During Tuesday’s presidential news conference, Jonathan Karl of ABC News asked the president if he still had “the juice” to get the rest of his agenda through Congress.
It was a funny exchange, but also a telling one, less about this president’s ability to maneuver and push policy than about media organizations that are forever looking beyond the moment, so much so that they do little justice to — and demonstrate a marvelous vacuity about — the present.
Too many people want to skip — or write off — the second term of this presidency and begin covering the contenders for the next one.
O.K., if that’s the way you want it, let’s take a glance at that lot of unbridled ambition and hapless long shots. Get your fill. Then maybe we can get back to talking honestly about the true encumbrances to Obama’s agenda. The president’s issue is not so much his unwillingness to coax or threaten or sweet talk or browbeat. It’s the compromise-resistant form of conservatism in this country that has fed on Obama’s very existence: an illogical, immutable opposition to him. In short, Obama leads an army amassed against him.
But, so that we can get this out of our system, here’s a look at the distant 2016 presidential race, the never-ending campaigning and invariably incorrect prognosticating.
The likely candidates are in full maneuver mode and the media are hanging on it. No sooner had the Republican Party released its autopsy of why Mitt Romney lost than a slew of Republican upstarts began stampeding over the campaign’s corpse.
Gov. Bobby Jindal of Louisiana — who chided his party for being the “stupid party” after the November election — has seen his poll numbers plummet, in part because of his failed, stupid plan to replace the state’s income tax with a higher sales tax. A Southern Media and Opinion Research poll released in March showed that his approval rating had dropped to 38 percent, down from 51 percent in September. Jindal is now even less popular than President Obama in Louisiana, and Obama lost that state by 18 percentage points.
The Washington Post reported this week that the F.B.I. was looking into the relationship between the Republican governor of Virginia, Bob McDonnell — “Governor Vaginal Probe” (remember that ultrasound bill he supported?) —and an executive who “gave more than $100,000 in political contributions and thousands of dollars more in gifts to McDonnell’s family.”
There was Senator Rand Paul’s disastrous speech at Howard University, where he sought to overlook decades of Republican Party hostility to African-Americans, subtly shift his own positions and educate students about a history they already knew all too well.
Gov. Chris Christie of New Jersey may be the Republicans’ best hope, but it’s not clear that he could even get the nomination: he’s so disliked by the G.O.P. base that he wasn’t even invited to speak at CPAC. One of the biggest laughs during the White House Correspondents’ Dinner on Saturday came when the host, Conan O’Brien, joked:
“I’d like to acknowledge that earlier this evening, there was some confusion with the seating chart. For a moment, someone accidentally sat Governor Chris Christie with the Republicans. That was awkward, and I apologize.”
Jeb Bush’s own mother threw him under the campaign bus last week, saying of a possible run by the former governor of Florida, “We’ve had enough Bushes."
National Review reported Wednesday that Senator Ted Cruz “is considering a presidential run, according to his friends and confidants.” Enough said.
This, of course, leaves Senator Marco Rubio. The problem is that he’s relatively unknown by most Americans. A February Fox News poll found that while 25 percent of respondents said that they thought he would make a good president, 33 percent said that they had never heard of him. Still, because he is Hispanic, the party may believe that he will up their support among that much needed voting bloc. But an April Wall Street Journal/Telemundo survey found that former Secretary of State Hillary Clinton’s approval rating among Hispanics was nearly three times higher than Rubio’s.
Clinton is still being coy about whether she can resist the gravitational pull of the most powerful job known to man — or woman — and the history she would make if she won.
Last week, the Democratic governor of Maryland, Martin O’Malley, announced while visiting Jerusalem that he might consider a run for president. He told reporters, “I plan for the latter half of this year to dedicate some more thought time — reflection time — to the question of whether or not I would run in 2016.”
And The Times reported this week that the Democratic governor of New York, Andrew Cuomo, who just passed a sweeping gun-control law, would be penning a memoir. We all know that memoirs by rising-star politicians are just 60,000-word résumés for the next job.
There you have it, many of the big names at least. (I’m sure you have others.) Now, any of these potentials could straighten things out — make up their minds or clean up their messes — before the next election. There’s time for them. But there’s also time for President Obama.
