Azimuthal is a type of map. (Wiki) Argentina has 13 bases in Antarctica (6 permanent ones, 7 seasonal ones), with 230 people living in the 6 permanent ones, and one of only two civilian settlements on the continent (Chile supports the other one). (Wiki)
That’s the subject of my weekend column over at RealClearHistory. The riots are all, by far, due to racism and nativism, but for some strange reason labor’s riots in the late 19th century get the lion’s share of the spotlight in history textbooks.
An excerpt:
6. Memphis, May 1-3, 1866. Another post-Civil War riot, the Memphis unrest was more violent and more organized than the brawl in New Orleans. Like N’awlins, Memphis was a Southern city long under Union occupation, but unlike the port city, Memphis had a large immigrant population of Irishmen who were in direct economic, political, and social competition with recently freed blacks. The Irish had such a large population in Memphis that they were able to take control of many levers of local government once Union troops banned native whites from holding office (for being Confederates), and the new group on the block was none too kind to the recently freed black population. Forty-eight people lost their lives, but the burning of homes (often with black families still inside of them) and churches, the raping of black women, and the fact that no prosecutions were carried out meant that Memphis would remain a hotbed of white supremacy for another century. (The riot enraged much of the Union, however, and led to a sweeping victory for Republicans later that year. The GOP quickly passed the First Reconstruction Act in 1867.)
Please, read the whole thing.
I’ve never been to Memphis, but it’s a city with good hip-hop music and good BBQ. Someday I’ll get up there for a long weekend or something.
That’s the title of my Tuesday column over at RealClearHistory. An excerpt:
The relevant socio political commentary is more interesting, in part because people today still use the film to attack media moguls they don’t like (such as Fox News’ Rupert Murdoch). One narrative about the film’s sociopolitical impact even likens the film to a subtle anti-fascist, and pro-war, production because of the attention it draws to the immense power media moguls wield, and the incentive structures they face (and produce). This argument has at least some bite to it, as one of America’s most powerful media moguls in the 1940s, William Randolph Hearst, refused to give the film any sort of advertisement in any of his many publications. This blackballing on the part of the powerful led, of course, to the Citizen Kane’s relative flop at the box office.
Read the rest, baby!
It seems that many observers believe that Brazil’s current political situation is one of instability and uncertainty. Since the mid-1990s the national political scene has been dominated by two parties: the Worker’s Party (Partido dos Trabalhadores, PT, in Portuguese) and PSDB. Now, with the main leader of the PT imprisoned – former president Lula da Silva – the PSDB also seems to have lost its rationale. It is clear that this party never had faithful voters, only an anti-PT mass who saw in it the only viable alternative. Given these factors, it is true that a political cycle that began in the 1990s is coming to an end, but far from being a moment of uncertainty and pessimism, this may be the most fruitful moment in the country’s history, as it seems that finally classical liberalism is being vindicated in Brazil.
Brazil began its political history as a semi-parliamentary monarchy. As one observer of the time put it, the country had a “backward parliamentarism”: instead of parliament controlling the monarch, it was the emperor who controlled parliament. Moreover, the Brazilian economy was extremely based on slavery. In theory, Brazil was politically and economically a liberal country. In practice, it was politically and economically a country controlled by oligarchies.
With the proclamation of the republic in 1889, little changed. The country continued to be theoretically a liberal country, with a constitution strongly influenced by the North American one and a tendency to industrialization. In practice, however, Brazil continued to be politically and economically dominated by oligarchic interests.
The republic instituted in 1889 was overthrown in 1930 by Getúlio Vargas. Vargas was president from 1930 to 1945, and his political circle continued to dominate the country until 1964. Once again, political language was often liberal, but in practice the country was dominated by sectorial interests.
Vargas committed suicide in 1954, and his political successors failed to account for the instability the country went through after World War II. The Soviet Union had been trying to infiltrate Brazil since the 1920s, and this was intensified with the Cold War. The communist influence, coupled with the megalomaniacal administrative inability of Vargas and his successors, led the country to such an instability that the population in weight clamored for the military to seize power in 1964.
The military that governed Brazil between 1964 and 1985 were influenced mainly by positivism. In simple terms, they were convinced they could run the country like a barracks. For them, the motto “order and progress” written on the Brazilian flag was taken very literally. One great irony in this is that Auguste Comte’s positivism and Karl Marx’s communism are almost twin brothers, products of the same anti-liberal mentality of the mid-19th century. The result was that Brazilian economic policy for much of the military period was not so different from that of the Soviet Union at many points in its history: based on central planning, this policy produced spectacular immediate results (the period of the “Brazilian miracle” in the early 1970s), but also resulted in the economic catastrophe of the 1980s.
