What? No, tears do not 'heal on their own', that's completely wrong. Famously, labral tears of the shoulder and hip do not heal in the slightest without external surgery- even tiny ones.
That doesn't mean that surgery is always the appropriate treatment (I'm living with a shoulder labral tear that's untreated). But it is not even remotely true that tears heal on their own. Example, I just had an MRI on my tear, and the ortho said it looked exactly the same as the last MRI I had 8 years ago- no better, no worse
Sorry to hear about your issue, that must be really aggravating.
Labral tears look bad, yes, I'm talking more about tendon partial tearing here, which I think is more common than labral tearing (though I think, like the meniscus in the knee, after a certain age we probably all have tears in these tissues that are asymptomatic, so it's really a matter of degree).
For a long time it seemed to be accepted wisdom that even a partial tendon tear required surgery, but there's a lot of newer evidence that the body can recover from these with the right rehab protocols and time.
Labral tears however are also commonly asymptomatic and occur in a large fraction of athletes and people who train. I don't think surgerizing those is usually indicated.
The whole 'AI can't automate a lot of jobs, because that's exactly what everyone in the past said about technological advances then!' is a classic fallacious argument. It simply fails as a logical thought pattern. Past technological gains that happened decades or a century plus ago are discrete events separated by time and space from today. 'It didn't happen in the past so it can't happen today' is the same logic as 'I've flipped this coin and gotten heads 5 times, so it will land on heads on every future throw too'. It's completely possible that several times in the past, humanity was wrong about widespread job automation- but they can be right this time.
The whole argument just irritates me on a logical basis. You're basically saying 'the future will unfold exactly the way the past did'. No that doesn't follow at all. We may have dodged widespread automation in past history, but that doesn't mean it will automatically happen every time in the future. You haven't discovered like an Iron Law Of History that repeats every single time. You're just reasoning from a very small sample size and overfitting. Sorry for the rant, the whole argument just annoys me
It's really not that rare for smaller companies. Every two-bit contractor, small landlord who thinks he's smart because he put his properties in an LLC etc. undoubtedly violates the corporate/personal distinction by comingling funds. If an attorney wants to sue Joe The Local Incorporated Contractor, or Alice The Local Slumlord, first thing they're going to do is discovery through a bunch of corporate records- they'll easily find that the owner is mixing personal & corporate cash, credit cards, etc. Takes a good lawyer about 10 minutes
Also there's a big difference between the sites that easily allow you to simply reject whatever their premade cookie settings are. And, the sites that only allow you to use them after you've accepted (example, politico.eu). Or, the sites that do have a 'reject' option, but you have to click through multiple screens and then manually reject each individual option.
Sites that easily allow you to simply reject everything are then a short hop, skip and a jump into browser settings where you auto-reject all cookie/tracking nonsense
Would love to see the overlap between the average anti-Big Tech HN commenter cheering on this regulatory advance, and the average HN commenter who thinks hard drugs should be legalized and that the War on Drugs is bad. Because these are contradictory positions! Either you think people should be free to do things that are addictive or you don't
I don't have time for a longer comment, but AIUI this is mostly a statistical illusion caused by changes to US tax law- previously income that was attributed to 'labor' shifted over to LLCs/S corps for more beneficial tax rates. The doctor, lawyer, financial advisor, CPA etc. that in past decades would have had his/her income run through a W2 arrangement shifted to becoming a one-person corporation
That said, it's a huge pet peeve of mine when someone makes a statement, and then provides sources to back up that statement, but the actual sources contradict their original statement.
You stated "but AIUI this is mostly a statistical illusion caused by changes to US tax law- previously income that was attributed to 'labor' shifted over to LLCs/S corps for more beneficial tax rates." But then your very first linked article states "First, about a third of the decline in the published labor share appears to be an artifact of statistical procedures used to impute the labor income of the self-employed that underlies the headline measure."
I think there is a huge difference between 1/3 (while still a lot and an important factor) and what you wrote, "mostly a statistical illusion", especially since other substantial factors proposed in that article are things like offshoring.
I'm a bit skeptical that you absorbed these 3 pieces in the time it took you to respond (they are 27, 29, and 63 pages, respectively), but they find a range of effect sizes here- the other two a bit more strongly. I feel comfortable with my original statement, though I suppose there's always room for nitpicking
No, I completely read the first article. It was quite clear in what percentage of the decline in labor's share that it attributed to differences in statistical assessment of sole proprietors. I then looked at the abstracts of the other two. The third one basically completely agreed with the first ("We find that reallocating activity to the form it would have taken prior to the Tax Reform Act of 1986 accounts for 30% of the decline in the corporate sector labor share between 1978 and 2017."), and that's when I wrote my reply.
Frankly, I don't know how you can call this "nitpicking". In no definition in the English language is "one third" remotely the same as "mostly".
Exactly. Crazy you are getting downvoted for having the most informed comment here. The other aspect of this is the rise of franchisees in America. Previously, the salary of the manager of a corporate store would be measured as labor income. In a franchise, it would be measured as capital income.
1. Due to geographic sorting smaller districts would be more intensely partisan than today, not less. A smaller land mass is going to be more deeply blue or red
2. A gigantic house would be less cacophonous and boisterous, not more so, because you'd need more hands-on party control to get anything done. It's deeply unrealistic that a huge mass of representatives are going to get anything passed on their own. You'd end up even closer to parliamentary-style party leader control of the House, which personally I'd like to avoid.
