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Patients See Drug Savings From Biden Law -- As Pharma Prepares To Sue

Patients See Drug Savings From Biden Law -- As Pharma Prepares To Sue

Last year alone, David Mitchell paid $16,525 for 12 little bottles of Pomalyst, one of the pricey medications that treat his multiple myeloma, a blood cancer he was diagnosed with in 2010.

The drugs have kept his cancer at bay. But their rapidly increasing costs so infuriated Mitchell that he was inspired to create an advocacy movement.

Patients for Affordable Drugs, which he founded in 2016, was instrumental in getting drug price reforms into the 2022 Inflation Reduction Act. Those changes are kicking in now, and Mitchell, 73, is an early beneficiary.

In January, he plunked down $3,308 for a Pomalyst refill “and that’s it,” he said. Under the law, he has no further responsibility for his drug costs this year — a savings of more than $13,000.

The law caps out-of-pocket spending on brand-name drugs for Medicare beneficiaries at about $3,500 in 2024. The patient cap for all drugs drops to $2,000 next year.

“From a selfish perspective, I feel great about it,” he said. But the payment cap will be “truly life-changing” for hundreds of thousands of other Medicare patients, Mitchell said.

President Joe Biden’s battle against high drug prices is mostly embodied in the IRA, as the law is known — a grab bag of measures intended to give Medicare patients immediate relief and, in the long term, to impose government controls on what pharmaceutical companies charge for their products. The law represents the most significant overhaul for the U.S. drug marketplace in decades.

With Election Day on the horizon, the president is trying to make sure voters know who was responsible. This month, the White House began a campaign to get the word out to seniors.

“The days where Americans pay two to three times what they pay for prescription drugs in other countries are ending,” Biden said in a February 1 statement.

KFF polling indicates Biden has work to do. Just a quarter of adults were aware that the IRA includes provisions on drug prices in July, nearly a year after the president signed it. He isn’t helped by the name of the law, the “Inflation Reduction Act,” which says nothing about health care or drug costs.

Biden’s own estimate of drug price inflation is quite conservative: U.S. patients sometimes pay more than 10 times as much for their drugs compared with people in other countries. The popular weight loss drug Wegovy lists for $936 a month in the U.S., for example — and $83 in France.

Additional sections of the law provide free vaccines and $35-a-month insulin and federal subsidies to patients earning up to 150% of the federal poverty level, and require drugmakers to pay the government rebates for medicines whose prices rise faster than inflation. But the most controversial provision enables Medicare to negotiate prices for certain expensive drugs that have been on the market for at least nine years. It’s key to Biden’s attempt to weaken the drug industry’s grip.

Responding to Pressure

The impact of Medicare’s bargaining over drug prices for privately insured Americans remains unclear. States have taken additional steps, such as cutting copays for insulin for the privately insured.

However, insurers are increasing premiums in response to their higher costs under the IRA. Monthly premiums on traditional Medicare drug plans jumped to $48 from $40 this year, on average.

On Feb. 1, the Centers for Medicare & Medicaid Services sent pharmaceutical makers opening bids for the first 10 expensive drugs it selected for negotiation. The companies are responding to the bids — while filing nine lawsuits that aim to kill the negotiations altogether, arguing that limiting their profits will strangle the pipeline of lifesaving drugs. A federal court in Texas dismissed one of the suits on Feb. 12, without taking up the substantive legal issue over constitutionality.

The nonpartisan Congressional Budget Office predicted the IRA’s drug pricing elements would save the federal government $237 billion over 10 years while reducing the number of drugs coming to market in that period by about two.

If the government prevails in the courts, new prices for those 10 drugs will be announced by September and take effect in 2026. The government will negotiate an additional 15 drugs for 2027, another 15 for 2028, and 20 more each year thereafter. CMS has been mum about the size of its offers, but AstraZeneca CEO Pascal Soriot on Feb. 8 called the opening bid for his company’s drug Farxiga (which earned $2.8 billion in U.S. sales in fiscal year 2023) “relatively encouraging.”

