Long waiting lists for drug treatment add to addicts’ desperation

Shawn Cross, at his home in Lisbon, Maine, is a recovering drug addict who began using heroin after switching from opiate painkillers. He now works at Catholic Charities and helps other recovering addicts. (Nikki Kahn/The Washington Post)

 

By Marc Fisher July 26

 

PORTLAND, Maine — Shawn Cross thought heroin was making him an excellent manager at the auto parts store where he had gone from delivery guy to manager in five years. On the job, every day, every four hours, he snorted opiate pills or heroin.

He hired addicts because they might help him score drugs. Sometimes he missed work to drive his supplier two hours south on Interstate 95 to Haverhill, Mass., where the dealer would call Dominican gang members, who would arrange a meeting along a country road, a quick hand-off car to car.

Cross had held it together while he was snorting Oxycontin, the prescription painkiller. But when the supply of illegal pills started to dry up five years ago, Cross did what he had promised himself he would never do: He made the switch to heroin.

“The withdrawals just trump everything,” he said, “and that’s what was available.”

Heroin delivered the most alluring highs he had ever experienced and drove him to a desperation he had never imagined. After a three-year descent into destitution, Cross would begin another quest, one that bedevils millions of addicts nationwide: a frantic, frustrating search for treatment.

[‘And then he decided not to be’: David McCarthy got clean, but heroin was too alluring]

 

From the moment he started using heroin, Cross thought of himself as a lost cause. “If you’re doing just pills, you can tell yourself, well, doctors prescribe them. You can tell people you’re doing pills,” he said. “You don’t get together with your friends and say, ‘Let’s do some heroin.’ ”

He spent all his income, and more, on drugs — easily $1,000 a week. He stopped paying for heating oil. He stopped paying rent. He persuaded his reluctant mother to take in his girlfriend and dog; his mother made him sleep in his car.

After a time, there was no pleasure in it. Cross did drugs to avoid feeling sick. Desperate for treatment, he went to the only rehab center in the area that accepted men as patients, Mercy Recovery Center. It was full. With limited state funding and low reimbursement rates from Medicaid, there was little incentive for medical facilities to add long-term rehab beds.

Last month, Mercy, Maine’s largest treatment center, closed its doors and eliminated 250 beds because of declining insurance reimbursement rates. For addicts such as Cross, that leaves only the state-funded rehab program; the wait is 18 months.

[Gallery: Family tragedies reflect the rise in heroin use]

 

And a political battle over treatment funding threatens to add to addicts’ desperation in Maine: Last year, about 40 percent of heroin addicts who got treatment were put on methadone therapy. But Gov. Paul LePage (R) has proposed ending state funding for methadone treatment, saving about $1.6 million over two years.

LePage wants addicts to be treated with suboxone, another replacement opiate that satisfies cravings but doesn’t make the user nearly as high. But suboxone can be prescribed only by doctors who have undergone special training, and federal rules allow each physician to treat only 30 patients at a time — or up to 100 with approval from drug enforcement officials. The strict controls shut out many addicts, leaving them to self-medicate by buying suboxone on the street, according to physicians, drug counselors and addicts.

“We have nowhere to put people who don’t have a wealthy mother in the suburbs,” said Caroline Teschke, who runs Portland’s public health clinic. “Every day, we have people begging for help. The only sure way to get help is to be a young pregnant female.”

“There’s no treatment,” added Maine Attorney General Janet T. Mills (D). “We had overdose deaths in every county in the state last year, but we have fewer treatment facilities and we’ve removed thousands of people from the Medicaid rolls. We don’t know how to deal with it. These are people who want treatment, and we have nothing for them.”

The damage mounts with each passing month: Over the past three years, child abuse and neglect cases have shot up by 58 percent. Over the past decade, the number of drug-affected newborns has spiked by 600 percent.

As wait lists for rehab grow longer, property crime has crept up, and more people have showed up at the homeless shelter in downtown Portland. Every day this April, someone in Maine died of a drug overdose, Mills said.

“Everyone knows some family affected by heroin by now,” Mills said. “Families are starting to speak out; they’re saying ‘heroin’ in the obituaries. But there’s still a level of embarrassment about it: ‘Heroin, that doesn’t happen here.’ ”

In interviews, addicts at a court-ordered counseling session in Portland said users are resorting to desperate measures to get help.

“Go to jail,” said a man in his 30s. “Have a kid so you can get insurance.”

“Work the system — play the suicide card,” said a man in his 50s.

Cross’s mother found a doctor who put him on suboxone. But Cross sold the pills to buy more heroin.

