Tag: feature
Indentured Servitude Gets A 21st-Century Makeover

Indentured Servitude Gets A 21st-Century Makeover

Reprinted with permission from AlterNet.

Indentured servitude is back in a big way in the United States, and conservative corporatists want to make sure that labor never, ever again has the power to tell big business how to treat them.

Idaho, for example, recently passed a law that recognizes and rigorously enforces non-compete agreements in employment contracts, which means that if you want to move to a different, more highly paid, or better job, you can instead get wiped out financially by lawsuits and legal costs.

In a way, conservative/corporatists are just completing the circle back to the founding of this country.

Indentured servitude began in a big way in the early 1600s, when the British East India Company was establishing a beachhead in the (newly stolen from the Indians) state of Virginia (named after the “virgin queen” Elizabeth I, who signed the charter of the BEIC creating the first modern corporation in 1601). Jamestown (named after King James, who followed Elizabeth I to the crown) wanted free labor, and the African slave trade wouldn’t start to crank up for another decade.

So the company made a deal with impoverished Europeans: Come to work for typically 4-7 years (some were lifetime indentures, although those were less common), legally as the property of the person or company holding your indenture, and we’ll pay for your transport across the Atlantic.

It was, at least philosophically, the logical extension of the feudal economic and political system that had ruled Europe for over 1,000 years. The rich have all the rights and own all the property; the serfs are purely exploitable free labor who could be disposed of (indentured servants, like slaves, were commonly whipped, hanged, imprisoned, or killed when they rebelled or were not sufficiently obedient).

This type of labor system has been the dream of conservative/corporatists, particularly since the “Reagan Revolution” kicked off a major federal war on the right of workers to organize for their own protection from corporate abuse.

Unions represented almost a third of American workers when Reagan came into office (and, since union jobs set local labor standards, for every union job there was typically an identically-compensated non-union job, meaning about two-thirds of America had the benefits and pay associated with union jobs pre-Reagan).

Thanks to Reagan’s war on labor, today unions represent about 6 percent of the non-government workforce.

But that wasn’t enough for the acolytes of Ayn Rand, Ronald Reagan and Milton Friedman. They didn’t just want workers to lose their right to collectively bargain; they wanted employers to functionally own their employees.

Prior to the current Reaganomics era, non-compete agreements were pretty much limited to senior executives and scientists/engineers.

If you were a CEO or an engineer for a giant company, knowing all their processes, secrets and future plans, that knowledge had significant and consequential value—company value worth protecting with a contract that said you couldn’t just take that stuff to a competitor without either a massive payment to the left-behind company or a flat-out lawsuit.

But should a guy who digs holes with a shovel or works on a drilling rig be forced to sign a non-compete? What about a person who flips burgers or waits tables in a restaurant? Or the few factory workers we have left, since neoliberal trade policies have moved the jobs of tens of thousands of companies overseas?

Turns out corporations are using non-competes to prevent even these types of employees from moving to newer or better jobs.

America today has the lowest minimum wage in nearly 50 years, adjusted for inflation. As a result, people are often looking for better jobs. But according to the New York Times, about 1 in 5 American workers is now locked in with a non-compete clause in an employment contract.

Before Reaganomics, employers didn’t keep their employees by threatening them with lawsuits; instead, they offered them benefits like insurance, paid vacations and decent wages. Large swaths of American workers could raise a family and have a decent retirement with a basic job ranging from manufacturing to construction to service industry work.

My dad was one of them; he worked 40 years in a tool-and-die shop, and the machinist’s union made sure he could raise and put through school four boys, could take 2-3 weeks of paid vacation every year, and had full health insurance and a solid retirement until the day he died, which continued with my mom until she died years later. Most boomers (particularly white boomers) can tell you the same story.

That America has been largely destroyed by Reaganomics, and Americans know it. It’s why when Donald Trump told voters that the big corporations and banksters were screwing them, they voted for him and his party (not realizing that neither Trump nor the GOP had any intention of doing anything to help working people).

And now the conservatives/corporatists are going in for the kill, for their top goal: the final destruction of any remnant of labor rights in America.

Why would they do this? Two reasons: An impoverished citizenry is a politically impotent citizenry, and in the process of destroying the former middle class, the 1 percent make themselves trillions of dollars richer.

