03/31/17

Agenda from a Dead Past

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I first became aware of John William Draper and Andrew Dickinson White from reading Alister McGrath’s book, Science & Religion soon after it was published in 1999. McGrath said they played an instrumental role in establishing the commonly held view that there was a conflict or war between science and religion. Two significant books, one by each, played central roles in the development of this false dichotomy. Draper’s 1874 book was titled: History of the Conflict Between Religion and Science, and White’s 1896 book was: History of the Warfare of Science with Theology in Christendom. Intriguingly, McGrath observed that this conflict model appears to have emerged from the rise of the “professional scientist” in Western culture.

Within nineteenth century English society there was a growing sense of competition between the two social groups: clergy and scientific professionals. “The clergy were widely regarded as an elite at the beginning of the century, with the ‘scientific parson’ a well-established social stereotype.” An emerging professional group of scientists sought to displace the entrenched position of the clergy. By the end of the 19th century, clergy were portrayed as enemies of science and social and intellectual progress. “As a result, there was much sympathy for a model of the interaction of the sciences and religion which portrayed religion and its representatives in uncomplimentary terms.”

Timothy Larsen observed in his essay “War is Over, if You Want It: Beyond the Conflict between Faith and Science,” that in the mid-nineteenth century, there was no such thing as a scientific profession. There were “men of science” just there were “men of letters,” referring more to the pursuits of gentlemen of leisure rather than what someone did for a living. In order to hold a teaching position at Oxford or Cambridge for much of the nineteenth century you had to be ordained within the Church of England. The biologist Thomas Huxley, famous as a champion of Darwinism, could not become a university professor at either Oxford or Cambridge because of his agnosticism.

Huxley and others who aspired to turn scientific pursuits into a profession, therefore, “needed” a war between science and religion. The purpose of the war was to discredit clergymen as suitable figures to undertake scientific work in order that the new breed of professionals would have an opportunity to fill in the gap for such work created by eliminating the current men of science. It was thus tendentiously asserted that the religious convictions of clergymen disqualified them from pursuing their scientific inquiries objectively.

One of the first encounters between Huxley and the English clergy was the so-called Huxley-Wilberforce debate. John William Draper was one of the scheduled speakers for the 1860 meeting of the British Association for the Advancement of Science. The organizers had to move his talk to a larger room, as they were expecting a crowd of over 500. The crowd was not really there to hear Draper, but because of the rumor that Bishop Wilberforce planned to use the occasion to critique Darwin’s recently published book, On the Origin of the Species. It was during the time for comments after Draper’s lecture that the infamous exchange between Huxley and Wilberforce occurred. While Draper’s long and reportedly boring lecture has become a historical footnote to that occasion, the importance of the moment was not lost on Draper himself.

Draper was an English-American scientist, philosopher, physician, chemist, historian and photographer. He was the first person to produce a clear photograph of a woman and the first one to compose a detailed photo of the moon in 1840. He has several important scientific discoveries to his credit and was a professor of chemistry and the president of New York University at the time of his lecture before the British Association for the Advancement of Science.

His 1860 lecture, “On the Intellectual Development of Europe, considered with reference to the views of Mr. Darwin and others, that the progression of organisms is determined by law,” preceded his 1862 book, The History of the Intellectual Development of Europe. He also wrote a three-volume history of the American Civil War, and famously, History of Conflict Between Religion and Science in 1874. The conflict thesis between religion and science takes its name from Draper’s book, which rejected the idea there could be harmony between religion and science. It went through fifty printings in the U.S. and was translated into ten languages. Read more about Draper here.

In his Preface, Draper said there was a great and rapidly-increasing departure from public religious faith. So widespread and powerful was this secession, that it could not be stopped. Ecclesiastical spirit no longer inspired the policy of the world. The antagonism witnessed between Religion and Science was said by Draper to be a continuation of a struggle that started when Christianity began to attain political power. Divine revelation was necessarily intolerant of contradiction; and it viewed with distain all improvement in itself that arose from “the progressive intellectual development of man.” Yet human opinions on every subject are continually liable to modification “from the irresistible advance of human knowledge.”

The history of Science is not a mere record of isolated discoveries; it is a narrative of the conflict of two contending powers, the expansive force of the human intellect on one side, and the compression arising from traditionary faith and human interests on the other. No one has hitherto treated the subject from this point of view. Yet from this point it presents itself to us as a living issue—in fact, as the most important of all living issues.

Darwinians claimed the gauntlet in the conflict between religion and science was first thrown at the so-called Huxley-Wilberforce “debate.” But some historians have recognized how that view was imputed onto the incident twenty to forty years after it happened by Darwin’s supporters. Draper’s book fails to mention Darwin, Huxley or Wilberforce.  But he seems to be one with Huxley in seeking to incite war or conflict between science and religion. Given his presence at the exchange between Huxley and Wilberforce and his early attempt to apply Darwin’s thought to social and political issues, it seems reasonable to see Draper’s book as one of the major “battles” of the so-called war between science and religion. See “A ‘Debate’ About Origins” for more on Huxley and Wilberforce.

John Dickinson White was the first president and a cofounder of Cornell University in 1865. According to Larsen, Cornell’s secular stance was used as a way to set it apart from the older Ivy League schools that still had mandatory chapel attendance. White said Cornell was established as an institution for advanced instruction and research where science would have an equal place with literature. He and Ezra Cornell wanted their university to be free from the “various useless trammels and vicious methods” which hampered many, if not most of the American universities and colleges at that time. They saw the sectarian character of other colleges and universities as a reason for “the poverty of advanced instruction” given in so many of them.

McGrath said many of the established denominational schools (Harvard, Yale and Princeton?) felt threatened by the new university and encouraged attacks on the new school. Both White and Cornell were accused of atheism. Angered by the accusations, White delivered a lecture in New York on December 18, 1869 entitled “The Battle Fields of Science.” An expanded version was published in 1876 as The Warfare of Science. Between 1885 and 1892, he published a series of articles in Popular Science Monthly, “New Chapters in the Warfare of Science.”  The two-volume 1896 book, History of the Warfare of Science with Theology in Christendom, was essentially a combination of these writings.