However, the worst consequence of the military governments was not in the economy but in the political culture. The military fought against communism in a superficial way, overpowering only the guerrillas and terrorist groups that engaged in armed struggle. But in the meantime, many communists turned to cultural warfare, joining schools, universities, newsrooms, and even churches. The result is that Brazilian intellectual life was taken over by communism.
Fernando Henrique Cardoso, elected president in 1994, is an important Brazilian intellectual. Although not an orthodox Marxist, his lineup is clearly left-wing. The difference between FHC (as he is called) and a good part of the Brazilian left (represented mainly by the PT) is that he, like Tony Blair in England and Bill Clinton in the US, opted for a third way between economic liberalism and more explicit socialism. In other words, FHC understood, along with leading PSDB leaders, that the Washington Consensus is called a consensus for good reason: there is a set of economic truths (pejoratively called neo-liberals) that are no longer the subject of debate. FHC followed these ideas, but he was heavily opposed by the PT for this.
Since the founding of the PT, in the late 1970s, Lula’s speech was quite radical, explicitly wishing to transform Brazil into a large Cuba. But Lula himself surrendered to the Washington Consensus in the early 2000s, and only then was he able to be elected president. Once in office, however, Lula commanded one of the greatest corruption scandals in world history. In addition, his historical links to the left were never erased. Although in his first term economic policy was largely liberal, this trend changed in his second term and in the presidency of his successor, Dilma Rousseff.
Today Brazil is still living in an economically difficult period, but an ironic result of more than a decade of left-wing government (especially the PT) is the strengthening of conservative and libertarian groups in Brazil. In the elections from 2002 to 2014 it was virtually impossible to identify candidates clearly along these lines. In this year’s election, we expected several candidates to explicitly identify themselves as right-wing. Jair Bolsonaro, the favorite in contention, is not historically a friend of the free market, but his more recent statements demonstrate that more and more he leans in this direction.
It is possible that in 2018 Brazil will not yet elect an explicitly libertarian president. But even so, the economic transformations initiated by FHC seem now to be vindicated. Only with the strengthening of the Internet did Brazilians have real access to conservative and libertarian ideas. With that, one of the most important political phenomena in Brazil in the last decade is the discovery of these ideas mainly by young people, and it is these young people who now cry for a candidate who defends their ideas. Bolsonaro seems to be the closest to this, although there are others willing to defend similar economic policy. After more than a decade of governments on the left, it seems that Brazil is finally going through a well-deserved right turn.
That’s the subject of my weekend’s RealClearHistory column. An excerpt:
7. Romania and the Iron Guard. Sandwiched between the communist Soviet Union and the fascist Axis powers of central Europe, Romanian society struggled to find its footing after a comparatively wonderful campaign during World War I, but Bucharest eventually chose to side with Berlin and Rome instead of Moscow. Romanian fascism was known for including the Orthodox Church into its anti-communist, anti-Semitic, and anti-capitalist rhetoric. Romania’s fascists almost made the Nazis look like boy scouts, especially when the Iron Guard organized and implemented one of Europe’s bloodiest pogroms, ever: the Iași pogrom. Just over 13,000 Jews, along with their liberal and Orthodox defenders in the city of Iași, were butchered on the streets where they once plied their trades. Romania, a member of the Axis for most of the war, was second only to Germany in the number of Jews it killed during World War II.
Please, read the rest.
Oh, and I wrote about America’s greatest maritime disaster on Tuesday for RCH‘s blog, the Historiat.
That’s the title of my weekend column over at RealClearHistory. Check it out:
5. The continued quartering of British soldiers. Imagine, for a moment, an Iraqi household being forced to give room and board to an American or a Polish soldier in 2005. That’s not quite what happened in the North American colonies but it’s not a far cry, either. The colonists of North America considered themselves to be British subjects of the Crown, and most were proud to be. (In fact, a little further down the list, you’ll see why the Americans, as rebels, were so adamant about liberalizing citizenship laws.) A much better analogy would be to imagine the LAPD or the Texas National Guard forcing households to give quarter to soldiers. The analogy is better, but the picture is still a frightening one.
Please, read the rest. The other 9 are also good. Heck, you might even learn something new…
The problem with Brazil is not Luis Inacio Lula da Silva. It’s not the Worker’s Party. It’s not Socialism.
Certainly one of the most important politicians in Brazilian History was Getulio Vargas. Vargas came to power in a coup (that symptomatically most Brazilian historians call a revolution) in 1930. He ended up staying in power, without ever being elected by popular vote, until 1945. Then he peacefully resigned, not without electing his chosen successor, Eurico Gaspar Dutra. Vargas came back to power immediately after Dutra, and committed suicide while in office. Almost all Brazilian presidents from 1945 to 1964 were from Vargas’ close circle.
