$100,000 in cash prizes will be awarded and shared between 150. next a look at the fight against opioid drug addiction and new ways of studying the impact. mr. gingrich, the founders for opioids recovery spoke at this event hosted by the american enterprise institute. it is one hour and 20 minutes. ..

what can policymakers do about this? that is what we are here to discuss today. i am joint and very honored. i think i you know them all. here is a brief introduction. newt gingrich former speaker of the u.s. house of representatives, throughout his political life he has worked for a health system that provides better care at lower cost. patrick kennedy represented the house of representatives in rhode island. he took a lead role in 2008

legislation that established coverage for mental health and last year he published a book called a common struggle which is part autobiography and part blue print. mr. jones in the middle, former adviser to president obama obama and went on to do many things, including establishing dream core which is dedicated to prison reform among other things. 2009 he was named man of the year 1995 and one of times most influential people. all three of them are founding members of a new group called advocates for opioid recovery. i will be asking them questions about how policy can promote recovery and "after words" we will take questions from viewers online and in the audience.

first i want to begin with a little overview of the scope of the opiate problem. as you can see, i hope you can see this well, clearly, clearly there has been a fourfold increase in the number of deaths from overdose from narcotics or heroin. the line that shows prescription narcotic and the purple are from heroin. there's a number of people who are addicted to heroin and it's actually very hard to get good numbers, but the numbers that you read about are about 2.5 million people misuse

narcotic pills. i'm talking about by kitten, oxycontin, percocet type pills and about 1 million people use heroin. that is higher than the numbers you will see from the cdc because as you can imagine many of those are not being surveyed. another important part of this slide is 80% of the people who are now using heroin started with pills, with painkillers. that wasn't true in the 60s or 70s, but, but it is true now. so who is that subset of people? these are folks who have misused painkillers. it's a subset of folks who have gone on to use heroin. not everyone who uses pink killers go on to use heroin. the risk factors tend to be having a prior history of

substance abuse, a prior history of major depression or other psychiatric problems or alcohol problems. that's an important thing to keep in mind. the next five, i'm just going to go quickly through this one. it shows you the kind of medication that opiate pain killer medications that have been prescribed since 1996 through through 2004. there are two points i want to make. the pink as you can see across our what are called oxycodone medication. the most common is percocet. the green is hydrocodone. most people know that is vicodin, but there are other formulations. the blue is other medication. interestingly, i was just going to call attention to the red on the bottom, that's oxycontin. even though it's gone on to play some role and lesser role after

it was reformulated and became harder to crush in 2010, the actual prescription is actually modest. the second part of the slide that is quite important is the fact that it is dipping off. doctors are prescribing fewer pills and that's because there has been so much attention to this. hopefully better training in how to deal with pain, although are were just beginning that kind of reeducation. also, prescription monitoring programs have kicked in in thousand ten in 2011. these pill mills in l.a. in florida and other places where the dea crackdown very heavily. prescribing is going down, but in some places, especially ohio, even though the prescribing is going down, the death rate from overdose are not and that's because people are moving on to other drugs and other painkillers.

i'm sure you're familiar with this, narcan, i just wanted just wanted to show that. clearly that is a godsend. it has truly saved lives. it is an antidote, rapid acting. it is also available by prescription in all states and you can pick it up. at about half the states you can get that without a doctor's prescription a large part of those opioid overdoses are due to fenton all. i'm sure of you heard of that. it's a very powerful jug drug and has a fine use in anesthesiology and pain control, but when when it's out there on the street, it is very dangerous because you can see from the relative potencies, that knowledge all is a hundred times as potent as morphine, although most people don't abuse morphine but they abuse heroin and they abuse percocet and vicodin which are somewhere between morphine

and heroin and that's why, in terms of potency, fenton all is 50 times as potent as heroin, and that shouldn't even be handled without gloves. now there's a new drug around, another variant which is 10000 times as potent as heroin. that can kill very efficiently. the fda is probably going to increase the dosage of narcan that's being administered in emergency situations to compensate for that. my last slide is just about the medications we may talk about today. were not going to get heavy into the medical. >> can you go back to the left side? >> sure. >> why was this made? where did this come from? >> actually elephants. it's an animal born.

>> thanks for bringing that up. >> so is at the potency or the size of it? >> the potency. >> these are just relative so to knock out an elephant is 10000 times morphine. now it's being introduced and diluted form for humans. >> not even diluted, mixed. >> yes and it's coming, a lot of the fenton all is coming from china and mexico. it's emphatic. >> are they cheaper than heroin or. >> while they are cheaper simply because there's so much more potent and one can wonder, even if we somehow managed to suppress heroin availability, will fenton all just replace it. >> carry-on. >> one last question so with methamphetamine, how hard is it

to manufacture these two? >> it's hard because it depends on some precursors that the dea tries to control very carefully. it's not something you can make a home in a lab. >> i hope all of you have learned something. i guarantee the three of us just did. >> when there's an elephant in the room, you you know what to do. [laughter] these are the fda medications that are approved in the reason i want to go over them very quickly is because this is what we are talking about getting more access to. the one you may have heard the most about is probably this one. it's in the class of opioid replacement replacement medication so it is a form of an opiate. it is not as dangerous an overdose as a medication called

methadone which i'm sure you will are familiar with, and it can be prescribed by doctors. that's a great advantage. you can go to the doctor, like a regular patient, get a prescription and go to your pharmacy and get it filled. comes in a little film that can go in the fattier mouth. it happens to be a pill form that dissolves under your tongue was just approved by the fda, and implant of it that goes into your arm under your skin, it's not major surgery by any means but the doctor will have to make a cut. that lasts for six months. as you can imagine it's a great advantage for people who don't take medications regularly. then there is the good old methadone. it's been around since 60s. i work in the methadone clinic, it's a great standby, but you have to get it in a clinic. also, finally, i hope you can see down here like narcan is an

opioid blocker. where narcan shoves an opiate molecule off the brain receptors , now this is a blocker that is sitting on the endorphin cells and infant opioid molecule comes it can't bind. you take this medication so if you were to get something on top of it would have no effect. it's been around for two decades at least in the united states, i think before that in france and the pill also comes in a monthly injection which is also good for compliance. it's so good for compliance that colleague was just telling me before we started that jails in maryland have used that and it has cut down on how many readmissions they have. they've injected inmates with

this medication with their permission and it has worked to keep them drug-free. okay. so end of my presentation, let me me explain what's going to happen now. i'm going to ask them questions of these gentlemen and then we'll have time for questions. let me tell you how these questions are supposed to go. okay. you can read this. then you can ask these questions at any point, although although i won't get to them until we are finished and they appear on this device. it should all work, and if it doesn't i'll have to use live human beings. so, as i mentioned i work in a methadone clinic near gw, and in many ways that's the vantage point from which i will actually ask most of these questions.