Finally, Cross was arrested and charged with felony drug trafficking: He drove his dealer to an apartment where she sold to an undercover agent. After his first stint in jail, he snorted Oxycontin in the parking lot as he left the facility. His dealer picked him up.

But after another arrest, in 2013, this time for violating probation, Cross went to drug court and spent four months in jail — long enough to go through withdrawal. “The jails around here are basically detox facilities,” he said.

He went on suboxone again but lost his insurance eight months later, after state officials refused to accept federal money to expand Medicaid. More than 25,000 people were forced off the public health-care rolls.
 

With no subsidy, Cross’s out-of-pocket cost for suboxone would jump from a $3 co-pay to $700 a month. His doctor told him it was time to taper off the drug, quickly. He went through violent withdrawal pangs for a month. Then he started working again, for the first time in five years, building houses, roofing.

He and his girlfriend now have a 10-month-old, a daughter who has “never known me as an active addict.”

“And she never will,” Cross said. “I owe her that.”

BLOGGER'S NOTE:   We were the, proverbial canary in coal mine on the issue of drug abuse.  Drugs ravaged our communities and America's response was jail - jail for the users and jail for the low level dealers; mandatory jail sentences, with no treatment options were the standard practice.  And property was confiscated, not just from users or sellers, but often from those unknowingly involved - cars and homes taken, and businesses shuttered.  Let's see what happens now that it's white communities being ravaged.

National push for $15 minimum wage hits home for U.S. Senate workers

A sliver of moon rises behind the Capitol dome. (Bill O’Leary/The Washington Post)

 

By Mike DeBonis July 21 at 7:13 PM

Errol Baker left his job at the Washington Hilton in 2004 after 12 years to pursue what he thought would be a better life working at the U.S. Capitol.

“I thought I was going to be working in a better environment,” he said. “I’d get to meet senators and congressmen and movie stars. I was very excited.”

Baker, 52, has brushed shoulders with the famous and the powerful in his years as a Senate food service worker — once, for instance, he received a $20 tip from then-Sen. Barack Obama — but he is otherwise no better off.

Unable to make ends meet on his $11.30 hourly wage, he now cleans offices for five hours at night after his eight-hour Capitol shift ends. It’s nearly midnight before he comes home to his D.C. apartment, hoping to catch a few hours of sleep before he reports to the Senate for his morning shift.

Baker is among a group of federal contract workers who are joining with union-backed advocates to call on lawmakers to do more to protect an increasingly privatized federal workforce, where low wages and minimal benefits often clash with the rhetoric espoused by elected leaders.

“We work for them every day,” Baker said. “They have a clean environment; they’ve got good food to eat. They say, ‘Thank you very much’ and ‘Good work.’ But that’s not enough. I need more so I can pay my bills. . . . $15 and a union.”

[ It’s not just fast food: The Fight for $15 is for everyone now ]

The national campaign for higher wages and better benefits — reflected in the “Fight for $15” backed by the Service Employees International Union — has landed squarely on Capitol Hill as the 2016 presidential race spins up.

“If the candidates can’t help the workers who cook and clean for them, how will they help the low-wage workers who labor all across America?” said Joseph Geevarghese, deputy director of the Change to Win labor coalition, a sponsor of the Good Jobs Nation campaign that is seeking to highlight job conditions among federal contract workers. “What happens at the Capitol is a litmus test about whether or not presidential candidates who know these workers really care.”

[ The homeless man who works in the Senate ]

A protest in April helped highlight the plight of Senate workers such as Charles Gladden, 63, who had been sleeping outside the McPherson Square Metro Station. On Tuesday, another Senate food worker, Sontia Bailey, wrote in the Guardian about having a miscarriage after working two jobs: Her full-time $10.59-an-hour Senate position, and an $11-an-hour part-time job at a Kentucky Fried Chicken restaurant.

On Wednesday, liberal members of Congress — including Sen. Bernie Sanders (I-Vt.), a Democratic presidential candidate — will appear on the Capitol grounds with worker advocates to call for a $15 minimum wage.

That proposal, which would more than double the current federal minimum wage, is almost certain to be dead on arrival in a Congress controlled by Republicans who argue that a minimum-wage increase would reduce the overall number of jobs. But advocates want President Obama to take executive action to improve standards for federal contractors, and there is hope that senators might try to improve the lives of contract workers such as Baker, Bailey and Gladden.

Senate food services were contracted out amid ongoing operating deficits in 2008, when Democrats were in the majority. “There are parts of government that can be run like a business and should be run like businesses,” Sen. Dianne Feinstein (D-Calif.), then-chairman of the Senate Rules and Administration Committee, said at the time.

The contract with New York-based Restaurant Associates is now up for review, and workers and advocates are pushing for a seat at the table to negotiate improvements for employees.