Brazilians to this day are still taught that Vargas was a hero, persecuted by an evil opposition. Initially, Vargas was some kind of Brazilian positivist. He was anti-liberal because liberalism is weak and slow. We need a strong technical government, able to identify problems and come with solutions fast. However, while in office, he became “the father of the poor,” a defensor of the lower classes. Nothing could be farther from the truth, of course, but that’s how Vargas is remembered by many.
One of my favorite interpretation of Brazil comes from Sergio Buarque de Holanda. According to Holanda, the problem with Brazil is that Brazilians are cordial. What he means by that is this: using Weber’s models of authority, he identified that Brazilians were never able to support a Legal-Rational authority. Vargas was seen as “a father.” not a president. The country is seen as a big family. Lula used a very similar vocabulary and tried to reenact Vargas’ populism.
As I mentioned, Holanda’s interpretation is Weberian. Weber’s most famous book is The Protestant Ethic and the Spirit of Capitalism. The problem with Brazil is that it never went through a protestant reformation. And because of that, it never developed the “spirit of capitalism” that Weber describes. Brazil is still, to a great degree, stuck with traditional and charismatic forms of authority.
To be sure, Brazil has many features of a modern liberal state. Since late 18th century Portugal tried to copy these from more advanced nations, especially England. Brazil followed suit. But you can’t have the accidents without the substance. Unless Brazil actually goes through a transformation in its soul, it will never become the modern liberal state many want it to be. Quoting Domingo Faustino Sarmiento, “An ignorant people will always choose Rosas.”
Seems to me that there is a strong tendency between contemporary Brazilian conservatives to consider the Brazilian Empire (1822-1889) a golden age in Brazilian history. Many Brazilian conservatives are now defending the monarchy as an ideal form of government for Brazil.
As someone said, “the more we change, the more we remain the same.” Brazil became independent from Portugal in 1822. The independence was officially proclaimed by Dom Pedro I, son of Dom João VI, the king of Portugal. I think that maybe Brazilians are so acquainted with this fact that they don’t realize how crazy it is: the prince of Portugal declared the independence of Brazil! That didn’t happen because Dom Pedro fought with his father. By all accounts, father and son enjoyed the best relationship possible. Dom Pedro declared Brazil’s independence because if he didn’t, someone else would.
Dom Pedro’s independence was just one among many others. Tiradentes tried to proclaim the independence of [at least part of] Brazil in 1789, basically 30 years before Dom Pedro! And this is just one example! Tiradentes independence was not successful because it was averted by Portugal. Dom Pedro’s independence was successful because he was Portugal (ok, he wasn’t Portugal, but he was part of it)!
The fact that Brazil’s independence was proclaimed by a Portuguese monarch gives a very special meaning to what means to be conservative in Brazil. Today, in the US, one may call himself a conservative because he defends the ideas of Thomas Jefferson. But in his day Thomas Jefferson was a radical! A rebel who revolted against the British monarchy. Dom Pedro was not exactly a rebel. He wanted, to a great degree, to maintain things just the way they were. Certainly, many of his supporters were afraid of a more radical independence movement. To say the least, Brazil’s independence was a compromise between radicals and conservatives.
Brazilian monarchy avoided many reforms, inspired by classical liberalism, that were happening in other places. To give just one example (in my personal view, the most glaring), Brazil was the last country in the Western Hemisphere to abolish slavery (in 1888). I don’t blame Dom Pedro I for this. I also don’t blame his son, Dom Pedro II, who ended up being emperor for the majority of the monarchical period (1840-1889). But the fact is that the monarchy maintained many of the privileges inherited from Portugal, and avoided reforms that Anglo-American conservatives would support.
Brazilian conservatives have to be careful with the use of this word. To be a conservative in Brazil is not necessarily the same as being a conservative in England or the US.
The line is often heard: economists are “scientific imperialists” (i.e. they seek to invade other fields of social science) jerks. All they try to do is “fit everything inside the model”. I have this derisive sneer at economists very often. I have also heard economists say “who cares, they’re a bunch of historians” (this is the one I hear most often given my particular field of research, but I have heard variations involving sociologists and anthropologists).
To be fair, I never noticed the size rift. For years now, I have been waltzing between economics and history (and tried my hand at journalism for some time) which meant that I was waltzing between economic theory and a lot of other fields. The department I was a part of at the London School of Economics was a rich set of quantitative and qualitative folks who mixed history of ideas, economics, economic history and social history. To top it all, I managed to find myself generally in the company of attorneys and legal scholars (don’t ask why, it still eludes me). It was hard to feel a big rift in that environment. I knew there was a rift. I just never realized how big it was until a year ago (more or less).
