Tuesday, March 27, 2007

Just Say No to this `radical rethink' on drugs

The latest British review of the drug problem peddles dangerous myths about helpless addicts, and suggests making the state drugdealer-in-chief

After a two-year review of the drugs problem in the UK, a prestigious commission established by the UK Royal Society for the Arts (RSA) has come up with a `radical rethink' aiming to influence the impending major government review of the National Drugs Strategy (1). Another current campaign against addiction - the `Get Unhooked' TV and cinema adverts featuring smokers impaled on fish-hooks - reveals the prevailing contempt for those regarded as being in the grip of a chemical dependency that also pervades the RSA report (2).

The common theme is that the user of drugs (whether nicotine, heroin or alcohol) is an automaton, a being without intentions and unable to make choices, a physiological system that requires pharmacological correction. To pursue the official metaphor, the drug user is on a par with a fish, a level of vertebrate life so low that only the most fundamentalist of animal rights activists can be bothered to protest against fishing.

The `Get Unhooked' adverts offer a powerful endorsement of the myths underlying both current drugs policy and the RSA's radical rethink. These myths are exposed by Theodore Dalrymple, whose devastating critique of `pharmacological lies and the addiction bureaucracy' is informed by the experience of working as a psychiatrist at a British prison (3).

The first myth is the notion that addiction is the result of an unfortunate accident: one minute the hapless victim is swimming happily in the pond of life and the next is impaled by the hook of the malign substance. The apparently random victim is instantly at the mercy of whoever holds the rod and line - and in the advert is agonisingly dragged along the floor. But, as Dalrymple shows, becoming addicted to heroin requires effort and discipline, determination and time. Though the notions that the drug is the active agent and the addict the passive victim are popular among users and drug workers alike, they deny both the responsibility of the individual for adopting this lifestyle and the possibility of rejecting it. The image of the pathetic addict squirming on the hook is also contradicted by the reality of the busy and purposeful life required to sustain a drug habit.

The second great myth is that withdrawal from drugs is a deeply traumatic process - like removing a barbed hook from your mouth. This myth has reached a high pitch of histrionic exaggeration in relation to heroin, in the familiar `cold turkey' horrors dramatised in novels and films. Reporting both extensive professional experience and the medical literature, Dalrymple confirms that heroin withdrawal is an uncomfortable, but not a serious condition, with a much lower rate of complications than withdrawal from alcohol, barbiturates or benzodiazepines.

A third myth is that once the victim is ensnared on the hook, addiction immediately becomes a chronic disease requiring medical treatment - in the forms of diverse regimes of detoxification and rehabilitation. This is contradicted by the familiar experience that many users of drugs abandon the habit spontaneously - if supply is interrupted (by imprisonment) or by some change in circumstances (a new relationship, having a baby). As Dalrymple observes, `a motive is both a necessary and a sufficient condition for them to give up'. This does not work for chronic diseases such as tuberculosis or rheumatoid arthritis. The `treatment' of opiate dependency with methadone - the mainstay of medical management of heroin addicts for decades - has had such a low success rate (in terms of achieving abstinence) that the goal of treatment has largely shifted to achieving `maintenance' on an indefinite supply of this stupefying drug.

Methadone has been associated with a steady expansion of heroin use (and a large number of deaths from methadone overdoses). The RSA's answer is more, but `better and more consistent' methadone prescribing, and - the ultimate badge of radicalism in drugs policy - `heroin prescribing wherever appropriate'. This is popular with the police who believe that it may reduce crime, but not with GPs who will be expected to do the prescribing. It is difficult to think of measures more likely to encourage both the scale of heroin abuse and the mortality and morbidity associated with it (apart, perhaps, from the provision of `shooting galleries' for intravenous drug use and rewarding addicts with residential rehab programmes of the sort promoted by celebrities - both measures approved in the RSA report).

The RSA report proclaims as the essence of its innovative approach its emphasis on `harm minimisation' as the central theme of drugs policy. Of course, `harm minimisation', the mainstay of official drugs `guidelines' since at least 1991, has been another spectacular failure (4). Depriving self-indulgent actions of their worst consequences is likely to encourage them to spread. Dalrymple is alert to the wider implications: `[I]f consequences are removed from enough actions, then the very concept of human agency evaporates, life itself becomes meaningless, and is thenceforth a vacuum in which people oscillate between boredom and oblivion.' The concept of harm minimisation assumes that the authorities take over responsibility for the consequences of individuals' behaviour. It is `inherently infantilising'.

The dogma promoted by the RSA report, that drug addiction is a chronic disease, is both absurd and irresponsible. Drug addiction, as Dalrymple insists, is `a moral or spiritual condition that will never yield to medical treatment'. The medicalisation of drug abuse is a combination of `moral cowardice, displacement activity and employment opportunity'.

