The Washington Post National Weekly - January 20, 2019

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THE FIX

Democrats’ capitulation to Barr BY

A ARON B LAKE

I

t’s no secret that William P. Barr is very likely to be confirmed as the next U.S. attorney general. But Democrats’ handling of his confirmation hearing was curious, at best — as if they didn’t fully appreciate how he was parsing the most important questions they asked.

Sen. Dianne Feinstein (Calif.), the ranking Democrat on the Judiciary Committee, declared midway through the opening day on Tuesday that Barr was “doing well.” She was then asked whether he had an easy path to confirmation. “I think so, we’ll see,” she said.

After Barr explained why he might not release special counsel Robert S. Mueller III’s report — citing legal constraints — but would be as transparent as he could in his own report, Feinstein thanked him, saying: “Well, I can only speak for this side and maybe not all this side, but we really appreciate that.”

Sen. Christopher A. Coons (D-Del.), likewise, seemed impressed with Barr’s answers regarding Mueller, telling him at one point, “I am encouraged by things you’ve said about this.”

Sen. Sheldon Whitehouse (D-R.I.) agreed that Barr “did pretty well” and left open the possibility of voting for him.

All of this despite three major red flags: • Barr said he would not abide by ethics officials’ advice regarding whether he should recuse himself from oversight of Mueller’s investigation, because of his past criticism of the inquiry. This, even though other top Justice officials including Jeff Sessions have made such promises in years past.

• He strongly suggested that the Mueller report couldn’t be made public under current Justice Department guidelines, and that his own report on it to lawmakers would deal only

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CAROLYN KASTER/ASSOCIATED PRESS

Attorney General nominee William Barr testifies before the Senate Judiciary Committee on Tuesday.

with things that will be prosecuted. Given that existing DOJ guidelines say a sitting president can’t be indicted, logically that could mean we won’t learn about what Mueller found on President Trump or those close to him, unless it happens to be a part of a prosecution.

• Barr’s explanation of his 2017 comments about investigating the Clintons resulted in the New York Times releasing an email he had sent.

In that email, Barr clearly suggested that the GOP-led Uranium One and Foreign Intelligence Surveillance Act conspiracy theories were more worthy of investigation than potential Trump campaign collusion with Russia.

Barr assured panel members that he wasn’t all that keen on investigating the Clintons, but, by extension, that means he didn’t have much regard at all for Mueller’s collusion inquiry.

The Democrats on the Judiciary Committee rarely connected the dots on these issues in real time. Feinstein even seemed to offer a coursecorrection Wednesday morning, when she started the next Barr hearing by saying she

This publication was prepared by editors at The Washington Post for printing and distribution by our partner publications across the country. All articles and columns have previously appeared in The Post or on washingtonpost.com and have been edited to fit this format. For questions or comments regarding content, please e-mail weekly@washpost.com. If you have a question about printing quality, wish to subscribe, or would like to place a hold on delivery, please contact your local newspaper’s circulation department. © 2019 The Washington Post / Year 5, No. 15

wouldn’t vote for him unless he would make the Mueller report public. That was difficult to square with her stated appreciation for Barr’s answer on that topic one day earlier.

Even when Democrats did raise concerns, they were generally muted. They didn’t really dispute Barr’s claims of his own limitations.

They could have come loaded with specific laws or Justice Department rules to fight back, but they didn’t. It was as though they were resigned to Barr’s confirmation. All of this despite three major red flags: bonuses, even. With the exception of a few members, they were largely deferential, even though they were questioning a man who could potentially bury the Mueller report.

Barr’s answers did give plenty of Trump’s opponents something to be happy about. He implicitly rebuked Trump’s “witch hunt” and “lock her up” rhetoric, and he defended Mueller as a public servant. Barr promised he would not let the president run roughshod over the process. He said it would be illegal for Trump to offer pardons in exchange for changing someone’s testimony. He even laid out a rationale for Trump to have obstructed justice and/or committed impeachable offenses.

As some have argued, you could look closely at what Barr said and see a guy who could one day help take down Trump.

But one of the best political attributes is the ability to be all things to all people — to say enough to mollify each group and make people think you’re on their side.

Democrats probably never could have defeated Barr, especially given the GOP’s 53-47 majority in the Senate. But sometimes you can force the issue and get the nominee to play ball with you. Barr seemed to be playing a different game than Democrats this past week. n ©The Washington Post

CONTENTS POLITICS THE NATION THE WORLD COVER STORY LEGISLATION BOOKS OPINION FIVE MYTHS

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POLITICS

Experiencing smaller government B Y L ISA R EIN, R OBERT C OSTA AND D ANIELLE P AQUETTE

P

resident Trump has cast the shuttering of federal agencies as a standoff over his plan to build a wall on the southern border. But for many White House aides and allies, the partial shutdown is advancing a long-standing priority: constraining government.

Prominent advisers to the president have forged their political careers in relentless pursuit of a lean federal budget and a reined-in bureaucracy. As a result, they have shown a high tolerance for keeping large swaths of the government dark, services offline and 800,000 federal workers without pay, with the shutdown now entering its fifth week.

Those encouraging a hard line include acting White House chief of staff Mick Mulvaney and acting White House budget director Russell T. Vought, as well as leaders of the House Freedom Caucus, whose members have taken on an influential role with the White House.

Mulvaney and Vought have taken steps to blunt some of the shutdown’s most unpopular effects, calling back furloughed employees to process tax refunds, collect trash in national parks and ensure food stamps will continue to be issued.

But Mulvaney is not rattled by the fallout and instead has been focused on protecting Trump from criticism, according to two administration officials not authorized to speak publicly.

Mulvaney did momentarily urge compromise on funding for a wall in a meeting on Jan. 4, the officials said. But Trump quickly shot down his suggestion, and Mulvaney has since been in step with Trump.

Reps. Mark Meadows (R-N.C.) and Jim Jordan (R-Ohio) — leaders of the Freedom Caucus and the president’s top allies in the House — have urged Trump to stay the course. They have built national profiles with calls to

JABIN BOTSFORD/THE WASHINGTON POST

Key Trump advisers not rattled as shutdown reins in bureaucracy slash federal spending — not as much on strengthening border security.

The shutdown is “a means to an end for something they have long pursued, which is limiting the size and scope and role of government,” former House GOP staffer Kurt Bardella said of the conservative Freedom Caucus.

Bardella became a Democrat in 2017.

“These are small-government guys, not wall guys,” one former White House official, who spoke on the condition of anonymity to discuss private exchanges, said of Meadows and Jordan.

Conservatives have for decades questioned the size and

effectiveness of the federal bureaucracy. The shutdown has in some ways underscored their view that government can function with fewer employees.

“There’s a moment when people say, ‘Did you notice what percentage of this agency was viewed as nonessential?’ ” said anti-tax activist Grover Norquist.

Former White House chief strategist Stephen K. Bannon called shutdowns “blunt-force measures that certainly show what’s essential and what’s not.”

More than 420,000 employees are still working without pay during the shutdown because their jobs are considered essential to public safety or national

Snow falls on the Capitol on the 23rd day of the shutdown.

Some advisers to the president have forged their political careers in relentless pursuit of a reined-in bureaucracy. As a result, they have shown a high tolerance for keeping large swaths of the government dark.

security. An additional 350,000 are on furlough. Both groups will get back pay when the government reopens.

“It’s inconvenient that they’re not getting paid,” Barry Bennett, a former Trump campaign adviser, said of the furloughed workers. “But it’s for time they’re not even going into the office.”

He said, though, that while conservatives want to rein in the size of government, a shutdown is not an optimal path: “We prefer to use a scalpel rather than a sledgehammer.”

For the most part, Trump has been unfazed about leaving so much of the government dormant. A week ago, he reinforced

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POLITICS his downplaying of the shutdown’s effects, tweeting, “The damage done to our Country from a badly broken Border Drugs, Crime and so much that is bad - is far greater than a Shutdown.”

And while the White House and federal agencies have been met with a blizzard of requests for help, Trump has remarked that he thinks his senior staff and Cabinet members are doing a good job blunting the impact.

“People are very impressed with how well government is working with the circumstances that we’re under,” he said to surrogates in a call Tuesday afternoon. “We’re working very hard to make sure that happens.”

The political costs for the Trump administration could mount more, as federal courts run out of money and more workers miss paychecks. Airports have begun closing terminals as baggage screeners call in sick instead of reporting to their jobs.

There is a growing sense within the White House that a protracted shutdown will produce a cascade of unanticipated effects that could eventually damage the president politically.

But for now, Trump’s conservative allies have few qualms about Washington’s empty streets and dark offices. The small-government contingent “is not a voice of constraint here,” said a former senior administration official who spoke on the condition of anonymity to describe private conversations. “There is a realization among some that the shutdown is not the end of the world.”

Trump’s inner circle is stocked with officials and senior advisers who have long shrugged off shutdowns as painful but needed lapses.

Mulvaney joked during last year’s brief shutdown that he has been accused by critics of being an “arsonist” of government.

“Cut it or shut it,” Vice President Pence, then an Indiana congressman, said at a tea party rally in 2011.

Larry Kudlow, a conservative commentator who now serves as the top White House economic adviser, the same year called a government shutdown “a minuscule price to be paid for the greater good of financial solvency and economic growth.”

From its start, the Trump coali-

tion has mixed small-government ideology with a penchant for disruption.

“The Democrats have always had much more anxiety about” a prolonged shutdown, said Republican former House speaker Newt Gingrich, an informal Trump adviser.

The shutdown follows two years of contraction of the federal workforce under Trump. During his first 18 months in office, the government shrank by 17,000 employees, according to an analysis of federal personnel data

by The Post — the first downward shift in two decades.

As one of his first acts, Trump froze hiring across the government, except at the Department of Veterans Affairs and a few other agencies. The freeze morphed into a slowdown that has left hundreds of jobs unfilled as employees retire and quit.

Trump has signed executive orders — later largely struck down by a federal judge — to weaken the powerful unions that represent federal employees and make it easier to fire them. Just before Christmas, he announced that civil servants would not receive a cost-of-living raise for 2019.

The quick fixes recently to patch programs with money from fees rather than salary budgets have provoked cries from Democrats that the White House is carving out exceptions

President Trump stops to talk to reporters Monday on the South Lawn of the White House, on Day 24 of the partial government shutdown.

“There is a realization among some that the shutdown is not the end of the world.”

a former senior administration official, speaking on the condition of anonymity

for political reasons to minimize the pain of the closures.

“The takeaway is, the commander in chief doesn’t care about the civil service,” said Sen. Chris Van Hollen (D-Md.). “It’s like they have a full-scale assault on the mission of the agencies.”

Some federal workers have reached the end of their patience with an administration that they say does not value the sacrifices they make to work in the public sector or support the mission of the federal workforce.

“Why do I need to put up with this nonsense when I’ve already done my duty?” asked Anel Flores, a furloughed mission systems engineer at NASA’s Goddard Space Flight Center in Greenbelt, Md. With 36 years of service and multiple shutdowns behind him, Flores is irked by Trump’s depiction of federal workers as Democrats who deserve a shutdown.

He said he is ready to file paperwork to retire when NASA reopens.

The prolonged shutdown is eroding morale in corners of the workforce where Trump has long enjoyed deep support, including airport baggage screeners, who have been calling in sick in a job action to protest working without pay, and Border Patrol agents, whose jobs are stressful to begin with.

The Transportation Security Agency acknowledged Thursday

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that the lengthy shutdown had affected its employees’ ability to come to work. Federal employees are generally barred from going on strike, even if they aren’t being paid, which has caused many to raid retirement accounts, accept free food, or sell possessions online to pay bills.

“I need to work just a few more years to not need to downsize — and we love our home — and I am not willing to work a few more years,” said a Customs and Border Protection employee in her 50s who works near the California border. She spoke on the condition of anonymity for fear of jeopardizing her retirement.

A lifelong Republican who recently turned independent, she blames an indifferent president she says has forced her to work without pay. And she plans to sell her house so she can quit sooner.

“I even applied for a promotion two months ago,” she said, “but now I would turn it down and leave.”