In his Introduction, White said while Draper saw the struggle as one between Science and Religion, he saw it as one between Science and Dogmatic Religion. While he admired Draper’s treatment of the questions involved, “More and more I saw that it was the conflict between two epochs in the evolution of human thought—the theological and the scientific.” It never entered his mind that he was doing something irreligious or unchristian by establishing Cornell as a secular institution. Far from trying to injure Christianity, he and Ezra Cornell were trying to promote it by not confounding religion and sectarianism.

McGrath observed that while perhaps White did not see religion and science as enemies, that was the impression he created by his work. “The crystallization of the ‘warfare’ metaphor in the popular mind was unquestionably catalyzed by White’s vigorously polemical writing.” For example:

In all modern history, interference with science in the supposed interest of religion, no matter how conscientious such interference may have been, has resulted in the direst evils both to religion and science, and invariably; and, on the other hand, all untrammeled scientific investigation, no matter how dangerous to religion some of its stages may have seemed for the time to be, has invariably resulted in the highest good both of religion and science.

McGrath pointed out how the story of warfare between science and religion is alive and well within the writings of New Atheists such as Christopher Hitchens and Richard Dawkins as well as the Christian fundamentalists who are determined to confront secular culture wherever possible. He said this propensity towards confrontation inevitably leads to a reinforcement of a warfare model of religion and society. The natural sciences (and supremely the theory of biological evolution) are then seen “as the advance guard of the secularizing trend within society as a whole.”

In The Big Question, McGrath proposed that we move on from a narrative of a conflict between science and religion. He said that narrative is locked into the agenda of a dead past. Instead, he suggested developing a narrative of enrichment between the two—one that accepts the empirical sciences, but rejects their claim of finality. “[It] is in conflict with the scientism that has become so characteristic of the New Atheism, but it is not in conflict with science, which has always been willing to recognize its limits.”

The American Association for the Advancement of Science (AAAS) made a series of short films available to spark discussion on several different topics related to science and religion. Here is a link to their video on the Draper-White Conflict Thesis discussed above.

03/28/17

Reproducibility in Science

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In 2011 a University of Virginia psychologist named Brian Nosek began the Reproducibility Project. He simply wanted to see if the reported problem with reproducing the scientific findings of published research studies in psychology was true. Nosek and his team recruited 250 research psychologists, many of whom volunteered their time to double-check what they considered to be the important works in their field. They identified 100 studies published in 2008 and rigorously repeated the experiments while in close consultation with the original authors. There was no evidence of fraud or falsification, but “the evidence for most published findings was not nearly as strong as originally claimed.”

Their results were published in the journal Science:Estimating the Reproducibility of Psychological Science.” In a New York Times article about the study, Brian Nosek said: “We see this is a call to action, both to the research community to do more replication, and to funders and journals to address the dysfunctional incentives.” The authors of the journal article said they conducted the project because they care deeply about the health of psychology and believe it has the potential to accumulate knowledge about human behavior that can advance the quality of human life. And the reproducibility of studies that further that goal is central to that aim. “Accumulating evidence is the scientific community’s method of self-correction and is the best available option for achieving that ultimate goal: truth.”

The present results suggest that there is room to improve reproducibility in psychology. Any temptation to interpret these results as a defeat for psychology, or science more generally, must contend with the fact that this project demonstrates science behaving as it should. Hypotheses abound that the present culture in science may be negatively affecting the reproducibility of findings. An ideological response would discount the arguments, discredit the sources, and proceed merrily along. The scientific process is not ideological. Science does not always provide comfort for what we wish to be; it confronts us with what is.

The editor in chief of Science said: ““I caution that this study should not be regarded as the last word on reproducibility but rather a beginning.” Reproducibility and replication of scientific studies has been a growing concern. John Ioannidis of Stanford has been particularly vocal on this issue. His best-known paper on the subject, “Why Most Published Research Findings Are False,” was published in 2005. A copy of one of his latest works, “Empirical assessment of published effect sizes and power in the recent cognitive neuroscience and psychology literature,” can be found here.  Szucs and Ioannidis concluded that false report probability was likely to exceed 50% for the whole literature. “In light of our findings the recently reported low replication success in psychology is realistic and worse performance may be expected for cognitive neuroscience. “

A recent survey conducted by the journal Nature found that more than 70% of researchers have tried and failed to reproduce another scientist’s experiments. More than half failed to reproduce their own experiments.  In response to the question, “Is there a reproducibility crisis?” 52% said there was a significant crisis; another 38% said there was a slight crisis. More than 60% of respondents thought that two factors always or often contributed to problems with reproducibility—pressure to publish and selective reporting. More than half also pointed to poor oversight, low statistical power and insufficient replication in the lab. See the Nature article for additional factors.

There were several suggestions for improving reproducibility in science. The three most likely were: a better understanding of statistics, better mentoring/supervision, and a more robust experimental design. Almost 90% thought these three factors would improve reproducibility. But even the lowest-ranked item had a 69% endorsement. See the Nature article for additional approaches for improving reproducibility.

In “What does research reproducibility mean? John Ioannidis and his coauthors pointed out how one of the problems with examining and enhancing the reliability of research is that its basic terms—reproducibility, replicability, reliability, robustness and generalizability—aren’t standardized.  Rather than suggesting new technical meanings for these nearly identical terms, they suggested using the term reproducibility with qualifying descriptions for the underlying construct. The three terms they suggested were: methods reproducibility, results reproducibility, and inferential reproducibility.

Methods reproducibility is meant to capture the original meaning of reproducibility, that is, the ability to implement, as exactly as possible, the experimental and computational procedures, with the same data and tools, to obtain the same results. Results reproducibility refers to what was previously described as “replication,” that is, the production of corroborating results in a new study, having followed the same experimental methods. Inferential reproducibility, not often recognized as a separate concept, is the making of knowledge claims of similar strength from a study replication or reanalysis. This is not identical to results reproducibility, because not all investigators will draw the same conclusions from the same results, or they might make different analytical choices that lead to different inferences from the same data.

They said what was clear is that none of these types of reproducibility can be assessed without a complete reporting of all relevant aspects of scientific design.