The New York Times has done some great reporting on this problem, with an article last May and a more recent piece about how the state of Idaho has made it nearly impossible for many workers to escape their servitude.

Historically, indentured servants had their food, health care, housing, and clothing provided to them by their “employers.” Today’s new serfs can hardly afford these basics of life, and when you add in modern necessities like transportation, education and child-care, the American labor landscape is looking more and more like old-fashioned servitude.

Nonetheless, conservatives/corporatists in Congress and state-houses across the nation are working hard to hold down minimum wages. Missouri’s Republican legislature just made it illegal for St. Louis to raise their minimum wage to $10/hour, throwing workers back down to $7.70. More preemption lawslike this are on the books or on their way.

At the same time, these conservatives/corporatists are working to roll back health care protections for Americans, roll back environmental protections that keep us and our children from being poisoned, and even roll back simple workplace, food and toy safety standards.

The only way these predators will be stopped is by massive political action leading to the rollback of Reaganism/neoliberalism.

And the conservatives/corporatists who largely own the Republican Party know it, which is why they’re purging voting lists, fighting to keep in place easily hacked voting machines, and throwing billions of dollars into think tanks, right-wing radio, TV, and online media.

If they succeed, America will revert to a very old form of economy and politics: the one described so well in Charles Dickens’ books when Britain had “maximum wage laws” and “Poor Laws” to prevent a strong and politically active middle class from emerging.

Conservatives/corporatists know well that this type of neo-feudalism is actually a very stable political and economic system, and one that’s hard to challenge. China has put it into place in large part, and other countries from Turkey to the Philippines to Brazil and Venezuela are falling under the thrall of the merger of corporate and state power.

So many of our individual rights have been stripped from us, so much of America’s middle-class progress in the last century has been torn from us, while conservatives wage a brutal and oppressive war on dissenters and people of color under the rubrics of “security,” “tough on crime,” and the “war on drugs.”

As a result, America has 5 percent of the world’s population and 25 percent of the world’s prisoners, more than any other nation on earth, all while opiate epidemics are ravaging our nation. And what to do about it?

Scientists have proven that the likelihood the desires of the bottom 90 percent of Americans get enacted into law are now equal to statistical “random noise.” Functionally, most of us no longer have any real representation in state or federal legislative bodies: they now exist almost exclusively to serve the very wealthy.

The neo-feudal corporate/conservative elite are both politically and financially committed to replacing the last traces of worker power in America with a modern system of indentured servitude.

Only serious and committed political action can reverse this; we’re long past the point where complaining or sitting on the sidelines is an option.

As both Bernie Sanders and Barack Obama regularly said (and I’ve closed my radio show for 14 years with), “Democracy is not a spectator sport.”

Tag, you’re it.

Thom Hartmann is a talk-show host and author of over 25 books in print

This article was made possible by the readers and supporters of AlterNet.

Hotelier-In-Chief: Here Are The Trumps’ New Hotels

Hotelier-In-Chief: Here Are The Trumps’ New Hotels

Reprinted with permission from ProPublica.
by Derek Kravitz, ProPublica, Alan Huffman, special to ProPublica, and Matt Drange, Forbes

Last August, Mississippi’s governor introduced a local hotel developer to then-Republican presidential nominee Donald Trump at a $1,000-per-plate private fundraiser in Jackson. The developer, Suresh Chawla, had long been a campaign donor to the governor, Phil Bryant.

At the fundraiser, Chawla told Donald Trump and his son, Donald Jr., about his latest project: a boutique hotel in Cleveland, Mississippi, the home of a new museum devoted to the Grammy Awards.

Donald Trump told Chawla to “think grand,” according to Chawla.

Two weeks later, Chawla donated $50,000, roughly half to Trump’s campaign and half to the Republican National Committee.

By March — two months into Trump’s presidency — Chawla and his brother were on the 26th floor of Trump Tower for contract negotiations. By June, the Trumps and Chawlas had a handshake deal for not one but four Trump-branded hotels in Mississippi, signing the deal 10 minutes before a public announcement.

President Trump, who still owns his businesses, stands to financially benefit from the hotel partnerships while in office. Trump has put management of his businesses in a trust controlled by his sons. But, as we have reported, he can take money from it at any time.

When Trump pledged in January to separate himself from his businesses, he promised that his business would “not reference or otherwise be tied” to the presidency.

