Sometimes Numbers Aren’t the Point: Children and Guns

Gun Child

The Children’s Hospital of Philadelphia, Research Institute, reports that one in three handguns in the United States is kept loaded and unlocked, and most children know where their parents keep their guns. [CHPRI]  Think about that for a second or two, then add the happy note that only about 1 in 3 households in the United States is “armed.” [NPR] In fact the number of households with a gun has dropped from 47% in 1973 to 31% in 2014. [NORC pdf] So, of the 1/3rd of the households that have guns in the U.S., 1/3rd of the hand guns are likely loaded and unlocked, and most of the youngsters know where those hand guns are located.  That’s a problem.  The first and most obvious problem is that guns kill quickly and efficiently – leading to fatal suicide attempts and homicides among the young.

Gun advocates often point to the fact that suicides are included in gun death reports, and opine that this is to “inflate the figures.”  No inflation is necessary.  Whether another person holds the gun or the victim holds the gun doesn’t alter the fact that the firearm was the proximate cause of death.  If we’re looking for ways to diminish the prospect of youth suicides and homicides then gun safety regulations are a point to consider.  Why?

“Homicide is the second leading cause of death for youth ages 10-24, and 82% of the homicides are firearm related. As a nation, the United States has a higher firearm mortality rate among children and youth than the next highest 25 industrialized nations of the world combined.” [JHSPH pdf]

[…] one third of all firearms deaths among adolescents are the result of suicide. Between 1994 and 2006, teen suicide rates have dropped from 11.1 per 100,000 to 6.9 per 100,000. Although adolescent females are more likely to attempt suicide than males, males are four times more likely to die from suicide.  As a result, roughly 83% of suicide deaths were males.” [JHSPH pdf]

These figures support the findings of the Philadelphia Children’s Hospital reports

  • “In 2013, 1,670 children (age 0 to 18 years) died by gunshot and an additional 9,718 were injured.
  • Among children, the majority of unintentional shooting deaths occur in the home. Most of these deaths occur when children are playing with a loaded gun in their parent’s absence.
  • 73 percent of children under age 10 know where their parents keep their firearms and 36 percent admitted handling the weapons, contradicting their parents’ reports. 
  • More than 75 percent of guns used by youth in suicide attempts were kept in the home of the victim, a relative, or a friend.”

However, there are times the statistics aren’t enough.  We can calculate the medical expenses of a homicide victim. We can figure out approximately what the average funeral expenses will be for a suicide victim. We can collate statistics on gun ownership, gun access, and gun availability.  What we can’t calculate, collate, or figure out is the incalculable grief brought to any and all families as a result of firearm use and misuse.

What calculation is possible when a two year old child dies as a result of shooting himself with a hand gun he found in his mother’s purse? [Indianapolis April 20, 2016]  When a 26 year old mother dies because a child in the back seat of a car got hold of a gun? [Milwaukee April 27, 2016]  When a five year old girl kills herself with her father’s gun? [LaPlace, LA May 22, 2016]  In one week in April 2016, four toddlers shot and killed themselves. [NYT]

What method categorizes the grief when an 18 year old youngster with learning disabilities commits suicide, and a community has to deal with two youth suicides in the same month? [Livingston MT February 2016]  How does a school deal with an adolescent murder/suicide? [Glendale AZ, February 2016] There are lawsuits, but what are the lasting damages for a young girl bullied so viciously that she, too, commits suicide on December 11, 2014, in Fairfield, Ohio?  Reporters agonize over how to cover teen suicides, such as the one in Maine, July 2004.  Does one “minimize it” in order to avoid copy-cat results among other unstable teens; or, “report it” seeking to highlight the nature of the problems felt by adolescents and encourage more preventative measures?

