Ep 337 - The Overdose Economy with Charles LeBaron

Steve Grumbine: 00:00:01

: All right, folks, this is Steve with Macro N Cheese. Today we're gonna go down a path.We're gonna go down an interesting path, a path of addiction, a path of official narratives and responses to crises involving the opioid epidemic. And this is particularly near and dear to my heart. Some of you all know that I am a recovering alcoholic. My sobriety date is September 15, 2006.You ever want to hear the deep dive on that story, check out Finding My Why. It was an episode about a year ago. Definitely. If you're interested in learning a little bit about me, be able to learn a whole lot about me. I was an open book in that.But part of my story goes beyond alcohol, and it involves my numerous addictions over the years, from cocaine to opioids, quite frankly. And I grew up in the 80s, and this is a big deal. A lot of us did this stuff, went to concerts and stuff like this. You can imagine that kind of world.But flash forward and things have changed, right? Opioids are prescription medication. And we go to our doctors, who we trust, and they prescribe these medications to us.And lo and behold, they make the pain go away and they make us feel better than we did before we took them. And then it's really, really hard to push them away, isn't it?It's really, really hard to make a decision to be in pain or to make a decision to not feel good when you don't feel great. And my story is not dissimilar to that. You know, my mother would get opioids. She would get oxycodone. She'd get Vicodin, she'd get a million of these.She'd just leave them up on her dresser.And I would saunter by and take 5 to 10 before I went into my day job, my office job, and my nose would be bright red and I'd be itching all over the place and horrible constipation, you name it. But it was a terrible, terrible, love/hate relationship with opioids. There were many times where I wondered if I was going to die.Crush them up, I'd snort them, all kinds of stuff. And when I finally did get sober, it was quite an experience, man, I had a lot to purge from my body. I had a lot, a lot to purge from my mind.I was not part of this designer drug era. And you watch as the news is filled, filled with people trying to stop the fentanyl crisis and blocking the border to stop the fentanyl crisis.But then you have the official narratives that come from places like the Center for Disease Control, CDC. And that right there is going to be largely the topic of this conversation.Kind of understanding the business, understanding whose interests, and understanding the official narratives and how these things come to be.And also how various political elements seize upon these very, very sad moments, quite frankly, these moments that are, let's just be fair, bad, okay? And then they try to throw the baby out with the bathwater.Like what we're seeing right now with the Trump administration and their attacks on the CDC. Obviously, we saw the mismatched messaging during the COVID crisis that led so many to doubt the official narratives. And with good reason.We have been led to believe certain things are healthy, certain things are good, certain things are not good. And you wonder whose interests, whose class interests are being served.And my guest today, he wrote the book, folks, it's called Greed to Do Good: The Untold Story of CDC's Disastrous War on Opioids. It's just an incredible expose into this kind of world.And to be fair, my guest, Charles LeBaron, MD, who's a retired CDC scientist who openly criticized the institution's handling of the opioid crisis, is leading the charge to defend the CDC against Trump's tax on it.And I know that there are many of you out there who doubt the official narratives of who, because you wonder who is forcing the hand, kind of like climate scientists. Where are these oil executives getting their ability to influence policy, to influence institutions, to influence whatever?Well, the same goes with the Big Pharma industry, and the same goes with the rotating door of big finances.You see people leave JP Morgan and come suddenly into the executive branch and become appointees, and then when the administration's gone, they go back to industry [through] the revolving door. We see that in all these things.So it's easy to develop a cynical view, especially in light of Princeton studies that show that we don't really live in a democracy in this country anymore. We live in an oligarchy. And the working-class people, the people without means, are neglected and ignored. And how do you deal with these things?How do you make sense of a world where we're not fit to make decisions, where we don't have enough information to make decisions.And when we do make decisions, there's always somebody there with a waggy finger, the puritanical waggy finger, telling you,"You should have made better choices," right? But you followed your doctor's instructions.You followed the official narrative of the CDC, and lo and behold, we have black markets, and lo and behold, we've got crises. And that is what my guest, Charles LeBaron, is going to discuss with me today. So with that, Charles, welcome to the show, sir.

Charles LeBaron: 00:06:11

: Steve, thanks. Very enlightening introduction as well. I'm not sure I can bring more enlightenment than you have already, but I'll see what I can do.

Steve Grumbine: 00:06:20

: I'm positive you can. In fact, the interest that I found in your book is quite amazing because literally, you're taking a very, very adult approach with this thing.It's like, "Hey, look, they got the CDC messaging wrong." And I hope we can go into the details of how they got it wrong, and the modus operandi, et cetera, that led to these things.But to be fair, you also approach it like, "Hey, we need the CDC. The CDC does really important things, even if they got it wrong over here."And the balance at which you approach this is in stark contrast to the way the Trump administration and guys like RFK Jr. and others approach these things. A lot of pseudoscience. A lot of reactionary decisions.But to be fair, there is an awful lot of misinformation out there that people are just not equipped to push back on. So how would they know what truth is? I think a lot of us feel like we're living in a Truman Show and we're kind of led by the nose. "Oh, it is good. No, it's bad. Oh, it's good. No, no, it's bad." Help me understand the opioid crisis as you know it through your lens, through your experience.

Charles LeBaron: 00:07:34

: Well, apropos of what you're saying, Steve, the thing that I found difficult to explain, even though it seems just crystal clear to me, is that in this book, which I call the Disastrous CDC War on Opioids, now I'm defending CDC, and people say, "Well, how could you do that? How could you attack CDC about one issue and then defend it in regard to others?"And I would say that the closest thing I can come to is Mark Twain defined a patriot as someone who supports his country all of the time and his government some of the time. And in my view, I should support public health all of the time.But the strategies that are taken in public health should not be reflexively supported all of the time. They should be examined critically.In my view, to say that CDC should be disassembled now is equivalent to saying we should be unilaterally disarming in the face of serious threats to our health. And that's basically the threat that's going on right now. And it's a serious threat. In the past, did CDC handle everything right?No, absolutely it didn't. And it needed to be helped with criticism. Now it needs to be helped to survive. I see those two activities as being really identical in many ways.

