Tuesday, May 06, 2014

Another TED Talk from Ken Robinson

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Gun Violence is a Public Health Emergency

It took only eleven minutes to transform a quiet elementary school into the scene of one of the deadliest school shootings in U.S. history. On December 14, 2012, Adam Lanza entered Sandy Hook Elementary with a Bushmaster Model XM15-E2S semiautomatic rifle. He used the weapon to murder twenty school children and six adults. One state trooper warned the medical personnel who arrived at the school to formally declare the victims dead: “This will be the worst day of your life.”
The Sandy Hook shootings prompted an outpouring of national grief and outrage. Yet sadly, this tragedy—while especially shocking and visible—only represents the tip of the iceberg when it comes to deaths from gun violence. Every day in the United States, friends and family must make funeral preparations for an average of 86 peoplewho were intentionally or unintentionally killed with a firearm.
If measles or mumps killed 31,672 people a year, we would undoubtedly consider the situation to be a public health emergency. And indeed, gun violence shares many characteristics with other widespread safety threats that have been framed as public health issues.
In a Q&A published in a 2008 bookThe Contested Boundaries of American Public Health, epidemiologist Mark Rosenberg recalls early efforts to frame gun violence as a public health issue in the 1980s. Finding that the burden of deaths from guns in the United States was similar to those of cars, he realized that gun violence was an area where public health could “make a big contribution and save lives by applying the same kind of science that had been applied to road traffic crashes.”
Indeed, like motor vehicle deaths, gun fatalities result from a consumer product that is integral to many Americans’ lives. Yet both cars and guns can be made safer with technology and engineering—air bags in cars and loading indicators for guns.
But efforts to frame gun violence as a public health challenge have met with considerable resistance, most notably from gun lobby groups, such as the NRA.
The NRA is a powerful force in American political life that attracts many supporters, not only with its ideological positions, but with its message of self-empowerment. And the organization has long and vociferously opposed the framing of gun violence as a public health issue, portraying research on the subject as biased and misguided. For instance, the NRA’s chief lobbyist, Chris Cox, told the New York Times that the CDC was guilty of publishing “political opinion masquerading as medical science.”
The NRA has worked to translate their objections into policies that circumscribe public health research on the effects of gun violence. In the mid-1990s, after a failed campaign to eliminate the CDC’s National Center For Injury Prevention, gun lobbyists helped persuade Congress to include language in its budget stating that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention may be used to advocate or promote gun control.”  (If the NRA is right about everything they preach, why are they so afraid of the data?)
Despite this limitation, the agency has since developed other mechanisms to study causes of violent deaths, notably the National Violence Reporting System. But to this day, the CDC’s funding level for research explicitly devoted to gun violence prevention remains at $0. And according to Dr. David Hemenway, director of the Harvard Injury Control Research Center, due to fears of getting attacked by the NRA lobby, many foundations have avoided funding such research. (Do you think Bill and Melinda are afraid of the NRA?) “It’s one of the reasons that there’s been relatively little gun research compared to other research in public health,” Dr. Hemenway says.
More recently, the NRA succeeded in adding a provision into the Affordable Care Act to limit doctors’ ability to gather data about their patients’ gun use. The Washington Post dubbed this provision “a largely overlooked but significant challenge to a movement in American medicine to treat firearms as a matter of public health.”
Then, in 2011, Florida Governor Rick Scott signed into law a “docs vs glocks” bill, which banned physicians from asking their patients about gun ownership. In 2012, a federal judge permanently blocked this NRA-backed law because it violated the First Amendment rights of doctors. Nonetheless, such laws and provisions indicates the extent to which policymakers have attempted to limit medical and public health conversations and research on gun safety.
