Showing posts with label healthcare. Show all posts
Showing posts with label healthcare. Show all posts

Monday, March 17, 2025

Walgreens in financial trouble — why?

cityscape

I enjoy Scott Galloway’s popular podcast Prof G Markets, and I was listening to him and co-host Ed Elson discuss why the private equity giant Sycamore Partners - which specializes in squeezing blood out of failing retailers - is buying Walgreens for $10 billion. Walgreens is America’s second-largest drug store chain, and has been a public company for more than 100 years. “Going private,” particularly to a fund like Sycamore, is an admission of failure.

The trends for Walgreens aren’t good - it has closed a thousand stores since 2018, and plans to shut 1,200 more this year. And if you look at the gross operating income of the U.S. retail segment, it is collapsing.
— Matt Stoller, The Real Reason Walgreens Collapsed: It's not that Walgreens didn't modernize or couldn't compete with Amazon. The 124 year old company is being squeezed to death by monopolistic pharmacy benefit managers. BIG, Mar 14, 2025

"Free DVDs is one thing. But in recent days, people have realized that they can, in some cases, get free Redbox kiosks. In an August filing, Walgreens told the bankruptcy court that it has 5,400 abandoned kiosks at its stores, and that it is spending $184,000 a month keeping them powered. “Walgreens should not be required to continue to ‘store’ and power Redbox kiosks across the country without any form of payment,” the company wrote. And so tinkerers and reverse engineers have begun asking stores whether they can take the devices off their hands."
— Jason Koebler, Reverse Engineering Redbox, 404 Media, Oct 17, 2024

See also:Amanda Mull, Retailers Locked Up Their Products—and Broke Shopping in America. CVS, Target and other chains have barricaded everything from toiletries to cleaning supplies. It’s backfired in almost every way. Bloomberg, August 1, 2024.
In response to which, Roxane Gay said: "Locking up everything in Walgreens and CVS was, apparently, a really bad idea. It drives me crazy. It makes shopping for toothpaste, TOOTHPASTE, impossible."

"In states where abortion is still legal but the state legislature is working on anti-abortion measures, Walgreens has decided not to carry mifepristone – a common medication used in over 50% of abortions in this country." — Katie Reiter, national program coordinator for Jews for a Secular Democracy, via email to the organization's mailing list, May 5, 2023

"Walgreens, one of the nation's largest pharmacy chains, announced that it will not dispense abortion pills in at least 10 states where abortion remains legal. The decision came in response to a letter from 20 state attorneys general who oppose abortion rights, encouraging Walgreens not to make the drugs available in their states. Walgreens' decision is part of a pattern of support for anti-abortion officials, including significant donations to officials seeking to ban or dramatically restrict abortion."
— Judd Legum and Tesnim Zekeria, How Walgreens supports the anti-abortion movement, Popular Information, Mar 06, 2023

"Yes, she smokes in her car. What of it? But only in the Walgreens parking lot next to the tutoring center where she works part-time, and only to spite her husband of twenty-odd years."
— Heather Brittain Bergstrom, the opening lines of Valley: An Essay, Narrative, October 2020

Wednesday, January 11, 2023

What would it take for someone to decide to get the COVID vaccine?

Originally published March 12, 2021 to Bob Lane's Episyllogism blog, which has gone offline.


When we are speakers, we may ask: How can I present my argument in a better way? Other times, as seekers, we need to ask what we can do to search, listen, and judge correctly.

A focus group of vaccine-hesitant Trump-Republicans

In mid-March 2021, Frank Luntz and Brian C. Castrucci held a focus group by videoconference with “19 vaccine-hesitant Trump Republicans” from “diverse economic backgrounds.” In the United States, fewer than half of white Republicans have already gotten the vaccine or told pollsters that they definitely will accept the vaccine when it is offered to them, so these “vaccine-hesitant” people are representative of a large demographic within the Republican Party. Luntz and Castrucci wanted to know what “ideas and messages” could possibly persuade these people to be vaccinated.

All participants agreed that the virus was real. To the extent that they were disposed to listen to anyone’s advice about vaccination, they said they’d rather take medical advice than ex-president Trump’s advice. Yet they didn’t understand why scientific predictions and recommendations had changed over time, and they felt that competing or changing information caused them to doubt the importance of vaccines.

