06/28/16

Down for the Count?

© Lesik Aleksandr | 123rf.com

© Lesik Aleksandr | 123rf.com

Approved for sale over one year ago, Palcohol may never make it to the shelves of retail stores for sale. Palcohol is a powdered alcohol product that puts the equivalent of one ounce of alcohol in a vacuum-sealed packet. Mix it with about five ounces of water, and voila! Instant cocktail! Mark Phillips, the creator of Palcohol, calls it “a revolutionary product.” He envisions it not only as a recreational beverage, but as also having industrial applications in products like windshield wiper fluid. And it could have military and medical applications. Unfortunately, it seems that unintentionally the makers of Palcohol may have been their own worst enemy.

The company’s website originally described Palcohol as a solution for problems like the overpriced drinks at stadium events. Supposedly, the site’s content was not meant for public viewing; the website was still in process. Then in April of 2014, U.S. Alcohol and Tobacco Tax and Trade Bureau (TTB) announced the approval of Palcohol. The result was a firestorm with a literal political backlash when people discovered the not-quite-ready website. The initial talking points were acknowledged by Phillips to have been “edgy” and “questionable.” Gawker quoted several of these now removed talking points:

What’s worse than going to a concert, sporting event, etc. and having to pay $10, $15, $20 for a mixed drink with tax and tip. Are you kidding me?! Take Palcohol into the venue and enjoy a mixed drink for a fraction of the cost.

We’ve been talking about drinks so far. But we have found adding Palcohol to food is so much fun. Sprinkle Palcohol on almost any dish and give it an extra kick.

Let’s talk about the elephant in the room … snorting Palcohol. Yes, you can snort it. And you’ll get drunk almost instantly because the alcohol will be absorbed so quickly in your nose. Good idea? No. It will mess you up. Use Palcohol responsibly.

Almost immediately, Phillips and his company, Lipsmark LLC, began backpedaling. Eater quoted Phillips as saying the company added “volume to the powder so that it would take more than a half of a cup of powder to get the equivalent of one drink up your nose.” The approval was quickly pulled for packaging discrepancies. In March of 2015 the TTB again approved Palcohol, but Senator Charles Schumer introduced legislation to make the production, sale and possession of powdered alcohol illegal. He also called on the FDA to immediately step in and halt the sale of Palcohol. Schumer said:

Underage alcohol abuse is already an epidemic with tragic consequences. A product like Palcohol would just exacerbate that scourge, which is why we must stop it. Support for this new amendment is the only way to make it illegal to produce or sell this Kool-Aid for underage binge drinking.

The Palcohol website touts its product as “safer than liquid alcohol.” Embedded there is a 16-minute YouTube video of Mark Phillips on “The Truth About Palcohol.” Among the potential benefits of Palcohol he described was how it could be used as an emergency fuel source—in other words, it’s flammable. Hotels in Hawaii and airlines were reportedly interested as it could save shipping and fuel costs, as Palcohol was only 1/3 the weight of regular alcohol. I could see the benefit in shipping alcohol to Hawaii, but won’t airlines have to carry water to hydrate the Palcohol on flights? Doesn’t that negate the weight savings? Claiming that Palcohol could help reduce the amount of greenhouse gas emissions—by saving fuel costs over shipping liquid alcohol—seemed a bit of a stretch. The website also says:

A proposed ban of powdered alcohol … is denying millions of responsible adults and hundreds of businesses a chance to use this legal, safe and revolutionary new product that has applications in medicine, energy, hospitality, the military, manufacturing, etc. as well as reducing the carbon footprint by being so much lighter to ship than liquid alcohol.

Legislators who are working to make Palcohol illegal are made out to be the villains. “The legislature is there to protect the citizen’s right to choose and support innovative business ideas, not to impose [their] values on them.” Weren’t the initial concerns for Palcohol generated from their own “edgy” copy on a not-ready-for-prime-time website? And don’t individual states have the right to ban products they don’t want to be sold in their states? In the video, Phillips said: “We need to act now before ignorance determines our future.”

However, it doesn’t seem that state legislators around the country are as ignorant of Palcohol as Phillips would like. Alcohol Justice reported on PR Newswire that 31 states have complete bans on powered alcohol, with the California Assembly unanimously passing a bill (AB 1554) to do the same. A companion bill unanimously passed the state Senate in March of 2016. Assembly member Jacqui Irwin, author of AB 1554, noted the overwhelming bi-partisan support behind the ban. She said:

Powdered alcohol is a dangerous product that has been designed and marketed as a way to make super-charged cocktails on the go. Binge drinking and alcohol related deaths are already a huge problem in California and adding powdered alcohol to the mix is a recipe for disaster.

Bruce Livingston, the CEO of Alcohol Justice, said they were grateful to the states that placed public health and safety above commerce. He encouraged elected leaders in states that have not yet taken action to do so. “We continue to agree with New York Senator Chuck Schumer who said Palcohol will become the ‘Kool-Aid’ of teenage binge drinking and will lead to acute alcohol poisoning and death.” A graphic on the Alcohol Justice website indicated that as of june 7, 2016, 32 states had banned powered alcohol. Ten states, including California, Pennsylvania and New York, have pending legislation to ban powered alcohol. Only three states allow powered alcohol: Colorado, Arizona and Texas.

Then on June 14, 2016, the American Medical Association (AMA) announced they were adopting a policy supporting the federal and state laws banning powered alcohol in the U.S. Jesse Ehrenfield, MD, an AMA board member said:

Given the variety of flavors that could be enticing to youth and concerns that the final alcohol concentration could be much greater than intended by the manufacturer, we believe that powdered alcohol has the potential to cause serious harm to minors and should be banned. . . . We urge states and the federal government to prevent powdered alcohol from being manufactured, distributed, imported and sold in the U.S.

Mark Phillips told Medscape Medical News that he thought the AMA’s decision was irresponsible. He said: “If the AMA would have taken the time to learn about the product, they would have realized that Palcohol is safer than liquid alcohol.” Reporting for Medscape, Robert Lowes said the AMA’s Council on Science and Public Health weighed Phillips’ arguments for Palcohol and still decided to support the ban: “”The harms that could arise from mixing powdered alcohol with liquid alcohol or even with energy drinks raises the potential for dangerous patterns of use.”

Palcohol is not down for the count just yet. Phillips and Lipsmark LLC are working hard to reverse the legislative bans and present Palcohol as an eco-friendly, potentially life-saving product that happens to be flammable and could be used by the military for “applications from transport fuel to fuel in a soldier’s backpack.” Is that military product going to be powered ethyl alcohol like recreational Palcohol? If it is, I wonder what the alcohol content will be? Do we want to send troops into combat situations with something they could potentially get drunk on? For more on powered alcohol see, “Hype over Powered Alcohol.”

06/24/16

Genesis, Science and Creation

© Oleg Dudko | 123rf.com

© Oleg Dudko | 123rf.com

For conservative Christians holding to the authority of the Bible “as the only rule of faith and obedience” in the modern world, there is perhaps no more important question than whether science is a competing or complementary form of knowledge and authority to Scripture. In a way, this dilemma is traceable to the third chapter of Genesis. Genesis 3 contains the story of the Fall of humanity, where Adam and Eve fell into the trap of striving to be “like God” by knowing good and evil independent of God and his revelation. Ironically, they did gain knowledge independent of God; and the first thing they discovered was their own “nakedness” apart from God. Autonomous knowledge comes with a price.

