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Alexander Hamilton and the public debt

I have not yet seen Lin-Manuel Miranda’s hit Broadway show Hamilton. I feel badly about this for three reasons. First, Miranda is a 2002 Wesleyan graduate, a loyal and generous alumnus who gave a great commencement speech in 2015 and remains solidly committed to the university. Second, the music and lyrics are, quite simply, amazing. Third, as an economic historian, it is heartening to see one of America’s economic heroes make it to Broadway. When Miranda presented a song from Hamilton at the White House in 2009 and said that the nation’s first Treasury secretary was the very embodiment of hip-hop, everyone laughed. No one is laughing now!

Although Hamilton’s personal life and death in a duel with Aaron Burr suggest that his judgement was not infallible, he was a brilliant thinker, a prolific writer, and a visionary economic policy maker. Hamilton’s influence upon American economic policy was so broad and deep that it is better captured in a book or scholarly article than a blog post. Nonetheless, it is worth discussing one element of Hamilton’s economic policy that is relevant to current-day policy makers—and a would-be policy maker named Donald Trump.

As odd as it may sound to the modern ear, one of Hamilton’s major achievements was being the father of the US public debt. When Hamilton became Treasury secretary in September 1789, the financial affairs of the United States were a mess. During the Revolution, the Continental Congress had no reliable way of raising money, so war expenditures were paid by issuing “Continental dollars.” Because the fiscal needs of the revolutionary government were great, too many of these dollars were issued and their value fell dramatically, which explains why the phrase “not worth a Continental” was commonly used to describe anything worthless.

Continental Currency 1/3-Dollar, Obverse by Benjamin Franklin (1706-1790). Public domain via Wikimedia Commons.

Under the Articles of Confederation, which governed the US between the Revolution and the enactment of the Constitution, the federal government had no taxing authority, and so had to beg the states for funds. This turned out not to be a particularly effective means of raising money, since the states were also heavily indebted and were often reluctant to contribute. Hence, when Hamilton took office after the Constitution was enacted, both the states and the federal government were deeply in debt. Opinions differed as to what the new federal government should do to solve the impending debt crisis. Some argued that the new government should partially or completely repudiate the debt incurred by its predecessor, in other words, default. Others argued that the government should use its new taxing powers to pay off the debt as quickly as possible.

Hamilton’s First Report on Public Credit, transmitted to Congress in January 1790, argued instead that the federal government ought to expand its debt by assuming the outstanding obligations of the states, and that the government should service its debts (i.e., pay what it owed in interest and principal) promptly in order to build up its reputation, rather than aim to pay them off quickly. His reasons for this were straightforward and brilliantly articulated. He argued that in times of emergency the government would need to borrow; in times of war the need would be even greater. Given that the United States was a new country which could not count on the fortunes of a few rich people to provide funds when needed, he further argued that it was necessary to have a money-raising mechanism in place, so that when emergencies arose money could be raised quickly. Finally, he argued that for the government to be able to borrow money on good terms (i.e., at low interest rates), it must establish its creditworthiness by maintaining and servicing its national debt. Hamilton’s debt assumption plan, which was the subject of a great deal of opposition–and political horse-trading—received Congressional approval six months after it was proposed.

The US government’s debt has waxed and waned since Hamilton’s time.

US federal government debt as a percentage of gross domestic product by Richard Grossman. Used with permission,

When the Constitution was adopted, the federal government’s debt was equivalent to about 40% of the country’s gross domestic product (i.e., total economic output)—a level it would not again reach until the Great Depression. During World War II and following the eruption of the subprime financial crisis, the US government debt soared to unprecedented levels. Whatever one thinks of the size of the federal government’s debt—and I would argue that increasing the debt to fight World War II and the Great Recession was the height of responsible policy—it is clear that without the US’s capacity to borrow, addressing these existential military and economic perils would have been far more difficult.

Hamilton has been proven right by more than 200 years of history. The US has an unmatched record of debt service and, as a result, is able to borrow more cheaply and in greater quantities than any other government on the face of the earth. This is why economists shuddered when in 2013 Senator Ted Cruz threatened to shut down the government and force a default if Obamacare was not repealed. Similarly, Donald Trump sent shivers through the financial community in May when he suggested that the United States might try to “renegotiate” its outstanding debt if the economy crashed.

The US has built up an unparalleled reputation as a debtor, thanks in large part to the insight of Founding Father Alexander Hamilton. Trump’s loose talk must have Hamilton spinning in his grave.

Featured image credit: The US 10 bill (front) Series 2004A by United States Treasury Bureau of Engraving and Printing. Public domain via Wikimedia Commons.

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An interview with music marketer and bass guitarist Helena Palmer

In the midst of celebrating the bass guitar all throughout the month of July, we sat down with music marketer for Oxford University Press Helena Palmer. Are four strings really easier than six? What is the most difficult aspect of learning to play the bass guitar? How would you ensemble your dream band? Get all the inside scoop on the bass guitar from an actual player.

When did you first start learning to play the bass guitar?