i will start with you. medical unit? >> yes. you reestablished opiate recovery engine. how did it come together. >> it's an interesting story about how you can be bipartisan if you allow your interest in solutions. back when i started, back in the 99 or 2000 time. we were very invested in electronic health records. i remember the best single press conference we did, he and tim murphy who is a republican were hosting a press conference and they invited hillary and me to come. then they came to see hillary and me just for the spectacle which was really a great event. we were working on those things and then since he was in

congress, he has really taken a national leadership role in brain science and organizing an annual conference and he invited me to come speak because of the background i've had. so the natural pattern there. at the same time, van and i got to know each other in the crossfire. we really found we had a mutual passion about criminal justice reform which is something i worked on a aei back in the '90s. we were really coming down the road. criminal justice reform in many ways overlaps with mental health and with addiction, because with the collapse of the mental hospital, the state hospital systems, et cetera, we often have jails where we may have 40% of the inmates really dealing with mental health problems rather than criminal problems. in almost every case, you have a

substantial number of inmates who have an addiction challenge and if you're ever going to get them out and back into society, you you have to have a strategy that deals with their addiction, otherwise use putting back on the street someone who will rapidly become a problem again. the three of us found that the place, as you know, in society this complex with this many different possible topics, if you're going to get attention in a general direction, you have to find something which is current and with peach people feel compelled with a sense of urgency. we have a general broad interest in mental health, i would describe it as inclusion, the idea that your brain is actually part of your body and any health program does is hears your body, here's your brain is by definition wrong.

you not to get much coverage talking about that in general, but the tragedy of the addiction rate and of the number of people dying from overdose involving opioids in a number of places, in new hampshire for example it's the number one issue politically. it beats the economy, it beats terrorism, you, you name it. people are really frightened because they are seeing their children die for their brother or their sister die. we decided, there's a second part of this intersection. one is to say here's a problem, but the thing that drives you crazy is we have pretty solid evidence, and you may want to dive in at some point because you're actually the technical expert that medication assisted recovery combined with cognitive retraining has a very high likelihood of succeeding but it

doesn't fit much of them medical profession and it doesn't fit many of the state and federal bureaucracies. you have this moment in time where you are losing 47,000 people. you. you probably, in theory could cut that by 45000. if you had the right kind of sophisticated approach to this whole thing. so many times in your life can you find an issue where you might potentially affect a half million people over at ten or 12 year period. we have found as you pointed out, were a little bit unusual, just, just the activity of the three of us talking about it automatically attracts a level of attention that no one of us would get on our own. >> that's my next question, what can you three do that other groups can't. one of the magic of this constellation of partners, but my other question was, what are

some of the agenda items? >> for so i just want to say it's really good to see this many people coming out. many of us, we live in washington d.c., we deal with issues all the time, i think when you saw that graph, maybe i'll just put it back up here. >> this month? that is shocking. those are just little numbers ticked up there. that is thousands and thousands of people who have died. that's thousands and thousands of funerals, parents, children, and some extra enemy that has figured out how to kill this many americans every year, we wouldn't be able to have a room the size. we would have a stadium full of people trying to figure out what

we are going to do. part of the reason i am here is because i had someone very close to me who died. i didn't see coming at all. didn't see the signs are the signals. i carry a lot of guilt about what could i have done. luckily i know him very well and they are already collaborating and have been able to make many great things happen. what i will say is simply this. it turns out, and patrick can talk more about this that this is completely unnecessary. it turns out there are two strategies, not one but two back to get this number way down. one is, people do have to change their mind, they have to have some willpower, but they also because the way opioids work

they have to change their brains back. this is a biological thing. this is your brain as an organ and once these doctors into these pills and say hey we took a more out of your mouth, take these pills are you're broke her collarbone, take these pills, for a lot of people those pills damage that organ. that's not about willpower or being a bad person, you have organ damage. you did with the doctor doctor told you. it also turns out that there's something they can give you to help you with that organ damage, but the stigma and all the theology and ideology once you say it's addiction, suddenly suddenly we turn our brands off and we don't look the evidence of the facts and we don't let doctors help the people who they initially hurt. this can be changed. this organization that we are part of, we want to go all around the country and have meetings just like this.

we want to create a situation where first of all doctors stop overprescribing these opioids. if the doctor gives you something and you take it in your life falls apart, that's a bad sign. if you can't trust what the doctor gave you, that's bad. we want for the insurance companies to pay for and give the medicines that correct this. we also want the government to speed up these approvals because there are a lot more drugs in the pipeline that can make a big difference. lastly, we have the drug works out there that we think happened during a good job but can be doing a better job. for me personally, year ago i wasn't thinking about this at all. it was not on my radar screen at all. i didn't think about addiction in any way except don't do drugs and if you're on drugs get off

of drugs. it was pretty straightforward in my view but my world got turned upside down like a lot of people and there's a lot more of us out there who, if we work together, we can can do something about it >> patrick i wanted to talk to about a study on medicaid. can you describe some of the highlights of the findings? >> thank you. appreciate this opportunity with good friends who i greatly admire and who are so impactful to hear a speaker gingrich talk about how this needs to be treated like any other illness. it is so powerful and then jones talks about how you can think one thing one year and have a totally different perspective after this has personally affected you. the endgame here is we just want addiction treated like the disease that it is. that is the end game. there are lots of things we can

do today to help make that a reality so there aren't as many people dying of overdose every year who are simply because of our neglect. literally, they are taking their time and putting out regulations to implement the recovery act. people are dying every day. literally today, fda is sitting on the release of medication that can also augment what's available out there for people with opioid addiction. people are dying every 19 minutes. this is about a sense of urgency , and it's about the fact that as dan said, if this were any other illness, they would be marching on washington right now and people would be throwing up their arms thing what are you doing about this. instead we get a bill passed with no funding, we've got

administration who instead of doing something about it the regulations are not forthcoming, instead we say this needs to be treated like any other illness, but the insurance parity is still not the law of the land because we don't require insurance companies to disclose their medical management practices which is the insidious way where they deny access to treatment for mental illness and addiction. so, this is not about not knowing what to do. people like you, you've got it, the position papers, you can bury yourself in position papers it's about political will. the reason we don't have political will is that we in our own lives are so ashamed of having these illnesses in our own personal lives are in our families life that we don't talk about it. guess what. if we can talk about it in our own lives, how do we expect the

government to talk about it for us? unlike every other issue, there aren't the advocates. very rarely do have someone who puts their hands up and says yes i am an opiate addict in recovery. yes addiction affected my family and it's an important issue to me and i'm going to vote on it. i'm going to advocate for it. i am just so excited, having worked in this for some time to see the beginning of the advocacy part of this change and, being being able to work with very public influential thought leaders, it's a real honor for me. >> thank you. just a little. >> we did a study of medicaid variation which was amazing. it runs from, i think it's $4 in mississippi to $68, just to give you a sense of range, there are

very wide ranges and how easy you can get access, ranges and what they will pay for, and almost no correlation of anybody stopping to say what what's the outcome affect. i helped founded the center, one of the greatest problems we have is that we get involved in budgeting cycles that don't have any kind of accumulation. you can walk again and you can we have a medication program that also has combined with the cognitive training so people are both training their brain and at the same time there reorganizing their brain medically. that cost x number of dollars. the state legislature will say well, we really don't have that kind of money this year. well, that person ends up, for for example, maybe being a prisoner who doesn't fully recover, who ends up back in prison so we pay 200 times as much money keeping them locked

up as we would have paid, but the prison money is over here and we have the prison money, and the mental health money is over here we don't have the mental health money and we can't figure out that doing the right intervention today, we did a tv show with sinclair this morning they had somebody on thereby remote from a different town two, 1313 years ago had become a recovering addict. all of you who are in this position you know that you never recover. you are recovering. it is a lifetime journey. you talked about, four times, he overdosed. overdosed. four times they brought him back the fourth time he finally got it. he went through the process and so he is now, for 1313 years, been holding down a job, has a family, living a full life as a citizen. how do you measure all that? if you do it based on an annual budget, it's actually cheaper for him to die. actually once had a director of the budget tell me that.

