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“That Escalated Quickly”: Mike Wilson Takes Victory Lap As Markets Crash, Sees S&P Tumbling To 3,400

"That Escalated Quickly": Mike Wilson Takes Victory Lap As Markets Crash, Sees S&P Tumbling To 3,400

One week ago, Wall Street’s second…

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"That Escalated Quickly": Mike Wilson Takes Victory Lap As Markets Crash, Sees S&P Tumbling To 3,400

One week ago, Wall Street's second biggest bear (after BofA's Michael Hartnett who turned rather apocalyptic last Friday, and of course excluding SocGen's Albert Edwards who is in a category of his own), said that "there is no place left to hide" in stocks as the rolling bear markets finally hit the broader index, and warned that the bear market rally (which he was correct about unlike all of his JPMorgan peers) was about to turn "grisly" (or is that grizzly).

Fast forward to his latest Weekly Warm-up note (available to professional subscribers in the usual place), where he takes a prompt, well-deserved (again) victory lap on his latest dismal forecast, and writes that after suggesting last week that the bear market was entering the phase when virtually nothing would work, even defensives, "based on the price action, that seems to be exactly what's happening" with price action turning "especially vicious" last week as we enter the next phase of the bear market. Indeed, while the S&P 500 dropped "only" 3.4%, the breadth suggested the move was even worse with the cumulative advance / decline line making new lows for this bear market. Defensives were a very modest underperformer for the week (-0.5% relative) even though they remain the unequivocal leader year to date (+15% relative).

Meanwhile, the negative fundamental news and data points are piling up fast as - according to Wilson - they "tend to follow stocks that have been signaling bad news was coming" and as such, last week's shockingly bad, pre-recessionary Q1 GDP at -1.4% fits the bill and "suggests Ice has arrived."

What was behind last week's sharp market repricing and earnings reassessment?

Recall one week ago - well before the dismal earnings from AMZN and the mediocre reports from the other gigacap GAMMA stocks - we said that "Q1 Earnings From Bad To Dismal: Tech Earnings Sliding, Guidance Collapsing." Looking back, Wilson agrees that the catalyst for the sharp and broad move lower last week "was the growing evidence that growth is slowing faster than most investors believe. In short, we believe earnings estimates remain too high over the next 12 months even though 1Q results have been better than expected, once again."

At the same time, another issue is that the quality of earning is deteriorating, and the commentary from management teams is getting incrementally cautious about the future path of growth. This, Wilson says, "is very much in-line with our view for earnings revisions breadth to continue falling as operating leverage turns negative. We think Amazon's earnings and commentary from CEO Andy Jassy may encapsulate this view better than anything else:

"Today, as we're no longer chasing physical or staffing capacity, our teams are squarely focused on improving productivity and cost efficiencies throughout our fulfillment network. We know how to do this and have done it before. This may take some time, particularly as we work through ongoing inflationary and supply chain pressures, but we see encouraging progress on a number of customer experience dimensions, including delivery speed performance as we're now approaching levels not seen since the months immediately preceding the pandemic in early 2020."

Meanwhile, Wilson also points to the S&P 500 real earnings yield which he observes is the most negative since the 1950s. As the MS strategist reminds us, the textbook view of valuation says that higher rates should lead to lower valuations, and sure enough today this story is painfully unfolding with "the highest inflation in 40 years and rates nearly doubling over the past two months, yet index valuations remain stuck at historically high levels." Add 8%+ YoY inflation into the mix and we are left with the most negative real earnings yield back to the 1950s!

This has translated into real S&P 500 returns at -7% YoY, and means that "the S&P 500 has come full circle on the year, starting in May 2021 at 4200 and now nearly a year later, we're at 4135." Worse, if one factors in the latest March CPI at 8.5%, trailing 12 month real returns were -10%, -8% including dividends. The real return is even worse for the Nasdaq 100 (-15%), and the Russell 2000 (-25%), or as Wilson puts it, "Anyone who tells you we are in a bull market has got a lot of explaining to do." We are confident Marko Kolanovic will get right on that...

Sarcasm aside, Wilson next makes a critical observation, noting that "perhaps stocks are no longer the inflation hedge investors expect" a point he made first several weeks ago in "Inflation Is No Longer A Positive For Earnings Growth... Or Stocks". As he adds, "rising inflation should theoretically pass through to top-line growth, making stocks a historically safe bet against inflation. Why is this time different" he asks rhetorically and answers that "valuations are still near their highest levels ever as shown by the earnings yield and subtracting inflation gives you a real negative earnings yield. This theoretically means you're buying -4% earnings contraction at today's levels."