The second term of the Obama administration isn’t over, it’s just beginning. There are three and a half years left, for Pete’s sake. The hapless and the hopeful for 2016 will take care of themselves.
In an effort to curb addiction, specialists are looking beyond opiates to treat chronic pain. Shane Savage, an injured military veteran, stopped taking pain medicine and is seeking other ways to cope.Published On May 10, 2014 CreditCreditErich Schlegel for The New York Times
On Sept. 3, 2010, the armored truck he was commanding near Kandahar, Afghanistan, was blown apart by a roadside bomb. His head hit the ceiling so hard that his helmet cracked. His left foot was pinned against the dashboard, crushing 24 bones.
Sergeant Savage came home eight days later, at age 27, with the signature injuries of the conflicts in Iraq and Afghanistan: severe concussion, post-traumatic stress and chronic pain. Doctors at Fort Hood in Killeen, Tex., did what doctors across the nation do for millions of ordinary Americans: They prescribed powerful narcotic painkillers.
What followed was a familiar arc of abuse and dependence and despair. At one point, Sergeant Savage was so desperate that he went into the bathroom and began swallowing narcotic tablets. He would have died had his wife, Hilary, not burst through the door.
Today Sergeant Savage has survived, even prevailed, through grit, his family and a radical experiment in managing pain without narcotics. When off-duty, he pulls on cowboy boots and plays with his children, does charity work and, as part of a therapy program, rides horses. The only medication he takes for pain is Celebrex, a non-narcotic drug.
“You have to find alternative ways to get out and do stuff to stay active, to get your brain off the thought process of ‘I’m in pain,’ ” said Sergeant Savage, whose ears push out from under a Texas A&M baseball cap.
The story of Sergeant Savage illuminates an effort by experts inside and outside the military to change how chronic, or long-term, pain is treated. By some estimates, tens of millions of Americans suffer from chronic pain, and the use of opioids — drugs like hydrocodone, methadone and oxycodone (the active ingredient in painkillers like OxyContin) — to treat such conditions has soared over the last decade.
This opioid boom was a result of a synchronized drumbeat sounded by pharmaceutical companies, pain experts and others who argued that the drugs could defeat pain with little risk of addiction. Insurers embraced opioids as a seemingly effective and relatively inexpensive solution to a complex problem that often involves psychological and emotional issues.
In recent years, sales of opioids have flattened because of their role in 16,000 overdose deaths annually in the United States, cases that often involve abuse of the drugs. But a growing number of specialists have sharply reduced or stopped their prescription of opioids for another reason: their belief that the drugs have led doctors to focus on the wrong goal in treating chronic pain.
Opioids blunt a patient’s discomfort for a time. But the drugs can become a barrier to improving how well a patient functions physically and socially, goals that appear crucial in combating chronic pain, many experts say. As a result, specialists are returning to strategies that were popular before the opioid era, like physical therapy, behavior modification and psychological counseling. Others are exploring alternative treatments like acupuncture and yoga.
Sgt. Shane Savage, seriously injured in Afghanistan four years ago, now participates in a horse-riding therapy program, one part of an experiment in managing pain without narcotics.CreditErich Schlegel for The New York Times
Many pain programs now use non-opioid drugs, including ones developed for conditions like epilepsy, that are also effective in relieving pain. “We have to change the paradigm and the culture,” said Dr. Karen H. Seal, who specializes in pain treatment at the Veterans Affairs Medical Center in San Francisco and has studied the use of opioids and other drugs in combat veterans.
These days, the biggest changes are taking place inside the military and the Department of Veterans Affairs, organizations that have drawn criticism from lawmakers and others for overprescribing opioids and other powerful medications. Physicians in those organizations have more leeway than other doctors to use alternative treatments because insurers do not govern their decisions.
Five years ago, approximately 80 percent of the injured soldiers treated at Walter Reed Army Medical Center in Washington were prescribed opioids. That figure has since plummeted to 10 percent, and many patients are benefiting from the change, said Dr. Christopher Spevak, a pain specialist there.
