Statistical Models vs. Front-Line Workers: Who Knows Best How to Spend Opioid Settlement Cash?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
MOBILE, Ala. — In this Gulf Coast city, addiction medicine doctor Stephen Loyd announced at a January event what he called “a game-changer” for state and local governments spending billions of dollars in opioid settlement funds.
The money, which comes from companies accused of aggressively marketing and distributing prescription painkillers, is meant to tackle the addiction crisis.
But “how do you know that the money you’re spending is going to get you the result that you need?” asked Loyd, who was once hooked on prescription opioids himself and has become a nationally known figure since Michael Keaton played a character partially based on him in the Hulu series “Dopesick.”
Loyd provided an answer: Use statistical modeling and artificial intelligence to simulate the opioid crisis, predict which programs will save the most lives, and help local officials decide the best use of settlement dollars.
Loyd serves as the unpaid co-chair of the Helios Alliance, a group that hosted the event and is seeking $1.5 million to create such a simulation for Alabama.
The state is set to receive more than $500 million from opioid settlements over nearly two decades. It announced $8.5 million in grants to various community groups in early February.
Loyd’s audience that gray January morning included big players in Mobile, many of whom have known one another since their school days: the speaker pro tempore of Alabama’s legislature, representatives from the city and the local sheriff’s office, leaders from the nearby Poarch Band of Creek Indians, and dozens of addiction treatment providers and advocates for preventing youth addiction.
Many of them were excited by the proposal, saying this type of data and statistics-driven approach could reduce personal and political biases and ensure settlement dollars are directed efficiently over the next decade.
But some advocates and treatment providers say they don’t need a simulation to tell them where the needs are. They see it daily, when they try — and often fail — to get people medications, housing, and other basic services. They worry allocating $1.5 million for Helios prioritizes Big Tech promises for future success while shortchanging the urgent needs of people on the front lines today.
“Data does not save lives. Numbers on a computer do not save lives,” said Lisa Teggart, who is in recovery and runs two sober living homes in Mobile. “I’m a person in the trenches,” she said after attending the Helios event. “We don’t have a clean-needle program. We don’t have enough treatment. … And it’s like, when is the money going to get to them?”
The debate over whether to invest in technology or boots on the ground is likely to reverberate widely, as the Helios Alliance is in discussions to build similar models for other states, including West Virginia and Tennessee, where Loyd lives and leads the Opioid Abatement Council.
New Predictive Promise?
The Helios Alliance comprises nine nonprofit and for-profit organizations, with missions ranging from addiction treatment and mathematical modeling to artificial intelligence and marketing. As of mid-February, the alliance had received $750,000 to build its model for Alabama.
The largest chunk — $500,000 — came from the Poarch Band of Creek Indians, whose tribal council voted unanimously to spend most of its opioid settlement dollars to date on the Helios initiative. A state agency chipped in an additional $250,000. Ten Alabama cities and some private foundations are considering investing as well.
Stephen McNair, director of external affairs for Mobile, said the city has an obligation to use its settlement funds “in a way that is going to do the most good.” He hopes Helios will indicate how to do that, “instead of simply guessing.”
Rayford Etherton, a former attorney and consultant from Mobile who created the Helios Alliance, said he is confident his team can “predict the likely success or failure of programs before a dollar is spent.”
The Helios website features a similarly bold tagline: “Going Beyond Results to Predict Them.”
To do this, the alliance uses system dynamics, a mathematical modeling technique developed at the Massachusetts Institute of Technology in the 1950s. The Helios model takes in local and national data about addiction services and the drug supply. Then it simulates the effects different policies or spending decisions can have on overdose deaths and addiction rates. New data can be added regularly and new simulations run anytime. The alliance uses that information to produce reports and recommendations.
Etherton said it can help officials compare the impact of various approaches and identify unintended consequences. For example, would it save more lives to invest in housing or treatment? Will increasing police seizures of fentanyl decrease the number of people using it or will people switch to different substances?
