Mind and Body

Profiles in cowardice

Who’s afraid of saying climate change out loud? How come governors failed to talk about harm reduction as a strategy to fight the ever-increasing death toll from ODs? Why did a state legislative commission enacted in 2016 by the R.I. General Assembly to investigate lead contamination in the state’s drinking water system vanish?

Photo by Richard Asinof

A tree of remembrance at the June 29 event at the First Baptist Church of America in Providence, where families placed butterflies with the names of those who had been lost to overdose deaths, as part of an interfaith service to remember the 1,250 Rhode Islanders who have died from opioid overdoses in the last five years.

Photo by Richard Asinof

Gov. Gina Raimondo signs a new executive order at the July 12 meeting of the Governor's Task Force on Overdose Prevention and Intervention, captured by the Governor's videographer, right, in photographs and video, as Dr. Nicole Alexander-Scott, director of the R.I. Department of Health, and Neil Steinberg, president and CEO of The Rhode Island Foundation look on. Sitting to Raimondo's right is Richard Baum, the acting director of the White House Office of National Drug Control Policy.

By Richard Asinof
Posted 7/24/17
Numerous local digital news platforms in Rhode Island are filling the void left by traditional news outlets in reporting on key issues around climate change, health care, innovation, preventing lead poisoning, and harm reduction strategies to halt the mounting death toll with drug overdoses and the diseases of despair.
If and when the Republican Senate efforts to pass a repeal or a repeal-and-replace Trumpcare fails, how much credit will go the resistance at the local, state and national levels, and will it be covered that way by the traditional news media in Rhode Island? Which reporter will be the first to ask R.I. House Speaker Nicholas Mattiello and Senate President Dominick Ruggerio: what happened to the legislative commission on lead contamination in drinking water? When will Gov. Gina Raimondo include harm reduction strategies as part of her stump speech on OD prevention and intervention? When will “A Lively Experiment” invite ConvergenceRI back on to talk about the diseases of despair and the links to the economic destruction of the middle class?
These days, Gov. Gina Raimondo is faithfully followed around by a more than $60,000 a year videographer, who captures her appearances and then his images are edited into a video feature story, such as the one sent out on July 21, entitled: “Raimondo’s Video Address Touts Rhode Island’s Recovery,” promoting her work “standing up for investments in job training, job placement and education.”
The effort clearly sets up an alternative messaging platform that creates a way for Raimondo to showcase her efforts without having to go through any traditional media filters.
The role of Jon Duffy as a principal behind the nonprofit that was set up to raise money for the National Governors Association summer meeting raises again the question about what his portfolio is – whether official or unofficial – in managing Raimondo’s messaging campaign on a national level.

PROVIDENCE – The numbers are overwhelming. The opioid epidemic engulfing our nation has killed more Americans from overdose deaths in 2016 [more than 59,000] than during the entire Vietnam War [58,220], according to a recent analysis published by The New York Times.

Here in Rhode Island, in 2016, there were 336 deaths from overdoses – more than half involved fentanyl – changing the face of the epidemic.

Research by Syracuse University sociologist Shannon Monnat has found that in Rhode Island, between 2010 and 2014, for white adults between the ages of 25 and 34, some 60 percent of all deaths for that age group and demographic were caused by what she calls the diseases of despair – alcohol, suicide and drugs, the highest such death rate in the nation, according to CDC data.

Translated, Rhode Island led the nation in such deaths of despair. The question is why.

Neil Steinberg, president and CEO of The Rhode Island Foundation, in a recent interview with ConvergenceRI, said the findings seemed to blow up many of the stereotypes about who is using drugs. The fact that the leading killer of white adults 25 to 34 in Rhode Island were diseases of despair, Steinberg continued, “Who the hell is going to guess that?”

“When you talk about the diseases of despair, I want to know: where does the despair come from?” Steinberg said. “I get the disease part. That has a lot of extra pieces that go with it. Are we not doing the right thing in education? Are we not mentoring? Are we not getting people jobs at the right time? Are we not identifying mental health issues?”

Monnat believes that the roots of the epidemic can be found in the economic devastation of the nation’s middle class – what she calls people’s loss of faith that they each occupy an important place in the American system.

The most recent job statistics for Rhode Island released on July 20 seemed to reinforce Monnat’s research: there are more jobs, but not for the middle class, according to reporter Kate Bramson’s analysis in The Providence Journal. “While state leaders [including Gov. Gina Raimondo] hailed Rhode Island’s jobs recovery from the Great Recession,” Bramson wrote, “…it has been fueled in large part by the growth of high-wage and low-wage jobs. Middle-class job recovery is still lagging.”

As Monnat has said: we’re not going to arrest our way or Narcan our way out of the opioid epidemic. But there has been little or no public conversation or media coverage about the connection between the opioid epidemic and the diseases of despair.

To remedy that, ConvergenceRI is making plans to bring Shannon Monnat to Rhode Island to speak at Rhode Island College this fall in October.

