PROPaganda, Part 1 of 2

Updated 8/9/18 and cut for length. Please see part 2 to view previous info, now in that segment.

“…A Terrible Disease.”

Addiction is, indeed, a terrible thing, and I am glad to see it being recognized, less stigmatized, and more genuine help offered to those struggling. But agenda-driven propaganda will not help those with addiction, in fact it has already been shown to cause harm to both addicts and chronic pain patients, who have found themselves blind-sided in recent years with a new stigma attached to their medical needs, particularly, the medications they need to stave off disability, poverty, loneliness, depression, anxiety, high blood pressure, loss of quality of life, and even early death (by natural-the body can only take so much untreated pain-and suicidal means). Those medications are overwhelmingly opioids.

A 2018 documentary called, “Do No Harm: An Opioid Epidemic,” featuring Dr. Andrew Kolodny (to whom I recently wrote an open letter) and “working closely with Dr. Kolodny and PROP“, is a classic propaganda film that’s been influencing a lot of viewers and, therefore, a lot of lives. I viewed this film a few nights ago, and 90 minutes and 9 pages of handwritten notes later, I began writing this *series of posts.

The film begins by insulting doctors, painting a portrayal of Purdue Pharma as an “evil” corporation (and, by extension, their products, aka opioids), castigating chronic pain patients (presumably for having the audacity to be in pain that only responds to opioids), and throwing out odd claims without sources of any kind. For example, one of the closing statements says:

“While watching this documentary, 6 Americans have probably died from an overdose.” -Narrator (my emphasis added)

We’re off to a great start already!

Throughout the film, people struggling with addiction are consistently portrayed as “brave survivors” and innocent victims who just didn’t know what they were getting into. A few blame Purdue Pharma (in particular) in the interviews, while others have a hard time admitting they did wrong or chose poorly. According to Alcoholics Anonymous, one of the classic first steps to addiction recovery is, “Admit you have a problem,” not “blame someone else.” Other steps include:

  • Make a searching and fearless moral inventory of ourselves.
  • Admit to God, to ourselves and to another human being the exact nature of our wrongs.
  • Make a list of persons we had harmed, and become willing to make amends to them all.
  • Make direct amends to such people wherever possible, except when to do so would injure them or others.
  • Continue to take personal inventory and when we were wrong promptly admitted it.

Even Do No Harm admits the high recidivism rate of all those interviewed as poster-recovered-addicts (all clients from the Beit T’Shuvah Recovery Center). Out of approximately 11 people (the film jumps back and forth quite a bit), 2 went back to heroin within 2 years or less, and 5 are never even followed up with. One interviewee who was also an employee at the Recovery Center, said, “You see people coming and going all the time. It’s sad.” The film never reveals the type of treatment or therapy given at the center, but an internet search for the site and phone call to the center, proved that medication-assisted treatment (typically Suboxone/Subutex, a popular form of bupenorphine) “may be used, if deemed appropriate by the resident psychiatrist there.” Furthermore, the site claims they do use a 12-step recovery model, based on AA, though the statements of the interviewees and the purpose of the documentary itself, don’t seem to line up with those recovery values.

Medication-Assisted Therapy

“We have to keep people alive so that they can recover,” states Casey’s mom, tearfully. Dr. Kolodny and the filmmakers of “Do No Harm” seem to think “recovery” means ongoing bupenorphine treatment for everyone, and sickeningly hints at the end of the film that all those dead children featured would probably be alive today, if bupenorphine had been a part of their treatment. For many people, medication-assisted therapy (MAT) is a part of their treatment, with highly mixed results. Furthermore, while heroin has a relative strength of 5x potency of oral morphine, bupenorphine has a relative strength of 40x, while hydrocodone (Vicodin) has a potency strength of -100x and oxycodone (the generic, short-acting version of Purdue Pharma’s oxycontin) has about 1x! see chart below.

In a separate phone conversation I had with Dr. Kolodny, as well as nearly every news article featuring him, Kolodny reiterates his strong support for MAT, or, ongoing management of addiction symptoms and behavior using drugs. Dr. Kolodny’s drug of choice for such treatment has long been bupenorphine, an opioid combined with Nalaxone (popularly known as Narcan). Why would he promote this opioid, while staunchly condemning all the rest, I asked? “Because of the Naloxone element,” he told me, people are less likely to die or even overdose to begin with.