there's a real problem with people living too long and that it increases their cost. i said never ever go on television. think about it. what we discovered in the study is that, this is one of the projects we want to launch after the election. every every governor in every state legislature should benchmark themselves against the medically appropriate standard and asked themselves how many of their citizens are they willing to have die because they don't want to go to the appropriate system. the numbers on that are very striking. i may get them slightly wrong off the top of my head, but essentially, today, 80% of the people who want to be in recovery don't get treatment. of the 20% who do get treatment, only 15% or 3% of the total, only 3% of the total population seeking treatment gets a

medication base sophisticated model. now if i told you that about diabetes or about cancer or kidney disease, you would say that's outrageous. but because we have always had a lagging indicator, i think for very practical reasons we are thinking about, for most of the past couple hundred years, we have gained more and more knowledge about every element of the body except the brain. it's only in the past 20 or 25 years that we have begun to have the kind of capability that allows us to actually watch living brains. prior to that except for very rare circumstances, we literally , the brains we studied were dead. we basically built this model of trying to theoretically understand what might be happening in your head without really knowing.

now you have, at the cutting edge, and she knows all of this, now you have at the cutting edge these amazing, down to the level of study where synapses are doing things and how the neurons fit together and things that are almost magic. the cultural understanding that the brain is integral to the rest, the truth is the brain is at the center. for example, depression depression is actually the most common single health problem in america and a surprising number of other health problems is depression. because we are only beginning to enter the age of the brain, all of our political behavior and all of our bureaucratic behavior is still locked in an op obsolete model that says i will spend anything to fix her cancer, but now this addiction problem, that means you're a bad

person. as opposed to this addiction problem you have is a biological function of how your brain has been reorganized around the chemical interface. >> you're talking about differential treatment at the level of the hospital the clinic and it's true, in some states there are duration limits on how long you can be treated, the dosage maximum, i've never heard of that kind of thing and preauthorization which takes up so much physician time which is time they should be spending with patients. the good news is, on on that last one, i think this was news on friday that cigna, the big insurance company has now dropped its authorization. this was under pressure from eric schneiderman who is the attorney general of new york.

maybe there is a role for atty. general. >> there is a huge role for attorney general's as consumers and patient advocates, we cannot get denials of care and the like. if we join together, we can appeal these denial to the is attorneys general in the various states are really consumer protection folks. they are just protecting the contrast law aspect of this that people are paying for insurance but aren't getting the coverage that they are actually paying for and we feel this is going to be the best way to advance. to this date, most people think we are going to get appeals with one at a time. we all know the best someone can get is their care paid for often when it's too late, a year or so later.

you need to be a harvard phd to understand how to do these bureaucratic peels. the insurance industry knows it and they are counting on it. we need to have a public movement that takes our grievances directly to the attorney general and that the ag take on insurance industry on our behalf as consumers. when you add up all these families i'm seeing around the country, the speaker and others, we are going to start a consumer revolution in this country and i hope the insurance industry knows what they are in for. we are going to start taking these stories to them and require that they not only follow the law but they keep taking care of the people who are suffering from these brain -related illness was as they are required to by law. >> next one for you. you mentioned drug court a while ago. i worked for a d.c. drug court about 20 years ago. for those of you who are familiar, they kind of bring the

medical and the moral model together in that these are for folks who have been arrested but it's a diversion type program. if you completed, your record is expunged. that's really a wonderful incentive to stick with it. what happens in a drug court is that the participants go through a treatment program and they are monitored pretty heavily in that swift, certain, but not severe consequences if someone misses an appointment with their counselor or doesn't show up for an appointment. the consequences are not severe. they may be one day of community service. they do escalate but they continue to fraction. that's behavior 101. you respond to some sort of

event that you want to change behavior immediately. >> by the way, airline airline pilots and physicians have 90% recovery and it's because they have the accountability piece. >> they have a lot to lose. >> when i was doing this, there were no medications then. now, with all these medications the drug court and the criminal justice system in general, we have patients in d.c., every week we would go over the patients and he's in jail, he's in jail, he's in jail, that happens, that happens a lot but at least the d.c. jail detoxes people. the virginia and jail don't. some people keep them on methadone which is very

constructive because you lower your tolerance and if you use again that's a prescription for overdosing pressure that you speak. what's the potential for all these medications that we mentioned earlier. >> one of the big myths about changes is changes about people learning new things. most change happens when you unlearn the old things first. what's holding back a lot of this is an old way of looking at addiction which we have touched on but i just want to go into more deeply. the good old 12 step model, the blue book, the idea that if you are addicted to something it's because you have some moral failing and you need moral redemption, you have a lack of willpower that you need to get your willpower together and you and a higher power working together can get you out of this.

that is, there is deep truth in that and there are people who can give testimony about the power of that approach. the challenges, 50 years later or 60 years when you're not merely talking about alcohol, you're talking about very complex substances, it turns out that is the past. until we get down to the point where we see the biological point of it as shame free, stigma free so we can just act intelligently, we are going to continue, i, i remember back in the 1980s, during the hiv-aids crisis, the government, we knew this was a medical emergency. there is millions of people affected. there is a slowness to respond.

the public concerns were going up and up but there is a stigma associated with hiv and aids that was rooted in homophobia primarily but a lot of fear and ignorance in the lag time killed millions of people. people said look, this is enough people on both sides of the political aisle, people of all races and all gender said the american government has got to do better and pressure was applied. and now, hiv is considered a chronic condition. there's medication available and certainly nobody wants to have hiv, but it's nowhere near the way that it was. that is the pathway we have to go. people have to unlearn a whole bunch of stuff in order to treat this like a disease without all the stigma. we have to have the same approach now, addiction, you

throwing kids, your children, your grandchildren are being thrown out into a world where people are bringing elephant tranquilizers to parties. now, that is not the world i grew up in but that is the world now. in that kind of a world, kids are going into your medicine cabinet in taking your leftover vicodin and everything else from your last dental surgeon and they're taking that to parties too. in that kind of world where were taking brains and dumping them into these dues of chemicals that can really change their brains, we have got to have a different approach. suddenly, up until recently it's like if you do something bad, you should go to jail.

