Blame to go around on the opioid epidemic

The Purdue Pharma settlement gave family members of people who were harmed by opioid prescribing the opportunity to confront Purdue family members, a dramatic spectacle that represents some measure of justice but casts blame for the disaster of the opioid epidemic on one family. That is not the whole story, or really a true story.

 

Prior to the 1980s, opioids were generally prescribed in the U.S. only for short-term use, after surgery or severe injury, or for people who were terminally ill.

In the 1980s, for reasons which are not entirely clear, attitudes in the medical profession began to shift and physicians began to treat chronic pain with opioids. States even passed laws to shield physicians from prosecution for prescribing them. In 1985 the American Pain Society, a physicians’ association, launched what they called “Fifth Vital Sign” campaign to encourage the profession to monitor patients for pain as routinely as they monitored blood pressure and heart rate, and to prescribe opioids.

It seems an inadequate explanation, but some people trace this shift to a letter to the editor in The New England Journal of Medicine published in 1980, which asserted that of 11,882 people who were prescribed opioids in a Boston teaching hospital, only 4 became addicted. The letter gave no credible evidence for this claim, and in any case it is irrelevant to the issue of long-term prescribing for chronic pain. A study published in 1986, based on only 38 people, claimed that prescribing for chronic pain was safe and effective. On this very flimsy evidence, it became conventional wisdom that opioids were not addictive only when to treat pain.

Not surprisingly, pharmaceutical manufacturers jumped on this development to create new products and aggressive marketing campaigns for them. The most notorious is Purdue Pharma, which developed a timed release version of an old drug, Oxycodone, called Oxycontin, which they claimed was particularly safe and not subject to misuse. In order to keep their licenses, physicians have to take what are called Continuing Medical Education courses, which are not really courses but two or three hour workshops. Purdue developed and funded these, as well as sending salespeople to visit doctors and tout the product.

Over time it became evident that some people who are prescribed opioids do become dependent on them, producing a catastrophe. In 1999, the death rate from opioid overdoses in the U.S. was 2.9 per 100,000. In 2019, it was 15.5, nearly 50,000 individuals. Initially, the increase was largely attributable to drugs available by prescription, which were associated with 1 death per 100,000 in 2019, but steadily increased until 2017, to 4.4.

But as you can see, that doesn’t account for the bulk of the increase in the later years. People who became dependent on prescribed opioids often found that they could not satisfy their addiction with prescribed drugs and began to buy illicit drugs on the street. They would buy prescription drugs diverted to the illegal market, and also heroin. To increase their profits, criminal syndicates began to mix heroin with much more powerful synthetic opioids, notably fentanyl. People thinking they were using heroin but who are actually consuming fentanyl can receive a fatal overdose. Deaths per 100,000 from overdoses of fentanyl and similar chemicals increased from just 0.3 per 100,000 in 1999 to 11.4 in 2019, or more than 36,000.[1] In 2020 and 2021, there was a further discontinuity. During the Covid 19 epidemic, deaths from opioid overdose jumped to more than 68,000.[2]

Of course, not everyone who uses illegal opioids and not everyone who dies from overdose began by taking prescription medications. As there was a growing market for illicit opioids and more people using them, the epidemic spread to some extent by social contagion, amplifying the iatrogenic epidemic. So this is a complicated story, that tells us as much about the medical profession and organized crime as it does about corporate greed.

---

[1] National Center for Health Statistics data brief 394, December 2020.

[2] NIDA Trends and Statistics Overdose Death Rates https://nida.nih.gov/drug-topics/trends-statistics/overdose-death-rates

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Sunday Sermonette: You didn't really expect it to make any sense, did you?

With Chapter 24 we come to the end of the Book of Samuel. The division seems arbitrary -- David is still around for the first couple of chapters of Kings. I suspect it has to do with the conventional length of a scroll rather than any literary consideration. In any event, this chapter is completely incoherent.

God is angry at Israel for no apparent reason, so he orders David to take a census, which is somehow supposed to be a punishment? Note that Moses took several censuses, in fact that is the reason for the title of the Book of Numbers, in which there are three. Saul also took a census. This was never any problem. Anyway, under protest, Joab takes the census, which actually only counts military age men, and he finds 1.3 million of them, which is absurd. 

Even though David was following God's orders by taking the census, he decides for some reason that it was sinful, and God agrees, even though it was God's idea in the first place. So God gives David the option of three years of famine, three months of military defeat, or three days of pestilence. David chooses the epidemic, so God sends an angel of death, who is evidently visible to David. God decides he'll stop killing the people if David buys a specific threshing floor and builds an altar on it. The owner tries to donate it but David insists on paying him. That ends the plague.

While this is batshit insane, I should note that the Book of Chronicles recapitulates some of this history, but with differences, the most notable difference being that it is Satan, not God, who tells David to take the census. That at least makes some sense, although why the census is offensive, no matter whose idea it was, it not apparent. You figure it out.