Combining these two points, you'd have even more ideologically intense & disciplined parties with smaller districts/a larger House- the exact opposite of what you're trying to achieve I think
3. 'Objections based on convenience and space, are not serious in terms of the meaning of the House' this would be news to say Germany, which recently ended its famous 70+ year old MMP system precisely because their lower house kept expanding too much. They found the issue logistically too difficult to deal with, and are now moving to a more classic PR setup
Bonus extra point- the UK already has one of the world's largest lower houses, with relatively small districts and lots of local representation. Is the UK particularly well-governed, do you think? Small single member districts are rent-seeking machines- way too easy for a local rep to get captured by Major Local Employer (or NIMBY group)
> It's deeply unrealistic that a huge mass of representatives are going to get anything passed on their own.
Every member should be able to bring some number of proposals to full vote and all members should be forced to make a vote. Make every GOPer put a No vote on the "release DJT rape transcripts" bill, instead of burying them in committee. Make every pretend liberal vote No on "Medicare 4 All".
Smaller districts, because of geographical sorting, or spatial covariance, or however you'd like to describe it, would be more homogeneous, and that is EXACTLY the point. What matters is that Representatives better reflect the opinions and beliefs of their constituents, not just the half that won the election, and that the people know their representative, and that the Representative does not need to depend on large donations in order to speak to those people.
What you implicitly describe as a strength, competitive districts, leads to winner take-all political dynamics and MORE extreme politicking, and leads to districts that are perpetually unhappy with their representation.
And in aggregate, the less the party and President can influence a Representative's re-election chances, the more independent that Representative can act, and the more that Representative can reflect their district's particular beliefs. This is a moderating dynamic. In fact, it threatens the two party system in the House allowing cross-party. They can try to be as disciplined as they want, but if they have little leverage over its members, then it will be a fruitless endeavor.
Re: govern-ability of a large House. This is repeated over and over, yet it seems more about opinions and reinforcing the status quo, which is not working, than evidence. And the larger point is that we need to start with the purpose of the House. First fulfill that: To Represent their Constituents faithfully. Without that, none of the other stuff matters. Working efficiently for the wrong ends is not winning.
In terms of the UK, while the ratio in the UK is 100,000 citizens per MP, for a citizen to be a candidate for MP, their Party must approve them, or at least, not veto them. That is not generally true in the U.S., and only true to the extent that the party can send ad money to someone else in the primaries. I think there is good reason to think that smaller districts in the U.S. would give weaker control to Parties, not stronger control.
You are correct that major local employers and NIMBY groups can dominate in small districts. Do they not now? Between begging for money from every monied power and hoping to avoid the ire of the Party and President, where does that leave the Representative in terms of representing their constituents?
In the end, I just don't find myself convinced by these objections, but I do thank you for your considered response.
I traced the two-party dynamic back to something underneath district size a while ago: how we vote. One person, one vote, actually encourages first past the post winners. Shrink the district, grow the district, doesn't matter, you're still forcing every voter into a single binary mark, and a binary mark always collapses into two stable attractors.
Consider the Olympics instead. Judges score, and 1st place, 2nd place, 3rd place simply fall out of the scores, nobody had to design a tournament bracket to make that happen. Give voters that same instrument: score every candidate on desirability. For a pooled multi-seat district, take however many winners the pool needs, ranked by score. Nothing stops someone from voting like they do now, give the candidate you despise a 0 and the one you want a 100, but most people think in preference, a first, second, third choice, not a single binary mark.
The numerology of district size and pop-per-rep will always be heuristic at best. If the goal is to improve representation, we should focus on the mechanism of selecting people and elevating them into office. That's the biggest bang for the buck.
Because the median voter doesn't realistically have that detailed a level of knowledge on legislators/their policies. This is tough for a lot of people to believe- especially the kind of high-information voters who propose these sorts of reforms to begin with. But there's an enormous, multi-decade literature on voter ignorance. They simply don't know much about who's running or what their policies are
1. I grew up in a small town, and occasionally ask my parents how mayoral/city council politics is going there. (Or, I check out the latest drama on Facebook about it). My good friend's uncle was our mayor for a long time, etc. People might know personalities, but they're still not following national policy positions. Not to mention that people would be voting purely for personalities/clan/ethnic affiliations, and again not policy- we have a term for that in poly sci, personalism
2. A country of 340 million people with an elected representative from every small town would have an unrealistic number of representatives. 1 for every 5k citizens would be 68,000 reps in the House
I get that you're fetishizing hyper-localism to the exclusion of all else, but it's just a bad basis to run a modern society. This is not a realistic vision
Was it hyper localism in the years between 1776-1930 to have 1 Representative per <=70k citizens. We do not need to go to 5k, and no one said that. But there are ways to aggregate and distribute processes for a larger House, and you have provided no reason for why the current fixed small number of 435 should be preferred, why that is workable, but not 870 (1:350k) or 1740 for 1:175k.
Practically, and with all due respect, you keep stating opinions why it is a "bad basis to run a modern society" but you never articulate why exactly. To my mind, the increased complexity of the world can use more Representatives to work and specialized in more specializes committees.
OK, but there are some logistical issues here- let's say Alberta votes to secede and this is somehow legally viable. All of the Albertan voters who didn't want to secede- including the native tribes- could then by your rules vote to secede from Alberta and join back to Canada. It'd be a mess. Towns and counties would split themselves in half, and so on.
What would happen if a landlocked town within Alberta wants to rejoin Canada- how would you handle that?
It's like having to belong to a higher imposed authority (either the original country or the seceded territory) is bad for the individual that doesn't want any of that. If only there was a solution to that problem...
