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A final comfort for dying children: 'Palliative transport' to send them home

By Melissa Bailey
A final comfort for dying children: 'Palliative transport' to send them home
Anne Brescia sits in the room of her only child, Anthony Gabriel Brescia-Connell, who died of cancer in 2011. The hospital sent him home so he could pass away there with his family. MUST CREDIT: Kayana Szymczak for Kaiser Health News

Anne Brescia sat beside her only child, Anthony, as he lay unconscious in a hospital bed at age 16. Just a few months before, he was competing in a swim meet; now cancer was destroying his brain. Brescia couldn't save her son. But she was determined to bring him home.

Anthony Gabriel Brescia-Connell was not conscious for his voyage from Boston Children's Hospital to his home in Medford, Massachusetts, where he died on March 3, 2011, surrounded by his family and beloved stuffed animals. He may not have heard the parting blessings before a doctor turned off his portable ventilator and let him die naturally.

But having the choice to take Anthony home, away from the beeping hospital monitors, "meant the world to me," his mother said.

Anthony's journey was made possible through swift and unconventional efforts by the hospital staff, including a critical care transport team accustomed to rushing kids to the hospital to save their lives, not taking them home to die.

The experience galvanized Harriett Nelson, a nurse on that team who helped arrange the trip. It inspired her to conduct pioneering research on and advocate for "pediatric palliative transport" - a rare but growing practice that aims to give families choice, control and comfort at the end of life.

Palliative transport lets families move critically ill children from the hospital intensive care unit to their home or hospice, with the expectation they will die within minutes to days after removing life support.

It means "having parents go through the hardest thing they'll ever know - in the way they want to do it," Nelson said. Boston Children's has sent 19 children to home or hospice through palliative transport since 2007, she said.

These final journeys - also offered by the Mayo Clinic, Children's Hospital of Philadelphia and Kentucky Children's Hospital - can involve elaborate planning, delicate transfers and even long helicopter rides. In some cases, families took a child far from home for a last-ditch effort to save their lives.

At the Mayo Clinic, palliative transport has helped culturally diverse families carry out end-of-life wishes for their dying children. In one case, a newborn girl rode 400 miles by ambulance to return to her Amish community, where she was extubated and died in her parents' arms, in the company of her 11 siblings. In another, an 8-month-old Native American girl traveled 600 miles by air and ground ambulance to her rural tribal reservation, where she could participate in end-of-life rituals that could not be done in the hospital.

These trips, which can cost thousands of dollars, are typically offered free to families, paid for by hospitals or charities. Most children are taken home, where they transition to receiving care from hospice staff. Some go instead to hospice facilities.

Megan Thorvilson, a pediatrician and palliative care specialist at Mayo, said palliative transport aims to address a gap between families' preference and reality.

Most parents of terminally ill children would prefer that their child die at home, but most of these children die in the hospital, most commonly in the intensive care unit. Most pediatric ICU deaths happen in a controlled way, following the removal of life support, she said. That means there may be time to move the child to an alternative location to honor a family's wishes.

Transporting children on life support is risky. At a palliative care conference, a nurse from Children's Hospital of Philadelphia described the difficulties staff faced in trying to fly a 10-year-old girl home to Michigan. After she was rolled on her side several times to be transferred between vehicles, the child died before the plane could take off.

And dying at home is not what every family wants.

"We do sometimes overly romanticize the death at home," Thorvilson acknowledged. Some parents would much rather have a child die in the hospital, with familiar nurses at the bedside for medical and emotional support. Some would rather keep this traumatic experience away from where they live.

Brescia, however, said she couldn't bear to return home without her son.

A biologist who used to run an electron microscopy lab, Brescia wasn't sure whether she and her husband, Brian Connell, would ever have children. Fertility treatments didn't work. But on June 23, 1994, seven days before Brescia turned 44, she gave birth to a baby boy.

"Anthony is the love of my life," said Brescia, who is now 68. "The OB/GYN put him on my chest and I really thought that my heart was going to burst."

The mother-son bond was especially close: Brescia home-schooled her son for most of his life. Anthony grew to be 6 feet tall, full of curiosity. He loved identifying mushrooms, studied Arabic and oceanography, and aspired to go to MIT. He was an avid swimmer, competing on a team in Belmont, Massachusetts.

One day in late 2010, while racing the backstroke, he became disoriented in the pool and was disqualified.

A neurologist prescribed rest. But over the next two weeks, Anthony grew only more tired and began to lose his balance. On Dec. 20, he was taken to Boston Children's Hospital and diagnosed with a brain tumor.

The disease "came out of nowhere," Brescia recalled. "He went from looking incredibly healthy and swimming like a healthy kid" to living at the hospital. At his bedside, she told him she'd bring him home to celebrate Christmas and eat stuffed shells.

His condition deteriorated quickly. The tumor could not be surgically removed. Anthony pushed through radiation and chemotherapy with the hope of going home, but the treatments failed. By late February 2011, the tumor began pressing on his brain stem, and fluid was building up in his brain.

Anthony was unconscious, relying on a ventilator to breathe. Brescia connected with the hospital's palliative care team.

"I want to bring him home tomorrow," Brescia told staff.

"I was scared to death he was going to have another incident," she recalled. "I didn't want them to do any more invasive procedures to reduce the pressure on his brain."

Staff from the ICU, palliative care and transport teams scrambled to honor her request. The critical care transport team arranged for the use of its ambulance, a mobile ICU the size of a small bus.