House workers have been unionized for nearly three decades, but Senate workers are not. Although the Restaurant Associates contract guarantees the right of workers to form a union, a 2012 SEIU-backed organizing drive failed

[ Why House cafeteria workers are paid better than Senate cafeteria workers ]

A spokesman for Sen. Roy Blunt (R-Mo.), the current chairman of the rules panel, declined to comment on the ongoing negotiations, saying they are now between Restaurant Associates and the Architect of the Capitol, not the committee. Sen. Charles E. Schumer (N.Y.), the top Democrat on the panel, said the contract workers are “part of the Senate family and they deserve to be treated as such.”

“A $15 minimum wage and better benefits would be a great way to say thanks for all that they do, and we’re working hard to make it happen,” Schumer said.

A Democratic aide who is familiar with the process but was not authorized to comment on it publicly said that “some progress” has been made but that “there is more to be done.”

A report issued this week by the D.C. Fiscal Policy Institute and Good Jobs Nation found that tens of thousands of federal contract jobs, about 30 percent of the total, pay less than the D.C. living wage for a family of four. That includes the vast majority of grounds maintenance and food service jobs. That, in effect, the report says, makes the federal government one of the Washington region’s largest low-wage employers.

The wages and benefits offered to Senate workers are made even starker by the internal disparities between Restaurant Associates employees. Those who were hired before privatization — such as 33-year worker Norma Rogers, 76 — receive higher wages and robust federal benefits.

The newer workers “are treated like when they had slaves, you know? ‘You got to do what I tell you or otherwise you go,’ ” said Rogers, who earns $17 an hour. “With us, it’s a little different.”

When Baker was hired at the Capitol in 2004, he took a temporary job expecting to transition into a good-paying job with federal benefits like Rogers’s. That hope ended once food services were contracted out in 2008.

Had he stayed at the Hilton, Baker probably would be much better off: Under the latest contract negotiated by the union representing most D.C. hotel workers, Baker would make at least $18 an hour now, plus employer-paid medical and dental benefits.

Baker said he regrets coming to work at the Capitol. “I’m not going to lie to you,” he said. “Especially now.”

New Alzheimer’s studies bolster evidence that women are more vulnerable to disease

“It’s not just that women are living to be older. . . . There’s something else going on in terms of biology [and] environment for women compared to men that may make them at greater risk.”
Kristine Yaffe, professor at the University of California at San Francisco

bolster evidence that women are at a higher risk, and decline faster, than men. Women who display the early signs of mental decline that can precede Alzheimer’s disease deteriorate faster than men with the same condition, a new study has found.

Another study suggests that women’s daily activities and cognitive abilities decline faster than men’s after undergoing surgery with general anesthesia. A third study has found that an abnormal protein that plays a key role in triggering Alzheimer’s accumulates at higher rates in women’s brains than in men’s.

The new research, presented this week at the Alzheimer’s Association International Conference in Washington, lends additional support to the view that women run a higher risk than men of developing Alzheimer’s disease and may be more vulnerable to its damaging effects once the illness gets going.

“The bottom line is, more and more we think there are some differences,” said Kristine Yaffe, a professor of psychiatry, neurology and epidemiology at the University of California at San Francisco. “It’s not just that women are living to be older— that’s true, and that drives some of this. But there’s something else going on in terms of biology [and] environment for women compared to men that may make them at greater risk or, if they have some symptoms, may change the progression.”

Of an estimated 5.4 million people with Alzheimer’s in the United States, about 3.4 million are female. Women have twice the lifetime risk of developing Alzheimer’s disease, which is the leading cause of dementia. The disease is progressive and incurable.

The distinguishing features of Alzheimer’s include the buildup of abnormal proteins that destroy brain cells in areas critical to memory and learning. These proteins — beta-amyloid, which forms waxy, insoluble plaques; and tau, which creates fibrous tangles — begin accumulating well ahead of symptoms such as memory loss, and advances in technology have allowed scientists to obtain images of them.

For a year or more, the Alzheimer’s Association has highlighted the disease’s disparate impact on women, both in its incidence and in the burden of caring for those who have it. The findings shared Tuesday bolster the theory that gender differences may have an effect on determining Alzheimer’s risk, perhaps because of hormonal interactions with genes, biochemistry and development in the brain.

Roberta Diaz Brinton, a professor at the University of Southern California’s School of Pharmacy, said her research has shown that women may have higher Alzheimer’s risk because estrogen has such an important effect on regulating the energy supply in the brain. At menopause, women’s bodies undergo radical transformations that can alter the brain’s ability to change glucose, a kind of sugar, into energy.

