Archives: 06/2019

Will “Internet Addiction” Be Our Next “Crisis?”

report on National Public Radio’s Morning Edition today discusses growing concerns about “internet addiction,” especially among adolescents. The reporter mentions that “internet addiction,” sometimes called “social media addiction,” is not recognized as a mental health disorder in the US, where the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) published by the American Psychiatric Association categorizes it as a “condition for further study.” This is not insignificant in light of the strong economic incentives for the psychiatric profession to medicalize behavioral problems. 

The World Health Organization recently recognized “internet gaming disorder” as an addiction in its eleventh revision of the International Classification of Diseases (ICD-11), and China, South Korea, Japan, and other countries now consider “internet addiction” a mental health disorder.

The NPR report interviews a psychiatrist who believes that internet addiction is indeed a mental health disorder and laments the paucity of programs available to treat afflicted adolescents. Because it is not recognized as a disease in the US, treatment is not usually covered by health insurance. The psychiatrist tells the reporter that some clinicians creatively assign as a diagnosis one of the psychiatric co-morbidities that accompany almost all of their patients with internet addiction, in order to get insurance to pay for it. The fact that almost all cases come with attached co-morbidities creates a “chicken or egg” situation that is one of the reasons why many researchers are reluctant to conclude internet addiction is a distinct disorder. 

Therapists usually engage in treatment techniques that are similar for the treatment of other addictive disorders. The report highlights a 12-step program (similar to Alcoholics Anonymous) recently begun in Minnesota, whose director encourages the recognition of internet or social media addiction as a disease, in order to promote the proliferation of affordable rehab and other treatment programs across the country that would be covered by health insurance.

I have written about the dangerous tendency to medicalize behavioral patterns, so-called “social media addiction” in particular, and to overuse the label of addiction. This report from a respected media source can be expected to fuel more animated discussions about internet or social media addiction in the public square.

As I pointed out in a recent article at, a meticulous examination of the evidence is crucial before concluding internet/social media addiction is an actual disorder. Such a determination may not just impact the fiscal stability of the health care system but, more importantly, may pose a potential threat to freedom of speech.

Shamefully, Only Two Justices Find that You Can’t Be Prosecuted by a State and the Feds for the Same Crime

This morning, in the case of Gamble v. United States, the Supreme Court ruled 7-2—with only Justices Neil Gorsuch and Ruth Bader Ginsburg in dissent—that state and federal governments can continue having a second bite at the apple, both prosecuting someone for the same crime if they wish. It’s really unfortunate that the justices declined to withdraw the “dual-sovereignty” exception to the Double Jeopardy Clause. The Court itself created this doctrine decades ago, before the federal criminal code (unconstitutionally) exploded and before the Double Jeopardy Clause even applied to the states. 

As Justice Gorsuch wrote, “the separate-sovereigns exception to the bar against double jeopardy finds no meaningful support in the text of the Constitution, it’s original public meaning, structure, or history.” To put a finer point on it, it’s fully consistent with federalism to say that nobody should be prosecuted twice for the same crime. 

That is, federalism—the division of sovereignty between the federal and state governments—exists to protect our liberties. It divides power to lessen the chance of government abuse. It decidedly does not multiply power or act as some sort of redundancy whereby the federal and state government both get to regulate in the same areas—including the criminal law. 

It’s a shame that the Supreme Court failed to correct the constitutional anomaly here, and to ensure that criminal defendants receive the protection against multiple prosecutions that the Fifth Amendment so plainly commands.

For more on this line of analysis, see Cato’s brief.

Toward a Healthy Relationship with Opioids

In the June 14th Wall Street Journal, Johns Hopkins University bioethicist Travis Rieder, in an excellent essay, shared with readers his battle with pain resulting from a devastating accident, the effectiveness of opioids in controlling the pain, and the hell he went through when he was too rapidly tapered off of the opioids to which he had become physically dependent. Like most patients requiring long term pain management with opioids, he developed a physical dependence, which is often mistakenly equated with addiction by policymakers and many in the media. 

