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The Surprising Way the Healthcare Industry Fuels Climate Change

If the global healthcare sector were a country, it would be the fifth-largest greenhouse gas (GHG) emitter on the planet, according to a new report. Its authors, who argue for zero carbon emissions, say it is the first-ever estimate of healthcare’s global climate footprint.

While fossil fuel burning is responsible for more than half of the footprint, the report says there are several other causes, including the gases used to ensure that patients undergoing surgery feel no pain.

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It is produced by Health Care Without Harm (HCWH), an international NGO seeking to change healthcare worldwide so that it reduces its environmental footprint and works for environmental health and justice globally. It was produced in collaboration with Arup.

The report says the European Union healthcare sector is the third largest emitter, accounting for 12% of the global healthcare climate footprint. More than half of healthcare’s worldwide emissions come from the top three emitters – the EU, the US and China. The report includes a breakdown for each EU member state.

An earlier report, published in May this year in the journal Environmental Research Letters, said the health care sectors of the 36 countries sampled were together responsible in 2014 for 1.6 GtCO2e (gigatonnes of carbon dioxide equivalent), or 4.4% of the total emissions from these nations, and 4.4% is the total used in the HCWH report.

(Carbon dioxide equivalency is a simplified way to put emissions of various GHGs on a common footing by expressing them in terms of the amount of carbon dioxide that would have the same global warming effect, usually over a century.)

“Places of healing should be leading the way, not contributing to the burden of disease”

HCWH says well over half of healthcare’s global climate footprint comes from fossil fuel combustion. But it identifies several other causes for concern as well. One is the range of gases used in anaesthesia to ensure  patients remain unconscious during surgery.

These are powerful greenhouse gases. Commonly used anaesthetics include nitrous oxide, sometimes known as laughing gas, and three fluorinated gases: sevoflurane, isoflurane, and desflurane. At present, the greater part of these gases enter the atmosphere after use.

Research by the UK National Health Service (NHS) Sustainable Development Unit shows the country’s anaesthetic gas footprint is 1.7%, most of it attributable to nitrous oxide use.

The UN climate change convention (UNFCCC) found that in 2014 a group of developed nations with 15% of the global population, 57% of the global GDP and 73% of global health expenditure was also responsible for 7 MtCO2e of medical nitrous oxide use. (“MtCO2e” means “million metric tons of carbon dioxide equivalent”.)

The UNFCCC concluded that the full impact of the gas’s global use in anaesthesia “can be expected to be substantially greater”.

Use is growing

For fluorinated gases used in anaesthesia, global emissions to the  atmosphere in 2014 were estimated to add 0.2% to the global health care footprint. Because of the growing use of these gases, increasingly chosen  in preference to nitrous oxide, the footprint from anaesthetic gases is also likely to increase.

In measured tones, HCWH says: “Wider adoption of waste anaesthetic capture systems has the potential to be a high impact health care-specific climate mitigation measure” – or in other words, trap them and dispose of them carefully before they can just escape through an open window to join the other GHGs already in the atmosphere.

But HCWH adds a warning: “For many individual health facilities and systems of hospitals the proportion of the contribution of both nitrous oxide and fluorinated anaesthetic gases to their climate footprint can be significantly higher.

“For instance, Albert Einstein Hospital in São Paulo, Brazil found that GHG emissions from nitrous oxide contributed to nearly 35% of their total reported GHG emissions in 2013.”

Its report said choosing to use desflurane instead of nitrous oxide meant a ten-fold increase in anaesthetic gas emissions.

Other remedies available

The HCWH report also sounds the alert about metered-dose inhalers (MDIs), devices which are typically used for the treatment of asthma and other respiratory conditions, and which use hydrofluorocarbons as propellants. These are also highly potent greenhouse gases, with warming potentials between 1,480 and 2,900 times that of carbon dioxide.

Again, though, the report says the full global emissions from MDIs will probably be much greater than today’s figure. Alternative ways of using MDIs, such as dry powder -based inhalers, it says, are available and provide the same medicines without the high global warming potential propellants.

The report argues for the transformation of the healthcare sector so that it meets the Paris Agreement goal of limiting temperature rise attributable to climate change to 1.5°C.

HCWH says hospitals and health systems should follow the example of the thousands of hospitals already moving toward climate-smart healthcare via the Health Care Climate Challenge and other initiatives.

Welcoming the report, the director-general of the World Health Organization, Dr Tedros Adhanom Ghebreyesus, said hospitals and other health sector facilities were a source of carbon emissions, contributing to climate change: “Places of healing should be leading the way, not contributing to the burden of disease.”

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Will John Bolton’s Firing Save Us From War With Iran?

This piece first appeared on Informed Comment

In the wake of the firing of national security adviser and full-time warmonger John Bolton, secretary of state Mike Pompeo and treasury secretary Dan Mnuchin held a press conference on Tuesday. Both reaffirmed that Trump is open to meeting Iran’s President Hassan Rouhani “without preconditions.” They also, however, affirmed that the Trump administration would continue its policy of “maximum pressure” against that country. This phrase is a euphemism for an American financial and trade blockade on Iran attempting to prevent it from selling its petroleum and to prevent countries from trading with Iran or investing in it.

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The American blockade has, as you might expect, made Iran more belligerent rather than less. It is gradually easing the restrictions it had accepted on its civilian nuclear enrichment program (though so far it hasn’t done anything with obvious military implications, and still has no military enrichment program, contrary to what American reporters and politicians mysteriously keep saying). The blockade has also led to what are likely Iranian acts of sabotage against oil tankers in the Straits of Hormuz (I suppose on the theory that if Iran can’t export its oil, then neither can anyone else in the Gulf).

One of Bolton’s many zany/ WW III-risking escapades was to convince Britain to detain an Iranian tanker off Gibraltar this summer, on extremely dubious legal grounds. The dubiousness was recognized by the Gibraltar supreme court, which ordered the tanker released, since the European Union stance on Iran is very different from that of the US. Iran replied by taking some British-flagged ships captive, which could have led to serious conflict if only Britain had, like, an actual government or one that could spare a thought for Iran in the midst of dealing with the dire threat of the phalanx of Polish waiters serving London’s diners.

Bolton also had plumped in mid-June for a US airstrike on Iran after it shot down an American drone over what Iran claimed was Iranian waters. Bolton had been having wet dreams about bombing Iran for decades and was on the verge finally of reaching climax, but deflation abruptly occurred as Trump stepped in to cancel the attack.

Trump is all for talking tough and deploying economic warfare, but he believes his base is tired of seeing US blood and treasure squandered in the Middle East. George W. Bush’s Iraq War is estimated to cost $6 trillion when you factor in medical care for the thousands of badly wounded veterans. The US deficit is $22 trillion, but would be a third of that without the Bush wars. The deficit is a drag on the US economy, which is why despite high employment rates most American workers aren’t paid a living wage.

Bolton, in contrast, never saw a war or military intervention he didn’t fall head over heels in love with. Trump himself joked that if Bolton had his way, we’d be in four wars now.

Trump, having never ceased being a reality show star, wants the big splash of a public summit with an enemy, as with North Korea. He is clearly completely uninterested in whether these personal summits actually achieve anything practical (as the ones with North Korea have not). He had been planning a similar photo op with the Taliban in Afghanistan, but for some reason choked like a dog at the last minute. Maybe it was *everyone* around him telling him it was a bad idea to host the Taliban at Camp David around the anniversary of 9/11.

To be fair, Trump’s personal summits are not the worst thing in the world. Churchill used to say that jaw-jaw is better than war-war. But Bolton thought that they were the worst things in the world, which is why he now has the leisure to write a memoir of regrets about how he never managed to get the US into another four wars.

The big question now is whether Trump will try to pull a North Korea with Iran, and whether Iran is pragmatic enough to do it. President Rouhani intimated in late August that he would even meet Trump if it resulted in good things for the Iranian nation. The next day he had clearly been slapped down by Iran’s clerical leader, Ali Khamenei, and other hard liners. Rouhani reversed himself and said he could only meet Trump if the US first cancelled the severe sanctions it had slapped on Iran.

Now that Bolton is out and Trump’s Afghanistan photo op may have fallen through, he may be hungering for a supposed foreign policy victory on which the Republicans could run in 2020. Trump has an idee fixe that getting out of the Middle East, or reducing tensions there dramatically, will be enormously popular with his base. That is why he tried to get entirely out of Syria (former secretary of defense James Mattis resigned over that one), and why he wanted to get entirely out of Afghanistan.

So maybe he will do something with regard to Iran, at least behind the scenes, that would make it attractive even to Khamenei for Rouhani to meet with Trump.

 

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GOP Holds N.C. House Seat but Shows Weakness in Suburbs

RALEIGH, N.C. — Conservative Republican Dan Bishop won a special election Tuesday for an open House seat in North Carolina, averting a demoralizing Democratic capture of a district the GOP has held for nearly six decades. But his narrow victory didn’t erase questions about whether President Donald Trump and his party’s congressional candidates face troubling headwinds approaching 2020.

Bishop, 55, a state senator best known for a North Carolina law dictating which public bathrooms transgender people can use, defeated centrist Democrat Dan McCready. Bishop tied himself tightly to Trump, who staged an election-eve rally for him in the district, and Tuesday’s voting seemed no less than a referendum on the president, who quickly took credit for the triumph.

“Dan Bishop was down 17 points 3 weeks ago. He then asked me for help, we changed his strategy together, and he ran a great race. Big Rally last night,” Trump tweeted. No polling has emerged publicly that showed Bishop with a deficit of that magnitude. Operatives from both parties and analysts had long said the race was too close to call.

The results in the district underscored the rural-urban split between the parties, with Bishop running up substantial numbers in outlying areas and McCready eroding GOP advantages in suburban areas. McCready’s moderate profile resembled that of many Democrats who won in Republican-leaning districts in the 2018 midterms and, even with the loss on Tuesday, showed the durability of that approach.

Bishop’s margin was far less than the 11 percentage points by which Trump captured the district in 2016. And it was only slightly greater than when then-GOP candidate Mark Harris seemed to win the seat over McCready, 36, last year — before those results were annulled after evidence surfaced of vote tampering.

Republicans have held the seat since 1963, and its loss would have been a worrisome preface to the party’s presidential and congressional campaigns next year.

“I think it means Trump is going to get a second term and Republicans will retake the majority,” House Minority Leader Kevin McCarthy, R-Calif., said in an interview with The Associated Press. Many analysts think a GOP takeover will be difficult.

Special elections generally attract such low turnout that their results aren’t predictive of future general elections. Even so, the narrow margin in the GOP-tilted district suggested that Democrats’ 2018 string of victories in suburban districts in red states including Texas, Oklahoma and Kansas could persist next year.

There is almost no pathway to Republicans regaining House control next year unless they avoid losing more suburban districts and win back some they lost last year.

The district stretches from Charlotte, one of the nation’s financial nerve centers, through its flourishing eastern suburbs and into less prosperous rural counties along the South Carolina line. More than half its voters were expected to come from the suburbs.

Since Trump became president, voters in such communities — particularly women and college-educated voters — have abandoned Trump in droves over his conservative social policies and vitriolic rhetoric on immigration and race.

Suburban defections would also jeopardize the reelection prospects of Trump, who’s already facing slipping poll numbers. Limiting the erosion of those voters will be crucial for him to retain swing states like North Carolina, which he won by less than 4 percentage points in 2016.

But Tuesday’s vote showed that Bishop benefited from the district’s conservative leanings.

“Bishop, his policies follow my convictions — after hearing Bishop, knowing that he’s for the Second Amendment and he’s against illegal immigration,” said Susie Sisk, 73, another retiree from Mint Hill. The registered Democrat said she voted for Bishop.

McCready, a former Marine turned financier of solar energy projects, was banking on the district’s suburban moderates to carry him over the top.

