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Is Marijuana as Safe as We Think ? | The New Yorker
▻https://www.newyorker.com/magazine/2019/01/14/is-marijuana-as-safe-as-we-think

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A few years ago, the National Academy of Medicine convened a panel of sixteen leading medical experts to analyze the scientific literature on cannabis. The report they prepared, which came out in January of 2017, runs to four hundred and sixty-eight pages. It contains no bombshells or surprises, which perhaps explains why it went largely unnoticed. It simply stated, over and over again, that a drug North Americans have become enthusiastic about remains a mystery.

For example, smoking pot is widely supposed to diminish the nausea associated with chemotherapy. But, the panel pointed out, “there are no good-quality randomized trials investigating this option.” We have evidence for marijuana as a treatment for pain, but “very little is known about the efficacy, dose, routes of administration, or side effects of commonly used and commercially available cannabis products in the United States.” The caveats continue. Is it good for epilepsy? “Insufficient evidence.” Tourette’s syndrome? Limited evidence. A.L.S., Huntington’s, and Parkinson’s? Insufficient evidence. Irritable-bowel syndrome? Insufficient evidence. Dementia and glaucoma? Probably not. Anxiety? Maybe. Depression? Probably not.

Then come Chapters 5 through 13, the heart of the report, which concern marijuana’s potential risks. The haze of uncertainty continues. Does the use of cannabis increase the likelihood of fatal car accidents? Yes. By how much? Unclear. Does it affect motivation and cognition? Hard to say, but probably. Does it affect employment prospects? Probably. Will it impair academic achievement? Limited evidence. This goes on for pages.

We need proper studies, the panel concluded, on the health effects of cannabis on children and teen-agers and pregnant women and breast-feeding mothers and “older populations” and “heavy cannabis users”; in other words, on everyone except the college student who smokes a joint once a month. The panel also called for investigation into “the pharmacokinetic and pharmacodynamic properties of cannabis, modes of delivery, different concentrations, in various populations, including the dose-response relationships of cannabis and THC or other cannabinoids.”

Not surprisingly, the data we have are messy. Berenson, in his role as devil’s advocate, emphasizes the research that sees cannabis as opening the door to opioid use. For example, two studies of identical twins—in the Netherlands and in Australia—show that, in cases where one twin used cannabis before the age of seventeen and the other didn’t, the cannabis user was several times more likely to develop an addiction to opioids. Berenson also enlists a statistician at N.Y.U. to help him sort through state-level overdose data, and what he finds is not encouraging: “States where more people used cannabis tended to have more overdoses.”

The National Academy panel is more judicious. Its conclusion is that we simply don’t know enough, because there haven’t been any “systematic” studies. But the panel’s uncertainty is scarcely more reassuring than Berenson’s alarmism. Seventy-two thousand Americans died in 2017 of drug overdoses. Should you embark on a pro-cannabis crusade without knowing whether it will add to or subtract from that number?

Drug policy is always clearest at the fringes. Illegal opioids are at one end. They are dangerous. Manufacturers and distributors belong in prison, and users belong in drug-treatment programs. The cannabis industry would have us believe that its product, like coffee, belongs at the other end of the continuum. “Flow Kana partners with independent multi-generational farmers who cultivate under full sun, sustainably, and in small batches,” the promotional literature for one California cannabis brand reads. “Using only organic methods, these stewards of the land have spent their lives balancing a unique and harmonious relationship between the farm, the genetics and the terroir.” But cannabis is not coffee. It’s somewhere in the middle. The experience of most users is relatively benign and predictable; the experience of a few, at the margins, is not.

The National Academy panel is more judicious. Its conclusion is that we simply don’t know enough, because there haven’t been any “systematic” studies. But the panel’s uncertainty is scarcely more reassuring than Berenson’s alarmism. Seventy-two thousand Americans died in 2017 of drug overdoses. Should you embark on a pro-cannabis crusade without knowing whether it will add to or subtract from that number?

Drug policy is always clearest at the fringes. Illegal opioids are at one end. They are dangerous. Manufacturers and distributors belong in prison, and users belong in drug-treatment programs. The cannabis industry would have us believe that its product, like coffee, belongs at the other end of the continuum. “Flow Kana partners with independent multi-generational farmers who cultivate under full sun, sustainably, and in small batches,” the promotional literature for one California cannabis brand reads. “Using only organic methods, these stewards of the land have spent their lives balancing a unique and harmonious relationship between the farm, the genetics and the terroir.” But cannabis is not coffee. It’s somewhere in the middle. The experience of most users is relatively benign and predictable; the experience of a few, at the margins, is not.

Late last year, the commissioner of the Food and Drug Administration, Scott Gottlieb, announced a federal crackdown on e-cigarettes. He had seen the data on soaring use among teen-agers, and, he said, “it shocked my conscience.” He announced that the F.D.A. would ban many kinds of flavored e-cigarettes, which are especially popular with teens, and would restrict the retail outlets where e-cigarettes were available.

