hctiB G: The 20% who stayed

posted Dec 27, 2005


Many made fatal choice to stay behind [dead nola.com link]

The anecdotes of voluntary decisions not to evacuate contradict the perception in some quarters that whose who didn’t get away from the strike zone were essentially trapped against their will, doomed by a belated evacuation push that made little use of buses and no use of trains in a city with a high incidence of households without private cars.

The evacuation faced withering criticism from some Republican members of Congress during a Dec. 14 hearing. “You are quick to talk about the inadequacy of the federal government. Please talk about New Orleans’ inadequacies,” U.S. Rep. Jeff Miller, R-Fla., told Gov. Kathleen Blanco.

Local emergency response officials say the rhetoric obscures an important truth: that the removal of 1.2 million people from southeast Louisiana, 80 percent of the population, was one of the most successful evacuations in U.S. history, far better than Houston’s snarled effort ahead of Hurricane Rita three weeks later. Officials credit a contraflow plan retooled by the Blanco administration after a disastrous trial run for Hurricane Ivan a year earlier.

The proportion of people fleeing Katrina far surpassed the 34 percent who said in a University of New Orleans survey, released in July, that they would “definitely” leave in advance of a Category 3 hurricane if urged by public officials to do so. As it made landfall, Katrina was exactly that, a Category 3 storm, but hours earlier meteorologists had warned of a potential Category 5 storm, a sharp stimulus to an intensified evacuation.

Most of the MSM and the Republicans who grilled Gov. Blanco and Mayor Nagin want the rest of you to believe that New Orleans and the state of Louisiana abandoned hundreds of thousands of people in the metro area—poor, disabled, elderly and not—to die out of ignorance, incompetence, heartless racism and “corruption,” a word thrown around by Congressional Republicans as if there is corruption only in Louisiana or black city mayors, not in House majority leaders or lobbyists or government contractors. Almost all the finger-pointers, congressional and otherwise, have no experiential understanding of evacuation, especially of living in an area that calls evacuations of some sort at least once if not three times in a 6-month period. To get 80% of people to do anything, much less anything as drastic, stressful and uncertain as leaving their homes and 99% of all they know, own and love, is something to be applauded. If 80% of my students turn in an assignment, I’m pleasantly shocked. If 80% of faculty showed up for a meeting, the provost would serve champagne! If 80% of people used turn signals or condoms or acetaminophen correctly [dead nola.com link]—shit, if 80% of registered voters bothered to vote!

There were folks, black, white, poor, rich, in between, who didn’t want to leave their homes, their pets, their city, who “simply said God would take care of them.” I mourn all those losses and feel them weighing down the air around me but when your great-auntie says God will spare her or take her Home, what can you say or do?

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Stand with LA Women Rally SATURDAY

Stand with Louisiana Women Rally
WHEN: 1:30pm Saturday, March 7
WHERE: The First Presbyterian Church, 5401 S. Claiborne Ave.
WEAR: Pink

 

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“inflammatory arthritis” + “pain management” = Tylenol?!?

Inflammatory arthritis [IA], an autoimmune condition, includes rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis.

Recommendation 2
Paracetamol is recommended for the treatment of persistent pain in patients with IA.

Data from 12 short-term randomized controlled trials (RCTs) at high risk of bias provided weak evidence for a benefit of paracetamol over placebo and an additive benefit of paracetamol in combination with NSAIDs [11]….

There was consensus among the experts that paracetamol is generally a safe and effective analgesic in IA, both alone and in combination with other pain pharmacotherapies. It was recognized that there is variation between countries in the maximum recommended dose and that clinicians should follow local dosing guidelines. No evidence exists regarding the preferred formulation or dosing interval.

Whittle, S., et al. (2012) Multinational evidence-based recommendations for pain management by pharmacotherapy in inflammatory arthritis: integrating systematic literature research and expert opinion of a broad panel of rheumatologists in the 3e Initiative. Rheumatology. Retrieved from http://m.rheumatology.oxfordjournals.org/content/early/2012/03/23/rheumatology.kes032.full.