Along with a GOP victory in a second vacant House district in North Carolina, Republicans pared the Democratic majority in the House to 235-199, plus one independent. That means to win control of the chamber in 2020, Republicans will need to gain 19 seats, which a slew of GOP retirements, anti-Trump sentiment among moderate voters and demographic changes suggest will be difficult.

In the day’s other special election, Republican Greg Murphy, a doctor and state legislator, as expected defeated Democrat Allen Thomas to keep a House district along North Carolina’s Atlantic coast.

That seat has been vacant since February, when 13-term GOP Rep. Walter Jones died, and Trump won it handily in 2016.

The bathroom law that Bishop sponsored was repealed after it prompted a national outcry and boycotts that The Associated Press estimated cost North Carolina $3.7 billion.

Bishop bound himself tightly to Trump, backing his proposed border wall with Mexico and accusing Trump critics of being intent on “destroying him.” In a TV spot airing Election Day, he said his opponent is “backed by radicals” as the screen flashed the faces of House Speaker Nancy Pelosi, Democratic presidential contender Bernie Sanders and outspoken liberal Rep. Alexandria Ocasio-Cortez.

McCready used his creation of a company that’s financed solar energy projects to cast himself as a job creator and environmental champion. He also focused on containing health care costs and ran a spot featuring his trademark promise to prioritize “country over party.”

In 2018, McCready lost by 900 votes to Harris, the Republican. That decision followed allegations of vote fraud by a Republican political consultant, and Harris opted to not run again.

Another jolt of notoriety occurred in July when Trump staged a rally for Bishop in nearby Greenville. Trump said four Democratic women of color should “go back” to their home countries, though all but one was born in the U.S. The crowd began chanting “Send her back.”

___

Associated Press writer Emery P. Dalesio contributed to this report from Raleigh, N.C.

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Netanyahu Vows to Begin Annexing West Bank Settlements

JERUSALEM — Israeli Prime Minister Benjamin Netanyahu vowed on Tuesday to annex the heart of the West Bank if he wins reelection next week, a move that could inflame the Middle East and extinguish any remaining Palestinian hope of establishing a separate state.

Arab leaders angrily condemned Netanyahu’s remarks, and a U.N. spokesman warned the step would be “devastating” to the prospects for a two-state solution.

Netanyahu said he would extend Israeli sovereignty over the Jordan Valley — an area seen as the breadbasket of any Palestinian state — shortly after forming a new government and would move later to annex other Jewish settlements.

Such action would swallow up most of the West Bank territory sought by the Palestinians, leaving them with little more than isolated enclaves.

Netanyahu said it was important to act as President Donald Trump prepares to unveil his Mideast peace plan after the Sept. 17 election.

“This is a historic opportunity, a one-time opportunity, to extend Israeli sovereignty on our settlements in Judea and Samaria, and also on other important regions for our security, for our heritage, and for our future,” Netanyahu said, using the biblical terms for the West Bank.

The prime minister was not clear about the status of the Palestinians on the West Bank.

Over 2.5 million Palestinians live there and in east Jerusalem, in addition to nearly 700,000 Jewish settlers. Israel already has annexed east Jerusalem in a move that is not internationally recognized.

Netanyahu is locked in a tight race, and his announcement, the most detailed vision for the region that he has presented during his decade in power, was the latest in a series of frenetic moves he has made in recent days to try to rally hard-line voters.

The proposal was dismissed by opponents as election theatrics. They have accused Netanyahu of trying to divert attention from a corruption scandal and Israel’s security challenges. Later in the day, he was whisked away from a campaign event in southern Israel after Palestinian militants fired rockets toward the area.

Netanyahu’s plan would hinge on a number of factors, most critically whether Trump would back him. But Trump’s team of Mideast advisers is dominated by supporters of the settlements, and the muted reaction Tuesday from the U.S. indicated there would be little resistance.

U.S. officials said Netanyahu had told them about his proposal ahead of time and that they had not raised any objections because they do not believe it will affect prospects for an eventual peace agreement. The officials spoke on condition of anonymity because they were not authorized to talk to the media.

The Israeli leader spoke as the White House announced the firing of national security adviser John Bolton. Bolton was a strong supporter of Netanyahu’s tough policies against Iran and had visited the Jordan Valley with the Israeli leader in June.

The Palestinians seek the West Bank, east Jerusalem and the Gaza Strip — areas captured by Israel in the 1967 Mideast war — as part of a future independent state.

For Israel, the Jordan Valley is considered a security asset because it provides a buffer zone against potential attacks from the east. Many moderate Israelis believe Israel should retain some element of control in the area under a peace deal.

Palestinians, however, say there can be no independent state without the area, which comprises nearly a quarter of the West Bank. It is home to many Palestinian farms and also is one of the few remaining areas of the territory where the Palestinians have open space to develop.

Palestinian President Mahmoud Abbas said all agreements with Israel will be canceled if Netanyahu presses forward.

“We have the right to defend our rights and achieve our goals by all available means, whatever the results, as Netanyahu’s decisions contradict the resolutions of international legitimacy and international law,” he said.

The international community, along with the Palestinians, overwhelmingly considers Israeli settlements in the West Bank and east Jerusalem illegal.

Netanyahu’s plan would turn Palestinian population centers into enclaves that he said he would seek to link to neighboring Jordan. Unlike Israeli settlers, West Bank Palestinians are not Israeli citizens and do not have the right to vote.

Jordan’s foreign minister, Ayman Safadi, condemned the announcement as “a serious escalation that undermines all peace efforts.”

At the United Nations, Secretary-General Antonio Guterres also rejected the proposal. “Such a prospect would be devastating to the potential of reviving negotiations, regional peace and the very essence of a two-state solution,” said U.N. spokesman Stephane Dujarric.

Netanyahu’s challengers accused him of playing politics. Yair Lapid, a leader of the Blue and White party, dismissed it as an “an election stunt.” Ehud Barak, a former prime minister who is campaigning to oust Netanyahu, said the prime minister “has no public or moral mandate to determine things so fateful to the state of Israel.”

During the hard-fought campaign, Netanyahu has alleged fraud in Arab voting areas and has been pushing to place cameras in polling stations on election day. He also claimed to have located a previously unknown Iranian nuclear weapons facility, and later this week he flies to Russia for a lightning meeting with President Vladimir Putin.

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The Opioid Crisis’ Chief Culprit Has No Defense

This story is a collaboration between ProPublica and STAT.

ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up for ProPublica’s Big Story newsletter to receive stories like this one in your inbox as soon as they are published.

Purdue Pharma has tried to refute accusations that it fueled the opioid crisis by arguing it was a small player in the U.S. market for prescription pain relievers. But a new ProPublica analysis of government data shows that the company, the maker of OxyContin, had a far bigger impact than it portrays.

Purdue’s position rests on a Drug Enforcement Administration database, made public by a court order in July, which shows Purdue sold 3.3% of the prescription opioid pain pills in the U.S. from 2006 to 2012.

Last month, when Purdue moved to dismiss a lawsuit by the Massachusetts attorney general alleging that it had downplayed the addiction risk of its potent drug, the company highlighted the DEA statistic in a slide presentation. One slide was headlined: “Purdue makes a very small fraction of opioids nationally.”

Company lawyer Timothy Blank told the judge, “The notion that Purdue has created this epidemic is a serious misconception.”

The number promoted by Purdue, however, is an inadequate measure of market share and understates the company’s role in the opioid epidemic, according to experts and the new ProPublica analysis. That’s because the percentage of sales doesn’t take the potency and dose of the pills into account. The analysis favored by Purdue treats every pain pill as the same, whether it is a 5 milligram Percocet or an 80 milligram OxyContin. It’s analogous to measuring alcohol sales by equating a 12-ounce glass of 100 proof whiskey with a similar-sized can of light beer.

ProPublica analyzed the same data set touted by Purdue but accounted for the wide variation in strengths of prescription painkillers. Besides counting the number of pills sold, the analysis measured the amount and potency of opioid that they contained. Higher doses of opioids are associated with a greater risk of overdose.

On that basis, the market share of Purdue is 16% — about five times higher than the number cited by the company. That makes Purdue the third-largest seller of opioids from 2006 to 2012, behind generic pain pill makers Actavis Pharma and SpecGx, a subsidiary of Mallinckrodt.

“All opioids are not created equal,” said Len Paulozzi, a former medical epidemiologist at the Centers for Disease Control and Prevention who researched prescription opioid overdose risk. He said it is important to adjust for potency because “the risk of an overdose, whether fatal or nonfatal, is directly related to the dosage a person receives.”

Purdue’s contention that it was a minor participant in the opioid painkiller market is both a legal and a public relations strategy. The company has been working to settle more than 2,000 lawsuits blaming it for helping to create the public health disaster, and also to protect the reputation and legacy of the Sackler family, its owners. Once praised for their philanthropy, the Sacklers have more recently been condemned by politicians and advocates for their stewardship of Purdue.

Settlement talks, which included a provision that the Sacklers contribute at least $3 billion of their own money, recently reached an impasse and Purdue is considering filing for bankruptcy, the Associated Press reported Saturday. The Sacklers have been separately sued by more than a dozen states, including Massachusetts and Connecticut, for their role in overseeing the company’s allegedly illegal marketing of OxyContin.

Purdue has long experience at countering criticism of OxyContin. The first reports that people were abusing the drug surfaced two decades ago. Since then, Purdue has repeatedly argued that its flagship drug has done more good than harm. Even when Purdue pleaded guilty in 2007 in federal court to a criminal charge of illegally marketing OxyContin by downplaying addiction risks, it blamed misstatements by employees who didn’t follow company directives. More recently, the company and representatives of the Sackler family have said that the opioid crisis is now driven by “illegal street drugs” such as heroin and fentanyl.

Purdue declined to comment on the ProPublica analysis.

By minimizing OxyContin’s market share, the per-pill sales data that Purdue prefers also muffles the drug’s outsized impact in certain states, especially in the Northeast. For example, Purdue’s lawyer told the Massachusetts judge that the company sold just 4.6% of the prescription pain pills in the state from 2006 through 2012. But when the total amount of opioid ingredient in each pill is considered, Purdue’s market share in the state is actually more than four times higher at 20.5%.

In some states, when sales are adjusted for potency, Purdue sold more painkiller medication than any other company: Purdue was the top seller in Rhode Island, with 31.2% of the opioid market, as well as in Connecticut, where it had 28.5%. In Ohio, which has consistently ranked among states with the highest rates of overdoses, Purdue had one-fifth of the market. In 13 states, Purdue was responsible for 20% or more of retail opioid painkiller sales.

The market share nationally of some companies dropped when potency was considered. SpecGx, which has 37.7% of the market on a per pill basis, fell to 29%. Actavis declined from 34.6% of the total pill market to 30.4% in the ProPublica analysis.

The analysis of the DEA data cited by Purdue was first done by The Washington Post. It partnered with the publisher of the Charleston Gazette-Mail in West Virginia in a joint legal action that prompted the release of the DEA database. The database, called Automation of Reports and Consolidated Orders System, or ARCOS, tracks every opioid pill sold in the country from manufacturer to distributor to pharmacy.

The Post limited its analysis to shipments of oxycodone and hydrocodone, which accounted for three-fourths of all pill shipments to pharmacies. ProPublica also restricted its analysis to the same two drug classes sold by retail outlets and practitioners because the numbers cited by Purdue in court are based on that methodology.

The reason Purdue’s market share is significantly larger when measuring the amount of opioid ingredient sold is because OxyContin is formulated at strengths many times higher than most other pain pills.

When Oxycontin was unveiled in 1996, Purdue’s marketing campaign touted it as providing longer pain relief while allowing patients to take fewer pills each day. To accomplish that, Purdue packed into each pill a large amount of opioid that was slowly released over a 12-hour period. Its largest dose, until it was taken off the market in 2001 amid safety concerns, was a 160 milligram pill.

