npr--2020-01-13--Sprawling Homeless Camps — Modern 'Hoovervilles' — Vex California

Charles Gibson pushes a shopping cart towards his soggy tent on a tenuous patch of a grassy drainage ditch along a bike trail in Santa Rosa , Calif .
He 's one of nearly 200 people living in a sprawling camp here that has sprung up along a popular recreation corridor .
It 's a community , Gibson says , that often feels caught between opposing forces who are n't always listening .
`` I mean , they [ local officials ] want us to be able to govern ourselves , but they are not giving us the tools we @ @ @ @ @ @ @ They do n't want you hiding , but they do n't want you in their face , you know ? ''
Across California and other parts of the country , these growing homeless encampments evoke shantytown `` Hoovervilles , '' where hundreds of thousands of destitute Americans lived during the Great Depression .
The encampments are frustrating residents , raising health and safety fears and fueling a debate over poverty and inequality in one of the nation 's wealthiest states .
The fight over the encampment in Santa Rosa in Northern California 's @ @ @ @ @ @ @ a lasting solution to the growing crisis .
Amid a growing chorus of outrage at filthy , unsanitary conditions and the presence of rats and used drug needles , the camp has divided locals and even prompted an effort to recall a local politician .
`` I never thought that I would drive past a mile-long shantytown on my way to work .
And yet , that 's the reality that we 're facing right now in Sonoma County , '' says county supervisor Lynda Hopkins , whose district includes the encampment .
@ @ @ @ @ @ @ and pallet `` homes '' have filled a stretch of the paved bike trail that sides right next to highway 12 , a major commuter artery into Santa Rosa , the county seat .
`` It 's incredibly challenging , '' Hopkins says , noting she gets scores of emails each day from frustrated , alarmed and angry constituents .
`` I also get emails of people who are just heartbroken at seeing the level of suffering — people freezing cold , living in a tent in the rain with no access to @ @ @ @ @ @ @ . ''
While homelessness is a hard-to-fix national problem , it is particularly severe in California .
The state 's homeless population jumped 16 % in the last year .
California has the highest number of tent cities , according to a report by the National Law Center On Homelessness & Poverty .
And according to a new report by the Department of Housing and Urban Development , California 's homeless population accounts for 53 % of all unsheltered people in the country .
Overall , the state has more than 150,000 people @ @ @ @ @ @ @ .
Given the growing crisis , the state 's governor , Gavin Newsom , recently proposed more than $ 1.4 billion in his new budget for expanded state and local efforts on immediate housing and services .
Some $ 750 million of that would be placed in a special fund to pay the rent of people facing homelessness and to jump-start the construction of more affordable housing .
The first-term Democrat has also ordered state agencies to do more to help find temporary sites — including decommissioned hospitals or unused land — for @ @ @ @ @ @ @ Across the state , residents are demanding robust coordinated action on what has now become a public health crisis .
There are rising concerns about health and safety problems inside the encampments , including disease , open drug use , violence , crime and fire risks .
In Los Angeles county alone , the death rate for homeless has risen steadily for years and in 2018 topped 1,000 — about three deaths a day .
Wiry , frenzied and with a ready smile through some missing teeth , Gibson says he prefers the @ @ @ @ @ @ @ , they call me cowboy , '' Gibson says , `` I always 'cowboy up ' for other people because I take care of others when I have nothing and stretch myself thin .
It 's very hard , '' he says of life among broken pallets and ripped tarps .
`` It 's a struggle for anybody to keep warm and keep your heart and head light and strong .
I 'm doing the best I can . ''
Gibson , who has lived here for nearly a year , says the @ @ @ @ @ @ @ .
People watch out for each other .
But he concedes the camp has serious problems with garbage , vermin , inadequate toilets and some drug use .
County and city agencies have tried to offer some services , including adding portable toilets and trash control .
But camp residents say it 's not enough .
`` If you do n't have someone taking out the trash , it 's gon na pile up , '' Gibson says .
`` Some people are elderly and ca n't really do a lot on their @ @ @ @ @ @ @ are very inexperienced with life .
I try to a be a guiding light . ''
At a nearby tent , an older woman pops her head out shouting obscenities at no one in particular .
`` People need to open up their eyes and realize they could end up like this , '' Gibson says .
`` A lot of people are one [ pay ] check away .
Show some humanity . ''
Soon a pick-up truck pulls up with donations .
Time to `` cowboy up , '' Gibson says @ @ @ @ @ @ @ used warm clothes from a local resident .
`` I drive by every morning and today I was just heartbroken , '' says commuter Vania Supulveda .
`` My daughter complains , 'Oh it 's so cold out today ' when we see this .
And we go back home to a nice warm home .
It 's depressing .
I grew up in Brazil , in a Third World country , and I 've never seen something like this so close to me , '' Supulveda says .
`` It just showcases @ @ @ @ @ @ @ to meaningfully have a safety net for human beings , '' says Hopkins , the county supervisor .
`` There 's just no room for error now , there 's no safety net . ''
Hopkins has helped lead efforts to find solutions for the camp , including the allocation of nearly $ 12 million in emergency funds and standing up an emergency operations center to better coordinate response to a complex problem with no easy fixes .
Still , the first-term politician is facing blowback over the camp .
A handful of @ @ @ @ @ @ @ recall her , even though she already faces an election in March .
Their petition accuses Hopkins of failing to act — `` her watch , her failure '' — and calls the homeless encampment - a `` public cesspool '' that 's undermining businesses , homes and quality of life .
The problem cuts across complex issues , including rising housing costs and skyrocketing rents , stagnant wages , poverty , addiction and mental health treatment .
Complicating attempts to find a solution in Sonoma is a local injunction that says the @ @ @ @ @ @ @ way out of the crisis .
A federal court ruling carries even more weight .
The federal 9th Circuit has ruled that homeless people essentially have a Constitutional right to camp on public property if local governments ca n't provide enough shelter beds and services .
The U.S. Supreme Court declined to hear an appeal in that case .
Those are services Hopkins says the county simply ca n't afford now on its own .
`` How can we provide alternatives when we do n't have enough money from the state or federal @ @ @ @ @ @ @ services , to actually provide adequate housing and shelter for these human beings ? ''
she asks .
President Trump has repeatedly criticized the state response to its homeless crisis , painting it as a result of failed Democratic leadership .
He has threatened federal intervention .
`` It 's a shame .
The world is looking at it , '' Trump said in September .
Hopkins and other politicians are promising to relocate the camp within weeks – most likely to a parking lot area near the airport while they design a @ @ @ @ @ @ @ concede that a lasting fix could take at least two years .
In the meantime , a new group of concerned citizens says that 's simply unacceptable .
They 're asking : if the community can pull together during a wildfire crisis , why not a homeless crisis ?
`` We know how to do this ; we know how to take care of people .
We 've just seen it recently with the Kincade fire , '' says artist and engineer Marcos Ramirez , one of the founders of the Squeaky Wheel @ @ @ @ @ @ @ group that is trying to break the familiar pattern of political outrage , hand wringing , wrangling and inaction .
`` If we can organize shelter support , huge amounts of response , emergency services , and these kinds of things , '' Ramirez says of the wildfires where thousands were temporarily displaced , `` there 's no reason why we ca n't do this for our unhoused neighbors .
It 's the middle of winter and things are only getting colder .
There 's no excuse for this . ''
The coalition @ @ @ @ @ @ @ retrofit an unused section of Sonoma County 's fairgrounds into a more permanent camp with onsite support , counseling and job services .
One key , coalition members say , has been spending time at the encampment to better understand the community living there .
`` A friend of mind said , 'You do n't know what 's going on down there . '
And I said , 'You 're right , ' '' Ramirez says .
`` And so I went down .
And so we 've spent months down there on @ @ @ @ @ @ @ our neighbors .
It should seem like a no brainer that you would need to go talk to the people and ask them what they would like . ''
These concerned bicyclists for social change hope their ideas gain more traction .
And they hope to inspire the formation of more `` squeaky wheel coalitions '' in cities across California – and other states - facing the same kind of homeless camp crisis .
`` I do n't like to use the term that we are trying to humanize these people because they @ @ @ @ @ @ @ to humanize them , '' says another Squeaky Wheel activist , Miles Sarvis-Wilburn .
`` And yet , we 're in a position where that kind of feels like what we have to do now , '' he says .
`` It seems like that should be more normalized . ''