Such transparency will allow scientists to evaluate the weight of evidence provided by any given study more quickly and reliably and design a higher proportion of future studies to address actual knowledge gaps or to effectively strengthen cumulative evidence, rather than explore blind alleys suggested by research inadequately conducted or reported.

In “Estimating the Reproducibility of Psychological Science,” Nosek and his coauthors said it is too easy to conclude that successful replication means the original theoretical understanding is correct. “Direct replication mainly provides evidence for the reliability of a result.” Alternative explanations of the original finding may also account for the replication. Understanding come from multiple, diverse investigations giving converging support for a certain explanation, while ruling out others.

It is also too easy to conclude a failure to replicate means the original evidence was a false positive. “Replications can fail if the replication methodology differs from the original in ways that interfere with observing the data.” Unanticipated factors in the sample, setting, or procedure could alter the observed effect. So we return to need for multiple, diverse investigations.

Nosek et al. concluded that their results suggested there was room for improvement with reproducibility in psychology. Yet the Reproducibility Project demonstrates “science behaving as it should.” It doesn’t always confirm what we wish it to be; “it confronts us with what is.”

For more on reproducibility in science, also look at: “The Reproducibility Problem” and “’Political’ Science?” on this website.

03/24/17

Not Meant for Human Consumption

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In September of 2015 federal and city authorities raided around 80 locations throughout NYC in a crackdown on the importation, distribution and sale of synthetic cannabinoids. Ten people were indicted and a minimum of 100 kilograms of illegal synthetic compounds was confiscated. This was enough to produce 260,00 retail packets with a street value of near $30 million. The operation imported the compounds in powdered form from China through commercial delivery services (like UPS and Federal Express). Then in a Bronx processing facility, the compounds were mixed with solvents and sprayed onto tea leaves.

Most of the ten individuals indicted were of Yemeni descent; four were still at large at the time of the raid. One of the indicted, but at large, individuals seems to have tipped off his operation in July of 2014 when he was stopped for using a cell phone while driving. He consented to a search of his vehicle, where DEA agents found $644,338 IN CASH. When his Queens home was searched, they found an additional $150,935.

The agents say they then read Deiban his Miranda rights but that he nonetheless told them the greater sum came from the sale of synthetic narcotics and was bound for a store in the Bronx. They also say Deiban said the smaller sum came from Bronx and Queens stores that sell his synthetic pot.

He also boasted about selling his products over eBay. He was questioned about a number of keys he had on his person, some of which he said belonged to a warehouse where he stored his synthetic marijuana. But he was not willing to tell DEA agents the warehouse’s address unless the DEA agents guaranteed he would not go to jail. The case was settled in November of 2014. Under the terms, Deiban did not admit to any of the allegations and he was repaid $477,163.80 of the seized money.

Instead of counting his blessings, Deiban allegedly sought to make more dough. The September 2015 complaint says that in the past year, Deiban and his cronies imported at least 220 pounds of banned powdered substances used to make K2 or “spice”—enough to manufacture at least 260,000 packets.

The above incidents really happened, even though they seem to be suspiciously like an Onion satire of really dumb drug dealers. You can read the Department of Justice announcement of the September 2015 indictments here. Additional information noted above can be found in an article on The Daily Beast here and a New York Daily News article here.

This isn’t the first time there has been a Yemeni connection to the sale and distribution of synthetic cannabinoids in the U.S. In 2014, a raid on a Birmingham Alabama warehouse found hundreds of thousands of Spice (synthetic marijuana) packets. Sales of the product were linked to $40 million in wire transfers to Yemen. Read more about this in “Strange Bedfellows: Terrorists and Drugs.”

If you aren’t too familiar with Spice and other so-called new psychoactive substances (NPS), here are some key facts from a World Health Organization “fact file on new psychoactive substances.” There are more than 500 different types of NPS recorded as of March of 2016. The number of NPS as of October 2015 was 602, 55% higher than in 2014. By December 2015, that total would rise to over 644, according to the UNODC Global SMART Update. The most common NPS are synthetic cannabinoids, which mimic the effects of THC, the main psychoactive ingredient in marijuana. “Collecting information on new psychoactive substances is difficult due to the sheer number and speed with which they appear on the market.”

The UN Office on Drugs and Crime (UNODC), the lead agency in international drug control, has identified nine groups of new psychoactive substances. These include synthetic cannabinoids, which mimic the effects of the main psychoactive substance of cannabis, THC; synthetic cathinones, which have stimulant properties and induce feelings of empathy; and phenthylamines, which have stimulant and hallucinogenic properties. Of new psychoactive substances reported in 2014, 39 per cent were synthetic cannabinoids; 18 per cent were phenethylamines and 15 per cent were synthetic cathinones.

UNODOC publishes a Global SMART (Synthetics Monitoring:  Analyses, Reporting and Trends) Update twice a year. Volume 16, published in September of 2016, said that synthetic drugs were one of the most significant global drug problems. As noted above over 644 NPS were reported from 102 different countries. “New NPS continue to emerge every year at an average rate of about one substance per week, making research and monitoring activities critical in improving understanding of the dynamic nature of the problem.” You can download a copy here.

NPS are diverse in terms of their effects and chemistry. Those identified so far seem to mimic the effects of the six main groups of substances controlled under international drug conventions. The six groups are: opioids, synthetic cannabinoid receptor agonists, dissociatives, like PCP, classical hallucinogens like LSD, sedatives/hypnotics like diazepam, and stimulants like cocaine and amphetamine-type stimulants. The following pie chart from the Global SMART Update illustrates the proportion of NPS by their pharmacological effect. The chart indicates how the three NPS noted above, synthetic cannabinoids, synthetic cathinones, and phenthylamines account for 88% of the total proportion of NPS indentified by December of 2015.

A major area of concern is with the unknown adverse health risks associated with using NPS. Obtaining health-related and toxicological data is crucial for making scheduling decisions with NPS. Synthetic cannabinoids have been linked to both fatal and non-fatal intoxications, along with seizures, tachycardia and hypertension. Synthetic cathinones like MDPV have been associated with severe agitation, violent behavior, tachycardia, psychosis paranoia and fatal intoxications. Dangers are accentuated by intentional mislabeling of products, as was noted above, as well as their unknown purity and composition.

