Helen H. Moore's Blog, page 261

What George Saunders can teach us about the value of sweetness

"Elements of Taste: Understanding What We Like and Why" by Benjamin Errett (Credit: Penguin Random House/Kate O'Connor)

The knock against sweetness, both in physical and cultural taste, is that it is so frequently overdone. Just as there is sugar added to spaghetti sauce for no good reason, so too are happy endings added to movies whether they make sense or not. In both instances, the result is cloying.

Our world is so saturated in sugar that it’s only logical to limit your intake after a while. But while a sugar-free diet may actually be nutritionally sound, cutting out sweet culture is as inadvisable as it is difficult.

Sweetness is correlated with innocence, and is inversely proportional to experience. The common extension of this is that warm and fuzzy feelings are for children, and the older and more educated we become, the harder our hearts must get. There’s the old saw about how if you’re not a liberal when you’re young, you don’t have a heart, and if you’re not a conservative when you’re old, you don’t have a brain. The underlying logic is that as the heart’s power recedes, the brain must take over.

In fact, the opposite is true. The writer George Saunders explained this simple concept in his speech to the 2013 graduating class of Syracuse University. As a recipient of MacArthur and Guggenheim grants, Saunders is as certifiable a genius as exists in literature. The one piece of wisdom he chose to impart, above all others, was to simply be kind to one another.

By his reasoning, this shouldn’t be something you know as an innocent child and forget as an experienced adult, but rather the opposite. As you age and if you are lucky, you will realize there are three fundamental lies we all start out believing:

“(1) we’re central to the universe (that is, our personal story is the main and most interesting story, the only story, really); (2) we’re separate from the universe (there’s US and then, out there, all that other junk—dogs and swing-sets, and the State of Nebraska and low-hanging clouds and, you know, other people); and (3) we’re permanent (death is real, o.k., sure—for you, but not for me).”

The older you get, the fewer excuses you have for not questioning these beliefs. As Saunders points out, everything from friendships to religion to education to children serves to teach us that it’s not about us. We are small, temporary, and insignificant — with the ability to become kind, loving, and luminous, should we choose this route. This idea is represented throughout culture by the Kindhearted Simpleton, or the Moral Moron. He is Shakespeare’s Falstaff and Dostoyevsky’s Idiot, Hanks’s Forrest Gump, and Buscemi’s Donny Kerabatsos.

This may be so hard to grasp because it’s so simple. Missing this point is confusing the sweet with the saccharine.

Sweetness, then, is the starting point but also the ideal place to end up. It’s the middle part — the experience that comes after innocence but before awareness — that we’re prone to get stuck in. If sweet culture is defined by people and relationships, it really is the thing that matters. All the other tastes are worth sampling, to be sure, and there are great things to be found in their many combinations and permutations. Ideally, though, you come back to a note of sweetness. And then you really appreciate it.

“Because kindness, it turns out, is hard,” Saunders told the graduates. “It starts out all rainbows and puppy dogs, and expands to include . . . well, everything.”

With Condé Nast banning Terry Richardson, is his alleged license to abuse finally expired?

Terry Richardson (Credit: Getty/Gustavo Caballero)

With the Harvey Weinstein controversy putting added pressure on companies to distance themselves from and weed out known sexual abusers, James Woolhouse, the executive vice president and COO of Condé Naste, has instructed all of its publications — including Vogue and Vanity Fair — to cut ties with fashion photographer Terry Richardson.

According to The Telegraph, an email circulating within the company Monday morning reads:

Condé Nast would like to no longer work with the photographer Terry Richardson. Any shoots that have been commission[ed] or any shoots that have been completed but not yet published, should be killed and substituted with other material . . . Thank you for your support in this matter.

In response to the email, a Richardson representative told Buzzfeed News that the photographer was “disappointed” with the email “because he has previously addressed these old stories.”

The representative continued, “He is an artist who has been known for his sexually explicit work so many of his professional interactions with subjects were sexual and explicit in nature but all of the subjects of his work participated consensually.”

While Weinstein’s abuse was, for the most part, only known among industry insiders, accusations against “Uncle Terry” (his nickname of choice) have been public knowledge since at least 2010.

Numerous models have come forward claiming that Richardson pressured them into posing nude or having sex with him while working on his photoshoots. Model Jamie Peck has openly claimed Richardson groped her and exposed himself. Another model, Anna del Gaizo, said Richardson raped her. These are just two of many, many allegations that have spanned over a decade, allegations which Richardson has fervently denied.

Furthermore, claims of Richardson sexually exploiting young models date back to as early as 2004, with the premiere of his exhibition “Terryworld” causing outrage in feminist and art circles, according to The New York Observer.

“He takes girls who are young, manipulates them to take their clothes off and takes pictures of them they will be ashamed of,” said model Rie Rasmussen, who confronted Richardson on the matter in 2010, only to face great backlash. “They are too afraid to say no because their agency booked them on the job and are too young to stand up for themselves.”

The models who have come forward have faced great backlash as well as efforts by Richardson’s team to delegitimize their claims. In 2014, model Emma Appelbaum took to Twitter to post a screengrab of an alleged conversation with the photographer, where he told her, “if I can fuck you I will book you in ny for a shoot for Vogue.” After Richardson’s spokeswoman spoke out against the claim, Appelbaum later tweeted that she regretted the post and didn’t want “abuse or attention.”

Though these countless allegations have been privy to the public for over a decade, brands, celebrities and public figures — from Miley Cyrus and Beyoncé to Barack Obama — have continued to work with the photographer. Though some, Cyrus included, have openly said they regretted working with him, he remains in demand.

At least one month ago, Richardson was shooting for brands and mainstream magazines alike, including high fashion-label Maison Valentino, Purple Magazine, Wall Street Journal Magazine, GQ, Town and Country and Dazed Magazine. Here is a comprehensive list of magazines that continued to work with Richardson up until at least 2014, compiled by Jezebel.

Figures prominent in the fashion industry have also been pictured by his side as of recent, including British Vogue Editor-in-Chief Edward Enninful, who is supposed to be bringing to the publication a new wave of intersectionality, and CR Fashion Book editor Carine Roitfeld. While he no longer surfaces photography of him hanging with famous friends the way he used to, he still maintains tight, personal connections in showbiz and fashion.