Abusers quickly figured out how to crush OxyContin tablets and remove the opioid inside. Some snorted it, while others reduced it to liquid form and injected it.

In determining the amounts of opioid painkillers sold by Purdue and other manufacturers, ProPublica calculated a rate called morphine milligram equivalent, or MME, which is commonly used by public health agencies, including the Food and Drug Administration and the CDC.

The calculation standardizes different types of opioids to the same morphine equivalent. Hydrocodone, the opioid in Vicodin, has a potency that is equivalent to morphine. Oxycodone, the opioid in OxyContin, is one and a half times more potent than morphine. When converting to morphine equivalents, the amount of hydrocodone in a pill is multiplied by one, while oxycodone is multiplied by 1.5.

Using this formula, an 80 milligram pill of OxyContin has an MME of 120 while a 5 milligram Vicodin pill has an MME of 5.

The average total MME for a pill sold by Purdue in the DEA database was 61.5. By comparison, the average MME per pill sold by the largest manufacturer during this time frame, Actavis Pharma, was 11. For the second biggest manufacturer, SpecGx, it was even lower at 9.6 MME.

CDC guidelines advise against prescribing more than 90 MME per day. OxyContin users are typically directed by their doctors to take two pills per day. Based on the DEA database, the typical prescription from 2006 to 2012 would have totaled 123 MME a day — an amount 37% above the maximum recommended by the CDC.

A CDC review in 2016 concluded that higher opioid dosages are associated with increased overdose risk. One of the studies cited by the CDC found that patients taking between 50 and 100 MME of painkillers a day were up to 4.6 times more likely to overdose than those taking less than 20 MME. For patients receiving more than 100 MME a day, the risk was up to nine times higher than for the lower dose group.

“If Purdue sold a lot of 80 milligram pills, they are going to have proportionately more of the market on an MME basis,” said Gary Franklin, the medical director for the Washington State Department of Labor and Industries. “That is an important point to get out. People are dying from these higher doses.”

Franklin, who is an unpaid expert for the state of Washington in its lawsuit against Purdue, cautioned that other factors increase overdose risk as well. For instance, people who take benzodiazepines, such as Xanax, at the same time as opioids can fatally overdose on lower doses of painkillers.

The FDA, in a staff report this year, also found that a higher daily dose of opioid pain relievers “likely contributes causally to increased risk of intentional and unintentional opioid overdose.” The agency noted that other factors influence overdose risk and that a substantial portion of overdose victims either did not have a prescription for the pills they took or were prescribed a lower daily dose.

Until 2010, according to the DEA’s National Drug Threat Assessment Summary, OxyContin was “by far” the most commonly abused prescription painkiller in the country. In 2010, Purdue introduced a reformulated version of OxyContin that is harder to abuse. The new version can still be abused if crushed or taken orally, but it does not provide as potent a high as the older version, according to the agency.

In the Massachusetts hearing last month, Purdue relied on the lower per pill market share in oral arguments before the judge and in the accompanying slide presentation of data. One slide stated, “DEA Data Refute the Commonwealth’s Allegations.”

“What the commonwealth has done is create an extraordinary misperception in the community, and it is a dangerous misperception,” Purdue’s attorney Blank told the judge at the Aug. 2 hearing, according to a transcript of the proceeding. “The attorney general says it is all on Purdue. It is not all on Purdue.”

“All those prescriptions are not equal,” responded Assistant Attorney General Sandy Alexander. “Some of those prescriptions are for two pills of the lowest dose opioid. Purdue specialized in the most dangerous prescriptions because they were the most profitable.”

The Massachusetts lawsuit cites internal Purdue records in alleging the company pushed higher doses because they were the most profitable. Authorities also allege that the company knew patients taking more of the drug were more likely to overdose. One Massachusetts doctor, who was paid more than $80,000 by Purdue to give talks to other physicians, prescribed 24 of the highest dose OxyContin pills a day for a single patient, according to the state complaint.

“Purdue specialized in getting patients on the highest doses for the longest periods of time,” Alexander told the judge. “Those prescriptions, when you count them, they’re not all equally valuable to a drug company and they’re not all equally dangerous to the people of Massachusetts.”

Purdue’s market share from 2006 to 2012 would have likely been even higher save for an anomaly in the history of the drug. For a brief time, including the years 2006 and 2007, OxyContin had generic competition. Its sales slumped from $1.3 billion in 2005 to $752 million in 2006 and $1 billion in 2007, according to health care data firm IQVIA. Purdue sued the generic makers and gradually eliminated competition from them so that by 2008, OxyContin sales more than doubled from the prior year to $2.3 billion.

By that measure, dollar sales, Purdue has long been the market leader for prescription opioids. Internal Purdue records indicate OxyContin had more than 28% of the total market share in gross sales each year from 2008 through 2018. Since 1996, sales of OxyContin have totaled more than $35 billion. The Sackler family received at least $8 billion in company profits during that time, according to court records.

ProPublica news apps developer Mike Tigas contributed to this report.

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Democratic Think Tank Center for American Progress Isn’t Fooling Anybody

The Center for American Progress has laid off the unionized staff members of its news site, ThinkProgress. In a statement posted on the ThinkProgress site, the center announced  it was “transitioning ThinkProgress back to its roots by offering analysis of the news, policy and politics.” Former staffers were concerned the site would turn into a communications arm for the think tank’s scholars and staff, which would be against the union contract that guaranteed editorial independence.

The Center for American Progress is one of the most prominent liberal think tanks in Washington, D.C. The nonprofit took in from $40 million to $50 million from 2013-16. It said editorially independent ThinkProgress, which, as the Daily Beast writes, “helped define progressivism during the Obama years,” was running a deficit for years, and it was looking to sell the site.

A statement from the ThinkProgress union countered that “ThinkProgress was not founded to be profitable.” When the center announced its plans for the site, the union’s statement continued, “We now know this was never about money. This was always about power and control.”

As Jack Crosbie writes in Splinter, “In the end, CAP’s arrogant certainty that it could essentially borrow a line out of the Bustle playbook after stressing its support for unions for years and years resulted in public humiliation and less revenue.” It’s not outright union busting, but nonetheless troubling for a supposedly liberal think tank to shutter its editorially independent and unionized news site.

Jason Gordon, the director of communications for the Writers Guild of America, which represents the union, told the Daily Beast, “in light of new developments on the future of ThinkProgress, we are continuing conversations with CAP and exploring our legal options.”

During the Obama presidency, ThinkProgress helped start the careers of multiple prominent journalists and political operatives. Per the Daily Beast:

<block>A testament to its success is found in the list of prominent alumni currently working in politics and journalism. That list includes Faiz Shakir, who now serves as Sen. Bernie Sanders’ campaign manager; Amanda Terkel, the D.C. bureau chief of the Huffington Post; Nico Pitney, the political director at NowThis; Alex Seitz-Wald, a top campaign reporter for NBC News; Ali Gharib, a senior news editor at The Intercept; and Matt Yglesias, one of the founding members of Vox.</blockquote>

Former ThinkProgress staffers, including The Intercept’s Lee Fang, also suggested the shuttering was about tensions between center-leaning higher-up staff and donors and more leftist writers:

<blockquote class=”twitter-tweet”><p lang=”en” dir=”ltr”>ThinkProgress used to dig into money in politics, influence of lobby power in DC. Then CAP leadership gutted it back in 2012. Later they got a &quot;union&quot; but that didn&#39;t change any of the fundamental power dynamics at CAP. Recent develops prove it.</p>&mdash; Lee Fang (@lhfang) <a href=”https://twitter.com/lhfang/status/1171190510486052864?ref_src=twsrc%5Etfw”>September 9, 2019</a></blockquote> <script async src=”https://platform.twitter.com/widgets.js” charset=”utf-8″></script>

 

The center’s initial statement on ThinkProgress’s closure said it would not be canceling recurring donations to ThinkProgress automatically; donors would have to contact the center to opt out. However, a center spokesperson later said it was reversing its initial decision and would end the recurring donations.

The Daily Beast reported the spokesperson also said the center was “shelving plans to keep the site running and would instead have it archived,” a small victory for the laid-off writers after the union said they were considering legal action.

 

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Proof Joe Biden Has the Mainstream Media in His Pocket

Democratic presidential candidate Joe Biden last month released a new Iowa TV ad called “Personal,” which recounts the former vice president’s personal tragedy of losing his wife and daughter to a car crash, and the subsequent loss of his son Beau Biden from brain cancer.

Biden presented his story as a celebration of for-profit health insurance by saying that he “couldn’t imagine” what it would’ve been like if their insurance didn’t cover the healthcare required “immediately,” and that he couldn’t “fathom” what would’ve happened if the insurance companies had said for the last six months of his son’s life, “You’re on your own.”

The advertisement continued Biden’s practice of dishonestly conflating Republicans who want to repeal the Affordable Care Act—also known as Obamacare—with those advocating a national health insurance program like most developed countries have. He mentions in the same breath Donald Trump’s efforts to repeal the ACA and proposals for a Medicare for All system, as advocated by rival primary contenders like Bernie Sanders and Elizabeth Warren:

Health care is personal to me. Obamacare is personal to me. When I see the president try to tear it down, and others propose to replace it and start over. That’s personal to me too. We’ve got to build on what we did because every American deserves affordable healthcare.

Corporate media uncritically transmitted the ad’s message as if it were merely a campaign strategy, instead of explaining what Biden, Sanders and Warren’s proposals actually are, and clarifying for voters whether Biden’s charges against his primary opponents are accurate.

CNN’s report (8/27/19), “Biden Gets ‘Personal’ in New TV Ad in Iowa Focused on Healthcare,” mainly noted that Biden’s new ad …

…highlights his continued support for the Affordable Care Act, at a time when other progressive Democratic candidates are pushing for a “Medicare for All” approach.

CNN also falsely asserted that Medicare for All advocates are proposing to enroll everyone in a national health insurance program and “eliminate” private health insurance. In fact, no Medicare for All proponent supports banning private health insurance. For example, Sanders’ Senate bill—which is cosponsored by other candidates like Cory Booker, Kamala Harris and Elizabeth Warren—bans private health coverage that duplicates the coverage offered by the government, because it would be rendered obsolete, and still allows for supplemental private coverage (The Week7/3/19).

The Washington Post’s “Biden Knocks Trump, Democratic Rivals in New TV Ad Touting Affordable Care Act” (8/27/19) trivialized the issue of healthcare by covering Biden’s ad in terms of the political horserace, emphasizing the role it plays in his campaign strategy—rather than explaining the differences between the various candidates’ proposals. The Post’s John Wagner merely notes that Biden’s ad “knocks both President Trump and some of his Democratic hopefuls” and “suggests they are all a threat to the Affordable Care Act.”

The Hill (8/27/19) continued the Post’s horserace-focused coverage, noting that Biden’s ad “appears to hit Biden’s 2020 rivals for proposing ideas to replace Obamacare,” and that it “illustrates the Biden campaign’s latest effort to tie the former vice president to the Obama administration.”

CBS (8/27/19) framed Biden’s ad as “an emotional appeal to Iowa caucus voters” and mentioned his proposal to add a public option, while uncritically transmitting Biden’s false assertion that his “Democratic rivals” want to “scrap the law and start over,” which Biden has slammed as “unrealistic.”

The New York Times’ report, “Why This Joe Biden Health Care Ad Stands Out” (8/27/19), stood out for its bad reporting, functioning essentially as an advertisement for the advertisement. The Times’ Katie Glueck described the ad as an “extraordinarily emotional appeal” for Biden’s candidacy and his healthcare proposal, describing it as being “striking” for its “wrenching images,” and mentioning how some voters have cited Biden’s “ability to connect with people after facing so much personal adversity of his own” to explain their support. The Times never mentions what Biden’s healthcare proposal actually is—perhaps because the ad itself doesn’t do so.