The aggressive schedule launched me into withdrawal, and I learned viscerally, firsthand, what the absence of opioids can do to someone whose brain has become accustomed to them. Those symptoms include increased sensitivity to the very pain that the opioids counteract, as well as extreme flu-like symptoms, insomnia and crippling depression. I came to understand why people sometimes go back onto deadly dangerous drugs: because the alternative is such profound suffering that it makes you want to die.

I have criticized policymakers for their ham-handed approach based upon a misinterpretation and misapplication of the guidelines on pain management with opioids, released in 2016 by the Centers for Disease Control and Prevention, herehere, and here. As explained in an article I co-authored in the Journal of Pain Research in February 2019, this blunt reaction is based upon the false assumption that opioid-related overdose deaths from nonmedical use is primarily a result of doctors treating patients in pain.

In his essay, Dr. Rieder levels similar criticisms:

Perhaps the greatest challenge about them [opioids] today is to resist the urge to be simplistic or reactionary. America’s current crisis of overuse has led some prescribers to avoid the drugs completely, and it has led politicians to occasionally consider ham-fisted policy solutions, like limiting the lengths or dosages of prescriptions regardless of any individual patient’s needs. But when a medication has both risks and benefits, what we need isn’t one-size-fits-all policies but nuance. 

Dr. Rieder was one of dozens of scholars, academics, physicians, and pain experts who signed a letter to the Oregon Health Authority in March, authored by Stanford University Medical School Professor Sean Mackey, urging against the Authority’s plans to force a rapid tapering off of opioids on all of the chronic pain patients in Oregon’s Medicaid system. That letter, plus push-back from patient advocacy groups, caused the Oregon Health Authority to put its plans on hold. It should not be lost on readers of this blog post that such interventions in the practice of medicine and the delivery of health care  are part and parcel of a state-run health care system.

The Annual Death Rate in Immigration Detention Rose in 2017 and Fell in 2018

Since the Trump Administration announced a punitive immigration detention policy in 2018 that separated families, reports have surfaced of immigrants who have died while in detention or shortly after being released to medical facilities for treatment.  It’s understandable why news consumers and suppliers are interested in deaths in detention facilities given the Trump Administration’s actions on this issue, but the distinct impression from reading all of these stories is that being detained is more dangerous than ever. 

To check whether this was true or if this impression was just an artifact of cognitive bias, I decided to estimate the annual death rate in immigration detention in the United States.  There are two primary pieces of data required to calculate this rate: The number of people in detention each year and the number of deaths.  Immigration and Customs Enforcement (ICE) runs all of the detention facilities and they provide the number of deaths and admissionsThe American Immigration Law Association provides some more recent numbers of deaths in detention, but I only include those that ICE also counts.  The admissions into ICE detention facilities variable is the proper one to use as it is closer to the number of unique individuals who were present in a detention facility in each year.  The numbers for both variables run through the end of Fiscal Year (FY) 2018.

The FY2018 death rate in ICE immigration detention was 2.3 per 100,000 detainees, a 39 percent drop relative to the rate for FY2017.  That’s good news, but the improvement in FY2018 follows on a deterioration in FY2017 from FY2016.  In FY2017, the death rate per 100,000 detainees increased by 31 percent relative to FY2016.  In other words, the chance of dying in detention rose in FY2017 – but the death rate began to rise in FY2015 from a low point of 1.4 per 100,000 in FY2014 in an uninterrupted trend.  The largest percentage increases during this time was a 60 percent jump from FY2014 to FY2015.  The Trump Administration inherited an ICE detention system where the death rate was rising, presided over a year when the death rate continued to rise, and then saw it fall by 32 percent in FY2018.  

Table 1: Deaths per 100,000 Detainees, By Year

Figure 1 shows the total number of ICE detentions and the total number of deaths in custody.  The absolute number and rates of death in ICE detention were highest during the George W. Bush administration at 6.4 per 100,000 per year.  Those death rates fell rapidly from 2004, the first full year when ICE was in operation, from 11.9 per 100,000 detainees to 2.9 per 100,000 detainees in 2008.  The death rate rose 26 percent during the first year of the Obama Administration in 2009, then started falling again the next year with an average annual death rate of 2.3 per 100,000 detainees during his entire presidency.  We only have data for two years of the Trump administration where the annual death rate is 2.9 percent – almost identical to that of the first two years of the Obama Administration. 

