I bought cheap drugs in Budapest

I handed the pharmacist my American prescription for Humalog insulin. “Szia,” I said in my best Google Hungarian, “töltse ki ezt a receptet?” She looked at the paper, and said in English, “Sure, but we have to order it. Is tomorrow okay?”

I asked how much it would cost. “Let’s see,” she said, tapping the keyboard. Then, almost apologetically, “Ten milliliters is . . . 6,543 Hungarian forins. About 20 euros.”

One bottle costs $22, the other $325. Same insulin, same company.

My phone’s calculator made the conversion to dollars: $22 and change for a two-inch vial of Eli Lilly and Company’s fast-acting Humalog insulin lispro, purchased in a random pharmacy near my hotel in Budapest. Back home in the United States, the list price for the same small vial — the exact same insulin, also made by Lilly, except that the labeling is in English instead of Hungarian — is $325.

I’m very fortunate to have health insurance, so I don’t actually pay the “cash” price of $325 per vial (the price paid at the pharmacy by someone who does not have health insurance). With Medicare, my copay in the United States is “only” $90 per vial.

It takes three vials a month to keep me alive.

Nearly a quarter-century ago, when Lilly first received approval from the U.S. Food and Drug Administration to sell it, the list price of a vial of Humalog was $21. Since then, Lilly has raised the list price more than 1,400 percent. Not surprisingly, the two other leading pharma companies that make a similar insulin (Novo Nordisk of Denmark and Sanofi of France) have jacked up their American prices in lockstep.

The formula hasn’t changed. It’s the same insulin today as it was back in the 1990s. It’s the same insulin that Lilly can sell at a profit for $22 to someone paying full price in Budapest. And it’s not just Hungary: Lilly sells Humalog insulin in Canada, Mexico, and other countries for a small fraction of the price it charges in the United States.

That’s why my endocrinologist in Philadelphia now advises her insulin-dependent patients to watch for cheap air fares to Amsterdam. That’s why people with Type 1 diabetes in the United States are increasingly caravaning across the borders to Canada and Mexico to buy insulin and other essential medications. For many of them, affordable insulin isn’t just bargain-shopping; it’s a matter of life or death.

For thousands of people with Type 1 diabetes, the Canadian and Mexican borders are too far away, transportation costs are too expensive, or they’re too ill to travel. For all too many more, even $22 is beyond reach for what is literally a life-saving drug.

The price of a vial of Humalog insulin was $122 in 2012 when Alex Azar II, a former drug industry lobbyist, took over as president of Lilly USA. Five years later it had soared to $274. That’s when President Donald J. Trump nominated Azar to be United States Secretary of Health and Human Services, saying Azar would be “a star for better healthcare and lower drug prices.”

Lilly’s media relations department has not responded to repeated requests for comment.

*

Type 1 diabetes used to be called juvenile diabetes because, cruelly, it most often strikes infants, children, and adolescents. It is currently incurable. No one knows what causes it, and it is not preventable, unlike the far more common Type 2 diabetes, which is closely linked to obesity and sedentary lifestyle.

Type 2 diabetes is the fastest-growing health crisis in the world, according to the World Health Organization (W.H.O.). An estimated 500 million people worldwide have Type 2 diabetes or have “pre-diabetes.” Type 2s still produce their own insulin, but their bodies either can’t make enough of it or can’t use it efficiently. In America an estimated 30 million people have Type 2 diabetes, roughly 1 of every 11 people, a number that has doubled in the 21st century. Some Type 2s require insulin injections, but most can be treated with diet, exercise, and pills.

Type 1 diabetes is a more exclusive club, but one that no one wants to join. An estimated 1.25 million people have Type 1 diabetes in the United States, all of whom need regular injections of insulin in order to stay alive, because some unknown trigger causes their immune systems to go haywire and attack and destroy the specialized cells in the pancreas that produce insulin. Without multiple daily injections of insulin we sicken and die.

