by John Dale Dunn MD JD
(video not yet available, text follows)
Texas Chapter AAPS annual meeting, May 19, 2018
Lecturer, Department of Emergency Medicine
Carl R. Darnall Army Medical Center, Fort Hood, Texas
Medical Officer, Brown County, Texas
Policy Advisor, American Council on Science and Health,
New York City, and Heartland Institute, Chicago, IL.
Dr. Dunn’s opinions are personal and not attributable to the US Army or Department of Defence the Sheriff of Brown County.
The tyrannical regulatory administrative state is built on the commitment to the idea that elite of “experts” can create a utopia. FAT CHANCE, but, nonetheless, they are convinced that the utopian ideal is well within the reach of the ruling elites—just ask them and they well reference their superior knowledge and good intentions, but most of all a belief that their wonderful ideas will be enough—if there are failures it was because of a lack of money, time, and energetic dedication to the cause of the socialist/collectivist cause.
The Noble Lie
Socrates in Plato’s dialogues explained how the Noble Lie is useful for achieving political harmony, a myth or story told for the masses to promote comity and popular agreement.
Over the centuries the Noble Lie in various forms has a constant and repeated means of manipulation of popular opinion, assuring the influence and power of the Oligarchy over a polity or society.
Plato (427 BC-347 BC) advocated a socialist order with property held in common (the state) and that human nature can and should be molded and transformed, influenced for the benefit of the state. NOT AN AMERICAN CONCEPT AT ALL BUT WELL DEVELOPED IN EUROPE.
On the other hand—Aristotle argued that the laws of nature and the rule of law demand that government should govern for the good of the people, not for the good of those in power.
Cicero (106 BC-43 BC) asserted that the “right of ownership is inalienable” His reasoning was rooted in natural law and the “laws of human society.” Aristotle also asserted that science required the assessment of evidence and observations that would lead to conclusions about how the world worked.
Environmentalism’s Noble Lies
The Noble Lies promoted by environmentalism are built on the foundational lie that humans are a cancer
on the earth and destructive of the beauty and perfection of nature.
Components of the Environmental Noble Lie essential to current environmental policy making are:
- There is no threshold, thus no tolerable or safe level of toxicity or harm from radiation or chemical agents, so they must be identified and eliminated from the environment, and zero tolerance should be the goal—the handmaiden of the precautionary principle.
- Small associations in population studies are adequate evidence of proof that ambient air pollution is toxic, harmful and very lethal, killing hundreds of thousands of Americans annually.
In matters of medical policy, the professional class must be tamed and the private medical system must be reined in and controlled to assure that medical care is available, affordable, safe and properly administered for the benefit of the collective.
The Administrative Regulatory State in America IS UNCONSTITUIONAL
Phillip Hamburger, Friedman Professor of constitutional law at Columbia, reminded me of the problem of administrative law growth in America with his 2017 bite-sized 70-page book, The Administrative Threat, that summarizes the points of his magisterial and erudite 650-page 2014 book, Is the Administrative State Legal? I liked the short book – but I was more taken by the long book because Hamburger moves into the weeds to explain in depth what motivated the American founders to write a Constitution that intentionally hobbled the power of the executive and created a 3 branch government with separation of powers. Hamburger explains the history of tyranny in England that was well known to the framers of the Constitution, abuses such as government by crown edict; crown-initiated Star Chamber prosecutions that were politically motivated; and the excessive and oppressive nature of the reigns of James I and Charles I, who were kings from 1603 to 1649, when Charles was beheaded after a civil war. The Americans, the founders, were acutely aware of royal tyranny and bound to avoid it.
The founders of the United States were students of government and political science, well informed on the question of how to form a government that provides liberty for the citizens and is framed to assure that government is by consent of the governed—in addition, the framers of the US Constitution were well informed of the problem of faction, and the tendency of democracies to become tyranny of the majority (we might use the epithet mobocracy) so the constitution was written to reduce the chance of tyranny of the majority and the powers of government, legislative, executive and judicial were carefully created to balance competing interests and authority.
When the administrative state developed a bad case of expansionism due partly to enablement by the judiciary and feeble reticence by the congress, the executive department agencies, formed under the executive powers in article II of the constitution, unfortunately acquired the nature of tyranny. The agencies were granted executive, judicial, and legislative powers, and carried out edicts and activities that were excessive. The edicts, legislative acts, judicial rulings and judgements that exceeded the bounds of executive authority, were allowed by a judiciary that was inclined to support executive branch actions. and Congress delegated power to excess in order to avoid the hard decisions.