Unfortunately, the plunging real earnings yield suggests even more downside from here according to Wall Street's second most bearish analyst. Looking back at history, Wilson notes that the real earnings yield leads the real returns by ~6 months. While the relationship is not perfect, it has held true during the 2001 and 2008 cycle with the real earnings yield leading real returns lower. And while Morgan Stanley thinks real earnings yields will likely bottom soon as inflation peaks, the market will continue to move lower from here. In short, the "ice" phase that Wilson has been predicting for a year, is now front and center and hard to deny. Stocks have been warning of this for months and now the evidence is becoming more obvious to all.

Meanwhile, even retail is realizing that pain is coming and margin accounts finally turned negative in April. Curiously, April is historically a strong seasonal month and 1Q22 earnings have been strong, yet the S&P 500 is down 8% and the NDX is down 12% in April. One possible factor in this according to Wilson, has been the first deleveraging in investor accounts since June 2020, as retail begins to sell (to hedge funds).

Why? Because rising rates are increasing the cost of margin while markets are 15-20% lower from 2021 highs, hurting the 'buy the dip' mentality. Here Wilson thinks that lower liquidity will continue to point to a broad de-rating and lower prices at the index level.

What does all this mean for stocks in the coming months? Nothing good: as Wilson concludes, from a technical standpoint "the S&P 500 has minimum downside to 3800 (-8%) in the near term. This represents 16x forward 12 month bottoms up consensus EPS which is looking more at risk now." In other words, 16x is fair value... but if forward EPS starts to fall, there could be "much" more downside.

Which means that as Wilson highlighted back in January, the true technical support lies at the 200 week moving average if there is going to be a true growth scare with recession probabilities rising materially. Unfortunately for bulls, that currently comes in at 3460, or 16% lower. It also lines up with the pre pandemic highs of 3400 which seems to be where a lot of stocks have already ventured.

In many ways, Wilson concludes, "this makes perfect sense from the point of view that the pandemic did not create real value for the economy or most companies, but rather destroyed it." On the positive side, even Wall Street's 2nd biggest bear concedes that the market is currently so oversold, any good news could lead to a vicious bear market rally, something which Goldman discussed in its bullish note. Which is why Wilson writes that while he can't rule anything out in the short term he wants to make it clear "this bear market is far from completed, in our view."

There is more in the full Wilson note available to professional subscribers in the usual place.

Tyler Durden Mon, 05/02/2022 - 13:10

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The War Between Knowledge And Stupidity

The War Between Knowledge And Stupidity

Authored by Bert Olivier via The Brownstone Institute,

Bernard Stiegler was, until his premature…

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The War Between Knowledge And Stupidity

Authored by Bert Olivier via The Brownstone Institute,

Bernard Stiegler was, until his premature death, probably the most important philosopher of technology of the present. His work on technology has shown us that, far from being exclusively a danger to human existence, it is a pharmakon – a poison as well as a cure – and that, as long as we approach technology as a means to ‘critical intensification,’ it could assist us in promoting the causes of enlightenment and freedom.

It is no exaggeration to say that making believable information and credible analysis available to citizens at present is probably indispensable for resisting the behemoth of lies and betrayal confronting us. This has never been more necessary than it is today, given that we face what is probably the greatest crisis in the history of humanity, with nothing less than our freedom, let alone our lives, at stake. 

To be able to secure this freedom against the inhuman forces threatening to shackle it today, one could do no better than to take heed of what Stiegler argues in States of Shock: Stupidity and Knowledge in the 21st Century (2015). Considering what he writes here it is hard to believe that it was not written today (p. 15): 

The impression that humanity has fallen under the domination of unreason or madness [déraison] overwhelms our spirit, confronted as we are with systemic collapses, major technological accidents, medical or pharmaceutical scandals, shocking revelations, the unleashing of the drives, and acts of madness of every kind and in every social milieu – not to mention the extreme misery and poverty that now afflict citizens and neighbours both near and far.