Although the causes and treatments differ significantly, Type 1s and Type 2s share the sickening and dying part. Diabetes kills some 250,000 Americans each year, either directly or indirectly through “diabetic complications” that include heart disease, kidney failure, limb amputations, blindness, nerve damage, and stroke.

Here, greatly simplified, is how it kills and debilitates:

Enzymes in the digestive system convert much of the food we eat into glucose, a simple sugar. In a “normal” body, the pancreas — an organ about the size of your open hand, located behind your stomach — secretes just enough insulin to enable the cells to metabolize glucose, which the cells, in turn, convert into energy.

Without insulin, or with insufficient amounts of it, our cells can’t absorb the fuel they need, any more than an automobile engine can absorb gasoline poured over the car. The cells begin to starve and toxic levels of glucose build up in the bloodstream, damaging blood vessels and organs and nerves and hindering the body’s ability to fight infections.

In its desperation to flush the higher concentrations of sugar from the blood, the body demands fluids, leading to relentless thirst, frequent urination, and, paradoxically, dehydration. At the same time, the starving brain sends signals to begin breaking down fat, then muscle, then organs.

For Type 1s, it happens quickly. In less than three months I went from 185 pounds to 140, attributing the loss to playing a 40-game baseball schedule in the broiling Texas summer sun while wearing catcher’s gear. I drank gallons of Gatorade and still fantasized about diving, mouth open, into a swimming pool. I had to pee between innings. My vision blurred. The baseball got fuzzy, which was not good as a batter nor as a catcher. My throws to second base started bouncing just past the pitcher’s mound.

Off the field, my concerned family tried to fatten me up by feeding me milkshakes and pizzas and extra desserts. I nodded off in meetings and woke up exhausted. The weight continued to melt away. Finally, certain that I had developed a rare form of narcoleptic, hydrophiliac cancer, I called the doctor.

“Classic Type 1,” the doctor said after examining me and doing some blood tests. He gave me a bottle of insulin and a pack of syringes and sent me to a Type 1 diabetes class, where we learned to check our blood glucose with fingersticks several times a day, and to calculate how much insulin we needed to stab into our bellies.

Insulin, it turns out, is an exceptionally powerful drug. Too little leads to hyperglycemia and diabetic complications, but too much leads to dreaded “hypoglycemic reactions,” where blood sugar gets dangerously low. The body slams out adrenalin, the brain becomes disoriented, muscles tremble, sweat pours uncontrollably, and language slurs. Unchecked, hypoglycemia can lead to coma, seizures, and all too often death.

Some of my classmates in “Welcome to Type 1 Diabetes” class were in elementary school. Some were frightened parents holding their newly diagnosed Type 1 toddlers. “If you’re going to get an incurable disease,” the nurse told us, “at least diabetes is a manageable incurable disease.”

As we would soon learn, the health care system apparently finds that managing diabetes is far more profitable than curing it.

*

Until less than a century ago, a diagnosis of Type 1 diabetes was a cruel death sentence. Healthy children and adolescents, but also some adults, were quickly reduced to emaciated, suffering husks. Perversely, the only known way to keep blood glucose from rising fatally was to radically reduce eating; already skeletal young patients were put on near-starvation diets. Life expectancy after diagnosis typically was less than a year.

C.H. Best and F.G. Banting, 1924

Then, in the summer of 1921, two young researchers in Canada — Dr. Frederick Banting, a surgeon not yet 30 years old, and his assistant Charles Best, a chemistry student at the University of Toronto — discovered a way to isolate and extract small amounts of insulin from the pancreases of dogs and other animals. That winter they injected the animal insulin into a boy, Leonard Thompson, who was dying at Toronto General Hospital. The boy recovered enough to be sent home.

The “discovery” of insulin 98 years ago by Banting and Best is now regarded as one of the most important advances in the history of medicine.

News of their success spread quickly through medical journals and word of mouth, and by the summer of 1922 it was impossible for Banting and his colleagues to extract and refine enough life-saving insulin to meet the desperate pleas from physicians and patients across the continent.

