The pain clinic tucked into the corner of a low-slung suburban strip mall was an open secret.
At least one of Zielke’s patients died of an overdose, and prosecutors say others became so dependent on oxycodone and other opioids they would crowd his office, sometimes sleeping in the waiting room. Some peddled their pills near tumble-down storefronts and on blighted street corners in addiction-plagued parts of Allegheny County, where deaths by drug overdose reached record levels last year.
But Robert Cessar, a longtime federal prosecutor, was unaware of Zielke until Justice Department officials handed him a binder of data that, he said, confirmed what pill-seekers from as far away as Ohio and Virginia already knew. The doctor who offered ozone therapy and herbal pain remedies was also prescribing highly addictive narcotics to patients who didn’t need them, according to an indictment charging him with conspiracy and unlawfully distributing controlled substances.
His indictment in October was the first by a nationwide group of federal law enforcement officials that, armed with new access to a broader array of prescription drug databases, Medicaid and Medicare figures, coroners’ records and other numbers compiled by the Justice Department, aims to stop fraudulent doctors faster than before.
The department is providing a trove of data to the Opioid Fraud and Abuse Detection Unit, which draws together authorities in 12 regions across the country, that shows which doctors are prescribing the most, how far patients will travel to see them and whether any have died within 60 days of receiving one of their prescriptions, among other information.
Authorities have been going after so-called “pill mills” for years, but the new approach brings additional federal resources to bear against the escalating epidemic. Where prosecutors would spend months or longer building a case by relying on erratic informants and only limited data, the number-crunching by analysts in Washington provides information they say lets them quickly zero in on a region’s top opioid prescribers.
“This data shines a light we’ve never had before,” Cessar said. “We don’t need to have confidential informants on the street to start a case. Now, we have someone behind a computer screen who is helping us. That has to put (doctors) on notice that we have new tools.”
And Rod Rosenstein, deputy attorney general, told AP the Justice Department will consider going after any law-breaker, even a pharmaceutical company, as it seeks to bring more cases and reduce the number of unwarranted prescriptions.
Attorney General Jeff Sessions has been in lock-step with President Donald Trump about the need to combat the drug abuse problem that claimed more than 64,000 lives in 2016, a priority that resonates with Trump’s working-class supporters who have seen the ravages of drug abuse first-hand. The president called it a public health emergency, a declaration that allows the government to redirect resources in various ways to fight opioid abuse.
But he directed no new federal money to deal with a scourge that kills nearly 100 people a day, and critics say his efforts fall short of what is needed. The Republican-controlled Congress doesn’t seem eager to put extra money toward the problem.
While the effectiveness of the Trump administration’s broader strategy remains to be seen, the Justice Department’s data-driven effort is one small area where federal prosecutors say they can have an impact.
The data analysis provides clues about who may be breaking the law that are then corroborated with old-fashioned detective work — tips from informants or undercover office visits, said Shawn A. Brokos, a supervisory special agent in the FBI’s Pittsburgh division. Investigators can also get a sense for where displaced patients will turn next.
Authorities acknowledge there are legitimate reasons for some doctors to prescribe large quantities of opioids, and high prescribing alone doesn’t necessarily trigger extra scrutiny. What raises red flags for investigators are the dentists, psychiatrists and gynecologists who are prescribing at surprisingly high rates.
The effort operates on the long-held perception that drug addiction often starts with prescriptions from doctors and leads to abuse of more dangerous black market drugs like fentanyl, which, for the first time last year, contributed to more overdose deaths than any other legal or illegal drug, surpassing pain pills and heroin.
But that focus can cause law-abiding physicians to abandon disabled patients who rely on prescriptions, for fear of being shut down, said University of Alabama addiction researcher Stefan Kertesz. Those patients will turn to harder street drugs or even kill themselves, he said.
“The professional risk for physicians is so high that the natural tendency is to get out of the business of prescription opioids at all,” he said.
Another addiction expert, Dr. Andrew Kolodny, founder of Physicians for Responsible Opioid Prescribing, said prosecutors’ emphasis on “drug-dealing doctors” is appropriate but inadequate on its own.
“It’s just not really going to have that much of an impact on an epidemic,” he said. The bigger change will come from a stronger push for prevention and treatment, he said. And, he added, “They should go after the bigger fish…. the legal narcotics distributors and wholesalers who have literally been getting away with mass manslaughter.”
Investigators said Zielke charged $250 a visit and made patients pay in cash. But Zielke said prosecutors unfairly targeted him. Instead of more prosecutions, he said, the government “should promote more alternative therapies,” he said. “And they should find out why so many people have pain.”