Has anyone had any luck deleting themselves from the data brokers who sell cell data to political texters and/or survey companies? Those are the ones I really want to opt out of
>The government should just regulate it, control purity and production and let people access small amounts for recreation/performance
Famously, the US spent about 15-20 years attempting this with opioids. They were widely available to people via a pseudo-medical process, or via secondhand dealing. Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. The result? A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War.
(For people saying 'no, that was illegal heroin or fentanyl that did all that damage'- the Wiki page for the opioid crisis is quite clear that at least 50% of all deaths were due to perfectly legal, regulated opioids).
When you make drugs legal & easy to get, lots & lots of people do them- who develop life-shattering addictions and OD en masse. They also build tolerance and then move on to even harder stuff. AFAIK out of the 300ish countries on the globe, there is not 1 that has decriminalized hard drugs in the modern era. And no don't say Portugal, contrary to widespread myth they forced people under threat of jail to attend drug rehab, and anyways they've recently curtailed even that.
I realize this is not going to get a lot of upvotes on HN, but yes making it difficult to do hard drugs is a reasonable public policy goal. (Which again, is why literally every country on the planet does it). There's room to argue about the exact tactics, but the broad goal is perfectly legitimate
I don’t think it’s fair to say we tried letting people access it for recreational or performance use. The insurance companies and doctors became drug pushers without an explicit acknowledgment of what was happening. Easy access to drugs without being able to discuss what was really happening is worse than prohibition sure, but that’s not informed consent. Informed consent is the patient tells the supplier what they’re doing and the supplier is trained to handle that. Our doctors are not drug shamen or addiction specialists, but we could imagine a situation where these are the people providing drugs, safe drug sites, and free counseling. Otherwise the solution is men with guns and weird geopolitical shit. Also the government gets to decide what drugs people can take which I disagree with in general. There has to be a better way.
Selling it in adults-only dispensaries, along with banning advertising seems like the best idea. I'd ban tobacco, liquor, and gambling advertising too while we are at it.
I think a astronomically better example would be programs in the Netherlands, Denmark or Switzerland, where people heavily addicted to heroine can get into programs that will provide them with pharmaceutical heroine.
Still prescribed by doctors (although specialized ones), but not just for pulling a wisdom tooth with huge margins for the Sacklers...
The last time I looked up the Swiss program it was only servicing a small number of people. Around 1500 in a country if 9 million. It also wasn’t prescribed like a typical medication but part of a program where they received other treatment as well. There was some exception where some people could get 2 days of it at a time to take home, but it wasn’t a free for all prescription where they could just talk to a doctor and get their monthly desired supply from a pharmacy.
Many countries, including the US, use methadone for maintenance. As I understand it it’s not as enjoyable as some people’s opioids of choice but it’s still an extremely powerful opioid depending on the dose (easily fatal).
So it’s not only the countries you mentioned that provide pharmaceutical opioids as maintenance treatment. The US does too, though the form is different.
I'd say it is about what you expect for a country with voluntary programs. In the Netherlands the original program like the Swiss, resulted in heroïne becoming a medication for heavily addicted people usable under supervision. In the Netherlands there are about 4000 people with medical prescriptions for heroine on a 18M population.
Note that it is free, supervised and voluntary so ymmv in other countries. The conclusions of the original program with methadone in the 80s was that it resulted in hardly any reduction amongst heavy and problematic users and they were likely to go back to using heroine with all the associated problems, the heroine distribution program worked but needed some tweaking, thus the program was fully legalised and put into law resulting in supervised consumption (at the distribution point) with dosage control and medical checkups and far less issues.
A problem LAR programs have had since the start is that although methadone is less attractive as a drug than heroin, it's still attractive, and basically the only way to figure out how much a heroin addict needs is to ask them. Leading to users asking for extra, selling the excess (to users who were not in the LAR program) and buying other drugs with the profits. For some years, more people died from methadone overdose in Norway than heroin.
Sure, you could demand injection on site to reduce this problem. But that just makes the program less appealing. You could also just hand out the users' drug of choice directly (heroin) rather than the less harmful substitute, but at some point that starts counting as physician-assisted suicide, really.
Don't Spain and Portugal also have fairly progressive policies/programs for drug harm reduction? I remember reading about it a while back, but it was a US source and they were trying really, really hard not to have to say "you know, this might actually be a good way to handle it".
Your opioid comparison is wildly apples to oranges. They were marketed and sold to consumers as safe, much more effective, and dramatically less addictive than it actually was. An industrial addiction machine ignored regulatory safeguards, built a 'pay for play' rewards structure to incentivize prescriptions, and a zillion other cartoonishly evil things .
There is a world of difference between something like that and government dosed methadone, meth, etc.
The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too.
If the drug is socially stigmatized only true addicts will use it. Those are exactly the people you want to have access to it because they can be gradually tapered off on a controlled dosage, they can be targeted for interventions, and it keeps them from stabbing you and stealing your wallet to get more meth.
Its incredibly counterproductive to just outlaw a thing that people need on a level that they will do almost anything to get it.
I think another under-discussed factor in the opioid crisis is that opioids are cheap, but (American) healthcare to treat underlying pain is not. You might not be able to afford six weeks of physical therapy, surgery, etc., but you can probably afford $11.23 a month for a generic prescription.
My view of a lot of the opioid crisis stuff aside from physical pain is psychological trauma - people self medicating as an alternative to doing the work.
That’s why I think the psychoactive legislation that’s introduced recently about psychedelics is so important because those things can rapidly accelerate processing and healing psychological trauma.
My view, is if this was done 20 - 30 years ago there wouldn’t be such a large demand for opiates. I take it further and say that probably some in the drug companies understand this already and were lobbying against the introduction of more curative psychedelic treatments so that they could sell subscriptions to painkillers.
