No, it isn't over

There are about 35 million people living with HIV on the planet, and fewer than half of them are receiving treatment. New infections continue to occur, people continue to die of AIDS, and by the way this is true in the U S of A.

According to the best current estimates, in the U.S. about 86% of people who are HIV infected know it. Of these, less than half are getting medical care for HIV meaning that 60% of people living with HIV in the U.S. are not getting any treatment. Since not everyone who is prescribed ARVs achieves viral suppression, we end up with only 30% of HIV+ people who don't have detectable virus in their bloodstreams.

That means the remaining 70% are at risk of getting opportunistic infections and other symptoms of HIV disease, and of infecting others. Right now the epidemic highly disproportionately affects African Americans, and to a lesser extent Latinos, which is probably a major reason why it doesn't get a whole lot of attention any more. But it is still an urgent problem. And by the way, in states that have refused to accept the Medicaid expansion, a lot of these people are uninsured. Which means they can't even afford the medications. Very wise fiscal conservatism, Republicans.

Still above water

Miami Beach, in case you didn't know, is a very bizarre place. The strip where I am, in the Eden Roc resort, next to the Fountainbleu, is in most ways that matter to me a wasteland. There are no stores or restaurants within easy walking distance, and even that's something of an understatement. Seven blocks to the south there is a Subway, a small cafe and grocery store, and a liquor store. That's all for maybe a mile in all directions -- well, there are only 2 1/2 directions available, actually. Five blocks south you can cross Indian Creek and get to an actual urban neighborhood, albeit a slightly odd one.

So you're pretty much a prisoner of the hotel, which is how they want it. $30 for breakfast, $20 for a hamburger. A margarita is $14, although it is big enough to drown in. Across the street, in Indian Creek, there's a marina full of enormous yachts, and, on the other side of the creek, enormous, ostentatious villas, with their own piers. The people don't seem to be home right now, presumably they are only here in the winter.

Anyway, I can't help where they send me. As I contemplate this gobsmacking week, I am here on business, so I'll tell you that this morning I attended a symposium on technology in support of self care in HIV, and HIV prevention. I expect that more and more, you'll be interacting with apps in place of conversations you might have had with your doctor. Or at least they're going to try to make that happen. I'm not convinced that it will. If I hear anything of more immediate interest, I'll let you know.

A final observation for now. If there is one category of human that airline employees hate, it is airline passengers. It would be so much easier for the planes to fly from point A to point B if they just didn't have to put up with fucking customers. So true, it would be.

Get it while you can

Specifically, I'm heading to Miami Beach today for the international conference on anti-retroviral adherence. If you've been here before, you know that it's critical for people with HIV to take their pills regularly, so that they will have suppressed viral loads, won't get sick, and won't be infectious. But that can be surprisingly challenging, for many reasons. I'll have more to say about that and give some updates from the conference.

The title of this post refers to the doom facing Miami Beach, which will be pretty much uninhabitable in about 25 years, with continual flooding and loss of access to fresh water as the sea infiltrates the Florida groundwater. By the end of the century, if we continue business as usual, it will be seafloor. With hotels sticking out.

This has been an incredible week for social policy in the U.S., and there are certainly hopeful signs there. But that isn't what the Koch brothers care about the most, and on fossil fuels, we haven't made an inch of progress in this country. The deniers are still in charge of the Congress and the corporate media still complacent. This is what will matter most in November, 2016.

Why exactly is the ACA bad again?

Now that Roberts and Kennedy have decided that it's better to be generally regarded as sane and responsible than it is to be popular with the willfully ignorant wingnuts who vote in Republican primaries, this seems a good occasion to revisit some basic truths about how the world works.

Pruger, Ruger and Annas in NEJM happen to get published on this very day a reflection on the underlying doctrines, both philosophical and constitutional, that fuel the controversies over health care policy in the U.S. The courts have found no affirmative right to health care in the constitution, but only what they call "negative" liberties to refuse health care, or to opt for abortion. However, there is no actual right to abortion, or contraception, or any other medical service or good, if you can't pay for it. Over the years Congress has taken various patchwork measures to extend an affirmative right to some amount of health care for various groups of people in various ways, but conservatives resist these efforts.