The night before the trip, Brescia said goodbye in the privacy of Anthony's hospital room.

"I don't want to lose you," she told him, holding his hands. "I'm going to let go. I want you to go where you need to be."

On March 3, 2011, Brescia and her husband boarded the bus along with Anthony, a chaplain, two doctors, Nelson and a nurse from the ICU. They rode 10 miles to the family's home, where Anthony was laid on a hospital bed in his living room, surrounded by his stuffed animals, on his favorite flannel sheets.

A pastor held a service for Anthony, and close family gathered to say goodbye. Then Brescia signaled for a doctor to disconnect the ventilator.

Anthony seemed to be at peace, Brescia said. After he died, she climbed into the bed with her son and held onto him for a while.

The death was still traumatic. But "it was really a gift to bring him home," she said. "It was a significant act of compassion and kindness and love on the part of the Children's staff."

After Brescia's experience, Nelson was inspired to offer the choice to more families.

First, she interviewed Brescia and other parents about whether palliative transport had a positive effect. All nine parents said it had. One family described holding a celebration when they brought their newborn baby home, even though he was about to die. They took family photos and used the nursery they had set up, establishing a brief sense of normalcy for four days before he died.

In her 14 years on Boston Children's critical transport team, Nelson has found that parents benefit from palliative transport for various reasons: At home, they're away from the noise of the hospital. They have control over who can visit. They feel more comfortable. And they don't feel rushed after their child dies.

Nelson created a protocol that allows the hospital to offer palliative transport in a more routine way. Now, when children come to any of the hospital's four ICUs, Nelson said, "we have the power to say, 'You have a choice when it comes to the end of life.' "

The practice appears to be spreading.

After Lindsay Ragsdale, the physician who is director of the palliative care team at Kentucky Children's Hospital in Lexington, presented her protocol for palliative transport at a conference last year, staff from 20 hospitals asked her to share her checklist, she said.

Mayo's Thorvilson, who has worked closely on a half-dozen palliative transports, said it's possible these last-minute trips from ICU to home could be avoided by earlier referrals to hospice, which might get kids home sooner. But when children with complex illnesses get sick, she said, "sometimes it's hard to know whether this is just another bump in the road, or whether this is the natural end of the child's life."

"There's something really unique about a child dying," she said. "Everyone's heart breaks, and we want to be able to do all that we can to be able to support the family in the midst of the tragedy."

Eight years after Anthony's death, his bedroom remains untouched, his socks still folded in his top drawer, swimming trophies on the cabinet, slippers under his chair. Pictures of him adorn every room in the house - on the fridge, the kitchen table, the living room stereo.

Looking through photos one recent morning of her son fishing and blowing out birthday candles, Brescia struggled to hold back tears.

"I couldn't cure him," she said. "I failed to protect him from a tumor - that's how you feel. They did all they could. It wasn't enough. Bringing him home was the best I could do."

---

This report was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.

The Willy Wonka of Wall Street has a sweet side hustle in New Jersey

By Sonali Basak
The Willy Wonka of Wall Street has a sweet side hustle in New Jersey
Parre Chocolat products at the company's facility in Fair Lawn, N.J., on May 16, 2019. MUST CREDIT: Bloomberg photo by Jeenah Moon.

Gary Parr watches with boyish wonder as hundreds of chocolate drops roll off a massive piece of Italian machinery.

The executive who has worked on some of Wall Street's biggest deals holds quite the golden ticket. Parr owns the equipment, hired the chocolate makers and approves the fillings for every ganache (caramel with sea salt and almond butter have already passed muster, while mint is in testing).

By day (and plenty of nights) Parr works at the second-largest private equity firm in the world. In his spare time, he's building a luxury chocolate brand using ethically sourced cacao from Latin America.

His colleagues at Apollo Global Management reap the benefits. Since the soft launch of Parre Chocolat a few months ago, he's had more requests for meetings at his conference table. It has a view of Central Park and dishes filled with 88% Super Dark Chocolate Drops.

"I shouldn't be an aficionado of chocolates, but I am, and Gary's chocolate is fantastic," said Leon Black, Apollo's chief executive officer.

The drops are made with only cacao beans, cane sugar and cocoa butter and cost $12 for a 150-gram (5.3-ounce) pouch.

"If you look at the ingredients of any chocolate, you'll see vanilla," said Parr, who's been thinking about the business for more than a decade. "We don't want vanilla. We just want you to taste the chocolate."

Parr loves the stuff, but that's not why he started Parre. With an investment so far of a few million dollars, he's betting that small-batch dark chocolate of ethical origin will follow the upward trajectory of craft beer and coffee, and is open to acquisitions.

All this seems worlds away from his decades as a investment banker at Lazard and Morgan Stanley, where he worked on transactions like the sale of Bear Stearns to JPMorgan and Lehman Brothers's North American investment-banking business to Barclays. But the 62-year-old financier has a history of creative pursuits, such as helping produce the film "Boys Don't Cry."

"I don't play golf," Parr said Friday in an interview on Bloomberg Television. "So I do chocolate."

For now the chocolate business is small. Parr approaches decisions with the hands-on dedication of an entrepreneur right out of "Shark Tank" -- except he already has the spoils of success, including homes on Park Avenue and in Palm Beach County, Florida, the latter built for Consuelo Vanderbilt Balsan with several rooms of French boiserie.

To furnish the Parre Chocolat showroom, he did a local search on EBay for a dining room set and brought some china from home. He studied the chocolate aisle at Whole Foods when he was working on packaging. The "mess of colors" he saw led him to Coco Chanel-inspired black and white designs.