I would heartily endorse Dalrymple's radical first step towards tackling the drugs problem: close down all clinics claiming to treat drug addicts (on the basis of my experience as an inner-city GP, I would also recommend closing down drug treatment programmes in primary care). Addicts would then have to face the truth: `They are as responsible for their actions as anyone else.' This measure might help to set them free - and it might also help to release doctors from the corrosive deceptions underlying current drug policies. It is striking that while the RSA report is piously non-judgmental towards drug users and eschews coercive policies, it seethes with righteous indignation at GPs who might refuse to follow its dogmatic approach and insists twice in the five pages of its executive summary that GPs should not be allowed `to opt out of providing drugs treatment'. The notion that doctors should be coerced into providing dangerous treatments for their patients in the hope that this might reduce the crime rate reflects the damaging effect of drug policy on the ethics of medical practice.

Dalrymple concludes with a discussion of the case for the legalisation of drugs, which he concedes is `not a straightforward matter'. After considering both philosophical and prudential arguments, `on balance' he does not favour legalisation - the only point on which he is in accord with the RSA. While recognising the enormous cost to individuals and to society of our relationship with our most familiar intoxicant, alcohol, I believe that we have to learn to live with other `substances', too, without resorting to criminal legislation. However, I strongly agree with Dalrymple's emphasis that `far more important in the long run than the question of legalisation.is our attitude towards addiction'.

The radicalism of the RSA's rethink of drugs policy is symbolised by its bold insistence on the repeal of the 1971 Misuse of Drugs Act - and its replacement with a Misuse of Substances Act. But changing the labels - while perpetuating the myths about drug use - will do nothing to tackle the damaging effects of drugs on individuals and society. The RSA report concedes that `drugs education' - a concept scarcely less mind-numbing than heroin addiction - has failed. The answer? Never mind that `there has been too little evaluation for anyone to be certain what works', we need more of the same, with the heart-sinking rider that it `should be focused more on primary schools'.

Why not teach children something interesting and inspiring, that might give them the truly radical idea that culture and society have more to offer than drug-induced oblivion?


Medical Leftism

No wonder the intellectual standard of many medical journal articles is so low when we have the sort of shallow thinking displayed below. That lives are saved when tyrannies are deposed or faced down by democratic forces is obviously too deep a thought for these would-be wise ones

Physicians from around the world urged the publisher of The Lancet medical journal to cut its links to weapons sales, calling on the editors to find another publisher if Reed Elsevier refused to stop hosting arms fairs. The doctors made their appeal in the latest edition of The Lancet, released Friday. Editors at The Lancet responded by backing the doctors, calling the situation "bizarre and untenable." They wrote in Friday's edition that - in the interest of health - they may have to consider an "organized campaign" against their own publisher. "The Lancet is one of the most respected international medical journals and should not be linked to an industry involved in weapons designed to cause physical harm and death," wrote Dr. Ian Gilmore, president of the Royal College of Physicians, and Dr. Michael Pelly, the association's international adviser.

Some scientists have called for a boycott of journals published by Reed Elsevier Group PLC. Editors at the British Medical Journal have appealed to researchers to stop sending certain studies to The Lancet and other Reed Elsevier titles. On Friday, The Lancet published three pages of protest letters from leading doctors and organizations, including the London School of Hygiene and Tropical Medicine, Doctors for Iraq and the People's Health Movement, a public health watchdog.

Reed Elsevier said it supported The Lancet editors' right to free speech, but had no plans to stop its involvement with arms fairs. "We accept that Reed Elsevier publications may occasionally take editorial positions which are critical of their owners," the company said in a statement. "We do not, however, see any conflict between Reed Elsevier's connections with the scientific and health communities and the legitimate defense industry."

The Lancet first learned of its publisher's involvement in the arms industry in 2005. Supported by Britain's Ministry of Defense, Reed Elsevier hosts arms fairs around the world that have showcased weapons - including a 1,100-pound cluster bomb, one of the deadliest known bombs. At the time, editor Richard Horton informed the journal's international advisory board, which urged Reed Elsevier to divest itself of its arms trade business. Last month, criticism of the company gained renewed prominence when the Joseph Rowntree Charitable Trust withdrew $3.9 million of its investment from the company, because of the publisher's ties to the arms industry. "The Lancet has a particular commitment to child survival, and cluster bombs are a major cause of morbidity and mortality in children, and cause horrendous disabilities," Horton said. "It is completely incompatible for Reed Elsevier to be in this business and also to be a health science publisher." The Lancet's editors said they spoke regularly to Reed Elsevier about their concerns, and have asked for further meetings, but have yet to receive a response.



Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike. (It is also typical of Leftist thinking: Scorning the individual and capable of dealing with large groups only).

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

8). And when are we going to ban cheese? Cheese is a concentrated calorie bomb and has lots of that wicked animal fat in it too. Wouldn't we all be better off without it? And what about butter and margarine? They are just about pure fat. Surely they should be treated as contraband in kids' lunchboxes! [/sarcasm].

Trans fats:

For one summary of the weak science behind the "trans-fat" hysteria, see here. Trans fats have only a temporary effect on blood chemistry and the evidence of lasting harm from them is dubious. By taking extreme groups in trans fats intake, some weak association with coronary heart disease has at times been shown in some sub-populations but extreme group studies are inherently at risk of confounding with other factors and are intrinsically of little interest to the average person.