Despite this already remarkable influence in setting and limiting the terms of public health research, this year the NRA has wielded its power in an extraordinary new way by obstructing President Obama’s nomination of Dr. Vivek Murthy as U.S. Surgeon General. The organization opposed Dr. Murthy’s characterization of gun control as a health issue and his support of regulatory measures, such as mandatory safety training for gun owners.
But by blocking Dr. Murthy’s nomination, the NRA prompted prominent medical and public health voices to take a stand. In a remarkable op-ed, the New England Journal of Medicine stated that “the NRA is taking its single-issue political blackmail to a new level.” And in April 2014, Michael Bloomberg took a bold step into the ongoing debate, announcing that he would donate $50 million of his own money to counter the NRA.
The New York Times describes how Bloomberg intends to restructure current gun control advocacy efforts to more effectively counter the NRA. Part of the idea is to combine forces and model advocacy efforts on the success of other safety-related groups, notably Mothers Against Drunk Driving. The resulting new group, Everytown For Gun Safety, has already produced an ad that directly challenges claims made by the NRA.
Whether these new strategies and influx of money can promote effectively a public health perspective on gun violence and safety interventions remains an open question with high stakes. In fact, even after the Sandy Hook shootings of 2012, many states have been loosening their gun restrictions. Georgia, one of the most prominent and recent examples of this trend, recently passed into law a bill that allows licensed gun owners to carry their weapons in schools, churches, bars, and airports. The public is often unaware of the extent to which gun owners may legally carry and display their weapons in public spaces across the country.
What policy changes do gun safety advocates seek? A recent Massachusetts report identified 44 strategies to reduce gun violence that all committee members, including public health professionals and gun owners, endorsed. Of the range of possible strategies to reduce gun violence, strengthening the existing background check system has the most public support. In fact, although the NRA as an organization does not support universal background checks, a 2013 poll found support among 74 percent of NRA members. (The NRA doesn't even support their own members!)
This approach is also supported by public health research. As reported by Nora Caplan-Bricker in The New Republic, a 2014 study found that the murder rate in Missouri jumped 16 percent after the repeal of a state law that required anyone purchasing a handgun to obtain a permit indicating a background check had been passed.
Safe storage practices and more safely designed guns would also likely make an impact on reducing the number of unintentional gun deaths among young children. As Dr. Hemenway told WBUR’s All Things Considered“We have childproof aspirin bottles; we should have childproof guns.”
Yet entrepreneurs seeking to market and sell “smart guns,” or weapons which can only be fired by authorized users, have encountered harassment and outrage from gun enthusiasts. This month, a Maryland gun dealer who had intended to sell the nation’s first smart gun backed down after enduring protests and death threats. And fewer than 20 states have enacted laws to hold adults criminally liable if they fail to safely store their gun, enabling children to access the weapon.
Former U.S. Surgeon General Julius Richmond and medical economist Rashi Fein have proposed three essential factors involved in addressing a societal problem: scientific data, a social strategy guiding the pursuit of public health goals, and political will. Public health researchers have sought to collect data on the effects of gun violence despite the obstacles, and gun safety advocates are currently seeking new strategies.
But ultimately, it seems that whether gun violence can be framed as public health problem will come down to political will. A public health frame for this fully loaded American issue can only be effective if it is built on a narrative of shared American values. These must include not only the second amendment, but also protecting our rights to life, liberty and the pursuit of happiness.

