Updated: May 27, 2022
Updated 27 May, 2022
First, a word on guns.
I am disgusted with us, and our strange addiction to them. Like many of you, I suspect, I wish the United States had far tighter rules governing the purchase and ownership of machines whose sole purpose is to kill humans and other animals as efficiently as possible. Please take that for a given.
But I am going to cut abruptly to the chase, here. Wishing doesn't get us very far, practically -- within the cultural and constitutional context that is a fact of American life. That context is wildly abnormal, internationally, but it is no less real here.
And practically, none of the broadly popular, yet polarizing, legislative measures we keep hearing about is likely to do much to curb mass shootings like the recent tragedies in Uvalde and Buffalo. Both killers seem to have bought their weapons legally, for example, so background checks would have changed nothing. Traditional handguns or hunting rifles that don't have to be re-cocked between shots (that is, handguns and long guns that are not flintlocks or matchlocks or bolt action rifles) are just as "semi-automatic" as an AR-15 -- and are used in more mass shootings. While it would be valuable to limit the size of "clips," or magazines, to say ten bullets, as Jess Barton suggests below, the difference between those familiar weapons and "assault style" rifles is largely cosmetic. They function the same way: you press the trigger and a bullet flies out the muzzle. You press the trigger again, as fast as you can make your finger move, and another bullet flies. So it's hard to see what a ban on those semi-automatic guns that happen to look scary would achieve. Far better -- to quote Jess again -- to try to enact limits on clip sizes.
But, as hard as it is to metabolize when we are all still reeling at this most shameful of American anomalies, school shootings remain infinitesimally rare. By far the most common way Americans die by gunshot is suicide. Next comes homicide, usually by someone known to the victim. Accidental discharge accounts for approximately 200 times more fatalities than school shootings, depending on the year. None of these forms of violence requires a 50-bullet magazine.
These are problems that can be addressed, practically, without legislation, by transforming some cultural aspects of our national love affair with guns. I am deriving these ideas largely from the work of my dear friend Sarah Peck, who has been applying her enormous intellectual and organizational creativity to this issue for years. Please see the groundbreaking work of her advocacy group UnitedOnGuns.
One element of that transformation might be a concerted push to reduce the glorification of firearms that pervades U.S. popular culture, including on television and in movies and music, and, of course, video games. Another element might be a focus on young adults, below the age of, say, 21. Could enhanced qualifications be required of that vulnerable -- and statistically most violent -- age group? Say, as Sarah Peck suggests, a valid hunting license, or completion of a gun safety and handling class with a required curriculum? Most importantly, perhaps, a major public focus on the safe storage of firearms as part of the ethos of responsible gun ownership would go a long way.
It's time to start thinking a lot more creatively about how to prevent needless human deaths by firearms, rather than using this issue -- as so many others -- mostly as a way to fly a flag demonstrating which "team" we're on.
Now, the guest contribution. I'd like to do more of this: make space here for thoughts from others amongst us.
One of you got my attention the other day by joining two dots I’d left languishing a hair’s breadth apart in my On Corruption in America — And What Is at Stake.
The reader, Wade Riddick, addressed my treatment of the 2016 Supreme Court decision in McDonnell v. U.S -- which I found shocking enough to make it the opening salvo of the book. Please bear with me for a moment here, because the underlying point he makes is crucial to our democracy.
Here are the basics of the case.
Then-Virginia Governor Bob McDonnell accepted tens of thousands of dollars in cash, loans, and gifts from a tobacco executive who was trying to rebrand what we've known for decades to be poison as medicine, by formulating pills whose active ingredient was a tobacco-based cousin to nicotine.
(Note the two industries that come together in this story: Big Tobacco and Big Pharma. Their tactics have often been similar.)
To get FDA approval to market his drug, the executive needed positive results from independent clinical trials -- a fact with which we are all too familiar these days. That’s where he hoped to secure the governor’s help. He asked McDonnell to get the University of Virginia to conduct the trials. Lacking the authority to issue orders to the state university, McDonnell did everything but.
For all the details, see the preface to On Corruption.
McDonnell was convicted of corruption for accepting what first a jury of his peers and then a panel of appeals court judges recognized as bribes. But the Supreme Court -- unanimously -- overturned his conviction. As the Roberts opinion saw it, what McDonnell was doing was no more than his duty: responding to a citizen’s concerns and requests.
“Yeah,” I would counter, in talks and such. “But most citizens don’t have Ferraris lying around to lend to elected officials, or thousands of dollars to pay for their daughters’ weddings.”
And I left it there.
Our friend Wade takes the crucial next step. “The McDonnell case," he writes, is the first instance I know about in which the Court explicitly condoned an elected official charging citizens to exercise a constitutional right — in this case, the right to petition.” (Italics mine.) “The decision is a shakedown license.”
Wade’s email turns then to the related Menendez case — one of the several that federal prosecutors had to drop in the wake of McDonnell. Again, I ask you to persevere through a few details, because Wade's insights help illuminate the other shocking current crises this country is facing, apart from gun violence: the baby formula shortage and the catastrophic state of our mental and physical health.
Please note: I have only done a cursory fact-check of the below, but it rings true in light of my related research, and I have found no inaccuracies.
So, the Menendez case. New Jersey Senator Bob Menendez had intervened with various U.S. government officials on behalf of a friend who was scamming Medicare by performing unnecessary eye surgery on elderly patients. Because of the new McDonnell precedent, prosecutors had to abandon the case against the senator, but the doctor was sentenced to 19 years in prison.
The injections he prescribed, says Wade, were already questionable, even if the patients had needed them. They “are part of the broader price-fixing that occurs through pharmacy benefit managers (PBMs)." That is, intermediaries between drug manufacturers and health insurance providers that negotiate the prices the large buyers will pay for their bulk orders of drugs. The FDA, explains Wade, has been trying to shut down...