The Mississippi deal includes a four-star hotel called Scion at West End and three other, more affordable hotels. Those hotels are the first of a new brand the Trump family has announced that’s targeted to Trump’s political base: the patriotically themed American IDEA.

A promotional video for the new Trump American IDEA Hotel brand that aired at the announcement event describes it as a mid-scale chain — “flea market chic,” Trump Hotels CEO Eric Danziger says — and “rooted in local culture and history and powered by gracious hospitality.” The video was mostly snippets of stock footage, including an apple pie being placed on a table, fans rooting on a sports team at a bar, and an American flag wafting in the breeze, along with the new American IDEA brand logo: a light bulb.

As part of its Scion hotel project, the Chawlas have been approved to receive public financing in the form of a tax-abatement program from the Mississippi Development Authority, which provides money for new projects through sales tax revenue. They will pay no local property taxes for seven years. Dinesh Chawla said the tax break, which was approved by the local city and county governments in January, is available to any project that meets the necessary criteria, adding, “We got no special consideration.”

That tax break could be worth millions but won’t be finalized until the property is assessed later this year.

The deals are some of the first tangible examples of how the Trumps are turning their newfound political capital into business.

“What’s new here is that an elected official, in this case the president, stands to personally benefit from a business brokered by political connections while still serving in office,” said Kathleen Clark, a law professor at Washington University in St. Louis who specializes in government ethics.

The Trump Organization has said it is moving ahead on 39 different deals for hotels around the country. But the company hasn’t said where the hotels will be or who the Trumps will be partnering with.

ProPublica and Forbes have found details of six deals — the four with the Chawlas, and one each in Dallas and St Louis.

We are asking local journalists and interested citizens to help find and ferret out the facts on the remaining 33 deals. It’s important to know who the president’s family is in business with since it’s possible that Trump’s business interests could conflict with his day job of representing the American people.

After the Trump Organization announced the Mississippi deal with the Chawlas in June, we sought to document it from available public records and on-the-ground reporting.

Last summer, Bryant, Mississippi’s Republican governor since 2012, read a letter in a local newspaper describing how, in 1988, a Mississippi businessman named V.K. Chawla had reached out to Trump for a $428,000 business loan, according to the Chawlas. Instead of the loan, Trump offered advice in a 30-minute phone call, suggesting Chawla apply for a Small Business Administration loan.

Chawla got the loan and built a chain of 17 hotels across the Mississippi Delta. He died in 2005 and his sons, Dinesh and Suresh, took over the family business. Suresh Chawla and Parveen Chawla, Dinesh’s wife, have been donors to Bryant since his first gubernatorial campaign in 2011.

Bryant immediately saw an opportunity.

“[Bryant] called and said, ‘Is that true? That’s wild. I’m going to meet with his campaign.’ So he arranged a meeting for us,” Dinesh Chawla said in an interview.

The backstory behind the Chawla and Trump connection appealed to Donald Trump Jr. personally. “It makes his dad look good. He likes the hominess of it,” Dinesh Chawla said. “It sheds a positive light on his dad even though he’s not supposed to be involved and he isn’t involved.” The American IDEA brand was already in the works; the Trumps filed an application to trademark the name “American Idea” in April 2016 and “Idea Hotels” a month later.

Bryant’s office did not respond to requests for comment.

The Trump Organization declined to make the two executives who worked on the deal with the Chawla brothers available for an interview. A spokeswoman for Trump Hotels declined to respond to a list of emailed questions, including the timing of conversations with the governor and the locations for other hotels that have yet to be announced.

“While we are pleased to share this inspiring story, which is one of hundreds throughout Mr. Trump’s career as a business leader and mentor, the process of assessing and finalizing a hotel opportunity is complex and incredibly thorough,” the spokeswoman said in a written statement. “Much like every other hospitality company, it comes down to the actual business.”

The Chawlas will partner with Trump Hotels on two properties in Cleveland and two in nearby Greenville and Clarksdale. The Chawlas own several hotels in the three cities; Dinesh Chawla declined to say which will be adapted for American IDEA properties, citing the contract he signed with the Trump Organization.

