The Real Cost Of The Opioid Epidemic: An Estimated $179 Billion In Just One Year
Paramedics in Portland, Maine, respond to a call for a heroin overdose. A new report estimates some $60 billion was spent on health care related to opioid addiction in 2018.
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There’s a reckoning underway in the courts about the damage wrought by the opioid crisis and who should pay for it.
Thousands of cities and counties are suing drug makers and distributors in federal court. One tentative dollar amount floated earlier this week to settle with four of the companies: $48 billion. It sounds like a lot of money, but it doesn’t come close to accounting for the full cost of the epidemic, according to recent estimates — let alone what it might cost to fix it.
Of course, there’s a profound human toll that dollars and cents can’t capture. Almost 400,000 people have died since 1999 from overdoses related to prescription or illicit opioids. There are more deaths every single year than from traffic accidents. These are lives thrown into chaos, families torn apart — you can’t put a dollar figure on those things.
But the economic impact is important to understand. The most recent estimate of those costs comes from the Society of Actuaries and actuarial consulting firm Milliman in a report published this month.
“We pride ourselves that this is objective, nonpartisan research,” says Dale Hall, managing director of research at the Society of Actuaries. He adds, “we’re not here to influence any court proceedings.” As actuaries, they calculate financial numbers associated with risks, for instance, for insurance companies.
So how much did the epidemic cost in just one year, 2018? The total number they came to was $179 billion. And those are costs borne by all of society — both by governments providing taxpayer-funded services (estimated to be about a third of the cost), and also individuals, families, employers, private insurers, and more.
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When you start to break that number apart, a picture emerges of how opioid addiction ripples out into communities and across generations.
Overdose Deaths: $72.6 Billion
It makes sense that the biggest contributor to the costs of the epidemic comes from overdose deaths, according to Stoddard Davenport of Milliman, one of the report’s authors.
“When you think about the course of a person’s life that struggles with opioid use disorder, early mortality is the most significant adverse event that can happen, and I think that bears out when you look at the economic impact,” he says.
Every day, 130 people die from opioid overdoses. Most of them are in the 25-55 age range, right in the middle of their prime working years, and lost earning potential accounts for most of those costs.
“The mortality costs have a small component of end of life health care, coroner expenses and things like that,” he says. “The grand majority of it, however, is composed of lost lifetime earnings.”
Preliminary data suggests overdose deaths dipped in 2018 for the first time in years, but many experts say it’s too early to say if that marks a turnaround or not.
Hall points out whether the annual death toll stays as high as 47,000 in coming years “will be certainly a driver of what these overall economic costs will be.”
Health Care: $60.4 Billion
The next biggest amount comes from health care costs. The researchers took several large databases of insurance claims that had been scrambled to hide the identity of the patients and flagged people who’d been coded as having opioid use disorder. Then the researchers calculated their overall health care costs — not just directly related to their addiction, but any additional costs — and compared them to similar patients without addiction.
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“Looking at the difference in costs gives us a sense for how much more complicated is their overall health care picture and what are those additional expenses look like for two otherwise comparable people,” Davenport explains.
Opioid addiction is linked to other health problems. Patients might have chronic pain or mental illness that underlies their addiction; infectious diseases like HIV and Hepatitis C can spread among injection drug users; and there can also be higher costs for other conditions like anemia, liver disease, and pulmonary heart disease, according to another Milliman analysis from earlier this year.
An infant born dependent on opioiods receives care at a neonatal intensive care unit in Charleston, West Virginia. Costs associated with treating such infants reached close $1 billion in 2018.
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There are also health costs for people who live in the same household as someone with an opioid use disorder — their lives might be more complicated and their mental and physical health can suffer as a result.
Then there are the costs for infants born dependent on opioids — what’s called neonatal abstinence syndrome. “The epidemic effect is starting to create a second generation that extends down to children and unfortunately newborns as well,” Hall says. In 2018 those costs were $800 million, but they estimate this year they could be almost $1 billion.
There are still more costs the report could not capture, including elevated costs for patients whose opioid use disorder is undiagnosed, and potential ongoing expenses for children born with neonatal abstinence syndrome as they grow up.
Lost Productivity: $26.5 Billion
When someone is addicted to opioids, they might not be able to apply for or hold down a job, or they might be incarcerated and unable to work. The researchers broke this section out into reduced labor force participation, absenteeism, incarceration, short and long term disability, and workers’ compensation.
“What we’re trying to capture is the amount of time that folks are spending not doing economically productive activities,” Davenport says. Other productivity costs — like “presenteeism,” when someone shows up at work but isn’t as productive as they otherwise would be — were not included here.
It’s also worth noting, many of these costs fall to private employers, for instance, and families who have a family member not bringing home income.
“It’s around 30 percent falling on federal state and local governments,” he says. “The rest [falls to] the private sector and then of course to individuals.”
Criminal Justice: $10.9 Billion
Measuring this part of the costs of the epidemic is a different beast. The researchers captured costs related to police, court cases, correctional facilities and property lost to crime, Davenport explains. They drilled down into criminal justice expenses to see “what proportion of those total budgets involve substance use disorders, and then what proportion of that is represented by opioids.”
Having an opioid addiction dramatically increases the chance of being caught up in the criminal justice system. As NPR has reported, only 3% of the general population reported being recently arrested, on parole or on probation. For people with opioid use disorder, that jumped up to nearly 20%.
Child And Family Assistance & Education: $9 Billion
The team took a similar approach to calculate the costs for things like food assistance, child welfare, income and housing assistance, and education. They took those total costs, figured out what portion was related to substance use, and what part of that was related to opioid use.