And yet, Etherton cautioned, the model is “not a crystal ball.” Data is often incomplete, and the real world can throw curveballs.
Another limitation is that while Helios can suggest general strategies that might be most fruitful, it typically can’t predict, for instance, which of two rehab centers will be more effective. That decision would ultimately come down to individuals in charge of awarding contracts.
Mathematical Models vs. On-the-Ground Experts
To some people, what Helios is proposing sounds similar to a cheaper approach that 39 states — including Alabama — already have in place: opioid settlement councils that provide insights on how to best use the money. These are groups of people with expertise ranging from addiction medicine and law enforcement to social services and personal experience using drugs.
Even in places without formal councils, treatment providers and recovery advocates say they can perform a similar function. Half a dozen advocates in Mobile told KFF Health News the city’s top need is low-cost housing for people who want to stop using drugs.
“I wonder how much the results” from the Helios model “are going to look like what people on the ground doing this work have been saying for years,” said Chance Shaw, director of prevention for AIDS Alabama South and a person in recovery from opioid use disorder.
But Loyd, the co-chair of the Helios board, sees the simulation platform as augmenting the work of opioid settlement councils, like the one he leads in Tennessee.
Members of his council have been trying to decide how much money to invest in prevention efforts versus treatment, “but we just kind of look at it, and we guessed,” he said — the way it’s been done for decades. “I want to know specifically where to put the money and what I can expect from outcomes.”
Jagpreet Chhatwal, an expert in mathematical modeling who directs the Institute for Technology Assessment at Massachusetts General Hospital, said models can reduce the risk of individual biases and blind spots shaping decisions.
If the inputs and assumptions used to build the model are transparent, there’s an opportunity to instill greater trust in the distribution of this money, said Chhatwal, who is not affiliated with Helios. Yet if the model is proprietary — as Helios’ marketing materials suggest its product will be — that could erode public trust, he said.
Etherton, of the Helios Alliance, told KFF Health News, “Everything we do will be available publicly for anyone who wants to look at it.”
Urgent Needs vs. Long-Term Goals
Helios’ pitch sounds simple: a small upfront cost to ensure sound future decision-making. “Spend 5% so you get the biggest impact with the other 95%,” Etherton said.
To some people working in treatment and recovery, however, the upfront cost represents not just dollars, but opportunities lost for immediate help, be it someone who couldn’t find an open bed or get a ride to the pharmacy.
“The urgency of being able to address those individual needs is vital,” said Pamela Sagness, executive director of the North Dakota Behavioral Health Division.
Her department recently awarded $7 million in opioid settlement funds to programs that provide mental health and addiction treatment, housing, and syringe service programs because that’s what residents have been demanding, she said. An additional $52 million in grant requests — including an application from the Helios Alliance — went unfunded.
Back in Mobile, advocates say they see the need for investment in direct services daily. More than 1,000 people visit the office of the nonprofit People Engaged in Recovery each month for recovery meetings, social events, and help connecting to social services. Yet the facility can’t afford to stock naloxone, a medication that can rapidly reverse overdoses.
At the two recovery homes that Mobile resident Teggart runs, people can live in a drug-free space at a low cost. She manages 18 beds but said there’s enough demand to fill 100.
Hannah Seale felt lucky to land one of those spots after leaving Mobile County jail last November.
“All I had with me was one bag of clothes and some laundry detergent and one pair of shoes,” Seale said.
Since arriving, she’s gotten her driver’s license, applied for food stamps, and attended intensive treatment. In late January, she was working two jobs and reconnecting with her 4- and 7-year-old daughters.
After 17 years of drug use, the recovery home “is the one that’s worked for me,” she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
The Best Foods For Collagen Production
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Dr. Andrea Suarez gives us the low-down on collagen synthesis and maintenance. Collagen is the most abundant protein in our body, and it can be fairly described as “the stuff that holds us together”. It’s particularly important for joints and bones too, though many people’s focus on it is for the skin. Whatever your priorities, collagen levels are something it pays to be mindful of, as they usually drop quite sharply after a certain age. What certain age? Well, that depends a lot on you, and your diet and lifestyle. But it can start to decline from the age of 30 with often noticeable drop-offs in one’s mid-40s and again in one’s mid-60s.
