Vox clamantis in deserto
Julie Appleby/Elizabeth Lucas: Surgeons handed out far too many opiates
Two milligrams of the synthetic opiate Fentanyl. — a lethal dose in most people
“Prescribers should have known better”
— Andrew Kolodny, co-director of opioid policy research at Brandeis University, in Waltham, Mass.
As opioid addiction and deadly overdoses escalated into an epidemic across the U.S., thousands of surgeons continued to hand out far more pills than needed for postoperative pain relief, according to a KHN-Johns Hopkins analysis of Medicare data.
Search individual prescribing habits by doctor name or associated hospitals based on data analysis by Kaiser Health News and Johns Hopkins School of Public Health.
Many doctors wrote prescriptions for dozens of opioid tablets after surgeries — even for operations that cause most patients relatively little pain, according to the analysis, done in collaboration with researchers at Johns Hopkins School of Public Health. It examined almost 350,000 prescriptions written for patients operated on by nearly 20,000 surgeons from 2011 to 2016 — the latest year for which data are available.
Some surgeons wrote prescriptions for more than 100 opioid pills in the week following the surgery. The total amounts often exceeded current guidelines from several academic medical centers, which call for zero to 10 pills for many of the procedures in the analysis, and up to 30 for coronary bypass surgery.
While hundreds of state and local lawsuits have been filed against opioid manufacturers, claiming they engaged in aggressive and misleading marketing of these addictive drugs, the role of physicians in contributing to a national tragedy has received less scrutiny. Research shows that a significant portion of people who become addicted to opioids started with a prescription after surgery.
In sheer numbers, opioid prescribing in the U.S. peaked in 2010, but it remains among the highest in the world, according to studies and other data.
In 2016, opioids of all kinds were linked to 42,249 deaths, up from the 33,091 reported in 2015. The opioid-related death rate jumped nearly 28% from the year before, according to the CDC.
Yet long-ingrained and freewheeling prescribing patterns changed little over the six years analyzed. KHN and Johns Hopkins examined the prescribing habits of all U.S. surgeons who frequently perform seven common surgical procedures and found that in the first week after surgery:
Coronary artery bypass patients operated on by the highest-prescribing 1% of surgeons filled prescriptions in 2016 exceeding an average of 105 opioid pills.
Patients undergoing a far less painful procedure — a lumpectomy to remove a breast tumor — were given an average of 26 pills in 2016 the week after surgery. The highest-prescribing 5% of surgeons prescribed 40 to 70 pills on average.
Some knee surgery patients took home more than 100 pills in the week following their surgery.
Those amounts — each “pill” in the analysis was the equivalent of 5 milligrams of oxycodone — are many times what is currently recommended by some physician groups to relieve acute pain, which occurs as a result of surgery, accident or injury. The analysis included only patients not prescribed opioids in the year before their operation.
“Prescribers should have known better” based on studies and other information available at the time, said Andrew Kolodny, co-director of opioid policy research at Brandeis University, in Waltham, Mass., and director of the advocacy group Physicians for Responsible Opioid Prescribing.
While the dataset included only prescriptions written for patients on Medicare, the findings may well understate the depth of the problem, since doctors are more hesitant to give older patients the powerful painkillers because of their sedating side effects.
Surgeons’ prescribing habits are significant because studies show that 6% of patients who are prescribed opioids after surgery will still be taking them three to six months later, having become dependent. The likelihood of persistent use rises with the number of pills and the length of time opioids are taken during recuperation.
Also, unused pills in medicine cabinets can make their way onto the street.
Dr. Marty Makary, a surgical oncologist at Johns Hopkins, admits that he too once handed out opioids liberally. Now he is marshaling a campaign to get surgeons to use these powerful painkillers more consciously and sparingly. “I think there’s an ‘aha’ moment that many of us in medicine have had or need to have,” he said.
But old habits are hard to kick.
KHN contacted dozens of the surgeons who topped the ranks of opioid prescribers in the 2016 database. They hailed from small, community hospitals as well as major academic medical centers. The majority declined to comment, some bristling when questioned.
Look Up Opioid Prescribers: Search KHN Database By Doctor, Hospital
Some of those surgeons were critical of the analysis, saying it didn’t take into account certain essential factors. For example, it was not possible to determine whether patients had complications or needed higher amounts of pain medication for another reason. And some surgeons had only a handful of patients who filled prescriptions, making for a small sample size.
But surgeons also indicated that the way they prescribe pain pills was less than intentional. It was sometimes an outgrowth of computer programs that default to preset amounts following procedures, or practice habits developed before the opioid crisis. Additionally, they blame efforts in the late 1990s and early 2000s that encouraged doctors and hospitals to consider pain as “the fifth vital sign.” A major hospital accrediting group required providers to ask patients how well their pain was treated. Pharmaceutical companies used the fifth vital sign campaign as a way to promote their opioid treatments.
Makary, who oversaw the analysis of the Medicare dataset, said that, while opioid prescribing is slowly dropping, to date many surgeons have not paid enough attention to the problem or responded with sufficient urgency.
Dr. Audrey Garrett, an oncologic surgeon in Oregon, said she was “surprised” to hear that she was among the top tier of prescribers. She said she planned to re-evaluate her clinic’s automated prescribing program, which is set to order specific amounts of opioids.
KHN will analyze data for 2017 and subsequent years when it becomes available to follow how prescribing is changing.
Prescribing Patterns Highlight What’s At Stake
The analysis examined prescribing habits after seven common procedures: coronary artery bypass, minimally invasive gallbladder removal, lumpectomy, meniscectomy (which removes part of a torn meniscus in the knee), minimally invasive hysterectomy, open colectomy and prostatectomy.
Across the board, the analysis showed that physicians gave a large number of narcotics when fewer pills or alternative medications, including over-the-counter pain relief tablets, could be equally effective, according to recent guidelines from Makary and other academic researchers.
On average, from 2011 to 2016, Medicare patients in the analysis took home 48 pills in the week following coronary artery bypass; 31 following laparoscopic gallbladder removal; 28 after a lumpectomy; 41 after meniscectomy; 34 after minimally invasive hysterectomy; 34 after open colon surgery; and 33 after prostatectomy.
According to post-surgical guidelines spearheaded by Makary for his hospital last year, those surgeries should require at most 30 pills for bypass; 10 pills for minimally invasive gallbladder removal, lumpectomy, minimally invasive hysterectomy and prostatectomy; and eight pills for knee surgery. It has not yet published a guideline for open colon surgery.