The epidemic has a profound impact on families and communities — parents with opioid use disorder have to navigate treatment and sometimes battle for custody of their kids; the state has to handle child welfare cases and find new homes for foster kids; and schools are providing counseling for kids with addicted parents.
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“Typically an epidemic will start in one place but then it broadens out,” says Hall. “We’re starting to see a broadening out of the impact of the opioid epidemic into some second generation effects.”
Hall adds there are also “the costs of educating people about the epidemic and ways to prevent future opioid use disorder.” Those costs — mostly from federal grants for elementary and secondary education programs — came out to $1.2 billion last year.
What’s Missing: Turning The Crisis Around
These are some solid numbers that capture the current economic burden of the epidemic. Estimating what it’s going to cost to fix the crisis — to treat those who are addicted, to reduce overdose deaths, and more — is another story.
“The notion of abatement is that we want to deal with the problem that exists but also to begin to remedy it,” says Christopher Ruhm, professor of public policy and economics at the University of Virginia. He worked for several years on a 30-year abatement plan for Oklahoma as part of that state’s case against several drug companies.
For Oklahoma, Ruhm estimated treatment, prevention, education, surveillance for one year would cost $836 million. The judge in the case made his own calculations and ordered Johnson & Johnson to pay $572 million, though the amount has since been adjusted, and the case is currently being appealed.
If you scale Ruhm’s numbers up from that one state to the whole country, you get $69 billion to fund a year’s worth of abatement programs.
“I’m not saying that’s an appropriate calculation in the sense that things could be different in Oklahoma from other places,” Ruhm cautions. There are also costs that might come up on the federal level that wouldn’t be factored in for Oklahoma, such as research into effective addiction treatments.
Still, it gives you a rough idea, as society starts to take stock of what this epidemic is costing already, how much it will cost to try to fix it, and who should ultimately pay.
Nationals Beat The Astros 12-3 In Game 2 Of The 2019 World Series
‘It’s Time To Get Something Back’: Union Workers’ Voices Are Getting Louder
United Auto Workers members picket Wednesday at a General Motors plant in Flint, Mich. Last year, more U.S. workers went on strike than at any time since 1986.
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As autoworkers at General Motors plants around the country vote this week on whether to accept a new contract, workers elsewhere see an opportunity to demand their own chance in the driver’s seat.
The U.S. is enjoying a record-long economic boom, but workers’ slice of the pie has barely increased. After decades of relative silence, newly emboldened workers are increasingly vocal in demanding higher pay and better working conditions.
“We have given enough. It’s time to get something back,” declared Stacy Davis-Gates, vice president of the 25,000-member Chicago Teachers Union, which has been on strike since last Thursday.
Over the last two years, hundreds of thousands of teachers, nurses and factory workers have walked off the job. Last year, more workers went on strike than at any time since 1986.
“Working people have taken it on the chin for four decades,” said Lawrence Mishel, a labor economist with the left-leaning Economic Policy Institute in Washington. “The workforce has been a tinderbox waiting to be lit. And if people see a way that they can solve their problems for themselves and their communities, they’re going to take it.”
In the 1950s, ’60s, and ’70s, it was routine to see hundreds of big strikes every year, idling a million workers or more. But in recent decades, work stoppages like the one at GM have been much less common. A turning point came in 1981, when President Reagan fired thousands of striking air traffic controllers.
Although Reagan was careful to distinguish the illegal controllers’ strike from lawful walkouts by private-sector workers, many private employers followed his example, firing strikers in the years that followed. With unemployment topping 10% in the early 1980s, replacement workers were not hard to come by.
Since then, the share of workers who are unionized has been cut by half, to just over 10% last year. Union membership in the private sector is less than 7%.
“Strikes bottomed out because the employers were using an unbelievably strong weapon and because the labor market allowed them to find people who were willing to cross a union picket line to take the job of a union worker who was out on strike,” said John Beck, a labor relations expert at Michigan State University.
Today, with unemployment near a 50-year low, there’s less danger that striking workers can be quickly replaced. Employees at GM and elsewhere are asking themselves, “If not now, when?”
“You’ve got really an economy that says to many workers, ‘This is the time for us to grab what we can,’ ” Beck said.
Teachers have been leading the charge, walking out of classrooms from Arizona to Oklahoma and West Virginia to protest wages that have lost ground to inflation.
Nurses have also been active on the picket lines. Like teachers, their jobs are not easily shipped overseas.
“We can’t continue to work off the clock, work without breaks, work without a lunch,” said Deborah Burger, a president of National Nurses United, which led one-day walkouts last month at hospitals in several states. “We’re trying to raise the awareness of the community. They understand that, and they support us.”
Public approval of organized labor is near its highest level in 50 years, a recent Gallup poll found. A separate survey found nearly half of all non-union workers would join a union if they could.
Still, any big rebound in union membership is unlikely, given the legal and cultural roadblocks.
“It’s very difficult to organize new members,” said Arthur Wheaton of the Industrial and Labor Relations school at Cornell University. “A lot of companies are hiring what they call ‘union avoidance’ law firms. And winning an election and getting the first contract negotiated is extremely difficult.”
Twenty-seven states — including union strongholds like Michigan — now have “right to work” laws, which make union membership and dues-paying optional. Last year, the Supreme Court ruled that government workers who choose not to join a union can’t be forced to pay a collective bargaining fee.
Some unions are now devoting more attention to improving pay and benefits for workers who aren’t union members, campaigning, for example, for a higher minimum wage.
If the UAW strike results in better pay for autoworkers, employees in other industries may be encouraged to test their own bargaining power.