Sprawling Homeless Camps — Modern 'Hoovervilles' — Vex California
Enlarge this image toggle caption Eric Westervelt/NPR Eric Westervelt/NPR
Charles Gibson pushes a shopping cart toward his soggy tent on a tenuous patch of a grassy drainage ditch along a bike trail in Santa Rosa, Calif. He's one of nearly 200 people living in a sprawling camp here that has sprung up along a popular recreation corridor. It's a community, Gibson says, that often feels caught between opposing forces who aren't always listening.
"I mean, they [local officials] want us to be able to govern ourselves, but they are not giving us the tools we need," Gibson says. "They don't want you hiding, but they don't want you in their face, you know?"
Across California and other parts of the country, these growing homeless encampments evoke shantytown "Hoovervilles," where hundreds of thousands of destitute Americans lived during the Great Depression. The encampments are frustrating residents, raising health and safety fears and fueling a debate over poverty and inequality in one of the nation's wealthiest states.
The fight over the encampment in Santa Rosa in Northern California's Sonoma County underscores the challenges of finding a lasting solution to the growing crisis. Amid a growing chorus of outrage at filthy, unsanitary conditions and the presence of rats and used drug needles, the camp has divided locals and even prompted an effort to recall a local politician.
"I never thought that I would drive past a mile-long shantytown on my way to work. And yet, that's the reality that we're facing right now in Sonoma County," says County Supervisor Lynda Hopkins, whose district includes the encampment.
For months, makeshift tarp, tent and pallet "homes" have filled a stretch of the paved bike trail that sides right next to Highway 12, a major commuter artery into Santa Rosa, the county seat.
"It's incredibly challenging," Hopkins says, noting she gets scores of emails each day from frustrated, alarmed and angry constituents. "I also get emails of people who are just heartbroken at seeing the level of suffering — people freezing cold, living in a tent in the rain with no access to running water or electricity or sewer services."
While homelessness is a hard-to-fix national problem, it is particularly severe in California. The state's homeless population jumped 16% in the past year. California has the highest number of tent cities, according to a report by the National Law Center On Homelessness & Poverty. And according to a new report by the Department of Housing and Urban Development, California's homeless population accounts for 53% of all unsheltered people in the country. Overall, the state has more than 150,000 people experiencing homelessness, according to the report.
Given the growing crisis, the state's governor, Gavin Newsom, recently proposed more than $1.4 billion in his new budget for expanded state and local efforts on immediate housing and services. Some $750 million of that would be placed in a special fund to pay the rent of people facing homelessness and to jump-start the construction of more affordable housing. The first-term Democrat has also ordered state agencies to do more to help find temporary sites — including decommissioned hospitals or unused land — for the state's expanding homeless encampments.
Across the state, residents are demanding robust coordinated action on what has now become a public health crisis. There are rising concerns about health and safety problems inside the encampments, including disease, open drug use, violence, crime and fire risks. In Los Angeles County alone, the death rate for homeless people has risen steadily for years and in 2018 topped 1,000 — about three deaths a day.
Living on the trail
Enlarge this image toggle caption Eric Westervelt/NPR Eric Westervelt/NPR
Wiry, frenzied and with a ready smile through some missing teeth, Gibson says he prefers the nickname "Cowboy."
"Well, they call me Cowboy," Gibson says, "I always 'cowboy up' for other people because I take care of others when I have nothing and stretch myself thin. It's very hard," he says of life among broken pallets and ripped tarps. "It's a struggle for anybody to keep warm and keep your heart and head light and strong. I'm doing the best I can."
Gibson, who has lived here for nearly a year, says the camp has a haphazard sense of community. People watch out for each other. But he concedes the camp has serious problems with garbage, vermin, inadequate toilets and some drug use.
County and city agencies have tried to offer some services, including adding portable toilets and trash control. But camp residents say it's not enough.
"If you don't have someone taking out the trash, it's gonna pile up," Gibson says. "Some people are elderly and can't really do a lot on their own. Some are young people that are very inexperienced with life. I try to be a guiding light."
At a nearby tent, an older woman pops her head out shouting obscenities at no one in particular.
"People need to open up their eyes and realize they could end up like this," Gibson says. "A lot of people are one [pay]check away. Show some humanity."
National Trump Continues Criticism Of Democrats On Homelessness, But Hasn't Intervened Trump Continues Criticism Of Democrats On Homelessness, But Hasn't Intervened Listen · 4:13 4:13
Soon a pickup truck pulls up with donations. Time to "cowboy up," Gibson says, as he moves to help unload used warm clothes from a local resident.
"I drive by every morning and today I was just heartbroken," says commuter Vania Supulveda. "My daughter complains, 'Oh it's so cold out today' when we see this. And we go back home to a nice warm home. It's depressing. I grew up in Brazil, in a Third World country, and I've never seen something like this so close to me," Supulveda says.
Public backlash in Sonoma County
"It just showcases the failure of government at all levels to meaningfully have a safety net for human beings," says Hopkins, the county supervisor. "There's just no room for error now, there's no safety net."
Hopkins has helped lead efforts to find solutions for the camp, including the allocation of nearly $12 million in emergency funds and standing up an emergency operations center to better coordinate response to a complex problem with no easy fixes.
Still, the first-term politician is facing blowback over the camp. A handful of angry constituents has started an effort to recall her, even though she already faces an election in March. Their petition accuses Hopkins of failing to act — "her watch, her failure" — and calls the homeless encampment a "public cesspool" that's undermining businesses, homes and quality of life.
The problem cuts across complex issues, including rising housing costs and skyrocketing rents, stagnant wages, poverty, addiction and mental health treatment.
Complicating attempts to find a solution in Sonoma is a local injunction that says the county can't arrest or fine its way out of the crisis.
National Court Ruling Limits What Cities In Western U.S. Can Do To Address Homelessness Court Ruling Limits What Cities In Western U.S. Can Do To Address Homelessness Listen · 2:40 2:40
A federal court ruling carries even more weight. The federal 9th Circuit has ruled that homeless people essentially have a constitutional right to camp on public property if local governments can't provide enough shelter beds and services. The U.S. Supreme Court declined to hear an appeal in that case.
Those are services Hopkins says the county simply can't afford now on its own.
"How can we provide alternatives when we don't have enough money from the state or federal government to actually provide adequate mental health services, to actually provide adequate housing and shelter for these human beings?" she asks.
President Trump has repeatedly criticized the state response to its homeless crisis, painting it as a result of failed Democratic leadership. He has threatened federal intervention. "It's a shame. The world is looking at it," Trump said in September.
Hopkins and other politicians are promising to relocate the camp within weeks — most likely to a parking lot area near the airport while they design a more permanent housing strategy.
But they concede that a lasting fix could take at least two years.
Volunteers begin to organize
In the meantime, a new group of concerned citizens says that's simply unacceptable. They're asking: If the community can pull together during a wildfire crisis, why not a homeless crisis?
"We know how to do this; we know how to take care of people. We've just seen it recently with the Kincade Fire," says artist and engineer Marcos Ramirez, one of the founders of the Squeaky Wheel Bicycle Coalition. It's a volunteer group that is trying to break the familiar pattern of political outrage, hand-wringing, wrangling and inaction.
"If we can organize shelter support, huge amounts of response, emergency services, and these kinds of things," Ramirez says of the wildfires where thousands were temporarily displaced, "there's no reason why we can't do this for our unhoused neighbors. It's the middle of winter and things are only getting colder. There's no excuse for this."
The coalition has drawn up a detailed proposal to retrofit an unused section of Sonoma County's fairgrounds into a more permanent camp with onsite support, counseling and job services.
One key, coalition members say, has been spending time at the encampment to better understand the community living there.
"A friend of mind said, 'You don't know what's going on down there.' And I said, 'You're right,' " Ramirez says. "And so I went down. And so we've spent months down there on the trail and actually getting to know our neighbors. It should seem like a no-brainer that you would need to go talk to the people and ask them what they would like."
These concerned bicyclists for social change hope their ideas gain more traction. And they hope to inspire the formation of more "squeaky wheel coalitions" in cities across California — and other states — facing the same kind of homeless camp crisis.
"I don't like to use the term that we are trying to humanize these people because they're people and we shouldn't have to humanize them," says another Squeaky Wheel activist, Miles Sarvis-Wilburn.
"And yet, we're in a position where that kind of feels like what we have to do now," he says. "It seems like that should be more normalized."


npr--2020-01-13--The Kratom Debate: Helpful Herb Or Dangerous Drug?

Americans know the dangers of drugs such as morphine and heroin .
But what about a supplement that acts in the brain a bit like an opiate and is available in many places to kids — even from vending machines .
Kratom , an herb that 's abundant , legal in most states and potentially dangerous , is the subject of an ongoing debate over its risks and benefits .
Usually , the leaf , which comes from a tropical Southeast Asian tree , is chewed , brewed or crushed into a bitter green powder .
The chemicals in the @ @ @ @ @ @ @ in the brain — some that respond to opioids , and others to stimulants .
Often sold in the U.S. in a processed form — as pills , capsules or extracts — a small amount of kratom can perk you up , while a large dose has a sedative effect .
Some people who have struggled with an opioid addiction and switched to kratom swear the substance salvaged their health , livelihood and relationships .
But the federal Food and Drug Administration and the Drug Enforcement Administration worry that kratom carries the risk @ @ @ @ @ @ @ in some people , addiction .
The FDA warns consumers not to use kratom , and the DEA threatened to prohibit kratom 's sale and use in the U.S. ( outside of research ) in 2016 ; advocates and lawmakers subsequently pushed back , and the stricter scheduling of kratom that would have prompted that sort of ban never occurred .
These days , the DEA lists it as a drug of concern .
Linda Kline , 33 , based in Reno , Nev. , sells kratom for a living .
She says @ @ @ @ @ @ @ given her a new purpose in life .
And while she herself does n't have an opioid dependency , she credits kratom with turning around her mental health .
`` I went from feeling desperate and hopeless to finding an alternative where I had full control over how I felt , '' she says .
She used to be paralyzed by anxiety and panic attacks .
When her insurance carrier threatened to cut her Prozac prescription , she felt desperate .
A friend suggested kratom , so she picked some up at a @ @ @ @ @ @ @ like you 're having just a little glass of wine , '' Kline says .
`` It 's really relaxing .
There 's no melting of the walls . ''
The new habit cost about $ 6 a day — less than a glass of wine or fancy cup of coffee .
But Kline says she could n't always find a high-quality supply .
The FDA has recalled dozens of salmonella-tainted products sold online or in convenience stores .
The agency has also found toxic heavy metals in kratom supplements .
That 's @ @ @ @ @ @ @ boutiques , Bumble Bee Botanicals , devoted exclusively to kratom products that , she says , are all lab tested to ensure purity .
She just opened her fifth location in less than two years .
The shops offer 15 kratom strains at outlets in California , Idaho and Nevada .
Though Kline 's website has a disclaimer that her products have not been evaluated by the FDA and `` are not intended to cure , treat or prevent any disease/illness , '' some of her clients ' online Yelp reviews claim kratom @ @ @ @ @ @ @ insomnia , restless legs syndrome and more .
`` My brother believed the marketing of kratom — that it was a natural herbal supplement that could provide you with the same benefits of an opioid without the risks , '' Mateo says .
Mateo 's younger brother , Marco , struggled with an opioid addiction in high school .
Mateo describes Marco as a charismatic , creative teen , passionate about video games , cartoons and anime .
Marco got hooked on painkillers , Mateo says , after his dentist pulled his wisdom @ @ @ @ @ @ @ in a way that was n't just for treating pain , '' Mateo says .
Email receipts show Marco used bitcoin to also buy Vicodin and fentanyl on the dark web .
Eventually Marco wanted to kick his opioid addiction and saw testimonials on YouTube and Reddit that promised that kratom could be a way out .
Soon Marco was popping kratom capsules multiple times a day .
During his freshman year at the University of California , Davis , the 19-year-old started hyperventilating regularly .
The incidents worsened , becoming seizure-like episodes @ @ @ @ @ @ @ room .
During each hospitalization , the doctors were stumped .
No one thought to test for kratom .
Marco died in his UC Davis dorm in February 2018 , late on a Sunday night .
The toxicology report listed `` acute mitragynine intoxication '' — a chemical constituent of kratom — as the cause of death .
`` I think kratom needs to come with a much more serious caution that it is not harmless , '' Mateo says .
`` I 'm very heartbroken . ''
In a recent 18-month period @ @ @ @ @ @ @ and Prevention reported 90 kratom overdoses , although most involved a combination of other substances too .
`` The data to support either the benefits or the harms for kratom is really , really poor , '' says C. Michael White , head of the Department of Pharmacy Practice at the University of Connecticut .
`` A lot of the information we have comes from single-case reports . ''
White says that animal studies suggest kratom could be an effective pain reliever , but the collection of human data has only just begun @ @ @ @ @ @ @ a lot more research before the appropriate level of regulation is clear .
White recently argued in the American Journal of Health-System Pharmacy that the safest place for kratom is behind pharmacy counters , for adults only , but with no prescription required .
McClain Haddow , spokesperson for the American Kratom Association , agrees that the product should be sold only to people over age 18 .
`` We would like vendors to register their product with the FDA and get a chemical analysis from a certified lab to insure the only @ @ @ @ @ @ @ the kratom plant , '' Haddow says .
`` Some manufacturers are spiking products with fentanyl , heroin or morphine to give users a high . ''
Dr. Scott Steiger , deputy medical director of the opiate treatment outpatient program at Zuckerberg San Francisco General Hospital and Trauma Center , says he does n't know how to advise patients who want to use kratom .
`` I tell them I just do n't know enough on the basis of science to tell them whether it 's a great idea or not , '' @ @ @ @ @ @ @ associate clinical professor of medicine at the University of California , San Francisco .
The DEA describes kratom as an addictive substance that causes hallucinations , delusion and confusion .
`` I have seen that people who use kratom end up having a very hard time stopping the use of it , '' says Steiger .
His patients report withdrawal symptoms such as nausea , sweats , aches and pains , loose stool , tearing and dysphoria .
There is growing concern about kratom 's effects on the heart and liver .
Steiger @ @ @ @ @ @ @ buprenorphine and methadone to help people with an opioid addiction .
He does n't recommend self-medicating with kratom until more research is available .
`` We just do n't know enough about this chemical and the long-term use of it to know whether experimenting would lead to complications , '' Steiger says .