What we cannot do is to remove the firearms from the discussion.  “Suicides are unstable, and this is a mental health problem?”  Yes, it’s a mental health problem – a mentally unhealthy youngster got a gun.  “It’s an inner city problem.”  Not really.   If by “inner city” the speaker is talking about African Americans, then the general numbers don’t support the isolation of the subject.  The numbers for U.S homicide murder victims by race for 2009 (2013 report) show White victims at 654 and Black victims at 639.  Under 22? White 1,381 and Black 1,813.  In fact, if we look at the numbers for victims under the age of 13, then White victims less than 1 year old – 106; Black victims 72; 1-4 years of age White 159, Black 129. And, 9-12 years old 43 White, 23 Black. It’s only in the 17-24 age range that there’s an observable disparity.  It’s too many young people who have too little judgment having access to too many guns:

“By age group, 69% of gun homicide victims are ages 18 to 40, a proportion that has changed little since 1993. These groups also have the highest homicide rates: In 2010, there were 10.7 gun homicides per 100,000 people ages 18 to 24, compared with 6.7 among those ages 25 to 40, the next highest rate.” [PewRes]

Good news and Bad news.  For good news we can look to numbers indicating a decline in gun ownership by household.  Fewer households with guns probably means fewer tragic family accidents, fewer youngsters with access to guns, and fewer opportunities for a younger person to take his or her own life.  We can also look to the decline in the overall homicide rates. Fewer people are doing fewer truly stupid things with guns.

On the counter side, only 11 states out of 50 have laws concerning firearm locking devices. Massachusetts is the only state that generally requires all firearms be stored with a lock in place. Only 5 states set standards for the design of locking devices.  This seems an unwarranted situation given that we know that about 1/3rd of accidental firearms deaths can be prevented by the use of a child proof lock and a device that indicates if a firearm is loaded. [SGL]

If we are truly concerned about our children and grandchildren, and we know that “73 percent of children under age 10 know where their parents keep their firearms and 36 percent admitted handling the weapons, contradicting their parents’ reports,” then requiring Safe Storage is a rational way to regulate the storage of firearms without impinging on a person’s right to ownership.

If we are truly concerned about our children and grandchildren, and we know that “More than 75 percent of guns used by youth in suicide attempts were kept in the home of the victim, a relative, or a friend,” then Safe Storage laws would be a sane way to restrict access to legally possessed firearms such that fewer young people might decide to take their lives in the wake of burgeoning personal problems.

If we are truly concerned about our children and grandchildren, then we’ll take a more rational perspective on the storage and access to firearms in the United States, so that the numbers will no longer matter all that much and we can concentrate on the quality of life we wish for those children.

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Roundup, including Nevada as a test of the GOP Autopsy

Heck photo There’s an interesting piece in Talking Points Memo today about the Nevada senate race, Representative Joe Heck, included, and questioning Heck’s capacity to attract Hispanic voters in the state.  Perhaps someone should ask the GOP candidate if he supports Donald Trump’s bid for the presidency? The answer should tell us if Heck listened to the “autopsy” or is part of the corpse of the Republican party?

Loon How can we miss you if you won’t go away?  The Malheur Refuge Loons, the ones wearing camo, and pretending to be “patriots,” are still in court – including one Larry “The Loon” Klayman who wants very much to insert himself and his stack of conspiracy theories into the “movement” supporting Cliven Bundy in court.    Ammon Bundy intends to argue he can’t be prosecuted because the Federal government really doesn’t own the Malheur Refuge, no matter that there are similar cases with decisions  on record which dismissed this argument as having no merit.  Meanwhile, a Nevadan who participated in the Loon-acy has entered a guilty plea to charges of conspiracy.

Trump white power We’re Shocked. Shocked I say… to discover that there’s another white nationalist on the list of Trump delegates to the Republican convention.  In her own words: “I’m all for closing the borders. I’m all for not allowing Muslims in this country. I’m all for keeping illegals out and get as many of them who are here out as soon as possible. … Why do I want my taxpayer money taking care of criminals and murderers who aren’t supposed to be here?” We can add her to the folks already on the list who have child porn and weapons charges on their CV’s.  Meanwhile, back on April 28th Pew Research reported Republican “favorability” ratings edging lower.

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Donald The Destroyer Aims at the Dodd-Frank Act

Trump 1 Nothing will set the DB flashing quite like a threat to deregulate the financial sector.  And  Donald the Destroyer has done it.

“The presumptive Republican presidential nominee told Reuters in an interview published Tuesday that in two weeks he’ll release a financial regulation platform that includes repealing most of the Dodd-Frank Wall Street Reform and Consumer Protection Act.