Furthermore, they had a number of other beliefs that dampened their interest in vaccines. Some had been previously diagnosed with COVID and believed that they were already immune and did not need to be vaccinated. Others were unafraid of the illness or were more afraid of the vaccine (which they called “experimental,” “rushed” and “unproven”), or felt that there would not be sufficient immediate payoff for taking the vaccine (as social distancing restrictions would likely remain in place for a long time in any case). Another complained of “opportunistic politicians” for whom the vaccine was a tool in a mysterious plot for the “manipulation” and “socialization of society.” One said that lockdowns were a method of political “control.”

The group participants needed information and comprehension

The group members were missing basic information. They needed to hear that the vaccine was developed according to existing technologies; that the trials involved an unusually large sample size; that the Trump administration deliberately lifted regulatory requirements to speed up approval; that the vaccine has never killed anyone; that no one who has been vaccinated has gone on to die of COVID-19, either; that almost all doctors are vaccinated when they have the opportunity. Once they absorbed these facts, they were more open-minded toward the vaccine.

Of course people “do not want to be ridiculed, embarrassed or told that their thinking is ‘Neanderthal,’” as Luntz and Castrucci wrote for the Washington Post. As in any dialogue, the discussion needs to focus on the issue and not the person, and people won’t remain in the discussion unless they are treated gently and kindly.

But also: This group was designed within the boundaries of a political affinity

Luntz and Castrucci said everyone in their focus group was “eager to hear the facts.” They described these facts as “apolitical notions” that swayed the participants’ opinions. However, while the facts may have been apolitical, the group dynamics surely were not. They didn’t point this out in their Washington Post article. I am pointing it out.

The focus group itself was a political affinity group. All 19 participants (the subjects, that is) were Trump-Republicans, and we might expect that they were more open-minded and trusting with each other than they would have been in a more politically diverse group, especially given their beliefs that Democratic politicians seek to manipulate and control Americans through COVID policy. It so happens that the focus group was co-led by former Centers for Disease Control and Prevention director Dr. Tom Frieden, as well as four prominent Republican politicians, two of whom also happen to be physicians. The focus group participants enjoyed a once-in-a-lifetime opportunity to speak directly to these people. I don’t think we can assume that they would have been as receptive to physicians’ messages if the physicians had not so thoroughly embodied the imprimatur of Republican leadership. “If we had that kind of time and space with all vaccine-hesitant Americans, we would surely be able to move the needle,” Luntz and Castrucci wrote. Of course. And obviously it’s not possible. Congressional Republicans, governors, and national medical leaders can’t hold the hands of every American in a two-hour personal conversation to catch them up on a year’s worth of news they’ve been choosing every day not to read or listen to.

In other words, for all that the cultural right mocks the desire for “safe spaces” that reduce the likelihood that one’s identity will be challenged, this focus group was the epitome of a “safe space.” And it was only within such a safe space that the group leaders were able to begin to break through a year’s worth of science denial and epidemiologically bad behavior.

People need to take responsibility for their own information diet Near the end of the Washington Post article, this statement was notable to me: one focus group participant expressed interest in more data, while another just needed to hear a single emotionally affecting story.

The latter is a known phenomenon to storytellers, psychologists, and marketing experts everywhere. People generally do respond better to a story. “A single death is a tragedy; a million deaths is a statistic,” the proverb goes.

As for the former phenomenon, the person who craved more information: There are, of course, always people who say they want the statistics and who might really be equipped to begin to make sense of those large numbers. If they are academically interested, or if their intellect gravitates them more toward the logical than the emotional, that is fine.

But what I can’t quite wrap my head around is that these people were speaking in March 2021 rather than March 2020. Now that nearly 3 million people have died worldwide, a half-million of those close to home in the US, with many more people having been seriously sickened from the same disease, we do have the answers. The emotion is there. The logic is there. The answers have been available, and they have been communicated. We don’t need more data before we can decide. We don’t need more people to tell their tales of woe. The right decision is clear, and the right action should follow as a consequence: We need everyone to wear a mask, socially distance, and get a vaccine.

Of course, data can always be corrected and enhanced, and storytelling can always be improved. This is part of maintaining good communication. But the audience also needs to work on reading and listening.

Often the audience isn’t paying attention. It does not help to wield that observation as a deliberate insult, nor to say it quite so directly to someone’s face, as it will be received as an insult. But it is nonetheless true. Scientists and communication professionals have been talking. An important piece of the question is who is listening. If someone doesn’t make an effort to seek good information, pay attention to what they find, and critically evaluate it, they won’t have the knowledge they claim to want. If someone wants epidemiologically correct information, they need to listen to epidemiologists. If a politician whose primary raison d’ĂȘtre is being a racist troll has taken up a media campaign telling people not to worry about a potentially fatal, highly contagious disease, the public needs to assume that the politician is not speaking in good faith, unfollow them on Twitter, and not vote for them again. If the audience isn’t getting what they want from their television series, they need to try a different one. They can’t just sit and complain and blame their own ignorance on the series’ director. For the first week, yes, it’s the television’s fault; for an entire year, no. They are choosing to watch the confusing material. They need to change their own behavior.