I first started taking lessons when I was in Year 8 at school, so I was around thirteen years old. My parents arranged lessons with the music teacher at the school where my dad works, and he was the best teacher I ever could have asked for!

What first made you choose the bass?

Being a teenager, and an impatient one at that, I was definitely swayed by the “four strings are easier than six” approach, and that probably influenced me more than I’d like to admit. The bass is definitely less of a party trick, and I can’t just pull it out to play Wonderwall at a moment’s notice, but I don’t regret my decision at all.

Do you play any other instruments? If not, which would you love to learn?

I don’t play any others – weirdly enough, I don’t consider myself to be particularly musical – but I would love to learn the piano. Or the six string guitar – you could say I’m two thirds of the way there already.

Do you play in any ensembles, bands, or orchestras?

Not at the moment, unless you count playing along to songs in my living room when no one else is home! I have however been in a number of bands (some more successful than others) and ensembles in my time.

What was the first piece you learnt on your instrument?

The exceedingly inventive Hitchin’ A Ride by Green Day, which probably uses about four notes in the whole song. The first song I learned and was really proud of was Otherside by the Red Hot Chili Peppers – an amazing song with an actual bass solo! It was my entry into the world of Flea and his exciting and inventive bass lines.

What is your favourite piece to perform?

It’s not the most extravagant or technically challenging piece of music, but the sheer joy I get from playing All My Loving by The Beatles cannot be matched. There’s something about the gentle meandering bassline that is so pure and wonderful – it’s simple enough that I can warble along with it and appreciate the delightfulness of the lyrics without even thinking about the notes.

Who inspires you when playing the bass?

I’m drawn to bands and musicians who make the bass a feature in their music – the main two (although definitely not the only or the best two) for me are Muse and the Red Hot Chili Peppers. I’ve grown up with their music and both Chris Wolstenholme and Flea have inspired and challenged me to push my bass playing further. I am however always open to recommendations for songs with prominent and interesting bass lines!

What is the most challenging thing about playing the bass?

I think for me personally the aspect I struggled with the most was the fingering. The frets on the bass are further apart than on a regular guitar and for a teenage girl with relatively small hands, that posed something of a challenge. Slap bass is also challenging but so satisfying when you finally get it right!

What advice would you give to someone starting to learn the bass?

Keep going! The bass may not be the flashiest of instruments but it is integral – listen to a rock song without the bassline if you disagree. Also: learn your scales. They may seem pointless at the time but if you’re undertaking any grades then they’re essential, but also really helpful for improvisation.

What are your fondest musical memories?

Earning my Grade 8 certification, despite vowing I would never do another grade after Grade 5. My teacher had the faith in me that I could do it, and I still don’t know how I managed it, but I’m really proud to have that piece of paper proving I did.

What would your dream band line-up be?

Me on bass (obviously), Matt Bellamy from Muse on electric guitar, Freddie Mercury on vocals (a girl can dream… failing that I would probably choose Dallas Green from Alexisonfire/City and Colour or Patrick Stump from Fall Out Boy), and my sister Liz on drums.

Featured Image: “Bass guitar” by Feliciano Guimarães.  CC BY 2.0 via Flickr.

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Ten interesting facts about a selection of Olympic sports

Every four years, when the Olympics come around, everyone suddenly becomes an expert in one, many, or all of the sports on show. Whilst you watch you know exactly when an athlete goes wrong with their run-up, or when a horse steps out of line in the Dressage, or how a tennis player could better their serve. But have you ever wondered about some of the lesser-known facts about Olympic sports, like where diving comes from, how fast a shuttlecock can be hit through the air, or what exactly the difference is between canoeing and kayaking?

To help you get a head start we have discovered a few interesting facts about some of the sports being showcased, to help you impress your friends and family.

‘Eli Bremer in 2008 Summer Olympics modern pentathlon fencing event’ by Tim Hipps. Public Domain via Wikimedia Commons.

In its modern form, the art of diving emerged from German and Swedish gymnastics, and it first appeared at the Modern Summer Olympics in 1908 (London).
The steeplechase, an established athletics event in the Summer Olympics, is run over 3,000 metres, including 28 hurdles and 8 water jumps.
In late 19th-century Britain water polo was called ‘football in the water’ – odd, as the ball is propelled by hand – and there was a variant played in the USA called ‘softball in the water’.
In badminton, the flight of the shuttlecock can exceed 270 km/h (or over 160 mph).
Canoeing is when the canoeist either sits or kneels in a central, forward-facing position, using a single- or double-bladed paddle. Kayaking is when the canoeist sits and uses a double-bladed paddle.
The word ‘decathlon’ comes from the Greek, meaning ‘ten prizes’, which is not surprising as it’s an event comprising ten activities: four track and six field.
In the Summer Olympics, the equestrian events are the only ones in which animals feature, and in which men and women compete routinely against each other on equal terms.
In competition, four swimming techniques are used (freestyle, breaststroke, backstroke, and butterfly), with four phases to each stroke: the reach, catch, pull, and recovery.
The modern pentathlon was first put together to show off the skills that could be required of a cavalry courier.
There are two types of wrestling: Freestyle and Greco-Roman. Freestyle wrestling dates from 1904 (men), and 2004 (women). The Greco-Roman form was invented in 19th century France, in tribute to ancient sporting cultures, and was first brought to the Olympics in 1924.