The Kratom Debate: Helpful Herb Or Dangerous Drug?
Enlarge this image toggle caption Catie Dull/NPR Catie Dull/NPR
Americans know the dangers of drugs such as morphine and heroin. But what about a supplement that acts in the brain a bit like an opiate and is available in many places to kids — even from vending machines.
Kratom, an herb that's abundant, legal in most states and potentially dangerous, is the subject of an ongoing debate over its risks and benefits.
Usually, the leaf, which comes from a tropical Southeast Asian tree, is chewed, brewed or crushed into a bitter green powder. The chemicals in the herb interact with different types of receptors in the brain — some that respond to opioids, and others to stimulants. Often sold in the U.S. in a processed form — as pills, capsules or extracts — a small amount of kratom can perk you up, while a large dose has a sedative effect.
Some people who have struggled with an opioid addiction and switched to kratom swear the substance salvaged their health, livelihood and relationships.
But the federal Food and Drug Administration and the Drug Enforcement Administration worry that kratom carries the risk of physical and psychological dependency and, in some people, addiction. The FDA warns consumers not to use kratom, and the DEA threatened to prohibit kratom's sale and use in the U.S. (outside of research) in 2016; advocates and lawmakers subsequently pushed back, and the stricter scheduling of kratom that would have prompted that sort of ban never occurred. These days, the DEA lists it as a drug of concern.
Like "a little glass of wine"
Enlarge this image toggle caption Lesley McClurg/KQED Lesley McClurg/KQED
Linda Kline, 33, based in Reno, Nev., sells kratom for a living. She says her several stores throughout the West have given her a new purpose in life. And while she herself doesn't have an opioid dependency, she credits kratom with turning around her mental health.
"I went from feeling desperate and hopeless to finding an alternative where I had full control over how I felt," she says.
She used to be paralyzed by anxiety and panic attacks. When her insurance carrier threatened to cut her Prozac prescription, she felt desperate. A friend suggested kratom, so she picked some up at a smoke shop.
"It almost feels like you're having just a little glass of wine," Kline says. "It's really relaxing. There's no melting of the walls."
The new habit cost about $6 a day — less than a glass of wine or fancy cup of coffee. But Kline says she couldn't always find a high-quality supply. The FDA has recalled dozens of salmonella-tainted products sold online or in convenience stores. The agency has also found toxic heavy metals in kratom supplements.
That's one reason Kline started her own chic boutiques, Bumble Bee Botanicals, devoted exclusively to kratom products that, she says, are all lab tested to ensure purity. She just opened her fifth location in less than two years. The shops offer 15 kratom strains at outlets in California, Idaho and Nevada.
Though Kline's website has a disclaimer that her products have not been evaluated by the FDA and "are not intended to cure, treat or prevent any disease/illness," some of her clients' online Yelp reviews claim kratom has dramatically relieved their chronic pain, insomnia, restless legs syndrome and more.
Enlarge this image toggle caption Lesley McClurg/KQED Lesley McClurg/KQED
Potential dangers
Glowing reviews like that haunt Mateo Martinez.
"My brother believed the marketing of kratom — that it was a natural herbal supplement that could provide you with the same benefits of an opioid without the risks," Mateo says.
Mateo's younger brother, Marco, struggled with an opioid addiction in high school. Mateo describes Marco as a charismatic, creative teen, passionate about video games, cartoons and anime. Marco got hooked on painkillers, Mateo says, after his dentist pulled his wisdom teeth.
"He was using them in a way that wasn't just for treating pain," Mateo says.
Email receipts show Marco used bitcoin to also buy Vicodin and fentanyl on the dark web.
Eventually Marco wanted to kick his opioid addiction and saw testimonials on YouTube and Reddit that promised that kratom could be a way out. Soon Marco was popping kratom capsules multiple times a day.
During his freshman year at the University of California, Davis, the 19-year-old started hyperventilating regularly. The incidents worsened, becoming seizure-like episodes and ending in trips to the emergency room. During each hospitalization, the doctors were stumped. No one thought to test for kratom.
Marco died in his UC Davis dorm in February 2018, late on a Sunday night. The toxicology report listed "acute mitragynine intoxication" — a chemical constituent of kratom — as the cause of death.
"I think kratom needs to come with a much more serious caution that it is not harmless," Mateo says. "I'm very heartbroken."
In a recent 18-month period, the federal Centers for Disease Control and Prevention reported 90 kratom overdoses, although most involved a combination of other substances too.
Slim science, so far
"The data to support either the benefits or the harms for kratom is really, really poor," says C. Michael White, head of the Department of Pharmacy Practice at the University of Connecticut. "A lot of the information we have comes from single-case reports."
White says that animal studies suggest kratom could be an effective pain reliever, but the collection of human data has only just begun. He says scientists need to conduct a lot more research before the appropriate level of regulation is clear. White recently argued in the American Journal of Health-System Pharmacy that the safest place for kratom is behind pharmacy counters, for adults only, but with no prescription required.
McClain Haddow, spokesperson for the American Kratom Association, agrees that the product should be sold only to people over age 18.
"We would like vendors to register their product with the FDA and get a chemical analysis from a certified lab to insure the only ingredient is the naturally occurring alkaloid in the kratom plant," Haddow says. "Some manufacturers are spiking products with fentanyl, heroin or morphine to give users a high."
Dr. Scott Steiger, deputy medical director of the opiate treatment outpatient program at Zuckerberg San Francisco General Hospital and Trauma Center, says he doesn't know how to advise patients who want to use kratom.
"I tell them I just don't know enough on the basis of science to tell them whether it's a great idea or not," says Steiger, who is also an associate clinical professor of medicine at the University of California, San Francisco.
The DEA describes kratom as an addictive substance that causes hallucinations, delusion and confusion.
"I have seen that people who use kratom end up having a very hard time stopping the use of it," says Steiger.
His patients report withdrawal symptoms such as nausea, sweats, aches and pains, loose stool, tearing and dysphoria. There is growing concern about kratom's effects on the heart and liver.
Steiger emphasizes that doctors have evidence-based treatments like buprenorphine and methadone to help people with an opioid addiction. He doesn't recommend self-medicating with kratom until more research is available.
"We just don't know enough about this chemical and the long-term use of it to know whether experimenting would lead to complications," Steiger says.


npr--2020-01-13--Something Is Missing in Iowa As Democrats Once Again Debate: A Clear Favorite