He’s been singing bupenorphine’s praises for decades, even formerly heading up a large chain of addiction centers called Phoenix House, that touted heavy use of MAT. But investigative articles have been coming forth more and more, showing how Suboxone has been increasingly “diverted” for abuse, and may be complicit in a rise of overdose deaths. When I asked Dr. Kolodny about this on the phone, he dismissed these articles as “bad journalism.”

Dr. Kolodny’s apparent obsession with opioids is hard to understand. While certainly a major issue that needs addressed (and has been), heroin is not the only drug people overdose on (and drugs are not the only things people can be destructively addicted to), and in fact, cocaine has been consistently number 2 and 3 for overdose deaths in 2010-2014 (Table B), according to the CDC. Other drugs include fentanyl (the illicit kind, not the prescription kind), methamphetamine (which is on the rise), hydrocodone (Vicodin/norco), and benzodiazepines (anti-anxiety medications).

The film throws shocking stats around — stats that have also appeared in other media — such as:

“The Centers for Disease Control and Prevention estimates that more than 500,000 people in the United States have died from overdoes of opioids since the year 2000,”

Thankfully, this is not accurate, neither is the study sourced in the film. Rather, this CDC media release from 2015 which states, “nearly a half-million Americans” have died from prescription opioid overdoses and heroin OD, is not shown via stats, just statements, by Tom Frieden, the then-CDC head until 2016. https://www.cdc.gov/media/releases/2015/p1218-drug-overdose.html. However, the CDC has NOT estimated anywhere near this number. The recorded number of deaths in 2016 was roughly 42,200, 5 times higher than in 1999, or roughly 8400. Even assuming that the death toll was 40,000 (it wasn’t) each year from 2000-2015, you still only get 200,000, not 500K. https://www.cdc.gov/drugoverdose/data/statedeaths.html

Even when presented with current studies and facts, Dr. Kolodny refuses to update his methods, teachings, or beliefs according to data and science. Although he invited me to share updated studies with him via email, he never responded to my email or a Tweeted reminder from myself. He goes so far as to directly blast anyone or any study that disagrees with his teachings, throwing them under the proverbial bus for not being as unbalanced in approach as he is.


Attacking Doctors and Other Medical Professionals (Along with the FDA, Purdue Pharma, and Whomever Else is Convenient)

The opening statement of the film reveals all:

“The drug companies are the cartel, the doctors are the pushers, and the pharmacists are the suppliers: that’s how the DEA is seeing it.” –Mark Borovitz, Rabbi/CEO, Beit T’Shuvah Recovery [Addiction] Center

That hard-line idea is pushed repeatedly throughout the film. In just the first 2 minutes, the notion of corrupt doctors, evil pharmaceutical companies, and irresponsible pharmacies, is reiterated 3 different times!

The narrator says early in the film that Purdue Pharma’s goal in marketing oxycontin was, “corrupting doctors and nurses to sell the Kool-Aid,” and later on at the 21 min. mark, giant text reads, “The Epidemic Spreads: From the Doctor’s Office to the Street.”

Much later in the film, Anna Lembke, MD Chief of Addiction Medicine at Standford claims, “Opioids are a proxy for doctor-patient relationships.” She then goes on to describe the euphoric high that addicts experience (it should be emphasized that the majority of pain patients do not experience this euphoric high), ending with, “…you feel cradled [by the doctor]…You thank them, the doctor feels gratified, the doctor writes another script.”

A chronic pain patient featured in the film, who had probably been over-medicated for a number of years and had since been tapered down from her previous fentanyl patches and oxycondone to a new, unrevealed dose, is described at the end of film by the narrator, “Linda lost years of quality of life by innocently trusting her doctors to do no harm.”

The film then switches tactics to blast the FDA for it’s “ludicrous” (and alleged conspiracy-theory) decision to add pain as the 5th vital sign in the 90s (actually a 2001 Joint Commission decision), because it was allegedly paid big money by Purdue Pharma. While no evidence has yet been found for this claim, the film blames “dark money”. Kolodny’s still pretty sore, I guess, that the FDA didn’t acquiesce to his demands in 2013 to strictly limit the use of opioids in chronic pain (see image below). Allegations are lobbed about an “unholy alliance” between the FDA and Purdue to get oxycontin approved, although this is exactly what the FDA does: approve pharmaceuticals if they meet government standards.