Considering the supply-and-demand of good information in the Information Age, the deficit is surely not in the supply. The supply is high-quantity, and people need to learn to weed out the low-quality material. People need to learn to curate what they’re taking in. If someone has had a poor “information diet” for the past year — whether by overconsumption of bad material festering in a terrible corner of the information ecosystem, or by neglecting to read or listen to anything at all — it is their responsibility to change the channel. Ultimately, no one can do it for them.

There are a number of “how-to” books on critical thinking. They come in different flavors: everything from making sound philosophical arguments, to listening to scientists, to escaping cults. A very recent title is Behind the Scoop: Why You Should Think and Act Like a Journalist by the journalist Johannes Koch. It is accessibly written, a manageable length, and it reminds people that they are empowered to clean up their own information diet. It is also a book that you might plausibly give to someone else since it covers other topics, too, beyond just boosting your critical thinking habits.

I can empathize with someone who is wrong, but they are still wrong

I can muster empathy, to a limited extent, for people who are vaccine-hesitant. The part I can potentially empathize with is their general feeling of alienation from some aspect of the modern world—science, politics, culture—or their anxiety that someone is trying to hurt them. I may disapprove of their reason for feeling alienated or anxious, yet, in a far broader sense, I too am a human who knows what alienation and anxiety are. If they say they’re “scared and outraged,” I hear that and I know roughly what they mean.

However: Even if I manage to empathize with them as people and understand that they are having feelings, that doesn’t mean I can tolerate their error. In this particular case, factually, they are simply wrong. We’re all factually wrong about something now and then. Sometimes it’s a tiny detail that can be glossed over. The COVID vaccine is a particularly grave matter, and it is important that we arrive at a general agreement on the indispensability of this virus-fighting tool and that we perform the necessary act of solidarity; otherwise, we will never reach herd immunity from the COVID disease.

I don’t need to actively, directly, personally insult individuals who are vaccine-hesitant. At the same time, when someone holds a dangerously false belief, it’s necessary to be blunt (either with them or about them). They need to begin listening to the general agreement of the scientific and medical community. There is just no way around that outcome. Unfortunately, not everyone has an invitation to a focus group in which they get to have a two-hour personal conversation with the former director of the U.S. CDC, so they need to find another pathway through roughly the same information that will lead them to the same conclusion.

If I were to make (in this context, anyway) too many suggestions about how to think critically, it would sound patronizing. Anyway, I’m neither a scientist nor a science communicator. I’m sure I don’t need to explain how to make a choice about a vaccine. People know how make good decisions about the health of themselves and others. They just need to do it. Critical thinking is a choice about who to trust, what to care about, and when to put the time in. Now is a good time.


Note: Wikipedia has an article called "vaccine hesitancy."


BREAKING: We obtained an email confirming the Trump admin is shutting down HHS's Office of Long Covid. RFK Jr. pledged in his confirmation hearing to support LC research, and prioritize tackling chronic diseases. 20m people have Long Covid and there's no cure. www.politico.com/news/2025/03...

[image or embed]

— Alice Miranda Ollstein (@alicemiranda.bsky.social) March 24, 2025 at 8:30 PM

To read a modern short fable about the vaccine: "The Princess Who Slept Through the Pandemic" (March 2, 2021). It's a 5-minute read on Medium.

To read more about conspiracy theories and resistance to facts, please see articles like "A Year Later, the Reckoning with Jan. 6 Continues" (Jan. 6, 2022). It's a 6-minute read on Medium.

an outward-facing palm is raised to say no

Iowa Republicans’ bill to criminalize vaccine providers advances amid funnel week chaos, Zachary Oren Smith, Iowa Starting Line, March 3, 2025

In 2025, Trump is pretending he didn't know all along that RFK is anti-vaccine: Trump Distances Himself From RFK Jr.: Vaccines That Work 'Should Be Used'. If Trump believes that some vaccines are important, why did he appoint RFK to be health secretary? (HuffPost)

Thursday, January 18, 2018

Conscience and Religious Freedom...isn't

On Jan. 18, 2018, the Dept. of Health and Human Services (HHS) announced that its Office for Civil Rights would have a new "Conscience and Religious Freedom Division." The idea of a need to protect "religious freedom" has been around for a while. Outwardly, it is based on the concern that a religious person might be forced to do something that violates their conscience or religious belief. Political scientist Andrew Lewis said recently:

"Federal religious freedom laws gained some steam in the mid-1990s, and a decent number of conservatives were involved in them, but there was very little public awareness that they were going on.

