s Trump has already authored his own tell-all

Trump is damaged most, not by sabotage, but by self-revelation.

.. The president has recently taunted FBI Deputy Director Andrew McCabe for “racing the clock to retire with full benefits,”

  1. attacked the “Deep State Justice Department,” taken credit for the lack of commercial airline crashes,
  2. urged“Jail!” for former Hillary Clinton aide Huma Abedin, called for the sacking of two journalists,
  3. claimed the news media will eventually “let me win” reelection to keep up their ratings,
  4. displayed a sputtering inability to describe his own health-care reform plan,
  5. claimed that a cold snap disproves global warming,
  6. boasted of having “a much bigger & more powerful” nuclear button than Kim Jong Un,
  7. tried to prevent the publication of Wolff’s book,
  8. and insisted he is “like, really smart” and “a very stable genius.”

.. More likely, Trump is exhibiting a set of compulsions and delusions that have characterized his entire adult life. You can’t have declining judgment that never existed. You can’t lose a grasp on reality you never possessed. What is most striking is not Trump’s disintegration but his utter consistency.

.. If the secret tape of a president threatening a private citizen with jail were leaked, it would be a scandal. With Trump, it is just part of his shtick.

.. The president’s defenders, in perpetual pursuit of the bright side, argue for the value of unpredictability in political leadership — which is true enough. But Trump is not unpredictable. He is predictable in ways that make him vulnerable to exploitation.

He is easy to flatter, easy to provoke and thus easy to manipulate.

.. The Chinese have made an art of this

.. “I like very much President Xi,” Trump has said. “He treated me better than anybody’s ever been treated in the history of China.” Contrast this with Germany’s Chancellor Angela Merkel, who has treated Trump like an adult with arguments and criticism. Big mistake.

.. Trump has revealed a thick streak of authoritarianism. “I have [an] absolute right to do what I want to do with the Justice Department,” he insists.

  • .. “Libel laws are very weak in this country,”
  • Rivals are not only to be defeated; they should be imprisoned.
  • Critics are not to be refuted; they should be fired.
  • Investigations are not to be answered; they should be shut down.

.. we are depending on the strength of those institutions, not the self-restraint of the president, to safeguard democracy.

.. At the beginning, they could engage in wishful thinking about Trump’s fitness. Now they must know he is not emotionally equipped to be president. Yet, they also know this can’t be admitted, lest they be accused of letting down their partisan team.

.. GOP leaders are engaged in an intentional deception, pretending the president is a normal and capable leader.

.. they will, eventually, be exposed. And by then, the country may not be in a forgiving mood.

 

Canada’s Health-Care Queues

Bernie Sanders’s model system makes patients wait and wait and . . .

surveyed physicians in 12 specialties across 10 provinces and found “a median waiting time of 21.2 weeks between referral from a general practitioner and receipt of treatment.” 

.. The wait to see a specialist for a consultation is now 177% longer than in 1993, while the wait from consultation to treatment is 95% longer than in 1993.

.. The shortest waits are in radiation and oncology. But long waits for orthopaedic surgery, neurosurgery and ophthalmology, among others, far exceed what’s recommended and aren’t benign.

.. Some provinces perform better than others. “The shortest specialist-to-treatment waits are found in Ontario (8.6 weeks)”

.. while the longest are in Manitoba (16.3 weeks),”

The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy

I focus on issues surrounding the promotion and marketing of controlled drugs and their regulatory oversight. Compared with noncontrolled drugs, controlled drugs, with their potential for abuse and diversion, pose different public health risks when they are overpromoted and highly prescribed. An in-depth analysis of the promotion and marketing of OxyContin illustrates some of the associated issues.

.. When Purdue Pharma introduced OxyContin in 1996, it was aggressively marketed and highly promoted. Sales grew from $48 million in 1996 to almost $1.1 billion in 2000. The high availability of OxyContin correlated with increased abuse, diversion, and addiction, and by 2004 OxyContin had become a leading drug of abuse in the United States.

.. The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular., In 2001 alone, the company spent $200 million in an array of approaches to market and promote OxyContin.

.. From 1996 to 2001, Purdue conducted more than 40 national pain-management and speaker-training conferences at resorts in Florida, Arizona, and California. More than 5000 physicians, pharmacists, and nurses attended these all-expenses-paid symposia, where they were recruited and trained for Purdue’s national speaker bureau.(p22) It is well documented that this type of pharmaceutical company symposium influences physicians’ prescribing, even though the physicians who attend such symposia believe that such enticements do not alter their prescribing patterns.

..One of the cornerstones of Purdue’s marketing plan was the use of sophisticated marketing data to influence physicians’ prescribing. Drug companies compile prescriber profiles on individual physicians—detailing the prescribing patterns of physicians nationwide—in an effort to influence doctors’ prescribing habits. Through these profiles, a drug company can identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the entire country. One of the critical foundations of Purdue’s marketing plan for OxyContin was to target the physicians who were the highest prescribers for opioids across the country.,, The resulting database would help identify physicians with large numbers of chronic-pain patients. Unfortunately, this same database would also identify which physicians were simply the most frequent prescribers of opioids and, in some cases, the least discriminate prescribers.

.. A lucrative bonus system encouraged sales representatives to increase sales of OxyContin in their territories, resulting in a large number of visits to physicians with high rates of opioid prescriptions

.. In 2001, in addition to the average sales representative’s annual salary of $55 000, annual bonuses averaged $71 500, with a range of $15 000 to nearly $240 000.

.. Purdue paid $40 million in sales incentive bonuses to its sales representatives that year.

.. A consistent feature in the promotion and marketing of OxyContin was a systematic effort to minimize the risk of addiction in the use of opioids for the treatment of chronic non–cancer-related pain.

.. Purdue trained its sales representatives to carry the message that the risk of addiction was “less than one percent.

The Antidote to Steve Bannon

One irony of Washington these days is that a press corps that claims to loathe right-wing political operative Steve Bannon can’t get enough of him. The media broadcast his every utterance, cheering on his declaration of “civil war” against Republicans in Congress.

.. “It’s a symptom of a greater problem. If we don’t cut taxes and we don’t eventually repeal and replace ObamaCare, then we’re going to lose across the board in the House in 2018. And all of my colleagues running in primaries in 2018 will probably get beat. It will be the end of [Majority Leader] Mitch McConnell as we know it.”

..  “Mitch McConnell is not our problem. Our problem is that we promised to repeal and replace ObamaCare, and we failed. We promised to cut taxes, and we’ve yet to do it. If we’re successful, Mitch McConnell is fine. If we’re not, we’re all in trouble, we lose our majority, and I think President Trump will not get re-elected.”

.. Mr. Bannon is recruiting carpetbaggers or multiple-race losers, but they’ll have a chance if Republicans can’t deliver on their campaign promises. Mr. Bannon’s best enablers are the GOP Senators who killed health reform: Susan Collins, John McCain, Rand Paul and Lisa Murkowski. If they want to make Mr. Bannon a kingmaker, they’ll do the same on tax reform.