The agencies that have seen the largest drops since Trump took office are the Departments of Housing and Urban Development, Education, Commerce and Energy. Many civil servants who have left say they objected to a new culture that seemed to undermine the mission of their agency and undermine their contribution.

Critics worry that the exodus is depleting the government of valuable expertise.

Almost 20 percent of the workforce overall was eligible to retire in October, including more than a quarter of HUD, the Treasury Department, the Environmental Protection Agency and NASA, according to data compiled by the nonpartisan Partnership for Public Service.

Just 6 percent of civil servants are 30 or younger, a trend that started in the Obama administration and has accelerated under Trump.

“It’s very hard to look a young professional in the eyes and tell them not only that their talents aren’t sorely needed but that they won’t find a rewarding career where their work and dedication will be valued,” said Phillip Cooper, a professor of public administration at Portland State University who is telling his students to steer clear of federal work. n ©The Washington Post

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POLITICS

Pelosi, Trump ramp up confrontation B Y P AUL K ANE, P HILIP R UCKER AND J OSH D AWSEY

H

ouse Democrats had been making plans to undermine President Trump at his Jan. 29 State of the Union address. Early Wednesday, the leadership’s communications arm distributed an email urging lawmakers to bring furloughed federal workers or other “message-related” guests to the event.

Unknown to most of her caucus, however, House Speaker Nancy Pelosi (D-Calif.) had decided on a more confrontational approach.

Addressing a closed-door meeting of House Democrats, the speaker read a letter she had just sent to Trump asking him to either postpone the speech until the federal government reopens or deliver the text in writing, citing security concerns.

Surprised Democratic lawmakers cheered their leader’s rationale: If the government stays shut down, Pelosi would deprive Trump of the spotlight he craves.

To a president especially sensitive to acts of disrespect, the so-called unvitation was not merely a power play. It was a calculated personal slight.

In the two weeks since she reclaimed the speaker’s gavel, Pelosi and Trump have been locked in a standoff over a partial government shutdown instigated by Trump’s demand to fund a portion of his promised border wall. Both Trump and Pelosi are gambling that the other will bear the brunt of the blame as the economic impact worsens, with the shutdown now dragging into a fifth week.

In her letter to Trump, Pelosi said the U.S. Secret Service and the Department of Homeland Security have been “hamstrung” by furloughs and therefore should not bear the burden of securing the president’s address in Congress.

Trump and the White House did not respond directly to the letter because it was unclear whether Pelosi was actually canceling the event or just making a

AL DRAGO/BLOOMBERG NEWS

Volleys over State of the Union address and travel are part of ongoing power play amid shutdown political statement, according to two people familiar with internal White House discussions who requested anonymity.

But on Thursday, Trump fired back, sending Pelosi a letter informing her he was canceling her imminent flight to visit U.S. troops in Afghanistan.

Trump wrote that “it would be better if you were in Washington negotiating with me and joining the Strong Border Security movement to end the Shutdown.”

A U.S. defense official said Pelosi submitted a request for support for overseas travel, which the Defense Department approved. The president has the authority to cancel such support, the official said.

On Friday, Pelosi said she and the delegation had abandoned plans to travel on a commercial flight instead, blaming the Trump administration for disclosing the trip, which she said increased security concerns.

Pelosi’s challenge to Trump comes with risk, for her and for Democrats. The more she becomes the face of Trump’s opposition, the more Republicans will probably use her unpopularity nationally to label vulnerable House Democrats as Pelosi clones — a potentially potent line of attack against sitting lawmakers who cast votes in lock-step with party leaders.

Still, Pelosi is helping to keep Democrats largely united while energizing liberals who have yearned for a leader to challenge Trump directly.

Rep. Steve Cohen (D-Tenn.) called her letter to Trump to delay the State of the Union speech her “Gene Hackman moment,” comparing it to an inspirational speech the actor gives a basketball team in the movie “Hoosiers.”

“It’s smart for two reasons,” Cohen said. “Number one, Pelosi would be right behind him, and

House Speaker Nancy Pelosi at the Capitol on Wednesday. Her approval rating has risen since the midterms, but she remains unpopular, which makes asserting herself as the face of presidential resistance risky.

she’d have to sit there as he put the onus on her for the shutdown.

Number two, it gives him a reason to end the shutdown, because he loves the TV audience and the attention.”

Marc Short, the Trump White House’s former legislative affairs director, said if security for the State of the Union truly were Pelosi’s concern, she would not have extended a formal invitation to Trump to deliver the address, which she did earlier this month after the shutdown began. Homeland Security Secretary Kirstjen Nielsen said her department and the Secret Service were “fully prepared to support and secure the State of the Union.”

House Minority Whip Steve Scalise (R-La.) said, “It’s just that Nancy Pelosi is afraid of hearing what the president has to say.”

One danger for Pelosi is that Democrats could eventually appear intransigent to voters. Having said she considers the president’s long-promised wall immoral — and joking that she would only agree to allocate a single dollar to it — Pelosi could find herself in a bind should Republicans offer a compromise deal that would partially meet Trump’s demand for $5.7 billion in wall funding.

Pelosi’s strategy was born of exasperation, advisers said. She has been deliberately trying to get under Trump’s skin and “to talk to him in a way he understands,” according to one person familiar with her views.

After Pelosi and Senate Minority Leader Charles E. Schumer’s Dec. 11 Oval Office meeting with Trump, their first since the midterm elections, the speaker-designate told House Democrats their session was like “a tinkle contest with a skunk” and that she felt his wall demand was “like a manhood thing for him,” according to an aide in the room.

Pelosi is setting the tone for how her party plans to confront the president over the next two years — in the political and legal fights consuming Washington as well as the presidential campaign taking shape across the country. n ©The Washington Post

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Ocasio-Cortez taunts critics on right B Y E LISE V IEBECK

T

he tweet instantly triggered an online melee over age, class and politics.

Rep. Alexandria Ocasio-Cortez “was so fiscally irresponsible that she hadn’t saved up enough money to rent an apartment in the Washington D.C. area,” wrote conservative commentator Candace Owens a week ago, adding the hashtag #SocialismSucks, as she blasted the New York freshman for complaining that some members of Congress have trouble paying for two residences. “But sure, let’s trust her with the future fiscal-planning of America.”

Ever since she burst onto the national political scene as a young socialist Democrat with a knack for making headlines, the 29-yearold Ocasio-Cortez has been an obsession for many on the political right.

As a young woman of Puerto Rican descent, a lawmaker from an ethnically diverse urban district and an outspoken liberal on issues of race, gender and class, she has in effect emerged as a living counterpoint to today’s heavily white, male and rural Republican Party — and has drawn ire from seemingly all corners of the conservative movement.

Commentators and politicians have criticized her intelligence, her clothing, even her claims of working-class roots. There are new examples all the time.

Republicans Ed Rollins and Rush Limbaugh recently dismissed Ocasio-Cortez as a “little girl” and “some young uppity.” The Washington Examiner’s Eddie Scarry tweeted a photo of her in November and wrote that she doesn’t “look like a girl who struggles.” The Daily Caller promoted what it described as a possible “nude selfie” of her a few weeks ago before walking back its headline.

The trend has been so relentless that even some Republicans are starting to come to her defense.

“Why do people persist in these shallow attacks on @AOC?” Republican Rep. Justin Amash

MELINA MARA/THE WASHINGTON POST

Attacks on her intelligence, clothing, roots have even brought some Republicans to her defense (Mich.) tweeted early Monday, referring to Owens’s comment.

“Let’s discuss philosophical and policy differences (and areas of agreement), not her rent.”

Ocasio-Cortez, who has amassed more than 2 million Twitter followers and has emerged as one of her party’s most prominent national figures, seems to relish beating back the attacks.

“It’s encouraging because this is my sixth day in Congress and they’re out of all their artillery,” she said in a recent interview.

Conservatives say they target Ocasio-Cortez because she is a rising star who promotes socialist views, occasionally botches facts and attracts widespread attention on social media.

In interviews, they defended their approach as fair game.

“This is called scrutiny for public figures,” said Scarry, rejecting the idea that conservatives are

fixated on Ocasio-Cortez. “This is just part of the bag . . . She’s 29.

She’s a woman. She can take care of herself. She can answer for herself.”

The youngest-ever female member of the House, Ocasio-Cortez arrived in Washington in an unusual position: without hard power but at the center of the political zeitgeist. Since her election, in which she defeated a highranking incumbent in a primary, she has been parodied on “Saturday Night Live” and defended by Paul Krugman in the New York Times. Sunday political panels discuss her views. Fact-checkers point out her errors and misstatements.

She sat for an interview on CBS’s premier news program, “60 Minutes,” that aired days after her swearing-in, generating buzz with her call for raising taxes on the super-rich. And when she cast her

Freshman Rep. Alexandra OcasioCortez (D-N.Y.) has been under unusual political scrutiny since she defeated a high-ranking incumbent in 2018.

vote for House Speaker Nancy Pelosi (D-Calif.), Republican lawmakers were heard in the chamber groaning with disapproval.

When Trump was asked recently about Ocasio-Cortez calling him a racist, he said, “Who cares?” and made a dismissive gesture. She tweeted in response: “We got under his skin.”

Social media has become her preferred platform for calling out political opponents, knocking competing ideas and highlighting comments she sees as unfair or biased. Ocasio-Cortez called the right’s coverage of her “completely disgusting” on Twitter after the Daily Caller promoted the story about a fake “nude selfie” of her in a way that suggested the image might be authentic, making it go viral online.

Figures on the right said her style invites attack.

“If you put yourself out there and throw stones, you’re going to get stones thrown back at you,” said Rep. Dan Crenshaw (R-Tex.), who has sought to engage with Ocasio-Cortez on Twitter about tax policy. “She operates in the same style that, say, President Trump does. Throw stones, stones get thrown right back.”

Other Republicans said they engage her because it is necessary to challenge her views.

“It’s important any time that a sitting member of Congress promotes socialist ideas to at least expose what it would do to destroy the ability for people to move into the middle class,” said House Minority Whip Steve Scalise (R-La.), who recently tweeted his opposition to the idea of a 70 percent marginal tax rate.

The congresswoman has faced conspiracy theories since she entered the political spotlight in June. Critics have argued that her story of working-class roots is fake, picking apart her clothes, education and even an apparent former nickname for evidence. An anonymous Twitter account affiliated with the far right sought to shame her this month by tweeting a video of her dancing “Breakfast Club”-style during college. n ©The Washington Post

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NATION

Lettuce industry awaits FDA’s return BY

J OEL A CHENBACH

I

t’s the peak of the leafy greens growing season in Yuma, Ariz., where irrigated valleys are lush and verdant amid cactus-covered mountains.

This is America’s Salad Paradise, which produces most of the fall and winter lettuce consumed in the United States.

Locals credit excellent soil, preposterously abundant sunshine and a steady supply of labor, thanks to Mexicans with work visas who cross the border checkpoint and ride buses to the fields.

But these are anxious times for the leafy greens industry, and the partial federal government shutdown and furloughing of many Food and Drug Administration officials has deepened the distress.

Three times in the past year, the industry has been roiled by foodborne-illness outbreaks linked to U.S.-grown romaine lettuce contaminated with a toxic strain of E. coli bacteria. The biggest outbreak, which sickened 210 people across the country beginning last March and left five dead, was linked to romaine grown in the Yuma area.

The multiple romaine lettuce disasters have exposed the complexity of the food system, in which a head of lettuce goes through so many facilities and is potentially mixed with so much other leafy produce that it can be impossible to trace the origin of a salad.

The outbreaks remain mysterious. The FDA’s investigations have produced plausible theories but nothing conclusive about how, when and where the bacteria contaminated the lettuce.

That’s a source of consternation for the $2 billion leafy greens industry, which desperately wants to avoid a repeat of what happened last year and is counting on the FDA for help. But because of the federal shutdown, the agency has barely been in the game.

“Our colleagues and I are kind

PAUL SAKUMA/ASSOCIATED PRESS

The federal shutdown has slowed efforts to make leafy greens safer after recent E. coli outbreaks of on hold, waiting for the FDA to come back into action,” said Paula Rivadeneira, an assistant professor who specializes in food safety at the University of Arizona Cooperative Extension in Yuma. “We need them to open their doors and get back to business.”

