Eric is a professor of politics at Birkbeck College, University of London, and he most recently wrote the book Whiteshift: Populism, Immigration, and the Future of White Majorities, which I reviewed here. Be sure to check out his recent report on the social construction of racism in the United States.

You can listen to the episode right away in the audio player embedded above, or right below it you can click “Listen in podcast app” — which will connect you to the Dishcast feed. For three excerpts from my conversation with Eric — on the comparatively little racism of the US compared to other countries; on the anti-immigrant views of new immigrants; and on why Barack Obama would be considered “white supremacist” today — head over to our YouTube page.

After listening to last week’s episode with Shawn McCreesh, a reader shares his own family experience with opioids:

My mother had terminal cancer when I was in college in the mid 1980s, in a far-ish suburb outside of Boston. After the cancer got to a certain point, and only then, she was prescribed morphine. It is my understanding it was only prescribed in terminal cases. Even after getting a prescription, it wasn’t easy to get. I remember my stepfather had to drive about 30 minutes to the nearest pharmacy that sold it, since it wasn’t available everywhere. He went to a pharmacy close to the hospital and handed over his license, and they logged where every drop went.

The question is, how did we go to a strictly controlled substance with very specific indications to a very similar class of drugs that was doled out like candy to high school football players with minor neck injuries?

I think the answer is that it was a patented pharma product where the owners could make a lot of money. They spent a lot of money lobbying doctors to write scripts and legislators to make sure the scripts could be written. Everyone made money but the patients. Voila. Here is your crisis. It was entirely manufactured because the healthcare system is not designed to keep the population healthy, but to make money for a certain group of people and companies. Health care, like so many other vital services in America, including higher education and housing, has been fully monetized.

As people like Shawn McCreesh continue to survey the carnage, the person at McKinsey who designed Perdue’s sales strategy probably made partner and is now a wealthy, respected, and an upstanding member of his community — and you can bet it isn’t Shawn’s hometown, Hatboro.

Another reader’s two cents:

I found the interview with Shawn McCreesh very interesting. Once again, a subject that I had no interest in turned out to be fascinating.

I have children around that same age who have dabbled in drugs. From my experience, this gets down to bad parenting. Leaving prescription drugs where they can be stolen. Being unaware that your medication is missing. Your children becoming addicts without you knowing.

Another reader lends his expertise to clarify a point about drug treatment meds:

Great conversation with Shawn McCreesh, thanks for doing it. I’m a psychiatrist with significant experience treating substance abuse (though not that much treating opioid addiction). Shawn mentions that Suboxone may be even worse than other opioids, and describes his friends having a very bad reaction. However, Suboxone (really the buprenorphine ingredient in Suboxone) is a “partial agonist”, meaning it binds to the opioid receptors very tightly, but does not stimulate them very strongly. This leads to a ceiling effect where once all the receptors are bound, more Suboxone doesn’t make one any more high, and it is extremely hard to overdose on Suboxone.

Other opioids bind less tightly, but stimulate the receptor more strongly, so the more one has in his system the more intoxicated/overdosed one gets. What this also means is if one already has other opioids in the body, Suboxone will kick them off the opioid receptors and that person will go into rapid opioid withdrawal, which is I think what happened to his friends.

People can still abuse and get addicted to Suboxone, and it can be very hard to discontinue as well so it is often used for long-term maintenance. But it is much safer than other opioids, and people can live normal lives for decades taking this once per day in the morning to block other opioid cravings and abuse. Basically all addiction specialists think it should be much more widely available.

Switching gears, this next reader offers her expertise on our immigration episode with Nick Miroff:

I love your stuff, but I can’t help but notice that your immigration conclusions fail to grapple with a huge empirical piece — which I report on these days from Mexico/Central America: the reality of war-zone-levels of insecurity on the ground here (not everywhere, but in vast swathes of territory). The discussion up north centers largely on the narrative that most asylum-seekers are mainly cheating economic migrants. I listened to your recent podcast and read your essay on immigration, and while deeply insightful on the US border and the view from Washington et al, they totally failed to acknowledge:

1) the clear and present dangers in Mexico to Central Americans. It wasn’t just squalid camps in Mexico that they were returned to — these are parts of Mexico that are so dangerous that most Mexicans avoid them, and you rarely read about that because Mexican journalists who write about those parts tend to be brutally murdered or disappeared and few other journalists take a plane or walk over the bridges of the Rio Grande to see for themselves.