if you break the rules you should go to prison. it turns out, it's a bad idea because so many people have now gone to prison that the stigma is not even really there anymore you've heard so many people and you look at the prison and it turns out, as we said, a lot of people have mental health issues. you haven't solved the underlying problem. you just hurt a lot of people who were already hurt. my hope is that the criminal justice system can start being data driven, evidence-based, i would love to see wardens. [inaudible]

i would rather they get paid based on people are here, i dealt with the addiction, i dealt with mental health issue, they did well and now i get a big bonus because i've actually been using a data driven evidence approach that outcome oriented. we have all these systems now. >> so i think this is a challenging question. this scenario in some places takes place with the same person, that guy, maybe ten maybe ten times in a three-month time. a lot of governors and the state senator from new york in particular is so concerned about this that he is thinking or has introduced legislation that would say pretty much, if there

is a consistent pattern of overdosing, someone has to step in. you mention someone overdosed four times, it could've been he never got to for after three. again, they are seeing seven and eight and nine and that's a lot. what the state senator is considering, and i must say is someone who has worked in all the elements, he's actually thinking about arresting for possession but diverting for treatment. that's what these people get. they're not going to jail. it's a strategy that one wouldn't use, but to me it seems reasonable or at least something to think about. >> i've gotten in a lot of

trouble when i first became speaker. i've been deeply influenced and she had been in new york city dealing with drug addictions. she described a woman who was an addict and her boyfriend was an addict and her boyfriend had abused her 3-year-old but the 3-year-old had been returned because of presumption that the mother is the best place and then the boyfriend got mad one evening and killed him pretty question is what do you do in a setting where you are faced with this. i said, very unwisely, we might might have to seriously look at taking children and those kind of circumstances and putting them in orphanages. of course people on the left like crazy and who would rip children away from their mothers and all this. then ted turner called and i actually got to go on, but i

realize later what i should've said is we need prep schools for the poor. if you are rich and you send little sammy to the prep school, nobody thinks that's an abuse yet, if your three or a four or five-year-old and a drug addicted household where you're in danger for your life, we don't have any good models and the foster system is not strong enough and now you come to this example. i am deeply anti- addictive drug use and i am deeply anti- addictive drug use because i believe in freedom. almost by definition, if you're you're an addict, you have given up your free will. i start with a very strong bias. i don't have a great deal of

sympathy that it's alright to be saved ten times in a row means that the rest of us have to pay for the ambulance to come once again to save you at the last possible second until the time we get there and then you die. it does strike me that there has to be some ability to look at patterns of behavior. you can make a cautionary argument, you over dollars once at the sign truly stupid and we will give you a pass. he overdosed twice, at that point, you clearly are out of control of your life and therefore we have an obligation to help you get back in control of your life so you can go back to being free. that's coercion. this is a very serious national dial log we need to have. there are a significant number

of homeless people who are homeless because they want to be those of you who drive over by union station know there is a homeless shelter and for most of the year, you drive by there. he will see somewhere between ten and 30 people who are sleeping on the street, outside the shelter. they go to the shelter to eat and they go back outside because they don't want to be in the shelter. they don't want to be controlled by anyone. now it makes you uncomfortable but on the other hand, as long as they are in control of their life and making decisions, i actually actually favor their freedom to be goofy. a person who shows up like this, they have lost control of their lives. they are not in control of their life. they are relying on society at large to save them. this goes back to your point about the brain.

i think i would favor states exploring. >> i would keep this at the state level. we need local communities trying to sort through, how do we maximize saving these lives and getting them to a point where they can return to society as a complete person capable of being free. >> i see it slightly differently and that i just don't have a good answer. you state your biases and i will state mine. my bias is that we should do what works and that if a coercive model doesn't work,

you're telling somebody you have to get clean yet to get clean right now. if that doesn't work and it makes things worse and it drives people underground to make people less likely to call for help, we at least have to be attentive to that. we share some bases as well which is that i am a thousand% against the use of addictive drugs. i grew up in a family where all the men in my family are incredibly hard workers, but at least until me, hard workers, hard smokers and hard drinkers. they wound up, all of them with good lives but they were also

impacted by alcohol. my father also died of lung cancer. i made the decision i wasn't going to drink or smoke and i can set never had a beer or a sip of alcohol, i'm extremist and all of that. for me, i look at any addictive behavior with some poor because i know in my own family, we have such a strong pattern of that. i live in california, but i am not one of these pro- drug, drugs are freedom, no drugs or slavery. to me it's the opposite of freedom in every way. my life is really, really bad and i want my drugs i might why don't you fix your life. your life would be great rather than having this horrible life that you need to have drugs to feel better about it. in that regard i think were similar. i just worry that if you get overly coercive you have

unintended consequences. >> we only have about ten minutes. my plan was to assess one last question which is another tough one, but follows along a man just ask one of you to sum up. that will go to questions. there's a lot of talk and i certainly understand it about reducing the six sigma. sometimes i wonder, in a way, how realistic, i'm thinking of that photo that went viral of these two adults who were overdosed in their car with the 4-year-old in the back and the parents, it was a grandson but the to a red adults were arrested for child endangering. the way the debate has been set up, as i've watched it and not as presented by you, but just

watching in general we have brain disease on one side and moral failing on the other, but when you say brain disease what conjures up in many people's mind is that the behavior is completely involuntary and hence no responsibility at all, but people take responsibility at at times looking at you. patients come into our clinic all-time because the wife was going to leave them or some consequence just got so much or they just got sick and tired of being sick and tired and they come in so it's a little bit more complicated than just having epilepsy or multiple sclerosis where, if i put you in a drug court with some sanctions , if you don't keep this appointment, in other words

that is a disease process that's autonomous. it doesn't respond to consequences but addiction can. guess the way i would sum up that question is, is there a way, is there a way, can social disapproval of addiction, i think everyone knows these people are suffering in my personal theory is that the form of self medication, but the point being, social approval for addiction, coexisting with compassion and greater treatment mothers against drunk driving has made great progress. >> think what you're after is how we frame this issue. my view is we haven't made the progress we would like to make in eliminating racism and prejudice in this country but with the 64 civil rights act, we

have done our job trying to outlawed discrimination. no matter what you think, you just can't act in a discriminatory way. that is my view as to how we move this forward on making sure that we get people treated. we are still going to be arguing, is the moral failing or medical failing. i wish i could say, i wish i had greater faith that we will overcome our biases and prejudices and all the sun that would mean insurance companies would pay we would fund and treat the sequel and integrate it with the rest of medicine. i don't think that's going to happen. i think we need to enforce the law and i think we need that moment of clarity, those of us who have been suffering from addiction and have had some chance to get some sobriety, and as a society we need a moment of clarity. we have 40000 people dying of

overdose, we have 42,000 and 2000 taking their own lives every year, this is a public health epidemic and it's like hello, where is our response. we are collectively stuck in a time warp where we are not understanding that we can do something about this. to your frame, i think we get away from having these debates and enforce the law so more people can get treatment. >> i want to be clear about that. i don't think people are as smart as you want us to be. just say one more time the law that you want us to enforce and why that would make everything different. >> so the law i want to enforce is the mental health parity which says the brain is part of the body, and you treat illnesses of the brain the same as other illnesses.