FDA rejects PROPs opioid limits on chronic pain proposal, 2003


Bad Science Leads to Bad Policies

Giant text on the screen reads, “Over 259 million opioids prescribed per year,” while narration adds, “at the height of the epidemic”. But which year is being referred to? Which study is being referenced? There are an estimated 326 million people currently in America, and we document EVERY prescription written, which means 1 prescription every month for chronic pain patients, or roughly 21.5 million per month. That’s only about 6.6% of the total population. Don’t the filmmakers know that the rate of opioid prescribing WAS ALREADY GOING DOWN by 2012, presumably because of far stricter state laws? Yet another bit of giant text reads, “From 1999-2017, over 500,000 opioid-related deaths.” Except that turns out not to be true at all. More like roughly 123,560, less than a quarter of the “estimated” number of deaths, according to the CDC (Table B).

Please read part 2 here.


Sources Cited:

http://www.donoharmdocumentary.com/

https://ramblingsoapbox.com/2018/06/26/an-open-letter-to-dr-andrew-kolodny/

https://lptv.org/do-no-harm-the-opioid-epidemic-3/

https://www.addictioncenter.com/treatment/12-step-programs/

https://beittshuvah.org/treatment/residential-program/

https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdf

https://www.cdc.gov/media/releases/2015/p1218-drug-overdose.html

https://www.cdc.gov/drugoverdose/data/statedeaths.html

https://www.medpagetoday.com/publichealthpolicy/publichealth/57336

https://www.nbcnews.com/health/health-news/number-prescriptions-opioid-painkillers-drops-dramatically-u-s-n867791

http://www.supportprop.org/faqs/

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Williamson, West Virginia and the Opioid Crisis (Fake News Alert!)

Headline: 20.8 Million Pain Pills Flood Tiny Town in WV

Let’s talk about Williamson, West Virginia, the little town in Mingo County that has been featured in the news for the past several years as a sort of starting point for the opioid epidemic.
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Downtown Williamson, WV, named for my grandfather’s side of the family!

According to sources, 20 million (give or take about 1 million) pain pills were sent to Williamson, WV, pop. 2900-3200 (depending on your source) over a 10 year period, and that those numbers are insanely high for such a little town. Sources imply the doctors there must be corrupt pill-pushers, with their pockets deep in Big Pharma, and/or Big Pharma picked on this unsuspecting underdog town for the purposes of corporate greed. 

This story is also meant to imply doctors cannot be trusted to prescribe pain pills appropriately, and therefore need major government oversight. Doctors are meant to be seen as directly responsible (along with Big Pharma) for “passing out pain pills like candy” and getting the population hooked on opioids.

The headline’s numbers look insane (which is the point), but NOT ONE article takes demographics into account. That little town’s elderly population consists of 22% elderly (65+), and 56% adults 18-64. Those working adults overwhelmingly hold/held manual labor jobs, which tend to lead to more serious and long-term, even lifelong injuries.


Break It Down:

  • 20 million pills divided by 10 years = 2 million pills per year.
  • To keep things simple, assume ONLY the elderly 65+ gets pain pills. That’s 22% (elderly pop.) x 3,000 (total pop. of town) = 660 elderly people.

  • 2 million pills per year divided by 660 (est. elderly pop.) = 3030 pills/year/elderly person.
  • 3030 pills per year divided by 365 days per year = roughly 8 pills/day.

  • 1 pill lasts 4-6 hours, so 24 hours/4 hours coverage = 6 pills per day*.

  • Before this opioid crisis started, 4-6 pills/day wasn’t an unusual amount, and patients could even sometimes take (gasp) 2 pills at a time, depending on the dosage and their situation.
And those figures are crunched just based on the elderly population alone. If you figure in other older adults like those in the 50-64 age range, that number of pills per day goes down even further.

There is a heroin epidemic, and there is an economic crisis, but as far as Williamson, WV and little towns like it being “flooded” with unnecessary pain pills, I call FAKE NEWS!