Featured image credit: ‘Background bar’ by anovva. CC0 Public Domain via Pixabay. 

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In the Information Age, why do Americans ignore facts during elections?

We are constantly told that we live in the Information Age. “Everyone has a smart phone.” “Over 25% of Americans have college degrees.” “Over one-third of the African-American community now lives in the Middle Class, with a high school or better degree.” “Over 95% of the population has a TV, 99% a radio.” In other words we have the education and the information tools with which to access a great number of facts on any topic, including about politics. But do we?

History books read largely by the public and used in schools would seem to confirm the same notion. The U.S. Constitution provides for freedom of speech. Congress established the Post Office in 1790 to insure the distribution of newspapers so that the public could be informed to make sound judgments as citizens and voters. Federal regulators and legislators encouraged the free flow of information across all manner of media, from printed materials to radio, television, and now the Internet. Economists and government officials have reported for over a century on the continuous increased consumption of printed matter, radio, television, computers, PCs, smart phones and smart watches as proof that we consume vast quantities of information. They are right, of course, as the evidence is overwhelming that as the nation prospered and innovated, they could afford to buy these and knew how to consume greater amounts of information over time.

So, it must be true about American elections. Right? Actually, wrong. When looking at the historical record of how Americans used information over the past two hundred years, the area in which they most did not use hard facts involved elections. Newspapers did, of course, so too agencies providing economic and social data, and pollsters since the 1820s. There always existed a kluge of “political junkies” in every election cycle—I am one of those as are most members of my family—but these are the exceptions. The historical evidence for every national election cycle suggests that rational, informed opinions, and voting practices were not as well exercised as perceptions of what conditions existed.

Political scientists for over a century have told us that voters respond to what was in their best economic interests, but these experts have done a poor job in demonstrating that truth. In the past two decades, economists studying the psychology of economic behavior—known as freakonomics—have provided overwhelming evidence that people do not make rational decisions in their best interests. They vote based on their perceptions, not through rational thinking and based on facts.

John F. Kennedy’s iconic campaign button used when he ran for president in 1960. He was seen as a fresh face, a new generation coming to power. Public Domain via the JFK Presidential Library.

What the historical record demonstrates is that the new generation of economists have much to teach us. Americans have gone to the polls over 50 times to elect their president in the past 200 years. Each time, in the majority, they voted for candidates who seemed more like themselves, who shared their perspectives about labor, immigrants, the economy, law-and-order, and the world at large. They did little or no fact checking, nor did they invest much time in understanding the nuances of issues important to them. Andrew Jackson appealed to the rough-and-tumble frontiersmen of the 1820s as much as Donald Trump to white men with a high-school education. More issue-oriented presidential candidates struggled in that kind of a world, from Thomas Jefferson to Hillary Clinton. Adlai Stevenson, the Democratic candidate who ran against General Dwight D. Eisenhower in 1956, was seen as too intellectual, while the good General, who led the successful Normandy invasion in 1944 that led to crushing Hitler’s German state, beat him, although his rival was a highly experienced senior public official, even a governor.

People voted their hearts and prejudices. You voted for Lincoln if you were a Northerner thinking the South should just eliminate slavery and stay in the Union. In the early 1900s, Teddy Roosevelt won because enough voters thought the nation needed to control the behavior of corporations and take its rightful place in the World. In 1932, they voted in his cousin, F.D.R., because they thought Herbert Hoover had not done enough to fight off the Great Depression. In fact he had done a great deal to do that. Roosevelt was able to launch his New Deal based on the work done by Hoover to figure out next steps in attacking economic problems. Kennedy was seen as fresh, Nixon as old school and “tricky.” Johnson’s important social and civil rights accomplishments were dismissed, because too many Americans saw the Vietnam War as purposeless and too many lower and middle class families were attending the funerals of dead soldiers.

Today, fact checkers constantly go after both Trump and Clinton, with Trump being caught on misinformation by a factor of almost 4 to 1 over Clinton. Yet it did not matter, as he spoke to the emotions, fears, and perceptions of over 10 million voters. Clinton, with her issue-based campaign, too, spoke to the pre-existing worldviews of moderate Democrats, although had to contend with an even more emotionally riled up far left represented by Senator Bernie Sanders.

The evidence lies all around us of emotion over facts, although hidden. All presidential candidates in the Information Age feel compelled to publish a book-length statement of their vision for America. These tomes are publishing flops, hardly bought, rarely read, and quickly the inventory of second-hand bookstores. Talking heads on television align by political orientation, MSNBC and FOX for example. The media’s own watchers acknowledge that Republicans largely watch FOX to reinforce what they already believe, rarely pay attention to liberal media, while Democratic-oriented voters, ignore FOX and listen to liberal TV hosts. For nearly a hundred years, political scientists have observed how young potential voters ignored election issues and when they voted, did so without having done their homework on such issues as the content of a party’s platform, biographies of the candidates, or their views.