Instead, the Times reported on Warren’s rising poll numbers in Iowa and how “emphasizing his partnership with Mr. Obama” has “been a central strategy in Mr. Biden’s campaign.” The piece claimed that Biden has “not always been comfortable” using the deaths of family members for political purposes, because it would tread on “sacred ground,” but this hesitation now appears to be gone.

But when reports on Biden’s “Personal” ad observe that it is an “oblique” attack against Sanders and Warren’s Medicare for All proposals, they have a journalistic obligation to investigate whether or not these attacks are true.

Corporate media have shown they have no problem devoting attention to tracking other falsehoods Biden has told on the campaign trail, like when he offered “my word as a Biden” that a false war anecdote was “the God’s truth” (Washington Post8/29/19). Perhaps this is because telling lies about Medicare for All protects insurance industry profits (FAIR.org4/29/19), which are not threatened by the exposure of fake war stories?

Others have already documented the numerous falsehoods Biden has told about Medicare for All, among them the notion that Medicare for All advocates are trying to “scrap Obamacare” and cause a “hiatus” or a lapse in coverage for up to three years (Jacobin7/18/19). Medicare for All advocates don’t support repealing the ACA or creating a lapse in coverage; Sanders’ bill in particular has a four-year transition period in which Medicare is continually expanded to cover everyone (Common Dreams7/15/19).

While horserace coverage predominated, some exceptional reports attempted to gauge the accuracy of Biden’s attacks on Medicare for All proponents by explaining their proposals. CNBC (7/15/19) explained that Medicare for All wouldn’t “do away with the ACA in the same way that repeal of the ACA would,” and noted that Sanders’ legislation would create a “more comprehensive government-run system” that would include dental, vision and mental health services, while eliminating deductibles and co-pays. Vice News’ “Joe Biden: It Would Be An Insult to My Dead Son for Everyone to Have Healthcare” (8/27/19) offered an excellent breakdown of Biden’s ad and its falsehoods:

In all, the ad is saying that healthcare is personal to Joe Biden because his son died; that as a father, he believes the best and most legitimate way to honor his dead son’s legacy would be to implement further incremental regulatory reform, along the lines of what Barack Obama did; and that people who disagree and think that radical reform is necessary—among them, presumably, the 80% or so of Democrats who say it’s important to nominate a presidential candidate who supports Medicare for All—are dishonoring his son’s legacy.

If Joe Biden wants to get personal, I can also get very personal. Before my mother passed away last month, following an amputation for bone cancer, I was caring for and accompanying her to many doctors’ appointments, and I recall the numerous times my mother was rejected from hospitals for not having the proper insurance, along with delays, redundant tests and the frequent anxiety of wondering whether her insurance would cover her treatment—because we don’t live in a country where healthcare is a human right.

People can use personal tragedies as justification for perpetuating and inflicting injustices on others, and they can also use those tragedies as inspiration and motivation to prevent others from going through the same hardships. Biden’s latest ad is an example of the former masquerading as the latter, and corporate media’s coverage of it exemplifies how some personal tragedies are amplified and others neglected to protect corporate profits.

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Donald Trump Smears the Victims of Hurricane Dorian

Echoing the racist and dehumanizing rhetoric he has repeatedly deployed against Mexican immigrants, Muslims, and others, President Donald Trump on Monday told reporters—without offering a shred of evidence—that there may be “very bad gang members” and “drug dealers” among those fleeing the Bahamas in the aftermath of Hurricane Dorian.

The president’s comments sparked outrage, with the Sierra Club responding that “Donald Trump’s racism and cruelty knows no bounds.”

“He needs to do his job and respond to the ongoing humanitarian crisis,” the group tweeted. “We rise in solidarity with the Bahamian people.”

Trump’s remarks came hours after hundreds Bahamian refugees were ordered off a ferry headed for Ft. Lauderdale, Florida, purportedly because they did not have U.S. visas. Brian Entin, a reporter for WSVN 7 News in Miami who was on the vessel, said “this is not normal” and noted Bahamians can usually travel to the U.S. with just a passport and a printout of their police record.

“We have to be very careful,” Trump told reporters Monday, defending the decision to remove hurricane victims from the ferry and warning that “very bad people” could be attempting to enter the U.S. after Dorian devastated the Bahamas, killing dozens and destroying tens of thousands of homes.

Watch:

Trump defends prohibiting some people from hurricane-ravaged Bahamas from entering the United States because he doesn’t want “very bad people and some very bad gang members and some very very bad drug dealers” here. pic.twitter.com/BL7q93xtfD

— Aaron Rupar (@atrupar) September 9, 2019

In a statement Monday night,  Varshini Prakash, co-founder of the youth-led Sunrise Movement, said the move to deny hurricane victims entry is “disgraceful and goes against everything we are supposed to stand for as a nation.”

“These are people whose homes and livelihoods have been totally destroyed, who have lost family members,” said Prakash. “But instead of welcoming them with open arms and offering support, we’re sending them back to an island with little shelter, no food, and no access to basic necessities.”

Prakash said Sunrise and allies are planning to rally outside Customs and Border Protection (CBP) offices in Washington, D.C. on Wednesday to demand that the Trump administration “stop turning away people fleeing destruction.”

“As the climate crisis makes storms like Dorian stronger and deadlier, will we build bigger walls and keep polluting and making the crisis worse, or will we give the most vulnerable a safe haven in their time of most dire need and commit ourselves to tackling this crisis?” added Prakash. “The survivors of Hurricane Dorian are climate change refugees fleeing disaster, and they deserve compassion and support, not isolation and exclusion.”

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Number of Uninsured Americans Rises for 1st Time in a Decade

WASHINGTON — The number of Americans without health insurance edged up in 2018 — the first evidence from the government that coverage gains from President Barack Obama’s health care plan might be eroding under President Donald Trump.

The Census Bureau also said in an annual report Tuesday that household income rose last year at its slowest pace in four years and finally matched its previous peak set in 1999. Median household income rose 0.9% in 2018 to an inflation-adjusted $63,179, from $62,626 in 2017.

The data suggest that the economic expansion, now the longest on record at more than 10 years, is still struggling to provide widespread benefits to the U.S. population. Solid gains in household incomes in the past four years have returned the median only to where it was two decades ago. And despite strong growth last year in the number of Americans working full time and year-round, the number of people with private health insurance remained flat.

One bright spot in the report was that the poverty rate fell for a fourth straight year to 11.8%, its lowest point since 2001. The proportion of households led by women that were poor fell to a record low.

“While any reduction in poverty or increase in income is a step in the right direction, most families have just barely made up the ground lost over the past decade,” said Elise Gould, senior economist at the liberal Economic Policy Institute.

Though income inequality narrowed last year, it remains near record levels reached in 2017. Last year, the richest 5% of the U.S. population captured 23% of household income.

An estimated 27.5 million people, 8.5% of the population, went without health insurance in 2018. That was an increase of 1.9 million uninsured people, or 0.5 percentage point.

More people were covered by Medicare, reflecting the aging of the baby boomers. But Medicaid coverage declined. The number of uninsured children also rose, and there were more uninsured adults ages 35-64.

Though the increase in the number of uninsured Americans last year was modest, it could be a turning point, the first real sign that coverage gains under Obama could be at least partly reversed. This year, the number of uninsured could rise again because a previous Republican-led Congress repealed fines under the Affordable Care Act for people who remain uninsured if they can afford coverage.

The Census report is sure to play into 2020 presidential politics. Health care is the leading issue for Democrats, with proposals including Sen. Bernie Sanders’ call for a government-run system to cover everyone and former Vice President Joe Biden’s idea for expanding Obama’s law and adding a government plan open to virtually anyone.

Democrats are laying the blame Trump, long accusing his administration of deliberately undermining Obama’s health care law. House Speaker Nancy Pelosi on Tuesday blamed Trump’s “cruel health care sabotage” for the rising number of uninsured people. In a statement, the California Democrat said Trump’s ongoing efforts to erode Obama’s health law have forced Americans to “live in constant fear of an accident or injury that could spell financial ruin for their families.”

Trump spent most of his first year in office unsuccessfully trying to get a Republican Congress to repeal the Affordable Care Act. He is now asking a federal appeals court to overturn it as unconstitutional. The president also slashed the program’s sign-up season ad budget and scaled back funding to help people navigate the enrollment process. Trump also removed a subsidy for insurers, thereby triggering a jump in premiums.

Yet ACA enrollment has held fairly steady, with about 20 million people covered by its mix of subsidized private plans and a Medicaid expansion for low-income individuals. The Census report found that Medicaid coverage declined by 0.7 percent from 2017.

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Trump Dismisses John Bolton, Says They ‘Disagreed Strongly’

WASHINGTON — President Donald Trump on Tuesday forced out John Bolton, his hawkish national security adviser with whom he had significant disagreements on Iran, Afghanistan and a cascade of other global challenges.

The two men offered opposing accounts on Bolton’s less than friendly departure, a leave-taking example of what had been a fractious relationship almost from the start.

Trump tweeted that he told Bolton Monday night his services were no longer needed at the White House and Bolton submitted his resignation Tuesday morning. Bolton responded in a tweet of his own that he offered to resign Monday “and President Trump said, ‘Let’s talk about it tomorrow.'”

Trump said that he had “disagreed strongly” with many of Bolton’s suggestions as national security adviser, “as did others in the administration.”

The departure comes at a trying moment for the Trump administration on the world stage, weeks ahead of the United Nations General Assembly and as the president faces pressing decisions on a host of foreign policy issues.

In recent months, tensions have risen between Bolton and Secretary of State Mike Pompeo over influence in the president’s orbit and how to manage the president’s desire to negotiate with some of the world’s most unsavory actors.

Since joining the administration in the spring of last year, Bolton has espoused skepticism about the president’s whirlwind rapprochement with North Korea and has advocated against Trump’s decision last year to pull U.S. troops out of Syria. He masterminded a quiet campaign inside the administration and with allies abroad to persuade Trump to keep U.S. forces in Syria to counter the remnants of the Islamic State and Iranian influence in the region.

Bolton was also opposed to Trump’s now-scrapped notion to bring Taliban negotiators to Camp David last weekend to try to finalize a peace deal in Afghanistan.

South Carolina Sen. Lindsey Graham, who was traveling with Trump Monday, said reports of Bolton’s dissent on the Taliban meeting was a “bridge too far” for Trump.

One Republican familiar with the disagreements between Trump and Bolton said the adviser’s opposition to a possible meeting between Trump and Iranian President Hassan Rouhani was a precipitating factor in the dismissal. French President Emmanuel Macron has been trying to broker such a meeting, possibly on the sidelines of the upcoming U.N. General Assembly, in the hope of salvaging the international Iran nuclear deal that Trump withdrew from.

Bolton and his National Security Council staff were also viewed warily by some in the White House who viewed them as more attuned to their own agendas than the president’s — and some administration aides have accused Bolton’s staff of being behind leaks of information embarrassing to Trump.

Bolton’s ouster came as a surprise to many in the White House. Just an hour before Trump’s tweet, the press office announced that Bolton would join Pompeo and Treasury Secretary Steven Mnuchin in a briefing. A White House official said that Bolton had departed the premises after Trump’s tweet and would no longer appear as scheduled.

In a further sign of acrimonious relationship, a person close to Bolton told reporters that they had been authorized to say one thing — that since Bolton has been national security adviser there have been no “bad deals” on Iran, North Korea, Russia, and Syria. The person, who did not divulge who had given the authorization, was not allowed to discuss the issue by name and spoke only on condition of anonymity.

When asked to respond to the person’s comment, White House press secretary Grisham smiled and told reporters: “I don’t know how to read” it. “Sounds like just somebody trying to protect him,” she added.