The problem of star chambers, edicts from the executive that plagued England in the reigns of Charles and James are now upon us, and the regulatory state, the tyranny of the executive branch, is upon us.
The excessive regulatory administrative state is built on another important development, government sponsorship of expert armies intended to provide justification for administrative state activities and to intimidate and censor any opposition. Armies of experts and bureaucrats presage tyranny by the regulatory state.
In April 2009 Angelo Codevilla wrote an extraordinary essay in American Spectator, “Scientific Pretense vs. Democracy”:
https://spectator.org/41862_scientific-pretense-vs-democracy/
Codevilla quoted President Obama in the intro “We will restore science to its rightful place…” Codevilla unpacked Obama’s statement—to this translation:
‘Under my administration, Americans will have fewer choices about how they live, and fewer choices as voters because, rightfully, those choices should be made by officials who rule by the authority of science.’
The argument “Do what we say because we are certified to know better” is a slight variant of “Do what we say because we are us.” (Make you think of the Noble Lie?)
Codevilla pointed out that the administrative state, that found it’s footing on the Continent as conceived and created by the French and then the Prussian government bureaucracies in particular, depends on the designation and sponsorship of an army of government “experts” that influence, persuade the populace and intimidate, supress and censor opposing viewpoints and attack and suppress opposing parties. The intimidation is totalitarian in nature and the expert army serves the paternalistic and tyrannical oligarchic state.
Codevilla:
Only in Switzerland and America did the theory and practice of popular government survive into the modern world. But note: they survived because they were planted on older, hybrid pre-Enlightenment roots. The Enlightenment is fundamentally very friendly to the administrative/regulatory tyranny promoted by Plato, the author of the concept of Philosopher Kings. Creatures of the Enlightenment suffer from a serious case of self-esteem.
Because the pretense of rare knowledge is the source of the modern administrative state’s intellectual and moral authority, its political essence is rule of the few, by their own authority, over the many.
It follows then that the modern struggle is over control of the process of accreditation, and that the arguments the masses hear must be mostly ad hominem, seldom ad valorem— not least because the experts deem the masses incapable and unworthy of hearing anything else.
Codevilla favorably quoted Eisenhower’s farewell speech:
The prospect of domination of the nation’s scholars by Federal employment, project allocations, and the power of money is ever present and is gravely to be regarded. Yet, in holding scientific research and discovery in respect, as we should, we must also be alert to the equal and opposite danger that public policy could itself become the captive of scientific technological elite.
Codevilla followed the 2009 essay on Scientific Pretense vs. Democracy with another stunning discussion of what has happened to America as it becomes an administrative state ruled over by a class of elites.
“America’s Ruling Class and the Perils of Revolution.” Summer issue 2010 American Spectator
https://spectator.org/39326_americas-ruling-class-and-perils-revolution/
Codevilla:
Hence more power for the ruling class has been our ruling class’s solution not just for economic downturns and social ills but also for hurricanes and tornadoes, global cooling and global warming. A priori, one might wonder whether enriching and empowering individuals of a certain kind can make Americans kinder and gentler, much less control the weather. But there can be no doubt that such power and money makes Americans ever more dependent on those who wield it. . . .
Today’s ruling class, from Boston to San Diego, was formed by an educational system that exposed them to the same ideas and gave them remarkably uniform guidance, as well as tastes and habits. These amount to a social canon of judgments about good and evil, complete with secular sacred history, sins (against minorities and the environment), and saints, certainly saints one could consider ideological partisans for the left.. Using the right words and avoiding the wrong ones when referring to such matters — speaking the “in” language — serves as a badge of identity. . . .
America’s ruling class speaks the language and has the tastes, habits, and tools of bureaucrats. It rules uneasily over the majority of Americans that Codevilla called the “Country Class.” The two classes have less in common culturally, dislike each other more, and embody ways of life more different from one another than did the 19th century’s Northerners and Southerners — nearly all of whom, as Lincoln reminded them, “prayed to the same God.” By contrast, while most Americans pray to the God “who created and doth sustain us,” our ruling class prays to itself as “saviors of the planet” and improvers of humanity. They lift high the beacon of secular enlightenment humanism and the evolution of the human condition to a socialist/collectivist utopia.