Steve Grumbine: 00:08:59

: I think you're spot on there. I do wonder.We understand, at least we're beginning to understand the depths of the lack of real agency working-class people have within this government.And really, quite frankly, you can look around the world and you can see largely the developed capitalist nations have very oligarch-driven societies and oligarch-driven governments and just a veneer of democracy. And so when you think about whose interests are being served, frequently you got to follow the money. Who's funding this research?Whose interests are being served here? And with the CDC, there was so much against it during the pandemic based on who was getting financed, who had something to gain.How did you come up with the answer so quickly? Why didn't we see the kind of outcomes that we thought we would? And now all of a sudden, "This pandemic is eradicated. It doesn't exist.Nobody's talking about it. It's gone." So you have to ask yourself, it may not be the scientists that are driving the narrative. It might be politics.And the politicians don't really necessarily care what the science says. They are serving a different master.They're serving who is financing their campaign or financing their pet projects or maybe even financing them with promises for post-political life. But when you think about it, we have an opioid crisis in this country.And the way that this all started, I mean, I think everybody was getting oxycodone for "Hey, I got a pulled tooth. "Here's some oxycodone." "Hey, I sprained my ankle." "Here's some oxycodone. Here's some Vicodin. Here's whatever." And then they flipped. They flipped it completely.And it was like, "You know, we're going to give you the minimal. We're going to make you sign over your children's lives. We're going to put 4,000 layers of buffer to make sure that it's really, really hard to get."And then that approach, which of course is the approach they've taken with just about everything, marijuana, you name it, creates black markets.And black markets are where we really start getting the hardcore negative externalities that impact people's lives more and more. So, I mean, you see Trump, "Fighting the fentanyl epidemic" by blocking the border and so forth.And in reality, a lot of this stems right out of the CDC's handling and guidelines and so forth and how the industry took on prescribing these medications. Can you take us through that a little bit? Your book covers it quite extensively.

Charles LeBaron: 00:11:34

: Well, I'll give you what I would conceive of as the 45-second history of opioids in the United States. And since you've lived it, you can bring a real-life critique to the very digested history.In the 1990s, they developed a sense, you might call an ethic in medicine, which had a good motivation. A lot of this is the story of good motivations, good intentions getting hijacked in some ways, along the lines, exactly what you're saying.But let's just confine ourselves to the facts for a while and then examine the motivations.The notion developed that pain was undertreated, which had an element of truth to it, that there wasn't enough attention to making sure that people weren't in pain.And they developed pain scales, which you go into your doctor's office and this still exists, and there'd be this big thermometer which would say, "What's your level of pain?"And the notion behind it was that if pain is undertreated, we should make sure that people walking into our clinics at least have that element addressed. And it was a merciful view of matters, but in fact, it took medicine in the wrong direction. Because the objective of medicine- this is going to sound cruel- is notto fix pain. It's to fix the cause of the pain and then thereby have the pain go away. You only treat the pain alone when you're either unable to address the cause or the cause is something that is not fixable in itself.The result of that was that there was an increased willingness to prescribe opioids.Amazingly enough, the folks who make opioids were very pleased with this whole ethic of let's reduce pain to zero and saw enormous profits to be made. And it's famous. Sackler's, Purdue and OxyContin, they're famous for that. So there's no need to dwell too much on that.So enormous profits were made off a whole variety of, in a sense, you might call designer opioids.And more and more and more opioids were prescribed to the point where in the United States, if you compare it to Europe with the same operation in Europe, 5% of people would get opioids afterwards. In the United States, 80% of people would get opioids. And I don't think the Europeans are that much tougher.They're probably a little bit tougher than we are, but not that much tougher.And what made it even sort of ironic is that for after certain operations which are associated with pain, even if the patient reported no pain, they were given opioids, 80% of them, same percent.So there's massive over prescription of opioids to the point where if you looked at prescription opioids, US with 5% of the world's population was getting 80% of the prescription opioids. So in a sense this was both a well-meaning and a profit-driven enterprise.The trouble is that opioids are not free of adverse effects and among the adverse effects is death. That's a relatively severe adverse effect.And death by overdose grew and grew and grew exactly in parallel to the number of prescriptions for opioids that were handed out went in parallel.Whereupon. CDC in around early part of the 2010's started looking at the situation and said, "This is a growing epidemic" and decide, "Well, we should do something about it. We're the epidemic guys."And 2016 they issued guidelines for prescription opioids and the guidelines were very restrictive in terms of who should get it, how much people should get and how long they should get. Those are in fact the major risk factors for continued opioid use. Addiction.So they're going after the major risk factors for subsequent addiction from prescription opioids that had the plausibility of attacking the problem that seemed to exist, number one. So plausibility is always a good thing to have.Number two, it had the extraordinarily attractive feature that required no zero, no investment whatsoever, no extra taxes, no extra appropriation, no nothing.And in fact nothing was essentially almost nothing was put in the recommendations about treatment of people who are already dependent on the opioids or handing out opportunities to get antidotes for those who get the adverse effects from it.The effect of this is again, good intentions was to take a large opioid dependent population and deprive them of access to safely manufactured FDA approved opioids.And amazingly enough, a group of entrepreneurs, as it turns out, south of the border, who now go by the name of Sinaloa and other cartels, said, "hey, you know, we've been sort of limited in our market share to heroin addicts. We see an opportunity here." And so they basically flooded the market with fentanyl.And sure enough, this large opioid dependent population had been basically made dependent by both original good intentions and then by profit motive. And there was this new profit motive coming out of the cartels that flooded the country.The difficulty with illegal opioids, illicit opioids, opioids that aren't made under scrupulous big pharma conditions, is the cartels aren't quite as scrupulous about how much opioid they put in their various cocktails. And fentanyl, the most potent at that time on the market. All you have to do is add something microscopic extra quantity and peel a die.And sure enough, the effect of the well meaning and plausible CDC recommendations was an explosion of overdose deaths. It doubled in the two years after CDC implemented its recommendations. And in a sense this book is a story of that.How that happened and how it didn't get undone either, which in some ways is more important because CDC has a view of itself as being, quite correctly, needing to be tenacious about going after health issues. I think that's a good quality. But many good qualities, if they're taken to extreme, becomes bad qualities.And Winston Churchill had a saying which I think is correct. He said, "No matter how beautiful the strategy, one should occasionally consult the results."If you implement a strategy to reduce overdose deaths and they double after you've implemented them, it's time to reconsider the strategy.But it took actually CDC more than five years to reconsider the strategy, during which time overdoses increased more and more to the point where 100,000 deaths a year. And in the time period up until 2020, a million people had died.But at the accelerated rate, by 2020, more than a million people were gone die every decade. That put it really almost in the holocaust level of death. And it didn't seem to be getting better at all.And finally, CDC in 2022 backed off on these draconian recommendations.Now, I know you're profit oriented on this show, so the question is why would there be a profit motive about draconian reductions? Well, obvious profit move by the cartels. But I don't think CDC is motivated by cartel profits.However indirectly there is a profit motive because insurance companies and others just were in love with the restrictive CDC recommendations and to pay for opioids anymore.So we ended up in the paradoxical situation, which continues now, in which we have right now about 80,000 deaths a year from opioids which means we'll have a million about every 12 years of death. At the same time that people who are in legitimate pain have great difficulty getting hold of opioids.And to a great extent this is a problem with a pure supply side orientation. What you need to do to address an opioid problem is not just cut back on the supply, but you have to address the demand.If people are opioid dependent, you have to address that.And it costs nothing to put in draconian recommendations, but does cost something to treat the people whom a progressive overuse of opioids have made dependent. And that does require funds.And people are very reluctant to invest those funds to address even a death rate that exceeds firearms and automobiles combined. The current death rate from opioids basically is more than any cancer other than lung cancer.It's more than prostate. It's more than breast. It's more than ovarian. It's the number one killer of people between the ages of 18 and 45, so the major adult killer.But we're extremely reluctant to invest a thing in addressing that issue.