Something Is Missing in Iowa As Democrats Once Again Debate : A Clear Favorite Viewers tuning in for the latest Democratic presidential candidates ' debate Tuesday night may sense something missing in Des Moines .
For starters , the well-lit stage on the Drake University campus may seem half empty .
There will only be six candidates raising their hands and vying for airtime .
That 's less than a third as many as qualified for the first round back in June .
At that point , the debate was held over two nights with 10 different candidates on stage @ @ @ @ @ @ @ crew have dropped out , including all the governors , Sen. Kamala Harris of California and former Cabinet secretary Julián Castro of Texas .
Others have been excluded as the qualifying criteria — poll standing and fundraising — have grown tougher .
Among the missing on Tuesday are some of the more memorable presenters from earlier debate stages , such as Sen. Cory Booker of New Jersey and businessman Andrew Yang .
Both are still running but missed the cut on polling performance .
Without them , the debate will not have even @ @ @ @ @ @ @ remain will , as always , strive to differentiate themselves from each other , while proving they have what it takes to defeat President Trump in November .
Iowans will have their chance to weigh in on that question in three weeks during the party 's precinct-level caucuses on February 3 .
And that suggests something else that may seem missing Tuesday night : a clear favorite .
The well-respected Des Moines Register/CNN/Mediacom poll now has Sen. Bernie Sanders of Vermont leading in Iowa , but the average of polls nationwide and in @ @ @ @ @ @ @ modest preference for former Vice President Joe Biden .
At this point , it is possible to imagine either emerging from the early voting states as a bona fide front-runner in time for Super Tuesday on March 3 , when 14 states will vote , including delegate-rich California and Texas .
But it is also possible to imagine neither of them doing so , and thus to imagine Super Tuesday as a hodge podge of conflicting results .
Testing the candidates is , of course , the first order of business in Tuesday @ @ @ @ @ @ @ is the trajectory of the Democratic Party in the state and the region and the importance of Iowa itself in the nation 's politics .
While we 're at it , let 's add that the entire system of defining the party 's field of candidates through televised debates and early voting in selected , albeit less populous , states is on trial as well .
Perhaps the one finding in the latest Des Moines Register/CNN/Mediacom poll that no one would dispute is this : the two most prominent progressives in the race @ @ @ @ @ @ @ the first choice among 37 % of those surveyed .
The three leading contenders in the more moderate space — Biden , former South Bend , Ind .
Mayor Pete Buttigieg and Sen. Amy Klobuchar of neighboring Minnesota— also totaled 37 % .
The longstanding division within the party 's ranks seems alive and well and remarkably even .
Iowa surely reflects that division , but it differs from the national Democratic Party in important ways .
Nationally , the Democrats are increasingly the party of younger voters and people of color .
@ @ @ @ @ @ @ and more than 90 % white .
( The same can be said of New Hampshire , the state that always holds the nation 's first primary , where the population is 93 % white and older than any state 's but Maine . )
For TV viewers , Tuesday 's confab among candidates will be a CNN show , heavily promoted by that cable news operation .
But in Iowa , it is widely known as the Des Moines Register debate , closely identified with that traditional newspaper and its longtime , @ @ @ @ @ @ @ The paper has long sponsored a debate that was a significant factor in the caucuses ' outcome .
The Register has been a strong advocate for the caucus format over the years , noting among other things that it has `` picked the nominee '' on the Democratic side in nine of the 11 cycles beginning in 1976 — Jimmy Carter twice , Walter Mondale , Bill Clinton , Al Gore , John Kerry , Barack Obama twice and Hillary Clinton .
The only exceptions came when a native son , Sen. Tom @ @ @ @ @ @ @ 1992 and when Richard Gephardt of neighboring Missouri won in 1988 .
Second place finishers have also gained significantly on their way to winning New Hampshire 's primary , including Sanders in 2016 and Gary Hart in 1984 .
The Register 's poll , directed by Ann Selzer , showed Sanders with his first lead in the state on Friday .
The Register poll has had the eventual Democratic caucus winner on top in each of the last six presidential cycles .
But the poll also showed Sanders to be the first choice @ @ @ @ @ @ @ with three other candidates closely bunched just behind him .
Sanders had 20 % , Warren 17 % , Buttigieg 16 % and Biden 15 % .
Joining this quartet on Tuesday night will be Klobuchar , who was the first choice among 6 % in the poll , and billionaire businessman Tom Steyer , whose late ad blitz in targeted states enabled him to meet the polling and donor thresholds for inclusion in the debate .
Steyer would not have made the stage based on his Iowa standing , however , as @ @ @ @ @ @ @ 2 % , behind Yang at 5 % and even Booker at 3 % .
Late-starting media mogul and former New York City mayor Michael Bloomberg is not taking donations so he is not in the running for the debates .
Six more debates are scheduled , three in February alone .
Much of the poll discussion focused on how both Warren and Buttigieg had fallen back since their impressive moves to the front of the Register poll in 2019 .
Warren still had the highest favorability rating among Democrats — 70 % @ @ @ @ @ @ @ `` mostly '' favorable — but had given ground to Sanders in the months since he came back from his October heart attack .
Sanders ' camp was quick to tout the Register poll , and to point to more good showings elsewhere .
But given the 3.7-point margin of error , it could be said the race was statistically close to being a four-way tie .
That should help keep curiosity and enthusiasm high for the devotees of the leading candidates and encourage turnout — a test of which candidate has the @ @ @ @ @ @ @ as the most fervent supporters .
Sanders ' fans have long been known as fiercely loyal , but Warren and Buttigieg are credited with building impressive organizations to manage caucus night .
High motivation is more important here than usual because these are not simple voting events .
They are true caucuses , party meetings , that require a time commitment and a degree of engagement with one 's neighbors on a weeknight deep in winter darkness .
Selzer , the poll director , found 45 % of Iowans interviewed said they were @ @ @ @ @ @ @ had yet to arrive at a preference .
`` The caucus process is an invitation to keep an open mind , '' she said .
At the Democrats ' caucus events , held in a variety of public and private venues , each candidate needs to muster support from at least 15 % of the participants to remain `` viable . ''
Those whose candidate does not meet this threshold are free to support another candidate .
Thus the tally taken at the end of the evening represents only the final choices , @ @ @ @ @ @ @ .
That is a system that some find off-putting .
But Iowa Democrats have remained attached to it , in part to avoid conflict with New Hampshire and its codified `` first in the nation '' primary .
Both major parties have ceded this first-caucus , first-primary status to Iowa and New Hampshire , respectively , attempting to counter-balance the two states ' demographic tilt by also scheduling Nevada caucuses and South Carolina 's primary in February .
Will this year 's flood of Super Tuesday votes wash away the relatively few actual @ @ @ @ @ @ @ the cue effects of Iowa and New Hampshire drive the next rounds of voting all the more ?
Tuesday night may begin to fill in some of the missing information .

Something Is Missing In Iowa As Democrats Once Again Debate: A Clear Favorite
Enlarge this image toggle caption Chip Somodevilla/Getty Images Chip Somodevilla/Getty Images
Updated at 12:25 p.m. ET
Viewers tuning in for the latest Democratic presidential candidates' debate Tuesday night may sense something missing in Des Moines.
For starters, the well-lit stage on the Drake University campus may seem half-empty. There will be only six candidates raising their hands and vying for airtime. That's less than a third as many as qualified for the first round back in June. At that point, the debate was held over two nights with 10 different candidates onstage each night.
Most of the original crew have dropped out, including Sens. Kirsten Gillibrand of New York, Kamala Harris of California and Cory Booker of New Jersey; and former Cabinet Secretary Julián Castro and former Rep. Beto O'Rourke, both of Texas.
Others have been excluded as the qualifying criteria — poll standing and fundraising — have grown tougher (and more controversial).
Among the missing on Tuesday are some of the more memorable presenters from earlier debate stages, such as businessman Andrew Yang, who is still running but missed the cut because he did not have 5% in enough DNC-approved polls.
Without Yang or Booker (who failed to qualify for the debate and suspended his campaign on Monday), the debate will not have even one person of color.
Those who remain will, as always, strive to differentiate themselves from each other while proving they have what it takes to defeat President Trump in November. Iowans will have their chance to weigh in on that question in three weeks during the party's precinct-level caucuses on Feb. 3.
And that suggests something else that may seem missing Tuesday night: a clear favorite. The well-respected Des Moines Register/CNN/Mediacom poll now has Sen. Bernie Sanders of Vermont leading in Iowa, but the average of polls nationwide and in other early voting states still shows a modest preference for former Vice President Joe Biden.
At this point, it is possible to imagine either emerging from the early voting states as a bona fide front-runner in time for Super Tuesday on March 3, when 14 states will vote, including delegate-rich California and Texas.
But it is also possible to imagine neither of them doing so, and thus to imagine Super Tuesday as a hodgepodge of conflicting results.
Testing the candidates is, of course, the first order of business in Tuesday's debate. But also at issue is the trajectory of the Democratic Party in the state and the region and the importance of Iowa itself in the nation's politics.
While we're at it, let's add that the entire system of defining the party's field of candidates through televised debates and early voting in selected, albeit less populous, states is on trial as well.
Perhaps the one finding in the latest Des Moines Register/CNN/Mediacom poll that no one would dispute is this: The two most prominent progressives in the race — Sanders and Elizabeth Warren — were the first choice among 37% of those surveyed. The three leading contenders in the more moderate space — Biden, former South Bend, Ind. Mayor Pete Buttigieg and Sen. Amy Klobuchar of neighboring Minnesota— also totaled 37%. The longstanding division within the party's ranks seems alive and well and remarkably even.
Iowa surely reflects that division, but it differs from the national Democratic Party in important ways. Nationally, the Democrats are increasingly the party of younger voters and people of color. Iowa is statistically older than most states and more than 90% white. (The same can be said of New Hampshire, the state that always holds the nation's first primary, where the population is 93% white and older than any state's but Maine.)
For TV viewers, Tuesday's confab among candidates will be a CNN show, heavily promoted by that cable news operation. But in Iowa, it is widely known as the Des Moines Register debate, closely identified with that traditional newspaper and its longtime, outsize influence in the Hawkeye State. The paper has long sponsored a debate that was a significant factor in the caucuses' outcome.
The Register has been a strong advocate for the caucus format over the years, noting among other things that it has "picked the nominee" on the Democratic side in nine of the 11 cycles beginning in 1976 — Jimmy Carter twice, Walter Mondale, Bill Clinton, Al Gore, John Kerry, Barack Obama twice and Hillary Clinton.
The only exceptions came when a native son, Sen. Tom Harkin, dominated the caucus tally in 1992 and when Richard Gephardt of neighboring Missouri won in 1988. Second-place finishers have also gained significantly on their way to winning New Hampshire's primary, including Sanders in 2016 and Gary Hart in 1984.
The Register's poll, directed by Ann Selzer, showed Sanders with his first lead in the state on Friday. The Register poll has had the eventual Democratic caucus winner on top in each of the last six presidential cycles.
But the poll also showed Sanders to be the first choice of just 1 Democrat in 5, with three other candidates closely bunched just behind him. Sanders had 20%, Warren 17%, Buttigieg 16% and Biden 15%.
Joining this quartet on Tuesday night will be Klobuchar, who was the first choice among 6% in the poll, and billionaire businessman Tom Steyer, whose late ad blitz in targeted states enabled him to meet the polling and donor thresholds for inclusion in the debate.
Steyer would not have made the stage based on his Iowa standing, however, as the Register poll found him at just 2%, behind Yang at 5% and even Booker at 3%. Late-starting media mogul and former New York City Mayor Michael Bloomberg is not taking donations so he is not in the running for the debates. Six more debates are scheduled, three in February alone.
Much of the poll discussion focused on how both Warren and Buttigieg had fallen back since their impressive moves to the front of the Register poll in 2019. Warren still had the highest favorability rating among Democrats — 70% found her either "very" or "mostly" favorable — but had given ground to Sanders in the months since he came back from his October heart attack.
Sanders' camp was quick to tout the Register poll, and to point to more good showings elsewhere. But given the 3.7-point margin of error, it could be said the race was statistically close to being a four-way tie. That should help keep curiosity and enthusiasm high for the devotees of the leading candidates and encourage turnout — a test of which candidate has the best "ground game" as well as the most fervent supporters. Sanders' fans have long been known as fiercely loyal, but Warren and Buttigieg are credited with building impressive organizations to manage caucus night.
High motivation is more important here than usual because these are not simple voting events. They are true caucuses, party meetings, that require a time commitment and a degree of engagement with one's neighbors on a weeknight deep in winter darkness.
Selzer, the poll director, found 45% of Iowans interviewed said they were still open to persuasion and 13% had yet to arrive at a preference. "The caucus process is an invitation to keep an open mind," she said.
At the Democrats' caucus events, held in a variety of public and private venues, each candidate needs to muster support from at least 15% of the participants to remain "viable." Those whose candidate does not meet this threshold are free to support another candidate. Thus the tally taken at the end of the evening represents only the final choices, which may differ from the initial preferences.
That is a system that some find off-putting. But Iowa Democrats have remained attached to it, in part to avoid conflict with New Hampshire and its codified "first in the nation" primary. Both major parties have ceded this first-caucus, first-primary status to Iowa and New Hampshire, respectively, attempting to counter-balance the two states' demographic tilt by also scheduling Nevada caucuses and South Carolina's primary in February.
Will this year's flood of Super Tuesday votes wash away the relatively few actual delegates committed in February? Or will the cue effects of Iowa and New Hampshire drive the next rounds of voting all the more?
Tuesday night may begin to fill in some of the missing information.