Sen. Chris Murphy, D-Conn., said the move was a cause for worry.

“I’m legitimately shaken by the grave instability of American foreign policy today,” Murphy tweeted. “I’m no Bolton fan, but the world is coming apart, and the revolving door of U.S. leadership is disappearing America from the world just at the moment where a stable American hand is most needed.”

White House spokesman Hogan Gidley said Charles Kupperman, the deputy national security adviser and a former Reagan administration official and defense contracting executive, would fill Bolton’s role on an acting basis. Trump said he would name a replacement for Bolton next week.

Bolton was named Trump’s third national security adviser in March 2018 after the departure of Army Gen. H.R. McMaster.

Bolton was always an unlikely pick to be Trump’s third national security adviser, with a world view seemingly ill-fit to the president’s isolationist “America First” pronouncements.

He’s championed hawkish foreign policy views dating back to the Reagan administration and became a household name over his vociferous support for the Iraq War as the U.S. ambassador to the U.N. under George W. Bush. Bolton briefly considered running for president in 2016, in part to make the case against the isolationism that Trump would come to embody.

Still, Trump has admired Bolton for years, praising him on Twitter as far back as 2014. Trump has told allies he thinks Bolton is “a killer” on television, where Bolton is a frequent face on Fox News, though the president has voiced some unhappiness about Bolton’s trademark mustache.

___

AP writers Matthew Lee and Jonathan Lemire contributed.

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American Barbarity on the Border

The United States’ current immigration system is functioning exactly the way it is supposed to—it is designed to make people suffer.

The amount of violence the U.S. inflicts on people from around the world is all done in our name. It has become such a common occurrence that, like a fire alarm that blares randomly every day, it has lost all sense of urgency. We tune it out until it becomes white noise.

This is the case for the tens of thousands of asylum seekers at the U.S.-Mexico border who are the targets of Trump and his administration’s dehumanizing, intentional cruelty.

The featured series of photographs is from my third assignment to that border, where I have been covering the ongoing and ever-escalating refugee/humanitarian crisis.

This time, I crossed over from Brownsville, Texas, into Matamoros, Mexico. I was embedded with the Atlanta-based group Lawyers for Good Government—a nonprofit organization founded by Traci Feit Love after the 2016 election that has not tuned out the border crisis. Members of the organization have spearheaded a program called Project Corazon and have mobilized nearly 50 other heavy-hitting law firms, all of whom are working on a pro-bono basis to help prepare asylum seekers for upcoming immigration court hearings.

This was unlike Tijuana, Mexico—across the border from San Ysidro, California—where hives of various law enforcement agencies were a common sight when I was there last December and January. In Matamoros, the cartels seem to rule and run the border. I saw a gaggle of armed Federales officers only once there, a half-dozen of them “Mad-Max”-ing atop two militarized trucks through the border area. They were gone within seconds.

Here in Matamoros, no one I speak with on the ground has much trust for the Federales (or the Mexican government, for that matter), and frankly, I could not determine whether their absence makes me feel better or worse.

Cartel scouts masquerade as penny entrepreneurs, selling trinkets and food while walking past the cars waiting in line to drive through customs and into the U.S. They watch everything that is going on in and around the plaza, where dozens of tents are set up on a swath of concrete and roast throughout the day as the temperature often climbs over 100 degrees.

Even now, during hurricane season, it is difficult to move the asylum seekers into shelters, farther from the border. Their overriding fear is that they’ll be taken away, perhaps bused back to the country they had fled. For many, that is a death sentence.

Two rugged trees offer umbrellas of dappled shade in this makeshift community. It’s prime real estate for everyone trying to find a modicum of normalcy, to have a family meal, charge a cellphone, create a sidewalk school for the children, learn the “next steps” from the volunteer lawyers, laugh, play, cry, joke, comfort and tell their stories, hoping that someone will listen.

In a pre-border-crossing meeting with the volunteer lawyers who have been flown in as part of Project Corazon, Texas-based lawyer Jodi Goodwin explains one of the cartel’s abduction tactics: “If you see a bunch of shiny SUVs pull up to the plaza, you alert each other and immediately leave, get across the border.” Goodwin speaks from experience; she has been working with asylum seekers in Mexico for over two decades.

Everyone is a target there. The children are in acute danger of kidnapping (and of contracting life-ruining illnesses). The women live in perpetual fear of sexual assault and, I was told, some carry condoms to—perhaps, maybe—engineer self-care while being brutally raped, a scenario that is baffling to fathom. Many of the men carry around an invisible bulk of their broken lives—which is true for the women and children, too.

Most everyone living in this camp had at one prior point made it into the United States and had made their case for asylum. Some had to swim across the Rio Grande, which is approximately 100 yards away from the tents, but they still had to pay the cartels to allow them to do so. And because there is no running water (or any services to speak of), they often pay the cartels so they can wash clothes or bathe in the river too.

Months before, Salvadoran migrant Oscar Alberto Martínez Ramírez and his nearly 2-year-old daughter, Valeria, had drowned on this very stretch of river trying to reach Brownsville, Texas. The viral photo of their bodies floating face-down near the riverbank depicts the desperation for a better life that more and more migrants are forced to endure.

It is because of Trump’s “Return to Mexico” policy that most asylum seekers are back in Matamoros, where they are stuck in horrific limbo, waiting for their day in U.S. immigration court. The backlog, however, is depressing. According to a New York Times article on the pending immigration cases in the court system, ”the average case now takes 578 days to complete.”

To read article after article about the disastrous U.S. immigration policy—or to simply listen to pundits or politicians argue about asylum seekers as if it’s an exercise in high school debate—can make the very real plight of thousands of people seem like an abstraction. But to see it, to bear witness to this suffering is a way of humanizing, a way of showing others that these are people who could be your sister, your brother, your mother, your father, your friend.

PHOTO ESSAY | 25 photosScenes From Matamoros (Photo Essay)

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Johnson to Suspend U.K. Parliament After 3 Defeats on Brexit

LONDON—The simmering showdown between Prime Minister Boris Johnson and Britain’s Parliament over Brexit came to a head as lawmakers delivered three defeats to the government’s plans for leaving the European Union, before being sent home early Tuesday for a contentious five-week suspension of the legislature.

In a session that ran past midnight, Parliament enacted a law to block a no-deal Brexit next month, ordered the government to release private communications about its Brexit plans and rejected Johnson’s call for a snap election to break the political deadlock.

Parliament was then set to be suspended at the government’s request until Oct. 14, a drastic move that gives Johnson a respite from rebellious lawmakers as he plots his next move.

Johnson said he would cut short the parliamentary term so he can outline his domestic agenda at a new session of Parliament in October. But opponents called the move anti-democratic and illegal.

“It is blindingly obvious why we are being shut down — to prevent scrutiny,” Labour Party Brexit spokesman Keir Starmer said.

In the first of the day’s blows to Johnson, an opposition-backed measure designed to stop Britain from crashing out of the EU on Oct. 31 without a divorce deal became law after receiving the formal assent of Queen Elizabeth II. The law compels the government to ask the EU for a three-month delay if no deal has been agreed by Oct. 19.

Legislators also demanded the government release, by Wednesday, emails and text messages among aides and officials relating to suspending Parliament and planning for Brexit amid allegations that the suspension is being used to circumvent democracy.

Under parliamentary rules, the government is obliged to release the documents.

In a statement, the government said it would “consider the implications of this vote and respond in due course.”

Britain is due to leave the EU on Oct. 31, and Johnson says the country’s delayed exit must happen then, with or without a divorce agreement to smooth the way. But many lawmakers fear a no-deal Brexit would be economically devastating, and are determined to stop him.

“I will not ask for another delay,” Johnson said. But he has few easy ways out of it. His options — all of them extreme — include disobeying the law, which could land him in court or even prison, and resigning so that someone else would have to ask for a delay.

The prime minister has had a turbulent week since Parliament returned from its summer break on Sept. 3. He kicked 21 lawmakers out of the Conservative group in Parliament after they sided with the opposition, and saw two ministers quit his government — one of them his own brother.

Early Tuesday, lawmakers rebuffed, for a second time, Johnson’s request for an early election, which he said was “the only way to break the deadlock in the House.”

Opposition parties voted against the measure or abstained, denying Johnson the two-thirds majority he needed. They want to make sure a no-deal departure is blocked before agreeing to an election.

“We’re eager for an election, but as keen as we are we, we are not prepared to inflict the disaster of a no deal on our communities, our jobs, our services, or indeed our rights,” Labour Party leader Jeremy Corbyn said.

Johnson acknowledged Monday that a no-deal Brexit “would be a failure of statecraft” for which he would be partially to blame.

On a visit to Dublin, Johnson said he would “overwhelmingly prefer to find an agreement” and believed a deal could be struck by Oct. 18, when leaders of all 28 EU countries hold a summit in Brussels.

The comments marked a change of tone, if not substance, for Johnson, who is accused by opponents of driving Britain at full-tilt toward a cliff-edge Brexit.

Irish Prime Minister Leo Varadkar warned Johnson that “there’s no such thing as a clean break,” and if Britain crashed out, it would “cause severe disruption for British and Irish people alike.”

Johnson and Varadkar said they had “a positive and constructive meeting,” but there was no breakthrough on the issue of the Irish border, the main stumbling block to a Brexit deal.

The EU says Britain has not produced any concrete proposals for replacing the contentious “backstop,” a provision in the withdrawal agreement reached by Johnson’s predecessor Theresa May that is designed to ensure an open border between EU member Ireland and the U.K.’s Northern Ireland.

An open border is crucial to the regional economy and underpins the peace process that ended decades of sectarian violence in Northern Ireland.

Opposition to the backstop was a key reason Britain’s Parliament rejected May’s Brexit deal with the EU three times earlier this year. British Brexit supporters oppose the backstop because it locks Britain into EU trade rules to avoid customs checks, something they say will stop the U.K. from striking new trade deals with countries such as the United States.

Varadkar said he was open to any alternatives that were “legally workable,” but none had been received so far.

“In the absence of agreed alternative arrangements, no backstop is no deal for us,” he said.

Meanwhile, Speaker John Bercow, whose control of business in Britain’s House of Commons has made him a central player in the Brexit drama, announced he would step down after a decade in the job.

The colorful speaker, famous for his loud ties and even louder cries of “Order!” during raucous debates, told lawmakers he will quit the same day Britain is due to leave the EU, Oct. 31.

Throughout the three years since Britain voted to leave the EU, Bercow has angered the Conservative government by repeatedly allowing lawmakers to seize control of Parliament’s agenda to steer the course of Brexit.

He said he was simply fulfilling his role of being the “backbenchers’ backstop” and letting Parliament have its say.

“Throughout my time as speaker, I have sought to increase the relative authority of this legislature, for which I will make absolutely no apology,” he said.

___

Gregory Katz contributed to this story.

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North Korea Fires Projectiles Hours After Offering Talks With U.S.

SEOUL, South Korea—North Korea launched two unidentified projectiles into the sea on Tuesday, South Korea’s military said, hours after the North offered to resume nuclear diplomacy with the United States in late September.

South Korea’s Joint Chiefs of Staff said in a statement that the North Korean projectiles fired from its South Phyongan province, which surrounds its capital city of Pyongyang, flew across the country before landing in the waters off its east coast.

It said South Korea will monitor possible additional launches by North Korea. But the statement gave no further details like exactly what projectile North Korea fired.

On Monday night, the North’s first vice foreign minister, Choe Son Hui, said North Korea is willing to resume nuclear diplomacy with the United States in late September but that Washington must come to the negotiating table with acceptable new proposals. She said if the proposals don’t satisfy North Korea, dealings between the two countries may come to an end.

Choe’s statement and the following projectile launches were apparently aimed at pressuring the United States to make concessions when the North Korea-U.S. talks restart. North Korea is widely believed to want the United States to provide it with security guarantees and extensive relief from U.S.-led sanctions in return for limited denuclearization steps.