Related Biden administration efforts, as well as legislation with bipartisan support, could complement the Inflation Reduction Act’s swing at drug prices.

The House and Senate have passed bills that require greater transparency and less self-serving behavior by pharmacy benefit managers, the secretive intermediaries that decide which drugs go on patients’ formularies, the lists detailing which prescriptions are available to health plan enrollees. The Federal Trade Commission is investigating anti-competitive action by leading PBMs, as well as drug company patenting tricks that slow the entry of cheaper drugs to the market.

‘Sending a Message’

Months after drug companies began suing to stop price negotiations, the Biden administration released a framework describing when it could “march in” and essentially seize drugs created through research funded by the National Institutes of Health if they are unreasonably priced.

The timing of the march-in announcement “suggests that it’s about sending a message” to the drug industry, said Robin Feldman, who leads the Center for Innovation at the University of California Law-San Francisco. And so, in a way, does the Inflation Reduction Act itself, she said.

“I have always thought that the IRA would reverberate well beyond the unlucky 10 and others that get pulled into the net later,” Feldman said. “Companies are likely to try to moderate their behavior to stay out of negotiations. I think of all the things going on as attempts to corral the market into more reasonable pathways.”

The IRA issues did not appear to be top of mind to most executives and investors as they gathered to make deals at the annual J.P. Morgan Healthcare Conference in San Francisco last month.

“I think the industry is navigating its way beyond this,” said Matthew Price, chief operating officer of Promontory Therapeutics, a cancer drug startup, in an interview there. The drugs up for negotiation “look to be assets that were already nearing the end of their patent life. So maybe the impact on revenues is less than feared. There’s alarm around this, but it was probably inevitable that a negotiation mechanism of some kind would have to come in.”

Investors generally appear sanguine about the impact of the law. A recent S&P Global report suggests “healthy revenue growth through 2027” for the pharmaceutical industry.

Back in Washington, many of the changes await action by the courts and Congress and could be shelved depending on the results of the fall election.

The restructuring of Medicare Part D, which covers most retail prescription drugs, is already lowering costs for many Medicare patients who spent more than $3,500 a year on their Part D drugs. In 2020 that was about 1.3 million patients, 200,000 of whom spent $5,000 or more out-of-pocket, according to KFF research.

“That’s real savings,” said Tricia Neuman, executive director of KFF’s Medicare policy program, “and it’s targeted to people who are really sick.”

Although the drug industry is spending millions to fight the IRA, the Part D portion of the bill could end up boosting their sales. While it forces the industry to further discount the highest-grossing drugs, the bill makes it easier for Medicare patients to pick up their medicines because they’ll be able to afford them, said Stacie Dusetzina, a Vanderbilt University School of Medicine researcher. She was the lead author of a 2022 study showing that cancer patients who didn’t get income subsidies were about half as likely to fill prescriptions.

States and foundations that help patients pay for their drugs will save money, enabling them to procure more drugs for more patients, said Gina Upchurch, the executive director of Senior PharmAssist, a Durham, North Carolina-based drug assistance program, and a member of the Medicare Payment Advisory Commission. “This is good news for the drug companies,” she said.

Relief for Patients

Lynn Scarfuto, 73, a retired nurse who lives on a fixed income in upstate New York, spent $1,157 for drugs last year, while most of her share of the $205,000 annual cost for the leukemia drug Imbruvica was paid by a charity, the Patient Access Network Foundation. This year, through the IRA, she’ll pay nothing because the foundation’s first monthly Imbruvica payment covered her entire responsibility. Imbruvica, marketed jointly by AbbVie and Janssen, a subsidiary of Johnson & Johnson, is one of the 10 drugs subject to Medicare negotiations.

“For Medicare patients, the Inflation Reduction Act is a great, wonderful thing,” Scarfuto said. “I hope the negotiation continues as they have promised, adding more drugs every year.”