While we think we live in an Information Age that does not mean Americans rely on information for all that they do. That is nowhere more the case than in how they respond to presidential elections.

Featured image credit: “N.Y. parks – bench warmers, Union Sq.” by George Grantham Bain Collection (Library of Congress). No known restrictions on publication via Library of Congress, Prints & Photographs Division.

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Solutions to reduce racial mistrust in medicine

Black women in the United States have about a 41% higher chance of dying from breast cancer than white women. Some of that disparity can be linked to genetics, but the environment, lingering mistrust toward the health care system, and suspicion over prescribed breast cancer treatment also play roles, according to a new study from the Brown School at Washington University in St. Louis.

Rachel, a 40-year-old female participant, explained her concerns: “I figure if they can find a cure for polio, then they can find a cure. I think they don’t really care because it’s mostly attacking the black community, so they don’t care. But if it attacks mostly the white community then it’s a problem.”

The study is based on findings from the first stage of the Center for Interdisciplinary Health Disparities Research process in which study participants shared their beliefs, concerns, and attitudes about breast cancer. Researchers recruited 503 women and men from 15 predominantly black South Side neighborhoods in Chicago, dividing them into 49 focus groups. Participants ranged in age from 18 to 87 years, 63.4% were female, and 96% self-identified as black or African American. Although 3.2% of participants had had breast cancer themselves, 75% reported that they knew someone with breast cancer. Each focus group was led by two trained facilitators.

Although there was an overall belief that government and business could not be trusted in general, many comments dealt with perceptions of racism, historical abandonment, and deliberate neglect of blacks by the medical community. Some cited past events, such as the Tuskegee Syphilis Study, as prelude to more current news. “Even though we think that time heals all wounds, increased access to events like Ferguson and to conflicting stories about what protects and is bad for health—through social and other media—may lead to mistrust,” said lead author Sarah Gehlert, PhD, the E. Desmond Lee Professor of Racial and Ethnic Diversity at the Brown School at the School of Medicine at Washington University. “It’s this mistrust that physicians need to be especially aware of,” Gehlert said, “especially since it affects how patients adhere to treatment.”

Doctor injecting a patient with placebo as part of the Tuskegee Syphilis Study by unknown author. Image originally from National Archives. Public domain via Wikimedia Commons.

Economic segregation also was cited as a factor that’s not being addressed adequately. Participants in 35 of the 49 groups expressed concerns with exposure to harmful effects of water and air pollution, and other environment toxins such as lead in water. “. . . [T]he waste dumps are in poor communities throughout the country, not just Chicago,” said Monica, a 38-year-old female. Added Meegan, a 37-year-old female: “Every day you hear on the news they have something in the water. You don’t know what to do.”

Lack of knowledge also contributes to higher breast cancer rates, according to some participants. “The bottom line, I feel that it’s the people that are not educated as far [as] how often they should get physicals,” said Charles, a 40-year-old male. Those are people that are at risk . . . you all in the medical field need to get a little more proactive instead of sitting back.”

“The approach taken in the study breaks new ground in the use of community-based participatory methods combined with qualitative methods to examine the issue of medical mistrust more in-depth,” said Vanessa B. Sheppard, PhD, associate professor of oncology and assistant director of health disparities research at Georgetown University in Washington, D.C. “Another strength of this study is the inclusion of a large number of male and female participants.”

Gehlert said one of the study’s aims is to increase trust. To that end, researchers are examining what had been uncovered in the focus groups. Also, Gehlert is leading a Vulnerable Communities grant from Susan G. Komen for the Cure with four community partners in the St. Louis ZIP code with the highest cancer mortality. “This research is vital in not only the African American community but also in other ethnic minority communities that have experienced historical oppression.”

Nancy Hodgson, PhD, RN, FAAN, said the study is important because it emphasizes that the pressing national problem of racism and racial tension extends into health care. “Health disparities and their historical antecedents are clearly not well recognized by most health care providers,” said Hodgson, associate professor of acute and chronic care at Johns Hopkins School of Nursing in Baltimore. “Yet, health care encounters are part of any society’s social contract and reflect current tensions and national discourse.”

Hodgson said what this study found to be true in Chicago also is true elsewhere. “The trauma and maltreatment experienced by individuals living in Chicago’s South Side is consistent with the sentiment expressed by older African Americans who were participants in our studies in Philadelphia and Baltimore.”

Sheppard offered a warning about making broad generalizations when one is trying to understand medical mistrust. She said that although in some instances medical mistrust may be directly associated with a particular outcome, in other instances it may involve multiple factors—for example, age and time to treatment. “Research is needed to disentangle the correlates and outcomes associated with medical mistrust to avoid generalizations.” She added, “For example, we found that medical mistrust was associated with uptake of genetic counseling and testing for hereditary breast and/or ovarian cancer. On the other hand, we have found varying levels of medical mistrust among African American breast cancer patients. This may suggest that not all persons from a subgroup have the same level of medical mistrust but that it is likely also related to one’s personal experiences and societal contextual observations about one’s own community via the media.”