24 Again the anger of the Lord was kindled against Israel, and he incited David against them, saying, “Go, number Israel and Judah.” ² So the king said to Jo′ab and the commanders of the army,^[a] who were with him, “Go through all the tribes of Israel, from Dan to Beer-sheba, and number the people, that I may know the number of the people.” ³ But Jo′ab said to the king, “May the Lord your God add to the people a hundred times as many as they are, while the eyes of my lord the king still see it; but why does my lord the king delight in this thing?” ⁴ But the king’s word prevailed against Jo′ab and the commanders of the army. So Jo′ab and the commanders of the army went out from the presence of the king to number the people of Israel. ⁵ They crossed the Jordan, and began from Aro′er,^[b] and from the city that is in the middle of the valley, toward Gad and on to Jazer. ⁶ Then they came to Gilead, and to Kadesh in the land of the Hittites;^[c] and they came to Dan, and from Dan^[d] they went around to Sidon, ⁷ and came to the fortress of Tyre and to all the cities of the Hivites and Canaanites; and they went out to the Negeb of Judah at Beer-sheba. ⁸ So when they had gone through all the land, they came to Jerusalem at the end of nine months and twenty days. ⁹ And Jo′ab gave the sum of the numbering of the people to the king: in Israel there were eight hundred thousand valiant men who drew the sword, and the men of Judah were five hundred thousand.

Judgment on David’s Sin

¹⁰ But David’s heart smote him after he had numbered the people. And David said to the Lord, “I have sinned greatly in what I have done. But now, O Lord, I pray thee, take away the iniquity of thy servant; for I have done very foolishly.” ¹¹ And when David arose in the morning, the word of the Lord came to the prophet Gad, David’s seer, saying, ¹² “Go and say to David, ‘Thus says the Lord, Three things I offer^[e] you; choose one of them, that I may do it to you.’” ¹³ So Gad came to David and told him, and said to him, “Shall three^[f] years of famine come to you in your land? Or will you flee three months before your foes while they pursue you? Or shall there be three days’ pestilence in your land? Now consider, and decide what answer I shall return to him who sent me.” ¹⁴ Then David said to Gad, “I am in great distress; let us fall into the hand of the Lord, for his mercy is great; but let me not fall into the hand of man.”

¹⁵ So the Lord sent a pestilence upon Israel from the morning until the appointed time; and there died of the people from Dan to Beer-sheba seventy thousand men. ¹⁶ And when the angel stretched forth his hand toward Jerusalem to destroy it, the Lord repented of the evil, and said to the angel who was working destruction among the people, “It is enough; now stay your hand.” And the angel of the Lord was by the threshing floor of Arau′nah the Jeb′usite. ¹⁷ Then David spoke to the Lord when he saw the angel who was smiting the people, and said, “Lo, I have sinned, and I have done wickedly; but these sheep, what have they done? Let thy hand, I pray thee, be against me and against my father’s house.”

David’s Altar on the Threshing Floor

¹⁸ And Gad came that day to David, and said to him, “Go up, rear an altar to the Lord on the threshing floor of Arau′nah the Jeb′usite.” ¹⁹ So David went up at Gad’s word, as the Lord commanded. ²⁰ And when Arau′nah looked down, he saw the king and his servants coming on toward him; and Arau′nah went forth, and did obeisance to the king with his face to the ground. ²¹ And Arau′nah said, “Why has my lord the king come to his servant?” David said, “To buy the threshing floor of you, in order to build an altar to the Lord, that the plague may be averted from the people.” ²² Then Arau′nah said to David, “Let my lord the king take and offer up what seems good to him; here are the oxen for the burnt offering, and the threshing sledges and the yokes of the oxen for the wood. ²³ All this, O king, Arau′nah gives to the king.” And Arau′nah said to the king, “The Lord your God accept you.” ²⁴ But the king said to Arau′nah, “No, but I will buy it of you for a price; I will not offer burnt offerings to the Lord my God which cost me nothing.” So David bought the threshing floor and the oxen for fifty shekels of silver. ²⁵ And David built there an altar to the Lord, and offered burnt offerings and peace offerings. So the Lord heeded supplications for the land, and the plague was averted from Israel.

Footnotes

1. 2 Samuel 24:2 1 Chr 21.2 Gk: Heb to Joab the commander of the army
2. 2 Samuel 24:5 Gk: Heb encamped in Aroer
3. 2 Samuel 24:6 Gk: Heb to the land of Tahtim-hodshi
4. 2 Samuel 24:6 Cn Compare Gk: Heb they came to Dan-jaan and
5. 2 Samuel 24:12 Or hold over
6. 2 Samuel 24:13 1 Chr 21.12 Gk: Heb seven

Like I said

Because of the NYT paywall, I'll give you Digby's repost of a Krugman column, which is not fair use but I suppose they can sue her if they want to. 