Mitchell, a PR specialist who had worked with such clients as the Campaign for Tobacco-Free Kids and pharmaceutical giant J&J, went to an emergency room with severe back pain in November 2010 and discovered he had a cancer that had broken a vertebra and five ribs and left holes in his pelvis, skull, and forearm bones. He responded well to surgery and treatment but was shocked at the price of his drugs.

His Patients for Affordable Drugs group has become a powerful voice in Washington, engaging tens of thousands of patients, including Scarfuto, to tell their stories and lobby legislatures. The work is supported in part by millions in grants from Arnold Ventures, a philanthropy that has supported health care policies like lower drug prices, access to contraception, and solutions to the opioid epidemic.

“What got the IRA over the finish line in part was angry people who said we want something done with this,” Mitchell said. “Our patients gave voice to that.”

Arnold Ventures has provided funding for KFF Health News.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.


Reprinted with permission from Alternet.

Irradiated Iraq: The Nuclear Nightmare We Left Behind

Irradiated Iraq: The Nuclear Nightmare We Left Behind

This post originally appeared in The Washington Spectator.

When the United States revealed in January that it is testing a more nimble, more precise version of its B61 atom bomb, some were immediately alarmed. General James Cartwright, a former strategist for President Obama, warned that “going smaller” could make nuclear weapons “more thinkable” and “more usable.”

However, what is little known is that for the past 25 years, the Unites States and its allies have routinely used radioactive weapons in battle, in the form of warheads and explosives made with depleted, undepleted, or slightly enriched uranium. While the Department of Defense (DOD) calls these weapons “conventional” (non-nuclear), they are radioactive and chemically toxic. In Iraq, where the United States and its partners waged two wars, toxic waste covers the country and poisons the people. U.S. veterans are also sick and dying.

Scott Ritter, a former Marine Corps officer in Iraq and United Nations weapons inspector, told me, “The irony is we invaded Iraq in 2003 to destroy its non-existent WMD [weapons of mass destruction]. To do it, we fired these new weapons, causing radioactive casualties.”

The weapons were first used in 1991 during Desert Storm, when the U.S. military fired guided bombs and missiles containing depleted uranium (DU), a waste product from nuclear reactors. The Department of Defense (DOD) particularly prized them because, with dramatic density, speed, and heat, they blasted through tanks and bunkers.

Within one or two years, grotesque birth defects spiraled—such as babies with two heads. Or missing eyes, hands, and legs. Or stomachs and brains inside out.

Keith Baverstock, who headed the radiological section of the World Health Organization’s (WHO) Center of Environment and Health in the 1990s, explained why: When uranium weapons explode, their massive blasts produce gray or black clouds of uranium oxide dust particles. These float for miles, people breathe them, and the dust lodges in their lungs. From there, they seep into the lymph system and blood, flow throughout the body, and bind to the genes and chromosomes, causing them to mutate. First, they trigger birth defects. Within five or more years, cancer. Organs, often the kidneys, fail.

At one Basra hospital, leukemia cases in children up to age 14 doubled from 1992 to 1999, says Amy Hagopian, a University of Washington School of Public Health professor. Birth defects also surged, from 37 in 1990 to 254 in 2001, according to a 2005 article in Environmental Health.

Leukemia—cancer of the blood—develops quickly. Chris Busby, a British chemical physicist, explains: “Blood cells are the most easily damaged by radiation and duplicate rapidly. We’ve known this since Hiroshima.”

Dai Williams, an independent weapons researcher in Britain, says the dust emits alpha radiation—20 times more damaging than the gamma radiation from nuclear weapons. The military insists the dust is harmless because it can’t penetrate the skin. They ignore that it can be inhaled.

Fast forward to 2003. When the United States reinvaded Iraq, it launched bunker-busting guided bombs, cruise missiles, and TOW anti-tank missiles. It also fired new thermobaric warheads—much stronger explosives with stunningly large blasts. Many of these, says Ritter, contained some type of uranium, whether depleted, undepleted, or slightly enriched.