The Johns Hopkins doctors developed their own standards because of a dearth of national guidelines for post-surgical opioids. They arrived at those figures after reaching a consensus among surgeons, nurses, patients and other medical staff on how many pills were needed after particular surgeries.
Hoping to reduce overprescribing, Makary is preparing to send letters next month to surgeons around the country who are among the highest opioid prescribers under a grant he received from the Arnold Foundation, a nonprofit group whose focus includes drug price issues. (Kaiser Health News also received funding from the Arnold Foundation.)
Even if the prescription numbers have fallen since 2016, the amounts given today are likely still excessive.
“When prescribing may have been five to 20 times too high, even a reduction that is quite meaningful still likely reflects overprescribing,” said Dr. Chad Brummett, an anesthesiologist and associate professor at the University of Michigan.
Brummett is also co-director of the Michigan Opioid Prescribing Engagement Network, a collaboration of physicians that makes surgery-specific recommendations, many of them in the 10- to 20-pill range.
“Reducing unnecessary exposure is key to reducing the risk of new addiction,” said former Food and Drug Administration commissioner Scott Gottlieb. In August 2018, when Gottlieb was at the agency’s helm, it commissioned a report from the National Academy of Sciences on how best to set opioid prescribing guidelines for acute pain from specific conditions or surgical procedures. Its findings are expected later this year.
“There are still too many 30-tablet prescriptions being written,” said Gottlieb.
Healers Sowing Disease?
Naturally, surgeons rankle at the idea that they played a role in the opioid epidemic. But studies raise serious concerns.
Transplant surgeon Dr. Michael Engelsbe, director of the Michigan Surgical Quality Collaborative, points to the study showing 6% of post-op patients who get opioids for pain develop long-term dependence. That means a surgeon who does 300 operations a year paves the way for 18 newly dependent people, he said.
Many patients do not need the amounts prescribed.
Intermountain Healthcare, a not-for-profit system of hospitals, clinics, and doctors in Utah, began surveying patients two years ago to find out how much of their prescribed supply of opioids they actually took following surgery.
“Globally, we were overprescribing by 50%,” said Dr. David Hasleton, senior medical director.
But Intermountain approached individual doctors carefully. “If you go to a prescriber to say, ‘You are overprescribing,’ it never goes well. A common reaction is, ‘Your data is wrong’ or ‘My patients are different than his,’” said Hasleton.
For the analysis, KHN attempted to contact more than 50 surgeons whose 2016 numbers ranked them among the top prescribers in each surgical category.
One who did agree to speak was Dr. Daniel J. Waters, who 13 years ago had his chest cut open to remove a tumor, an operation technically similar to what he does for a living: coronary artery bypass.
“So I have both the doctor perspective and the patient perspective,” said Waters, who practices in Mason City, Iowa.
In 2016, Waters’ Medicare bypass patients who filled their prescriptions took home an average of nearly 157 pills each, according to the KHN-Johns Hopkins analysis.
“When I went home from the hospital, 30 would not have been enough,” said Waters of the number recommended by the Hopkins team for that surgery.
But he said he has recently curbed his prescribing to 84 pills.
Nationally, the average prescription filled for a coronary artery bypass was 49 pills in 2016 and had changed little since 2011, the analysis shows.
Others who spoke with KHN said they had developed the habit of prescribing copiously — sometimes giving out multiple opioid prescriptions — because they didn’t want patients to get stuck far from the office or over a weekend with pain or because they were trying to avoid calls from dissatisfied, hurting patients.
In the KHN-Johns Hopkins data, the seven patients of Dr. Antonio Santillan-Gomez who filled opioid prescriptions after minimally invasive hysterectomies in 2016 received an average of 77 pills each.
A gynecologic oncologist, Santillan-Gomez said: “I’m in San Antonio, and some of my patients come from Laredo or Corpus Christi, so they would have to drive two to three hours for a prescription.”
Still, he said, since e-prescribing of opioids became more widespread in the past few years, he and other surgeons in his group have limited prescriptions to 20 to 30 pills and encouraged patients to take Tylenol or other over-the-counter medications if they run out. E-prescribing can not only help track patients getting opioids but also reduce the problem of patients having to drive back to the office to get a written prescription.
Dr. Janet Grange, a breast surgeon in Omaha, Neb., said that in her experience, opioid dependence had not been a problem.
“I can absolutely tell you I don’t have even 1% who become long-term opioid users,” said Grange.
The analysis showed that Grange had 12 opioid-naïve Medicare patients who had a lumpectomy in 2016. Eight of them filled prescriptions for an average of 47 pills per patient.
She called Johns Hopkins’ zero-to-10-pill pain-control recommendation following that procedure “miserly.”
The Pendulum Swings
Some of the higher-prescribing surgeons in the KHN-Johns Hopkins analysis reflected on their potential contribution to a national catastrophe and are changing their practice.
“That is a shocking number,” said oncologist Garrett, speaking of the finding that 6% of patients who go home with opioids will become dependent. “If it’s true, it’s something we need to educate physicians on much earlier in their medical careers.”
Garrett, in Eugene, Ore., said she has cut back on the number of pills she gives patients since 2016. The KHN-Johns Hopkins analysis showed that seven of her 13 opioid-naïve Medicare patients undergoing minimally invasive hysterectomies filled a prescription for opioids in 2016. Those patients took home an average of 76 pills each.
Johns Hopkins guidelines call for no more than 10 opioid pills following this procedure, while Brummett’s Michigan network recommends no more than 15.
Surgeon and researcher Dr. Richard Barth, once a heavy prescriber himself, said that his own experience convinced him that physicians’ preconceptions about how much pain relief is needed are often way off.
The analysis showed his lumpectomy patients in 2013 filled an average of 33 pills in the week after surgery. By 2016, that average had dropped to seven pills. Many patients, he said, can do just fine after lumpectomy with over-the-counter medications — and often no opioids at all.
The key, he said, is to set patients’ expectations upfront.
“I tell them it’s OK to have a little discomfort, that we’re not trying to get to zero pain,” said Barth, who is chief of general surgery at Dartmouth-Hitchcock Medical Center and has published extensively on opioid prescribing.
After lumpectomy, “what I recommend is Tylenol and ibuprofen for at least a few days and to use the opioids only if the discomfort isn’t relieved by those.”