Gehlert and Hodgson agree that the health disparities that exist will not change without fundamentally transforming the environments that helped to create these disparities and the culture of health professionals’ practice and education. “Greater diversity in the health care workforce and efforts to increase cultural competency training that emphasize the deep historical roots of mistrust of health professionals are some steps that can be made to address this issue,” Hodgson said.

Sheppard said that when interacting with patients it is important to consider their social context that may affect her trust and willingness to adhere to medical advice. “Physicians especially have an important role because every positive interaction that a community member of color has with her provider can potentially help rebuild positive perceptions of the health care research enterprise overall. It cannot be taken for granted that because of one’s position as a health care provider that all patients will begin with trust. Trust, in fact, needs to be earned.”

A version of this article originally appeared in the Journal of the Nation Cancer Institute.

Featured image credit: Stethoscope by Parentingupstream. CC0 Public domain via Pixabay.

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George R. Terry Book Award winners – past and present

We are proud to announce that the winner of this year’s George R. Terry Book Award is Trust in a Complex World, by Charles Heckscher. The George R. Terry Book Award is awarded to the book that has made the most outstanding contribution to the global advancement of management knowledge. What’s more, a further two Oxford University Press titles were named as finalists this year: Making a Market for Acts of God, and Hyper-Organization. The prize will be presented at the Academy of Management’s annual conference, and we would like to take this opportunity to congratulate all of our authors on this prestigious achievement. To celebrate, we are taking a look back at previous Terry Award winners and finalists.

Trust in a Complex World by Charles Heckscher


2016: Winner

This book explores current conflicts and confusions of relations and identities, using both general theory and specific cases. It argues that we are at a catalyzing moment in a long transition from a community in which the prime rule was tolerance, to one with a commitment to understanding; from one where it was considered wrong to argue about cultural differences, to one where such arguments are essential.

Hyper-Organization by Patricia Bromley & John W. Meyer


2016: Finalist

Provides a social constructivist and institutional explanation for expansion of organizations and an overview of main trends in organization theory. Much expansion is hard to justify in terms of technical production or political power, it lies in areas such as protecting the environment, promoting marginalized groups, or behaving with transparency.

Making a Market for Acts of God by Patricia Jarzabkowski, Rebecca Bednarek, and Paul Spee 


2016: Finalist

This book brings to life the reinsurance market through vivid real-life tales that draw from an ethnographic, “fly-on-the-wall” study of the global reinsurance industry over three annual cycles. This book takes readers into the desperate hours of pricing Japanese risks during March 2011, while the devastating aftermath of the Tohoku earthquake is unfolding. To show how the market works, the book offers authentic tales gathered from observations of reinsurers in Bermuda, Lloyd’s of London, Continental Europe and SE Asia as they evaluate, price and compete for different risks as part of their everyday practice.

A Process Theory of Organization by Tor Hernes


2015: Winner

This book presents a novel and comprehensive process theory of organization applicable to ‘a world on the move’, where connectedness prevails over size, flow prevails over stability, and temporality prevails over spatiality. The framework developed in the book draws upon process thinking in a number of areas, including process philosophy, pragmatism, phenomenology, and science and technology studies.

The Institutional Logics Perspective by Patricia H. Thornton, William Ocasio, and Michael Lounsbury


2013: Winner

How do institutions influence and shape cognition and action in individuals and organizations, and how are they in turn shaped by them? This book analyzes seminal research, illustrating how and why influential works on institutional theory motivated a distinct new approach to scholarship on institutional logics. The book shows how the institutional logics perspective transforms institutional theory. It presents novel theory, further elaborates the institutional logics perspective, and forges new linkages to key literatures on practice, identity, and social and cognitive psychology.

Neighbour Networks by Ronald S. Burt


2011: Winner

There is a moral to this book, a bit of Confucian wisdom often ignored in social network analysis: “Worry not that no one knows you, seek to be worth knowing.” This advice is contrary to the usual social network emphasis on securing relations with well-connected people. Neighbor Networks examines the cases of analysts, bankers, and managers, and finds that rewards, in fact, do go to people with well-connected colleagues. Look around your organization. The individuals doing well tend to be affiliated with well-connected colleagues.

Managed by the Markets by Gerald F. Davis


2010: Winner

Managed by the Markets explains how finance replaced manufacturing at the center of the American economy, and how its influence has seeped into daily life. From corporations operated to create shareholder value, to banks that became portals to financial markets, to governments seeking to regulate or profit from footloose capital, to households with savings, pensions, and mortgages that rise and fall with the market, life in post-industrial America is tied to finance to an unprecedented degree. Managed by the Markets provides a guide to how we got here and unpacks the consequences of linking the well-being of society too closely to financial markets.