Steve Grumbine: 00:21:24

: Can I jump in momentarily? From my vantage point, as I stated with you in the beginning, this podcast looks at economics frequently. And it's not just the profit motive. It's the austerity motive as well.And when you think about austerity, my tagline on Twitter is Austerity is Murder.And if you think about the criminal underfunding of treatment, the fact that that there is a libertarian ideology that has atomized us all, it has created a "You know what? You're the reason why success happens and you're the reason failure happens. Everything is your problem, it's your fault, you are great.So therefore you win the game of life, et cetera." It's this very makers and takers, Ayn Rand approved army of one, "You're on your own. There is no such thing as a collective," et cetera.And so the concept of individuality.And "the problem is you," prevents or is used, if you will, as the rationale for not funding anything that would go towards the common man, which would be rehabilitation, working with people to help them, like when they leave the military.How many people in the military walk away with PTSD, lots of pain and suffering, frequently hooked on medications and have lost the will to live and then become suicidal? Right? We've got a suicide epidemic in this country as well, but it doesn't matter because, "That's the individual's problem.It's not our problem, it's theirs. They made bad choices. They should have done things differently. They should have chosen differently."But there's another side to that that I don't think is talked about nearly enough, and that is the fact that there are a lot of little branch industries that come off of this. Drug, policing, private prisons, all the apparatuses that check for these things.In other words, the punitive side of all of these ideas to pull the narrative goods, the undesirables, out of circulation, put them behind bars and make money off of that frequently become the rationale for government.Now, I'm not talking about the CDC, which is an institution, a scientific institution that I do believe probably has political influences to keep your job and whatever, but politicians have different groups that they serve, right? Different interest groups. And the police state that we see ramping up using militarized gear, et cetera, has gotten all the funding.The enforcement industry has gotten all the funding. The idea of financing health as a public right is completely off the table.There is no such thing as the public good, the public purpose, the public space. And yet almost every one of these drugs have been funded through research and development by federal grants, federal monies, public money, not taxpayer dollars.Because taxes do not finance our currency-issuing federal government. They serve as a monopoly power to create a demand, an obligation payable only in that currency.So this sleight of hand that makes us feel like it's all our fault, that it's on us and then we're the ones stuck with the pain. We're the ones stuck with the addiction. We're the ones chasing after it. And then you have a black market that opens up. I blame the government for that.I blame the government for placing national resources into shooting people at the border, to jailing people for using drugs as they did the entire time through this ridiculous drug war, and spending approximately 0.0 on helping patients get out of this hellhole that they're in. What are your thoughts on that? I'm curious.