While these words are certainly as applicable to our current situation as it was almost 10 years ago, Stiegler was in fact engaged in an interpretive analysis of the role of banks and other institutions – aided and abetted by certain academics – in the establishment of what he terms a ‘literally suicidal financial system’ (p. 1). (Anyone who doubts this can merely view the award-winning documentary film of 2010, Inside Job, by Charles Ferguson, which Stiegler also mentions on p.1.) He explains further as follows (p. 2): 

Western universities are in the grip of a deep malaise, and a number of them have found themselves, through some of their faculty, giving consent to – and sometimes considerably compromised by – the implementation of a financial system that, with the establishment of hyper-consumerist, drive-based and ‘addictogenic’ society, leads to economic and political ruin on a global scale. If this has occurred, it is because their goals, their organizations and their means have been put entirely at the service of the destruction of sovereignty. That is, they have been placed in the service of the destruction of sovereignty as conceived by the philosophers of what we call the Enlightenment…

In short, Stiegler was writing about the way in which the world was being prepared, across the board – including the highest levels of education – for what has become far more conspicuous since the advent of the so-called ‘pandemic’ in 2020, namely an all-out attempt to cause the collapse of civilisation as we knew it, at all levels, with the thinly disguised goal in mind of installing a neo-fascist, technocratic, global regime which would exercise power through AI-controlled regimes of obedience. The latter would centre on ubiquitous facial recognition technology, digital identification, and CBDCs (which would replace money in the usual sense). 

Given the fact that all of this is happening around us, albeit in a disguised fashion, it is astonishing that relatively few people are conscious of the unfolding catastrophe, let alone being critically engaged in disclosing it to others who still inhabit the land where ignorance is bliss. Not that this is easy. Some of my relatives are still resistant to the idea that the ‘democratic carpet’ is about to be pulled from under their feet. Is this merely a matter of ‘stupidity?’ Stiegler writes about stupidity (p.33):

…knowledge cannot be separated from stupidity. But in my view: (1) this is a pharmacological situation; (2) stupidity is the law of the pharmakon; and (3) the pharmakon is the law of knowledge, and hence a pharmacology for our age must think the pharmakon that I am also calling, today, the shadow. 

In my previous post I wrote about the media as pharmaka (plural of pharmakon), showing how, on the one hand, there are (mainstream) media which function as ‘poison,’ while on the other there are (alternative) media that play the role of ‘cure.’ Here, by linking the pharmakon with stupidity, Stiegler alerts one to the (metaphorically speaking) ‘pharmacological’ situation, that knowledge is inseparable from stupidity: where there is knowledge, the possibility of stupidity always asserts itself, and vice versa. Or in terms of what he calls ‘the shadow,’ knowledge always casts a shadow, that of stupidity. 

Anyone who doubts this may only cast their glance at those ‘stupid’ people who still believe that the Covid ‘vaccines’ are ‘safe and effective,’ or that wearing a mask would protect them against infection by ‘the virus.’ Or, more currently, think of those – the vast majority in America – who routinely fall for the Biden administration’s (lack of an) explanation of its reasons for allowing thousands of people to cross the southern – and more recently also the northern – border. Several alternative sources of news and analysis have lifted the veil on this, revealing that the influx is not only a way of destabilising the fabric of society, but possibly a preparation for civil war in the United States. 

There is a different way of explaining this widespread ‘stupidity,’ of course – one that I have used before to explain why most philosophers have failed humanity miserably, by failing to notice the unfolding attempt at a global coup d’etat, or at least, assuming that they did notice it, to speak up against it. These ‘philosophers’ include all the other members of the philosophy department where I work, with the honourable exception of the departmental assistant, who is, to her credit, wide awake to what has been occurring in the world. They also include someone who used to be among my philosophical heroes, to wit, Slavoj Žižek, who fell for the hoax hook, line, and sinker.

In brief, this explanation of philosophers’ stupidity – and by extension that of other people – is twofold. First there is ‘repression’ in the psychoanalytic sense of the term (explained at length in both the papers linked in the previous paragraph), and secondly there is something I did not elaborate on in those papers, namely what is known as ‘cognitive dissonance.’ The latter phenomenon manifests itself in the unease that people exhibit when they are confronted by information and arguments that are not commensurate, or conflict, with what they believe, or which explicitly challenge those beliefs. The usual response is to find standard, or mainstream-approved responses to this disruptive information, brush it under the carpet, and life goes on as usual.

‘Cognitive dissonance’ is actually related to something more fundamental, which is not mentioned in the usual psychological accounts of this unsettling experience. Not many psychologists deign to adduce repression in their explanation of disruptive psychological conditions or problems encountered by their clients these days, and yet it is as relevant as when Freud first employed the concept to account for phenomena such as hysteria or neurosis, recognising, however, that it plays a role in normal psychology too. What is repression? 