Monday, May 05, 2014

A New Epidemic is Targeting Good Kids

This story is playing itself out all over the country.  There is no community that isn't being effected by the heroin epidemic.  The difference in this epidemic from any other is that it is targeting the "good kids."  The "bad kids" are dealing, not using.

Heroin’s New Hometown

On Staten Island, Rising Tide of Heroin Takes Hold

The obituaries have a certain sameness to them: full of praise and regret for lives cut short, marked by telltale details and omissions. The deaths occurred at home, or at a friend’s house elsewhere on Staten Island. The mourned were often young and white, and although how they died was never mentioned, nearly everyone knew or suspected the cause.

A 23-year-old man, a cello student in high school and the son of an elevator company vice president died in March. A former high school hockey player who delivered newspapers died in 2013 at 22. Another 23-year-old man who was working construction died at home in July 2012. Family members and autopsy reports revealed that they died from heroin or combinations of drugs including heroin.

Staten Island, long a blue-collar bastion of police officers and other New York City workers, is confronting a heroin epidemic.

Thirty-six people died from heroin overdoses in 2012, the highest number in at least a decade, according to the most recent available city health department records; the death rate was higher than the city’s other four boroughs had seen in 10 years. The amount of heroin seized by the Police Department on Staten Island has jumped more than 300 percent from 2011 to 2013, and this year shows no sign of abating: Through April 13, officers seized roughly 1,700 glassine bags of heroin, up from about 1,200 bags over the same period in 2013. That number does not include the 347 bags seized on Wednesday in raids at an auto-repair shop and its owner’s home.

Drug treatment facilities and addiction programs teem with patients; informal support groups for addicts’ relatives have had to find larger meeting spaces. And last month, the city authorized nearly all Staten Island police and emergency medical workers to carry naloxone, a drug to counteract heroin overdoses.

“You’ve got kids falling apart. You’ve got families falling apart,” said William A. Fusco, the director of Dynamic Youth Community, a drug-treatment center in Brooklyn whose clients include many young Staten Islanders. “You’ve got people who have got no idea what to do, and they’re all saying the same thing: This was a good kid. This was a good kid.”

For decades, heroin was mostly found in the urban sections of the island’s north, where the ferry docks from Manhattan and the Verrazano-Narrows Bridge touches down from Brooklyn. It afflicted the borough’s poorest areas, with sales concentrated in open-air markets at a few notorious housing developments like Stapleton and Park Hill.

But as in towns and cities from Vermont to Washington State, heroin’s new surge on Staten Island has ravaged primarily its working- and middle-class communities, especially in the borough’s south.
Numerous heroin addicts and dealers said in interviews that the drug was usually purchased in bulk elsewhere in New York City or in New Jersey, then resold on Staten Island. Law enforcement officials back that account, noting that they have not found any heroin mills in the borough, requiring the police to fight an army of small-time dealers.

“They hide in plain sight,” Detective Ray Wittick said on a recent Wednesday as he steered an unmarked police minivan through a Waldbaum’s grocery store parking lot in Princes Bay, where drug deals are not uncommon.

Some parents have taken to sending their children for treatment in Brooklyn, in part to avoid the glare of those who would recognize them at facilities on Staten Island.

Candace Crupi said she did not want to leave any mystery about her son’s death. The obituary in The Staten Island Advance in March said Johnathan Crupi, 21, had been overwhelmed by addiction. He died at home of a heroin overdose.

“I wanted people to know that I wasn’t ashamed of him,” she said. “People are so ashamed of addiction. There’s such a stigma, and it’s just not right.”

On the family’s kitchen table, among funeral bouquets of red and yellow roses, sat a photograph of Johnathan. It had been a formal occasion, the young man in a tuxedo, his hair closely cropped in a Caesar-style cut.

In a back bedroom, where his body was found on March 28, the smell of cigarettes still lingered 10 days later.

Since the obituary appeared in late March, Ms. Crupi, 60, said she had been approached by people she knew well, and those she only barely recalled, offering condolences and praising her bravery. At Johnathan’s funeral, hundreds showed up, including many strangers who described their families’ own struggles with heroin.

“People that I never knew were going through the same thing,” her husband, Barry Crupi, said. “It was so many people. So many people.”

Spread across an island more than twice the size of Manhattan, Staten Island’s 470,000 residents live in a collection of small communities often arranged around short main streets, the neighborhoods bearing the names of early residents — Tottenville for John Totten and his family — or for the industries once prevalent, like Graniteville for the quarries once active there.

Until 1964, when the Verrazano Bridge opened, Staten Island had no physical connection to the rest of New York City; older bridges led only to New Jersey. That long separation gave Staten Island its own sense of identity and culture, from the centrality of the Staten Island Mall to the wooded brush vulnerable to fires set by bored teenagers.

There is also a sense of continuity: Staten Island’s demographics have not greatly changed since the 1970 census. In contrast to the rest of the city, the borough’s white non-Hispanic residents outnumber minorities, accounting for about 64 percent of its residents, according to the 2010 census. Most homes are owner-occupied, and unemployment is below the city average.