“As we decrease the amount of opioids, their healing and recovery has gotten much quicker,” Dr. Spevak said. The implications go far beyond the military because most patients at Walter Reed in recent years have not been suffering from serious battlefield injuries but from problems many civilians face, like back injuries.
As long as a decade ago, some drug industry researchers questioned the value of opioids in the treatment of chronic pain even as drug producers promoted their widespread use, emails reviewed by The New York Times show.
“The important issue in the treatment of chronic pain is recognizing patients with chronic and acute pain are different and require different approaches,” Dr. David Hewitt, who was then the medical director of Ortho-McNeil Pharmaceutical, a division of Johnson & Johnson, wrote in 2003 to an academic researcher. “Employing a drug alone is unlikely to lead to a successful outcome.”
Asked about the email, Dr. Hewitt, who later moved to Merck, declined to comment through a company spokeswoman.
All Shane Savage wanted was to be a soldier. He joined the Marines in June 2001, a day after graduating from high school in Olive, Okla. He stood 6-foot-5, had six-pack abs and was ready for adventure.
After the Sept. 11 attacks, his engineering unit was sent to Iraq, where he served three tours before being honorably discharged in 2005. Nine months later, he wanted back in.
“I missed the uniform,” Sergeant Savage recalled. “I missed the brotherhood, the camaraderie, getting to go places and do cool stuff.”
To keep his rank, he enlisted in the Army and went back to Iraq in 2007 for a fourth tour. Then, in 2010, he was deployed again, this time to Afghanistan.
He soon asked for a transfer from a construction detail to one closer to the action and was reassigned to lead a unit clearing roadside bombs.
Once Sergeant Savage was back at Fort Hood, doctors put him on an array of medications; at one point, he was taking 12 different drugs, Hilary Savage recalled.
“They put him on anything and everything,” she said. “They had him on pain blockers and narcotics, antidepressants, Concerta for A.D.H.D. They had him on stuff for tremors. Like, I mean, you name it, we had it in our cabinet.”
A month after Sergeant Savage’s return, he and his wife went to pick up their daughters, Jada, 13, and Ameliea, 11, from a neighbor’s house. On the way, they ran into the young daughters of the Fort Hood soldier who had been killed by a roadside bomb shortly after taking Sergeant Savage’s place in Afghanistan.
“They just kind of peered into Shane’s soul, and Shane kind of turned into a completely different person,” Hilary Savage said.
For two days, Sergeant Savage sat in his home and cried. Then he reached for a handful of pain pills and tried to end his life.
After a few weeks in a psychiatric hospital, he no longer felt suicidal, but his pain and other problems persisted. He tried a program at Fort Hood in which soldiers suffering from trauma learned tai chi, yoga and other relaxation techniques. But he was not ready to change.
“I was very naïve,” Sergeant Savage said. Today, most doctors remain focused on treating physical pain, which is just one symptom of chronic pain, experts say. And as a result, they also often “chase” pain, increasing opioid dosages as lower amounts become ineffective, exposing patients to more side effects.
“It becomes a vicious cycle,” said Roger Fillingim, a pain researcher at the University of Florida and a past president of the American Pain Society, a professional medical group.
A 2008 study by the Mayo Clinic found that patients who were weaned off opioids and put through a non-drug-based program experienced less pain than while on opioids and also significantly improved in function. Other studies have had similar findings.
In some cases, insurers will pay for such treatments, but the practice is not widespread because there are few standards to judge their value, said Dr. Jeffrey Livovich, a medical director at Aetna. Dr. Edward Covington, the director of the Neurological Center for Pain at the Cleveland Clinic, said he believed that companies like Aetna had another incentive not to pay: Programs like his are initially more expensive than opioids, and insurers are loath to invest in patients when they do not know if they will be their customers next year.
Whatever the case, physicians treating soldiers or veterans are free of insurance industry dictates. And a growing number of doctors are largely abandoning opioids for the same reason that Dr. Hewitt, the former Ortho-McNeil medical director, suggested a decade ago: The drugs do not seem to help many with chronic pain.