Showing us what we’re made of
There’s a lot more to having good collagen levels than just how much collagen we consume (which for vegetarians/vegans, will be “none”, unless using the “except if for medical reasons” exemption, which is probably a little tenuous in the case of collagen but nevertheless it’s a possibility; this exemption is usually one that people use for, say, a nasal spray vaccine that contains gelatine, or a medicinal tablet that contains lactose, etc).
Rather, having good collagen levels is also a matter of what we eat that allows us to synthesize our own collagen (which includes: its ingredients, and various “helper” nutrients), as well as what dietary adjustments we make to avoid our extant collagen getting broken down, degraded, and generally lost.
Here’s what Dr. Suarez recommends:
Protein-rich foods (but watch out)
- Protein is essential for collagen production.
- Sources: fish, soy, lean meats (but not red meats, which—counterintuitively—degrade collagen), eggs, lentils.
- Egg whites are high in lysine, vital for collagen synthesis.
- Bone broth is a natural source of collagen.
Omega-3 fatty acids
- Omega-3s are anti-inflammatory and protect skin collagen.
- Sources: walnuts, chia seeds, flax seeds, fatty fish (e.g. mackerel, sardines).
Leafy greens
- Leafy dark green vegetables (e.g. kale, spinach) are rich in vitamins C and B9.
- Vitamin C is crucial for collagen synthesis and acts as an antioxidant.
- Vitamin B9 supports skin cell division and DNA repair.
Red fruits & vegetables
- Red fruits/vegetables (e.g. tomatoes, red bell peppers) contain lycopene, an antioxidant that protects collagen from UV damage (so, that aspect is mostly relevant for skin, but antioxidants are good things to have in all of the body in any case).
Orange-colored vegetables
- Carrots and sweet potatoes are rich in vitamin A, which helps in collagen repair and synthesis.
- Vitamin A is best from food, not supplements, to avoid potential toxicity.
Fruits rich in vitamin C
- Citrus fruits, kiwi, and berries are loaded with vitamin C and antioxidants, essential for collagen synthesis and skin health.
Soy
- Soy products (e.g. tofu, soybeans) contain isoflavones, which reduce inflammation and inhibit enzymes that degrade collagen.
- Soy is associated with lower risks of chronic diseases.
Garlic
- Garlic contains sulfur, taurine, and lipoic acid, important for collagen production and repair.
What to avoid:
- Reduce foods high in advanced glycation end products (AGEs), which damage collagen and promote inflammation.
- AGEs are found in fried, roasted, or grilled fatty proteinous foods (e.g. meat, including synthetic meat, and yes, including grass-fed nicely marketed meat—although processed meat such as bacon and sausages are even worse than steaks etc).
- Switch to cooking methods like boiling or steaming to reduce AGE levels.
- Processed foods, sugary pastries, and red meats contribute to collagen degradation.
General diet tips:
- Incorporate more plant-based, antioxidant-rich foods.
- Opt for slow cooking to reduce AGEs.
- Since sustainability is key, choose foods you enjoy for a collagen-boosting diet that you won’t seem like a chore a month later.
For more on all of this, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
We Are Such Stuff As Fish Are Made Of ← our main feature research review about collagen
Take care!
Share This Post
-
Live Long, Die Short – by Dr. Roger Landry
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
First know: “die short” is not about your height—although on average, short people do live longer, partly because insulin-like growth factor (IGF-1) promotes both tallness and accelerated DNA damage (thus, aging and cancer), and partly because if someone is very tall, it can cause circulatory problems, and without a nice easy flow of blood through the brain, bad things happen (such as accumulation of harmful detritus in the brain, and increased stroke risk too).