We can see this compulsion for autonomous knowledge clearly within a short discussion of the encounter of God and His Word with science and nature. In Escape from Reason, Francis Schaeffer noted how early scientists shared the outlook of Christianity in believing that a reasonable God created a reasonable universe; and humans, by using their reason, could become knowledgeable about the universe. Early science was natural science, but it wasn’t naturalistic. There wasn’t an assumption that reason could be exercised independent of God; that nature could be known autonomous of God’s revelation.

Alister McGrath’s discussion of the relationship between science and religion in his book Science & Religion is helpful here. McGrath said there were three broad positions on the relationship between the natural world and the divine. The first is that the natural world is divine. This is certainly not a position that either Christianity or modern science would take. A second position is that the natural world is created and bears some resemblance to its Creator. The third is that the natural world has no relation to God. This third position underlies the view of what Schaeffer calls modern, modern science. And the second is necessary for a two books view of Scripture and Nature.

This idea (which is sometimes expressed in terms of the “two books” of Scripture and Nature) gave additional impetus to the study of nature. If God could not be seen, yet had somehow imprinted his nature on the creation, it would be possible to gain an enhanced appreciation of the nature and purpose of God by studying the natural order.

Science and the Bible were able to peacefully coexist for centuries. Nature was the “textbook” of God’s general revelation; and the Bible was the handbook of his special revelation. This “two books theology,” as noted above, was an essential foundation for the rise of modern science. Denis Lamoureux quoted Sir Francis Bacon (1561-1626), a scientist and Christian, on the “two books” of God’s revelation:

Let no woman or man out of conceit or laziness, think or believe that anyone can search too far or be too well informed in the Book of God’s Works or the Book of God’s Words. Instead, let everyone endlessly improve their understanding of both.

A related issue concerns the order of nature within a doctrine of creation. “The doctrine of creation leads directly to the notion that the universe is possessed of regularity which is capable of being uncovered by humanity.” Encapsulated within “the laws of nature,” this was of fundamental importance to the emergence and development of the natural sciences. But how then do science and religion interact? Are they part of the same reality? Are the insights of science and religion contradictory or complementary to each other?

McGrath said one view of the interaction of science and religion sees them as in conflict or at war with each other. A second view sees science and religion as convergent; “all truth is God’s truth.” Developments in science should be welcomed and accommodated within the Christian faith. The third view sees science and religion as distinct. In other words, the natural sciences ask the “how” questions, while theology asks the “why” questions.

In his book, Understanding the Present: Science and the Soul of Modern Man, Bryan Applyard dated the birth of modern science to the time of Galileo. The moment that Galileo looked through his telescope in 1609 contained “all that was new and revolutionary in science.” He looked through his crude telescope and believed what he saw with his own eyes. The method of science (or wisdom, as Appleyard called it) that existed before Galileo was different in many ways from what ruled after 1609. “Its foundation was neither observation nor experiment, but authority understood through reason.” But from that time onward, “a new and unprecedentedly effective form of knowledge and way of doing things appeared.”

This science inspired a version of the universe, of the world and of man that was utterly opposed to all preceding versions. Most importantly, it denied man the possibility of finding an ultimate meaning and purpose for his life within the facts of the world. If there were such things as meanings and purposes, they must exist outside the universe describable by science.”

Francis Schaeffer called this the birth of “modern, modern science.” And he believed this was a radically different way of doing science than what Bacon and Galileo did. A necessary presumption for any scientific endeavor is the uniformity of natural causes. Early scientists like Bacon and Galileo saw this existing within the open system of nature, where God could and did have a sustaining influence on His creation. Christians were free to pursue science and maintain their belief in a Creator God who was still active within His creation.

But within modern, modern science, this unity of natural causes exists within a closed system of nature. There cannot be any intervention from forces or influences outside of nature. Science necessarily is done within the assumed closed system of nature. If it isn’t, then it is not science. In Escape From Reason, Schaeffer said:

That little phrase [the uniformity of natural causes within a closed system] makes all the difference in the world. It makes the difference between natural science and a science that is rooted in naturalistic philosophy.

So science as it is widely practiced today, what Schaeffer called modern, modern science, begins with a philosophical assumption that excludes the potential influence of a creative God, or a creative force. I think this is one reason why scientists today are so antagonistic towards Intelligent Design Theory. To them it feels and looks like cheating; an undermining of this basic philosophical foundation of the modern scientific method. Any attempt to accommodate the discoveries within the Book of God’s Works with the Book of God’s Word, as in the “two book” theory, is not legitimate science. Modern, modern science is autonomous from God.

So when interpreting Genesis 1, it matters which view of science you bring to the process. Is it the open system of nature within the two books theory, or the closed system of modern, modern science? If nature is open to God’s interventions, was it designed to exist independent or autonomous from God after creation, like a giant watch with God as the Watchmaker; or is creation sustained by a Creator? If creation is not independent of its Creator, can a study of creation tell us something about its Creator? Can knowledge of the works of God inform us about the Word of God? Will knowledge of the watch tell us anything about the Watchmaker? Is that knowledge independent, complementary and accommodating, or in conflict to what the Bible reveals to us about God and His creation? And if in conflict, does that mean that biblical religion and science are at war with each other?

In “Origins and Creation” I looked at several different ways to understand the Genesis account of creation. The categories were drawn from the web lectures and writings of Denis Lamoureux, an Evolutionary Creationist. The categories were: Young Earth Creation (YEC), Progressive Creation (PC), Evolutionary Creation (EC), Deistic Evolution (DE) and Atheistic Evolution (AE). Look at “Origins and Creation” for more information on how these views of creation differ from each other. Drawing on the above discussion, we can then suggest views of origins have the following relationships between nature and science, creation and God, and the interaction of knowledge found within science and the Bible:

Creation Origins

Nature as an Open or Closed System

Relationship of Creation to God

Interaction of Knowledge in Science & the Bible

YEC

Open

Creation is sustained by God

Accommodation conflict/war

PC

 

Open

Creation is sustained by God

Some accommodation; Some conflict

EC

Open

Creation is sustained by God

Complementary &

no conflict

DE

Open at first

Creation is autonomous of God

Some relationship

No interaction

AE

Closed

Creation is autonomous of God

No relationship

conflict/war

It’s not enough to select which of the three creation positions available to a conservative Christian (YEC, PC and EC) appeals to you. Each of the three positions carries interpretive decisions with regard to Scripture and with regard to science that have to be made. The views you hold with regard to the interaction of science and Scripture, nature and the Bible, influence your views on creation. They influence how you interpret both Genesis 1 and the other passages of Scripture. Modern knowledge of the works of God is not autonomous from the Word of God. So when God created the heavens and the earth in the beginning, how do you think He did it?

For more articles on creation in the Bible, see the link “Genesis & Creation.”

06/21/16

Now There’s Chewable Speed

© vogelsp | 123rf.com

© vogelsp | 123rf.com

Do you have a difficult time giving your child ADHD medication? Not that you don’t want them to take it—you do. But they don’t like the taste; or they have problems swallowing pills; or they just don’t like how it makes them feel. Or maybe you’re an adult who chronically forgets to take your medication in the morning. You don’t want to carry a prescription bottle around with you. People may wonder why you are popping pills in the middle of the day. Now there is an ADHD medication that is right for you! It’s chewable and comes in fruit flavors too!