During the shutdown, the FDA is not allowed to participate in conference calls or webinars with state officials, industry leaders and research scientists, said Jennifer McEntire, vice president for food safety at United Fresh Produce Association. She said the lack of FDA help has had a “ripple effect” as outside experts are forced to try to do their work without FDA data.

“We cannot afford to get bounce-back from people who are unable to check their email because they’re furloughed,” McEntire said.

Without improvements in the system, food safety lawyer Bill

Marler said, “we’re just going to limp from outbreak to outbreak, from litigation to litigation. We’ll be having the same conversation this spring or next winter.”

Frank Yiannas, FDA deputy commissioner for food policy and response, said the agency continues to investigate the most recent romaine-linked outbreak, which was traced to central California.

He said the agency is also maintaining heightened surveillance of romaine. What the agency isn’t doing during the shutdown, according to industry leaders and researchers, is playing an active role in reforms to curb future outbreaks.

On Tuesday, roughly 150 FDA inspectors and technical staffers returned to work without pay to conduct inspections of facilities across the country, according to FDA Commissioner Scott Gottlieb. The recalled inspectors will work on “high risk inspections” that “could potentially include

In March, an E. coli contamination of romaine lettuce sickened 210 people and left five dead.

leafy greens, including romaine lettuce,” the FDA said.

The agency provided limited details about what it is and isn’t doing during the shutdown. “All our work is important, but only some of the FDA’s work is permitted to continue during a lapse in funding, which may include some activities with industry and other groups,” the FDA said.

The leafy greens industry has already made changes. Lettuce sold at stores is now more likely to be clearly labeled to reveal its origin. There are new requirements for cleaning farm equipment. And in Arizona and California, required buffer zones between fields and concentrated animal feeding operations (CAFOs) have tripled, from 400 feet to 1,200 feet.

“Everybody recognizes that it’s not good enough to do business as usual,” said Scott Horsfall, CEO of the California Leafy Greens Marketing Agreement.

Many consumers have been reluctant to consume romaine since the most recent disaster two days before Thanksgiving, when the FDA and the U.S. Centers for Disease Control and Prevention revealed that 32 people in 11 states had been sickened by contaminated lettuce. Initially unable to pinpoint the source of the problem, the FDA and CDC asked retailers to pull all romaine from the shelves and told consumers to throw away any lettuce they had purchased.

In Yuma, where fields had already been planted, countless heads of romaine were simply plowed back into the soil.

In December, the FDA revealed that a soil sample from an irrigation reservoir on a farm in Santa Barbara County, Calif., had tested positive for the E. coli strain associated with the recent outbreak. But that didn’t solve the case. The FDA said that “our traceback work suggests that additional romaine lettuce shipped from other farms could also likely be implicated in the outbreak.” n ©The Washington Post

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NATION

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Carmakers look for new avenues BY

B RIAN F UNG

M

otown’s glitziest annual tradition kicked off this past week with Cadillac, one of the most venerable brands in the business, taking the cover off a three-row luxury SUV it calls the XT6. Rolling out to a cheery soundtrack, fog and roving spotlights, the XT6 was introduced as “a vehicle that offers room for new possibilities.”

But behind the confident razzle-dazzle, a darkening cloud hangs over Cadillac’s parent company, General Motors, as well as the broader auto industry. Caught between political and economic crosswinds, carmakers in the United States face what could be the most challenging year ahead since the auto bailout.

Executives are grappling with a generational shift in consumer tastes as year-over-year sales of the sedan plummet in favor of SUVs and crossovers. Some, such as GM, have moved to halt production at sedan-oriented factories.

But that has put them in the crosshairs of President Trump and others in Washington, who decried the moves, especially those in swing states such as Ohio.

The colliding pressures from declining car sales and politicians have put automakers in a lose-lose situation, some analysts said. Beyond that dynamic, they are also facing fears of an economic slowdown in China and Trump’s trade war, which automakers say has raised costs of manufacturing.

Few companies have been as exposed to Trump’s mercurial attitudes as GM and Ford. Trump was quick to dole out praise and claim credit early in his administration when the firms announced big investments to create jobs. But now, as GM prepares to wind down five plants in North America and discontinue many of its sedans, including the Chevrolet Cruze and Impala, it has found itself on the wrong end of Trump’s ire.

“The U.S. saved General Motors, and this is the THANKS we get!” he tweeted in November. Trump went further by threatening GM’s federal support, specifically invok-

TIMOTHY A. CLARY/AGENCE FRANCE-PRESSE/GETTY IMAGES

As sedan sales reach the end of the road, factory closures put auto industry in Trump’s crosshairs ing a tax subsidy designed to juice demand for electric cars.

In her latest remarks defending the changes, which could cut as many as 14,000 jobs, GM chief executive Mary Barra said she is committed to “doing the right thing” for workers displaced by the restructuring and to be transparent about other necessary changes to GM’s business.

“We’re taking steps to make sure not only that we have a strong core business, but that we’re in a leadership position in new technologies,” she said.

Ford is not far behind, with an $11 billion restructuring plan that could lead to thousands of layoffs.

Ford has announced deep changes to its U.S. lineup, saying it will suspend nearly all passenger cars, including the Fiesta, Focus, Fusion and Taurus; the market’s only surviving Ford sedans will be the Mustang and the Focus Active, a hatchback crossover.

Yet just as car companies have begun putting their plans in mo-

tion, Trump’s own policies and proposals risk creating additional head winds, analysts said. Targeting the electric-car incentives could put U.S. automakers at a disadvantage when many foreign firms, such as Toyota, MercedesBenz and Volvo, are moving ambitiously to electrify their portfolio.

Meanwhile, by hiking the price of steel and aluminum, Trump’s tariffs are expected to make buying a car more expensive in the United States — which, along with rising interest rates, could suppress U.S. vehicle demand in 2019. Trump’s trade barriers cost GM and Ford up to $1 billion each last year.

Even Trump’s friendliest overture to the industry — a proposal to halt the toughening of emissions targets — is generating uncertainty. GM, Ford, Toyota and Honda have all argued against the proposal, saying it would invite legal challenges, complicate strategic planning and hinder the transition to electric cars.

Trump’s moves have complicat-

In Detroit on Monday, people attend the North American International Auto Show, where Cadillac revealed its XT6 luxury SUV.

ed the picture amid a major shift in consumer preferences.

The most visible example is a sustained surge in SUV sales. In recent years, breakthroughs in materials and manufacturing processes have mitigated some downsides of owning a sport utility vehicle, such as reduced fuel efficiency.

With advances including lighter, unibody frames and electronically enhanced suspensions, analysts say, SUVs are offering much better fuel economy than previous years and more cargo room than sedans.

Half of new vehicle sales this year are expected to be SUVs, according to Edmunds forecasts.

Just 1 in 4 will be passenger cars — underscoring the pressure on carmakers to retool their production to satisfy demand.

Meanwhile, the industry’s trend toward electrification is only intensifying as policymakers in Europe weigh new auto emissions rules and China, the world’s biggest auto market, saw massive jumps in demand for green vehicles last year. Those factors promise to make gas-guzzling vehicles less attractive globally as carmakers seek to simplify and streamline their offerings, Osborne said.

And innovations pushed by Uber, Waymo, Tesla and others are forcing traditional automakers to think differently about what it means to make and sell a car.

After decades of marketing vehicles to individual owners, automakers are increasingly confronting the prospect of subscriptionbased, self-driving taxis that are operated by fleets rather than owned by a single person or family.

That approach requires big investments in software and tech.

Although legacy carmakers have devoted millions of dollars to catch up in these arenas, they still lack the technology prowess of some newer rivals, analysts say.

“They’re still figuring it out, and it comes down to access to talent and culture,” said Adam Jonas, an industry analyst at Morgan Stanley. “The average incumbent auto company is nowhere remotely near Tesla in terms of software and [tech] capability.” n ©The Washington Post

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Young activist rises as foe to Maduro B Y A NTHONY F AIOLA

T

en days ago, few outside of Venezuela knew of Juan Guaidó. But the 35-yearold industrial engineer has suddenly emerged as a cause celebre, heralded by global leaders for his challenge to the neartotal power of President Nicolás Maduro.

Following May elections internationally derided as a fraudulent power grab, Maduro was sworn in for a new six-year term on Jan 10.

One day later, Guaidó — the new head of the opposition-controlled National Assembly — took a step Venezuelan critics had long considered too dangerous: invoking articles in the constitution that allow the head of the assembly to assume national leadership if a “usurper” takes office.

In a socialist country buckling under the weight of corruption, mismanagement and hyperinflation that has left food and medicine scarce, Guaidó stopped short of declaring himself Venezuela’s interim president. But he appeared to energize the moribund opposition, emerging as a symbol of hope for Maduro’s detractors.

“We will oust Maduro and his gang from power,” Guaidó said recently. “We’re entering the most dangerous stage of our history.”

His comments were prescient.

On Jan. 13, Guaidó was on his way to a rally just outside Caracas when he was intercepted by the intelligence police and detained for about 45 minutes. He was released unharmed, but his detention showed how dangerous his bid to oust Maduro has become. It also showed how quickly he had captured the public’s imagination: In just one day, he tripled his Twitter followers — from 100,000 to 334,000.

There are signs, however, that the government may tread more lightly with Guaidó than with other dissident politicians it has arrested, tortured or exiled. After Guaidó’s detention, Communications Minister Jorge Rodriguez told the media that the intelligence officers involved had acted

CARLOS GARCIA RAWLINS/REUTERS

In Venezuela, Juan Guaidó has emerged as a symbol of hope for the president’s detractors on their own and would be fired, suggesting the government isn’t willing to risk jailing the leader for now.

Two journalists, CNN’s Osmary Hernández and Colombian Radio Caracol’s Beatriz Adrián were also briefly held by authorities while reporting on Guaidó’s detention.

They were pushed by police, and Hernández was grabbed by her neck, the reporters said in telephone interviews.

“My friends, the game has changed now,” Guaidó said upon his release. “If they wanted to send us a message of intimidation, the answer is: We are not afraid.”

Guaidó has held one public post when he was elected legislator for the state of Vargas, in 2015.

Before that, he was part of a student movement that protested then-President Hugo Chávez in 2007.

The son of a commercial pilot

and teacher, Guaidó grew up in a middle-class family, one of eight children. His mentor, Leopoldo López, founded the Popular Will party in 2009 and led a wave of protests in 2014 before being jailed.

“Obviously Guaidó is not the seasoned veteran that other politicians are, but that can actually work in his favor,” said David Smilde, senior fellow at the Washington Office on Latin America.

“He doesn’t have the old backdoor political culture, and he brings something different.”

Guaidó inherited the top post at the Popular Will party, partly because most of its leadership has been jailed or fled the country. On Jan. 5, he was named the head of the opposition-controlled National Assembly, which maintains broad recognition internationally despite having been stripped of its powers by Maduro in 2017.

Juan Guaidó, president of Venezuela’s National Assembly, invoked articles in the constitution that allow him to assume leadership of the nation if an “usurper” takes office.

His detention followed arguably the most radical step the country’s opposition has taken since Maduro rose to power in 2013, succeeding the leftist firebrand Chávez, who died of cancer that year. Violent repression of protests in 2017 led to the deaths of more than 100 people. Since then, the opposition has fizzled.

Guaidó, however, appears to be gaining traction. Chile and Colombia expressed support for the National Assembly. The head of the Organization of American States, Luis Almagro, and Brazil’s new far-right president, Jair Bolsonaro, effectively recognized Guaidó as Venezuela’s interim president, even though he has not yet claimed that mantle himself.

In a tweet on Jan. 13, Vice President Pence and national security adviser John Bolton condemned Guaidó’s arrest and praised what they called his “courageous decision” to challenge the authority of Maduro, whom they denounced as “illegitimate.”

Although Maduro’s government could be severely damaged by further erosion of its relationship with Washington — including potential loss of its controlling rights over U.S.-based oil company Citgo — the United States also stands to lose. A complete severing of ties could pose new challenges for U.S. refineries designed to process Venezuela’s sludgelike heavy crude and could raise questions about the status of Washington’s embassy in Caracas.

