flwyd: (farts sign - Norway)
My employer-sponsored health plan has a "specialty pharmacy" insurance which is separate from the ordinary pharmacy benefits. Painkillers for surgery post-op, antibiotics when you're sick, prescription NSAIDs for chronic inflammatory disease, and all those other medicines that come in an orange plastic container are reliably dispensed by my local King Soopers pharmacy with what I would describe as a high level of competency. Other than "we haven't filled it yet, can you come back in an hour" I haven't had any problems acquiring or paying for any of these medications for fifteen years.

The "biologic" disease-modifying drug I take for psoriatic arthritis, on the other hand, is considered a "specialty medication" which means it's paid for by CVS Specialty Insurance, filled and delivered by CVS Specialty Pharmacy, and picked up at my local CVS Pharmacy. Despite all having the word "CVS" in the name, as far as I can tell they're three separate entities who are almost incapable of coordinating with each other.

Drug manufacturers have learned that they can charge a lot of money for biologics. But if they charge too much money, patients with a 10% copay will balk at the price, avoid filling the prescription, and the drug company will miss out on the other 90% that would've been paid by insurance. So they came up with a way to hack the U.S. health payment system: offer patients a "co-pay assistance" card, which is basically a persistent coupon lowering your out-of-pocket costs to almost nothing. Patients will then keep filling the prescription because it's basically free, leading to something of a principal–agent problem where the person making buying decisions has no incentive to consider the cost of the item. My employer ends up footing the bill, but I'm only annoyed with this situation in principle: in practice I get free drugs. (My employer benefits too, because I was not very productive when my symptoms were causing problems and I wasn't taking the drugs.)

In late January or so of this year, I received notification that starting April 1st, our CVS Specialty Insurance plan would no longer cover Humira—the name-brand adalimumab—and would instead be covering Hyrimoz, a cheaper generic adalimumab. This seemed like a bit of an unfair move, since employees can only change decisions about health care plans near the end of the year, but as a fan of generic medicines this seems like a sensible choice. However, although this change was announced in January so people could start worrying about it, we couldn't actually take any action like getting a doctor to change prescriptions for more than a month. Come mid-March I called CVS Specialty Pharmacy to fill my new Hyrimoz prescription, but was told that since CVS Specialty Insurance didn't cover it until April 1st I couldn't actually place an order until April (including "place an order in March for April delivery"). This was rather inconvenient, since I was leaving town for two weeks starting April 1st and didn't want to spent my road trip vacation arguing with pharmacy customer service people when things would eventually go awry. The customer service rep did inform me that I could set up the co-pay assistance card in advance, though. After several attempts to use the drug manufacturer's website that had some technical hot mess I can't recall, I finally got a PDF that had two sets of discount code numbers on it, one "for NDC starting with 61314" and one "for NDC starting with 83457." As a health insurance policy holder I still have no idea what NDC stands for, nor how I would figure out which of those two apply to me. I relayed this to the person at CVS Specialty Pharmacy who suggested she take down both sets of numbers and put them both in their system so they could figure it out once the prescription actually gets filled.

Come April I was able to order a 3-month supply of Hyrimoz, plus a bag of alcohol wipes and a sharps container. I was somewhat surprised that the medication was delivered without much issue, given my prior experience of organizational incompetence ordering Humira. When I tried to pick everything up, though, the retail CVS Pharmacy folks were getting some indication in their system that they shouldn't hand over the sharps container and alcohol swabs, so I walked away with a couple thousand dollars of medicine and not ten dollars worth of common medical supplies ¯\_(ツ)_/¯ (It only took a day or two for them to realize I could take a sharps container to dispose of the future medical waste they handed me the previous day.)

A few weeks later, someone from CVS Specialty Pharmacy billing department called and informed me that I still hadn't paid my copay for that order. I was surprised, since I'd given them all the information on the card which claimed my copay would be zero dollars. I think we discovered that there wasn't a card on file, so I gave both sets of numbers again and the rep said she would rebill. Problem solved? Hardly. I don't recall the exact timeline, but when I attempted to refill the prescription in the early summer I discovered it was on hold because the prior order hadn't been paid. So I called CVS Specialty Pharmacy; we went through the numbers again, and she determined that based on the diagnostic code from CVS Specialty Insurance the code for the wrong NDC was in their system and she didn't have the other code, so I re-provided all the digits. After some time on hold she confirmed the order had been rebilled.