(This is a serious article by a serious researcher. There exists good work on Frontiers in….)
The 5-HT2A receptor is profoundly immunomodulatory. (Acid is arguably a more potent immunomodulator – an antiinflammatory one – than it is psychoactive.) Local inflammation is a thing in injury, "global" inflammation as well – there is strong interplay between cytokines and metabolic/anabolic/catabolic process; Interleukin-6 stimulates osteoclasts which actively break down joint tissue – and neuroinflammation also affects physiology. Muscle tone, blood flow, pulmonary function, and so on.
Ego death happens to be a phenomenon or qualia when you boop that receptor hard. I'm not sure ego death necessary for anything. It might be. Ego death is very intimately related to the individual neuronal state and memory, and inflammation is quite enmeshed with that. (Cf. cortisol.)
I was quite surprised to find that paper! Thank you for… the audience?, for your consideration? It's quietly somewhat maddening that this is on the books and there's so little mention of it.
Like, psychedelics? I'm not a hippie. I'm not into psychedelics. I'm into neuroinflammation, haha
Chronic Back pain is correlated with emotional trauma. The physical body is a mere projection of the energetic and spiritual being. This is wahy meditative spiritual practices such as yoga and taiji are good for chronic pain, as the physical pain is a mere projection of a deeper trauma that needs released.
Ignoring the spiritual part, emotional state does have a well-known feedback loop with physical state. There’s a (largely incorrect) idea in pop psychology that just as happiness leads to smiling, smiling leads to happiness. It’s not nearly that simple, but there are some more straightforward examples: lots of tense emotional states (anger, anxiety) lead to tense muscles (jaw being the classic example). Relaxing your jaw can lead to a (temporary) relaxation of your emotional tenseness. I’ve never heard of a similar result for the lower back, but it’s not hard to imagine. If nothing else, they must be correlated through sedentary lifestyle.
> (largely incorrect) ... just as happiness leads to smiling, smiling leads to happiness.
I don't have a citation to hand and it's really old but there was academic research supporting that at some point. IIRC they used some clever request to get people to move their facial muscles in various ways without tipping them off about what was really going on and then asked them lots of questions that touch on emotional state.
By directing your attention towards, or away from, physical phenomena that mechanically affect your lower back: overexertion, underexertion, posture, nutrient intake, crowd...
Setting the woo aside, there is a lot of data on disorders like central sensitization syndrome that show our psychological state has a very strong modulating effect on our perception of pain.
I mean tons of back pain is medically unexplained. It's not like physiology has a perfect record here that can be used to dismiss alternative theories.
There's a really neat book called Gift of the Raven about an athlete with chronic knee pain that doctors couldn't figure out any plan to stop. He rowed from Alaska to Siberia and the book goes on about a shaman that performs a healing ritual (psychedelic mushrooms were involved) and he finds himself cured. So, there are times I suppose when the pain is all in your head, and maybe has a feedback loop since pain will also cause muscle contraction which can pull bones out of alignment. Relax enough and the pain stops.
>Those are exactly the people you want to have access to it
Yes but that's different from 'every random person can buy some meth at 7-11 or the government store' though. I'm fine with a controlled program for registered, hardcore addicts- the 2% who do 50% of the drugs or what have you.
>The problem was not in fact opioids. It was the profit structure behind the distribution network. Remove that and the bulk of the problems go away too
I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though? If 'removing the profit structure' worked magically, more countries would do it. AFAIK rates of alcoholism aren't even different between state-run and private sector models
State run liquor stores in the US don’t prevent companies advertising alcohol on TV. The US is really bad at allowing drugs without then also allowing drug promotion.
A better comparison is probably countries where prescription drugs can’t be advertised to the general public. But, then you’re dealing with a lot of differences in other government policies.
> I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though
They have less of it. Reducing access and increasing price reduces consumption, as any economist would expect.
The main problem with government monopolies of this sort is that they usually lack democratic legitimacy (i.e. would be voted away in a single issue vote) are under constant PR attack from people who profit from the regulated product. Leading to concessions such as the Norwegian monopoly being run as a for-profit corporation.
> If 'removing the profit structure' worked magically, more countries would do it.
No they wouldn't, for the obvious reason: those who profit from it have a voice, and are better organized than the ones who suffer from it (many who are addicts and want easy access anyway).
That's a bit of an apples and oranges comparison. The thing about for-profit prescriptions is that they incentivize doctors to prescribe opiates for people who don't need them, people who may not have even been interested in them. A for-profit retailer selling alcohol doesn't have that aspect at play at all; at most the for-profit aspect encourages flashy advertising and displaying alcohol more prominently, but nothing to the level of having a trusted expert in a one-on-one setting personally pushing for you to consume.
Instead the pressure to consume alcohol comes at a grassroots level. Social alcohol consumption is deeply rooted in human culture, and it's generally the people around you who will push you to consume. This pressure is independent of any profit motive, so removing the profit motive does nothing to affect it.
> AFAIK rates of alcoholism aren't even different between state-run and private sector models
Looking at some 2016 WHO statistics, the US seems to have ~3x the rate of alcholism as Iceland, but I recognise these are cherrypicked examples and I'm not interested enough to do a deep dive aggregating countries. Still, it seems plausible that government intervention can reduce alcholism rates. The fact that it's not 0% means nothing; nothing in the world is 0%, outlawing murder doesn't mean murder doesn't happen, but you can strive to reduce it as much as reasonably possible.
Alcoholics (the really bad ones that we're presumably talking about here) don't consume because of social pressure. It's addiction and all the associated psychological and sociological complexity that implies.