The internet is an important distribution channel. It provides easy, anonymous and low-risk supply of NPS. Not to mention the high rewards to suppliers and retailers. Websites may be in different countries from those where the NPS are manufactured and/or where they are supplied. “The disparity of laws in various regions poses a challenge in adopting a comprehensive approach for the prosecution of violations.” Then there is the sale of products on the darknet, which is only accessed by anonymizing software.

The number of NPS and the rapidity with which new ones emerge presents a challenge to drug control systems. Placing a potentially harmful substance under legal control can be a lengthy process of evidence-gathering and a scientific review of its harms. This means there is a time lag between emergence of an NPS and when legal control is implemented. “NPS manufacturers o en exploit this inevitable me lag by developing and marketing alternative substances to circumvent established controls. “

In the U.S., the 2016 National Drug Threat Assessment (NDTA) reported that NPS are available throughout the U.S. The two most common are synthetic cannabinoids and synthetic cathinones. Although synthetic cannabinoids are usually ingested by smoking, they are also available as a liquid or oil to use in e-cigarettes or vape pens. In 2015, synthetic cannabinnoids were found in counterfeit Xanax bars. Calls to the AAPCC, the American Association of Poison Control Centers, totaled 7,779. This was a 111% increase over 2014. This was the highest number of calls recoded since the drugs first appeared on the market. See the following figure taken from the 2016 NDTA.

Inmates in prisons and jails use synthetic cannabinoids because they aren’t typically tested for in mandatory drug screens. “The drugs are also difficult to detect during screenings by prison officials and narcotics dogs.” Liquid cannabiniods are sprayed onto paper products, like greeting cards or letters, and then dried. When successfully smuggled into a prison, the drug-saturated pages are torn into small squares, then chewed or smoked. In October of 2015, the FBI issued a warning that synthetic cannabioids in prisons may result in inmates becoming agitated and aggressive.

The foil packets used to package synthetic cannabinoids can be purchased in bulk. The empty packets are already branded with various cartoon logos and brand names. The contents of the packets can vary widely. A DEA forensic lab tested 28 identical packets from one seizure in 2015. “The packets contained a total of seven different synthetic cannabinoids.” Many contained more than one variety of synthetic cannabinoid.

Ironically, the synthetic cannabinoid problem seems to have originated by classifying marijuana as a Schedule I controlled substance. In 1970, marijuana and its cannabinoids were given a Schedule I designation. This meant that marijuana was difficult to obtain for research on its therapeutic effects. Then John W. Huffman and his team of researchers at Clemson began developing cannabinoid compounds to aide in the research of multiple sclerosis, HIV/AIDS, and chemotherapy. Their research was funded by: the National Institute on Drug Abuse (NIDA).

Over the next twenty years, they developed 450 synthetic cannabinoid compounds. Some of those, including: JWH-018, JWH-073, JWH-210, JWH-250, and JWH-081 are among the dozens of synthetic cannabinoids on the streets today. Notice the compound names begin with Huffman’s initials: “JWH.” Like any self-respecting scientist, he published his research, which included step-by-step instructions on how to recreate the substances. Then around 2008, JWH-018 appeared in Germany as a recreational alternative for marijuana known as “Spice” and “K2.” Huffman said: “I always had a hunch that someday somebody would say, ‘Hey, let’s try smoking them.’ … These things are dangerous—anybody who uses them is playing Russian Roulette. . . . We never intended them for human consumption.”

03/21/17

A “Debate” About Origins

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Winston Churchill’s famous saying, “History is written by the victors,” is certainly true with regard to the so-called “Huxley-Wilberforce Debate.” It has been regularly portrayed as a classic example of the war between science and religion. According to the popular version of the meeting, Thomas Huxley, a young biologist and defender of Darwin’s On the Origin of the Species, responded to an insulting question by Samuel Wilberforce, the Bishop of Oxford, in a way that exposed both the bishop’s ignorance of science and his ungentlemanly behavior. But, as Jonathan Smith said in his essay on the event, “There was no such thing as the Huxley-Wilberforce debate.”

The exchange between Huxley and Wilberforce took place on June 30, 1860 at the meeting of the British Association for the Advancement of Science. According to the popular version of the meeting, as Wilberforce completed a 30-minute critique of Darwin and his recently published book, he turned and asked Huxley whether it was through his grandfather or grandmother that he descended from apes. Huxley is to have responded that he would rather have an ape as an ancestor than a bishop who distorted the truth. You can watch a four-minute excerpt from a PBS documentary, “Evolution” that portrays the Huxley-Wilberforce exchange. A two-hour section of that documentary titled “Darwin’s Dangerous Idea” is available here.

But recent historical scholarship concluded that wasn’t really how it actually happened. In The Big Question, Alister McGrath said: “The popular image of Huxley’s triumphant defeat of a reactionary religious opponent of evolution is now generally seen as a myth created by the opponents of organized religion in the 1890s.”

This revisionist account of the meeting does not deny its historical factuality. The new research of the meeting calls into question overblown and inaccurate accounts of its significance and offers an informed reconstruction of the debate, which accounts better for the historical evidence at our disposal.

As McGrath related the events, the British Association for the Advancement of Science’s annual meeting moved from city to city throughout Britain at the time in order to promote the pursuit of science. In 1860, the Association’s meeting was scheduled to meet in Oxford. Some of the meetings were open to the public, as it seems this one was. This also was the first meeting of the society since Darwin’s book, On the Origin of the Species, had been published the previous year. Darwin was not able to come because of heath reasons, so Huxley was invited in his place.

Wilberforce was not there as a representative of the Church of England. He was invited to speak at the meeting because he was a past vice president of the Association and because he was familiar with Darwin’s writings. He had just written a review of On the Origin of the Species that was to appear in The Quarterly Review soon after the June 30th meeting. McGrath commented:

 It is quite clear from Wilberforce’s careful and insightful published review of Darwin’s Origin of the Species that religious issues did not feature prominently in his mind; the issue was the scientific case for evolution, not its religious implications or complications. The fact that Wilberforce was Bishop of Oxford has clearly led many to conclude that religion was at the forefront of the debate and that Wilberforce opposed Darwin on religious grounds. The evidence dose not support this interpretation of events. . . . Darwin himself remarked, after reading Wilberforce’s review of his work, that it was “uncommonly clever; it picks out with skill all the most conjectural parts, and brings forward well all the difficulties.”