pharmacy and benefits. at the primary care, secondary and tertiary levels. in other words, the whole whole spectrum. today we only treat addiction as a stage for illness. to go to your issue about how do we address that gentlemen who needed four times, you wouldn't come in the future let that person get that far because they would have grown up in a household where you would've known their parents, they had addiction, depression and anxiety, you would've known they had exposure to violence deprivation, ever other causes of trauma and you would know that they are at a high-risk. the future is avoiding having to use it because we are waiting too long. that is not the paradigm we should be thinking about. the paradigm is not how are going to have more advanced directive and coercive

treatment, although i know today having been guardian to my mom, there are near-term realities you have to deal with. the future, let's keep in mind, let's move upstream and tackle these problems as stage i illnesses where people are at risk for the illness. to your point, you were a walking risk. you had no help from your medical system, i guarantee you, intervening and saying tell us about your family history of alcoholism and addiction, i guarantee they didn't say that. you made it your own personal, we in the future need medical consulting, we need the medical system to say like cardiovascular disease, like cancer, what are you at risk of. let me see what you can do to curb your chances of getting cancer and having addiction. if i have that on my medical

record, because we should be treating this as something separate from medical care which is what we do in medical records today is keep them all silo, then i think think we have a chance of absolutely changing the course of these illnesses to the benefit of our criminal justice system, our healthcare system, the whole country we live in today. >> any last words? >> that's great. thank you so much. [applause] >> no wonder i couldn't see the question. >> okay, so here are the questions. we have until about 4:50 and

it's 4:30 right now. that's a generous amount of q&a. and i must ask when parents are able to get into treatment programs with the kids, two thirds complete the program. i guess the answer is obvious, shouldn't such programs be prioritized? in fact, i will just answer that and say yes, i'm sure you all agree. those kinds of treatment programs are excellent. they are expensive. >> the problem sally is insurance complain about all these rogue rehabilitation places that dry you out, err you out, out, send you out and your relapsing in no time well then, put more evidence-based programs in your network mr. insurance company and stop complaining about the road ones that aren't doing their job. right now my fellows and recovery can't get access to treatment in your narrow network which is a problem. you can't complain about the

five by day, stay here here for recovery when all you are doing is collecting the premium and sending people out the door. until you help us pay for what works, you will be paying for what doesn't work which is the problem today. >> let me tell you about a brilliant program and welfare reform. it's called america works and it was founded by two social workers who went out and created a business. they contract with the state and they only get paid if the person they have helped is still on the job six months later. so if you had an insurance contract that said we will pay a base rate to this point, but you don't actually get the bonus, as the person is still drug-free a year later.

you actually build and a huge incentive. it might be the best program of taking hard-core people and moving them into jobs. the problem is there isn't any continuity. you have some inpatient and then they are referred and there's no connection to the outpatient and we wonder why people fall through the cracks. in addition to getting in the er and having to be revived and then they have no aftercare. >> you mentioned, basically you're talking about incentive, with respect to addiction, when we talk about this were talking about sanctions and negative consequences, but positive are

extremely helpful. there is literature on contingency management, working with people on addiction programs that the better they do they get rewards or more freedom and they don't have to report as often. : we don't create another problem.

i think first of all the long-term goal would be to help the person initially be able to cope with the effects of their brain having been rewired. it's almost proven to be a guaranteed failure. i would like to live in a world where nobody was addictive and needed that kind of help. it enables you to go through what may be a segway or process.

it's hard for the other private practitioners to describe because they don't have that backup with the counseling. in other words, the sciences and guiding the policymaking and it's happening all over the country. at the height of the crisis, we are not following what the science tells us to do. this is i think for those of us that have been thrown into this world if we had more detox centers people would go and get detox and get a phd and everything would be fine.

it turns out that isn't true. in fact people are at a great risk after a shot or detox their brains have begun to rework a little bit and there they are back in the world. they don't have any other medicine to rely on. what happens to people they go back and see what was i relying on before and they take the same dosage and it now gets them de dead. literally detox turns out to be a springboard into the morgue and we've been fighting for the wrong thing because we are not paying attention to the science. we have these theologies are bound peace talks but guess what it turns out for a lot of these

things a 13 step getting medical support and if we tell people 12 steps we will be going to more funerals, not fewer. >> this questio >> this question is from the legislative exchange council. do you have any policy solutions you can offer to those? >> we have to appreciate the multiplier effect when someone is ill and desist amid the costs

of the. of people are getting better and it's like the trifecta and what do we do, we don't have that model easily replicable because no one is going around the country saying here's the step-by-step process mr. state legislator. they don't -- we need that roadmap and it needs to be available so that they know what to do to make a difference in this issue.

>> you do see a wave going across the country but is having a significant impact. people who are not a danger to society are being reintegrated. south carolina, mississippi, another number of places where they are doing is crazy. it's breaking up communities by taking people who are nonviolent and nonthreatening and turning them into real criminals and taking that out of the community so in that sense if you can have a wave of examples you find a lowouldfind a lot of state legis and governors who are prepared to do those kind of changes and it could be enormously powerful.

[inaudible] >> does someone have a microphone? it's related to all the others. they can also show us many other areas and you talked about the

attitude about addiction but there is a pretty significant percentage that feels differently. there is no communication like so many other things and i think this is an issue if you missed the rest, it's too late. this is an issue that we need that kind of dialogue between those that feel as you do that this is a medical problem and there are medical solutions and others who still feel that it's a moralist issue. >> they are one of the centers of concern because the different

impact us in their lives and the degree that we have to worry about the addiction rate at the same time. i'm not quite sure how one has a dialog. the plaintiff that we were entering and i would be quite happy to have a debate on this at some time, somebody that is in their tenth recovery from overdose i'm terribly comfortable saying that's bad. maybe somebody wants to save it as a neutral experience and we shouldn't prejudge it, but there is a huge difference between addictive drugs to take control of your life and that is part of where i grew up. there are certain drugs you take to rewire your brain so it's not like you're walking around saying i think i will make this choice is a.

we have to have a national dialogue and i thought patrick did a beautiful job of saying it. i am very prepared to be hostile to the idea of becoming addicted and at the same time sympathetic and open to a person that is trying to deal with their addiction. i want to encourage someone to come out and say i have a problem. i want to really intensely discouraged them from thinking that it is an acceptable gamble to see whether or not because i think it would be a terrible thing to have happened and it has all sorts second order risks

including suicide so that is my bias. >> this is some of the hardest stuff. what is the right mix of carrots and sticks. the. i don't think that anyone being enslaved to addiction is a good outcome and it's something i will fight until the last dog barks to keep my children safe. at the same time, they are coming out of the society that we lived in that is so

judgmental and lacking empathy. we are missing it somehow. there is a new place we have to arrive where we are wanting people to live full lives. we are willing to fight for that and use the right. and sticks ansince sticks and ae time, we are assigning the right causal factors in the genetics and medicines and we can't escape it they are going to get bigger and bigger. we are being dragged into a different conversation and i can't telcantell you very much e you having given 15, 20 years more but this is the one issue.