Williams says thermobaric weapons explode at extremely high temperatures and “the only material that can do that is uranium.” He adds that while today’s nuclear weapons are nominally subject to international regulations, no existing arms protocol addresses uranium in a non-nuclear context.

While the U.S. government has cleaned up some contaminated sites at home—such as a former uranium munitions plant in Concord, Mass.—it has yet to acknowledge the mess in Iraq.

“Iraq is one large hazardous waste site,” Ritter says. “If it was the U.S., the Environmental Protection Agency would declare it a Superfund site and order it be cleaned.”

We invaded Iraq to destroy its non-existent weapons of mass destruction. To do it, we fired these new weapons, causing radioactive casualties.

 

Left behind in Fallujah

Fallujah (pop. 300,000) is Iraq’s most contaminated city. The U.S. military attacked it twice in 2004, and in the November siege, troops fired thermobaric weapons, including a shoulder-launched missile called the SMAW-NE. (NE means “novel explosive.”)

Ross Caputi was there with the U.S. 1st Battalion 8th Marines. He told me, “We used the SMAW-NE and guys raved about how you could fire just one round and clear a building.” Concrete bunkers and buildings were instantly incinerated and collapsed. The DOD was not disappointed.

Cancers in Fallujah catapulted from 40 cases among 100,000 people in 1991 to at least 1,600 by 2005. In a 2010International Journal of Environmental Research and Public Health article, Busby and two colleagues, Malak Hamden and Entesar Ariabi, reported a 38-fold increase in leukemia, a 10-fold increase in breast cancer, and infant mortality rates eight times higher than in neighboring Kuwait.

Busby sampled the hair of Fallujah women with deformed babies and found slightly enriched uranium. He found the same thing in the soil. “The only possible source was the weapons,” he states.

These numbers are probably low. “Iraqi women whose children have birth defects feel stigmatized and often don’t report them,” says Mozhgan Savabieasfahani, a Michigan-based environmental toxicologist who won the 2015 Rachel Carson Award.

Besides the cancers and birth defects, an Irish pathologist (who asked for anonymity) said an unusually high number of children have cerebral palsy (CP) near the city of Hawija. “I was skeptical when Iraqi doctors told me, but I examined 30 and saw it was classic CP. I don’t know what caused this, but the increase is almost certainly war-related.”

It is often argued that uranium occurs in nature, so it’s impossible to link soil and other samples to the weapons. But, Ritter told me that when experts examine a site, they take samples, study them in a special lab, and can easily tell the difference between uranium that is natural and that which was chemically processed. “The idea that you can’t link soil samples to weapons because of the presence of natural uranium is simply ludicrous. It’s done all the time by experts in the International Atomic Energy Agency and within the nuclear programs of all major nuclear powers,” Ritter says.

 

Burn pits and toxic clouds

In addition to the weapons’ lethal dust, Iraqis and coalition troops were exposed to poisonous smoke from huge open burn pits, some stretching 10 acres. From 2003 to 2011, U.S. military bases burned waste in the pits around the clock—spewing toxic clouds for miles.

Two were near Fallujah. Caputi says,“We dumped everything there. Our plastic bottles, tires, human waste, and batteries.”

Rubber, oil, solvents, unexploded weapons, and even medical waste were also tossed into the pits. As a 2008 Army Times article noted, Balad Air Base burned around 90,000 plastic bottles a day.

When plastic burns, it gives off dioxin—the key ingredient in Agent Orange, which caused malformations and cancer in Vietnam. Burn pits also produce hydrogen cyanide gas, Ritter says, which U.S. prisons used in their execution chambers from the mid-1920s until 2010, and which Nazis used at the Auschwitz and Majdanek concentration camps. Moreover, pits burning uranium-tinged debris produce uranium oxide dust.

When U.S. General Accountability Office (GAO) inspectors visited bases in 2010, they found much to criticize. Contractors running the pits—U.S. companies such as KBR and Halliburton—didn’t collect data on what they burned. (KBR said it wasn’t in their contract.) Few separated out toxic materials. Most burned plastics, although banned by regulations.