State Civil Rights Commissions: The New Inquisition? Part 2 of 2

A response to John Corvino, continued from Part 1

The Game of Risk

The legal line between small businesses and giant corporations is wide and well established, but anti-discrimination cases like the ones in question, all center around small businesses. Why? Could it be that small businesses are easier for states and state regulatory commissions to pick on?

Larger corporations are likely to have a team of lawyers on hand, but independently owned businesses may have none. Without the same legal standing or protections as corporations, when small business owners come under the radar of radical state commissions like Oregon’s Civil Rights Commission, they often fold altogether. Not only are the owners out of a job, they may be financially, reputationally, and creatively ruined. Those business owners have not been “educated” or “taught a lesson to,” their homes and holdings have been forfeit. They have been effectively obliterated from society, just as ancient Inquisitors did to so-called heretics.

 

 

 

 

 

As Roger Parloff pointed out in the March, 2017 New Yorker piece, Christian Bakers, Gay Weddings, and a Question for the Supreme Court,

…From the standpoint of individual liberty, a mammoth corporation, such as Woolworth’s, is different from a mom-and-pop business. The regulatory machinery has been hesitant to tell individuals how to behave on their own premises, no matter how repugnant their behavior may seem. To this day, as Eskridge observes, the federal employment-discrimination laws do not apply to businesses with fewer than fifteen employees, and housing-discrimination laws do not affect owner-occupied buildings with four units or fewer…”

As an independent business owner and contractor, I absolutely value my ability to choose not to work with certain clients for any reason. They may be a pain to work with and a potential liability, and that liability and work outcome are my direct responsibility. I do not get to pass the buck, I do not get to hide in corporate shadows, and I can’t even be fired. Therefore, as any good business owner, I will pick and choose whom I work with very carefully and attempt to further protect myself and clients with fair contracts for us both. But those measures don’t offer protection against rapidly changing (and often unknown) laws or interpretations of them. Small business owners are screwed.


Custom-Made Cakes, etc.

The main difference between a cake bought from the case, versus a custom-made cake via Cake Boss, is the risk and time and talent involved in the creation of the custom cake. If a generic cake gets accidentally dropped on the floor, there may be 5 more just like it in waiting. If a custom cake gets dropped, it’s a potential disaster (the worst part about watching Cake Boss is worrying those big cakes won’t make it to their intended destination in tact!).

 

 

 

It bears repeating that many of those who have won financial settlements against small business owners like bakers and florists, have done so without ever having a contract to begin with for customized creative services. Many cases do not end up in court, but are investigated (which is appropriate), prosecuted with the force of law (not appropriate), and legally penalized by certain state Civil Rights Commissions working independently from impartial judges, lawyers, etc. (really, really not appropriate).

We should not tolerate such behavior, particularly if we fancy ourselves as supporting small businesses. It’s legally outrageous, and sets a frightening precedent for small service providers who cannot always cope with the legal or media outcomes of major lawsuits or “legal” fines.

Bacon or Buttercream?

Some readers might respond to the above, “Well if business owners would only follow the law to begin with, they wouldn’t get in trouble.” Unfortunately, as we saw in part 1, state anti-discrimination laws are interpreted subjectively and, as we will see, are sometimes applied “unevenly.”

Mr. Corvino’s examples of Kosher and vegan bakeries not making bacon cakes or buttercream cakes for anyone (and therefore, no one), is a false dichotomy. Those bakeries have set professional limitations on what they will produce, based on sincerely held beliefs. It would be offensive to knowingly go into a Kosher bakery and ask for a bacon cake, or to ask a vegan baker for a meat pie, though they surely have the technical skills to produce such things. So how is it different when the bakery is a Christian one? Christian bakers also refuse to produce certain products based on sincerely held beliefs, but for them this is reprehensible, because their particular belief is culturally reprehensible.

 

*I do not necessarily endorse all views contained within this video or within others by Louder with Crowder


Neglected

In addition to anti-discrimination laws being culturally and judiciously haphazardly applied, I am angry by the underlying societal devaluation of creative talents and skills. It’s not “just a cake,” but a carefully crafted work of art, unless you are buying from a generic, big-box retail store.