I expect any comparison of alcoholism rates will need to account for social (particularly religion) and socioeconomic factors. An awful lot of addicts are engaging in escapism.
Addiction doesn't start until you've first started consuming a substance. The means by which you first start consuming alcohol vs. opioids are completely different, and the former is virtually always the result of social environment.
Sure, recreational social interactions tend to be the introduction since it's legal and a common pastime. But such interactions are almost never the primary driver of alcoholism except perhaps in specific college environments where you might reasonably describe the pastime as competitive drinking. That's far from the norm though.
Coincidentally, aside from official prescriptions recreational social interactions are also the primary method of introduction to drugs of all sorts.
> Social alcohol consumption is deeply rooted in human culture
This is actually dependent on the culture and not all are the same, interesting paper on the topic (in cultures with higher agricultural interdependency alchool was not used as a tool for social cohesion): https://www.researchgate.net/publication/404116345_On_the_Fu...
>The government should just regulate it, control purity and production and let people access small amounts for recreation/performance. It’s not an evil drug per se
>Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production. The result? A shattering drug addiction crisis
>They were marketed and sold to consumers as safe, much more effective, and dramatically less addictive than it actually was. An industrial addiction machine ignored regulatory safeguards, built a 'pay for play' rewards structure to incentivize prescriptions, and a zillion other cartoonishly evil things
>I mean, states & countries that have completely state-run liquor stores still have alcoholism and serious alcohol problems though?
I tried to draw upon the main central point of each comment to this point. This discussion felt reasonably solid until this point where I feel like you failed to refute their main point. Your counter-example is still apples and oranges. State run liquor stores don't have the strong financial incentives to push alcohol and they don't downplay the addictive potential of their wares using fake science and they don't have authority figures give their patients official recommendations to take alcohol as a treatment with that fake science and financial motivation. Obviously people can and do still get addicted to all kinds of things without that scheme in place but I feel your initial example is pretty uniquely evil and not something we can learn generalizable lessons from, other than "don't do super evil stuff". Surely if your initial point is strong enough you can still make your case using other more generalizable examples.
All Scandinavian countries except Denmark have some form of state-run monopoly on the sale of harder alcohol, and of these countries, Denmark is the country where people drink the most, in particular among the youth.
It is disingenuous to claim that something doesn't work if it doesn't eliminate it completely. It is pretty well recognized that tight regulation of alcohol sales and marketing together with taxation helps reduce overall consumption. Alcohol consumption was also not eliminated during the prohibition in the US.
It's also important to recognize that making a drug legal is not the same as regulating it properly, and just making it legal can very well bring more harms than keeping it prohibited if no regulation of its sale and marketing is introduced.
Lets not forget that in the US not only opioids get legalized, but they were given to people as a substitute for aspirins. And then retired without mercy. Did you get addicted? Well, you are on your own now, go get some fentanyl under a bridge.
I live in Spain. Alcohol is not tighty regulated here, and is cheap if we compare with nordic countries. But we, overall, have a culture of knowing how to drink, low proof drinks and in low quantities. The worst drinkers here are tourists from northern countries that binge on high grade alcohol because it is cheap. I had never seen someone chugging a liter of beer like it is water, or do that thing with a can of beer where you force the whole can, or that other thing with the funnel and a tube, like you were in a hurry to get drunk. You just drink a beer whenever you want, at slow pace. Spain, overall, consumes a lot of alcohol, but the consumption is so spread among the population that you rarely see adults drunk.
Our neighbor in the south, Morocco, allows for marihuana consumption and selling, and they have way less problems with it than any european country. But they have alcohol tightly forbidden, and it is a big problem there.
I went to Finland, and there were ships going from Finland to Estonia, carrying people just to buy cheaper alcohol there. They went back to Helsinki with shopping bags full of vodka. Makes you wonder how does it look Tallin in drinking statistics. I bet something similar is going on between Sweden and Denmark or Germany, whatever trip is shorter and cheaper.
The point is that a culture of taking drugs needs time to develop.
We raised the drinking age from 16 to 18. The end result is more underage drinking but now illegal, more heavy drinking under 18, a rise in hospitalisations and a rise in problematic alcohol usage of the 18-23 group. The rise correlated strongly with the change in law. Let's see if it drops after a decade or so but I doubt it.
Yes, the swedes take the ferry to Denmark and the danes take the car over the border to Germany.
There has also been a movement to change the culture of drinking in Denmark, and the consumption has generally been going down, although it still remains high among youth. This also goes to show that there are many complex factors at play and that legal status alone cannot explain consumption patterns.
I do believe that prohibition makes it a lot harder to influence the culture around consumption compared to a legalized and regulated market.
> I went to Finland, and there were ships going from Finland to Estonia, carrying people just to buy cheaper alcohol there. They went back to Helsinki with shopping bags full of vodka. Makes you wonder how does it look Tallin in drinking statistics.
They just need to exclude the shops in a 150 m radius from Terminal D in the Tallinn harbor to get accurate statistics, the Finns rarely go beyond that ;)
Could you then be more clear where exactly your claim came from? I did not find it, but rather this:
"According to medical professionals, supervised injection sites are effective in reducing overdose deaths and the transmission of infectious diseases."
"From 1999 to 2020, nearly 841,000 people died from drug overdoses,[7] with prescription and illicit opioids responsible for 500,000 of those deaths"
Here's a chart showing overdose deaths from all drugs in the US- yes there's definitely a large spike from 'synthetic opioids' at the end there that's probably all illegal fentanyl. But notice the blue line for 'prescription drugs' was very very steady for the entire length of the chart. That's an enormous number of deaths from completely legal, regulated drugs!
