Map of life expectancy at birth from Global Education Project.

Wednesday, February 14, 2018

Ideology vs. Science

Joshua Sharfstein in JAMA discusses the opioid abuse epidemic and what to do about it. This is an opinion piece that doesn't have references, but I can assure you that he is right on the facts. People with opioid addiction seldom succeed in maintaining long term recovery without what we call Medication Assisted Treatment. That means either methadone or buprenorphine, both of which are themselves opioids. As Sharfstein tell us, "Many still believe that those who take methadone or buprenorphine are 'trading one addiction for another,' 'in bondage,' or 'taking a cop-out.'" People who are using these medications may face reprisals from judges or social service agencies.

Here is the reality. People on Medication Assisted treatment don't get high, and are not impaired. These particular opioids have a pharmacokinetic profile (as we say) that keeps them at a fairly steady concentration in the blood for a long time, meaning that they can eliminate craving without the side effects of intoxication. That means people can work, go to school, take care of their families, whatever they need to do. They are no longer committing crimes or at risk for overdose.

There are lots of chronic diseases for which people have to take medications every day, for a lifetime. These include diabetes, HIV, high blood pressure, high cholesterol . . . If you are over 45 or so, you probably take at least one medication every day yourself. If you didn't, you would be at higher risk for death and if you are, say, an insulin dependent diabetic or have HIV, you will certainly die. Do you consider yourself to be "in bondage," or that you have an addiction? No. You're just stayin' alive.

Now, these are true facts about medication assisted treatment for opioid addiction. There is no defensible reason to oppose it other than an ideological commitment to the principle that "Drugs" (meaning some drugs, when used by some people, in some contexts) are evil. This is also the reason why people who are caught with small amounts of opioids are put in jail, thereby ruining their lives and making recovery all the more difficult. That is pointless, but it happens because people morally condemn addicts. And why is that? Nobody sets out to become addicted, just as nobody tries to become diabetic. It's a disease.

As Lawrence Gostin tells us in the same issue, the present administration has abandoned truth:

Science and technology have not been salient in the Trump administration, including taking longer than any other modern president to name a science adviser, tasked with providing scientific guidance in “areas of national concern.”7 The administration has fired or reconfigured several science advisory boards, including at the Environmental Protection Agency (EPA), Interior Department, and National Oceanic and Atmospheric Administration. Scientific information regarding climate change was removed from official websites at the White House, EPA, and Department of Energy. Lesbian, gay, bisexual, and transgender (LGBT) content was removed from White House and State Department websites, and HHS removed LGBT questions from its survey of priority health needs for older US residents. . . .

The administration plans to eliminate the ACA’s Prevention and Public Health Fund. In addition, the president proposed deep budget cuts to research agencies, such as the National Institutes of Health, CDC, and the Energy Department.
The reason is, of course, that reality has a well-known liberal bias. The Republicans want to take us back to the 12th Century, before the Enlightenment, where truth was what the Pope said it was and the sun went around the earth.


Don Quixote said...

It seems to me that another main reason why the Republicans and the people running the idiot Trump want to take us back to the Middle Ages is that many so-called Christians--especially so-called evangelicals--are members of a religion based in ignorance, prejudice and superstition. Science is dangerous to these people. They want to bring about "end times" and they are overwhelmingly comprised of ignorant caucasians who are anti-education, anti-science, anti-reality. And they vote.

It seems to me that Republicans could be run out of Washington if only the American populace was cajoled into turning out to vote. The apathy now is of epidemic proportions. Ignorance reigns.

All powerful nations recede or disappear. Not sure what our decline is due to, but I think it has a lot to do with the fact that the country was founded, originally, on lies and genocide. It was rotten to begin with. We had a few eras of tolerance and progressivism, but in general our history in the USA seems to be one of rampant capitalistic wars and subjugation of indigenous and imported dark-skinned people.

Don Quixote said...

To "Stayin' Alive" readers:

I haven't read the above comment from the asinine contributor who identifies himself as "Gay Boy Bob." I don't read his comments anymore because I've learned through experience that he is an annoying, inexplicably persistent commenter who is ignorant, rude, and stupid. I've asked Cervantes to boot him off the site, but Cervantes is maddeningly committed to freedom of speech (i.e., he respects the Constitution, unlike congressional Republicans and Trump).

But I'm here to say that "Gay Boy Bob" is obviously a negative little hater who knows only ignorance and the pursuit of negative attention. No one really knows why he visits this blog site. He's the kid who always got beat up in class because his ignorant parents treated him like shit, and he's never learned to be positive. One day he'll be gone and we'll celebrate :-)

Gay Boy Bob said...

There is always a little sadness when someone who holds themselves out to be an "intellectual" cannot tolerate a different, yet reasoned, point of view.

Don Quixote said...

I'm aware the idiot "Gay Boy Bob" left another comment ... I still don't read his! Soon, perhaps, we'll be free of his perfidy. And mark my words, one way or another, within the year--or less--we'll be free of the ersatz fascism of one Donald J. Trump. Then we'll be able to deal with the perfidy of the Republicans.