It’s not until you see the legalization of same-sex marriage that you see this real drive to protect religious freedom. The day that the Obergefell case was decided...They knew that they were losing this cultural battle and this was a way to preserve what they thought was their orthodox faith in action."

During the 1990s and 2000s while same-sex marriage was debated nationally, many people claimed to oppose legalizing it on the premise that clergy should not be forced to perform same-sex weddings. This threat was never real, since clergy have always been free to refuse to marry people (divorcees and interfaith couples) and to impose religious requirements on the couple before and during the wedding. Since same-sex marriage was legalized nationwide, no clergy have been forced to perform one. The obviousness of the non-threat did not stop it from seizing people's imaginations. Having lost the same-sex marriage battle, Christian conservatives now aim for "religious freedom" laws to ensure that religious people are not forced to do...well, anything that they claim offends their beliefs.

For now, the new HHS division does not directly create or change laws (though it might encourage them). It is supposed to enforce whatever federal laws exist. Its activities will depend in part on what federal laws are created or struck down and what complaints are filed. Its new website does not contain a comprehensive list of all possibly relevant laws, so it is hard to predict what will happen.

The agency is already being selective about how it promotes what it does. Its website talks a bit about abortion and euthanasia and the nondiscrimination provisions in the Affordable Care Act that relate to them, but it doesn't mention the ACA’s Section 1557 which forbids discrimination based on markers including “pregnancy, gender identity, and sex stereotyping" and whose enforcement has been in question since Trump’s election. Its website doesn't mention transgender people at all, but this is one of the points at issue in the public consciousness. If that part of the ACA is repealed, the new Conscience and Religious Freedom Division will have responsibility for enforcing the right of healthcare workers to discriminate against people based on pregnancy and gender.

Drilling down through the website’s complaint process reveals a list of a wide range of relevant employment situations including agencies for adoption, foster care, and social services; mental health centers; drug rehabs; homeless shelters; nursing homes; researchers; insurance companies; and pharmacies. This suggests that religious people anticipate wanting to reserve the right to deny service based on a client’s identity or behavior, not just on specific procedures.

Someone might want the birth control pill or the "Plan B" pill to interrupt a possible pregnancy. Someone might want pre- or post-exposure prophylaxis for HIV. It would be good if one's pharmacist would dispense it. The pharmacist's prerogative to make judgments about others does not seem to outweigh the client's prerogative to make choices about their own life. That doesn't seem to be a good definition of political freedom.

If a cosmetic implant ruptures it would be nice to think that one could just get it taken out without starting a debate about whether the patient is really a woman, whether it's really an emergency and exactly how many hours are estimated to remain to allow a different healthcare staff to be recruited,, whether repairing it counts as a sex-reassignment surgery as opposed to only removing it and sending her elsewhere to get it fixed. What kind of moral calculus is that, and what is the benefit? It is much simpler to accept that this is a person who needs the same kind of treatment as anyone else with that problem. But the insistence on so-called "religious freedom" is the endorsement of just that kind of presumptuous, time-wasting, anxiety-provoking, us/them polarizing moral calculus, and there is now a federal agency to attempt to culturally legitimize it.

The scope of the types of discriminations allowable under "religious freedom" is likely to increase. State laws branded under the same “religious freedom” concept are not all healthcare-specific. Some apply more broadly to general business dealings. So, even though this new federal agency may not have the mission of enforcing state law, we should pay attention to how the idea of "religious freedom" is variously interpreted and what versions politically succeed.

#WarIsPeace
#DiscriminationIsFreedom
#HateIsReligion
#IgnoranceIsConscience

In 2018, did Republicans intend to ban abortion?

Do Republicans want to ban abortion after 20 weeks with no exceptions?, Analysis by Salvador Rizzo, Washington Post, February 5, 2018

Rizzo's conclusion, following his fact-check:

"NARAL says the bill bans abortion after 20 weeks with “no exception to protect a woman’s health.” Smith also says there’s “no exception to protect a woman’s health.” The American College of Obstetricians and Gynecologists warned that “there are many reasons a woman may seek abortion care at 20 weeks, including fatal or serious medical conditions to the woman.” None of these statements makes reference to the exception for life-threatening cases.