While Condé Nast has, at last, taken the step so many have asked them take in the past, it now comes across as a calculated decision rather than one made for the safety of its models or for other pressing ethical reasons.

Rather, it appears made under the pressure of Weinstein’s sexual misconduct, but also perhaps influenced by a scathing editorial that ran in The Sunday Times over the weekend which questions the merits of publications that continue to stand by Richardson.

What’s always complicated this is the “attention grabbing ploy” of sexual exploitation present in Richardson’s work. Even his work with celebrities exudes explicit sexuality. He’s often used his randy aesthetic as a defense against all charges, claiming he’s being hunted for such explicitness. It’s not the case, of course.

What is in question is how lesser-known, often powerless models looking to get a leg up in the industry fare under his duress. DAME’s Jess Zimmerman went so far as to call the photographer “a predator” — perhaps now a given.

He is a man with power and influence who tells teenage girls to suck his dick when they don’t feel empowered to refuse, so yes. His behavior is predatory; he uses his relative strength and their relative weakness to get what he wants. The fact that he and his friends will disingenuously protest that these girls are mistaken about how they feel, and the fact that this gets treated with equal weight as the models’ own testimonies, only means that they all live in the same messed-up society as the rest of us.

If these allegations are to be taken seriously — as, perhaps, they should be — one thing is evident: Richardson remains a clear-and-present danger who, for some less and less understandable reason, some continue to stand by.

Now, that Condé has officially cut ties, we may finally see brands enforcing Richardson’s exit in full. No, Richardson’s alleged chain of abuse isn’t done yet, but he’s quickly running out of shadows to hide in and friends to run to.

“I spent the first 28 years of my life as a f**k up and a failure”

Weird in a World That's Not: A Career Guide for Misfits, F*ckups, and Failures by Jennifer Romolini (Credit: Harper Collins)

Jennifer Romolini’s media career has been impressive, but before her success at Yahoo and other companies, she moved to New York as a self-proclaimed “awkward 27-year-old misfit,” the skinny, long-limbed daughter of a working-class Philadelphia couple. Her new book, “Weird in a World That’s Not,” which is part memoir and part career guide, begins, “I am not supposed to be here. I spent the first 28 years of my life as a fuckup and a failure. I failed and I failed and I failed.”

How did she get to the point where she wrote a book about professional success? Through one struggle after another.

“I had a miscarriage at four and a half months — a week before my wedding — and I went through with the wedding anyway, even though I knew I shouldn’t,” she told me on “The Lonely Hour.”

“We stayed married for three years. We moved around quite a bit because he was a hotel manager and he worked in different hotels, some of which we lived in. The night that I decided to leave him, I decided that I was going to start to really get control of my life.”

She had to find herself, and then trust herself.

“I wasn’t refined. I still had this lingering Philly accent, and I just had not hung out in the worlds that everybody else had seemed to hang out in. But the adventure was thrilling to me, and I think that was enough. I rented a U-Haul that I had to drive from Boston to New York and it was fucking terrifying; I had to stop every half hour because I was having panic attacks.”

But I got that truck to New York and I unpacked my shit, and then I sat in my tiny little shitty room in Brooklyn,” she continued. “The feeling of accomplishment filled me up. It curbed my loneliness.”

Listen to find out where Romolini is now.

The Lonely Hour is a podcast that explores the feeling of loneliness — and solitude, and other kinds of aloneness — at a time when it may become our next public health epidemic. The show is co-produced by Julia Bainbridge and The Listening Booth. Julia, the host and creator, is an editor and a James Beard Award-nominated writer.

Republican retirements pile up: Jeff Flake’s exit is a win for Steve Bannon

Mitch McConnell; Donald Trump; Jeff Flake (Credit: AP/Evan Vucci/Getty/Michael Reynolds)

In a strong condemnation of President Donald Trump, his administration and the politics the modern Republican party has helped usher into the mainstream, Sen. Jeff Flake, R-Ariz., announced he would not seek reelection in the 2018 midterms on Tuesday afternoon.

“Mr. President, I rise today to address a matter that has been much on my mind, at a moment when it seems that our democracy is more defined by our discord and our dysfunction than it is by our values and our principles,” Flake began from the floor of the U.S. Senate on Tuesday afternoon.

Flake continued, “It must also be said that I rise today with no small measure of regret. Regret, because of the state of our disunion, regret because of the disrepair and destructiveness of our politics, regret because of the indecency of our discourse, regret because of the coarseness of our leadership, regret for the compromise of our moral authority, and by our – all of our – complicity in this alarming and dangerous state of affairs.”

“We must never regard as ‘normal’ the regular and casual undermining of our democratic norms and ideals,” he added. “We must never meekly accept the daily sundering of our country – the personal attacks, the threats against principles, freedoms, and institutions, the flagrant disregard for truth or decency, the reckless provocations, most often for the pettiest and most personal reasons, reasons having nothing whatsoever to do with the fortunes of the people that we have all been elected to serve.”

The decision puts an unexpected Senate seat in a traditionally Republican state up for the taking.

The GOP is clinging to its 52-seat majority and certainly not looking to lose a seat to the Democrats. But Flake has been one of a few GOP members of Congress that the president has openly feuded with, so it’s very likely that Trump will spin this as a win for him and his base. This could be especially true, considering Flake has performed poorly in recent polls, The Arizona Republic reported.

It’s also possible that Flake is scared of running for reelection, out of fear of a contentious primary.

Kelli Ward, the former Arizona state senator who lost a primary bid against Sen. John McCain last year, has emerged as the likely Republican favorite, The Arizona Republic reported.

Ward has been endorsed by former White House chief strategist and prominent “alt-right” leader, Steve Bannon, who is leading an insurgency against establishment Republicans, whom he views as obstructors of Trump’s agenda.

Ahead of his decision, Flake said that “there may not be a place for a Republican like me in the current Republican climate or the current Republican Party,” according to The Arizona Republic.

“Here’s the bottom line: The path that I would have to travel to get the Republican nomination is a path I’m not willing to take, and that I can’t in good conscience take,” Flake added. “It would require me to believe in positions I don’t hold on such issues as trade and immigration and it would require me to condone behavior that I cannot condone.”

But maybe, just maybe the discord within the Republican establishment and a vacant Senate seat can incentivize the Democrats to try to take advantage, though Arizona will prove to be a difficult state for the party to galvanize.