“People don’t revolt when things are at their worst,” Beck said. “They revolt when things are getting better but not fast enough.”
Mark Zuckerberg Offers A Choice: The Facebook Way Or The China Way
Facebook CEO Mark Zuckerberg is scheduled to appear before the House Financial Services Committee on Wednesday. He’s likely to face a broad range of questions about his company’s influence.
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Mark Zuckerberg says it’s Facebook’s way — or China’s way.
Facebook’s founder and CEO will tell Congress that the social network’s controversial digital currency project, Libra, is essential to projecting American leadership around the world.
He will warn that any delay risks losing that leadership to China, according to prepared remarks released ahead of a House Financial Services Committee hearing on Wednesday.
“While we debate these issues, the rest of the world isn’t waiting. China is moving quickly to launch similar ideas in the coming months,” Zuckerberg will say.
“I believe [Libra] will extend America’s financial leadership as well as our democratic values and oversight around the world. If America doesn’t innovate, our financial leadership is not guaranteed.”
Zuckerberg frequently invokes China as a rival to American technology supremacy, and American values.
Last week in a speech at Georgetown University in Washington, he warned that calls for Facebook to exercise more limits on what people can and can’t say on its platform endangered its commitment to free speech — and America’s global influence.
“Until recently, the Internet in almost every country outside China has been defined by American platforms with strong free expression values. There’s no guarantee these values will win out,” he said.
Zuckerberg is back in the Capitol Hill hot seat as Facebook faces immense pressure over how much influence it has over the lives of its more than 2 billion users.
Members of Congress will seize the opportunity to grill him about a whole host of topics.
Here are five questions he could face in the hearing room.
Is Facebook really going to launch a currency?
Facebook says Libra would let users around the world — especially those without traditional bank accounts — send money as easily as sending a text message. And while the project was originally Facebook’s idea, it is meant to come to life with the help of 27 founding partners, including financial services companies.
But Libra hit hurdles as soon as it was announced. Regulators around the world have taken a dim view of the project, sounding fears that it could pose a threat to financial stability and be used to fund terrorism and other illegal activities.
In recent weeks, several of the initial partners backed away — including the credit card companies Visa and MasterCard and the digital payment firms PayPal and Stripe. People close to some of the companies that have dropped out told NPR they were concerned about angering regulators, given that they already operate in highly regulated industries.
Their departures have left some analysts doubting that the project can go forward.
“Libra sounds dead on arrival,” said Michael Pachter, an equities analyst at Wedbush Securities. “I don’t think Facebook can pull it off without the support of all the different banking and credit card processors and payment processors. I just don’t think that they have the wherewithal to actually do it themselves.”
In his prepared remarks, Zuckerberg acknowledged that Facebook is “not the ideal messenger right now. We’ve faced a lot of issues over the past few years, and I’m sure people wish it was anyone but Facebook putting this idea forward.”
And he said Libra will not be launched “anywhere in the world unless all US regulators approve it.”
Has Facebook done enough to stop discrimination in advertising?
Housing is the other headline subject of Wednesday’s hearing. Facebook has been hit with a federal lawsuit by the Department of Housing and Urban Development for allegedly enabling housing discrimination.
The allegations stem from Facebook’s ad targeting tools. The company lets advertisers select who can and cannot see ads, based on a range of different categories.
“Facebook is discriminating against people based upon who they are and where they live,” in violation of the Fair Housing Act, HUD Secretary Ben Carson said when the suit was filed in March.
The company has also been accused of allowing age and gender discrimination in job ads.
Nicol Turner Lee, a fellow at the Brookings Institution’s Center for Technology Innovation who studies access to technology, said Facebook may not have intended its advertising tools to be used this way.
But she said Internet platforms need to take more care to consider the consequences of the technologies they build.
“We have to ask ourselves, are companies like Facebook clear about the guardrails that are protecting human and civil rights, and the extent to which they’re building products and services that comply with those laws?” she said.
Facebook has stopped letting advertisers target ads for housing, jobs and credit to people based on their ethnic group, gender, age or zip code.
On Tuesday it pledged $1 billion toward affordable housing in California.
In Zuckerberg’s prepared remarks, he said Facebook is taking “a broader view of our responsibility. That includes making sure our services are used for good and preventing harm. People shouldn’t be discriminated against on any of our services.”
Why won’t Facebook stop politicians from lying?
Facebook’s latest firestorm is also about advertising.
Critics are furious about the social network’s policy of allowing politicians to publish misleading or downright untrue posts and ads on its platform. Zuckerberg will likely be pressed about this topic again on Wednesday.
Facebook says its policy flows from its commitment to free speech. It says it does not want to judge whether political speech is true or not, and that users should be free to hear from politicians and make up their own minds.
Zuckerberg strongly defended this position in his Georgetown speech last week, positioning Facebook as a champion of free expression and reiterating that his company should not be the arbiter of truth.
“While I certainly worry about an erosion of truth, I don’t think most people want to live in a world where you can only post things that tech companies judge to be 100% true,” he said.
But that has not satisfied critics. Democratic presidential candidate Sen. Elizabeth Warren of Massachusetts ran her own deliberately false Facebook ad to protest the policy. In it, she incorrectly claimed Facebook and Zuckerberg had endorsed President Trump.
“Once again, we’re seeing Facebook throw its hands up to battling misinformation in the political discourse, because when profit comes up against protecting democracy, Facebook chooses profit,” Warren tweeted in explanation of her ad.
In his Georgetown speech, Zuckerberg said he had considered dropping political advertising altogether — noting that it contributes just a tiny fraction of Facebook’s billions of dollars in annual sales. But he argued that could have the effect of favoring incumbents and candidates favored by the media.