Because some of these statements give an incomplete picture of the exceptions in the bill, we award One Pinocchio.

That's interesting, an exception for the woman's life. Hey — where are we in 2023?

"The Republican Party remains bitterly divided on abortion, with some pushing for a 15-week national abortion ban, while others, such as newly elected House Speaker Mike Johnson, have supported a proposed federal ban on abortion as early as six weeks." — Republicans face 2024 dilemma after abortion rights issue powers Democrats Gabriella Borter and Tim Reid, Reuters, November 8, 2023

To clarify: Plan B is to prevent ovulation/implantation w/in 72 hrs of sex. Available over the counter many places. Plan C / Abortion medication is to terminate a pregnancy /help w/miscarriage up to about 10 weeks’ gestation (from last menstrual period). After implantation. Get online in the US.

[image or embed]

— Rabbi Danya Ruttenberg (@theradr.bsky.social) February 2, 2025 at 12:10 AM

Tuesday, November 11, 2014

The surge in OxyContin abuse in the United States

OxyContin is Purdue Pharma's brand name for the opiate painkiller oxycodone; the generic version of the drug became available in 2004.

Originally posted to Helium Network on Dec. 25, 2012.

OxyContin tablets are designed to be swallowed so that the medication releases slowly over twelve hours. When the drug is abused, the addict generally crushes the tablets to enable faster delivery, after which the drug is swallowed, snorted, or injected.

The drug can be legally prescribed, and some addictions begin inadvertently. The patient may ingest too much, or a family member may be tempted to try the drug or sell it to others. The U.S. Substance Abuse and Mental Health Services Administration reports that the street value of OxyContin can be up to ten times its retail value. When someone dependent on OxyContin begins to withdraw from the drug, they may experience coughing, yawning, heart palpitations, insomnia, and general "jitteriness" – accompanied by a desire to use the drug again.

Some unscrupulous providers will sell large bottles of the pills that far exceed the amount that most patients need. In the United States, serious government-level efforts to introduce legal requirements for online pharmacies to disclose their "owners, locations, doctors, affiliated pharmacies, and telephone numbers" were made in 2000, but an actual federal Food and Drug Administration requirement was not implemented until 2009. On the state level, Massachusetts Gov. Deval Patrick signed legislation in 2012 to mandate that doctors register for a tracking program designed to flag drug abuse.

The New England states of Maine and Vermont have a treatment rate for oxycodone abuse that is high above the U.S. national average, according to federal data from the years 1998-2008. The abuse rate seems to be climbing. In 2010, the number of OxyContin pills prescribed in Maine was five times the number that were prescribed in 2006, and the number of pharmacy robberies in Maine in 2010 increased tenfold over 2008.

In the New England state of Massachusetts, between 2002 and 2007, the number of residents who died from overdosing on opiates was shockingly more than 40 times the number who died in military service in Afghanistan and Iraq.

Other regions of the United States are also affected, especially in rural areas. Kentucky's Rockcastle county, with a population of 16,000, has an average of one drug-related death every week. In Knott County, "more than half of the children have lost their parents due to death, abandonment or legal removal....And in nearby Johnson County, so many children have lost parents that school administrators there changed 'Parents' Day' to 'Guardians' Day.'" CNN's story on this topic implied that much of this drug abuse involves prescription medications. Operation UNITE, an organization fighting drug abuse in Kentucky, said that drugs killed more people in the state in 2011 than did motor vehicle accidents. Over a two-year period, the organization's mobile medical incinerator destroyed over 1 million pills surrendered by individuals, medical providers, and police.

Purdue Pharma and three of its executives pled guilty in 2007 to providing misleading information to its sales representatives about the drug's addictive properties, which the legal system considers to be only a misdemeanor. The company had falsely promoted the claim that OxyContin was less addictive than other painkillers on the market. It agreed to pay $634.5 million in fines. While the executives were sentenced to probation and community service, Judge James P. Jones commented at their sentencing that he wished that prison could have been an option.

This outcome did not seem to much injure the health of the company. Erin Baldassari wrote for the Boston Phoenix that "Purdue's Oxy profits soared from $800 million in 2006, the year before the federal settlement, to over $3 billion in 2011." However, the company's current patent on the drug will expire in 2013.

Information about treatment options is available on the website of the Substance Abuse and Mental Health Services Administration.

In case you missed it

Have you seen inside the book 'To Climates Unknown'?

The alternate history novel To Climates Unknown by Arturo Serrano was released on November 25, the 400th anniversary of the mythical First ...