In The Language of Psychoanalysis (p. 390), Jean Laplanche and Jean-Bertrand Pontalis describe ‘repression’ as follows: 

Strictly speaking, an operation whereby the subject attempts to repel, or to confine to the unconscious, representations (thoughts, images, memories) which are bound to an instinct. Repression occurs when to satisfy an instinct – though likely to be pleasurable in itself – would incur the risk of provoking unpleasure because of other requirements. 

 …It may be looked upon as a universal mental process to so far as it lies at the root of the constitution of the unconscious as a domain separate from the rest of the psyche. 

In the case of the majority of philosophers, referred to earlier, who have studiously avoided engaging critically with others on the subject of the (non-)‘pandemic’ and related matters, it is more than likely that repression occurred to satisfy the instinct of self-preservation, regarded by Freud as being equally fundamental as the sexual instinct. Here, the representations (linked to self-preservation) that are confined to the unconscious through repression are those of death and suffering associated with the coronavirus that supposedly causes Covid-19, which are repressed because of being intolerable. The repression of (the satisfaction of) an instinct, mentioned in the second sentence of the first quoted paragraph, above, obviously applies to the sexual instinct, which is subject to certain societal prohibitions. Cognitive dissonance is therefore symptomatic of repression, which is primary. 

Returning to Stiegler’s thesis concerning stupidity, it is noteworthy that the manifestations of such inanity are not merely noticeable among the upper echelons of society; worse – there seems to be, by and large, a correlation between those in the upper classes, with college degrees, and stupidity.

In other words, it is not related to intelligence per se. This is apparent, not only in light of the initially surprising phenomenon pertaining to philosophers’ failure to speak up in the face of the evidence, that humanity is under attack, discussed above in terms of repression. 

Dr Reiner Fuellmich, one of the first individuals to realise that this was the case, and subsequently brought together a large group of international lawyers and scientists to testify in the ‘court of public opinion’ (see 29 min. 30 sec. into the video) on various aspects of the currently perpetrated ‘crime against humanity,’ has drawn attention to the difference between the taxi drivers he talks to about the globalists’ brazen attempt to enslave humanity, and his learned legal colleagues as far as awareness of this ongoing attempt is concerned. In contrast with the former, who are wide awake in this respect, the latter – ostensibly more intellectually qualified and ‘informed’ – individuals are blissfully unaware that their freedom is slipping away by the day, probably because of cognitive dissonance, and behind that, repression of this scarcely digestible truth.

This is stupidity, or the ‘shadow’ of knowledge, which is recognisable in the sustained effort by those afflicted with it, when confronted with the shocking truth of what is occurring worldwide, to ‘rationalise’ their denial by repeating spurious assurances issued by agencies such as the CDC, that the Covid ‘vaccines’ are ‘safe and effective,’ and that this is backed up by ‘the science.’ 

Here a lesson from discourse theory is called for. Whether one refers to natural science or to social science in the context of some particular scientific claim – for example, Einstein’s familiar theory of special relativity (e=mc2) under the umbrella of the former, or David Riesman’s sociological theory of ‘inner-’ as opposed to ‘other-directedness’ in social science – one never talks about ‘the science,’ and for good reason. Science is science. The moment one appeals to ‘the science,’ a discourse theorist would smell the proverbial rat.

Why? Because the definite article, ‘the,’ singles out a specific, probably dubious, version of science compared to science as such, which does not need being elevated to special status. In fact, when this is done through the use of ‘the,’ you can bet your bottom dollar it is no longer science in the humble, hard-working, ‘belonging-to-every-person’ sense. If one’s sceptical antennae do not immediately start buzzing when one of the commissars of the CDC starts pontificating about ‘the science,’ one is probably similarly smitten by the stupidity that’s in the air. 

Earlier I mentioned the sociologist David Riesman and his distinction between ‘inner-directed’ and ‘other-directed’ people. It takes no genius to realise that, to navigate one’s course through life relatively unscathed by peddlers of corruption, it is preferable to take one’s bearings from ‘inner direction’ by a set of values which promotes honesty and eschews mendacity, than from the ‘direction by others.’ Under present circumstances such other-directedness applies to the maze of lies and misinformation emanating from various government agencies as well as from certain peer groups, which today mostly comprise the vociferously self-righteous purveyors of the mainstream version of events. Inner-directness in the above sense, when constantly renewed, could be an effective guardian against stupidity. 