What is Facebook doing to prevent the 2020 election from being a repeat of 2016?
With U.S. intelligence agencies warning that foreign governments may try to influence American politics leading up to next year’s election, lawmakers may want to know how Facebook is defending its platform from manipulation.
Zuckerberg gave an update about Facebook’s election security efforts on Monday. That included a number of new features and updates to existing policies to provide more transparency about who is posting on Facebook.
For example, the site will now labeling content from media outlets it considers to be “state-controlled,” which Facebook defines as “wholly or partially under the editorial control of their government.”
But the scope of the problem Facebook must confront was also highlighted on Monday when the company said it had taken down four more networks of fake accounts. Facebook said it has removed more than 50 such networks, which could attempt to manipulate its users, in the past year.
Three of the newly disabled networks were tied to Iran, while the fourth originated in Russia and showed some links to the Internet Research Agency, the Kremlin-backed troll farm involved in political interference in 2016, Facebook said.
Zuckerberg told reporters on Monday that election security “is one of my top priorities for the company” and that Facebook is no longer “on our back foot” when it comes to identifying fake accounts.
Is Facebook too powerful?
Congress is not the only branch of government asking tough questions about Facebook. The Federal Trade Commission, the Department of Justice and a group of 47 state attorneys general are all investigating Facebook for potential antitrust violations.
The state prosecutors are “concerned that Facebook may have put consumer data at risk, reduced the quality of consumers’ choices, and increased the price of advertising,” New York Attorney General Letitia James said Tuesday.
Some critics are calling for the company to be broken up, or for its acquisitions of Instagram and WhatsApp to be unwound. Warren has made the breakup of Facebook — along with Google and Amazon — a key part of her campaign platform.
Some tech veterans agree. Marc Benioff, the CEO of software company Salesforce, told CNN that Facebook is “addictive” and has too much control of users’ data — and therefore should be broken up. “They’re having an undue influence as the largest social media platform on the planet,” he said.
And even a Facebook co-founder has turned on the company. Chris Hughes, who was one of Zuckerberg’s roommates at Harvard, launched a $10 million anti-monopoly fund to support policy, academic research and organizing to take on corporate power in tech and other industries.
Zuckerberg bristles at the idea of breaking up his company. In leaked audio from staff meetings this summer, obtained by the website The Verge, the CEO said Facebook would “fight” any effort to do so and expected to win any legal challenge.
At Georgetown last week, Zuckerberg acknowledged criticism of big tech — but deflected the argument.
“I understand the concerns that people have about how tech platforms have centralized power. But I actually believe the much bigger story is how much these platforms have decentralized power by putting it directly into people’s hands,” he said.
Editor’s note: Facebook is among NPR’s financial supporters.
Nationals Beat Astros 5-4 In Game 1 Of World Series
Washington Nationals’ Juan Soto hits a home run during the fourth inning of Game 1 of the World Series against the Houston Astros on Tuesday.
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Updated at 1:35 a.m. ET
The Washington Nationals beat the Houston Astros 5-4 in Game 1 of the 2019 World Series, led by Juan Soto who homered and doubled in his first Series game.
Soto also had a single and a stolen base to go with his 3 RBIs. The young standout turns all of 21 on Friday.
“After the first at-bat, I just said, ‘It’s another baseball game,'” Soto said, according to The Associated Press. “In the first at-bat, I’m not going to lie, I was a little bit shaking in my legs.”
The victory gives the Nationals what they wanted: a win in Houston against one of baseball’s best pitchers, Gerrit Cole. It was Cole’s first loss since May.
Houston Astros’ Yuli Gurriel hits a two-RBI double during the first inning of Game 1 of the World Series against the Washington Nationals Tuesday in Houston.
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The Nats lead the Series 1-0.
The Astros, the American league champions, jumped out to an early lead, scoring two runs in the bottom of the first inning off Nationals ace Max Scherzer. Astros slugger Yuli Gurriel doubled home teammates George Springer and José Altuve.
The Nationals responded in the top of the second inning with a solo home run by Ryan Zimmerman on a two-out, first pitch by Cole.
The 35-year-old Zimmerman was the Nationals’ first player to be drafted by the team after its move from Montreal to Washington, D.C. in 2005.
“It’s been a long ride,” Zimmerman said according to the AP. “First at-bat, to hit a home run and run around the bases, you’re kind of almost floating around the bases.”
“I’ll be honest with you, my eyes got a little watery for him,” manager Dave Martinez said. “He waited a long time to be in this position, and for him to hit that first home run and put us on the board was awesome.”
The Nationals evened the score at 2-2 on Soto’s solo home run off of Cole to open the fourth frame.
Washington, the National League champions, took the lead for good in the top of the fifth inning on a single by third baseman Adam Eaton, scoring Kurt Suzuki who had opened the inning with a walk, making the score 3-2. Two batters later, Soto smacked a two-run double to left field, bringing the score to 5-2.
The Astros narrowed the lead to 5-3 in the bottom of the seventh inning with a solo home run by Springer off of Nats reliever Tanner Rainey. They loaded the bases on two walks and an infield hit, when Daniel Hudson relieved Rainey and closed the inning by striking out Yordan Alvarez.
The Astros opened the bottom of the eighth inning with a single by pinch-hitter Kyle Tucker, who advanced to second on a fly-out and then scored on a double by Springer, cutting the lead to 5-4.
Nats ace reliever Sean Doolittle, the fifth pitcher put in play by the team, retired the Astros in the bottom of the ninth inning without incident. The Astros left 11 runners on base, the Nationals only four.