npr--2020-01-13--In Tennessee, Tourists Rediscover The First President Who Was Impeached

In Tennessee , Tourists Rediscover The First President Who Was Impeached The impeachment of President Trump has revived interest in the first president ever to be impeached over 150 years ago , Andrew Johnson .
In Greeneville , Tenn. , the site where Johnson 's former home is preserved has seen a recent surge in visitors , similar to a spike around the time that former President Bill Clinton was impeached in 1998 .
`` We do have a lot of people kind of veering off the highway when they see the brown sign because they recognize Andrew Johnson 's @ @ @ @ @ @ @ first president to be impeached .
And they come on in to learn about why , '' says park ranger Emma Murphy .
Many people know little more about Johnson than that he took office after Abraham Lincoln was assassinated shortly after the Civil War ended and was later impeached .
Few understand what led to Johnson 's near removal from office , or the similarities between how the 17th president and the current president weathered the process .
A pro-Union Democrat , Johnson was chosen to run on a unity ticket with @ @ @ @ @ @ @ 1864 election .
After Lincoln 's death thrust Johnson into the presidency , he began to pardon Confederates and push for letting states that had seceded back in the Union without any real consequences .
Johnson also repeatedly blocked efforts from Congress to enfranchise and give basic rights to newly-freed slaves , which led to clashes with the Radical Republicans who were in power .
Murphy points out that Johnson 's actions led to another century and beyond of struggles for African-Americans .
`` The nation that Johnson sets up is what lends @ @ @ @ @ @ @ leads for the next hundred years of what Johnson wanted , leads all the way into the civil rights movement , '' Murphy says .
Congressional Republicans eventually passed the Tenure of Office Act , which barred Johnson from removing Cabinet officials without congressional approval .
They knew Johnson wanted to remove Lincoln 's Secretary of War Edwin Stanton from his post , and they were essentially daring him to .
Johnson did , and that action led to Congress quickly passing 11 articles of impeachment .
While most dealt with Johnson 's @ @ @ @ @ @ @ just how deep the animus ran between the executive and legislative branches .
`` So Article 10 is that Johnson brought 'disgrace , ridicule , hatred , contempt and reproach ' to Congress , '' says Murphy .
Johnson would frequently rail against Congress , and he even went on speaking tours to drum up support .
The raucous events were not unlike the rallies Trump holds today , where he also mocks and rebukes legislators who oppose him .
`` [ Johnson ] would become vulgar , coarse , he would rant @ @ @ @ @ @ @ `` He would do so much ranting in public that people thought he must be drunk , and he was n't . ''
Wineapple details the trial of Andrew Johnson in her book The Impeachers : The Trial of Andrew Johnson and the Dream of a Just Nation , which was released last year .
She imagines that if Johnson were president today , he would handle impeachment a lot like Trump .
`` Johnson would be on Twitter day and night .
He would not sleep , '' Wineapple says .
`` @ @ @ @ @ @ @ for expression and reaching the people that he believed loved him . ''
Back in Greeneville , the vitriol many people felt for the president is captured in a very unique way .
Practically every inch of his home was left covered with graffiti , most of it having been scrawled by Confederate squatters during the war .
The markings are now mostly covered with wallpaper , but the park service has preserved a small section so visitors can see the slurs and name-calling .
`` You 're going to see funny jokes @ @ @ @ @ @ @ professions of hate , '' Murphy points out on the tour .
`` We 're going to see him deemed a traitor and committing Treason , spelled T-R-E-E-S-O-N ... very creative . ''
Other exhibits in the visitors center detail the battles with Congress that led to Johnson 's impeachment .
On a late December afternoon , Tiffany Owen is one visitor who decided to drop by the Andrew Johnson National Historic Site after seeing impeachment coverage on the news .
She lives in West Palm Beach , Fla. , now but was @ @ @ @ @ @ @ the holidays .
`` I find Johnson really interesting , and especially given the climate that we 're in now , understanding what is happening in modern context in terms of historical context is really interesting , '' Owen says .
Visitors also get a replica impeachment trial ticket to cast a ballot on whether or not they would have voted in the Senate to remove Johnson from office .
Ultimately , Johnson survived removal by just one vote ; most visitors agree and cast their votes for `` not guilty . ''
@ @ @ @ @ @ @ Trump trials .
She says they both deserved to be impeached by the House , but to her that was enough of a punishment in itself .
`` Is it a strong enough offense that it rises to the level of removal ?
And in my opinion it 's not , '' she says .
Locals largely feel the same way in this small town that 's about an hour east of Knoxville .
Greene County Historian Tim Massey says they 're proud of Johnson , who worked his way up from being @ @ @ @ @ @ @ .
Massey says Johnson 's conduct was driven by his strict interpretation and fealty for the Constitution — he was even buried with a copy of it resting under his head , even though it was the same document that made it possible for him to be the first president ever impeached .
`` He 's overshadowed because of that one blot that seems to permeate his record , '' Massey says .
And he also sees similarities between the Johnson and Trump impeachments , especially with the House approving articles of impeachment @ @ @ @ @ @ @ the current president all but certain to be acquitted by a GOP-controlled Senate .
`` I think both have a lot more to do with politics than him actually committing a high crime or misdemeanor , '' Massey says .
`` And I think with the thing with the Trump trial , it seems to be strictly along political lines . ''
Every presidential impeachment spurs strong emotions .
And to Murphy , the park ranger who is tasked with explaining the complexities of Johnson and his views on race especially , it @ @ @ @ @ @ @ given the collision of past and current events .
`` Bring it .
Let 's talk about it .
Let 's talk about Andrew Johnson .
Let 's talk about this process , '' Murphy says with a smile .

