In the next week or so, the U.S. Senate may vote on a health care bill that would repeal and replace some parts of the Affordable Care Act, better known as Obamacare.
This 1993 lecture in Houston, Texas by FEE president Lawrence Reed (then president of the Mackinac Center for Public Policy in Michigan) is full of important fundamentals about both health care and government. In the quarter century since then, the bottom line remains unchanged: more government can hardly be the solution to problems that too much of it gave us in the first place:
http://drrichswier.com/wp-content/uploads/HEALTHCARE-CRISIS-e1498423645357.jpg380640Foundation for Economic Education (FEE)http://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngFoundation for Economic Education (FEE)2017-06-25 16:47:322017-06-25 17:02:02VIDEO: Is There a Health Care Crisis?
Most of Ossoff’s money came from outside of the 6th District. Ossoff spent 7 times what Handel spent and lost by 6 percentage points. Democrats are living in La La Land if they believe this gives them “hope” as they look forward to 2018.
But wait, not so! The DCCC believes the Congress is in play in 2018!
The DCCC email contains a link to a video made by DCCC Chairman Ben Ray Luján who declares that the Democrats have a “real shot” at taking back the U.S. House of Representatives in 2018:
To date Democrats have lost 4 special elections. The DCCC and Luján made the Georgia District 6 race a referendum on President Trump and his make America great again (MAGA) agenda. The DCCC was right, it was a referendum on President Trump’s agenda. That’s why Handel won handily. The DCCC has lost every special election, against a President and Republican Party that has relentlessly been demonized in the media, by some Republicans and most all Democrats.
So the Democrat base wants the DCCC to do more of the same, expecting different results?
This reminds us of how the media and Democrats treated candidate Trump during the 2016 presidential election. They lost in November 2016. They continue to lose.
The DCCC message has not changed. Luján keeps singing the same tune. The Democrats will keep losing if they go down the path of hating Republicans, moving even further to the left, hugging one another and abandoning civility and resisting anything and everything proposed by Republicans.
Democrats are still in La La Land, while Republicans are laughing their Ossoffs.
When your opponent is committing suicide, don’t interfere.
http://drrichswier.com/wp-content/uploads/democrats-weeping.png360640Dr. Rich Swierhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Rich Swier2017-06-22 06:00:492017-06-23 16:46:00Democrats in La La Land, while Republicans are laughing their Ossoffs
SB 8-A — Medical Use of Marijuana implements the provisions of Art. X, s. 29, of the State Constitution. The bill builds on the existing compassionate use of low-THC and medical cannabis program with additional provisions to implement the Constitutional Amendment passed by Florida voters in the 2016 General Election.
Provisions in the bill relating to patients:
Exempt marijuana and marijuana delivery devices from sales and use tax that would otherwise be imposed under ch. 212, F.S.
Establish procedures for physicians to issue physician certifications to patients who have qualifying medical conditions. The bill includes all debilitating medical conditions listed in the State Constitution as a qualifying medical condition: cancer, epilepsy, glaucoma, HIV, AIDS, PTSD, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, or other debilitating medical condition of the same kind or class as or comparable to those enumerated. The bill also includes as a qualifying medical condition:
Chronic nonmalignant pain, which is defined as pain that is caused by or that originates from a qualifying medical condition and persists beyond the usual course of the qualifying medical condition.
A terminal condition.
Eliminate the 90-day waiting period before the qualified physician may register a patient as qualified to receive low-THC cannabis or medical marijuana.
Ensure that qualified patients can receive low-THC cannabis as well as full-THC marijuana.
Allow marijuana edibles and vaping, but prohibit the smoking of marijuana.
Establish residency requirements for patients to be issued a Medical Marijuana Use Registry Identification Card (ID card). The bill specifies documentation that must be provided to document residency, including documentation required for a seasonal resident.
Grandfather in existing patients from the low-THC and “right to try” programs registered in the compassionate use registry so that they may continue receiving their medication ordered through those programs.
Provisions in the bill relating to caregivers:
Establish qualifications to become a caregiver, which include:
Being at least 21 years of age and a resident of this state.
Agreeing in writing to assist the qualified patient and serve as the patient’s caregiver.
Passing a 2-hour caregiver course that is administered by the Department of Health (DOH).
Passing a background screening unless the patient is a close relative of the caregiver.
Limit the number of caregivers each patient may have and the number of patients each caregiver may assist.
Require a caregiver to be registered on the medical marijuana use registry and possess a caregiver identification card. The caregiver must be in immediate possession of his or her medical marijuana use registry ID card when in possession of marijuana or a marijuana delivery device and present the ID card upon the request of a law enforcement officer.
Require a caregiver to purchase or administer marijuana for medical use by a qualified patient who is younger than 18 years of age.
Prohibit a caregiver from receiving compensation, other than the actual expenses incurred, for any services provided to the qualified patient.
Provisions in the bill relating to qualified physicians and physician certifications:
Require a physician to complete a 2-hour course and examination relating to the requirements of this law for approval as a qualified physician. A qualified physician must also comply with a 2-hour continuing education requirement for licensure renewal.
Prohibit a qualified physician from being employed by, or having a direct or indirect economic interest in, a medical marijuana treatment center or marijuana testing laboratory.
Establish standards for a qualified physician to issue a physician certification to include:
Conducting a physical examination while physically present in the same room as the patient and a full assessment of the patient’s medical history.
Diagnosing the patient with at least one qualifying medical condition.
Determining, and documenting in the patient’s medical record, that the medical use of marijuana would likely outweigh the potential health risks for the patient. If a patient is younger than 18, a second physician must concur with this determination and this determination must be documented in the patient’s medical record.
Determining, and documenting in the patient’s medical record, whether the patient is pregnant. A physician may issue a physician certification for low-THC cannabis only, to a patient who is pregnant.
Reviewing the patient’s controlled drug prescription history in the prescription drug monitoring program database.
Reviewing the medical marijuana use registry to confirm that the patient does not have an active physician certification from another qualified physician.
Registering as the issuer of the physician certification for the named qualified patient on the medical marijuana use registry.
Updating the registry with specified relevant information concerning the physician’s certification for the patient’s medical use of marijuana.
Limit certifications to no more than three 70-day supply limits of marijuana.
Require a qualified physician to evaluate an existing qualified patient at least once every 30 weeks before issuing a new physician certification for that patient.
Provisions in the bill relating to Medical Marijuana Treatment Centers (MMTCs):
Require the DOH to license the seven existing dispensing organizations as MMTCs. These MMTCs may begin dispensing marijuana pursuant to this law on July 3, 2017.
Require the DOH to license as MMTCs 10 applicants by October 3, 2017.
The first group of licensees, which are to be licensed as MMTCs by August 1, 2017, include applicants that submitted an application under the compassionate use law in 2014, which was reviewed, evaluated, and scored by the DOH; which had an administrative or judicial challenge pending as of January 1, 2017, or had a final ranking within one point of the highest final ranking in its region; which meets the requirements of this law; and can document that it has the ability to begin cultivating marijuana within 30 days after registration as an MMTC.
The next group of licenses must be licensed by October 3, 2017. These applicants must submit an application to be reviewed, evaluated, and scored for selection to be licensed as an MMTC. Within this group, one license must be awarded to an applicant that is a recognized class member of specified litigation and a member of the Black Farmers and Agriculturalists Association-Florida Chapter. All applicants must meet the requirements of this law. In the scoring of applications, the DOH is directed to give preference for up to two of these new licenses to applicants that demonstrate in their applications that they own and will use or convert a facility or facilities that are, or were, used for the processing of citrus fruit or citrus molasses for the processing of marijuana.
Require the DOH to license four additional MMTCs within 6 months after the medical marijuana use registry contains 100,000 active qualified patients, and upon each additional 100,000 active qualified patient registrations.
Limit MMTCs to 25 dispensing facilities statewide until the medical marijuana use registry contains 100,000 active qualified patients. When that occurs, an additional five dispensing facilities are authorized for each licensed MMTC.
Upon each additional 100,000 active qualified patient registrations, an additional five dispensing facilities are authorized for each licensed MMTC.
The bill also requires each MMTC to locate its authorized dispensing facilities within five regions statewide according to county population estimates for the counties within each region.
An MMTC that chooses not to establish a dispensing facility within a region as authorized, may sell that regional slot to another MMTC.
These limitations on dispensing facilities expire on April 1, 2020.
Detail requirements for MMTC applicants and standards that each MMTC must meet to obtain and maintain licensure; including a diversity plan that promotes and ensures the involvement of minority persons, minority business enterprises, or veteran business enterprises.
Authorize alternate forms of assets to satisfy the performance bond requirements.
Require an MMTC to perform all functions of cultivating, processing, transporting, and dispensing marijuana for medical use; including ensuring that low-THC is available for the medical use of qualified patients.
Require MMTC processing facilities to pass a Food Safety Good Manufacturing Practices inspection by a nationally recognized certifying body.
Require laboratory testing of MMTC products and create a certification program for medical marijuana testing laboratories.
Establish standards for advertising and requirements for a professional appearance and operation of dispensing facilities.
Require background screening of MMTC owners, officers, board members, managers, and employees, and of medical marijuana testing laboratory owners and managers.
Authorize a change of ownership for an MMTC under specified parameters and prohibit ownership in multiple MMTCs or certain profit-sharing arrangements.
Preempt the regulation of cultivation and processing of marijuana to the state.