(Dunn: That is why they can live with their NOBLE LIES)
Eric Hoffer:
Faith in a holy cause is to a considerable extent a substitute for lost faith in ourselves. Our sense of power is more vivid when we break a man’s spirit than when we win his heart.
Friedrich Hayek called it the Fatal Conceit, the pretense of knowledge.
CS Lewis—“Of all tyrannies a tyranny sincerely exercised for the good of its victims may be the most oppressive.”
Joseph Schumpeter said the first casualty of idealism is the truth.
Thomas Sowell and William Voegeli have eloquently pointed out in their writings that Intellectuals who traffic in abstract concepts and notions are never required to show that their ideas work. They have no accountability but have a high opinion of themselves and their good intentions.
George Orwell: “During times of universal deceit, telling the truth becomes a revolutionary act.”
Karl Popper (influential philosopher of Science) thought the Noble Lie smelled of totalitarianism.
The point is that political tyrannies and totalitarian states are built on lies, and the populace is tamed by lies and intimidated by lies, particularly if compliant in voicing those lies. As Orwell told in 1984, it is important to get the populace to believe the lie, to assert the lie. Orwell invented Newspeak that included terms that describe the nature of totalitarian society—goodthink crimethink, doublethink, thought crime, thoughtpol, all part of the effort to control the populace, a strategy to impose the big lie as part of the project to intimidate and control the citizens.
Dissent and disagreement are fundamentally democratic and statists are dedicated to suppression of dissent, censorship of opposition. I would suspect the totalitarians are a little uneasy with the nature of the audience at this physicians’ conference, people who hold to their right to an opinion and that liberty comes with dissent and exercise of free will, but most of all the right to act independently according to one’s conscience and moral beliefs. This room is full of people who are dangerous to and detested by the ruling class.
HL Mencken said—
The whole aim of practical politics is to keep the populace alarmed (and hence clamorous to be led to safety) by menacing it with an endless series of hobgoblins, all of them imaginary.
The Precautionary Principle and the goal of practical politics energize and enable the Noble Lie and paternalistic tyranny.
The Noble Lie creates the hobgoblins and enables the statist tyrants.
Fear and anxiety expressed in the political mind set of zero tolerance and the precautionary principle is also the key to enablement of the state and it’s its apparatchiks and bureaucrats, who derive their power from their ability to designate “experts” in the service of the state and who pose as rescuers of the populace from the hobgoblins and uncertainties that make the populace so clamorous to be led to safety.
Frank Furedi (British Social Scientist and philosopher) described the problems of relying on the precautionary principle and how fear is the precursor to irresponsible behavior and adoption of the zero tolerance precautionary principle approach to risk management in a speech he gave to a philosophy conference in Modeno, Italy in September 2010:
Back in ancient times, different gods were endowed with the ability to thwart our ambitions or to bless us with good fortune. The Romans worshipped the goddess Fortuna, giving her great power over human affairs. Nevertheless, they still believed that her influence could be contained and even overcome by men of true virtue. As the saying goes: ‘Fortune favours the brave.’ (Dunn would add that Aristotle said Fortitude enables all the other virtues.) This belief that the power of fortune could be limited through human effort and will is one of the most important legacies of humanism. . .
The belief in people’s capacity to exercise their will and shape their future flourished during the Renaissance, creating a world in which people could dream about struggling against the tide of fortune. Implicitly, and sometimes explicitly, advocates of worst-case thinking argue that society should stop looking at risk in terms of a balance of probabilities. These critics of probabilistic thinking are calling for a radical break with past practices, on the grounds that today we simply lack the information to calculate probabilities effectively. Their rejection of the practice of calculating probabilities is motivated by a belief that the dangers we face are so overwhelming and catastrophic– the Millennium Bug, international terrorism, swine flu, and climate change – that we cannot wait until we have all the information before we calculate their destructive effects. ‘Shut it down!’ is the default response. One of the many regrettable consequences of this outlook is that policies designed to deal with threats are increasingly based on feelings and intuition rather than on evidence or facts. . .