Work has all but stopped at the new Scion hotel as a result of the new Trump Organization partnership, as the two parties work out the details, said Cleveland Mayor Billy Nowell. (Dinesh Chawla said those details primarily concern the hotel’s design; Trump Organization officials have asked for information about the community to incorporate into the decor and the Chawlas have scoured local archives to find such images, including those of local churchgoers from the 1950s and ‘60s.)

For its part, the city of Cleveland has primarily acted as “cheerleaders” for the new development, Nowell said. The Cleveland hotel carrying the Trumps’ Scion brand name is slated to open in March 2018.

Cleveland officials say the city is in sore need of more hotel rooms and welcomes the Trump projects. In addition to deferring taxes as incentive for the Chawlas to open the hotel, the tax abatement also requires that the project generate at least 10 full-time jobs, according to county documents. (Dinesh Chawla estimates the hotel will bring between 30 and 40 jobs to the small town.)

“When we have events like [Delta State University] ball games and at the Grammy museum, our hotels are full and people have to go to other towns,” said Judson Thigpen, head of Cleveland-Bolivar County Chamber of Commerce. “With this we’ll be able to recruit small conferences.” The city currently has fewer than 300 hotel rooms, and the Scion will have three complexes, with 100 rooms, he said.

The $20 million project is being built with $5 million in financing from Mississippi-based Guaranty Bank & Trust and will be managed by Trump Hotels in a partnership with Chawla Pointe LLC. All of the other American IDEA properties are existing hotels that will be adapted to the brand.

As for the other Trump-branded hotels, the Chawlas and Trumps have signed a franchising agreement, with the Trumps taking a cut of revenue and leaving the management of the buildings to the Chawlas. The approach is similar in other cities, where hotel operators have signed letters of intent with the Trump Organization.

Dinesh Chawla said he didn’t support President Trump during the campaign, largely because he didn’t think he would win. “I admire Hillary Clinton quite a bit,” he said. He says he voted for Obama in 2008 and 2012, in part, because he “stayed at our hotel.” (His brother, Suresh, said that he doesn’t understand President Trump’s travel ban. “The whole concept of what’s going on there … I kind of stay away from all that.”)

“We don’t do things based on politics,” Dinesh Chawla said. “It’s about business.”

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.

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The Myth Of Drug Expiration Dates

The Myth Of Drug Expiration Dates

Reprinted with permission from ProPublica.
by Marshall Allen ProPublica

The box of prescription drugs had been forgotten in a back closet of a retail pharmacy for so long that some of the pills predated the 1969 moon landing. Most were 30 to 40 years past their expiration dates — possibly toxic, probably worthless.

But to Lee Cantrell, who helps run the California Poison Control System, the cache was an opportunity to answer an enduring question about the actual shelf life of drugs: Could these drugs from the bell-bottom era still be potent?

Cantrell called Roy Gerona, a University of California, San Francisco, researcher who specializes in analyzing chemicals. Gerona had grown up in the Philippines and had seen people recover from sickness by taking expired drugs with no apparent ill effects.

“This was very cool,” Gerona says. “Who gets the chance of analyzing drugs that have been in storage for more than 30 years?”

The age of the drugs might have been bizarre, but the question the researchers wanted to answer wasn’t. Pharmacies across the country — in major medical centers and in neighborhood strip malls — routinely toss out tons of scarce and potentially valuable prescription drugs when they hit their expiration dates.

Gerona and Cantrell, a pharmacist and toxicologist, knew that the term “expiration date” was a misnomer. The dates on drug labels are simply the point up to which the Food and Drug Administration and pharmaceutical companies guarantee their effectiveness, typically at two or three years. But the dates don’t necessarily mean they’re ineffective immediately after they “expire” — just that there’s no incentive for drugmakers to study whether they could still be usable.

ProPublica has been researching why the U.S. health care system is the most expensive in the world. One answer, broadly, is waste — some of it buried in practices that the medical establishment and the rest of us take for granted.  We’ve documented how hospitals often discard pricey new supplies, how nursing homes trash valuable medications after patients pass away or move out, and how drug companies create expensive combinations of cheap drugs. Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

What if the system is destroying drugs that are technically “expired” but could still be safely used?

In his lab, Gerona ran tests on the decades-old drugs, including some now defunct brands such as the diet pills Obocell (once pitched to doctors with a portly figurine called “Mr. Obocell”) and Bamadex. Overall, the bottles contained 14 different compounds, including antihistamines, pain relievers and stimulants. All the drugs tested were in their original sealed containers.