McGrath thought the real debate seems to have been between two visions of science and not between science and religion. One view was defined by “naturalist” assumptions, while the other was more open to theistic beliefs. Jonathan Smith also thought that Wilberforce’s case against Darwin was made primarily on scientific and philosophical grounds, not religious ones.

Verbatim quotes of Wilberforce’s question and Huxley’s reply are uncertain. The most detailed journalistic account of their exchange, in the Athenaeum, mentioned neither one. One of the few journalistic accounts ironically said the event was “a sign of toleration, not hostility between science and religion.” And some of those who were at the conference thought that Joseph Hooker (another friend and ally of Darwin’s) gave a more effective defense of evolution at the meeting than Huxley.

Having recently completed his soon-to-be published review of Darwin’s book, Wilberforce repeated many of the observations he made there in his remarks at the Association’s meeting. In his opening comments for the review, Wilberforce said the Origin of the Species was a most readable book, full of facts in natural history. He acknowledged that it had some clear import not only for scientists, “but to every one who is interested in the history of man and of the relations of nature around him to the history and plan of creation.” Towards the end of his review Wilberforce commented that his readers should have noticed that he had objected to Darwin’s views purely on scientific grounds.

We have no sympathy with those who object to any facts or alleged facts in nature, or to any inference logically deduced from them, because they believe them to contradict what it appears to them is taught by Revelation.

So where did the legendary account of Huxley vanquishing his arrogant, sneering, scientifically ignorant foe come from? Jonathan Smith said that account was formed by Darwinians and their allies in the 1880s and 1890s. Darwin’s son, Francis, and Huxley’s son, Leonard, gathered reports overwhelmingly from Darwin’s partisans. Most of them were recollections made twenty to forty years after the fact.

The story told by Francis Darwin and Leonard Huxley was, not surprisingly, the story the Darwinians had long told amongst themselves, in which they were the clear victors and natural science stood up to religious ignorance and obscurantism. Once ensconced in the three Life and Letters, this version became the established account, repeated and recycled, often with additional embellishments.

Alister McGrath pointed to a particular recollection by Mrs. Isabella Sidgewick that appeared in the October 1898 issue of Macmillan’s Magazine, in an article entitled “A Grandmother’s tales.” He said her account was idiosyncratic and inconsistent with most of the accounts in circulation or published closer to the time of the meeting of the Association. Another article by J. R. Lucas, “Wilberforce and Huxley: A Legendary Encounter,” made the same point. Lucas also gave the following quote of Mrs. Sidgewick’s recollection from the article:

I was happy enough to be present on the memorable occasion at Oxford when Mr. Huxley bearded Bishop Wilberforce. There were so many of us that were eager to hear that we had to adjourn to the great library of the Museum. I can still hear the American accents of Dr Draper’s opening address, when he asked `Air we a fortuitous concourse of atoms?’ and his discourse I seem to remember [was] somewhat dry. Then the Bishop rose, and in a light scoffing tone, florid and he assured us there was nothing in the idea of evolution; rock-pigeons were what rock-pigeons had always been. Then, turning to his antagonist with a smiling insolence, he begged to know, was it through his grandfather or his grandmother that he claimed his descent from a monkey? On this Mr. Huxley slowly and deliberately arose. A slight tall figure stern and pale, very quiet and very grave, he stood before us, and spoke those tremendous words – words which no one seems sure of now, nor I think, could remember just after they were spoken, for their meaning took away our breath, though it left us in no doubt as to what it was. He was not ashamed to have a monkey for his ancestor; but he would be ashamed to be connected with a man who used great gifts to obscure the truth. No one doubted his meaning and the effect was tremendous. One lady fainted and had to be carried out: I, for one, jumped out of my seat; and when in the evening we met at Dr Daubeney’s, every one was eager to congratulate the hero of the day. I remember that some naive person wished it could come over again; and Mr. Huxley, with the look on his face of the victor who feels the cost of victory, put us aside saying, `Once in a life-time is enough, if not too much.’

Jonathan Smith described how the context of the conference contributed to the exchange between Huxley and Wilberforce. The meeting of the British Association for the Advancement of Science had already met for two days. In the discussion following a previous presentation, Huxley had affirmed the substantial and significant similarities between humans and apes. Human dignity and privilege were not imperiled by such a connection. Even clergy “had nothing to fear … should it be shown that apes were their ancestors.”

The talk given by John William Draper drew a large crowd because of a rumor that Wilberforce would use the occasion to critique Darwin’s theory. The organizers of the conference had to move it to a larger room because of the size of the audience. Huxley was going to skip the presentation, but was persuaded to attend by Robert Chambers, who said by leaving he would be deserting the evolutionary cause. Draper’s address was followed by a number of comments. Wilberforce’s comments reflected those he made in his article for the Quarterly Review. He said Darwin’s theory was speculative rather than a valid induction from established facts. It also lacked an observational or experimental basis.

In his closing remarks, Wilberforce, who was well known for both his humor and rhetorical skills, played off of Huxley’s remarks two days before, where he had said human privilege and moral responsibility would not be endangered by sharing a genealogy with apes. Wilberforce turned to Huxley and asked him where apes were located in the Huxley family tree. The exact wording is uncertain, but it seems Wilberforce asked Huxley “whether he would prefer a monkey for his grandfather or his grandmother?” This corresponded to what Huxley said in a letter two months after the event, where he said the question was concerning “my personal predilections in the matter of ancestry.”

Huxley stood and said he had heard nothing new in what Wilberforce said, except for the question about his ancestry. Although it was a topic he would not have introduced, he would reply. Smith said Huxley’s report of what he said two months later in a letter was probably fairly accurate:

If then, said I, the question is put to me would I rather have a miserable ape for a grandfather or a man highly endowed by nature and possessing great means & influence & yet who employs those faculties & that influence for the mere purpose of introducing ridicule into a grave scientific discussion—I unhesitatingly affirm my preference for the ape.”