Copy: Table 1: Deaths per 100,000 Detainees, By Year

This excellent study of death rates in ICE detention gives three reasons for why death rates fell so much during the Bush years and remained low thereafter.  The first is that the length of time that immigrants spent in detention fell, which means there was less opportunity for each individual to die even though more were in detention.  The second was that ICE increasingly relied on Secure Communities and local law enforcement to first arrest illegal immigrants and then transfer them to ICE.  Local law enforcement agencies typically provided any healthcare that the immigrants needed before being transferred to ICE or, tragically, many of them died in local law enforcement custody.  The third is that ICE medical policies and practices improved during this time. 

Although it may seem like there is a major spike in deaths in immigration detention, and the FY2019 could show that (although that is extremely unlikely), that is simply not true.  Although there was an increase in death rates in FY2017, they were down considerably in FY2018 and show all indication of falling further in FY2019.

Justin Amash and His Opponents

Rep. Justin Amash (R-MI) is the most libertarian member of Congress. His view of his role in Congress is deeply rooted in his commitment to the Constitution. Amash told the New York Times in 2011, “I follow a set of principles, I follow the Constitution. And that’s what I base my votes on. Limited government, economic freedom and individual liberty.”

Amash has a remarkable knack for drawing opponents who are ignorant or dismissive of the Constitution. His 2014 primary opponent, Brian Ellis, strikingly dismissed Amash’s principled, constitutional stand: “He’s got his explanations for why he’s voted, but I don’t really care. I’m a businessman, I look at the bottom line. If something is unconstitutional, we have a court system that looks at that.” 

Most members of Congress vote for unconstitutional bills. Few of them make it an explicit campaign promise.

And now, just today, one of his pro-Trump challengers in next year’s primary, Tom Norton, “passed out press releases calling on the House to expel Amash for allegedly failing to represent constituents in a district that backed Trump.”

Needless to say, Congress does not and would not expel a member for such a reason. Not that it matters, in 2016 Amash carried his district by 22 points while Trump had a 9-point margin.

Meanwhile, here’s an article on Amash’s differences with Sen. Rand Paul (R-KY) on what libertarians should think about the behavior described in the Mueller Report.  

Market-Based Visas: Problems, Criticisms, and Solutions

Steven Kopits of Princeton Energy Advisors wrote a few criticisms of our proposal to sell Gold Cards through a market-based program that I’ve called an immigration tariff.  An immigration tariff is an attempt, based largely on Nobel Prize-winning economist Gary Becker’s idea to sell visas, to create a market-based visa that accounts for many of the most trenchant criticisms of liberalized immigration  The idea is simply to create a new visa called a Gold Card without numerical quotas or caps.  The Gold Card would supply permanent legal residency and work permission, but cannot be used to naturalize –like a green card lite.  The government would then sell those Gold Cards for a price set with three goals in mind.  Those goals are to make sure that the Gold Card is a net-fiscal windfall for the federal government, to outcompete human smugglers, and to create a more flexible immigration system that responds to the U.S. market demands. 

The prices that I’ve recommended for the Gold Card are designed to more than offset the worst-case scenarios as outlined by the National Academy of Sciences fiscal cost projections by age of entry and education level for individual immigrants.  This is an earnest and direct answer to a forceful conservative criticism of immigration based on its supposedly negative fiscal effect.  Although I dispute the notion that immigrants are a net fiscal drain, that criticism is still politically popular and must be addressed in any final policy.  

In most cases the prices for Gold Cards would compete favorably with human smugglers and drive most illegal immigrants and many asylum-seekers into the Gold Card market.  A legal Gold Card visa guarantees legal work and residency, so long as the migrant doesn’t commit a deportable offense, while smuggling is an expensive and risky chance at potentially working illegally in the United States with the ever-present risk of deportation and abuse in the black market.  Furthermore, the prices charged by human smugglers are not so much lower than Gold Cards in my mock tariff schedule.    Lastly, an immigration tariff is the most market-friendly visa that still offers some protections for the U.S. labor market, the last point being politically necessary.