There is, however, something that annoys me: the contempt appears to be self-reinforcing. Elsewhere on this blog (here and here) (and in a forthcoming book chapter in a textbook on how to do economic history), I have explained that economists have often ventured into certain topics with a lack of care for details. True, there must be some abstraction of details (not all details are useful), but there is an optimal quantity of details. And our knowledge grows, the quantity of details necessary to answering each question (because the scientific margin is increasingly specialized) should grow. And so should the number (and depth) of nuances we make to answer a question. There is a tendency among economists to treat a question outside the usual realm of economics and ignore the existing literature (thus either rushing through an open door or stepping in a minefield without knowing it). The universe is collapsed into the model and, even when it yields valuable insights, other (non-econs) contributors are ignored. That’s when the non-econs counter that economists are arrogant and that they try to force everything into a mold rather than change the mold when it does not apply. However, the reply has often been to ignore the economists or criticize strawmen versions of their argument. Perceived as contemptuous, the economists feel that they can safely ignore all others.
The problem is that this is a reinforcing loop: a) the economists are arrogant; b) non-economists respond by dismissing the economists and ridiculing their assumptions; c) the economists get more arrogant. The cycle persists. I struggle to see how to break this cycle, but I see value in breaking it. Elsewhere, I have made such a case when I reviewed a book (towards which I was hostile) on Canadian economic history. Here is what I said for the sake of showcasing the value of breaking the vicious circle of ignoring both sides:
These scholars (those who have been ignored by non-economists) could have easily derived the same takeaways as Sweeny. Individuals can and do engage in rent-seeking, which economists define as the process through which unearned gains are obtained by manipulating the political and social environment. This could be observed in attempts to shape narratives in the public discourse. According primacy to the biases of sources is a recognition that there can be rent-seeking in the form of actors seeking to generate a narrative to reinforce a particular institutional arrangement and allow it to survive. This explanation is well in line with neoclassical economics.
This point is crucial. It shows a failing on both sides of the debate. Economists and historians favorable to “rational choice” have failed to engage scholars like Sweeny. Often, they have been openly contemptuous. The literature has evolved in separate circles where researchers only speak to their fellow circle members. This has resulted in an inability to identify the mutual gains of exchange. The insights and meticulous treatments of sources by scholars like Sweeny are informative for those economists who consider rational choice as if the choosers were humans, with all their flaws and limitations, rather than mechanistic utility-maximizing machines with perfect foresight (which is a strawman often employed to deride the use of economics in historical debates) . In reverse, the rich insights provided by rational choice theorists could guide historians in elucidating complex social interactions with a parsimony of assumptions. Without interaction, both groups loose and resolutions remain elusive.
See, as a guy who likes economics, I think that trade is pretty great. More importantly, I think that trade between heterogeneous groups (or different individuals) is even greater because it allows for specialization that increases the value (and quantity) of outputs. I see the benefits of trade here, so why is this “circle of contempt” perpetuating so relentlessly?
Can’t we just all pick the 100$ bill on the sidewalk?
The first academic paper I ever published was about Brazil-Africa Relations, approximately from the 1960s to the 2000s. The main point of the article was to compare three moments of Brazilian Foreign Policy Towards Africa: the Independent Foreign Policy of the Early 1960s; the Foreign Policy of the latter Military Governments (late 1970s) and the Foreign Policy of the Lula administration (2003-2011). My main conclusion was that the foreign policy towards Africa of these three moments was very similar. Although some would exalt Lula’s foreign policy as something extraordinary, the truth, as I saw it, was that it was very well grounded in a tradition of Brazilian Foreign Policy.
Today I feel somewhat ashamed of that paper. I failed to highlight the irony: the leftist government of Lula had a foreign policy strikingly similar to that of the (supposedly) far-right military regime. The information, to be sure, is all there. One has simply to come to this obvious conclusion.
The foreign policy of Lula and Dilma was indeed very similar to that of Ernesto Geisel and João Batista Figueiredo, the last two generals to be presidents of Brazil, and not only regarding Africa. Dilma’s economic policy was extremely similar to that of Geisel, the same policy that, by the way, led Brazil to the hyperinflation of the 1980s and early 1990s.
It is definitely ironic. The Workers Party began as an opposition to the military government in Brazil. Dilma was a terrorist guerrilla warrior who fought against that regime (and never publicly apologized for that). However, once in power, they became very similar to their enemies. I’ll leave the readers to come to their own conclusions about this. But regarding Africa: I wasn’t able to continue my research. But I’m still very interested in that continent. Brazil is geographically and culturally very similar to many African nations. I believe there are great opportunities for mutual aggrandizement. But “mutual” is not what I saw in my research. I saw Brazil being hypocritical: The US is (in the sick mind of some leftist Brazilian politicians and diplomats) imperialist towards Brazil; therefore, Brazil will be imperialist towards Africa. I hope that a more market-friendly Brazil will be able to do something different.