Today, the problems associated with risk and uncertainty is constantly being amplified and, courtesy of our own imaginations, are turned into existential threats. Consequently, it is rare for unexpected natural events to be treated as just that; rather, they are swiftly dramatised and transformed into a threat to human survival.
http://www.frankfuredi.com/article/fear_is_key_to_irresponsibility
Scientists who enable the Noble Lies
So the reasonable person would ask the question, how does the oligarchy get scientists to support and declaim the Noble Lie, whether it is environmental, social, or other forms of scientific inquiry? Richard Feynman, a physicist, great teacher and Nobel Prize winner warned a Cal Tech commencement group about the problems of scientific dishonesty and how it comes about. Ambition, intellectual passion, a lack of discipline all contribute, and certainly the attractions of being well paid.
Richard Feynman on Cargo Cult Science (Cal Tech Commencement speech 1974)
http://www.lhup.edu/~DSIMANEK/cargocul.htm . . . The first principle is that you must not fool yourself–and you are the easiest person to fool. So you have to be very careful about that. After you’ve not fooled yourself, it’s easy not to fool other scientists. You just have to be honest in a conventional way after that. . . . you should not fool the layman when you’re talking as a scientist. It is very dangerous to have such a policy in teaching–to teach students only how to get certain results, rather than how to do an experiment with scientific integrity. It’s easy to see how a scientist offered a good job, and income for producing results that please the funding source would stray from the principles recommended by Feynman. Is there a path in America to rational science and policy making? One way to prevent the Noble Lie from dominating policy making?
Scientific Evidence Reliability and Admissibility in Court
Daubert v. Merrell Dow 509 US 579 (1993)
Justice Blackmun wrote the opinion for the Supreme Court that established new and more rigorous rules for admissibility of scientific evidence and discarded relaxed admissibility standard of general acceptance from 1923, Frye v United States, 293 F. 1013 (DC Cir. 1923). Blackmun made the general assertion that the science offered should be the product of methods and processes used by professionals in their daily conduct of science and specified the characteristics of good science that would characterize admissible evidence and testimony based on the qualifications of the expert and the evidence or testimony offered and the basis for that evidence or testimony. If the professional qualifications are accepted then the criteria are applied by the judge, who is required to be the gatekeeper for evidence to assure reliability.
From the Cornell Law School web site:
https://www.law.cornell.edu/wex/daubert_standard
Daubert Standard
Standard used by a trial judge to make a preliminary assessment of whether an expert’s scientific testimony is based on reasoning or methodology that is scientifically valid and can properly be applied to the facts at issue. Under this standard, the factors that may be considered in determining whether the methodology is valid are: (1) whether the theory or technique in question can be and has been tested; (2) whether it has been subjected to peer review and publication; (3) its known or potential error rate; (4) the existence and maintenance of standards controlling its operation; and (5) whether it has attracted widespread acceptance within a relevant scientific community.
The Reference Manual on Scientific Evidence (RMSE) (3rd Ed. 2011) is published by the Federal Judicial Center to educate federal judges and attorneys on scientific evidentiary admissibility issues under the dicta and guidance of Daubert (1993). RMSE 1st ed. was in 1995, 2nd in 2000, the latest is the 3rd Edition (2011) with additional subjects and greater length, now 958 pages, 15 chapters on various scientific subjects.
The RMSE provides chapters, each written by science experts and at least one legal expert, to educate judges and lawyers on scientific evidence admissibility issues under they Federal Rules of Evidence (1973) with particular attention to Federal Rules of Evidence 104, the guidance on relevance and fit and 702 on Expert Testimony. Pertinent to our discussion of the Noble Lies, the toxicology and epidemiology chapters are valuable and comprehensive.
https://www.nap.edu/read/13163/chapter/1
The epidemiology chapter discusses how to determine reliable proof of causation:
The Bradford Hill criteria for proof of causation on page 600
- 1. Temporal relationship,
- 2. Strength of the association,
- 3. Dose–response relationship,
- 4. Replication of the findings,
- 5. Biological plausibility (coherence with existing knowledge),
- 6. Consideration of alternative explanations,
- 7. Cessation of exposure,
- 8. Specificity of the association, and
- 9. Consistency with other
I would recommend the discussions in the chapter on epidemiology related to proof of causation and the importance of showing a strong relationship between the alleged toxin and the effect, the effect of 100%, a relative risk of 2.0 being a critical minimum, pages 597-618.
EPA studies on air pollution NEVER achieve that Relative Risk of 2.0 or more. The Relative Risk of their results always hovers around 1.05-1.10.