Although Huxley’s rejoinder drew cheers and laughter, it certainly didn’t silence the critics or settle the issue. “Significantly, both at the time and many years later, Huxley took pains to deny the widely circulated claim that he had said he would rather be an ape than a bishop or had in any way insulted Wilberforce in his reply.” Several others spoke afterward, a number of who rejected evolution. Joseph Hooker spoke last and it was he who gave the most extensive defense of Darwin’s theory, and the most direct critique of what Wilberforce had said. Opinions at the time as to who “won” the debate were divided. Some thought Huxley had, others thought it was Wilberforce; still others thought it was a draw.

Wilberforce told a correspondent that he had “thoroughly beat” Huxley. Huxley and Hooker were confident the supporters of Darwin had prevailed. Darwin himself thought the exchange was momentous; that it marked a turning point for Darwinism within the scientific community and for its struggle for independence from religious authority.

Smith said it was not surprising that a generation later, when Francis Darwin and Leonard Huxley, drew on the correspondence of their fathers and the recollections of their fathers’ friends and allies, the story of the events on June 30, 1860 were told in that way. Even Leonard Huxley admitted the encounter could not be described as “an immediate and complete triumph for evolutionary doctrine.” However, its importance lay “in the open resistance that was made to authority, at a moment when even a drawn battle was hardly less effectual than acknowledged victory. Instead of being crushed under ridicule, the new theories secured a hearing.”

So the “debate” between Huxley and Wilberforce did not happen the way it is widely presented and understood today. The “received” account was codified when Darwinian thought was in its ascendency some twenty to forty years later. J. R. Lucas astutely observed, “The quarrel between religion and science came about not because of what Wilberforce said, but because it was what Huxley wanted; and as Darwin’s theory gained supporters, they took over his view of the incident.”

Alister McGrath pointed to another facet of the 1860 Oxford conference of the Association that was often overlooked. “On Sunday July 1, the day after the confrontation between Wilberforce and Huxley, the conference delegates heard a sermon preached on the theme of ‘The Present Relations of Science to Religion.’” Its significance lies in highlighting the harmony possible between the scientific investigation of nature within general revelation and the special revelation of God in Scripture. The minister who gave that sermon, Fredrick Temple, would go on to become the Archbishop of Canterbury.

He asked if science and the Bible were foes. And if not foes, were they so distinct as to have no point of contact?  “Not so.” The harmony between them would not be found in the “petty details of fact,” but rather in the “deep identity of tone, character, and spirit which pervade both” the book of Nature and the book of Revelation. “The more the Bible is studied, and the more nature is studied, the deeper will be found the harmony between them in character, the more assured the certainty that whomever inspired the one also made the other.”

03/17/17

Broken Promises with Abilify

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Based upon sales data for the world’s 15 top selling drugs, Abilify was ranked fourth, with $9.3 billion of sales in 2014. Reflect for a moment what this means; an antipsychotic drug had greater worldwide sales than Nexium (for acid reflux) and Crestor (for high cholesterol). While it is an approved medication in the US for bipolar 1 and schizophrenia, it is likely these sales figures reflect it use as an adjunct medication for major depression. Oh, and along with other antipsychotics, it is used off label to treat several other behavioral disorders such as Tourette’s and irritability associated with autism. This popularity is despite the reality that antipsychotics have a high incidence of negative side effects—greater than antidepressants and anti-anxiety medications.

The problems with antipsychotics have been known for a few years. As far back as 2010, Robert Field wrote: “Antipsychotic Medications Are Spelling Legal Trouble for Drugmakers” for the journal Pharmacy and Therapeutics. In 2007, Bristol-Myers Squibb paid $515 million to settle charges of illegally marketing Abilify for children and the elderly, “In contravention of FDA-approved labeling.” But that hasn’t been the end of legal troubles regarding Abilify. On May 3, 2016, the FDA published a safety announcement warning that Abilify (aripiprazole) can trigger impulse-control problems such as “compulsive or uncontrollable urges to gamble, binge eat, shop, and have sex.” These urges reportedly stop when the drug is discontinued or the dose reduced.

These compulsive behaviors can affect anyone who is taking the medicine. As a result, we are adding new warnings about all of these compulsive behaviors to the drug labels and the patient Medication Guides for all aripiprazole products.

The mechanism of action for Abilify is not clearly understood, but researchers think it over-stimulates dopamine 3 (D3) reward receptors, which are mainly located in the limbic system. This in turn triggers the compulsive behaviors. Gaboriau et al. reviewed case reports in Addictive Behaviors and indicated that pathological gambling (PG) appeared as quickly as a few days after Abilify was started; sometimes after an increase in dosage with 7 of the 8 case reports. PG then decreased after Abilify treatment was stopped or decreased; again sometimes as soon as a few days afterwards.

Limitations on the Gaboriau et al. findings included that most of the patients were already gambling before starting with Abilify. Several patients also had a history of substance use disorders. However, the authors noted that the same D3 receptor was implicated in another study by J. E. Ahiskog of the dopamine agonist medications, pramipexole and ropinirole, which are commonly used to treat Parkinson’s disease.

This hyperstimulation would apparently be particularly enhanced in cases of a previous treatment by antipsychotics acting as a dopaminergic receptors antagonist, owing to the up-regulation and the dopaminergic receptor hypersensitivity processes. The partial agonist action of aripiprazole then causes stronger effects. Moreover, the intrinsic dopamine pharmacodynamic activity of aripiprazole imparts it less action agonist than a complete agonist, which could explain why the occurrence of PG is sometimes late or due to dosage increase.

The above concern with Abilify was also supported by the findings of a study by Moore, Glenmullen and Mattison reported in JAMA Internal Medicine. Adverse drug event reports received by the FDA from 2003 to 2012 were reviewed for the six dopamine receptor agonist drugs marketed in the U.S. The review identified 1580 reports of impulse control disorder events, including pathological gambling, hypersexuality, compulsive shopping and others. They also detected weaker signals for antidepressants and antipsychotics.

