What is a double-blind, placebo controlled study?

A double-blind, placebo controlled study follows a specific set of procedures to ensure that the results obtained are dependable and free from subjective bias. It is considered the ‘gold standard’ of clinical research studies.

Until the study is complete, neither the study researchers nor the participants know who received the study test substance, and who received an identical dummy substance, called a placebo. This ‘blindness’ ensures that the personal beliefs and expectations of either the researchers or the study subjects do not undermine the objectivity of the results. [emph. add] – Baylor College of Medicine

Recently I was on the phone with a colleague I work very closely with, a woman around my age who lives in Los Angeles. She’s witty, very intelligent, spirited, and a die-hard Jewish progressive and a seemed surprised to hear that I watched Fox News. I reminded her that I was a libertarian, and Fox News is the most sympathetic news channel to libertarians, but she said Fox News was so biased it was “right wing propaganda.”

Later that day on Facebook a Japanese non-profit organization I follow posted a link to a Fox News article that mentioned the possible extinction of the Japanese people by the year 3011 due to declining birth rates. Japan’s declining birth rate and aging society is nothing new and has been predicted for decades. The causes of this are numerous: working women, high cost of living, high cost of raising children in Japan, easy access to abortion, and even porn. The source of the article was a report by Tohoku University in Japan that extrapolated the current birth rate forward and came up with the year 3011 for the demise of the Japanese people. Instead of discussing the article, however, several posters took issue where the article appeared: Fox News. One commenter wrote, “... it’s Fox news. I can’t expect anything newsworthy from them…” Another wrote, “I would prefer some more solid evidence. And the extinction of Japanese is nothing more than laughable BS. Fox news, you need to do better than scaring peoples like that. Time to do homework.” Finally, another wrote, “LOL FOX news once again succeeding at rotting feeble american [sic] brains.”

Hating Fox News is almost as much a central plank of American progressives as unrestricted access to abortion that progressives don’t even question this belief anymore. They support billionaire George Judenrat Soros’s effort to shut down the 100% privately funded news station while encouraging government support of NPR, a publicly funded organization which, even New York Times reporter David Carr and the Columbia Journalism Review admit, leans to the Left. One could argue that it should be possible for any intelligent person to separate their ideology and personal beliefs from their job and report in an unbiased fashion, and they would be wrong for the very reason that double blind studies are the gold standard in research.

Double blind studies were developed as analysis of study participants found that those administering a particular test were statistically likely to influence the results simply by knowing whether they were administering a placebo or the actual drug even without consciously intending to. Such bias occurred on the unconscious level, and a double blind study where the person administering the drug did not know whether she was giving the compound being tested or the placebo was the only way to rule out this bias.

So why should we expect journalists, liberal or conservative, to report completely objectively about news stories and events?

We shouldn’t and more importantly we should give up on the concept of unbiased news reporting completely, spreading only through the consolidation of newspapers by large corporations and the requirement of a journalism degree from an accredited journalism school to be hired as a reporter by them. For example, in 1886 my hometown of St. Louis had 18 active newspapers. In 1986 it became a one-newspaper town when the St. Louis Globe Democrat ceased publication. Towards the end of its life it shared the market with the St. Louis Post Dispatch, and while the latter appealed to Democrats the Globe was read widely by the city’s Republicans. When the Globe went out of business, the owners of the Post Dispatch promised that the Post would moderate its stances and broaden its appeal to former Globe readers, and for the first few years after the merger, the Post attempted to do so by adding columnists and reporters from the Globe. But it wasn’t too long before the Post resumed it’s leftward slant, leaving St. Louis without a local conservative newspaper.

Had this happened a century before it would have been a disaster for the city. However it came at a time when people had begun getting their news from a variety of news sources including TV, national editions of newspapers such as the New York Times and Washington Post, national broadsheets like USA Today,  magazines, and talk radio. A few years later the Internet came online, and everything changed. The explosion of web sites catering to every ideology no matter how fragmented or extreme could not have been imagined by the Founder Fathers 220 years before. Suddenly Republicans in St. Louis or anywhere for that matter had access to the Washington Times, New York Daily News, National Review Online, and aggregation sites such as Drudge Report, RedState, FreeRepublic, Powerline, and of course, Instapundit.  It didn’t matter if St. Louis Post Dispatch leaned left when it’s bias could be countered by facts easily found in other sources.

That doesn’t mean that these other sources can be trusted 100% just because they agree with your opinion, though. I might watch Fox News but I watch it critically, just as I read the New York Times but do so aware of the liberal bias. At a time when we are bombarded by facts coming from an assortment of sources each with their own bias and agenda it is more important than ever to read, listen and watch critically. While it may take some effort up front, it also exposes one to new ideas and perspectives that could be missed if one stayed in a cocoon of  opinions that perfectly matched one’s own. Such diversity of opinions and perspectives allow a critical thinker to construct a philosophy or  world view that is much more complex, robust, and ultimately accurate than any contrived through a single ideological filter whether liberal or conservative.

Bias isn’t a notion to be fought; it’s one to be recognized. Survivalists know that in the wild a trekker will favor one foot over the other making it impossible to walk a straight line. To account for the bias one realizes it exists then deals with it by carrying a compass or through techniques such as using a marker or a succession of markers to help move in a consistent direction. In the intellectual sphere there aren’t such markers but there is the compass of critical thought that works just as well to help us evaluate the source of information and discover biases, either hidden or explicit.

Bias exists, and anyone who believes that their favorite newspaper or website isn’t biased is just as deluded as those they claim who read or watch a “biased” news source are.

Every white person below the age of 50 or so understands why Elizabeth Warren lied about being a minority. Every college applicant forced to tick the “caucasian/white” box on an entrance application, every job applicant forced to do the same knows the cost of that mark, how the color of your skin determines whether or not your application is accepted or you get the interview. It’s hard to fight affirmative action quotas designed to redress racial discrimination decades or even centuries before you were born, so if you can’t beat the system, why not play it?

And that’s exactly what Warren did. Warren became a minority because it benefited her career. It made her stand out from all the other white faculty members at the University of Pennsylvania. More importantly it carried a certain cache important to a monied liberal like herself working with minorities in Philadelphia; a little street cred with her students that perhaps encouraged them to relate more to her. Sure she may have been playing fast and loose with the System, but that’s what everybody does, right? Besides, it was for a worthy cause: the minority students whom she would mentor and lead to better lives.

What Warren never considered was how playing the race card at UPENN may have kept a real minority out of the position. Faculty positions are limited so she beat someone out of the job. Faced with a real minority and a fake one like Warren, it’s possible that she was chosen for the position because she was blonde and blue-eyed and a minority as well. It’s the best of both worlds to some university administrators: a woman they can feel comfortable with who shares their same culture and upbringing yet a minority that they can add to their diversity statistics.

A lot of white people have stretched the truth in the cut throat world of academia. The only difference is that most of them don’t run for the US Senate a quarter century later and get caught.

Many of you have been reared on the cliché that the purpose of education isn’t to stuff your head with facts but to teach you how to think. Wrong. I routinely interview college students, mostly from top schools, and I notice that their brains are like old maps, with lots of blank spaces for the uncharted terrain. It’s not that they lack for motivation or IQ. It’s that they can’t connect the dots when they don’t know where the dots are in the first place.

Sometimes the best advice is that which you don’t want to hear. If that’s the case then the Class of 2012 – and future classes and their parents, should read the entire thing here.

When we arrived the place was hopping, with young men directing people to park on a newly-mowed hay field. We parked, and as I walked past the cars I automatically scanned the bumper stickers, a bit of a habit of mine. The first one I saw as expected was an Obama ‘08 sticker, but the next one I saw surprised me: a Gadsden flag of the Tea Party along with a sticker that read “God Bless Our Military, Especially Our Snipers.” North Carolina is much bluer than I expected when I moved down here, and I’ve learned that while I might live in a predominantly conservative part of the state it is full to the brim with people of all political philosophies and walks of life.

All were represented at the organic farm. There were gay couples and old hippies, as well as clean-cut military men and their families, their kids petting goats and chasing free range chickens. A man dressed in a checked shirt beneath blue overalls stood alongside a young woman with more piercings than a rural stop sign, listening to one of the founders of the farm talk about its history and how it has grown over the years. Hispanics mingled with blacks who in turn stood in line with monied white suburbanites and their kids to take a turn at the pottery wheel and throw their own pot. Smiles were everywhere, and the place seemed as alive as the show hive of bees that stood on saw horses in the middle of a vegetable patch.

I was an odd child growing up. Some of my first memories are not of clowns or birthdays but of political events. I watched Nixon’s visit to Beijing broadcast on network TV in 1972. Two years later I rushed home from school and flipped on the Watergate hearings instead of game shows or cartoons. I grew up living and loving politics, and had I been born with a more gregarious personality I would have pursued a career in it. Instead I was socially inept, perhaps even autistic, so politics could never be more than a spectator sport for me, but that didn’t stop me from enjoying it.

But I’ve lost that joy. It has been years since I felt something other than doom and dread about politics, and the organic farm reminded me why.

We are divided, almost atomized these days. It has been years since we felt unity, the last time being the unity of grief by the 9-11 attacks. Since then our leaders have failed us. President Bush famously promised to be a “uniter not a divider”, but then went and did what he wanted to do in Iraq and in the biggest failure of his administration, presided over an explosion of government and spending. The Department of Homeland Security wasn’t a Clinton creation, it was a Bush one after all. While I agreed with his policies in Iraq at the time, Bush failed to support his actions at home against his critics. He just did what he wanted because he knew it was right, but didn’t even try to convince people otherwise.

Obama hasn’t even attempted to unite us. He took office reminding Republicans that he won and has governed accordingly, ramming through his signature health care legislation without a single Republican vote. A year later Americans clipped his power by taking away the House from the Democrats and ending their filibuster-proof majority in the Senate, but Obama didn’t miss a beat. Instead of moving to the center and working with the opposition to get legislation passed, he went to the extreme, and decided to wait things out to the next election, blaming the GOP and his Republican predecessor for the fruits of his own failure to lead.

Leadership in a democracy requires skills in the art of compromise. It’s hard to imagine but Ronald Reagan whom even Obama himself has claimed for his own never had a friendly majority in the House during his 8 years yet managed to pass budgets and legislation with bipartisan support with no less a political mastermind like Speaker of the House Tip O’Neill. We have yet to have a single budget from the president even during the 2 years his own party held both the House and Senate.

In fairness to Obama he never was much of a leader. His career reflects the Peter Principle more than the exercising of leadership skills to make it to the top, always having a mentor in higher position who can push him further up the political ladder. Unfortunately Obama now finds himself at the top with no mentor other than his usual billionaire friends like George Judenrat Soros and Warren Buffet. While these men may support him with their financial acumen and deep pockets, there is no one above Obama that can protect him anymore so he must rely on his skills. The problem is that the process that led to his ascension to the highest office in the land avoided cultivating those skills.

George W. Bush had a similar rise through the ranks, although based on his name rather than mentors. Samuel P. Bush, George W’s great-grandfather, built a successful career as an industrialist and dabbled in politics during World War I. His son Prescott continued the path of mixing success in business with politics that lead to George Bush’s ascendance to the presidency in 1988. While George W. Bush showed the ability of a leader to make difficult decisions such as to attack Afghanistan in 2001 and Iraq in 2003, an upbringing where his name alone opened doors and convinced people made it unlikely that he would develop other leadership skills such as the ability to convince others and charm one’s opponents.

The last president that had such leadership skills? Bill Clinton. Clinton is a self-made man and rose through the political ranks solely on his wit and charm. During his 8 years in office Clinton was able to pass budgets and bipartisan legislation with die-hard partisans such as Newt Gingrich. Clinton understood how to work with Congress, and his domestic policy record proves it (on the other hand his foreign policy record was in retrospect a disaster, consciously ignoring the threat posed by al Qaeda even though numerous terrorist attacks occurred on his watch.)

We have gone 11 years with weak leadership and our nation has suffered. You can’t compromise with someone you call a racist. You can’t cut deals with a party you demonize as misogynistic and homophobic. Leadership doesn’t pit one group of people against another; it fuses them together in a shared purpose.

A true leader does more than call his opponents names and make grand promises in eloquently delivered speeches from teleprompters. He inspires but also delivers on his promises. He doesn’t hold grudges but also makes it clear that he will not be played the fool. He understands the responsibility that comes with his position and serves all the people, not just those who voted for him. Most importantly he appreciates and respects the ideals that bind us together as a people and a nation, recognizing that while we might disagree vehemently on issues big and small, we are all bound by the love of freedom and hope for a better future for our children and our country.

While it is clear that leader is not Obama, neither is it clear that it is Romney. But I do wish that both men could have taken a moment from their politicking to talk to the farmer selling hand raised beef, watched the Montagnard women weaving brightly colored fabrics, and tasted the red pepper goat cheese. Perhaps they would have understood that if we could put aside our differences at a goat farm founded by a woman driving around with two goats in the front seat of her Toyota looking for a farm in North Carolina, we are a people ready to be led, and who deserve a good leader.

Sometimes I slip.

A very good friend of mine shared a post that read, “Like, if you are a supporter of same-sex marriage. Share if you aren’t afraid to admit it.”

As a libertarian I have been a consistent supporter of the so-called “gay agenda” for decades because I’ve been around gays most of my adult life and I simply don’t see how one can support small government yet demand that it poke it’s bureaucratic head into the bedroom. Honestly I want to see the government completely out of the marriage business, and leave the sacrament up to religions to administer as they see fit.

But is this really necessary?

Changing people’s minds requires more work than sharing political messages among friends on Facebook. If I opposed gay marriage it is highly unlikely a Facebook post would change my mind. In fact, sharing a photo or message does very little because it’s preaching to the choir: how many of one’s friends posting this entreaty really AREN’T supporters of same sex marriage?

On May 8th North Carolina is voting to amend the state constitution to ban civil unions, domestic partnerships and other types of domestic legal unions, specifying marriage as the sole legal union between a man and a woman. I think this is stupid on so many levels that it makes me spit. Not only does it discriminate against gays and lesbians, it discriminates against straight, non-religious people who are committed to each other but view marriage as a religious vow. So instead of sharing the photo, I’m going to drive 15 minutes to the polling station, wait in line for probably another 15-30 minutes, and cast my vote on this one issue AGAINST a stupid law. That’s an hour of my time I’d rather waste doing something else but instead I’m going to vote. Given the opposition to gay marriage in my community where Baptist churches outnumber gas stations and fast food restaurants, there’s a good chance my vote will be only one of a very few opposing the measure.

I am a secularist. It’s a word that’s often misunderstood and abused by the religious minded and those who hate them. A secularist is not anti-religion. He or she is someone who believes there is a line between the sacred and the profane, and on one side there is religion, and the other politics. A secularist cares just as much when a religion is forced by the state to obey a law that undermines its core beliefs, as when a religion attempts to force its beliefs on the state. A secularist believes that both entities have their spheres in modern life, and trouble comes when they rub together.

The First Amendment of the US Constitution states, “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof; or abridging the freedom of speech, or of the press; or the right of the people peaceably to assemble, and to petition the Government for a redress of grievances.” This has come to be interpreted as the separation of Church and State put forth by Thomas Jefferson in a letter to the Danbury Baptist Association in 1802 in which Jefferson wrote, “I contemplate with sovereign reverence that act of the whole American people which declared that their legislature should ‘make no law respecting an establishment of religion, or prohibiting the free exercise thereof,’ thus building a wall of separation between Church & State.”

Secularists can trace this doctrine back even further, to Jesus Christ’s answer to the Pharisees seeking to entrap him. “Then went the Pharisees, and took counsel how they might entangle him in his talk. And they sent out unto him their disciples with the Herodians, saying, Master, we know that thou art true, and teachest the way of God in truth, neither carest thou for any man: for thou regardest not the person of men. Tell us therefore, What thinkest thou? Is it lawful to give tribute unto Caesar, or not? But Jesus perceived their wickedness, and said, Why tempt ye me, ye hypocrites? Shew me the tribute money. And they brought unto him a penny. And he saith unto them, Whose is this image and superscription? They say unto him, Caesar’s. Then saith he unto them, Render therefore unto Caesar the things which are Caesar’s; and unto God the things that are God’s.When they had heard these words, they marvelled, and left him, and went their way.” Matthew 22:15-22. This doctrine was later expanded upon by St. Augustine writing four centuries later noting  the differences between an “earthly city” and the “City of God.” Martin Luther took St. Augustine’s ideas even further in his Doctrine of the Two Kingdoms which postulated that God worked his will through secular institutions as well as through divine acts. Luther also promoted secularism in his book “On Secular Authority,” writing that a government could not force spiritual beliefs on someone because such beliefs would be held insincerely and would therefore be invalid in God’s eyes. Luther’s ideas would then be picked up by John Calvin and other Protestant reformers, and later James Madison and Thomas Jefferson in the United States.

Even with a relatively clear and consistent philosophical lineage the United States has struggled with the concept of separation of Church and State almost since its inception. For the first hundred years of the Republic the First Amendment was viewed as applying specifically to the federal government; states were free establish official religions. Massachusetts supported Congregationalism until 1833. States continued supporting religion by enacting Blue Laws, abiding by religious holidays and providing other public concessions to religious groups. The Supreme Court finally began to weigh in on the issue, ruling in Reynolds v. United States (1878) that state laws prohibiting bigamy trumped religious laws (Mormonism in this case) that allowed it. It banned school prayer in public schools in its rulings in Engel v. Vitale (1962) and Abington School District v. Schempp (1963). Since then the Supreme Court has delineated a distinct line between religion and secular society. Nevertheless that line continues to be defined by lawsuits challenging the legality of public religious displays and the wearing of religious head coverings on the job, and the rise of gay rights requires further definition.

Marriage has been a component of government since Ancient Greece when Solon wrote a series of laws covering all aspects of daily life including marriage. Since marriage between men and women resulted in children, and children were necessary for the continuation of the State, the State took an early interest in marriage, an interest that continued through the centuries to the present. For most of history, God and the State were one in the same, and the idea of separating the two made little sense. It wasn’t until the modern era that the concept of marriage without the State could be imagined, but even today in states across the country one must acquire a marriage license from the state and have a religious ceremony conducted to make the contract binding. There is no other civil agreement that requires a cleric’s signature.

From a civic standpoint, marriage makes sense. It legitimizes property ownership and distribution. It tames young men and lays the foundation for the means to support children. It pools wealth. Studies continue to show that children from an intact marriage do better in school, and that on average a pair of married people are wealthier than two singles. But these benefits to society will not go away if the state gets out of the marriage business.

America continues to be a country of the religious. According to a Pew 2007 study only 16% of Americans claimed no religious affiliation. Marriage will not disappear. Instead it will fall under the complete control of religious authorities who can marry whomever they wish as they see fit. If a Protestant sect sanctions gay weddings, fine – but Baptists, Catholics and Muslims can forbid such vows without fear of persecution by the state. Separation of church and state cuts both ways, after all, and leaving marriage to the religions creates a barrier to prevent state meddling in religious beliefs.

What about the distribution of property? There’s already a document for that: a will. There are plenty of other existing legal documents that can be used to handle other situations usually covered in a blanket fashion by a marriage certificate like power of attorney and articles of incorporation. These documents can protect a pair (or more) of people regardless of sex, and treats them as equals before the law, something that existing law does not.

Disentangling marriage from the state and undoing 2,500 years of custom will not happen overnight, nor will sharing posts supporting the idea on Facebook change anything. But it is worth considering as the ultimate solution to the gay marriage issue and weakens the war on Christianity that gay marriage supporters unleash in response.

As I told my wife, I honestly don’t know what happened that night. When the story broke there was bipartisan outrage. I remember watching Fox News anchor Shepherd Smith have a meltdown as he referred to 17 year old Martin as a child and spoke scathingly of Zimmerman. Skittles candy was mentioned so often it sounded as if Martin was a modern-day Hansel and Zimmerman was a pistol packing Old Witch. In the heat of the moment there weren’t conservatives and liberals there were only parents, and losing a child is the stuff of nightmares that wake us up screaming and chill our blood whenever a story breaks of a child killed, especially one near the age of our own. Years ago we lost sleep over the Grossberg-Peterson baby murdered in Delaware, a baby only a few weeks younger than our own. In the years since other children have been killed in accidents or murdered, and their deaths, even to complete strangers like us, were slaps to the face, reminders of our own blessing and luck. The experience of loving a child trumps political ideology. Politics are petty and meaningless when compared to the life of a child.

But past events have taught me to question initial reports, or preferably, to avoid them when possible because they are usually wrong. It takes time for the signal of the truth to be discerned through the noise, and the more high profile the case, the noisier environment the signal hides in. In some cases, such as the Jon Binet Ramsey murder the signal is overwhelmed and the truth is never known.

What happened that night has become a screen for people to project their own biases and fears thanks to the politicization of the murder by the Obama administration, the Justice Department, and race-baiter Al Sharpton. These entities have raised Martin’s death up to the status of icon for their own political gain, and their opponents have begun to do the same. Gun rights supporters initially left Zimmerman alone to take the heat of his shooting Martin, saying that Florida’s “stand your ground” self-defense law didn’t apply because the 9-11 dispatcher suggested Zimmerman avoid confronting Martin. But as gun control advocates began using the shooting as evidence to support the rollback of such laws, they pushed gun rights advocates to take the opposite position, providing at least some support for Zimmerman albeit reluctantly at first.

Coming to gun ownership later in life I am fully aware of the arguments on both sides of the gun issue. “I think he is just a vigilante,” the wife said, and she might be right. Carrying a loaded weapon does provide a measure of power, and that power might cloud judgement and embolden some to cross the line between self-protection to armed aggression. In most cases that line is clear, and in the cases that it’s not, any decent CCW class can provide needed clarity. As one firearms instructor once told me, “Every bullet comes with a lawyer attached,” so gun owners must be more responsible than those who don’t own guns when it comes to the law and know it to the letter. Responsible gun owners also understand that carrying and firing a gun is a last resort. It is the last option when all other options have been tried and none others remain. Guns have life changing consequences, for people at both ends of the barrel, and gun owners must exercise a level of judgement that they know will have to stand the scrutiny of police, prosecutors, judges and juries and ultimately one’s conscience.

None of us was there that night, but the question remains: Did carrying a gun cloud Zimmerman’s judgement? I have been in dangerous situations both in front of the gun and behind it. In the latter case I was with a desperate stranger who claimed to have survived an horrific ordeal, and the guns provided the only protection available in the creeping minutes until the police arrived. Both instances have taught me keeping a clear head in the midst of a traumatic experience where the outcome is unknown is a challenge requiring a tremendous effort of willpower and focus. It’s easy for people to judge when they already know the outcome of an event; it’s much more difficult when you are in the middle of the event, have little or no information to base your decisions on, the police are nowhere around and it’s dark.

Zimmerman needs this trial almost as much as the Martin family does. Perhaps everyone does. We need to learn exactly what happened that night, to put ourselves in Zimmerman’s – and Martin’s – shoes, and determine exactly how and why a 17 year old kid’s life ended. But unfortunately the echoes of that night will not end with a verdict. If Zimmerman is convicted many will think he was railroaded by an administration keen to please its minority base and a special prosecutor doing its bidding. If he is acquitted, many will believe that he got away with murder, adding Martin to the long list of innocents killed by whites over the centuries abetted by a judicial system that is unfair to minorities. Zimmerman has already been judged guilty by many and innocent by others. The verdict will only confirm their beliefs in the fairness/unfairness of the System, it will not change them. As I told my wife as I watched his bail hearing, I am going to try to keep an open mind about his guilt or innocence, but it won’t be easy, I doubt it will be popular, and it may not even be possible.

Cross posted at The Moderate Voice.

Freakin’ cool.

Space enthusiasts have struggled to get their bearings after the demise of the Apollo program and the disappointment of the shuttle program. They’ve had to content themselves with government funded missions with increasing costs and decreasing utility as taxpayers have demanded Apollo-like bang for pennies of what the program costs.

It’s well past time the exploration of space became the prerogative of private enterprise, and if it takes flaming liberals like Sergey Brin, Larry Page and James Cameron to do it, so be it.

Walter Russell Mead challenges that belief by comparing the arguments supporting legalization with the reality of prescription drug abuse. Try as I might I’m finding it difficult to argue with the points he makes. Mead writes, “Legally prescribed drugs are now regulated the way many legalization advocates think illegal drugs should be. The flourishing black market in prescription painkillers and the thousands of deaths associated with their use demonstrate that drug use will not be magically fixed by regulating currently illegal drugs. While legalization advocates argue that putting heroin and similar drugs on a prescription basis would reduce fatalities associated with their use, the high toll from overdoses of legal painkillers suggests that this argument is weaker than often believed.

The statistics about prescription drug abuse, to pardon the pun, are sobering. According to the CDC deaths from legal prescription painkillers now surpass those from heroin and cocaine combined. In 2008, 15,000 died from painkiller overdoses. In 2010 12 million Americans used legal painkillers to get high, and that year enough prescriptions were written to keep every single American stoned for a month. That’s 4x more drugs prescribed than in 1999. Today pain is the most common reason for physician visits in the US.

As with any complex issue, there is no simple solution. Until recently doctors had taken more of a “what we cannot cure we must endure” stoic approach with their patients when it came to pain. It wasn’t until the 1970s that doctors began studying pain and specializing in pain treatment and management. Progress has been slow. The foundation of pain management remains addictive narcotics with broad effects instead of the development of drugs that target specific pain. Worse, when used to treat chronic pain these medications may increase pain sensitivity. Even when pain isn’t chronic it may take months, sometimes even years for the underlying injury to resolve. If narcotics are the main treatment for pain, should we be surprised when a patient becomes addicted to pain medications?

There is a big difference between the perception of prescription pain medications and illicit drugs. Generations have been indoctrinated into viewing crack and heroin as “dirty” and socially unacceptable. It takes years for newer drugs such as methamphetamine and ecstasy to be recognized by society as a threat and subject to a mix of propaganda and truth to stigmatize the drug and curtail its usage. In the 1980s and early 1990s meth was underground and commonly used for all night cram sessions by college students and by long haul truck drivers. Now it has been stigmatized as a cheap high for rednecks a step above huffing paint. Prescription drugs have an aura of acceptability that illicit drugs currently lack but would attain if they were legalized. Legalization presents a legitimacy which in turn implies safety. People may naturally view heroin and cocaine as dangerous and consider Oxycontin as innocuous even though one can overdose on Oxycontin as well as heroin. People believe that because a drug is prescribed by a doctor it is somehow completely safe.

While it is possible that after legalization the negative perceptions of the formerly illegal drugs would remain, it is expected legalization would expand usage and abuse. Those favoring the legalization of illicit drugs need to accept this and modify their arguments to reflect this reality. One way to do this is to focus on the core arguments for legalization such as individual freedom and personal responsibility. In the case of prescription drug abuse, doctors need to recognize the danger of supplying patients with narcotics, including the likelihood that the drugs will fall into the hands of others. It is much easier for a physician to prescribe narcotics than it is to advise patients on non-medication pain management therapies such as deep breathing, meditation and exercise. Those that need more should be sent to pain clinics which specialize in pain therapy (and can be monitored closely by authorities).

People need to be educated about pain. Pain is a reality of life and in most cases such as injury it is an important component of the healing process. Dulling it at every opportunity may feel good in the short term but present long term dangers such as prolonged healing, re-injury or addiction. Similarly people need to learn the truth about pain medications. The narcotics on grandma’s shelves are just as dangerous as those being offered for sale on the street a few blocks down.

The solution for drug abuse, whether illegal or legal, is education along with treatment options offered by for-profit and charities. As far as solutions go it’s a lame one, but the alternatives such as the continued prohibition of illicit drugs and the jailing of addicts is far worse. Far better to increase awareness and encourage personal responsibility.

As a recovering alcoholic with 11 years of sobriety under my belt, personal responsibility is the one key component to wellness that gets ignored in the debate. To those sympathetic to the addict and those who take a hard line against illicit drugs, the addict is powerless to resist the drug so the addict must either be protected from his drug or kept away from it through its illegality. Hardly anyone dares tell the addict “You live in a world with your drug. You can have it and ruin your life, or not and live a decent life without it.” There is proof that addiction has a genetic component. For some it may have an epigenetic basis. But regardless of its origin, whether the addict was born that way or acquired it later in life, one is ultimately responsible for one’s own destiny, not Society.

UPDATE:
A documentary on the Oxy Express. The most chilling documentary I’ve seen in years.
An in-depth series on prescription drug abuse by the Delaware News Journal.

The American Board of Internal Medicine Foundation in partnership with Consumer Reports has announced Choose Wisely, an educational initiative recommending physicians avoid 45 unnecessary tests and procedures the group believes are performed unnecessarily. These include routine EKGs and Stress Tests as well as prescribing antibiotics for minor ailments such as mild sinusitis. Oncologists are also encouraged not to perform cancer screens on breast cancer and prostate cancer patients diagnosed with non-metastatic forms of these cancers.

But as the New York Times article states, these recommendations are controversial and there is fear among some patients and doctors that they will be applied too broadly. The newspaper quotes Dr. Eric Topol, chief academic officer of Scripps Health who says, “These all sound reasonable, but don’t forget that every person you’re looking after is unique…This kind of one-size-fits-all approach can be a real detriment to good care.”

As a resident of the great state that raised John Edwards to the heights of power on the backs of doctors he sued for malpractice, I’m skeptical over this recommendation for a number of reasons. Dr. Topol makes an excellent point. Those who aren’t health care practitioners may fail to understand that patients often do not present with clear cut symptoms. There is a finite number or reasons your car won’t start in the morning such as the battery is dead, the tank is empty or the ECM needs replacement. But the human body is infinitely more complex. What may present as back pain from too much Pilates can turn out to be bone cancer that had metastasized from the esophagus, as happened to my father-in-law. The chronic tickle in the back of the throat that drove my mother-in-law crazy for months, turned out to be an atypical and rare form of breast cancer. Both were dead within months of their initial complaints both were misdiagnosed by their primary care physicians, though it is unlikely in either case the proper diagnosis would have mattered much. But both cases of cancer could have been treated had they been detected early. Obviously doctors cannot perform these tests on everyone because it would take too much time and cost too much, but this decision should be left to the judgment of the doctor and not interfered with by the government, an insurance company or a non-elected body such as the American Board of Internal Medicine Foundation.

These recommendations will no doubt be cheered by insurance companies and the government (since Medicare, Medicaid and Obamacare make the government a de facto insurance company I’ll lump it together with the likes of Kaiser Permanente and Blue Cross for the rest of the article.) Insurance companies can now refuse to pay for these tests or at the least requiring doctors jump through time-consuming and money-losing hoops such as requiring pre-authorization to do them. The article claims that as much as 1/3 of the $2 trillion spent on health care in the USA is unnecessary, so imagine the savings to their bottom lines these companies will enjoy by cutting nearly $700 million from their payments. The problem with this figure is that it’s like the old saying about half of marketing dollars being wasted, but no one knows which half. Because it is impossible to accurately determine which person needs a test and which doesn’t it will be impossible to reap the savings hinted at in these recommendations.

Doctors are taught the cliche, “When you hear hoofbeats, think horses, not zebras.” The problem is in the real world zebras aren’t limited to the Serengeti, they are mixed in with the horses here. And doctors are blind. The practice of medicine remains an art where such non-quantifiable processes as “intuition” still play an important role. A doctor might be presented with a healthy young man in his prime with no signs of heart problems, but something might trigger his intuition to call for an EKG. While rare, young people do make the headlines when they drop dead of cardiac arrest caused by a previously undiagnosed heart condition. The physician suspecting he might have a patient with an undiagnosed heart problem will have to fight to get the insurance company to pay for the EKG, skip the EKG and console himself that the young man is healthy, or do the test for free.

Imagine the doctor finds himself in the dock, facing an attorney hired by the family of his patient. “Why didn’t you do the test, doctor? It’s a simple test you could have performed in your office that would have saved the life of my client’s son. Yet you didn’t. Why?” The American Board of Internal Medicine Foundation will not be on the stand, the doctor will, and parroting off the American Board of Internal Medicine Foundation’s recommendations will not play very well to the jury.

So to avoid that possibility, the doctor will either have to fight the insurance company to pay for the test or will have to perform it gratis. Either way the physician is the one left bearing the responsibility for these recommendations. And 99% of the time the doctor will find that the patient’s heart is fine, in which case outside groups like Consumer Reports will wail about unnecessary tests. But the doctor knows that without tort reform she must do everything to protect herself including ordering tests which may seem considered medically unnecessary but will protect her in court. The tests might be medically unnecessary but until there is tort reform they will be legally necessary and will continue to be performed.