2) the expansion of asylum definitions in recent years to encompass the reality that, say, gang control in parts of the Northern Triangle is so extensive, and the corruption or failures of the security services such a known quantity, that civilians in large parts of the country are as good as “persecuted” or harmed by their de facto rulers. It’s not just city-based crime. It’s epidemic violence, compounded by impunity and levels of corruption and complicity all up and down the political and security chains of command at a degree that is hard for Americans or Europeans to fathom.

3) It’s hard not to include in that argument the consequences of direct US meddling in causing much of the harm that laid foundations for state failures in the region today, a well-documented history that disappears into the vast oubliette of US self-knowledge.

So aside from the inherent absurdities of Trump era policies — including destroying all the effective on-ground USAID and State Department-funded highly targeted, anti-violence and anti-corruption programs the Obama administration had started in Central America to tangibly improve conditions at home so fewer people would leave; or forcing genuine asylum-seekers to seek asylum in “third countries” as crazily dangerous and incapable of offering safety — I’d argue that places an onus on US policy to better adapt to the migrants arriving from down south than those claiming refuge from places like Sudan or Congo.

I say this as a foreign correspondent who is deeply immersed in reporting on reality from the ground — weeks in Congo, years in junta-ruled Myanmar, and now here in Mexico/Central America (lately with Reuters, now with a book and some long form-in-progress on the brokenness of Honduras). Viz. on the realities of Honduras, here’s my most recent piece, and here are a couple pieces on the dangers of the Return to Mexico program.

I may well be under-estimating the awfulness of the conditions in parts of Central America, and I favor the kind of aid we provided under Obama. But if a criterion for asylum is living in lawless, violent places, then we are going to be getting a whole lot more migration — which, in turn, reduces pressure for failing governments to do better.

Another reader looks back at the trans/detrans episode with Buck and Helena:

Buck Angel is so refreshing. I appreciate that he is using his trans privilege to criticize current trans activism. What stood out in Helena’s story is how casually she was given testosterone. My son started testosterone treatments for delayed puberty and there was nothing casual about it: blood tests, bone age scans, a pituitary MRI, a thyroid ultrasound … we are on a first name basis with security at the children’s hospital. Our endocrinologist (who coordinated with our pediatrician) has been monitoring my son for several years and it still took three months between when she recommended testosterone and when my son had the first shot. She’s called twice to remind me she has to see him in person before the second shot (not a call from her receptionist, but the doctor herself). And my son was born a biological male, who should at this point have large quantities of testosterone in his system already.

So it’s crazy that a biological female can get a same-day testosterone shot.

This is my worry: that medicine and activism have become too entwined, and that false diagnoses and bad treatment will come back to haunt us. Lastly, a trans reader tackles my latest essay on the subject:

I am writing to express some concerns about your call for compromise and a truce in the trans wars. I actually support both of those things but I find some of the compromise proposals for trans-identified children and adolescents problematic. (By way of full disclosure, I am a trans woman, who is currently transitioning late in life.)

There is no recognition of the simple fact that a trans person going through the physical development of their birth sex’s puberty is a devastating experience to them. It is not delaying a decision until adulthood. It is making a decision in adolescence. Indeed, language like “disfigurement,” while hyperbolic, is not far from the mark. Trans people will suffer from going through it and struggle mightily as adults to undo as much of the damage as possible.

No one could deny that this involves making significant decisions at an early stage of life, but deferring them carries its own set of harms, and sadly, crystal balls are not available. In my opinion, the compromise solution is puberty blockers. It allows more significant medical treatment to be deferred to a later point without the damage of development in puberty.

By all means, psychological counseling should be a part of this process. Standards should be established, however, to strip agendas or preconceptions from such therapy. Therapists should accept transitioning as an acceptable and supported outcome, just as they should accept a decision to not transition. Conversion therapy should have no role.

I would also challenge your suggestion of requiring the consent of both parents. A deeply conservative parent should not weld veto power over the child, the other parent, the counselors and medical professionals involved.

Admittedly, this is a difficult issue. It involves areas of human development and personality that are not well understood. Is there an innate and immutably sense of gender that forms early in life? My experience suggests the answer is yes, but that is admittedly not dispositive. The trans experience challenges the long-standing and widely understood ontology of gender, and it forces an examination of the extent to which gender and gender roles are socially constructed. These are all hard questions that we are groping to answer as society continues to involve. I obviously have a vested personal interest in them, but I would hope all interested parties would have as the ultimate goal happy, well-adjusted members of a harmonious, just society.

Thanks for listening.

You’re welcome. Our in-tray is always open: dish@andrewsullivan.com.

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Eric Kaufmann On Race And Demographics In The West

The Dishcast with Andrew Sullivan