So I'm going to repeat an exercise I've done here before, but not for several years. That is to deconstruct the so-called "free market" dogma that the libertarian right uses to confuse people about the nature and meaning of liberty. In the first place, the claim that there even exists something called the free market that allows us to achieve individual freedom and justice without the oppressive hand of government is nonsense. Markets are social constructions that cannot exist without massive, sustained government involvement. Government writes and enforces all of the rules that structure the market, from property and contract law to the issuance of money to the charters of corporations and the status of employees. All of these rules can be written in innumerable different ways to benefit one or another class of people.

That aside, free market fundamentalism rests on various assumptions which are taught to college freshmen as if they are facts, whereas none of them is ever true. This is particularly obvious in the case of health care (or medical services, which I would prefer to say but nobody will go along with me).

The first is the self-evidently ridiculous assumption that all of the costs and benefits to society of a transaction are felt by the parties to the transaction. This is the assumption of no "externalities." In fact 100%  of economic transactions involving every conceivable category of good and service produces externalities, but if you don't see this in the case of health care, you aren't just misinformed, you are willfully blind. Here are a few:

• People who have curable infectious diseases can infect others. Everybody benefits when infectious diseases are prevented, or detected and cured.

• People who are healthier are more productive and better able to support themselves and their dependents, to add to the common wealth, and to pay taxes.

• People care about other people. When their friends and family members are sick and can't get health care, they become distressed and sad. They may have to quit their own jobs or neglect other dependents to take care of their sick relative or friend who, with health care, would be more self-sufficient.

I'm sure you can easily think of more.

Here's another really obvious false assumption. Health care is not an ordinary good like food, clothing, shelter or  transportation among which people can freely choose to allocate their resources. We all have wildly different needs for it, over our lifetimes and at any given time. It isn't a question of "personal responsibility" or "individual choice" whether you get lymphoma or are poisoned by a "grocery manufacturer" (that's what they call themselves) who was not subject to sufficiently burdensome and oppressive government regulation. You might even be born with a disease, or a genetic predisposition to disease. That is why it is completely obvious to anyone who is not delusional that the "free market" cannot possibly produce justice in health outcomes.

Sure, medical services contribute only a portion to health outcomes -- more than previously but maybe only half or less. Still, if you care about the other determinants of health you'll be for all the other stuff you are against -- guaranteed full employment and income for people who can't work, excellent education for all, environmental regulation, workplace safety, tobacco control, gun safety regulation, you name it. "Personal responsibility" is in there somewhere but only if people have the opportunity to exercise it, which in general, they don't.

I will continue this, but I have already proved that libertarianism is utter bunk. It is internally incoherent and obviously inconsistent with observable reality. The controversy over health care is a very easy way to prove that, even if the corporate media don't understand it.

The weed with roots in hell

A few items in the new JAMA concerning medical marijuana. As usual, I'm not sure how much you worthless rabble are allowed to read, but if you want to give it a shot, there's an opinion piece by a guy named Deepak, but fortunately not the quantum woo guy. Actually his last name is D'Souza but equally fortunately his first name is not Dinesh. Anyway, he doesn't think we know enough about it yet to be prescribing.

A systematic review by Deepak and a multitude does not, it seems to me, entirely support his editorial opinion. There's reasonably good evidence that the herb or cannabinoids are beneficial for the major indications for which they are usually touted, e.g. nausea from chemotherapy, spasticity from MS and paralysis, HIV-related appetite loss, chronic pain. Other indications are lacking in good evidence but maybe it does some good. The main problem is that we don't have much in the way of long-term follow-up data. There can be short-term adverse effects, of course -- not everybody likes the evil whoopee weed at first try. But these are not serious and go away if you stop toking (or swallowing). But we don't know what might happen long term. Well, that's true, but from a couple of millennia of observational data there doesn't appear to be any obvious major worry.

Well yeah, but that also happens to be true for most of the pharmaceuticals on the market. The FDA approves them after trials with 6 month follow up, on evidence no better than the evidence for ganja. The real problem, as I see it, is that as a bunch of chemists discovered, you don't know what you're buying. They copped a whole lot of medical marijuana products from legal dispensaries in California and Washington and found the labeling of THC content was just completely unreliable. So the obvious answer for that is to eliminate the federal prohibition so the FDA can regulate manufacture and assure quality.