Here is a full transcript of Flake’s announcement.

The American un-society

The key lesson from the Las Vegas inferno extends far beyond the cynical action patterns of the National Rifle Association, the omnipotence of U.S. lobbies, or the campaign finance-induced corruptibility of members of the U.S. Congress.

Upon closer inspection, the really frightening fact is that the very idea of the existence of an American “society” is increasingly becoming pure fiction.

A significant share of the people living in today’s United States lacks the will to live together. In contrast to Europe, the desire to stand apart from one another as much as possible is one of the foundational leitmotifs of the country. From early on, settlers have been on the move when they felt someone came too close to them.

The real tragedy of the West is to acknowledge that today’s United States is increasingly becoming synonymous with grotesque levels of inhumanity.

In that sense, events such as the Las Vegas mass shooting are just sideshows. For a moment, they create an illusion of vowing improvement — until the next morning or the day after, when the defenders of the status quo once again become merciless.

Police brutality

How else would one understand the fact that, half a century after the allegedly fundamental civil liberties reforms, black citizens are now shot down by the police as if they were prey? And essentially without a single policeman having been successfully prosecuted to date? In fact, they often don’t even get indicted.

And how can we in the rest of the world consider a country as a strong civilization that is worth emulation if that country’s preeminent political party, the Republicans, consider it a national sport to deny poorer Americans access to health insurance, with all conceivable and unthinkable means?

The only “good” news in this regard is that this form of discrimination is no longer imposed solely on blacks, but also on the white proletariat. (This term is deliberately chosen; with the lack of social security, lack of paid vacation and the like, any other word would be off the mark).

Whoever wants to admire American-style individualism in the face of such perversions of the political system must also understand how selectively this individualism can be applied. For the most part, it is reserved for the pluto-crats, the uppermost part of the U.S. population’s income pyramid.

The absurd fascination with the “winner takes all” mantra explains why the American dream is increasingly becoming a nightmare. The widespread use of opioids among those who are not well off speaks volumes.

Worse yet, on this frontline of American death, the same absurdity applies as for gun violence: The “civilized” thing to do, proper regulation by the government, could stop many though not all, of the excesses.

Salvaging American society

Having lived in the American capital for thirty years until a year ago, I was recently asked by a prominent European transatlanticist how to save the transatlantic relationship in view of the Trump factor. My reply alarmed my interlocutor: “This is basically impossible. To achieve this, American society would have to be salvageable.”

But this cannot be expected to happen in the foreseeable future. At the core, the Civil War, officially ended in 1865, continues to this day.

As if that weren’t bad enough, the United States is the leading industrial country in which close to half of the population rejects many forms of Western rational thought. The refusal of progress itself is alarming. It bears an eerie resemblance to Germany in the late stage of the Weimar Republic.

As radical as the thesis is, in the rigorous rejection of universally accepted empirical facts of civilized societies — for example, acceptance of evolution and climate change — the Republican half of the American population has more in common with Saudi Arabia, Turkey and other fundamentalist Muslim countries than with EU Europeans.

This is the real message that we should be able to hear from the United States, despite the latest pictures.

A tribal United States

For this reason, too, we cannot really be surprised that the United States is more and more characterized by tribal structures, similar to the ones that, with only very brief interludes, have always shaped Afghanistan.

The economic crisis that continues to affect the lower half of the U.S. income bracket intensifies these latent tendencies.

No wonder, then, that it seems impossible to arrive at long overdue compromise. The U.S. Congress is the perfect expression of this collective impotence. Although both houses are extremely well-equipped in terms of staff and the like, and although there is a crying need for common-sense legislation, none has been forthcoming.

This impotence is also reflected in American everyday life, not only among business partners, but even in one’s own neighborhood. People prefer to talk about the latest movies, instead of risking to embark in any way onto the treacherous issue of politics.

Once again, the historical associations that this triggers in the minds of any nation that has lived under totalitarian rule speak for themselves.

There will be no sensible reform

What the Las Vegas incident will once again prove, not just to the American public but to the entire world, is the futility of the belief in sensible reform.

This basically shatters the long-held belief question in much of the world that Americans are dynamic, modern and capable of change. This is also why the people in the rest of the world are well advised to focus more on their own paths.

US health care system: A patchwork that no one likes

(Credit: AP Photo/J. Scott Applewhite)

Almost all parties agree that the health care system in the U.S., which is responsible for about 17 percent of our GDP, is badly broken. Soaring costs, low quality, insurance reimbursements and co-payments confusing even to experts, and an ever-growing gap between rich and poor are just some of the problems.

And yet, this broken system reflects the country’s constitutional foundation and its political culture. At the very core of both is a strong suspicion of governmental intervention and a disdain for concentrated power, paired with an exaltation of individual liberty and personal responsibility.

Translating this ideology into a modern state is a complex endeavor that often leads to constructs that resemble creations envisioned by Rube Goldberg. Perhaps nowhere else is this more obvious as in the American health care system. The result has been the creation of an uncoordinated, often inefficient, patchwork of programs that does not cover everyone, is excessively costly and often provides low-quality care.

The conflicts of the past linger into the present, as seen in the dozens of Republican unsuccessful attempts to repeal and replace the Affordable Care Act, the Obama administration’s signature, if maligned, law.

More generally, ideologically, the country has failed to reach a consensus about the appropriate role of government in the provision of health care for its citizens. Politically, reforming any part of the health care system becomes a third rail. Yet practically, while often left unacknowledged, government involvement is ubiquitous. Indeed, over time, governments, at both the state and federal level, have come to influence every component of the American health care system.

A fragmented “system”

Governments have three major options to provide benefits. They can regulate the conduct of private entities, provide services directly or merely provide financing while having services provided by other entities. In the United States, state and federal governments rely on all three options.

Today, half of all Americans obtain their insurance through an employer. Depending on the nature of the arrangement, these are subject to an often complex web of state and federal regulations.

However, over time, the federal government has taken on an ever-larger role in the regulation of insurance, most recently culminating with the passage of the Affordable Care Act in 2010. The federal government also provides generous tax incentives to encourage the employer-sponsored provision of insurance at an annual cost exceeding US$260 billion.

Yet, even despite regulatory action and financial support, more than half of all Americans are not covered through employer-sponsored insurance, thus requiring other, more active forms of government involvement.