Indeed, the data analysis showed that a significant number of patients given prescriptions for opioids never filled them because they don’t need that level of pain relief.
Between 2011 and 2016, for example, only 62% of lumpectomy patients in the analysis filled prescriptions, similar to hysterectomy patients.
In 2016, patients of Dr. Kimberli Cox, a surgeon in Peoria, Ariz., were prescribed about 59 pills in the week following lumpectomy, well above the recommendations from both Johns Hopkins and others.
But the KHN-Johns Hopkins analysis of that year’s data shows that half of her patients never filled a painkiller prescription — a fact she acknowledges has changed her thinking.
“I am now starting to prescribe less because many patients say, ‘You gave me too many’ or ‘I didn’t fill it,” she said.
Julie Appleby and Elizabeth Lucas are Kaiser Health News reporters.
Julie Appleby: jappleby@kff.org, @Julie_Appleby
Elizabeth Lucas: elucas@kff.org, @eklucas
David Warsh: Trump, North Korea and China
North Korean soldier points to the demilitarized zone between the two Koreas.
From economicprincipals.com
SOMERVILLE, Mass.
One consequence of government by bluster and contempt is that, even when Donald Trump is right, the president is unable to make the case for his policies. Take those “beautiful letters” he keeps getting from Kim Jong Un, leader of North Korea. The editor of a new book of essays outlines the logic that Trump has failed to present.
North Korea: Peace? Nuclear War? (Mosavar-Rahmani Center for Business and Government, 2019 ), edited by William Overholt, contains 18 essays by leading Korea specialists, including one by China’s foremost expert on Korean affairs and another by former U.S. Ambassador to Korea Kathleen Stephens, who as U.S. chargé d’affaires in Belfast oversaw Northern Ireland’s Good Friday agreement. (Stephens first learned Korean as a Peace Corps volunteer, before entering the Foreign Service.) A wide range of views are represented, but the authoritative voice in the volume belongs to Overholt. His summary is here. In a separate letter about the book, the veteran Asia hand compressed the argument of his essay.
“A strategy of forced denuclearization by bludgeoning through sanctions has no chance of success. A strategy of achieving denuclearization as a byproduct of achieving peace has some chance of success.’’
North Korea invaded South Korea in 1950, backed by Stalin and Mao Zedong. U.N. forces, led by the United States, defended the south. Soon Chinese troops and Soviet pilots supported the north. The war ended in stalemate in 1953. North Korea has been ruled ever since by three generations of the Kim family: Kim Il Sung, until 1994; his son, Kim Jong Il, until 2011; and his grandson, Kim Jong Un, since the death of his father.
The situation has changed over the years, says Overholt: gradually since 1978, when China put aside autarkic revolutionary ideology and began its “great leap outward” into the global market economy; rapidly, after 2011. As a scion of the ruling dynasty, Kim Jong Un was educated, among other places, in Switzerland. He has absorbed the lessons of an Asian style of development strategy that has lifted almost all of the region to prosperity. He also has a longer time horizon than his father, says Overholt. His father had been 57 when he acceded to power.
Kim has risked his position by imposing very different budget priorities from those of his father and grandfather, including the development of nuclear weapons. He has opened his country socially, at least to the extent that North Korean citizens now know what they are missing. He has employed traditionally brutal methods to protect his power.
The U.S. has replied with sanctions, demanding denuclearizaion before any relief. Both sides have good reason to mistrust one another, Overholt says. North Korean behavior in the past often has been deceptive, unreliable, and vicious. The US pursued a policy of “regime change” in Libya after Muammar Gaddafi de-nuked and set an alarming example.
But the situation in China has changed, too, in the space of years since it became a great power. China’s policy is to stabilize the peninsula. Any deal will require Chinese security guarantees for the North Korean regime. South Korea will have to agree, too. The South Korean population is fully supportive of the peace process; its government is fully engaged. So are the Chinese and U.S. negotiators, especially after Kim was said to have executed one of the negotiators and four other advisers after the breakdown of his second summit with the American president.
Time is short, Overholt says. “Kim is vulnerable and may be overthrown or killed if there is no early progress toward peace and economic development. His opponents want a return to the old military priorities and confrontational ways. Kim Jong Un has promised de-escalation, but only in stages and over a considerable period of time. Trump and Kim and their respective advisers are thus in somewhat parallel positions, dealing with a national establishment that looks to the past instead of the future. Overholt: “Early incremental but decisive progress is the only hope.”
Trump can’t do the job of building support for a China-mediated agreement to begin to lift sanctions, and the press won’t do it for him. The Great Successor: The Divinely Perfect Destiny of Brilliant Comrade Kim Jong Un (TK, 2019), by Anna Fifield, of The Washington Post, has just appeared. It looks interesting, in this adaptation from the book on Kim’s four years in Europe, or this New Yorker interview with the author. But the ridicule of the title delivers her ultimate judgment. There is much to object to about both Kim Jong-un and Donald Trump. Failing to seek to act on an urgent problem is not among them.
. xxx
Martin Feldstein died June 11, at 79. A Harvard University professor and long-time president of the National Bureau of Economic Research, he was the most influential policy economist of the Reagan generation. He was remembered by The Wall Street Journal, the Financial Times, The New York Times, The Washington Post, and The Economist. Economic Principals appreciated Feldstein in 2008, on the occasion of his retirement from the NBER. Friends who provided encouragement and social support to the engagement of a Long Island Jew and an Irish Catholic from Boston consider Feldstein’s marriage to Kathleen Foley Feldstein, also an economist, to have been spectacularly successful.
. xxx
Added this week to EP’s Bookshelf: Fault Lines: A History of the United States since 1974, by Kevin Kruse and Julian Zelitzer (Norton, 2019)
David Warsh, a Somerville-based veteran columnist and economic historian, is proprietor of economicprincipals.com.
'Look, don't touch' Snapping Turtles
Photos and text from Thomas Hook, a veteran New England Diary correspondent
Driving in Woodbury Conn., I saw this Snapping Turtle in the road. I stopped to make sure that it crossed the road safely. I know better than to pick one up so I thought a stick might prod it toward the pond on the other side of the road.
But before helping the turtle, I wanted pictures.
By luck, the first car to come by was the animal-control officer for nearby Watertown. He was off duty visiting a friend and saw me with the turtle and camera. He was worried that I would pick up the creature and so decided to come to the rescue of both me and the turtle. He found a metal rod with a loop in his van, using it to lasso the turtle and drag it to the pond and release it. Subsequently, It entered the water and disappeared.