“I would say it’ll be close to a dismantling of Dodd-Frank,” Trump said. “Dodd-Frank is a very negative force, which has developed a very bad name.” [TheHill]

Let’s be very clear at this point.  Here’s what the Dodd-Frank Act contains:

“Taxpayers will not have to bear the costs of Wall Street’s irresponsibility: If a firm fails in the future it will be Wall Street – not the taxpayers – that pays the price.

Separates “proprietary trading” from the business of banking: The “Volcker Rule” will ensure that banks are no longer allowed to own, invest, or sponsor hedge funds, private equity funds, or proprietary trading operations for their own profit, unrelated to serving their customers. Responsible trading is a good thing for the markets and the economy, but firms should not be allowed to run hedge funds and private equity funds while running a bank.

Ending bailouts: Reform will constrain the growth of the largest financial firms, restrict the riskiest financial activities, and create a mechanism for the government to shut down failing financial companies without precipitating a financial panic that leaves taxpayers and small businesses on the hook.” [Link for more information]

So, let’s review.  What Donald the Destroyer is proposing is that in repealing the Dodd-Frank Act – taxpayers WILL be on the hook for Wall Street debacles, and there will be NO mechanism by which a failing financial institution can be shut down without damaging taxpayers and small business.  What Mr. Trump is advocating is essentially more taxpayer secured bailouts, more financial system insecurity, and more games played by bankers/hedge fund managers with depositors money.  Like that?

Dodd-Frank is a very negative force?  Says whom?  Certainly not the writers at Fortune magazine

“The U.S. economy has recovered since the financial crisis, and it’s impossible to know how much lending would have increased without Dodd-Frank. Indeed, the amount of cash that banks hold collectively is up nearly $700 billion in the same time. At least some of the jump has to do with the fact that Dodd-Frank was passed after lending had dropped considerably. But even factoring in that plunge, there are now $800 billion more in bank loans outstanding than there were before the financial crisis, when everyone seems to agree there was less financial regulation.”

What “negative force?”  With $800 billion more in outstanding bank loans than there were before the crash and smash of 2007-2008, the provisions of the bill obviously haven’t diminished lending.  But wait, as they say in the infomercials, there’s more:

“Recently, business lending—the kind that Donald Trump says Dodd-Frank has hurt the most—has increased rapidly. Lending to commercial and industrial companies, which often referred to as C&I lending, jumped $71 billion in the first quarter, and it is up 60% since Congress passed Dodd-Frank. In the first quarter, C&I lending eclipsed residential mortgage lending for the first time since the 1980s.”  [Fortune] (emphasis added)

But, why take Fortune’s word for it? Let’s take a look at the Federal Reserve’s tracking of C&I loans for the last ten years.

FRED C&I lending

Does the line on this chart indicate to you that anything (the Dodd-Frank Act included) has a “negative impact” on commercial and industrial lending by all commercial banks?  As of April 2016 all commercial banks in this country had loaned $2,047.4917 Billion in U.S. dollars.  The current level is a 72.36% increase over the commercial lending level of $1187.9395 in August 2010.  So, the Dodd-Frank Act was signed into law on July 21, 2010 and now we see a 72.36% increase in C&I lending by commercial banks.   Only by turning the FRED chart upside down, could we remotely conclude that the Dodd-Frank Act has been a negative force on commercial bank lending.

Perhaps he’s talking (through his hat) about mortgage lending?  FRED has some handy data in its Make-A-Chart system for that too.

FRED Mortgage lending

The direction of the line on the chart since August 2010? UP.  Not quite up all the way to the $13,830,587.23 million level of the 4th Quarter of 2010 as the housing bubble fizzled, but close enough to call it a recovery, i.e. a decrease of 0.2513%.

The one chart that is “down” is that for residential mortgage holders in one to four family housing units.

FRED Family mortgage lending

At the height of the housing bubble (Q1 2008) the total was $11,320,563.29 million; as of Q4 2015 the total was $9.986,024.00 million.  However, before attributing that to the “negative force” of the Dodd-Frank Act there are some other factors which ought to be considered:

  1. Some of the loans made during the Housing Bubble should never have been made in the first place.  That was the era in which Wall Street demanded, and got, subprime and other faulty loans from mortgage lenders who were anxious to sell them to those banking institutions which wanted to securitize them.
  2. Wage growth hasn’t increased to an extent that families can afford to purchase new homes, which in turn puts some pressure on the housing marker. [BusInsider]
  3. The 2016 “spring housing season” kicked off with a record low supply. [cnbc]

In short, Mr. Trump is simply parroting some line he heard on the golf course?  Some quote he got from the American Enterprise Institute, the American Bankers Association? The Heritage Foundation? From an amalgam of opponents of Wall Street regulation?  He’s certainly not done any serious thinking about the state of commercial and mortgage lending in this country.