In Tennessee, Tourists Rediscover The First President Who Was Impeached
Enlarge this image toggle caption Jessica Tezak for NPR Jessica Tezak for NPR
The impeachment of President Trump has revived interest in the first president ever to be impeached over 150 years ago, Andrew Johnson.
In Greeneville, Tenn., the site where Johnson's former home is preserved has seen a recent surge in visitors, similar to a spike around the time that former President Bill Clinton was impeached in 1998.
"We do have a lot of people kind of veering off the highway when they see the brown sign because they recognize Andrew Johnson's name, and that he's the first president to be impeached. And they come on in to learn about why," says park ranger Emma Murphy.
Enlarge this image toggle caption Jessica Tezak for NPR Jessica Tezak for NPR
Many people know little more about Johnson than that he took office after Abraham Lincoln was assassinated shortly after the Civil War ended and was later impeached. Few understand what led to Johnson's near removal from office, or the similarities between how the 17th president and the current president weathered the process.
Discord after the Civil War
A pro-Union Democrat, Johnson was chosen to run on a unity ticket with Lincoln, a Republican, in the 1864 election. After Lincoln's death thrust Johnson into the presidency, he began to pardon Confederates and push for letting states that had seceded back in the Union without any real consequences.
Johnson also repeatedly blocked efforts from Congress to enfranchise and give basic rights to newly-freed slaves, which led to clashes with the Radical Republicans who were in power. Murphy points out that Johnson's actions led to another century and beyond of struggles for African-Americans.
"The nation that Johnson sets up is what lends itself into the Jim Crow era and leads for the next hundred years of what Johnson wanted, leads all the way into the civil rights movement," Murphy says.
Congressional Republicans eventually passed the Tenure of Office Act, which barred Johnson from removing Cabinet officials without congressional approval. They knew Johnson wanted to remove Lincoln's Secretary of War Edwin Stanton from his post, and they were essentially daring him to. Johnson did, and that action led to Congress quickly passing 11 articles of impeachment.
While most dealt with Johnson's actions in removing Stanton, one underscored just how deep the animus ran between the executive and legislative branches.
"So Article 10 is that Johnson brought 'disgrace, ridicule, hatred, contempt and reproach' to Congress," says Murphy.
Johnson would frequently rail against Congress, and he even went on speaking tours to drum up support. The raucous events were not unlike the rallies Trump holds today, where he also mocks and rebukes legislators who oppose him.
"[Johnson] would become vulgar, coarse, he would rant," said author Brenda Wineapple. "He would do so much ranting in public that people thought he must be drunk, and he wasn't."
Enlarge this image toggle caption Jessica Tezak for NPR Jessica Tezak for NPR
Wineapple details the trial of Andrew Johnson in her book The Impeachers: The Trial of Andrew Johnson and the Dream of a Just Nation, which was released last year. She imagines that if Johnson were president today, he would handle impeachment a lot like Trump.
"Johnson would be on Twitter day and night. He would not sleep," Wineapple says. "Twitter would be his go to medium for expression and reaching the people that he believed loved him."
Is impeachment punishment enough?
Back in Greeneville, the vitriol many people felt for the president is captured in a very unique way. Practically every inch of his home was left covered with graffiti, most of it having been scrawled by Confederate squatters during the war. The markings are now mostly covered with wallpaper, but the park service has preserved a small section so visitors can see the slurs and name-calling.
Enlarge this image toggle caption Jessica Tezak for NPR Jessica Tezak for NPR
"You're going to see funny jokes, games, professions of love, professions of hate," Murphy points out on the tour. "We're going to see him deemed a traitor and committing Treason, spelled T-R-E-E-S-O-N... very creative."
Other exhibits in the visitors center detail the battles with Congress that led to Johnson's impeachment. On a late December afternoon, Tiffany Owen is one visitor who decided to drop by the Andrew Johnson National Historic Site after seeing impeachment coverage on the news. She lives in West Palm Beach, Fla., now but was back home in Tennessee visiting family over the holidays.
"I find Johnson really interesting, and especially given the climate that we're in now, understanding what is happening in modern context in terms of historical context is really interesting," Owen says.
Visitors also get a replica impeachment trial ticket to cast a ballot on whether or not they would have voted in the Senate to remove Johnson from office. Ultimately, Johnson survived removal by just one vote; most visitors agree and cast their votes for "not guilty."
Enlarge this image toggle caption Jessica Tezak for NPR Jessica Tezak for NPR
Owen sees parallels between the Johnson and Trump trials. She says they both deserved to be impeached by the House, but to her that was enough of a punishment in itself.
"Is it a strong enough offense that it rises to the level of removal? And in my opinion it's not," she says.
Locals largely feel the same way in this small town that's about an hour east of Knoxville. Greene County Historian Tim Massey says they're proud of Johnson, who worked his way up from being a local tailor to the White House. Massey says Johnson's conduct was driven by his strict interpretation and fealty for the Constitution — he was even buried with a copy of it resting under his head, even though it was the same document that made it possible for him to be the first president ever impeached.
Enlarge this image toggle caption Jessica Tezak for NPR Jessica Tezak for NPR
"He's overshadowed because of that one blot that seems to permeate his record," Massey says.
And he also sees similarities between the Johnson and Trump impeachments, especially with the House approving articles of impeachment against Trump with no Republican votes and the current president all but certain to be acquitted by a GOP-controlled Senate.
"I think both have a lot more to do with politics than him actually committing a high crime or misdemeanor," Massey says. "And I think with the thing with the Trump trial, it seems to be strictly along political lines."
Every presidential impeachment spurs strong emotions. And to Murphy, the park ranger who is tasked with explaining the complexities of Johnson and his views on race especially, it's a challenge she's excited about given the collision of past and current events.
"Bring it. Let's talk about it. Let's talk about Andrew Johnson. Let's talk about this process," Murphy says with a smile.


npr--2020-01-13--In New Book, Retired Pope Benedict Breaks Silence To Speak Out On Priestly Celibacy

In New Book , Retired Pope Benedict Breaks Silence To Speak Out On Priestly Celibacy Retired Pope Benedict XVI , who promised to remain silent when he resigned as head of the Roman Catholic Church seven years ago , has stepped back into the ongoing debate over priestly celibacy with a new book defending the traditionalist view .
The surprise move is seen as a rebuke to Pope Francis , who is weighing the possibility of a revolutionary move to relax the strict celibacy requirement for ordination in some South American countries where the shortage of priests is particularly acute @ @ @ @ @ @ @ title translates as From the Depths of Our Hearts , Benedict and his co-author , Guinean Cardinal Robert Sarah , defend the `` necessity '' of celibacy in the priesthood .
On Sunday , the French newspaper Le Figaro printed excerpts , which were also obtained by The Associated Press .
`` The priesthood of Jesus Christ causes us to enter into a life that consists of becoming one with him and renouncing all that belongs only to us , '' the pope emeritus writes .
`` For priests , this is the @ @ @ @ @ @ @ also of liturgical prayer , meditation on the Word of God and the renunciation of material goods . ''
Since a married man is devoted entirely to his family and `` serving the Lord '' requires a similar degree of devotion , `` it does not seem possible to carry on the two vocations simultaneously , '' which is why celibacy `` became a criterion for priestly ministry , '' according to the authors .
In countries such as Brazil , a shortage of priests prevents many faithful from attending Mass for months @ @ @ @ @ @ @ a month-long meeting of senior clergy in South America , the Synod of Bishops for the Pan-Amazon Region , ended with a vote to suggest that the pope allow older , married men to be ordained to fill the shortfall .
Francis is said to be preparing a response to the synod 's recommendation .
Excerpts of the book indicate that the 92-year-old Benedict , and Sarah , a fellow conservative , wrote separate portions , according to the National Catholic Reporter .
In a joint introduction , the co-authors said they had @ @ @ @ @ @ @ obedience , to Pope Francis . ''
However , they also said the current `` crisis '' in the church compelled them to speak out .
In one passage , Sarah addresses the current pontiff directly : `` I humbly beg Pope Francis to ... veto any weakening of the law of priestly celibacy , even limited to one or the other region . ''
`` It is urgent and necessary for everyone — bishops , priests and lay people — to stop letting themselves be intimidated by the wrong-headed pleas , the @ @ @ @ @ @ @ the fashionable errors that try to put down priestly celibacy , '' the authors write , adding that the practice helps the church `` [ protect ] her mystery . ''
Upon stepping down from the papacy on February 28 , 2013 , the conservative Benedict pledged to remain `` hidden from the world '' and promised `` unconditional reverence and obedience '' to his successor .
Even so , this is not the first time that Benedict has contradicted the more liberal-minded Francis by commenting from his position of retirement on current @ @ @ @ @ @ @ 6,000-word essay released last April , the pope emeritus blamed the church 's sex abuse scandal on the secularization of the West , the sexual revolution of the 1960s and more generally , `` the absence of God . ''
Massimo Faggioli , a noted historian and theologian at Villanova University , told the National Catholic Reporter that Benedict 's decision to write the book was a `` serious breach . ''
`` It interferes with a synodal process that is still unfolding after the Amazon synod ... and threatens to limit the @ @ @ @ @ @ @ Faggioli said .

In New Book, Retired Pope Benedict Breaks Silence To Speak Out On Priestly Celibacy
Enlarge this image toggle caption L'Osservatore Romano/AP L'Osservatore Romano/AP
Retired Pope Benedict XVI, who promised to remain silent when he resigned as head of the Roman Catholic Church seven years ago, has stepped back into the ongoing debate over priestly celibacy with a new book defending the traditionalist view.
The surprise move is seen as a rebuke to Pope Francis, who is weighing the possibility of a revolutionary move to relax the strict celibacy requirement for ordination in some South American countries where the shortage of priests is particularly acute.
In the as-yet-unpublished book, whose title translates as From the Depths of Our Hearts, Benedict and his co-author, Guinean Cardinal Robert Sarah, defend the "necessity" of celibacy in the priesthood. On Sunday, the French newspaper Le Figaro printed excerpts, which were also obtained by The Associated Press.
"The priesthood of Jesus Christ causes us to enter into a life that consists of becoming one with him and renouncing all that belongs only to us," the pope emeritus writes. "For priests, this is the foundation of the necessity of celibacy but also of liturgical prayer, meditation on the Word of God and the renunciation of material goods."
Since a married man is devoted entirely to his family and "serving the Lord" requires a similar degree of devotion, "it does not seem possible to carry on the two vocations simultaneously," which is why celibacy "became a criterion for priestly ministry," according to the authors.
In countries such as Brazil, a shortage of priests prevents many faithful from attending Mass for months at a time. In October, a monthlong meeting of senior clergy in South America, the Synod of Bishops for the Pan-Amazon Region, ended with a vote to suggest that the pope allow older, married men to be ordained to fill the shortfall.
Francis is said to be preparing a response to the synod's recommendation.
Excerpts of the book indicate that the 92-year-old Benedict, and Sarah, a fellow conservative, wrote separate portions, according to the National Catholic Reporter.
In a joint introduction, the co-authors said they had written "in a spirit of filial obedience, to Pope Francis." However, they also said the current "crisis" in the church compelled them to speak out.
In one passage, Sarah addresses the current pontiff directly: "I humbly beg Pope Francis to ... veto any weakening of the law of priestly celibacy, even limited to one or the other region."
"It is urgent and necessary for everyone — bishops, priests and lay people — to stop letting themselves be intimidated by the wrong-headed pleas, the theatrical productions, the diabolical lies and the fashionable errors that try to put down priestly celibacy," the authors write, adding that the practice helps the church "[protect] her mystery."
Upon stepping down from the papacy on Feb. 28, 2013, the conservative Benedict pledged to remain "hidden from the world" and promised "unconditional reverence and obedience" to his successor.
Even so, this is not the first time that Benedict has contradicted the more liberal-minded Francis by commenting from his position of retirement on current issues in the church. In a 6,000-word essay released last April, the pope emeritus blamed the church's sex abuse scandal on the secularization of the West, the sexual revolution of the 1960s and more generally, "the absence of God."
Massimo Faggioli, a noted historian and theologian at Villanova University, told the National Catholic Reporter that Benedict's decision to write the book was a "serious breach."
"It interferes with a synodal process that is still unfolding after the Amazon synod ... and threatens to limit the freedom of the one pope," Faggioli said.