Featured image credit: Books by Christopher. CC-BY-2.0 via Flickr.

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Music for adolescent voices and the nightmare problem of ‘cool’

Oxford University Press has taken the risk of providing for the UK what the Cambiata Press has for many years been providing in the US – “quality music for adolescent choirs containing changing voices.” I use the word “risk” because cambiata music is a small market and the music teachers and choir conductors who understand what it is and why it’s needed are a small proportion of the minority who might even consider that choral work with adolescent boys is important. A minority they may be, but they are a growing minority and through this growth comes growth in the market.

The editors of the new Emerging Voices choral series have had a difficult task. First, there is the question of developing for use in the UK authentic guidelines on writing for boys’ changing voices. Those I have created are based on the extensive research programme begun in the States by Irvin Cooper that I have sought to continue with English (and Scottish!) boys. Second there has been the task of finding composers and arrangers of sufficient calibre to craft good work that conforms to these research informed guidelines. Third, and this has been by far the biggest challenge, there has been the issue of pitching the series at the right level for the right users and negotiating the nightmare problem of “cool.”

Image credit: Boys singing at a workshop. Used by permission of Martin Ashley

Many people believe that boys will only be interested in current chart and hit music. That’s a big mistake as anybody who works regularly with boys’ choirs will tell you. Nevertheless the culture gap cannot be too big and there has to be progression from the familiar and the accessible to the challenging and venturesome, particularly if boys from not necessarily musical families are to be recruited to singing. So there is a place for what some people might carelessly call “popular”. Unfortunately, if it’s in any way “popular” it comes with a huge price tag in terms of royalty payments and the like.

A small market of course means a small budget so it’s inevitable that the series has had to look to sources that are out of copyright. Folk songs, shanties and spirituals are there, first and foremost, because they are good music and boys need to know and appreciate them. We know that under the inspirational guidance of an enthusiastic conductor, boys will enjoy singing them. We are also confident that through them, boys will learn a lot about music and develop good musical skills. They are also there, though, because they are freely available for talented arrangers to re-work.

Many people believe that boys will only be interested in current chart and hit music. That’s a big mistake.

We have also, for similar reasons, invited our pool of composers and arrangers to submit original work. The result has been gratifying, but it’s another risk. People say they “know what they like” when actually they mean they “like what they know”. So once again, we are looking to the teachers and conductors who have the talent and enthusiasm to bring to life compositions that have never been heard before. My research tells me that they’re more likely to be successful than the timid and over-cautious who buy into the myth that boys will only sing “pop”. You’re more likely to succeed if you introduce music that comes without baggage, and in the insight and craftsmanship of Alan Bullard, Ian Crawford, Russell Pascoe, Sarah Quartel and Oli Tarney you have material you can use with confidence. We did have some budget to be carefully spent on royalties for a classic “hit”. We looked at many and finally chose Billy Joel’s Piano Man. (I’m listening to it whilst I type and lovin’ it!) It’s a great song and the arrangement by my co-editor Andy Brooke really shows off the extent to which Andy totally “gets” quality choral music, the adolescent male voice and psyche. My biggest problem as series editor was in sending Andy out of the room (so to speak) and selecting which of his brilliant arrangements to use. I am proud of all our composers and arrangers though particularly grateful to Andy for his contribution as co-editor. The next big project for Boys Keep Singing and BKS Media is a CD of all the songs in the Emerging Voices series sung by some of the choirs I’ve worked with over the years. That CD, I know, will bestow pride and esteem on the many boys who will be involved.

Meanwhile, here’s a podcast about what voice change and cambiata was like for just one of those boys. It’s just over twenty minutes in length and I would like to make it compulsory listening for anybody who’s contemplating the vital task of keeping boys singing or wants to get better at it. I have many, many times examined my conscience over cambiata. Is it the best choice? Each time I look closely at the development of a young voice such as that of Harry (featured in the podcast), I think “yes”.

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Elie Wiesel: the Hillel of our time

I first met Elie Wiesel in the summer of 1965. Wiesel’s book Night had been translated into English five years earlier. Night was just beginning to be recognized in English-speaking countries. Wiesel was not yet then the impressive speaker he was soon to become. As he addressed the audience that summer about the horrors of the Holocaust, Wiesel was diffident to the point of shyness. As an overly-confident high school debater, I thought Wiesel was a great writer who would never learn to speak.

I was profoundly wrong.

Soon thereafter Wiesel emerged as the dominant voice of the survivors of the Holocaust. The culmination of that emergence came during the 1985 controversy about President Reagan’s planned visit to the Bitburg military cemetery in Germany. Unbeknown to President Reagan and his trip planners, the cemetery contained the graves of 47 SS guards, not exactly the individuals whose memories should be honored by the President of the United States.

“That place, Mr. President, is not your place,” Wiesel memorably declared to Reagan of the Bitburg cemetery. “Your place is with the victims of the SS.”

