We Need Rapid Antigen Testing NOW

What if I told you there is an inexpensive test that can tell you in about 15 minutes whether or not you were actively shedding the Covid virus? A test you can take in the privacy of your home, and that is as easy to read as a pregnancy test. 

Sounds pretty good, right? Seems like something that everyone should have, right?

The number one problem in public health is identifying asymptomatic infectious carriers and preventing them from spreading the virus, especially from so-called outbreak events. With more contagious variants now in the US, the urgency is even more crucial. 

Now news of the vaccine, and of new highly transmissable variants, share the stage with pleas for wearing masks.  Taking in the totality of the coverage on MSNBC, the narrative reads like this: We have vaccines, but it will be awhile before most of you get one. In the meantime the rollout has been horriffic, and on top of that we are facing new variants that are exponentially more transmissable. So keep wearing your masks, keep social distancing, and keep waiting your turn. 

The public is suffering from Covid fatigue.The vast majority of people wear masks, but they see little improvement in the pace of infection and hospitalization. Part of that is no doubt due to mixed messaging, some from frustration with the pace of recovery, and part due to the lack of control people feel. There is a sense that there must be something else we can do to combat this viral enemy. 

 MSNBC does a wonderful job covering the human interest stories about front line workers, health care professionals, about the inequities exposed by the virus. But the network, which prides itself on its wokeness and focus on diversity, nonetheless lacks intellectual diversity in its coverage and a lack of perspicacity in its pursuit of Covid stories. 

Rarely are public health experts and epidemiologists given time on the air. This is their wheelhouse. While the on air doctors speak eloquently, they speak generally, and do not broach the issue of rapid antigen testing at all. Frequent guest Dr. Ashish Jah, who signed a letter with 50 other experts imploring for the use of these tests, has never been asked even one question on the matter.

I'm hopful that new leadership at the FDA and CDC will broach this impass and support the mass production and distribution of this critical public health tool. I believe new CDC Director Rachel Wallensky has spoken approvingly.

If we want our schools, indoor venues, restaurants, and small businessess reopened, we have to continue masking and physical distancing. But we have another weapon in our arsenal, and its time we put it to good use. 

Crush Them, Then Talk

Regardless of what you call it- addiction, dependence, obsession- the effect is the same. For 6 years my daily life was driven by a need. The need was insidious, affecting almost every decision and choice I made. Either directly or indirectly, opiates were always on my mind. For those six years I believed that IT is what made me feel normal. I still think of opiates, especially heroin, as a living thing. 

Models exist to help explain the causes of addiction and efficacious modes of recovery, and likewise many models have been suggested to explain Trump's hold on putative leaders and fanatical supporters. A mob boss model. A cult leader model. A host of mental health models. Whether through fear, narcissistic reward, demagogury, or some other mechanism, he succeeds in tapping into the character defects of others, generating extreme loyalty and a willingness to threaten violence.

I'm sure that even the most virulent Trump supporters don't feel like "extremists;"  they believe what they are doing makes complete sense. It is necessary. They have biases, but they look around and see that bias "confirmed." They don't define normal the way you and I might. 

 He peddles The Big Lie and continues his lifelong contempt for democracy and the rule of law. But in spite of this, very few supporters have rejected the Big Lie; even fewer have repudiated Trump and the carnage he creates.

The attack on our Capitol created small but possibly significant fissures in support for Trump. Are there people out there struggling with Trumpism in silence, who are having doubts, who would be open to another path? It is so hard to walk away from a fix, whether its a voice that validates the way you think or a drug that makes you feel "normal."

Until you can get people to accept thay they have a problem, take ownership of their situation, and express a willingness to change, recovery can't occur. The number of people I know who failed, who died from overdosing or still "half ass" recovery, far exceeds those who succeeded. My personal recovery required many difficult but necessary needed things to fall into place. The difficult thing for me today isn't the opiates, its resisting the temptation to blame others, to let resentments and grievances contaminate my thinking.  

The path from denial to acceptance to willingness is impossible without the help of others, and impossible without honesty and humility.

Much serendipity. Much support. 

There is a lot of chatter about the impeachment path, and about prospects for healing and unity as we confront the chaos and crises in front of us.  

One thing that binds ideas like honesty, humility, healing, and unity is TRUTH, or at the very least an agreement on facts, and that won't happen until enough people extricate themselves from Trump and the malignancies that define his existence.

It was at this point that I was going to impress you with a "12 Step Program"for recovery from Trumpism, but I've had a change of heart. The more I learn about Trump supporters, the more skeptical I become that the clearest path to "unity" is to both change the minds of Trump voters and hope for elected officials to have a sudden epipheny. If insurrection can't kindle humility, honesty, and a willingness to change, Democrats should stop hoping. It ain't happening.

If the Republican Party is going to change, it must come from within. Elected officials who are fearful of being "primaried" from Trump zealots are not acting on principal, so don't go looking for it. I think they need to be threatened by the party center too. Few people pay much attention to the center, because being more moderate means practicing more moderation, and that can be very boring in an age of visceral politics and news coverage. I"m sure its nothing personal, but cable news eschews the center for the extremes, and they always will. 