The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations.

“Lo and behold,” Cantrell says, “The active ingredients are pretty darn stable.”

Cantrell and Gerona knew their findings had big implications. Perhaps no area of health care has provoked as much anger in recent years as prescription drugs. The news media is rife with stories of medications priced out of reach or of shortages of crucial drugs, sometimes because producing them is no longer profitable.

Tossing such drugs when they expire is doubly hard. One pharmacist at Newton-Wellesley Hospital outside Boston says the 240-bed facility is able to return some expired drugs for credit, but had to destroy about $200,000 worth last year. A commentary in the journal Mayo Clinic Proceedings cited similar losses at the nearby Tufts Medical Center. Play that out at hospitals across the country and the tab is significant: about $800 million per year. And that doesn’t include the costs of expired drugs at long-term care pharmacies, retail pharmacies and in consumer medicine cabinets.

After Cantrell and Gerona published their findings in Archives of Internal Medicine in 2012, some readers accused them of being irresponsible and advising patients that it was OK to take expired drugs. Cantrell says they weren’t recommending the use of expired medication, just reviewing the arbitrary way the dates are set.

“Refining our prescription drug dating process could save billions,” he says.

But after a brief burst of attention, the response to their study faded. That raises an even bigger question: If some drugs remain effective well beyond the date on their labels, why hasn’t there been a push to extend their expiration dates?

It turns out that the FDA, the agency that helps set the dates, has long known the shelf life of some drugs can be extended, sometimes by years.

In fact, the federal government has saved a fortune by doing this.

For decades, the federal government has stockpiled massive stashes of medication, antidotes and vaccines in secure locations throughout the country. The drugs are worth tens of billions of dollars and would provide a first line of defense in case of a large-scale emergency.

Maintaining these stockpiles is expensive. The drugs have to be kept secure and at the proper humidity and temperature so they don’t degrade. Luckily, the country has rarely needed to tap into many of the drugs, but this means they often reach their expiration dates. Though the government requires pharmacies to throw away expired drugs, it doesn’t always follow these instructions itself. Instead, for more than 30 years, it has pulled some medicines and tested their quality.

The idea that drugs expire on specified dates goes back at least a half-century, when the FDA began requiring manufacturers to add this information to the label. The time limits allow the agency to ensure medications work safely and effectively for patients. To determine a new drug’s shelf life, its maker zaps it with intense heat and soaks it with moisture to see how it degrades under stress. It also checks how it breaks down over time. The drug company then proposes an expiration date to the FDA, which reviews the data to ensure it supports the date and approves it. Despite the difference in drugs’ makeup, most “expire” after two or three years.

Once a drug is launched, the makers run tests to ensure it continues to be effective up to its labeled expiration date. Since they are not required to check beyond it, most don’t, largely because regulations make it expensive and time-consuming for manufacturers to extend expiration dates, says Yan Wu, an analytical chemist who is part of a focus group at the American Association of Pharmaceutical Scientists that looks at the long-term stability of drugs. Most companies, she says, would rather sell new drugs and develop additional products.

Pharmacists and researchers say there is no economic “win” for drug companies to investigate further. They ring up more sales when medications are tossed as “expired” by hospitals, retail pharmacies and consumers despite retaining their safety and effectiveness.

Industry officials say patient safety is their highest priority. Olivia Shopshear, director of science and regulatory advocacy for the drug industry trade group Pharmaceutical Research and Manufacturers of America, or PhRMA, says expiration dates are chosen “based on the period of time when any given lot will maintain its identity, potency and purity, which translates into safety for the patient.”

That being said, it’s an open secret among medical professionals that many drugs maintain their ability to combat ailments well after their labels say they don’t. One pharmacist says he sometimes takes home expired over-the-counter medicine from his pharmacy so he and his family can use it.

The federal agencies that stockpile drugs — including the military, the Centers for Disease Control and Prevention and the Department of Veterans Affairs — have long realized the savings in revisiting expiration dates.

In 1986, the Air Force, hoping to save on replacement costs, asked the FDA if certain drugs’ expiration dates could be extended. In response, the FDA and Defense Department created the Shelf Life Extension Program.

