Tobacco Settlement Turned Upside Down

“Tobacco bonds” link state budgets to cigarette sales.

Bob Sullivan of MSNBC reports that ten years after a group of states wrestled Big Tobacco to its knees in a $200 billion settlement, the creation of “tobacco bonds” by Wall Street has allowed investors and state governments to borrow against their future tobacco settlement payments. The result? Money that was to be paid out over the next thirty years for smoking cessation programs is being redirected into infrastructure projects and shoring up municipal credit.

“A review of 660 leading bond funds covered by the investment research firm Morningstar Inc., conducted at msnbc.com’s request, showed that more than 260 are invested in tobacco bonds,” Sullivan writes on his blog, The Red Tape Chronicles.

What, you may well ask, are tobacco bonds, and where did they come from? “Perhaps from you,” Sullivan writes. “When Wall Street talked 25 states into borrowing against future tobacco payments—a process known as ‘securitization’—it sold bonds to individual investors and mutual funds that buy municipal bonds.”

The irony of that approach, says Sullivan, is that “because these states have essentially borrowed against future payments from the tobacco industry, they are now dependent on the continued vitality of cigarette sales. If Big Tobacco stumbles, states will be on the hook for these massive, billion-dollar loans.” As a lawyer involved in litigation over the tobacco settlement put it to Sullivan: “Now [the states] have an incentive not to put tobacco out of business.” More than that, any significant failure by the tobacco industry to make its payments would be “catastrophic both to state budgets and individual investors.”

It wasn’t supposed to be this way. But the settlement from the lawsuit designed to blow up Big Tobacco was just too attractive to investment bankers. Sullivan notes that Oppenheimer’s Rochester family of bond funds includes funds with up to 20 per cent of assets held in tobacco bonds. The lure to the states was that, rather than waiting for the money, they could opt for an attractive lump sum payment up front. And many states did just that.

The problem, according to a tobacco policy researcher quoted on Sullivan’s blog, is that “the states have this horribly naive view that they will outsmart Wall Street. Wall Street always gets the better deal.” Many states have settled for a payout of 50 cents on the dollar, plus additional insurance fees against the risk of tobacco companies going out of business.

Eric Lindblom, a director of the Campaign for Tobacco-Free Kids, told Sullivan: “There is a horrible failure of the states to invest even a minuscule amount of the funds for tobacco control. It’s a real tragedy for our country.”

Roughly 3 per cent of tobacco settlement money has been paid out for smoking cessation efforts over the decade since the settlement, Sullivan writes.

Photo Credit: www.treasury.state.la.us

addiction smoking

[Guest Post] Food For Thought--Are You Addicted?

Can you eat your way to happiness?

(This article is contributed by Sarah Scrafford, who regularly writes on the topic of Becoming an Ultrasound Technician. She invites your questions, comments and freelancing job inquiries at her email address: sarah.scrafford25@gmail.com.)


Food is essential for life, but there are times when it becomes the reason for death. If you’ve heard of addictions, you’ll know what I’m talking about – addictions and substance dependence extend beyond the realm of drugs, nicotine and alcohol. There are times when it can become as simple, and as complicated, as being addicted to food. Some people have a sweet tooth and get their rush from sugar; others limit themselves to chocolate; but there are a few people who need to eat all the time – they eat when they’re sad and when they’re happy; they eat because food is available; they eat because they’re bored; they eat because they’re stressed; in short, they eat all possible reasons and for no reason at all.

Too much of anything is bad for you, and so you have food and eating related disorders. The compulsive eaters are beset with various medical problems, all of which begin and end with obesity. Large people with fat deposits on various parts of their body are prone to illnesses like diabetes, hypertension, stroke and cardiac diseases. They’re also bound to be in poor general health because of their low level of fitness and sedentary lifestyle that comes about automatically when you’re fat and unable to move around without difficulty. Besides these, they’re also plagued by knee and back pains because of their weight – their knees are unable to support their body weight and become weak as time goes by.

On the other end of the spectrum are those obsessed with thinness – they love to eat too, but they do it on the sly. And when they’re done, they make themselves throw up either by retching or by using emetics. This disease, called bulimia, is characteristic of food addicts who feel guilty that they eat so much, and who are scared of the weight they’re going to put on because of the amount they’ve consumed. Bulimics are prone to binge eating, where they eat much more than normal amounts.

The best cure to an eating disorder or food addiction is self-control, and if you cannot control yourself, then get someone to help you do so. De-addiction from alcohol, tobacco or any other drug happens when you avoid the substance altogether, but it’s not that easy to overcome an addiction to something that’s a basic necessity for life. The trick is to learn to count your calories or to get someone to do it for you. You could also begin a sensible exercise routine where you concentrate on losing weigh in a healthy manner. A more active lifestyle gives you less time to sit around doing nothing, and so frequenting the path between your couch and your refrigerator.