Charles LeBaron: 00:25:24

: Well, you're certainly right. The CDC recommendations were adopted with a speed and enthusiasm that is really unparalleled in my experience with any other recommendations.Usually we issued recommendations, you know, eat better and get more exercise. And those things gather dust within seconds of issuance and nobody even hears about it.Recommendations to restrict prescription opioids, they were just adopted. People couldn't adopt them fast enough, whether it was at the VA or Blue Cross, Blue Shield, or Medicare or Medicaid or anything.And part of that came into something that you're talking about. We have a, what you might call a pornography puritanism, duality around opioids, as well as around a whole bunch of other things. And we review opioids not as a medication, which have uses and toxicities and value and potential for bad and good things. We regard them as somehow a radioactive element that we're attracted to at the same time, don't want to have anything to do with.And we alternate between that feeling, being seduced by them at the same time, being repelled by them. And the thing that's interesting, that's worth keeping in mind, is there are two other legal addictions. One is tobacco and other is alcohol.And if you look at the total number of deaths currently, and it's not a fair comparison, but if you look at the current number of deaths, which is 80 to 100,000 overdose deaths from opioids, they're actually dwarfed by the deaths from alcohol, which is about 175,000 each year. In other words, about twice the amount from opioids, and really dwarfed by the deaths from smoking, which is about 250,000.But we don't have that same approach avoidance view of them.We're not launching tariffs, and army groups are not marching on France to eliminate the wine coming over or try and burn all the tobacco fields in North Carolina with that kind of same virtuous zeal.So there are strange, in a sense, discrepancies in how we view threats to our health. In each case, whether it's alcohol, tobacco, or opioids, folks who make those things have strong economic interests in making sure that these things get consumed.The one thing I'll say that's sort of interesting, that's different between tobacco and alcohol and opioids is that opioids have a legitimate medical purpose. There is no legitimate medical purpose for smoking tobacco. And drinking alcohol has an extraordinarily rare usage.Basically, you can say it has no usage in medicine, yet the major attack has been on a medication, which is essential, and there's a high degree of tolerance for two other substances which actually have a higher death rate but are essentially ignored.

Steve Grumbine: 00:28:30

: Let me ask you this question slightly differently. What does the chain of custody look like in terms of process? I mean, you've got CDC researchers researching a subject.They in turn have someone to answer to before that information makes it out to the public. There's some review, whether it be internal, whether it be political,through Congress, whatever, and then it makes it out to the world. And then it also starts hitting to the doctors, and it starts hitting to the law enforcement agency.How does that chain of custody work from recommendation by the CDC and research all the way through the food chain to person gets prescribed the medication, the person ends up dying, whatever. Walk me through this process, because it seems like there is- I don't know if corruption is the correct word-but maybe it is corruption, maybe it is payola, who knows? Maybe you do. But walk me through this. How does the CDC decide to embark on something?Is this something that a politician comes and says, "We need to address this," and then they do the research, or do they do the research and then tell the politicians, "Here's what we found." What does that look like in Praxis?

Charles LeBaron: 00:29:43

: There are two components. One of the previous directors is actually a very good director, had a number of things that he defined as CDC activities.His first priority, which I think was correct. He said, "Develop good scientific data to guide public health policy." In a sense, we develop the science that can guide policy. We don't make policy.We offer the science that could guide policy. But an interaction in that situation is that you can't do the science without being funded.So you have to convince the policymakers that this is something worth investigating.And as an example, a very, very contentious field which has sometimes been funded depending on the administration, sometimes not, has been scientific research in the public health issues around firearms.How many people die? How many people are wounded? What group seems to be affected? What are the preventive measures that seem to work? Which preventive measures don't work? And so forth. Periodically that gets funded, depending on the party in power, and periodically it's cut off from all funding and the science comes to a dead halt.So there's an inherent dialogue between the people who fund things and what CDC is able to look at. And CDC can advocate for funding but doesn't necessarily get it. If it doesn't get funding, we're in essence silenced on a topic.So that's the first element. Second element is if we are funded to look at a topic, say, birth defects, which doesn't have the charged element that, say, firearms would.We're funded, but we take specific interest based on what previous data has shown. And the interest we usually take at CDC as opposed to, say, a university, is what can we do about the problem?

Intermission: 00:31:40

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Charles LeBaron: 00:32:03

: We do science that is inherently directed at potential interventions and for birth defects and effect.One of the great discoveries was that folate, folic acid supplementation can prevent a large slew of birth defects, and folate is present in leafy green vegetables. But often people don't get enough of those.And as a result, one of the effects on that was to fortify certain foods like flour and bread and so forth with folate to assure that people get adequate amounts.And the number of birth defects that are attributable to deficiencies in folate, which are usually problems in the spine and in the brain, went down enormously as a result. So our research is very directed at what we can do about a problem rather than what is theoretically useful to know about a problem.And same director who said, "Our job is to develop good scientific data to guide policy," his second goal illustrates, in a sense, both the importance of what we do and then the limitations of what we do.He said, "Our job is to develop the scientific information that would help us mitigate the health consequences of social inequities, and it indicates both the power and the limitation of what we do. Our job is not to eliminate social inequities. We're a health agency.Our job is not to eliminate all the health consequences of social inequities because we're incapable of doing that. You can't do that unless you eliminate the inequities themselves. But our job is to mitigate those consequences."And it's an important statement about what our goals should be to direct those inequities. But it's also a statement of what we cannot do ourselves but others have to do. In other words, eliminate the inequities.

Steve Grumbine: 00:34:07

: Let me ask you real quickly in that same vein. You make the point that these policies that led to this opioid epidemic in particular had very, very unequal distribution and impact on the poor.Obviously, in this country, the United States, that typically involves people with multiple marks against them, if you will. I hate to think of it that way.But minorities that have other issues they're dealing with, poverty that they're dealing with, and a host of kind of empirical policing issues that we know impact them very differently as well. Can you talk about how the opioid war has directly impacted the poor and perhaps minorities, et cetera, in this country?