Different plans for the old, the poor and veterans

Elderly Americans and some of those afflicted with disabilities and end-stage renal disease, about 14 percent of the population, are covered by a purely federal, social insurance, single-payer arrangement, Medicare.

Antiquated in its design because it separates hospital coverage from physician coverage, all working-age Americans are required to pay into the system that entitles them to hospital insurance at age 65. Voluntary physician and prescription drug coverage are subject to a combination of individual premiums and government subsidies. Many elderly choose to buy additional insurance protection to make up for the often limited benefits under these programs. Alternatively, eligible individuals can choose to obtain comprehensive coverage through private insurers in a program called Medicare Advantage.

Coverage for the poor and near-poor has been established through a joint state-federal program called Medicaid, providing coverage for almost 20 percent of Americans. Lacking the constitutional power to force states into action, the federal government necessarily seeks to entice states into cooperation by shouldering a majority of the cost and allowing states broad authority in structuring their individual programs. As a result, programs vary significantly across the states in terms of who is eligible and what benefits they have access to.

One peculiar exception is the way America provides health care to its veterans. Inherently ironic, in an arrangement that can only be described as socialistic, America’s veterans are able to obtain access to comprehensive services, often at no cost, through a national network of clinics and hospitals fully owned and operated by the federal government. Similar arrangements are in place for Native Americans.

Those left out of the various, decidedly limited, arrangements are left to seek coverage on their own from private insurers. Indeed, with the insurance market reforms and financial support of the ACA, today about 7 percent of Americans are able to purchase insurance privately, while 9 percent remain uninsured. Another patchwork of programs seeks to provide decidedly limited benefits to these individuals including through emergency rooms, government-supported private community health centers and hundreds of clinics and hospitals owned by cities, counties, states and state-university systems.

Has the ACA changed anything?

When the ACA was passed in 2010, supporters hailed it for moving the United States in line with its industrialized peers. Detractors demonized it by saying it was the final step toward socialism in America.

Neither side was correct in its assessment.

Within the American system, particularly as it has been used to expand access to health care, the ACA was a very substantial, but nonetheless natural, continuation of a long series of incremental, trial-and-error adjustments to new circumstances hailing back to the early 1900s. For the most part, the ACA perpetuates a system patched together from various private and public components by merely pairing some, albeit important, insurance market reforms with additional funding.

With regard to Medicaid, it simply added more, mostly federal, funding to bring more individuals into the program. For those buying insurance on their own, it facilitated purchasing insurance by establishing online marketplaces and by providing funding for lower-income individuals in the form of subsidies for premiums and out-of-pocket costs. Most importantly, it initiates meaningful insurance market reforms intended to facilitate access including the requirement to provide insurance regardless of preexisting conditions, by limiting how much consumer could be charged based on gender and age, and by requiring a minimum amount of services included, among others.

Yet even if the ACA were to be fully implemented, millions of Americans will be left without insurance, and the thorny issues of quality and costs will largely be left untouched.

The future is . . . uncertain

The American health care system is a complex amalgam. Evolving over time, we can see incremental, haphazard adjustments to changing circumstances over time, without much rationality or overarching forethought.

Conceptually, one can easily imagine a simpler approach. For example, the U.S. could adopt a single-payer system similar to those in many other wealthy industrialized countries. Practically, however, limited national authority, stark ideological divisions over the appropriate role of the national government in the provision of health care, and the creation of vested interests make other than a continued evolutionary approach politically unlikely, if not wholly implausible.

In such a system, exploiting the shortcomings of the American health care system and blaming it on the other party becomes a political imperative. No one party alone can truly reform the system by itself without risking the wrath of the electorate. Indeed, no underlying ideological consensus even exists about what kind of health care system the United States should have.

Under these conditions, neither party has much incentive to cooperate to initiate the meaningful reforms necessary to improve quality, access and costs. Thus, we are left with a system that is excessively costly and often of inferior quality that denies millions of American from accessing adequate care.

Chomsky: Trump has pushed Doomsday Clock close to midnight

(Credit: fotostory via Shutterstock)

Noam Chomsky sat down earlier this summer with actor Wallace Shawn for the New York Public Library podcast. Chomsky brought his traditional dry sense of humor to the wide-reaching conversation, which ranged from the threats facing the survival of the human species to the popularity of Bernie Sanders.

Commenting on the threat of nuclear annihilation, Chomsky explained the history of the Doomsday Clock, which is a “very revealing, brief analysis of the state of the potential for human survival.”

Of the clock, he said, “Two years ago it was pushed forward to three minutes to midnight. A week into Trump’s term, it was moved to two and a half minutes to midnight—that’s the closest it’s been since 1953… Now it’s more dangerous than it has been throughout the whole nuclear age, and that’s now combined with the threat of global warming. So what are we doing about it? Well, what we’re doing about it is ignoring it.”

Shawn asked Chomsky about his belief in giving power to everyday people, even those “who are controlled by Fox News.” Chomsky elaborated on the distinction between elite power and the people in American history, beginning with the influence of slave-owning elites during the American Revolution, and how that’s manifesting in the Trump era:

“You take a look at the factors behind… what we call the American Revolution and this talk about taxation without representation, and so on, but there were other factors which were more significant… One of them was a decision by the British court [and] Lord Mansfield, a high British legal official in 1772 [who] declared that slavery is so odious that it cannot be tolerated in Britain…. American elites who were mostly slave-owners saw the handwriting on the wall, and that was undoubtedly a factor in their concern a couple of years later to liberate themselves from a country which might impose that here….

“The Vietnam War was the elites, the Iraq invasion was the elites…Take today’s policies. Today’s Republican leadership…is trying to carry out some of the most savage attacks on the American population in recent history… The [attacks are] not coming from Trump, they’re coming from Paul Ryan and the Republican leadership and his billionaire cabinet. That’s elites.”

Chomsky offered a theory on Trump voters as well.

“If you ask, why did people vote for Trump, there’s a lot of reasons. Some of them are understandable, quite understandable. As I’m sure you’ve seen it’s been discovered the last couple of years, that among the American white working class—lower middle class, white males mainly—something quite remarkable is happening, an increase in mortality. That doesn’t happen in developed societies except in war or something like that. And it’s apparently a kind of hopelessness, despair… Many of the people who voted for Trump, voted for Obama, working people, because they believed the propaganda about hope and change…They didn’t get hope, they didn’t get change, and now they’re listening to a con man who’s saying the same things.”