In the dozen years since e-cigarettes were introduced into the marketplace, they have attracted an enormous amount of attention. There are scores of studies and papers on the subject in the medical and legal literature, grappling with the questions raised by the new technology. Vaping is clearly popular among kids. Is it a gateway to traditional tobacco use? Some public-health experts worry that we’re grooming a younger generation for a lifetime of dangerous addiction. Yet other people see e-cigarettes as a much safer alternative for adult smokers looking to satisfy their nicotine addiction. That’s the British perspective. Last year, a Parliamentary committee recommended cutting taxes on e-cigarettes and allowing vaping in areas where it had previously been banned. Since e-cigarettes are as much as ninety-five per cent less harmful than regular cigarettes, the committee argued, why not promote them? Gottlieb said that he was splitting the difference between the two positions—giving adults “opportunities to transition to non-combustible products,” while upholding the F.D.A.’s “solemn mandate to make nicotine products less accessible and less appealing to children.” He was immediately criticized.

“Somehow, we have completely lost all sense of public-health perspective,” Michael Siegel, a public-health researcher at Boston University, wrote after the F.D.A. announcement:

#Santé_publique #Marijuana

The Philosopher Redefining Equality | The New Yorker
▻https://www.newyorker.com/magazine/2019/01/07/the-philosopher-redefining-equality

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At fifty-nine, Anderson is the chair of the University of Michigan’s department of philosophy and a champion of the view that equality and freedom are mutually dependent, enmeshed in changing conditions through time. Working at the intersection of moral and political philosophy, social science, and economics, she has become a leading theorist of democracy and social justice. She has built a case, elaborated across decades, that equality is the basis for a free society. Her work, drawing on real-world problems and information, has helped to redefine the way contemporary philosophy is done, leading what might be called the Michigan school of thought. Because she brings together ideas from both the left and the right to battle increasing inequality, Anderson may be the philosopher best suited to this awkward moment in American life. She builds a democratic frame for a society in which people come from different places and are predisposed to disagree.

As the students listened, she sketched out the entry-level idea that one basic way to expand equality is by expanding the range of valued fields within a society. Unlike a hardscrabble peasant community of yore in which the only skill that anyone cared about might be agricultural prowess, a society with many valued arenas lets individuals who are good at art or storytelling or sports or making people laugh receive a bit of love.

As a rule, it’s easy to complain about inequality, hard to settle on the type of equality we want. Do we want things to be equal where we start in life or where we land? When inequalities arise, what are the knobs that we adjust to get things back on track? Individually, people are unequal in countless ways, and together they join groups that resist blending. How do you build up a society that allows for such variety without, as in the greater-Detroit real-estate market, turning difference into a constraint? How do you move from a basic model of egalitarian variety, in which everybody gets a crack at being a star at something, to figuring out how to respond to a complex one, where people, with different allotments of talent and virtue, get unequal starts, and often meet with different constraints along the way?

In 1999, Anderson published an article in the journal Ethics, titled “What Is the Point of Equality?,” laying out the argument for which she is best known. “If much recent academic work defending equality had been secretly penned by conservatives,” she began, opening a grenade in the home trenches, “could the results be any more embarrassing for egalitarians?”

The problem, she proposed, was that contemporary egalitarian thinkers had grown fixated on distribution: moving resources from lucky-seeming people to unlucky-seeming people, as if trying to spread the luck around. This was a weird and nebulous endeavor. Is an heir who puts his assets into a house in a flood zone and loses it unlucky—or lucky and dumb? Or consider a woman who marries rich, has children, and stays at home to rear them (crucial work for which she gets no wages). If she leaves the marriage to escape domestic abuse and subsequently struggles to support her kids, is that bad luck or an accretion of bad choices? Egalitarians should agree about clear cases of blameless misfortune: the quadriplegic child, the cognitively impaired adult, the teen-ager born into poverty with junkie parents. But Anderson balked there, too. By categorizing people as lucky or unlucky, she argued, these egalitarians set up a moralizing hierarchy.

To be truly free, in Anderson’s assessment, members of a society had to be able to function as human beings (requiring food, shelter, medical care), to participate in production (education, fair-value pay, entrepreneurial opportunity), to execute their role as citizens (freedom to speak and to vote), and to move through civil society (parks, restaurants, workplaces, markets, and all the rest). Egalitarians should focus policy attention on areas where that order had broken down. Being homeless was an unfree condition by all counts; thus, it was incumbent on a free society to remedy that problem. A quadriplegic adult was blocked from civil society if buildings weren’t required to have ramps. Anderson’s democratic model shifted the remit of egalitarianism from the idea of equalizing wealth to the idea that people should be equally free, regardless of their differences. A society in which everyone had the same material benefits could still be unequal, in this crucial sense; democratic equality, being predicated on equal respect, wasn’t something you could simply tax into existence. “People, not nature, are responsible for turning the natural diversity of human beings into oppressive hierarchies,” Anderson wrote.