The officer explained that the turtle has a very long neck and can reach around more than halfway back the length of its shell and SNAP!
Having seen Snapping Turtles before that were much larger than this one, it was good to know specifically why you should leave them alone. You could injure (or lose) a finger or the better part of a hand, so "look but don’t touch" is good advice.
In Boston, MFA grads' marvels
From left, detail of works by Dennis Svoronos, Corinne Planche and Jeffery Nowlin in the July 17-Aug. 11 show at Boston Sculptors Gallery titled “MassArt Masters 2019’’
From Boston Sculptors Gallery: “Each summer Boston Sculptors Gallery hosts a special guest group exhibition, and this year we’re showcasing the work of 12 newly minted MFA {master of fine arts} grads from the Massachusetts College of Art & Design. It’s composed of individuals from three generations and four countries, and from across our nation and in our own backyard.’’
Image caption
From left to right:
Details of works by Dennis Svoronos, Corinne Planche, and Jeffery Nowlin
Tim Faulkner: Offshore wind boom continues, with snags
From ecoRI News (ecori.org)
The demand for offshore wind continues, as the designated wind zones in waters south of Rhode Island, Martha’s Vineyard and Nantucket fill with projects.
At the June 11 meeting of the Rhode Island Coastal Resources Management Council (CRMC), Grover Fugate, executive director, recounted the growing pains to accommodate as much as 22,000 megawatts of offshore wind.
“This industry has literally exploded overnight,” said Fugate, as he highlighted issues confronting several projects.
The 800-megawatt Vineyard Wind facility, for instance, is deadlocked with the National Oceanic and Atmospheric Administration (NOAA) over the project’s environmental impact statement.
“That’s not something that’s been done before in the NEPA (National Environmental Policy Act) world,” Fugate said. “So we’re not quite sure where that is going to end up.”
The Nantucket Historical Commission is seeking $16 million from the Vineyard Wind developer, according to Fugate. The island town has sought funds to compensate for adverse visual impacts the 84 turbines may have on tourism.
Connecticut recently announced it wants to add 2,000 megawatts of offshore wind to the power grid but the state lacks approved offshore wind areas.
“Connecticut, of course, does not have any offshore sources,” Fugate said. “The closest ones to Connecticut are us (Rhode Island).”
Connecticut is already signed on for 300 megawatts from the Revolution Wind project located in one of four wind-lease areas that require CRMC approval.
Rhode Island has already signed up 400 megawatts from the same wind project managed jointly by Ørsted US Offshore Wind and the Massachusetts utility Eversource.
Massachusetts has a goal of 3,200 megawatts of offshore wind by 2035. It has already agreed to buy 800 megawatts from the Vineyard Wind project and the state has issued a request for proposal for an addition 800 megawatts that may come from the second half of the Vineyard Wind lease area.
Vineyard Wind went through a lengthy and contentious review for its initial wind facility and wants to meet with CRMC about a review of the second half of its wind-zone lease.
Bay State Wind, another Eversource and Ørsted project, is also moving forward with an 800-megawatt wind project in the same region. Fugate met with Bay State Wind’s CEO and discussed how the project fails to conform with a 1-mile spacing of turbines within its grid configuration.
Fugate said Bay State Wind is using a European design that doesn’t meet the fisheries requirement for U.S. projects.
“So they are taking that back under consideration,” Fugate said.
Vineyard Wind has filed a proposal to deliver 1.2 gigawatts of wind power to New York along a 95-mile transmission line from Vineyard Wind’s second wind zone, in the easternmost section of the federal wind-lease area. In all, New York is looking for some 9,000 megawatts of wind energy.
“If you add it all up it’s about 22,000 megawatts from New York to the Cape that's under consideration,” Fugate said.
He expressed frustration with the federal Bureau of Ocean Energy Management for not requiring an extended analysis of proposed offshore wind project sites.
“If you don't get two years of baseline data you have no way of measuring the impact,” Fugate said. “That may be intentional on their part, I don't know. But we have pushed for baseline data so that you can measure before and after, so that you know what you just did and how to adjust to it. But without that baseline, we don't know what we just did.”
Cable congestion
The surge in offshore wind development has created a need for transmissions lines and onshore connections to the electric grid. Wakefield, Mass.-based Anbaric Development Partners is creating a renewable-energy center on a leased site at the former Brayton Point coal-fired power plant in Somerset, Mass. Anbaric wants to install two high-voltage electric cables from Brayton Point to serve wind facilities off the coast of Massachusetts and Rhode Island. Ørsted would also like to run two cables from its Bay State Wind project to the mainland at Brayton Point.
The transmission lines would run through the the Sakonnet River along the easternmost channel of Narragansett Bay.
Fugate noted that the passage can only accommodate two power cables because of the narrow Stone Bridge corridor between Portsmouth and Tiverton. He said the activity at Brayton Point and other wind-facility operations within Narragansett Bay will be busiest during the summer, causing congestion along the East Passage, which runs between Newport and Jamestown.
“There’s a huge interference with a lot of existing uses down there,” Fugate said.
Federal review
NOAA officials will perform a three-day review of CRMC’s overall coastal program, including a public hearing scheduled for June 18. The review, required every seven years, will culminate with a report of findings that will offer suggested and required actions needed to adhere to federal grant requirements.
In a worst-case scenario, CRMC could face sanctions, which include a loss of federal funding for CRMC’s coastal programs. More than half of CRMC’s budget comes from federal sources.
NOAA’s last evaluation of CRMC was conducted in 2010.
The public hearing will be held at the Department of Administration building, conference room A, One Capital Hill, at 6 p.m.
Matunuck seawall
Hearings are expected in the fall for phase two of a seawall project on Matunuck Beach Road, in South Kingstown, R.I. The first phase was a highly controversial and meaningful case for the CRMC, as it confronts sea-level rise and shoreline erosion from climate change.
Tim Faulkner is an ecoRI News journalist.
Abstraction of liberty
Oil on canvas from Carl Mehrbach’s ”Doctrine of Liberty’’ show at Bromfield Gallery, Boston, through June 30, It’s a collection of paintings of 3D abstractions.