Let’s save a discussion of what dismantling the Dodd-Frank Act would do to the average American in terms of personal financial products, student loans, and consumer loans for another post – which I’m sure will yield the same result – Donald the Destroyer doesn’t have a clue what he’s talking about.

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Filed under Economy, financial regulation, Republicans

Clinton on Quarterly Capitalism

Clinton “We need an economy where companies plan for the long run and invest in their workers through increased wages and better training—leading to higher productivity, better service, and larger profits. Hillary will revamp the capital gains tax to reward farsighted investments that create jobs. She’ll address the rising influence of the kinds of so-called “activist” shareholders that focus on short-term profits at the expense of long-term growth, and she’ll reform executive compensation to better align the interests of executives with long-term value.” [Clinton]

I could happily live with this.  She had me at “… where companies plan for the long run.”  Let me start here, and then move forward into a familiar topic on this digital soap box.  I, too, have had enough of “quarterly capitalism,” and it is high time someone offered a cogent proposal to deal with the specter.

First, no one should try to argue that all short term equity and bond purchases are necessarily bad – there are some valid reasons for such trading. However, as in most other things in life it is possible to have too much “of a good thing.”  Let’s face it, high frequency traders aren’t investors – they’re traders, and shouldn’t be confused with those who are putting capital into the distribution system.    Too much short term investing (trading) in the mix and we’re asking for problems, three of which from the investment side are summarized by PragCap:

    1. A short-term view tends to result in account churning, higher fees, higher taxes and lower real, real returns.
    2. A short-term view often results in reacting to events AFTER the fact rather than knowing that  a well diversified portfolio is always going to experience some positions that perform poorly in the short-term.
    3. Short-term views are generally consistent with attempts to “beat the market” which is a goal that most people have no business trying to achieve when they allocate their savings.

If short term investing isn’t good on the investor’s side of the ledger, it’s not good on the corporate side either.  Generation Investment Management (UK) issued a report in 2012 on “Sustainable Capitalism,” [pdf] that emphasizes this point:

“The dominance of short-termism in the market, often facilitated and exacerbated by algorithmic trading, is correlated with stock price volatility, fosters general market instability as opposed to useful liquidity and undermines the efforts of executives seeking long-term value creation. Companies can take a proactive stance against this growing trend of short-termism by attracting long-term investors with patient capital through the issuance of loyalty-driven securities. Loyalty-driven securities offer investors financial rewards for holding a company’s shares for a certain number of years. This practice encourages long-term investment horizons among investors and facilitates stability in financial markets, therefore playing an important role in mainstreaming Sustainable Capitalism.”

Or, put more succinctly, short-term vision creates market volatility (big peaks and drops) which makes our stock markets more unstable, and undermines executives who are trying to create companies with staying power.  Instability and volatility improve the prospects for traders but not for investors, and not for the corporations and their management.

If we agree that “quarterly capitalism,” or “short-termism” isn’t a good foundational concept for our economy – from either the investors’ or the company’s perspective, then what tools are available to make long term investing more attractive, and to help corporations seeking “patient capital?”

rats rear end One tool in the box is the Capital Gains Tax. If only about 14% of Americans have individual investments in “The Market” [cnbc] why should anyone give one small rodent’s rear end about the Capital Gains Tax structure? 

Because:  The present capital gains tax structure  rewards investment transaction income more than on earned income. If we are going to allow this lop-sided approach, then there has to be some economic benefit in it for everyone?  The current system:  

“Capital gains and losses are classified as long term if the asset was held for more than one year, and short term if held for a year or less. Taxpayers in the 10 and 15 percent tax brackets pay no tax on long-term gains on most assets; taxpayers in the 25-, 28-, 33-, or 35- percent income tax brackets face a 15 percent rate on long-term capital gains. For those in the top 39.6 percent bracket for ordinary income, the rate is 20 percent.” [TPC]

Thus, if one’s income is “earned” by trading assets then the tax rate is 20% at the top of the income scale, but if the income is earned the old fashioned way – working for it – the rate could be 39.6%.  This is supposed to incentivize investment.  But note the definition of a “long term asset,” as one held for more than 12 months… that’s right: 12 months. 