> with prescription and illicit opioids responsible for 500,000 of those deaths"
So... it's not saying 500K deaths are from prescription drugs, it's saying 500K deaths are from opioids (some of which were prescription)
Also, in the chart you mentioned, it's not clear if the opioid deaths were from legally produced prescription opioids. Certainly fentanyl is one of the biggest killers, and fentanyl is used in medical settings, but the fentanyl killing people is usually not from legal drug manufacturers.
I wonder what sort of environment and conditions contribute to large populations seeking to use opioids in the first place?
Theory: this is a socioeconomic problem rather than a public health problem. Our systems care too little for people. The easiest solution then is for people to self-medicate.
It's easier to deny people a harmful salve that they feel they need than to provide them the social supports that they deserve.
Exactly. It's more helpful to look at this from the perspective of solving problems that push people toward unhealthy choices than from the perspective of how we can limit the freedom of adults for their own good. A few other thoughts:
1. US tobacco policy is far more liberal than the War on Drugs, yet which of the two is a successful case study in curbing harmful addiction?
2. The recent opioid epidemic is far more complex than "the government tried legalizing opioids and it failed". Whatever policies did exist weren't legalization of opioids, and didn't exist in a vacuum. You can't model that policy without factoring in the wide availability of contaminated street drugs and absence of safer OTC cannabis alternatives. More importantly, the drugs weren't merely available, but actively pushed in a way that should have been legally discouraged.
3. The above analysis completely ignores the most important point raised in the top-level comment: prohibition simply redirects capital from businesses that are regulated to those that are not. Say what you will about Big Pharma, but they usually don't go around hanging mutilated bodies from bridges.
4. Even if drug prohibition were the optimal policy for reducing addiction rates, at some point protecting people from their own choices ceases to be a valid excuse for harming the rest of us. We've punished countless marijuana users who mostly aren't addicts, inflicted terror and destabilization upon our neighbors to the south, and created what at least half of America believes to be an illegal immigration crisis.
5. The claim that drug prohibition even helps the people it's ostensibly supposed to help is extremely dubious. We're subjecting addicts to more dangerous substances than the ones they're actually seeking out, and locking up the ones who survive. Maybe there's a narrow slice of people who really want narcotics but lack the motivation to navigate black markets, but otherwise who is this all for? We're hurting everyone in our confusion just to enrich a cabal of warlords.
Drugs are an alluring and easy avenue for people who have a difficult time fitting into their social expectations and dealing with pressures. Obviously this isn’t where it starts, but treatment is so difficult and the punitive effects are so harsh that it creates a system that’s incredibly difficult to get out of…so why would you?
This isn’t always the case, of course, but my own anecdote:
My best friend in high school got hooked on heroin - not sure exactly what started him on it or why, but I could tell that he knew he didn’t want to be in that place, and that he as genuinely trying to get clean but the resources were limited and often harsh.
He did get clean for a while and applied for a job at Walmart - this kid was stupid smart, we’d do EE and programming projects all the time and I always felt like he was miles ahead of my understanding of technology - but this was what he had available because of his history.
The Walmart drug test popped for the drugs he was using _to get clean_ and they denied his application. Went home, relapsed, got found dead by his mother. It’s awful.
> When you make drugs legal & easy to get, lots & lots of people do them- who develop life-shattering addictions and OD en masse. They also build tolerance and then move on to even harder stuff.
That depends on the drug. Both it's addictiveness and its destructiveness. It's likely true for meth. I doubt it's true for weed. It's demonstrably not true for many of the OTC drugs that have been easy to get for hundreds of years without the collapse of society
> Famously, the US spent about 15-20 years attempting this with opioids. They were widely available to people via a pseudo-medical process, or via secondhand dealing. Opioids were/are manufactured by regulated, publicly traded companies with inspectors who controlled purity and production.
There is a pretty decent argument that this was still a result of pseudo-prohibition, which goes like this:
Opioids were easy to get a prescription for, but still required a prescription (and were covered by insurance), and were still highly restricted in who could manufacture them. That made the margins high, and consequently created a perverse incentive for the manufacturers to want patients taking the high margin insurance-funded opioids rather than a cheap commodity out-of-pocket NSAID or acetaminophen.
Because they still required a prescription, getting people taking them meant they had to capture the prescribing physicians, who now get their own perverse incentives. Not only marketing/kickbacks/incentives from the pharma companies, if something over the counter would work and that's what you recommend, the patients buy a bottle at Walmart for $5 whenever they need it and you never see them again, but prescribe something stronger and you get to bill their insurance again and again every time they need another appointment to re-up.
But "ask your doctor" was supposed to be the thing you do to get sound advice. Give the medical establishment a profit incentive to over-recommend the addictive thing and what do you expect?
Meanwhile if they were all available at the convenience store for the same price, nobody would have the incentive to push the addictive one, and then when you ask your doctor (or for that matter anyone else) what they recommend, they would generally tell you not to take opioids unless you really need them.
Surely both manufacturer and convenience store have incentive to push the addictive product in this scenario.
In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves. Have you ever taken an opioid? The idea that unfettered access would result in less addiction and death is a pretty remarkable POV
> Surely both manufacturer and convenience store have incentive to push the addictive product in this scenario.
In this scenario the addictive product has the margins of a generic commodity and 75 competing suppliers. Getting the customer addicted has close to zero returns because the margins are thin and the customer's future purchases are more likely than not going to a random competitor rather than you. Notice how little advertising you see for things like flour or onions. If something is completely fungible and commoditized the incentive to push it on you is minimized.