Anyone who thinks Democrats and Trump supporters can "work it out" is either naive or delusional. Trump supporters are the unrepentent addicts, the ones you wave goodbye to when leaving rehab. And its not just a matter of Trump's hold wearing off. It is much easier to switch from one addiction to another than giving them up completely. 

Traditional Republicans from the center-right need to put up a fight for control. The 2022 GOP primaries will tell us everything we need to know about the future of the Republican Party.

A RIFF ABOUT TRUMP, OPIOIDS, AND PUBLIC POLICY

I'm disappointed in both the substance and emphasis of President Trump's prescription for gaining some "upper ground" in the battle against substance abuse, primarily but not exclusively opiate abuse. He seems to lack empathy and fails to realize how quickly opioid (includes opiates and opioids) dependence can spread through a community, and how urgently we need to encourage and support people who would like to find a better path. His list of priorities reads more like a buffet, palatable to most but an unpersuasive recipe for aggressive action.

He failed to clearly articulate that opioid addiction is a health crisis- both physical and mental- demanding an enormous dedication of resources. The President, and frankly the media as well, spent too much time focused on his desire to broaden the death penalty. If Trump wants to talk law and order, he could point to the growth of Drug Court programs around the country. The rate of complete success is still too low, but from my view in the program, some of the "lack of success" is due to the attitude of too many participants. New Jersey Drug Court got me into an excellent rehab, followed that with a beneficial IOP program, and made having a job essential. Graduation allowed me to have my single but very damaging and debilitating charge expunged.

Not only is he underfunding- along with Congress it should be said-  this initiative but he is also reducing overall government funding to Medicaid and the large population that utilizes the addiction services they support. Budgets are a reflection of choices and priorities, and if governments cannot or will not allocate enough money, then the money and resources that are available must be used more efficiently and effectively.

Epidemiologists can pinpoint places around the country where rates of addiction are highest. These places should receive disproportionately greater resources and be used as "incubators" to develop effective recovery programs and networks. Areas like Philadelphia's Frankford neighborhood and certain communities in rural West Virginia are two that quickly come to mind.

Education programs that are heavy on preachiness, platitudes and finger wagging do not go over well with teenagers. In sobriety programs like AA an important aspect is "to identify and not to compare." When talking to teenagers, getting their actual attention is much harder than you think. It is important that, as much as possible, "in person" events with teens and parents involve people in recovery and those who are most affected by them. These presenters are the experts the kids may actually listen to.

Even though the number of rehabilitation centers has increased, a highly disproportionate number of these facilities are designed for a wealthier clientele with excellent insurance and quality resources. In the health care system, and the justice system, a recurring theme is that the poor are denied fairness. Government needs to support fairness as a vital imperative in opioid policy, especially if the private sector and NPO community-for whatever reason- come up short.

My experience, observations, and much empirical reporting leads me to believe that when it comes to opiate addiction recovery, a minimum of 30 days at a rehab facility, followed by an intensive outpatient program, a support system, access to mental health care, and a healthy lifestyle are critical to successful recovery. Probably as important, people need to embrace ideas like humility, honesty, and willingness to act if these programs are to be most effective.

One thing about programs like NA and RA is that they truly synthesize the idea of addiction or alcoholism as a disease with the idea that there is an important spiritual dimension to recovery. The disease model is evidence based and provides practical solutions, while the spiritual side reinforces ideas like choice and consequencs, encouraging members to aspire to do better and be better.

Two things that the President did address fairly well are to challenge the pharmaceutical industry to develop non-addictive alternatives to opioids, and to the insurance industry to fund pain management alternatives. Opioids like Percocet are true gateway drugs. I believe that about 80% of all heroin users got their start with prescription drugs. Companies in both these industries must be nudged to change.

Legislation and litigation might also be necessary. Whatever will work. Its gotta be all hands on deck. Addiction specifically, and mental health in general, must be treated as a  health crisis.  The consequences of failure corrode our civil society and ruin lives. But equally important, the nation needs to have a "conversation" about those things that make people more susceptible to legal and illegal drugs.

One of my IOP leaders really got my attention one day when he said, "drugs aren't your problem, they are the solution you have sought for problems you can't or won't take on." He's absolutely right. I also believe that America's character as a people is a problem in need of some resolution. How we as a people address this opiate crisis will say a lot about us.

Election Note to Democrats: Keep It Local

The Democratic Party is struggling to find a unifying message as it heads into the midterm elections. The energy and drive seems to be coming from the so-called Progressive Wing, and there is a good chance that the "politics of inclusion" that often defines them will be embraced at the national level and encouraged as a kind of platform for candidates.

However, what the election of Conor Lamb demonstrates is that- at least for this election cycle- it might be better for the Party to let the candidates themselves define the debate and be willing to support them regardless of their allegiance to a national Democratic agenda.