The GAO wrote that the fumes could irritate the eyes and lungs, damage the liver, kidneys, and central nervous system, and cause cancer, depending on how much is inhaled and for how long. Troops breathed them 24/7 during their tours, which were usually one year. Iraqis breathed them for eight years.

The now-closed Balad Air Base burned up to 200 tons of waste a day, and many U.S. troops stationed there now have diseases that mirror the diseases suffered by the Iraqis. Some have already died from brain and lung cancers, or leukemia, says Rosie Torres, who started burnpits360.org, when her husband, an Army captain, returned in 2008 with severe breathing problems.

The U.S. Department of Veterans Affairs (VA) x-rayed Captain LeRoy Torres’s lungs and diagnosed a disease of “unknown etiology.” When more veterans presented similar symptoms, the DOD asked Dr. Robert Miller, Vanderbilt’s Chief of Pulmonary Diseases, to study them. Dr. Miller told me, “We biopsied 200 veterans’ lungs and found they had constrictive bronchiolitis, a very debilitating disease. The DOD didn’t like that we biopsied them and that we found the disease was caused by what they were exposed to—which included the burn pits. After that, it didn’t send us more veterans to evaluate.”

Even as evidence mounts, the DOD and VA steadfastly deny the health effects of the weapons and pits. The Defense Health Agency website states, “No human cancer of any type has been seen as a result of exposure to either natural or depleted uranium.”

From 2003 to 2011, U.S. military bases burned waste in the pits around the clock— spewing toxic clouds for miles.

Further, in a 2011 DOD report, Exposure to Toxins Produced by Burn Pits, the VA adds: “The effects from burn pits are only temporary and the negative health effects dissipate once a soldier is removed from the source.” In 2014, the VA website assured veterans that “So far, no health problems have been found in veterans exposed to DU.”

While the military admits it used DU in Iraq from 2003 to 2011, it has downplayed the extent. U.S. Marine Corps Captain Dominic Pitrone told The Washington Spectator, “The only weapons with DU in the USMC inventory were 120mm tank rounds.” As for the new SMAW-NE warhead, he said it “does not contain uranium.”

But Ritter says these claims are disingenuous. Though other DU munitions, such as aerial bombs and 25mm cannon rounds, may not have been in the USMC inventory, they were still “available to and used by USMC units in Iraq.”

And while the USMC may not label the SMAW-NE and thermobaric Hellfire missile as uranium weapons, Ritter says that “this doesn’t resolve whether the shaped-charge warheads [inside them] make use of uranium-enhanced liners.”

U.S. coalition partners—such as Britain, which also used uranium weapons—echo the denials. So too do the WHO and the Iraq Ministry of Health, which concluded in 2012 that Iraq had fewer birth defects and cancers than developed countries.

But Hagopian says the ministry surveyed households instead of using hospital records. Finding this unscientific, a 2013Lancet article called for a new study. Last November, the American Public Health Association asked the military to ban burn pits and fund research on their health effects. It also asked the WHO to rethink its conclusion.

Researchers tell of attempts by authorities to quash investigations. In 1991, for example, the United States tried to keep the WHO from “surveying areas in southern Iraq where depleted uranium had been used and caused serious health and environmental dangers,” Hans von Sponek, a former U.N. official, told the Guardian.

Karol Sikora, a British oncologist who headed WHO’s cancer program in the 1990s, told me his supervisor (who focuses on non-communicable diseases) warned him that they shouldn’t speak publicly about the cancers and birth defects “because this would offend member states.”

Similarly, Baverstock says, “I was on a WHO editorial committee and I warned about the uranium weapons’ geno-toxicity effect on DNA. My comments were rejected—probably because the WHO monograph didn’t include this.”

Those who persist fare badly.