States' addiction promotion
From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com
As they did with gambling (which can be highly addictive), states, including Rhode Island, Massachusetts and Connecticut, are jumping into the marijuana business. Massachusetts (along with Maine and Vermont) has fully legalized pot use and Rhode Island and Connecticut have decriminalized its “recreational’’ use. Meanwhile, it’s full speed ahead for “medical marijuana,’’ which some truly sick people use, along with others who just want to get stoned.
For the states, it’s all about trying to find new ways of increasing government revenue without raising broad-based taxes, which is usually political poison. It’s a regressive way of doing it since those wanting to gamble and smoke pot tend to be in lower socio-economic levels. Some old-fashioned types might even call this addiction promotion immoral.
Pot promoters, for their part, have long asserted that it’s not a “gateway drug’’ – an assertion that has always struck me as dubious. Perhaps they should read a new paper, in the Proceedings of the National Academy of Sciences, in which researchers looking at states that enacted medical marijuana laws saw a 23 percent increase in opioid-overdose deaths. There are lots of people with addiction tendencies. And use of one drug leads, in many people, to a desire for stronger ones.
Other studies have shown a high incidence among opiate addicts of the use and abuse of other drugs, be they amphetamines, alcohol, nicotine or others.
To read the study, please hit this link.
Negin Owliaei: Medicare for all would save lives -- and money
From OtherWords.org
One night a few years ago, my partner woke up delirious with fever, a bright rash, and joint pain so bad he couldn’t get out of bed without help. I was scared — mostly for his health, but also for our financial situation, which weighed heavily on me during our 4 a.m. ride to the emergency room.
As a freelancer, his catastrophic health insurance plan had an outrageously high deductible, and every day he couldn’t work was a day he wouldn’t get paid. I’d lost my job — and my own health insurance — earlier that year, and was still piecing together a livelihood from gig to gig. I didn’t know what we’d do if something went seriously wrong.
We left the hospital several hours later after an IV and a couple of ibuprofens — and no diagnosis. Even after insurance kicked in, we were billed about $1,000 for the experience. My partner’s joints hurt for months afterwards, but the already hefty price tag scared him off following up.
It turns out he’s far from the only one who looked at a bank statement before considering a trip to the doctor.
A recent study found that 65 million Americans had a health issue in the last year that they didn’t treat because they were worried about the cost. And 45 percent of Americans — including a third of households making more than $180,000 a year — worry they could go bankrupt over a major health issue.
Nearly half of those survey respondents said they thought U.S. health care was either the best or among the best in the world. But our actual health tells another story.
By a long shot, the U.S. has the most expensive health-care system among the 36 mostly high-income countries that make up the Organization for Economic Cooperation and Development, or OECD. But for all that money, we rank just 28th in life expectancy and 31st in infant mortality.
Nothing about this system is healthy or caring. But it doesn’t have to be this way.
In 2014, the same year we worried about a $1,000 trip to the emergency room, our insurance company spent nearly $20 million executive compensation. More than $5 million went to the CEO alone.
What if our health care system didn’t allow people to make these exorbitant profits off our pain? What — and who — could we save?
By one assessment, a universal, single-payer system like Medicare for All could expand coverage to everyone while reducing the cost to American businesses and people by as much as $310 billion — primarily by cutting down on industry bloat and by negotiating fairer pharmaceutical prices.
While our monstrously expensive health care system is maddening, the harm done to people who can’t afford to participate in that system is what’s truly enraging.
Read the stories attached to the third of GoFundMes specifically devoted to crowdsourcing money for medical costs and I’m sure you’ll feel the same. Thousands of people in the United States die preventable deaths each year simply from lack of insurance.
Fortunately, there’s a groundswell of support for a publicly funded health care system. And researchers say one proposal — the Medicare for All Act of 2019 that’s in front of Congress right now — sets “a new standard for universally and equitably guaranteeing health care as a human right in the United States.”
No one should have to worry about bankruptcy before seeking out the treatment they need. Health care is a human right, and we deserve no less than a system that provides it universally and equitably.
Negin Owliaei is a researcher at the Institute for Policy Studies and a co-editor of Inequality.org.
Chris Powell: No state is big enough to hold back a big business
Headquarters of United Technologies Pratt & Whitney unit, in East Hartford, Conn.
Connecticut has been more surprised than it should have been by the announcement from United Technologies Corp. that upon its merger with Raytheon Co. it will move its headquarters from Farmington to Raytheon's outside Boston, in Waltham.
As much as some politicians feared and others hoped that the move was prompted by the state's awful economic conditions, it wasn't. Rather the move was just another natural step in the evolution of a company that began a century ago as the Pratt & Whitney machine tool shop in Hartford.
The tool shop became a manufacturer of aircraft engines, merged with the predecessor of Boeing to become United Aircraft and Transport Corp., started making airplanes as well as their engines, was broken up by New Deal-era antitrust legislation, kept growing anyway, and became a conglomerate -- United Technologies -- that was heavily dependent on government contracts. As such UTC came to need political support outside Connecticut, so it diversified operations into other states and even other countries.
As a result UTC's employment in Connecticut, around 19,000, has declined to a fraction of what it was a few decades ago, and state government could have done little to prevent it. For these days no conglomerates and big government contractors are going to stick to one state. It's not just their need for national political influence for securing federal government business. It's also to avoid becoming hostage to any one predatory state government.
So Connecticut's economic future does not depend on the big companies already here. For the same reasons motivating UTC, they are more likely to expand out of state. Instead Connecticut's economic future depends on growth by smaller companies already here and entry here by companies elsewhere.
But good luck drawing or keeping anyone here while the most important thing state government has to offer anyone is the duty to share the burden of $70 billion or so in unfunded state and municipal employee retirement obligations -- that is, the duty to pay more in taxes every year [ITALICS] forever [END ITALICS] to sustain a pension-and-benefit society.
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SLUSH FUND MAY EXPLAIN IT: Maybe there's a good case for giving an exemption from state freedom-of-information and ethics laws to the Partnership for Connecticut, the entity just created by billionaires Ray and Barbara Dalio and state government in the name of improving public education. The Dalios are donating $100 million, state government is appropriating an equal amount, and more donations will be sought from other wealthy people.
But if there is a good case for the exemption, nobody is making it.
Spokeswomen for Governor Lamont and the Dalios insist that the partnership should be exempt from the accountability laws because it's not really a state agency. But it was created and funded by the new state budget, a majority of its board will be state officials, and it will dispense public money to public schools. Private entities don't need any provision in the state budget exempting them from FOI and ethics laws, since those laws apply only to government agencies.