Recall that Stiegler warned against the ‘deep malaise’ at contemporary universities in the context of what he called an ‘addictogenic’ society – that is, a society that engenders addictions of various kinds. Judging by the popularity of the video platform TikTok at schools and colleges, its use had already reached addiction levels by 2019, which raises the question, whether it should be appropriated by teachers as a ‘teaching tool,’ or whether it should, as some people think, be outlawed completely in the classroom.

Recall that, as an instance of video technology, TikTok is an exemplary embodiment of the pharmakon, and that, as Stiegler has emphasised, stupidity is the law of the pharmakon, which is, in turn, the law of knowledge. This is a somewhat confusing way of saying that knowledge and stupidity cannot be separated; where knowledge is encountered, its other, stupidity, lurks in the shadows. 

Reflecting on the last sentence, above, it is not difficult to realise that, parallel to Freud’s insight concerning Eros and Thanatos, it is humanly impossible for knowledge to overcome stupidity once and for all. At certain times the one will appear to be dominant, while on different occasions the reverse will apply. Judging by the fight between knowledge and stupidity today, the latter ostensibly still has the upper hand, but as more people are awakening to the titanic struggle between the two, knowledge is in the ascendant. It is up to us to tip the scales in its favour – as long as we realise that it is a never-ending battle. 

Tyler Durden Fri, 03/15/2024 - 23:00

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Government

“I Can’t Even Save”: Americans Are Getting Absolutely Crushed Under Enormous Debt Load

"I Can’t Even Save": Americans Are Getting Absolutely Crushed Under Enormous Debt Load

While Joe Biden insists that Americans are doing great…

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"I Can't Even Save": Americans Are Getting Absolutely Crushed Under Enormous Debt Load

While Joe Biden insists that Americans are doing great - suggesting in his State of the Union Address last week that "our economy is the envy of the world," Americans are being absolutely crushed by inflation (which the Biden admin blames on 'shrinkflation' and 'corporate greed'), and of course - crippling debt.

The signs are obvious. Last week we noted that banks' charge-offs are accelerating, and are now above pre-pandemic levels.

...and leading this increase are credit card loans - with delinquencies that haven't been this high since Q3 2011.

On top of that, while credit cards and nonfarm, nonresidential commercial real estate loans drove the quarterly increase in the noncurrent rate, residential mortgages drove the quarterly increase in the share of loans 30-89 days past due.

And while Biden and crew can spin all they want, an average of polls from RealClear Politics shows that just 40% of people approve of Biden's handling of the economy.

Crushed

On Friday, Bloomberg dug deeper into the effects of Biden's "envious" economy on Americans - specifically, how massive debt loads (credit cards and auto loans especially) are absolutely crushing people.

Two years after the Federal Reserve began hiking interest rates to tame prices, delinquency rates on credit cards and auto loans are the highest in more than a decade. For the first time on record, interest payments on those and other non-mortgage debts are as big a financial burden for US households as mortgage interest payments.

According to the report, this presents a difficult reality for millions of consumers who drive the US economy - "The era of high borrowing costs — however necessary to slow price increases — has a sting of its own that many families may feel for years to come, especially the ones that haven’t locked in cheap home loans."

The Fed, meanwhile, doesn't appear poised to cut rates until later this year.

According to a February paper from IMF and Harvard, the recent high cost of borrowing - something which isn't reflected in inflation figures, is at the heart of lackluster consumer sentiment despite inflation having moderated and a job market which has recovered (thanks to job gains almost entirely enjoyed by immigrants).

In short, the debt burden has made life under President Biden a constant struggle throughout America.

"I’m making the most money I've ever made, and I’m still living paycheck to paycheck," 40-year-old Denver resident Nikki Cimino told Bloomberg. Cimino is carrying a monthly mortgage of $1,650, and has $4,000 in credit card debt following a 2020 divorce.

Nikki CiminoPhotographer: Rachel Woolf/Bloomberg

"There's this wild disconnect between what people are experiencing and what economists are experiencing."

What's more, according to Wells Fargo, families have taken on debt at a comparatively fast rate - no doubt to sustain the same lifestyle as low rates and pandemic-era stimmies provided. In fact, it only took four years for households to set a record new debt level after paying down borrowings in 2021 when interest rates were near zero. 

