatch: One CDC report found that nearly half of such ODs nationwide involved consumption of drug cocktails, and in New York City, the local health department has repeatedly reported that upwards of 90 percent of overdoses involved the interaction of multiple drugs. In Ohio, meanwhile, a study in 2015 found that the cause of death for 73 percent of overdose victims was linked to more than one drug—and nearly a quarter had four or more drugs listed. As for meth: The Times wants you to know that it's still around and still very bad. This sequence of paragraphs is particularly illuminating: Here in Oregon, meth-related deaths vastly outnumber those from heroin. At the United States border, agents are seizing 10 to 20 times the amounts they did a decade ago. Methamphetamine, experts say, has never been purer, cheaper [...]

Is Keto the Cure for Type II Diabetes?

Wed, 28 Feb 2018 14:40:00 -0500

Type II diabetes is one of America's most ubiquitous—and expensive—chronic diseases. Patients often require a suite of pharmaceutical products to manage high blood glucose levels, and the complications that arise over the long term, ranging from loss of vision and limbs to kidney failure and coronary artery disease, strain the resources of patients, their families, and the health care system. The financial strain on insurance companies, employers, and Medicaid and Medicare is even more enormous. A 2013 study in the American Journal of Preventive Medicine put the lifetime direct medical costs for type II diabetes treatment at $124,000 for patients diagnosed in middle age. With nearly 30 million Americans affected by the disease, the American Diabetes Association estimates the national cost of direct diabetes care to be roughly $176 billion per year. But unlike type I diabetes, which is an autoimmune disorder that destroys insulin-producing cells in the pancreas, type II diabetes is a lifestyle disease, and thus reversible. Over time, people with type-II diabetes can be made more receptive to their own insulin, which in turn allows their bodies to effectively clear glucose from the blood without insulin medication. The trick for the vast majority of type II patients is as simple as losing weight. ("The relationship between obesity and diabetes is of such interdependence that the term 'diabesity' has been coined," two diabetes researchers wrote in 2005.) But that "trick" is actually pretty hard. Permanent weight loss without bariatric surgery is practically impossible at the population level. A 2014 study by Kaiser Permanente that looked at incidents of non-surgical diabetes remission in 122,781 patients found that it basically doesn't happen. The most commonly cited number among obesity researchers, meanwhile, is five percent—only five percent of people who lose weight without surgery will succeed in keeping it off over the long term. Now Virta Health, a Silicon Valley startup, has developed a lifestyle modification system that can reverse the markers of type II diabetes. In a study published this month, Virta researchers found that over the course of a year, they were able to achieve remission of symptoms and a cessation of several pharmaceutical products in nearly two hundred patients using a "novel metabolic and continuous remote care model." Virta uses a combination of the ketogenic diet—which involves moderate fat and protein intake combined with very low carbohydrate intake—and frequent remote contact with a physician and a health coach to help patients change their lifestyle and lower their body weight, their blood glucose, and their HbA1c (a biomarker for diabetes). In its February study, 94 percent of patients in the intervention arm of the trial were able either to cease using insulin or to radically lower their insulin dose, and all of the patients in the intervention arm were able to stop using a class of antidiabetic drugs called sulfonylureas, which increase the amount of insulin released by the pancreas. The control group meanwhile, increased its insulin use over the course of that same year. At $370 a month, Virta's model isn't cheap, but it's cheaper over the course of a year than the suite of drug therapies many type II patients require. And if Virta's model is scalable, the long-term savings on dialysis, hospital stays, and management of diabetic foot ulcers could be massive. Already, the company has partnered with Purdue University and Nielsen to offer the Virta system as a covered health benefit to employees with type II diabetes. The company's stated goal is to reverse diabetes in 100 million people by 2025. I recently spoke to James McCarter, Virta's head of research, about the company's treatment model and the broader landscape of type II diabetes care. McCarter received his A.B. in biology from Princ[...]

Banning Porn Is a Bad Idea. Half a Century of Science Shows It.