..."the last holdouts still able to buy raw ingredients directly from FDA-inspected manufacturing plants and sell to customers outside the PBM price-fixing chain: compounding pharmacies. Big Pharma has been trying to shut them down for years, fishing around for excuses. Are you aware of the state attorneys general civil suits over generic drug price fixing? (Odd, isn’t it, how drug shortages always seem to be for cheap chemicals and not the presumably rarer expensive ones?)
The attorneys general have the corporate officers dead to rights colluding on price hikes and creating shortages by shutting down manufacturing facilities — like Enron did with power plants to raise electricity prices. Yet, not a single criminal case is going forward. It’s all civil.”
As seems to be the pattern when corporations commit crimes. The individual human beings who made the decisions enjoy impunity. In the context of war crimes, by contrast, the concept of “command responsibility” prevails. That is, a general or a president does not have to have pulled any triggers to be guilty. If he conveyed instructions or even tolerance for such practices, he can be considered legally responsible. But that obvious principle does not seem to apply to corporate crime and corruption in the United States -- which likely cost many more lives each decade than crimes of war.
“Anyway,” continues Wade, here’s how...
"...this price-fixing fight intersects with Menendez. The doctor on whose behalf he intervened was injecting Lucentis into healthy eyes. The thing is, Lucentis itself is already a scam. It’s an anti-angiogenic designed to slow age-related macular degeneration (AMD, which causes elderly people’s vision to blur) by inhibiting the growth of blood vessels. When the high blood sugar of uncontrolled diabetes intersects with the low oxygen environment of the eye, runaway blood vessel formation can result, leading to blindness.
The first anti-angiogenic drug was Avastin, initially a cancer treatment, which went off patent and became a cheaper generic, compounded for off-label use to treat AMD. Compounding pharmacies manufacture it under contract, and the drug works great. $50 an eye, twice a year.
Another company comes along [San Fransisco-based Genentech, famous for plying doctors with freebies and generously paid speaking engagements], designs and tests a different drug, Lucentis, directly for AMD. It works about as well as compounded Avastin. Except Genentech charges $3,000 an eye, because now it has an exclusive patent.
Then the FTC lets it buy the rights to Avastin.
[I'm not sure how a company can buy "rights" to a drug that is off patent. If anyone can elaborate, please do!]
Roughly half the Medicare/Medicaid billing on AMD injections is spent on treatments using Lucentis, and half for Avastin treatments. (That’s a 60:1 cost-effectiveness disparity.). And Genentech, which owns both drugs, is breaking contracts with the little mom & pop compounders that don’t have big legal teams — that is, using hardball tactics to force compounded generic Avastin off the market.
Meanwhile, around this time, the FDA goes to war with compounding pharmacies.
This is part of a larger story involving price-fixing for specialty chemicals like the components of baby formula or some cancer drugs, on the part of FDA-regulated companies that are large political donors. These shortages are often deliberately engineered to jack up prices. Or they result from cuts to manufacturing and maintenance budgets by companies bent on keeping returns high for investors. That’s what happened with Abbott, which ‘outsourced’ quality control to the detriment of its employees’ wages and customers’ safety.
What we’re seeing here in the baby formula shortage is a war of Enclosure [that is, the fencing off of common agricultural and grazing land and its conversion to private property in medieval England]. Vast corporations are shearing off pieces of nature that we desperately need — clean air and water, nutritious foodstuffs, and so on — and privatizing them for profit.”
More on that larger issue — a kind of slow-motion collective suicide — in an upcoming post.
Thanks, Wade, for this sobering glance at a corner of a health care system anyone can see is broken: betraying the public while feeding certain executives' addiction to money.
Many thanks for the thoughtful comments, friends. And, please forgive me, for republishing. I'm having trouble logging into my own blog to reply. So for this one, I'm force to revise the whole text each time.
James Rodell, below, makes an important point about the difficulty in even tracing political contributions. Thomas Ferguson, at the Institute for New Economic Thinking has done remarkable and persistent work on that issue, over decades. He combs through the actual data, finding the same individual making multiple donations, but changing a single letter in their name, for example, or numerous people who work for the same large corporation neglecting to fill in the "employer" field, etc. While much public attention is focused on SuperPACs, he examines 527 organizations (named after a segment of the tax code, like 501(c)(3)s) and other such opaque vehicles.
Given the Supreme Court's 2010 Citizens United decision, the U.S. context on political spending is about as abnormal, internationally, as is the context on guns. Nowhere else, so far as I know, are corporate expenditures on politics explicitly protected under a strict right to the free speech guaranteed to human citizens. Within that context, California tried to address some of the concerns about who, individually, is paying for political speech by requiring that non-profits disclose the names of their principal donors to the state attorney general. Last year, the Supreme Court ruled the law unconstitutional.
One of the best organizations I know working in this space is Citizens for Responsibility and Ethics in Government. With a team of lawyers on staff, as well as researchers and advocates, they engage in strategic litigation as well as consciousness-raising.
Senator Sheldon Whitehouse (D-RI) is also superlative.
You'll find a few other amendments, in response to comments, in bold italics in the text. But I'm a little concerned that our focus on such details as the practical definition of an "assault rifle," or what a "semi-automatic" mechanism does, or what types of guns can take what size of magazines, may be distracting us from the main point.
That point is this. Mass shootings in schools -- though a single one is too many -- represent a tiny proportion of gun deaths in this country. Far more little children are killed in accidental discharges, which don't get reported and aren't addressed in any kind of public policy approach. And they can be, without legislation. A massive and well-tailored public information campaign, championed by the right influencers, could make a world of difference over a relatively short period of time.