Charles LeBaron: 00:34:51

: Well, it's a complex issue and intriguing issue, too, because back in the 90s and the 2000s, that era was the era of prescription overdoses and heroin overdoses, and to a first approximation, heroin was an addiction of inner-city groups.The interest that suddenly became very prominent in the 2010's when the cartels got involved is that opioids expanded well beyond the heroin addicts of the inner city to a much wider demographic. Private school kids taking a happy pill on their graduation party and then never waking up.Suddenly at that point, people got really upset where they previously, and I'll be a little harsh on this, almost regarded heroin overdoses as sort of Darwinian justice, that, "Okay, we're getting rid of the people who we didn't want around in the first place, but when we get rid of the, you know, salutatorian at Andover on his graduation night, suddenly we decide that there's something going on." And you were discussing libertarian views on things.What was interesting is that that suddenly converted us from a Darwinian approach to a demonization of Big Pharma, where the Purdue pharma and the Sackler's getting sued for doing things. And we suddenly developed a kind of interesting reflexive view of the matter that "It's not our fault we're taking opioids. It's their fault."And that became basically mainstream. However, what we didn't cease doing was arresting the little guys and putting them in jail.The Sackler's might have to give up a billion or so of their family fortune, but if you were a guy who has had more than a gram of fentanyl that you were selling on the street, you got a mandatory minimum of 5 years in jail for it. So very different approaches to how the opioid distribution system is working.It's estimated in the federal jail environment, and I have a whole chapter of having worked in that environment, that about 80% of people in jail in the federal environment, maybe as well, in many states are there for drug-related offenses. And we have the highest incarceration rate of any nation in the world. Though I understand El Salvador is now starting to surpass us.And that obviously hasn't done a thing other than terrorize a portion of the population and make them unemployable in many ways but hasn't reduced in itself the overdose problem.

Steve Grumbine: 00:37:39

: I think to myself when I was in high school, and that's a long time ago, I graduated high school in '87. It's the Reagan era and the war on drugs was really in high gear.You had Nancy [Reagan] running around, you know, D.A.R.E. [Drug Abuse Resistance Education] taking the D.A.R.E. challenge and all this good stuff and "Just Say No" was the thing. But that was the time of crack, and I lived in Washington D.C. or just in the DMV [DC, Maryland, Virginia] outside of D.C. and the deaths from crack were very real.There's always another drug because people are hurting. Let's just take a second and acknowledge that. Forget the actual, you know, "Hey, I broke my leg. I need drugs."Think about just surviving this capitalist hellscape where people are literally running from a meat cleaver to be laid off.They're trying to pay their mortgage. They're trying to take care of their kids. Maybe they had to raise themselves and just life doesn't really look all that worth living, you know. I come from a recovery environment.Obviously I came from an addiction environment first, but then going into a recovery environment, I got to see people.The real challenge for them is learning to live life on life's terms and learning that they have value and that their entire inventory of who they are and what they've done is not just a bunch of negative things. There's positive things in there as well. There's things that they can hang their hat on about value that they bring to the table, good and bad.And people are running from staring that devil in the eye. So people as a whole are trying to avoid reality.They're trying to avoid staring into the abyss because they think all that's waiting for them is death anyway. So they try to self-medicate and they try to feel better.And to me, the criminal behavior is that life in this country is unnecessarily painful, that we make things unnecessarily difficult on people to raise their children.Running from second and third jobs and hoping the kids raise themselves well enough to get their homework done, and eating horrible food that the schools provide. Grape drank and not real, actual nutritious foods and no safety. I mean, kids come home from school and there's bullets whizzing by them.And we asked, "Well, why are there bullets where they should have made better choices?" Well, the capitalist system has given them a black mark for being a drug dealer and so now they're unemployable and they have to survive somehow.And that leads to black markets at the worker bee level. That's not just rich cartels, that's capitalism. And that's our proclivity for "othering" people, for making them outcasts.And you see a lot of privileged people who I would just as soon punch in the mouth for being snooty and snotty and looking down their nose at these folks instead of taking a step back and realizing the system creates these people.You know, there was a recent discussion about building a stadium in Washington D.C. not just for the Commanders here recently, but previously for the Washington Capitals and The Washington Wizards. And the take on this was they wanted to move the stadium out of the District because there was so much crime. Okay, now I'm a dialectical guy.I look at history through a different lens and I ask myself "What contradictions caused the crime rate to go up in the nation's capital?" If even such a thing existed to begin with anyway. And you start looking, well, the pandemic took away a lot of jobs.You look at a lot of gentrification and the increased costs of living there without the economic opportunities. And families don't know what to do. And nobody addresses these things. It's just, "Hey, you made a mistake. You're going to jail. Your life is forfeit. You are no longer a productive member of society. You now have to go into an alternative lifestyle to provide for your family."And this isn't talked about, it's just put out as a character flaw in the individuals.And unfortunately, your rank-and-file soccer mom and the rest of the let me go ahead and drive an electric car that costs $60,000 crew, they look down their nose because after all, they've been sipping out of the chalice of Abundance. And yes, I use that term intentionally because of this ridiculous Abundance movement that's coming around now.Real Reaganism warmed over for the Democrats.But this nonsense that places the blame on these people, the little people, fundamentally misses the root cause of the problem to begin with, the society that creates these things. And I'm interested in understanding why, not just the policy, but why the science is written seems to place so much onus on the individual as a bad person. Why we villainize poverty, why we villainize depression, why we villainize mental illness as opposed to treating it.  What do you think is the underlying motivation that creates these conditions?