It’s not “just photography” or “just a painting,” as if no real heart, imagination, or effort goes into these things. But customers really do know better; they are attracted to artistic works precisely because they are different. Customers can see the difference, and are willing to pay higher prices because of the quality and creativity involved. Not just anyone can make beautiful cakes. Not just anyone can take gorgeous pictures, and not just anyone can fix computers or human hearts. These things require serious investments of time, experimentation, specialized equipment, and education.

So when people imperiously declare that small business owners should “suck it up” and “perform” on command, so long as potential customers throw money at the owner/creator, it is incredibly insulting. It is, in fact, prostitution!

This scene from Les Miserables 25th Anniversary Concert Edition by Universal, shows that even Fantine, an actual prostitute, should still be able to choose with whom she works. The result of her refusal and self-defense, eerily echoes the legal retribution some shop owners have unfairly faced. This clip was taken from my legally purchased, home copy DVD. 


Show Your Local Small Businesses Some Love

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One of my family’s favorite candy shops in Indiana. The saltwater taffy is a must!

In general, Americans love funky little shops and hole-in-the-wall restaurant discoveries. They are personable, more welcoming, custom-geared for certain clientele (like my new favorite local bar geared towards gamers, D20), and tend to have higher quality customer service and products. Customers love these places not just for the food or flowers or art (products), but also for the atmosphere (heart). These are places where memories are made with family and friends, as opposed to generic retail stores which supply general goods and public services.

Most anti-discrimination laws, therefore, make no sense when applied to privately owned small businesses. For proof, let’s define the confusing term, “public accommodations,” which has been broadly (and unusually) interpreted by Oregon’s Civil Rights Commission to mean essentially any place “the public” might be. However, according to Wikipedia,

“Title II of the Civil Rights Act of 1964 defines public accommodations as a limited number of facilities which are open to the public. Examples include hotels, motels, restaurants, theaters, and all other public accommodations engaged in interstate commerce; exempted private clubs without defining the term “private”.

In other words, privately owned small businesses are not generally considered “public accommodations”.


Coercion and Prohibition Never Work

 

 

 

 

 

 

Lastly, let’s say just a word about prohibition and coercion and how the attempt to legalize something via these hard lines never, ever, ever, ever works. Ever. Even when the cause is noble, like protecting women and children from the abuse or neglect of drunk fathers. Even when parents are seeking to protect their kids from getting addicted to hard drugs, and even when we long to see all people treated the same everywhere because they are people (though you know, that road goes two ways).

Community and education are the keys to societal changes, albeit those things take much longer to implement and see progress. It isn’t as satisfying as exacting a kind of vengeance upon others who share the same ideas with people who may have hurt us, or our friends, or loved ones. But vengeance is not justice, and change only starts with an army of one.

Otherwise, just let our robot overlords rule and program us outright.

*I had no idea when writing this that “Robot Overlords” was a real film. But now I do, and since it features Gillian Anderson (X-Files) and Ben Kingsley, I must watch it.


Works Cited

https://louralawrence.com/2017/05/26/state-civil-rights-commissions-the-new-inquisition-part-1-of-2/?preview_id=51276&preview_nonce=21411b9b44

http://www.oregon.gov/boli/CRD/Pages/C_Crprotoc.aspx

https://en.wikipedia.org/wiki/Public_accommodations

http://www.imdb.com/title/tt2145829/

Going Home for Christmas to Coal Mining Country

See more “misty mountain” photos from my trip here

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Tiny towns dot the landscape in rural, Eastern Kentucky.

 
These communities rely almost solely on the dying coal industry that operates mines in the Appalachia mountains throughout Kentucky, Southern Ohio, Pennsylvania, and West Virginia. Not only do these areas struggle with economic depression, and an aging population, the heroin epidemic has hit these communities particularly hard as well.


The mountains here have been dynamited over the years to make room for better, wider, and safer roads. Shale rock breaks easily, so “steps” and ditches have been formed to prevent accidents from falling boulders and rock-slides.

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Remains of the Sidney Coal Mining Company, now defunct. Images of the dying coal mining industry are tucked everywhere in the Appalachia mountains near Pikeville, KY.

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