Her first book, “Value in Ethics and Economics,” appeared that year, announcing one of her major projects: reconciling value (an amorphous ascription of worth that is a keystone of ethics and economics) with pluralism (the fact that people seem to value things in different ways). Philosophers have often assumed that pluralistic value reflects human fuzziness—we’re loose, we’re confused, and we mix rational thought with sentimental responses. Anderson proposed that, actually, pluralism of value wasn’t the fuzz but the thing itself. She offered an “expressive” theory: in her view, each person’s values could be various because they were socially expressed, and thus shaped by the range of contexts and relationships at play in a life. Instead of positing value as a basic, abstract quality across society (the way “utility” functioned for economists), she saw value as something determined by the details of an individual’s history. Like her idea of relational equality, this model resisted the temptation to flatten human variety toward a unifying standard. In doing so, it helped expand the realm of free and reasoned economic choice.

Broadly, there’s a culturally right and a culturally left ideal theory for race and society. The rightist version calls for color blindness. Instead of making a fuss about skin and ethnicity, its advocates say, society should treat people as people, and let the best and the hardest working rise. The leftist theory envisions identity communities: for once, give black people (or women, or members of other historically oppressed groups) the resources and opportunities they need, including, if they want it, civil infrastructure for themselves. In “The Imperative of Integration,” published in 2010, Anderson tore apart both of these models. Sure, it might be nice to live in a color-blind society, she wrote, but that’s nothing like the one that exists. In one study she cited, sixty per cent of people who saw a crime report on TV that hadn’t identified the suspect thought that it had; seventy per cent of those people thought that the suspect was black. Other research found that when white people pretended not to notice race they often acquired alienating tics, such as avoiding eye contact. Color blindness would simply lock in problems past correction.

But the case for self-segregation was also weak. Affinity groups provided welcome comfort, yet that wasn’t the same as power or equality, Anderson pointed out. And there was a goose-and-gander problem. Either you let only certain groups self-segregate (certifying their subordinate status) or you also permitted, say, white men to do it, and—well, we have a lot of data from that experiment, and they’re not encouraging.

Anderson’s solution was “integration,” a concept that, especially in progressive circles, had been uncool since the late sixties. Integration, by her lights, meant mixing on the basis of equality. It was not assimilation. It required adjustments from all groups. Anderson laid out four integrative stages: formal desegregation (no legal separation), spatial integration (different people share neighborhoods), formal social integration (they work together, and are one another’s bosses), and informal social integration (they become buddies, get married, start families). Black students in integrated high schools, according to one study, had higher graduation rates than those in segregated schools, even controlling for socioeconomic background, parental education, and other factors. Students—black and white—at integrated schools went on to lead more integrated lives.

Many people still believed that market economies were a sound foundation of freedom. Yet, she found, ninety per cent of female restaurant workers reported being sexually harassed. Some poultry-industry employees were said to have worn diapers for lack of breaks. About seven million American workers had been compelled to support political positions under threat from their bosses. Such people could not be called free.

Anderson zeroed in on Adam Smith, whose “The Wealth of Nations,” published in 1776, is taken as a keystone of free-market ideology. At the time, English labor was subject to uncompensated apprenticeships, domestic servitude, and some measure of clerical dominion. Rigid hierarchies, from the king to the pauper, were maintained by an arcane system of debts, favors, and gifts. Smith saw the markets as an escape from that order. Their “most important” function, he explained, was to bring “liberty and security” to those “who had before lived almost in a continual state of war with their neighbours, and of servile dependency upon their superiors.”

Smith, in other words, was an egalitarian. He had written “The Wealth of Nations” in no small part to be a solution to what we’d now call structural inequality—the intractable, compounding privileges of an arbitrary hierarchy. It was a historical irony that, a century later, writers such as Marx pointed to the market as a structure of dominion over workers; in truth, Smith and Marx had shared a socioeconomic project. And yet Marx had not been wrong to trash Smith’s ideas, because, during the time between them, the world around Smith’s model had changed, and it was no longer a useful tool.

“You can see that, from about 1950 to 1970, the typical American’s wages kept up with productivity growth,” she said. Then, around 1974, she went on, hourly compensation stagnated. American wages have been effectively flat for the past few decades, with the gains of productivity increasingly going to shareholders and to salaries for big bosses.

What changed? Anderson rattled off a constellation of factors, from strengthened intellectual-property law to winnowed antitrust law. Financialization, deregulation. Plummeting taxes on capital alongside rising payroll taxes. Privatization, which exchanged modest public-sector salaries for C.E.O. paydays. She gazed into the audience and blinked. “So now we have to ask: What has been used to justify this rather dramatic shift of labor-share of income?” she said.

#Philosophie #Etats-Unis #Egalité