Each year, drugs from the stockpiles are selected based on their value and pending expiration and analyzed in batches to determine whether their end dates could be safely extended. For several decades, the program has found that the actual shelf life of many drugs is well beyond the original expiration dates.

A 2006 study of 122 drugs tested by the program showed that two-thirds of the expired medications were stable every time a lot was tested. Each of them had their expiration dates extended, on average, by more than four years, according to research published in the Journal of Pharmaceutical Sciences.

Some that failed to hold their potency include the common asthma inhalant albuterol, the topical rash spray diphenhydramine, and a local anesthetic made from lidocaine and epinephrine, the study said. But neither Cantrell nor Dr. Cathleen Clancy, associate medical director of National Capital Poison Center, a nonprofit organization affiliated with the George Washington University Medical Center, had heard of anyone being harmed by any expired drugs. Cantrell says there has been no recorded instance of such harm in medical literature.

Marc Young, a pharmacist who helped run the extension program from 2006 to 2009, says it has had a “ridiculous” return on investment. Each year the federal government saved $600 million to $800 million because it did not have to replace expired medication, he says.

An official with the Department of Defense, which maintains about $13.6 billion worth of drugs in its stockpile, says that in 2016 it cost $3.1 million to run the extension program, but it saved the department from replacing $2.1 billion in expired drugs. To put the magnitude of that return on investment into everyday terms: It’s like spending a dollar to save $677.

“We didn’t have any idea that some of the products would be so damn stable — so robustly stable beyond the shelf life,” says Ajaz Hussain, one of the scientists who formerly helped oversee the extension program.

Hussain is now president of the National Institute for Pharmaceutical Technology and Education, an organization of 17 universities that’s working to reduce the cost of pharmaceutical development. He says the high price of drugs and shortages make it time to reexamine drug expiration dates in the commercial market.

“It’s a shame to throw away good drugs,” Hussain says.

Some medical providers have pushed for a changed approach to drug expiration dates — with no success. In 2000, the American Medical Association, foretelling the current prescription drug crisis, adopted a resolution urging action. The shelf life of many drugs, it wrote, seems to be “considerably longer” than their expiration dates, leading to “unnecessary waste, higher pharmaceutical costs, and possibly reduced access to necessary drugs for some patients.”

Citing the federal government’s extension program, the AMA sent letters to the FDA, the U.S. Pharmacopeial Convention, which sets standards for drugs, and PhRMA asking for a re-examination of expiration dates.

No one remembers the details — just that the effort fell flat.

“Nothing happened, but we tried,” says rheumatologist Roy Altman, now 80, who helped write the AMA report. “I’m glad the subject is being brought up again. I think there’s considerable waste.”

At Newton-Wellesley Hospital, outside Boston, pharmacist David Berkowitz yearns for something to change.

On a recent weekday, Berkowitz sorted through bins and boxes of medication in a back hallway of the hospital’s pharmacy, peering at expiration dates. As the pharmacy’s assistant director, he carefully manages how the facility orders and dispenses drugs to patients. Running a pharmacy is like working in a restaurant because everything is perishable, he says, “but without the free food.”

Federal and state laws prohibit pharmacists from dispensing expired drugs and The Joint Commission, which accredits thousands of health care organizations, requires facilities to remove expired medication from their supply. So at Newton-Wellesley, outdated drugs are shunted to shelves in the back of the pharmacy and marked with a sign that says: “Do Not Dispense.” The piles grow for weeks until they are hauled away by a third-party company that has them destroyed. And then the bins fill again.

“I question the expiration dates on most of these drugs,” Berkowitz says.

One of the plastic boxes is piled with EpiPens — devices that automatically inject epinephrine to treat severe allergic reactions. They run almost $300 each. These are from emergency kits that are rarely used, which means they often expire. Berkowitz counts them, tossing each one with a clatter into a separate container, “… that’s 45, 46, 47 …” He finishes at 50. That’s almost $15,000 in wasted EpiPens alone.

In May, Cantrell and Gerona published a study that examined 40 EpiPens and EpiPen Jrs., a smaller version, that had been expired for between one and 50 months. The devices had been donated by consumers, which meant they could have been stored in conditions that would cause them to break down, like a car’s glove box or a steamy bathroom. The EpiPens also contain liquid medicine, which tends to be less stable than solid medications.