The larger question is: when will Rhode Island’s elected officials engage in such a public conversation? Will such a discussion become part of the agenda on the Governor’s Task Force on Overdose Prevention and Intervention? And, poking the bear a bit, when will the traditional news media outlets in Rhode Island do a better job of asking questions and covering the story?

The recent National Governors Association summer meeting in Providence provided a number of incidences of what might be termed profiles in cowardice – the fear of saying climate change out loud, the failure to talk about harm reduction strategies, such as safe injection sites, to halt the surge in deaths from ODs, and the limits of investing in “innovation” in health care.

Instead, it was local online digital news platforms in Rhode Island that led the way. And, ConvergenceRI believes in giving credit to good reporting.

Mercy mercy me, the ecology
As detailed by Tim Faulkner, staff reporter with ecoRI News, a digital news platform that covers what the traditional news media outlets in Rhode Island no longer do, the governors attending the recent National Governors Association, including R.I. Gov. Gina Raimondo, had a difficult time uttering the phrase “climate change” in public.

Perhaps, some may have honestly believed that such an act of political cowardice would hold still the waves of rising ocean waters or somehow keep melting ice covers intact – at least until they left office. Or, perhaps some governors feared that by uttering “climate change” out loud, they might get zapped by ray guns from trolling alt-right social media bots, and their Facebook pages and Twitter handles would suddenly erupt in nasty pustules of hate.

As Faulkner reported, few governors found it worthy enough to attend a session about resilience – one of those words, like “innovation,” that can be used to provide political cover for a multitude of sins. [See link to story below.]

Beyond Faulkner at ecoRI News, more likely the governors realized that no one in the traditional news media was going to hold them accountable for their sins of omission. After all, Canadian Prime Minister Justin Trudeau’s derriere apparently made for a much more compelling front-page story in The Providence Journal.

What is the potential cost of such obfuscation? The latest estimate by the World Health Organization is that climate change will cost between $2 billion and $4 billion a year in direct health costs by 2030. Can you say Zika, malaria, cholera, dengue and yellow fever?

There’s no success like failure, and failure’s no success at all
Equally provocative was the reporting by John McDaid about the National Governors Association meeting, focused on “the crisis in innovation.” The story by McDaid appeared in RI Future, a digital news platform covering Rhode Island with an unabashedly progressive slant – a perspective often missing from the state’s traditional news media outlets and talk shows.

McDaid described how a drone employed to hand the baton of leadership from current NGA Chair Virginia Gov. Terry McAuliffe to incoming NGA Chair Nevada Gov. Brian Sandoval crash landed – a problem that McDaid said was probably the result of too many humans in the drone’s viewing device.

McDaid wrote: “Health care is a prime example of an innovation crisis. While the knee in the curve arguably dates to the late 1800s with the invention of anesthesia and antiseptic technique, the acceleration in the past 50 years has been exponential, as has, not entirely coincidentally, been the cost of delivering these new miracles to a population living 20 years longer than their 1960s counterparts.”

McDaid continued: “[Vice President Mike] Pence’s attack on the [Affordable Care Act] reflects the underlying tension of a 21st-century health care technology landscape yoked to a mid- [20th] century modern insurance and payment model. The only rational way forward is single payer, but there are those pesky human hurdles to overcome.” [See link to story below.]

Much of the focus around health care was the debate around the efforts by Senate Republicans to enact Trumpcare, with its devastating cuts to Medicaid. A more fundamental problem, not discussed at the governor’s meeting, was that the economic model for the health care delivery system, built upon a system of investment in hospitals and ever-escalating medical costs, does not necessarily lead to improved health outcomes or a reduction in health disparities.

The changing methods of reimbursement through global payments to cover a continuum of care across a community of patients, being driven by both Medicare and Medicaid, is disrupting the previous business model of fee-for service. Providers are being asked to assume the financial risk, hospitals are being asked to function as insurers, and crunching the numbers through population health management big data analysis becomes the linchpin of future financial success. Who owns the data in an electronic health record or in wearable device and what is its value? [That’s a story for another day; stay tuned.]

It’s hard to run with the weight of gold/Other hand I’ve heard it said/It’s just as hard with the weight of lead
In her latest in a series of blog posts, entitled “Providence Rules,” Johanna Harris continued her dogged investigation supporting the conclusion that “a significant portion of the lead in Providence tap water is coming from public mains and service lines.” [See link to story below.]

Harris has pursued the details in tenacious, terrier-like fashion, refusing to let go of the facts in her analysis that show the high concentrations of lead in public water sources in Providence.

Once again, it is a story that has, in large part, been ignored by most of Rhode Island’s traditional media outlets and talk shows.

If anything, what has been missing from Harris’s blogs is the broader context of childhood lead poisoning in Rhode Island, something that ConvergenceRI has covered extensively:

The vanished legislative commission, enacted by the R.I. General Assembly in 2016, to be led by former State Rep. Eileen Naughton, to investigate lead contamination in Rhode Island’s water systems. The commission never met, following Naughton’s defeat in the 2016 primary elections.