Note that only paracetamol/acetaminophen, NSAIDs and placebos were studied. If NSAIDs do not provide enough pain relief? There’s no answer to that because the question wasn’t asked.

The panel’s findings:

  • Paracetamol (acetaminophen) is recommended for the treatment of persistent pain.

  • Weak opioids are recommended for short-term treatment of pain only when other treatments have failed or are contraindicated but caution should be advised for long-term use and strong opioids should only be used in extreme cases under close supervision.
  • A drug with a different mode of action should be added if acetaminophen or nonsteroidal anti-inflammatory drug (NSAID) monotherapy is inadequate, but 2 or more NSAIDs should not be combined.

(2012) 11 recommendations reported for arthritis pain management. Drug Topics. Retrieved from http://drugtopics.modernmedicine.com/drug-topics/news/clinical/pharmacy/11-recommendations-reported-arthritis-pain-management?page=full.

Yes, Tylenol, the liver-demolishing pain reliever, is considered the best pain relief and management for inflammatory arthritis pain in rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. The pain of inflammatory arthritis is not temporary and lasts a lifetime, so a lifetime of Tylenol is the best “recommendation.”

Even though Tylenol most likely does not cause serious liver damage in recommended doses, it can cause elevations of liver enzymes in the blood suggesting injury to the liver. In a study of 145 healthy subjects who were randomized to receive placebo or 4 grams of Tylenol daily for two weeks, subjects in the placebo group experienced no elevations of ALT, a liver enzyme, but 33%-44% of the subjects in the Tylenol group had ALT elevations greater than three times the upper limits of normal. The highest ALT elevation was greater than 500 which is approximately 10 times the upper limit of normal. All enzyme elevations returned to normal after stopping Tylenol. Thus, recommended doses of Tylenol given to healthy subjects for two weeks can cause mild to moderate reversible liver injury. [emphasis added]

Lee, D., & Marks, J. Tylenol Liver Damage. MedicineNet.com. Retrieved from http://www.medicinenet.com/tylenol_liver_damage/page2.htm.

Tylenol is not without its serious complications. It is the leading cause of acute liver failure in the United States, and the drug in some cases led to fatalities. The active ingredient in Tylenol, acetaminophen, accounts for more than 100,000 calls to poison centers, roughly 60,000 emergency-room visits and hundreds of deaths each year in the United States. In England, it is the leading cause of liver failure requiring transplants. In 2009, the FDA issued guidelines for adding overdose guidelines to packages and in 2011, the agency confirmed the link between the drug and liver damage.

In October 2013, Johnson & Johnson will add a warning to the caps of bottles of Extra Strength Tylenol warning consumers that the drug contains acetaminophen and may cause liver failure. Severe liver damage from the drug led people to file lawsuits against Johnson & Johnson and/or McNeil. On April 1, 2013, a judge consolidated several federal lawsuits in multidistrict litigation (MDL) in the U.S. District Court for the Eastern District of Pennsylvania.

Tylenol. Drug Watch.

Acetaminophen is often used in pain medications with opioids such as oxycodone (Percocet), hydrocodone (Vicodin) and codeine (Tylenol with Codeine). These are called combination drugs, and the Food and Drug Administration is asking doctors to stop prescribing those that have more than 325 mg of acetaminophen per dose.

The FDA says no data show that taking more than that amount provides enough benefit to outweigh the risk of liver damage.

FDA: Acetaminophen doses over 325 mg might lead to liver damage. CNN.

Q. Are there risks from taking too much acetaminophen?

A: Yes, acetaminophen can cause serious liver damage if you take too much. It is very important to follow your doctor’s directions and the directions on the medicine label.

You may not notice the signs and symptoms of liver damage right away because they take time to appear. Or, you may mistake early symptoms of liver damage (for example, loss of appetite, nausea, and vomiting) for something else, like the flu. Liver damage can develop into liver failure or death over several days.