Authorize local governments to ban MMTC dispensing facilities within their borders. However, if a local government does not ban dispensing facilities, it may not place any restrictions on the number of dispensing facilities allowed within its jurisdiction. Also, it may not adopt any regulations or fees for dispensing facilities that are more restrictive than its ordinances regulating pharmacies.
Additional provisions in the bill:
Establish administrative, disciplinary, or criminal penalties for prohibited acts by physicians, patients, caregivers, MMTCs, medical marijuana testing laboratories, and other persons. These prohibited acts include, but are not limited to:
A qualified patient or caregiver cultivating marijuana or acquiring marijuana from anyone other than an MMTC.
A qualified patient or caregiver in possession of marijuana or a marijuana delivery device who fails or refuses to present his or her marijuana use registry identification card upon the request of a law enforcement officer. However the bill includes certain mitigating actions that may enable a patient or caregiver to avoid prosecution.
An MMTC providing kickbacks to a qualified physician.
Counterfeiting marijuana or a marijuana delivery device purporting it to be from a licensed MMTC.
Possessing or making a counterfeit or otherwise unlawfully issued medical marijuana use registry identification card.
Authorize the DOH to pursue certain enforcement action for violations of this law.
Specify that this act does not limit an employer’s ability regarding a drug-free workplace program or policy, does not require an employer to accommodate the medical use of marijuana in the workplace or an employee working while under the influence of marijuana, does not create a cause of action against an employer for wrongful discharge or discrimination, and that marijuana is not reimbursable under ch. 440, F.S., relating to workers’ compensation.
Require the DOH and the Department of Highway Safety and Motor Vehicles to establish public educational campaigns related to the medical use of marijuana.
Require the Department of Law Enforcement to develop initial training and continuing education for law enforcement agencies relating to activities governed by this law and criminal laws governing marijuana.
Create the Coalition for Medicinal Cannabis Research and Education (Coalition) to conduct rigorous scientific research, provide education, disseminate research, and to guide policy development for the adoption of a statewide policy on ordering and dosing practices for the medicinal use of cannabis.
Include rulemaking and other provisions to aid the DOH in adopting rules and implementing the provisions of Amendment 2 within the time frame specified in the amendment.
Require each district school board to adopt a policy and procedure for allowing a student who is a qualified patient to use marijuana obtained pursuant to this law.
Rename the Office of Compassionate Use in the DOH, the Office of Medical Marijuana Use.
Rename the compassionate use registry, the medical marijuana use registry.
Provide a severability clause so that if any provision of the act or its application is held invalid, the invalidity does not affect other provisions or applications which can still be given effect.
Include appropriations for the state 2017-2018 fiscal year for the DOH, the education programs, and the Coalition.
http://drrichswier.com/wp-content/uploads/marijuana-florida-Large-840x440-1.jpg335640Dr. Rich Swierhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Rich Swier2017-06-15 20:26:422017-06-15 20:27:09Florida's Medical Use of Marijuana Law
As Obamacare continues to reveal itself as an economic and policy disaster, it strikes me that in undoing this healthcare mess, we are not following the path forged for us by the Framers of the Constitution.
For them, the overarching, driving concern was the protection of the liberties of the nation’s citizens from the intrusions of an excessively powerful government. Translated to healthcare, this would mean protecting patients and their doctors from government interference in their most private and personal dealings.
The Framers accomplished this by creating a national government of specific and enumerated powers that was prohibited from directly regulating the actions of the American people. This latter authority was retained by the states, and specifically not given to the federal government.
So, under this strategy, what would the nation’s health care system look like?
Protecting freedoms, not relying on government
In a truly American healthcare system, the responsibility for funding one’s medical care would fall squarely upon the treated individual. In cases where the cost of receiving treatment became excessive, the individual would be aided by his or her family, local churches, and community charitable organizations dedicated to helping those who couldn’t help themselves.
More importantly, healthcare would be delivered in a society where God and worship played a central role in human interaction. And no, not because the government demanded it, but because the people spontaneously shared this unyielding resolve in a state where an environment encouraging public worship existed and the family was viewed as society’s foundational building block.
It was a milieu where people were continuously reminded of their direct relationship with God and of His greatest commandment; that each person love God with all his might and that he love his neighbor as he does himself.
If the healthcare system needed to be more formalized so that hospitals and healthcare could be regulated or a risk-diverting network could be implemented, then such a structure would be generated and executed by the state, not by the federal government. In fact, if the Constitution were properly interpreted, the courts would hold that the federal government was prohibited from directing the states on creating, implementing, or administering a health care program, or taxing the people directly for the purpose of creating a healthcare insurance company.
Healthcare not part of limited federal government
Other than Dr. Benjamin Rush, who voiced his concern for the potential of healthcare being used as a tool in support of a dictatorial regime, it is likely that the Founders gave little thought to the design of the new nation’s healthcare system. Not only was it orders of magnitude beyond their primary concern of building a functional system of government, but they would have clearly maintained that such was not the role of the new federal government. In fact, they did. It was no enumerated, as mentioned above.
If asked, the Framers would have undoubtedly agreed that the solution to the nation’s healthcare challenges lay not in the acts of politicians, but in the moral compass provided to the people by their Creator and in the unyielding pledge that each and every person had instinctively made to his or her neighbor through his or her faith in God.
It is within these concepts that the true solutions to our healthcare woes is to be found, not in the machinations conceived by politicians or bureaucrats.
Hopefully, we as a nation will recall and apply these self-evident truths before we irreparably tarnish our Great Experiment and make true the warnings of Dr. Rush some 240 years ago.
http://drrichswier.com/wp-content/uploads/I-was-for-obamacare-before-e1497396878654.jpg300576Dr. Julio Gonzalezhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Julio Gonzalez2017-06-13 19:25:382017-06-13 19:34:50A True American Healthcare System
President Trump and congressional Republicans have a second chance to take a whack at the Obamacare piñata – and the beauty of it is that this time, Democrats may want to take a swing at it, too.
“It” being the Independent Payment Advisory Board (IPAB), a.k.a the death panel that was much in the news during the debate over passage of the Affordable Care Act but which then quietly faded away. For the time being.
And for good reason – especially as far as Democrats are concerned.The IPAB/death panel is to be composed of 15 bureaucrats appointed to six-year terms by the President. Future tense because the 15 bureaucrats haven’t been appointed yet. Because the IPAB hasn’t been “constituted” yet. Thankfully.
It is, however, slated by statute to come online once Medicare spending reaches a certain threshold relative to the Consumer Price Index. Kind of like an alarm clock you hope never goes off.
Given the continued rise in health care costs, especially Medicare costs (the “Affordable” Care Act’s easy promises of reduced costs notwithstanding), this could happen as early as next year. As soon as the actuary for Medicare/Medicaid Services issues a report – already overdue for 2017 – that the “targets” have been exceeded, the IPAB automatically rises to life – in order to dispense death.
And that is what has Democrats worried.
Bureaucrats Directing Your Doctor
Nominally, the IPAB was created to control Medicare spending – supposedly by cutting red tape and so on. In practice, and notwithstanding assurance to the contrary, it would inevitably become a de facto price control/care-rationing body, cutting costs by unilaterally reducing “authorized” payments to doctors and other providers and by the simple expedient of declaring various treatments “not cost-effective,” thereby denying treatment outright.
To paraphrase Joe Stalin: No care, no problem.
It is Orwellian that the same Democrats who endlessly accuse Republicans of seeking to “deny care” to people have done exactly that by legislative and bureaucratic fiat.By statute, the IPAB is required to cut costs in line with arbitrary “targets” – regardless of the effect on care. There is no provision for judicial or administrative review. Even the President is powerless to remove IPAB bureaucrats, once they are appointed. The IPAB is effectively both omnipotent and unaccountable.
It is, in a very real sense, the not-yet-popped kernel of a UK-style single payer system in which neither you nor your doctor decide what care is needed, nor what care you’ll get. Instead, faceless bureaucrats – people neither you nor your doctor will ever meet or even talk with – would determine the care you’ll be allowed to get.
This, perhaps, is what former Speaker of the House Nancy Pelosi – an ardent backer of the Affordable Care Act – meant when she said, “You have to pass it in order to find out what’s in it.”
The Chance to End the IPAB Before It Happens
It’s no surprise that almost everyone who has found out – or will soon – what the IPAB actually is either loathes it or is uneasy about defending it. Which presents a fantastic opportunity to do away with it.
Republicans have of course always objected in principle to the idea of empowering government bureaucrats to interpose themselves between patients and doctors and to the rationing of care – and to government death panels.
Democrats, on the other hand, are boxed into a corner. The whole point of Obamacare was to increase access to care – or so they claimed. But the ugly fact is that the IPAB will reduce access to care. Will ration care. Will deny people care. In particular, to older people – those dependent on Medicare.
This time, it won’t be hard-hearted insurance companies that pull the proverbial plug on grandma. It will be the much harder-hearted government. One can always change insurance policies. But there is no way to get away from government.
If the IPAB is ever “constituted,” it will be compulsory. You will not be allowed to say “no, thanks” to it. You will not even be asked. The 15 unelected bureaucrats will simply decree.
Democrats will have a tough time facing their constituents once they find out what the IPAB is all about.The good news – the huge news – is that it’s politically feasible to prevent the IPAB from ever being “constituted” if action is taken within the next couple of months. A provision was built into the arcana of the Affordable Care Act that makes it possible to hit the ”delete” button on the IPAB without broaching the broader issue of the ACA itself.