Chomsky said that while many things have not changed since Trump’s election, the focus on climate change has taken a large turn for the worse.

“Maybe the most dramatic of all is one that’s barely getting discussed and that’s the U.S. withdrawal from the rest of the world on the issue that’s of greatest significance to the prospects for human survival….Every country in the world with the exception of the United States is now committed to at least some actions on this issue. The U.S. was, too, up until November 8.”

COP 22, the climate conference in Morocco, took place the same time as the 2016 election.

“It was the follow-up to the Paris negotiations of December 2015…The intention in Paris was to reach a verifiable treaty, but that could not be done because of the Republican Party. The Republican Party would not accept binding commitments, so there were only sort of verbal commitments, and this follow-up conference was intended to sort of put teeth into the agreement. And the conference started, early November, taking place November 8. The day of the election, the World Meteorological Organization submitted a report of the situation of global warming, climate, a very dire report, and then the conference ended. The election returns came in, everybody was stunned. The rest of the conference was essentially, Can we continue, is there any hope of continuing when the most powerful, wealthiest country in world history is deciding not only not to participate but to drive the train backwards? And that’s been what’s proceeding since.”

Chomsky also looked back at the 2016 election results.

“I think if you take a look at the last election the outcome in many ways is extremely optimistic. And the reason is the quite remarkable success of the Sanders campaign. Which remember, is a break, a sharp break of at least 100 years of American political history.”

Chomsky explained that despite campaign funding being a typical indicator of election results, Sanders surprised everyone.

“Sanders totally broke it, no funding, enormous success, now he’s the most popular candidate in the country. What does that tell you about the electorate? If somebody could approach people with policies that mean something to them, those… working people who voted for Obama and were disillusioned, don’t have to be disillusioned. There are policies, very sensible policies that could meet their perfectly justified hopes and aspirations. It doesn’t look like to me a hopeless situation—it seems to be a dysfunctional political and economic system which can be changed…The fact that it is a very free country, gives us the opportunities, just have to grasp them.”

How drug manufacturers are fighting to push their drugs for unapproved purposes

(Credit: Shutterstock/science photo)

On Oct. 26, 2005, Alfred Caronia, a sales consultant for a little-known pharmaceutical company based in California, met with a doctor to discuss promotion of one of the firm’s  drugs.

The drug, a depressant called Xyrem, had been approved by the U.S. Food and Drug Administration to treat only certain patients with the sleep disorder narcolepsy. But Caronia maintained, in a conversation with a doctor that was recorded by federal investigators, that the drug could be used to treat an array of other sleep and muscle ailments.

There was a problem with Caronia’s claims: None of those extra uses for Xyrem, the prescription version of a “date rape” street drug, had been approved by the FDA. In the eyes of the agency, the benefits of the unapproved uses were unproven and the results  potentially dangerous.

In 2008, Caronia was convicted of violating federal law by pushing Xyrem for unapproved purposes, a practice known as off-label promotion. But in 2012, a federal appeals court, in a 2-to-1 decision, threw out Caronia’s conviction on grounds that had nothing to do with the safety of the drug or its potential misuse. The court found that “the government prosecuted Caronia for mere off-label promotion,” and that such activity is protected commercial speech under the First Amendment, as long as it not shown to be false or misleading.

The case smoldered for several years, but is now increasingly being recognized as a potential landmark decision that could have profound implications for the FDA and  public health.

Two settlements since late 2015 apparently influenced by the Caronia ruling, and a case pending before another federal appeals court, are fueling debate about whether the First Amendment’s protection of commercial speech could undermine the FDA’s ability to prevent drug marketing abuses.

What’s more, changing political dynamics — especially the anti-regulatory aims of the Trump administration and Republican-dominated Congress — could free drug makers to push the boundaries of the law.

The stakes are high. Off-label promotion has long been considered a serious white-collar crime. The FDA has fined drug companies billions of dollars for off-label violations. The aim has been to prevent them from overstating the benefits and understating the risks of their products, a practice known as misbranding — and one that sometimes leads to patients getting drugs that prove harmful or even deadly.

The trend toward curtailing off-labeling restrictions worries Aaron Kesselheim, a physician and lawyer at Harvard University and an expert on drug and medical device policy issues. “Pharmaceutical manufacturers have a long history of making promotional statements around biased studies, or emphasizing the positive studies and deemphasizing the negative studies,” Kesselheim said.

“When they’ve done that in the past, it’s led to substantial morbidity and mortality because of the power of manufacturers’ promotional measures in influencing physicians’ prescribing methods.”

As an example of past drug company abuses, Kesselheim cited the promotion of antipsychotic medicines to elderly patients, which he said were associated with a 60 percent to 70 percent increase in death rate, and the promotion of antidepressants to children, which were linked to an increase in suicidal behavior.

Federal prosecutors haven’t quit pressing ahead with off-label marketing lawsuits. In July, for example, Celgene Corp., a drug company based in Summit, N.J., agreed to pay $280 million to settle fraud allegations linked to the promotion of two cancer treatment drugs for uses not approved by the FDA. Unlike the Caronia dispute, though, the case focused not on free speech issues, but with allegations the company violated the federal False Claims Act by submitting false claims to Medicare, and to 28 states and the District of Columbia.

The Caronia decision meshes neatly with the Trump administration’s anti-regulatory agenda. On Jan. 31, just days after his inauguration, President Trump delivered a welcome message to a gathering of pharmaceutical industry executives that he would be “streamlining” the FDA’s approval process. “We’re going to get rid of a tremendous number of regulations,”  he said, according to a White House press release.

Trump in March also pleased industry executives with his choice to head the FDA, Scott Gottlieb, a physician who favors allowing the promotion of unapproved uses for drugs. “The sharing of scientific evidence can sometimes have important public health benefits,” he wrote in a 2008 commentary. He chastised those who “pursue a rigid adherence to restrictions” on drug promotion.

The FDA turned down a request for an interview with Gottlieb. The agency, which held a little-noted meeting on off-label promotion last November just two days after the presidential election, said it is “engaged in a comprehensive review of its regulations and policies” regarding off-label communications. The outcome is being eagerly awaited by the Pharmaceutical Research and Manufacturers of America, the dominant pharmaceutical industry trade group. It said at the meeting that its members are asking “that FDA establish a clear, safe harbor” for drug makers to “share truthful and non-misleading information” about off-label uses.