The Daily Beast reported on a massive tort lawsuit being filed against Otuska and Bristol-Myers Squibb charging that Abilify created a compulsion for sex and gambling. Moreover, the suit claims the drug makers knew of the serious side effects because of required changes in Canadian and European warning labels, but waited for years to warn U.S. consumers. Thomas Moore of the Institute for Safe Medication Practices explained the drug triggers an urge to gamble constantly, sometimes with people with no prior interest. “It might be people starting to spend $300 a week on lottery tickets, and in other cases people will gamble away tens of thousands of dollars.” Moore went on to say:

We live in a society whose rules and laws assume people are responsible for their actions, including running up a large gambling debt. . . But we have scientific evidence that sometimes a drug can trigger a pathological urge to gamble so severe it can ruin someone’s life.

A woman who began using Abilify to aid in treating her PTSD developed a compulsive gambling problem. She used up her unemployment checks, pawned her husband’s automotive tools, and lied about needing money for baby formula. “Nothing was off-limits when it came to getting the money I needed to keep up the ruse.” She’d stuff her bed at night in order to fool her husband into thinking she was asleep when she was actually at the casino playing the slot machines.

Another woman developed hypersexuality. She started with online chatting with men. She became obsessed with sexual fantasies and took sexualized pictures of herself and sent them to select ‘friends.’ “I just couldn’t stop with the pictures and fantasies.” She also went on shopping sprees. Then her husband caught her. “The drug has destroyed my life, my reputation, and the lives of those I love.”

The website RxISK has multiple reports on adverse events with Abilify. “Abilify from the Inside Out” described bouts of akathisia (a state of agitation, distress, and restlessness), unusual aggression or anger, first time episodes of psychosis, suicidality, at least three confirmed suicides, movement disorders such as tremors, and (of course) compulsive gambling. The author said the reports were hard for him to read. Since most of the patients were on several meds, some patients couldn’t be sure that Abilify alone caused the problem. Even stopping Abilify was related to adverse drug events.

The above noted 2007 lawsuit, where Bristol-Myers Squibb paid $525 million to settle charges of illegal marketing, unveiled some of the marketing records for Abilify. Remember, one of the concerns was that it was illegally marketed for use with the elderly. The sales reps for Abilify would invite nursing home staff to picture a new resident, hunched in their chair, staring off into space because of ‘depression.’ “’Who wants to see that when they come to visit Mom on a Saturday?’ the reps would ask. ‘Wouldn’t we like to see her up and about, looking lively?’” The sale pitch worked. One woman wrote the following to RxISK:

I have seen many commercials about how drugs like Abilify can perk people right up. . . So I was not only disappointed and frightened by the results, but felt once again tricked and exploited by the big promises that drug companies make but never seem to keep.

I wish the above concerns weren’t true. But I’ve known individuals whose experiences on Abilify are consistent with the above discussion of its adverse effects. Sadly, even when sanctions are in the millions of dollars, the profits are higher. And it seems the cards are stacked against pharmaceutical companies being held accountable financially. So consumers have to fight against this by refusing to use Abilify and telling others what you have read here. If you are interested in other articles on the problems with Abilify and the other antipsychotics, try: “Antipsychotic Big Bang” or “Abilify in Denial” on this website.

03/14/17

Fentanyl: Fraud and Fatality

© Alexi Novikov

In December of 2016, several former pharmaceutical executives and managers of Insys Therapeutics were arrested on charges they participated in a nationwide conspiracy to bribe medical practitioners to prescribe one of the company’s fentanyl products, Subsys. The medication is approved for treating cancer patients suffering intense episodes of breakthrough pain. “In exchange for bribes and kickbacks, the practitioners wrote large numbers of prescriptions for the patients, most of whom were not diagnosed with cancer.” The indictment also alleges that these same former Insys executives conspired to “mislead and defraud” health insurance companies who were reluctant to approve payment for Subsys when it was prescribed for non-cancer patients.

The Special Agent in Charge of the Boston Field Division of the FBI said top executive of Insys Therapeutics, Inc. allegedly paid kickbacks and committed fraud in selling the highly addictive opioid. “The indictment also alleges that the conspiracy to bribe practioners and to defraud insurers generated substantial profits for the defendants, their company, and for the co-conspirator practioners.” The investigative team included multiple federal agencies, including: FBI, FDA Office of Criminal Investigations; Health and Human Services (HHS), U.S. Postal Service, the Department of Labor, and the Department of Veterans Affairs.

Reporting for STAT News on the indictments, David Armstrong said a Florida doctor was invited to Insys headquarters near Phoenix, where sales officials took him out for a night on the town. In a text message to a sales rep, one of the company’s regional sales managers said: “He had to have had one of the best nights of his life.”  The next week the doctor wrote 17 prescriptions for Subsys, when he usually wrote three. “He also received $260,050 in payments over three years for participating in the Insys speaking program — something federal officials allege was nothing more than a mechanism for bribing doctors.”

Subsys was launched in March 2012 into a crowded field of competitors, which included other brand-name medications and several generics. The drug was approved only for cancer patients with intense flares of pain — a narrow market — and only about 2,000 doctors in the country prescribed fentanyl products. The drug is also expensive, costing thousands of dollars a month.

Prosecutors allege the company overcame these challenges with a speaker program, where “educating” doctors on the use of the drug was actually a way to bride them. A former chief executive of Insys wrote to sales managers that they needed to make it clear to sales reps how having one of their top targets as a speaker “can pay big dividends for them.” Doctors didn’t need to be good speakers; they just needed to “write a lot of” Subsys prescriptions. The indictment did not identify any of the parishioners by name who allegedly received and kickbacks.

To sweeten the pot, the Insys employees allegedly scheduled speaking events at establishments owned by doctors, or their families and friends. The events allegedly had little do with education: They were often held at high-priced restaurants and attendees were frequently just friends of the doctor hired as the speaker, the indictment alleges. Fake names were used on sign-in sheets, and some events had no attendees at all, according to prosecutors.

The cancer market for Subsys was considered to be “small potatoes” by one of the indicted former Insys executives. While the alleged bribes led doctors to prescribe more prescriptions for Subsys, insurance companies were reluctant to pay when the drug was prescribed for non-cancer patients. So a system was created to deceive insurers into paying for off-label uses of the drug, which is incidentally, quite expensive. A call center was created at Insys to handle insurance reimbursement approvals for doctors prescribing Subsys.