Contrast that definition of a long term investment with the Clinton proposal:

Clinton Cap Gains Tax ChartNotice that in Secretary Clinton’s structure the combined rate on capital gains moves from 47.4% for those “short term” investments, down to 27.8% if the investor holds the assets for more than six years.  Five and six years fits my definition of “long term” much better than a “little over 12 months.”

Thus we have an incentive for longer term investments, which means less instability and less volatility.  This seems a much better plan to practice “Sustainable Capitalism.”

rats rear end

But, what of the executive compensation packages that are tied to short term stock prices?   Yes.  That’s a problem. [NYT] And yes, President Bill Clinton’s attempt to rein in executive pay back-fired. However, Secretary Clinton has proposed legislation to provide shareholders a vote on executive compensation, especially on benefit packages for executives when companies merge or are bought out. Her proposal would have created a three year “claw back” period during which the SEC could require CEOs and CFOs to repay bonuses, profits, or other compensation if they were found to have overseen – or been intentionally involved in misconduct or illicit activity.  Granted that doesn’t cover the entire landscape of corporate misadventure, but this could be combined with the following excellent suggestion for amending the tax code:

“Instead, Section 162(m) could be rewritten to allow a deduction for compensation paid to any employee in excess of $1 million only if the compensation is paid in cash, deferred for at least five years and unsecured (meaning that if the company goes bankrupt, the executive would not have a priority over other creditors). This approach would encourage corporate executives to act more like long-term bondholders and obsess less about short-term stock price movements.” [NYT]

Every bit of “encouragement” might help.  I’d be very happy to see CEOs thinking like long term bond holders (if long term means more than 13 months) and less like the traders/gamblers in the Wall Street Casino.

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Filed under Clinton, Economy, financial regulation, Hillary Clinton, Politics, Taxation

I Guess I’m The Establishment

Clinton Logo

At the risk of bringing out the woodwork crowd, let’s open the door anyway. I’m a Clinton Supporter, and have been for some time.  Not that my support is exactly a necessity for anyone’s campaign – I supported Biden in 2008.  Kerry in 2004, and Bradley in 2000.  No one is now speaking of Presidents Biden, Kerry, or Bradley.  However much my endorsement may be the Kiss of Ultimate Obscurity, it does come from a recovering Republican whose former party went berserk in 1968 and over the edge in 1980.

I am a Democrat because I believe in capitalism.  As anyone who’s visited this blog more than a handful of times can attest, I do believe that capitalism works, and that it works better when financialism is restrained.  Wall Street is not an existential enemy.  For all the flaws in the system there has to be some way to distribute capital from sources of surplus to sectors of need, and no one has figured out a better way to do that than capitalism to date.  In short, a mixed economy provides the best way for businesses large and small to obtain the capital they need to sustain themselves and grow.  A mixed economy is, in my definition, capitalism regulated by rational restraints on the tendency to monopoly and financialism.

Therefore, it would be out of character for me to worry about Secretary Clinton’s speeches to Wall Street gatherings; I’m certainly not a Socialist by any stretch of the definition.

I am a Democrat because I believe there is strength in diversity.  We’ve become the greatest nation on this planet because, not in spite of, the cultural diversity of this country.  This is the nation that gave the Jewish genius Albert Einstein a safe haven in 1933, and we were better for it.  Sergey Brin came from Russia, and founded Google – pretty good for an immigrant. Jerry Yang came from Taiwan, to found Yahoo! I’m certain we’re better for attracting Carlos Santana and enjoying his music, and I’ll always think of Albert Pujols in “cardinal” red.  There’s Puebla Foods entrepreneur Felix Sanchez de la Vega Guzman whose NJ based company is now worth $19 million.  Interested in drones? Then you probably already know about Jordi Munoz who co-founded 3D Robotics.  I have to admit that I have mixed feelings about Garrett Morgan, the African-American inventor of a modern traffic light – I’m not sure I like him when stopped for a long pause, but he’s probably saved my life innumerable times.