“Every cell — every single cell in your body — has a sex. The X chromosome or the XY chromosome is within all of our cells, and that very likely has an effect on cell function,” said Brinton, who helped organize the Alliance of Women Alzheimer’s Researchers, a professional interest group within the Alzheimer’s Association.

A study led by scientists at UC San Francisco explored the connection between gender and a gene whose ability to raise the risk of developing Alzheimer’s disease is already well known. The study— conducted by Duygu Tosun, an assistant professor of radiology, and others— used data from brain scans to investigate links between gender and a gene variant known as APOE4.

The gene is one of several variants that code for an apolipoprotein, a protein that shuttles cholesterol and fatty substances in the body and the brain. Having a single copy of the gene raises the risk of Alzheimer’s at least twofold; having a copy from each parent boosts the odds even higher.

The study found that men who carried the APOE4 gene had higher accumulations of beta-amyloid in their brains than men who did not. But the study’s major finding was that women had higher accumulations of the abnormal protein in their brains, regardless of whether they carried the APOE4 gene.

“This study shows women have more amyloid in their brain than men in general, and especially once the women are in the late stages where they’re having dementia. They’re going to have higher levels than men, and the APOE4 isn’t going to affect that,” said Michael W. Weiner, a radiology professor at UC San Francisco and principal investigator of the Alzheimer’s Disease Neuroimaging Initiative.
That heightened vulnerability may also affect the rate of decline among women who already show signs of dementia.

Katherine Amy Lin, an undergraduate at Duke University, said her team used data from the neuroimaging initiative to track the erosion of cognitive ability in men and women who already suffered mild cognitive impairment.

Lin, who worked with the university’s medical school, said the study examined 257 men and 141 women, mostly in their mid-70s, and their performance on cognitive tests over an eight-year period.
The study found that people with the APOE4 gene had a faster rate of decline. But after adjusting for genetic disposition and other factors, the study showed that women who suffered from mild cognitive decline saw their performance deteriorate twice as fast as men’s.

“Our findings do suggest that there is greater vulnerability to women,” Lin said. She cautioned, however, that the results are preliminary and in need of further gender-specific research.

In a similar study, Katie J. Schenning, a physician at Oregon Health & Science University in Portland, said her team explored gender differences in people who suffer cognitive decline after undergoing surgery with general anesthesia. Though most people do not experience any lasting effects from surgery involving anesthesia, recent research has found that older people are susceptible to progressive cognitive and functional decline after such procedures. Older adults receive about a third of the anesthesia administered in the United States, Schenning said.

Using data from the Oregon Brain Aging Study and a project called Intelligent Systems for Assessing Aging Changes, the team looked at 527 people, including 182 who underwent 331 procedures using general anesthesia. The average follow-up was seven years. It found that men who were exposed to general anesthesia during surgery declined faster on measures of cognitive performance and daily activity than men who had not had surgery; women who underwent surgery with anesthesia also declined faster than women who did not. But women also declined more rapidly than men. The rate was even faster for women who had multiple surgeries using anesthesia.

Women had more rapid erosion in measures of both cognition and ability to perform daily activities.
“I do want to stress that, at this time, it’s uncertain which specific surgical or anesthetic factors might contribute to postoperative cognitive or functional decline,” Schenning said. “It’s also very important to note that this is just not an effect of anesthesia itself but rather a combination of the effects of anesthesia and surgery together.” 

But Schenning also said the findings suggest that physicians should advise older patients of the risk of decline after surgery with a general anesthetic and perhaps urge them to carefully weigh whether to undergo nonessential procedures.

Questions linger about Trump’s draft deferments during 

Vietnam War

Republican presidential hopeful Donald Trump appears at a campaign rally in Bluffton, S.C. (Stephen B. Morton/Associated Press)

 

By Craig Whitlock July 21 at 11:32 PM

 

A few weeks after his 22nd birthday, Donald Trump received a notice from the federal government. On July 9, 1968, his local draft board had scrawled a “1A” beside his name in its handwritten ledger, classifying him as available for unrestricted military service.

For the previous four years, Trump had avoided the draft — and the possibility of being sent to fight in the Vietnam War — by obtaining four separate deferments so he could study at Fordham University and the University of Pennsylvania. With his diploma in hand and his college days over, he was suddenly vulnerable to conscription.

Trump’s exposure to the draft, however, didn’t last long. Two months later, on Sept. 17, 1968, he reported for an armed forces physical examination and was medically disqualified, according to the ledger from his local Selective Service System draft board in Jamaica, N.Y., now in the custody of the National Archives.

The ledger does not detail why Trump failed the exam — the Selective Service destroyed all medical records and individual files after the draft ended in 1973 and the military converted to an all-volunteer force.