The continuing research, led by Anna Aizer of Brown University and Janet Currie of Princeton University, which correlated the improvement in third-grade reading scores by African Americans in Providence schools to a decline in levels of childhood lead poisoning. Their most recent research, continuing with the same cohorts, using Rhode Island-specific data, has shown that there is direct correlation between childhood lead poisoning and increases in suspensions and delinquencies in young adults.

If you want to improve third-grade reading scores and decrease delinquency, the best solution may be not in what teachers do or what parents do, but instead in getting rid of lead contamination. Yet Raimondo and her team at the R.I. Department of Education have never responded to one of the co-authors of the initial study, Peter Simon, who sent them copies of the study in September of 2016.

Despite the improvements in prevention of childhood lead poisoning, based upon improved laws and public health interventions, nearly 1,000 children in Rhode Island are newly poisoned by lead each year, sentencing them to the potential of a lifetime of irreversible mental impairment and disability. By comparison, that’s about three times the number of the 336 Rhode Islanders who died from drug overdoses in 2016.

Ellen Liberman of Rhode Island Monthly is said to be busy working on a story for Rhode Island Monthly to be published in September that may or may not connect the dots. It would be a nice surprise if Liberman gave credit in her story to the body of work published by ConvergenceRI in the last two years. [See links below to ConvergenceRI stories.]

I am as constant as a northern star/And I said, constantly in the darkness/Where's that at?

It was remarkable that this year’s summer meeting of the National Governor Association held a featured discussion, “Curbing the Opioid Epidemic: A discussion with governors on the front lines.”

The discussion, which featured Mass. Gov. Charlie Baker, N.C. Gov. Roy Cooper, R.I. Gov. Gina Raimondo, Richard Baum, interim director of the Office of National Drug Control Policy, as well as remarks by William C. Bell, president and CEO of Casey Family Programs, and Dr. Michael McGinnis, executive of the National Academies of Medicine, drew an overflow crowd of local and national news media.

The governors admitted that their results in fighting the epidemic have been, to date, meager. But, just as with their inability to say the phrase “climate change” out loud, none of the governors spoke about harm reduction as a strategic policy initiative to pursue, particularly as fentanyl has emerged an increasingly potent factor in the rising death toll.

What are harm reduction strategies? They include the creation of safe injection sites, and the ability for active users to test their product to determine if it contains fentanyl, by distributing fentanyl testing strips along with Narcan.

The conversation is ongoing nationwide, even if it was not discussed by the governors. On July 13, the opening day of the National Governors Association summer meeting in Providence, Dr. Leana Wen, the Baltimore health commissioner, tweeted: “With safe injection sites, needle exchanges, and fentanyl testing, the point is to save lives, not to encourage drug use. #opioid crisis”

As Monica Smith, executive director of RICARES, a recovery community advocacy group, told ConvergenceRI in a recent interview: One idea to talk about is whether or not to create a safe space in Rhode Island for illicit drug users to test for the presence of fentanyl, similar to the pilot program to test illicit drugs at Vancouver, British Columbia’s supervised-injection site. Vancouver Coastal Health began offering its Insite clients fentanyl test strips in July of 2016, enabling them to find out, within a minute, whether there is fentanyl in the drug they are about to inject, according to CBC News. As a result, clients are 25 times less likely to overdose, according to Mark Lysyshyn, a medical health office with Vancouver Coastal Health, according to a May 15 story by reporter Matt Meuse.

About 80 percent of the samples tested positive for fentanyl, according Lysyshyn. The limitations of the inexpensive test strip, which cost about $1, were that they currently test for the presence of fentanyl but not the amount. The strips are also not able to test for the presence of fentanyl analogues, such as carfentanil, many times more potent than fentanyl.

Lysyshyn told Meuse that the next steps for his team at Vancouver Coastal Health include getting more people to test their drugs before consumption, and to work with the strip vendor to improve the test for fentanyl analogues. Lysyshyn also said that they are exploring the possibility of using the testing strips outside of the safe injection site, in coordination with the health authority’s take-home naloxone program.

For the record, one of 20 items in a new executive order signed by Gov. Gina Raimondo on July 12 and diligently recorded by her videographer for posterity, under the topic of “Rescue,” was to ask the staff at the R.I. Department of Health and the R.I. Department of Behavioral Healthcare, Developmental Disabilities and Hospitals to propose a comprehensive harm reduction strategy for intravenous drug users “to decrease the risk of overdose, infection and assault” by November.

Yet, for whatever reasons, harm reduction efforts were not brought up by Raimondo during her participation in the dialogue with the other governors, nor was it brought up in the media scrum following the event.

Instead, Raimondo repeated the same story she told at the July 12 meeting of the Governor’s Task Force on Overdose Prevention and Intervention, about how a local business owner had to rescue his son from an overdose in a men’s room, as an example of how the epidemic had touched so many lives.


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