Meanwhile, that increased debt load is exacerbated by credit card interest rates that have climbed to a record 22%, according to the Fed.

[P]art of the reason some Americans were able to take on a substantial load of non-mortgage debt is because they’d locked in home loans at ultra-low rates, leaving room on their balance sheets for other types of borrowing. The effective rate of interest on US mortgage debt was just 3.8% at the end of last year.

Yet the loans and interest payments can be a significant strain that shapes families’ spending choices. -Bloomberg

And of course, the highest-interest debt (credit cards) is hurting lower-income households the most, as tends to be the case.

The lowest earners also understandably had the biggest increase in credit card delinquencies.

"Many consumers are levered to the hilt — maxed out on debt and barely keeping their heads above water," Allan Schweitzer, a portfolio manager at credit-focused investment firm Beach Point Capital Management told Bloomberg. "They can dog paddle, if you will, but any uptick in unemployment or worsening of the economy could drive a pretty significant spike in defaults."

"We had more money when Trump was president," said Denise Nierzwicki, 69. She and her 72-year-old husband Paul have around $20,000 in debt spread across multiple cards - all of which have interest rates above 20%.

Denise and Paul Nierzwicki blame Biden for what they see as a gloomy economy and plan to vote for the Republican candidate in November.
Photographer: Jon Cherry/Bloomberg

During the pandemic, Denise lost her job and a business deal for a bar they owned in their hometown of Lexington, Kentucky. While they applied for Social Security to ease the pain, Denise is now working 50 hours a week at a restaurant. Despite this, they're barely scraping enough money together to service their debt.

The couple blames Biden for what they see as a gloomy economy and plans to vote for the Republican candidate in November. Denise routinely voted for Democrats up until about 2010, when she grew dissatisfied with Barack Obama’s economic stances, she said. Now, she supports Donald Trump because he lowered taxes and because of his policies on immigration. -Bloomberg

Meanwhile there's student loans - which are not able to be discharged in bankruptcy.

"I can't even save, I don't have a savings account," said 29-year-old in Columbus, Ohio resident Brittany Walling - who has around $80,000 in federal student loans, $20,000 in private debt from her undergraduate and graduate degrees, and $6,000 in credit card debt she accumulated over a six-month stretch in 2022 while she was unemployed.

"I just know that a lot of people are struggling, and things need to change," she told the outlet.

The only silver lining of note, according to Bloomberg, is that broad wage gains resulting in large paychecks has made it easier for people to throw money at credit card bills.

Yet, according to Wells Fargo economist Shannon Grein, "As rates rose in 2023, we avoided a slowdown due to spending that was very much tied to easy access to credit ... Now, credit has become harder to come by and more expensive."

According to Grein, the change has posed "a significant headwind to consumption."

Then there's the election

"Maybe the Fed is done hiking, but as long as rates stay on hold, you still have a passive tightening effect flowing down to the consumer and being exerted on the economy," she continued. "Those household dynamics are going to be a factor in the election this year."

Meanwhile, swing-state voters in a February Bloomberg/Morning Consult poll said they trust Trump more than Biden on interest rates and personal debt.

Reverberations

These 'headwinds' have M3 Partners' Moshin Meghji concerned.

"Any tightening there immediately hits the top line of companies," he said, noting that for heavily indebted companies that took on debt during years of easy borrowing, "there's no easy fix."

Tyler Durden Fri, 03/15/2024 - 18:00

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Spread & Containment

Sylvester researchers, collaborators call for greater investment in bereavement care

MIAMI, FLORIDA (March 15, 2024) – The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater…

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MIAMI, FLORIDA (March 15, 2024) – The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater risk for many adverse outcomes, including mental health challenges, decreased quality of life, health care neglect, cancer, heart disease, suicide, and death. Now, in a paper published in The Lancet Public Health, researchers sound a clarion call for greater investment, at both the community and institutional level, in establishing support for grief-related suffering.

Credit: Photo courtesy of Memorial Sloan Kettering Comprehensive Cancer Center

MIAMI, FLORIDA (March 15, 2024) – The public health toll from bereavement is well-documented in the medical literature, with bereaved persons at greater risk for many adverse outcomes, including mental health challenges, decreased quality of life, health care neglect, cancer, heart disease, suicide, and death. Now, in a paper published in The Lancet Public Health, researchers sound a clarion call for greater investment, at both the community and institutional level, in establishing support for grief-related suffering.

The authors emphasized that increased mortality worldwide caused by the COVID-19 pandemic, suicide, drug overdose, homicide, armed conflict, and terrorism have accelerated the urgency for national- and global-level frameworks to strengthen the provision of sustainable and accessible bereavement care. Unfortunately, current national and global investment in bereavement support services is woefully inadequate to address this growing public health crisis, said researchers with Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations.  

They proposed a model for transitional care that involves firmly establishing bereavement support services within healthcare organizations to ensure continuity of family-centered care while bolstering community-based support through development of “compassionate communities” and a grief-informed workforce. The model highlights the responsibility of the health system to build bridges to the community that can help grievers feel held as they transition.   

The Center for the Advancement of Bereavement Care at Sylvester is advocating for precisely this model of transitional care. Wendy G. Lichtenthal, PhD, FT, FAPOS, who is Founding Director of the new Center and associate professor of public health sciences at the Miller School, noted, “We need a paradigm shift in how healthcare professionals, institutions, and systems view bereavement care. Sylvester is leading the way by investing in the establishment of this Center, which is the first to focus on bringing the transitional bereavement care model to life.”

What further distinguishes the Center is its roots in bereavement science, advancing care approaches that are both grounded in research and community-engaged.  

The authors focused on palliative care, which strives to provide a holistic approach to minimize suffering for seriously ill patients and their families, as one area where improvements are critically needed. They referenced groundbreaking reports of the Lancet Commissions on the value of global access to palliative care and pain relief that highlighted the “undeniable need for improved bereavement care delivery infrastructure.” One of those reports acknowledged that bereavement has been overlooked and called for reprioritizing social determinants of death, dying, and grief.

“Palliative care should culminate with bereavement care, both in theory and in practice,” explained Lichtenthal, who is the article’s corresponding author. “Yet, bereavement care often is under-resourced and beset with access inequities.”

Transitional bereavement care model

So, how do health systems and communities prioritize bereavement services to ensure that no bereaved individual goes without needed support? The transitional bereavement care model offers a roadmap.

“We must reposition bereavement care from an afterthought to a public health priority. Transitional bereavement care is necessary to bridge the gap in offerings between healthcare organizations and community-based bereavement services,” Lichtenthal said. “Our model calls for health systems to shore up the quality and availability of their offerings, but also recognizes that resources for bereavement care within a given healthcare institution are finite, emphasizing the need to help build communities’ capacity to support grievers.”

Key to the model, she added, is the bolstering of community-based support through development of “compassionate communities” and “upskilling” of professional services to assist those with more substantial bereavement-support needs.

The model contains these pillars:

  • Preventive bereavement care –healthcare teams engage in bereavement-conscious practices, and compassionate communities are mindful of the emotional and practical needs of dying patients’ families.
  • Ownership of bereavement care – institutions provide bereavement education for staff, risk screenings for families, outreach and counseling or grief support. Communities establish bereavement centers and “champions” to provide bereavement care at workplaces, schools, places of worship or care facilities.
  • Resource allocation for bereavement care – dedicated personnel offer universal outreach, and bereaved stakeholders provide input to identify community barriers and needed resources.
  • Upskilling of support providers – Bereavement education is integrated into training programs for health professionals, and institutions offer dedicated grief specialists. Communities have trained, accessible bereavement specialists who provide support and are educated in how to best support bereaved individuals, increasing their grief literacy.
  • Evidence-based care – bereavement care is evidence-based and features effective grief assessments, interventions, and training programs. Compassionate communities remain mindful of bereavement care needs.

Lichtenthal said the new Center will strive to materialize these pillars and aims to serve as a global model for other health organizations. She hopes the paper’s recommendations “will cultivate a bereavement-conscious and grief-informed workforce as well as grief-literate, compassionate communities and health systems that prioritize bereavement as a vital part of ethical healthcare.”

“This paper is calling for healthcare institutions to respond to their duty to care for the family beyond patients’ deaths. By investing in the creation of the Center for the Advancement of Bereavement Care, Sylvester is answering this call,” Lichtenthal said.

Follow @SylvesterCancer on X for the latest news on Sylvester’s research and care.

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Article Title: Investing in bereavement care as a public health priority

DOI: 10.1016/S2468-2667(24)00030-6

Authors: The complete list of authors is included in the paper.

Funding: The authors received funding from the National Cancer Institute (P30 CA240139 Nimer) and P30 CA008748 Vickers).

Disclosures: The authors declared no competing interests.

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