A second indictment by the anti-fraud unit involved a cardiologist in Elko, Nevada, accused of routinely providing patients fentanyl and other painkillers they did not need. Justice officials hope to expand the data-driven work nationwide.
Will it work? As Soo Song, who watched addiction warp communities while serving as acting U.S. attorney in western Pennyslvania, put it: “The best measure of success will be if fewer people die.”
Fake news evolved from seedy internet sideshow to serious electoral threat so quickly that behavioral scientists had little time to answer basic questions about it, like who was reading what, how much real news they also consumed and whether targeted fact-checking efforts ever hit a target.
Sure, surveys abound, asking people what they remember reading. But these are only as precise as the respondents’ shifty recollections and subject to a malleable definition of “fake.” The term “fake news” itself has evolved into an all-purpose smear, used by politicians and the president to deride journalism they don’t like.
But now the first hard data on fake-news consumption has arrived. Researchers last week posted an analysis of the browsing histories of thousands of adults during the run-up to the 2016 election — a real-time picture of who viewed which fake stories, and what real news those people were seeing at the same time.
The reach of fake news was wide indeed, the study found, yet also shallow. One in four Americans saw at least one false story, but even the most eager fake-news readers — deeply conservative supporters of President Trump — consumed far more of the real kind, from newspaper and network websites and other digital sources.
While the research can’t settle the question of whether misinformation was pivotal in the 2016 election, the findings give the public and researchers the first solid guide to asking how its influence may have played out. That question will become increasingly important as online giants like Facebook and Google turn to shielding their users from influence by Russian operatives and other online malefactors.
“There’s been a lot of speculation about the effect of fake news and a lot of numbers thrown around out of context, which get people exercised,” said Duncan Watts, a research scientist at Microsoft who has argued that misinformation had a negligible effect on the election results. “What’s nice about this paper is that it focuses on the actual consumers themselves.”
In the new study, a trio of political scientists — Brendan Nyhan of Dartmouth College (a regular contributor to The Times’s Upshot), Andrew Guess of Princeton University and Jason Reifler of the University of Exeter — analyzed web traffic data gathered from a representative sample of 2,525 Americans who consented to have their online activity monitored anonymously by the survey and analytic firm YouGov.
The data included website visits made in the weeks before and after the 2016 election, and a measure of political partisanship based on overall browsing habits. (The vast majority of participants favored Mr. Trump or Hillary Clinton.)
The team defined a visited website as fake news if it posted at least two demonstrably false stories, as defined by economists Hunt Allcott and Matthew Gentzkow in research published last year. On 289 such sites, about 80 percent of bogus articles supported Mr. Trump.
The online behavior of the participants was expected in some ways, but surprising in others. Consumption broke down along partisan lines: the most conservative 10 percent of the sample accounted for about 65 percent of visits to fake news sites.
Pro-Trump users were about three times more likely to visit fake news sites supporting their candidate than Clinton partisans were to visit bogus sites promoting her.
Still, false stories were a small fraction of the participants’ overall news diet, regardless of political preference: just 1 percent among Clinton supporters, and 6 percent among those pulling for Mr. Trump. Even conservative partisans viewed just five fake news articles, on average, over more than five weeks.
There was no way to determine from the data how much, or whether, people believed what they saw on these sites. But many of these were patently absurd, like one accusing Mrs. Clinton of a “Sudden Move of $1.8 Billion to Qatar Central Bank,” or a piece headlined “Video Showing Bill Clinton With a 13-Year-Old Plunges Race Into Chaos.”
“For all the hype about fake news, it’s important to recognize that it reached only a subset of Americans, and most of the ones it was reaching already were intense partisans,” Dr. Nyhan said.
“They were also voracious consumers of hard news,” he added. “These are people intensely engaged in politics who follow it closely.”
Given the ratio of truth to fiction, Dr. Watts said, fake news paled in influence beside mainstream news coverage, particularly stories about Mrs. Clinton and her use of a private email server as secretary of state. Coverage of that topic appeared repeatedly and prominently in venues like The New York Times and the Washington Post.
The new study does not rule out the possibility that fake news affected the elections, said David Rand, an associate professor of psychology, economics and management at Yale University.
Americans over age 60 were much more likely to visit a fake news site than younger people, the new study found. Perhaps confusingly, moderately left-leaning people viewed more pro-Trump fake news than they did pro-Clinton fake news.
One interpretation of that finding, Dr. Rand said, may be that older, less educated voters who switched from Obama in 2012 to Trump in 2016 were particularly susceptible to fake news.
“You can see where this might have had an impact in some of those close swing states, like Wisconsin,” Dr. Rand said. “But this of course is a matter of conjecture, reasoning backward from the findings.”