The news also attracted investors eager to capitalize on the new discovery. An American businessman raced to Toronto to offer Banting one million dollars in cash if he would hand over the patent to a group on Wall Street. The group would in turn secure a patent on insulin in every country of the world, and would pay Banting a five percent royalty on all insulin sold. Banting would be fabulously wealthy, the investor told him, and would no longer have to see patients “except for a few very wealthy ones by appointment.”

“I only asked him one question,” Banting recalled years later in his memoir. “What would you do for the poor diabetic who could not pay?” Unsatisfied with the man’s answer, Banting told him, “The indigent diabetic is our greatest problem. Every effort must be made to reduce the cost of insulin . . . ”

As a physician, Banting argued, he was bound by his profession’s code to make such a life-saving advance in health care freely available to mankind. It was immoral, in his view, to profit from the misfortunes of those who were desperately ill. At the same time, Banting recognized that patenting the discovery would be a safeguard against unscrupulous or incompetent companies that would make and market inferior, perhaps dangerous, insulin.

An ethical compromise was reached: Charles Best and another researcher, neither of them physicians, would patent the process (Banting was eventually persuaded to add his name), and then, in return for the sum of one Canadian dollar each, they would assign the patent to the University of Toronto. The University would in turn freely publish details of the insulin preparation process, thereby preventing any one company from ever establishing a monopoly.

Patent issues aside, the more immediate challenge was to produce more insulin. The researchers were able to harvest only a few cubic centimeters of insulin solution in one production run, barely enough to treat one patient, and their repeated efforts to scale production to commercial levels failed. Even though the number of patients who were given the experimental treatment was kept deliberately small, an “insulin famine” ensued. The researchers resorted to rationing what meager supplies they had, with predictable results.

In February 1922 an emaciated young girl, a friend of Charles Best, was admitted to Toronto General. She showed improvement soon after receiving insulin injections, but then the insulin supply ran out and she slipped into a coma. Doctors scrounged what they could of partially prepared insulin from the lab, and the girl awakened, the first time any diabetic patient in Toronto had recovered from coma. But once again the supply was exhausted. The girl died in April, becoming perhaps the first person to die from inability to obtain insulin since the miracle treatment was discovered. She would not be the last.

The best hope of rapidly producing large quantities of high-quality insulin, the University of Toronto’s Insulin Committee decided, was to partner with Eli Lilly and Company of Indianapolis, Indiana, the leading “ethical” pharmaceutical company in the United States, at a time when quack medicines and snake-oil charlatans were common. Already in business for nearly 50 years, Lilly had earned a deserved reputation for medical rigor and manufacturing expertise.

Lilly was eager to help, on the condition that it receive an exclusive, one-year license to sell insulin in the Americas outside of Canada. In return, Lilly promised to supply Banting and the university with all the insulin they needed for their patients; any surplus insulin, Lilly promised, would be sold at cost. Afterward, Lilly would also pay royalties to the University of Toronto to support its medical research program.

The deal was struck. By the summer of 1923 Lilly was churning out enough therapeutic-grade insulin to save the lives of some 20,000 Type 1 diabetics.

Later that year Frederick Banting was awarded a share of the 1923 Nobel Prize in Medicine, which he insisted on sharing with his assistant, Charles Best.

The patent they had willingly relinquished for one dollar each would soon generate millions of dollars in royalties for the University of Toronto, and millions more in profits for Lilly, which had parlayed its exclusive license into a dominant market position.

Also, without informing the Canadians, Eli Lilly and Company had also secretly applied for the American patent covering the process that the Canadians had invented. It was necessary, Lilly executives argued when confronted by the Canadians, to protect the investments Lilly made to scale up and refine the manufacturing process.

End of Part I.

Go for Baroque

A review: Bach for Banjo: 20 Pieces Arranged for 5-String Banjo, by Mark Phillips, Jon Peik and Jim Schustedt ($9.99, Hal Leonard, 2013).