Food addiction, like all other addictions, is a psychological problem that can be cured if treated at an early stage. All you need is a lot of will power and a little determination.

The Seasonal Addiction: Christmas Lights

Do you or a loved one suffer from CLA?

In 2004, psychologist John M. Grohol wrote a satirical piece for The Psych Central Report. It seems appropriate to excerpt it here:

"It is an age-old question that has haunted people since the first string of lights was strung in the 20th century," Grohol wrote. "Why do some people seem to go a little crazy with the amount of lights and displays they put on their homes and lawns? What makes some people think that this is a good idea? This growing phenomenon has turned into a full-blown behavioral addiction for some."

Indeed it has; one with its very own WebRing. It’s the time of year when afflicted people manifest CLA—Christmas Lights Addiction.
"It is an extreme behavior of an otherwise normal expression of a celebration of the holidays,” Grohol continues. “If you're one of these folks who can't live without their million-light holiday display, seek help. Imagine how much better your gift to the world would be if you donated your electricity costs to a local charity or homeless shelter.

"Leave the holiday lighting spectaculars to Radio City Music Hall or professional displays found in most communities done in formal gardens or the like. Let's try and get back to celebrating Christmas in a way that honors the heart of the tradition without turning it into some sort of glitzy and tacky sideshow of lighting horror.

Merry Christmas, Happy Chanukah, and Happy New Years to you All!"

Photo Credit: Gizmodo

Obama’s Addiction

President-elect should come clean about cigarettes.

For a candidacy built on transparency and straightforward messaging, the Obama juggernaut is missing a wonderful opportunity to send direct aid and comfort to struggling addicts everywhere. All the president-elect has to do is admit that he is still struggling to quit smoking cigarettes.

It doesn’t take a campaign genius to understand the reasoning during the primaries: Smoking, something now done behind closed doors, or while leaning against a dark wall out back, was not something Obama’s handlers were eager to have taken up as a topic of discussion with respect to their candidate. The U.K. Guardian maintains that certain opinion polls found Obama’s smoking to be a greater hindrance to his election than the color of his skin.

The recent release of candid black and white photos from Obama’s college years, showing him casually smoking, has brought the issue back to the forefront. “It is a sign of our anxious, needy condition,” opined the Guardian, “that Americans are willing to overlook the president-elect's filthy habit.”

While Nancy Reagan banned smoking in the White House years ago, the cigar-smoking Clinton seems to have gotten a pass, cigars in the popular culture being to cigarettes as the occasional brandy is to a six-pack. While the New York Times debates whether graphic warning labels only increase people’s desire to smoke, nobody seems to be asking whether a president who sneaks out to the Rose Garden to field-strip a Marlboro will serve as a role model or an enabler for fellow smokers.

In a separate article in the Guardian, Alexander Chancellor writes that “Obama appears to have tried really hard to stop, and says he had cut his smoking down to the occasional fag bummed from a member of his staff; but he still hasn’t give up completely, despite being a fitness fanatic who spends more than an hour a day in the gym.” As every addicted smoker who ever tried to quit has discovered, nobody ever sneaks by for long on two or three bummed cigarettes a day. “You either smoke none or you smoke 20,” writes Queenan. “There is no middle ground.”

More to the point, President-Elect Obama is missing out on an opportunity to speak out on a major public health issue. By coming clean about his struggle to overcome his nicotine addiction, Obama would give renewed hope and courage to struggling smokers and ex-smokers everywhere. If Obama, the icon of cool, the Unruffled One, cannot make good on a promise to his wife to quit smoking, then quitting smoking must be one hell of an undertaking.

As Chancellor writes: “The most striking thing about it all is that a man as calm, controlled and disciplined as the next president should have so far failed in his efforts to set himself free. At least I can take comfort from the fact that I am in the most distinguished company. But I also intend to join him in his New Year resolution to stop smoking, mainly in my case because it’s just too expensive.”


Photograph: Lisa Jack/Bloomberg News/Time

addiction smoking nicotine

A Dubious Choice for Drug Czar

Obama should just say no to Congressman Ramstad.

At the Huffington Post, Maia Szalavitz deconstructs the exaggerated outcome data being used by Minnesota Teen Challenge (MNTC) to document the supposed effectiveness of their addiction treatment program. Plenty of treatment programs inflate their success numbers, knowingly or unknowingly, by using flawed statistics to support their arguments. Often--as in this case--there is no control group, thereby making firm statements about the “success” of a treatment all but impossible to prove.

So why bother pointing out such obvious problems in the case of Minnesota Teen Challenge? Primarily, Szalavitz writes, because “the sole sponsor of an earmark providing $235,000 to Minnesota Teen Challenge, a branch of a national anti-addiction group which believes that recruiting people into the Assemblies of God ministry will cure their addiction,” was none other than Jim Ramstad (R-Minnesota) a populist conservative Obama is considering as the nation’s new “Drug Czar.”