That’s the title of my weekend piece over at RealClearHistory. The structure of the pieces, if you’ll remember, is Top 10 style, but I try to throw some more in-depth stuff into the mix, too. An excerpt:
3. World War I showed the world what a united Germany could do. Germany was formed in 1871, making it almost 100 years younger than the United States and much younger than France and the United Kingdom. Prior to the formation of Germany, which came about due to Prussian diplomat Otto von Bismarck’s genius machinations, observers and thinkers throughout the world penned works speculating on what a unified German-speaking world would do, politically, economically, culturally, and militarily. Rome’s decentralized barbarian enemies were from Germania, the Holy Roman Empire (which was neither Holy nor Roman nor an Empire), the Hanseatic League, and the German Confederation which all tried, in vain, to do what Bismarck did. Many of the attempts to unite Germany were foiled by French, British, Austro-Hungarian, and Russian statesmen because of fears that a united Germany would come to dominate Europe and upset the balance of power that European elites had come to rely on as their foreign affairs blueprint. They weren’t wrong.
Please, read the whole thing.
I was fortunate to be invited give the Epstein Lecture at LSE this March. The series is named after the great LSE economic historian Larry (Stephen) Epstein. Here I’ll summarize why it was such an honor to give the lectures. The content of the lecture will be another post.
Epstein was a historian whose origin field of expertise was medieval Italy. I encountered him through Freedom and Growth. Published in 2000, I first read it a couple of years later, perhaps in 2002 or 2003. At the time I was devoted to a story of economic growth shaped by Douglass North, particularly Structure and Change in Economic History (1981).
The focus of Structure and Change was on transaction costs. High transaction costs limited market exchange and kept societies poor for most of history. Sustained economic growth could only occur once transaction costs fell to a level that allowed markets to expand and the division of labor to develop. On this view, market expansion or Smithian growth was itself a stimulus to technological innovation. But what kept transaction costs high?
One answer North gave was the state. To paraphrase: the state had the ability to both keep a society mired in poverty through predatory behavior and to provide the preconditions for growth by securing property rights. The origins of sustained economic growth for North lay in institutional changes that occurred secured property rights and lowered transaction costs. The most important such institutional change was the Glorious Revolution of 1688.
North’s account received many challenges, but the issue that Epstein honed in on was the assumption that there was such a state, able to either revoke or secure property rights. It was assumed that “rulers rule”. Epstein contested this arguing that New Institutional Economists
“project backwards in time a form of centralised sovereignty and jurisdictional integration that was first achieved in Continental Europe during the nineteenth century; they therefore fundamentally misrepresent the character of pre-modern states.”
North, Wallis, and Weingast would address this in their 2009 Violence and Social Orders. But Epstein’s criticism was spot on in 2000. Epstein argued that alongside the problem of predatory states, a central problem was the lack of integrated markets. He attributed market disintegration to coordination and prisoners’ dilemma problems between political authorities. In so doing, Epstein set the agenda for the subsequent “state capacity” research agenda.
Epstein made several points which continued to be expanded upon by current research (see here). First, he documented that the lower interest rates that the British state paid after 1688 were characteristic of city republics from the middle ages onwards. He argued that the English monarchy in the 17th century was characterized by an anomalously backwards financial system. Lower interest rates after 1688 partly represent a convergence to the Republican norm achieved by Italian city-states centuries earlier.
Second, he challenged the argument that monarchies “overtaxed” cities. There was “no evidence that townspeople paid higher taxes under monarchies than republics”. Per capita taxes were likely higher in Republican city-states.
Third, he disputed that Republican city-states like Florence brought economic freedom noting that “republican subjects faced several limitations to their economic and political freedoms that monarchical subjects did not”. All of this challenged generalizations made by historical sociologists like Charles Tilly and economic historians like North.
Epstein’s historical evidence came from medieval Italy. Late medieval Italy was highly urbanized and prosperous by pre-industrial standards. According to Broadberry’s estimates, per capita GDP in Italy in 1450 was not matched by England until 1750. Like growth elsewhere in the premodern world, it was Smithian growth, driven by trade, market integration, and the division of labor. But unlike in England, this Smithian growth did not continue and blossom into modern growth. Epstein’s explanation for why this did not take place was that late medieval Italy suffered an “integration crisis”.