So imagine my surprise this weekend when I was sorting through an accumulated pile of mail and discovered that the charge from April had been sent to collections. I called CVS Specialty Pharmacy this morning, and pointed out they had a discount card on file. The representative said they would rescind the bill from collections and rebill insurance. Will CVS manage to pay itself this time? Who knows! The two companies seem to share the same name but otherwise lack the ability to communicate effectively.

Payment aside, order fulfillment and delivery is also a comedy of errors. In early September I received a text message from CVS Specialty Pharmacy that said my prescription was ready to be refilled, but when I went to CVS Specialty Pharmacy's website it said I couldn't refill for another week and a half, and once that time passed I could only schedule delivery for another week and a half later. When I arrived at the retail CVS Pharmacy I was handed a large paper bag that was wet and soggy on the bottom. This contained a cold bag with three ice packs and a single box of medicine, 90 alcohol swabs, and three sharps containers. It's unclear to me whether the Specialty side (which distributes this temperature-controlled medication from a warehouse somewhere) or the retail side (which keeps medicine in the refrigerator until I pick it up) were the ones who decided to keep sharps containers and alcohol swabs should be kept refrigerated, but I'm quite glad I didn't pick this one up on a bicycle commute day because that bag was a wet mess. More importantly, I was rather miffed at CVS Specialty for taking my "Please send me three months worth of medicine, alcohol swabs, and a sharps container" into one month of medicine, a year's worth of sharps disposal, and three years worth of swabs. The order sheet says "2 ml" of Hyrimoz, and each box contains two 0.4 ml pens, so it would take two and a half boxes to match two milliliters of medicine; I only got 0.8. I attempted to call CVS Pharmacy retail about this problem, but every attempt to use their phone tree's "Leave a voicemail and we will call you back" feature resulted in the computer voice saying they were sorry. So I stopped by the pharmacy in person to tell them (1) file a ticket to get your phone system fixed and (2) you didn't give me my whole order. The pharmacist explained that they could view and dispense CVS Specialty Pharmacy orders but couldn't do anything else like investigate why it was wrong, so she gave me the phone number for Specialty. You guys are both CVS Pharmacies, why can't your computers talk to each other? Another call to the other CVS turned up the fact that two prescriptions, one for a one-month supply and one for a three-month supply, were both in the computer system, and the system automatically selected the first and billed insurance for it. She said she put a note on my record to do the three-month supply next time, and assured me that I would be able to place that order in October. I've a rather sneaking suspicion that they'll manage to fumble something again and I'll have to take another adventure through their customer support lines to convince their computer that I'm eligible for more drugs before December. (I discovered my previous order sheet this evening which says it was filled for 6 ml, which would be a 10 week supply rather than a 6 week supply. I guess I shouldn't be surprised that CVS Specialty can't even get arithmetic right.)

I wonder if it's occurred to the folks who run my company's benefit plan that I'm not doing anything productive for the company if I spend half a day getting derailed by systematic incompetency every few months.

Core Oh No Virus

Friday, May 13th, 2022 11:16 pm
flwyd: (intense aztec drummer DNC 2008)
The past couple months have felt like things were getting back to normal. In March(?) we got to have assigned desks again at work, which meant I could do things like stand on a stress mat, not bike with a laptop every day, leave a box of Altoids on my desk, and see what Chrome tabs I had open on March 11th, 2020. In early April I took a road trip, then met our Canadian coworker in person for a week of team bonding. I'd been reminded that Happy Thursday is a thing I used to do, and made it to three weeks in a row of colorful people riding colorful bikes around town. Eating food in restaurants feels normal. After a chilly spring season, I'm summer season captain for the office softball team, which has been playing pretty well.

On Sunday I climbed around on ladders and garage roofs to help a blind friend get his ham radio antenna re-attached after the big wind storms this winter. I then took my parents out for Mothers' Day dinner. After I got home from dinner I noticed a bit of a scratchy throat, so I took some vitamin C and went to bed at a reasonable hour. I'd been feeling more sore and tired than usual during the previous week, including discomfort lying in bed and being really tired when waking up. This feeling was reminiscent of my state a few years ago before I started taking Humira to tamp down my immune system, so I wondered if the drug wasn't working as well as it used to, or if I'd ended up with a weaker batch. I also reflected that I'd had lots of late nights sitting in a somewhat awkward chair being engrossed in the Internet, so self-induced posture problems were a possible cause.

On Monday I was extra sore and tired when I woke up at about 10:30, so I decided to work (and slack off a bit) at home, given the scratchy throat. I took a fancy Cue home COVID test in the afternoon, which was negative. I worked on some code on the back porch, and finally took the initiative to call the power company about an every-10-second beep that had been annoying for months. I used the last of the light to attempt to get the sprinkler system running again, but didn't have quite the right setup. My arms, particularly the right one, were still sore (I chalked it up to lots of computer mouse use) and my pelvis felt out of shape, but overall not terrible. I took a long bath; it took all my energy to get up and out of the water, but that's usually how I feel when I'm drained enough to need a hot bath. On Tuesday I woke up around 11 with a similar lack of satisfying sleep and lots of sore body parts, so I decided to take another light day from home, including taking part of the afternoon to get the sprinklers working right. Our softball team didn't have any subs available, and I felt good enough to pitch the whole game while wearing a mask. (The tricky bit was positioning my sunglasses so they wouldn't fog up from the mask, but still keep the setting sun at bay.) Wednesday was another day of waking up sore and tired. It took me several hours to get through a bowl of granola, but that sometimes happens if I end up pouring more in, or I hit a patch with a lot of finely-crushed bits. I did some more work-from-porch relaxing and decided that a walk might help me feel better, so I got dressed and headed over to a meeting where we were testing out technology and room arrangement for a hybrid meeting setup. I was wearing a cloth mask, the other participants were wearing N95s, and we were about 10 feet apart. Going in I'd felt pretty confident that I didn't have COVID (see: test from two days before), wasn't contagious (very little coughing), and was probably having an immune overreaction to something. I started questioning the decision during the meeting, though, as I started having some very shallow coughs and was feeling a mild fever. Later on Wednesday night I felt extra drained, requiring a significant fraction of my spoons to empty and load the dishwasher, which I hadn't mustered the energy for in several evenings.

Thursday was the worst day. The week of ache had compounded, I was frustrated that lying in bed hurt and therefore wasn't restful, and I was exhausted. This was clearly not a "short overreaction to a minor virus" experience. I still didn't have much appetite, was coughing more (still shallow), and had approximately no energy. Kelly thought she saw some concerning signs in my mouth, and encouraged me to see a doctor. In 2022 if you feel sick you're not supposed to go physically to the doctor, so I had a telehealth adventure: sticking my tongue out close to the webcam, trying to shine a small ring light on just the right tongue spot, using a butter knife to sample mucus, and grabbing a home thermometer for a quick test. No stethoscope was simulated, and I didn't record my own height and weight to completely virtualize an office visit, though. The doctor hypothesized a bunch of possible illnesses from flu to COVID to strep throat. They had me do a drive-through test at the hospital. COVID testing has progressed to the point that there's now a combined respiratory test where a single nasal swab will produce test results for COVID, influenza, bronchitis, and about a dozen other respiratory illnesses. The strep test gets swabbed in a different hole, but also gets cultured for a whole raft of possibilities.

Late in the evening my email told me to check my medical portal, where I learned I'd tested positive for coronavirus. D'oh. I quickly emailed the folks I'd met with on Wednesday with profuse apologies and warnings. I emailed next week's planned house guests and recommended that they seek other accommodation. I texted my radio friend a warning. I called my parents. I emailed my softball team and texted the other team's captain. I emailed the coworkers who sit near me. I filled out a "Report Covid" form at work which had a bunch of questions like "What are your symptoms" and "Have you been in close contact with someone who has tested positive" which should be unnecessary if I could start the form with "I tested positive for COVID, tell anyone who badged in to my floor about it." Wow is it a lot of work to do your own contract tracing, it's a good thing I didn't have the "can barely get out of bed" flavor of COVID.

While pursuing responsible disclosure, I opened the Colorado Exposure Notifications app on my phone to figure out how to report a positive test there. I was greeted with a big button asking me if I wanted to enable exposure notifications, and that doing so would require Bluetooth. "Um, yes, please, what in the world have you been doing this whole time?" was roughly my reaction. I'm pretty sure I installed this app in 2020, turned it on, and assumed it would quietly do its thing. I took not having received an exposure notification so far as a sign that my mostly-isolated life over the last two years had meant no close contacts with anyone who tested positive. I hadn't considered the alternative theory that the app had quietly turned itself off (maybe when the phone was in Airplane mode, or after an OS upgrade?) who knows how long ago. I don't recall seeing any "Exposure notifications are turned off" system notifications. This felt like a smoke alarm which doesn't beep when the batteries run low. YOU HAD ONE JOB! I also did another Cue home test, which came back positive. It's encouraging that it detects it (the virus hasn't evolved to evade detection), and an important data point that it might take a couple days of feeling lousy before the test is accurate.

On Friday I woke up to a call from a medical assistant at my doctor's office who said the doctor could send a prescription for Paxlovid, an antiviral medication for COVID. (I haven't been closely following the coronavirus news for awhile, so I was unaware that such a treatment was now available.) They said they could send it to CVS Pharmacy inside Target, an establishment I'm familiar because, for reasons of opaque employer insurance pricing, is where I get my "specialty" medication, even though all the rest of my prescriptions go through the pharmacy at my local King Soopers. I've speculated that this arrangement might be because it was such a pain in the ass to get the prescription set up with CVS Speciality that maybe someone saves money from people giving up and not ordering their specialty drugs. I called their phone system in the early afternoon, giving "Prescription status" to the automated voice system. It asked me for the prescription number which of course I didn't have because I am calling to find out whether you received the prescription. When I convinced the AI that I didn't know the prescription number, it attempted to transfer me to the pharmacy, which was closed for lunch. After lunch I called back twice; the first time "Prescription status" got interpreted as "Covid masks" and without asking for confirmation started to explain that the store sold those. I hung up and tried again, this time "Check prescription status" somehow became "Covid vaccinations" and it transferred me to a recording about how to schedule a vaccination. I called my doctor's office instead, which at least has a recording of a human reading numbers you can press. I reached someone who said they only saw the King Soopers entry in my records as a pharmacy. I explained that I didn't care what pharmacy filled this prescription, I just wanted to know if it had been sent and where it had gone. They called me back shortly and said it was sent to CVS. I called CVS back and hoped that pressing 0 would put me in the queue for talking to a human being physically present in the same place as my drugs. After 15 minutes on the same automated message cycle, including a point when the recording drops out for a few seconds, giving you false hope that someone's actually answering the phone, I asked if any of my teammates were at work this afternoon and could they do me a favor. I armed my manager with my date of birth and got him to walk next door to the pharmacy in Target and check if they'd received the prescription. After a couple minutes of confusion they realized that for a freshly-received prescription they needed to check a different computer system, where it had in fact been received. My manager told me it would be filled in about 25 minutes. I was still in hold message limbo, 50 minutes after starting the call. Not sure what I would've done if I didn't have allies within walking distance of the pharmacy. The "You're not allowed to pick up your medication yourself" challenge builds on the "When you're sick you shouldn't go to the doctor's office" wrinkle from the 2020s expansion pack.

Ironically, after spending all afternoon trying to make sure I could get my hands on Paxlovid before the pharmacy closed and the "Start taking within 5 days of symptoms" window expired I was actually feeling fairly good, way better than Thursday when I'd made the doctor's appointment. (Hail to the vaccines that gave my immune system practice last year.) Another coworker dropped off the medication, my dad brought over a grocery delivery of coconut water, soup, ginger beer, orange juice, and grapefruit (you can tell we're in a mindset). I'm celebrating the fact that I haven't lost any sense of taste by eating kim chi and chocolate fudge brownie ice cream. Kelly and I live in a house where we can easily avoid direct contact, each getting a bedroom, living room, and bathroom to ourselves. All in all, things could be a lot worse.

Inflammation Update

Thursday, May 19th, 2016 12:40 am
flwyd: (intense aztec drummer DNC 2008)
As previously mentioned, I started the year with an autoimmune attack on my eye. This occurred after a month of over-extension: after a long day at work, I'd come home and spend a bunch of energy planning a trip to Australia and New Zealand, then not get a lot of sleep before doing it all again. The first sign of autoimmune inflammation, though I didn't realize it at the time, was soreness in the arch of my right foot. I chalked it up to old orthotics and added new boot inserts to the trip shopping list. I'd also been using a standing desk at work for two months in an attempt to reduce sitting-induced back pain and see if reduced slouching helped my esophagus's acid problem.

My eye recovered fully and my vision is back to 20/15; the only sign of the attack is a small "battle scar" blip on the iris. The only autoimmune blood test that came back positive was HLA-B27. This wasn't too surprising, since it's linked to ankylosing spondylitis, a condition which led to my uncle's fused spine. This antigen marker led to a referral from the eye surgeon to a rheumatologist.

After getting help from my parents to figure out all the causes of death in my family history, the first rheumatology appointment resulted in a diagnosis of psoriatic arthritis (a relative of ankylosing spondylitis), a prescription for meloxicam as needed, an NSAID (similar family ibuprofen, but with longer duration and more powerful per milligram), and instruction to get x-rays of my spine and pelvis. The x-rays showed signs of calcification of my spine and SI joint, so I had another rheumatologist appointment to talk about chronic disease management and treatment options. Basically, my immune system works too well, so it attacks various parts of my body like joints, skin around my scalp, and occasionally my eye. Biologics are the big-gun drugs for autoimmune diseases, which are expensive and increase the likelihood of serious infection. They sound pretty scary, so I decided to focus on "diet and lifestyle" and NSAIDs for a while to see how far I can get with adjusting my environment and routine.

So yeah, that was January. I averaged a health-care office visit every other day, but by the end of the month I wasn't feeling too bad. In February we spent two weeks in Maui, where I was able to do low-impact activities like snorkeling, scuba diving, hiking, mini golfing, and hanging out on the beach. Eating was still a bit of a challenge: the acid reflux and esophageal challenges in swallowing that were my main health problem in 2015 persisted, so there were a lot of rather slow meals. Then, half way through the trip and the day after a hike on the wet side of the island, I started to feel a bit sick, maybe a mild viral or bacterial infection. That night I had a crazy intense acid reflux experience, preventing me from sleeping all night. Around 3:30 I took a famotidine (Pepcid) pill that I'd been prescribed but hadn't really used. Two and a half hours later, we got on the ferry to Moloka'i. With only a few thousand residents, no stoplights, and a laid-back culture, Moloka'i is a great place to feel crappy. I started feeling better, and acid issues started to fade. Remarkably, I've had hardly any acid reflux in the three months since returning, though I've still got some swallowing challenges.

My mom gave me a copy of The Anti-Inflammation Zone by Barry Sears, the creator of the Zone diet. The book explained, to a moderate degree of satisfaction, how pro- and anti-inflammatory responses work (arachidonic acid versus eicosanoids and other long Latin names). Sears's primary recommendations, repeated over and over, are the Zone diet and high-dose, high-purity fish oil for EPA and DHA. I found his discussions of the diet kind of annoying, particularly since his extensive biography wasn't footnoted from the text, so I couldn't tell what was part of the diet plan because of sound science and what was present arbitrarily. The fish oil recommendation, on the other hand, seems to have solid science behind it. I've been taking fish oil for a couple months, currently around 2 teaspoons per day (~3 grams of ω-3 fats), and eating salmon and herring whenever I get the chance. The EPA doesn't seem to have done much for my foot/ankle/SI joint inflammation, but my psoriasis symptoms seem to have improved, perhaps from the DHA. During the winter I was drinking a lot of homemade chai, with the goal of increased intake of the anti-inflammatory ginger and turmeric. I even brewed a tamarind turmeric galangal brown ale. Keeping a crock pot of warm chai has been less appealing as the weather has gotten warmer.

I've been back and forth on the meloxicam. The side effects so far haven't been too bad&endash;mostly mild dehydration from my kidneys working hard–but stomach issues and intestinal bleeding are possible. When I take it for several days, my ankle/foot pain is a lot less, and I think it may help my esophageal troubles. After taking it all last week and experiencing very few choking incidents, I stopped taking it over the weekend. The last two days have featured moderately increased foot pain and some distressingly intense swallowing problems (leading to unpleasant regurgitation), so I'm taking the drug again in the hope that my eating challenge can be addressed by reducing inflammation.

Emotionally and intellectually, I've been adjusting to a lifestyle focused on eliminating stress, reducing voluntary commitments, and enhancing physical health. My natural tendency is to overcommit and prioritize tasks over sleep, exercise, and hygiene. That's a good recipe for accumulating inflammation, so I'm learning to say "no" and prioritize my own health over being helpful all the time. I've also been riding my bike (yay springtime!) and more regular about stretching on the floor and not sitting still for hours, though I've been in basically the same position in my hammock for the last two and a half hours of blogging. The nice thing about chronic illness is that if I don't do things right today, I can get back on target tomorrow.
flwyd: (intense aztec drummer DNC 2008)
This TED talk by Rodrigo Canales draws parallels between prominent Mexican drug cartels and more ordinary businesses. Brand, markets, and social involvement all play a key role. Canales describes Los Zetas as a franchise business for ex-military members and local gangs. They're credited with many of the most gruesome killings in the drug war, and part of that is their brand. There are parallels here with Al Qaeda, which is also a franchise organization with an interest in tooting their own horn about how destructive they are.

Los Caballeros Templarios Guardia Michoacana (Knights Templar Cartel, successor to La Familia Michoacana) control some very important transit territory. They operate on a very local basis with social programs, and are loved by many in the communities. They portray many of their killings as community defense (petty criminals, local drug dealers, outside organized crime) and have played a significant role in local politics. This sounds to me a lot like Hezbollah, which operates schools, hospitals, and other social capital-building enterprises along side their long-running battles with Israel and arab governments. Other paramilitary organizations have had similar success with social programs and local support including the IRA and loyalists in Ireland and the Basque ETA. It's very hard to destroy an organization like this; they have the benefits of guerrilla warriors plus the financial resources of a major corporation.

The Sinaloa Federation operates a lot like a multinational corporation, including an executive on the Forbes billionaires list. They innovate in product delivery technology, they have executives (aka family members) supervise new ventures, they outsource tasks that would damage their brand, and so forth. In addition to parallels with legal corporations like oil companies I think they also bear a striking resemblance to historic organized crime groups like the Mafia and Yakuza. The salient feature is the organized part moreso than the crime. The latter is only present because the business's products happen to be illegal.

I think it's helpful to think of these groups as companies with violence as one of their business methods rather than a grand version of random street violence. It also suggests that tourist fears about travel in Mexico may be unnecessarily elevated: would killing you further the business interests of the cartels?

A TED blog post about this video links to a few others on similar topics, including a suggestion that the best way to fight these organizations is to devalue their brands.

One interesting twist in the Mexican drug war is that the Americans are funding both sides. The cartels make most of their money by selling drugs to the U.S. distribution network, not to mention side businesses like smuggling migrants for the labor market. Meanwhile, the U.S. government subsidizes the Mexican government's anti-cartel activities, with gun manufacturers from the States profiting from sales to both sides. Not to mention the money spent on border enforcement and anti-drug efforts north of the border, a chunk of which also goes to American arms dealers.
flwyd: (requiem for a dream eye)
With the exception of alcohol, I'm a pretty anti-drug kind of guy. Not that I think other people should be prevented from using drugs, I just prefer to have an unaltered experience.