Next know: “die short” is, in this book, actually about shortening the decline at the end of life. Sometimes people say “I don’t want to live 10 years longer; they’ll be the 10 most miserable years”, but in fact if we look after our health, we will be healthy for perhaps >9.5 of our last 10 years, while an unhealthy person may just get their expected “10 most miserable years” 10 or 20 years earlier (and then die).
So, in short (so to speak), it’s about increasing healthspan.
To enjoy the longest and healthiest healthspan, Dr. Landry offers 10 tips. We’ll not keep them a secret; they are:
- Use it or lose it
- Keep moving
- Challenge your brain
- Stay connected
- Lower your risks
- Never act your age
- Wherever you are, be fully there
- Find your purpose
- Have children in your life
- Laugh to a better life
Each of these has a chapter devoted to them, in section 2 of the book (section 1 is about what we know about healthy aging, and section 3 is about where we go from here).
You’ll notice that one item not generally found on such lists is “have children in your life”; to be clear, they don’t have to be your children, and/but they do have to be actual current children; any now-grown-up progeny aren’t what’s being talked about here (wonderful as they may be, any support role they may play gets filed under “stay connected” instead).
The style is mostly impersonal pop-science with occasional personal anecdotes, and the book’s formatting (many subheadings within chapters) makes it easy to read a bit at a time, if that’s your preference. There’s a modest, but extant, bibliography.
Bottom line: if you’d like to stay younger as you get older, this book goes into a lot of detail about 10 ways to do just that.
Click here to check out Live Long, Die Short, and live long, die short!
Share This Post
-
Buckwheat vs Bulgur Wheat – Which is Healthier?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
Our Verdict
When comparing buckwheat to bulgur, we picked the buckwheat.
Why?
First, some things to know up front:
- Bulgur wheat is a kind of cracked wheat product. As such, it contains wheat, and yes, gluten.
- Buckwheat is not a wheat, nor even a grass, but a flowering plant. Buckwheat is as related to wheat as a lionfish is to a lion. It does not contain gluten.
- Buckwheat can be purchased whole or hulled. We went with whole. If you go with hulled, the percentages of vitamins and minerals will be relatively higher, and/but this will be because you lost the fibrous husk, so they’ll be commensurately lower in fiber. If you were to go with hulled, we’d still pick it over bulgur wheat though, just for a different reason (as in that case, the vitamin and mineral contents would be more overwhelmingly in buckwheat’s favor, even though it’d have less fiber).
Ok, now that those things are covered…
Looking at the macronutrients, there’s not a lot between them, except that buckwheat has the much lower glycemic index (this is only the case if you got whole, not hulled—if you got hulled, the glycemic index would be about the same).
In terms of vitamins, buckwheat has more of vitamins B2, B5, B9, E, K, and choline, while bulgur wheat technically has more vitamin A, but the numbers are tiny; a cup of bulgur wheat will give you 0.12% of the RDA. So, an easy win (functionally: 5:0) for buckwheat.
When it comes to minerals, buckwheat has more copper, magnesium, potassium, and selenium, while bulgur wheat has more calcium and manganese. They’re equal on iron and phosphorus, making this a 4:2 win for buckwheat.
Adding up the categories makes this a clear win for buckwheat!
Want to learn more?
You might like to read:
Take care!
Share This Post
-
Can You Shrink A Waist In Seven Days?
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
We don’t usually do this sort of video, but it seems timely before the new year. The exercises shown here are very good, and the small dietary tweak is what makes it work:
The method
Firstly, the small dietary tweak is: abstaining from foods that cause bloating, such as flour and dairy. She does say “брожение” (fermentation), but we don’t really use the word that way in English. On which note: she is Ukrainian and speaking Russian (context: many Ukrainians grew up speaking both languages), so you will need the subtitles on if you don’t understand Russian, but a) it’s worth it b) the subtitles have been put in manually so they’re a respectable translation.
Secondly, spoiler, she loses about 2 inches.