Based on everything I've read, if you have any of the problems for which there is reasonable evidence, and the alternatives aren't working for you, it's reasonable to give it a try. However, it is something adolescents should stay away from, I am increasingly convinced. Also, too, obviously a lot of people who get medical marijuana prescriptions may or may not have a real medical need, but they also want to get high. That's okay with me if you don't have work or driving obligations that make it counter-indicated.

So I think this is much better than criminalizing people who are legitimately trying to get relief from very unpleasant symptoms, and have an option that just might work for them. I'm also in favor of legalization and regulation of recreational Mary Jane, because people can make their own decisions about it and 99% of the adverse consequences are caused by prohibition.

Your Intertubes

NHTSA sent me this resource, which allows you to enter your Vehicle Identification Number and find out if there are any open recalls on your vehicle. (Not to worry, the inquiry goes to the manufacturer, not Admiral Rogers, and you don't have to give any other info. Your state registry of motor vehicles already knows you own the car.) This is a very handy way to possibly save your life, but it also got me to thinking.

I believe I mentioned here a few weeks ago a bizarre incident my freshman year in college, when a guy who was a Harvard graduate pretended to have spent his post-high school years in the army and managed to get admitted to, and briefly attend, Swarthmore College as a freshman. Still don't know why he did it, but this story would play out entirely differently today. In fact, I believe it would have been pretty much impossible. If his name was Bob Smith, he might have had an outside chance but even then I don't think so. And even if he made it as far as freshman orientation, he would have lasted two days, tops. So there are good things and bad things about our loss of privacy, actually. If you were thinking about dating Bob, or investing in his brilliant business idea, you might want to know that he was a fraud.

But then I got to thinking about other technological differences in how this story would have transpired, as well as how our entire lives were organized. We obviously didn't have our own telephones. There was one telephone at the end of the dormitory hallway. Your mother could call, whereupon somebody would possibly answer it and write down a message, which you might eventually see. But you couldn't call her back on the same phone, you had to go to the pay phone in the lobby. If you wanted to track down your girlfriend, you'd just have to tell people you were looking for her and somebody might bump into her. But by that time you would be somewhere else.

If you wanted to track down a fact, you've have to go to the library and consult reference books, which were at least 18 months out of date. If somebody was reading the magazine you wanted, you'd just have to wait. If they had stolen it (not unlikely), you were SOL. The first time I wanted to do a Medline search, which became possible around 1986, I had to mail $50 to the National Library of Medicine along with a list of keywords. They then mailed me a printout of abstracts. I then had to go to the library and if they happened to subscribe to that journal, I could read the paper, assuming I had a library card.

I could go on but you get the idea. The way we live has changed so drastically during my lifetime that it is largely unrecognizable. Yet I hardly noticed as it was happening and it all just seems normal now. Well, it isn't.

Charleston

I attended the Spoleto festival some years back. A friend of mine was in the orchestra (he may read this and may want to comment) so he snuck me into the rehearsals and the concerts, and I slept in a College of Charleston dorm with the orchestra. Emmanuel AME Church is just 3 blocks from there.

One thing I definitely remember about Charleston was that the racism was palpable -- so thick you could cut it, in fact you needed a sharp knife.  The city was completely segregated. The only black people you saw around the touristy part of town were menial workers, and the audiences at the concerts were 100% white. When my friend and I left town, we stopped for gas in a big, block-owned gas station in a black neighborhood, and the miasma of resentment was inescapable. Maybe thing have changed a bit -- it seems like it, from the news reports -- but Dylann Roof didn't just happen. Judging from the way his friends are talking, yeah, he was a little more up front but they didn't think there was anything strange about his virulent racism.

As for the Confederate flag. Yes it celebrates heritage, but the specific heritage it celebrates is white supremacy and treason. And, as I have asked before, exactly what is it supposed to mean on all those pickup trucks in Connecticut? Just the same thing it means in South Carolina, I would say. It certainly isn't about Connecticut history and our Civil War dead.

Only her hairdresser knows for sure

Given the unending torrent of commentary and comedy (100% of Larry Wilmore and most of John Stewart on Monday, e.g.), I didn't think I'd have anything unique and worthwhile to say about the bizarre tale of Rachel Dolezal. But having absorbed much of this slice of zeitgeist, I realize I do need to say something.