The linear no threshold toxicology scam
In regards to the other noble lie—Linear No Threshold Toxicology, the chapter on Toxicology of the RMSE, touches on the issue of normal toxicology with thresholds and the toxicology of carcinogens that keeps up the scam of Linear No Threshold toxicology.
From the Toxicology Chapter of the RMSE p 641-2, here’s how toxicologists parse and slice the matter:
- Dose–response relationships –An important component of toxicological research is dose–response relationships. Thus, most toxicological studies generally test a range of doses of the chemical. Animal experiments are conducted to determine the dose–response relationships of a compound by measuring how response varies with dose, including diligently searching for a dose that has no measurable physiological effect. This information is useful in understanding the mechanisms of toxicity and extrapolating data from animals to humans.
- Acute Toxicity Testing—Lethal Dose 50–To determine the dose–response relationship for a compound, a short-term lethal dose 50% (LD50) may be derived experimentally. The LD50 is the dose at which a compound kills 50% of laboratory animals within a period of days to weeks. The use of this easily measured end point for acute toxicity to a large extent has been replaced, in part because recent advances in toxicology have provided other pertinent end points, and in part because of pressure from animal rights activists to reduce or replace the use of animals in laboratory research.
- No observable effect level (NOEL)–Using a dose–response study also permits the determination of another important characteristic of the biological action of a chemical—the no observable effect level (NOEL).25 The NOEL sometimes is called a threshold, because it is the level above which observable effects in test animals are believed to occur and below which no toxicity is observed.26 Of course, because the NOEL is dependent on the ability to observe an effect, the level is sometimes lowered once more sophisticated methods of detection are developed.
- Benchmark dose–For regulatory toxicology, the NOEL is being replaced by a more statistically robust approach known as the benchmark dose (BD). The BD is determined based on dose–response modeling and is defined as the exposure associated with a specified low incidence of risk, generally in the range of 1% to 10%, of a health effect, or the dose associated with a specified measure or change of a biological effect. To model the BD, sufficient data must exist, such as at least a statistically or biologically significant dose-related trend in the selected end point.
- No-threshold model and determination of cancer risk–Certain genetic mutations, such as those leading to cancer and some inherited disorders, are believed to occur without any threshold. In theory, the cancer- causing mutation to the genetic material of the cell can be produced by any one molecule of certain chemicals. The no-threshold model led to the development of the one-hit theory of cancer risk, in which each molecule of a cancer-causing chemical has some finite possibility of producing the mutation that leads to cancer. (See Figure 1 for an idealized comparison of a no-threshold and threshold dose– response.) This risk is very small, because it is unlikely that any one molecule of a potentially cancer-causing agent will reach that one particular spot in a specific cell and result in the change that then eludes the body’s defenses and leads to a clinical case of cancer. However, the risk is not zero. The same model also can be used to predict the risk of inheritable mutational events.
The net effect of the toxicology guidance in the RMSE is good, and the dancing that they do around the one hit theory of toxicology will have to be resolved, but it is clear that they recognize and install the importance of legitimate toxicological methods to establish proper and reliable standards.
The requirement in certain jurisdictions for epidemiological evidence of a relative risk greater than two (RR > 2) for general causation also has limited the utilization of toxicological evidence.72 A firm requirement for such evidence means that if the epidemiological database showed statistically significant evidence that cohorts exposed to 10 parts per million of an agent for 20 years produced an 80% increase in risk, the court could not hear the case of a plaintiff alleging that exposure to 50 parts per million for 20 years of the same agent caused the adverse outcome. Yet to a toxicologist there would be little question that exposure to the fivefold higher dose would lead to more than a doubling of the risk, all other facets of the case being similar. p. 659
There is no doubt that proper toxicology is critical to the assessment of risk, and we judge the work of the EPA in the past 2 decades to be data dredging and scaremongering in pursuit of a regulatory objective. Scientific activity in pursuit of a political objective, that must be reassessed under more rigorous standards than were used in the outcome-oriented science environment of the EPA and other Federal Agencies.
We can always hope that in the proper when the proper arguments are presented, good science will win.
The GRADE Working Group
GRADE Working Group research on epidemiological methods and reliability of epidemiological research is the product of cooperative work of an international group of academic and public entity researchers. The list of participants is impressive.