So sometimes it takes me a while to remember that when I'm sick and have a nasty headache, ibuprofen can allow me to function much better.
flwyd: (requiem for a dream eye)
At the P-Funk concert last night, three people asked if I'd "Seen Molly." Since I'd already bumped into a friend of my brother's I didn't recognize, I had to stare at the first girl who asked and think "Do I recognize this person? Why would she be asking about my friend without introducing herself?" I answered "Not here" to see if she would ask a follow-up question.

In case you're keeping track, more people asked me for drugs at George Clinton & Funkadelic than at The Chemical Brothers. I don't remember anyone asking me for drugs at Michael Franti & Spearhead or Kraftwerk (all shows at the Fillmore). I don't think anyone's ever asked me for drugs at the Boulder Theater or the Fox Theater. P-Funk is also the only show I've seen where somebody (two, in fact) tossed a joint to someone on stage who then lit up. Caveat: I've never been to Reggae on the Rocks. And in a reversal of stereotypical roles, a black guy with corn rows secretly reached over and touched my hat. Oh, and Maggot Brain is totally awesome.

One of my favorite Onion articles ever was Clinton to Parliament: It's Time To Drop DA BOMB On Iraq.
flwyd: (Om Chomsky)
Americans who posture about immigrants and drugs crossing from Mexico into the U.S. ought to consider what moves in the other direction. It's easy to get drugs in Mexico. It's easy to get guns in the U.S. Drug smugglers want guns to protect them from law enforcement. Guess what they can trade?

Incidentally, it's not just a North American Secret Trade Agreement issue. It's easy for soldiers to score heroin in Afghanistan. Soldiers have some even more impressive technology to trade for drugs. I wonder how many steps it takes for the Taliban to get their hands on American military toys.

Drugs, guns, and gems form the tripod upon which international crime stands. They can be mutually exchanged without tax or easy tracing, easily concealed and transported, and are highly desired by the those who use them.

Dealing with the problems of weapon, drug, and diamond smuggling is not easy. I suspect that legalizing drug use and possession would take a lot of power away from the criminals: nobody packs heat and smuggles fruit into the U.S. because it can be legally imported or grown locally. The expenses of growing marijuana in California, shipping it to Missouri, and paying sales tax at a strip mall probably are probably lower than the cost of growing marijuana in Guatemala, shipping it to the border, bribing officials, smuggling it through the desert, and letting every dealer it passes through take a cut. Legal drugs may be safer and healthier.

Demand-side changes could also affect the profitability of diamonds, and therefore their usefulness to international criminals and African warlords. If diamond consumers chose man-made diamonds on the grounds of price, social responsibility, and environmental impact, the (cartel-driven) artificially high price of diamonds would drop, making them far less lucrative as a black market currency. As a side effect, it might make your computer faster, too.

But I don't think a purist market approach is a complete solution. Guns are readily available in the U.S., but they still cause problems where they're legal and illegal. Just as the mob moved in on legal gambling in Nevada, I don't expect well-armed, well-paid drug smugglers to take undercutting lightly. And sudden legalization of drugs, especially easily overdosed ones like heroin and cocaine, without a simultaneous public health and education outreach could easily kill more folks than smuggler/DEA conflagrations and drug dealer turf wars.

Undercutting the diamond trade isn't so simple either. A significant portion of the value of a diamond is its price. People buy diamonds to show that they can afford to buy diamonds. If everyone could afford to buy diamonds, rich people would buy something else hard to find. And if it's hard to find, criminals are probably willing to kill for it.

Lethal Injunction

Wednesday, April 26th, 2006 11:50 am
flwyd: (requiem for a dream eye)
I heard on NPR today that the Supreme Court is hearing a case related to an appeal that the drug cocktail used in lethal injection is Cruel and Inhuman Punishment.

Perhaps they should change the substance to an extra large dose of pure heroin. The executees could then enjoy at least the end of their life, the justice system could unload some confiscated contraband, and for convicts involved in drug-related murder the punishment would suit the crime.
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