He saw the late medieval period as characterized by new opportunities for growth and innovation. Urbanization increased. Capital markets expanded and deepened. Interregional trade developed. Proto-industrialization took place. But Epstein contended these opportunities were only seized in areas where political authority was centralization.
In reference to proto-industrialization, he observed that
“Crucially, the success of regional crafts was inversely proportional to the concentration of economic and institutional power in the hands of a dominant city.”
With respect to the establishment of permanent fairs, he noted that
In fifteenth-century Lombardy, new fairs proliferated only after the balance of power shifted decisively from the former city-states to the territorial prince with Francesco Sforza’s victory in 1447.
Market integration was complemented and perhaps driven by political integration. Integrated urban hierarchies were themselves the product of political centralization.
“Centralisation underlies all the major institutional changes to market structures previously described. It lowered domestic transport costs, made it easier to enforce contracts and to match demand and supply, intensified economic competition between towns and strengthened urban hierarchies, weakened urban monopolies over the countryside, and stimulated labour mobility and technological diffusion.”
The more centralized parts of Italy — notably Lombardy — were better able to benefit from these trends than was Tuscany. But in general, political fragmentation and regional diversity were “distinctive features of pre-modern Italy” in general and an impediment to its long-run growth prospects.
Unlike in his analysis of interest rates, Epstein brought little data to bear on these claims and I am unaware of subsequent research on late medieval Italy. As such, the thesis of a late medieval integration crisis laid out in Freedom and Growth remains speculative. Epstein would no doubt have fill in the details had he lived longer. Subsequent research has mostly focused on early modern rather than medieval Europe (see here). But the larger message: the importance of the state for premodern economic development has been central to subsequent research, including my own work (e.g. here).
I think the border dates for Europe are a disingenuous in places, such as the Czech Republic’s 1459 border with Germany (neither of these two countries existed then) and the borders of the Balkan states (Yugoslavia?). Other than a few discrepancies here and there, it’s a pretty cool map. (h/t Bill Easterly)
Given Zachary’s post on the drug war and opioid crisis, I thought I would share parts of an essay I wrote for a class last semester about Trump’s commission on opioids, which is the first policy step the new administration took in dealing with the issue. It’s edited for links and language and whatnot.
One of the more recent executive steps to combat the opioid crisis — the “abuse” of prescription and illegal opioid-based painkillers — was the creation of The President’s Commission on Combating Drug Addiction and the Opioid Crisis (hereafter, the Commission) two years ago by the Trump administration. The commission, led by Chris Christie, was instituted to investigate the issue further and produce recommendations for the government and pharmaceutical industry. It released its final report in November and seems set to work on opioid use with the same sort of strategies the federal government always treats drugs, except maybe a little more progressive in its consideration of medicinal users. Looking at the Commission’s report, I argue that a refusal to treat unlike cases dissimilarly will lead to less than effective policy.
The President’s Commission
The DEA first asserted that overdose deaths from opioids had reached an epidemic in 2015. In March of last year, Donald Trump signed an executive order establishing the policy of the executive branch to “combat the scourge of drug abuse” and creating The President’s Commission. The Commission is designed to produce recommendations for federal funding, addiction prevention, overdose reversal, recovery, and R&D. Governor Chris Christie of New Jersey served as Chairman alongside Gov. Charlie Baker (R-MA), Gov. Roy Cooper (D-NC), representative Patrick J. Kennedy (D-RI), former deputy director of the Office of National Drug Policy and Harvard professor of psychobiology Bertha Madras, and Florida Attorney General Pam Bondi.
Included in the final report is a short history of opioid use in the United States, characterized by a first crisis in the mid- to late-19th century of “unrestrained … prescriptions,” eventually reversed by medical professionals “combined with federal regulations and law enforcement.” A public distrust of opioids developed afterward, but this was “eroded,” and now the new crisis, traceable to 1999, has become more perilous by innovations since the 19th century: large production firms for prescription drugs, a profitable pharmaceutical industry, cheaper and purer heroin, new fentanyl imports from China.
Since the Commission’s report, several bills have been introduced in the House or Senate currently awaiting judgment (e.g., H.R.4408, H.R.4275, S.2125). Declaring widespread addiction and overdoses to be a national emergency in August, Trump fulfilled one of the interim steps proposed by Christie in an early draft of the report; since, the President has met with drug company executives to discuss nonopiate alternatives for pain relief. Within the next few months we should start to see large scale moves.
Through all of this, the treatment of opioids by the Commission and the US government uses a traditional framing. The National Institute on Drug Abuse (NIDA) defines drug abuse in the following way:
[Use of substances] becomes drug abuse when people use illegal drugs or use legal drugs inappropriately. This includes the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality. It also includes using prescription drugs in ways other than prescribed or using someone else’s prescription. Addiction occurs when a person cannot control the impulse to use drugs even when there are negative consequences—the defining characteristic of addiction.