“If the U.S. government recognizes Juan Guaidó as president, U.S. courts would see his government as the only one that can manage assets,” said Francisco Rodríguez, chief economist at the New York-based Torino Capital investment firm. “A parallel government could have significant economic power.”

The challenges for the current government are far from hypothetical. A group of bondholders said that it would not negotiate impending payments with Maduro’s government because of its illegitimacy. n ©The Washington Post

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A bad look for crazy-rich Iranians Sasha Sobhani, the son of an Iranian diplomat, has taunted his half a million followers on Instagram with boasts about his wealth and shared images clearly demonstrating it.

B Y E RIN C UNNINGHAM in Istanbul

T

he lifestyles of Iran’s privileged youths — including expensive holidays, glitzy parties and access to cash and jobs — have sparked public anger in recent months as U.S. sanctions squeeze the economy.

The young elite, some with government connections, flaunt their wealth on Instagram and in the streets of the capital, Tehran, sporting designer clothes and flashy cars and vacationing at posh resorts.

They are promoted to state jobs, granted lucrative scholarships and travel with ease. Even the granddaughter of the late leader of Iran’s Islamic revolution, Ayatollah Ruhollah Khomeini, was photographed last year in London with what appeared to be a $3,800 handbag — though some have speculated that it was fake.

But few in Iran can afford such comforts as costs rise and wallets shrink. And Iranians have started speaking out against inequality and a culture of nepotism that they say favors what are called the “aghazadeh,” or “noble born” children of the elite.

Last month, President Hassan Rouhani’s son-in-law Kambiz Mehdizadeh was forced to step down after just two days as head of the Geological Survey of Iran following a public outcry and online accusations of cronyism. Mehdizadeh, 33, had previously served as an adviser to Iran’s Oil Ministry, but for many Iranians his ties to Rouhani were proof that favoritism was at play.

By all accounts, Iran’s economy is crumbling — and ordinary people are feeling the pinch.

Unemployment is high, shortages are rampant, and the currency lost more than half its value last year.

In November, the United States reimposed sanctions that have since battered Iran’s oil and banking sectors and crippled its outside trade. The sanctions follow the Trump administration’s decision to abandon the nuclear pact that Iran negotiated with world pow-

SASHA SOBHANI

As elite youths flaunt their wealth, citizens denounce growing inequality ers in 2015. That agreement curbed Iran’s nuclear program in exchange for major sanctions relief.

But even before sanctions were reimposed, inequality was on the rise in Iran, the result of years of government austerity, said Djavad Salehi-Isfahani, a professor of economics at Virginia Tech.

“Iran’s economic system does not treat people at the bottom of the economic ladder as well as those at the top,” he wrote in his blog on Iran’s economy.

According to Reza Akbari, who researches Iranian politics at the Washington-based Institute for War and Peace Reporting, dire economic conditions have bred “extraordinary resentment toward corruption, nepotism and

the aghazadeh, who seem immune to the country’s topsy-turvy realities.”

While members of Iran’s ruling class once kept their opulent lifestyles under wraps, today’s elite Iranians boast brazenly of their wealth online and in the media.

One diplomat’s son, Sasha Sobhani, has taunted his half-million followers on Instagram in posts from Greek islands or aboard yachts decked with champagne.

“How long will you be jealous of me?” he said in one post that has been taken down.

A shamelessly named Instagram account, “Rich Kids of Tehran,” showcases the lives of some of Iran’s most glamorous youths, with footage of raucous pool parties, exclusive dinners and retreats

in the mountains.

A video posted last year — in the midst of nationwide protests over poor living conditions — included footage of the young elite partying and on private jets, with dollar bills superimposed on the images.

Other posts feature bikini-clad women drinking beer poolside and, in one case, someone taunting a pet cheetah.

“This is RKOT,” the caption to the video said, using an acronym for the Rich Kids of Tehran. “If you’re politically frustrated,” it said, “exit this area like a fart.”

Akbari, the researcher, noted that “the lives of the elite and their statements about their good fortune are plastered all over the Internet . . . and are being witnessed by the masses in a much more ubiquitous fashion.” He added, “The current government is certainly sensitive to the criticism and is aware that it cannot remain silent in the face of public outrage.”

Iran’s aghazadeh, originally defined as young men of means and influence, emerged in the 1990s, when the children of the revolutionary elite rose to prominence using family ties.

In 2017, the son of prominent reformist politician Mohammad Reza Aref triggered a firestorm by declaring that his success in life was the result of “good genes,” inspiring a viral hashtag that Iranians still use to mock the upper class.

In November, when his father posted on Twitter urging Iranians to work hard and unite in the face of renewed U.S. sanctions, one Iranian lawyer replied with a quip that the first thing Iranians should do is “get rid of the #goodgenes.”

But the culture of connections is so pervasive that Iranians say there is little they can do — at work, school or sometimes in their daily lives — that does not require some sort of leverage with influential contacts in government or elsewhere. From business deals to real estate to arts and the humanities, it is almost always those with ties to power who are promoted or given priority. n ©The Washington Post

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Life, Death and Insulin

As the cost of the lifesaving medication skyrockets, some desperate diabetics are rationing — and risking their lives. Was Alec Raeshawn Smith one of them?

S TORY

BY

T IFFANY S TANLEY

A

t first, it seemed like the stomach flu. Weeks before his 24th birthday in May 2015, Alec Raeshawn Smith was overcome by troubling symptoms. His body ached, his stomach hurt, and he wasn’t sleeping well. Laine Lu, a co­worker at his restau­ rant job, urged him to see a doctor. “This is not normal,” she recalls telling him. “Go get checked out.” His mother, Nicole Smith­Holt, worried too. He called her when he decided to go to a health clinic near Minneapolis. He said, “Seriously, Mom, I think something is really wrong with me.” The diagnosis was surprising: Type 1 diabetes. Alec’s blood sugar levels were nearly twice the healthy limit. His family didn’t have a history of diabetes, and lanky, 6­foot­3 Alec looked like the picture of health. At 23, he seemed too old for Type 1 diabetes, once known as juvenile dia­ betes because it often strikes children.But as Alec discovered, Type 1 diabetes is an ILLUSTRATION BY EDMON DE HARO

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PHOTOS BY CAROLINE YANG FOR THE WASHINGTON POST

Laine Lu, Alec Raeshawn Smith’s girlfriend, top, had looked for prescription discounts for him; she eventually would find him dead in his apartment. Erick Borrome shows a photo of his best friend.

autoimmune response that can appear at any age. It is not preventable, and there is no known cure At the clinic, a nurse practitioner discussed the potential complications of the chronic disease, including blindness, nerve damage, and kidney and heart problems, according to medical records. Alec came home with prescriptions for two kinds of insulin: One was long-acting; the other gave him short bursts before meals. He wrote on Facebook: “Today a lot has changed. . . . I would never wish this upon anybody. So

whoever reads this take care of yourself.”

Even for his older sister, Brittany Smith, who is a nurse, the learning curve about Type 1 diabetes was steep. “I didn’t really have a handle on it,” she says. Most of her diabetic patients had the far more common Type 2. Both types involve an imbalance of insulin, a hormone that helps regulate blood glucose levels. For Type 1 diabetics, the body produces little to no insulin. In Type 2, generally, the body has become resistant to insulin’s effects. Not all Type 2 diabetics take insulin, but all Type 1 diabetics do. Alec would need a steady supply for the rest of his life.

What had been a carefree 20something existence was now dominated by insulin injections, timing of doses and taking a blood sample four times a day to measure glucose levels. “I know he’d get frustrated,” Nicole says. Within three months, though, Alec had gotten his blood sugar under control. He maintained healthy levels as that first year wore on. He began dating Laine and worked as a manager at the restaurant where

they had met. Eventually, he moved out of his parents’ home and into his own apartment on a tree-lined street near downtown Minneapolis.

In 2017, as his 26th birthday neared, his mother had a new worry: He would no longer be covered by her health insurance through her job in the financial aid department of a community college. Nicole paid about $100 per biweekly paycheck for a family plan, and it had not cost extra to include Alec.

With it, she says, he initially had been paying about $200 to $300 a month out-of-pocket for his diabetic supplies and prescriptions, an amount he could just afford.

The restaurant did not offer insurance, and his $35,000 salary put him above the income limit for Medicaid in Minnesota.

His mother helped him look for a health plan on the marketplace set up by the Affordable Care Act, but his options were expensive. To keep going to the same doctors, she says, he was looking at paying about $450 monthly, in addition to a high deductible of more than $7,000, which would mean months of paying out-of-pocket

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for most of his medical care. He opted to go without insurance, forgoing that expense to focus on paying for his insulin and supplies until he could find a better option.

What Alec soon learned was just how much his insulin would end up costing: more than $1,000 a month. The price of insulin — once modest — has skyrocketed in recent years, making the lifesaving medication a significant, even burdensome, expense, especially for the uninsured and underinsured. The costs are so heavy that they have driven some patients to ration their supplies of the drug in a dangerous gamble with lifethreatening consequences.

At the time Alec discussed skipping insurance coverage, he told his mother, “It can’t be that bad.”

Within a month of going off her policy, he would be dead.

Insulin, in its various manufactured forms, has been used to treat diabetes for almost a century, since Canadian researchers isolated the hormone in a lab in 1921.

Before their discovery, what we now know as Type 1 diabetes was fatal. Even after being put on starvation diets, patients often lived no more than a few years. The researchers who transformed diabetes treatment won the Nobel Prize, and they sold their patent to the University of Toronto for a total of $3. “Above all, these were discoverers who were trying to do a great humanitarian thing, and they hoped their discovery was a kind of gift to humanity,” historian Michael Bliss told The Washington Post in 2016.

Soon, though, insulin became a commercial enterprise. By 1923, the American pharmaceutical company Eli Lilly was manufacturing enough insulin for diabetics across North America. For decades, manufacturers improved formulas, first using animal parts, then producing human insulin using bacteria and recombinant DNA. The 1990s saw the advent of insulin analogs, synthetic drugs made to better mimic the body’s own insulin production.

Today, critics argue that the price of insulin has far outpaced any innovations. In the past decade alone, U.S. insulin list prices have tripled, according to an analysis of data from IBM Watson Health. In 1996, when Eli Lilly debuted its Humalog brand of insulin, the list price of a 10-milliliter vial was $21. The price of the same

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vial is now $275. Those costs can be compounded by the multiple vials that diabetics may require to survive each month. “It’s a very big problem,” says Robert Gabbay, chief medical officer at the Joslin Diabetes Center in Boston. “It’s a tragic barrier to care.”

The global insulin market is dominated by three companies: Eli Lilly, the French company Sanofi and the Danish firm Novo Nordisk. All three have raised list prices to similar levels. According to IBM Watson Health data, Sanofi’s popular insulin brand Lantus was $35 a vial when it was introduced in 2001; it’s now $270.

Novo Nordisk’s Novolog was priced at $40 in 2001, and as of July 2018, it’s $289.

In Washington, the soaring price of insulin has provoked bipartisan concern. Members of Congress are trying to parse the factors that have caused the spike.

In November, a congressional caucus released a report on insulin, urging legislation aimed at lowering prices through increased competition and pricing transparency, among other recommendations.

In June, the American Medical Association called on the government “to monitor insulin pricing and market competition and take enforcement actions as appropriate.” Insulin, in some ways, serves as a proxy for the rising prices across the U.S. prescription drug market. On the campaign trail in 2016, Donald Trump railed against high drug prices, and his administration has vowed to lower them, releasing a flurry of proposals in the past year.

In the meantime, a portion of the more than 7 million diabetic Americans who take insulin are stuck with debilitating costs.

Though most don’t pay the full list price for insulin because of insurance coverage and other rebates, some do, especially those who are uninsured, underinsured or facing a coverage gap through Medicare. “The most vulnerable patients are subsidizing the system,” William Cefalu, the chief scientific, medical and mission officer of the American Diabetes Association, told a Senate committee in May. At the same hearing, a father from Maine told senators that a 90-day prescription for just one of his son’s insulins would cost him $1,489.46. That’s with his high-deductible insurance. He testified

Alec’s mother, Nicole Smith-Holt. Under her insurance, he initially had been paying about $200 to $300 a month for his supplies and prescriptions.