Testing showed 24 of the 40 expired devices contained at least 90 percent of their stated amount of epinephrine, enough to be considered as potent as when they were made. All of them contained at least 80 percent of their labeled concentration of medication. The takeaway? Even EpiPens stored in less than ideal conditions may last longer than their labels say they do, and if there’s no other option, an expired EpiPen may be better than nothing, Cantrell says.

At Newton-Wellesley, Berkowitz keeps a spreadsheet of every outdated drug he throws away. The pharmacy sends what it can back for credit, but it doesn’t come close to replacing what the hospital paid.

Then there’s the added angst of tossing drugs that are in short supply. Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available. He holds up a purple box of atropine, which gives patients a boost when they have low heart rates. It’s also in short supply. In the federal government’s stockpile, the expiration dates of both drugs have been extended, but they have to be thrown away by Berkowitz and other hospital pharmacists.

The 2006 FDA study of the extension program also said it pushed back the expiration date on lots of mannitol, a diuretic, for an average of five years. Berkowitz has to toss his out. Expired naloxone? The drug reverses narcotic overdoses in an emergency and is currently in wide use in the opioid epidemic. The FDA extended its use-by date for the stockpiled drugs, but Berkowitz has to trash it.

On rare occasions, a pharmaceutical company will extend the expiration dates of its own products because of shortages. That’s what happened in June, when the FDA posted extended expiration dates from Pfizer for batches of its injectable atropine, dextrose, epinephrine and sodium bicarbonate. The agency notice included the lot numbers of the batches being extended and added six months to a year to their expiration dates.

The news sent Berkowitz running to his expired drugs to see if any could be put back into his supply. His team rescued four boxes of the syringes from destruction, including 75 atropine, 15 dextrose, 164 epinephrine and 22 sodium bicarbonate. Total value: $7,500. In a blink, “expired” drugs that were in the trash heap were put back into the pharmacy supply.

Berkowitz says he appreciated Pfizer’s action, but feels it should be standard to make sure drugs that are still effective aren’t thrown away.

“The question is: Should the FDA be doing more stability testing?” Berkowitz says. “Could they come up with a safe and systematic way to cut down on the drugs being wasted in hospitals?”

Four scientists who worked on the FDA extension program told ProPublica something like that could work for drugs stored in hospital pharmacies, where conditions are carefully controlled.

Greg Burel, director of the CDC’s stockpile, says he worries that if drugmakers were forced to extend their expiration dates it could backfire, making it unprofitable to produce certain drugs and thereby reducing access or increasing prices.

The 2015 commentary in Mayo Clinic Proceedings, called “Extending Shelf Life Just Makes Sense,” also suggested that drugmakers could be required to set a preliminary expiration date and then update it after long-term testing. An independent organization could also do testing similar to that done by the FDA extension program, or data from the extension program could be applied to properly stored medications.

ProPublica asked the FDA whether it could expand its extension program, or something like it, to hospital pharmacies, where drugs are stored in stable conditions similar to the national stockpile.

“The Agency does not have a position on the concept you have proposed,” an official wrote back in an email.

Whatever the solution, the drug industry will need to be spurred in order to change, says Hussain, the former FDA scientist. “The FDA will have to take the lead for a solution to emerge,” he says. “We are throwing away products that are certainly stable, and we need to do something about it.”

ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign up for their newsletter.

The Senate Bill On Health Care Imploded, And Pro-Trump Media Is A Mess. Sad!

The Senate Bill On Health Care Imploded, And Pro-Trump Media Is A Mess. Sad!

Reprinted with permission from MediaMatters.

The Senate health care bill is dead again after two conservative Republican senators said last night they would not vote to advance the legislation because it does not repeal enough of former President Barack Obama’s signature health law. As GOP leaders scramble to find a new tactic that will allow them to strip health insurance from millions while slashing taxes for the wealthy, President Donald Trump’s media supporters have been left grasping for a message.

The original bill, which Senate Majority Leader Mitch McConnell assembled through a secretive process and tried to rush through with little public debate, would lead to 22 million more Americans being uninsured at the end of the decade, largely due to cuts to Medicaid; many of those who retain insurance under the bill would pay more for fewer benefits. The bill was amended after the Congressional Budget Office offered that verdict, but the GOP decided not to wait for a new score before moving forward. Democratic senators are universally opposed to the legislation, while the most moderate and conservative Republicans have also refused to sign on, either because it does too much or too little to move away from Obamacare’s improvements to the health care system.

