I can relate to this

China’s great leaps forward: in charts

We in the USA have some catching up to do.  Just a reminder.

Face it: The war in Ukraine has been lost

Russian soldier launches missile at Ukrainians in Donetsk.

The United States and its NATO allies are at a crucial turning point.  They (we) have been defeated in their proxy war in Ukraine.  They must choose between accepting defeat or trying to escalate to a larger and wider war, which would lead a bigger and more humiliating defeat.

For the purposes of this post, I am not talking about the moral justification for the war or the lack of it.  I am talking about facing facts.

The U.S. and its NATO allies are outnumbered and outgunned.  Russia has a larger fighting force in Europe than the NATO allies combined, and greater capacity to produce essential weapons – missiles, drones and artillery shells.

Ukrainian leaders have frankly stated that they cannot win under present conditions.  So they are trying to take the war to Russia by means of missile and artillery attacks on Russia, and by means of assassinations, terrorism and sabotage inside Russia.

By this means, they hope to undermine Russian morale and to bring about a wider war that would involve NATO forces directly.

I can understand why the Ukrainians feel they must do this.  They were led by false promises into a war of attrition they cannot win.

They were promised military and financial support “for as long as it takes.” But the Western alliance has emptied its arsenals and is reaching the limits of what it is willing to give financially.

Ukrainians were promised that economic sanctions would bring Russia to its knees.  But Russia is stronger than ever.  The ones who are suffering most are European allies of the U.S.

Ukrainians could have avoided the 2022 invasion by accepting the first Russian ultimatum.  They would have had to renounce NATO membership and grant home rule to the Donbas provinces of Luhansk and Donetsk, but they would have retained their sovereignty and their territory.

Now they are faced with a worse ultimatum.  In return for a cease-fire (not peace), they are asked to renounce future NATO membership and accept Russia’s annexation of Donetsk, Kherson, Luhansk and Zaporizhzhia.  Then they will enter into discussion of  Russia’s demand for demilitarization and “denazification.”

An even worse ultimatum will come if they allow the USA and NATO allies to pressure them into keeping the war going or if they try to escalate into a wider conflict.

It’s time for us Americans to cut our losses.  The Ukrainians, our allies we ourselves will suffer by keeping the war going.  If the U.S. and NATO allies escalate the war into a broader conflict in Europe, Russia has the means to win.  The only step of escalation beyond this is use of nuclear weapons, and no sane person would want to do this.

The study that justified mass opioid sales

The following is from the latest blog post by emergency room doctor Matt Bivens, M.D.

Once upon a time we’d killed babies with morphine syrups, and destroyed lives by treating laryngitis with heroin. Eventually we wised up. Yet now, a single publication was being cited, over and over again, to contradict everything we’d learned through a century of tragic experience. This publication, called “Porter & Jick” after its authors, was receiving hugely respectful attention from hundreds of other doctors and scientists, writing in hundreds of other medical journals.

Porter & Jick was even enjoying glowing write-ups in mainstream media.  TIME magazine called it a “landmark study,” one that showed fears of opioid addiction had been “exaggerated,” and were “basically unwarranted.”  Scientific American said Porter & Jick’s “extensive study” was evidence for a new modern understanding that “morphine taken for pain is not addictive.”

So, what was this landmark, game-changing, extensive study?

Brace yourself: It was a letter to the editor, and just five sentences. 

Five sentences! 

The letter’s authors were Jane Porter, a grad student, and Hershel Jick, a physician. Porter and Jick reported reviewing 11,000 patients in “our current files” at a Boston hospital who were treated with an opioid and finding only four cases of “reasonably well-documented addiction,” whatever any of that means. As evidence goes, it’s so low-quality for decision-making purposes that it borders on useless.

And that’s okay, by the way: When your research findings are too weak to merit a full publication, eking a letter to the editor out of them is a common tactic in publish-or-perish academia. Everyone understood this at the time; upon publication the Porter & Jick letter was thus promptly and appropriately ignored; and that should have been the end of it.

But, no. Many years later, unscrupulous pharmaceutical companies dusted off this five-sentence letter. Their marketing departments had come up with a clever use for it. They would claim that addiction happens far less than 1% of the time (four cases out of 11,000 would be 0.036%). They would cite The New England Journal of Medicine. Then they would grin slyly, because no one ever reads the footnotes.

And if some skeptic did read the footnotes? At the dawn of the Opioid Crisis, the New England Journal’s archives weren’t even available on-line; they were only uploaded and made accessible around 2010. Before then, doubters who wondered what this Porter & Jick citation was about would have had to go to a brick-and-mortar library for a physical copy of the journal, if they wanted to be let in on the joke.

As that should suggest, the Porter & Jick letter was ancient: Like, pre-computer ancient. It was published in 1980. (When Porter and Jick described reviewing “our current files,” they meant actual paper files.)

When the letter was rediscovered some 20 years later, the explosion of new academic citations stunned and distressed the letter’s authors. Dr. Jick came to wish he’d never published it.

“Only years and years later, that letter was used to advertise by new companies that were pushing out new pain drugs,” Dr. Jick later told NPR. “I was sort of amazed. None of the companies came to me to talk to me about the letter.” (Dr. Jick passed away in October at age 91).

Bivens on the sociopathy of the opioid crisis.

Matt Bivens, blogger and full-time emergency room doctor, today came out with the second part of his series on “the sociopathy of the option crisis.  The first part came out in early May.  A third part is yet to come.

He shows that the pharmaceutical companies knowingly lied when they claimed opioids were not addictive to most patients.  The “study” they used to support the claim was a five-sentence letter to the editor of the New England Journal of Medicine in 1980.