The study found that Facebook was by far the platform through which people most often navigated to a fake news site. Last year, in response to criticism, the company began flagging stories on its site that third-party fact-checkers found to make false claims with a red label saying “disputed.”
Most people in the new study encountered at least some of these labels, but “we saw no instances of people reading a fake news article and a fact-check of that specific article,” Dr. Nyhan said. “The fact-checking websites have a targeting problem.”
In December, Facebook announced a change to its monitoring approach. Instead of labeling false stories, Facebook will surface the fact-checks along with the fake story in the user’s news feed.
Elon Musk is right: silly and fun things are important. But some of them are an indefensible waste of resources
On Wednesday, two things happened. In Syria, 80 people were killed by government airstrikes. Meanwhile in Florida, Elon Musk fired a sports car into space. Guess which story has dominated mainstream news sites?
The much-anticipated launch of Musk’s Falcon Heavy rocket, the most powerful every launched by a private company, went off without a hitch. Musk successfully sent his cherry-red Tesla roadster hurtling toward Mars, launching what a CNN commentator called “a new space age”.
Musk expects the rocket and car to orbit the sun for hundreds of millions of years, though some experts have speculated that it will disintegrate within a year. The event attracted phenomenal publicity: at one point, 2.3 million viewers were watching the event’s livestream, making the rocket launch a masterstroke of advertising for Tesla.
Meanwhile, in Syria, where hundreds of thousands of refugees may be forced to return to unsafe homes amid “global anti-refugee backlash”, an anti-government activist said despondently that he is no longer sure why he bothers to videotape the effects of bombing, since nobody ever pays attention: “I don’t know what the point is.” The UN human rights coordinator for Syria pondered what level of violence it would take to make the world care, saying that they are “running out of words” with which to try to describe the crisis.
There is, perhaps, no better way to appreciate the tragedy of 21st-century global inequality than by watching a billionaire spend $90m launching a $100,000 car into the far reaches of the solar system.
Musk said he wants to participate in a space race because “races are exciting” and that while strapping his car to a rocket may be “silly and fun … silly and fun things are important.” Thus, anyone who mentions the colossal waste the project involves, or the various social uses to which these resources could be put, can be dismissed as a killjoy.
But one doesn’t have to hate fun to question the justification for pursuing a costly new space race at exactly this moment. If we examine the situation honestly, and get past our natural (and accurate) feeling that rockets are really cool, it becomes hard to defend a project like this.
A mission to Mars does indeed sound exciting, but it’s important to have our priorities straight. First, perhaps we could make it so that a child no longer dies of malaria every two minutes. Or we could try to address the level of poverty in Alabama that has become so extreme the UN investigator did not believe it could still occur in a first-world country. Perhaps once violence, poverty and disease are solved, then we can head for the stars.
Many might think that what Elon Musk chooses to do with his billions is Elon Musk’s business alone. If he wanted to spend all his money on medicine for children, that would be nice, but if he’d like to spend it making big explosions and sending his convertible on a million-mile space voyage, that’s his prerogative.
But Musk is only rich enough to afford these indulgent pet projects because we have allowed gross social inequalities to arise in the first place. If wealth were actually distributed fairly in this country, nobody would be in a position to fund his own private space program.
Yet even on the theory that there’s no moral problem with frittering away hundreds of millions of dollars, and inequality is fine, there’s another reason we are permitted to care about what Musk does. A great deal of his fortune is not actually his own: it’s ours.
Musk’s empire is fueled by billions of dollars in government subsidies. The Los Angeles Times revealed in 2015 that Musk’s companies benefit from “grants, tax breaks, factory construction, discounted loans and environmental credits”, plus the tax credits and rebates that are granted to consumers for buying his products.
The average household income of a Tesla purchaser is in the multiple hundreds of thousands, yet the federal government pays people $7,500 to buy them through tax credits, and many states offer their own cash handouts. Because we’re all giving Elon Musk money, what he chooses to do with that money is very much our business.
Elon Musk is right: silly and fun things are important. But some of them are an indefensible waste of resources. While there are still humanitarian crises such as that in Syria, nobody can justify vast spending on rocketry experiments. That point was made plain in 1970 by poet Gil Scott-Heron, in his record Whitey On The Moon, which criticized the US for spending millions to send men on a pointless moon adventure while the country’s inner cities languished:
“I can’t pay no doctor bills
But whitey’s on the moon
Ten years from now I’ll be payin’ still
While whitey’s on the moon.”
Whitey may not have gone back to the moon recently. But his sports car is now in space.
- Nathan Robinson is the editor of Current Affairs