He's considering a subscription program that would send boxes of chocolate in Baccarat crystal. As of now, the chocolates are available only online, but he's considering opening a retail store in Manhattan.

On a recent Thursday, Parr whisked himself away from his 57th Street office and donned a hair net to give a tour of his factory in Fair Lawn, New Jersey, which formerly manufactured Lea & Perrins Worcestershire sauce.

There are no Oompa Loompas. But there are conveniently placed paper swatches to dip into steel vats of melted chocolate on its way to being tempered.

"I can't help myself when we pass there," Parr said as he took a sample. "It tastes good, huh? But now we have to go to where it starts."

Standing next to jute bags filled with cacao beans, he notes how everything hinges on how the fruit is transformed into a bean.

"Beans not fermented correctly, it tastes like sourdough bread," Parr said.

He leaves the job of choosing beans to chocolate maker Pearl Wong, who previously worked at San Francisco-based Dandelion. When she saw Parr's job advertisement for the post, Wong was intrigued by the "fully financed" part of the job description.

"He likes to say 'there's no budget, focus on good value,'" she said.

Wong has visited farms in Latin America with Parr's wife, Katherine, and together they've identified projects to improve farming communities.

In Guatemala, the Parrs funded the construction of a fermentation center in Cahabon and drying platforms in Asochivite. "This is so the farmers can turn out at a higher-quality product, so we can pay them a higher premium for the beans," Parr said.

One of Parr's ideas is to market the chocolate expressly for social tasting, as people do with wine.

"It's great fun to realize how many flavor profiles there are," Parr says. "That's why we have three 75% bars. There's Guatemala, Dominican Republic and Colombia. They taste different."

He envisions people holding tastings in their homes, and is setting up events at cultural venues including the New York City Opera. In June, he'll be offering the chocolates at a concert he and his wife are hosting in their home theater in Tuxedo Park, New York.

But first, the beans have to be roasted and the shells removed with cracking rollers and fans. Then the nibs fall down and get broken into bits.

"I eat nibs. It's healthy. It's pure chocolate, so it will be bitter," Parr said. "The more you chew it, you're turning it into chocolate in your mouth."

- - -

Bloomberg's David Scheer contributed.

Washington cemetery hosts goat yoga among the headstones

By Orion Donovan-Smith
Washington cemetery hosts goat yoga among the headstones
During a goat yoga session on May 18, 2019 at Congressional Cemetery in Washington, a baby goat joines Beth Horowicz in cat pose. MUST CREDIT: Washington Post photo by Orion Donovan-Smith

WASHINGTON - A gentle breeze blew through the Congressional Cemetery in Southeast Washington, a more than two-century-old site whose weathered headstones stand in tribute to some of the District's most notable residents, from John Philip Sousa to Marion Barry. It was a balmy Saturday morning and the atmosphere was solemn - except for the bleating of no fewer than 15 baby goats.

They were there, of course, for yoga.

It was Washington's first foray into goat yoga, an activity that pairs meditative poses with what amounts to an all-ages petting zoo. The concept originated in 2016 in Oregon, at a birthday party. It was never meant to be a thing. But now it's a thing.

For Paul Williams, the director of the Congressional Cemetery, goat yoga was a long time coming. Until recently, District law forbade the activity under a long-standing no-touching-goats policy.

"I tried everything I could for about a year to get goat yoga," Williams said, "and the Health Department just put up every obstacle they possibly could." He recalled meeting with a room full of lawyers who "had the law books all spread out on the table and said, 'This is not happening.'"

The cemetery already hosted classes among the tombstones - "Yoga Mortis," they call it - and found a loophole in D.C. regulations that allowed them to use goats to clear out invasive plants.

But the no-touch policy, based on the Animal Control Act of 1979, meant goat yoga was out of the question.

The city council's Health Committee was already in the process of trimming regulations. The council expedited the issue by tacking a farm animal provision onto a bill that overhauled the District's vital records system. The bill passed in October, allowing goats and sheep into Washington for the purposes of, among other things, "participating in yoga or similar activities."

Williams learned of the change only after the church that owns the cemetery property sought a permit for a live-nativity scene - "a couple sheep, goats, a llama or something" - and was informed of the District's new, pro-goat stance.

Goats are still considered a "prohibited species" and require a special permit and immunizations. They must be inspected by a veterinarian within 30 days of an event, according to Vito DelVento, executive director of the Health Department's Board of Veterinary Medicine. This leaves a narrow window for goat yoga, when baby goats are old enough to be vaccinated but still small enough to comfortably climb atop a yogi.

Saturday evinced the fruit of the goat lobby's labor.

"The karma of fighting for this class for the past two years is that the universe gave us this gorgeous day in this beautiful space," said yoga instructor Kelly Carnes, standing in a clearing where the first 50 goat yoga participants sprawled out on mats. All five opening-weekend sessions sold out, with proceeds going to the nonprofit that runs the cemetery, Williams said.

Carnes led each group through what she said was a gentle sequence of poses inspired by the kids' low center of gravity, not only to avoid injury to either species, "but also to give ample opportunities for the goats to crawl all over us, because that's part of the fun, right?"

"It was a pretty easy sell," said Carnes, who had already led the cemetery's Yoga Mortis sessions. "'Hey, resident yoga teacher, do you want to add baby goats into your practice?' Hell yeah, I do."

After the first session, the participants were similarly enthusiastic.