Anyway, the price of  gasoline and diesel fuel is determined almost entirely by the cost of crude oil. Crude oil is sold on a global market, and guess what? The price of crude oil and fuels derived therefrom has increased the world over, by the same amount. This has happened in the UK, in Germany, and in every other country in the world where Joe Biden is not president. As Krugman explains:

[R]ising gas prices in America are part of a global story that has nothing to do with the policies of the current administration. Still, can’t the United States have some impact on that global story? We are, after all, the world’s largest oil producer, accounting for about 20 percent of world output in 2020. Can’t America do something to reduce global oil prices?

Yes, in principle. Not so much in practice.

U.S. oil production did increase a lot after 2010 — a trend that, as it happens, began under the Obama administration and continued for part of Donald Trump’s term.

But this had little to do with policy; it was all about new technology, specifically fracking. Oil production then slumped in 2020, not because of policy but because prices plunged during the pandemic. Now it’s coming back, again thanks to events rather than policy. It seems safe to say that nothing either Trump did or Biden did has had any appreciable effect on U.S. oil production, let alone U.S. gasoline prices.

Of course, that’s not what Republicans would have you believe. They want the public to give Trump credit for low prices in 2020, when demand for oil was low because Covid had the world economy on its back. They want voters to blame environmental concerns, which have blocked the Keystone XL pipeline and might block drilling on public land, for high prices at the pump right now — even though it will take years before these policy changes will have any effect, and that effect will be modest even then.

I suppose we shouldn’t be surprised. After all, we’re talking about a party that’s in denial about everything from climate change to vaccine effectiveness, so what’s a bit of economic nonsense thrown into the mix? But somehow I find myself shocked all the same. For you don’t need scientific understanding or even rudimentary statistical analysis to see that President Biden can’t possibly be responsible for high U.S. gasoline prices; all you need to do is spend five minutes looking at what’s happening in the rest of the world.

 

Doesn't matter. They lie, all the time, about everything. It works.

Freeze Peach

Michelle Mello, writing in the JAMA Health Forum,  is frustrated that the Supreme Court considers vaccine disinformation to be protected under the first amendment. 

 

As many as 12 million persons may have forgone COVID-19 vaccination in the US because of misinformation, resulting in an estimated 1200 excess hospitalizations and 300 deaths per day. If 5 fully loaded 747s crashed each week due to wrong information, regulators would be apoplectic.

 

She points out that there are many circumstances in which potentially harmful falsehoods can be policed. This includes advertising -- an ad claiming that Ivermectin is safe and effective against Covid-19 can and would be banned. State medical licensing boards can suspend the licenses of physicians who convey false information to their patients. However, these same people can go on Faux news and make the same claims, and there is nothing to be done except to rebut them.

While Mello seems to want the court to allow policing of harmful falsehoods, there are difficulties. Someone has to decide that a claim is indeed objectively false, and sufficiently harmful that it should be banned from public discourse. I can see why the courts are reluctant to allow this. Scientific conclusions can change with new evidence, and may have varying degrees of uncertainty in the first place. People who make false assertions may believe what they are saying and again, some regulatory authority has to conclude that their reasoning is unsound. 

 

However, it occurs to me, although she does not mention it, that the possibility of civil litigation might be entertained. If someone's relative died of Covid-19, and the person refused to be vaccinated because of the ravings of a TV personality, the bereaved party might have grounds for a lawsuit, it seems to me. That would allow the claims to be adjudicated and evaluated by a judge or jury. I don't see why people don't try it.

Also, too, Pfizer and Moderna could sue for defamation. Sandy Hook parents sued Alex Jones and they won. Dominion Voting Systems sued Faux News and Faux stopped lying about them. Hillary Clinton threatened to sue Faux News and they stopped lying about her. It works!

The Rule of Rescue

I'm going to do a series on some of the fundamentals of public health. I'll start with a concept called the Rule of Rescue, a term coined by bioethicist Albert R. Jonsen in 1986.[i] When a child falls down a well, and the rescue is difficult, the attention of the entire country may focus on a remote small town until the drama is resolved. But children in low income countries die of preventable causes every five minutes, and few Americans seem to care. You might chalk this up to racism, and you’d be partly right, but white American children also die of preventable causes every day, and it gets little attention.

The Rule of Rescue applies when a specific, identifiable individual is in mortal danger. People instinctively feel that everything possible should be done to save that person, without regard to cost or even, to some degree, immediate peril to others. This instinct is usually fairly egalitarian. It applies to old as well as young, and with little regard to people’s station in life or perceived worthiness, so long as the individual is within the category that is attributed human rights. (Of course, historically some groups of people have not ascribed humanity to some others, but that’s another matter.)

It might cost tens of thousands, or a hundred thousand dollars, to save little Molly from the well. It doesn’t matter. Anyone who tried to say it wasn’t worth it would be regarded as depraved. But that money could be invested in ways that would save dozens of children. Their misfortune is that they are not specifically identifiable, they are only statistical. We don’t know which child will die from contaminated water, or a preventable infectious disease, or a car crash, or violence, because we haven’t taken measures that could have prevented it. In political debates, the cost of investing in public health and safety is always an issue, and politicians often decide that we just can’t afford some investment that is proven to prevent death and disease.