“When I was growing up, you’d see people riding horses on Hylan Boulevard,” Detective Wittick, 45, said. “You felt like it was something out of a movie, you know. These little towns with the perfect life. You knew all your neighbors.”

That familiarity still exists, but now it carries a burden when drugs are involved.

For a time, a culture of recreational prescription pill abuse seemed like just the latest way for many on Staten Island to deal with weekend boredom. Pills could be found at the cafeteria in Tottenville High School, or at local bars where older men sold their medications, like Roxicodone, Vicodin or Percocet, for a healthy profit. A young barber on Amboy Road said some customers asked to pay for their haircuts in pills.

“You could make money off it,” said Andrea, a 21-year-old recovering addict from Great Kills. “It didn’t seem like there were any consequences.”

Or, in the words of a local rap song from 2012: “Pain killer paradise, Staten Island.”

Pills began showing up in drug seizures around the island, often traced to doctors whose offices were flooded by users seeking illegal prescriptions. One such physician, Dr. Felix Lanting, was 85 when he pleaded guilty to distributing oxycodone in 2012.

His arrest caused a momentary jump in prices, recovering addicts said, but he was just one source among many, including a Lickety Split ice cream truck where 30-milligram oxycodone pills were sold on the side.

An Inexpensive High
Gradually, dealers and users switched to heroin. Some opioid addicts found that their habits required 20 or 30 pills a day, an unsustainable proposition at as much as $30 each. Heroin, already available around New York City for about $5 to $10 for a single glassine, became a cheap alternative.

Brandon, 22, of the south shore town of Eltingville, remembered when the police arrested a group of young men in 2012 for selling pills around Tottenville. His supply dried up.

Then a fellow addict took him over the Goethals Bridge to an open-air heroin market in Newark. “It was so much easier, it’s $6 and it’s always there,” said Brandon, who is now in a 12-step recovery program. “I’ve done one pill since I got introduced to heroin.”

Another recovering addict, Nikki, 29, said she began each day with 15 or 20 Vicodin pills. “I would take them in one shot,” she said.

The daily hunt for money to buy more, usually raised by finding and selling scrap metal with her boyfriend at the time, finally became too much. One day in 2009, the boyfriend came home with something new — 50 little bags of heroin. “I told him, ‘Once we go this way, there’s no going back,’ ” she recalled in an interview. “This is the beginning of the end.”

She said she got hooked.

Four years later, Nikki said, she was clean but admitted that there were lapses. During a recent period of recovery, a friend of a friend asked her to deliver some heroin to a buyer. She agreed but was subsequently arrested. She is now out on bail, raised through pawnshop proceeds from her jewelry. She is also pregnant: The baby is due in July and, once born, will immediately require detoxification from the methadone that Nikki takes every day. She and her new boyfriend will remain on methadone for the foreseeable future, but Nikki said heroin and pills are behind her.

“I’m going to become a mother,” she said.

Most of the addicts interviewed for this article passed through the Dynamic treatment center in Brooklyn, a Y.M.C.A. on southern Staten Island or a Pills Anonymous group that has expanded to include heroin addicts; all requested that they be referred to by only their first names as they rebuild their lives.

Nearly all began by sniffing heroin, much as they had sniffed crushed pills. Soon many sought out the greater high that a needle provided. For Brandon, his first time shooting up was in January 2013, with a fellow addict in the bathroom stall of the Wendy’s on Richmond Hill Road. “I’m thinking, I could be dead in 30 seconds,” Brandon said of his mind-set at the time. He did it anyway.

Mike, 23, of Tottenville said he could find bundles of glassine bags in Newark for as little as $3 or $4 apiece. What he did not use, he sold on Staten Island for $10. Other recovering addicts described similar trips to East New York, Brooklyn, or Elizabeth, N.J. Any profits would go straight back into buying more heroin.

Although deaths from heroin are apparent here, evidence of the drug on the streets is less so. Sales take place by arrangement over the phone, a quick stop in a shopping center parking lot or in the house next door.