"I'm so blissed out," said Rachel Holmes of D.C., who brought her mother, Susan Coursey. "I feel like you're a little bit more inward usually with regular yoga, and this sort of opens you up to what's going on in nature around you. Plus they're soft and cuddly."

Coursey, who was visiting from Long Island, N.Y., said she does yoga only occasionally but had no trouble following along. "It made it more of a personal experience for me. More free-form, less regimented, more spontaneous."

Beth Horowicz of Chevy Chase summed up the appeal of the event. "I love cemeteries, I love yoga, I love animals, so I could not miss this," she said.

But one person's bliss is another's bane, and critics say goat yoga is a bridge too far.

"Yoga needs lot of effort," said Viswanatha Gupta, a postdoctoral researcher at SOAS University London's Hatha Yoga Project. "It's not doing some poses and playing with animals. It's divine."

David Gordon White, professor emeritus of religious studies at the University of California at Santa Barbara, echoed that sentiment. "Yoga involves concentration, and I find it hard to fathom how you could be concentrated on anything when baby goats are running around."

For Carnes, it's simpler. "If it's a thing that brings people joy, then why not?" she said. "Bring it on. That's yoga."

The goats belong to Mary Bowen, whose daughter also leads goat yoga sessions at their farm in Sunderland, Md. Bowen emphasized the therapeutic value of interacting with the animals.

"For children that have ADHD, or autistic children, it really helps them to connect and be in the present moment," she said, referring to the research of Temple Grandin, an autism advocate and professor of animal science at Colorado State University.

"If you really notice," Bowen said after the cemetery's first session wrapped up, "it's not about the yoga. These people really want the baby goats to hold."

Anita Teel Dahnke, executive director of the American Goat Federation, said her organization has no official stance on the new practice, but she sees both pros and cons.

"If done right," she said, "it's a great way to get people who normally wouldn't be around domesticated livestock to see what they're like."

But there is always some risk of disease transmission between animals and people, Teel Dahnke said, and the steps taken to prevent it may contribute to a larger problem of overuse of antibiotics in livestock leading to antibiotic-resistant bacteria.

After the District's inaugural weekend of goat yoga, the event's organizers were effusive.

"Just watching them interact with the babies," Carnes said, "I was like, 'Okay, my heart's filled with joy. I'm done. I can die happy now.'"

Williams said there were immediate calls to schedule another session, but he offered a reminder that he also has a cemetery to run.

"Working on a date," he wrote in an email, "but not sure we'll have the staff to pull off another weekend - lots of funerals coming up."

Pulitzer-winning opinion from the most respected voices in the world.

The calmest of times

By dana milbank
The calmest of times

DANA MILBANK COLUMN

(Advance for Sunday, May 26, 2019, and thereafter. Web release Saturday, May 25, 2019, at 8 p.m. Eastern time.)

(For Milbank clients only)

By DANA MILBANK

It is the best of times. It is the worst of times.

In our current age of foolishness, things are "incredible," "thriving," "booming," "prospering," "tremendous," "beautiful," "very much happy" -- the "greatest," "best" and "most."

It is also a "disaster," a "mess," "disintegrating," "really bad," "even worse" than the "worst," "ridiculous," "nasty" and "fake"- with "abuses," a "lot of problems" and in a "spiral down."

All of the above thoughts were proclaimed by President Trump within the span of a few minutes this last week. So extreme is his rhetoric that even an attempt to portray himself as calm devolved into hysterical hyperbole.

"I was so calm," he said. "I was extremely calm. ... Kellyanne, what was my temperament?"

"Very calm," aide Kellyanne Conway replied.

"You were very calm," aide Mercedes Schlapp assured him.

Aide Larry Kudlow concurred: "You were very calm."

"So I was very calm," said Trump.

"Very calm," spokeswoman Sarah Sanders echoed.

"Couldn't have been more calm," Trump summarized. "We had this instance at least once before where I was very, very calm. ... So I was extremely calm, very much like I am right now."

Totally!!! He was so preternaturally pacific, so stupendously serene, so transcendentally tranquil that there has never, ever been a person, dead or alive, as utterly, astonishingly and overwhelmingly calm as Trump.

We have by now become accustomed to such extreme emotion -- both hot and cold -- from the president. Routine though it is for him, it is not normal. Now we know exactly how abnormal it is.

I asked Factba.se, a data analytics company that analyzes language with artificial intelligence, to do a sentiment analysis of Trump's speech compared to that of his predecessors. Factba.se's Bill Frischling had his computers sift through millions of words uttered by presidents back to Herbert Hoover and compute the intensity of each one's average positive comment and average negative comment.

The presidents were in a tight band. With +1.0 being the most favorable possible statement, their positive statements averaged from +0.22 to +0.33. With -1.0 being the most adverse possible statement, their negative statements averaged from -0.19 to -0.27.

And then there was Trump. His average positive statement: +0.64 (+0.66 on Twitter). His average negative statement: -0.53 (-0.61 on Twitter). He is literally twice as extreme as all predecessors over the past century.

And it's not just presidents. Trump's rhetoric is also about twice as extreme as the most extreme members of the last Congress (-0.31, +0.36).

But if Trump is without peer in the American political tradition, he unfortunately has equals in another tradition. Such rhetoric is a hallmark of totalitarianism.

"It's using emotion to circumvent reason, to overwhelm reason," says Jason Stanley, a Yale philosopher specializing in language and author of the book "How Fascism Works."