As we continue, I'll discuss how public health researchers evaluate policies and practices. They do indeed consider cost, but they also consider what we get for the money. They don't conclude that we shouldn't save Molly from the well, but they do come to some conclusions that many people find difficult to understand, or accept. We'll wrestle with them.

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[i][i][i] Jonsen, A. R. (1986). Bentham in a box: Technology assessment and health care allocation. Law, Medicine and Health Care, 14, 172–174.

Selective attention

I'm certainly not going to let this blog get bogged down in discussion of the Syrian civil war. If you want to read reasonably detailed but succinct accounts there is this from the BBC, which uses data from various sources including the Syrian Observatory for Human Rights; The Council on Foreign Relations; and for a more international view, the International Institute for Security Studies. 

They are all in agreement on the main points. The war began with peaceful pro-democracy demonstrations in March, 2011, which the Assad government violently repressed, sparking widespread uprisings nationwide that quickly evolved into armed conflict. Over time, many foreign actors intervened in various ways, and various factions within Syria organized and entered into conflict with government forces, and with each other. Turkey and Israel also intervened directly on Syrian territory. The U.S. is among the outside agencies that played a role, but it was a relatively small one. By far the most important outside participants are Iran, which backs the Assad regime with weaponry and financing to the tune of billions of dollars, and has also imported militias is sponsors from Lebanon and elsewhere; and Russia, which essentially serves as Assad's air force. 

The U.S. has played a comparatively small role. Initially, the U.S. and its allies provided support for what they thought were "moderate" rebel groups, but as I have said before this turned out to be a mistake as these groups were dominated by Islamists, and that support ceased. In 2014 the U.S. switched its support to a Kurdish-led coalition that also included some Arab militias, called the Syrian Democratic Forces, to capture territory held by Islamic State and protect the Kurdish enclave in the north. 

 

The claim that the civil war would have ended in 2012 without U.S. intervention is Q-anon level nonsense. The U.S. role in Syria has been of some importance in reducing IS and maintaining Kurdish autonomy, but it has otherwise had little or no impact on the situation overall. Assad has regained control of most of the country with the overwhelmingly important assistance of Iran and Russia, against forces and in parts of the country in which the United States had no involvement. Whatever you think of the U.S. role in Syria, it has been a fairly small part of the story, and as far as I'm concerned to blow it up into the main plot is a case of motivated reasoning. 

And that's all we'll say about that here. It's really not on topic.

Last Words -- Not

Ch. 23 first purports to give us David's last words, but they aren't. David's actual last words are given in 1 Kings 2, three chapters and some considerable time later. This chapter then goes on to list David's captains and their incredible feats of slaughter, in some cases killing hundreds of Philistines single-handed. Why this list of names and associated mass killings is of interest I cannot say, especially since they were supposedly long dead and forgotten at the time this was written. (Most likely none of them existed at all.) Make of this what you will. Also, since I'm sure you won't count, I'll do it for you. This lists 36 mighty men, but at the end says there are 37.

23 Now these are the last words of David:

The oracle of David, the son of Jesse,
    the oracle of the man who was raised on high,
the anointed of the God of Jacob,
    the sweet psalmist of Israel:^[a]

² “The Spirit of the Lord speaks by me,
    his word is upon my tongue.
³ The God of Israel has spoken,
    the Rock of Israel has said to me:
When one rules justly over men,
    ruling in the fear of God,
⁴ he dawns on them like the morning light,
    like the sun shining forth upon a cloudless morning,
    like rain^[b] that makes grass to sprout from the earth.
⁵ Yea, does not my house stand so with God?
    For he has made with me an everlasting covenant,
    ordered in all things and secure.
For will he not cause to prosper
    all my help and my desire?
⁶ But godless men^[c] are all like thorns that are thrown away;
    for they cannot be taken with the hand;
⁷ but the man who touches them
    arms himself with iron and the shaft of a spear,
    and they are utterly consumed with fire.”^[d]

David’s Mighty Men

⁸ These are the names of the mighty men whom David had: Josheb-basshe′beth a Tah-che′monite; he was chief of the three;^[e] he wielded his spear^[f] against eight hundred whom he slew at one time.

⁹ And next to him among the three mighty men was Elea′zar the son of Dodo, son of Aho′hi. He was with David when they defied the Philistines who were gathered there for battle, and the men of Israel withdrew. ¹⁰ He rose and struck down the Philistines until his hand was weary, and his hand cleaved to the sword; and the Lord wrought a great victory that day; and the men returned after him only to strip the slain.

¹¹ And next to him was Shammah, the son of Agee the Har′arite. The Philistines gathered together at Lehi, where there was a plot of ground full of lentils; and the men fled from the Philistines. ¹² But he took his stand in the midst of the plot, and defended it, and slew the Philistines; and the Lord wrought a great victory.