And retailers have the opposite incentive, because making a $0.05 margin on a bottle of pills once a month is worth far less to them than not having someone who is a repeat customer lose their job to addiction or die of an overdose and then stop buying all of their other products.
> In any case, drug dealers really don’t need to do any pushing, the drugs sell themselves.
If the drug dealers don't need to do any pushing then why do they spend so much time and effort on pushing? It'd have to be because pushing gets results, and therefore blunting the incentive for pushing gets results the other way.
>The idea that unfettered access would result in less addiction and death is a pretty remarkable POV
It's not that crazy, but it has to be coupled with accessible recovery programs. The classic tale (one that people in my life have gone through) is the prescribed opiates -> street heroin when the scrip runs out / when they change the oxy recipe so that it doesn't dissolve in water anymore so you can't shoot it.
This is obviously much more dangerous than getting oxy from your doctor, so the logic of "keep people from seeking heroin on the street" actually does make sense to me from a public health perspective.
I'm not aware that anyone every tried to do it right.
Like how about you have to do a short course which actually explains to you how a drug works, how to use it correctly, what are potential downsides, what are markers of overuse/wrong use.
And the other main issue with opioids and co: some people really have constant / chronic pain.
Do you know how exhaustive it is to constantly have pain? How annoying it is that you can't just go to bed and sleep?
But also we can't play devils advocate to say "you are not allowed to do drugs to num whatever issue you have" and also "but i don't want to take time and effort of helping you".
Oh i don't want you to kill yourself! But i don't want to spend time tomorrow afternoon either with you.
Our society is very hypcritical in this sense. Honestly i think people just don't want to see homeless people or fentapoeple. Its not about helping, its just about not being disturbed by them.
This is a tired trope but must be made: society has accepted that drugs can be dangerous but we won't stop people from using them -- leading with alcohol and tobacco. Yes, restrict access to youth and avoid reckless advertising, but still the people's choice.
If the drugs are pure, and health problems that occur with abusing them (overdoses and addiction) are treated as health issues rather than criminal issues, then it's all a solvable problem.
Heroin being illegal didn't stop my brother from dying on it.
Opioids have never been made legal for recreational purpose. They were sold as painkillers by pharma corporations lying about their addictive effects and promoted through marketing campaign targeting doctors to prescribe them.
I has nothing to do with the topic of recreational drugs.
Many opioids, including opiates, used to be OTC. I personally know someone who used to smoke paregoric (camphorated tincture of opium), which was OTC in the US until 1970.
I believe 1970 was also the year when amphetamine (Benzedrine) inhalers stopped being OTC.
In low doses most hard drugs that are uppers are pretty decent performance enhancing drugs. It's dumb that society can't get energy drinks and stuff with "low enough you can't realistically abuse them because you'll spend too much time going to piss" amounts of cocaine, amphetamines, etc.
What if they were legal but hard to get? Say, we stop/arresting for possession or use in private, stop giving dealers and producers harsh sentences, but still give them moderate to weak sentences, stop proactively searching for dealers and producers, allow companies to produce with strict KYC, and don't allow retail sale in stores?
In California weed is legal but highly regulated. It's easy to buy weed in the legal market but very difficult to be licensed to sell or grow it.
The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers.
Note that the consumers who choose the illegal market are not in general socially excluded, habitual criminals or broken down addicts. Weed is widespread in almost all parts of society and probably less prevalent along dirt poor, mentally unwell or homeless drug users, who favour fent or meth.
People with jobs and houses choose illegal weed because it's both cheaper and easier to get hold of.
Isn't it illegal in the entire US? The question doesn't seem to be whether you can obtain it legally, but how many laws you'd rather break in the process, and how much trace you'd like to leave behind. I imagine the illegal vendors are less likely to leave a discoverable trace (that could affect your future background checks etc.) than the "legal" vendors, which itself is an incentive to obtain it illegally even when it's cheaper and safer and easier to obtain less-illegally right next door.
Which basically means the US hasn't really tried legalizing it at all.
(Not advocating for any position here, just commenting on the facts.)
> The result is that the illegal market dwarfs the legal market. The legal suppliers simply can't compete with efficient and untaxed illegal or grey market sellers.
Source for this? I mean consumer buying habits not illegal grow ops in general (which are selling a lot of their product out-of-state).
Even with California taxes an 1/8th of flower is often less than half what I’d typically pay back in 2008 or so, even without adjusting for inflation.
Also, I suspect middle class buying preference in the last decade or so has heavily shifted to gummies/edibles and vape carts which are much sketchier in the black market vs relatively interchangeable flower.
The idea of smoking a literal bowl to get high wouldn’t even be in the first like 5 methods among the people I know. It’s not super appealing in your 30s-40s while living in apartments/not wanting to reek of weed in the office. So buying off the black market just isn’t attractive even if possible cheaper.
California is probably the best example going of how not to "legalize" weed.
However, this also highlights the primary difference between weed and meth, opiates: ease of manufacturing. The only other common drugs that come close are things like mushrooms and fermented beverages, and I'd argue both of those are still riskier.
Not every drug is an opioid. We have prohibition laws designed for opioids blindly applied to any (in the western context) nontraditional drug. The German law on drugs is literally called "the painkiller law", for instance.
The meaning has drifted, appropriately enough. Betäubungsmittel originally meant painkillers, as you can tell from the word. It's just that now every recreational drug is labeled as such.
You seem to be confusing the words "Schmerzmittel" (analgesic, pain killer) and "Betäubungsmittel" (narcotic). Those two classes of substances are not the same.
"Betäubung" has a similar etymology as "narcotic". Both mean to numb the senses or put to sleep (hence e.g. "narcolepsy"), and in German it's therefore also used for sedatives and anesthetic drugs. In modern use, "narcotic" has also semantically shifted to include any illegal drug, as with "Betäubungsmiddel".