Okay, the paragraph above was a tad satirical, but it is entirely true in what it said about ADHD medication. In mid-May of 2016, Adzenys, a chewable, fruity form of amphetamine became available. As STAT reported, Adzenys XR-ODT was approved by the FDA in January of 2016 by the FDA for patients six and older. The CEO of Neos Therapeutics said they were “launching now at full speed.” They want to get “ahead of back-to-school season.”

Vipin Garg, the CEO of Neos, said the new quick-dissolving formula will help “harried mothers” get their children medicated faster in the morning before school. And if adults forget to take their pill at breakfast, they can “pop a tablet” on the way to work—it comes in a blister pack, not in a pill bottle. “You go to a pharmacy, and everything is in gummy bear format. . . . Why would that be the case if there wasn’t a need for this?” Garg sees the dissolving tabs as part of a trend to make medications more pleasant to take.

All that adds up to a booming market. Sales for ADHD medications were at $4.7 billion in 2006, had nearly tripled to $12.7 billion by last year, and are projected to grow to $17.5 billion by 2020, according to a 2015 report from market research firm IBISWorld.

Adzenys is not alone as a chewable ADHD medication. In December of 2015, one month ahead of Adzenys, the FDA approved QuilliChew for Pfizer. Similar to Adzenys, it is an extended release tablet and was approved for patients six and older. The tablet is even scored, so it can be easily halved to individualize the needs of the patient taking it. The active ingredient in QuilliChew is methylphenidate hydrochloride.

Ann Childress, the president of the Center for Psychiatry and Behavioral Medicine in Las Vegas, was quoted by Medscape as saying: “As a physician, it is important to have treatment choices for patients with ADHD and their caregivers. QuilliChew ER extended-release chewable tablets give healthcare providers an additional treatment option to meet their patients’ needs.”

Dr. Childress was a paid consultant and spokesperson for Pfizer according to ProPublica. Between August 2013 and December of 2014 she received $25,911 for “consulting”, “promotional speaking/other” “travel and lodging” by Pfizer for activities related to Quillivant XR. Looking at the archived data on ProPublica, she has had a speaking, consulting and research relationship with Pfizer for several years. She has also been paid $17,998 during the same time period for consulting and other activities by Shire, which makes Vyvanse, another ADHD medication.

Shire recently applied to the FDA to be allowed to bring a chewable Vyvanse to market. On April 14, 2016 Shire announced they had submitted a new drug application to the FDA for a chewable tablet version of Vyvanse for individuals who may have problems swallowing or opening a capsule. The existing Vyvanse capsules can be swallowed whole or opened so that the medication can be mixed into food or water. “Vyvanse chewable tablets will offer an additional administration option for patients.”  The proposed indications for chewable Vyvanse would be the same as the existing uses for Vyvanse capsules—ADHD and Binge Eating Disorder. By the way, sales for Vyvanse more than doubled between 2010 and 2014, from $986 million to $2.1 billion.

Opinions are mixed on the new chewable formulas, according to STAT.  Dr. Ben Biermann, an assistant professor of psychiatry at the University of Michigan, thought there was nothing revolutionary about Adzenys. “It’s simply another delivery mechanism for a medication that already exists and has widespread use.” On the other hand, Dr. Mukund Gnanadesikna, a child and adolescent psychiatrist in Napa, California, thought it was a recipe for people to request it and then sell it: ““I’m not a big fan of controlled substances that come in forms that can be easily abused — and certainly a chewable drug falls into that category.”

Both Adzenys and Vyvanse are amphetamines, as is Adderall. Quillivant and Quillichew are methylphenidate, as are Concerta and Ritalin. All ADHD stimulants are Schedule II controlled substances, meaning they have a high potential for abuse and dependence. And there are multiple potential issues when using stimulants. Here are some of the precautions noted on the Adzenys-XR-ODT medication guide: serious cardiovascular reactions including sudden death, stroke and myocardial infarction; adverse psychiatric reactions such as psychosis or mania. Other adverse reactions can include insomnia, loss of appetite, nervousness, weight loss, and agitation.

The existing and potential harm to children from stimulant medications like Adzenys and Quillichew are well documented and described by Dr. Peter Breggin on his website, breggin.com. He said too many children grow up believing they are inherently defective. The latest scientific literature indicates the potential consequences of boys aged 7-9, who were given a diagnosis of mild hyperactivity in the 1970s and treated with Ritalin. Those boys have much higher rates of early death, atrophy of the brain, suicide, psychiatric hospitalization incarceration and drug addiction than a control group of children from the same time period.

Breggin gave multiple reasons for these potentially dreadful outcomes, including the misinterpretation of adverse effects like depression, anxiety, agitation, insomnia psychosis and aggression. Instead of seeing these as adverse drug reactions, they are viewed disorders that were “unmasked” by the stimulants, which leads to further prescriptions to deal with these newly uncovered mental disorders. Embedded in his linked page are several videos he has done that explain the harmful effects and method of action of stimulants; the negative effects of diagnosing children with ADHD; and the long term consequences to children using stimulants like Ritalin.

There is more information available on the problems with ADHD medications and ADHD diagnosis on this website. Try  “A Drug in Search of a Disorder”, “Pseudoscience with Vyvanse?” or “ADHD: An Imbalance of Fire over Water or a Case of the Fidgets?” Also try a search of “ADHD.”

06/17/16

Impeccable Timing

31118385_sTiming is everything—even with medications coming to market. In the last few years new, effective treatments for the Hepatitis C Virus (HCV) have come to market as the death rates steadily climbed. Solvadi (12/2013) and Harvoni (10/2014) by Gilead Sciences; Viekira Pak (12/2014) by AbbVie and Zepatier  (01/2016) by Merck are the main ones. They have cure rates over 90% in many cases. Although their prices have been sky high, according to the WHO, the production costs of these drugs are quite low. Harvoni prices were expected to drop, but I haven’t anything much cheaper than $94,500 for 12 weeks of medication. Viekira Pak lists at $83,300 for 12 weeks; Zepatier is the bargain at $54,600.

New CDC data in May of 2016 indicated that HCV deaths for 2014 reached an all-time high of 19,659. The rates have been steadily rising since 2010 when the total was 16,627. The CDC also stated their numbers were most likely a fraction of the deaths attributable in whole or in part to chronic hepatitis C. There are an estimated 2.7 to 3.9 million chronic cases of HCV in the U.S. New acute cases of HCV have also been steadily increasing. In 2014 there were 2,194 new cases of HCV reported, a 300% increase since 2005. The CDC suggested that actual cases are estimated to be 13.9 times higher than the number of reported cases in any year. The following chart was compiled from the CDC data.

2010

2011

2012

2013

2014

Actual 

New HCV

853

1,230

1,778

2,138

2,194

Estimated

New HCV

11,800

16,500

24,700

29,700

30,500

Cause of Death

as HCV

16,627

17,721

18,650

19,368

19,659

A study done on the CDC HCV data found that from 2003-2013 the number of deaths from HCV surpassed the combined total of 60 other infectious conditions. This was despite the improving therapies now available. The HCV death statistics could begin decreasing in the next few years, as the impact of the new drugs is felt in treatment. But the high cost of medications has resulted in health insurance companies prioritizing treatment for the worst HCV cases. So as the heroin and prescription pain medication epidemic rages on, new HCV patients have to wait their turn until their HCV gets serious enough for their health insurance to approve treatment.

Despite enthusiasm for the new curative, brief (12-week), all-oral antiviral treatments for hepatitis C virus (HCV) infection, the continued health burden and increased mortality for HCV-infected patients in the United States remain underappreciated.