Acetaminophen is generally safe when taken as directed. To lower your risk of liver damage make sure you do the following:

  • Follow dosing directions and never take more than directed; even a small amount more than directed can cause liver damage.
  • Don’t take acetaminophen for more days than directed. [Chronic pain is every day so recommending acetaminophen for inflammatory arthritis is recommending that it be taken for years, even decades.]
  • Don’t take more than one medicine that contains acetaminophen at a time. For example, your risk of liver damage goes up if you take a medicine that contains acetaminophen to treat a headache, and while that medicine is still working in your body, you take another medicine that contains acetaminophen to treat a cold.

FDA: Acetaminophen and Liver Injury: Q & A for Consumers

But is Tylenol really the answer for inflammatory arthritis pain?

The clinical trials identified compared paracetamol to placebo, NSAID, or weak opioids; 2 compared paracetamol + NSAID to placebo + NSAID. Several studies included multiple arms using different comparators and were therefore included in the analysis for more than 1 comparator group. Eight articles, with a total of 9 separate trials, included pain as an outcome measure and were included in the efficacy analysis (7,8,9,10,12,13,14,15). Three articles included safety data but did not include pain as an outcome measure and were therefore included only in the safety analysis (5,6,11). Two trials were parallel-group design (10,11) and the remaining were crossover. The included studies were older (1959–1993), had small sample sizes (range 12–143), short trial duration (range 6 –13 wks), and often used atypical doses of paracetamol (range 650 mg/day–7.5 g/day). 

Based on 8 trials with high risk of bias we found weak evidence for the following in patients with RA: an increased benefit of paracetamol over placebo, an uncertain benefit of NSAID over paracetamol, no difference between paracetamol and weak opioids, and an additive benefit of paracetamol in combination with NSAID. There was no evidence in patients with other forms of inflammatory arthritis. For the efficacy of paracetamol versus NSAID in patients with RA, the SLR we identified in our search drew a similar conclusion: the trials were of poor quality and it was uncertain whether NSAID were superior to paracetamol.

The design of the studies was not reflective of current practice, leading to difficulties in extrapolating the results to treatment recommendations. The doses of medications used were atypical, the study duration was too short for the treatment of a chronic pain condition, and the comparators included medications not commonly used. 

Extrapolating these results to treatment recommendations is difficult. When limited disease-specific data are available to guide the therapeutic choice, other disease models may provide insight. When pain medications are tested in chronic pain, osteoarthritis is often the model used. In a recently updated Cochrane Review on the efficacy and safety of paracetamol in osteoarthritis that included 15 RCT with a total of 5986 patients, there was evidence to support the efficacy of paracetamol in comparison to placebo, but with a low overall effect size (SMD –0.13, 95% CI –0.22 to –0.04) (18). When compared with NSAID, paracetamol was found to be less effective, but had a decreased risk of any GI event when compared with traditional NSAID (number needed to harm 12, 95% CI 6 to 66) (18). In summary, the results of this systematic review showed that there is limited disease-specific evidence to support the role of paracetamol in the treatment of pain in patients with inflammatory arthritis. The available evidence, all with high risk of bias, suggests that there is a potential benefit of paracetamol, alone or when combined with NSAID in patients with RA. Given the relative paucity of information, recommendations should incorporate expert opinion and may rely on extrapolation from evidence in other chronic pain conditions. [emphasis added]

Hazlewood, G., van der Heijde, D., & Bombardier, C. (2012) Paracetamol for the Management of Pain in Inflammatory Arthritis: A Systematic Literature Review. Journal of Rheumatology. Retrieved from http://www.jrheum.org/content/supplements/90/11.full.pdf?keytype=ref&siteid=jrheum&ijkey=ImD9.ayCp0G5Y [PDF].