Charles LeBaron: 00:42:32

: Well, you know, Steve, in some ways, actually, I'll throw the question back to you in a peculiar way but brings it to current events. Our current Director of Health and Human Services, RFK Jr., is an openly recovering heroin addict.And he, to his credit, states that he's recovered but still recovering and as I understand, goes to 12-step meetings himself. In a sense, you would expect out of that experience that he would bring a certain amount of collaborative empathy to the situation.But his current approach to opioids, and this is what's actually in front of Congress right now, since this is the hot topic in terms of actually what's going to happen, he's basically going to eliminate the Division of Overdose Prevention at CDC, which maintains surveillance over how many overdoses. And so it's very unclear as to in the future if we'll even know what the overdose rate is.It basically has cut back immediately and then proposes much more cutback on the distribution of naloxone, otherwise known as Narcan, which is the antidote to overdose.And if we have any indicator as to why perhaps we have reduced the number of overdoses, it appears to be that widespread distribution of the antidote to people at risk has been quite effective.He's eliminating the Substance Abuse and Mental Health Agency, which provides the major funding for treatment and for naloxone distribution to the states.And he's additionally eliminating by, in a sense, combining it with other entities, the National Institute for Drug Abuse, which does research into how to develop opioids that are less addictive and how to develop pain medications which have no addictive qualities. And that's his program. He did a documentary last year. You try to say, if his program is eliminating all that, what is he planning on doing?Who knows if this meant anything other than a documentary.But he wants to have healing farms in which we send opioid dependent people out to organic farms in rural areas and have them work doing organic farming for at least six months on the premise that when they come back from having done organic farming, we won't have an opioid or drug or overdose problem anymore. That's a pretty curious approach to opioids. But in fact, that's what's on the table in Congress right now.The elimination of CDC's Division of Opioid Overdose Prevention, the elimination of the National Institute for Drug Abuse, the elimination of the Substance Abuse Agency. And basically it's incomprehensible, but it's coming from someone who is a recovering heroin addict.And as someone who has firsthand experience in that area, I almost put to you, I have trouble understanding that psychology.

Steve Grumbine: 00:45:51

: Well, you remember one of the questions I asked you earlier was about the chain of custody with these things, the way they flow through the system, right?

Charles LeBaron: 00:45:58

: Yeah.

Steve Grumbine: 00:45:59

: And at a higher level, I want you to think about something. The Trump administration has spent its time out of office and in office demonizing immigrants and particularly folks coming up the Southern border.And those individuals do a lot of the farm labor in this country, seasonal work, and they go back home and they come back up and they do this stuff. And you never see them attacking the farmers for hiring them. You just see us deporting the poor people trying to earn a living.But when you lose a working group, okay, you gotta find a replacement. And one of the things that feeds that Libertarian narrative and I'll use Ron Paul's famous words during one of his prior runs for president, he talked about the glorious days of the early 1900s when Galveston, Texas was hit hard by a horrific hurricane. And they used the poor to clean up the dead at gunpoint, by the way, because this is how they earn their keep, man.Because you know, we're giving you these benefits, you better do something for them. So we're going to go ahead and make you clean up the dead at gunpoint, mind you.Well, when you eliminate the cross border seasonal workers that do a lot of this work that most Americans don't want to do, all of a sudden now you've got prison labor and you've got prison labor cropping up all over the place. This, in my opinion, is the congruent answer to a country that is xenophobic and disgracefully unimaginative of how it could solve problems.Now, I will tell you, fundamentally I can see giving people something productive like that to do.Just speaking as somebody who has been around for a minute, giving something to somebody to sink their teeth into and not worry about other aspects of life temporarily, to take them kind of off the grid and give them a chance to bury themselves and touch grass, right? To be out in the- smell the air and whatever.I could see some therapeutic value there because one of the things I find incredibly therapeutic is going for a walk in the woods and to work in a garden, et cetera. I don't think that is necessarily a bad thing.But when you make that your business model, because let's be fair, it's not like these businesses are throwing the stuff those folks are making in the trash. They're going to sell them. Somebody's going to make money off of that. And I guarantee you it's not the person in the camp.In fact, I wouldn't be shocked if they were forced to pay for their own care doing that. I wouldn't be shocked at all if it wasn't somehow or another, because you know, "we got to protect taxpayer money" when taxpayer money isn't a thing.Sorry, Margaret Thatcher, Ronald Reagan, the government, the coupon issuer creates its own coupons. It doesn't need your coupon, it needs you to need its coupon. So when government spends, money happens and when government taxes, money is destroyed.So the opportunity for the government to do these things in the absence of kind of a weird, "We'll make them pay for their room and board, we'll make them pay for their therapy, we'll make them pay for this stuff," it flies right out the window. But there is an opportunity for cheap labor even cheaper than immigrant labor.And I know for a fact me and my 12-step programs, I go, and the most I ever pay is maybe I threw 50 cents or a dollar in the cup when it comes around. And I tend to drink a cup of co coffee out of the free coffee that they provide at the meeting.But there's not really a whole lot of overhead costs there. Usually the room is donated by a church or a civic organization of some flavor.So it's really kind of low cost, you know, DIY sobriety, a group of drunks, God, you know, good orderly direction, et cetera. I don't like the idea of the federal government mandating labor camps to get you out of addiction.Now again, you're kind of going back to your whole theory of the CDC's approach. You know, we don't want to throw the baby out with the bath water.I don't want to act like there isn't therapeutic value in getting your feet in the dirt. But to have it mandated in a for-profit industry where you're working to "Clean yourself up," I think that's morally reprehensible.That's slavery in my opinion. So I have a lot of problems with that. And fancy that- a Republican administration not batting an eye at slave labor seems kind of part and parcel with their whole project here as they've put tariffs up, trying to create some sort of pressure to bring the jobs home. Well, those jobs aren't coming home that way. In fact, they're going to automate most of them. They're going to use AI for most of them.In fact, you know, I had a recent guest on that, talked about manufacturing in China where they are dark manufacturing plants, meaning there are no lights because it's all done by robots. There's no need for lights.So the idea of taking addicts and saying, "Hey, you're going to work in this organic farming thing," and try to put a smile on it by making it seem like, "Hey, they're working in an organic farm," or whatever. Sadly, I bet you that resonates with some people, I'm sure. "Yeah, they should pay for their own way. They should do something more. They're criminals or bad people."There's an elite in this country and I'm not just talking about the ruling elite.I'm talking about the people that are 2 inches above the pig slop to look down their narrow noses at everybody and think, "Look at these ne'er-do-goods."And I think they'll probably support that because there's this weird push to make life more difficult for everyone, to make it just a horrible existence, "You either do it our way or you're going to literally suffer." And I think that plays into this.I don't see a rhyme or reason other than a secondary reason, which is part of the Trump administration's plan to replace migrant workers with prison workers and people that are suffering from addiction. I can't think of a single reason how this would even be a thing otherwise.