When Wiesel received the Nobel Prize in 1986, my mother-in-law, a survivor of Auschwitz, was as proud as if she were Wiesel’s big sister – which, in an important sense, she and her fellow Holocaust survivors were. An important reason that Wiesel emerged as a respected moral voice is that he embodied the classic Jewish insistence that particularism and universalism are not opposites but complements: Those grounded in their own identity are best-positioned to express their common humanity with others.

In one of the famous articulations of this perspective, the Jewish sage Hillel rhetorically asked: “If I am not for me, who will be for me? If I am for myself alone, what am I?” Wiesel embodied this ethic. The Holocaust, he proclaimed in his writings and speeches, was an assault upon Jews and Judaism. The forces which underlay the Holocaust are with us today. Israel and the worldwide Jewish community legitimately protect themselves from those who think the Nazi’s work is unfinished.

Because the threat of anti-Semitism remains so virulent, Jews also have an obligation to protest simultaneously the oppression of others. Thus, Wiesel, as he emphasized the anti-Semitic origins of the Holocaust and the current implications of the Holocaust, was equally outspoken about the contemporary tragedies of the 20th and 21st centuries.

Wiesel played an important role in bringing to the world’s attention the genocide in Dafur. With equal vigor, he denounced Turkey’s efforts to minimize the Armenian genocide. Precisely because Wiesel was so grounded in the Jewish community and its history, Wiesel’s voice carried enormous weight when raised for others.

The United States today, torn by racial and ethnic divisions, badly needs Wiesel’s Hillel-like vision to bridge the gaps which divide us: We must be for each other even as we are for ourselves. As for Wiesel, we can now only bestow upon him the final and traditional Jewish blessing for the departed: May he rest in Paradise. He earned it.

Featured image credit: Dr. Mashkevitch and Nobel Peace Prize Winner Elie Wiesel by Sbakuria. Public domain via Wikimedia Commons.

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Emergency Departments as front line for opiate epidemic

There is no question that opioid use disorders are a serious problem in the United States. Increasing recognition of the scope of the problem has led to political and policy attention. While evidence-based treatments for opioid dependence are available, they remain difficult to access. Treatments that involve opiate replacement such as methadone are particularly stigmatized. The approval of buprenorphine by the FDA for office-based treatment is a step forward, as it can be administered in a non-clinic setting, enables the patient to have increased privacy and freedom within the treatment, and is felt to be safer than methadone in overdose due to its unique pharmacology. There remain barriers to access, however, including cost issues, the need for doctors to obtain additional training to prescribe, a cap on the number of patients an individual physician can treat, and the stigma attached to addiction.

Buprenorphine is an opiate that acts as both an agonist and antagonist at the opioid receptor. This is important for two reasons. First, if someone is dependent on opiates and takes a dose of buprenorphine it can induce withdrawal symptoms due to the displacement of the other opiate at the receptor. This makes it somewhat less attractive as a substance of abuse, as a patient who is opiate-dependent would prefer to avoid withdrawal. Second, it is very difficult to overdose on, due to its natural “ceiling”, as with escalating doses, the partial antagonism counteracts its cumulative effects.

Buprenorphine is typically dispensed in pill form as a combination of the active buprenorphine opiate and an inactive form of the opiate antagonist, naloxone, which becomes active if the pills are dissolved for the purposes of injection, thus further limiting its abuse potential, as injection would trigger a powerful and unpleasant withdrawal. All of these factors combined are what made it possible for buprenorphine to gain approval as a treatment for addiction that was felt to be safe enough that it could be dispensed to the patient to take at home, in up to a one-month supply, as opposed to methadone maintenance, which requires that the drug be administered as a licensed clinic with only limited potential for “take-home” doses.

Suboxone (trade name for Buprenorphine/naloxone combination). “Suboxone sublingual tablets” by Supertheman. CC BY-SA 3.0 via Wikimedia Commons.

The US Drug Enforcement Authority (DEA) did, however, put significant limits on buprenorphine prescribing. First, physicians must take an eight-hour course on the drug’s pharmacology and safe prescribing methods. Then the physician must apply for a waiver from the DEA that allows them to prescribe. For the first year of prescribing, they can only treat 30 patients, (afterwards, they can apply to treat up to 100) and must keep records that the DEA can demand to see at any time. The additional scrutiny and training does add an additional hurdle to recruiting clinicians who want to provide buprenorphine treatment.

Why is opiate replacement even necessary?  It seems more and more clear that long-term opiate users have an abysmal rate of success with therapies that involve detoxification only, and detoxification can in the actually increase the risk of overdose. Long-term opiate craving appears to have a neurologic basis, and it is more and more recognized that a harm-reduction approach keeps patients engaged in treatment and alleviates some of the physical factors that may drive patients to relapse.