Interestingly, in both cases the semantic shift seems to have been caused by the enactment of laws to control drugs. The legal term these days is probably "controlled substance" in English, but "narcotic" now definitely refers to many drugs that are not medically narcotic.
It can also mean anesthetics, which coincidentally would include cocaine as a strong local anesthetic, but not a narcotic in the pharmacological sense.
Look at alcohol. How many lives are negatively affected because of alcohol being freely available? By numbers alone when something is legal there are people who will participate who would otherwise never go near it if it were illegal. We're seeing this with weed right now imo.
Because it's legal, people will try it. And because we live in a country where it is celebrated, encouraged, and every holiday seems to be an excuse for folks to get hammered, A LOT of people will try it. How many would never touch it if it were illegal? How many wouldn't drink and drive and kill themselves? How many innocent people in the other car, completely sober, would still be here? Because remember, booze, or drugs in general, impact more than just the user. Their families, friends, and other random people can be impacted. How many kids grow up with a drunk parent, unable to properly express or process emotions, might not have to grow up unable to maintain healthy friendships because they don't know what they look like, or won't be taken advantage of because they have a caretaker/fixer mentality because that's what they had to do as a kid.
We know making booze illegal doesn't work, and that's not what I'm suggesting here. I'm not even suggesting anything. I'm just saying, the blast radius of booze impacts a lot of people beyond the alcoholic, and statistically, a portion of those lives negatively impacted are the direct result of alcohol being legal. I can speak from firsthand experience the impact of an alcoholic single parent growing up, which would be the reason I look at this topic the way I do. Would I have been given a more healthy and "normal" childhood had booze been illegal? Idk. But some kid out there would have, which might be all that matters.
> A shattering drug addiction crisis that at its height killed more people annually than the entire Vietnam War.
Except that you're wrong. The war-on-drugs kept drugs under control. It did not _eliminate_ them, but they also were not available on every street corner.
Once we stopped the war-on-drugs, the abuse rates skyrocketed. Not just opiods, but also meth. You can see it on the graphs in this article, the general wind-down of drug abuse policies started around 2008-2010.
I personally consider the war on drugs to be a colossal failure and there tends to be widespread agreement that the War on Drugs was somewhat effective at enabling enforcement, but ineffective or counterproductive at eliminating drugs or reducing long-term harm.
What America continues to ignore, intentionally or not, is the root cause of drug addiction which tends to be a more complicated and nuanced
Well, now the war on drug is over and we see that the harms from _not_ doing it are worse. In 2023, overdoses overtook gun and traffic deaths _combined_.
Surrendering to the drugs was a mistake.
Yeah, we should have changed tactics. Zero-tolerance policies were terrible nonsense, long prison terms were not helpful, and we should have clamped on prescription pills way sooner.
> but ineffective or counterproductive at eliminating drugs
It was effective in _controlling_ their level. And alternative approaches are just not working.
It seems like you've already made up your mind what to believe. In particular you've failed to critically analyze the broader context in which overdose deaths went up and I also have to question your suggestion that the war on drugs in the US ever ended.
Sure, marijuana is largely accepted at this point. Most other things you still buy from gangsters on a street corner or via the darknet and will still be arrested for having, frequently losing your job as a side effect.
To overdose deaths, those largely correlate to the Sacklers (ie medical professionals inappropriately pushing product with a veneer of legitimacy) and to fentanyl. The latter is particularly deadly due to the combination of accessibility to amateurs with the inherent difficulty of safely compounding such a potent chemical as part of a clandestine operation.
The prescription pills epidemic was largely over by 2018. And yes, then fentanyl started picking up speed.
> suggestion that the war on drugs in the US ever ended.
It has not happened evenly across the country, but it happened on the Pacific coast. Drug use stopped being punished, with people openly consuming drugs in front of the police. Oregon even made that official.
This is an important point. Drug enforcement operations did not stop, because no large-scale bureaucratic system can stop at once. But they became a futile theater.
Curtailing cocaine/opium traffic was hard, but not impossible. Cocaine had to flow from growers high up in the mountains, through multiple countries and transportation modes. Each step increased the price for the end-consumers. And cocaine/opiates are relatively bulky, so smugglers couldn't just do one high-risk operation, they had to build a robust supply chain.
Fentanyl upended that. It can be cooked in a lab in Mexico just outside of the US border. The precursors aren't particularly expensive either. It's also highly potent, so that one milk jug of pure fentanyl powder can supply a large-ish state in the US for a year. So high-risk high-reward one-off smuggling operations are much more feasible.
They're not. In 2023 the overdose deaths were more than 100k. They have gone down a bit since then, for a very grim reason: they killed enough people to affect the statistics.
This is complete rubbish. The peak years of the war on drugs had a variety of hard drugs available on street corners across all major cities.
At best it kept some amount of some drugs less visible in some suburbs and communities, while making it profitable for suppliers to cross those lines.
The main effect of the war on drugs was a level of incarceration outdoing almost any society in human history. The fact that the numbers jailed for victimless and quality of life 'crimes' kept going up is testament to the fact that there was hardly any effective deterrence.
To me this reads as naive because I could get most any drug on many street corners easily any time within the last 30 years once I was old enough to realize what was going on and notice.
That doesn't mean that surgery is always the appropriate treatment (I'm living with a shoulder labral tear that's untreated). But it is not even remotely true that tears heal on their own. Example, I just had an MRI on my tear, and the ortho said it looked exactly the same as the last MRI I had 8 years ago- no better, no worse
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