In other words, it is not necessary to repeal and replace Obamacare in order to get rid of the IPAB death panel. It’s an a la carte opportunity to nix a dangerous provision of Obamacare.
This must, however, be done by August 15, 2017 – just two months from now.
Republicans not only oppose the IPAB as a matter of principle, they very much need a legislative victory, particularly on the health care issue.
Democrats may not be particularly interested in helping them win one, of course. But they aren’t in a strong position to prevent one, either.
It will be very politically difficult for them to defend rationing health care – and denial of care outright – to their constituents. They may not smile and shake hands for the cameras over this, but it’s not likely they’ll mount a vigorous opposition, either. Democratic Sen. Ron Wyden of Oregon has already joined with Republican John Cornyn of Texas on bipartisan legislation to repeal the IPBA – and there is a companion repeal measure in the House that has 124 co-sponsors.
Republicans could easily jump-start the effort to get repeal and replace Obamacare by getting rid of it one piece at a time.
Eric Peters is an automotive journalist. Eric started out writing about cars for mainstream media outlets such as The Washington Times, Detroit News and Free Press, Investors Business Daily, The American Spectator, National Review, the Chicago Tribune and Wall Street Journal.
http://drrichswier.com/wp-content/uploads/faceless-beaurocrats-e1497314813131.jpg376640Foundation for Economic Education (FEE)http://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngFoundation for Economic Education (FEE)2017-06-12 20:47:302017-06-12 20:48:4015 Faceless Bureaucrats Will Decide what Health Care You're Allowed to Have by Eric Peters
I had the opportunity to visit Cuba. I flew via Southwest Airlines from Tampa International Airport to the José Martí International Airport in Havana, Cuba on June 4th and returned on June 9th, 2017.
After my short visit to Cuba I now fully understand why I spent my entire 23 years in the U.S. Army fighting against Communism.
Cuba is the poster child for Communism (i.e. socialism). It is a country with full control of its people by their government. Arriving was like an episode of the Twilight Zone where I was transported back to the 1950s. The 26th of July Movement began in July 1953 and ended when rebels finally ousted Cuban President Fulgencio Batista on 1 January 1959. Not much has improved for the Cuban people since then.
The graffiti, in the featured image above, reads, “Cuba, socialism or death!” I saw this graffiti along with pictures of Fidel Castro and Che Guevara throughout the country. On highway billboards, on the walls of buildings, in government museums and in the public square. It is a constant reminder to the Cuban people of where their loyalty lies – to defend Communism at all cost, and the cost is high, very high.
The greatest threat to the survival of the Cuban people is “socialismo.”
ITS THE ECONOMY STUPID!
As former Bill Clinton said, “It’s the economy stupid!” For the Cuban people it truly is the economy, stupid.
Perhaps a few of my first hand experiences in Cuba will help those who favor big government understand where “socialismo” leads.
One of the things some people, many of whom have never visited Cuba, tout is their “excellent” healthcare system. Let me explain about the Cuban single payer government healthcare system. First, every visitor to Cuba must purchase health insurance from the Cuban government. For example, the cost of my health insurance was automatically included in the price of my plane ticket. So how much does the Cuban government pay its doctors to provide universal healthcare? The salary of a doctor is $30 a month.
In 2013 Brazil hired 4,000 doctors from Cuba to “work in areas where medical services and physicians are scarce.” These Cuban doctors were to be paid approximately $30,000 a year to provide medical services to remote areas of Brazil. According to U.S. News & World Report, “Analysts say the export of medical services adds about $6 billion a year to Cuba’s economy.”
How does this work? Brazil paid the Cuban government the $30,000 annual salaries of the Cuban doctors and the Cuban government then paid the doctors $30 a month or $360 a year. This equates to an 83% profit for the Cuban government. Not surprisingly many of these Cuban doctors sought asylum in Brazil to be paid what they actually earned, $30,000.
In socialist governments the “minimum wage” inextricably becomes the prevailing wage.
It’s the economy stupid.
WORKING IN THE CUBAN TOURISM INDUSTRY
In 1991, after the fall of the former Soviet Union, the Cuban economy collapsed because economic aid provided by the Russians ended. More recently Cuba’s main international commercial partners—Venezuela, Brazil, China—have lost their appetites for subsidizing the anemic Cuban economy, lending a new urgency to grow perennially lethargic exports, and forcing the Cuban authorities to look for new sources of foreign exchange – tourism.
As U.S. News & World Reportnoted, “[T]ourism, the official No. 1 source of incoming cash, brought in $2.5 billion in 2011, according to the most recent statistics available.”
With the opening of tourism to U.S. citizens this incoming cash has increased. According to the Brookings Institute, “In the wake of the December 2014 rapprochement, the United States significantly relaxed restrictions on U.S. travel to the island, and prospective tourists in other nations saw Cuba in a new light. As a result, tourist arrivals jumped by over 16 percent in 2015 to 3.5 million. U.S. travelers, including those from the Cuban diaspora, now amount to roughly 14 percent of new arrivals, and are expected to nearly double in 2016.”
Our party was nine individuals, all U.S. citizens. We stayed in a large villa, owned by a Spanish citizen, located near embassy row in Havana. The villa could accommodate up to 14 people and came with a staff of five. The cost, including breakfast, for the villa was $10,000. We also hired two drivers with vans to take our party to various sites within Cuba. The cost to hire the two drivers amounted to an additional $2,000.
The manager of the villa was paid $15 a month, with individual staff members paid less. The manager went to Havana University and became a statistician. The manager for a number of years was a professor but decided to work in the tourism industry because the pay was better.
During our stay I went on a one-hour carriage ride through the heart of Havana. I paid the driver of the carriage $30 for two people to ride in his horse drawn carriage. The driver made $30 in one hour. This one carriage driver made as much in one hour as does a doctor working in a Havana hospital who earns $30 a month.
Given the price our party paid to rent the villa and the clear disparity between the wages of those in the tourism industry and the prevailing wage, in Communist Cuba it truly is the economy, stupid.
WORKING IN THE FARMING INDUSTRY
Tobacco rancho in the Vinales valley. Note the picture of Che Guevara on the water tank.
To meet the Cuban people we decided to travel outside of Havana. Our group visited a tobacco rancho (farm) about 200 kilometers west of Havana located in the Vinales Valley, the heart of tobacco growing in Cuba. It is in Vinales Valley that Cuban farmers grow what is considered the finest cigar tobacco in the world.
The farm we visited has been owned by a Cuban family for generations. We went into a tobacco curing barn and we received a talk about how the tobacco seeds were planted, how the plants were cultivated and how the tobacco was grown, harvested and then cured for a full year or more. We then went to another gazebo type structure to see how cigars are rolled.
The tobacco farmer told us that every year he must send 90% of his tobacco crop to the government where it is processed and made into Cuban cigars for sale and export.
So how does the farmer survive with just 10% of his crop as his reward for all of his and his families hard work?
He produces his own cigars and sells them to tourists. This is a limited form of capitalism in a repressive socialist society. The farmer partnered with a local tour guide to bring foreign visitors to his farm to see his work, try and buy his cigars. His cigars do not have a label like the government brand Cohiba. The government forbids him from branding his cigars and putting them into boxes. This farmer sells his cigars in packets made from palm leaves holding 14 or 20 cigars.
A Cohiba cigar sold in Cuban government stores costs from $20 to $30 per cigar. This farmer sells his cigars for $3 each. His cigars are no different than those made in government factories, except his are better. His cigars are cured longer, he removes the stem of the tobacco leaf, which contains all of the nicotine, and wraps them in paper for five days to further age them.
This one farmer selling one pack of 20 cigars makes $60 or twice the monthly salary of a doctor. While there our party alone bought 6 packs of 20 cigars or $360 worth of cigars. There were a dozen other tourists at the farm when we arrived. Many of them also bought his cigars. Capitalism works, even in a socialist society.
It’s the economy stupid.
The Cuban people I spoke with were friendly toward us Americans. Those who provided us with personal services whether in local restaurants, while on tours, our drivers and those who took care of us where we stayed were professional, hard working and kind.
But Cuba’s desire to be a tourist attraction is waning. MarketWatch’s Kari Paul reports:
A flash of excitement about travel to Cuba after the country opened its borders to the U.S. in 2016 for the first time in decades may have lost some of its shine.
Americans are less interested in travel to Cuba this year than they were in 2016, a survey from insurance provider Allianz Global Assistance found. Some 76% of the 1,514 respondents said they were not likely to plan a trip to Cuba in 2017 compared to 70% in 2016.Only 2% of those surveyed planned to visit Cuba in the next six months or by the end of 2017, the same as 2016 despite a projected increase in travelers from the country’s ministry of tourism. It also found that 60% of Americans said “would not like to travel to Cuba” compared to just 58% in 2016.
[ … ]
Indeed, the initial excitement about the formerly closed off country gave way to moral dilemmas over food shortages and other problems caused by tourism, as well as disappointment over limited working internet, lower hotel standards, and lack of running water there. The Allianz study found lack of travel infrastructure was a major cause of anxiety about traveling to Cuba for 13% of Americans.
The slide in demand has led a number of airlines to reduce or completely eliminate flights to the country, including Silver Airways, a Florida-headquartered domestic airline that dropped all nine of its planned routes to Cuba. Frontier is dropping its Miami-Havana route by June 4, after costs in Havana “significantly exceeded our initial assumptions,” a spokesman told MarketWatch. Spirit Airlines will drop its last flight to Cuba by June 1: “The costs of serving Havana continue to outweigh the demand for service,” Spirit Airlines president and chief executive officer of Bob Fornaro said in April.