The most glaring and cynical example their attitude is an Austin Powers-themed motivational and training video by the opioid manufacturer Cephalon in 2006.

Click on this to watch the full video

As Dr. Bivens described it:

This Austin Powers-themed motivational video … … was made by the opioid manufacturer Cephalon, Inc. for its sales staff, and discusses how they will market their new dissolve-in-the-mouth fentanyl tablet. Cephalon was able to patent generic fentanyl as Fentora® by adding in Alka Seltzer®-style “plop plop fizz fizz” effervescence. It was also able to patent generic fentanyl as Actiq® by making it into a lollypop. Feel free to eye-roll in disgust, but that’s how you make a cheap drug expensive: Tweak how the medication gets delivered into the body, and claim it’s now a completely new substance, worthy of a new patent. … …

The 2006 Fentora® motivational video, shown to a New York jury in 2021 over the strenuous objections of the Cephalon legal team, edits new audio into scenes from the cult classic movie Austin Powers: International Man of Mystery. “Gentlemen! I have a plan. It’s quite brilliant,” says Dr. Evil. “We are going to roll out a blockbuster marketing campaign, focusing on ‘effervescent speed’ — a concept so nebulous, so indecipherable, it will absolutely help drive prescriptions … to Fentora®!”

When his staff of fellow villains tell him that’s already been tried but “FDA shut it down,” a disappointed Dr. Evil quickly recovers. Punctuating his speech with frequent air quotes, he outlines his next evil plan:

“We will do studies in low-back breakthrough pain, neuropathic breakthrough pain and for all non-cancer breakthrough pain — a new ‘pivotal study.’  Using these ‘studies,’ we will … show doctors around the world that Fentora® ‘works for all breakthrough pain.’ “

Cephalon (later taken over by Teva Pharmaceuticals) failed to get the FDA to agree that fizzy or lollypop fentanyl were safe for anyone other than a patient with terminal cancer, and in 2008 had to pay a $425 million fine for marketing fun-and-fizzy fentanyl too broadly.

But at moment, I’m more interested in the frank, mocking acknowledgement of how pharmaceutical companies fund and organize “studies” — the very studies used to justify their commercially-sold products. That practice has massive implications for what we call evidence-based medicine. … …

Donald Trump and equal justice under law

My good friend John sent me this Tom Tomorrow cartoon about the conviction of Donald Trump on falsification of business records.  But I don’t find the talking points in the cartoon as ridiculous as my friend does.

We have a presidential election campaign going on in which an ex-president, Donald Trump, is running against an incumbent president, Joe Biden.  This means we don’t have to speculate on what they’d do about the nation’s multiple crises if elected.  We already know, based on their records.

Instead of attacking Trump’s record, the Democratic Party, supported by the establishment news media, national security apparatus or criminal justice system, are trying to pre-determine the results of the election by abusing the criminal justice system by searching for something – anything – that can knock Trump out of the running.

There was a parallel in the “vast right-wing conspiracy” to generate a scandal to drive Bill Clinton from office in the 1990s.  As a result of a campaign by right-wing private foundations, news organizations and politicians, a special counsel was appointed to investigate a real estate deal by Bill Clinton when he was governor of Arkansas.  

The result was an impeachment trial in Congress, based on Clinton’s having been entrapped into lying to the special counsel about his sex life.  Clinton did perjure himself, but Congress correctly decided this was not a serious enough offense to drive an elected President from office.

Similarly, everything I know of that Trump has been accused of since 2016 has proved to be bogus, trivial or outside the statute of limitations.  None of this is serious enough to drive an elected President from office or prevent a party’s nominee from running for office.

I am not defending overall Trump’s record as President.  That is not the issue in this post.  The issue is his trial and conviction on charges of supposed crime of falsification of business records in the first degree.

Let’s consider Tom Tomorrow’s talking points, one by one.

How many dogs it takes to change a light bulb

Time for something a little lighter.  I forget where I came across this.

Putin outlines next step in escalation

Ukrainian anti-aircraft weapon. (via RT News)

Russia’s President Vladimir Putin yesterday explained how he can retaliate against the United States for supplying Ukraine with weapons to attack the Russian homeland.

The next step won’t be to start a full-scale war against NATO nor to use tactical nuclear weapons, although Russia has not ruled out either one in extreme circumstances.

Instead Russia will arm nations and groups that are attacking U.S. bases and forces.

If the USA can wage proxy wars, so can Russia. Tit for tat.

Putin didn’t specify what he had in mind to arm, but the Houthis in Yemen have successfully attacked U.S. shipping and Shiite militias have attacked U.S. bases in Syria and Iraq.  U.S. forces are also engaged in low-level conflicts with radical extremist Muslim groups in Africa.

Russia could also begin or step up arms shipments to nations on the U.S. enemies list, such as Iran, Syria, North Korea and Venezuela.

U.S. military supremacy is based on having the world’s largest and most powerful Air Force and Navy.  But aircraft and surface ships are vulnerable to attack from long-range missiles, of which Russia is the leading producer.  By providing Russia’s superior military technology to nations and groups hostile to the U.S. and its allies, Russia can neutralize the U.S. advantage.

It would be a tragedy if the proxy war in Ukraine is followed by more proxy wars.

On the other hand, a war against the global U.S. empire of military bases might possibly prove to be a good thing for the USA, just as U.S.-led sanctions against Russia are proving to be a good thing for Russia.

Cutting off Western trade with Russia enabled Russia to grow its home industries and motivated it to find new markets, leaving it stronger than before.

Likewise, forcing U.S. leaders to give up on dominating the world militarily might result in them concentrating on rebuilding U.S. economic strength and seeing to the wellbeing of the American people.  One can hope.