"He wants to get the situation such that it's a crisis and there's such fear and suspicion that the only happiness, the delivery, is winning over his enemies," Stanley tells me. Hence, the lavish praise of and great love for his supporters and the unalloyed vitriol toward foreigners, racial minorities, elites and socialists.

Trump isn't necessarily fascist, but his language is. "Goebbels talks about propaganda being best when it appeals to straightforward emotion: fear, suspicion, anger, and then it would be culminated with 'we're winning,' 'we're going to get them,'" Stanley says. A speech of this method was often very long, "with extremes of paranoia and then praise of 'us,' 'our' greatness, and a desire for revenge for lost greatness. ... When our emotions are being overwhelmed it's because people are trying to manipulate us and drive us toward a desired goal."

That Trump loves to insult is obvious. But he's actually more extreme in his positive sentiments -- his own greatness and his paternalistic love for supporters. "He couldn't have that sort of negative campaign without also having the positive -- it's the contrast," explains Texas A&M communications professor Jennifer Mercieca, author of a forthcoming book on Trump's rhetoric.

His supporters, lovingly embraced, feel as if they're in on the joke; they know he often lies, but they believe he's lying for them -- lying to the liars. Us-vs.-them thinking becomes so powerful that the enemy's humiliation can be more gratifying than one's own betterment.

How to counter this extreme emotion? The evidence that not a single member of Congress comes close to Trump's rhetorical excess raises hope that this will pass. The best opponents can do until then is to cling to truth. Emotion can only overwhelm reason for so long.

Follow Dana Milbank on Twitter, @Milbank.

(c) 2019, Washington Post Writers Group

Caution, Uber and Lyft, wrecking taxis may turn out to be a multi-company pileup

By megan mcardle
Caution, Uber and Lyft, wrecking taxis may turn out to be a multi-company pileup

MEGAN MCARDLE COLUMN

(FOR IMMEDIATE PRINT AND WEB RELEASE)

(For McArdle clients only)

By MEGAN MCARDLE

This week, The New York Times did something I would have thought impossible: They made New Yorkers feel bad for cabdrivers. Until Uber and Lyft arrived on the scene, a surefire way to liven up a dull Manhattan dinner party was to broach the topic of taxis -- never around when you need one, everyone would moan, and if you do finally luck out, you'll discover it's filthy and invariably driven by a maniac.

But as revealed by the Times investigation of lending practices in the business of buying and selling the medallions required for yellow cab ownership in New York -- with prices reaching $1.3 million in 2013 -- it turns out that the cabdrivers have their own tales of woe. Many of them took out high-six-figure loans to buy the medallions, on income that barely did more than cover the loan payments. Bad enough when taxi medallions were a scarce and valuable commodity; ruinous now that ride-hailing services have cut into their profits.

Yet, funnily enough, Uber and Lyft aren't doing so well either. Both companies recently went public, only to see their stock trade well below the IPO price. That's because the companies are burning great bonfires of investor cash every quarter, having so far failed to discover a working business model.

Uber and Lyft are discovering that the regulatory monopolies they smashed had existed for a reason. Before Uber's 2009 launch, and Lyft's a few years later, almost every sizable city tightly controlled its taxi market. Government commissions set fares and limited the supply of taxi licenses. These regulations existed because without government intervention, no one would make any money. In a country with tens of millions of driver's licenses, and automobiles to match, the supply of potential taxis far outstripped any possible consumer demand.

Virtually everything people hated about taxis stemmed from that underlying market problem and the regulatory apparatus that tried to fix it. Couldn't get a cab when you needed one? Taxi commissions were protecting incumbent profits by sharply limiting the number of licenses or medallions. Cabs were disgusting, and piloted through congested streets at death-defying speeds? Artificial scarcity normally drives up prices, so governments set regulated fares, usually by time and distance. There was no premium for a comfortable and soothing customer experience. Naturally, drivers focused on hauling the maximum number of people every shift.

Everyone complained about the result, but for decades, nothing ever changed. Then came Uber. The company did an end run around that regulatory stalemate, pushing into markets with better service and then daring the taxi commissions to shut them down.

Some cities did just that. But often, by the time the commissioners got around to it, Uber had acquired a rabid fan base, which the company wasn't shy about weaponizing. Amazingly, improbably, Uber broke the taxi commissions -- and then broke the people who owned those previously valuable taxi medallions, from individual driver-owners to the operators of taxi fleets.

It was a triumph for libertarian ideals. For Uber's and Lyft's investors, however, it may have been an empty victory.

The companies' problems essentially boil down to this: The barriers to entry into the driving-people-around business are functionally nil. Whenever the profits in the market rise above a subsistence wage, more drivers will enter, thus competing those profits away.

That was the problem taxi medallions had been designed to solve. Drivers still didn't make much money, because all you needed to get started in the business was a driver's license. But the people who owned the right to drive were able to make a tidy living, with almost no downside risk. That's why New York City taxi medallions got so valuable: Two decades of low-interest rates made them an attractive alternative to bonds offering yields in the low single digits.

Then a hidden downside emerged, as ride-hailing companies disrupted that previously stable regulatory equilibrium. People who had bought into the medallion market at inflated prices saw the value of their assets crater, and many of them ended up insolvent.

But destroying a profitable business isn't the same thing as creating one. Without the regulatory monopoly they disrupted, how are Uber and Lyft going to make money?