Sumers suggested confusion over the approved reasons to go to Cuba is keeping the average American visitor away still. As of May 2017, visitors to the country have to select one of 12 categories for their visit, which include religious activities, humanitarian projects, “support for the Cuban people,” and journalistic activities. “You can’t go to Cuba to sit on the beach and have fun and that’s what Americans like to do on vacation,” he said. “Cuba is a bit of an outlier still — it is not easy to visit and for a lot of people it’s still a pain. You have to really want to go there.”
What I observed is that the Cuban people have great potential if they are unleashed and allowed to earn what they are truly worth. Socialismo is slowly but surely killing their lives and doing them great harm. I noticed on the ride West of Havana through the rural areas of Cuba hundreds of people waiting along the road trying to get a ride. Some were nurses in their white uniforms thumbing rides to the hospital where they are needed. I saw horse drawn carriages along the major highway carrying people because the public transportation system cannot keep up with the demand. The horses and cattle we saw were emaciated. The roads were in poor shape including the national highway system.
As one Cuban man put it, “the people have no love for their work.” They have no love for their work because Cuba needs a change in direction. Raul Castro has announced that he will step down as President of Cuba in February 2018. This is a chance for Cuba to change direction. To move to a capitalistic society where the individual benefits from what he or she produces, not the government. However, the Selous Foundation for Public Policy Research reports:
The Cuban media has been emphasizing that Raul Castro is leaving power. He announced in 2016 that he would be stepping down as President in 2018. Yet, he was reelected for five years as Secretary General of Cuba’s Communist Party and will remain as head of Cuba’s Armed Forces. The position of President, which will become mostly ceremonial, will be held by Miguel Diaz Canel, a low-level Communist Party bureaucrat with little military or public support.
In Cuba, power resides in the military and the Politburo of the Communist Party, both of which will continue to be controlled by Raul and his military comrades.
We shall see what happens in February 2018. The great fear among those to whom I spoke with is the new leadership will keep the ways of the old regime.
Socialismo o Muerte (socialism or death) must be replaced with Liberar al pueblo cubano (free the Cuban people).
http://drrichswier.com/wp-content/uploads/socialismincuba.jpg407638Dr. Rich Swierhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Rich Swier2017-06-11 18:36:572017-06-12 09:40:47My Visit to Cuba -- An American in Havana
I was speaking to a legislator this week readying himself for his vote on Florida’s medical marijuana legislation when he posed an interesting question: How can we defend voting in favor of any medical marijuana legislation if in so doing we are essentially passing a state law that is prohibited by federal law?
It’s a great question! Not only because it cites a potential and obvious quandary, but also because it speaks of matters of preemption and federal supremacy.
Article I, Clause 2 of the United States Constitution reads that the Constitution and laws of the United States “shall be the supreme Law of the Land,” and clear as it may appear, it took a Civil War and hundreds of thousands of American deaths to settle this question. But although the question has been settled conceptually, controversies still arise about the extent of that doctrine and the limitations of its scope.
Enter the medical marijuana debate.
Clearly unconstitutional, but…
The Controlled Substances Act (CSA), first passed in 1970, is very clear in Congress’s intent to cover the field of regulating mood-altering drugs such as marijuana.
Citing the lack of any medically accepted use, its high risk of abuse, and its lack of accepted safety for use under medical supervision, the Food and Drug Administration classified marijuana as a Schedule I drug. As such, the use, possession, or manufacture of marijuana is a federal criminal offense, except when used as part of a federally supported research project. There is no exception in federal statutes for any medical use of marijuana.
It would appear, then, that federal law is completely clear on its prohibition of medical marijuana.
So, how is it possible that a state can pass a law, or even a constitutional amendment legalizing marijuana, for any purpose?
The short answer, of course, is that a state may not do so. The closest case to directly address this matter was decided by the Supreme Court of Colorado in 2015; Coats v. Dish Network, LLC. In it, the Colorado Supreme Court summarized the concept of federal supremacy and said that an activity deemed lawful under state law, but unlawful under federal law, cannot be construed to be a lawful activity.
In other words, just because the state says medical marijuana is legal does not make it legal because such a declaration is superseded, and preempted, by federal law.
This being the case, it should be easy to argue that any state law, whether it is mandated by the state’s constitution or passed by a state legislature is unconstitutional because it would be offensive to the Supremacy Clause.
Maybe not unconstitutional
But here’s the rub.
In 2014, Congress passed the Consolidated and Further Continuing Appropriations Act prohibiting the use of any funds appropriated to the Department of Justice (DOJ) to keep a state from implementing laws relating to the use, possession, distribution or cultivation of medical marijuana. As a result, the federal government, specifically the DOJ, cannot interfere with a state sanctioned medical marijuana program.
So, is medical marijuana legal in a state that has implemented such a program? Odd as it may sound, the best answer I can give you is that it is not legal, but Congress has decided not to do anything about it — for now, or maybe forever.
Is it Constitutional under the Supremacy Clause? This question has not yet been decided, and it is ultimately up to the courts to make the call, but I will give you my opinion. In order for a law to be offensive to the Supremacy Clause, Congress must act in a manner that makes clear its intent to preempt all conflicting laws. Although the Controlled Substance Act qualifies as such a law, the injection by Congress of the medical marijuana provision in the Consolidated and Further Continuing Appropriations Act gave the states the autonomy they need to regulate medical marijuana.
As a result, if asked, I believe the courts will rule that state laws relating to medical marijuana are not unconstitutional despite the prohibition in the Controlled Substances Act.
http://drrichswier.com/wp-content/uploads/marijuana-florida-Large-840x440-e1470154355514.jpg335640Dr. Julio Gonzalezhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Julio Gonzalez2017-06-10 18:17:572017-06-10 18:17:57America’s Ramshackle Marijuana Laws
Let’s have a frank discussion about EDC, the everyday carry. The internet is overflowing with pictures, threads, and suggestions from self-proclaimed experts on the subject. I have never considered myself a subject matter expert on EDC; however, much like Liam Neeson, I have had a unique set of life experiences and skills that may give some credibility to what I have to say. I am a member of the Special Operations community. I have carried concealed weapons and mission essential equipment when lives have depended on it. I have protected diplomats all the way up to the vice-president of the United States. I am a qualified and current Advanced Tactical Paramedic, certified by Special Operations Command. I have treated life-threatening trauma at both the point of injury and at higher echelons of care. I teach various tactical skills to militaries, government employees, law enforcement, and private citizens. Lastly, and perhaps most important, I am in a constant state of learning in order to employ and teach the latest science, tactics, and techniques based on research and events.
Let’s strip away, the shemaghs, infidel t-shirts, and talk about what works. This will not be a conversation about what pistol to carry (Glock 19). That is a forum unto itself. Today I will tell you what I carry and why. I will tell you what I think you should carry and why. This writing has zero product placement or endorsement of any kind. This is all my opinion. My opinion is probably better than yours. Buckle up.
EDC should not be about your gear. I know, that sounds counter-intuitive. Bear with me. There are multiple reasons we should not be dependent on our equipment. The biggest reason is that our environment does not typically allow us to carry the equipment we would like to. Anyone who drives in the Northern Virginia or West Virginia area knows this frustration. Drive across the wrong bridge and you are instantly transformed from a responsible law-abiding citizen to a felon. This concept applies everywhere. Can you carry a pistol in a bank? What about picking your kids up from school? Auditoriums, ball parks and other venues of mass congregation are typically no-carry zones. Every place I just listed are also historically targets for violent crime or terrorism. Your EDC needs to start with your thinking, not your gear. It is possible to go out and have a good time and still be situationally aware.
“Your EDC needs to start with your thinking, not your gear.”
Here’s some homework: without being the overly sensitive veteran who just has to have his back to the wall in a corner booth, go out to a coffee shop or a bar. Order your drink, sit down, and observe. How many entrances and exits do you see? Can you get to them in a timely manner? Does the bathroom lock? Where do people park? Is there anything stopping a vehicle from driving through the entrance? Is there security? How many? What, if anything, are they carrying? What are they looking at? Do they have communication? What are people around you wearing? Look at hands and shoes. Hands can show intention. Shoes can show planning (you ever hear of anyone robbing a bank in flip flops?). Now try the same thing in a mall. Do this exercise a few times and you should notice your situational awareness in public settings increase. You may be amazed what you’ve never noticed. *Note: don’t do this exercise in a bank unless you want to answer some uncomfortable questions.
Unless I am trying to present the picture of a tactically prepared individual, I do not carry anything in Coyote Brown, Multicam, or other tactical colors. Similarly, I stay away from bags that have molle loops and more velcro than I have morale patches for. This is a personal choice. I know my training. I know what capabilities I have. I prefer that to be a surprise to anyone that needs to bear the brunt of that training. I have two bags that I normally use for my EDC. Neither are designed for this purpose, but they work well. The first is my Timbukt2 laptop bag. Women generally have an advantage over men in EDC as it is normal for a woman to carry a purse. Well, my man purse…satchel…has been in some pretty sketchy areas and has held everything from a side arm to a full chest rack. I find the top zipper particularly useful as I do not have to open the flap to draw my weapon. My second bag, a small Mountain Hardware padded ruck, also is meant to be a laptop case, and also has fast access via a zipper. Both of these bags have traveled the world with me. Neither has ever raised suspicion. When selecting your bag, go through this short checklist:
Will I carry this?