A CDC press release indicated the greatest HCV burden falls on baby boomers, born between 1945 and 1965. A study published in The Lancet Infectious Diseases in 2016 suggested injection and blood transfusion technologies were not as safe as they are today, so many boomers may have been unknowingly living with HCV for many years. Jonathan Mermin of the CDC said: “Why are so many Americans dying of this preventable disease? Once hepatitis C testing and treatment are as routine as they are for high cholesterol and colon cancer, we will see people living the long, healthy lives they deserve.” The outrageous price for HCV medications may be part of your answer, Dr. Mermin.

A Live Science article on the CDC study noted that HCV is primarily spread today through people sharing needles, syringes or other equipment used when injecting drugs. “But before 1992, when the U.S. began screening the blood supply for the virus hepatitis C was also commonly spread through blood transfusions and organ transplants.” The following chart from Wikimedia Commons, composed by Opigan13, was compiled from CDC figures. It shows data on hepatitis C infection by source.

 576px-Hepatitis_C_infection_by_source_(CDC)_-_en

HCV can be a “silent illness,” with people having no symptoms for decades. This allows the disease to progress unnoticed. Hepatitis C is “a different beast” from other liver infections that have more symptoms or are shorter in duration, according to Dr. Raymond Chung, director of hepatology and the Liver Center at Massachusetts General Hospital. Dr. Chung thought the increase in HCV deaths could continue for five more years or longer.

Amy Nunn, an associate professor of behavioral and social sciences at the Brown University School of Public Health said the rise in HCV deaths was alarming. About 85 percent of individuals who are infected with HCV don’t know they have it. Most people are not routinely screened for the virus. Nunn also pointed to the high cost of the new hepatitis C drugs as one reason that some people are having trouble getting access to them in the early stages of the disease.

A report by IMS Health for 2015 indicated that nearly 250,000 new patients received treatment for HCV in 2015. Added to the 170,000 new patients in 2014, the past two years have seen 5 times the number of patients than the previous three years combined. The majority of patients were treated by Medicare (50%); followed by commercial insurance (28%) and Medicaid (19%); 3% paid cash. Non-discounted spending over the past two years for the newer HCV drugs was $31.0 billion. “The discussion continues over the price of these medicines and the criteria for determining patient access and insurance coverage.” See chart 10 in the report for this data.

Spending on HCV went from so small an amount in 2013 that a figure couldn’t be shown in chart 8, to 12.2 billion in 2014 and 18.8 billion in 2015. Looking at the top medicines by spending in 2015, Harvoni was #1 with $14.3 billion. Solvadi dropped to 19th with $3.0 billion spent. In 2014 Solvadi had been tied for 1st with Humira at $7.8 billion in spending.

The World Health Organization (WHO) estimates that 130 to 150 million people globally have chronic hepatitis C infection. Around 500,000 people die yearly from HCV-related liver diseases. The most affected regions are Africa, Central Asia and East Asia. Populations at risk of HCV include: people who injects drugs, people who have used intranasal drugs, people who have tattoos or piercings, people with HIV, prisoners or previously incarcerated individuals, and children born to mothers with HCV.

The incubation period for hepatitis C ranges from 2 weeks to 6 months. After the initial infection, 80% of people do not show any symptoms. Individuals who are acutely symptomatic could exhibit “fever, fatigue, decreased appetite, nausea, vomiting, abdominal pain, dark urine, grey-coloured faeces, joint pain and jaundice (yellowing of skin and the whites of the eyes).” The WHO said:

Recently, new antiviral drugs have been developed. These medicines, called direct antiviral agents (DAA) are much more effective, safer and better-tolerated than the older therapies. Therapy with DAAs result can cure most persons with HCV infection and treatment is shorter (usually 12 weeks) and safer. Although the production cost of DAAs is low, the initial prices are very high and likely to make access to these drugs difficult even in high-income countries.

So pharmaceutical companies like Gilead Sciences, AbbVie and Merck are making enormous profits from their HCV treatments and will continue to do so for many years (see “Riding the Hep C Gravy Train”). The low production cost for HCV drugs is also an explanation for why Gilead Sciences was so willing to offer steep discounts to countries like Egypt (See “Is There No Balm in Gilead?” and “Hepatitis Hostages”)—it’s good PR and they either still make a profit or buy a lot of goodwill for a nominal cost. As Amy Nunn said, “This is an epidemic of enormous magnitude.” And it looks like it will be around for awhile longer. Gilead, Merck and AbbVie, your timing for drug development was impeccable.

06/14/16

Descent into Hell

© LoraLiu | stockfresh.com

© LoraLiu | stockfresh.com

I confess, I am not much of a listener of Contemporary Christian Music (CCM). So I had never heard of the CCM artist Kari Jobe or her music until someone asked me about a theological controversy that is making the rounds online about one of her songs, titled Forever. Apparently, the dispute is over a reference in her song to Jesus as the Son of God descending into hell where He defeated the enemy. The person was asking me to see whether I thought that lyric was heretical, and whether Jobe was spreading heresy. My initial reaction was to recall that some versions of the Apostles’ Creed made a similar claim and say that those who are critical of Jobe and her song seemed to be majoring on minor points.

Here is a description of one view of the controversy written by Jeff Maples on his blog, Pulpit & Pen: “Popular Charismatic Worship Artist, Kari Jobe, Teaching Dangerous Heresy.” Maples began by criticizing the Outcry 2016 music festival that will be held in several U.S. cities this year. Kari Jobe is part of the tour. He said: “Now, I’m not exactly sure who these people are worshiping, but it isn’t Jesus. Yet, thousands of Christians are blindly sending their children to partake in this evil.” This is provocative stuff to be saying about the participants of the Outcry 2016 and those who attend it.

His beef seemed to be focused primarily on something called the New Apostolic Reformation (NAR), which he said is a movement that elevates experience above doctrinal truth. Whether NAR is or is not heretical is not the focus here. Someone who wants more information on the movement or its beliefs can easily find discussions online. To get you started, try a Fresh Air podcast in 2011, “The Evangelicals Engaged in Spiritual Warfare”; or a Charisma News response to the NPR interview and article: “The New Apostolic Reformation Is not a Cult” by C. Peter Wagner. Also try “New Apostolic Reformation” on Wikipedia.

In his article, Maples quoted the lyric from Jobe’s song that he saw as offensive:

One final breath He gave
As heaven looked away
The Son of God was laid in darkness
A battle in the grave
The war on death was waged
The power of hell forever broken

Also there is a YouTube clip embedded on the page where Jobe said her favorite part of the song was the part that talks about the time in between the cross and the resurrection when “Jesus was in hell … defeating the enemy … taking those keys to death and hell and the grave to be victorious over that when he rose from the dead.”  Maples then equated this with an old heresy he said is found in the Word of Faith circles, that Jesus died spiritually and was “born again” after defeating Satan in hell. Personally, I’m not a fan of the teachings of Joyce Meyer or Kenneth Copeland, who Meyers quotes as promoting this heresy. But it seems to me the “culprit” behind Jobe’s lyric is the Apostle’s Creed rather than the Word of Faith movement.

The Apostles’ Creed has been a confessional element of orthodox Christian belief since the times of the early church. Ambrose and Augustine suggested repeating it in daily devotions. Luther saw it as one of three binding summaries of belief. Calvin divided his Institutes into four parts that corresponded to the Apostles’ Creed. See “Christian, What Do You Believe?” for more background on the Apostles’ Creed.