Charles LeBaron: 00:51:52

: Yeah, I hear you. Obviously there are scalable problems on this.We have a very vague estimate between 10 and 20 million people who are opioid dependent in the United States.When you think of the number of organic farms, in other words, we're talking about not high-tech farms where these people are going to work hard, you know, growing strawberries or something. And what's the dimension of that? It's hard to imagine that we'll employ 15 million people suddenly on organic farms requiring hand farming.

Steve Grumbine: 00:52:26

: Agreed.

Charles LeBaron: 00:52:27

: So it's almost a appeal to an imaginary world.

Steve Grumbine: 00:52:32

: Absolutely.

Charles LeBaron: 00:52:33

: But I guess the question, I'm coming back to you, Steve, because you have the first-person knowledge, you expect so much more from somebody who's gone through it themselves, who's a recovering guy.

Steve Grumbine: 00:52:45

: You know, don't hold your breath on that. And I'll tell you this, we all learn different lessons.

Charles LeBaron: 00:52:50

: Yeah.

Steve Grumbine: 00:52:51

: And RFK Jr. is a reprehensible human being in my opinion, from his views on Gaza to his views on a whole host of things. This is a man who I wouldn't let clean my toilets, much less take on the role that he has.And when you think about it, there are some people that learn all the wrong lessons from recovery. You learn to be very self-righteous in your recovery.

Charles LeBaron: 00:53:15

: Yeah.

Steve Grumbine: 00:53:16

: There's nothing worse than a former ex-smoker, right?

Charles LeBaron: 00:53:19

: Yeah.

Steve Grumbine: 00:53:20

: And you think about the lessons they learned. And mind you, I'm an ex-smoker as well. And I went through a period of time where the very smell got me so sick that I couldn't be around it.It wasn't fake, it was real. I had convinced myself so I could quit that just smelling it would make me throw up.So I can see how people, in their quest for superiority and their quest to show that they deserve it more, they've earned it more, come out tough on crime. And there's folks in the African American community that will talk about their friends and family that have gone into law enforcement.You're like, "You lived with us, you saw what we went through. And here you are now with a badge on, hitting us harder than the white cop did. What's going on?" And I think that is kind of part of the RFK Jr. story.I don't believe him to be a good man. I don't believe him to have noble intentions. I don't believe that his recovery brought about any kind of compassion or empathy.I believe that he does a lot of the same right-wing pseudoscience and pseudo-facts. You know, the factless facts. And they sell the folksy wisdom, right? This folksy wisdom that people just assume is true.And I think you address this very well in your book also, and you said it in this podcast early on, the Winston Churchill quote. This may be what you believe, but do the facts measure up? Did the outcomes match the rhetoric? Did you deliver the outcomes you claimed you would get?And if not, it might be time to course correct.

Charles LeBaron: 00:54:54

: Right?

Steve Grumbine: 00:54:55

: I believe that this is politically motivated. I believe this is part of a larger, I'm just going to use the word.I believe it's part of a larger fascist push, a nakedly fascist push towards tough on crime, tough on people. And let's be fair, RFK Jr. gladly accepted a role in the Trump administration. He eagerly accepted it, and now he's part of that apparatus.And the reason he's part of that apparatus, because he protects the apparatus. And the apparatus is one that castigates immigrants. It deifies the do-gooders and it vilifies the others.So I believe this is part of an ideological push.I believe that he didn't learn the same lessons some do of empathy and trying to make life better for all, not just those with money who just don't want to see the poor laying on a park bench. Look at what Gavin Newsom did in California. I mean, they literally got rid of all the tent cities, put spikes in all the benches.They made it so homelessness was the most vilified thing you could possibly do. Baked it in to sneer at them and to hate them and to just vilify them and criminalize their lives.Why would it be any different with RFK Jr.? Why would it be any different with the Trump administration, who is decidedly more draconian than even Gavin Newsom, who has the mystical D in front of him that protects him from all critique from the liberals, when in reality he may as well just be another Sieg Heil right-winger instead of fighting to end homelessness. Criminalizing it. What's the difference? I don't...This seems to be the soup du jour, the flavor of the day that right-wing fascist governments deploy Mussolini-style stuff. And I don't want to gloss over and create like a melodramatic version of this. I genuinely believe that.And I believe that it's become politically okay, because people with money don't want to see poor people bringing down the property values. They don't want to see people laying on the benches. They want to protect their investments and they don't want poor people breaking into their house.Well, who wants to be robbed or whatever? No one does. Fix the problem. Attack inequality, attack wealth distribution, attack opportunity, attack these things.But we can't get that done because we have a bourgeois democracy that allows the rich and the well-to-do to be the only people that are considered. They're the only ones who have a valid grievance.And so therefore, when they say, "They don't want to see the poor this way. It looks very noble because after all, they made all the right decisions." They went to the Ivy League school. Nobody asks how they afforded it, because the rich don't have to go into student debt for their college.They just go. They have their legacy. They get accepted into Harvard. That's not the way it is for everybody else.And so it's a carry on from class war that I believe is ever prevalent in society, and it's only getting worse. That's my take on it Charles.