* * *

Under federal law, the FDA approves drugs for particular uses when drug makers submit scientific evidence demonstrating that those uses are safe and effective. At that point the companies are allowed to promote the drugs for those specific uses.

With doctors, the situation is different. The FDA says it is not eager to interfere with “the practice of medicine,” so it has allowed doctors the flexibility to prescribe drugs for unapproved uses. Doctors and researchers can also share information about unapproved uses at medical meetings or in the pages of medical journals. Part of the reasoning in the 2012 Caronia ruling was that, if doctors are going prescribe off-label uses anyway, shouldn’t all of the truthful information about the drugs be available to them?

Drug companies that violate the law sometimes have paid a steep price. The pharmaceutical industry paid more than $30 billion in fines between 2006 and 2015 for off-label promotion and other offenses. At the top of the list is pharmaceutical giant GlaxoSmithKline. In 2012, it pleaded guilty and paid $3 billion to settle criminal and civil charges related to the off-label promotion of the antidepressants Paxil and Wellbutrin, and the diabetes drug Avandia.

The Justice Department said the company, among other things, sponsored “dinner programs, lunch programs, spa programs and similar activities to promote the use of Paxil in children and adolescents” — even though the anti-depressant hadn’t been approved for use in patients under 18. The Justice Department also said Glaxo prepared a misleading medical article portraying Paxil as effective, while suppressing two studies that found that it wasn’t.

* * *

The drug at the center of the Caronia case,  Xyrem, won FDA approval in 2002. It was marketed by Orphan Medical Inc., a small company in Minnetonka, Minn., that specialized in so-called orphan drugs. Such drugs treat rare diseases and, as a result, often bring in little revenue and get scant attention from drug marketers or researchers. By 2005, Xyrem was generating $20 million in revenue, pocket change in an industry where blockbuster drugs can yield annual sales in the billions.

Xyrem’s prospects seemed limited in part because the FDA required every package to carry a “black box” warning, the agency’s most serious advisory for  prescription drugs. The current wording of the warning, in an apparent reference to the drug’s link to date rape, cites the risks of “misuse and abuse,” and noted that the “adverse reactions” associated with Xyrem’s active ingredient have included “decreased consciousness, coma and death.” The active ingredient, often called GHB, can “make you become weak and confused — or even pass out — so you can’t tell if you are being drugged,” says the federal government’s Office of Women’s Health.

The FDA also required Orphan Medical to establish a tightly regulated distribution and education network for Xyrem.

Yet Orphan Medical — and later on its new owner, Jazz Pharmaceuticals Inc., which moved its headquarters from Palo Alto, Calif., to Dublin, Ireland, in 2012 — had ambitious plans. Alfred Caronia was hired to promote Xyrem in and around the New York City area as part of an aggressive marketing effort.

Caronia’s charge was to boost sales and make Xyrem much more than a niche drug. His approach was revealed in the October 2005 taped conversation with a doctor who was serving as a government informant in an investigation of Orphan Medical. Caronia suggested unapproved uses of the medicine; he also told the doctor about the diagnostic codes to use to get insurance reimbursement. And Caronia encouraged the doctor to prescribe it for children and elderly patients, for whom it had not been approved. According to the recording, Caronia said: “There have been reports of patients as young as fourteen using it and obviously greater than sixty-five,” Caronia said. “It’s a very safe drug.”

Drug-enforcement officials did not see it that way. On the streets, Xyrem was known as GHB, or liquid ecstasy. It became popular in the 1990s at “raves” in which it was used to boost libido and to cause amnesia, leaving users vulnerable to sexual assault. Its sometimes deadly side effects include difficulty breathing while asleep, depression, nausea, vomiting, seizures and comas.

Investigators eventually zeroed in on Caronia. In July, 2007, a grand jury returned an indictment charging him with two misdemeanor offenses related to introducing a misbranded drug into interstate commerce. (Another Jazz Pharmaceuticals consultant was also indicted in connection with running a speakers’ program promoting Xyrem.) In October, 2007, Caronia sought to have the charges dismissed on the grounds that it restricted his First Amendment free speech rights and that the misbranding provisions were unconstitutionally “vague and broad.”

In October, 2008, a jury convicted Caronia “of conspiring to introduce a prescription drug into interstate commerce with the intent that it be used in ways its labeling neither disclosed nor described.” Just over a year later, he was sentenced to one year of probation, 100 hours of community service, and a small fine. He appealed.

In December, 2012, the Second Circuit Court of Appeals in New York, in a 2-to-1 decision, vacated the conviction on free-speech grounds. “We do not hold, of course, that the FDA cannot regulate the marketing of prescription drugs,” the court said. “We conclude simply that the government cannot prosecute pharmaceutical manufacturers and their representatives . . . for speech promoting the lawful, off-label use of an FDA-approved drug.”

But the dissenting judge, Judge Debra Ann Livingston, wrote that “the majority calls into question the very foundations of our century-old system of drug regulation,” leaving companies with little incentive to seek approval for off-label uses of a drug.

Caronia was fired by Jazz, has left the pharmaceutical industry, and is now working as a carpenter, according to his attorney in the case, Thomas Liotti of Garden City, N.Y. Caronia “didn’t do anything wrong here,” said Liotti. “He presented the warning labels to the doctors.” The doctor who cooperated with federal investigators “had a script prepared by FDA agents” to get Caronia “to say this, or get him to say that,” Liotti said.

* * *

The Caronia case is now beginning to cause some ripples. “Caronia upended decades of pharmaceutical law,” Christopher Robertson, a  University of Arizona’s law professor, wrote in June in a discussion paper called “The Tip of the Iceberg.” He noted that the FDA did not appeal the decision, maintaining that the ruling would have little effect on other cases.

But recent history has proven otherwise. Last year the FDA agreed to a settlement that allows Amarin Corp. to engage in truthful promotion of its fish oil drug Vascepa for unapproved uses. And it allows the company to affirm whether the promotion meets the standard.

In 2012, Amarin won FDA approval for Vascepa to treat high levels of certain fats in the blood. In the wake of the decision, the company sought permission from the FDA to promote the drug for use in patients with lower levels of the fats, called triglycerides.