J. N. D. Kelly, in Early Christian Creeds, pointed out that the first appearance of saying that Jesus “descended to hell” appeared in the Aquleian version of the creed referred to by Rufinus, a fourth century monk and theologian, in his Commentary of the Apostles’ Creed. There he noted the phrase “He descended into hell” was not part of the Roman Creed (See “The Old Roman Creed”) or those of the Eastern (Oriental) churches. Nevertheless, it seemed to be implied in saying that Jesus was buried. Kelly said the clause was also present in some Spanish creeds of the sixth century and Gallican creeds of the seventh and eighth centuries.

Rufinus remarked in his commentary that Jesus descending into hell was foretold in the Psalm 22, classically seen as intimately associated with the passion of Christ. The first words of the Psalm, “My God, my God, why have you forsaken me?” are cried out by Jesus as he was dying (Matthew 27:46; Mark 15:34). Psalm 22:7-8 is alluded to in Matthew 27:39, 43, “All who see me mock me; they make mouths at me; they wag their heads; He trusts in the Lord; let him deliver him!” The final words of the Psalm, “he has done it” were said in Hard Sayings of the Bible to have been alluded to by Jesus in John 19:30 as he bowed his head and died: “It is finished.” Rufinus saw similar references to a descent into hell in Psalm 22:15, “you lay me in the dust of death”; Psalm 30:3, “O Lord, you have brought up my soul from Sheol; you restored me to life from among those who go down to the pit”; and Psalm 30:9, “What profit is there in my death, if I go down to the pit?”

Tom Macy also expressed concern with Jobe’s reference to Jesus descending into hell in his article, “Did Jesus Go to Hell?” Macy said it was bad theology that taught an error striking at the heart of understanding the death and resurrection of Jesus. He said it taught the battle was not won on the cross. Rather, the real battle took place in hell between the death and resurrection of Jesus. “That is what seriously distorts the truth and why this song must not be used.”

A further example of the confusion arising from this reference to a descent into hell in the Apostles’ Creed is in this short video by Garrett Kell from Capitol Hill Baptist Church. I don’t concur with his explanation, but it does show how wild speculation creeps in to explain difficult passages of the Bible. Macy attributed the root of this confusion to Roman Catholic teaching. He then referenced Wayne Grudem’s Systematic Theology to explain passages that have been used to support Jesus’ decent into hell.

Fanciful interpretations of difficult passages must not override the declarations from the cross definitively showing that Jesus did NOT spend Saturday in hell, was NOT fighting Satan to finish the work of salvation, was NOT preaching a second chance salvation or simply condemning to those in hell. Jesus was with the repentant thief in Paradise in the presence of the Father.

And yet, the descent into the underworld was specifically mentioned by: Ignatius, Polycarp, Irenaeus, Tertullian and others, according to Kelly. “The belief that Christ spent the interval between His expiry on the cross and His resurrection in the underworld was a commonplace of Christian teaching from the earliest times.” One strand of patristic teaching thought Jesus himself hinted at it when he said in Matthew 12:40 that the scribes and Pharisees seeking a sign would get only the sign of the prophet Jonah: “For just as Jonah was three days and three nights in the belly of the great fish, so will the Son of Man be three days and three nights in the heart of the earth.”

Attempts to explain where Jesus was when his body was in the tomb ask space and time-oriented questions about something that occurred beyond the space and time of the created universe. The answer can’t fit within the cosmos in which we live and move and have our being. And yet, we still wonder where Jesus was when he wasn’t with his body in the tomb. The question says more about us, and our view of the cosmos, than it does about what actually happened to Jesus between about 3 pm Friday afternoon and early Sunday morning.  In a similar way, the addition to the Apostles’ Creed of Jesus descending into hell, and the Old and New Testament passages supposedly referencing the same, tell us more about how the people of Biblical times viewed the cosmos than where Jesus was between his death and resurrection.

In his book, Scripture and Cosmology, Kyle Greenwood described how ancient Hebrew cosmology of a three-tiered universe of the heavens, earth and sea had a place for the underworld or the abode of the dead—Sheol. “When people died, they were buried in the ground, and their bodies remained in Sheol, the abode of the dead.”  This three-tiered cosmology was shared by other Near Eastern cultures. “It was the abode of the dead, the final resting place beneath the earth for all who once lived.”

OT cosmos

 On the BioLogos website is a series of blog articles on a scholarly paper by Brian Godawa, “Mesopotamian Cosmic Geography in the Bible.” Here is a link to Part 4 of that series where there is a discussion of Sheol; here is a link to Godawa’s entire paper. The following quotation can be found under either link.

Sheol was the Hebrew word for the underworld. Though the Bible does not contain any narratives of experiences in Sheol, it was nevertheless described as the abode of the dead that was below the earth. Though Sheol was sometimes used interchangeably with “Abaddon” as the place of destruction of the body (Prov. 15:11; 27:20),and “the grave” (qibrah) as a reference to the state of being dead and buried in the earth (Psa. 88:11; Isa. 14:9-11) it was also considered to be physically located beneath the earth in the same way as other ANE worldviews.

The New Testament was written during a time of transition to an Aristotelean cosmology of spheres within rotating spheres.  “In time Aristotelean cosmology and biblical faith became inseparable, not because Aristotle was a Christian, but because his system was easily reconciled with biblical anthropology and monotheism.” While the idea of Sheol or the grave underwent some major changes in the Christian era, Aristotelean cosmology didn’t require an abandonment of the idea that beneath the surface of the earth was a region where the dead went. Greenwood added this shows up conspicuously within the Apostles’ Creed.

The added phrase of “descended to hell” to the Apostles’ Creed is then simply making clear that Jesus truly died. Like all people, the humanity of the Son of God died. Not only was he crucified and buried, as it was said within the Roman Creed; Jesus was crucified [dead] and buried [He descended into Hell]. So on the third day, He would arise from the dead; the grave; Sheol. In other words, he would live again. This is the promise of faith in Christ. He reversed the irreversible, according to the ancient thinking about death. I think Kari Jobe can sing about it Forever, if she likes.

06/10/16

Psych Drugs and Violence

© stocksnapper | stockfresh.com

© stocksnapper | stockfresh.com

A man began taking Zoloft because of some anxiety over whether he could cope with high school students as a student teacher. By the second day on Zoloft, he was having delusions. By day three, he believed aliens were hiding in the normal bodies of people all around him. He thought the alien leader had taken over his wife’s body. On the seventh day of Zoloft, he became certain that he had to kill the alien inside his wife to save himself and the world. So he drove their car full speed into a road barrier, unbuckling her seatbelt just before the crash. Finding her lying on the ground and alive after the wreck, he began to bang her head against the concrete and choke her. His wife survived, but their marriage did not.

A psychiatrist with a successful practice was stressed because of difficulties that ended up with him taking another psychiatrist to court. She in turn sued his son, who was involved in the business.  He prescribed himself Prozac hoping to relieve some of his tension and raise his spirits, but that didn’t help. He sought out treatment from another psychiatrist who treated him with more antidepressants, which led to further deterioration. Eventually he was placed on Luvox—the same antidepressant one of the Columbine shooters was taking. He became increasingly incensed at the psychiatrist who countersued his son and attacked her with a tack hammer.