So the recommendation is a guess based on an arthritis not like rheumatoid arthritis, spondyloarthritis or ankylosing spondylitis that leaves out many variables and conditions, such as long-term use for chronic pain, and is drawn from studies with bias and reporting problems. But even with “difficulties in extrapolating the results to treatment recommendations,” it is still in the recommendations, and implies to me that rheumatologists and pain management doctors are being advised that acetaminophen/paracetamol is an effective pain reliever for chronic inflammatory arthritis pain and is safe for long-term use, safer and far more “desirable” than opiates, even “weak” ones.

Really.

If Tylenol handled my inflammatory arthritis pain, I never would’ve gotten a diagnosis because I never would’ve mentioned to my motherfucking doctor how much fucking pain I was [and am] in.

So if my severe pain isn’t alleviated by Tylenol or NSAIDs, I’m shit out of luck and have the privilege of living with severe pain every day until I fucking die? That’s medical care? That’s pain management? Am I getting something wrong here? I know I’m kind of pain-addled right now but I am seeing what I’m seeing, am I not? 

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National Eating Disorders Awareness Week 2015

National Eating Disorders Awareness Week 2015: The Importance Of An Early Intervention:

Signs of disordered eating aren’t always obvious, Health reported. Subtle insecurities, excessive exercise, and feeling shy or self-conscious about eating in public are all warning signs a loved one may have a problem.

There are physical symptoms, too, apart from dramatic weight loss. According to Health, “people who have been depriving their bodies of nutrition for extended periods of time often develop soft, downy body hair — almost a thin film of fur — on their arms and other parts of the body.” It’s a symptom of starvation and the body’s attempt at keeping itself warm, Dr. Cynthia M. Bulik, author of The Woman in the Mirror: How to Stop Confusing What You Look Like with Who You Are, told the magazine.   

That said, feeling cold is another result of decreased nutrition and body fat. Though there’s no clear-cut way to spot a developing eating disorder. 


 

There’s nothing mild or cute or girly or white about having an ED: 10 Things I Wish People Understood About Eating Disorders:

1. Eating disorders do not discriminate.

2. There are more than two eating disorders.

Anorexia nervosa, bulimia nervosa, orthorexia, yogarexia, binge eating disorder, EDNOS, and more.

3. Eating disorders are mental illnesses with physical side effects.

…At the end of the day, eating disorders aren’t really about food. They’re so much more complicated than that. And when you try to simplify them, you really do a disservice.

In other words, sending your ED or ED-recovery friend pictures of food, recipes, or “encouragements” to “just eat” are not recovery, do not help, and are a sign that actually you don’t know what the fuck you’re doing or talking about. If you have an ED friend, please check out NEDA’s site before you talk to her or him or them.

4. Eating disorders do not determine your body type.

5. Similarly, your body type doesn’t determine having an eating disorder.

6. Eating disorders are not a choice.

…Eating disorders choose you. And as such, giving “advice” like “Just eat!” really isn’t helpful.

You can’t tell a depressive to just “cheer up.” You can’t tell someone with an anxiety disorder to just “relax.”

7. Eating disorders are not diets.

8. Recovery is a long, hard process.

9. Recovery doesn’t look the same for everyone.

10. Eating disorders matter.


MyBodyScreening.org—are you at risk for an eating disorder? [I am at risk for disordered eating. But I knew that, mostly, already.]


And because it merits saying again and again, EDs are not confined to white college girls:


And recovery? 5 Common Questions About Eating Disorder Recovery Answered

Look around this week. Does someone need your understanding and support?


 

Shit—now you fucking tell me. 

OSFED stands for “Other Specified Feeding and Eating Disorders” and is a subclinical categorization to describe eating disorders that do not meet all of the required qualifications of anorexia nervosa, bulimia nervosa, and binge-eating disorder, as recognized by the Diagnostic Statistical Manual (DSM).

Diagnosing these eating disorders requires a specific list of symptoms. If you only have some of the symptoms, you don’t get the official diagnosis.

For example, a bulimia diagnosis requires that a person both binge eats and purges their food. So eating a normal-size meal and throwing it up doesn’t qualify as bulimic, even though it’s clearly an unhealthy eating behavior. Similarly, people may exhibit all the symptoms of anorexia but not be far enough below a healthy weight to meet an official diagnosis.