npr--2020-01-13--Volcanic Eruption In Philippines Causes Thousands To Flee

Volcanic Eruption In Philippines Causes Thousands To Flee A volcano south of the Philippine capital has sent a massive plume of ash and steam spewing miles into the sky and pushed red-hot lava out of its crater , prompting the evacuation of thousands of people and the closure of Manila 's airport .
In a matter of hours on Sunday , the Philippine Institute of Volcanology and Seismology raised the alert level for Taal Volcano from level 1 to 4 — level 5 being the highest .
It warned that a larger `` explosive eruption '' could occur within hours @ @ @ @ @ @ @ reports of casualties or major damage from the initial eruption , but authorities advised a total evacuation within a 14-kilometer ( 8.7-mile ) radius of the volcano , which is located about 45 miles south of Manila .
Dozens of earthquakes preceded Sunday 's eruption and authorities warned that a tsunami was possible in the freshwater lake surrounding the volcano .
Flashes of lightning lit up the plume , lending the scene an otherworldly appearance .
The National Disaster Risk Reduction Management Council , the Philippines ' disaster-response agency , said 13,000 villagers @ @ @ @ @ @ @ evacuation centers in Batangas and Cavite Provinces .
It said nearly 25,000 people had been displaced by the eruption .
Some residents refused to leave their homes and farms , officials said , while others reportedly could not leave because of a lack of transport or poor visibility due to the thick ash , the AP says .
`` Our people are panicking due to the volcano because they want to save their livelihood , their pigs and herds of cows , '' Mayor Wilson Maralit of Balete town told local DZMM radio @ @ @ @ @ @ @ `` We 're trying to stop them from returning and warning that the volcano can explode again anytime and hit them . ''
The Volcanology Institute cautioned that fine ashfall could causing breathing problems , especially among young children and the elderly and advised the public in affected areas to use face masks or wet towels to protect themselves .
It also advised motorists that the ash could reduce visibility and make roads slippery .
In Manila , long lines formed at shops selling face masks , with many residents no doubt remembering @ @ @ @ @ @ @ , about 55 miles northwest of the capital , an eruption that killed more than 350 people and blanketed the area for miles around in thick ash .
`` Taal is a very small volcano , but a dangerous volcano , '' Renato Solidum , the head of the Volcanology Institute , told Reuters .
Ash clouds stretched 62 miles north , forcing authorities to shut down Ninoy Aquino International Airport , causing the cancellation of more than 500 international and domestic flights , according to The Associated Press .
The Civil Aviation @ @ @ @ @ @ @ also shut down an airfield at Clark Freeport Zone , home of the former U.S. air base , if ash threatened fights there .
President Rodrigo Duterte 's office ordered a halt to government work in Manila and the closure of all schools in the capital .
It advised private companies to do the same .
The area immediately around Taal has been designated a `` permanent danger zone . ''
It last erupted in 1977 and another eruption in 1911 killed an estimated 1,500 people .
NPR 's Julie McCarthy in Santo @ @ @ @ @ @ @ this report .

Volcanic Eruption In Philippines Causes Thousands To Flee
Enlarge this image toggle caption Kester Ragaza/Pacific Press/LightRocket via Getty Images Kester Ragaza/Pacific Press/LightRocket via Getty Images
A volcano south of the Philippine capital has sent a massive plume of ash and steam spewing miles into the sky and pushed red-hot lava out of its crater, prompting the evacuation of thousands of people and the closure of Manila's airport.
In a matter of hours on Sunday, the Philippine Institute of Volcanology and Seismology raised the alert level for Taal Volcano to Level 4 from Level 1 — with Level 5 being the highest. It warned that a larger "explosive eruption" could occur within hours or days.
Enlarge this image toggle caption Ted Aljibe/AFP via Getty Images Ted Aljibe/AFP via Getty Images
Enlarge this image toggle caption Kester Ragaza/Pacific Press/LightRocket via Getty Images Kester Ragaza/Pacific Press/LightRocket via Getty Images
There were no immediate reports of casualties or major damage from the initial eruption, but authorities advised a total evacuation within a 14-kilometer (8.7-mile) radius of the volcano, which is located about 45 miles south of Manila.
Dozens of earthquakes preceded Sunday's eruption, and authorities warned that a tsunami was possible in the freshwater lake surrounding the volcano. Flashes of lightning lit up the plume, lending the scene an otherworldly appearance.
Enlarge this image toggle caption Ted Aljibe/AFP via Getty Images Ted Aljibe/AFP via Getty Images
Enlarge this image toggle caption Bullit Marquez/AFP via Getty Images Bullit Marquez/AFP via Getty Images
The National Disaster Risk Reduction Management Council, the Philippines' disaster-response agency, said 13,000 villagers were moved away from the area to evacuation centers in Batangas and Cavite provinces. It said nearly 25,000 people had been displaced by the eruption.
Some residents refused to leave their homes and farms, officials said, while others reportedly could not leave because of a lack of transportation or poor visibility from the thick ash, the AP says.
"Our people are panicking due to the volcano because they want to save their livelihood, their pigs and herds of cows," Mayor Wilson Maralit of Balete town told local DZMM radio, according to the news agency. "We're trying to stop them from returning and warning that the volcano can explode again anytime and hit them."
Enlarge this image toggle caption Ted Aljibe /AFP via Getty Images Ted Aljibe /AFP via Getty Images
The Volcanology Institute cautioned that fine ashfall could cause breathing problems, especially among young children and the elderly, and advised the public in affected areas to use face masks or wet towels to protect themselves. It also advised motorists that the ash could reduce visibility and make roads slippery.
In Manila, long lines formed at shops selling face masks, with many residents no doubt remembering the 1991 eruption of Mount Pinatubo, about 55 miles northwest of the capital, an eruption that killed more than 350 people and blanketed the area for miles around in thick ash.
LOOK: The municipality of Taal under a thick layer of ash. The only signs of life are mostly the ongoing evacuations. | via @reetuquero #TaalVolcano #TaalEruption2020 pic.twitter.com/MKHz3AzwNJ — Rappler (@rapplerdotcom) January 13, 2020
"Taal is a very small volcano, but a dangerous volcano," Renato Solidum, the head of the Volcanology Institute, told Reuters.
Ash clouds stretched 62 miles north, forcing authorities to shut down Ninoy Aquino International Airport and causing the cancellation of more than 500 international and domestic flights, according to The Associated Press. The Civil Aviation Authority of the Philippines said it would also shut down an airfield at Clark Freeport Zone, home of the former U.S. air base, if ash threatened flights there.
Enlarge this image toggle caption Ted Aljibe /AFP via Getty Images Ted Aljibe /AFP via Getty Images
President Rodrigo Duterte's office ordered a halt to government work in Manila and the closure of all schools in the capital. It advised private companies to do the same.
The area immediately around Taal has been designated a "permanent danger zone." It last erupted in 1977, and another eruption in 1911 killed an estimated 1,500 people.
NPR's Julie McCarthy in Santo Tomas, Batangas Province, contributed to this report.


npr--2020-01-12--U.S. Officials: More Than 20 Saudi Students To Be Expelled In Wake Of Fla. Shooting

U.S. Officials : More Than 20 Saudi Students To Be Expelled In Wake Of Fla .
Shooting The Trump administration is planning to announce on Monday that more than 20 Saudi students receiving military training in the United States will be sent back to their home country , according to two U.S. officials familiar with the matter .
The expulsions come in the wake of a Pentagon review of the Saudi officer who opened fire last month at a naval base in Pensacola , Fla. , leaving three young sailors dead and wounding eight others .
Earlier reports indicated that @ @ @ @ @ @ @ out of the country .
However , those reports did not include Saudis who will be expelled from military bases other than Naval Air Station Pensacola , according to the U.S. officials who spoke to NPR on the condition of anonymity .
The Saudis who will be removed from the country raised a number of concerns among federal investigators , the officials said .
Some Saudi trainees failed to alert authorities about the shooter 's extremist leanings .
Investigators believe the gunman and other Saudi trainees watched videos of other mass shootings at @ @ @ @ @ @ @ Saudis are being expelled because they viewed child pornography , according to the officials .
Other Saudi officers in the U.S. were involved in extremist online chat rooms , according to one of the officials .
The shooting prompted the Pentagon to suspend operational training of all Saudi Arabian military students in the U.S. indefinitely , as federal investigators conduct a security review of the some 850 military students in the U.S. from Saudi Arabia .
The Justice Department , which has been investigating the incident as an act of terrorism , is @ @ @ @ @ @ @ Saudi removals and the results of its criminal investigation into the Pensacola shooting .
In Saudi Arabia , news of the expulsions is expected to be greeted as unwelcome news , according to Daniel Byman , a Middle East expert and professor at Georgetown University 's School of Foreign Service .
`` They do n't like public embarrassment .
So having have these individuals be expelled , having it make the news , is not something the Saudi regime wants , '' Byman said .
The expelling of the Saudi students arrives amid @ @ @ @ @ @ @ American drone strike that killed Iranian military leader Qassem Soleimani .
Byman said pushing out the students could make a precarious situation with Iran even more uncertain .
`` If there 's going to be efforts to do diplomacy with Iran , no matter which direction the United States wants to go in , Saudi Arabia is going to be important for that , '' according to Byman .
Authorities identified the victims of the December attack in Pensacola as Joshua Kaleb Watson , 23 , of Enterprise , Ala. ; Mohammed Sameh @ @ @ @ @ @ @ , Fla. ; and Cameron Scott Walters , 21 , of Richmond Hill , Ga .
Some members of Congress used the incident to renew attention on foreign military exchange training programs , which bring thousands of students from dozens of countries to be taught at U.S. bases .
Top military officials view the programs as a way to boost relationships with foreign militaries and to increase the sharing of intelligence around the globe as a national security measure .
When asked on Fox News Sunday about the move to kick out Saudi @ @ @ @ @ @ @ said U.S. officials , including Defense Secretary Mark Esper , are exhibiting caution in the aftermath of the bloody rampage .
`` I think we 're being very careful .
Obviously , Pensacola showed that there had been errors in the way that we vetted , and out of an abundance of caution Secretary Esper has taken these actions to protect our service men and women , '' O'Brien said .
The Saudis set to be expelled from the U.S. are not accused of aiding the 21-year-old Saudi gunman who carried out the @ @ @ @ @ @ @ first reported Saturday night that more than a dozen Saudi servicemen would be removed from the country .
Federal investigators believe the Saudi gunman , who legally purchased a handgun before the shooting , acted alone and was not part of a larger network .
A sheriff 's deputy shot and killed him .
Shortly after the shooting , an account linked to the gunman surfaced showing vitriolic posts on social media criticizing American foreign policy and military action , saying the country had become `` a nation of evil . ''
The @ @ @ @ @ @ @ and the Federal Bureau of Investigation all declined to comment on the pending announcement about the Saudi students being expelled .