Horst Gunther, a German physician, went to Iraq to study the spiking diseases. He saw children play with DU shells on Basra’s battlefield, took one to Germany to study, and found it was extremely radioactive. He told German authorities and was arrested for possessing it.

In 2003, Chief Justice Y.K.J. Yeung Sik Yuen of Mauritius, a delegate to the U.N. Sub-Commission on Human Rights, wrote of “the cavalier disregard, if not deception, on the part of the developers and users of these weapons regarding their effects.” After he refused to reverse his position that DU weapons are illegal and violate the Geneva Convention, the U.S. and Britain campaigned against his reelection to the subcommission. He lost.

Hagopian says researchers can’t study the uranium weapons’ effects because “the U.S. won’t fund the work.”

Why can’t the DOD, VA, Iraq government, and WHO come clean?

Ritter says, “The DOD doesn’t want the public to know about the toxic dust, because of the liability. As for Iraq, it will agree with the U.S. as long as it depends on the U.S. for financial and military support. As for the WHO, the U.S. contributes more to U.N. agencies and the WHO than any other country.”

Williams adds that there’s growing international concern about uranium weapons, since they’re radioactive. As early as 1991, Army Lt. Col. Ziehm warned in a memo that because DU weapons “may become politically unacceptable,” after-action reports must “keep this sensitive issue at mind.” In other words, don’t tell.

Media coverage of uranium weapons and the spiraling sickness has been meager. Malak Hamden said when she and colleagues published the 2010 Fallujah study, “CNN said something, but no newspapers touched the story.” A BBC reporter told Williams the public doesn’t want to know about uranium weapons.

In the meantime, the United States continues to build them. Williams notes that U.S. Patent Office records show Lockheed Martin and Raytheon hold patents for enhanced bombs and cruise missile warheads that include uranium options.

Today, with the U.S., Britain, France, Saudi Arabia, and Russia bombing Syria, and with the Saudis bombing and the U.S. firing drones into Yemen—with some of the same kinds of weapons unleashed in Iraq—it is likely that the people living there, along with fleeing refugees, will suffer just as the Iraqis and veterans have.

As Busby notes, uranium oxide dust is like a bomb that keeps going off. “People’s genes are damaged for generations. Scientists found this in 22 generations of mice, after Chernobyl. The only way mutated genes disappear is when carriers don’t have children.”

Barbara Koeppel is a Washington D.C.-based investigative reporter.

Photo: Iraqi security forces secure a road after bomb attacks outside the Green Zone in Baghdad February 5, 2014 REUTERS/Thaier al-Sudani

Joe Biden: I Made ‘The Right Decision’

Joe Biden: I Made ‘The Right Decision’

By Margaret Talev, Bloomberg News (TNS)

WASHINGTON — More than six months after his eldest son, Beau, died of brain cancer and six weeks after effectively ending his political career, Vice President Joe Biden is mostly at peace.

Atop his desk aboard Air Force Two as he returns from a trip to the Ukraine is a red folder with the word “cancer” scribbled across the tab, filled with notes and names. On his left wrist, a bracelet made of dark beads and a cross. It’s the rosary Beau fingered until he died in May.

He misses his “exceptional son” terribly and, while he admits to a certain wistfulness for the campaign trail, he has come to terms with his decision not to follow through on Beau’s wish that he make a third run for the presidency.

“My decision, I know, was the right decision,” Biden says of his October announcement that he would not be challenging Democratic front-runner Hillary Clinton and her rivals, Sen. Bernie Sanders of Vermont and former Maryland Gov. Martin O’Malley of Maryland, for the nomination.

“I believed I could win, but that’s not enough. I know myself. And I know it takes time,” says Biden of the process of finding his way back to life. “You’ve got to get through the first Thanksgiving — the first empty chair; the first Christmas, the first smell of spring.”

In the course of a 40-minute interview, the vice president comes across as much more emotionally settled than over the summer and fall when he was mulling a presidential run. Yet he is still clearly vulnerable, a man trying to make the transition from grieving what’s gone to treasuring what’s left — his wife, Jill; his surviving adult children Hunter and Ashley, five grandchildren and the next chapter in his professional life.