The FDA refused, and Amarin sued, making a First Amendment argument and invoking the Caronia case as a precedent. In August, 2015, a federal judge in Manhattan agreed with the company, ruling that under Caronia, the FDA can’t accuse a company of misbranding “based on truthful promotional speech alone.”

In March, 2016, the FDA settled the case with Amarin and said it would allow the expanded promotion “based on scientific evidence that was previously submitted.” That outcome demonstrated that the agency “has departed significantly from its traditional position on the issue,” policy analysts Deborah Mazer and Gregory Curfman wrote on the blog of the journal Health Affairs. They added that “its potential reach is vast.”

In December, 2015, while the Amarin battle was under way, the FDA settled with another company that raised a First Amendment argument, Pacira. The company won the ability to promote the expanded use of its pain drug Exparel. The FDA rescinded a warning letter it sent the company the year before noting that the drug was approved by the agency only for treatment of pain after surgery for bunions or hemorrhoids.

Meanwhile, another new legal battle with free speech implications has come up in the First Circuit Court of Appeals in Boston. It is the first off-label promotion case outside the Second Circuit, where the others arose.  It involves a medical device to clear sinuses, made by Acclarent. Two executives convicted of marketing the device for off-label uses are appealing.

Congress has also shown interest in loosening restrictions. On July 12, while efforts to repeal and replace Obamacare were dominating the headlines, the House Subcommittee on Health held a hearing to review two bills relating to promotion of off-label uses of drugs and devices.

The subcommittee, chaired by Texas Republican Michael C. Burgess, a doctor, said the idea behind the bills was to spread scientific information to help doctors make the right decisions on use of drug. “A lack of relevant information can lead to physicians making patient care decisions with incomplete information. This is both unfair to the physician and unsafe for the patient.”

Oregon Republican Greg Walden, chairman of the Energy and Commerce Committee, of which the health subcommittee is a part, said the bills “do not provide manufacturers with free rein to communicate any and all information about their products,” but they do allow drug companies to “responsibly disseminate accurate, and up-to-date information about medical products.”

In a background memo prepared for the hearing, the subcommittee said that proposed legislation would clarify what drug makers can say without fear of retribution — namely, they must be clear about the data supporting their claims and not claim that unapproved uses are safe and effective.

But R. Alta Charo, a professor of law and bioethics at the University of Wisconsin, raised warning flags. In prepared testimony for the hearing, she said the bill “risks eviscerating the general rule against off-label promotion,” with potential harm to patients. “Studies have repeatedly shown that even products that look promising in early trials will usually be shown to be unsafe or ineffective when larger trials are completed.”

Other observers, such as the University of Arizona’s Robertson, view the push toward greater latitude for off-label promotion as part of a broader legal pattern, including U.S. Supreme Court rulings striking down laws on First Amendment grounds. He pointed to the Citizens United case that expanded free speech protections to corporations, and a ruling that overturned a law banning depictions of dog fighting. Robertson also cited the Hobby Lobby decision, which recognized the religious freedom rights of business owners. “In almost every way you can imagine, they are breaking down the wall over what is protected speech, what isn’t. And in every case, it’s always more power to the First Amendment,” he said.

 

How to stamp out sexual harassment when it’s reached the ends of the Earth

(Credit: AP Photo/Natacha Pisarenko)

On Oct. 6, the day after The New York Times broke the story that Harvey Weinstein had serially sexually assaulted and harassed women across Hollywood, Science Magazine published a quieter exposé of abuse. Geoscientist Jane Willenbring — along with several other women — brought allegations of sexual harassment against her former advisor at Boston University for his conduct with her on a field research trip in 1999.

In a written complaint to BU’s Dean of Arts and Sciences, Willenbring alleges that Antarctic Research Group director David Marchant threw rocks at her as she tried to urinate; ranted about her being a “slut” and a “whore”; insisted that his brother, another researcher on the trip, expose himself to her in the tent that they shared; and shoved and otherwise physically abused her. Daily, Willenbring says, Marchant would insist that he needed to break her down and build her up “in his image.”

While the Weinstein allegations were bleakly unsurprising to many women — there is the expectation, however depressing, that the film industry operates on the exploitation of women — Willenbring’s story carries a fresh element of awfulness: “Can you believe women even have to defend themselves in Antarctica?”

But yes? Of course? Because there is nowhere that the lure of misusing power will not be tempting to certain men. And that power, cruelly wielded across ice sheets, classrooms, and laboratories, pushes hordes of women from scientific pursuits. In any effort to fight climate change, we cannot afford that kind of attrition.

There is something uniquely lawless about remote, field-based research: A 2014 survey of field researchers found that 64 percent of respondents experienced sexual harassment in their fieldwork. When I asked whether Marchant’s behavior changed between campus and Antarctica, Willenbring said yes: “That was when the civilized constraints seemed to be lifted.”

“I remember going through, in my mind, all the possible things I could do: saying nothing and ignoring him, or yelling at him,” Willenbring told me. “I tried to swear at him. I tried to joke back a couple times. There was nothing that would work. The more I didn’t get bothered by it, the more he would get annoyed, and sometimes he would get really violent.”

“Civilized constraints,” however, don’t deter men in more formal settings. In fact, most of the institutions that we consider exemplars of modern civilization — like universities — function on the power of men and their ability to silence women.

To report Marchant, on whose recommendation the rest of Willenbring’s career depended, would have threatened her employment opportunities. (According to Willenbring, another female student had reported Marchant for sexual harassment before her time at BU, to no result. BU would not confirm this.) When Willenbring concluded her master’s program, she decided to pursue her doctorate in Arctic as opposed to Antarctic science to avoid any further interaction with him.

When success is predicated upon silence about sexual harassment, we get an impossible, self-defeating dichotomy. It is courageous to jeopardize the career that you have worked so hard to build. But to identify that decision as brave creates a flip-side in which the women who do not report harassment can be considered cowardly (even by themselves). Add to that the fact that we praise women who break glass ceilings in STEM fields for their commitment to their work — the very trait that might dissuade them from reporting sexual discrimination. Willenbring waited until she was secure in her career as a professor at the Scripps Institution of Oceanography to speak up.