In recent days, Trump, a Republican presidential candidate, and his campaign have said that he received the medical deferment because he had bone spurs in his feet. But rather than clear up all questions about why he did not serve in the military during the Vietnam era, they have given shifting accounts that are at odds with the few remaining documents in his Selective Service file.

[Trump surges to big lead in GOP presidential race]

 

Trump has given limited information about the nature of his medical ailment from 1968 that left him classified as “1-Y,” or unqualified for duty except in the case of a national emergency.

On Saturday, during a campaign stop in Iowa, Trump said he had a bone spur in his foot but couldn’t recall which one.

Pressed for details, he told reporters to research his draft records. “You’ll have to look it up,” he said. Later that day, his campaign issued a statement saying he had bone spurs in both of his heels.Trump’s draft board records show that he had another armed forces physical two years earlier, on Dec. 15, 1966. Although the ledger does not spell out the results, he was not granted a medical deferment at the time — indicating that he was found fit for duty.

When Trump registered for the draft at 18 in 1964, he had just graduated as a decorated cadet from the New York Military Academy in Cornwall, where he played football and basketball.

His draft registration card lists him as being 6 feet 2 inches tall, weighing 180 pounds and having birthmarks on both heels. Almost immediately, as he enrolled at Fordham, he was granted the first of his four education deferments.

In 1968, Trump obtained his medical deferment at a time when the Vietnam War was intensifying and the military needed a wave of new conscripts. To help meet the demand, a national draft lottery was held in December 1969, for the first time since World War II. Men born between 1946 and 1950 were assigned a draft number — based on the order in which their birthdates were pulled randomly out of a jar.

Trump, who was born in 1946, and his campaign have given conflicting explanations about how he came to be protected from the draft that year.In some interviews, Trump has cited his medical deferment and the bone spurs in his feet. But his campaign has given a different reason, saying that he simply lucked out in the 1969 lottery. 

That year, young men with the same birthdate as Trump — June 14 — were assigned draft number 356 out of 366, almost last. Anyone with that number was almost guaranteed to avoid being drafted, unless the entire country mobilized.

 

“When the draft occurred, they never got near his number and he was therefore exempt from serving [in the] military,” Trump’s campaign said in its Saturday statement. “Although he was not a fan of the Vietnam War, yet another disaster for our country, had his draft number been selected he would have proudly served and he is tremendously grateful to all those who did.”

The campaign statement described the medical deferment as “minor” and only “expected to be short-term,” suggesting that it did not shield him from the 1969 draft lottery.

But Trump’s Selective Service record indicates otherwise. The draft board ledger states that his medical deferment remained in place from 1968 until 1972, when it was changed to a similar classification: 4-F, or not qualified for service.

On Tuesday, Trump spokeswoman Hope Hicks did not respond to written questions from The Washington Post about the discrepancy and declined to comment beyond the statement that the campaign had released three days earlier.

Trump was not affected by national draft lotteries that were held in subsequent years; he kept the high draft number he was originally assigned in 1969, as well as his medical deferment.

OPM to federal agencies: We got hacked, but you have to help pay for the response

By Eric Yoder July 21 at 10:23 AM

After it failed to safeguard millions of files filled with sensitive personal information, the government’s personnel office is now telling other federal agencies they will be expected to cover the costs of responding to the massive computer breach.

The cost of addressing the breach – which compromised security clearance files affecting 21.5 million federal workers, military personnel and contractor employees – represents an unanticipated expense hitting late in the government’s fiscal year, when agency budgets are especially tight. And agencies whose employees have been put at risk should expect to absorb even more costs in the future, according to a previously undisclosed memo from the Office of Personnel Management, whose systems were breached.

“Given the limited resources available to OPM at this time to deal with a contract of this size, agencies will be asked to contribute FY 2015 funding to cover the first full year’s costs of credit monitoring and related services / benefits” for the incident, wrote acting OPM director Beth Cobert.

The breach involves highly personal information on virtually everyone who applied for a security clearance or had one renewed since 2000, and in some cases before.

[Hacks of OPM databases compromised 22.1 million people, federal authorities say]

OPM has come under intense fire from employees and lawmakers over the failure to prevent several computer breaches and over the response to those hacks. The agency’s director, Katherine Archuleta, resigned under pressure earlier this month.

Some federal employees were taken aback after officials from government agencies were informed at a briefing late last week that they would be expected to pay for the costs of responding to the breach of the security clearance database.

“My mouth dropped open when I read this. I get the fact that the money has to come from somewhere, but, man, oh man,” said a federal official, who was not authorized to speak on the record on the matter.

The amount of the costs is still unknown, since OPM has not yet issued a contract to notify and provide services to those affected by the clearance files breach.