“I think that the more appropriate use of opioids is in the acute pain setting and the surgical setting,” said Dr. Seal, the expert in San Francisco. “I am not convinced that opioids are any better than non-opioids” for chronic pain, she said.
For three years, Sergeant Savage struggled to navigate through a drugged fog. Surgeons repeatedly tried to fuse the smashed bones in his foot, using metal screws and bone grafts, but each procedure eventually failed.
There were periods when he limited his use of opioids, but after each operation, he started again. By last spring, he was taking over 300 milligrams of morphine daily, a very high amount. As his dosage increased, he became more lethargic and detached.
“He would just zone out on something, and he’d start looking at the computer or whatever” for hours, Hilary Savage recalled. “The next thing he knew, we were getting ready to go to bed.”
Dr. Karen Seal, center, met with other members of a patient care team at Veterans Affairs Medical Center in San Francisco.CreditPeter DaSilva for The New York Times
Sergeant Savage’s relatives tried to intervene, but nothing worked. Then, last summer, his older daughter, Jada, confronted him. She said she could no longer bear the person he had become.
That night, Sergeant Shane decided to wean himself off opioids and other powerful drugs. Soon, he and his wife were hunting for pills to throw away.
“I had some in my Jeep,” Hilary Savage said. “I had some in his car or his truck. I had some in my bedroom.”
“The pain medication, it might make me feel great and golden, you know, in here,” he said, pointing to his chest. “But it didn’t do anything for me.”
His pain continued, however, and last fall he started to consider another option: having his foot amputated. Around that time, he also heard about a V.A. hospital in Tampa, Fla., that ran a multidisciplinary pain treatment program. He arrived there in September. Some patients were much older than him, and many in the program had been on opioids for decades. Their pain and the drugs had left them housebound, disabled or addicted.
Despite feeling like the odd man out, Sergeant Savage threw himself into the program, which ran three weeks. When his first attempt to make a Western-style belt in a crafts class failed because his hands were shaking too much to control the stamping tools, he didn’t give up. He got a new leather strip and tried again.
Jennifer Murphy, a psychologist working in the Tampa program, said doctors are often too quick to dole out pain pills rather than to take advantage of alternative treatments. “What may be easy in the moment may not be the right thing, now or down the road,” she said.
Two months later, Sergeant Savage and his family visited a horse arena not far from Fort Hood. It was a cool November evening, and he looked far better than he had in Tampa. He was calmer, and his tremors, while not gone, were less frequent.
He had left the Tampa program with mixed feelings. He wished that there had been more people his age in the program and wondered why the Army didn’t run similar programs for soldiers who wanted to be able to work after they left the service. Once back home, he began his own recovery plan, one that involved volunteering with groups that helped soldiers dealing with pain and trauma — work that he had done previously. But now, having found ways to cope with his pain without narcotics, he was able to throw himself into that work with new energy.
Dr. Christopher Spevak says many people are benefiting from a shift away from opioids to treat pain.CreditDrew Angerer for The New York Times
That night at the horse arena, he took part in a therapy program in which horses are used to help injured soldiers regain their sense of self-control and trust. He also volunteered for a group that ran off-road Jeep excursions for veterans and for another organization that rescued wild mustangs from federal lands for adoption.
“They can sense your emotions and feelings,” he said, patting a mustang. “If you are tense, they are going to be tense. If you are anxious, they are going to be anxious. Especially, if you are in pain, they are going to sense you are in pain as well.”
In recent years, insurers have started cracking down on doctors who overprescribe narcotics. But it is not clear when, or if, they will embrace alternative pain treatments. Critics of the military and the Department of Veterans Affairs say the pace of change in those organizations has been too slow.
At bases like Fort Hood, soldiers like Sergeant Savage can spend years heavily medicated while awaiting a medical discharge, Ms. Savage said.
“I call it purgatory — you are not in heaven, and you are not in hell,” she said. “I can go in there and I can immediately spot people that are on narcotics or on drugs.”
Changing how doctors practice is not easy, but experts like Dr. Spevak and Dr. Seal are trying to push alternatives to opioids further down the chain of treatment so that patients will get them more quickly after an injury. Dr. Spevak, for example, said he expected this year to give 130 lectures about such techniques to military doctors working worldwide.