¹³ And three of the thirty chief men went down, and came about harvest time to David at the cave of Adullam, when a band of Philistines was encamped in the valley of Reph′aim. ¹⁴ David was then in the stronghold; and the garrison of the Philistines was then at Bethlehem. ¹⁵ And David said longingly, “O that some one would give me water to drink from the well of Bethlehem which is by the gate!” ¹⁶ Then the three mighty men broke through the camp of the Philistines, and drew water out of the well of Bethlehem which was by the gate, and took and brought it to David. But he would not drink of it; he poured it out to the Lord, ¹⁷ and said, “Far be it from me, O Lord, that I should do this. Shall I drink the blood of the men who went at the risk of their lives?” Therefore he would not drink it. These things did the three mighty men.

¹⁸ Now Abi′shai, the brother of Jo′ab, the son of Zeru′iah, was chief of the thirty.^[g] And he wielded his spear against three hundred men and slew them, and won a name beside the three. ¹⁹ He was the most renowned of the thirty,^[h] and became their commander; but he did not attain to the three.

²⁰ And Benai′ah the son of Jehoi′ada was a valiant man^[i] of Kabzeel, a doer of great deeds; he smote two ariels^[j] of Moab. He also went down and slew a lion in a pit on a day when snow had fallen. ²¹ And he slew an Egyptian, a handsome man. The Egyptian had a spear in his hand; but Benai′ah went down to him with a staff, and snatched the spear out of the Egyptian’s hand, and slew him with his own spear. ²² These things did Benai′ah the son of Jehoi′ada, and won a name beside the three mighty men. ²³ He was renowned among the thirty, but he did not attain to the three. And David set him over his bodyguard.

²⁴ As′ahel the brother of Jo′ab was one of the thirty; Elha′nan the son of Dodo of Bethlehem, ²⁵ Shammah of Harod, Eli′ka of Harod, ²⁶ Helez the Paltite, Ira the son of Ikkesh of Teko′a, ²⁷ Abie′zer, of An′athoth, Mebun′nai the Hu′shathite, ²⁸ Zalmon the Aho′hite, Ma′harai of Netoph′ah, ²⁹ Heleb the son of Ba′anah of Netoph′ah, It′tai the son of Ri′bai of Gib′e-ah of the Benjaminites, ³⁰ Benai′ah of Pira′thon, Hid′dai of the brooks of Ga′ash, ³¹ Abi-al′bon the Ar′bathite, Az′maveth of Bahu′rim, ³² Eli′ahba of Sha-al′bon, the sons of Jashen, Jonathan, ³³ Shammah the Har′arite, Ahi′am the son of Sharar the Har′arite, ³⁴ Eliph′elet the son of Ahas′bai of Ma′acah, Eli′am the son of Ahith′ophel of Gilo, ³⁵ Hezro^[k] of Carmel, Pa′arai the Arbite, ³⁶ Igal the son of Nathan of Zobah, Bani the Gadite, ³⁷ Zelek the Ammonite, Na′harai of Be-er′oth, the armor-bearer of Jo′ab the son of Zeru′iah, ³⁸ Ira the Ithrite, Gareb the Ithrite, ³⁹ Uri′ah the Hittite: thirty-seven in all.

Footnotes

1. 2 Samuel 23:1 Or the favorite of the songs of Israel
2. 2 Samuel 23:4 Heb from rain
3. 2 Samuel 23:6 Heb worthlessness
4. 2 Samuel 23:7 Heb fire in the sitting
5. 2 Samuel 23:8 Or captains
6. 2 Samuel 23:8 1 Chr 11.11: Heb obscure
7. 2 Samuel 23:18 Two Hebrew Mss Syr: MT three
8. 2 Samuel 23:19 1 Chr 11.25: Heb Was he the most renowned of the three?
9. 2 Samuel 23:20 Another reading is the son of Ish-hai
10. 2 Samuel 23:20 The meaning of the word ariel is unknown
11. 2 Samuel 23:35 Another reading is Hezrai

Propaganda

I don't reject comments just because I disagree with the commenter's opinion. If you actually read the comments, you will see that I often publish comments by people who disagree with me in some way. I do reject comments that are factually ridiculous or illogical. Sometimes I publish them and rebut them, but I can't be bothered to do that with all of the nonsense that comes my way. 

Because I don't read Faux News, Newsmax, Onan, or Russian propaganda, half the time I don't even know what the bizarre conspiracy theory is that they're talking about. But just for example, claiming that NATO broke up Yugoslavia or the U.S. provoked the Syrian civil war by financing IS and Al Qaeda is not worth my time or anybody else's to argue with. These claims are as absurd as saying that the United States caused Hitler to attack Poland. Now supposedly CDC is withholding data of some kind, although what that data may be and why it matters is unspecified. If you want to do your own research, go here. They push out data to the public through a firehose.

Sorting truth from fiction is apparently harder for some people than it seems to me. But the first piece of advice I can give is to understand what sources are at least trying to proffer truth, and which ones are blatantly lying to you. I have plenty of criticisms of the New York Times, their conventional ways of framing issues, how they treat lying politicians,what they treat as important. (Hillary Clinton's e-mails?) You have to learn how to read between the lines sometimes. But they do have standards of factual accuracy and they correct their errors, at least in the news columns. (Not so much in the opinion columns.) This is not true of Fox News, which constantly spews blatant lies. 