In the GRADE Working Group series (Grade Working Group publications) of articles on research guidelines published in the Journal of Clinical Epidemiology Guidelines paper no. 9 discusses quality of evidence in observational studies:
- Introduction
In prior papers in this series devoted to exploring
GRADE’s approach to rating the quality of evidence and
grading strength of recommendations, we have dealt with
issues of framing the question; introduced GRADE’s
conceptual approach to rating the quality of a body of evidence;
and presented five reasons for rating down the quality
1 The GRADE system has been developed by the GRADE Working Group. The named authors drafted and revised this article. A complete list of contributors to this series can be found on the journal’s Web site at www.elsevier.com.
* Corresponding author. CLARITY Research Group, Department of Clinical Epidemiology and Biostatistics, McMaster University, Room 2C12, 1200 Main Street, West Hamilton, Ontario L8N 3Z5, Canada.
Tel.: 905-525-9140; fax: 905-523-8781.
E-mail address: guyatt@mcmaster.ca (G.H. Guyatt).
Key points
GRADE includes three criteria for rating up quality
of evidence particularly applicable to observational
studies.
- Rating up one or even two levels is possible when
effects in observational studies are sufficiently
large, particularly if they occur over short periods
of time.
- A dose response gradient, or a conclusion that
plausible residual confounding would further support
inferences regarding treatment effect, may
also raise the quality of the evidence.
This ninth article in the series examines the criteria for rating up the quality of evidence.
The three primary reasons for rating up the quality of evidence
are (Table 1) as follows:
- When a large magnitude of effect exists,
- When there is a dose response gradient, and
- When all plausible confounders or other biases increase
our confidence in the estimated effect. . . .
Grade Working Group Publications and International organization
http://www.gradeworkinggroup.org/
Guyatta G, Oxman A, Sultand S, et. al. GRADE guidelines: 9. Rating up the quality of evidence J Clin Epidemiol. 2011 Dec;64(12):1311-6.
https://www.ncbi.nlm.nih.gov/pubmed/21802902
HOW THE OLIGARCHY TOOK
CONTROL OF MEDICAL CARE
In an administrative state structure, taking down a private sector capitalistic system involves what always drives government projects—good intentions and the Mencken rule of practical politics—create a hobgoblin, a threat that makes the populace clamorous to be led to safety, and safety is offered by the administrative state apparatus and its expert army.
In the case of Medical Care
- It’s too expensive, and it’s not available. There is a social justice right to medical care that must be imposed.
- Medical Care as provided is dangerous and policy measures must be taken to root out incompetence and dangerous practices employed by selfish and greedy private institutions and actors.
- Experts must be in place to determine methods that assure efficiency and control costs. (Here’s where some rationing and determinations of who gets what always end up in the hands of the elites.)
So the media and government/political/ruling class entities publicize and pound on the problems, create a hobgoblin and a crisis and of course propose the only rational solution—GOVERNMENT AUTHORITY AND GOVERNMENT EXPERTS WITH CONTROL AND AUTHORITY.
Socialized medicine is the goal of any collectivist/socialist—it is what statist tyranny is all about along with thought control and indoctrination to the Statist attitudes.
I have expounded on managed care and the patient safety crisis in these essays linked below:
https://www.americanthinker.com/articles/2010/04/the_myths_of_managing_healthca.html
JPANDS on healthcare policy myths
http://www.jpands.org/vol15no4/dunn.pdf
Central Planners and visions of the fatal conceit
http://www.jpands.org/vol16no4/dunn.pdf
Dunn J. Patient safety research—creating crisis. American Council
on Science and Health, Jan 10, 2005.
http://acsh.org/news/2005/01/10/patient-safety-research-creating-crisis/
Gerard J. Gianoli and John Dunn in American Thinker on Patient Safety
http://www.americanthinker.com/articles/2016/08/american_patient_safety_crusade_politics.html
Unreliable Research on Error-Related Hospital Deaths in America
Gerard J. Gianoli, M.D. John Dale Dunn, M.D., J.D
http://www.jpands.org/vol21no4/gianoli.pdf
Let’s talk the OPIATE CRISIS
Medicalizing everything is a product of the theory of Determinism, the Marxist/Socialist claim that people are not responsible, they are victims, a moral alternative to human responsibility for choice, freedom of conscience, culpability.
