In the New York Post article written by Ken Scheve and David Stasavage, the co-authors of Taxing the Rich: A History of Fiscal Fairness in the United States and Europe, the real motivation behind opposition to the GOP tax bill is examined in light of their research. 

To read the full article, please visit the Washington Post (Monkey Cage) webpage.

At least 91 Americans die every day from an opioid overdose. The epidemic has claimed more than 300,000 lives since 2000 and is expected kill another half million over the next decade.

So perhaps it’s time to step up lawsuits against the drug manufacturers that sell the opioids to the tune of $13 billion per year, Stanford Health Policy’s Michelle Mello argues in a commentary in the current issue of The New England Journal of Medicine.

Mello, a professor of law and of health research and policy, and co-author Rebecca L. Haffajee, an assistant professor of health management and policy at University of Michigan School of Public Health, note that although heroin and illicitly manufactured fentanyl account for an increasing proportion of opioid overdoses, the majority of people who are addicted to opioids get hooked on prescribed painkillers.

While clinicians and health-care providers are trying to prescribe fewer opioids, Mello and Haffajee believe litigation is another crucial method to fight the crisis.

“The search for solutions has spread in many directions, and one tentacle is probing the legal accountability of companies that supply opioids to the prescription market,” the authors write.

The final report of President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis details decades of aggressive marketing of oxycodone from 1997-2002 that led to a tenfold rise in prescriptions to treat moderate to severe pain. “To this day, the opioid pharmaceutical industry influences the nation’s response to the crisis,” the report said, noting the industry had sponsored some 20,000 conferences for physicians on managing pain with opioids while claiming their potential for addiction was low.

Mello and Haffajee argue that similar to the early cigarette promotions by Big Tobacco, opioid manufacturers have failed to adequately warn patients about addition risks on drug packaging and in their marketing campaigns.

“Some recent claims allege that opioid manufacturers deliberately withheld information about their products’ dangers, misrepresenting them as safer than alternatives,” they write.

Early attempts to bring class-action suits against opioid manufacturers have encountered procedural barriers. Judges typically find that proposed class members lack sufficiently common claims because of different circumstances surrounding opioid use and clinical conditions.

But the tide may be turning. There has been an uptick in litigation against Big Pharma since Purdue Pharma, the maker of the blockbuster painkiller, OxyContin, agreed in 2007 to pay $600 million to settle charges that it misled federal regulators, doctors, and patients about the drug’s risk of addiction and its potential to be abused.

“As the population harmed by opioids grows and more information about the population is documented, it becomes easier to identify subgroups with similar factual circumstances and legal claims — for example, newborns with neonatal abstinence syndrome,” they said.

Perhaps most promising, the authors write, is the “advent of suits brought against drug makers and distributors by the federal government and dozens of states, counties, cities, and Native American tribes.

“Because the government itself is claiming injury and seeking restitution so that it can repair social systems debilitated by opioid addiction, these suits avoid defenses that blame opioid consumers or prescribers,” they said. “They also garner substantial publicity.”

The government is borrowing from the playbooks used to sue tobacco and firearms companies, relying on four strategies:

• Focus on the “public scourge” created by the opioid manufacturers due to their oversaturation of the market, arguing that opioids constitutes a public nuisance;
• Paint the opioid companies’ business practices as deceptive;
• Call out the manufacturers’ lax monitoring of suspicious opioid orders; and
• Ask courts to make companies disgorge the “unjust enrichment” they have reaped at the government’s expense through their unfair business practices.

Two large settlements have occurred in state cases that included unjust enrichment claims, the authors note, although the pharmaceutical companies avoided admitting fault. The Commonwealth of Kentucky settled with Purdue Pharma for $24 million in 2015 over allegations that it had profited while Kentucky was left paying associated medical and drug costs of those who became addicted.

Earlier this year, drug wholesaler Cardinal Health Inc. agreed to pay $20 million to settle a lawsuit brought by West Virginia’s attorney general over accusations that it flooded the market with opioids in a state that now has the highest opioid overdose rate in the nation.

Such lawsuits have garnered a lot of media attention and contributed to pressure on the U.S. government to take action against the abusive practices of drug manufacturers and distributors.

“Win or lose, lawsuits that very publicly paint the opioid industry as contributing to the worst drug crisis in American history put wind in the sails of agencies and legislatures seeking stronger oversight,” Mello and Haffajee write. “Together, litigation and its spillover effects hold real hope for arresting the opioid epidemic.”

Listen to a podcast with Haffajee talking about the opioid crisis.

Political scientist Anna Grzymala-Busse finds that authoritarians face a choice in the face of change: try to cling to power, exit governing or reinvent themselves as democrats. It’s those who reinvent themselves as newly minted democrats who fare the worst in the long run.

In the years since World War II, as the global geopolitical map was drawn and redrawn along ideological lines, the world witnessed ascension of many authoritarians. They often ruled for long stretches, but eventually most faced a political reckoning. The people they governed no longer accepted their authority and demanded change.

Ironically, Grzymala-Busse found that the best choice for authoritarians is simply to cling to power “counting on a loyal if unhappy electorate,” even if it means ceding much of their once-monopolistic grip on power to democratic reforms.

81 governments studied

For her study, Grzymala-Busse examined and quantified the resulting political denouements of 81 authoritarian governments spanning the period from 1945 to 2015. Countries studied include the former Soviet Bloc, China, Cuba, several in Southeast Asia, many African nations and Mexico. The governing systems ranged from the communism of the Soviet Bloc and socialism to secular state-building and rule for the sake of national security.

The success of the reinventors can be rapid and remarkable, but so too can be the demise. Grzymala-Busse noted that the Hungarian Socialist Party won 43 percent of the vote and 49 percent of the seats in 2006, only to succumb to allegations of deception, mismanagement and fraud soon afterward. In Poland, the Democratic and Left Alliance (SLD), which won 41 percent of the vote in 2001, watched as its power steeply declined in the subsequent decade until the party dissolved entirely in 2011.

“Those who reinvented shone more brightly for a brief time, but burned out. Those who chose orthodoxy never enjoyed the great success of the reinventors, but they survived,” she said.

And what of those authoritarians who choose neither to remain nor to reinvent? Grzymala said that they simply dissolve back into society where former members often capitalize on their connections to become captains of industry.

“Some become oligarchs,” she said, “retaining power by other means.”

Lessons on change

The takeaway of her study for at-risk authoritarians, Grzymala-Busse said, is that reinvention alone is not enough to carry the party. New parties cannot survive as the remnants of their former selves. They must become entirely new organizations with viable programmatic approaches. Likewise, she said, when newly minted democrats hail competence as a competitive advantage, they must make good on the promise. If they fall short, they face exceptionally harsh outcomes at the polls.

“The irony is, without real change, the parties that built democracy by supporting free elections fall victim to those same democratic forces they championed.”

Anna Grzymala-Busse is the Kevin and Michelle Douglas Professor of International Studies and a senior fellow at the Freeman Spogli Institute for International Studies at Stanford University.

The study was made possible by financial support from the Carnegie Foundation.

The Freeman Spogli Institute for International Studies is proud to congratulate Stanford’s 2018 Rhodes and Schwarzman Scholars. In today’s climate, our scholarly work on foreign policy and international issues can feel ominous, so FSI is especially pleased to share the good news that four of the Rhodes and three of the Schwarzman Scholars studied with us.

Among the newly-appointed Rhodes scholars are Jelani Munroe, Alexis Kallen and Qitong “Tom” Cao, all current or former honors students in the Fisher Family Undergraduate Honors Program at FSI’s Center for Democracy, Development, and the Rule of Law (CDDRL). Madeleine Chang, co-president of the FSI-sponsored American Middle Eastern Network for Dialogue at Stanford (AMENDS), joins them as well. The Rhodes Scholarships provide all expenses for study at Oxford University; all four will commence in October 2018.

The Schwarzman Scholarships fund one-year master's degrees in global affairs at Beijing’s distinguished Tsinghua University. Scholars include Claire Colberg and Daniel Kilimnik, alumni of the Center for International Security and Cooperation (CISAC) Honors Program, and Lucienne “Lucy” Oyer, a current Fisher Family honors student at CDDRL. They will begin study in August 2018.

“We are very proud of these terrific students in the FSI family and our exceptional faculty who have mentored them,” said FSI Director Michael McFaul. “These seven have exhibited extraordinary ideas and leadership here at FSI, and we look forward to seeing the great contributions they will make in their fields.”

While working on his honors thesis on the role of the armed forces in German security policy, Daniel Kilimnik relied on an FSI research grant that enabled him to interview legislators, government officials and academics in Berlin. Once he heads to Beijing, Kilimnik will investigate relationships between China, the U.S. and Europe.

“I can't imagine my undergraduate experience without the professors, mentors, friends and peers I got to know through FSI,” he said. “Without support from CISAC and FSI, I would not have been able to write my thesis.”

One CISAC mentor is Donald Emmerson, an emeritus senior fellow at FSI. As honors student Claire Colberg explored Vietnam’s policies toward China, Emmerson advised her to challenge conventional wisdom.

“All I did for Claire was to encourage her to be intellectually less respectful and more creative,” he said. “I would like to believe that merely by giving her free rein, I helped her develop her own voice.”

Madeleine Chang found her voice by embracing creative problem-solving. With help from FSI Student Programs, Chang was able to do the seemingly impossible: work around President Trump’s travel ban to hold a conference with undergraduates from all over the world, including students affected by the ban.

“The irony of being an American-Middle Eastern group unable to meet in America itself spoke to why we needed to meet: to remind ourselves and others of the incredible potential of young people connecting across borders,” Chang told Stanford News.

Unable to bring all students to the United States, Chang looked across the pond and was able to hold the AMENDS conference at Oxford. FSI senior fellow Larry Diamond and academic program manager Gina Gonzales provided support on- and off-the-ground to keep things moving, even outside the Stanford realm.

“It was incredible to see Maddie leverage her connections at Oxford to turn the challenge of overcoming the travel ban into a fantastic opportunity,” said Gonzales.

Diamond believes interactions with international students are particularly valuable to the academic community. He has advised several Rhodes-bound students who grew up outside the United States.

“It is always a particular joy working with foreign students,” he said. “They teach us so much about their countries, the development challenges they face, and how other parts of the world view the United States.

“You know when you are teaching students like Qitong and Jelani that you are engaging, in some way, future leaders in their fields.”