It may be tempting to fit the facts to your preconceptions or the way you want the world to be, but you have to learn to work in the opposite direction. The world is what it is, whether you like it or not.

Sunday Sermonette: Singer-songwriter

David now sings a lengthy song, and on account of this and a passage in the next chapter that calls him the "psalmist" the Book of Psalms is traditionally attributed to him. Of course since he did not actually exist that seems likely inaccurate. In any case the literary quality of the Book of Psalms, as well as the prevailing sentiment, is (fortunately) very different. The content of this song is morally depraved. To quote SAB, "David is one of the most despicable characters in all fiction, yet here he brags about how perfect he is. (And God agrees with him!)" God favors David by letting David exterminate his enemies and subjugate his neighbors. God will also favor David's descendants "forever," but of course that doesn't happen. Note that Yahweh is still anthropomorphic, and of course he is not a universal God but the particular God of Israel. The theology has yet to evolve in any meaningful way.

22 And David spoke to the Lord the words of this song on the day when the Lord delivered him from the hand of all his enemies, and from the hand of Saul. ² He said,

“The Lord is my rock, and my fortress, and my deliverer,
³ my^[a] God, my rock, in whom I take refuge,
my shield and the horn of my salvation,
    my stronghold and my refuge,
    my savior; thou savest me from violence.
⁴ I call upon the Lord, who is worthy to be praised,
    and I am saved from my enemies.

⁵ “For the waves of death encompassed me,
    the torrents of perdition assailed me;
⁶ the cords of Sheol entangled me,
    the snares of death confronted me.

⁷ “In my distress I called upon the Lord;
    to my God I called.
From his temple he heard my voice,
    and my cry came to his ears.

⁸ “Then the earth reeled and rocked;
    the foundations of the heavens trembled
    and quaked, because he was angry.
⁹ Smoke went up from his nostrils,
    and devouring fire from his mouth;
    glowing coals flamed forth from him.
¹⁰ He bowed the heavens, and came down;
    thick darkness was under his feet.
¹¹ He rode on a cherub, and flew;
    he was seen upon the wings of the wind.
¹² He made darkness around him
    his canopy, thick clouds, a gathering of water.
¹³ Out of the brightness before him
    coals of fire flamed forth.
¹⁴ The Lord thundered from heaven,
    and the Most High uttered his voice.
¹⁵ And he sent out arrows, and scattered them;
    lightning, and routed them.
¹⁶ Then the channels of the sea were seen,
    the foundations of the world were laid bare,
at the rebuke of the Lord,
    at the blast of the breath of his nostrils.

¹⁷ “He reached from on high, he took me,
    he drew me out of many waters.
¹⁸ He delivered me from my strong enemy,
    from those who hated me;
    for they were too mighty for me.
¹⁹ They came upon me in the day of my calamity;
    but the Lord was my stay.
²⁰ He brought me forth into a broad place;
    he delivered me, because he delighted in me.

²¹ “The Lord rewarded me according to my righteousness;
    according to the cleanness of my hands he recompensed me.
²² For I have kept the ways of the Lord,
    and have not wickedly departed from my God.
²³ For all his ordinances were before me,
    and from his statutes I did not turn aside.
²⁴ I was blameless before him,
    and I kept myself from guilt.
²⁵ Therefore the Lord has recompensed me according to my righteousness,
    according to my cleanness in his sight.

²⁶ “With the loyal thou dost show thyself loyal;
    with the blameless man thou dost show thyself blameless;
²⁷ with the pure thou dost show thyself pure,
    and with the crooked thou dost show thyself perverse.
²⁸ Thou dost deliver a humble people,
    but thy eyes are upon the haughty to bring them down.
²⁹ Yea, thou art my lamp, O Lord,
    and my God lightens my darkness.
³⁰ Yea, by thee I can crush a troop,
    and by my God I can leap over a wall.
³¹ This God—his way is perfect;
    the promise of the Lord proves true;
    he is a shield for all those who take refuge in him.

³² “For who is God, but the Lord?
    And who is a rock, except our God?
³³ This God is my strong refuge,
    and has made^[b] my^[c] way safe.
³⁴ He made my^[d] feet like hinds’ feet,
    and set me secure on the heights.
³⁵ He trains my hands for war,
    so that my arms can bend a bow of bronze.
³⁶ Thou hast given me the shield of thy salvation,
    and thy help^[e] made me great.
³⁷ Thou didst give a wide place for my steps under me,
    and my feet^[f] did not slip;
³⁸ I pursued my enemies and destroyed them,
    and did not turn back until they were consumed.
³⁹ I consumed them; I thrust them through, so that they did not rise;
    they fell under my feet.
⁴⁰ For thou didst gird me with strength for the battle;
    thou didst make my assailants sink under me.
⁴¹ Thou didst make my enemies turn their backs to me,
    those who hated me, and I destroyed them.
⁴² They looked, but there was none to save;
    they cried to the Lord, but he did not answer them.
⁴³ I beat them fine as the dust of the earth,
    I crushed them and stamped them down like the mire of the streets.