Charles LeBaron: 00:57:52

: okay, well, you come from a personal experience on that.

Steve Grumbine: 00:57:57

: Let me tell you one more quick story here, and this is one that the listeners will know, but I think plays into our conversation. December 14, 2002. Not to put too fine a point on it, I was arrested for drunk driving and possession of marijuana.And I was put into a holding tank in Charles County, Maryland. And in that holding tank were six other very, very young. I don't even know if they were 21 yet. They were like young black kids.And I'm sitting there freaking out because the next day is my daughter's birthday and these kids are in there and all of a sudden one of them says, "What are you in here for?" I said, "Drunk and had a whole bunch of weed on me." They go, "Oh, wow." They said, "What do you think's gonna happen?" I said, "I don't know. It's my first time ever really being arrested other than pulled over many moons ago for drunk driving in '93." And they're like, "Wow." I said, "So what are you guys in here for?" And they said, "We got caught with a joint." I was like, "Oh, okay."Well, I went down to the commissioner's office shortly thereafter. And the commissioner, who was black, said to me, he goes, "Mr. Grumbine, it looks like you have a great job and you're active in the community. You go to church and blah, blah, blah, and have a family. So I'm going to release you on your own recognizance. Just make sure you don't make a fool out of me and show up for court."I said, "Oh, thank you very much." They sent me back to the cell to wait for processing. And I asked the kids what was going on with them, what had transpired with them.And they said, "Well, they're going to hold us for the next two weeks until our court hearing." And I was like, "What?" And that was my first awakening to the inequality. That was my first real in your face, first moment of recognizing it.And that was the beginning of a transformation in my own self, which really took off in 2006 when my father took my keys from me and I stopped drinking and everything. But you can clearly see there is a class war.There is a group of people that are expected to be at the bottom, and there is a group of people that are always given a second, third, fourth, and tenth chance at life. And then there are people who, the very first thing they do, they are immediately part of the system and never to come out.And I think that's a big part of what we got going on here. I really do. Really do.

Charles LeBaron: 01:00:09

: Well, you're certainly right. The war on drugs is a war on people, not on drugs. The people who are war gone are usually the people who are least capable of defending themselves.

Steve Grumbine: 01:00:22

: Absolutely. So with that said, Charles, I appreciate you giving me some platform time here. Your story is what I came for.Tell us, as we part, what is the main takeaway from your book that we didn't cover today that maybe people would want to know and why they should go get your book.

Charles LeBaron: 01:00:40

: Well, public health is a noble profession. You're trying to prevent illness across all spectra of society.But it's only noble to the extent to which there's science directing it and then a willingness to examine the consequences. And in the case of opioids, unfortunately, that has not always been the case. So we can retain it as an ambition.And if the methods with which we can do something about it are taken away, we're still going to keep fighting, but it's going to be much more difficult given the current environment. That doesn't mean our motivation should go down. It means our motivation should go up.

Steve Grumbine: 01:01:20

: All right, well, I appreciate the time here, folks. The book is called Greed to Do Good and I strongly recommend picking this book up. The author, Charles LeBaron, my guest. Charles, where can we find more of your work?

Charles LeBaron: 01:01:32

: On Amazon. But I'm still back in the era when you basically picked up the phone, called people. So people say, "How can I follow you?" I don't know. You have to...When I go out to Kroger, maybe you can follow me to Kroger. That's about the only way to follow me, you know.

Steve Grumbine: 01:01:49

: Fair enough. So the book. Let's go get a book. Go pick up the book, folks. It's a really great read.All right, Charles, with that, let me go ahead and take us out here. Folks, on behalf of my guest and myself, I want to thank you all for tuning in to Macro N Cheese.Macro N Cheese is a part of Real Progressives, which is a 501(c)3, not for profit institution. We strive to bring you relevant information regarding macroeconomics, civil and geopolitical issues that are directly impacting your and our lives.If you feel there's value in what we do, and we believe there is value, we believe what we're doing is worth the time, we live and die on your contributions. So there's no amount too small and no amount too great and it's all tax deductible, folks.If you guys decide that what we're doing here is worth your time, please consider going to our Patreon. Patreon.com/RealProgressives. You can go to our website, RealProgressives.org select the dropdown, click donate.You can go to our Substack, which is realprogressivesubstack.com all of these places have an opportunity for you to donate, to become a volunteer even. We are a volunteer organization. So if you're interested in serving and working with us, that's great. Now also, one other thing.Every Tuesday night we take the podcasts that we record and we turn them into short videos and we listen in 15-minute increments together in a webinar series we call Macro N Chill. That Macro N Chill is an opportunity to build community, share experience, strength and hope with one another and figure out how we can fight back.You know, I get a lot of critiques from people that don't do a deep dive on what we do and don't realize, hey, we're telling you how to handle things. We're in there working together, identifying the problems and coming up with solutions.Because let's be fair until we acknowledge what the problems are, we can't develop effective solutions.So with that, on behalf of my guest Charles LeBaron, on behalf of Macro and Cheese and Real Progressives, my name's Steve Grumbine and we are out of here.01:04:03 Production, transcripts, graphics, sound engineering, extras, and show notes for Macro N Cheese are done by our volunteer team at Real Progressives, serving in solidarity with the working class since 2015. To become a donor please go to patreon.com/realprogressives, realprogressives.substack.com, or realprogressives.org.