(Earlier this year, Congressman Ramstad came out in opposition to plans for the crescent-shaped Flight 93 Memorial Project, arguing that the design had “Islamic features.”)

NORML, the National Organization for the Reform of Marijuana Laws, gives Ramstad a grade of 30, indicating a “hard-on-drugs” stance. Ramstad, an alcoholic in recovery, backs expanded drug testing for federal employees, and beefed-up military patrols along the Mexican border in order to battle “drugs and terrorism.”

Unfortunately for the country’s hard drug addicts, Ramstad is also adamantly opposed to such things as needle exchange programs and medical marijuana.

No word yet from Ramstad on sentencing issues or the matter of addiction treatment rather than incarceration.

medical marijuana

Doctors Still Don’t Understand Addiction

Med schools ignore major health problem.

If there is one thing most workers in the field of addiction treatment can agree upon, it is that doctors are inadequately trained to deal with addicted patients.

Researchers at the Boston Medical Center recently reported that “education on addiction is inadequate during medical training, resulting in suboptimal medical care for those at risk.” In a study published in the Journal of General Internal Medicine, the Boston researchers found that a “Chief Resident Immersion Training” program yielded significant benefits. This “train the trainers” approach “effectively transferred evidence-based addiction knowledge and practice to 64 chief residents in generalist disciplines and more importantly, enhanced the addiction curriculum in 47 residency programs,” according to Daniel P. Alford, associate professor of medicine at Boston University School of Medicine.

The problem is not a new one. In 2003, Howard Markel of the New York Times wrote that the failure of primary care physicians to diagnose substance abuse was due to “insufficient training in the treatment of addiction, doctor’s frustration with afflicted patients, the common perception among doctors that treatment for substance abuse does not work, and a poor rate of insurance reimbursement for such services.” Dr. June E. Osborn of the Josiah Macy Jr. Foundation put it bluntly: “In clinical situations where they don’t know exactly what they are doing, doctors tend to walk away and adopt an attitude of blaming the patient.”

The Times article concluded that “scant formal training on addiction and substance abuse is available in American medical schools. Now, most of them offer only a few hours on these complex subjects and even less is offered during most residency or postgraduate programs.”

Moreover, in actual practice, insurance benefits for substance abuse problems present a difficult reimbursement problem in many cases. Hence doctors may be more reluctant to offer a formal diagnosis of addictive disorder.

Joseph Califano Jr. of Columbia University’s National Center on Addiction and Substance Abuse told a conference in October: “Although doctors and nurses have the best opportunity to intervene with alcoholics and substance abusers, our research indicates they are woefully inadequate at even diagnosing someone with this disease." Surveys conducted by the center showed that 90% of primary care doctors fail to offer a diagnosis of addiction even in patients clearly displaying classic hallmarks of the condition.

To redress the current state of affairs, the center recommends formal substance abuse training for med students, residents, and doctors, expanding drug dependency coverage under Medicare, Medicaid and private insurers, and “adding legal accountability” for doctors who fail to diagnose addiction when warranted.

To be fair, however, the plight of doctors in this regard is not to be underestimated. Dr. Catherine D. DeAngelis, editor-in-chief of the Journal of the American Medical Association, told the New York Times that “caring for patients with substance abuse is one of the most difficult things I have ever had to deal with as a doctor.... when the ailment in question carries a substantial behavioral component, like substance abuse, physicians get frustrated and don’t do as well.”

Graphics Credit: Codinghorror.com

Rate Your Drugs

Web site gives patients a chance to sound off.

A reader kindly pointed me to www.rateadrug.com, which claims as its mission the creation of “healthcare’s most comprehensive user-sourced database of short and long- term prescription drug side-effects, efficacy and overall benefits information.”

RateADrug, with a small but growing database, says that the site “picks up where clinical trials and FDA disclosures leave off. By taking a free five-minute survey, the users of over 5,000 prescription drugs can complete an unprecedented evaluation of their own experiences and reactions and then compare them with other users worldwide.”

“If Vioxx has taught us anything,” according to the site’s home page, "it’s that sometimes it takes a while for adverse effects to be identified.”

RateADrug claims to provide “an online, community-based rating system that allows users to share information about possible side effects and benefits they experience from prescription drugs, medical procedures and nutritional supplements. The site uses anecdotal reports from highly diversified user groups to add to data from clinical trials and FDA disclosures. Users can evaluate and share their experiences about a broad range of medical treatments, alternative therapies and prescription drugs by participating in RateADrug's ongoing surveys.”

The surveys are anonymous, the site declares, and become part of statistically aggregated scores for each prescription medication.

RateADrug does not accept advertising or infomercials from pharmaceutical companies. Doctors and other health care providers are invited to participate and submit comments.

According to Mark Deuitch, RateADrug.com founder and CEO:

"The one constant in health care is the need for greater creativity, discovery, and transparency in dealing with the effectiveness and potential negative side effects of prescription drugs and other medical treatments."