This definition by the federal government does not discriminate between various levels of damaging consumption behavior. The weakness of this definition is that, because all illicit drug consumption is categorized as abuse, there can be no standard for misuse of a black market drug for recreation. An entry-level dose of heroin qualifies as equally “abusive” as a lethal dose because of the binary character of the definition. Other federal agencies give similar definitions; in its report on recommendations for abuse-deterrent generic opioids (see below), the HHS and FDA use a definition of abuse characterized by the “intentional, nontherapeutic use of a drug product or substance, even once, to achieve a desired psychological or physiological effect.” This terminology still characterizes any and all recreational consumption of opioid analgesics as abuse, and not misuse, regardless of dosage or long-term dependency. It will be seen that this is a problem for the success of any sort of policy aimed at quelling usage, and particularly hazardous for the opioid problem.
Legal Background
First, the legal background and a more extensive history. The category “opioid” covers much drug terrain both prescription and illegal. Opioids in the most expansive sense are synthetic derivatives of alkaloids in the opium of the West Asian poppy species Papaver somniferum. Opium resin contains the chemicals morphine, codeine and thebaine. Morphine is the basis for powerful pain relievers like heroin and fentanyl. Codeine is considered less powerful for pain relief but can be used to produce hydrocodone; it also doubles as a cough suppressant. Lastly, thebaine is similar to morphine and is used for oxycodone. 90% of the world’s opium production is in Afghanistan.
All opioids are criminalized under federal Drug Scheduling. Heroin is a Schedule I drug as part of the Controlled Substances Act. Several synthetic opioid drugs that contain hydro- or oxycodone are Schedule II (Vicodin, Dilaudid, OxyContin). Fentanyl is also a Schedule II drug. Heroin is just a brand name for the chemical diacetylmorphine (invented by Bayer), still used as treatment in plenty of developed nations like the United Kingdom and Canada; after heroin was completely criminalized in the United States (“no medical benefits”), synthesized opiate drugs became more popular for prescriptions.
The Pure Food and Drug Act of 1906 introduced labels on medicine containing codeine and opium in general after Chinese immigrant workers introduced the drug to the states. Through 1914, various federal laws restricted opium further until the Harrison Narcotics Tax Act on opium and coca products (which are not narcotics, and the colloquial language has been messed up ever since) effectively criminalized the prescription of opioid products to addicted patients. Shortly afterward, the amount of heroin in the U.S. skyrocketed. Only in recent decades have synthesized opiates occupied the public mind, however. Between 1999 and the present, deaths from overdoses of opioids and opioid-based painkillers like OxyContin, Vicodin, morphine and street heroin have risen almost fourfold.
The data on overdoses and deaths does not paint a straightforward picture, and the group “opioid” obscures the different trends between drugs. The CDC classifies data according to four varieties of opioids: natural/semi-synthetic opioid analgesics like morphine, codeine, oxy- or hydrocodone, and oxy- or hydromorphone; synthetic opioid analgesics like tramadol and fentanyl; methadone; and heroin. The last is the only completely illegal opioid. Overdose deaths that have included heroin and completely synthetic opioids have increased exponentially from 2010 and 2013, respectively, while deaths from natural/semi-synthetic opioids and methadone have roughly stabilized or gone down over the last decade. Taken altogether, the deaths from opioid overdoses per 100,000 from 2000 to 2015 have increased from three to eleven people. (As of 2016, natural/semi-synthetic opioid deaths have actually started to go up again, but its still recent in the trend.)
In 2016, the CDC issued guidelines for treating chronic pain that warned physicians against prescribing high dose opioids and suggested talking about health risks. It also advised to “start low and go slow” — a slogan later mocked by John Oliver in a segment on opioids. And, according to a CDC analysis, prescriptions for the most dangerous opioids have dropped 41% from 2010 to 2015, and so have opioid prescriptions in general dropped. This has resulted in patients with physical dependency suffering withdrawal, often without programs to ease the transition to nonopioid pain relievers. Opioid dependants with withdrawal, or average citizens in need of pain relief, often turn to stronger street narcotics, since heroin is the cheaper and stronger alternative to oxycodone. For example, with the drop in first-time OxyContin abuse since 2010, heroin use has spiked. In Maine, a 15% decrease in opioid analgesic overdoses came with a 41% increase in heroin overdoses in 2012. The use of prescribed opioids, then, looks like it might be strongly connected to the use of street narcotics. The Commission, for its credit, notes that “the removal of one substance conceivably will be replaced with another.”