These are just two of the case studies described by psychiatrist Peter Breggin in his book, Medication Madness. However, you don’t have to read it to find further examples. Read about the speculation after the Sandy Hook shootings about Adam Lanza. Or read this 2010 article by Moore, Glenmullen and Furberg, “Prescription Drugs Associated with Reports of Violence Toward Others.” Thirty-one different drugs met the study’s criteria for a disproportionate association with violence. The drugs included 11 antidepressants, 5 hypnotic/sedatives, 3 ADHD drugs and varenicline (Chantix). “SSRI Stories” describes over 6,000 stories where it seems prescription drugs  (primarily SSRIs) were linked to adverse outcomes, including violence. Also look at “Drugs, Violence and Revolution” or “Smoke and Mirrors” on this website.

These data provide new evidence that acts of violence towards others are a genuine and serious adverse drug event that is associated with a relatively small group of drugs. Varenicline, which increases the availability of dopamine, and serotonin reuptake inhibitors were the most strongly and consistently implicated drugs. Prospective studies to evaluate systematically this side effect are needed to establish the incidence, confirm differences among drugs and identify additional common features.

Several years ago I attended a conference and heard a presentation by Yolande Lucire on her research into the association of violence and psychiatric medications.  At the time I found her presentation both fascinating and concerning in that she thought she had identified a biomedical association between antidepressant medications and some perpetrators of violence. Could there actually be medical evidence of an association between antidepressants and violence? But I didn’t hear anything more about this finding, despite the parade of case studies and anecdotes like those above that did suggest a connection. Then I saw where she was the coauthor of an article in the April 2016 issue of Forensic and Legal Medicine, describing a forensic investigation of three individuals who committed homicide, two of which also intended suicide while taking antidepressants.

The article by Eikelenboom-Schieveld, Lucire and Fogleman was a forensic investigation of three cases they believed to be instances of antidepressant-induced akathisia-related homicide. They suggested that mutations in the CYP450-encoding genes of these individuals contributed to problems metabolizing psychiatric medications and were thus contributing factors to their homicides. The cytochrome P450 family of enzymes is responsible for metabolizing most of the drugs used in psychiatry. “These individuals also had diminishing mutations in the CYP450 family of metabolizing enzymes and all were taking medicines that further decreased metabolism by inhibition.”

None of the three individuals knew they were supposed to take their medication regularly or how to stop taking it safely; and none of them improved on the medications. In addition, none of the prescribers recognized their complaints as adverse drug reactions. Nor were they aware of any impending danger from their patients. Interviews with the individuals indicated they had struggled with akathisia (agitation or distress), confusion, delirium, euphoria, extreme anxiety, obsessive preoccupation with aggression, and an incomplete recall of events. Impulses to kill were acted on without warning. Upon recovery, they all saw their actions as out of character. Their beliefs and behaviors horrified them.

They were all prescribed medications that interacted with one another and one person combined these with alcohol. The drug-to-drug interactions further decreased their metabolizing capacity and increased their risk for adverse events by prolonging the half-life of the medications and raising their blood levels.

Fast-changing levels of psychotropic substances, up or down, can cause behavioural changes, as the neurotransmitters in the brain react to reach some equilibrium. This phenomenon makes starting and stopping medication the most dangerous times for suicide and violence, but both can happen at any time, with stress, provocation, dose change, addition or subtraction of a medication. These toxic responses to antidepressants may occur early or later in treatment.

When reading this paper, I saw that Dr. Lucire had previously published an article in 2011 on anti-depressant-induced akathisia-related homicide and the CYP450 genes. In Lucire and Crotty they found that CYP450 allele frequencies were higher in those individuals who had experienced akathisia/serotonin toxicity after taking psychiatric medications. They presented ten cases whose the use of antidepressants had not mitigated their distress. Every person’s emotional reaction worsened while their treating physician attempted a “trial and error” method of increasing doses and then changing to another antidepressant when the previous one did not work.

The symptoms of antidepressant drug toxicity were not recognized as such by the subjects or their physicians. In many cases, the dosage of the antidepressant was increased while other medications were given to address the side effects Frequently the adverse effects were compounded.

In some cases the violence ensued from changes occasioned by withdrawal and polypharmacy. In all of these cases, the subjects were put into a state of drug-induced toxicity manifesting as akathisia, which resolved only upon discontinuation of the antidepressant drugs.

This paper has detailed and substantiated in specific terms how the metabolism of each of the antidepressant drugs used by the subjects would have been seriously impaired both before and at the time they committed or attempted homicide. They were experiencing severe reported side effects, adverse drug reactions due to impaired metabolism complicated by drug–drug interactions against a background of variant CYP450 alleles.

Eikelenboom-Schieveld, Lucire and Fogleman concluded that CYP450 was an important factor for determining who could tolerate a drug or combination of drugs from who could not. “Testing for cytochrome P450 identifies those at risk for such adverse drug reactions.” They hoped that as awareness of the biological causes of these disastrous side effects became more known, justice would be better served for both the victims and perpetrators of akathisia-related violence. “The medicalization of common human distress has resulted in a very large population getting medication that may do more harm than good by causing suicides, homicides and the mental states that lead up to them.”

06/7/16

Buyer Beware Drugs

© Yurly Kirsanov | 123rf.com

© Yurly Kirsanov | 123rf.com

At the end of March in 2016, detectives with the Onondaga County Sheriff’s Office executed a search warrant at a split level home in quiet suburban neighborhood about 8 miles north of Syracuse, New York. They discovered a fentanyl processing operation where six people were mixing and packaging fentanyl for street-level sales. Detectives found an estimated 5,866 doses of fentanyl, 2 ounces of A-PVP (flakka), a loaded 12-gauge shotgun, a replica sub machine gun, drug paraphernalia and $3,571. The total street value of the drugs was $60,000.

The individuals arrested were considerate enough to warn the arresting officers not to touch the fentanyl without gloves. The drug is potent enough to be absorbed through the skin if you touch it without gloves. I guess they were concerned about a possible felony murder charge on top of the drug charges. Although the source of the drug was not known at the time of the drug bust, it typically comes from international sources in Mexico and increasingly from China.

A similar arrest took place near Los Angeles, where four men were operating a pill lab in Baldwin Park. Police found several pill presses and large quantities of variously colored powders, among them acetyl-fentanyl and methamphetamine. DEA Agent David Dowling said: “Fentanyl and its analogues pose a serious public health risk. Even small doses absorbed through the skin or accidentally inhaled can be fatal.” They were getting their drug supply from China. The Southern California lab was just one of four by law enforcement in the U.S. and Canada in March of 2016.

David Armstrong reported for STAT News on both of the above incidents as well as a lab in a custom car business in British Columbia that was shipping 100,000 fentanyl pills monthly to nearby Calgary, Alberta. Police reported that the equipment used to press the pills had come from China. Recently a quarter-ton pill press was intercepted before it was transported to a suburban Los Angeles drug lab. It had been labeled as a “Hole Puncher.”

In an affidavit, DEA agent Lindsey Bellomy said that based on wire transfers and other evidence, she “strongly believes” the Southern California group acquired its fentanyl from China. The affidavit lists a dozen deliveries from China to members of the group in January and February.

The China connection is allowing local drug dealers in North America to mass produce fentanyl in pill form, in some cases producing tablets that look identical to an oft-abused version of the prescription painkiller OxyContin. It also has been added to Xanax pills.

The emergence of decentralized drug labs, using materials obtained from China, makes it difficult to police fentanyl sold as a street drug. A report from the Department of State’s Bureau for International Narcotics and Law Enforcement Affairs indicated China is still a major producer and exporter of fentanyl and other drugs for illicit international markets. Lax regulation, low production costs, and government corruption, mixed in with the country’s large chemical and pharmaceutical industries, makes China a perfect supply source for the materials needed for the illicit drug labs.