For instance, Angelo Gallo and his father, Ugo Gallo, pleaded guilty to selling heroin last year out of their two-story detached house on David Street in Eltingville. A city sanitation worker now rents the home, a few doors down from a police officer.

In the similarly sleepy bedroom community of Oakwood, police officers caught Frank Monte, 47, in the act of selling 300 glassine envelopes in a white plastic bag for $1,320 in cash.

Mr. Monte, who pleaded guilty to felony drug possession, denied any involvement in the sale, saying his previous time in prison for selling drugs had biased the officers. “When you go to jail on Staten Island, you’re labeled for life with these cops,” he said in a phone interview in March.

A few days after that conversation, he was arrested in a car near Clove Road and the Staten Island Expressway with 531 bags of heroin, according to the arrest report. He pleaded guilty, this time to a higher degree of felony possession.

Sabrina, a recovering addict, remembered telling her parents she was going out for ice cream only to go see a dealer by the public pool near her family’s Woodrow home. The dealer took her $100 and drove off.

Desperate for a hit and out of cash, she returned home and told her mother she had been robbed. Her mother questioned why she needed so much money for ice cream. Incensed, Sabrina began tearing apart the home. In the struggle, she shoved her mother, breaking her ankle. Soon after, Sabrina, 25, checked into rehab.

Difficult to Police

Unlike more established drug markets that predominate in other areas of the city, those running heroin here are mostly independent and deal in small quantities. Narcotics officers on Staten Island who have worked in other parts of New York say that dealers and buyers here tend to be even more suspicious of outsiders than elsewhere in the city.

That complicates catching dealers here, as the Police Department has had more difficulty conducting the sort of buy-and-bust operations that are the baseline of narcotics work in other boroughs. “There are those inherent challenges because of the closeness of Staten Island,” said Capt. Dominick D’Orazio, the commanding officer of the borough’s narcotics squad.

Most heroin gets to Staten Island by car and is delivered that way by the dealers who crisscross its neighborhoods, officials said.

“They’re not coming down with a kilo,” said Daniel M. Donovan Jr., the Staten Island district attorney. “They’re going uptown and getting an ounce and then breaking it out.”

Prosecutors and the police said they have noticed that violent drug gangs who have long operated on the north shore of the island — selling mostly crack and marijuana — are switching to selling heroin, where the profit is.

New York City authorities are moving to track the incoming, often prepackaged heroin. Investigators have had some success in turning small-time players to catch those coming onto the island with greater quantities. The goal is to follow the trail back to the major suppliers in the city, who are believed to be primarily in Upper Manhattan and the Bronx, where the police have discovered the city’s largest heroin mills.

That many middle-class Staten Island families send their kids to Brooklyn for treatment speaks to the pervasiveness of the problem and the shame it carries in an insular borough. “Families generally feel better when their child is out of the community,” said Karen J. Carlini, the associate director at Dynamic.

Last year, parents began gathering informally in the backyard of Alicia Reddy’s home in the Huguenot neighborhood. A registered nurse with experience in detox, Ms. Reddy, 44, had been fielding so many calls from parents about addiction, she said, that she decided to hold a monthly meeting to provide information.

“A big factor was that parents were ashamed,” she said.

As the problem worsened, the gatherings quickly outgrew her yard. They are now held at a nearby school, attached to Our Lady Star of the Sea, a Roman Catholic church on Amboy Road, two miles down from a tight cluster of businesses — a decorator, a barber shop, a bagel store — tied in recent years to illegal pill sales, guns or heroin.

Nearby, in the basement of the church rectory, a Pills Anonymous group meets. On a recent Tuesday night, 36 people gathered, describing feelings of helplessness, as well as the strength they found in one another. The program’s 12 steps, written out by hand, hung on a table at the front.

Brandon told his story of repeated episodes of treatment and relapse. In an interview after the meeting, he said that he has been clean for nearly a year, since June 16, 2013.

He counted at least 10 people who he knew had died from pill or heroin overdoses, including an acquaintance from high school he saw again while in treatment for heroin. The classmate died last month.

“There’s no reason that I’m different from Adam,” he said. “I should be dead too.”