Tue, 20 Feb 2018 09:50:00 -0500

Is porn fueling a "public health crisis?" That's the breathless and baseless worry spreading from Utah's legislature to other statehouses (most recently, Florida and Kansas) and the pages of papers like The New York Times. These latest legislative freakouts are part of a rich history of government ignoring science and common sense in an emotional crusade against pornography, be it in the form of photos or cable movies or internet clips. I talked with Fox News correspondent Ellison Barber about the issue last night on Fox News @ Night: I was on @foxnewsnight last night talking to @ellisonbarber about porn being a "public health crisis." Check it out: — Elizabeth Nolan Brown (@ENBrown) February 20, 2018 I also wrote last week for Buzzfeed about how would-be porn prohibitionists such as Times columnist Ross Douthat are part of a long, dumb, and dishonorable tradition—one that always tries to claim that this time it's different—that whatever new medium exists for producing or distributing porn is uniquely dangerous to the youth and degrading to good women. For decades now, this supposed difference has been chalked up to the proliferation of online pornography. Though the 1970s and '80s panic over porn had begun to simmer down by the early '90s, the advent of the internet fueled its slow burn back into a full-scale boogeyman. A 1997 op-ed from Cox News Services fretted over "cybersmut" being easily accessible to teens on their home computers. "For the first time, collectors of deviant material" have a "free place to trade and barter," cautioned one activist. And the new wave of amateur porn was "especially dangerous for children." Just as earlier fears that novels, nudie mags, and Skinemax would ruin our youth have proved unfounded, there's no evidence that internet porn has been destroying millennials—some of whom now have two decades of post-high-school (and first-porn-viewing) data to offer. Read the whole thing here. Two presidential study commissions have found no reason to panic about porn. "Exposure to pornography during adolescence had little effect on persons who later became rapists and child molesters," reported the Associated Press, 48 years ago, on the first commission's findings. "One's family background and his current attitudes...seem much more likely to determine his sexual behavior" than access to porn, reported researchers Harold S. Kant and Michael J. Goldstein in a Psychology Today piece about their work. In fact, "normal adults...reported more experience with pornography as teenagers than any deviant group we studied and, as adults, they continue to see more erotica than sex offenders do." The AP explained that "sexual deviates generally came from homes where pornography was restricted and sex was never discussed," and "most deviates had been severely punished as teenagers by their parents when caught with pornographic material." The federal commission recommended against a porn ban. But the Nixon administration disavowed the report, and the Senate voted on a resolution condemning it as "unscientific." Neither offered any substantive critique of the scientists' work or any reasons to think the research was deficient; it simply didn't fit with their political aims and was thus reflexively rejected as fake news. A Reagan-era commission also found few links between porn consumption and social harm, concluding that watching pornography is "predominantly harmless"; it too was ignored by officials who found its conclusions inconvenient. Again and again, the power of scientific study seems no match for the power of political propaganda. But as Reason's Peter Suderman wrote last week, "prohibition never works, and internet smut is no exception." A new paper from psychologist David Ley tackles "the pseudoscience" behind porn health crisis legislation. "There ar[...]

San Francisco to Open Safe Drug Injection Sites by Summer

Tue, 06 Feb 2018 15:50:00 -0500

(image) San Francisco may end up being the first city in the United States to open injection sites where drug addicts can shoot up safely.

Several other major cities are considering proposals. Seattle has been planning injection sites but has had to fight off a ballot initiative to try to stop them. San Francisco is now moving forward with plans to open two sites by July.

Barbara Garcia, director of the city's Department of Public Health, told the San Francisco Chronicle that facilities' operators would be selected from the small group of nonprofits that already operate needle exchange programs in San Francisco. The facilities will be funded from private sources, though Garcia declined to say where specifically the money will come from.

The private operations should ease some heartburn among people who don't like the drug war but aren't fond of the notion of using public dollars to subsidize drug use.

The reason the sites will be privately funded, Garcia explained, is to avoid any potential liability for the City of San Francisco, since the sites will be operating in defiance of state and federal law. San Francisco is already in the Department of Justice's crosshairs because of its status as a sanctuary city for illegal immigrants.

San Francisco has an estimated 22,000 intravenous drug users, and they often shoot up in public. City officials think 85 percent of those drug users would use an injection facility if they could. They also think this could potentially save the city $3.5 million in medical costs, given that it will be overseen by professionals and will hopefully reduce the need to call emergency responders.

Some lawmakers and prosecutors complain that allowing for drug injection facilities "normalizes" heroin use. But that ship has long sailed. Studies have shown that in practice, safe injection sites reduce overdoses and help marginalized users find access to health care, and that they do not lead to more drug use, drug trafficking, or crime. Other Western countries have opened such facilities; as overdose deaths climb, it's time America tried this option too.