Fentanyl pills masquerading as hydrocodone were recently blamed for a wave of overdoses and 11 deaths in the Sacramento California area. The Sacramento Bee reported on April 13, 2016 there had been 51 fentanyl-linked overdoses since late Mach of 2016. By April 27th, the death toll was up to 14. The pills were exact replicas of a medium-strength opioid painkiller, Norco. The CDC discussed this outbreak in detail in one of their Morbidity and Mortality Weekly Reports (MMWR).

Analysis of the fake Norco pulls showed they contained fentanyl, promethazine, acetaminophen and trace amounts of cocaine. Normally used to treat nausea vomiting and motion sickness, promethazine is used here to boost the high of the opioid. Reporting for the Digital Journal, Karn Graham said the pills were exact replicas for the real ones. It was only pure luck that health officials were able to get one of the fake pills from an overdose patient in order to analyze its ingredients.  Keri Blakinger, writing for The Fix, said in Canada, British Columbia has declared a public health emergency from the increase of fentanyl overdose deaths in the province.

Lookalike oxycodone pills containing fentanyl have also appeared in Tennessee and Ohio. In testimony before the Committee on Homeland Security and Government Affairs in the U.S. Senate, Carole Rendon, the Acting U.S. Attorney for Northeastern Ohio said the overdose deaths from heroin and fentanyl had risen until they began to see an average of two overdose deaths per day in March of 2016.  She said: “Opioid addiction knows no boundaries. It is an equal opportunity killer of old and young, men and women, urban, suburban, and rural, rich and poor, black, white, and Hispanic. We are all at risk.”

In February, Tennessee officials warned about the availability of counterfeit drugs, specifically pills being sold as Percocet that actually contained fentanyl. David Reagan, the Chief Medical Officer of the Tennessee Department of Health said: “When people sell fake pills appearing to be oxycodone but actually containing the more powerful pain medicine fentanyl, lives are at risk.” During a traffic stop in May of 2015 a police officer discovered several 30 mg pills of what appeared to be oxycodone, with its signature A/215 stamp characteristic. Lab analysis showed they were fentanyl. In January of 2016, 300 pills stamped with the characteristic markings for Percocet were found to be fentanyl.

Even worse, counterfeit Xanax pills that contain fentanyl are appearing. In October of 2015 at least three people died from ingesting the combination drug in San Franciso. Saint Petersburg Florida reported that nine people died in Pinellas County from what was being sold as Xanax on the street. The pills were actually a combination of fentanyl and Xanax. The Daily Mail said the combination is sold as “Super Pill” on the street for as little as $5 a pill.

Last, and probably worst, there is another synthetic opioid coming onto the illicit drug market, W-18. It is 100 times more powerful than fentanyl; 10,000 times more powerful than morphine. And again, the likely source for the drug is China. Alan Hudson, an associate professor with the department of pharmacology at the University of Alberta, said W-18 is one of the most dangerous drugs in the whole spectrum of analogs. A tiny speck can cause respiratory failure and kill you.

Global News reported that the drug comes from a “W-series” of opioid compounds first discovered at the University of Alberta in Canada in 1982. Of the 32 compounds, W-1 to W-32, W-18 was the most toxic. As little as four kilograms of the drug is enough to produce millions of tablets. An Edmonton-area drug bust in December 2015 netted four kilograms of W-18.

Because of its potency, W-18 exponentially raises the stakes for potential overdoses. “It’s just too potent to even consider using.”  It was never listed as a controlled substance; never tested on humans. So it is technically legal and for sale online—typically from China. “Obviously somebody in China has picked up on the fact that W-18 is quite easy to make in large quantities and they’re trying to sell it to the North American market.”

If you are having trouble understanding why the practices above persist, think about basic branding, marketing and salesmanship. Established brands in the drug market include “heroin” and various pills like: “OxyContin”, “Percocet”, “Xanax”, and even “MDMA.” A significant segment of the drug market has a negative view of heroin, so they prefer to use pharmaceutical versions of opiates/opioids. So they seek out “OxyContin”, “Percocet”, and others. There is also a higher production cost for pills due to their stricter regulation. Pharmaceuticals are legally produced; heroin is not.

Over the past 100 years or so, the government has developed a regulatory process to give consumers some assurance that when they buy pharmaceuticals, they are getting what they paid for. Even with all the problems in the existing regulatory procedures, the modern pharmaceutical consumer is better protected today than they were during the time of patent medicines. THERE IS NO REGULATORY PROCESS FOR ILLICITLY PRODUCED DRUGS.

So if drug dealers and manufacturers want to increase their profits, they produce knockoffs of the more popular drug brands (like Percocet or heroin) by substituting cheaper products for the known brands. Since there is no regulatory process, they can and do sell knockoffs to their customers as the real thing with relative impunity. Illicit drugs today are truly a “buyer beware” market. The consumer/user is risking their health and their life as they seek out the newest, best high.

06/3/16

Origins and Creation

© David Carillet | 123rf.com

© David Carillet | 123rf.com

Believers in the authority of the Bible “as the only rule of faith and obedience” take different stands on how the Genesis account of creation should be interpreted. Despite the claims of some Young Earth Creationists, there is not only one single legitimate Christian position on what is meant in Genesis 1:1, “In the beginning God created the heavens and the earth.” A related, but overlapping concern in understanding the Genesis account of creation is how the creation days in Genesis 1 should be understood. Six sequential 24-hour periods of time, marked by evenings and mornings, is the 24-hour view. Or are the “days” six sequential periods of time or ages, without a specification for a length of time. This is called the day-age view. While understanding the six days of is an important issue in its own right, here I want to focus on the creation perspectives available to believers in the authority of Scripture.

Two of the primary scientific origins issues here are the age of the “heavens and earth” (the earth and universe) and whether life was created by evolution. I think it can be helpful to think about the various positions on how to interpret the Genesis account of creation as summarized here. This is a brief description of several interpretations of Genesis discussed by Deborah and Loran Haarsma in their book, Origins.

Denis Lamoureux, has several web lectures available on a range of topics from the Evolutionary Creation (EC) perspective. One series, “Beyond the ‘Evolution’ vs. ‘Creation’ Debate,” is an introduction to the various views on origins, both Christian and non-Christian. His personal story is one of the lectures, describing his journey from Young Earth Creationism to Evolutionary Creationism while achieving advanced degrees in theology and biology. The fifth lecture, “Summary and Conclusions,” has a helpful overview of the various perspectives on creation. It also highlights the similarities and differences between Christian and nonChristians views on creation.

There is a helpful handout for Lamoureux’s lecture series, “Beyond the ‘Evolution’ vs. ‘Creation’ Debate,” that summarizes and compares various Christian and non-Christian views on the origin of life and the universe. These range from Young Earth Creationism (YEC), which allows little or no accommodation for interpreting the creation account of Genesis with the findings of science. At the opposite pole is Atheistic Evolution (AE), which rejects the creation account in Genesis as pure myth and allows no possible accommodation with its view of science. I’ll follow Lamoureux’s categories in the discussion that follows. You can also find an overview of several positions on creation here from the Evolutionary Creation website, BioLogos. Deborah Haarsma is the current president of BioLogos.