Without insurance, he would pay more than $1,000 a month for insulin.

that he has taken to buying the same three-month supply from a Canadian pharmacy for about $300 plus $50 in shipping. (It’s technically illegal to import medication from other countries, but the Food and Drug Administration generally doesn’t prosecute individuals if it’s a short-term supply for personal use.) He is not alone in his dilemma: The website GoFundMe has thousands of posts with people pleading for help to pay for insulin.

Patients who struggle to afford insulin sometimes ration their supply to make it last longer — a dangerous practice that can create disabling or deadly complications.

“It’s very shortsighted to skimp on insulin,” says Kasia Lipska, an endocrinologist and diabetes researcher at Yale School of Medicine. “In the long term, it’s going to cost us much more.” Poor glycemic control can lead to blindness, kidney failure, amputation, heart disease and stroke. In the short term, patients who stop taking enough insulin can lapse into diabetic ketoacidosis, a condition where blood sugars get too high and the body’s blood becomes acidic. It can become fatal in just hours or a

few days.

At the Yale Diabetes Center, Lipska and her colleagues recently found that one in four diabetic patients reported rationing insulin because of the cost. Very few of those patients were uninsured, but their out-of-pocket expenses still created a financial burden.

These patients were also, not surprisingly, almost three times as likely to have poor blood sugar control as patients who didn’t underuse insulin.

Did Alec die because he was rationing? The answer may never be absolutely clear, but his family is convinced that he was skimping on his doses. He never told his loved ones that he was rationing because of the expense, but they knew that the disease and its cost wore on him. He had talked to his parents about searching for jobs that offered health insurance.

Laine had scouted the Internet for prescription discounts. Alec vented to his best friend, Erick Borrome, whose wife, Arizbeth, offered to get him cheap insulin from a pharmacy in Mexico, where she had family and a vial cost roughly $50. She says: “We had many conversations about the in-

sulin and the cost. He was pretty worried about it.” But, she adds, “he was too shy to accept help.” He never took her up on the offer.

Nicole got the call that Alec had died on a Tuesday. It was Laine who found him. She hadn’t heard from him since Sunday night, so she went to his apartment to check on him. He was on the floor beside his bed. “I grabbed his shoulder, and it was ice cold,” Laine says. “I just knew he was gone.”

Alec’s funeral was held the day after the Fourth of July, his favorite holiday. Family and friends gathered at his parents’ house in Richfield, a Minneapolis suburb, to shoot off fireworks in his memory. Those first few weeks were a blur, as Nicole tried in her grief to piece together the last days of Alec’s life. The medical examiner had listed diabetic ketoacidosis (DKA) as the cause of death. By definition, he had died of a lack of insulin, but why and how did that happen?

In speaking with Laine, Nicole learned that Alec had indicated he was running low on insulin before he died. That Sunday, Laine had suggested they go to a food truck festival, but she remembered Alec

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COVER STORY saying, “No, I don’t think I have enough insulin for that.” That night, he was tired and complaining about abdominal pains. Hearing this, Nicole deduced that those symptoms may have been warning signs of DKA. There were more clues: There was some healthy food in his fridge, but no stockpile of insulin.

As Nicole cleaned out his cluttered blue car, littered with old prescription receipts, she started to cobble together just how much his insulin and blood sugar testing supplies cost without insurance or discounts. The total, by her count, was nearly $1,300 per month. That was roughly the same amount that Alec’s local pharmacy tallied for me nearly a year later, using a list of his medications and medical supplies. “It’s very expensive to be diabetic without insurance,” the pharmacist said. That $1,300 was almost $200 more than Alec’s biweekly paycheck.

Nicole now believes that Alec was rationing his insulin because of the cost. “Based upon what he had left when he was found, we came to the conclusion that he had not filled his prescription, so he had to have been rationing for a short period of time,” Nicole told me. “We realized that he had been taking less insulin and less often than he should, trying to make it stretch until he got his next paycheck.” He was found dead three days before payday.

No one can truly know what happened in those final days. Alec may not have realized that his condition was so serious, or perhaps he thought he would be fine, just as he had been when he was diagnosed. DKA creates confusion as it progresses, and it can progress quickly, shutting down vital organs.

“If I could go back in time,” Nicole says, “I would have found a way for him to not move out . . . so I could monitor this or see that he was struggling in some kind of way, and force him to take our help.” One afternoon, sitting at their dining room table, her husband, James Holt, recalled encouraging Alec to get his own place. “I think back and regret that,” he said, wiping away tears.

In their search for answers, there was enough blame to go around. His family blamed the broken health-care system. They blamed unaffordable insurance and high out-of-pocket costs. They

blamed a lot of things, including, in darker moments, themselves.

But they kept coming back to the price of insulin. Why was a treatment that had been around for nearly 100 years so expensive?

And what could be done about it?

Nicole hadn’t known much about the world of diabetes advocacy before Alec died. But now she felt a budding activism as she encountered a flood of information and stories like her own online.

Advocates were rallying around the hashtag #insulin4all, which the nonprofit organization T1International helped create in 2014 to raise awareness about the inaccessibility of insulin, particularly in developing countries.

T1International’s founder, Elizabeth Pfiester, an American Type 1 diabetic who now lives in the United Kingdom, still marvels at how much more affordable diabetes care is in her adopted country. “It’s really a shame that #insulin4all is needed as a rallying cry in the U.S.,” she says.

There are T1International activists like Hattie Saltzman, a college student in Missouri who went a year without buying insulin because she couldn’t afford her monthly $550 insulin bill. Her father shared some of his insulin, and she got free samples from her doctor. At one point, she told me, “I had rationed insulin so extensively that it expired. I didn’t catch that until I went to the ER because my blood sugars were through the roof.” When the diabetic daughter of family friends died of cystic

Alec’s sisters Brittany Smith, left, and Alexis Holt look at old family photos.

“We’ve taken out loans.

We’ve borrowed from retirement.

You think, ‘Where else can I get it?’ ”

Doreen Rudolph, on the struggle to afford insulin for her daughter

fibrosis, the family donated her leftover insulin to Saltzman. That got her through the year until she qualified for better insurance coverage.

There are new cases all the time.

In July, Long Island resident Doreen Rudolph tweeted about her young adult daughter’s struggle to afford insulin: “I just bought 2 vials of insulin for my daughter cost me $524. With a discount card. All I could buy. I left the pharmacy and sat in my car and cried.” Her message struck a chord: Within five days, her tweet had been liked 70,000 times, and her $8,000 GoFundMe campaign was fully funded. To buy insulin, Rudolph told me, “We’ve taken out loans. We’ve borrowed from retirement. You think, ‘Where else can I get it?’ ” A pharmacist and a number of physicians told me about older insulins available from Walmart.

The type of insulin first came out in the 1980s and now costs about $25 per vial. So-called “Walmart insulin” is a controversial solution for Type 1 diabetics, many of whom believe that older formulas are more likely to lead to dangerously low blood sugar levels. A few doctors echoed that concern. Yet it could still save lives. “It’s very good insulin,” one physician told me.

Another said, “It’s obviously better than nothing.” Researchers have found that these older insulins work just as well for Type 2 diabetics as pricier analog insulins, but some research shows a slightly better outcome for Type 1 diabet-

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ics on newer formulas.

Many diabetics continue to hunt for coupons and discounts on high-priced insulins. Some doctors will give out samples to struggling patients. The constant search for more insulin can become all-consuming. “I think about it when I wake up. I think about it when I go to bed,” says Michelle Fenner, an #insulin4all activist whose diabetic son is 17.

She worries about what will happen when he is a young adult and on his own. “There is no way he can pay what I do,” she says.

Eli Lilly, which hasn’t raised its insulin prices since May 2017, declines to discuss its pricing strategies in general. Asked for comment, it offered a statement: “Some people pay too much for insulin at the pharmacy, and there are several reasons — including high deductible insurance plans that require people to pay thousands of dollars in medical bills before coverage is triggered. We’re focused on finding solutions to the problem.”

In August, the company started the Lilly Diabetes Solution Center, a help line to “assist people who need help paying for their insulin.”

Fenner said a coupon she received from the help line dropped the monthly cost of one of her son’s insulins from $900 to $95. It’s an incredible boon, but she already worries how long Eli Lilly will keep the savings going. According to the American Diabetes Association, these kinds of measures are just a stopgap: The organization’s June 2018 report concluded that corporate patient assistance programs are “not deemed to be a long-term or comprehensive answer to the rising cost of insulin for the vast majority of people with diabetes.” Several people, including Fenner, described insulin as being like oxygen: Scavenging for it invokes a primal fear, like the gasp you make just before you run out of air.

In early May, 10 months after Alec died, Nicole flew to Indianapolis to attend a shareholder meeting at Eli Lilly headquarters.

Her trip had been coordinated in part by T1International. Before the meeting, a small band of activists gathered outside. One held a neon-pink poster that read: “Your insulin is a life saver. Your prices are poison.”

Camera crews set up on a street corner. For more than half an

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hour, Nicole answered the same questions from reporters. Why are you here? What do you want from Eli Lilly? She told them she was there for Alec. “I feel like I am leaving a legacy for him,” she said.

“That’s what is really important to me. I don’t want any other person to die the way that he did. If I can prevent it, that’s what I’m here to do.”

Nicole wanted pharmaceutical companies to start by being more transparent about their prices — to disclose how much it costs to manufacture a vial of insulin and what the profit margin on each vial is. Ultimately, she wanted them to reduce the price. “They’re going to tell you it’s complicated or they can’t share that information with you,” she said to a reporter.

“It’s not all that complicated.

They’re choosing to make it complicated. It’s just plain greed.”

The rising prices from Eli Lilly, Sanofi and Novo Nordisk have raised suspicions. The companies appear to have increased them in lockstep over a number of years, prompting allegations of price fixing. All three companies denied these charges when I contacted them. (In 2010, Mexico fined Eli Lilly and three Mexican companies for price collusion on insulin, an allegation Eli Lilly also denied.)

In the United States, a federal prosecutor and at least five state attorneys general are currently investigating the companies’ pricing practices, according to Kaiser Health News. In October, Minnesota became the first state to sue the companies over insulin prices.

And in January 2017, potential class-action lawsuits alleging price fixing by the three companies began making their way through the courts on behalf of diabetics. The companies denied the suits’ allegations.

There is also another, less known corporate entity in the mix: pharmacy benefit managers (PBMs), which include Express Scripts, OptumRx and CVS Health; all are now named in lawsuits on high insulin prices, but these companies also deny any wrongdoing. PBMs manage the prescription drug benefits that are part of insurance plans, working with pharmaceutical companies to negotiate discounts on behalf of insurance providers. “Every time a PBM extracts a deeper discount, an insulin manufacturer has the incentive to take a price increase

to quote ‘make themselves whole,’ ” says Rena Conti, a health economist at Boston University.

That’s probably one reason why, even as Eli Lilly’s list price for Humalog insulin has increased by 175 percent since 2009, the company maintains that its net price — the amount the company earns after rebates, discounts and fees — has remained steady.

Both drug companies and PBMs play a role in escalating drug prices. “It’s almost like Kabuki theater where one guy points to the other guy and says, ‘It’s not me, it’s him,’ ” says Jing Luo, an instructor at Harvard Medical School and a faculty member at Boston’s Brigham and Women’s Hospital who studies insulin pricing.

These corporate entities are powerful special interests. In 2017, the pharmaceutical and health product industry — which includes drug companies and PBMs — spent nearly $280 million on lobbying, the biggest spender by far of 20 top industries, according to the Center for Responsive Politics. Even some patient advocacy organizations, like the American Diabetes Association, receive millions in funding from pharmaceutical companies. The industry also has a revolving door to govern-

Alec’s family, from left: Alexis Holt, James Holt, Nicole Smith-Holt, Brittany Smith and Jamisen Holt at their home in Richfield, Minn.

Nicole Smith-Holt is working to get drug manufacturers to lower the price of insulin.