E-Cigarettes Can Be Lifesavers

Wed, 24 Jan 2018 00:01:00 -0500

This week the National Academies of Sciences, Engineering, and Medicine (NASEM) weighed in on the question of whether e-cigarettes are a public health menace or a public health boon. The answer is yes, according to a NASEM report published on Tuesday. The report, which was sponsored by the Food and Drug Administration (FDA), concludes that "e-cigarettes cannot be simply categorized as either beneficial or harmful to health." While that is true in principle, the report gives too much weight to scenarios in which these products could be harmful, even while confirming that they dramatically reduce exposure to toxins and carcinogens for smokers who switch to them. NASEM's advice is important because it will guide the FDA as the agency decides how to regulate the vaping industry, which last year got a four-year reprieve from rules that threatened to drive the vast majority of companies out of business. The demands that the FDA ultimately imposes on manufacturers of vaping equipment and liquids will affect the options available to consumers and their knowledge of them, which in turn will determine the extent to which they take advantage of products that could save their lives. The NASEM report, which is the work of a committee chaired by University of Washington toxicologist David Eaton, acknowledges the harm-reducing potential of e-cigarettes. "E-cigarette aerosol contains fewer numbers and lower levels of most toxicants than smoke from combustible tobacco cigarettes does," Eaton et al. say. "Laboratory tests of e-cigarette ingredients, in vitro toxicological tests, and short-term human studies suggest that e-cigarettes are likely to be far less harmful than combustible tobacco cigarettes." When people who otherwise would be smoking use e-cigarettes instead, that represents an unambiguous gain from a public health perspective, which seeks to minimize disease and preventable death. "If e-cigarette use by adult smokers leads to long-term abstinence from combustible tobacco cigarettes," the report says, "the benefit to public health could be considerable." But Eaton and his colleagues worry that e-cigarettes also could increase tobacco-related morbidity and mortality if they encourage teenagers to smoke. Depending on how big that effect is, they say, it might even outweigh the benefit from smoking cessation among adults. That concern seems wildly implausible in light of current trends. Cigarette smoking by teenagers has continued to fall despite a surge in experimentation with vaping, and last year it reached the lowest level ever recorded by the Monitoring the Future Study, which began surveying high school students in 1975. Two other factors make it unlikely that significant numbers of teenagers become smokers after getting hooked on nicotine in e-cigarettes. The vast majority of nonsmoking teenagers who vape do so only occasionally, and most of them use nicotine-free e-liquids. Against these facts, the NASEM report cites studies that find teenagers who try vaping are more likely than those who don't to subsequently try smoking. According to Eaton et al., these studies amount to "substantial evidence that e-cigarette use increases risk of ever using combustible tobacco cigarettes among youth and young adults." As the report acknowledges, however, these observational studies do not distinguish between correlation and causation. They may simply show that teenagers who are inclined to try vaping are also inclined to try smoking. Such research cannot tell us how many of these teenagers become regular smokers or whether they would have experimented with tobacco even if e-cigarettes did not exist. Under the collectivist calculus prescribed by the Family Smoking Prevention and Tobacco Control Act, Eaton et al. note, it is not enough to show that e-cigarettes are mu[...]

The Feds Are Willing to Let More Medical Workers Treat Opioid Addicts. Now the States Need to Step Up and Allow It.

Tue, 23 Jan 2018 15:30:00 -0500

The Drug Enforcement Administration (DEA) announced today that it will begin granting waivers making it easier for nurse practitioners and physician assistants to administer a drug designed to wean people off prescription painkillers and heroin without inducing withdrawal. Under the new rule, they'll be able to give patients the drug—buprenorphine—in outpatient settings without requiring that care providers register as narcotics treatment programs. If the state where they practice allows it, nurse practitioners will also be allowed to administer the drug without a physician on the premises. The Food and Drug Administration approved buprenorphine in 2002. That same year, the Department of Health and Human Services created a waiver program that would allow physicians to administer the drug in a primary care setting. The waiver system was designed to provide an alternative to the regulatory obstacles physicians must navigate to set up a treatment center. Establishing a federally approved treatment program requires you to submit an application to both the DEA and the Food and Drug Administration, plus a state regulatory agency. Applicants must then be interviewed and have their facilities inspected by all three agencies. The waiver provision—which also involves a fair amount of paperwork—was intended to expand treatment access to Americans in rural areas. But nurse practitioners and physician assistants weren't allowed to apply for the waivers. In 2016, the Comprehensive Addiction and Recovery Act changed the waiver eligibility language from "qualifying physician" to "qualifying practitioner." The DEA's notice states that the definition of "qualifying practitioner" will include physicians, physician assistants, and nurse practitioners until October 2021, at which point the language will have to be reauthorized. Under the new regulations, any nurse practitioner or physicians assistant who is licensed to administer a schedule III drug can now apply for a waiver. (Schedule III drugs have moderate potential for abuse and can be mildly habit forming.) They will be required to undergo 24 hours of training, and they will need a physician's authorization if their state requires them to work under a doctor's supervision. All physician assistants require such supervision, but 22* states and the District of Columbia allow nurse practitioners "full practice" status, meaning they can prescribe drugs independently of a medical doctor. Unfortunately, many of the states hit hardest by opioids do not allow nurse practitioners this independence. Pennsylvania, New Hampshire, Kentucky, West Virginia, and Ohio had the highest overdose death rates in 2016. Of those five, only New Hampshire allows nurse practitioners to prescribe independently. That blunts the impact of today's announcement. According to the DEA, "rural providers of buprenorphine report a demand far beyond their capacity and say they lack the resources to adequately support themselves and patients in treatment." A 2017 report from the National Rural Health Association revealed that only 39 percent of rural counties have a waivered physician. Meanwhile, a 2016 survey found that 36 percent of waivered physicians who are not treating the maximum number of patients allowed by Health and Human Services say it's because they lack the time to treat additional patients. A 2015 research review by the Kaiser Family Foundation found that nurse practitioners "can manage 80–90% of care provided by primary care physicians" and that primary care outcomes between nurse practitioners and physicians are roughly identical. The DEA took a step in the right direction today. Now states need to make it easier for non-physicians to keep their patients alive. *Correction: This post erroneously stated[...]

Good Samaritans in Southern California Cited for Feeding the Homeless

Tue, 16 Jan 2018 11:45:00 -0500

Police in the City of El Cajon (near San Diego) spent part of the Martin Luther King holiday weekend citing people for feeding the homeless. Now those people are fighting back. On Sunday, police cited about a dozen people—including one 14-year-old girl—with misdemeanor charges for feeding homeless people in a public park. El Cajon passed this law as an "emergency" in October, claiming it was needed due to a rise in Hepatitis A in Southern California last year, an outbreak that has hit the homeless especially hard. Hepatitis A can be spread quite a few ways among those who live unsanitary lives (as the homeless typically do), but it seems unlikely that it's a result of non-homeless people giving homeless people food. El Cajon's City Council is abusing a health scare to make it harder for the public to provide assistance to homeless people because they want them off the streets and into managed shelters and churches. This "solution" then criminalizes voluntary charitable interactions between citizens for not fitting into the model of how the city wants people to behave. High school teacher Matthew Schneck shared his citation on Twitter: Today I got arrested for feeding the homeless in Wells Park in El Cajon. The City of El Cajon has made it illegal to share food with homeless people. "...One has a moral responsibility to disobey unjust laws" —Martin Luther King Jr. — Matthew Schneck (@matthew_schneck) January 15, 2018 Listen to El Cajon City Council member Bob McClellan complain about people finding their own ways of helping the homeless and not complying with the city's master plan (via the San Diego Union Tribune): Councilman Bob McClellan said the city has published a list of churches where people can get food and where activists can help serve food, in an effort to contain food sharing to closed and sanitary environments. "They don't have to feed them in the park where it could cause a problem according to the health authorities," McClellan said. "If they want to help the homeless, look at the list of places. All they have to do is read the list." The group responsible for the event on Sunday knew full well what was going to happen. The group—named Break the Ban—is defying the ordinance on purpose. They and their lawyers are now going to use the citations to challenge the constitutionality of the law itself. This was their fourth event feeding the homeless in defiance of the law. They're planning another event for January 27. The American Civil Liberties Union (ACLU) describes the ban as "unconstitutional and unnecessarily cruel." They're claiming the sharing ban violates freedom of speech. It may seem strange to say that giving food is a form of speech, but the ACLU argues that the city is picking and choosing who can express charitable attitudes toward the homeless and the circumstances of how they may do so: "By prohibiting food sharing only when done for 'charitable purposes,' El Cajon is regulating food sharing because of its expressive content, punishing only those who share food to express their religious or political beliefs in ministry or charity but not those who share food for other purposes," said David Loy, ACLU SDIC's legal director. "If charitable appeals for funds are within the protection of the First Amendment, the same is true for charitable giving, whether of money or food." El Cajon is hardly alone here. Atlanta has targeted good Samaritans for feeding the homeless in public spaces, as have such cities as Orlando, Tampa, Houston, and Philadelphia, among others. Watch ReasonTV's video from 2012 about Philadelphia's attempt to stop people from feeding the homeless: src="[...]

Adolescent Smoking Rates Reach Historic Lows, Despite Vaping's Popularity

Thu, 14 Dec 2017 14:30:00 -0500

Survey data released today show that cigarette consumption by teenagers has reached "historic lows," nothwithstanding warnings that the rising popularity of vaping would make smoking cool again. In an interview with The New York Times, Thomas Glynn, former cancer science director at the American Cancer Society, called the dramatic decline in adolescent smoking since the late 1990s "an astounding accomplishment in public health." But he added that "I think we have to have alarms out" about adolescent vaping, which may yet lead to a surge in smoking. Don't give up fear!

The share of high school seniors reporting past-month cigarette use in the Monitoring the Future Study has fallen from 36.5 percent in 1997 to 9.7 percent this year—a 73 percent drop. The declines among younger students have been even more dramatic: from 30.4 percent in 1996 to 5 percent this year among 10th-graders (an 84 percent drop) and from 21 percent in 1996 to 1.9 percent this year among eighth-graders (a 91 percent drop). These downward trends have continued even as adolescent experimentation with e-cigarettes has become increasingly common.

(image) The survey puts past-month vaping this year at 16.6 percent among 12th-graders, 13.1 percent among 10th-graders, and 6.6 percent among eighth-graders. Those rates are up significantly since last year but about the same as in 2015 and lower than they were in 2014, when the survey first asked about vaping. Earlier data from the CDC's National Youth Tobacco Survey indicate that past-month e-cigarette use by teenagers tripled between 2011 and 2013.

One reason that teenagers who vape have not gotten hooked on nicotine and graduated to combustible cigarettes is that most of them are not consuming nicotine. In the Monitoring the Future Study, 58 percent of 12th-graders who reported vaping in the previous month said their e-liquid contained "just flavoring." Even those who vape nicotine rarely do it often enough to develop a habit. The Monitoring the Future Study does not report numbers for daily vaping. But in the National Youth Tobacco Survey, less than 1 percent of middle school students and less than 3 percent of high school students report vaping on 20 or more days in the previous month.

Another possible reason why adolescent vaping and smoking rates have been moving in opposite directions, of course, is that teenagers who otherwise would be smoking are vaping instead. Since the hazards of vaping pale beside the hazards of smoking, such substitution also should count as an "accomplishment in public health."

Goat Yoga Gets Baaaaaa-nned

Fri, 01 Dec 2017 16:12:00 -0500

Good, old-fashioned goats and the ancient Hindu practice of yoga are two things that don't seem to go together.

(image) And yet, last year, a small farm in Corvallis, Oregon started offering classes that combined the two. Goat yoga is exactly what it sounds like: the practice of yoga in the presence of goats.

Soon these classes had a 900-person waiting list for an hour of ritual calisthenics with a bunch of horned ruminants. Within a year, the unlikely trend had spread across the nation.

"We would go through the different asanas and the different flows," explains Amanda Bowen, a goat-yoga instructor with GoatToBeZen in Maryland, "and the goats will come around and interact with people as we're doing the class."

And then the unstoppable force of goat yoga locked horns with the immovable object of the Washington, D.C. Department of Health. When Congressional Cemetery Director Paul Williams applied for a livestock permit in the District of Columbia, he was greeted by four lawyers "ready to throw every curve ball they possibly could at me to prevent goat yoga."

But goat springs eternal. Since Manchester, CT. reversed its ban late last summer, the only place in the country where risk-averse municipal bureaucracies are undermining this fitness-to-farm trend threat is the nation's capital.

Produced, shot, narrated, and edited by Todd Krainin.

J.S. Bach, BWV 536 Prelude and Fugue in A Major, performed by James Kibbie
J.S. Bach, BWV 546 Prelude and Fugue in C Minor, performed by James Kibbie
Front Porch Sitter, by Audionautix

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