U.S. Officials: More Than 20 Saudi Students To Be Expelled In Wake Of Fla. Shooting
Enlarge this image toggle caption Cliff Owen/AP Cliff Owen/AP
Updated 8:38 p.m. Sunday ET
The Trump administration is planning to announce on Monday that more than 20 Saudi students receiving military training in the United States will be sent back to their home country, according to two U.S. officials familiar with the matter.
The expulsions come in the wake of a Pentagon review of the Saudi officer who opened fire last month at a naval base in Pensacola, Fla., leaving three young sailors dead and wounding eight others.
Earlier reports indicated that about 12 Saudi trainees would be kicked out of the country. However, those reports did not include Saudis who will be expelled from military bases other than Naval Air Station Pensacola, according to the U.S. officials who spoke to NPR on the condition of anonymity.
The Saudis who will be removed from the country raised a number of concerns among federal investigators, the officials said.
Some Saudi trainees failed to alert authorities about the shooter's extremist leanings. Investigators believe the gunman and other Saudi trainees watched videos of other mass shootings at a party before the attack.
Some Saudis are being expelled because they viewed child pornography, according to the officials. Other Saudi officers in the U.S. were involved in extremist online chat rooms, according to one of the officials.
The shooting prompted the Pentagon to suspend operational training of all Saudi Arabian military students in the U.S. indefinitely, as federal investigators conduct a security review of the some 850 military students in the U.S. from Saudi Arabia.
The Justice Department, which has been investigating the incident as an act of terrorism, is planning on Monday to publicly announce the Saudi removals and the results of its criminal investigation into the Pensacola shooting.
In Saudi Arabia, news of the expulsions is expected to be greeted as unwelcome news, according to Daniel Byman, a Middle East expert and professor at Georgetown University's School of Foreign Service.
"They don't like public embarrassment. So having have these individuals be expelled, having it make the news, is not something the Saudi regime wants," Byman said.
The expelling of the Saudi students arrives amid heightened tensions in the region following the American drone strike that killed Iranian military leader Qassem Soleimani.
Byman said pushing out the students could make a precarious situation with Iran even more uncertain.
"If there's going to be efforts to do diplomacy with Iran, no matter which direction the United States wants to go in, Saudi Arabia is going to be important for that," according to Byman.
Authorities identified the victims of the December attack in Pensacola as Joshua Kaleb Watson, 23, of Enterprise, Ala.; Mohammed Sameh Haitham, 19, of St. Petersburg, Fla.; and Cameron Scott Walters, 21, of Richmond Hill, Ga.
Some members of Congress used the incident to renew attention on foreign military exchange training programs, which bring thousands of students from dozens of countries to be taught at U.S. bases.
Top military officials view the programs as a way to boost relationships with foreign militaries and to increase the sharing of intelligence around the globe as a national security measure.
When asked on Fox News Sunday about the move to kick out Saudi trainees, National Security Adviser Robert O'Brien said U.S. officials, including Defense Secretary Mark Esper, are exhibiting caution in the aftermath of the bloody rampage.
"I think we're being very careful. Obviously, Pensacola showed that there had been errors in the way that we vetted, and out of an abundance of caution Secretary Esper has taken these actions to protect our service men and women," O'Brien said.
The Saudis set to be expelled from the U.S. are not accused of aiding the 21-year-old Saudi gunman who carried out the attack, according to CNN, which first reported Saturday night that more than a dozen Saudi servicemen would be removed from the country.
Federal investigators believe the Saudi gunman, who legally purchased a handgun before the shooting, acted alone and was not part of a larger network. A sheriff's deputy shot and killed him.
Shortly after the shooting, an account linked to the gunman surfaced showing vitriolic posts on social media criticizing American foreign policy and military action, saying the country had become "a nation of evil."
The Department of Justice, Department of Defense and the Federal Bureau of Investigation all declined to comment on the pending announcement about the Saudi students being expelled.
NPR's Ryan Lucas contributed to this report.


npr--2020-01-14--FDA Approves Drugs Faster Than Ever, But Relies On Weaker Evidence, Researchers Find

FDA Approves Drugs Faster Than Ever , But Relies On Weaker Evidence , Researchers Find The Food and Drug Administration has gotten faster at approving new prescription drugs over the last four decades , but the evidence it relies on in making those decisions is getting weaker , according to new research published Tuesday .
As a result , there are more cures and treatments on the market , but less proof that they are safe and effective .
`` There has been a gradual erosion of the evidence that 's required for FDA approval , '' says lead study @ @ @ @ @ @ @ Harvard Medical School 's Program on Regulation , Therapeutics and Law .
As a result , patients and physicians `` should not expect that new drugs will be dramatically better than older ones . ''
Almost half of recent new drug approvals were based on only one pivotal clinical trial instead of the two or more that used to be the norm , according to the study published Tuesday in JAMA , the journal of the American Medical Association .
And the reliance on surrogate measures — stand-ins for presumed patient benefits — @ @ @ @ @ @ @ cancer drugs , a surrogate measure could be shrinkage of tumors instead of improvements in survival after treatment .
Darrow and his colleagues analyzed FDA drug approvals , changes in laws and regulations and the rise in industry funding of the agency 's reviews from 1983 through 2018 .
The researchers found that the average number of new drug approvals per year increased from 34 in the 1990s to 41 in the 2010s , after a dip to 25 a year in the 2000s .
New drugs are getting through the FDA process @ @ @ @ @ @ @ review time for standard drug applications was 10.1 months compared with 2.8 years for standard and priority applications for the period from 1986 and 1992 .
Faster approvals were the goal of many legislative and regulatory changes made starting in the 1980s .
For instance , in 1983 , Congress passed the Orphan Drug Act to encourage drugmakers toward developing rare disease treatments that otherwise might not be profitable .
The FDA allowed approval for these drugs based on smaller trials with more flexible evidence standards , and it offered more time on @ @ @ @ @ @ @ competition .
Drugmakers also began paying the FDA fees to fund the review process after AIDS activists protested the agency 's sluggishness in the 1980s .
The FDA collected $ 29 million in fees in 1993 , the year after Congress passed the Prescription Drug User Fee Act for the first time .
The fees rose to $ 908 million in 2018 .
That year , industry fees amounted to about 80 % of the money spent on FDA employee salaries for drug reviews , according to the study .
`` There is @ @ @ @ @ @ @ is created within the FDA , '' says Darrow .
`` And whether it has created a culture in the FDA where the primary client is no longer viewed as the patient , but as the industry . ''
Former FDA Principal Deputy Commissioner Dr. Joshua Sharfstein says the FDA has succeeded in approving more drugs , but he also says that more changes are needed to make sure the medicines are worthwhile for patients .
`` Some of them are really great , and some of them [ are ] not so @ @ @ @ @ @ @ a professor at the Johns Hopkins Bloomberg School of Public Health .
`` And a lot of them are very expensive . ''
In an accompanying editorial in JAMA , Sharfstein offers several suggestions for change , including a reevaluation of the FDA 's expedited approval programs to see which ones are working and which ones are mainly driving up health care costs .
`` We 've kind of reached a point where it makes sense to pause and see whether we can do things better , '' Sharfstein says .
`` And @ @ @ @ @ @

FDA Approves Drugs Faster Than Ever But Relies On Weaker Evidence, Researchers Find
The Food and Drug Administration has gotten faster at approving new prescription drugs over the past four decades, but the evidence it relies on in making those decisions is getting weaker, according to new research published Tuesday.
As a result, there are more cures and treatments on the market but less proof that they are safe and effective.
"There has been a gradual erosion of the evidence that's required for FDA approval," says lead study author Jonathan Darrow, a lawyer with Harvard Medical School's Program on Regulation, Therapeutics and Law. As a result, patients and physicians "should not expect that new drugs will be dramatically better than older ones."
Almost half of recent new drug approvals were based on only one pivotal clinical trial instead of the two or more that used to be the norm, according to the study published Tuesday in JAMA, the journal of the American Medical Association. And the reliance on surrogate measures — stand-ins for presumed patient benefits — has increased. In the case of cancer drugs, a surrogate measure could be shrinkage of tumors instead of improvements in survival after treatment.
Darrow and his colleagues analyzed FDA drug approvals, changes in laws and regulations and the rise in industry funding of the agency's reviews from 1983 through 2018.
The researchers found that the average number of new drug approvals per year increased from 34 in the 1990s to 41 in the 2010s, after a dip to 25 a year in the 2000s.
New drugs are getting through the FDA process faster. In 2018, the median review time for standard drug applications was 10.1 months compared with 2.8 years for standard and priority applications for the period from 1986 and 1992.
Faster approval was the goal of many legislative and regulatory changes starting in the 1980s. For instance, in 1983, Congress passed the Orphan Drug Act to encourage drugmakers toward developing rare disease treatments that otherwise might not be profitable. The FDA allowed approval for these drugs based on smaller trials with more flexible evidence standards, and it offered more time on the market for the medicines without generic competition.
Drugmakers also began paying the FDA fees to fund the review process after AIDS activists protested the agency's sluggishness in the 1980s.
The FDA collected $29 million in fees in 1993, the year after Congress passed the Prescription Drug User Fee Act for the first time. The fees rose to $908 million in 2018. That year, industry fees amounted to about 80% of the money spent on FDA employee salaries for drug reviews, according to the study.
"There is some concern about the incentives that this is created within the FDA," Darrow says. "And whether it has created a culture in the FDA where the primary client is no longer viewed as the patient, but as the industry."
Former FDA Principal Deputy Commissioner Dr. Joshua Sharfstein says the FDA has succeeded in approving more drugs, but he also says that more changes are needed to make sure the medicines are worthwhile for patients.
"Some of them are really great, and some of them [are] not so great," says Sharfstein, now a professor at the Johns Hopkins Bloomberg School of Public Health. "And a lot of them are very expensive."
In an accompanying editorial in JAMA, Sharfstein offers several suggestions for change, including a reevaluation of the FDA's expedited approval programs to see which ones are working and which ones are mainly driving up health care costs.
"We've kind of reached a point where it makes sense to pause and see whether we can do things better," Sharfstein says. "And I think we can."