Young Earth Creationism (YEC) holds to a 24-hour view of the six creation days, but also claims that a faithful reading of Scripture dates the age of the earth to between 6,000 and 10,000 years old. Old Earth Creationism (OEC) holds that the scientific evidence for a greater age of the earth (4.6 billion years) and the universe (13.7 billion years) is strong. So it sees the days of creation in Genesis 1 referring to long periods of time. The day-age view of creation days fits with the OEC perspective in what Lamoureux called Progressive Creation (PC). These three perspectives all reject the possibility that God created life through the process of macroevolution.

Then there is Intelligent Design (ID). It has been consistently ridiculed by modern day science as a “God of the gaps” argument that deceitfully tries to sneak theology into the scientific method. ID believes that: “the existence of an intelligent cause of the universe and of the development of life is a testable scientific hypothesis.” According to William Dembski ID is three things. First, it is a scientific research program investigating the effects of intelligent causes. Second, it is an intellectual movement that “challenges Darwinism and its naturalistic legacy.” And third, it is a way to understand divine action. In Intelligent Design, Dembski said:

The universe provides a well-defined causal backdrop (physicists these days think of it as a field characterized by field equations). Although one can ask whether that causal backdrop is itself designed, one can as well ask whether events and objects occurring within that backdrop are designed.

I think Lamoureux rightly positioned ID within his Progressive Creation category. But if weakened in its Christian presuppositions, such as the possibility of an intelligent (personal?) designer, the search for design in nature will easily fit within one of his non-Christian categories on origins, Deistic Evolution. Some books supporting ID include The Design Inference and Intelligent Design by William Dembski and Darwin’s Black Box by Michael Behe. If you want to read something that refutes the idea of design in the universe, there is the Richard Dawkins book, The Blind Watchmaker. Dawkins believes in Atheistic Evolution.

Evolutionary Creation (EC) affirms that God is the Creator of all things, including humans made in his image. But it accepts the science of evolution “as the best description for how God brought about the diversity of life on earth.” So the days of creation in Genesis are not literal 24-hours days and they do not necessarily occur in a sequence of time. According to Lamoureux’s comparison, EC differs from YEC and Progressive Creation positions by accepting macro-evolution, having a completely indirect sense of God’s activity in the origins of the universe, life, and humanity as well as denying a literal interpretation of Genesis 1 through 11 with regard to creation and the Flood. Francis Collins, the director of the National Institutes of Health (NIH), is a proponent of evolutionary creation. In his book, The Language of God, Collins said: “Believers would be well advised to look carefully at the overwhelming weight of scientific data supporting this view of the relatedness of all living things [evolution], including ourselves.”

Lamoureux then noted two non-Christian perspectives on origins, Deistic Evolution and Atheistic or Dysteleogical Evolution. “Dysteleology” is a philosophical view holding that there is no telos or final cause for the origin of the universe or life.  Seeing a plan or purpose in creation is a delusion. There is no evidence of design or a Designer. Blind chance working in natural process resulted in the existence of the Earth and life on it. The anthropic principle doesn’t point to the possibility of design in creation. God is a delusion. Some modern advocates here would include Richard Dawkins, Christopher Hitchens and Daniel Dennett.

Deistic Evolution (DE) agrees there is evidence of design within creation, but denies that God is personally involved within His creation. Either a Designer or a Force could have resulted in the kind of universe that we live in. Whether or not there is a personal God as the Designer is irrelevant. “God never enters the world.” Intriguingly, Lamoureux categorizes Charles Darwin as DE.

Although advocates of ID such as Michael Behe, Phillip Johnson, and William Dembski are Christians, and infer “an intelligent cause” behind the evidence of design in the universe, such an interpretation is not necessary to search for design in nature. Stripped of its Christian leanings, some ID beliefs could fit within Deistic Evolution. Consider the idea of the anthropic principle.

If you begin with the premise of a personal Designer behind the origins of the universe, you can see evidence of design almost everywhere you look. Hugh Ross, in his book The Creator and the Chaos, noted there were more than two-dozen parameters in the universe that necessarily had to fall into “narrowly defined ranges for life of any kind to exist.” The Privileged Planet by Guillermo Gonzalez and Jay Richards builds on the anthropic principle to show that not only is our planet amazingly fitted to support life, but that it also gives us “the best view of the universe.” It is as if the heavens and earth were designed for both life and scientific discovery. Show Me God by Fred Heeren examines “What the Message from Space Is Telling Us About God.” The Privileged Planet is also available as a DVD for purchase and to watch through Netflix.

But the anthropic principle doesn’t have to lead you inevitably to a belief in a personal Designer. There is the weak anthropic principle (WAP) which observes the parameters noted by Ross, Gonzalez, Richards and other ID advocates must be set as they are, “or we wouldn’t be here.” In other words, human existence puts us within a coincidentally “privileged time and place.” Fred Heeren said:

In a universe that is sufficiently large, the right conditions for life might occur in certain times and certain rare regions. Thus an intelligent observer should not be surprised if he finds himself in a time and place where the conditions are just right for his existence.

A so-called strong anthropic principle (SAP) holds that these “right conditions” are to be expected if we can in fact observe them. As Gonzalez and Richards said: “We can expect to find ourselves in a universe compatible with our existence.” There are even stronger versions of the anthropic principle, namely the Participatory Anthropic Principle (PAP), which holds we created ourselves by observing ourselves. The Final Anthropic Principle (FAP) suggests humankind itself might be the intelligence behind the design evident in the universe. Holding a somewhat science fiction-like sense of some day conquering time’s one-way arrow, humans evolve into all-knowing, all-powerful, omnipresent gods. “Having amassed such powers, this evolved god may then be able to create in the past.”

So if we look at the various ways to understand the Genesis account of creation as existing on a continuum, we have the following progression: Young Earth Creation, Progressive Creation, Evolutionary Creation, Deistic Evolution and Atheistic Evolution. Young Earth Creation has little or no accommodation with science where it may intersect with Scripture, while Atheistic Evolution sees the Genesis creation as pure myth with no evidence of science. Progressive Creation (including OEC and day-age theorists), Evolutionary Creationists and Deistic Evolution are progressively more accommodating to science. This follows the presentation and discussion of the views on origins given by Denis Lamoureux in his web lectures.

Young Earth Creation (YEC), Progressive Creation (PC), and Evolutionary Creation (EC) are all legitimate perspectives for believers in the authority of the Bible “as the only rule of faith and obedience.” Evolutionary Creation accepts God’s use of macro-evolution as the manner in which He created the heavens and the earth through what Lamoureux described as indirect, but “ordained and sustained natural processes.” That is, God planned and upheld the creation of the heavens and the earth and the life within it, but did so through natural processes like evolution. Evolution here is theological not naturalistic—in God’s hands, it was part of His plan and purpose—and not due to chance or chaos. Both YEC and PC reject the idea that God used macro-evolution in His creation of the heavens and earth.

Young Earth Creation sees God directly involved in creation; and believes He created all things within the timeframe of six 24-hours days. The earth and universe are only 6,000 to 10,000 years-old. YEC also asserts that chapters six through nine of Genesis describe a global flood. OEC sees the six days of creation as sequential, but not six sequential 24-hour days. The “days” could even represent long periods of time, as in the day-age view. The universe is 10-15 billion years old and developed through an indirect ordained and sustained natural process. But not so for the different kinds of life, which were directly created by God; possibly over billions of years of time. OEC holds the Flood narrative in Genesis to describe a local flood, not a global flood.

For more articles on creation in the Bible, see the link “Genesis & Creation.”