“Beau was my soul. Beau was an exceptional son,” Biden says. “When I lost Beau, I lost the most honest, insightful, knowledgeable political adviser I had. He managed me well, for real.”

Biden says he wants to honor Beau by spending much of his last year in office and his post-political life making cancer research and treatment a bigger national priority. Right now, he’s trying to learn the science, the finance, the politics and complexities of a disease that is dreaded and yet ubiquitous. He hopes it will soon be treatable with an arsenal of new discoveries. He meets with cancer experts. He attends conferences. He carries his red folder with him to Ukraine and back.

“What I’m doing now, I’m meeting with every center of power within the cancer world. I’m meeting with billionaires who have set up foundations. I’m meeting with everyone from the Mayo Clinic to one of the largest outfits that took care of Beau,” he said, as well as “all the researchers.”

He is not yet quite sure the direction it will take him, but he’s following a lesson he learned early in his Washington career, when he swaggered onto the Senate floor for an energy debate, armed with a series of talking points. He encountered Sen. Russell Long, son of the legendary Louisiana “kingfish,” Gov. Huey Long. Russell Long had been in the Senate a quarter-century when Biden was elected. He didn’t need talking points to debate energy.

As he describes his humiliation at the hands of the wily Louisianian over the technicalities of oil drilling, Biden jumps from his chair and imitates the late senator’s pigeon-like posture and his thick accent, saying “earl” for oil. For Biden, whose career was bookended by personal tragedies, the Senate has been his energy source, the bipartisan family that sustained him after his first wife and infant daughter were killed in an automobile crash shortly after his election in 1972. As he reminisces about those days, his joie de vivre returns.

Biden doesn’t share the widespread cynicism about politics. Calling Donald Trump’s politics a “dangerous brew,” he expresses confidence that Americans will reject it. “Even though it appeals to some people who are really frightened and scared, even though it appeals to some prejudice and fears, I don’t think it’s sustainable.”

He admits he hasn’t let the 2016 election go, sometimes measuring the candidates’ actions and statements against what he would have done. “I’ve always thought in those terms, from the time I was a 29-year-old senator,” he says. “How would I have done it differently?”

©2015 Bloomberg News. Distributed by Tribune Content Agency, LLC.

Photo: U.S. Vice President Joe Biden  in Washington October 21, 2015. REUTERS/Carlos Barria

 

5 Things You Should Actually Be Afraid Of

5 Things You Should Actually Be Afraid Of

Fear presides over this presidential campaign, a perpetual fear.

For Democrats, it’s the fear that the real but elusive gains of the Obama Administration will be wiped away the same way much of eight years of imperfect but immense progress under Bill Clinton was sapped in just a few years of George W. Bush.

For Republicans, it’s the fear of a demographic apocalypse in which decades of well nurtured racial resentments and authoritarian instincts are rising to the surface right at the moment when the party most desperately needs to appear inclusive.

For both sides, it’s the fear that the other will wrest control of a rapidly aging Supreme Court, setting the course of our democracy for a generation.

And for all Americans, it’s the fear that the tragedies of 9/11 and the financial crisis, from which we still haven’t properly healed, may inevitably be relived, again and again, as farce.

The fears are real — but fear can be as promiscuous as an unchecked libido.

We know this from the Ebola freakout of last year and from the focus on Islamic terrorism.

The shooting at Planned Parenthood in Colorado Springs on Friday reminds us that the majority of incidents of domestic terrorism we’ve experienced on these shores since 9/11 has been caused by non-Muslims, mostly white supremacists. That’s a pretty heavy “since,” but it does underscore that while we fixate on fears from abroad, the greatest threats to our individual lives remain among us. That could change rapidly, especially if terrorists figure out how to smuggle weapons of mass destruction into this country. Vigilance against terror in the era of ISIS, with its fanatical and savage barbarism, is absolutely necessary. That’s why the U.S. has launched thousands of strikes against the terror group, aiming to destroy it without replicating the disastrous mistake that made ISIS possible — a western occupation of a Middle Eastern country.