Bach for Banjo book cover

Music scholars agree: Johann Sebastian Bach never composed anything for the banjo.[i] A virtuoso on the pipe organ, Bach also played the violin, viola, harpsichord, clavichord, and even a prototype of a newfangled instrument called a “piano,” although he never composed anything for it, either.

Even so, Bela FleckJohn BullardJens KrugerMichael J. Miles (clawhammer), Rob MacKillop (tenor banjo), and many others have demonstrated that Bach’s compositions lend themselves well to the four- or five-string banjo. (Keep this in mind when friends and relatives ask, “Please, can’t you play something other than ‘Shove That Pig’s Foot Farther in the Fire’?) With a mute, one can almost convince oneself that the banjo sounds like a clavichord.

The newest Bach songbook for banjo is Bach for Banjo, from Hal Leonard. Intended for advanced novice to intermediate pickers, the songbook provides tabs for the most familiar parts of 20 pieces that Papa Bach wrote for other instruments. The pieces are expertly arranged for the 5-string banjo by Mark Phillips, Jon Peik (a BHO member), and Jim Schustedt.

Bach for Banjo is not to be confused with Bach for the Banjo, by John Bullard (also a BHO member), with accompanying guitar arrangements by John Patykula (Mel Bay, $17.99). Nor is it to be confused with Bach on the Banjo, Bullard’s impressive audio CD from 1997.

Let’s call the newer book P.P.S. Bach, for Phillips, Peik, and Schustedt, and the older book let’s call J.B. Bach, or “Bullard’s book.” Although the two songbooks are similar, there are important differences.[ii]

The most important similarity, though, is that these are true classical interpretations of Bach, not goofy, twangy bluegrass versions. People rarely grin when they pick these ditties, and there are no lyrical references to lost love, the mountains of Kentucky, or dogs and pickup trucks. And both books attribute to Johann Sebastian Bach a piece or two that weren’t actually written by him, but that’s just a quibble.

The main difference is that the majority of selections in P.P.S. Bach are less technically demanding than in the Bullard book, and thus less intimidating to novice players. Bullard does provide right-hand picking suggestions, but only for selected passages; P.P.S. Bach adds T-I-M advice for every note. Both books will give a workout to your left hand, but Bullard seems to torture it with more of those four-fret reaches and thumb-fretting on the fifth string. P.P.S. Bach, the newer book, mercifully cheats a bit by substituting slides, hammer-ons and pull-offs to avoid, say, fretting on the 16th fret of the 5th string.

Take Bach’s Prelude for the Partita No. 3 for Solo Violin, for example. P.P.S. Bach dispatches just the prelude to the prelude, in just three pages of tab, while Bullard annotates the whole shebang over 12 pages. (A third hand would be helpful to help turn pages.) Bach composed this piece as a marathon of advanced bowing technique on the fiddle; those who want to really showcase their banjo chops will probably enjoy Bullard’s endurance version.

P.P.S. Bach provides tablature for banjo only[iii]; Bullard’s book includes accompanying guitar arrangements on a few of the pieces, and traditional (piano) accompaniment elsewhere. I’m not a guitar player, so I can’t comment on the guitar arrangements.

The P.P.S. Bach tablature is, to my eyes, much easier to read. The type is cleaner and more modern and, unlike the Bullard book, the layout doesn’t require bouncing your eyes between the banjo and piano notation to determine whether the note is a 16th, an 8th, a quarter-note, and soforth. If you’re comfortable reading music and have the tunes already in your head, it probably won’t be a problem. For the rest of us it can be a challenge.

The newer book has 20 pieces; Bullard’s book has 17. Both books include some of “Bach’s Greatest Hits,” but there is surprisingly little overlap. But then, Bach was astonishingly prolific as a composer, especially for a guy who also fathered at least 20 children.[iv] The books intersect only on the Minuet in G Major, the Prelude to Cello Suite No. 1, and the Prelude to Partita No. 3 for Solo Violin. The contents of each book are listed below.