By focusing on local issues that people can identify with, combined with a general appeal to the issue of "economic insecurity," Democrats will be able to compete more effectively in districts where they hope to unseat Republicans. This is especially true in more rural areas, where quite frankly the populace is not particularly receptive to perceptions that their District is being unduly influenced by "outsiders."

Democrats at the national level highlight issues like economic inequality and the concentration of wealth. These are serious problems facing our country, but these issues are somewhat superfluous to day to day life. On a local level, candidates might due far better framing economic issues in terms of "economic insecurity," the decline of the middle class, and issues like economic opportunity and fairness. I don't feel unequal as much as I feel insecure. I deal with exposure to economic risk every day. 

The lack of humility by political leaders at the national level will lead to critical miscalculations that could sink potential victories, especially in middle America. Democrats would be wise to heed the message in Conor Lamb's victory and learn that discretion is often the better part of valor.

Moderation in the Age of Visceral Democracy

Most popular thinking believes that political energy, enthusiasm, and activism is skewed towards political extremes on the Left and Right. Implicit in that statement is the belief that moderates are on the sidelines, unable to exert much influence on political debate. That might be true, but it is certainly possible that moderates aren't seeking the limelight because that's not what moderates too. To me,  people with a moderate or pragmatic mind tend to display more humility than others, and that it's not in our nature to proselytize or engage in showmanship. Moderates are out there, frustrated, to be sure, but patient and hopefully optimistic.

We are living through a period I term the Age of Visceral Politics. Dominated by emotional pleas and arguments, visceral politics also seems defined by appeals to things that those in addiction recovery often refer to ask "character defects." In this environment people are less willing to engage with  those with opposing views. Attitudes harden, tolerance ridiculed.

I am frankly pessimistic that visceral politics is leaving any time soon. Today's political discourse- limited as it is- is defined by voices on the Right and Left, voices that have openly rejected any concession with those in opposition. This is not to say that  political consensus building isn't possible, but passing reasonable, centrist legislation is at best problematic and more often illusory.

However, in terms of electoral politics, it is my belief that the more liberal and extreme views of the Left will define Democratic Party debate in this coming election cycle- both legislative and presidential. And with the GOP this cycle still firmly entrenched in that "thing" called Trumpism, if Democrats are victorious in November it will validate the Left's own visceral thinking and ensure more years of this destructive form of politics. The visceral world of politics brings out the worst in people in both attitude and willingness to compromise. 

Moderate minds in the House and Senate need to effectuate the equivalent of a third party, a voting bloc. They need to find consistent partners of the other Party and be willing to vote with them on legislation. They need to have  unified voices on policy. And finally, moderates need patience as the power struggle between the Left and Right plays out. Hopefully we'll have enough pieces to rebuild the destruction that defines this visceral political age. 

Strengthen the Core

It is generally accepted that a healthy body needs a healthy core. A healthy core improves coordination, stability, and strength throughout the entire body. It is pretty likely that those who allow their core to get weak are probably suffering from other health problems.

Suffice to say, I am trying to make a greater point. If you look at both our political and economic health, it has become abundantly clear that the political center and the economic center are struggling. In the absence of these strong cores, political extremism and economic inequality have exacerbated, leading to a cascade of other attendant problems that risk the health of both.

Unfortunately, the voices of moderation, reason, and common sense in politics have been drowned out by those once considered on the margins-both left and right. People on either side have created a bunker mentality where each creates accepts their own set of facts. The effects- which include ideas like confirmation bias and the backfire effect- simply reaffirm this sense that "we are right" and that the only way to confront the opposition is through political power at all costs. In this environment the common good is seen as secondary, questionable ethics and questionable behavior are tolerated, and the willingness to "meet" the opposition "in the middle" is seen as tantamount to abandoning principle. Pragmatism isn't seen as a principle but as a sign of weakness.

In economics, the middle class of workers, entrepreneurs, and middle managers has become so severely compromised that the United States now has the worst Gini coefficient- the standard measurement of inequality in a country- of any country in the Western World and eerily similar to that of nations we generally consider to be among the most unstable on Earth. This growing abyss at the core of our economy has literally severed any connection between those at the bottom and those at the top of our economic ladder. Upward economic mobility and economic opportunity are becoming illusory ideas, and our lack of a political core means that we also lack the political will to purposefully address these problems.

Sometimes I feel like we are reliving the fall of the Roman Republic, when leaders accumulated greater autonomous power, giving the people "bread and circuses" to keep them distracted and satiated.

Our Nation is at a critical moment in its history. We are at a point that our Founders feared the most, where the consent of the governed became an empty slogan, where Machiavellianism guided our political discourse, and where the voices of moderation and reason were subsumed to the will of those expressing extreme, anti-intellectual, and intolerant beliefs.

Restoring the core to our politics and economics is the greatest challenge of our age. If we cannot, America will become a hollow place, no longer willing or able to lead the world, trapped in a vicious cycle of extremism from both the left and right, and dangerously close being a country defined by civil unrest, cynicism, and distrust. We must find a way.