She reported her case in October 2016, and it has been under investigation by BU’s Title IX department for the past year. A statement from BU noted that the time elapsed since the events of the case makes it difficult to investigate, but Willenbring points out that the Science reporter investigated it in a matter of weeks. Last week, in light of the Science report, Marchant was placed on administrative leave from his position as chair of the Earth and Environment department.

Still, Willenbring notes that reporting harassment alone isn’t going to solve the problem. What women scientists really need are female mentors in their fields who will invest in and support their careers. The problem being, of course, that women occupy a fragment of positions of power in STEM fields. In doctorate-level positions in science and engineering, they are outnumbered nearly 2 to 1 by men. It’s a difficult riddle.

But it’s one that management consultant Fabian Dattner and marine ecologist Jess Melbourne-Thomas are trying to solve. They co-founded the Homeward Bound Program in 2015, an Australia-based, international initiative devoted to increasing the number of women in positions of power in science across disciplines, like academia, business, communications, and the arts. Specifically, they want to elevate 1,000 women to leadership roles by 2026. Their 12-month program culminates in a research trip to Antarctica.

Lee Constable hopes to be one of those thousand women, and she’ll be trekking to the icy shores of our most remote continent in February 2018 through Homeward Bound.

At 27, Constable is the host of an Australian public television show called Scope, which is kind of like “Bill Nye: The Science Guy” if it were hosted by someone who yells at their audience less. Constable, who is warm and instantly personable over Skype, tells me that she has never felt that she was somehow inadequate in science as a woman. She’s acutely aware, however, that her experience is not the norm.

That can be attributed to Constable’s undergraduate experience with Marilyn Ball, an environmental biologist at Australian National University, studying coastal mangroves and then spending a year in Ball’s lab. While Constable loved the work, she became interested in how people who may never see a mangrove forest think about and act on climate change.

In 2016, she took over Scope from a male host who had launched it 11 years prior. The transition marked a change in the show’s approach: a less academic slant, and more intentionally accessible to kids who might not consider themselves stand-out students. She applied to the Homeward Bound program specifically to develop her leadership skills, now that she has the platform to involve more young people — and hopefully, more young women — in science.

“For me, being a leader might mean actually setting an example or having a positive influence on someone I may never meet,” Constable explains. “Now that more people are listening to me and asking for my opinion on things, I’m seriously considering how to make that into something positive in terms of climate action.”

There are a few networks that share the goals of Homeward Bound — Million Women Mentors, for example, or eAlliances, an initiative of the American Association of Physics Teachers. Neither are as interdisciplinary, or as specifically programmed, as the fledgling Homeward Bound, which is funded by a motley handful of public and private entities. The $26,000 cost of the trip to Antarctica is partially borne by the participants themselves, which obviously excludes low- or even middle-income women who cannot secure outside funding. Homeward Bound is currently developing scholarships for women from the most immediately climate change-impacted countries.

As Constable points out, these initiatives tend to be directed and founded by women. “Women are the ones who are always organizing the ways to help women stop their own discrimination,” she notes.

If you would like to play your part in ending discrimination in science, regardless of whether or not you are a woman, try any of these:

Be able to identify and respond to sexual harassment of your peers and colleagues when you see it.
Install — and support — women in visible positions of authority, both in academia and media.
Help fund programs and initiatives that support mentorship of women in science — particularly those in communities most endangered by climate change.
In short: Do anything you can do to ensure that a man in power is balanced by a woman.

The current and coming generations of young women in science should not have to wait nearly 20 years to report their abuse, as Jane Willenbring did. Multiple women have contacted Willenbring to thank her for coming forward — and to agree that they, too, would have waited (or are waiting) until they are more secure in their careers to do the same. But Willenbring’s decision to come forward was also catalyzed by her daughter.

“I took her to my lab, and she realized with me in my lab coat that I was actually a scientist and not just telling her that,” she recounts. “She said, ‘I want to be a scientist just like you, mommy,’ and that hit me so hard.”

Her voice breaks, barely perceptibly. “I imagined her going through the exact same thing, and I’m coming apart, again, just thinking about it.” And then, firmly: “That can’t happen.”

Bill Nye on his climate change education efforts: “I am a failure”

Bill Nye (Credit: AP/Michael OKoniewski)

Between hosting “Bill Nye the Science Guy” and serving as CEO of The Planetary Society, Bill Nye’s career as a science educator means he is also, inherently, an activist when it comes to combating climate change.

Nye joined Jeremy Binckes on “Salon Talks” to discuss his efforts raising awareness around climate change over the years, and to scoop a new documentary film that chronicles his rise from lively children’s show host to national science defender and advocate.

“I am a failure!” Nye exclaimed when reflecting back on the shows he created over two decades ago about the Earth’s warming.

Nye blamed the fossil fuel industry for creating the schism between climate deniers and believers, saying “they have worked so hard to introduce doubt.” He went on to say that he believed climate change was discovered in the 1970s, “and we’ve done virtually nothing about it all this time.”

This is partially because climate change has become a highly politicized and polarizing topic in America: Republicans tend to deny the issue even exists, while Democrats generally see it as a legitimate concern. Yet like most science, it is not something that you “believe” in, but rather, a tested observation based on overwhelming empirical evidence.

In 2012, Donald Trump tweeted this:

The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive.

— Donald J. Trump (@realDonaldTrump) November 6, 2012

And Scott Pruitt, administrator of the Environmental Protection Agency, has repeatedly denied climate change, claiming that “human activity” is not “a primary contributor to the global warming that we see,” according to CNBC.

Nye implored the public to take a stand against climate deniers.

“What I tell everybody is vote,” Nye told Salon. “We don’t want everybody to be a scientist; that would be unwieldy. We need accountants and artists, filmmakers, journalists — but we want everybody to appreciate science,” and appreciate “the value of science to your everyday life, to the economy of whatever country you live in and to the future of humankind as we face the biggest challenge so far,” he continued.

Visit billnyefilm.com to learn about where you can see the new documentary “Bill Nye: Science Guy.”

Watch the full “Salon Talks” conversation with Nye on Facebook to hear him discuss why he thinks his lessons on climate change failed to convince the public.

Tune into Salon’s live shows, “Salon Talks” and “Salon Stage,” daily at noon ET / 9 a.m. PT and 4 p.m. ET / 1 p.m. PT, streaming live on Salon and on Facebook.