U.S. President Donald Trump called North Korea’s announcement “interesting.”

“We’ll see what happens,” Trump said. “In the meantime, we have our hostages back, we’re getting the remains of our great heroes back and we’ve had no nuclear testing for a long time.”

There was no immediate comment from the White House following reports of the launches.

In the late-night statement carried by state media, Choe said North Korea is willing to sit down with the United States “for comprehensive discussions in late September of the issues we have so far taken up, at a time and place to be agreed.”

Choe said she hopes the United States will bring “a proposal geared to the interests of the DPRK and the U.S. and based on decision methods acceptable to us.” DPRK stands for the Democratic People’s Republic of Korea, the North’s official name.

She warned that “if the U.S. side fingers again the worn-out scenario which has nothing to do with new decision methods at the DPRK-U.S. working negotiation to be held with so much effort, the DPRK-U.S. dealings may come to an end.”

Talks on North Korea’s nuclear disarmament fell apart in February when Trump rejected North Korean leader Kim Jong Un’s demand for sweeping sanctions relief in return for partial disarmament at their second summit in Vietnam.

It was a huge embarrassment for the young North Korean leader, who made a dayslong train trip to the Vietnamese capital to obtain the sanctions relief he needs to revitalize his country’s troubled economy.

In April, Kim said he was open to another summit with Trump but set the end of the year as a deadline for the U.S. to offer improved terms for an agreement to revive the nuclear diplomacy.

Kim and Trump met again at the Korean border in late June and agreed to restart diplomacy, but there have no public meetings between the sides since then.

In recent months, North Korea has carried out a slew of missile and rocket tests to protest joint military drills between the U.S. and South Korea that North Korea views as an invasion rehearsal. Some experts said the North Korean weapons tests were also a demonstration of its expanding weapons arsenal aimed at boosting its leverage ahead of new talks with the United States.

Most of the North Korean weapons tested in July and August have been short range. This suggests that North Korea hasn’t wanted to lift its self-imposed moratorium on nuclear and long-range missile tests, which would certainly derail negotiations with Washington.

Trump has downplayed the latest North Korean weapons tests, saying the U.S. never restricted short-range tests.

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The Secret to Living Longer Is Being Rich, Study Reveals

The top 400 richest Americans have more wealth than the 150 million Americans in the bottom 60% of the country’s wealth distribution, according to a January working paper from University of California at Berkeley economist Gabriel Zucman.

America’s rich frequently pay lower taxes, use their money to influence public policy and do not have to choose between paying medical bills and paying their rent. They also don’t suffer the indignity of having strangers comment on the groceries they purchase with SNAP benefits, as Stephanie Land describes in her memoir, “Maid.” Add to all this another benefit of wealth, according to a new study from the Government Accountability Office: a longer lifespan.

Even as life expectancy in general is on the rise, it “has not increased uniformly across all income groups, and people who have lower incomes tend to have shorter lives than those with higher incomes,” the report reveals.

Both poor and middle-class Americans are less likely than the wealthy to live into their 70s and 80s, the GAO found. More than 75% of the wealthiest Americans who were in their 50s in 1991 were still alive in their 70s in 2014. By contrast, less than half of the poorest 20% of 50-somethings surveyed were alive by the same year.

The GAO report attributes this discrepancy to multiple factors, including a large gap in retirement savings and a lack of assets like homes to draw on to help offset unexpected costs for lower-income Americans. This causes a dependence on Social Security benefits to pay bills of all kinds, including medical bills.

The GAO report’s results echo previous studies on the relationship between wealth and lifespan in America. A 2016 study by economists from Stanford, Harvard and McKinsey and Co, among others, found that “In the United States between 2001 and 2014, higher income was associated with greater longevity, and differences in life expectancy across income groups increased over time.” Low-income residents in wealthier areas, however, tended to live longer than residents of uniformly poor communities, with a difference of up to 15 years for men, and up to ten for women.

A University of Washington study from 2017 found the gap could vary by up to 20 years depending on the region of the United States.

“Over time, the top fifth of the income distribution is really becoming a lot wealthier — and so much of the health and wealth gains in America are going toward the top,” Harold Pollack, a health care expert at the University of Chicago who is not affiliated with the report told the Post. He called those disparities “a failure of social policy.”

Senator and presidential candidate Bernie Sanders, I-Vt., commissioned the GAO report in 2016, The Washington Post explains, after meeting with residents of MacDowell County, W.Va., where, Sanders aides tell the Post, the average life expectancy is 64 years old.

“We are in a crisis never before seen in a rich, industrialized democracy,” Sanders said in a statement. “For three straight years, overall life expectancy in the wealthiest nation in the history of the world has been in decline.” He adds, “If we do not urgently act to solve the economic distress of millions of Americans, a whole generation will be condemned to early death.”

Read the entire GAO report here.

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Judge Reinstates Nationwide Halt on Trump Asylum Policy Plan

OAKLAND, Calif. — A U.S. judge in California on Monday reinstated a nationwide halt on the Trump administration’s plan to prevent most migrants from seeking asylum at the U.S.-Mexico border.

U.S. District Judge Jon Tigar ruled in Oakland that an injunction blocking the administration’s policy from taking effect should apply nationwide.

Tigar blocked the policy in July after a lawsuit by groups that help asylum seekers. But the 9th U.S. Circuit Court of Appeals limited the impact of Tigar’s injunction to states within the area overseen by the appeals court.

That meant the policy was blocked in the border states of California and Arizona but not in New Mexico and Texas.

In his ruling, Tigar stressed a “need to maintain uniform immigration policy” and found that nonprofit organizations such as Al Otro Lado don’t know where asylum seekers who enter the U.S. will end up living and making their case to remain in the country.

“The court recognized there is grave danger facing asylum-seekers along the entire stretch of the southern border,” Lee Gelernt, an attorney for the American Civil Liberties Union, said in a statement.

Mark Morgan, acting commissioner of Customs and Border Protection, criticized the ruling at a White House briefing.

“I’m frustrated at the unprecedented judicial activism that we have experienced every single time that this administration comes up with what we believe is a legal rule or policy that we really believe that will address this crisis, we end up getting enjoined,” he said. “It’s very, very frustrating.”

The courts have halted some of Trump’s key policy shifts on immigration, including an earlier version of an asylum ban. The president has prevailed on several fronts after initial legal setbacks, for example, when the Supreme Court recently lifted a freeze on using Pentagon money to build border walls.

The rules issued by the Trump administration in July apply to most migrants who pass through another country before reaching the United States. They target tens of thousands of Central Americans fleeing violence and poverty who cross Mexico each month to seek asylum and would affect asylum seekers from Africa, Asia and South America who arrive regularly at the southern border.

The shift reversed decades of U.S. policy in what Trump administration officials said was an attempt to close the gap between an initial asylum screening that most people pass and a final decision on asylum that most people do not win.

U.S. law allows refugees to request asylum when they get to the U.S. regardless of how they arrive or cross. The crucial exception is for those who have come through a country considered to be “safe,” but the law is vague on how a country is determined to be safe. It says pursuant to a bilateral or multilateral agreement.

People are generally eligible for asylum in the U.S. if they fear returning to their home country because they would be persecuted based on race, religion, nationality or membership in a particular social group.

The Border Patrol apprehended about 50,000 people at the southern border in August, a 30 percent drop in arrests from July amid summer heat and an aggressive crackdown on both sides of the border to deter migrants.

___

Associated Press writers Elliot Spagat in San Diego contributed to this report.

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House Panel to Escalate Trump Impeachment Inquiry

WASHINGTON—The House Judiciary Committee will vote Thursday to establish rules for hearings on impeachment, escalating the panel’s investigations of President Donald Trump even as many Democrats remain wary of the effort.

The resolution is a technical step, and the panel would still have to introduce impeachment articles against Trump and win approval from the House to bring charges against Trump. It’s unclear if that will ever happen, as House Speaker Nancy Pelosi has urged caution on the issue, saying the public still isn’t yet supportive of taking those steps.

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Even if the House did recommend impeachment charges against the president, the Republican-led Senate is unlikely to convict him and remove him from office.

Still, House Judiciary Committee Chairman Jerrold Nadler has said that the committee will move forward with impeachment hearings this fall, bolstered by lawmakers on the panel who roundly support moving forward. The vote on Thursday will set rules for those hearings, empowering staff to question witnesses, allowing some evidence to remain private and permitting the president’s counsel to respond to testimony.

The committee says that the resolution is similar to procedural votes taken at the beginning of the impeachment investigations into Presidents Richard Nixon and Bill Clinton.

“The adoption of these additional procedures is the next step in that process and will help ensure our impeachment hearings are informative to Congress and the public, while providing the president with the ability to respond to evidence presented against him,” Nadler said in a statement. “We will not allow Trump’s continued obstruction to stop us from delivering the truth to the American people.”

The committee has also filed two lawsuits against the administration after the White House repeatedly blocked the panel from obtaining documents and testimony. Pelosi has said she wants to see what happens in court before making any decisions on impeachment.

The first hearing under the new impeachment rules would be with Corey Lewandowski on Sept. 17, the panel also announced Monday. Lewandowski was frequently mentioned in former special counsel Robert Mueller’s report, which the committee has been investigating. According to Mueller’s report, Trump asked Lewandowski to deliver a message to then-Attorney General Jeff Sessions asking him to limit Mueller’s probe.

The committee has also invited two other witnesses mentioned in the report, former White House aides Rick Dearborn and Rob Porter. The White House has previously blocked former employees from testifying, but Lewandowski never officially worked for the White House.

The resolution that the committee will consider Thursday would set parameters for the panel’s impeachment hearings in an attempt to give lawmakers more powers to investigate the president. It would allow committee lawyers to question witnesses for an additional hour — 30 minutes for each side — beyond the five minutes allowed for committee lawmakers. Evidence would be allowed in private session to protect the confidentiality of sensitive materials, and any full committee or subcommittee hearing could be designated by Nadler as part of the committee’s probe into whether to recommend articles of impeachment.

The procedural vote comes as the panel broadens its impeachment probe beyond Mueller’s report, which has consumed most of the committee’s energy since it was released in April. The Judiciary panel, along with the House Oversight and Government Reform Committee, announced Friday that they are demanding information about the spending of taxpayer money at the president’s hotels and properties, partly to inform the impeachment investigation.

The committees said there have been “multiple efforts” by Trump and administration officials to spend federal money at his properties, including Vice President Mike Pence’s stay last week at a Trump resort in Doonbeg, Ireland .

Aside from reviewing his use of Trump’s properties, the Judiciary panel is also expected to investigate hush money payments Trump made to kill potentially embarrassing stories, and has subpoenaed the Department of Homeland Security to explore whether the president offered pre-emptive pardons for lawbreaking. More subpoenas are likely.

Meanwhile, several other committees are also investigating the president — though not under the auspices of impeachment, which is the jurisdiction of the Judiciary panel.

In one of those probes, House Intelligence Committee Chairman Adam Schiff wrote former National Security Adviser Michael Flynn and demanded that he appear for testimony on Sept. 25. In the letter, dated Friday, Schiff said that Flynn had failed to comply with the panel’s June subpoena or “cooperate with the committee’s efforts to secure your compliance.”

Flynn admitted lying to the FBI about his conversations with the Russian ambassador to the United States and awaits sentencing.

The intelligence panel said also Monday that it will investigate possible efforts by Trump and his personal lawyer, former New York City Mayor Rudy Giuliani, to pressure the government of Ukraine to assist Trump’s 2020 presidential campaign.

The intelligence panel, along with the House Foreign Relations Committee and the Oversight committee, are demanding records related to those efforts. The committees said in a joint release that the record request is a “first step in a broad investigation into this matter.”