If addiction is a disease and can’t be controlled then no one is to blame for anything that might be harmful—they are just victims—Medicalization is a very flexible thing—the list of medical conditions that might control people and remove culpability or responsibility is as long as the lexicon—easy stuff for smart people just say _______ addiction and propose a “treatment.”
I did my internship at Harlem Hospital, a brand new gigantic 1000 bed hospital built in the late 60s at a 135 and Lenox (now called, of course, Martin Luther King Ave). Across the street weather permitting, were the tables promoting the back to Africa movement, on the streets were various drugs, but mostly heroin, smoked or injectable.
Our approach to addicts or people who claimed addiction was simple—no. As I always tell jailors and those with less experience—heroin withdrawal is overrated—heroin kills people when overdosed, but withdrawal causes some anxiety, itching, yawning, and a feeling of unease—like a mild case of the flu. Man with a Golden Arm (Frank Sinatra movie) drama is an exaggeration.
Methadone Clinics were starting to be stylish during that period, since opiate addiction had been around for decades and people felt the need to “help” addicts. Methadone clinics attracted addicts with variable commitments to quitting, and perverse incentives since Methadone is an opiate, so addicts, not a very honest bunch for sure, figured–what the hell, go to the clinic, get your Methadone and use what’s on the street as an alternative. Variable Quality and potency Heroin sometimes would bite the user population and people would die—I guess that was an OPIATE CRISIS—Right?
I practiced in South Florida during the mid-80s when Cocaine became a major factor at all levels of society—as an emergency physician practicing north of Fort Lauderdale, I knew, for example, how much a key of cocaine was selling for on the street—but cocaine deaths were not a big factor—guess that was a COCAINE CRISIS—Right? Meth is a CRISIS now, right? It has been a crisis for a long time—widely used, big industry, ruins people. They don’t die of overdoses, much, but they end up a mess for sure. I take care of a rural Texas county jail, lots of meth users in jail, but they also use weed and pills and opiates, even some hallucinogens. When mood and mind altering substances are available some people partake. They choose too to.
Well it depends on what the public health community wants to discuss, right? And what the media wants to discuss. OPIATE CRISIS is a big deal because it seems to be appearing in working class white populations and it is considered another thing that can be blamed on prescribers and drug companies because—because bureaucrats and Government “experts” and the media have found a new and novel way to attack physicians and drug companies for creating this newly defined group of “VICTIMS” and I put them in quotes because they are their own worst enemies, but in the new world of DETERMINISM and with a well-developed canard that addiction is a disease, the deaths are deaths of poor victims and sad people who couldn’t control their urges and ended up dying from drug abuse.
I recommend a book Romancing Opiates by an insightful psychiatrist and writer/essayist Anthony Daniels (Pseudonym Theodore Dalrymple). He takes the hokum out of the addiction story and shows opiates are not the magical and awful thing that they are cracked up to be (pardon the pun). \
As for the public health community promotion of this new CRISIS I offer some nuggets for your consideration. And I warn you of the theme of this paper—Government programs are often founded on a new CRISIS that is created by the people who need to DO SOMETHING that will make them feel good about themselves and also expand their power and influence.
Remember, some of this CRISIS might be laid at the feet of people who 20 years ago said physicians and nurses were not attentive enough to people’s pain, and that pain should be another vital sign measured as ?/10, always dependent on what the patient subjectively responded, sometimes even though they weren’t even tachycardic and their behavior was not the behavior of a person with 8 or 10 over 10 pain. Everyone in medicine remembers when the Joint Commission and everybody in government jumped on the bandwagon—treat pain.
Back to the recent developments.
This OPIATE CRISIS is all about definitions and counting—it’s about overdose deaths and Dr. Josh Bloom at American Council on Science and Health shows how the CDC just plain lied—but what’s the surprise, they got sloppy and didn’t count overdose deaths properly to identify fentanyl, that came into the picture when Purdue Pharmaceuticals changed its Oxycontin (oxycodone) prep to prevent recreational users from grinding and mixing, then injecting. So guess what, no surprise, users turned to other drugs, and the CDC failed to take into account what’s on the street, so they started counting the deaths and asserting the problem was prescription opiates. How ‘bout a simpler answer, users turned to illicit heroin and fentanyl and continued to use other sedatives, the increase in overdose deaths was the result in a change in abuse patterns, but the CDC didn’t do the counting very well because they had an agenda.