They could try to replicate the monopoly, only without the governmental assist, exerting such firm control over the ride market that new competitors effectively can't enter. The other option: They can't. Uber and Lyft may discover, like taxi-medallion owners before them, that in this business, there's always another guy with a car waiting around the corner to overrun your seemingly impregnable market position.

Follow Megan McArdle on Twitter, @asymmetricinfo.

(c) 2019, Washington Post Writers Group

I, Nancy Pelosi, wish someone would do something about Trump

By alexandra petri
I, Nancy Pelosi, wish someone would do something about Trump

ALEXANDRA PETRI COLUMN

(FOR IMMEDIATE PRINT AND WEB RELEASE)

(For Petri clients only)

By ALEXANDRA PETRI

(BEG ITAL)"I pray for the president of the United States. I wish that his family or his administration and staff would have an intervention for the good of the country."

-- House Speaker Nancy Pelosi(END ITAL)

Something in our president is deeply broken. It pains me to look on, helpless, as he flails and burbles in the Oval Office. To watch him chewing listlessly on the Fabergé egg of this republic, throwing cherished norms to the ground just to hear the noise they make when they shatter -- oh, it is agony to behold, and I, Nancy Pelosi, wish someone could exercise some oversight over him.

I am praying that maybe somebody, perhaps constitutionally empowered to wield equal power as a branch of government, might take some action, or even start the process of inquiring into taking some kind of action, to restrain his excesses. If only our system were set up in that way, and there were such a body, and the leaders of that body were not insensible to the wishes of me. Alas!

There is a word starting with "I" that I wish people would move forward on. That word is "infrastructure." And as long as President Trump is not checked by any other branch of government, it looks as though we won't be able to. Which is a shame.

I feel powerless as I, the speaker of the House of Representatives, look on and see this dreadful man carrying on in this way. I don't think anyone could feel anything but helpless, looking at the things this man is doing. Did you see how he threw a news conference in the Rose Garden to insist that he was very stable and very smart and did not throw a tantrum? And then a day later he kept demanding that people who had not even been in the room insist that he had not had a tantrum. This is alarming! I am alarmed! And why is he so creepy and secretive about his finances? Are his tax returns wrapped around a human corpse? What is going on? What is happening?

Maybe his family could do something? They have, historically, succeeded at tempering his outbursts. Or am I thinking of the laws of New York State? Or am I thinking of -- neither? Something, surely, must have been able to contain him. Surely his party cares about the kind of impression he is leaving on the world. Surely Republicans will rise to the occasion, like a very slow cake. Surely someone out there in a position of power could do something about this.

I will do the only thing that I, a legislator, indeed the speaker of the House, who could really move things onto the floor if such were my wish, am empowered to do at such times: Send my prayers. Prayers are the most powerful thing you can send. That is why we legislators send them so often after shootings, in lieu of legislation.

If someone could check him and force him to comply with congressional inquiries, that would be incredible. If only that power existed! Sure, it might be "divisive." If you remove a drunk man from behind the wheel of a school bus, it is divisive -- the schoolchildren are happy, but on the other hand, the man will be upset. But I am not sure why we are worried about upsetting him. Why would "divisive" be the standard we are holding ourselves to? Any act of political courage that has ever happened, ever, has been divisive, including but not limited to the Declaration of Independence and the 13th, 14th and 15th amendments. And, of course, whatever they did to Andrew Johnson. There's a word. It's on the tip of my tongue.

If only there were someone who could put a check on this man, constitutionally.

I, personally, wish that I could do something about this iniquitous scamp -- maybe even something that starts with I. I could send an illustration, or perform an illusion, or give him an illuminated manuscript with a fisherman staring out of the first letter making a disapproving face. Gosh, something.

Something in this man is deeply broken, and I am doing all I can. I just wish I could do more.

Follow Alexandra Petri on Twitter, @petridishes.

(c) 2019, Washington Post Writers Group

The Trump administration's war on statistics isn't slowing down

By catherine rampell
The Trump administration's war on statistics isn't slowing down

THE MILLENNIAL VIEW

(FOR IMMEDIATE PRINT AND WEB RELEASE)

(For Rampell clients only)

By CATHERINE RAMPELL

Don't like the numbers? Invent new numbers instead.

Or make it harder to collect trustworthy numbers next time.

Or just put the squeeze on the number crunchers themselves.

Slowly but surely, the Trump administration has been chipping away at the independence and integrity of our federal statistical agencies, whose data is critical to keeping our democracy functioning and our economy healthy. So far as we know, the administration still hasn't managed to pierce the citadel of the Bureau of Labor Statistics (the independent agency that releases jobs and inflation numbers) or Bureau of Economic Analysis (the independent agency that tabulates gross domestic product). But around the edges, it's trying to compromise lots of other official government data.

This week, The New York Times reported that the Environmental Protection Agency plans to massage the model it uses to determine how many people die of pollution. The goal is to make the rollback of the Obama-era Clean Power Plan look significantly less deadly than the current models suggest. This is also part of a broader administrative effort to downgrade official estimates of environmental harm resulting from the administration's deregulatory agenda.

It's reminiscent of another proposal the administration made this month, relating to how we measure poverty. That's also a technical, boring-sounding, deep-in-the-weeds change that most of the public won't notice.

At least, not at first.

But over time, the change would reduce the number of Americans officially counted as poor -- not because they've started earning more money but because this technical, boring-sounding change would redraw the line for who is in or out of poverty.

If you're a right-wing politician, this change would be a double win. It allows you to claim your policies have lifted families out of poverty, even if they're still struggling. It's also a backdoor way to slash spending on the safety net.