So the budget writers thought the partnership would be considered a state agency subject to the accountability laws unless another law asserted, against the evidence, that it wasn’t a state agency.
Why did the budget bestow such an exemption and exactly who asked for it and why? The spokeswomen for the governor and the Dalios were asked about this more than a week ago but have declined to provide an answer. So here's a guess: The partnership will make a great slush fund.
Chris Powell is a columnist for the Journal Inquirer, in Manchester, Conn.
'Yearnings for wholeness'
Work by Joel Moskowitz, in his joint show “Unspooled,’’ with Sylvia Sluis, at Fountain Street Fine Art, Boston, through June 30. The gallery says he “draws long, spiraling lines, mesmerized. He erases and revises over time, building up a shape that seems, finally, both loose and tightly wound. One end of the line typically hangs free, giving the viewer a way into the maze. Ink grows dense and looping like script. He blends minimalism and expressionism with a metallic sheen. His work, says Moskowitz, ‘is influenced by religious icons, yearnings for wholeness.”’
Why should Vermont grow?
On Vermont’s Mt. Mansfield
From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com
Vermont is doing what some other states with slow or nonexistent population growth, including Rhode Island, have talked about – bribing people to move there. In the Vermont plan, The Boston Globe reports, those who qualify get up to $10,000 over a two-year period to pay for their “moving and home-office costs, and in return, the state gets additional taxpayers to help fund schools and roads and social services.’’
Joan Goldstein, Vermont’s economic development commissioner, told The Globe: “The population needs to grow in order for the economy to grow.’’ It’s the mantra that everything must always grow.
Vermont, generally a very congenial state and one with an astonishingly low 2.3 percent jobless rate, would seem to already be doing quite well. I think that Ms. Goldstein is repeating the mantra that economic growth per se is the be-all and end-all of public policy. But economic growth per se doesn’t necessarily mean a higher quality of life.
To read The Globe’s story, please hit this link:
'Beauty of what they left behind;'
Watercolor by Joyce McJilton Dwyer in her show “Old Spaces, Ancient Places: Scotland & Ireland,’’ at 8 Bridges Gallery, Maynard, Mass., through June 29.
The gallery says: “Dwyer's watercolor paintings and pencil and ink drawings depict the landscapes, waterscapes, and archaeological sites of Scotland and Northern Ireland. She imagines what the settlement of Skara Brae and other villages might have looked like thousands of years ago in their prime. ‘Much is unknown about these cultures of so long ago, but the beauty of what they left behind caught me up,’ Dwyer says. She also replicates the land and water, putting them back in time with her watercolors. Her works create a time capsule, taking the viewer back in time to a younger, simpler world. ‘‘
Frank Carini: The uncertain future of 'the Yellowstone of the North Atlantic'
Kelp forest on Cashes Ledge
— Conservation Law Foundation photo
From ecoRI News (ecori.org)
Robert Lamb, as a Ph.D. student at Brown University, saw firsthand the “incredible diversity, breathtaking plant life, and healthy fish populations” that call Cashes Ledge home.
Lamb recently told ecoRI News that this pristine ecosystem is unlike anything else in the Gulf of Maine. That’s why he was part of a team that worked to permanently protect the 550-square-mile area that is 80 miles off the coast of Gloucester, Mass.
Led by Brown University Prof. Jon Witman, a team of divers from the Providence university, the Woods Hole Oceanographic Institution, the University of New Hampshire, and the National Park Service worked with the Conservation Law Foundation to document the bounty of marine life that exists at Cashes Ledge — a 22-mile-long underwater mountain range with average depths of 90 to 130 feet — and assess its vulnerability. This 4-minute video highlights some of that work.
The team’s efforts of four years ago, including holding roundtables and giving talks across the region, were undertaken in hopes that Cashes Ledge would be awarded a monument designation. The effort failed, but it did play a part in the creation, three years ago, of the Northeast Canyons and Seamounts Marine National Monument, the only national monument in the Atlantic Ocean.
Lamb, who now works with the Witman Lab and the Woods Hole Oceanographic Institution on various marine issues, believes that Cashes Ledge deserves the same protection, especially since the Gulf of Maine is one of the fastest-warming bodies of salt water in the world. He said the destruction of such an important underwater habitat would be devastating.
During the many dives the researchers and scientists took, censuses they conducted, and comparisons they made between Cashes Ledge and exploited coastal areas, such as the Isles of Shoals and Star Island, they found that fish biomass was about 500 times greater there than anywhere in the near shore and kelp biomass was also significantly greater, according to Lamb.
He noted that Cashes Ledge’s dense kelp forest is the most productive one in the North Atlantic.
The peaks and canyons of Cashes Ledge create nutrient- and oxygen-rich currents that support diverse habitats. The area is home to Atlantic wolffish, cod, cusk, sea stars, sea squirts, sea pens, horse mussels, anemones, rare sponges, and the largest continuous kelp forest along the Atlantic Seaboard. It also acts as a migratory pass for blue and porbeagle sharks, humpback and right whales, and bluefin tuna.
The value of Cashes Ledge has been recognized by the New England Fishery Management Council, as it has designated a large swath of the area as “essential fish habitat” for American plaice, Atlantic cod, haddock, halibut, monkfish, pollock, white hake, and witch flounder. The area is currently restricted, meaning most forms of fishing are prohibited.
Those protections, however, are “too little,” according to Lamb.
“It’s one of those places that is so unique and so beautiful … a treasure,” he said. “It merits protection for that reason alone, if not for the fisheries benefits. If you have a place where fish are allowed to grow unchecked and unimpeded by fishing, that creates a surplus of individuals that will swim, or disperses larvae, to other places that then can he caught, so it indirectly benefits fisheries.”
The partially protected area is also home to Ammen Rock, a peak so tall that it disrupts the Gulf of Maine current and creates upwellings of cold, nutrient-rich water which sustains the ledge’s vast variety of life.
Noted marine biologist Sylvia Earle has called Cashes Ledge “the Yellowstone of the North Atlantic.”
Modern commercial fishing technologies, however, make Cashes Ledge susceptible to damage. A bottom trawl, for example, could strip clear the kelp forest on Ammen Rock and completely alter the ecosystem, according to the Conservation Law Foundation. The Boston-based environmental advocacy organization has noted that some anemone populations could take up to 230 years to recover from a single drag of a bottom trawl.