One of the byways in my career was as research director of the New England Coalition for Health Equity, concurrently with occupying the same role for Latino Health Institute in Boston. (Both now, alas defunct. I guess they couldn't survive without me.) Anyhooo, in said roles one of my major preoccupations was with the definition, measurement and amelioration of health disparities, which in turn meant a deep dive into how we classify people and the meaning of race and ethnicity. So, here's the 4-1-1.

Yes, race is a socially constructed category, not a biologically valid or useful concept. We arbitrarily circle certain ancestral regions and call the people who come from them members of a "race," even though they have no more in common genetically than any given one of them might with somebody who happens to be outside that zone. And then of course people actually have mixed ancestry so we need to decide who is in and who is out based on a complicated set of rules. In the U.S., there's a "one drop" rule for being "black." Tiger Woods, for example, whose mother is from Thailand and whose father has mixed African, European and Native American ancestry, is generally considered to be black. Culturally, he's probably more Thai than black since he follows his mother's Buddhist religion but that's apparently beside the point. So even though race is a social, rather than a biological category, it's a social reality.

Ethnicity is different, however. Ethnicity means affinity with a culturally distinct community. It's a much more fluid concept, and heavily dependent on context. For example, a person who was born in Mexico and lives in Mexico may be defined ethnically as part of a particular indigenous people, or as part of an immigrant enclave, or whatever. If the person moves to the U.S., however, they acquire the label of Latino or Hispanic, which is how most Americans will see them. They themselves may not accept that label and may continue simply to consider themselves Mexican, but now that's a new kind of ethnicity within a wider society.

Ethnicity, unlike race, is a matter of degree. You can feel a strong or weak affinity to an ethnic group, and outsiders may also perceive you as fully or only partly in it -- depending on the context, of course. In Nazi-occupied Europe, there weren't any degrees of Jewishness. On the other hand Judaism, apart from the thinking of some racists, is not a race. It's an ethnicity which is partly, but not entirely, defined by religion. You can join it. If you marry a Jew and convert to Judaism, and start going to the temple, you'll be as Jewish as anybody else and so will your kids. Not all ethnic groups allow it, but as a generality, you can assimilate and change your ethnicity over the life course; or it may happen willy-nilly if you migrate. Ethnicities can also more or less disappear. Not many places are left in the U.S. where you can really be Irish, or Polish, but those used to be clearly defined minorities.

So African American and Black don't mean the same thing. Barack Obama's father was African, but he was not African American as a child an adolescent. He belonged to a white family and had no contact with any African American community. Then he started organizing in African American communities in Chicago, married an African American woman, and attending an African American church. So before, he was just Black (thanks to the one drop rule), but now he is African American, because that's the community with which he has affiliated.

However, note something important here: people perceive race and ethnicity, in this particular case, as being closely linked. The New York Times once called Lennox Lewis an "African American" boxing champion, even though he is of course a subject of Her Majesty Elizabeth II.  People mix them up. If you have the defining physical characteristics of black race, then you can't stop being African American. On the other hand, if you don't, you can, as many people did in the early 20th Century by passing. Some of them later went back to being African American. And so there are people who consider themselves African American, and who as shorthand call themselves black, who don't really look like people of African descent are supposed to look like.

But here's the thing. Obama isn't trying to fool anyone. He wrote a whole book about his life, with a major focus on the fact that he didn't know his father. His story is as public and as fully revealed as it gets. You can decide for yourself if he's black enough for you, if that's something you care about.

So it would be perfectly fine for a white woman to feel an affinity for the African American community, marry an African American man, teach African American studies and work for the NAACP. If she even said, "You know what, I have really come to identify as African American," okay. Somebody might say, you can't really know what it's like because you didn't grow up with it, and I suppose that's an argument you can have, but she can probably have a pretty good idea, especially if she has black (one drop does it!) kids.

But that's not what Dolezal did. She darkened her skin, died and curled her hair, even presented a photo of a black man who she claimed was her father. She didn't tell people, "I have an affinity for the African American community," she told people that she is, in fact, black, and let it be believed that she grew up that way. Which is not true.

This seems like a pretty obvious distinction but it's one that a lot of people seem to miss. For some reason. So there you are. She can feel as black as she wants, but she has to tell the truth.

This is a BFD

The FDA has just announced that partially hydrogenated oils are no longer considered "generally recognized as safe," which means that artificial trans fats will be essentially gone from the U.S. food supply in three years. (There is a small amount of trans fats in beef and dairy products, but it isn't comparable to the added artificial trans fats in processed foods.)