opens up a whole different door i feel a. to the point about veterans that was four times that of the opioid overdose but they are not only dealing with the va trying to access care most get it through employer-sponsored health care. people don't know that. we need to make sure the parody is out there for the patriots.

they can't get treatment for the signature wounds of war of post traumatic stress that is on all of us. after the phoenix debacle, veterans started the weight of the kerry and they monitor the va across the country and how long it took to get the disability claims adjusted. we need to do the same for private insurance. we are working out with the afghan veterans of america to report when they can't get access to and from, united, humana insurance so we can tell the insurance industry you are not only denying the run-of-the-mill person with this disease, you are also denying those that served the country and that ought to get their

attention because there is a certain moral hazard continuing to deny treatment for these illnesses in a way we were never denied for cancer, cardiovascular disease or any other illness. so i appreciate you bringing this out and thank you for all you do for the nation's veterans. >> unfortunately, we have to and pretty sooendpretty soon in face have to end now. i apologize.

but [inaudible conversations]is brou

today by your cable or satellite provider. next come the remarks by wikipedia founder jimmy wales talks about the online encyclopedia and the role of contributors and its success. this was hosted by the cato institute.

[inaudible conversations] good evening thanks for being here it is a pleasure to welcome you to the cato institute and also to welcome those viewing on c-span. before we start i want to tell you about that joseph mclaughlin lecture series and i would like to tell you a little bit about joseph mclaughlin, the world-renowned epidemiologist who received his doctorate from the university of minnesota in

1981 at the cancer institute and 1994 was the cofounder of the international epidemiology institute where he served as president and was also an adjunct professor at johns hopkins university. he was a cancer epidemiologist and believed in the rigorous application of the scientific method and was occasionally known to the node in the state of the field of science. they occasionally fall prey to the bias correlation can be the causality to resist that impul impulse. that's not the only reason we

are honoring joe tonight. he was a generous sponsor group for two decades but he also had the broad accomplished intellect which so many of us aspire and failed to reach. the economics and genetics and it was particularly interested in the correlation between geography and achievement or civilization questions like why is silicon valley, why did hollywood become the home to the film industry.

joe attended a lunch where he was seated to an equally impressive intellect and that was just a few weeks before the untimely passing. but we arthough we are delightet through the generosity of gene rosenthal with his daughter allison through the series has been made possible. [applause] for those that are not as familiar in the institute, we view the mission as defense and

advancement into the american values of individual liberty and peace at a time when those values feel under assault and when the political process is dealing of choices that we find unpalatable. but it's important not to get discouraged and to kind of open the aperture little bit. all the freedom it's given us. it's given us the environment in which innovation can take place, and as a result i see people that know me i will be a bit of a broken record there is no better time to be alive as a human being than today.

we enjoy them in the united states and other countries but more importantly the greatest level of prosperity that has increased as global poverty has decreased substantially. he told a story about how to appreciate the miracle of free enterprise and the markets. you don't tell them what you want but when you get there, dozens of things you do want are there and high-quality modest cost. it's the miracles like this that remind me of a person that we are going to cure from tonight.

it's the information superhighway on a dial-up modem. if i told you there was going to be an encyclopedia available and it was going to be published in 295 different languages you'd stop me and say i didn't even know there were 295 different languages. unlike the stack of books available on the shelf that that would be online, the largest english version was going to have 5.2 million articles and i believe 3.2 billion words and you were going to be able to accept this as well free of charge, whenever you wanted to. ..

>> how that was going to be written without compensation by registered users of which now there are almost 30 million. we would've thought this could not be possible. but it is the genius of friedrich hayek, the the namesake of this auditorium that partially explains how merchant orders like wikipedia can come

to pass. it was the genius of jimmy wales that brought wikipedia into existence. jimmy was born in alabama, he attended and until eighth grade a one-room school that was run by his mother and grandmother which i believe was based on the montessori approach. i suppose it would not have to be this way but he really enjoyed pouring through encyclopedias as a child. he credits a self-directed upbringing as being the source of his creativity, he got a bachelor's degree at auburn university and a masters at the university of alabama.

i guess that means that iron ball they must be difficult for him. that is when auburn plays university of alabama every year. or maybe it's easy because he doesn't care who wins. he went to work as a researcher as a researcher at a chicago financial option firm where he worked from 1994 until 2000. in 2000 he left his job and became increasingly interested in the internet and started an internet company which did not succeed, but then founded wikipedia's forerunners pedia, i don't think it's technically a forerunner but forerunner but his first venture in first attempt at an online encyclopedia and then in 2001 launched wikipedia and the rest as they say is history which i will let him describe for us. it's a real pleasure to welcome jimmy wales. [applause] >> thank you very much.

it is great to be here. i actually did visit the cato institute about 150 years ago i think it was. i'm joking. it was maybe 20 or so. i had a girlfriend at the time was an intern here and i actually popped up by one day. that was fun. i will talk today about this topic, wikipedia and reason of discourse. for me this is one of the most important features of wikipedia which is something that is lacking in the world today. one of the reasons for the popularity of wikipedia is it's a place -- here's the original vision statement for wikipedia and that's for all of us to imagine a world where every single part person on the planet

is given free access to the sum of all human knowledge. that's what we're doing at wikipedia. one of the reasons that it has been so successful is that we have managed together this incredible group of volunteers, this group that's very passionate about wikipedia, but but getting it right in sharing knowledge, one of the reasons they are passionate is that we have a really big vision, let's get together and write, they say every single person on the planet give them free access to the sum of human knowledge. since 2001 this community has been more than 40 million entries. we have monthly over 400 million unique visitors, it's a staggering number to get your head around, our internal server suggest a higher traffic, this is the official numbers from the

comp store we know that's very good at measuring traffic in the u.s. and the they are improving all the time, but we believe this number is a little bit low, still a big enough number so we are happy with that. wikipedia is in 284 languages. i was think this number is a little unfair, i don't claim 240 languages goes a fair number of very small. there's 284 websites that have a very tiny community working and so if you want to get an idea of the scope of wikipedia in the scale some of the key statistics we have ten languages with over 1,000,000 entries. entries. i'm excluding two languages that are primarily written by bots

which is another topic we could talk about. in terms of human written languages there ten languages over 1,000,000, 48, 48 have at least 100,000, 128 have 10234 have at least a thousand. so thousand entries is quite small, it's not a useful or functional encyclopedia yet. that's a number i look at because was there's a thousand entries and others a small community there. there are 5 - 10 active users and another 20 or 30 and they start to think about how to we get more volunteers and so on. one of the things to think about is wikipedia is not easily distributed round the world. the distribution of where wikipedia is bigger not big in many ways you could predict it easily. what are some of the factors. the degree of education is it important. access to broadband is