One fact lost in the discussion is that the use of nonmedical opioids has decreased but the amount of overdose deaths has increased. And “opioid epidemic” when discussing overdoses highly obscures that heroin is the major contributor alongside fentanyl — not merely prescription analgesics. We hear a lot about OxyContin and Vicodin, which are actually leveling out (or were until 2015), and less about the drugs which are already policed more, have been policed longer, and cause more physical problems.
What the Commission proposes
In its report, the Commission concludes the goals of its recommendations are “to promote prevention of all drug use with effective education campaigns and restrictions in the supply of illicit and misused drugs.” The President’s Commission doesn’t want to interfere too strongly, despite all of Trump’s suggestions of a revamped drug war. The report notes that coming down hard on opioids will hurt patients with real needs, as has already happened, and, in a way, has happened since 1924. Much of the Commission’s recommendations come from a market approach, e.g. the suggestion (Rec. 19) to reimburse nonopioid pain treatments. The current Centers for Medicare and Medicaid Services (CMS) policy for reimbursement for healthcare providers treats nonopioid, postsurgical pain relief treatments the same as opioid prescriptions, issuing one inclusive payment for all “supplies” at a fixed fee. Nonopioid medications and treatments cost more, and so hospitals opt for dispensing opioids instead. The Commission recommends “adequate reimbursement [for] a broader range of pain management” services, changing the bundle payment policy to accommodate behavioral health treatment, educational programs, “tapering off opioids” and other nonopioid options.
Trump himself suggested an educational approach in a public announcement, which triggered critical comparisons to the failed D.A.R.E. program and “your brain on drugs” commercials. Educational programs are a less coercive option than direct regulation of opioids, but their effectiveness seems to be hit and miss. The Commission cites the Idaho Meth Project from 2007 (ongoing), conducted by a private nonprofit to inform young adults on the health problems associated with methamphetamine use, as a success story: “The Meth Project reports that 94% of teens that are aware of the anti-meth campaign ads say they make them less likely to try or use meth, and that Idaho has experienced a 56% decline in teen meth use since the campaign began.” This meth project is one success story out of many failures. For instance, the Montana Meth Project from 2005, on which the Idaho project was modelled, “accounting for a preexisting downward trend in meth use,” was determined to have “effects on meth use [that] are statistically indistinguishable from zero,” according to an analysis by the National Library of Medicine. Then again, one large scale anti-drug educational campaign, truth, which encourages youth to avoid tobacco, might be having success. Their modern guerrilla tactics are a major improvement on the old model of Partnership for a Drug-Free America.
In another market approach to help recovering addicts reenter society, the Commission recommends decoupling felony convictions and eligibility for certain occupations (Rec. 50). The report cites Section 1128 of the Social Security Act, which prohibits employers that receive funding from federal health programs from hiring past convicts charged with unlawfully manufacturing, distributing or dispensing controlled substances. Any confrontation with law enforcement is a barrier to landing a job — a protected area of discrimination — and government laws that specifically ban their hiring make it worse on ex-users and -dealers trying to get clean. Recommendations like these lessen the role that the state has in keeping ex-convicts out of work.
Much of the funding requested by the President’s Commission is authorized by the Obama administration’s major contribution to combating opioid usage, the Comprehensive Addiction and Recovery Act (CARA), signed into law July 2016 and credited as the “first major federal addiction legislation in 40 years.” CARA helped implement naloxone (an opioid overdose-reversal nail spray) in firefighting departments and strengthen drug monitoring programs.
I’ll post the second half soon, and then a bonus post on my personal favorite solution.
My latest over at RealClearHistory went up on Tuesday. The schedule for my work over there goes as follows: I’ve got a regular Friday column and a Tuesday blog post, so be on the lookout! Here’s an excerpt:
The volunteers were to be used as cannon fodder for the Republicans, which explains the high casualty rate, but it was the disorganized front put on by the democratically-elected Republican government that is to blame for the high casualty rates, rather than some sort of prejudice or malice on the part of the Spanish Left. The volunteers almost all came from non-military backgrounds, too, as most were starry-eyed urban idealists who believed they were fighting injustice. After a meager 30 days of training, the Lincoln Battalion was marched to the front lines to fight a bunch of battle-hardened troops that mostly hailed from Spain’s colonies, where military governance was practiced and honed to near perfection.
Read the rest. This was a fun one to write. I initially wanted to do something about the Spanish Civil War and international meddling (Madrid fell to Franco on March 29), before tying it in to the events in Syria.
My editor gently reminded me that the blog posts should be about American history, so I threw in the Abraham Lincoln Brigade. And check out my RCH colleague’s post on the birth and rise of the Republican Party.