So, taking all of this into account, it is actually quite remarkable that scientists recently explored the idea of emergency department (ED) physicians intervening with patients who were found to have opiate dependence during their ED visit. The study looked at a group of 329 opiate-dependent patients who were treated at an urban teaching hospital over the course of a four year period. The patients were randomized to receive either a handout about available treatment services without any motivational enhancement; a brief standardized motivational enhancement interaction, direct linkage to aftercare that the patient’s insurance would pay for, and transportation to that treatment; or the motivational interview, referral, linkage, and take-home doses of buprenorphine with a follow-up medical appointment in 72 hours for possible prescription renewal. Patients who received the third option – coming from a group in which half of the subjects had co-occurring psychiatric problems, and over half were injecting opiates – had significantly higher rates of engagement in treatment at 30 days, greater reduction in days of illicit opiate use, and used inpatient addiction services at a lower rate than the other groups. In summary, in a group that is considered very difficult and risky to treat, this intervention seemed to work, and work in a way that was more cost-effective than usual care, in that it reduced use of expensive inpatient addiction treatment.

Historically, the ED has been a place of triage and stabilization, and the focus has not been on primary prevention or public health measures. There are significant barriers to implementing such a program. Staff must be trained, prescribers must have a DEA waiver, the hospital must agree to dispense medication, provisions need to be made for uninsured patients, and simply checking someone’s insurance can be an arduous task. Immediate referral to follow-up is probably the biggest barrier, so coordination with a clinic or provider(s) willing to take these patients on would be necessary. Start-up costs are high. However, the biggest barrier is probably that of re-thinking the idea of what can or should be done in an ED setting. A significant portion of the patients in this study were people who were in the ED as a result of an opiate overdose. Opiate maintenance therapy reduces the risk of overdose, and thus, death. This alternate option for those dependent on opioids has challenged me to re-think what services we can provide for opiate users who present to the hospital where I work, and hopefully will expand other physicians’ ideas of what is possible in the emergency department.

Featured Image Credit: Pop life by frankieleon. CC BY 2.0 via Flickr. 

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Best beach classics: the books you should be reading this summer

In a recent article for The Huffington Post, journalist Erin Schumaker advises students not to let their brains waste away over the summer: “you might be better off skipping the beach read this summer in favor of something a little more substantive.” Yet some of us might find the idea of settling down on a sun lounger with War and Peace less than appealing. To help you out, we asked staff at Oxford University Press for a list of summer classics that will help you relax without letting your brain get lazy!

“Every summer in Oxford I go to Christ Church meadow, sit by the river and read Kenneth Grahame’s classic, The Wind in the Willows. Grahame lived most of his life near the Thames so it is not much of a stretch to imagine Ratty and Mole stopping off there for a picnic!” – Katie Stileman, Publicist on the Oxford World’s Classics

“The Adventures of Tom Sawyer and Adventures of Huckleberry Finn were on my summer reading list at school and bring the memories of long carefree summers full of mischief and adventures. I’ve been recently thinking how much I miss these kind of summers and revisiting these classics is probably as close as I can get to reliving this feeling again.” – Anna Gell, Publicist for Paperbacks 

“I recommend The Complete Short Stories by Oscar Wilde. I read this collection of short stories for the first time a number of years and have gone back to them many times since! My favourites include ‘The Happy Prince’ and ‘Lord Arthur Savile’s Crime’.” – Richard Fry, Sales Manager for the Oxford World’s Classics 

“I saw a village production of The Prisoner of Zenda one summer when I was younger. It was raining and the cast all had umbrellas, and I enjoyed it so much that I got the book out of the library the next day. Uncanny likenesses, adventures, and one of the most memorable endings to a book I’ve read.” – Kirsty Gibson, Marketeer for Oxford Dictionaries 

Summer is a perfect time to revisit something from your childhood.

 

“My summer read is The Call of the Wild, White Fang, and Other Stories by Jack London. One of my all time favourite films as a child, White Fang, ‘did it for me’!  Whilst I generally advocate book before film there are times when film leads to book and I am not disappointed.” – Kate Farquhar-Tompson, Head of Publicity 

“The last classic I read on the beach was Nana by Émile Zola. It was the first time I had read anything by Zola and had me gripped from start to finish. The way he unravels the corruption of the cosmopolitan elite is delightfully scathing. It’s not a cheerful summer read, but it completely transported me, and that’s what you want on holiday, right?” – Chloe Foster, Publicist for Literature and Dictionaries 

“I can’t strongly enough recommend The Vampyre And Other Tales of the Macabre by Polidori. I recently re-read Frankenstein, and I want to complete the set –  and see where it all started. The OWC edition also contains ‘Some Terrible Letters from Scotland’ by James Hogg, which I’m looking forward to as I’m very fond of The Private Memoirs and Confessions of a Justified Sinner (so convincing and terrifying).” – Luciana O’Flaherty, Editor for the Oxford World’s Classics 

“To The Lighthouse by Virginia Woolf might not be everyone’s first pick for a summer read – it’s not exactly a comfort read – but the seaside setting and Woolf’s beautiful, fluid, observant writing make this a joy of a novel to immerse yourself in on hols this year. If you’ve never tried Woolf, it’s time to give her a go.” – Simon Thomas, Content Manager for the Oxford Words blog 

Image Credit: Summer Reading by CC-BY-SA-2.0 via Pixabay

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