For a separate breach involving personnel records of some 4.2 million current and former federal employees held for OPM on computers at the Department of Interior, the cost of sending notices and providing services was $21 million. OPM and Interior paid for that contract, but officials said they cannot afford to cover what could be much higher costs to address the breach of the security clearance database.

The Office of Management and Budget “fully supports the decision for cost sharing across all agencies given these circumstances,” wrote Cobert, who was transferred from her post as OMB deputy director for management after Archuleta stepped down.

[OPM Director Katherine Archuleta resigns under pressure]

The decision by senior Obama administration officials to distribute the costs across the government means that agencies will have to find potentially substantial savings in their budgets late in the current fiscal year.

Typically, when agencies  must find such savings, they look to cutting administrative costs, such as employee awards, training and travel, and overhead such as office equipment. Those accounts, which in many cases already are pinched by years of budgetary restrictions, also pay employee salaries. While salaries could not be cut, restrictions on those accounts could translate into pressure to hold down the number of employees.

Finding the funds will be all the more difficult since there are now barely two months left in the budget year.

In addition to paying costs for credit monitoring, personal identify protection and other measures related to the hack of the the clearance files, the memo says, agencies will be charged higher rates for OPM to process clearance applications on their behalf, retroactive to the start of this fiscal year.

[$21 million tab to taxpayers for clean up after massive Chinese hack of federal database]

It adds that while the total costs won’t be known until the second contract is issued, “OPM is currently working to approximate each agency’s portion of the total number of individuals impacted and we are gaining more information on the anticipated cost per person in the coming week based on requirements.”

 BLOGGER'S NOTE:  This is utter and complete BULLSH*T

Colon Cancer Deaths Tumble, But Not In These Hotspots

by Maggie Fox

Dr. Pedro Jose Greer, right, preparing to do a colonoscopy at Mercy Hospital in Miami. Greer has made a career of offering treatment without regard to patients' ability to pay. Lynne Sladky / AP

Colon cancer deaths are moving briskly down across the U.S. — with the exception of three large hotspots, researchers reported Wednesday.

A "perfect storm" of high obesity rates, low education and a lack of access to medical care make for frighteningly high colon cancer rates in the Mississippi delta, western Appalachia and the borderland between Virginia and North Carolina, the American Cancer Society finds. 

"In the Mississippi delta, rates among black men are not declining at all," said Rebecca Siegel of the

American Cancer Society, who led the study.
Colon cancer has become one of the most easily prevented cancers. Colonoscopy can spot and remove pre-cancerous growths before they become malignant, or find tumors early, when they are still easy to treat. Surgery can remove colon cancers, and there are several good chemotherapy drugs that can control it.

"It really is like a perfect storm."

And the 2010 Affordable Care Act means that health insurers must pay for colon cancer screening. But that only works if people actually have health insurance, and that's a challenge on some of these areas, Siegel said. 

"Particularly in the lower Mississippi delta and Appalachia, there are longstanding challenges, with high poverty, unemployment which coincides with less insurance coverage," she told NBC News.
A diet that's rich in fat, sugar and red meat and low in fiber doesn't help.

These three regions are 'hotspots' for colon cancer deaths, a new study finds. Graphic Courtesy of the American Cancer Society

"It really is like a perfect storm," Siegel said.

Politics may be interfering, too. The Affordable Care Act, widely known as Obamacare, helps subsidize health insurance for low-income people. But it also relies on states expanding Medicaid, the joint state-federal health insurance plan for the poor. "Only half of the 12 states that are involved in these high-risk areas have expanded Medicaid," Siegel said. 

That means many people whose incomes are too low to qualify for subsidized insurance are left with very few options for paying for health care.

Study: Changing diet may affect colon cancer risk 0:28

 

Colorectal cancer is the second leading cause of cancer deaths in the United States and the fourth worldwide. More than 132,000 new cases and 50,000 deaths from the disease are expected this year in the U.S. alone.

But rates have been heading steadily down, part of a larger trend for many common cancers. In 2011, more than 140,000 Americans got colon cancer. That's even though only about 60 percent of people advised to get screened do so now. 

Siegel and colleagues used software to calculate death rates from colorectal cancer on a county-by-county basis, comparing trends from 1970 to 2011. Deaths from colon cancer were 40 percent higher in the Mississippi delta than in average areas across the country in 2009-2011, according to their report in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research.

Ironically, in the early 1970s, colon cancer death rates in the Mississippi delta were 18 percent lower than the average death rates in the country. But they began to rise, by a steady 3.5 percent a year for black men between 1970 and 1990. They haven't moved since, even as rates fall in the rest of the country.

"Targeted interventions, like using people within the community to talk to their neighbors about screening, are likely to be effective."