Protected areas also have been shown to be more resilient to climate change, and provide sea life places to adapt to warming and acidifying waters.
See this video about Cashes Ledge.
Frank Carini is editor of ecoRI News.
Mountain in flames
“Sunset over Baxter Mountain’’ (oil on cardboard), by Harold Weston, in the show “Harold Weston: Freedom in the Wilds,’’ at the Shelburne (Vt.) Museum through Aug. 25.
Jeffrey Roy/Edward Lambert Jr.: Listen to Lowell students on expanding vocational opportunities
From The New England Journal of Higher Education, a service of The New England Board of Higher Education (nebhe.org)
A shared challenge for our higher education institutions and employers is the large number of students graduating high school unprepared for success in college and the workforce. It leads to lower-than-acceptable college completion rates, particularly for our most disadvantaged youth, and a broken workforce pipeline that threatens economic growth and opportunity.
The lack of skilled workers to fill open positions is a growing concern for our economy. The talent search firm Korn Ferry has estimated that the U.S. could face a deficit of 6.5 million highly skilled workers by 2030, and the skills gap could cost the country $1.75 trillion in revenue by that same year. More important, our failure to better connect k-12 education to college and workforce success translates into lost opportunities for students. Put simply, we need to do more to help young people seize the many excellent opportunities our economy creates.
A proposal we have introduced and are championing in Massachusetts aims to do just that. House Bill 567 would expand opportunities for high school students to earn industry-recognized credentials (IRCs) that data confirm are of high employment value. The proposal will fuel a diverse, highly skilled workforce pipeline that is the engine of growth and prosperity and provides students with opportunities for upward mobility.
Many students in our vocational technical schools are already earning IRCs in information technology, welding, construction, healthcare and other fields. We can and should make these available to students in our traditional high schools as well. IRCs certify the student’s qualifications and competencies and are often “stackable,” meaning they can be accumulated over time to build the student’s qualifications to pursue a career pathway or another postsecondary credential. Some IRCs also earn the student college credit.
For students going directly into the workforce from high school and for those who enter but never complete college, credentials can be the difference between low-wage positions and better paying jobs that offer opportunities for growth. Earning credentials in high school can also lead to stronger preparation for higher education. Students who earn them are exposed to career pathways before entering college and deciding on a major. In Florida, students earning credentials in high school were more likely to take Advanced Placement or dual-enrollment courses and to go to college.
We heard from students at Greater Lowell Technical High School in Massachusetts who have earned multiple web development, programming and IT credentials that having those credentials will help them secure the higher paying jobs they need to help them afford their college education and in the fields they plan to ultimately pursue.
Our legislative proposal would require the state Executive Office of Labor and Workforce Development to provide the Department of Elementary and Secondary Education with an annual list of high-need occupations that require an industry-recognized credential, ranked by employment value. The top 20% of the list will be credentials that lead to occupations with annual wages at 70% of average annual wages in the Commonwealth. The idea is to ensure we’re sending the right signals to schools and students about where the opportunities lie. The district would get a financial award for each student who earns a credential that has high employment value, is recognized by higher education institutions and addresses regional workforce demands identified by the local MassHire Workforce Board. To ensure that all districts have equal opportunity to participate, the bill includes start-up funding for implementation to encourage less well-resourced districts to get the programs up and running. The funds can support teacher training or cover assessment costs or equipment needs.
This proposal dovetails and complements several state and regional initiatives already underway, including the New England Board of Higher Education’s High Value Credentials for New England initiative launched last summer that is identifying high-value credentials in key growth industries and making that information more easily accessible to the public. The ultimate goal is to enable students to make informed decisions about their course of study and future employment opportunities.
Several other states have adopted similar incentive strategies or integrate credentials into the school curriculum and career preparation activities like work-based learning and internships. In Ohio, students can earn industry-recognized credentials in one of 13 career fields with a choice of more than 250 in-demand credentials. Students in any district can sign up for an industry-recognized credential course. Florida, Wisconsin and Louisiana provide a financial incentive such as the one we propose. Students enrolled in the program in Florida demonstrated higher GPAs, graduation rates and postsecondary enrollment rates.
Massachusetts can provide these important opportunities to students in our traditional and comprehensive high schools by providing the right incentives to our schools. It is an important step in addressing our urgent need for a highly skilled workforce and ensuring our education system is creating pathways to economic opportunity and success.
Jeffrey Roy is a member of the Massachusetts House of Representatives and chairs the Joint Committee on Higher Education and the Legislature’s Manufacturing Caucus. Edward Lambert Jr. is executive director of the Massachusetts Business Alliance for Education.
New England Council pushes post-NAFTA agreement
The Haskell Free Library and Opera House is a neoclassical building that straddles the international border in Rock Island, Quebec and Derby Line, Vermont.
This is from The New England Council (newenglandcouncil.com)
“The New England Council is calling on Congress to approve the US-Canada-Mexico Agreement (USMCA), a free trade agreement that makes critical updates to the North American Free Trade Agreement (NAFTA). In a letter sent on June 10, 2019, to members of the region’s House and Senate delegations, the Council stressed the importance of free trade with these two key trade partners for the region’s continued economic growth.
“Canada and Mexico are two of New England’s top trading partners, and it is vital to our region’s economic wellbeing that we continue to have free trade with our neighbors to the north and south,” said James T. Brett, President and CEO of The New England Council. “We have heard from Council members throughout the region, representing a wide array of industries, that they support the USMCA and the important updates it makes to NAFTA by addressing such issues as digital commerce and intellectual property protection. We are hopeful that Congress will take action to approve the agreement in the near future.”
In its letter, the Council noted that Canada is a top export market for New England businesses, with nearly $8.8 billion in goods exported in 2018 alone, plus another $3.3. billion in services exported. The letter also noted that and that more than 430,000 jobs in New England rely on trade and investment with Canada. With regard to Mexico, the Council noted in its letter that exports from the six New England states to Mexico totaled nearly $4.2 billion in 2018, and in five states Mexico is a “top ten” goods export market. The Council expressed its belief that these numbers will only be bolstered by the USMCA, as the U.S. International Trade Commission recently estimated the agreement will increase U.S. national employment by upwards of 176,000 jobs and raise U.S. real GDP by $68.2 billion.