“People should not have to pay significant high prices for accessing a treatment that keeps them well.”

Economist Rena Conti

ment. Alex Azar, the head of the Department of Health and Human Services, was the president of Eli Lilly’s U.S. division until 2017.

Under his watch, the price of the company’s analog insulin doubled. Now he is tasked with overseeing the government’s plan to lower those same prices.

At Eli Lilly, Nicole met with Mike Mason, the vice president of U.S. Lilly’s diabetes division. The company declined to make Mason available for an interview for this article, but Nicole says he seemed compassionate. She held a photo of Alec during the meeting and placed it on the table in front of her while she read a statement. “Profits should never come before the lives of people,” she told Mason and the other representatives in the room, before asking them to remember her family’s grief. She struggled to maintain her composure, she told me later, but when she brought up “corporate greed” with Mason, she says, “I stopped and looked him dead in the face.

He looked away.”

On May 11, four days after Nicole’s trip to Eli Lilly, President Trump and Azar stood in the White House Rose Garden to unveil “American Patients First,” the administration’s “blueprint to lower drug prices and reduce out-

of-pocket costs.” The president told the crowd, “We will have tougher negotiation, more competition and much lower prices at the pharmacy counter. And it will start to take effect very soon.”

The blueprint includes more than 50 proposals. “There is not a single silver bullet that’s going to reduce drug prices across the board,” says Aaron Kesselheim, an associate professor and drug-pricing researcher who is a colleague of Luo’s at Harvard Medical School and Brigham and Women’s Hospital. Some of the proposals are nonstarters, he argues, such as punishing other countries for the low prices they pay on drugs.

(Americans pay more for drugs than any other nationality, but the governments of many other developed countries regulate drug prices, which keeps them lower.) “A better solution would be to focus on what makes our pharmaceutical market inefficient,” Kesselheim says. “Focusing on this concept of foreign freeloading is, I think, a political distraction.”

For Conti, the Boston University economist, the administration’s blueprint doesn’t go far enough in addressing insurers. To guarantee that “real people pay lower prices” at the pharmacy, the first thing she would do is elimi-

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LAWS nate insurance plans that allow large out-of-pocket costs for prescription drugs — including the kind of high-deductible plan that Alec opted not to take. “It’s insurance principles 101,” Conti says.

“People should not have to pay significant high prices for accessing a treatment that keeps them well.”

The blueprint overall is just that: a starting framework. One promising idea calls for increased pricing transparency, a popular idea among insulin-access activists that has also been gaining ground in state legislatures. The blueprint also recommends bringing more generic drugs onto the market. Right now, the United States has two relatively new “follow-on” insulins, which are similar to generics, but they are only marginally cheaper. Some experts say more competition is needed to lower prices. In December, FDA Commissioner Scott Gottlieb issued a statement on policies that will put more generics on the U.S. market, including for insulin starting in 2020, as part of a transition that was written into the Affordable Care Act. “We’ve heard frequent reports of patients rationing insulin, and in some cases dying because they can’t afford the injections they need to survive,” the statement read. “These tragic stories aren’t isolated occurrences. And they’re not acceptable for a drug that’s nearly a century old.”

Trump has said that drug companies are “getting away with murder,” and he has singled them out on Twitter, but some experts say his administration’s blueprint takes a harder line on PBMs than it does on pharmaceutical companies. And though Trump pledged in late May that drug manufacturers would lower their prices — and a few voluntarily did so — none lowered the price of insulin. In July, Novo Nordisk raised its list prices on two insulins another 5 percent.

May through July would bring some of the hardest days, but Nicole and James pressed on, hosting a rally for affordable insulin at the Minnesota state Capitol. Their story reached the ears of lawmakers: In the state legislature, the Alec Smith Emergency Insulin Act was introduced to provide insulin to those in need. It didn’t come up for a vote, but they laminated a copy of the bill’s text anyway.

On her first Mother’s Day with-

out Alec, Nicole spent hours planting a memorial garden in a corner of her yard. A week later, on May 20, the family invited loved ones over to visit the space and commemorate Alec’s first “heavenly birthday.” Brittany had driven a half-hour across the Wisconsin state line to buy fireworks. In the kitchen, there were hamburgers and hot dogs waiting. There was even a cake: store-bought with thick white frosting — the kind a diabetic might be told to avoid. In green letters, it read: “Forever 26.”

The long Minnesota winter had given way to one of those perfect days, 70 degrees and sunny. James fired up the grill, and music piped through speakers. The Borromes arrived, and so did Laine, who dabbed her eyes with a napkin as they shared stories about Alec.

For Nicole, it was too much at times. When she needed to, she retreated from the 40 people gathered and smoked a Newport alone on the deck. When James escorted a group of Alec’s friends over to the garden, where they sprinkled some of Alec’s ashes, Nicole backed away from the huddle, saying, “I can’t do this.” Some days, she told me later, “it’s all a lot.”

Alec would continue to be the face of a growing movement. In a few weeks, a letter from Nicole would be read at a conference in Washington about making prescription medicine affordable. In June, during a hearing on rising drug prices with Azar, Democratic Sen. Tina Smith of Minnesota would invoke Nicole: “Her son Alec passed away last year because he couldn’t afford his insulin,” she told Azar. Later in the summer, Democratic senators would invite the family to Washington to share their story.

There would be plenty of time for more activism, but today was meant for those who knew Alec best. At dusk, Brittany handed out sparklers and Roman candles, and the crowd gathered in a circle on the grass. They launched the fireworks into big bursts of yellow and green, with sparks and ash raining down over the yard. It had been a hard day, but it was still a party.

Nicole stood on the deck to record the scene on a cellphone as friends and family called out: “Happy birthday, Alec!” “We love you!”

“We miss you.” Everyone stared up at the sky, watching until the last flare burned out. n ©The Washington Post

KLMNO WEEKLY

From roadkill to main course BY

K ARIN B RULLIARD

O

Alec’s best friend, Erick Borrome, whose wife, Arizbeth, offered to get Alec cheap insulin (about $50 per vial) from Mexico.

regon state Sen. Bill Hansell’s rural district is the size of Maryland, and it is crisscrossed with hundreds of miles of road splayed with all manner of roadkill. While driving one of those routes a couple of years ago, Hansell spotted a dead deer and had what he called an “aha moment”: Could the carcass feed someone?

Chowing down on roadkill was not legal in Oregon then. But as of Jan. 1, it is. With the enactment of a bill sponsored by Hansell and unanimously passed by the legislature, Oregon became the latest of about 20 states that allow people to scoop dead animals off the road and serve them for dinner.

Among them are Washington, which issued 1,600 roadkill salvaging permits within one year of legalizing the practice in 2016; Pennsylvania, where more than 5,600 vehicle-deer crashes were reported in 2017; and Georgia, where motorists may take home struck bears. The rules vary by state, though most require timely reporting of the collection to authorities, and most absolve the state of responsibility if the meat turns out to be stomach-turning.

Oregon allows the salvaging of deer and elk for human consumption only (sorry, Fido). People who pick up a carcass must apply online for a free permit within 24 hours, and they must turn over the animal’s head and antlers to the state wildlife agency within five business days. That is for two reasons, Hansell said: Antlers can be sold to collectors, and no one wanted to create a financial incentive for crashing into wild critters; wildlife authorities also want to test head tissue for chronic wasting disease.

Importantly, the roadkill must have been produced by accident.

That is, drivers are not allowed to “hunt with their automobiles,” Hansell said. Drivers who inadvertently strike a deer or elk but only wound it may “humanely dis-

patch” the animal with a firearm, then salvage the meat, according to regulations published by the Oregon Department of Fish and Wildlife.

Oregonians are already taking advantage of this new right. Hansell, citing figures from the fish and wildlife department, said a dozen salvaging permits had been issued by that Friday morning.

“That’s 12 carcasses that are not strewn alongside of the road, that are being harvested and consumed,” he said. “It’s exciting.”

It also might sound a little, well, gross. But it should not, said Thomas Elpel, a Montana author and wilderness survival instructor whose how-to video on the practice is posted on YouTube.

“It’s meat. Whether you buy it in a store or pick it up on the side of the road, it’s the same thing. In the stores, it’s packaged with Styrofoam and plastic, which maybe looks pretty but is harmful to the environment,” he said.

Elpel said he grew up eating roadkill harvested by his grandmother, though it was not explicitly legal when he was a kid. The state began issuing permits in 2013, and Elpel said he salvages carcasses several times a year — enough that his freezer is full.

In one of his books, Elpel walks readers through his roadkill salvaging method. Among his tips: If it is green and “the smell makes you want to barf,” then pass, he writes. The choicest carcasses have been hit in the head, leaving the body intact, but broken bones and bloodied flesh can be trimmed off. Gutting and butchering is otherwise similar to the process hunters use.

Support for the Oregon roadkill bill was strong and came from an unlikely array of groups, Hansell said. Hunters liked it, but so did animal welfare types. Road crews tasked with scraping up rotting animals were pleased by the prospect of a little less work, and nutritionists got behind the idea of free organic protein, Hansell said. n ©The Washington Post

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BOOKS

20 years on, we still can’t say no to Tony Soprano N ONFICTION

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REVIEWED BY

H ELENE S TAPINSKI

W

THE SOPRANOS SESSIONS

By Matt Zoller Seitz and Alan Sepinwall Harry N. Abrams.

464 pp. $30

Actor James Gandolfini, right, and David Chase, creator of the “The Sopranos,” in 1999.

The show first aired on Jan. 10 of that year.

hen I first heard about “The Sopranos,” I was reluctant to watch it. I knew this world — two-bit Jersey mobsters, their consiglieri and goomars — way too intimately. As a fledgling reporter, I had covered a mob trial back in the ’80s in Newark and heard my cousin’s name mentioned in the secretly recorded FBI tapes. I’d even written a book, “Five-Finger Discount,” with real characters from my own family — including a murderous grandfather called Beansie — that were eerily similar to David Chase’s creations. How could a TV show capture the world that I genuinely understood from the inside out?

Though I was a huge “Godfather” fan, I hated movies that poked fun at Italian Americans — “My Blue Heaven” and even “Moonstruck,” which I did come to love in time. Italian Americans aren’t all morons existing for your comic pleasure.

But out of curiosity, I tuned in to “The Sopranos.” From the opening credits, with Tony’s drive out of the Lincoln Tunnel through the urban wasteland where I grew up and into the “safety” of the suburbs, I was hooked. Because of my own life and my family’s hilarious and alarming story, I identified with Tony when he told his therapist, “I find I have to be the sad clown. Laughing on the outside, crying on the inside.”

I wasn’t the only one who identified.

“The Sopranos” was a huge hit with both critics and viewers — here was a family comedy and drama that didn’t insult our intelligence, that told a layered story, punctuated with a smart and varied playlist. Its characters were sometimes dumb, but they were always complex and genuine with an incredible cast led by James Gandolfini, who walked the line between brutal and sensitive every week and made “The Sopranos,” well, sing.

Like most family milestones, it’s hard to believe that 20 years

JILL CONNELLY/ ASSOCIATED PRESS

have passed since the first episode of “The Sopranos” aired. To celebrate the anniversary, festivals and other events are being planned, as is a prequel feature film. A dense, all-encompassing book about the show — “The Sopranos Sessions” — has just been released, a psychological and philosophical deep dive written by two former Star-Ledger writers who were there on the ground floor. (The Ledger is the paper Tony memorably picked up in his driveway.)

I approached the book as I did the show: with trepidation. But like Chase and Gandolfini, these guys — Matt Zoller Seitz, TV critic for New York magazine, and Alan Sepinwall, chief TV critic for Rolling Stone — are the real deal.

Their analysis of that openingcredits drive — which compares the ride to the evolution of immigrants in American society — is enough reason for any fan to buy this book.

Then there are the exclusive interviews with Chase, who

doesn’t talk to many reporters.

Brilliantly, they start with the question: Tell us about your mother. (Chase admits he based Tony’s mother, Livia, on her and says actress Nancy Marchand eerily channeled her. “My mother was nuts,” says Chase, “and she obviously did not have a happy childhood.”) There’s also lengthy discussion of that controversial, ambiguous last episode. (Chase tries to keep his responses ambiguous.)