At a sober post-game news conference, Astros manager AJ Hinch acknowledged it was not the opener he had expected.
“[Cole’s] been so good for so long that there builds this thought of invincibility and that it’s impossible to beat him,” Hinch said according to the AP. “So when it happens it is a surprise to all of us.”
“I didn’t have my A-game tonight,” Cole said. “Outside of a few pitches that tacked on a few runs, we worked pretty well with what we had. These are the two best teams in the world right now so you try not to beat yourself up too much, especially if you’ve got to grind in those situations.”
43,339 watched the Series opener in Houston’s Minute Maid Park. Game 2 is Wednesday night.
CDC Studying Tissue To Try And Track Down Root Cause Of Vaping-Related Lung Damage
The Centers for Disease Control and Prevention is starting to study lung tissue and chemicals from electronic cigarette vapor to track down the root cause of lung damage caused by vaping.
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Mysterious lung injuries have killed at least 33 e-cigarette users and sickened nearly 1,500. The Centers for Disease Control and Prevention is digging deeper to find the exact cause. NPR science correspondent Richard Harris traveled to Atlanta to learn about the latest twists in their investigation.
RICHARD HARRIS, BYLINE: The calming sound of a fountain echoes between two laboratories on the CDC’s Chamblee campus, but it’s fair to say that for many scientists working on vaping injuries at the federal health agency, the mood is not so serene. I’m told that in one of these laboratory buildings, they’ve actually started testing fluid that had been taken from the lungs of people who had been exposed to vaping products and ended up with severe lung disease. That’s a new step in the investigation, which has now swollen to include more than 140 CDC scientists and staff. The lab buildings are off-limits to most visitors, so on a visit Friday, I am guided instead into an adjoining building to meet the man who’s overseeing the labs.
Hey. Richard Harris.
JIM PIRKLE: Jim Pirkle. Nice to meet you.
HARRIS: Nice to meet you.
PIRKLE: Yeah. Come on in. Have a seat.
HARRIS: Dr. Pirkle has seen many investigations in his time. Best case, there’s a straight line from a health problem to the cause. Vaping lung disease, well, that’s a different story.
PIRKLE: There wasn’t something that just stood out in everything that closed the case and said, we know exactly what it is.
HARRIS: Pirkle realized early on that his labs, which started out studying the toxic chemicals in cigarettes, could be brought to bear for this mystery.
PIRKLE: We have 13 smoking machines, and we’re smoking cigarettes and e-cigarettes all the time – maybe not what you’re classically thinking CDC is doing.
HARRIS: Elsewhere, the Food and Drug Administration labs have been studying the vaping fluid from suspicious products, but people don’t just breathe that stuff in. E-cigarettes vaporize those components by heating them up.
PIRKLE: So after you’ve heated the fluid, it’s possible you’ve made something else that’s dangerous.
HARRIS: Pirkle shows me some components of the testing equipment.
PIRKLE: We have a pad here that’ll collect the aerosol and all the lipid-like substances, and then the stuff that goes through as gases – that is trapped on another trap. And so it’s just – it’s like a super filter right there.
HARRIS: Pirkle says they’ll compare what they find from the devices to what’s in the lungs of patients who fell ill. The first fluid samples from vapers’ lungs are just now being analyzed at the CDC.
PIRKLE: So that gives us kind of a sampling of what’s on the inside surface of the lung, and that’s actually very important because we think that’s where the problem is. It’s when things go in and get in contact with that inside surface of the lung.
HARRIS: One item on that list is to look for oils which have been observed in some samples. They’re also measuring natural compounds called terpenes that, among other things, contribute to the pungent flavor of THC extracted from marijuana – yes, terpenes as in turpentine. In all, they’re planning to run about a dozen tests on each vape and lung fluid sample, Pirkle says.
PIRKLE: It took a while to get all those methods developed, all that interpretation stuff figured out. But it started this morning, so we’re chugging on it. We’re out at 60 miles an hour.
HARRIS: Discoveries in this lab will get relayed back to Dr. Rom Koppaka, a lung specialist who got tapped to join the CDC’s vaping investigation team.
ROM KOPPAKA: From the beginning, the approach has been to entertain all potential theories.
HARRIS: And it’s often tricky to sort out cause and effect. For example, is oily material seen in some lung samples causing the problem or part of the body’s reaction? What about the signs of direct chemical damage in victim’s lungs? Koppaka is hoping the labs will provide answers. That can help guide treatment, but it is also urgently needed so doctors can know exactly what to look for to diagnose this condition.
KOPPAKA: We don’t have that yet. Certainly, if the cause or causes of the lung injury are identified, that would advance that effort a great deal because there might be a way to detect them in the lungs or in the blood or in the tissues or whatever. But we’re not there yet.
HARRIS: The consensus around the CDC team, though, is that they are heading in the right direction.
Richard Harris, NPR News.
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A Push To Have Cars Say ‘No’ To Drunk Drivers
The Driver Alcohol Detection System for Safety Program, funded largely by the federal government, seeks to develop devices that will automatically detect when a driver is intoxicated with a blood-alcohol concentration over the legal limit.
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As cars become smarter and safer, some members of Congress want to require them to be built to prevent drunk driving.
Sens. Tom Udall, D-N.M., and Rick Scott, R-Fla., introduced legislation last week that would make it mandatory for all new cars and trucks to come loaded with passive, virtually unnoticeable, alcohol detection systems by 2024.
The Reduce Impaired Driving for Everyone Act of 2019, called the RIDE Act, would also allocate $10 million to continue government-funded research into new breath and touch-based sensors designed to monitor a driver’s blood alcohol level in real-time, without having the driver do anything. The measure would set aside another $25 million to install and test the technology in government-owned fleets.