The USMCA was signed by the three nations on November 30, 2018, following months of negotiations. On May 30, 2019, U.S. Trade Representative Robert Lighthizer sent a letter to Congressional leaders to begin the approval process and allow for the President to send the agreement to Congress within 30 days.
The New England Council has a long history of support for free trade. In recent years, the Council endorsed legislation to allow for Trade Promotion Authority, supported free trade agreements with such nations as South Korea, Panama, and Columbia, and called for multi-lateral trade agreements with important trade partners in Europe and Asia.’’
Tim Faulkner: Battle over 'canned hunting'
From ecoRI News (ecori.org)
Think of invasive species and Canada geese and knotweed come to mind. But wild boar and elk could join that list, if Rhode Island allows trophy hunting, according to critics of the practice.
Opponents of so-called canned hunting are worried that these and other popular hunting animals could be brought to Rhode Island to populate enclosed, private hunting areas. The animals may eventually escape and destroy wildlife and introduce disease.
“It has the potential to devastate the hunting community, as well as native wildlife populations,” said Arianna Mouradjian of the Wildlife Rehabilitators Association of Rhode Island, a wildlife rescue facility in Saunderstown.
A bill (H5849) that would allow canned hunting in Rhode Island was introduced by Rep. Stephen Ucci, D-Cranston, but a hearing scheduled for March was postponed. The bill was also introduced last year at the behest of the exclusive The Preserve at Boulder Hills Club & Residences in Richmond. The bill allows hunting of game animals and birds on shooting preserves of 500 acres or more.
Although the prospects for this year's bill are uncertain this late in the legislative session, a hearing was recently held in the Senate for a bill (S880) that would outlaw importing wild animals for the practice of captive hunting.
Mouradjian testified at the June 4 hearing. She said importing animal for trophy hunting only benefits the small number of wealthy people who own and visit game-hunting ranches.
Michael Woods a hunter and board member for the New England chapter of Backcountry Hunters & Anglers spoke about the devastation and millions of dollars other states have spent to mitigate the impact of imported wildlife, such as old boars, that have migrated from hunting facilities and started breeding.
“How are we going to come up with the resources to manage them and what are we going to do with a Department of Environmental Management that’s already strapped with financial resources and personnel?” Woods asked.
No one spoke against the bill.
Even importing native animals such as white-tailed deer can spread illnesses like chronic wasting disease (CWD), a contagious and fatal brain illness that infects deer, elk, reindeer, and moose. There are no treatments or vaccines. The disease first appeared in Colorado and Wyoming in 1967 and can be fund in 25 states. CWD hasn’t been found in New England but is endemic in New York. A new study found that the disease could spread rapidly in the Northeast.
Connecticut and Massachusetts have laws that prohibit importing wild and domestic game. Maine imposed new restrictions on wild game imports after CWD was discovered in the province of Quebec.
Members of the Senate Judiciary didn’t comment on the bill and held it for further study. A House version of the bill (H5130) had a hearing in February and was held for further study.
Tim Faulkner is an ecoRI News journalist.
'In the summer heaven'
— Photo by Rlevse
Others taunt me with having knelt at well-curbs
Always wrong to the light, so never seeing
Deeper down in the well than where the water
Gives me back in a shining surface picture
Me myself in the summer heaven godlike
Looking out of a wreath of fern and cloud puffs.
Once, when trying with chin against a well-curb,
I discerned, as I thought, beyond the picture,
Through the picture, a something white, uncertain,
Something more of the depths—and then I lost it.
Water came to rebuke the too clear water.
One drop fell from a fern, and lo, a ripple
Shook whatever it was lay there at bottom,
Blurred it, blotted it out. What was that whiteness?
Truth? A pebble of quartz? For once, then, something.
— "For Once, Then, Something,’’ by Robert Frost
Chris Powell: Pandering with courses; local nullification of immigration law
Year after year most Connecticut high school seniors are graduated and given diplomas without ever mastering high school math and English, and year after year most of those who are admitted to a community college or a regional state university have to take remedial high school courses. The problem is social promotion.
So what did the General Assembly do about public education in its session just concluded? Both houses appropriated more money for teacher salaries (called "aid to education"). They both passed legislation requiring high schools to offer a course in African-American and Latino history. The House passed a bill that would have required elementary schools to teach climate change.
State Sen. Douglas McCrory, D-Hartford, argued that minority students are discouraged in school by the supposed lack of attention to the history of their ethnic groups. But what of the discouragement they may suffer when they discover that they haven't learned to read and do math at an adult level?
As for the climate change bill, introduced by state Rep. Christine Palm, D-Chester, state Education Department standards already called for incorporating the subject in science curriculums, making the bill unnecessary. Further, this subject too can hardly be mastered if reading and math aren't mastered first.
Of course the objective of these bills wasn't to teach students anything but to let legislators strike politically correct poses and pander. After all, what legislator would be re-elected if he told his constituents that their kids are goofing off in school and if he scolded their teachers that they should stop being silent about it?
* * *
WHAT 'PRIORITY' FOR DEPORTATION?: Maybe it would be too punitive to deport Sujitno Sajuti back to Indonesia. Sajuti, 70, had been living in West Hartford but for 19 months until last week he claimed sanctuary in a church in Meriden because federal immigration authorities had told him to leave the country. Now, because many years ago he was the victim of an assault in Hartford, Sajuti has been granted a waiver and can stay indefinitely.
But the protests by Sajuti's supporters that he is the victim of the excessive zeal of the immigration authorities are also too much.
State Atty. Gen. William Tong declared, "There is something horribly broken with our immigration system when this 70-year-old man who has lived peacefully here for three decades was deemed a priority for deportation."
U.S. Sen. Richard Blumenthal called Sajuti "a man who spent decades in this country causing nobody any harm, doing nothing wrong, committing no violations of law."
A priority for deportation? No violations of law? But Sajuti has been living in the United States illegally for nearly 25 years after overstaying a visa.
Tong and Blumenthal imply that there should be no consequences for violating immigration law, that if one breaks it long enough, it should be forgotten -- and the news reporters who quoted them failed to ask them about that.
Nullification of federal immigration law and open borders seem to be state government's policy now that the General Assembly and Governor Lamont have enacted a law forbidding municipal authorities from cooperating with immigration authorities in almost any way.
While the Trump administration is deficient and sometimes hateful, controlling immigration is a crucial function of the federal government, and hindering it is a form of secession.
Chris Powell is a columnist for the Journal Inquirer, in Manchester, Conn.