In January, Sergeant Savage underwent another operation to reconstruct his foot. He took narcotic painkillers for only a few days, and initially the procedure appeared to have stabilized his foot and reduced his pain. Then, that procedure also failed. Now, after four years of struggle, Sergeant Savage plans to undergo an amputation of part of his left leg, from the midcalf down. He’ll use a prosthetic device in place of the missing limb.
His commanders at Fort Hood recently nominated him for an honor known as the Meritorious Service Medal in recognition of his volunteer work. He expects to leave the Army by the end of this year or in early 2015. Once that happens, he said, he hopes to find a job that will allow him to spend most of his time outdoors, such as running a therapy program for other veterans.
Sergeant Savage expects that even after the amputation, pain will be his companion wherever he goes. But he believes he can deal with it.
“Am I the person that I was four years ago? No. Will I ever be? No. Will I ever be able to run down the street and chase my girls? I really don’t know,” he said. “But you know what? I can get a bike and I can ride with them.”
A version of this article appears in print on , on Page BU1 of the New York edition with the headline: A Soldier’s War on Pain. Order Reprints | Today’s Paper | Subscribe
President Trump has narrowed his Supreme Court list. Not surprisingly, the names on it will hearten conservatives and anger liberals. Three names are getting the most attention:
■ Neil Gorsuch. Scotusblog notes he has much in common with Antonin Scalia, whose death created the vacancy last year. Like Scalia, Gorsuch is an “exceptionally clear and routinely entertaining” writer.
He is also extremely conservative — “one of the judiciary’s leading spokespeople” for hobbling “progressive labor and environmental regulations,” according to Ian Millhiser of ThinkProgress. Vox, on the other hand, sees Gorsuch as more sympathetic to criminal defendants than many conservatives.
■ William Pryor, a former attorney general of Alabama and aggressive opponent of abortion and homosexual rights. Pryor is the highest profile of the possibilities, with Senate Democrats initially blocking his 2003 nomination to the federal bench. He is also a protégé of Jeff Sessions, Trump’s choice for attorney general.
But Pryor has more recently signaled some support for transgender rights, which may be why some observers believe his chances have slipped a bit.
■ Thomas Hardiman, a first-generation college graduate who drove a taxi to help pay for Georgetown law school.
“Hardiman is a solid, although hardly knee-jerk, conservative who was active in Republican politics before joining the federal bench,” Amy Howe of Scotusblog writes, “and his jurisprudence as a Supreme Court justice likely would be closer to another justice who hails from the 3rd Circuit: Justice Samuel Alito.”
Whomever Trump chooses, don’t forget that Senate Republicans stole this seat from the president who rightly should have filled it. Democrats probably can’t prevent Trump from filling the seat, but they also should not forget the theft — and look for ways to get even in the future. Harsh as that may sound, it’s also fair.
The Times's David E. Sanger discusses Pyongyang's apparently successful attempt to put a satellite into orbit, the timing of which caught the United States by surprise.
The cockroach on the wall next to the nightstand. Being woken up by the young child doing jumping jacks in the room above us in the morning. The maid banging on the door next to ours and yelling "housekeeping" five times before entering the room just after 9am and then banging the vaccuum cleaner repeatedly into the common wall when check out is not until 11am. The person in the McDonalds drive thru at 1am with the booming stereo so loud that it vibrated our second story room windows. The mini fridge that ran the Whole time we were in the room and never once stopped humming or turned off. The air conditioning unit that was so loud that it sounded like a helicopter outside so we just ended up sweating and sticking to the sheets while the thermostat indicated 78 degrees in the room.
Conveniently located off Highway 99 in the heart of California Central Valley Wine Country, this Ramada Fresno Northwest hotel is near the unparalleled underground house and garden the Forestiere Underground Gardens, concerts and rodeos at Save Mart Center, and California State University Fresno. Take a short drive to dining and entertainment at Tower District Fresno. Refresh at this hotel with complimentary wireless Internet access, complimentary continental breakfast, Ramada Mart convenience store, complimentary parking, fitness room, covered outdoor pool, meeting and conference rooms, and 24-hour business center. Guest room amenities include refrigerator, microwave, desk and TV. Suites and handicapped-accessible rooms are also available. Pets are welcome at this smoke-free lodging. There is no charge for children 17 and under with an adult.