The bill follows a similar effort in the House by Rep. Debbie Dingell, a Democrat from Michigan.
Udall said he’s been haunted by the pain and havoc drunk driving accidents wreak on families for decades. “When you meet with families, and when you see the devastation that this causes, it’s something that really moves you,” he said in an interview.
During the 1990s, when Udall was New Mexico’s attorney general, he agonized over how to reduce the state’s drunk driving related crashes, which at the time were the highest in the country per capita.
“We kept trying to wonder, how do we get out of this?” he recalled.
The answer, at least in part, was technology. New Mexico became one of the first states to require convicted drunk drivers to use a breathalyzer to start a car.
But in a world where driverless cars are being tested, Udall said he’s become exasperated by the lack of innovation and buy-in from the auto industry. He is urging auto manufacturers to partner and fellow lawmakers to commit to a five-year plan to develop less cumbersome and more consumer friendly devices.
Helen Witty, president of Mothers Against Drunk Driving, also noted the auto industry’s reluctance to mandated safety improvements.
“I don’t think the industry wanted to put in airbags or seat belts,” Witty said. “Think about how those … were a fight to get through.”
But now, she said, several companies have cameras that warn drivers if they appear impaired or have taken their eyes off the road. Those types of advances have given Witty hope that automakers will be persuaded by consumers, who want more safety features.
But she is impatient for that to happen. In 2000, Witty’s 16-year-old daughter was killed by another teen who’d had too many tequila shots and was driving 65 miles per hour in a 30 mph zone. According to Witty, the young driver, who was drunk and high on marijuana, “lost control of her car and spun off the road onto the bike path” where her daughter was rollerblading.
“And so my daughter, Helen Marie, looked up and saw the car coming toward her and there was nothing she could do at all but die,” Witty said.
It’s a tragic story that Witty has been telling for years to educate the public. She’s hopes the message will help spare other families the pain of her own.
“Not only did her life end, the life that we had as a family ended. … We had to figure out how to live again,” she added.
Drunk driving fatalities have declined significantly since the 1980s. But according to the National Highway Traffic Safety Administration they still account for about a third of all traffic deaths. In 2017, more than 10,800 people were killed in drunk driving incidents.
Since 2008, the federal government has spent $50 million on a project between NHTSA and an automaker group called Automotive Coalition for Traffic Safety to develop the Driver Alcohol Detection System for Safety.
The endeavor is overseen by Robert Strassburger, who represents the automakers. He expects a breathalyzer-type product to be ready for licensing by next year. While the ultimate goal of the project is aimed at creating something that detects alcohol without the driver doing anything, Strassburger said, they’re not there yet. After more than a decade of work, researchers have managed to develop a more streamlined version of a breathalyzer — a small device built into the driver-side door that the driver blows into.
However, the device is can’t detect a precise blood alcohol level yet. Instead, it can only determine the presence of alcohol, Strassburger said.
So it can’t tell the difference between someone who’s had one glass of wine and someone who’s had four shots of whiskey. Still, Strassburger said, there’s already a market for the device, including trucking companies with a zero-tolerance policy for their drivers or parents with underage children.
Strassburger says there’s plenty of momentum to make vehicles with technology that keeps dangerous drivers off the road.
The question is how that will happen and when.
Horses Have Continued To Die As New Season Begins At Santa Anita Park
The Santa Anita race track near Los Angeles is preparing for the high profile Breeders’ Cup next month. But horse deaths have continued this season, despite government investigations.
AILSA CHANG, HOST:
It’s a new season at the Santa Anita Racetrack outside Los Angeles, but one troubling aspect has not changed. Horses keep dying. One died over the weekend, bringing the total to 34 since December. That’s despite warnings from California Governor Gavin Newsom that he will shut down horse racing in the state if the industry doesn’t clean up its act, and it’s despite a criminal investigation from the L.A. district attorney’s office. Ben Bergman has more.
(SOUNDBITE OF BUGLE PLAYING)
BEN BERGMAN, BYLINE: Looking out across the track to the palm trees and the mountains in the distance, it’s hard to imagine a more picturesque setting for horse racing.
(SOUNDBITE OF HORSES RACING)
BERGMAN: On a recent 87 degree fall day, 2-year-old fillies – those are young females – competed for a $50,000 purse.
(SOUNDBITE OF HORSES RACING)
BERGMAN: There were less than 5,000 fans in the stands. Attendance is down this season. On Saturday a 3-year-old gelding broke his front left ankle and was euthanized. Last month a colt broke both front ankles and had to be put down a month after testing positive for an illegally high dose of painkillers.
KATHY GUILLERMO: I’m angry.
BERGMAN: Kathy Guillermo is senior vice president of PETA.
GUILLERMO: I’m angry because we asked the Los Angeles district attorney to launch an investigation seven months ago, but we still have no results from those investigations.
BERGMAN: The DA’s office wouldn’t comment. Guillermo says it’s unacceptable that racing continues.
GUILLERMO: I think we need to suspend racing until we have solid answers. I just don’t think a sport is worth the lives of these animals.
BERGMAN: So why not halt competition?
ALEXIS PODESTA: I mean, I think that’s a good question.
BERGMAN: Alexis Podesta oversees the California Horse Racing Board, which regulates the industry.
PODESTA: I would respond to it by saying that this is a big industry. There are a lot of jobs and livelihoods involved in it. I would want us to be very cautious about ending an industry and killing a number of jobs without all of the facts.
BERGMAN: Podesta says racing has become much safer in California because of new rules like increased drug testing and exams. Thanks to a new state law, the board now also has the power to suspend races. Last season it tried to do that at Santa Anita but didn’t have the authority to do so. Podesta says there’s also this.
PODESTA: Over the last decade we’ve seen a fairly dramatic decline in the number of horse fatalities during racing.
BERGMAN: This will surprise a lot of people. Despite all the attention, according to the racing board, during the last fiscal year, there were actually slightly fewer deaths than normal at Santa Anita, and statewide, there were 144 fatalities. That’s by far the lowest in the past decade. The board’s chief veterinarian Dr. Rick Arthur says most people haven’t thought about how dangerous the sport is until recently.
RICK ARTHUR: I think historically, horse racing has kind of lived in a bubble, and I think the anger of the public about these fatalities has made people wake up.
BERGMAN: Earlier this year the embattled Stronach Group, which owns Santa Anita, appointed Dr. Dionne Benson at its first chief veterinary officer. She says any number of deaths is unacceptable.
DIONNE BENSON: Our goal and our true finish line is to have zero fatalities. Whether we ever reach that is a different story, but we have to keep moving in that direction.
BERGMAN: Next month one of horse racing’s biggest events, the Breeders’ Cup, will be held at Santa Anita. Organizers had considered moving the race, but they decided not to because they said the track enacted effective and meaningful changes.
For NPR News, I’m Ben Bergman in Los Angeles.
Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
Get Your Flu Shot Now, Doctors Advise, Especially If You’re Pregnant
Though complications from the flu can be deadly for people who are especially vulnerable, including pregnant women and their newborns, typically only about half of pregnant women get the needed vaccination, U.S. statistics show.
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October marks the start of a new flu season, with a rise in likely cases already showing up in Louisiana and other spots, federal statistics show.
The advice from federal health officials remains clear and consistent: Get the flu vaccine as soon as possible, especially if you’re pregnant or have asthma or another underlying condition that makes you more likely to catch a bad case.
Make no mistake: Complications from the flu are scary, says Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tenn., who is part of a committee that advises federal health officials on immunization practices.
“As we get older, more of us get heart disease, lung disease, diabetes, asthma,” Schaffner says. “Those diseases predispose us to complications of flu — pneumonia, hospitalization or death. We need to make vaccination a routine part of chronic health management.”
Federal recommendations, he says, are that “anyone and everyone 6 months old and older in the United States should get vaccinated each and every year.” People 65 and above and pregnant women, along with patients who have underlying medical issues, should make haste to get that shot, if they haven’t already, Schaffner says.
Within a typical year, about two-thirds of people over 65 get vaccinated against the flu, studies show, compared with 45% of adults overall and 55% to 60% of children. But only about half of pregnant women get vaccinated, and immunization rates for people with chronic diseases hovers around 30% to 40%.
Take the case of JoJo O’Neal, a 55-year-old radio personality and music show host in Orlando, Fla., who was diagnosed with adult onset asthma in 2004 at age 40. For years she didn’t get the flu vaccine, figuring her healthful diet, intense exercise and overall fitness would be protective enough.
“I skated along for a lot of years,” O’Neal says, “and then, finally, in 2018 — boom! It hit me, and it hit me hard.” She was out of work for nearly two weeks and could barely move. She was extremely nauseated and had an excruciating headache and aching body, she says. “I spent a lot of time just sitting on my couch feeling miserable.”
O’Neal says it takes a lot to “shut her down,” but this bout with the flu certainly did. Even more upsetting, she says, she passed the virus on to her sister who has chronic obstructive pulmonary disease. Fortunately, neither she nor her sister had to be hospitalized, but they certainly worried about it.
“We have lung issues and worry about breathing, so having the flu created lots of anxiety,” O’Neal says. This year, she’s not taking any chances: She has already gotten her flu shot.
That’s absolutely the right decision, says Dr. MeiLan Han, professor of internal medicine in the division of pulmonary and critical care medicine at the University of Michigan Health System and a national spokesperson for the American Lung Association.
If generally healthy people contract the flu, they may feel sick for a week or more, she says. But for someone with underlying lung conditions, it can take longer to recover from the flu — three to four weeks. “What I worry about most with these patients,” Han says, “is hospitalization and respiratory failure.”
In fact, Han says, 92% of adults hospitalized for the flu have at least one underlying chronic condition such as diabetes, asthma, or kidney or liver disorders.
When people with underlying lung conditions contract the flu, she says, “the virus goes right to the lung, and it can make a situation where it’s hard to breathe even harder.”
Other chronic health conditions — diabetes, HIV and cancer, among them — impair the immune system, Han explains, making people with those conditions unable to mount a robust response to the flu virus without the immunization boost of a flu shot.
That means the inflammation and infection when they get the flu can become more severe, she says.
Even many of her own patients don’t realize how bad a case of the flu can be, Han says.
“People often tell me, ‘That’s not me. I’ve never had the flu. I’m not at risk, and I’m not around people who might give me the flu.’ “
O’Neal says she’d always figured she wasn’t at risk either — until the flu flattened her.
Healthy pregnant women, too, are more prone to complications and hospitalization if they contract the flu and are strongly urged by the Centers for Disease Control and Prevention and OB-GYNs to get vaccinated against both influenza and pertussis. Yet the majority of mothers-to-be surveyed in the United States — 65% — have not been immunized against those two illnesses, according to a recent CDC Vital Signs report.
Some women mistakenly worry that the flu vaccine isn’t safe for them or their babies. “I think some of the fears about safety are certainly understandable, but they’re misinformed,” says Dr. Alicia Fry, chief of the epidemiology and prevention branch of the CDC’s Influenza Division.