"These areas are low-hanging fruit for colorectal cancer screening interventions," Siegel said.
"Although we've made great strides against colorectal cancer in a fairly short time period, there are a lot of vulnerable populations that aren't benefiting. Now that these groups have been identified, there is a moral obligation to do something about it," Siegel added. "Targeted interventions, like using people within the community to talk to their neighbors about screening, are likely to be effective."
Programs that target churches and other community organizations are often effective, experts say.

Why do people believe myths about the Confederacy? Because our textbooks and monuments are wrong.

The Confederate flag waves over the South Carolina statehouse. (Joe Raedle/Getty Images)

False history marginalizes African Americans and makes us all dumber.

 History is the polemics of the victor, William F. Buckley allegedly said. Not so in the United States, at least not regarding the Civil War. As soon as Confederates laid down their arms, some picked up their pens and began to distort what they had done, and why. Their resulting mythology went national a generation later and persists — which is why a presidential candidate can suggest that slavery was somehow pro-family, and the public believes that the war was mainly fought over states’ rights.

The Confederates won with the pen (and the noose) what they could not win on the battlefield: the cause of white supremacy and the dominant understanding of what the war was all about. We are still digging ourselves out from under the misinformation that they spread, which has manifested in both our history books and our public monuments.

Take Kentucky. Kentucky’s legislature voted not to secede, and early in the war, Confederate Gen. Albert Sidney Johnston ventured through the western part of the state and found “no enthusiasm as we imagined and hoped but hostility … in Kentucky.” Eventually, 90,000 Kentuckians would fight for the United States, while 35,000 fought for the Confederate States. Nevertheless, according to historian Thomas Clark, the state now has 72 Confederate monuments and only two Union ones.

Neo-Confederates also won western Maryland. In 1913, the United Daughters of the Confederacy (UDC) put a soldier on a pedestal at the Rockville courthouse. Montgomery County never seceded, of course. While Maryland did send 24,000 men to the Confederate armed forces, it sent 63,000 to the U.S. Army and Navy. Nevertheless, the UDC’s monument tells visitors to take the other side: “To our heroes of Montgomery Co. Maryland / That we through life may not forget to love the Thin Gray Line.”

In fact, the Thin Grey Line came through Montgomery and adjoining Frederick counties at least three times, en route to Antietam, Gettysburg and Washington. Lee’s army expected to find recruits and help with food, clothing and information. They didn’t. Maryland residents greeted Union soldiers as liberators when they came through on the way to Antietam. Recognizing the residents of Frederick as hostile, Confederate cavalry leader Jubal Early demanded and got $300,000 from them lest he burn their town, a sum equal to at least $5,000,000 today. Today, however, Frederick boasts what it calls the “Maryland Confederate Memorial,” and the manager of the Frederick cemetery — filled with Union and Confederate dead — told me in an interview, “Very little is done on the Union side” around Memorial Day. “It’s mostly Confederate.”


In addition to winning the battle for public monuments, neo-Confederates also managed to rename the war, calling it “the War Between the States.” Nevermind that while it was going on, no one called it that. Even “Jeopardy!” accepts it.

[Why people convince themselves that the Confederate flag represents freedom, not slavery]

Perhaps most perniciously, neo-Confederates now claim that the South seceded for states’ rights. When each state left the Union, its leaders made clear that they were seceding because they were for slavery and against states’ rights. In its “Declaration Of The Causes Which Impel The State Of Texas To Secede From The Federal Union,” for example, the secession convention of Texas listed the states that had offended them: Maine, Vermont, New Hampshire, Connecticut, Rhode Island, Massachusetts, New York, Pennsylvania, Ohio, Wisconsin, Michigan and Iowa. These states had in fact exercised states’ rights by passing laws that interfered with the federal government’s attempts to enforce the Fugitive Slave Act. Some also no longer let slaveowners “transit” through their states with their slaves. “States’ rights” were what Texas was seceding against. Texas also made clear what it was seceding for: white supremacy.

We hold as undeniable truths that the governments of the various States, and of the confederacy itself, were established exclusively by the white race, for themselves and their posterity; that the African race had no agency in their establishment; that they were rightfully held and regarded as an inferior and dependent race, and in that condition only could their existence in this country be rendered beneficial or tolerable.

Despite such statements, during and after the Nadir, neo-Confederates put up monuments that flatly lied about the Confederate cause. For example, South Carolina’s monument at Gettysburg, dedicated in 1965, claims to explain why the state seceded: “Abiding faith in the sacredness of states rights provided their creed here.” This tells us nothing about 1863, when abiding opposition to states’ rights as claimed by free states provided South Carolinians’ creed. In 1965, however, its leaders did support states’ rights. Indeed, they were desperately trying to keep the federal government from enforcing school desegregation and civil rights. The one constant was that the leaders of South Carolina in 1860 and 1965 were acting on behalf of white supremacy.