Terror is real, but living in terror is a choice. Doing so enables demagogues who feed on our worst instincts. So here’s a cold, rational examination of the threats you actually face, just so you’ll know that if someone is trying to make you scared of other things more than these, he probably has an agenda that won’t make you any safer.

1. Heart Disease and Cancer
If you’re reading this, chances are you’ll die after you reach your seventies, in a hospital bed, hopefully surrounded by people you love. And chances are you’ll die of heart disease or cancer, as more than 600,000 Americans do each year. The good news is you can avoid this fate or, at least delay it. The Centers for Disease Control reports that 91,757 premature heart disease deaths and 84,443 cancer deaths a year are preventable with an increase of “risk factor prevention and reduction, screening, early intervention, and successful treatment of diseases or injuries.” What are the greatest risk factors of heart disease and cancer? Pretty much exactly what you’d expect. You’ll notice that not properly fearing Muslims is not on the list.

2. Smoking
While cable news spent a year looking for a lost plane during the safest year of plane travel ever, more than 41 million Americans kept smoking. “Tobacco use is a major factor in four out of the five leading causes of death: heart disease, cancer, lung disease and stroke,” the CDC’s Dr. Tom Frieden wrote. “It causes about a third of heart disease and cancer, and most emphysema.” If terrorists could cause the damage we do to ourselves with tobacco, we’d probably never leave our homes.

3. Motor vehicle accidents and gun deaths, especially for gun owners
While it’s still the CDC’s fifth leading cause of preventable death, we’ve actually made huge advances in preventing automobile-related mortality. With regulations and advances in technology, the percentage of Americans killed while driving in a car continues to drop each year. It’s still a significant threat, however, with two of five workplace fatalities in 2013 having taken place in a motor vehicle. For young males, car accidents and use of firearms are far too likely causes of death — and 2015 may be the first year ever when gun deaths outnumber automobile deaths. We know a great deal about car deaths but way too little about death by bullet, due to an intentional blackout on scientific research, enforced by the gun lobby. But we do know that most gun deaths are suicides. It’s not just a logical conclusion that fewer guns lead to fewer gun suicides, it’s also the result of a Harvard study, which “found that in states where guns were prevalent—as in Wyoming, where 63 percent of households reported owning guns—rates of suicide were higher. The inverse was also true: where gun ownership was less common, suicide rates were also lower.”

4. Inequality
A new study has found that middle aged members of America’s majority group are seeing a sudden spike in deaths. “The mortality rate for white men and women ages 45-54 with less than a college education increased markedly between 1999 and 2013, most likely because of problems with legal and illegal drugs, alcohol and suicide, the researchers concluded,” The Washington Post reported. The results of three decades of conservative economic policy, emboldened by the deterioration of the labor movement, has been misery for white people who lack college degrees (ironically, the same voters who have largely migrated rightward since the mid-1970s). While encouraging white resentment of affirmative action and welfare recipients, conservatives have helped immiserate the same group of workers who most need support from the government and labor to secure decent wages, benefits, and working conditions. And the result — the loss of pensions, of bargaining power, of an evaporating safety net — is a new set of mortality rates that increasingly resemble what America’s minorities, conservatives’ favorite targets of resentment, have long experienced. What would Republican candidates do about the growing crisis of inequality? They’ve promised to make the problem far worse with trillions more in tax breaks for the rich.

5. Climate change
So you don’t believe the scientists, the generals or even the insurance industry, all of whom understand that climate change isn’t just a vague theoretical threat, but may be our greatest long-term risk? Fine, you know better than any of them. But why not at least be agnostic about climate change, if for no other reason than to keep the starving hordes from feasting on your descendants? The likelihood of the oceans drowning our most populated regions is far greater than ISIS ever wresting control of our shores.

Photo: Barry Shaffer via Flickr