The evidence is clear, Fry says: The vaccine is extremely safe. And she points to a recent study showing that immunization against flu reduces the risk of flu hospitalization among pregnant women by 40%.
As for worries that the woman’s vaccination might not be safe for her developing fetus, Fry says the opposite is true. When a pregnant woman is immunized, antibodies that fight the flu virus cross the placenta and can protect her baby in those critical months before and after birth.
“It can prevent 70% of the illness associated with flu viruses in the baby,” Fry says. “So it’s a double protection: Mom is protected, and the baby’s protected.” Infants can’t get the flu vaccine themselves until they are 6 months old.
Now, the vaccine won’t protect against all strains of the flu virus that may be circulating. But Schaffner says the shot is still very much worth getting this year and every year.
“Although it’s not perfect, the vaccine we have today actually prevents a lot of disease completely,” he says. “And even if you do get the flu, it’s likely to be less severe, and you’ll be less likely to develop complications.”
Kara Swisher’s Take On Mark Zuckerberg’s ‘Free Speech’ Speech
NPR’s Michel Martin speaks with the editor-at-large of Recode, Kara Swisher, about Mark Zuckerberg’s controversial speech at Georgetown University on Facebook’s policy governing political ads.
MICHEL MARTIN, HOST:
We’re going to revisit a story we’ve covered regularly on this program – Facebook and how it handles false or misleading content. Critics from around the world have become increasingly vocal about this, saying Facebook has become a vehicle for the rapid dissemination of lies and needs more regulation. Despite this, Facebook has reaffirmed that it will continue to exempt politicians from fact-checking, allowing them to make false statements in their paid advertisements. On Thursday, though, Facebook founder Mark Zuckerberg decided to address the matter further with a nearly 40-minute speech at Georgetown University on the value of free expression.
(SOUNDBITE OF SPEECH)
MARK ZUCKERBERG: Giving more people a voice gives power to the powerless, and it pushes society to get better over time.
MARTIN: To talk more about this, we’ve called on Kara Swisher. She is the co-founder and editor at large of Recode. That is a media outlet that covers the digital world.
Kara, thank you so much for joining us.
KARA SWISHER: Thanks so much.
MARTIN: And I do want to disclose here that Facebook is among NPR’s recent financial supporters. Having said that, what was the importance of this speech, Kara? Was any news made there?
SWISHER: Well, I’m sort of trying to figure it out still. He’s sort of on a PR offensive again. And right now, it’s around free speech and trying to defend what has happened on Facebook as being sort of a binary choice between free speech or, I guess, China. I can’t really quite figure it out I actually thought the speech was pretty thin intellectually on an incredibly complicated topic.
MARTIN: The New York Times posted a piece this weekend that talks about the overwhelming financial advantage that the Trump campaign…
SWISHER: Yeah.
MARTIN: …Has. And even as some of the broadcast networks are refusing to air certain ads, Facebook is taking advantage of the fact that the platform has said it will not subject politicians’ statements to fact-checking. And so they’re posting ads that say things that have been completely debunked. Did he directly address that?
SWISHER: Well, he did. He – there was a question about that. And he said he had thought about removing political advertising from Facebook, which was a – it’s not really news because he didn’t do it. But it’s very clear he could remove people who are running for office. You know, and I don’t know what he would do about super PACs. But I think the issue was is, this has been something that’s been actually in place – is that Facebook and Twitter – and not just Facebook but Twitter and YouTube – they allow all kinds of egregious lying to go on. And especially when they’re newsworthy figures on Twitter – they use the term newsworthy to allow, say, Donald Trump to violate its terms daily, essentially.
And so they’re saying because we want all the voices to speak, we’re not going to be the ones that are arbiters of what politicians say. We’ll let the public at large decide even if they’re lying and that there’s a mechanism in place, which is called the press, that will say, these are lies. The problem is, once these lies get out there, they get the same amount of attention that it’s hard to pull them apart.
And that’s the one thing they don’t realize – they’re not like television, which has certain rules around what it’s allowed to broadcast or any other medium because it’s so pervasive. It’s so hard to understand what’s real and what’s not. And it’s everywhere around us. And I think that’s the part he missed out. He was trying to compare himself to radio or TV, and it’s not – it’s just simply not the same thing.
MARTIN: Before we let you go, Zuckerberg is going to testify for the second time in front of Congress. He’s expected to speak before the House Financial Services Committee next Wednesday. What is that about?
SWISHER: Well, it was supposed to be about Libra, which is this currency that Facebook – (laughter) they’re moving into dating and currency, which, what could go wrong? So they have this currency called Libra that they’re in a consortium with. A number of big payment providers pulled out of the consortium last week. And so it’s going to be very hard for them to talk about it because now it’s not quite the same thing as they initially introduced. They’re trying to do this in a partnership style, as they should.
But I think people are worried about Facebook having any control over money. And so I’m not sure what he’s going to say because there’s not a lot he can say about what’s going on. So I suspect they’ll be asking all kinds of different questions about Facebook’s intentions around payments. It could be a big player, or it could be – and it could be a dangerous player. So we’ll see.
MARTIN: That was Kara Swisher, co-founder and editor-at-large of Recode.
Kara, thanks so much for talking with us.
SWISHER: Thank you so much
Copyright © 2019 NPR. All rights reserved. Visit our website terms of use and permissions pages at www.npr.org for further information.
NPR transcripts are created on a rush deadline by Verb8tm, Inc., an NPR contractor, and produced using a proprietary transcription process developed with NPR. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.