Can I get to what I need in a hurry?
Does it have enough pockets to segregate my kit?
Does it have so many pockets that I don’t know where anything is when I need it?
Is the construction durable enough to stand up being carried everyday?
Why do you not have a tourniquet? You have a full basic load and a four-hundred dollar reflex sight, but you didn’t drop a few bucks on a tourniquet. Look at that, you’ve made your little sister cry. Dammit Daryl. Here a few down and dirty facts:
You can bleed to the point of no recovery in 3-5 minutes from an arm or leg wound.
You will not lose your limb simply because you applied a tourniquet.
Improvised tourniquets will likely take longer to gather and build than 3-5 minutes
Your belt is not a tourniquet.
Tourniquets save lives.
Now that we’ve established that you need a commercially produced one-handed tourniquet, the harder decision starts. The online tourniquet battle about what is best or what is crap is pretty heated. There are more people making comments about tourniquet effectiveness than are actually applying tourniquets. I’ll let you in on a secret: applied correctly, they all work. Every one of them. Anyone who tells you otherwise hasn’t used the product or is selling a product. Like every medic, I have my preferences. I feel a Combat Application Tourniquet (CAT) is more reliable on the average arm and has a faster application time than the Special Operations Forces Tactical Tourniquet – Wide (SOFTT-W). The exact opposite is true for the leg. I know that both of these tourniquets require a minimum limb circumference for effective application, i.e. it may not work on your kid. The Stretch Wrap And Tuck Tourniquet (SWAT) will work on your kid or your dog, but good luck applying it to yourself with one hand. The Rapid Application Tourniquet (RATS) is fast and, on most limbs, effective.
In the interest of integrity, I need to disclose that I not only know the inventor of the RATS, but we served together. I count him as a friend. There is both political and medical controversy over this device. It is unwarranted and gets in the way of saving lives. I had my doubts about the RATS when it was first shown to me. For educational purposes, I had the RATS tested by Special Operations Medics using Doppler Radar to detect a distal (away from the heart) pulse. Applied to the arm, the RATS was 100% effective in eliminating a pulse. On the leg, the pulse was diminished, but not fully eliminated. The test subject was a Navy SEAL with “tree trunks for legs.” I have trained thousands of individuals in the use of tourniquets. What I have seen, without bias, is that the layperson is able to apply a RATS tourniquet faster and more effective than any other commercial tourniquet. After training, most students opt for the RATS over other commercial tourniquets. Again, this is not bias. This is what I have seen (called “empirical evidence” in the medical community).
I carry multiple CAT and SOFTT-W’s in my vehicles and aid bags. My EDC has the RATS. Based on what I have seen with my students, I recommend it for your carry.
Regardless of which tourniquet you choose, have it staged for easy access with one hand, and ready for one-handed application. Take the tourniquet out of the wrapper. Adjust the slack (big for the CAT, smaller for the SOFTT-W, three finger for the RATS) for one-handed use. Watch the manufacturer’s videos. Practice, practice, practice. I have trained government employees that refuse to recognize violence is a real thing to the standard of a 15-second application. Shoot for that standard. If you are carrying a CAT, ensure that the CAT you are training with is not the CAT you are expecting to control actual hemorrhage. The parts are made for single use and weaken under torque. Buy a blue CAT for training and a black or orange CAT for real-world use.
Other Medical Supplies
I prefer to keep it simple in my EDC. I could easily make my EDC into an aid bag. I don’t want that. That’s why I have an aid bag. One pack of compressed gauze and a small roll of duct tape are enough to fix everything from a large laceration to detaining a dirt bag till I get to more supplies. I don’t have a preference for untreated gauze. Hemostatic agents are a longer discussion for another post. If you are carrying medical tape for anything other than making a name tag, go ahead and slap yourself. I’ll wait. Medical tape, despite it’s purpose, does not stick well to wounds or anything wet. I carry a small roll of Duck Tape purchased at Home Depot and a roll of Gecko Tape from North American Rescue Products. Pro-tip: if the tape is open, dog ear it. You will be shaky and limited to gross motor skills under stress. Not being able to find the end of your tape costs cool points.
If you choose to carry a commercial dressing in your EDC, I recommend the Olaes Dressing from Tactical Medical Solutions. The dressing has multiple uses in one package. The gauze can be removed from the dressing to pack wounds. A small sheet of plastic can be removed to seal chest wounds. The elastic bandage has velcro strips sewn in increments to counter shaky-operator syndrome. A side-note personal soap box on the Olaes: the dressing is named after my friend and classmate SSG Tony Olaes who was killed in action in 2004. He pronounced his name Oh-Lie-Es. Please do the same. Thank you.
Your knife needs to be sharp, durable, and short enough that it won’t be confiscated at a security check-point. Everything else is sprinkles on the ice cream. I carry a Benchmade Triage because of the blade quality, the rescue hook, the glass breaker, and because I didn’t have to pay for it. It is worth the nearly $200 price tag, providing you’re not prone to leaving it with the bouncer at a West Virginia strip club (can I get that back? Asking for a friend.) I also carry a Leatherman Wave for all my multi-tool needs. I do have bias on these brands, as all three of us are from Portland.
Not every light needs to be tactical to be useful. This $5 LED light has multiple functions and affixes to metal for hands free use.
We have also proven ourselves on the job.
Light (Flashlights/Tactical Lights, etc.)
Flashlights are similar to knives, in that you can lose it faster than the hours it took you to make enough money to buy it. I have been carrying the same Surefire Z2 Combat Light for 10 years. It’s durable, fist size, and has worked every time I needed it to. I’m sure there are better, newer lights out there, but I haven’t needed to find out. I also carry a five buck construction job site light I bought in the checkout line at Home Depot. It takes conventional batteries, uses LED, has spot and flood functions, and has a convenient magnet on the back. Maybe not my first choice for room clearing, but it’s great for lighting up a work space (think trauma, not cars). Both of my bags have headlamps. My primary is my Petzl, that everyone in SOF has a few of. There is no need to go out and spend big money on a headlamp. You’re not spelunking. Go to Home Depot and buy the three-pack for 10 bucks. Most of them even have red light capability. I’ve used them.
Phone charger and External Battery Pack – In an emergency, communication is key. If you spent your battery SnapChatting LOL’s to your contact list right before shit hits the fan, you’re going to need some juice. I’ve opted for an Otterbox uniVERSE case with a modular accessory slot. The external battery pack for this case is made by Polar Pro and is about $50 on Amazon. I have two of them.
Sharpie Marker & 3×5 Index Cards – Make an incident timeline. Mark casualties. Pass a note. Don’t forget to buy milk on the way home.
Cash – Lower denominations. A couple hundred dollars or so. Bribing rarely works with a credit card. Credit card machines do not work in power outages.
Gum – I like to chew gum when I think I’m about to get in the mix. I’m sure I could say something medical like, “activates the salivary glands to counter dry mouth secondary to stress-induced acid reflux”, but it just gives me something to do while I wait.
After packing your EDC bag, test it. Do not fall in love with one particular set-up if it isn’t working as well as it should. Once you think you have it set, practice. Use multiple conditions: low light, darkness, loud background.
Now that you’ve seen my kit and read my secrets, I’ll need to destroy you. Best of luck out there.
Since speaking of the fantastical nature of medical marijuana, I have been bombarded with commentaries and concerns regarding the legal status of the plant in Florida. Sadly, most of the comments have been hateful, demeaning, and designed only to intimidate.
But hidden amongst the hate speech are some communications that honestly raise questions of a medical role for marijuana and report favorable experiences with its use.
So here’s the bottom line: As a physician, I completely acknowledge the pain and suffering of those afflicted with chronic and debilitating diseases and of the sometimes tragic shortcomings of our pharmacopeia, but the data supporting marijuana as a bona fide medicinal tool is simply lacking… and may always be.
Any honest discussion regarding medical marijuana must begin with the full acknowledgment of the secondary interests motivating it. Many pro-medical-marijuana advocates eagerly cite alleged conspiratorial efforts by pharmaceuticals to stifle its use, but they fail to acknowledge the millions of dollars pumped into the campaign for its legalization by the growing marijuana industry, and the even greater amounts of money some stand to gain from favorable policy decisions.
So, let’s be honest and admit that there are pecuniary interests on both sides of the issue striving to skew the conversation in their favor.
Asking the tough questions
With this admission in mind, I begin with one simple question: If marijuana is truly a medicine, then what about its pharmacology makes it so different as to allow it to bypass the scrutiny applied to all others medications? What is medically so different about marijuana that states can implement laws with insufficient study for the sole purpose of bypassing the FDA, and constitutional amendments are passed to allow for its use as a medicine?
The answer, of course, is nothing, which adds to the contention that something much bigger than the use of the plant as a medication — perhaps the quest to legalize its recreational use — is the true driver of the medical marijuana debate. If that be the case, then ransacking the nation’s health care system for the mere promotion of a recreational drug is dishonest, reckless, and dangerous.
Then there’s the pesky issue of the science.
First, marijuana is not one substance, but rather a complex of more than 400 biologically active compounds including, terpenoids, flavonoids, and over 70 cannabinoids. The interactions between these substances and their specific benefits are not understood. What’s more, their specific combinations vary between strains of the plant, growth conditions, the manner in which the plant is prepared for consumption, distribution methods, storage times, and storage conditions.