The authors explain, in extended “Infinite Jest”-like annotations, the actors’ ties to “The Godfather,” “Goodfellas” and the rest of the world that came before and after, and reintroduce us to Livia, Silvio and Carmela and Uncle Junior and Christopher and all the characters who have been standing there all these years in the shadows of our subconscious, waiting to whack us once again.

They hit, head on, the Italian American community’s hatred of the show, glorifying gangsters at the expense of all the hard-work-

ing Italian Americans. (“I think it did a lot to raise the profile of Italians,” says Chase. “I know they were gangsters and killers, but I think for the right audience, they were very innocent. . . . they were human beings.”) They call out episodes that alienated viewers, such as the one in Season 3 when a stripper is violently killed.

They discuss Chase’s use of symbolism — eggs as a harbinger of death and the number seven — as well as literary and cinematic allusions, making the show seem even more of a dark masterpiece than we thought. The writers pick apart and analyze, in exhaustive and exhausting detail, each hilarious and disturbing episode of the seven seasons, making you want to go back and watch them all over again. n Helene Stapinski is the author of “FiveFinger Discount: A Crooked Family History,” “Baby Plays Around: A Love Affair, with Music” and “Murder in Matera: A True Story of Passion, Family, and Forgiveness in Southern Italy.”

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BOOKS

KLMNO WEEKLY

Cranking up the volume on rock

Death and loss mix everybody up

N ONFICTION

F ICTION

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REVIEWED BY

M ICHAEL L INDGREN

onsider the Fender Stratocaster. Asked to picture an electric guitar, most people will bring to mind inventor Leo Fender’s most famous creation. Upon its introduction in 1954, the Stratocaster not only redefined the sound of American music but became, with its sweeping curves and jewel-like colors, a stunning piece of midcentury design on par with a Bel Geddes radio or an Eames chair.

Yet the Strat’s iconic shape was an on-the-fly modification. Many musicians found the Stratocaster’s predecessor, the Telecaster, cumbersome, so Fender simply streamlined the instrument with beveled contours that echoed a player’s body — and a classic was created. “A radical design had been born through Leo’s obsession with practicality,” author Ian S. Port writes.

This and many other fascinating accounts are the bounty of “The Birth of Loud: Leo Fender, Les Paul, and the Guitar-Pioneering Rivalry That Shaped Rock ’n’ Roll.” Port’s book is a lively and vivid account of the careers of Fender and his main competition, Les Paul, the star guitarist whose name adorns the Gibson sixstring that rivals Fender’s instruments in popularity and influence.

“The Birth of Loud” traces the dual arc of the men’s rise with consummate skill and authority.

Although they were close for a few years in the late 1940s and would be forever linked in their fame, they were in many respects opposites. Fender was a taciturn man who could be found tinkering in his laboratory until late at night, whereas Paul was a showman, a musical and technical whiz who was one of the biggest stars of the postwar, pre-rock ‘n’ roll pop era.

What they shared was that ineffably American knack for experimenting and stirring the pot, for trying out harebrained ideas and pushing homemade contraptions to their limits.

They also shared a keen itch for the main chance. Fender, Port relates, frequented the gritty honky-tonk joints in the crude postwar boomtowns springing up around Fullerton, Calif., talking shop with rawboned country musicians; what they needed, he quickly sussed out, was an electrified guitar that could be cranked up for maximum volume, and that was cheap, sturdy and easy to repair.

Out in New York City, Paul was experimenting along similar lines; in 1940, he had created a Frankenstein’s monster-like object called “the Log,” an ur-electric guitar fashioned out of a plank of pine and a crude pickup.

The reaction he got one night from a stunned crowd in a bar in Sunnyside, Queens, of all places, told him everything he needed to know about the future of the instrument. The guitar arms race was on.

The next two decades were probably the most transformative in the history of American music, and Port does an outstanding job of tracking the ways each new musician vaulted over the next, engaging the new instruments with ever-surprising results. Port tells the story elegantly and economically, but two turning points are identified.

In 1960, now-forgotten surf icon Dick Dale pushed Fender’s amplifiers to the limit and beyond during his thunderous concerts at roadhouse in Orange County, Calif. And the 1966 recording of John Mayall’s album “Bluesbreakers With Eric Clapton,” in Port’s estimation, was a ground-zero moment when the signature sound of an overdriven Les Paul — “a molten, billowing wail” — was first recorded.

The story of these instruments is the story of America in the postwar era: loud, cocky, brash, and aggressively new. n Lindgren is a frequent contributor to The Washington Post.

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THE BIRTH OF LOUD Leo Fender, Les Paul, and the Guitar-Pioneering Rivalry That Shaped Rock ‘n’ Roll

By Ian S. Port Scribner. 352 pp. $28.

LATE IN THE DAY

By Tessa Hadley Harper. 288 pp. $26.99.

REVIEWED BY

R ON C HARLES

ith each new book by Tessa Hadley, I grow more convinced that she’s one of the greatest stylists alive. The British author of seven novels and several story collections, Hadley regularly inspires such praise, but her success was hardly a foregone conclusion. Her first novel, “Accidents in the Home,” didn’t appear until she was 46, practically geriatric compared with those wunderkinds who secure contracts at the Iowa Writers’ Workshop and graduate into a field of laurels.

There are compensations, though, for achieving literary success later in life. Unable to sell her first stories while she was raising a family, Hadley went back to school and wrote a PhD thesis on Henry James. That long immersion in James’s canon offered a study of psychological acuity that now illuminates Hadley’s work. But her quietly elegant style and muted wit are triumphs all her own. To read Hadley’s fiction is to grow self-conscious in the best way: to recognize with astonishment the emotions playing behind our own expressions.

Her previous book, “The Past” — one of the best novels of 2016 — involves four adult siblings enjoying their last vacation in a summer cottage. It focuses on the passing of an era, a melancholy transition that everyone knows will reshape their relations to each other.

Her new novel, “Late in the Day,” zeros in on a similar, but more dire moment of adjustment that arrives with the speed of a swinging scythe. The story involves two married couples who have known each other since their university days. Lydia is married to Zachary, a wealthy man who owns a London art gallery. Christine is married to Alex, a poet who teaches at a primary school. On the opening page, Lydia calls from the hospital with news that Zachary has suffered a heart attack.

Christine listens in alarm for several minutes before asking, “Are

they going to operate?”

“I told you,” Lydia says, “he’s dead.”

It’s a moment perfectly constructed to capture the confusion of life-changing news, those moments when the roof blows off our well-organized lives and we rush to close a window. “He wasn’t the dying type,” Zachary’s widow objects. Suddenly alone for the first time in years, she’s terrified by her own incompetence, and Zachary’s friends are discombobulated by having the polished structure of their quartet torn apart.

“Late in the Day” moves forward and backward in alternating chapters. The earliest sections show Christine and Lydia as students, respectively cautious and reckless, in their pursuit of Alex and Zachary. Here Hadley lays the cornerstones of the lives and romances the four of them will construct over the next decades. How easy it is to forget the cracks in those foundations, but when Zachary dies, they will discover that the intimacy of a long friendship equips them to help — and devastate — each other.

In the novel’s present-day sections, we watch Zachary’s widow and his surviving friends struggle to recalibrate their world without him. Moments of sympathy and understanding are strafed with acts of callousness that shock even the perpetrators.

The tone of “Late in the Day” is perhaps Hadley’s most delicate accomplishment. The whole griefsteeped story should be as fun as a dirge, but instead it feels effervescent — lit not with mockery but with the energy of Hadley’s attention, her sensitivity to the abiding comedy of human desire.

Despite its grim opening, this is a novel about the persistence of life, the agonizing but clarifying effect of great loss. Even late in the day, Hadley suggests, there’s still time to begin again. n Charles writes about books for The Washington Post.

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KLMNO WEEKLY

OPINIONS

Honoring MLK at 90: An urgent call to action JONATHAN CAPEHART is a Washington Post opinion writer.

On Jan. 15, 1929, the Rev. Martin Luther King Jr. was born in Atlanta. By 1954, he was the leader of one of the greatest movements for freedom in history. A push for equality and justice for African Americans that became the model for other liberation struggles around the world.

But King’s assassination in 1968 change the trajectory of the social justice movement he led forever.

The people who worked with King, a mass of ordinary men and women whose extraordinary actions all across the South brought the United States closer to the ideals espoused in its founding documents, carried on without him as best they could.

Now, 90 years after his birth and with President Trump in the White House, the veterans of the movement are worried.

Worried about the erosion or reversal of the hard-fought gains of the last 50 years. Worried that the lessons they learned will be forgotten. Worried that time is running out for them to pass on their knowledge, encouragement and support to the next generation of leaders. Worried enough to convene an incredible gathering the first weekend of 2019 at the Annenberg Retreat at Sunnylands in Rancho Mirage, Calif. That I was asked to participate in this remarkable assembly called by Clarence Jones, King’s personal attorney, will remain one of the true honors of my life. The gathering was the launch of the Gandhi King Institute for Nonviolence and Social Justice, which is based at the University of San Francisco and co-founded by Jones and Jonathan D. Greenberg, a lecturer in law at Stanford University.

Jones’s invitation expressed the urgency that he and the veterans feel.

The veterans around the table the first night were some of the

men and women who became icons of the civil rights movement. Minnijean BrownTrickey was 15 years old when she integrated Central High School in 1957 as part of “the Little Rock Nine.” J.T. Johnson participated in the mass protests in Albany, Ga., and jumped into a whites-only swimming pool in St. Augustine, Fla., in 1964. The ensuing response by the police and the Ku Klux Klan is credited with pushing the passage of the Civil Rights Act. Bernard Lafayette participated in the Freedom Rides in Alabama and was a co-founder of the Student Nonviolent Coordinating Committee (SNCC). Bob Moses was the field secretary for SNCC and was a renowned leader of its voter-registration effort in Mississippi. Andrew Young was part of King’s inner circle and the executive director of the Southern Christian Leadership Conference (SCLC) before becoming a member of Congress, U.S. ambassador to the United Nations and mayor of Atlanta.

The members of the “next generation” who joined the conversation were equally impressive. They included LaTosha Brown, co-founder of Black Voters Matter Fund; gun control advocate Clifton Kinnie, whose activism started in Ferguson, Mo.; and Lateefah Simon, president of the Akonadi Foundation whose pioneering work in low-income communities in the San

MICHAEL S. WILLIAMSON/THE WASHINGTON POST

Ninety years after the Rev. Martin Luther King Jr. was born, veterans of the civil rights movement gathered to make a recommitment to their work and call for “a new moral fusion movement on a mass scale.”

Francisco area earned her a MacArthur Foundation “Genius” fellowship in 2003.

Don’t think of the Sunnylands assembly as a kind of passing of the torch. Instead, it was a unification of effort. One that recognized that the struggle for social justice is work that is ongoing. That the next generation is mirroring what the veterans before them did by taking the reins of leadership while being guided by those who came before. They’ve had no choice, given the onslaught of tragedy and policy retrenchment over the past few years.

In a document titled “A Call to Conscience on the 90th Birthday of Martin Luther King, Jr.,” those who gathered at Sunnylands and others who weren’t able to make it announced their recommitment to the work.

“Today, as we remember Reverend Dr. Martin Luther King, Jr.,” the communique opens, “we watch in anguish as many achievements toward a more just and equal society we believed were secure are being eviscerated in front of our eyes.”

The entire call to action ripples with anxiety and urgency as it “affirm[s] the bonds of friendship and fellowship across

generations” by calling for “a new moral fusion movement on a mass scale.” It is a commitment to “dedicate ourselves to this struggle to realize the promise of American democracy on behalf of all of us who live here” while also fighting to “cool a world on fire, and save the planet from destruction, on behalf of our children’s children and their progeny into the future.”

But the anxiety of the here and now gives way to the optimism that fueled King’s and the veterans’ heralded efforts to make this a more perfect union.

“The existential choice before us has become more urgent today than at any time in our lives since our beloved friend and pastor was assassinated more than fifty years ago.” the signatories write. “We cannot repair America and the world with hate, only with love.”