Giuliani said earlier this year that he would travel to Kiev to urge the government to investigate the origins of Mueller’s probe and the involvement of former Vice President Joe Biden’s son in a gas company owned by a Ukrainian oligarch. Giuliani later scrapped that trip.

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Climate Change Is Already Hitting Europe Harder Than Anyone Expected

Europe’s rapid warming means the world’s hottest property could now be on the continent. It has seen the strongest intensification of heat waves anywhere in the world in the last 70 years. The hottest of hot summers are now 2.3°C hotter than they used to be.

And winter extremes of cold are dwindling. The number of extremely cold days has fallen twofold or even threefold, and the coldest days are now 3°C milder than they used to be, according to readings from 94% of the continent’s weather stations.

This, say Swiss scientists, adds up to “a climate change signal that cannot be explained by internal variability.”

That is, thanks to a steady increase in atmospheric greenhouse gases driven by ever-increasing use of fossil fuels, Europe is warming even faster than global climate models predict.

“In at least one region of the globe, global heating is already happening, and at a rate faster than predicted”

“Even at this regional scale over Europe we can see that these trends are much larger than what we would expect from natural variability,” said Ruth Lorenz, a researcher from the Swiss Federal Institute of Technology, also known as ETH Zurich. “That’s really a signal from climate change.”

She and colleagues report in the journal Geophysical Research Letters that they looked at observations and measurements from around 1,000 weather stations between 1950 and 2018 and then analysed the top 1% of the highest extremes of heat and humidity, and the top 1% of coldest days during the same timespan.

Since 1950, the number of days of extreme heat in Europe has tripled. The number of extreme cold days has been reduced, twofold in some places, and by a factor of three in others.

Accelerating change

For years, researchers have been predicting ever-greater extremes for Europe. They have warned that rising temperatures will hit the continent both economically and in health terms, and that as the thermometer rises so will the hazards of fire and drought.

Researchers have even checked the changes in land use in the last three decades to find that political changes – the collapse of the Soviet Union and the formation of the 28-state European Union – helped damp down what still proved one of the worst heat waves ever recorded, in 2003.

But research has largely focused on what could happen if global heating continues, and fossil fuel use continues to grow. What the latest study demonstrates is that in at least one region of the globe, global heating is already happening, and at a rate faster than predicted.

And the rate of change is accelerating. The number of extreme hot days overall has trebled since 1950, but the frequency of these has doubled just between 1996 and 2018.

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Afghanistan Is Both Stalemate and Quagmire

This piece originally appeared on antiwar.com.

When they saw Afghanistan, all they could think of was Iraq. Indeed, most military thinkers are perennially driven by the tunnel-vision of personal experience; rarely a good thing. Indeed, the generals and colonels managing the foolish, politically driven 2009-12 Obama “surge” into Afghanistan – what he’d absurdly labeled the “good war” – had few fresh ideas. Convinced, and feeling vindicated, by the myth that Baby Bush’s 2007-09 Iraq surge had “worked,” most commanders knew just what to do and sought to replicate these tactics in the utterly dissimilar war in Afghanistan. That meant the temporary infusion of some 30,000 extra troops, walling off warring neighborhoods, and plopping small American units among the populace.

Some of us, mostly captains who’d cut our teeth in the worst days of the Iraq maelstrom, were skeptical from the start. I, for one, had long sensed that the “gains” of that surge were highly temporary, that the U.S. military had simply bought the fleeting loyalty of Sunni insurgents, and that the whole point of the surge – to allow a political settlement between warring sects and ethnicities – had never occurred. The later rise of ISIS, breakdown of centralized governance, and rout of the U.S.-trained Iraqi Army in 2013-14 would prove my point. But that was in the future. From my viewpoint, the legacy of surge 1.0 had really only been another 1,000 or so American troop deaths – including three of my own men – and who knows how many Iraqi casualties.

Then again, no one cared what one lowly, if dreamy yet cynical, officer thought anyway. I was a tool, a pawn, a middle-managing “company man” expected to carry out surge 2.0 with discipline and enthusiasm. And so I tried. My team of cavalry scouts raised a dubiously loyal local militia, partnered with the often drug-addicted, criminal Afghan Army and police, and parsed out my squads to live within the local villages semi-permanently. That’s when things got weird.

Impressed by the minor, momentary drop in violence – such deceptive stats were a way of life in the US Army – these early measures had allegedly produced, both my squadron commander, and his boss, the brigade commander, suddenly took interest in my troop. Now they wanted to expand on what we were doing and toss in their own misguided two cents. What was needed, my colonel informed me, was to wall off the nearest contested village – Charcusa – with tall concrete “T-walls.” That way, so his twisted logic went, the Taliban couldn’t get in. See, for him, a complex war was that simple. In an oddly prescient foreshadowing of his future commander-in-chief, Donald Trump’s, border tactics, my squadron commander never saw a problem a section of wall couldn’t solve.

Now, once again, it was my turn to attempt to pour a dose of reason all over his best laid plans. This rarely ended well. Thus, I explained that surrounding the small agricultural village with concrete barriers would separate farmers from their fields, and thus their livelihood. Besides, even if we created a few guarded exits to the fields, the T-walls would seal off the many canals the villagers used for drinking and irrigation, essentially drying out the whole joint. Oh, and the Taliban could climb, I reminded him. The Taliban were probably already in the village, related to the villagers, and didn’t wear uniforms or big Ts on their foreheads. The aesthetic nightmare of walling off a village would alienate the people and cause psychologically deep reactions of insecurity combined with resentment of us Americans. I tried, well, every single argument I could muster.

Mister “lower-caters-to-higher” was far from pleased. See, the real brainchild of the Charcusa concrete bonanza was actually the brigade commander, and my lowly unit certainly couldn’t defy his wishes. Heck, my squadron commander’s own evaluation and career progression might be on the line. Weighed against that, what did tactical commonsense or the livelihood of meaningless Afghans matter? The brigade commander had himself been a battalion commander in Western Baghdad during surge 1.0, where he and others, gleefully walled off the area neighborhoods and divided conflicting Muslim sects. It “worked” in urban Baghdad, so why not rural, no electrical grid, religiously homogenous, Southern Afghanistan? There it was again: a colonel who saw an Afghan problem and reflexively sought to apply an uncreative Iraqi solution.

Well, after weeks of wrangling, and certainly another blight on my leadership reputation with the squadron commander, my irrigation ditch argument won out with the more practical elements on the brigade staff…sort of. There’d be no concrete barriers, the commander reluctantly conceded, but we just had to “throw a bone” to the brigade commander’s Baghdad-based vision. The solution: I was ordered to surround the village after all, only with thousands of strands of menacing, ugly, triple strand concertina (barbed) wire. I wasn’t going to stop this one, and hardly bothered.

For days on end my weary troopers turned the village of Charcusa into what discomfiting resembled a concentration camp. Not that it worked, or mattered. The results produced amounted to little more than the few hundred cuts on my soldiers’ hands. Within a couple years my unit was gone, and so were our successors. Today, most of Kandahar is again contested by the Taliban, the rusting barbed wire naught but a monument to American obtusity. Still, it pleased both of my bosses, one off which told me I’d done a “great” job with the concertina wire mission, a macabre gold star of sorts for my own impending evaluation.

So today, on that wars rolls in an ongoing combination of stalemate and quagmire. Just this week, another American soldier was killed by a suicide car bomb. His death, ultimately, changes nothing as the Afghan War now has a preposterous inertia all its own. As for my colonel, he got the next promotion and his own brigade. His boss, the king of concrete himself, well he’s a rising star and a prominent general officer today. Now that President Trump has foolishly called off seemingly promising peace talks with the Taliban, maybe my old brigade commander will lead the next phase of an Afghan War with no end in sight. If he does, expect more of the same. He’ll have his troops and their Afghan mentees needlessly walling off more tiny villages in no time…

Series note: It has taken me years to tell these stories. The emotional and moral wounds of the Afghan War have just felt too recent, too raw. After all, I could hardly write a thing down about my Iraq War experience for nearly ten years, when, by accident, I churned out a book on the subject. Now, as the American war in Afghanistan – hopefully – winds to something approaching a close, it’s finally time to impart some tales of the madness. In this new, recurring, semi-regular series, the reader won’t find many worn out sagas of heroism, brotherhood, and love of country. Not that this author doesn’t have such stories, of course. But one can find those sorts of tales in countless books and numerous trite, platitudinal Hollywood yarns.

With that in mind, I propose to tell a number of very different sorts of stories – profiles, so to speak, in absurdity. That’s what war is, at root, an exercise in absurdity, and America’s hopeless post-9/11 wars are stranger than most. My own 18-year long quest to find some meaning in all the combat, to protect my troops from danger, push back against the madness, and dissent from within the army proved Kafkaesque in the extreme. Consider what follows just a survey of that hopeless journey…

Danny Sjursen is a retired US Army officer and regular contributor to Antiwar.com. His work has appeared in the LA Times, The Nation, Huff Post, The Hill, Salon, Truthdig, Tom Dispatch, among other publications. He served combat tours with reconnaissance units in Iraq and Afghanistan and later taught history at his alma mater, West Point. He is the author of a memoir and critical analysis of the Iraq War, Ghostriders of Baghdad: Soldiers, Civilians, and the Myth of the Surge. Follow him on Twitter at @SkepticalVet.

Copyright 2019 Danny Sjursen

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Joe Biden Must Be Stopped

The man quickly identified himself as a vice chair of the Democratic National Committee. He didn’t need to tell me that he was hopping mad.

Ken Martin was angry that my colleagues and I were handing out a flier—providing some inconvenient facts about Joe Biden—to delegates and activists as they entered the New Hampshire Democratic Party convention on Saturday. The headline, next to Biden’s picture, quoted a statement he made last year: “I don’t think 500 billionaires are the reason why we’re in trouble.”

While not flattering to the current frontrunner for the Democratic presidential nomination, the carefully documented RootsAction flier offered information that news coverage has rarely mentioned—and that party activists as well as voters overall should know.

But Martin had a very different perspective. He heatedly told me that distributing such a flier was divisive and would harm the cause of defeating Donald Trump.

I’m as eager to defeat Trump as anyone. At the same time, we need primaries for good reasons—including fact-based scrutiny of candidates’ records before they’re nominated. I tried to assure Martin that I’m as eager to defeat Trump as anyone. At the same time, we need primaries for good reasons—including fact-based scrutiny of candidates’ records before they’re nominated. However, I found it difficult to get words in edgewise, as Martin continued to denounce the leafleting.

After a few minutes, I asked: “Do you want to have a conversation, or do you want to lecture me?” Martin’s reply came in a split-second: “I want to lecture you.” Give him credit for honesty.

A few hours later, Martin addressed thousands from the convention podium and—in more restrained tones—focused on blaming nonresponsive voters for the failures of Democratic candidates to inspire them. “In 2016 we had 10 percent of Democrats who voted for Donald Trump,” he said. “We had 53 percent of white women who voted for Donald Trump. We had a tripling of the third-party vote throughout our country. And probably most discouraging to me: as consistent Democratic base voters, people who always show up in elections, many of them didn’t show up to vote at all.”

A logical question would be: Why did many of them not show up to vote at all? But Martin wasn’t going there. Instead, he went on: “You see, Democrats, we’ve got great candidates on full display today and I can guarantee you one of them is going to be the next president of the United States. But we have to come together, we have to come together. Let’s not confuse unanimity with unity, we’re Democrats, we don’t agree on everything. But I will tell you, if we’re not unified we will not win this election. We have to come out and support whoever the Democratic candidate is.”

Martin is in major positions of power within the Democratic Party, not only at the DNC but also as chair of the party in Minnesota (the Democratic-Farmer-Labor Party) and as president of the Association of State Democratic Committees. For the bulk of the party leadership, in sync with frontrunner Biden, self-critical assessments are essentially off-limits. The boilerplate calls for “unity” serve to distract from tough-minded examination of the reasons for widespread distrust and low vote rates.