This corrects a scientific error. When I was a youngster, margarine was touted as a healthier alternative to butter. We now know the opposite is true. Yes, olive oil is the best, but saturated fats -- typical animal fats -- aren't really harmful. Certainly they're much better than trans fats. The result of this error was that food manufacturers were systematically poisoning the U.S. population for decades.  Now that we're stopping that, we should see a substantial decline in heart attacks and strokes, and even a reduction in the incidence of dementia. This is a public health advance comparable to getting the lead out of gasoline and paint and, yes, sanitary sewers. Now if we could just eliminate tobacco . . .

When New York City moved to ban trans fats from restaurant foods, the wingnuts were outraged by what they claimed was an assault on their liberty. No. When you eat in a restaurant, you have no idea what they're putting in the food. And it turns out that you can't tell the difference when trans fats are removed. So your liberty as a diner is enhanced, since you're free from getting poisoned just as the kitchen inspector is keeping you free from salmonella.

We'll see what Ted Cruz and Marco Rubio have to say about this, but I'm betting it will be nothing.

Follow the gold brick road

I believe I have linked before to Julia Belluz, who has been doggedly on the trail of Dr. Oz. In the latest installment, medical students have persuaded the AMA to promulgate ethical standards for physicians communicating through mass media.

However, I caution everyone to get a grip. This has generated considerable excitement in the anti-quackosphere, but we don't actually know yet what those standards will be. What's more, we don't know if they will make any difference. The AMA has no regulatory authority. Only the state licensing board can defrock Dr. Oz, and only Columbia can expel him from its faculty. No doubt they will both have various weaselly reasons why they can't do that.

In the first case, they'll say that they only regulate actual medical practice, and lying to 4 million people to the possible detriment of their health and bank accounts doesn't come under their jurisdiction. In the latter case, they have already said "academic freedom yadda yadda yadda."

Well, this is really a legal issue. The first amendment doesn't permit you to falsely yell "Fire!" in a crowded theater, nor does it condone fraud, i.e. lying for money. I continue to be baffled by the failure of prosecutors to go after quacks who are in fact con artists. Quackery is fraud, which is a crime. Let's start treating it as such.

Celebrating the ADA

Next July 26 will be the 25th anniversary or the Americans with Disabilities Act. It was actually signed by George Bush the First, although he had nothing much to do with it. Here Lawrence Gostin, in JAMA, calls it "the highest expression of American values." I'm not sure what "American values" are these days, but it is certainly a powerful expression of my values, and of Mr. Gostin's.

I entered the doctoral program at Brandeis University just as the ADA became the law. It took quite a while after that for the new law to have practical effect. In fact, what Gostin doesn't really tell us is that it required a social movement to enforce it's requirements. The ADA didn't change our culture, but it was a powerful tool in the hands of those who did. This is a story we scarcely remember today, because the disability rights movement was so successful.

My mentor at Brandeis was the late Irving Kenneth Zola, who you can read about here. Irv was a founder of the sociological study of disability - before he came along it was studied as a form of what sociologists call "deviance," and there was some interest in how people with disabilities were stigmatized. Medical sociology pretty much ignored them, with its focus on Talcott Parsons' concept of the "sick role," which included the obligation to get better and resume one's work and family obligations, which it was generally assumed that disabled people could not perform.

Irv helped found the self-help and independent living movements, and yes, such movements were necessary. Back then people were secreted away in institutions, and if you couldn't climb stairs, or you were blind, or disfigured, or had cognitive limitations, you couldn't work. The movement Irv and others pioneered made a different claim: that society had an obligation to value all of its members and to include everyone as much as possible, and give everyone an opportunity to reach his or her potential.

Despite the law, this required activism, including in many cases civil disobedience. I worked my way through grad school doing consulting for community based organizations, including the Massachusetts Coalition of Citizens with Disabilities. In order to get the ADA enforced, they did wheelchair sit ins and blockades, to force businesses and yes, municipalities, to comply with the law. And they were cultural activists. The most difficult changes were not in the physical construction of public spaces, but in people's attitudes. Nowadays you expect to see people with disabilities in public, at work, in the grocery store, on the bus and subway. You expect those places to be accessible and you expect the people to be welcomed. In case you are too young to remember, 25 years ago, that was not the world we lived in.