important, various other cultural factors if you look at the top entries per capita some of the top languages per capita it would be icelandic, swedish, so why is that but i have a theory, the italians tend to go out in the evening with gelato this is a joke but it is true that we did see some of the factors are hard to predict. we see that european countries are hard and strong and wikipedia. we talked about the global nature of wikipedia one of the questions whereas have is the question of china, quite famously china is the most of

they have the biggest internet net. we have a long history in china we are blocked in for many years and then unblocked. we were for very long time and on easy equilibrium. they were able to block individual pages from wikipedia. then unblocked a most all wikipedia but filtering certain pages. the pages there filtering where the most part. these are the kind of things that she felt third out but they let most of wikipedia through, we made a commitment that we

never cooperate and never participated censorship we can't stop them from filtering their own network. and they really wanted us to come into china. they wanted to make sure that it was all legal but we said no to that because we believe that fundamentally the right to an encyclopedia is a fundamental human right. as it's equivalent of the right of freedom of expression. whatever restrictions you might expect on speech in different societies, the facts of the world should not be part of that. well, now due in no small part to the revelation of ed snowden about the nsa program in which there's one particularly sly that we found annoying which said that it's an easy site to

spike as is not encrypted we move very quickly to encrypt encryptions to wikipedia. what this is meant for the freedom of expression worldwide is quite interesting. when ht tps that means anybody who is spying on the connection cannot see which page you are reading. they can see that you're talking to wikipedia but they can't see which page you're reading. the policy option of filtering out specific pages is no longer available to governments worldwide. so they have to adopt an all or none approach. almost every country in the world can use that, it's too great a price to pay to ban all of wikipedia so that is been a big win. this has not worked in china. china is now completely blocking wikipedia. we will continue to have dialogue with them and i'm very

much a believer in having conversations and trying to bring them along. we are very patient, patient, we have no plans to compromise, fortunately i don't exactly in state compromise to learn a deadlock. i will say there is something interesting that is happened over the years, we were blocked in china for several years and then just before the beijing olympics china experienced a period of more openness, they knew that foreigners were coming from overseas and trying to use the internet. so they unblocked a lot of websites that were previously blocked. someone sent me an interesting man menu in beijing and it said that wikipedia fried with eggs. another one beef brisket and wikipedia flavor. someone semi- this and they said what does this mean?

and i wrote back and i said, i have no idea. but i do know who probably will know so i sent an e-mail to the beijing area wikipedia and so i said what does this mean? and they conferred and wrote me back and said we have no idea. the best that we can figure is that because we wikipedia had just opened up a lot of restaurants decided they needed to translate their menus so they are going on google to translate and anything you type into google the name of the food was the first thing that comes up, wikipedia. must be pdf. so i like it spicy myself.

we have had a cultural impact in china. even though we are currently blocks and we are nonprofit and we think about the state about the for the long run. so one of the other things that people are interested in but we talk about the global nature of wikipedia's and all of these languages and it's important to understand it's not written in english and then translated in other languages it's written organically and then a lot of translation goes on. as much translation goes into english is out of english. what's interesting to think is how does it differ across different countries? we did a study, pulmonary study where we looked at what are the most popular pages in wikipedia. this is not the content, this is

what the readers are interested in. if you take a look i don't know if this is a point or not, the graphs are for english, chinese, japanese, french, german russian and spanish. one of and spanish. one of the first things that pops out of people's if you see the big green bar for japan this is pop culture. if you know anything about japan this makes sense that japanese love pop culture, american pop culture, japanese pop culture, it's a big part of the japanese intranets of this sort of makes sense. another one is the germans are the most interested in geography. i'm not sure that's a good thing i don't make that joke when i'm in germany. so there little sensitive about

that sort of thing. and then finally you'll see that most all of the languages, 11 of the top interest is human sexuality, topics about sex is a topic people are interested in. in france and spain which puzzled me the someone explain that in france and spain there actually having sex. and the rest of us are just reading about it in the internet. while it's fun to joke about one of the interesting things about our community we have a very diverse community, a lot of people from different cultures around the world and people do like a pit playful and positive way to go around with this daria types but one of the things is that this is a group of people who are global in their outlook. they made friends from the world, they don't think of themselves as being inherently in conflict with other cultures, their learning about each other. one of the important questions that we should all ask ourselves because wikipedia is now part of the structure of the world this

who writes wikipedia. why do we want to know who they are? is a quote from twitter, this is from school library and he said, yesterday asked one of my students if she knew what an encyclopedia is and she said is it something like wikipedia? so if you think about wikipedia it is now 15 years old it's been around for 15 years now. that means that for kids who are entering university today, wikipedia has existed from the time they were learning to read. the kids entering university's today the wikipedia generation. certainly the last five years when they're old enough to start researching topics online for school wikipedia was huge and ubiquitous as part of the atmosphere. for that generation wikipedia is truly part of the infrastructure. something very familiar to them.

so we should really care who writes wikipedia. we should care about the quality of wikipedia because it's important to the world. just a few things by the numbers, our numbers, our community is about 87% male. we looked at the number multiple times, sometimes as little for lower, or a little higher. i think it's more like '80s. it's not good. we know the gender imbalance in wikipedia is something that probably has to change in order to address the problems we have with the unbalanced content. people in wikipedia right about what they know. we have an average age of 26, about double the percentage -- compared to the general public. these are basically find except the gender imbalance is a problem. an example we give to illustrate the problem, if you look at award-winning novelist, people

people who have one major literary prizes for their work and you look at the entries on the mail novelist versus the female novelist, the mail novelist had much longer entries. i know many wikipedia ends this is not because they go all it looks about books about girls. it's that people write about their passion about the books they've read. there's a truth that among great literature there books that are primarily aimed at a female audience in that readership directly translates into bias in wikipedia when we don't have enough women participating. something we want to address. another thing that when you're using wikipedia your typing, your reading and it's written in a very authoritative style. it somewhat impersonal. it's not like a message board message board where you feel the

personality of the person who wrote it and things like that. so for many people new to wikipedia it seems institutional and hard to imagine the volunteer. i'm going to show you a short video of some volunteers showing you, letting them speak their own words. >> you have knowledge why keep it by yourself. you must share it. i think. >> i like that the purpose of this website didn't say website. didn't say website. didn't say wiki, didn't say internet, it just said free knowledge for everyone in our language. when it's open it's really made up those who are taking the invitation. course you don't have to take it but there is an invitation up there to say, and

be part. what you know is as important as what we know. >> you giving education to people in the whole world. so that's great by contributing to wikipedia can be available to everyone. >> is making yourself happy by helping others. that's it. i want to be healthy i help others. you're you're working together were so many different people and it's just amazing. >> the thing amounted to me is it's about really sweet people, there's the sweet people who are just going on and typing them instead of yelling at each other having a conversation or reading about gossip they're trying to build something that everybody else will find. that's sweet. >> let's talk let's talk about the real community. one of the things that i complained about a lot in the internet world is people talk