⁴⁴ “Thou didst deliver me from strife with the peoples;^[g]
    thou didst keep me as the head of the nations;
    people whom I had not known served me.
⁴⁵ Foreigners came cringing to me;
    as soon as they heard of me, they obeyed me.
⁴⁶ Foreigners lost heart,
    and came trembling^[h] out of their fastnesses.

⁴⁷ “The Lord lives; and blessed be my rock,
    and exalted be my God, the rock of my salvation,
⁴⁸ the God who gave me vengeance
    and brought down peoples under me,
⁴⁹ who brought me out from my enemies;
    thou didst exalt me above my adversaries,
    thou didst deliver me from men of violence.

⁵⁰ “For this I will extol thee, O Lord, among the nations,
    and sing praises to thy name.
⁵¹ Great triumphs he gives^[i] to his king,
    and shows steadfast love to his anointed,
    to David, and his descendants for ever.”

Footnotes

1. 2 Samuel 22:3 Gk Ps 18.2: Heb lacks my
2. 2 Samuel 22:33 Ps 18.32: Heb set free
3. 2 Samuel 22:33 Another reading is his
4. 2 Samuel 22:34 Another reading is his
5. 2 Samuel 22:36 Or gentleness
6. 2 Samuel 22:37 Heb ankles
7. 2 Samuel 22:44 Gk: Heb from strife with my people
8. 2 Samuel 22:46 Ps 18.45: Heb girded themselves
9. 2 Samuel 22:51 Another reading is He is a tower of salvation

Tighten your belts

 I refer you to this extensive, comprehensive, and apprehensive Kos diary by Bilboteach. I discussed this with a friend the other day and I'm not sure he took me seriously. A consequence of the Russian invasion of Ukraine will be a global food shortage. Ukraine is a major grain exporter, and Russia is a major exporter of nitrogen fertilizer on which, unfortunately, the global food supply is completely dependent. Higher fuel costs will also increase the cost of food.

Futures prices for basic food commodities -- wheat, maze, soybeans -- have soared already. It seems inevitable that there will be famine in poor countries, while in the rich countries people's grocery bills may double. The world has become so interdependent that a disruption such as the loss of Ukraine's grain crop will unravel the global network that gets calories into humans. There is barely enough agricultural land on the planet to sustain the current population as it is, and it's only enough because of intensive additions of synthetic fertilizer, along with plants that have been highly modified by selective breeding or genetic engineering that can't grow in natural soil, planted in vast monocultures tended by immense machines. The whole enterprise depends on fossil fuels. It wasn't sustainable but now it's going to be tested as never before.

The result may be political disruption, not only in poor countries that experience famine but also in wealthy countries where food will become unaffordable for low income people and food prices will create substantial stress on the middle class. We know how short-sighted and misinformed the American people are, and we know they will blame the incumbent president and party no matter how irrational that may be, and we can't count on the corporate media to explain things to them either. 

This is real, folks. We need to fundamentally change the way we live, replacing our fossil-fuel powered momentary hallucination of prosperity with a civilization fueled by renewable energy and sustainable agriculture. In that world, the global plutocrats who are sucking our blood, including the insane ones like Vladimir Putin, will wither away. But it has to start happening now, or God help us, and he won't.

Public health law

To those of us who work in the field of public health, the so-called "trucker" convoys heading to D.C. are totally ridiculous. The kinds of mandates the purport to be protesting are entirely a state, not a federal responsibility. The Supreme Court ruled in 1902 to Massachusetts could impose a vaccine mandate, based on the police power that pertains to the states. The federal government has no police power.

The federal government's powers in public health are actually quite limited. Since drugs are sold in interstate commerce, the FDA can regulate them. Federal funding for hospitals, health centers and state health departments can come with strings attached, up to a point. 

State actions to protect public health are limited by various constitutional provisions, including due process and non-discrimination principles. But the bottom line is, if you don't like mask mandates or vaccine mandates (which for the most part there aren't any) take it up with your state government, not D.C.

Wednesday Bible Study: Human Sacrifice

 Literally. The first part of this chapter is a story of human sacrifice to appease Yahweh. It is also riddled with contradictions, which I'll note. In the second part, the Giants return. Remember that there has been a race of giants in Palestine going back to Genesis. They appear again in Numbers and of course earlier we had the story of Goliath. A giant named Goliath appears again here. The editors of the KJV inserted the words "the brother of" to cover up the apparent contradiction, but we'll give the benefit of the doubt and assume he's Goliath Jr. 