All this may be totally acceptable for a recreational product, but it is the death knell of a prospective medication.
What’s worse, there is very little data supporting the use of marijuana for many of the claimed indications.
What thorough marijuana study reveals
Perhaps the most thorough and objective review on this topic appeared in 2015 in the Journal of the American Medical Association.
Researchers studied 23,754 “hits” on their search engines. They arrived at 79 studies reported in 151 papers from all over the world (encompassing 6,462 participants) that the authors found were of sufficiently low bias and high scientific control to be taken seriously as scientific analyses.The researchers then stratified the collective results of the studies into varying levels of data quality to support a recommendation for the use of marijuana and its derivatives in health care. Neither, the cannabinoids nor marijuana, received a rating of high confidence in the treatment of a single symptom or condition!
Conclusion: the science supporting the use of marijuana or cannabinoids as a medicine is simply not there. In fact, only in the treatment of chronic neuropathic, cancer pain, and spasticity was any data found that rose to a level of moderate scientific quality.
Additionally, when marijuana was used for pain control it did not diminish the demand for opioids, thus eviscerating the contention that by allowing for the use of medical marijuana there would be fewer complications related to opioid use and opioid addiction.
Nausea and vomiting, HIV/AIDs, depression, anxiety disorder, psychosis, sleep disorders, and Tourette syndrome received either low quality support or very low quality support. Studies regarding other conditions such as the actual treatment of cancer, glaucoma, seizure disorders, Crohn’s disease, sickle cell disease, psoriasis, and Parkinson’s disease were so poor that they did not even rise to the level of meriting inclusion in the JAMA study.
Risks lacking known rewards
On the flip side, the risks of treatment with marijuana are not inconsequential.
First, dosing of smoked marijuana remains unpredictable. And although much of the medical marijuana debate centers on the effects of single exposures, insufficient information exists regarding the effects of repeated exposures. Approximately 10% of people routinely using marijuana become addicted, with a higher incidence amongst adolescents. Tolerance and down-regulation of receptors have been documented with repeated marijuana use. A marijuana withdrawal syndrome has also been recognized, as has an association with psychosis.
Despite the lack of scientific evidence to support the use of medical marijuana, the states have run the gamut on the list of scientifically unsupported treatments they will allow. For example, last year, Florida approved a constitutional amendment listing cancer, epilepsy, glaucoma, HIV/AIDs, PTSD, ALS, Crohn’s disease, Parkinson’s disease, MS, any medical condition similar to those listed above, and terminal conditions as ones for which marijuana may be used. And in Connecticut, the use of marijuana for the treatment of sickle cell disease and psoriasis is also allowed.
The endocannabinoid ruse
There are those, particular amongst the more vitriolic advocates, who misguidedly cite the endocannabinoid system as evidence for the benignity of marijuana use, suggesting that we should allow for marijuana’s medicinal use because cannabinoids are already existing inside our bodies. In fact, the existence of such a system should result in further caution against the proliferation of marijuana use.
The human body does produce cannabis-like substances, but they naturally exist in very small quantities, are precisely released, and linger for very brief periods of time. These endocannabinoids affect nerve growth and maturation, and guide intercellular connections during pruning (the process by which nerve cells find and refine their connections).
Exocannabinoids, on the other hand, those that are ingested or inhaled like marijuana, are long lasting, exist in higher quantities, and are relatively indiscriminate in their distribution.
The consequences of taking these substances from an external source are not only unknown, but potentially very disruptive to human development — an even more disturbing consideration since brain development continues until the age of 25 years. Such indiscriminate and physiologically disruptive effects may explain the negative behavioral and emotional changes associated with adolescents who are repeatedly exposed to marijuana.
Study and FDA approval needed
Yes, as a legislator, I am aware that in Florida, 71% of the electorate voted for the medical marijuana constitutional amendment. But such an outcome, promoted by monied interests, does not negate the fact that marijuana is not a medicine.
Like any other physiologically acting collection of substances, marijuana is a potentially dangerous, incompletely understood, and improperly controlled combination of chemicals whose benefits have not been found to sufficiently outweigh its risk.
I continue to call for the FDA and the federal government to devote resources to the study of this plant and its effects. With adequate support for well-controlled, scientific research, there may come a day when sufficient, meritorious information will be available to allow the FDA to provide health care providers with reliable prescribing information and for manufactures to create products known to be beneficial to patients.
But until such time, physicians need to shy away from the indiscriminate, and still illegal, use of marijuana in their patients, and states need to be leery of policies enacted in contradiction to federal law.
As for the advocates, if their goal is to legalize marijuana for recreational use, then let’s have that discussion and not use our nation’s health care system as a ruse for the promotion of marijuana’s greater acceptance as a recreational drug.
In the meantime, and despite the accusations, bully tactics, and vitriol, I will continue to evaluate the medical literature regarding marijuana with a scrupulous eye and a mind open to the strengths of both sides of the argument.
http://drrichswier.com/wp-content/uploads/legal-medical-marijuana-Large-e1492549570307.jpg384640Dr. Julio Gonzalezhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Julio Gonzalez2017-06-01 16:49:322017-06-01 16:49:32The Illusion of Marijuana As Medicine
Robert Royal notes that the progressive future can’t be great since it doesn’t concern itself with the future of children and societies fertile enough to reproduce themselves.
Last week, when the leader of the free world was (depending on which sources you paid attention to) either destroying America’s carefully constructed system of international alliances or shaking up the policy establishment at home and abroad to deal with the new world environment, something equally consequential – and more fundamental – took place, almost unnoticed, in Hungary.
I’ve mentioned in passing several times in recent days that I spoke at the Eleventh World Congress for Families that has just finished in Budapest. But it’s difficult to convey what an inspiring and hopeful – and unexpected – event it was.
We almost never hear about it, mired as we are in our political obsessions, but there are thousands of family and marriage activists and organizations at work around the world. Most of them were present in Budapest last week. And most important of all, outside of Western Europe, North America, and their offshoots in places like Australia and New Zealand, countries are not at all following the absurd and suicidal trends on marriage and children that we (falsely) believe have gripped the whole world.
Hungary is a leading example in Europe itself. Prime Minister and former anti-Soviet dissident Viktor Orban has succeeded in starting to reverse the disastrous trends in marriage and births that Hungary, like Western Europe, had been showing for years. This has been the result partly of social commitment, partly of specific policies.
The 2011 Hungarian Constitution, the first one adopted since it regained freedom after the fall of the Soviet Union, states this:
Article L (1) Hungary shall protect the institution of marriage as the union of a man and a woman established by voluntary decision, and the family as the basis of the survival of the nation. Family ties shall be based on marriage and/or the relationship between parents and children. (2) Hungary shall encourage the commitment to have children.
That may seem an empty gesture given the dominant culture of our international elites, but ten years ago, Hungary had a marriage rate of around 3.6 per thousand, the same as Southern European countries like Italy, Spain, and Portugal. Now it’s nearly 4.75, and steadily climbing.
EDITORS NOTE:Friends: Today we end nine years and tomorrow begin our tenth year of daily publication. I’ve been reading the very kind notes you’ve been sending along with your donations and am deeply grateful to all of you for your loyalty and encouragement over the years. As you know, we’re in a immense struggle, both in our society and in our Church – a struggle even worse than when we began in 2008. (By the way, I’ll be on EWTN again this evening at 8 PM ET – there are rebroadcasts and YouTube if you can’t tune in tonight – to talk with Raymond Arroyo and Fr. Gerald Murray about several recent developments in the Church.) Yet there are also hopeful signs and I write about one of the most hopeful in this column. Good and evil will be at war until the Second Coming. In the meantime, we all have to do our part. Mine is to call on you at this special moment to do yours, to make a financial contribution so that our special Thing may be even more present, more energetic, more effective in bringing Catholic truth to a world that is in turmoil for lack of it. – Robert Royal
http://drrichswier.com/wp-content/uploads/hungarian-woman-pregnant-e1496312130854.jpg408640The Catholic Thinghttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngThe Catholic Thing2017-06-01 06:15:362017-06-01 06:15:36The Other Europe
The Congressional Budget Office score of the American Health Care Act [claims to shows] that the bill will reduce deficits by $119 billion over the next decade and result in 23 million more people being uninsured by 2026. This leaves the impression that people would be better off if Obamacare were unchanged. But a new report from the Department of Health and Human Services dispels this myth.
Premiums have doubled and tripled and are rising further.
The HHS report shows that premiums in the individual market exchanges increased by 105 percent in the 39 states using Healthcare.gov from 2013 to 2017. This is equivalent to $244 per month in additional premium payments for people buying insurance through the exchanges, or $2,928 over the course of a year. People not eligible for exchange subsidies are fully exposed to these increases, while taxpayers will bear the brunt in the form of higher outlays for subsidies for enrollees who are eligible.Despite the promises that Obamacare would “cut the cost of a typical family’s premium by up to $2,500 a year,” average premiums on the exchanges more than doubled over this period. In some states, such as Alabama and Alaska, the average premium more than tripled.
The high average increase is not driven by a few outliers, as 23 out of the 39 states included in the analysis experienced premium increases in excess of 105 percent. Only three states, North Dakota, New Hampshire, and New Jersey, had cumulative premium increases below 50 percent.
As the report acknowledges, the composition of the population enrolling in plans through the exchanges has changed over time due to the adverse selection problems created by the laws subsidy and regulation frameworks.
For example, the community rating age bands, which dictate how much more companies can charge older, higher-risk enrollees, were set at 3:1 under Obamacare. A recent study by Milliman estimated that relaxing these age bands to 5:1 would reduce premiums for people aged 20-29 by 15 percent while increasing premiums for older enrollees.
Lower premiums for younger, healthier people would encourage more of them to enroll through the exchanges instead of foregoing health insurance because it is too expensive for them. Older, less healthy people make up a larger share of the exchange population now than in earlier years, which exacerbates the premium increases on that population.
Due to data limitations, the report does not deal with the population getting plans on the individual market but not through the exchanges. These people accounted for more than a third of the total individual market. They are not eligible for the law’s subsidies, so there is likely less adverse selection for the off-exchange population, but these enrollees have to bear the entirety of the costs of those increases.
Families choosing a plan through the exchanges have seen their premiums more than double since 2013. In some states, a wave of insurers leaving the exchange market has created situations where only one insurer is offering products for entire states.
Alabama and Alaska, which have seen the two highest cumulative premium increases, are both down to only one insurer. In the entire country, only Virginia saw the number of participating insurers increase from 2016 to 2017. Just today, Blue Cross Blue Shield of Kansas City announced it would be exiting the exchange, leaving 25 counties in Missouri without a participating insurer for now.The lack of choices and competition in a growing number of places makes it unlikely that there will be an end to rapid premium growth, absent reform. While the CBO estimates will provide some insight into the effects of the bill in its current iteration, a working group of Senators is crafting a revised bill with major alterations.
Getting the design of replacement legislation right is important, and the CBO score will give the working group of senators more information about which aspects of the bill that passed the House need the most adjustment. Provisions that allow for more competition and choice for people trying to get insurance through the individual market will help bring down annual premium increases.
Since 2013, this group has had to grapple with fewer choices while their premiums doubled. A well-crafted bill could go some way to reversing that unsustainable trend.
http://drrichswier.com/wp-content/uploads/obamacare-house-of-cards.jpg360640Foundation for Economic Education (FEE)http://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngFoundation for Economic Education (FEE)2017-05-26 17:15:312017-05-28 14:22:57There's No Way Obamacare Can Last by Charles Hughes
There is a moment I found a bit startling in the new Anne of Green Gables series on Netflix. The farm is in trouble and the bank is talking foreclosure. The family starts to panic. Anne suggests that many people will chip in and help the family through these hard times.
The mother reacts with firmness and conviction: “Absolutely not. We do not accept charity.”How old fashioned! The statement alone reveals we are talking about the past here. I vaguely recall people in my own extended family – at family reunions in West Texas, sitting around shelling peas – saying something similar. It was a matter of pride, even morality.
When was the last time you have heard that assertion? I personally can’t remember hearing that in many years.
Maybe it is time to bring back that ethos and ethic.
What we have here is a principle at work, a matter of character. Don’t live at other’s expense. Make your own way in this world. Keep your independence and retain your dignity.
Is there any virtue here? I would suggest so. It is a forgotten virtue, to be sure, but a virtue nonetheless.
Charity with Dignity
The family in the story truly needed help. Rather than beg, they gathered up many of their possessions and took them to town to sell them. Merchants had heard about the family’s need, so some actually overpaid as a way of helping without letting the family know what was going on.
This is a great way to be charitable without letting the person know about it, which is yet another expression of virtue. The Bible tells people to give unto others without letting the left hand know what the right hand is doing – which is to say, don’t congratulate yourself and likewise expect others to praise you for your generosity. This is what the neighbors did.
By the same token, the shame associated with begging is ever-present in the Bible. In the parable of the unrighteous steward, the guy complains that he is been released from his master, but he is too weak to dig and “too ashamed to beg.”
Ashamed! Can you imagine? Social welfare professionals have been trying to remove the stigma of welfare for a century. But let’s face: it will never entirely go away. That might even be a good thing.
Don’t Be a Beggar
The story of Anne is set in Canada, but the attitude behind it feels quintessentially American. It is fundamentally a character trait forged in a setting of freedom. You encounter this often in the Little House books too, this attitude that it represents something of a humiliation to accept charity from others.
Even when the opportunity is there, there once seemed to be a cultural commitment against dependency, against living off others. Think of the old term hobo. The hobo ethic was never to beg – that’s what bums do – but rather to completely avoid all forms of dependency, even the need for a comfortable bed and nice clothes, and to travel and work small jobs to get enough to live and then move on. The hobos believed that this was the only way to stay free.In the American spirit, the hobo was making a dignified choice. The bum? Never.
Even when the redistributionist state came along, the American spirit of individualism rebelled.
Rose Wilder Lane, the daughter of the author of those books, writing at the height of the New Deal, put it like this:
The spirit of individualism is still here. The number of us who have been out of work and facing actual hunger is not known; the largest estimate has been twelve million. Of this number, barely a third appeared on the reported relief rolls. Somewhere those millions in need of help, who were not helped, are still fighting through this depression on their own. Millions of farmers are still lords on their own land; they are not receiving checks from the public funds to which they contribute their increasing taxes.
Millions of men and women have quietly been paying debts from which they asked no release; millions have cut expenses to the barest necessities, spending every dime in fear that soon they will have nothing, and somehow being cheerful in the daytime and finding God knows what strength or weakness in themselves during the black nights.
Americans are still paying the price of individual liberty, which is individual responsibility and insecurity.
This view is of course routinely lampooned in the progressive press, overtly by socialists like Elizabeth Warren but implicitly in venues like the New York Times and National Public Radio. Their voices drip with disdain for what they say is the myth of “rugged individualism,” a phrase popularized at the end of the 19th century. It is the supposedly cruel and unrealistic idea that people should get by on their own wherewithal.
The idea behind this phrase is to celebrate individual achievement and to suggest that it is a compromise of your potential as a human being to expect others to care for you if it is not necessary.Too often the idea has been caricatured, at least since the New Deal sought to break down the social stigma of dependency on government. For example, maybe people associate this with selfishness. It’s not true. There is a paradox that the more independent you are, the more you are willing to step up and help others. As Lane says: “We are the kindest people on earth; kind every day to one another and sympathetically responsive to every rumor of distress. It is only in America that a passing car will stop to lend a stranded stranger a tire-tool.”
This is not living off others. This is benefitting from the kindness of others when it is necessary and helpful. You accept it because you would certainly do the same for them. And you don’t expect it from others. And you certainly don’t craft your life around the idea that everyone or anyone is morally obligated to help you when you encounter misfortune.
Help Yes, Dependency No
It’s not complicated: you accept help when necessary but don’t make a habit of it. My own mother, who comes from the stock and heritage that celebrated self-reliance, used to say to me, very simply: “never be beholden.” If you owe others, you have given up that most precious thing, your independence, which means giving up some of your freedom.
Private creditors are bad enough. It is surely worse to be beholden to government. Right now 43 million Americans are on food stamps. That is not a mark of national pride. And this is true even in times when groceries are absurdly cheap and available by any historical standard.
Once you accept the largesse, you have a political investment in continuing it. Your loyalties gradually change.
People justify this based on observing how much they are paying into the system. It pillages them with every paycheck, so they might as well get something back. No matter how much welfare they pay in, they can never take enough out to make the bargain work out equally. For most people, this is surely true.Once you accept the largesse, you have a political investment in continuing it. Your loyalties gradually change. The state becomes your benefactor. Your sense of self reliance is compromised.
Do you see the vicious cycle? You are forced to pay in, so you have no moral resistance about taking out when the time arises. Pretty soon you find yourself part of the Bastiatian calculus: the state becomes the great fiction by which everyone tries to live at everyone else’s expense.
In service of people’s dignity, programs like food stamps ought to be abolished, as much as that would upset the corporate agricultural interests that are forever lobbying for this racket to continue.
It seems that government does everything possible to rope people into the role of dependent these days. Whether it is student loans, Obamacare, or just guilt tripping us all to love the highways and glorious national defense we get for our tax dollars, we are supposed to feel forever on the hook, forever beholden. Forever indentured.
This is not the attitude of a free people.
A Word for Individualism
To hear about “rugged individualism” is a bit strange for us today. We have a vague sense that people used to believe this. We feel mischievous even to sense that there might be a grain of truth in it. The attitude built the world’s most prosperous economy. It gave us new inventions. It created the most dynamic, thriving, progressing society in history, and this became a model for the world.
To be sure, there is often a confusion over the phrase self-reliance. It does not mean to grow your own food, make your own furniture, and walk instead of drive. It has nothing to do with the technology you use, and there is a sense in which the market and the division of labor it creates makes us all deeply dependent on each other. That is a beautiful thing.
The point is that market dependency is rooted in exchange and mutual benefit. We go into every exchange with the freedom to change our minds, and we benefit from exchange as much as the other party. We aren’t doing favors for each other. We cooperate together in our own interest.Self-reliance really means something else. It means not being on the hook for a favor someone else did you or being expected to live in a constant state of owing others for some act of benevolence on their part. It certainly rejects forcing others through the state to be productive so that you can get a free ride.
Pay Your Debts
My mother is right. It’s not good to be beholden to others. This idea was once baked into our institutions. Government had no charity to offer anyone. Your debts had to be paid. Americans didn’t rush to create the cradle-to-grave welfare state. The thing existed in Europe long before it came to our shores. Even when we created the institutions, people were reluctant to use them.
And it’s not just about the compromise of your individualism that you make when you accept welfare. It is also about the annoyance others feel when forced to pay for it. Both sides are degraded in this forced wealth transfer.
For our ancestors, it was a matter of personal character.
This is the underlying thinking behind the quote that Ayn Rand’s Atlas Shrugged worked to forge into a life doctrine: “I swear, by my life and my love of it, that I will never live for the sake of another man, nor ask another man to live for mine.”It’s best to think of that line, not as a hard religious doctrine but just very solid life advice, a good bedrock practice for how to think of yourself in relation to others. With that idea in place, all the rest of the virtues fall into place.
What Can We Do About It
The idea of rejecting charity means that you should take charge of your own life, regardless of pressures around you to do otherwise. This is possible even today. It’s true that you are forced to pay into the system. But no one is forcing anyone to take food stamps, to live on handouts, to be dependent on government programs. It’s not so easy to refuse them anymore. The struggle is real. Still, this is something you can control – unlike national politics.For our ancestors, it was a matter of personal character. It is always easier to take the more temporarily lucrative path and the safer route. Maybe you feel like a chump for turning down government money when it is so easily available. But if you relent, what are you giving up in the exchange?
We don’t need to bring back the shame that comes with living off others. Anyone who does that when it is not absolutely necessary knows in his or her heart that there is a better way. If we can choose the better path, we should.
If everyone did this, the welfare state would be de facto abolished overnight.
Jeffrey Tucker is Director of Content for the Foundation for Economic Education. He is also Chief Liberty Officer and founder of Liberty.me, Distinguished Honorary Member of Mises Brazil, research fellow at the Acton Institute, policy adviser of the Heartland Institute, founder of the CryptoCurrency Conference, member of the editorial board of the Molinari Review, an advisor to the blockchain application builder Factom, and author of five books. He has written 150 introductions to books and many thousands of articles appearing in the scholarly and popular press.
http://drrichswier.com/wp-content/uploads/pioneers-catching-fish-lawlor-276501-print-e1495705485517.jpg379640Foundation for Economic Education (FEE)http://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngFoundation for Economic Education (FEE)2017-05-25 05:50:132017-05-25 05:50:13Yes, it is a Virtue to Reject Charity by Jeffrey A. Tucker
NOM has just released an important new video calling on all marriage supporters to sign our new petition to Attorney General Jeff Sessions to issue comprehensive rules to protect the religious liberty of people who support marriage, life and the truth of gender and ensure we are not targeted by the federal government because of our views. Please watch the video.
This powerful new video is part of our ongoing commitment to pressure the Trump administration to once and for all fulfill President Trump’s repeated promises to people of faith that his administration would “do everything in its power to defend and protect religious liberty.”
There are a number of things that we have applauded President Trump on since his election, especially the appointment of Neil Gorsuch to the US Supreme Court and the rescission of President Obama’s illegal transgender bathroom mandate in the public schools. But we are obligated to call President Trump out when he has not done what he has promised to do – and protecting the religious liberty of people of faith to continue to live out their beliefs about marriage, gender, life and human sexuality is at the top of the “unfulfilled promises” list.
NOM is a top group in the country continuing to pressure the Trump administration to fulfill the president’s promises to provide comprehensive religious liberty protections. We need to raise additional funds to expand the launch of this video and invite more people to sign the petition.
Thank you for all your support, and for helping us continue to fight for religious liberty for everyone who believes in the truth of marriage.
Brian S. Brown
President, National Organization for Marriage
http://drrichswier.com/wp-content/uploads/religious-liberty.jpg402640National Organization for Marriagehttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngNational Organization for Marriage2017-05-22 15:58:562017-05-22 16:01:38TAKE ACTION: Ask President Trump and AG Sessions to protect religious liberty [Video]
Dr. Randy Brinson, candidate for U.S. Senate from Alabama.
MONTGOMERY, Ala. /PRNewswire-USNewswire/ — Montgomery businessman and physician, Dr. Randy Brinson, candidate for the U.S. Senate seat previously held by U.S. Attorney General Jeff Sessions, spoke yesterday at Alabama Republican Party Headquarters. Brinson outlined his plans to fight corruption, repeal and replace Obamacare, protect the Constitution, end Common Core, grow the economy, create jobs, and promote common-sense Alabama values in Washington, D.C.
Brinson touched on Alabama’s multiple recent political scandals, saying, “The people of Alabama deserve better” than “a shady appointment which put a permanent Alabama politician into a vacant Senate seat, or a current Congressman who keeps making incendiary comments. Both of these characters are career long politicians who currently swim in the swamp.”
A practicing physician, Brinson called Obamacare “a huge overreach of federal power that puts government bureaucracy between you and your doctor,” and supports repeal and replacement of the ACA.
Brinson has a history of involvement in Christian values-based political action, including founding Redeem The Vote in 2003. He emphasized his support for the 1st Amendment, saying “When government can restrict our faith, there is nothing that they cannot restrict.”
An avid hunter, Brinson said, “I understand the need to protect our right to keep and bear arms,” and vowed to fight any attempt to erode that right.
Brinson vowed to end Common Core “because it’s an attempt to instill politically correct ideology, contrary to our values and beliefs.” He proposed a shift in emphasis to trade internships and business partnerships in education to help more students prepare for jobs in the real world.
An Air Force veteran, Brinson supports a strong national defense strategy, as well as support for law enforcement, firefighters and first responders. “We must see to it that they have the equipment, the training and the resources to continue to protect us.”
Brinson touted his experience creating Alabama jobs, saying, “We need more good jobs in this country, and trade is one of the best ways to create those good jobs. Fair trade benefits all of us, but it should be Fair, both ways, so I’ll fight against any trade deals that are unfair.”
Brinson closed by saying, “It takes character, core convictions, and competency to make a difference for the people of Alabama.”
http://drrichswier.com/wp-content/uploads/brinson-sharing-e1495011921605.jpg336640Dr. Rich Swierhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Rich Swier2017-05-17 05:06:332017-05-17 05:11:53Former Christian Coalition President Enters U.S. Senate Race Against Career Politicians
Kára Deidra McCullough, born on September 9, 1991, is a physical scientist at the Nuclear Regulatory Commission. On May 14, 2017, she represented District of Columbia at Miss USA 2017 and was crowned Miss USA 2017.
Kára was born in Naples, Italy to Betty Ann Parker and Artensel E. McCullough Sr. Her father was a member of the United States Marine Corps, and she thus lived in various places such as Sicily, South Korea, Japan, and Hawaii. Kára was later raised in Virginia Beach, Virginia. McCullough attended South Carolina State University, where she graduated with a Bachelor of Science degree in chemistry with a concentration in radio-chemistry and served as the school’s 75th Miss South Carolina State University. While a student, Kára was a member of the American Chemical Society, the Health Physics Society, and the American Nuclear Society. She has been inducted into the Golden Key International Honour Society and the National Society of Black Engineers.
Kára works as an emergency preparedness specialist in the Nuclear Regulatory Commission’s Office of Nuclear Security and Incident Response.
You would think that women and men across America would be celebrating this special woman. But you would be wrong.
The feminists and those who hate America, hate Miss USA Kára Deidra McCullough. Why?
Kara McCullough, of the District of Columbia, was asked during Sunday night’s pageant whether she thinks that affordable health care for all U.S. citizens is a right or a privilege. She said it is a privilege.
“As a government employee, I’m granted health care and I see firsthand that for one to have health care, you need to have jobs,” the 25-year-old shared.
Later in the competition, she also was asked what she considers feminism to be and whether she considers herself a feminist. McCullough said she likes to “transpose” the word feminism to “equalism.”
The U.S. Nuclear Regulatory Commission scientist’s answers did not sit well with some viewers, who took to social media to slam her remarks.
An accomplished woman who is articulate, beautiful, has strong beliefs about serving the nation and feels healthcare is a privilege is now demonized. Do you see a pattern here? If you are successful you are the enemy of the state. If you believe government is the problem and not the solution then you are an enemy of the state. Even if you work for the government and express your views you are an enemy of the state.
It finally struck me why. For this crowd [the center-left], all their hopes and dreams are bound up with particular political processes, outcomes, and institutions. The state is their favorite tool for all the good they aspire to do in this world. It must be protected, guarded, defended, celebrated. The illusion that the government is not a taker but a giver and the source of all good things must be maintained. The gloss of the democratic process must be constantly refurbished so that the essential sanctity of the public sector can be constantly cited as the highest calling.
The center-left has at least one hundred years of work and resources invested in the state’s health, well being, reputation, and exalted moral status. Nothing must be allowed to threaten it or take it down a peg or two. Any failures must be deemed as temporary setbacks. The slightest sign of some success must be trumpeted constantly. The population must be subjected to unrelenting homilies on the essential holiness of the public sector.Their education told them this. Their degrees and ruling-class pedigree were hard earned. This is what has inspired them. They believe so strongly that they can make the world a better place through the managerial state that it has become their religion. It’s their very core!
If you are against the state then you are an enemy of the state. The center-left has declared Kára Deidra McCullough an enemy of the state.
http://drrichswier.com/wp-content/uploads/Kára-Deidra-McCullough-e1494927823220.jpg416639Dr. Rich Swierhttp://drrich.wpengine.com/wp-content/uploads/logo_264x69.pngDr. Rich Swier2017-05-16 05:59:412017-05-16 06:00:40Meet Kára Deidra McCullough, Miss USA -- Daughter of a Marine, Scientist, Engineer, American Woman