That's because the poverty threshold is used to determine eligibility for lots of safety-net services, meaning those newly defined as not-poor would also become newly defined as not-eligible for food stamps, Medicare's Part D Low-Income Subsidy program and other benefits. After 10 years, for instance, more than 300,000 children would lose comprehensive coverage through Medicaid and the Children's Health Insurance Program (CHIP), according to an estimate from the Center on Budget and Policy Priorities.

When directly manipulating official government measures isn't an option, the administration can also mess with the data-collection process.

That's precisely what's behind the Commerce Department's last-minute decision to jam a citizenship question into the 2020 Census, the constitutionally mandated enumeration of all "persons" (not just citizens) in the United States.

Immigrant and ethnic minority populations in this country already have high levels of distrust of government, thanks to xenophobic rhetoric and actions by President Trump (including, at one point, a proposed Muslim registry). Now just imagine what happens if the government suddenly demands that every household in America report the citizenship status of every occupant.

Significant population undercounts and otherwise inaccurate data can be expected to result, and the consequences of these distortions would be far-reaching. An inaccurate count would skew congressional representation and the allocation of hundreds of billions of federal dollars each year. It would also warp the many other public and private data measures that use the census as a baseline.

The Supreme Court will soon decide whether the administration's plans can proceed; three lower courts have blocked the question, on the grounds that the administration's actions violate administrative law or the Constitution.

Finally, there's the Economic Research Service, the independent statistical agency housed within the Agriculture Department.

Its researchers compile and analyze data related to crops, yes, but also poverty, food stamps, trade and climate change, among other politically sensitive issues. And right now these economists and statisticians are quitting in droves. That's because the Trump administration abruptly decided to relocate hundreds of positions. Workers were told that if they want to keep their jobs, they have until the end of September to move their families to ... a still as-yet-unnamed new city.

The relocation is, ostensibly, to save money. But it sure seems like a backdoor purge of an independent agency that has produced analyses inconvenient to the administration, including on the harms caused by Trump's trade wars and how little the 2017 GOP tax overhaul has helped small farmers.

Presumably the Trump administration has calculated that doctoring statistical models, skewing survey results and trying to strong-arm statisticians will serve its near-term political interests. In the long term, however, sowing distrust in government data only reduces the ability of policymakers, businesses and voters to make informed decisions.

Of course, maybe that was the goal all along.

Catherine Rampell's email address is crampell@washpost.com. Follow her on Twitter, @crampell.

(c) 2019, Washington Post Writers Group

Europeans must accept responsibility for their jihadist 'foreign fighters'

By david ignatius
Europeans must accept responsibility for their jihadist 'foreign fighters'

DAVID IGNATIUS COLUMN

(Advance for Friday, May 24, 2019, and thereafter. Web release Thursday, May 23, 2019, at 8 p.m. Eastern time.)

(For Ignatius clients only)

By DAVID IGNATIUS

WASHINGTON -- For sheer hypocrisy, it's hard to match the European nations that are refusing responsibility for dozens of their nationals who became jihadist "foreign fighters" over the past five years and are now warehoused in makeshift prisons in northeast Syria.

U.S. officials say that about 2,000 foreign fighters from more than 50 nations are among the roughly 10,000 captured Islamic State fighters held in several dozen ramshackle prisons in Syria. The detention facilities are run by the Syrian Democratic Forces, the Kurdish militia that partnered with a U.S.-led coalition to defeat Islamic State. The other 8,000 captives are Syrian and Iraqi fighters.

The Pentagon and State Department have implored European nations to repatriate their nationals for trial and imprisonment, or at least pay the SDF to hold them temporarily. But so far, most European nations have refused. The SDF warns that it can't imprison them indefinitely and doesn't have laws that would allow formal prosecution in the Kurdish-controlled zone.

"If these prisoners are not going to be taken, what is the endgame?" complained one frustrated Pentagon official in an interview: "What comes next? People haven't thought about it."

The Europeans protest that they don't have adequate laws to try their nationals who committed terrorist offenses on foreign soil, and that they don't have evidence that would stand up in court. They worry, too, that jihadists in European prisons would radicalize other Muslim prisoners, and then be released back into society in a few years, perhaps to commit new terrorist acts.

It's a political problem for Europe, too, explained one European who has talked extensively with officials there about the repatriation issue. "The European Union is in denial," he told me. "The security and interior ministers don't want to hear about it. The Europeans feel that a government that takes them back has no chance for reelection."

The problem isn't just the foreign fighters in the prisons, but their wives and children living in camps. Experts estimate that of the 74,000 people at a huge camp known as Al Hol, about 11,000 may be related to fighters who aren't Syrian or Iraqi.

The European desire for self-protection was epitomized by Ben Wallace, British security minister, who told The Guardian: "I'm not putting at risk British people's lives to go looking for terrorists or former terrorists in a failed state."

The International Committee for the Red Cross, which visits prison and civilian camps in northeast Syria, said in a statement: "Countries of origin cannot turn their backs. People -- especially children -- cannot be made stateless. Faced with this complex problem, moral inertia is not an option."

What peeves some U.S. officials is that the European nations shunning responsibility for Islamic State prisoners have for years been lecturing the United States about its immoral treatment of prisoners at Guantanamo Bay. Facing a post-conflict dilemma now that's similar to what the U.S. encountered with al-Qaida, the Europeans are ducking the problem.