The Most Common Eating Disorder Is One You’ve Probably Never Heard Of. Buzzfeed, 2/24/15.

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“he doesn’t belong.”

Rudy Giuliani Reportedly Says Obama Doesn’t ‘Love America.’ TPM, 2/19/15.

Bobby Jindal On Whether Obama Loves America: It’s ‘Immaterial.’ TPM, 2/19/15.

Rand Paul Has No Comment On Whether Obama ‘Loves America.’ TPM, 2/20/15.

Scott Walker: ‘I Don’t Really Know’ Whether Obama Loves America. TPM, 2/21/15.

Erickson: I Don’t Think Obama Is A Christian. TPM, 2/21/15.

Scott Walker Says He Doesn’t Know If Obama Is Christian. TPM, 2/21/15.

History rolls though every page of [Orlando] Patterson’s Slavery and Social Death. “Slavery has existed all over the world,” he says, even if many Americans imagine it was unique to the antebellum South. “I asked if there were any common attributes to slavery that differentiate it from other forms of oppression, like serfdom,” he says. “What I came up with is that the fundamental feature of being a slave is that slaves are socially dead—both metaphorically and literally. They have no recognized legal existence in the society. They do not belong to the community, because they belong only to the master, and exist only through the master. I use the concept of natal alienation: they have no rights at birth. This doesn’t mean slaves don’t have communities of their own—they did have a slave life, a slave village. But in the eyes of non-slaves they do not belong, they are non-citizens. So after the United States abolished slavery, one of the first things they had to do was to amend the Constitution to make slaves citizens!

“The idea of social death became very powerful, very useful, especially in explaining what happens after slavery is formally ended,” he continues. “For example, Southern Americans, and Americans generally, found it so hard to accept black Americans after slavery was abolished. The culture of slavery still persisted, which is the idea that ‘you do not belong.’ They were nobodies; people were horrified at the idea that they could vote, like citizens. It even lingers to this day. What is the thing people who don’t like Obama say? They try to make out that he doesn’t have a birth certificate—that he doesn’t belong. Even a black president does not belong!” [emphasis added]

Craig Lambert. The Caribbean Zola. Harvard Magazine, November-December 2014.

Rudy Giuliani questioned how much,or even if, President Obama loves America.Maybe he thinks he loves it 3/5 as much as Giuliani & his pals 

— Steve Cohen (@RepCohen) February 20, 2015

Dem Rep: Giuliani Thinks Obama Loves America ‘3/5 As Much’ As He Does. TPM, 2/20/15.

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Yes/No

Yes, you may have seen me at some parades, especially during the day the first weekend and the second Saturday. 

No, I am not “feeling better.” “Feeling better” is a fucking tease. AS in general is fairly miserable. Even if my pain drops a point or 2, I’m still compromised, exhausted and uncomfortable. The difference between 8 and 6 is real but that doesn’t mean 6 is any fucking fun.

And yes, you did see me at Muses.

Yes, I had some people over and cooked. It was joyful. I made three king cakes this Carnival season, each one a crowd-pleaser and talked about long afterwards.

No, I’m not “doing better these days.” I can’t wait until “better” or “those days” to have some joy in my life, to enjoy one of my favorite times of year, to see people I love to see and never do because I am sick and they are not [or they also are], to wear a tank top on a sunny day, to get a new tattoo [or 3].

“Chronic” means every day, every single day, every single fucking day. Pain-wise, this is day 2226 for me.

Comparative Pain Scale, 0-10

Comparative Pain Scale, 0-10

As a PDF.

I generally live between 7-8 with occasional journeys to 9 and 9.5. I rail against antidepressants but “have” to take them because of that whole “severe personality change” thing—in my case, that “change” is depression, then depression with irritability, then depression with near-catatonic despair. 

So no, I can’t wait until I’m “better,” whatever the fuck that means in terms of AS, to do __. The list of things I don’t do will always be longer so don’t let the short list fool your ass. An outing or physical expenditure doesn’t mean I’m “better” or “cured.” It means I’m on an outing or expending some physical energy because I want.

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“Allowing people to suffer with unmanaged pain is immoral and unethical”

Consumer Pain Advocacy Task Force (CPATF)

Who We Are & What We Believe
Formed in 2014, the CPATF is a coalition of 16 consumer organizations working to improve the well-being of those living with pain. With decades of combined advocacy experience, we know first-hand the hardships of people living with pain, and how critical a national action plan that addresses this complex issue is.

Integral to our collaboration, we unite with the following beliefs, which guide our collective work:

  • Chronic pain is a real and complex disease that may exist by itself or along with another medical condition
  • Chronic pain is an unrecognized and under-resourced public health crisis with devastating personal and economic impact
  • Effective pain care requires access to a wide range of treatment options
  • Allowing people to suffer with unmanaged pain is immoral and unethical

Quick Facts, CPATF, 2015

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Chronic Pain Is Not Criminal (Really!); A Better Way to End Addiction No One Wants to Use

My chronic pain isn’t a crime. Boston Globe, 2/3/15. HT: Jenni Prokopy at ChronicBabe FB feed

My latest pain contract, presented as a requirement for obtaining care, included a demand that I appear, whenever ordered, before any practitioner in the health maintenance organization to which I belong, within an hour’s time, with my medication bottle in hand.

For a pill count.

How, exactly, is that supposed to work?

I have a job, a family, a life. I can’t carry around a bottle of prescription narcotics; the contract deems loss, theft, or damage as suspicious activity, and the pills would not be replaced. So I would have to interrupt teaching, go home, retrieve the pills, and report to a practitioner.

Within an hour.

I would rarely be able to do this, and when I could, doing so within an hour would usually be impossible. But in failing to comply, I would risk the revocation of my “pain medication license.”

Again, abuse of prescription pain medication is a serious problem; people are dying. But a vastly larger group of us are living — in unremitting pain, in the face of which we do the best we can to remain productive and independent, to benefit, rather than burden, our families and society at large. Most of us have accepted ever-more-onerous restrictions, no matter how humiliating — urination on command, guilty-until-proven-innocent — regardless of how they clash with American values and medical ethics.

Do we have a choice?

Well, sadly . . . yes. Street narcotics. They are broadly available, and they’re less expensive. There’s no oversight, and no humiliating urinalysis.

But is this the direction we want to go?


The Wonder Drug. Slate, 2/9/15.

Late last month, though, came an entirely new explanation for Suboxone’s limited reach in many heroin-wracked parts of the country. Following a year-long investigation, Huffington Post released a powerful multimedia package, edited by Ryan Grim and centered on a 20,000-word article by reporter Jason Cherkis that described a whole other source of resistance to the medication: the drug-treatment industry’s self-interested bias against a medical approach to treating opiate addiction. Cherkis focuses on Kentucky, where, despite an especially large spike in heroin deaths, the main publicly funded network of treatment programs remains insistently—and infuriatingly—wedded to an abstinence-based, 12-step approach to addiction recovery, despite the programs’ high drop-out and failure rates and the heaps of research showing that heroin dependence is so difficult to overcome that many addicts have far better prospects if they taper off the drug for months or years using a “maintenance” medication like methadone or Suboxone. Kentucky, reports Cherkis, “has approached Suboxone in such a shuffling and half-hearted way that in 2013, just 62 or so opiate addicts treated in all of the state’s taxpayer-funded facilities were able to obtain the medication that doctors say is the surest way to save their lives. Last year, the number fell to 38, as overdose deaths continued to soar.”