Refusals to examine the patterns of the past render many party leaders unable to recognize or acknowledge what a disaster a Biden campaign against Trump would so likely be. It’s of little use to plead for strong turnout from “Democratic base voters” after nominating a weak and uninspiring candidate.

“A core challenge for the Democratic Party will be to raise the voter participation rate while drawing presently apathetic and uninvolved nonvoters and occasional voters into the process — largely younger people and African Americans,” the report “Autopsy: The Democratic Party in Crisis” said two years ago. The report (which I co-authored as part of a task force) pointed out that “a party doesn’t grow by simply tallying up members and scolding them into showing up.”

The specter of Joe Biden as the party’s nominee runs directly counter to what the Autopsy called for: “To flourish, the Democratic Party needs an emphatic mission and a clear moral message that excites and provides a purpose that is distinct from the otherwise cynical spectacle of politics. Inspiring programs for truly universal health care, racial justice, free public college tuition, economic security, new infrastructure, green jobs and tackling the climate crisis can do this. This is about more than just increasing voter turnout. It is about energizing as well as expanding the base of the party.”

As presidential candidates crisscross the country, only two are showing how to energize activism on a large scale while inspiring voters. That was apparent again inside the arena in New Hampshire, where Bernie Sanders (who I continue to actively support) and Elizabeth Warren delivered high-voltage progressive speeches that left others in the dust.

Biden’s mediocre speech at the New Hampshire convention on September 7 is already a historic record of a dismal candidate for president whose nomination promises to be a disaster. To pretend otherwise is hardly a service to the crucial task of defeating Donald Trump.

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The Carnage of War Is Tearing Humanity Apart

Do you remember July 8, 2011? Where you were? What you did? Whom you talked to? Anything at all?

I couldn’t pin down one single thing for that day. I couldn’t even locate an email I had sent or a photo I might have taken. It’s all evidently lost in the ether, known only to tech and telecom firms. But maybe, unlike me, you have a diary or save your calendars or just happen to have fantastic recall. Maybe you remember it because it was the day NASA launched the Space Shuttle on its 135th and final mission.

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Unlike me, Abdul Hamid Frefer recalls every detail of that eighth of July. It was a Friday and he remembers exactly where he was, who he was with, what he saw, what he heard, even what he said. It’s tattooed on his brain, but more than that, it’s written on his body — only not in a conventional sense. Writing isn’t just words. IfItWereJustWordsThisWouldBeEasyToRead. Writing doesn’t exist without the blank spaces between the words. It’s these blank spaces that are especially integral to Frefer’s story because his is a tale of absence, one that’s been retold — and that he’s been reminded of — every day since.

For Frefer, there was life before July 8, 2011, and life after; life, that is, before the moment his world changed forever and then what followed. The last thing he heard before that unforgettable moment was “Run!”

“But there was nowhere to run,” he told me.

After all, no man can outrun a rocket.

When that rocket hit, the shockwave burst his eardrums and he was knocked to the ground. White noise dissolved into unbearable pain. When he tried to lift his left leg, he watched his shoe fall off — with his foot still in it. Only skin held his right leg below the knee to the top of that limb.

“Go!” he remembers screaming at his friends. “I’m dead anyway! Save yourself!” They did go. They saved themselves. But not before saving him. They wrapped Frefer in a blanket, hoisted him up and took off running.

Revolutionary Road

I met Abdul Hamid Frefer in the coastal city of Misrata earlier this year while on assignment in Libya. Bald with lively brown eyes and a bristly, close-cropped white beard, he was dressed in a loose-fitting, baby-blue ensemble that resembled silk pajamas. I noticed his black metal crutches immediately, but didn’t initially grasp that he was missing his left foot and his right leg below the knee.

Eight years before, at age 39, Frefer’s heart had been touched by fire. To be exact, the self-immolation of Mohamed Bouazizi, a Tunisian vegetable seller pushed past the brink by corruption and police brutality. On December 17, 2010, a policewoman confiscated his cart and wares, slapped him, and spit in his face. Humiliated, stripped of his livelihood, and deeply in debt, he went to the governor’s office. “If you don’t see me, I’ll burn myself,” he reportedly said. The governor refused to meet him and Bouazizi was true to his word.

When he lit that match, the blaze that erupted would become known as the Arab Spring. When it set Libya alight in February 2011, dictator Muammar Gaddafi’s draconian response to the demonstrations touched off an uprising that soon became a revolution, transforming ordinary Libyan civilians into soldiers overnight.

“In 2011, we fought a war to dispatch a dictator” was how Frefer put it. “We struggled to build a free country. A democratic country with basic rights and free speech.”

On the morning of July 8, 2011, he was sitting in an abandoned home in Dafnia, a town about 40 miles from Misrata on the road to the country’s capital, Tripoli. The battlefront was fast becoming a charnel house for the under-armed citizen-soldiers of the revolution, as Gaddafi’s forces pressed closer to the rebel stronghold.

After cleaning and loading their rifles, Frefer and his comrades stacked the remaining ammunition in pickup trucks, 20 of which began rolling toward Gaddafi’s forces, while about 25 infantrymen, including him, followed. The previous night, however, Gaddafi’s forces had evidently advanced further than Frefer and his compatriots realized. “They must have watched us with binoculars. They saw us, but we didn’t see them,” he told me. Soon, a barrage of rockets was screaming toward them.

“Run!” someone yelled, but there was nowhere to run. His friend Mustafa and a neighbor from Misrata were both killed by the strike. For a while, they believed that a third man, also from the neighborhood, had bolted and never stopped running. Later, his comrades determined that he had, in fact, been nearly obliterated by a rocket. In all, Frefer told me, 36 revolutionaries died at Dafnia that day.

With the trucks involved in the battle and no way for a car to come forward, Frefer’s comrades began carrying — and soon dragging — him for the better part of half an hour before they could stop and tie tourniquets on both legs. Then they set off for a field hospital.

It’s common to lose consciousness from the physiological shock of traumatic injuries, or from blood loss, or both. But for that first mile, as his friends pulled him along the hard ground, Abdul Hamid Frefer remained fully conscious — and in burning agony. It was the same for the second mile. And the third. “I was conscious the whole time,” he told me. “And when I finally got to the hospital and they put me on an IV with a painkiller, the anesthesia didn’t work.”

It took him three years to recover. After one, he was using a wheelchair. After two more, he could finally move about with prostheses and crutches.

Men Without Legs and One-Eyed Women

In my line of work, I meet more amputees, war victims who are missing body parts, and terribly scarred individuals than the average American. There was the woman with bright white hair who survived a massacre by South Korean troops. Her left foot was nothing but a stump. No toes. Hardly a sole. Mostly just a heel. Her right foot was missing entirely. In its place, she had the functional equivalent of a tin can with a rubber disk at the bottom.

Then there was the six-year-old Congolese girl whose arm had been hacked off by a machete-wielding militiaman. And her aunt who lost both hands to the same attackers. And her great-aunt who lost several fingers.

In the same part of Congo, I met toddlers whose faces had been split by machetes. I met an elderly woman with a shattered arm who had been shot in the face with an arrow. And there was that man missing a chunk of his calf, which, he said, enraged militiamen had tried to force him to eat.

There was the South Sudanese man who had lost a leg after being shot by soldiers. And another who had lost an eye.

All of these people were civilians in the wrong place — home — at the wrong time. Abdul Hamid Frefer was not. At least, not entirely. A civilian at the dawn of 2011, by July he was a soldier of the revolution. Given the tremendous price paid by Libya’s rebels, he’s lucky to be alive.

Today, Libya is again — or rather, still — a country at war. For months now, Tripoli has been menaced by the self-styled Libyan National Army of warlord General Khalifa Haftar, a U.S. citizen, former CIA asset, and longtime resident of Virginia (who was lauded by President Donald Trump in an April phone call). Just as in Frefer’s war, the city of Misrata is still hemorrhaging young men. Its militias make up the bulk of the armed forces protecting the capital and the Government of National Accord, the U.N.-backed, internationally recognized government of Libyan Prime Minister Fayez al-Serraj. (Two years ago, Mistrata’s militiamen also engaged in house-to-house fighting with Islamic State militants in the city of Sirte, as American drones and manned aircraft hunted those ISIS fighters from the skies.)

Frefer and I first ran into each other at his place of business, Misrata’s municipal offices. A member of the city council, he’s very much a man of his town. And both he and it bear the grim scars of that revolution. While the city itself hasn’t seen war since 2011, so much of it still bears battle scars. High-rise apartments pockmarked by thousands of machine-gun bullets sit empty. Other buildings still bear gaping holes from mortars and rockets. A warehouse remains largely roofless thanks to a NATO airstrike, in support of the revolutionaries, on a Gaddafi regime tank that had been parked inside. Almost a decade later, such urban landscapes like Abdul Hamid Frefer’s body, serve as an ongoing testament to war’s long legacy of destruction.

The Medium Is the Message

Since 2001, more than 1,500 U.S. military personnel have lost limbs to the wars in Iraq and Afghanistan. Since 1995, the International Committee of the Red Cross alone has supplied 109,303 prostheses to replace Afghan arms and legs.

Giles Duley lost limbs in Afghanistan. Three of them. But he wasn’t an American, nor an Afghan. He wasn’t even a soldier. And to say that he was a civilian doesn’t quite capture his story.

For 10 years, Duley was a music and fashion photographer, shooting the likes of Oasis, Marilyn Manson, and Lenny Kravitz for GQEsquireVogue, and other publications. Then he threw his camera out a window, burned his film, and resolved never to shoot a photo again. But that decision didn’t last. Instead, he followed a circuitous path back into photography, one that led him into conflict and crisis zones like the Democratic Republic of the Congo, South Sudan, and Lebanon.

In 2011, while on patrol with U.S. troops in Afghanistan, he stepped on an improvised explosive device that nearly killed him and left him with just one intact limb, his right arm. “At first, I was devastated by what had happened, obviously,” he said in a 2012 TED talk.

“I thought my work was over, I thought — everything didn’t make sense to me. And then I realized: I never set out to Congo, to Angola, to Bangladesh to take photographs. I went to those places because I wanted to make some kind of change, and photography happened to be my tool. And then I became aware that my body was, in many ways, a living example of what war does to somebody. And I realized I could use my own experience, my own body, to tell that story.”

War stories like Duley’s have been written on so many bodies. They have been written on the faces of one-eyed women and men whose features were melted by incendiary agents. They are told in the very existence of one-armed children and legless men.

As Abdul Hamid Frefer recounted detail after detail of that distant July 8th, a smile slowly crept across his face. “I was just about dead when I got to the field hospital,” he told me. “The doctors were amazed that I was still alive — and conscious.” He felt lucky, or rather blessed, he said, to be alive. “It’s all God’s will” was a phrase he kept repeating.

For him, that July day eight years ago is always present — as similar days are for so many other victims of armed conflict. Frefer’s body tells a story of one war, one day, one rocket, three miles of being dragged, three years of becoming mobile again. His is the story of one life built on the corporeal wreckage of war. But it says something larger, something more universal, too.

“I’m never going to be well. I still have pain,” Abdul Hamid Frefer told me as he rubbed what’s left of his right leg. His is a war story written on his own body in both absence and trauma. That limb, what remains of it, and its phantom half most certainly tell, as Duley put it, “what war does to somebody.” But Abdul Hamid Frefer’s body, just like Duley’s, says something more. It tells not just a story but perhaps the story of war. “My legs are gone,” said Frefer wincing and gritting his teeth, “but the pain remains.”

The post The Carnage of War Is Tearing Humanity Apart appeared first on Truthdig: Expert Reporting, Current News, Provocative Columnists.

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