Why Bach? It’s lovely music, for starters, some of the most sublime compositions in the history of music.[v] It’s a delightful break from the kinds of tunes most of us associate with the banjo. Bach’s genius is reflected in the fact that so many different instruments have adapted his music and made it their own, not just the banjo, but also mandolin, guitar, even ukulele.

And here’s another reason: Learning to play Bach on the banjo will improve your banjo skills and technique, regardless of the kind of music you normally play. Bach’s eldest sons told an early biographer that Bach wrote many of these compositions for his students. “The first thing he did,” the biographer wrote, “was to teach his pupils his peculiar manner of touching the instrument. For this purpose, he made them practice, for months together, nothing but isolated exercises for all the fingers of both hands, with constant regard to this clear and clean touch. For some months, none could get excused from these exercises; and, according to his firm opinion, they ought to be continued, for from six to twelve months. But if he found that anyone, after some months of practice, began to lose patience, he was so obliging as to write little connected pieces, in which those exercises were combined together.”

That’s pretty good practice advice for any banjo player, and the authors of Bach for Banjo (as well as the earlier Bach for the Banjo) have been very obliging in arranging these little connected pieces for our favorite instrument.

Bach for Banjo features the most recognizable parts of these pieces:

  • Air on the G String
  • Arioso
  • Be Thou with Me (from the Anna Magdalena Notebook)
  • Bourrée (from Cello Suite No. 3)
  • Bourrée in E Minor
  • Brandenburg Concerto No. 3, First Movement
  • Gavotte (from French Suite No. 5)
  • Gavotte (from Cello Suite No. 6)
  • Chorale (from St. Matthew Passion)
  • Jesu, Joy of Man’s Desiring (from Cantata No. 147)
  • Keep, O My Spirit
  • Little Prelude No. 2
  • Minuet in G (now attributed to Christian Petzold, not J.S. Bach)
  • Minuet I (from the Anna Magdalena Notebook)
  • Prelude (from Cello Suite No. 1)
  • Prelude (from Violin Partita No. 3)
  • Prelude in C Major (from The Well-Tempered Clavier, Book 1)
  • Sheep May Safely Graze (from Cantata No. 208)
  • Siciliano (from Flute Sonata No. 2)
  • Sleepers, Awake (from Cantata No. 140

Bach for the Banjo (Bullard’s book) includes:

  • Invention #13
  • Invention #14
  • Invention #1
  • Invention #8
  • March (by Carl Philipp Emanuel Bach)
  • Minuet in G Major (by Christian Petzold)
  • Polonaise in G Minor (by C.P.E. Bach)
  • Minuet in G Minor (by Petzold)
  • Musette
  • Minuet in G (by Petzold)
  • Prelude/Partita No. III for Solo Violin
  • Bourrée II/Suite IV in E flat Major for Solo Cello
  • Menuets I & II/Suite II for Solo Cello
  • Courante/Suite 1 for Solo Cello
  • Gavotte en Rondeau/Partita No. III for Solo Violin
  • Bauerntanz/For Two Banjos (by C.P.E. Bach)
  • Prelude/Suite 1 for Solo Cello

[i] We can’t entirely rule it out. A 1678 document from the Caribbean island of Martinique refers to an instrument called the “banza” that was played at slave gatherings. Johann was born in 1685. Around the time that “Old Wiggy” Bach died in 1750 there were references aplenty to the banjar, the banshaw, the banjil, and the bangoe. An English poem from 1763 included the couplet “Permit thy slaves to lead the choral dance / To the wild banshaw’s melancholy sound …”

[ii] Bach was a genius at counterpoint, the musical technique of composing two or more melodies played simultaneously. (A dazzling example of this can be heard, and seen, here.) So, as a contrapuntal nod to the master, let’s review both books together.

[iii] This is a bit unexpected because P.P.S. Bach co-author Phillips is best known as a guitar arranger. He has also arranged songbooks for Led Zeppelin, which isn’t as weird as it sounds; the band was known to drop a bit of Bach’s Bourée in E Minor into live performances of the song Heartbreaker. Phillips is also the co-author of Guitar for Dummies, Metallica Riff by Riff, and several other guitar books. Wisconsin picker (and BHO member) Jon Peik provides the banjo expertise, along with Jim Schustedt, who previously arranged Disney Songs for Banjo.

[iv] (I say “at least” because there is some evidence of a “forgotten” twenty-first offspring, P.D.Q. Bach, composer of such deservedly neglected works as Pervertimento for Bicycle, Bagpipes and Balloons, and The Short-Tempered Clavier.)

[v] Today, of course, Johann Sebastian Bach is considered one of history’s greatest composers and musical scientists. But at the time of his death in 1750 (the result, a contemporary newspaper reported, of “the unhappy consequences of [a] very unsuccessful eye operation”) Bach was regarded as merely a middling composer. In a music world soon to be dominated by Mozart and Beethoven, Bach’s compositions were considered hopelessly old-fashioned. His grave was unmarked until 1894.

Alabastardization

Vice President Mike Pence,  a white man who is preternaturally white, and President Donald Trump, a white man who is prematurely orange, spent more than $200,000 in taxpayers’ money to protest the right of black athletes to peacefully protest racial oppression and inequality.

In a stunt that Trump later tweeted was his idea, Pence and his wife/chaperone Karen “Mother” Pence flew to Indianapolis on Air Force Two to attend a National Football League game. As expected, more than a dozen black players knelt, rather than stand, during the pre-game national anthem as a way to call attention to systemic injustices to blacks in the United States.

(Photo by Bobby Ellis/Getty Images)

Pence and his entourage walked out. He then issued a statement (scripted before the game) saying “President Trump and I will not dignify any event that disrespects our soldiers, our flag, or our national anthem.” Within hours, the Trump campaign carpet-bombed his support base with fundraising appeals that said,

… your Vice President REFUSED to dignify their disrespect for our anthem, our flag, and the many brave soldiers who have died for their freedoms.

Friend, I was so proud of the Vice President. But immediately after the Vice President’s honorable display of leadership and patriotism, the Fake News Media relentlessly ATTACKED him.

Please make a contribution of at least $5 to show your support, and our team will send you an ‘I STAND FOR THE FLAG’ sticker.

— Donald J. Trump

While Trump found it easy to assert that there were “some very fine people on both sides” when white supremacists, Ku Klux Klan members and neo-Nazis clashed with protesters in August in Charlottesville, the man who claims to have the best words was unable to find even a syllable to acknowledge the racial inequality issues that the black players are protesting.

This is the alabastardization of the protest … white people attempting to de-legitimize black people’s concerns, avoid talking about real issues behind the protests, and recast the protesters as disrespectful, unpatriotic, anti-Americans. Who just happen to be black.

Example: The Civil War was about states’ rights (not slavery).

Example: Donald Trump’s “birther” movement was about citizenship qualification to be president (not the fact that Obama is black).

Example: Voting restrictions in southern states are about preventing voter fraud (not preventing black people from voting).

And shame on the news media for megaphoning this alabastardization, and not calling out this obvious and dishonest redirection. It’s out of the same playbook Trump applied so effectively against the media itself. When they report truthfully on issues, or point out his failures, he attempts to de-legitimize the media and divert attention away from the discussions we ought to be having.  Fake news! Dishonest media! Enemy of the American people!

The current protest by black athletes, as they’ve said from the start, is about systematic mistreatment of blacks and other nonwhites by the white majority.

Eli Harold, Colin Kaepernick, Eric Reid in 2016

Colin Kaepernick, then quarterback for the San Francisco 49ers, started quietly sitting during the national anthem in August 2016. “I am not going to stand up to show pride in a flag for a country that oppresses black people and people of color,” he said.