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A new Māori speed sign at the southern gateway into Rotorua was unveiled this morning, heralding the start of Māori Language Week.
"It makes sense ... our city's entrance ways to Rotorua reflect our culture and that in essence is both English and Māori. Ahakoa he iti, he pounamu.
"Although this unveiling of a single new Māori speed sign is a small gesture, its value is huge. It follows the path laid out by the Rotorua reorua movement and plans we have for the future but also strengthens our resolve to negotiate, plan and work with council and the NZ Transport Agency."
Rotorua mayor Steve Chadwick welcomed the occasion, saying it showed the district's commitment to Rotorua Reorua.
"We have a lot to do and this single speed sign marks a commitment to follow through and continue to make progress.
"This Māori speed sign sets a precedent although there is a similar sign in the Rotoiti community, Hemo Rd is the first main reo speed sign at a Rotorua entrance way, which we will need to build on."
NZTA Bay of Plenty transport system manager Rob Campbell said the sign showed what could happen when groups worked together.
"The transport agency respects and values the importance of te reo Māori as one of our country's official languages, and we are working with local councils to incorporate bilingual road signage while achieving safety outcomes.
"We are looking forward to continuing to work with the Rotorua Lakes Council and Te Tatau o Te Arawa on their plans to recognise te reo Māori in Rotorua."
A number of events have been organised by the community for Te Wiki o te reo Māori including a language expo, lectures and a parade.
Babyetta was born on Father's Day, and is Baby's 13th calf and fifth consecutive heifer calf. Farm owner Dave Hunger says mother and daughter are both doing well.
" Babyetta is doing well, tucked up in a warm dry shed. Baby is finding this bad weather a bit of a trial. I will consider making this her last calf and just keep her as pet after this season."
Baby is one of Stratford's most famous, and most loved, cows who was the star attraction of the now closed Fernbrooke Farm Amusement Farm / Park.
Visitors used to enjoy petting, milking and even sitting on Baby, and while the amusement farm is now closed to the public, she has still has a loyal following online.
The weaker New Zealand dollar is boosting New Zealand commodity prices in local terms, ASB senior rural economist Nathan Penny says.
"For us, the fall in the dollar means we can now reconfirm our 2018-19 milk price forecast at $6.50 a kg/ms."
Dairy auction prices had fallen about 9% in the past three months and had led the ASB to put its forecast "under review".
However, it was anticipated the weaker New Zealand dollar was enough to offset the fall in dairy auction prices.
As China was the largest export market for most New Zealand commodities, further yuan weakness — in the absence of commensurate weakness in the kiwi — posed a risk to the commodity price outlook, he said. BNZ senior economist Doug Steel said New Zealand exports were "firmly higher" than a year ago through a mixture of volume expansion and higher prices.
Horticulture continued to be a strong performer. All three components in New Zealand's case — wine, apple and kiwifruit — were showing positive trends.
Wine exports in the year to June were 2% higher than a year earlier, driven more by volume than price changes.
Apple exports continued to perform strongly, building on success in recent years, Mr Steel said. Export values had pushed to a record high and well through the $700 million mark in the year to June — up 6% on a year ago.
Generally buoyant prices, combined with increasing volumes of new varieties earning premium prices, were underpinning value growth.
Further growth was expected, initially as the remainder of the bumper 2018 crop was sold and, over time, as the industry headed towards $1 billion in exports on expanding planted areas and as more trees came into production.
Sheepmeat exports had lifted in the past 18 months, and were up more than a quarter in the past year alone, he said.
In the coming year, sheepmeat export values were expected to be similar to the past year as higher average pricing offset forecast lower volumes, Mr Steel said.
Lower volume was expected in the coming 12 to 18 months on an assumption lamb numbers this spring would be down 4% on last year along with the possibility of more ewe lamb retentions.
The latter was mainly a case of reducing elevated inventory of coarse wool rather than stronger underlying demand. Prices were well down during the year.