Nature or Nurture?

You may have heard about this meta-analysis published Nature Genetics which combined data from all the twin studies ever done to make the claim that our "nature" -- personality, intelligence, all that --  is about 50% due to heredity and 50% due to our environment. It appears that a lot of people who should know better, including Jeremy Dean, author of "Psyblog" to which I link above, fell for this claptrap unquestioningly.

A feature-length deconstruction by Jonathan Kaplan at Scientia Salon will reward your time if you want to know more about both meta-analysis and heritability, but I will give you the short version and say a bit about why the pervasive misconception about this subject is so pernicious.

To say that a trait is 50% "heritable" is to say, roughly, that 50% of the variation in a specific, observed population is associated with the genes a person is born with. In humans, these conclusions are usually derived from twin studies -- researchers compare identical (monozygotic) with fraternal (dyzygotic) twins and see how much difference there is in the variability of some trait. The idea is that twins, identical or not, are raised in very similar environments, so you can parse out the effect of genes vs. environment. This is questionable, of course -- parents and others probably treat identical twins differently than they do fraternal twins. Every child in a family lives in a different micro-environment.

But leaving that aside, it does not follow that genes explain 50% of the variability of the trait in humans in general. That's because genes are associated with a particular phenotype (the actual characteristics of an organism) only given a particular environment. Your genes won't make you tall if you are malnourished as a child, and they won't make you able to bench press 250 pounds if you don't work out. For children born into the same family, of the same socioeconomic status, in the same culture and community, 50% of the variability in IQ might be associated with genetic predisposition. I don't think the twin studies really prove this (see Kaplan) but even if conceding the point for the sake of argument, average IQ in the U.S. has risen by some 20 points since widespread testing began. The average American in 1940 would be a special needs student today.

This is of course one reason -- not the only one -- why Charles Murray and his racist followers (a group which includes Jeb Bush, by the way) are wrong. More generally, it strikes at the heart of political conservatism, including its so-called "libertarian" variant. The liberal view of human nature is that it is what we make of it. That is my view -- we can become better.

Ray Kurzweil is nuts

That is all. Our brains are not going to directly interface with the cloud, in 2030 or at any foreseeable time. We certainly won't be able to back up our brains -- although it's pretty hard to know what that would mean.

Suppose there were two or three copies of your neural contents -- your memories, skills, personality and self-consciousness, running on different hardware. Would the extras be you? Don't lose sleep thinking about it, because it is not going to happen.

The Alcoa Sombrero

It's apparently a very popular fashion nowadays. The City Council of Richmond, California, passed a resolution of solidarity with people who believe they are under attack from space-based weapons. The police and mayor's office are now fielding an overwhelming barrage of phone calls from around the nation and the world from people seeking protection.

"We are getting numerous requests from individuals all over the country--some even from other countries related to the Council's recent resolution," police chief Chris Magnus said in a statement released by the mayor's office. "Richmond now seems to be known as the 'resource or helpers' for folks from many states with a myriad of mental health and other problems." The department does not have the resources to field such a large number of calls, Magnus said.

[Mayor] Butt said his office has been receiving requests for help as well, including a message from a woman living in her car in Carson City, Nevada, who says she has been electronically stalked but has received no help from law enforcement.

Okay, that's bad. What's worse is that the only 2 votes against the resolution were from Mayor Butt and Councilor Pimple. And it's not The Onion.

Bob Stiglitz flies in on a black helicopter . . .

. . . to call for a global tax system so that corporations can no longer evade their responsibilities to the governments that make their profits possible. While he is obviously right, I have a unicorn to sell him.

In fact, we need global compacts to save our asses from numerous pending apocalypses, but I just don't see it happening. The power of nationalism -- which is a largely irrational ideology with mystical power for many people -- just won't allow for it; nor will the power of multinational corporations. Instead, the international compacts we do get, like NAFTA and the looming Trans-Pacific Partnership, are sponsored by multinational corporations for their benefit, not ours. 

The irony is that ordinary people think the UN one-world government is going to take away their guns and put them in concentration camps, so they vote for politicians who claim to be defenders of national sovereignty, who do not in fact give a rat's ass about national sovereignty when it comes to workers' rights, environmental protection, or taxation.

Not going to happen.