The exercises are:
- Pelvic swing-thrusts: sit, supporting yourself on your hands with your butt off the floor; raise your pelvis up to a table position, do 30 repetitions.
- Leg raises in high plank: perform 20 lifts per leg, each to its side.
- Leg raises (lying on back): do 20 repetitions.
- V-crunches: perform 30 repetitions.
- V-twists: lean on hands and do 25 repetitions.
These exercises (all five done daily for the 7 days) are great for core strength, and core muscletone is what keeps your innards in place, rather than letting them drop down (and out).
Thus, there’s only a small amount of actual fat loss going on here (if any), but it slims the waistline by improving muscletone and simultaneously decreasing bloating, which are both good changes.
For more on all of these plus visual demonstrations, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Visceral Belly Fat & How To Lose It
Take care!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
Lies I Taught in Medical School – by Dr. Robert Lufkin
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
There seems to be a pattern of doctors who practice medicine one way, get a serious disease personally, and then completely change their practice of medicine afterwards. This is one of those cases.
Dr. Lufkin here presents, on a chapter-by-chapter basis, the titularly promised “lies” or, in more legally compliant speak (as he acknowledges in his preface), flawed hypotheses that are generally taught as truths. In many cases, the “lie” is some manner of “xyz is normal and nothing to worry about”, and/or “there is nothing to be done about xyz; suck it up”.
The end result of the information is not complicated—enjoy a plants-forward whole foods low-carb diet to avoid metabolic diseases and all the other things to branch off from same (Dr. Lufkin makes a fair case for metabolic disease leading to a lot of secondary diseases that aren’t considered metabolic diseases per se). But, the journey there is actually important, as it answers a lot of questions that are much less commonly understood, and often not even especially talked-about, despite their great import and how they may affect health decisions beyond the dietary. Things like understanding the downsides of statins, or the statistical models that can be used to skew studies, per relative risk reduction and so forth.
Bottom line: this book gives the ins and outs of what can go right or wrong with metabolic health and why, and how to make sure you don’t sabotage your health through missing information.
Click here to check out Lies I Taught In Medical School, and arm yourself with knowledge!
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
-
How We Age: The Science of Longevity – by Dr. Coleen Murphy
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
The author is not a glossy “name brand” and has nothing to sell (besides her book). This shows, because it’s clearly not a book that was rushed out as a marketing ploy. Indeed, she begins with the words:
❝This book took me several years to write and is largely based on information I gathered while teaching my class, “Molecular Mechanisms of Longevity: The Genetics, Genomics, and Cell Biology of Aging,” at Princeton University.❞
~ Dr. Coleen Murphy
Thus, as you may imagine, it’s a thorough book, thoughtful, with conscientious attention to detail. As a reader, you are essentially getting the knowledge of a Princeton genomics class.
She covers what’s going on in our genes, in our cells, and in our bodies, when we age; why some animals don’t, and what things affect that. She talks biomarkers of aging and the industry gold standard “Health-Related Quality of Life” metrics. We learn about insulin signalling and FOXO targets; the role of caloric restriction or intermittent fasting, topics such as molecular homeostasis in the regulation of longevity (hello senolytics and chaperone-mediated autophagy), the microbiome and epigenetics, as well as mitochondrial management, cell replacement (including induced pluripotent stem cells), and even DNA repair. And yes, a lot about cognitive aging and how to slow it too.
The style is academic and/but perfectly readable; she explains everything as we go. We’ll note, though, that it’s not dry academic—her personality comes through throughout, in a good way that makes it a pleasant read as well as an informative one.
Bottom line: if you’d like a much deeper understanding of the mechanics of aging than we have room to get into in our articles at 10almonds, this book is a highly recommendable perfect opportunity.
Click here to check out How We Age, and learn about the science of longevity!
PS: we’ve reviewed a few books about the science of aging/longevity recently, and they’ve each been good, but if you’re going to get only one, we recommend this one, as in this reviewer’s opinion, it’s the best 😎
Don’t Forget…
Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!
Learn to Age Gracefully
Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:
