Stripped of the medicalese, what the researchers found is that if you give heroin addicts heroin, they will keep coming back for more. They will also be less likely to buy heroin on the street or commit crimes to support their habit. These findings, similar to the results of European studies, are not exactly surprising. The puzzling thing is that we’re asked to pretend that heroin is a “treatment” for heroin addiction. “Study Backs Heroin to Treat Addiction,” says the headline over a New York Times story that begins, “The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form.”
What the study actually shows is that the problems associated with heroin addiction are largely caused by prohibition, which creates a black market in which prices are artificially high, quality is unreliable, and obtaining the drug means risking arrest and associating with possibly violent criminals. The drug laws also encourage injection by making heroin much more expensive that it would otherwise be and foster unsanitary, disease-spreading injection practices by treating syringes and needles as illegal drug paraphernalia. When you take these dangers out of the equation, regular use of heroin is safe enough that it can qualify as a “treatment” dispensed by men in white coats. That rather startling fact should cause people to question not just current addiction treatment practices but the morality of trying to save people from themselves by making their lives miserable.
Jacob Sullum, “This Just In: Heroin Addicts Like Heroin”, Hit and Run, 2009-08-21
August 21, 2009
QotD: Heroin as a treatment for addiction
August 15, 2009
The high cost of coping with Celiac Disease
An article in the New York Times discusses something near and not-particularly-dear to our hearts — Celiac Disease:
Seven years after receiving his diagnosis, Mr. Oram, who is married and has one daughter, is symptom-free, but the cost of staying that way is high. That’s because the treatment for celiac does not come in the form of a pill that will be reimbursed or subsidized by an insurer. The treatment is to avoid eating products containing gluten. And gluten-free versions of products like bread, pizza and crackers are nearly three times as expensive as regular products, according to a study conducted by the Celiac Disease Center at Columbia University.
Unfortunately for celiac patients, the extra cost of a special diet is not reimbursed by health care plans. Nor do most policies pay for trips to a dietitian to receive nutritional guidance.
In Britain, by contrast, patients found to have celiac disease are prescribed gluten-free products. In Italy, sufferers are given a stipend to spend on gluten-free food.
Some doctors blame drug makers, in part, for the lack of awareness and the lack of support. “The drug makers have not been interested in celiac because, until very recently, there have been no medications to treat it,” said Dr. Peter Green, director of the Celiac Disease Center at Columbia University. “And since drug makers are responsible for so much of the education that doctors receive, the medical community is largely unaware of the disease.”
Elizabeth has suffered from gluten intolerance for most of her life, so we’re very aware of the difficulty (and added cost) of finding food that doesn’t contain wheat gluten. Wheat is a very cheap way of adding bulk and body to foods that traditionally do not contain it . . . it’s distressing the number of times we’ve discovered that a packaged food that used to be gluten-free has been “improved” . . . and the extent of the improvement has been to add wheat in place of more expensive non-gluten ingredients.
August 14, 2009
August 12, 2009
August 10, 2009
August 8, 2009
Dieting and obesity
Megan McArdle had an interesting-but-lengthy post earlier this week on obesity and both the scientific and political issues surrounding it:
I don’t agree with Paul Campos about everything, but I do agree with some of his core propositions:
- Study after study shows that most people are unable to lose more than a small percentage of their body weight and keep it off without major surgery
- There is evidence to show that this is physiologic rather than pyschological — it is nearly impossible for very heavy people to simply “eat less and exercise more” to a “normal” weight (given that 2/3 of the country is overweight or obese, normal weights, aren’t.)
- The fact that this often operates through the appetite system does not mean it’s “all in their heads” or a lack of willpower. Appetite is a signal as powerful as thirst or pain. Most people can’t ignore it.
- The largest environmental determinant of this trend is probably simply cheaper, tastier calories, which will be very hard to reverse
[. . .]
This really is a pattern that you see over and over again in obesity research. It’s as if researchers are terrified to say anything that might be viewed as giving people license to get fat. The CDC researcher who sharply revised downward the estimates of deaths from obesity, finding that overweight was actually healthier, fell all over herself proclaiming that of course, this didn’t account for quality of life. Because we know that a woman who weighs 160 pounds couldn’t possibly have a decent quality of life . . . ?
[. . .]
I know, I know . . . it’s for the children! I am very fond of children. But I do not actually think that they are some sort of master race in whose name anything at all can be justified. And if I did, I’d be a lot more worried about, oh, abortion, than McDonalds ads.
Two final points. Everyone likes to focus on their favorite boogeymen. To read a left-wing blog, you’d think that about 95% of the leading cause of obesity was agribusiness, chain restaurants, and automobiles. To read a right-wing paper, it’s all the infamous lack of self-control displayed by the poor.
But in fact, most of the things effecting kids are side effects of other efforts a lot of people are rather fond of. Processed foods and chain restaurants have exploded in the last two decades because Mom spends more time outside the home, generating more market income, and less time for home cooked meals. Kids exercise less not because crime is higher, or even because we’ve become more suburban, but because they’re no longer allowed to operate unsupervised until they’re quite old, and Mom and Dad both work. Schools don’t have P/E because they’re using the time to teach kids to read. Maybe those were bad tradeoffs. But they’re not irrational tradeoffs, and switching them back is not costless.