European castigation of Guantanamo abuses included German Chancellor Angela Merkel's statement that "an institution like Guantanamo can and should not exist" and the European Parliament's demand that the U.S. close Guantanamo "without delay." (These criticisms were gathered by the Center for the Study of Human Rights in the Americas.)

President Trump tweeted about the problem on April 30, as the last holdouts of the Islamic State were being routed and sent to the overcrowded, underfunded SDF prisons: "European countries are not helping at all, even though this was very much done for their benefit. They are refusing to take back prisoners from their specific countries. Not good!" For once, Trump was right.

But U.S. pleas have yielded little response, especially from Europe. The only countries to accept significant transfers from the SDF prisons are Kazakhstan, Macedonia, Kosovo, Morocco and Bosnia, a Pentagon official said. Some prisoners have also been transferred to Iraq, which has offered to take thousands more, but only if paid.

The SDF, which has limited resources and faces a Turkish threat of attack, has kept holding the prisoners but warned it can't do so indefinitely. Abdulkerim Umer, an SDF representative, told The Associated Press: "We can't put up with this burden alone. ... The international community has evaded its responsibility, so we ask that they help us set up the court here."

European nations talk of some sort of international tribunal for the jihadist prisoners, but there's been no significant movement to make that happen.

Defeating the Islamic State was a worthy goal. Ignoring the prisoners who were captured in that war, and leaving the problem to others, is reprehensible.

Follow David Ignatius on Twitter: @IgnatiusPost.

(c) 2019, Washington Post Writers Group

China's Sputnik moment

By fareed zakaria
China's Sputnik moment

FAREED ZAKARIA COLUMN

(Advance for Friday, May 24, 2019, and thereafter. Web release Thursday, May 23, 2019, at 8 p.m. Eastern time.)

(For Zakaria clients only)

By FAREED ZAKARIA

NEW YORK -- Many of us have been waiting for a new Sputnik moment, the point at which the challenge from China spurs America to get its act together. We may now be witnessing such a watershed, but in Beijing. The Trump administration's decision to blacklist Huawei -- the world's seventh-largest technology company -- might well be China's Sputnik moment, with seismic consequences.

The administration has provided some temporary exemptions to the blacklist, but it seems that Huawei will lose key hardware (ARM's chip design) and software (from Google) that it relies on for its cellphones and associated technology. This move can only be interpreted as an attempt by the Trump administration to kill the company, already the world's second-largest maker of smartphones.

The Chinese will see this as a turning point. If Washington can cut China off from American technology at will, China will be determined to build its own technological infrastructure, top to bottom. Huawei, anticipating this moment, has been developing its own operating system, which doesn't rely on American companies, and says it could be in place by year's end. (Losing ARM is actually a much more crippling loss for the Chinese company, making it extremely difficult for Huawei to produce its own chips.) Watching China's technological prowess these days, it is easy to imagine the country rising to this challenge.

We might be moving toward a bipolar world in digital technology with two walled-off ecosystems: American and Chinese. This division would erode the open world economy, the deep levels of interdependence and the cross-border investments and supply chains that characterize the global economy today. Before traveling down this road, the U.S. should ensure that it has the smartest strategy in place to deal with the real challenge from China.

First, the Trump administration should make clear the broad principles it is defending in punishing Huawei. It has so far been reluctant to outline the evidence, perhaps because it is classified. It must help the world understand that it is not simply blocking a successful foreign competitor but acting to preserve the security of networks and the privacy of individuals. The British government has concluded that it can use Huawei's technology as long as certain safeguards are put in place. We need to understand why London is wrong and Washington right.

Second, the United States should have built an international coalition to confront Beijing. From the start, I have supported the Trump administration's tough stance on China. But I am still bewildered as to why they are going solo, rather than forging a broad alliance. Pulling out of the Trans-Pacific Partnership remains a foolish "own goal," only hurting America and helping China. A senior European leader told me that Trump has dismissed European offers to act together on trade.

Third, we should think through what this bipolar world will look like. China's technology will be cheaper because of its lower labor costs, looser regulations and government assistance. Huawei is already dominant in the developing world. Many of those countries might well keep opting for the cheaper technology. In their view, whatever technology they choose comes with the risk that a government -- China or America -- will snoop on them.

Fourth, is it realistic to take on China through bans and blacklists? The world is so deeply interdependent. Is there another, smarter way? A senior technology executive I spoke with suggested that the better response would be for America to become the world's leader in encryption and countering cyberespionage. He suggested that a university like MIT be tasked with using only Huawei products to build a system that is encrypted end to end, which would shield all data from the company. "It would be a tall challenge but definitely one America's best engineers could solve," he said.

Finally, isn't the real answer to China's extraordinary gains in technology to make the policy changes and investments that allow America to compete with Beijing? It is difficult to imagine that Washington would be able to shut down the economic rise and innovations of a dynamic country of 1.4 billion people that already boasts many of the globe's top tech companies. Instead, we need our own Sputnik moment, focusing the country to outcompete China.

This technology strategy is far more consequential than trade talks. On trade, the Trump administration has many legitimate complaints about Chinese behavior. It is playing hardball with Beijing. But the end goal is to create (BEG ITAL)more(END ITAL) economic interdependence between the two countries. If there is a deal, China will buy more American goods, invest more in America and provide more market access to American companies.

A technology war would take us in a very different direction. It would lead not to a cold war, but a cold peace, in a divided and less prosperous world.

Fareed Zakaria's email address is comments@fareedzakaria.com.

(c) 2019, Washington Post Writers Group

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