Trump’s propagandists look to him to set the tone for how to respond to bad news. But the message out of the White House has always been incoherent on health care, largely because the president seems to have no real interest in the various, serious policy debates surrounding the future of health insurance for the American people — he just wants a win. In May, the president held a Rose Garden event to celebrate the passage of the House bill, which he described as a “great plan.” Weeks later, he turned around and privately called that legislation “mean.”

That sort of policy incoherence gets in the way of formulating messaging around legislative setbacks. Last night, for instance, Trump tweeted that “Republicans should just REPEAL failing ObamaCare now & work on a new Healthcare Plan that will start from a clean slate. Dems will join in!” But that tactical messaging completely ignores the question of what a good health care plan would look like, and whether the Senate bill that just went down in flames met that criteria. Without clearly defined heroes and villains or a clear policy vision, his media allies have been left to their own devices. The noise machine is grinding to a halt.

Absent messaging from the top, here are a few ways the pro-Trump media are responding:

The GOP leadership failed Trump

Most of Trump’s propagandists are of the opinion that Trump cannot fail; he can only be failed. As such, they’ve quickly turned their fire on McConnell and Speaker of the House Paul Ryan (R-WI).

“I know the president is frustrated with the situation. A lot has been promised to him and not much delivered,” Fox host Kimberly Guilfoyle said last night. “I think this is a failure on the part of the leadership, to be quite honest. Because they needed to get this to stick and to coalesce and get it done.”

“Second failure for Mitch McConnell,” Steve Doocy added on Fox & Friends this morning, pointing to the bill’s previous collapse last month.

Even Matt Drudge is getting in on the act:

If the Senate bill continues to struggle, and Trump doesn’t publicly support McConnell, we could see calls for his replacement in the near future.

“It was a lousy bill”

Trump’s lack of interest in policy leaves his supporters plenty of room to say that they didn’t like the bill, without creating any dissonance about the fact that the president supported the legislation.

Doocy went after the bill from the start this morning, saying, “Ultimately, what undid this bill is — the one that they are not going to vote on now —  is it was a lousy bill. I mean, it still had big taxes. It still had a lot of regulations. It had that insurance company subsidy slush fund that Rand Paul was talking about. It was not what the American people” wanted. Notably, since Doocy also has little knowledge of or interest in policy, he can’t really say what a good replacement would look like either, simply saying Congress should “get rid of all that stuff and come up with something new.”

“Maybe it’s time to nuclear option things”

One of the problems Senate Republicans faced in trying to push through health care legislation is that because they knew no bill would attract enough Democratic support to overcome a filibuster, they were trying to pass the bill with a 50-vote threshold through the budget reconciliation process. But that process limits what can actually go into the bill, making full repeal of Obamacare extremely difficult.

In order to sidestep that process, the hosts of Fox & Friends are calling for Senate Republicans to deploy the “nuclear option” and eliminate the filibuster altogether, making all votes subject only to a majority vote. It’s unclear how this would help pass a health care bill since Republicans just demonstrated they don’t have 50 votes in the Senate, but this morning Doocy, co-host Brian Kilmeade, and former White House press secretary Ari Fleischer all seemed eager to push through that proposal.

A few hours later, Trump, who regularly watches Fox & Friends, chimed in, tweeting, “The Senate must go to a 51 vote majority instead of current 60 votes. Even parts of full Repeal need 60. 8 Dems control Senate. Crazy!”

Hey look over here!

For some, the best way to get through a crushing defeat for the president is to downplay that it happened.

Time to move on to tax reform

Another option is to give up altogether. That’s the current recommendation of Fox News host Eric Bolling, at least until the president makes clear that he’s sticking with health care.

“Let’s just say this thing fails. They put it off to the side,” he said on this morning’s Fox & Friends. “They screwed up. They failed. You shore up the individual insurance markets. You put it off to the side. Then you take up something that I think every single American, whether you are Democrat, independent, or Republican, can wrap their brain around, tax reform.”

The good news for the pro-Trump media is that tax reform is a very simple issue with few stakeholders and broad agreement in Congress on a way forward. It also helps that the president has learned important lessons from the health care fight about overconfidence in the face of policy fights.

Header image by Sarah Wasko / Media Matters