Kopits also combines some criticisms of Cato’s immigration tariff with that of the IDEAL immigration plan that charges $2500 a year for a work permit.  The IDEAL plan has a lot of merit and it’s worth examining in detail, but I’m going to focus on the points that Kopits raises about Cato’s immigration tariff proposal here.  I take Kopits’ criticisms seriously because he is a proponent of creating a market-based visa system for the United States, he has written thoughtfully on this and other immigration issues, and he’s a smart and respectable individual.  Kopits’ criticisms are in quotes below and my responses follow.


The fee is too low and the market is too big

Both the Cato and Ideal fees are too low, particularly as they offer permanent residency in some form.  From the conservative perspective, the idea is to limit or reduce the number of immigrants and reduce tenure of migrants in the US.  A low fee will not only encourage immigration, it will crush the system.”

The Gold Card is a form of specially designed permanent residency that is not a pathway to citizenship.  The Gold Card does not preclude its holder from earning a green card through one of the existing legal channels and eventually naturalizing that way, but it does not provide a special path toward citizenship.  The non-immigrant feature of the Gold Card is intended to cater to conservative worries that Gold Card purchasers will all naturalize and vote against them, just like they fear new immigrants and those legalized in an amnesty for illegal immigrants will vote against them.  Anecdotally, this fear is an important reason why many Republicans and conservatives are skeptical of increasing legal immigration.  I think their fear has all of the hallmarks of a self-fulfilling prophecy, but it’s probably come true to some extent because of Republican positions on the issue of immigration, so the Gold Card is designed to deal with that.

“Consider Cato’s $15,000 fee for young adults without high school educations.  How big is the potential market?  If we apply the offer to 133 low income countries globally – to Latin America, East and South Asia and Africa – then we are speaking of a gross population of 6.5 bn.  If just 0.1% decided to take up the offer … well, it would be game over in a matter of days.”


U.K.’s “Unexplained Wealth Orders” Give the State Too Much Power

I’ve got a piece in the Washington Examiner this morning on a remarkable new law enforcement tool in Britain:

It’s like, “Your papers, please,” but for things you own.

Authorities in Britain have begun trying out a new police power called unexplained wealth orders under a law that took effect last year. The police go to a court and say you’re living way above any known legitimate income. The judge then signs an order compelling you to show that your possessions (whether a house, fancy car, or jewelry) have been obtained honestly and not with dirty money. In the meantime, the boat or artwork or other assets get frozen, and you can’t sell them until you’ve shown you obtained them innocently.

The kicker: The burden of proof falls on you, not the government. If you don’t prove the funds were clean, Her Majesty may be presumed entitled to keep the goodies….

Related to the flipping of the burden of proof, the law says information dug up via one of the orders can’t then be used in criminal charges against the target.

…advocates want this to be the start of hundreds of seizure actions against other rich foreigners in the British capital.

Some are already calling for bringing a law like this to the United States, and maybe we’re halfway there already. Asset forfeiture laws, blessed by the Supreme Court, already let police seize your property on suspicion of involvement in a crime and make you go to court to get it back. We’ve been chipping away at financial privacy in this country for decades, through Know Your Customer, suspicious-activity reports, and FATCA (expatriate tax) rules.

Ironically — though recent enactments by Parliament may be changing this, too — Britain’s own peripheral territories and dependencies, including the Channel Islands, British Virgin Islands, Cayman Islands, etc. have long made a good business out of furnishing the rest of the world with the means of financial privacy.

The reversal of the presumption of innocence troubles many Britons, too. For the moment, use of the orders is limited to a few elite law enforcement agencies. One of those agencies, however, is Her Majesty’s Revenue and Customs — the tax collectors. It’s not wrong to worry about where this idea is headed.

Whole thing here.