In short, I’m not in need of a revolution of any sort.  I certainly don’t feel the need to make American great again – what’s not great about a country that attracts the best and brightest from all over the world?  Nor do I feel the need to upend the socio-economic system, remember I’m not a Socialist.  We can, and should, do a better job of diminishing the income inequality gap in this country.  However, that doesn’t require a “re-distribution” of any sort.  We need to adopt economic policies which encourage entrepreneurship and the expansion of the American middle class.

I am a Democrat because I believe John Donne was right. No man is an island. All that “rugged individualism” palaver is just so much gibberish seeking to justify selfishness, or “I got mine, now you try to get yours…sucker.”  Perhaps someone with money to burn can hire a private security company – but I need the local police.  And, even the family which can afford the security company still needs someone to insure that the clothing on their children’s’ backs isn’t highly flammable or toxic.

When the woman in the family is earning only about 3/4th of what a man in the family can make, then the entire family suffers for it, and so do the merchants who would otherwise see more retail sales at their grocery stores. How much productivity do we lose each day a youngster has to endure crowded classrooms and underfunded education systems?  How much more attractive are our cities and towns when they have libraries, parks, and an investment in the arts?

I am a Democrat because I believe in democracy.  Notice please that’s not libertarianism of any sort. My definition of the little d – democracy holds that where there are no holds barred there’s the least real freedom.  Without rules we’d be back to ‘might makes right’ and reverting to the savagery of ages past, like bronze, iron, and stone.

Again, let me affirm that I believe we have one of the best political systems on Mother Earth, if we truly cherish it and make it possible for more people to vote in our local, state, and national elections.  Getting registered to vote in this nation should be far easier than the effort required to buy a gun.  We need to renew our Voting Rights Act, to revisit our campaign funding schemes, and to require that the FEC  truly have the capability to ferret out and punish untoward practices.

I tire very quickly when individuals launch into conspiracy theories and assorted assertions of fraud and misadventure.  At the beginning of this piece I said that I’d backed several candidates none of whom were elected to the office aspired to; I could have named many more from state and local elections.  With the exception of the 200o election, which I believe to have been messed up by election rigging in key states, I do not believe that if a specific candidate loses a specific election it must be because of some nefarious plot to defy Democracy and Vox Populi.  The glazed over look in my eyes is probably there because I stopped believing in conspiracy theories long ago.

If this renders me “establishment” so be it. I do not expect any other person in this great free land to pass my political purity test and I have no interest in sitting for anyone else’s.

There’s a difference between partisanship and zealotry. I am a partisan.  Perhaps in the eyes of some I am worse yet – a pragmatist. I don’t believe in intransigent positions for the sake of intransigency and purity – if I did I’d still be a Republican.  I believe that compromise is a good word, and a good political outcome.  So, here I am, and if that’s “Establishment” it’s a badge I’ll gladly assume.

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Harbinger of Events Yet to Come?

Humboldt County Democrats

LogoMonday, May 16, 2016

Mr. Jim Roosevelt and Ms. Lorraine Miller
Co-Chairs, Rules and Bylaws Committee
Democratic National Committee
430 South Capitol Street Southeast
Washington, DC 20003

To the Co-Chairs and Members of the DNC Rules and Bylaws Committee:

By this letter, the Nevada State Democratic Party (“NSDP”) hereby lodges a formal complaint regarding the conduct of supporters of Senator Bernie Sanders at the recent State Convention held in Las Vegas, Nevada on Saturday, May 14, 2016, as well as the conduct of representatives of Senator Sanders’ presidential campaign (the “Sanders Campaign”).

We believe, unfortunately, that the tactics and behavior on display here in Nevada are harbingers of things to come as Democrats gather in Philadelphia in July for our National Convention. We write to alert you to what we perceive as the Sander Campaign’s penchant for extra-parliamentary behavior—indeed, actual violence—in place of democratic conduct in a convention setting, and furthermore what…

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Physicians Could Use A Bit Of Healing in Nevada: Opioid Prescription Problems

oxycontin  The Reno Gazette Journal has done a piece of highly recommended reporting – an in-depth account of opioid prescribing in Nevada.