about online communities, but often times they just mean the general public when they talk about communities. in fact it's not really the right way to understand wikipedia. if your mental model of how wikipedia works is 100 million people writing one sentence each , this is not correct. in the introduction i forget the number listed there is a total of 4 million, however many people but this number is irrelevant because what really matters is that there 80000 or so volunteers, loosely defined who these are people who edit at least five times a month. a lot of people just make one edit a month and they never come back and so on. those people are important to the overall process but they're not really the community. the community as the people who take care of wikipedia and look after it. that's really the 3 - 5000 people who are organized. these are people who build

wikipedia. the eight dear that you can throw up a wiki and it will turn into it and encyclopedia is impossible. what is possible is organize small group collaboration, self organize for the most part and the key here is these are people who know each other and they work together a set of guiding principles. were talking about human being saul tell you a lot of good things about the community and how to work together but we can't forget that we talk about human beings. you'll get if i sent in arguments and there's a lot of drama noise underneath the surface. several of these things were going to talk about which are fundamental that people turn to to help resolve disputes. before going to that i want to talk a little bit about the influence of hayek on my thinking. one of his most famous essays was the use of knowledge of society 1945, if you haven't

read it, you don't really need, you can google it and it's available online. it's very assessable. basically he's discussing a problem that we wish to solve when we have a rational order. there's an analogy here to wikipedia. basically what he said is the problem and at that time was a really live intellectual dispute. the question of whether essentially planned economy could outperform a market economy. what he pointed out was that the key question was that for a planned economy you need to pull in all the information you need and then the advance of economic science and mathematics you can solve the system and determine the optimum factors of production in their ego. and he pointed out the problem is we can't gather that information or it would be too expensive together to the center. given that the question is do we

bring the information in the make decisions in the center or do we push it out? by analogy this is part of the concept of wikipedia that we could try in a traditional way to hire experts and gather information of the world and synthesize it but it out in that way. we come up with something fairly decent but small and limited and errors would be hard to correct because we did have a small group of experts and if they were about wrong. the wikipedia model you is putting the decision-making to the endpoint. with a people come and take whatever interest they have and they work on the entries. often times we find is people who are experts in expertise is widely distributed in society. it's not necessarily going along professional lines. i'll give an example.

i've taken up a new interest and i don't know if i can explain why but i've become interested in the history of aviation. in the early development. i don't know why, it's not something i been interested in before but i've been reading a lot about it. it's astonishing to read. if you want to read about the history of the d.c. eight passenger jet, it's incredible, there's huge long entry including every variant of it, all of those are listed there, you cannot pay anyone to write this stuff. it will cost a fortune and also you wouldn't necessarily find that person who knows the most about is sitting somewhere at a university know something is so esoteric that someone cannot understand. what you find is that there's airplane geeks and hobbyists who found each other online, discuss these things, they debate and they work on this. but pushing the decision-making to them points we don't have to push it into the center and

judge it they work on it together. they do so as i say under the set of guiding principles, share concepts. one of the concept is wikipedia is an encyclopedia. there's a page that says what wikipedia is not. what it is not is a history book, it's not a library, for very early in the history of wikipedia someone started uploading the full text of hamlet we had a debate about whether it belongs there. we said no the full text of hamlet is not an encyclopedia article but in fact, it should be the full taxes should be the history and you know in your mind exactly what it would look like for hamlet. it is not you too.

as much as i love a funny cat video they don't belong in wikipedia. this idea of an encyclopedia something that's easy for someone to share. five say to you encyclopedia entry about the eiffel tower everyone in this room knows what that will look like. will tell the history when it was built, what was the cultural impact, there should be pictures. we can fight about details forever and they will, but we know it were driving after that. it's not a travel guide. so our entry on the eiffel tower when i tell you here's the five best restaurants nearby. we have a travel site around that thing. the idea that it's an encyclopedia is important and gather in the community together and allow people to understand more try and accomplish. another core value is neutral points of view. on any controversial topic wikipedia itself should not take

a stand on that topic but should describe the major sites in a fair way. the idea is that it's both a social idea and a mythological idea. it's really the only way to get people to work together. if her can organ have a controversial issue let's say abortion, you can imagine a very kind and thoughtful catholic priest in a very kind and thoughtful activist and as long as you understand that wikipedia is not good to tell you whether or not abortion is good or bad but describe it the priest will understand that wikipedia can't lead off saying abortion is a sin but they can say catholic church's position is such and such and so system logically what's great is this is what i want, i don't want to come to an encyclopedia and there's only one side of the story. finally want 11 side of the story i can click on your favorite news channel they're very good at telling you one side of the story.

actually one here an argument that i agree with or disagree with and understand why people are saying the different things. when this works well that catholic priest in that planned parenthood activists they can both paint to entry with pride and say like if you read this you will understand the debate. and that's really important. it's really one of the fundamental goals of wikipedia. not to persuade people of any particular point of view but to persuade them that learning and knowledge about the world is the best way to come to a particular point of view. another core principle is that it's free. we wanted to be free to redistribute so it means that you can copy, modify, redistribute versions commercially or noncommercially. people can take the concept and repurpose it into whatever they want and were happy when they do that.

what is this mean? in order to make it legally possible we have to respect the law so we respect copy right, we don't allow copyright violations but is broader than that. you can play try something without technically violating copyright but we don't want to plagiarize things. it's important as an ethical thought within the community to say whatever problems are with wikipedia we can say that we made that. we cited our sources and this is important from an ethical point to be for us in the community is very passionate about it. if you think about the kinds of legal problems that we might have dealing with copyright infringement is very minimal for us. the community police does the copyright complaint rise to the legal department. another core value is civility.

one of the earliest rules of wikipedia is no personal attacks. we all know if you go online to any kind of discussion of anything it can quickly descendent to vicious personal attacks. tax on you as a person. this is against -- all pretend to you it doesn't happen. people get upset and yell and insults but there is a fundamental pipe in the community that is wrong. but if you've done that you should apologize. if you don't apologize you should be banned and we do ban people who can't behave in a proper manner. it's. it's not a perfect system but it works well. it does help to attract a good group of people. who really care about getting it right. one of the areas where newcomers actually have a hard time because they come from other environments where the way to get something done is to yell at people and insult people

that's normal behavior fear. you come to wikipedia had its like like whoa, he immediately start off to edit the entry on hillary clinton and you immediately come in and start going you left us in were like hold on were writing an encyclopedia so relax a little bit. let's try to improve the entry together. one of the strangest rules is iar which is ignore all rules. this again has two meanings to it. one is it's basically we want to be able to question our roles. are they actually valid and helpful? so we want people to say if you see a way to improve it that's against some alleged role go ahead and do it but you better be ensured that you're improving it. it's not an easy thing to ignore all the rules. the rules themselves should be