21 Now there was a famine in the days of David for three years, year after year; and David sought the face of the Lord. And the Lord said, “There is bloodguilt on Saul and on his house, because he put the Gib′eonites to death.” ² So the king called the Gib′eonites.^[a] Now the Gib′eonites were not of the people of Israel, but of the remnant of the Amorites; although the people of Israel had sworn to spare them, Saul had sought to slay them in his zeal for the people of Israel and Judah. ³ 

To be clear, in case you thought you weren't remembering something, there is no previous mention anywhere of Saul slaying Gibeonites. Saul has of course slain a lot of people, and the only time he got in trouble with Yahweh about it was because he failed to kill a guy he was supposed to kill. So now, decades after Saul's death, Yahweh is suddenly inflicting a famine on Israel because of something Saul did that has never before been mentioned. Just so you've got thata. 

And David said to the Gib′eonites, “What shall I do for you? And how shall I make expiation, that you may bless the heritage of the Lord?” ⁴ The Gib′eonites said to him, “It is not a matter of silver or gold between us and Saul or his house; neither is it for us to put any man to death in Israel.” And he said, “What do you say that I shall do for you?” ⁵ They said to the king, “The man who consumed us and planned to destroy us, so that we should have no place in all the territory of Israel, ⁶ let seven of his sons be given to us, so that we may hang them up before the Lord at Gibeon on the mountain of the Lord.”^[b] And the king said, “I will give them.”

⁷ But the king spared Mephib′osheth, the son of Saul’s son Jonathan, because of the oath of the Lord which was between them, between David and Jonathan the son of Saul. ⁸ The king took the two sons of Rizpah the daughter of Ai′ah, whom she bore to Saul, Armo′ni and Mephib′osheth; and the five sons of Merab^[c] the daughter of Saul, whom she bore to A′dri-el the son of Barzil′lai the Meho′lathite; ⁹ and he gave them into the hands of the Gib′eonites, and they hanged them on the mountain before the Lord, and the seven of them perished together. They were put to death in the first days of harvest, at the beginning of barley harvest.

So that's how Yahweh works. Hand over seven descendants of Saul, who presumably had nothing to do with the massacre of the Gibeonites decades before, and have them murdered. Then Yahweh lifts the famine. Makes perfect sense.

¹⁰ Then Rizpah the daughter of Ai′ah took sackcloth, and spread it for herself on the rock, from the beginning of harvest until rain fell upon them from the heavens; and she did not allow the birds of the air to come upon them by day, or the beasts of the field by night. ¹¹ When David was told what Rizpah the daughter of Ai′ah, the concubine of Saul, had done, ¹² David went and took the bones of Saul and the bones of his son Jonathan from the men of Ja′besh-gil′ead, who had stolen them from the public square of Beth-shan, where the Philistines had hanged them, on the day the Philistines killed Saul on Gilbo′a; ¹³ 

No, the Philistines did not kill Saul. In 2 Samuel 1, "And he [Saul] said unto me, Who art thou? And I answered him, I am an Amalekite. He said unto me again, Stand, I pray thee, upon me, and slay me. So I stood upon him, and slew him." In 1 Samuel 31, Saul killed himself. In Chronicles, there are two more accounts of Saul's death, one having him slain by his armor bearer at his request, in the other God kills him. Take your pick.

and he brought up from there the bones of Saul and the bones of his son Jonathan; and they gathered the bones of those who were hanged. ¹⁴ And they buried the bones of Saul and his son Jonathan in the land of Benjamin in Zela, in the tomb of Kish his father; and they did all that the king commanded. And after that God heeded supplications for the land.

Exploits of David’s Men

¹⁵ The Philistines had war again with Israel, and David went down together with his servants, and they fought against the Philistines; and David grew weary. ¹⁶ And Ish′bi-be′nob, one of the descendants of the giants, whose spear weighed three hundred shekels of bronze, and who was girded with a new sword, thought to kill David. ¹⁷ But Abi′shai the son of Zeru′iah came to his aid, and attacked the Philistine and killed him. Then David’s men adjured him, “You shall no more go out with us to battle, lest you quench the lamp of Israel.”

¹⁸ After this there was again war with the Philistines at Gob; then Sib′becai the Hu′shathite slew Saph, who was one of the descendants of the giants. ¹⁹ And there was again war with the Philistines at Gob; and Elha′nan the son of Ja′are-or′egim, the Bethlehemite, slew Goliath the Gittite, the shaft of whose spear was like a weaver’s beam. ²⁰ And there was again war at Gath, where there was a man of great stature, who had six fingers on each hand, and six toes on each foot, twenty-four in number; and he also was descended from the giants. ²¹ And when he taunted Israel, Jonathan the son of Shim′e-i, David’s brother, slew him. ²² These four were descended from the giants in Gath; and they fell by the hand of David and by the hand of his servants.

Footnotes

1. 2 Samuel 21:2 Heb the Gibeonites and said to them
2. 2 Samuel 21:6 Cn Compare Gk and 21.9: Heb at Gibeah of Saul, the chosen of the Lord
3. 2 Samuel 21:8 Two Hebrew Mss Gk: Heb Michal