“…a Reno Gazette-Journal analysis of DEA data showed that for certain drugs, Nevada ranks among the highest in the country.

Take oxycodone, Nevada’s most widely prescribed opioid. In 2012, nearly 1.04 million grams was distributed via retail in the state. That’s more than double what doctors prescribed in 2006. Nevada’s distribution rate is third highest in the country.

Nevada also ranks third for its hydrocodone distribution rate. In 2012, doctors prescribed more than 799,000 grams of hydrocodone — nearly three times the rate of New Jersey, which has triple Nevada’s population.”

OC pill There are some important points to take away from the article.  One of the first is that physicians, themselves, have opposed greater oversight of opioid distribution to patients, specifically in regard to SB 459.  One physician testified to the Assembly Committee on Health and Human Services that SB 459 sections 1-12 should be adopted, but the rest of the bill including reporting and medical education requirements should be dropped because it wouldn’t prevent overdoses. [AHHS pdf] Another doctor offering testimony “went there,” comparing the regulation of opioids to Nazi Germany:

“When people come to Las Vegas and need surgery or have chronic conditions and they hear that the climate here is like Nazi Germany in terms of regulations, the tightening of prescription pain medications, and the prosecution of doctors, it has a very chilling effect on these people who need those medications. […] there are folks who have chronic pain. I am an internist and I see this every single day. I sit there arguing with them about cutting their medications down and they start crying and throwing a fit because they need it.”  [AHHS pdf]

He continued:

We pull the DEA reports now and, as a private practitioner with a two- or three-man office, it creates a lot of extra work for my staff and more
documentation. It makes me pause every time I start to write a script for any controlled substance; I should not have to feel like that. At the end of the day, the doctor and the patient have the relationship, not the government in the middle. Doctors should be the ones who decide what is best for their patients. This bill has a chilling effect on that. [AHHS pdf]

The good news is that the language requiring that a doctor check the prescription drug monitoring database before writing a prescription for a narcotic to a new patient was retained in the bill.  However, the testimony presented should cause some alarm from members of the general public.

OC pill

As the article points out, a state with one third of the population of another probably shouldn’t be prescribing three times the amount of narcotic painkillers.

The argument that the state legislature shouldn’t try to do something to mitigate the problem if the proposal won’t fix the entire problem sounds altogether too analogous to the NRA’s arguments for doing absolutely nothing to prevent guns getting into the hands of felons, fugitives, and domestic batterers.  “If it doesn’t solve the whole problem, then it shouldn’t be done.”  The second piece of testimony is, itself, chilling.

Hyperbole rarely provides productive content in a civic discussion, and Godwin’s Law applies.  Bring up Hitler, and the audience moves along assuming the argument has been abandoned.  Secondly, it’s a bit more than disturbing that a licensed physician would be argued into prescribing medication he or she knows is deleterious or even dangerous for a given patient.

OC pill

No one wants the Hot Potato.  The state pharmacy board doesn’t want to use its database to flag doctors who are over-prescribing narcotics.  Their director: “Who’s to say what’s normal or what’s OK,” Pinson said. “It might be appropriate for a physician to be prescribing a ton of narcotics according to his specialty.” [RGJ]  It might be, and then again, it might very well not be. And the Board of Medical Examiners isn’t enthusiastic about clearing out their ranks either:

“It would be inappropriate, and it’s not the intent of the (prescription monitoring program), to find cases to investigate,” said Edward Cousineau, executive director of the Board of Medical Examiners, which licenses medical doctors and investigates malpractice complaints in the state.” [RGJ]

Again, we might ask: Why isn’t it appropriate to weed out physicians who are creating a situation in which Nevada is among the top five states for opioid pushing? Perhaps the next session of Nevada’s Assembled Wisdom will find the intestinal fortitude to (1) require that the Pharmacy Board use its drug monitoring database to look for BOTH doctor shopping patients and pill pushing physicians; and (2) more thoroughly investigate drug overdose deaths. 

OC pill

Kentucky, Tennessee, Texas, and Arizona have enacted such legislation. [RGJ] Nevada should join them.

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Filed under health, Health Care, nevada health, Nevada legislature, Pharmaceuticals, Politics, public health