[The racist assumptions behind how we talk about shootings]

So thoroughly did this mythology take hold that our textbooks still stand history on its head and say secession was for, rather than against, states’ rights. Publishers mystify secession because they don’t want to offend Southern school districts and thereby lose sales. Consider this passage from “The American Journey,” the largest textbook ever foisted on middle-school students and perhaps the best-selling U.S. history textbook:

The South Secedes
Lincoln and the Republicans had promised not to disturb slavery where it already existed. Nevertheless, many people in the South mistrusted the party, fearing that the Republican government would not protect Southern rights and liberties. On December 20, 1860, the South’s long-standing threat to leave the Union became a reality when South Carolina held a special convention and voted to secede.

Teachers and students infer from that passage that slavery was not the reason for secession. Instead, the reason is completely vague: [white] Southerners feared for their “rights and liberties.” On the next page, however, “Journey” becomes more precise: [White] Southerners claimed that since “the national government” had been derelict “by refusing to enforce the Fugitive Slave Act and by denying the Southern states equal rights in the territories — the states were justified in leaving the Union.”

[Only white people can save themselves from racism.]

“Journey” offers no evidence to support this claim. It cannot. No Southern state made any such charge against the federal government in any secession document I have ever seen. Presidents Buchanan and before him, Pierce, were part of the pro-Southern wing of the Democratic Party. For 10 years, the federal government had vigorously enforced the Fugitive Slave Act. Buchanan had supported pro-slavery forces in Kansas even after his own minion, the Mississippi slave owner Robert Walker, ruled that they had won only by fraud. The seven states that seceded before February 1861 had no quarrel with “the national government.”
 
Teaching or implying that the Confederate states seceded for states’ rights is not accurate history. It is white, Confederate-apologist history. It bends — even breaks — the facts of what happened. Like other U.S. history textbooks, “Journey” needs to be de-Confederatized. So does the history test we give to immigrants who want to become U.S. citizens. Item 74 asks, “Name one problem that led to the Civil War.” It then gives three acceptable answers: “slavery, economic reasons, and states’ rights.” If by “economic reasons” it means issues about tariffs and taxes, which most people infer, then two of its three “correct answers” are wrong! No other question on this 100-item test has more than one “right” answer. The reason is not because the history is unclear, but because neo-Confederates still wielded considerable influence in our culture and our Congress until quite recently, when a mass of politicians rushed to declare the Confederate flag unsuitable for display on government grounds.

Now the dean of the National Cathedral in Washington, D.C., has noted that the cathedral needs to de-Confederatize its stained glass windows. That would be a start for D.C., which also needs to:

• remove its statue of Albert Pike, Confederate general and leader of the Arkansas Ku Klux Klan, from Judiciary Square. 
• The Pentagon also needs to de-Confederatize the Army. 
• No more Fort A.P. Hill. 
• No more Fort Bragg, named for a general who was not only Confederate but also incompetent. 
• No more Fort Benning, named for a general who, after he had helped get his home state of Georgia to secede, made the following argument to the Virginia legislature:

What was the reason that induced Georgia to take the step of secession? This reason may be summed up in one single proposition. It was a conviction … that a separation from the North was the only thing that could prevent the abolition of her slavery…. If things are allowed to go on as they are, it is certain that slavery is to be abolished. By the time the north shall have attained the power, the black race will be in a large majority, and then we will have black governors, black legislatures, black juries, black everything. … The consequence will be that our men will be all exterminated or expelled to wander as vagabonds over a hostile earth, and as for our women, their fate will be too horrible to contemplate even in fancy.

With our monuments lying about secession, our textbooks obfuscating what the Confederacy was about, and our army honoring its generals, no wonder so many Americans supported the Confederacy until last week. We can literally see the impact Confederate symbols and thinking had on Dylann Roof, but other examples abound. In his mugshot,

• Timothy McVeigh, who bombed the Murrah Building in Oklahoma City in 1995, wore a neo-Confederate T-shirt showing Abraham Lincoln and the words, “Sic semper tyrannis!” 
• When white students in Appleton, Wis., a recovering sundown town that for decades had been “all white” on purpose, had issues with Mexican American students in 1999, they responded by wearing and waving Confederate flags, which they already had at home, at the ready.  
• Across the country, removing slavery from its central role in prompting the Civil War marginalizes African Americans and makes us all stupid.

De-Confederatizing the United States won’t end white supremacy, but it will be a momentous step in that direction.