Cherkis introduces readers to one after another set of parents mourning children in their 20s who dutifully went through medication-free 12-step programs, only to relapse and fatally overdose soon after their release (a time when addicts are particularly vulnerable to overdosing, because their tolerance has decreased during detox). And he introduces us to one after another anti-science obstructionist in the local treatment industry and judicial system, where judges insist that addicts can only avoid jail time for a stay in treatment if they avoid Suboxone. There is the intake supervisor for one treatment center who, when asked if Suboxone might’ve saved a former client who fatally relapsed, shrugged and responded: “Could have. But it’s not sobriety. It’s being alive. But you’re not clean and sober.” There is the state senator in northern Kentucky—which is being hit particularly hard by the heroin wave—who compares using Suboxone to being “in bondage.” And there is the judge who oversees Kenton County’s drug court, who won’t allow Suboxone for defendants’ treatment plans. When presented with the data that shows how risky it is to detox without medication, he says, “I’m not an expert on what works and what doesn’t work.” A sign was recently posted outside a Kenton County courtroom addressed to all “Suboxin users,” warning that “IF YOU WANT PROBATION OR DIVERSION AND YOUR ON SUBOXIN, YOU MUST BE WEENED OFF BY THE TIME OF YOUR SENTENCING DATE.”

 

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“in Louisiana the poverty rate increased more than in most states over that time”

6. Louisiana
Middle income growth 2009-2013: -4.9%
Fifth quintile income growth 2009-2013: 1.0%
Fifth quintile share of income: 51.9%
Middle class household income: $44,442 (8th lowest)

The widening income gap in Louisiana does not bode well for the state’s poorest residents. The poorest 20% of Louisiana households earned $8,851 on average in 2013, lower than in every state except for Mississippi and a substantial decrease from 2009. In addition, the combined incomes among the poorest fifth of households accounted for 2.8% of the state’s total income in 2013, down from 3.2% in 2009, one of the largest drops nationwide. Meanwhile, the wealthiest 20% of Louisiana households held nearly 52% of the state’s income in 2013, higher than the comparable national figure, and also a substantial increase from 2009. While the widening income gaps in the states where the middle class is suffering did not always mean a higher poverty rate among residents, in Louisiana the poverty rate increased more than in most states over that time. By 2013, nearly one in five Louisiana residents lived in poverty, one of the highest poverty rates in the country.

States Where the Middle Class Is Dying. 24/7 Wall Street, 1/22/15.

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“a federal prosecutor who doesn’t give a fuck”

Preet!

The Most Dangerous Man In American Politics. BuzzFeed News, 1/22/15.

His frontal assault on the open secrets of New York political power has been a genuine shock to the state’s politics and even to its press, who missed the secret payments that appear to be at the heart of the reported Silver indictment. The process began last year, when Andrew Cuomo cut a particularly crude variety of the deal on which most statehouses operate: He shut down an ethics investigation into the state legislature in exchange for legislative support for his policies. His gambit became the subject of an excellent Times investigation — and then, to everyone’s surprise, Bharara essentially reversed Cuomo’s move, using his expansive power to seize the evidence Cuomo’s Moreland Commission had gathered and turn it over to his own investigators.

Silver’s indictment cites the Moreland Commission files, and notes that Silver had blocked the commission from investigating lawmakers’ outside income before shutting it down. Bharara’s move has already done massive damage not just to Silver, whose spokesman didn’t respond to an email Thursday morning, but also to Cuomo, implicated by extension in a cover-up.

Now Bharara is at war, and should he win (and even if he loses — some of Giuliani’s Wall Street prosecutions fell apart), he is now an obvious candidate for any of the major New York political offices. And as Mike Bloomberg’s allies, in particular, look for a new challenger to Mayor Bill de Blasio, the prosecutor who took on his own party will likely be the first man they call.

Bharara was, briefly, among the figures mentioned last fall for another top job, attorney general of the United States, replacing a loyalist who served as President Obama’s “heat shield.” Obama went instead with the U.S. attorney for the Eastern District of New York, Loretta Lynch, a well-regarded prosecutor who has not shown the same eagerness to indict prominent Democrats. Bharara, with two more years in office, is that particularly dangerous and rare political figure: a federal prosecutor who doesn’t give a fuck.

 

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