One thing Megan doesn’t touch on in the post (although she had done in earlier posts on this topic) is that metabolic changes over individuals’ lifetimes can actively sabotage good intentions on maintaining a given weight. Up until my late 20s, I could lose weight just by thinking about it, and then suddenly in my early 30s, I discovered that taking weight off was something that now needed a more conscious effort. Now I’m finding it even tougher to manage my weight (and also harder to make and take advantage of opportunities to get some exercise). My innate laziness and enjoyment of good food and good wine can usuallyalways overwhelm any urge to go do something healthy instead.
And no, I didn’t copy the entire post . . . there’s lots more, and it’s all worth reading.
August 7, 2009
August 6, 2009
QotD: Depression
I will meet October with a great weight off my chest. I will meet December with the novel mostly done. In between now and then I just want to be happy and content and useful. The last two weeks have been a bit unfortunate, with the Black Dog prowling and growling in the bushes outside the reach of the campfire light; I just lost enthusiasm for my enthusiasms. I think it’s lifted. The worst thing about Depression isn’t the sense that you’re ac-centuating the negative, it’s that you’re seeing things the way they really are, stripped of the illusions you use every day to divert yourself from the Yawning Maw of Futility. It’s the wind that blows off the snow and reveals the stone.
James Lileks, Bleat, 2009-08-04
August 5, 2009
Blotting out Rorschach tests
Colby Cosh examines the furor around James Heilman’s posting of the original Rorschach inkblots to Wikipedia:
It is probably no great loss. Critics of Heilman complain that “decades” of research will have to be abandoned if the Rorschach test becomes impossible to use. But most of this research has been shown, in the last 20 years, to be flapdoodle. As soon as the test became popular — so much so that it became a staple of comedy routines about Freudian psychotherapists, along with couches and thick German accents — it had critics who pointed out that there was little or no statistically validated basis for its interpretation. After the psychiatric profession got around to trying to establish such a basis — and this happened disgracefully late in history — there was little or nothing left of what had once been perceived as the broad general usefulness of the Rorschach.
Much of the folklore that had grown up around specific elements of the test had to be thrown in the trash. It appears to have modest predictive or diagnostic power for a few very specific aspects of personality, and even this surviving foundation is shaky. Yet supporters gave, and some are still giving, the same indignant defences that pseudoscience always receives. Interpreting responses to Rorschach blots is more “art” than “science,” they have insisted. (The mating call of the quack.) Only those who are intimately familiar with the test — i. e., those who believe in it and have come to depend on it — are really qualified to judge whether it “works.”
But can the thousands of psychologists and psychiatrists who have considered the Rorschach test a useful item in the healing toolbox for generations really all have been wrong? Keep in mind that the same practitioners were eagerly recommending and performing lobotomies throughout the same period, and you have your answer.
July 28, 2009
QotD: Re-interpreting that number
There have been two trends in US health care over the last decade. On the one hand, a lot of Americans have become, in any rational sense, over-insured: They get tested for things they’ll never get. On the other, there has been an abandonment of health insurance by the rich. If you peel the Census Bureau and DHHS figures, of those alleged “45 million uninsured Americans”, one-fifth aren’t Americans; another fifth aren’t uninsured but are covered by Medicare; another two-fifths are the young and mobile (they don’t have health insurance, but they don’t have life insurance or home insurance, either: they’re 22 and immortal and life’s a party); and the remaining fifth are wealthier than the insured population. Really. According to a 2006 Census Bureau report, 19 per cent of the uninsured have household income of over $75,000. Since the last round of government “reform” in the Nineties, wealthy Americans have been fleeing insurance and opting to bring health care back to a normal market transaction. And, if you look at the “uninsured discount” offered by doctors, one can appreciate that, for everything but chronic disability, it’s not an irrational decision to say I’ll get a better deal for my broken leg or my colonoscopy or my heavy cold if I just write a check for it.
Mark Steyn, “The Nationalization of Your Body”, National Review, 2009-07-28
July 22, 2009
July 21, 2009
iPhone as convenient marijuana lookup device
This is quite a cool idea:
We’ve seen a lot of unexpected, and sometimes cool, iPhone apps approved by Apple, but today’s news might top the rest. Apple has approved a marijuana — that’s right, marijuana — app called “Cannabis,” which lets users find the nearest (don’t worry: legal) supplier of medicinal marijuana.
Created by the founder of Ajnag.com, which was founded in 2006 and was the first medicinal marijuana locater on the Web, the new app is quick and easy to use. Simply open it up on your iPhone or iPod Touch and you’ll see a map with the nearest distributors. The app gives you information on each of the locations, and even step-by-step directions with Google Maps.
That’s not all, though — the creators thought of everything. If you run into any, erm, legal troubles with your newly-secured marijuana, Cannabis also gives you the locations of the nearest lawyers who specialize in marijuana cases. And, if you happen to live in one of the 37 states where marijuana is not legal, the app also provides you with the location of the nearest marijuana activist groups — so you can do your part to promote reform.