Eric Reid, another player, joined Kaepernick in protest. He said:

We spoke at length about many of the issues that face our community, including systemic oppression against people of color, police brutality and the criminal justice system. We also discussed how we could use our platform, provided to us by being professional athletes in the N.F.L., to speak for those who are voiceless.

After hours of careful consideration, and even a visit from Nate Boyer, a retired Green Beret and former NFL player, we came to the conclusion that we should kneel, rather than sit, the next day during the anthem as a peaceful protest. We chose to kneel because it’s a respectful gesture. I remember thinking our posture was like a flag flown at half-mast to mark a tragedy.

Trump earlier said any “son of a bitch” player who refused to stand should be fired, and said that team owners (nearly all of whom are white) should force the ungrateful players to honor the flag. If the black players and their sympathetic teammates refuse to end their protest, Trump said, NFL fans (who are overwhelmingly white, according to NFL research) should boycott the game.

You know, sort of like a silent, nonviolent protest.

It seems nonviolent protests are approved by Trump and Pence when it’s white people and white supremacists protesting, and condemned by Trump and Pence when it’s black people or people of color protesting against racism.

The attempt by white people to silence the already silent black protesters is not new. It predates the American revolution. Almost 50 years ago, to call attention to racial injustice in the United States, Americans Tommie Smith (gold medal) and John Carlos (bronze medal ) stood silently, heads bowed, black-gloved fists in the air, as the national anthem played during the medals ceremony at the 1968 Mexico City Olympics.

They were shoeless, and wore black socks to represent black poverty. They wore black gloves to represent black unity. Carlos wore beads to represent the “strange fruit” of lynched blacks hanging from trees; Smith a black scarf to represent black pride.

The New York Times reported:

Mexico City, Oct. 18–The United States Olympic Committee suspended Tommie Smith and John Carlos today for having used last Wednesday’s victory ceremony for the 200- meter dash at the Olympic Games as the vehicle for a black power demonstration.

The two Negro sprinters were told by Douglas F. Roby, the president of the committee, that they must leave the Olympic Village. Their credentials also were taken away, which made it mandatory for them to leave Mexico within 48 hours.

Carlos said years later, “I went up there as a dignified black man and said: ‘What’s going on is wrong.”

Smith said the protest “was a cry for freedom and for human rights. We had to be seen because we couldn’t be heard.”

Jackie Robinson, who in 1947 officially became the first black player in major league baseball, recalled shortly before his death in 1972:

There I was, the black grandson of a slave, the son of a black sharecropper, part of a historic occasion, a symbolic hero to my people. …The band struck up the national anthem. The flag billowed in the wind. It should have been a glorious moment for me as the stirring words of the national anthem poured from the stands. … As I write this twenty years later, I cannot stand and sing the anthem. I cannot salute the flag; I know that I am a black man in a white world. In 1972, in 1947, at my birth in 1919, I know that I never had it made.

As a reminder, nonviolent expression of free speech is specifically protected by the First Amendment in the Bill of Rights of the Constitution of the United States. Even burning the American flag in protest is protected, the Supreme Court ruled, as “symbolic speech.”

There is no law requiring people to stand for the national anthem. Sitting, kneeling, or otherwise silently protesting during the national anthem is a Constitutional right, and free speech is a core value of the United States. The flag is a symbol of those core values.

Many thousands of American soldiers have died defending those core values, fighting against regimes that deny their citizens the right to peaceably protest against the government.

The President, the Vice President, members of Congress, members of the armed services, and local and national law enforcement officials all take oaths to defend and uphold the principles of the Constitution.

So, who is disrespecting the flag and the values it stands for? It’s not the players.

P.S.

I disapprove of what you say, but I will defend to the death your right to say it.

The British historian Evelyn Beatrice Hall (1868-1956), writing under the name Stephen G. Tallentyre, wrote this powerful sentence in 1906 as an imagined statement that she said encapsulated the views of François-Marie Arouet, who was known as Voltaire, who never actually said it.