When we remember this — when we honor King, those who follow in his giant footsteps and their collective efforts to make this a more perfect union — we not only stand a much better chance of withstanding the strong head winds lashing us today. We also stand a chance of getting closer to “the promised land.” n

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OPINIONS

KLMNO WEEKLY

TOM TOLES

Leaving our troops exposed MAX BOOT is a Washington Post columnist, the Jeane J. Kirkpatrick senior fellow for national security studies at the Council on Foreign Relations, and a global affairs analyst for CNN.

“How do you ask a man to be the last man to die for a mistake?” I thought of John Kerry’s words from 1971 when I heard the terrible news Wednesday about the death of four Americans (two soldiers and two civilians) and the wounding of three others in a suicide bombing in Manbij, Syria. In the present instance, however, you would have to amend the quote to say: “How do you ask a man to be the last man to die for a war supposedly won?”

On Dec. 19, recall, President Trump announced the withdrawal of roughly 2,000 U.S. troops from Syria with these words: “We have defeated ISIS in Syria, my only reason for being there during the Trump Presidency.” This was news to analysts, who pointed to intelligence reports that, while the Islamic State has lost most of its territorial control, it still had some 30,000 fighters in Iraq and Syria, making it one of the largest and most dangerous terrorist groups on the planet.

Under criticism from his own party, Trump backtracked slightly, announcing on Jan. 7, “We will be leaving at a proper pace while at the same time continuing to fight ISIS and doing all else that is prudent and necessary!”

Apparently all this meant was that withdrawal would now take

four months rather than one. Two weeks ago, the pullout began with the removal of the first U.S. equipment, if not yet personnel, from Syria. On Wednesday, Vice President Pence, eager to play Little Jeff to Trump’s Jeff Dunham, faithfully announced: “The caliphate has crumbled and ISIS has been defeated.” This was after the terrible news from Syria, which in one day has tripled the total number of fatalities (now up to six) suffered by U.S. forces in Syria.

It is impossible to say why the Islamic State struck now, except that it could. But there is little doubt that the announced U.S. withdrawal gives the terrorists an inducement to attack. Gayle Tzemach Lemmon, a colleague of mine at the Council on Foreign Relations, writes about a recent trip to Syria in Foreign Affairs.

She notes that the U.S. troop presence in towns such as Raqqa and Manbij was virtually invisible yet highly significant. Two female university students she met in Raqqa told her that the Americans “provided the invisible force field that kept ISIS down and the Russians, Iranians, and Turks at bay.”

Now the force field is dissolving, and all the regional actors are rushing in to try to fill the vacuum. The Islamic State has an incentive to attack U.S. troops to claim credit for their withdrawal and to demonstrate that it remains undefeated. We will see now what the other regional actors do, but it is unlikely to be what Washington wants.

Aware of the danger that the Turks would massacre the United States’ Kurdish allies, Trump’s national security adviser, John Bolton, tried to obtain assurances from Ankara that the Kurds would be protected. Turkish President Recep Tayyip Erdogan offered no such assurances. But the pullout went ahead anyway behind a smokescreen of bluster.

Trump tweeted this past week: “Starting the long overdue pullout from Syria while hitting the little remaining ISIS territorial caliphate hard, and from many directions. Will attack

again from existing nearby base if it reforms. Will devastate Turkey economically if they hit Kurds.

Create 20 mile safe zone . . . ” This type of empty threat is worse than useless, because it undermines whatever scant credibility America has left. How could the United States “devastate” Turkey, a NATO ally that is our 34th-largest supplier of imported goods and 28thlargest export market? How could the United States create a “safe zone” without any troops on the ground to enforce it? And how could the United States use a “nearby base” to keep the Islamic State from re-forming? President Barack Obama tried that very strategy after he pulled U.S. troops out of Iraq in 2011. The United States had lots of nearby bases in countries such as Turkey and Kuwait, but they could not slow the rise of the Islamic State.

Eastern Syria had, until now, been an island of stability thanks to the U.S. alliance with the Syrian Democratic Forces. The U.S. achieved outsize strategic returns for a small troop investment. But now Trump appears determined to fritter those hard-won gains away. And in the process of pulling out, he leaves U.S. soldiers who are tasked with carrying out his incoherent policy fatally exposed. n

SUNDAY, JANUARY 20, 2019

22

KLMNO WEEKLY

OPINIONS

BY KAL FOR THE ECONOMIST

Ginsburg’s health is not the issue MORGAN JERKINS is the author of “This Will Be My Undoing” and a visiting professor in the Columbia University’s MFA program in nonfiction.

In the first scene of the documentary “ RBG,” Gloria Steinem calls Supreme Court Justice Ruth Bader Ginsburg “a superhero.” The label could not be more appropriate — or more stifling.

In recent years, Ginsburg, 85, has acquired a cultlike following.You can buy baby onesies and stud earrings of the jabot she wears when she delivers dissents; her workout routine has become a source of fitspiration; and, most recently, Felicity Jones played a young Ginsburg in the movie “On the Basis of Sex.” But, at the same time, her fragility has become clearer. Since Ginsburg’s appointment to the Supreme Court, she has survived both colorectal and pancreatic cancers. In November, she took time off after a fall. And this month, Ginsburg missed her first oral argument in 25 years while recovering from surgery for lung cancer. The result has been an unusually intense cultural preoccupation with Ginsburg’s mortality. Ginsburg deserves our esteem. But we can’t ask an octogenarian to take sole responsibility for preserving women’s rights.

Ginsburg cemented her legacy long before Donald Trump’s presidency led to her adoption as a symbol of resistance. She studied and practiced law in a time when women were predominantly confined to domestic spaces and not courtrooms. Her steadfast work in the 1970s helped turn the Constitution into a powerful tool in the fight for gender equality.

She’s also made it very clear that she’s not going anywhere.

On the left, Ginsburg’s superhero status intensified after

Trump’s election and his appointments of Neil M. Gorsuch and Brett M. Kavanaugh to the Supreme Court. States such as Ohio have passed laws that not only restrict abortion for their residents but also set up court battles that could chip away at, or even overturn, Roe v. Wade. In this environment, those of us who admire Ginsburg need her, both to stand against attempts to ban abortion and to give us someone on the court we feel we can trust.

For many, the nightmare scenario is that Ginsburg will

BY SHENEMAN

pass away while Trump is in office. Her health is breaking news. Her trainer calls her a “cyborg.” Irin Carmon, co-author of the biography “Notorious RBG,” has assured the public that Ginsburg is a resilient figure.

Politico’s Roger Simon asked his Twitter followers if they would donate a day of their lives to keep Ginsburg on the job.

This ongoing panic reflects Ginsburg’s stature — but it also reveals the limits of our own thinking. The pressure on Ginsburg to stay physically and mentally fit for the maintenance of our democracy illustrates our desperation in this new political landscape: It’s easier to focus on keeping one woman alive than to tackle our broader national dysfunction and division. We need to prepare ourselves for the 2020 election and elevate new people at all levels of politics, especially those willing to fight for more liberal judicial nominees. And we need to expand the infrastructure to develop, elevate and support those nominees who will match conservative institutions such as the Federalist Society.

At the same time, let’s continue to channel our strength toward the other women on the court who are tirelessly working as well. The obsession with

Ginsburg’s health obscures the contributions of her colleagues, Elena Kagan and Sonia Sotomayor. The emphasis on how well Ginsburg is doing at her age stagnates the conversation about her work and legacy, placing death at the center of our concern for her.

Mother Jones’s Stephanie Mencimer touched upon the darker side of Ginsburg fandom, arguing that Ginsburg made an irrevocable mistake in not stepping down while President Barack Obama was still in office and that fans who argued that the push for her retirement was sexist are partially to blame for it. The result of her decision to stay on the bench is that our discussion has shifted from the substance of her work to a macabre waiting game that does not soothe our concerns or show compassion for Ginsburg as a human being facing her mortality and some very difficult professional decisions.

If Ginsburg were to die, then Trump would have to find her replacement, and that is a terrifying thought. Yet, one woman cannot embody the entirety of our democratic ideals.

The best tribute we can give Ginsburg isn’t to say that she’s irreplaceable. It’s for all of us to use the rights she won for women to take up her fight for justice. n

SUNDAY, JANUARY 20, 2019

23

KLMNO WEEKLY

FIVE MYTHS BY

R ICKARD L . S JOBERG

It’s not unusual to hear the term “witch hunt” in politics, but it has no greater devotee than President Trump, who uses it when complaining about the Mueller investigation. How does this modern meaning — which has to do with supposedly unjust harass­ ment of an individual — map onto the historical phenomena that the term derives from? Perhaps we do not do the original victims of witch hunts justice when we carelessly compare contemporary events to their experiences, which remain clouded by myths.

Here are five of the most common. during the late 19th and early 20th centuries. The most prominent proponent of this theory was the Egyptologist Margaret Murray, who argued, for instance, in her 1931 work, “The God of the Witches,” that accused witches were actually followers of a religion far older than Christianity.

Despite their continued influence, Murray’s theories have been consistently and repeatedly debunked by scholars, and were never taken seriously by the scientific community when they were presented.

MYTH NO. 1 Most witch hunts happened in 17th-century New England.

During the 1692-93 witch panics in and around Salem, Mass., 14 women and five men were executed by colonial authorities. Because these events often show up in American plays, films and works of art such as Arthur Miller’s “The Crucible,” it should come as no surprise that these “witch hunts” are the most well-known to the American public.

From a European perspective, however, the events in Salem were a relatively peripheral episode in the history of witch persecutions. In fact, scholars estimate that from the 15th through the 18th centuries, about 60,000 Europeans were executed for allegedly being witches.

MYTH NO. 2 European witch persecutions were during the Dark Ages.

Until the mid-1970s, most scholars believed that the myth of the Witches’ Sabbath — central to most witch panics — first emerged in the Medieval period.

Transcriptions of documents that supposedly supported this premise, such as those describing mass trials in Toulouse, France, from 1335 to 1350, found their way into the authoritative set of original sources on witch panics published by Joseph Hansen in 1901.

Yet in 1975, scholar Norman Cohn demonstrated that these documents were not original and would be most appropriately described as early instances of research fraud. For instance, the description of the Toulouse trials includes several historical inaccuracies, and the original documents have never been located. If one disregards such dubious records, there is no evidence that large-scale witch persecutions occurred during the

Witch hunts ASSOCIATED PRESS

Thanks to works like “Witch Hill (The Salem Martyr),” an 1869 painting

by Thomas Satterwhite Noble, many Americans may think that New England was home to most of history’s witch trials. But Europe had many more, with thousands of alleged witches being persecuted.

“Dark Ages.” Instead, the phenomenon first seems to have appeared during the Renaissance.

MYTH NO. 3 Witch hunts relied primarily on testimony from children.

In fact, in most cases, far more testimonies came from adults and were provided under torture, as Brian P. Levack and H.C. Erik Midelfort show. During interrogations carried out with torture, suspects would not only willingly confess to deeds that

were inconsistent with the rules of nature (like flying) but also provide the names of an abundance of alleged accomplices. As these accomplices were subsequently rounded up and interrogated, even more names of yet more suspects would appear.

MYTH NO. 4 European witches were members of a fertility cult.

The idea that witches were members of an ancient fertility cult was floated repeatedly

MYTH NO. 5 Most witch hunters were sadistic torturers.

The stereotype of the witch hunter as a cruel inquisitor who deliberately frames innocent people is prevalent in literature, movies and artworks.

But ignoring what appeared to be credible allegations of child abductions, Satanism and ceremonial cannibalism would have been a grave oversight by anyone in a position of authority.

That people tasked with the judicial handling of witch persecutions regularly approached their duties with a serious and critical attitude is illustrated by the fact that these very people were often the ones responsible for putting an end to these explosive events. As historian Bengt Ankarloo describes it, the Great Swedish Witch Panic of 1668-76 ended after members of a royal commission in Stockholm decided to critically reexamine all evidence. n Sjoberg is a neurosurgeon at the University Hospital of northern Sweden. He is also affiliated with Umea University, where part of his scholarly work focuses on the psychological mechanisms behind the Swedish witch persecutions.