What was their agenda—get big Pharma and Physicians. Oh, and by the way—throw the chronic pain patients under the bus for the agenda. And what a bonus, sic the DEA on any physicians who try to stay in pain management and do the right thing for their patients with chronic severe pain.
Dr. Bloom has written a series of articles that show that CDC officials have cheated on their death counts—are you surprised? Big lie, Big Crisis, some more power ceded to the government.
https://www.acsh.org/news/2018/03/19/cdc-quietly-admits-it-screwed-dishonestly-counting-pills-12717
Dr. Bloom points out that the data shows a majority of people who overdose on opiates didn’t start off using them for pain, so the restriction of prescription opiates is another example of the idiocy of government projects that fail to recognize the problem and then create solutions that have unintended negative consequences.
Only one to two percent of overdoses from heroin, fentanyl, and other drugs involve people who were prescribed pain medicine for pain conditions. So the campaign to reduce access to opiates penalizes those who need pain management, chasing the CRISIS OF DEATHS of recreational users who are using multi pharmacy and illicit fentanyl as well as street drugs of variable content and potency. By getting sloppy with definitions and ignoring the impact of sedatives and mixed overdoses, the CDC is irresponsible and involved in scientific misconduct. Anyone who knows the problem of overdoses in the recreational drug community knows that mixtures of sedatives and opiates are a factor and synthetic fentanyl is notoriously potent—potent at microgram levels, easy to make in home labs, and so any research in deaths from opiates should be done carefully and with attention to the details—but NOT IF YOU ARE JUST INTERESTED IN CREATING A CRISIS. Now everyone is making the OPIATE CRISIS a big deal—and prescribers are being harassed. More important, pain management is being compromised.
The DEA should deal with the pill mill problem and leave practicing physicians with ethical practices alone.
According to Dr. Bloom, the issue of who is likely to OD is significant because, in response to the rising death tolls, regulatory bodies have been restricting opioids and sometimes keeping them from people who need them. “Worse than the downside of pain drugs is withholding them from people,” Bloom says. “That’s barbaric.” One of the really bad results is the return of codeine, a pain med that I found a very bad choice many years ago. Now T-3s and 4s are making an undeserved comeback.
Once it was impossible to abuse Oxycontin and take massive doses all at once, recreational use of the drug declined steeply. This is when heroin and fentanyl use started to skyrocket. “Those lines crisscross. It’s not an accident,” says Dr. Bloom. A year after abuse-resistant Oxycontin hit the market, the Centers for Disease Control officially declared an opioid crisis. “Fentanyl is the worst drug that has ever hit the streets in the history of the world,” says Dr. Bloom
Drug dealers often tell customers about fentanyl is in their products sold. Drug dealers won’t even mention or know that they’re actually selling one of the deadliest opioids and fentanyl is so cheap and easy to acquire that it’s started showing up in non-opioids, like cocaine along with other designer drugs coming out of illicit drug labs. Fentanyl certainly could be mixed with any recreational concoction, smoked with weed or cocaine.
Dr. Bloom asserts that in places like New Hampshire, one of the states most afflicted by the crisis, fentanyl played a part in 70 percent of drug overdoses. The CDC doesn’t even discuss that in its reports and scare public releases. According to Bloom, lawmakers and other organizations have largely ignored fentanyl, instead focusing on pills “which were never the problem anyhow.” Bloom proposes Methadone as the answer for addicts. Methadone, in my opinion, is overrated for addicts—who just use it as a substitute and still abuse—Methadone is a long acting opiate, and may not give the same buzz as Heroine, but it certainly doesn’t cure the habit. Methadone overdoses are common if users have access to Methadone, that’s why clinics only dole out enough for maintenance, don’t prescribe bottles of Methadone to avoid two things, overdose, and trafficking.
Conclusion
The growth of the regulatory administrative state crushes liberty, and imposes a top down bureaucracy that results in tyranny, loss of freedom and most of all socialist ideas and policy making that are insanely stupid and harmful to the human welfare. Many statist regulatory actions are counterproductive because of unintended consequences.
Dr. Waldman will discuss today his diagnosis of the problems and proposals for solutions that are based on liberty, free markets and the pillars of Western Civilization and Morality.
John Dale Dunn MD JD
Brownwood, Texas