Employees in this unit are alleged to have contacted insurers, giving the appearance they were calling from the doctor’s office.  Along with the supposedly deceptive medical information given to the insurers, they reportedly said patients had difficulty swallowing, which meant Subsys, as a nasal spray, had a distinct advantage over similar products that were in pill form. “Employees of the unit were rewarded with lucrative financial bonuses if the entire unit met a weekly target of reimbursement approvals.”

The Subsys fiasco is not the only fentanyl-related contribution to the opioid problem in the U.S. Two years ago the DEA issued a nationwide alert on fentanyl as a threat to health and public safety. State and local labs reported 3,344 fentanyl submissions in 2014, an increase from 942 in 2013. “In addition, the DEA has identified 15 other fentanyl-related compounds.” Warnings were issued to law enforcement about guarding against fentanyl absorption through the skin or accidental inhalation of airborne powder, as it is 30 to 50 times more potent than heroin. Ingesting as small as .20 mg to 2mg of fentanyl can be lethal. The following image, taken from the 2016 National Drug Threat Assessment (NDTA), illustrates the size of 2mg of fentanyl compared to a penny.

 

Globally, fentanyl abuse has increased in Russia, Ukraine, Sweden and Denmark. Mexican authorities have seized fentanyl labs run by the drug cartels. Intelligence indicated the precursor chemicals for fentanyl have come from companies in Mexico, Germany, Japan and China.

According to the 2016 NDTA, licit fentanyl is only diverted on a small scale. Illicit fentanyl, typically manufactured in China or possibly Mexico, is smuggled into the U.S. across the border with Mexico. Traffickers usually obtain fentanyl and mix it with heroin on their own. This happens at a variety of locations, including homes and even hotel rooms.

In August 2015, the DEA Manchester, New Hampshire DO, along with the Salem, New Hampshire Police Department, conducted an enforcement operation at a fentanyl mill in a hotel in New Hampshire. The traffickers used a hotel room kitchenette for mixing heroin and fentanyl together. Upon entry by law enforcement officers, the traffickers attempted to dispose of the drugs down the sink, spilling the highly lethal drugs all over the room.

Traffickers in the U.S. are also using fentanyl powder and a pill press to create counterfeit pills of oxycodone and other drugs. Officials in New Jersey and Tennessee seized pills that appeared to be oxycodone. But laboratory analysis indicated they were fentanyl or acetyl fentanyl. In May of 2015, Orange County Police Officers in California seized what appeared to be black tar heroin. “Upon laboratory analysis, the substance was revealed to be fentanyl and showed no traces of heroin or any other drug.”

In another article for STAT News, David Armstrong described the China connection with fentanyl. Raw fentanyl and the machinery necessary for assembly-line production of the drug are coming from Chinese suppliers. “The fentanyl pills are often disguised as other painkillers because those drugs fetch a higher price on the street, even though they are less potent, according to police.” A Southern California fentanyl lab had a dozen different packages shipped to mail centers and residences. A box labeled as a “Hole Puncher” was in fact a quarter-ton pill press. “The Southern California lab was just one of four dismantled by law enforcement in the United States and Canada in March [of 2016].”

In British Columbia, police raided a lab at a custom car business that was allegedly shipping 100,000 fentanyl pills a month to Calgary, Alberta. Federal agents shut down a Seattle lab set up in the bedroom of a home in a residential neighborhood. Police near Syracuse New York raided a similar residential lab, where they were warned by the people there not to touch the fentanyl without gloves because of its potency. “The emergence of decentralized drug labs using materials obtained from China — and often ordered over the Internet — makes it more difficult to combat the illicit use of the drug.” See “Buyer Beware Drugs” for more on this topic.

In January of 2017 the acting administrator of the DEA met with Chinese officials to address the synthetic drug crisis in the U.S. He said: “These meetings underscore our improving relationship and cooperative efforts as we work to stem the flow of dangerous synthetic opioids and related chemicals.  I appreciate the good work they are doing in China to help us address our opioid epidemic.” The DEA maintains an office in Beijing and hopes to expand its presence in China. Hopefully, if the China connection with fentanyl is turned off, the future outlook from the 2016 NDTA will not be as bleak.

Fentanyl will remain an extremely dangerous public safety threat while the current production of non-pharmaceutical fentanyl continues. Fentanyl poses not only a threat to users, but also to law enforcement personnel and postal service employees as minute amounts of the drug are lethal and can be inadvertently inhaled or absorbed through the skin. Although many drug users avoid fentanyl, still others actively seek it out for its strong and intense high. In 2015 traffickers expanded the historical fentanyl markets as evidenced by a massive surge in the production of counterfeit tablets containing the drug, and manipulating it to appear as black tar heroin. The fentanyl market will continue to expand in the future as new fentanyl products attract additional users.

In February 2017, Time reported that China announced that carfentanyl (carfentanil) and three related synthetic opioids would be added to its list of controlled substances effective March 1, 2017. The DEA called China’s action a potential “game changer.” Russell Baer, a DEA special agent said: “It’s a substantial step in the fight against opioids here in the United States. . . We’re persuaded it will have a definite impact.” In October, the Associated Press identified 12 Chinese companies the offered carfentanyl for export. That same month China began evaluating whether to add it and three other fentanyls to its list of controlled substances. “Usually, the process can take nine months. This time, it took just four.”

03/10/17

Let Your Yes Be Yes

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While some oath-breaking leads to serious consequences, oaths just don’t seem to have the same significance in the modern person’s life as they did in biblical times. Most people know oaths occur in legal proceedings, where witnesses swear to tell the truth before giving testimony. Willfully give false testimony in this context is considered to be the crime of perjury. But outside of this sphere, taking an oath in modern times is largely reserved for times of ritual or ceremony.

In American culture, we see a newly appointed or elected government official swear an oath before taking office. Immigrants take an oath of citizenship when they become naturalized citizens of a country. When reciting the American Pledge of Allegiance, citizens pledge or swear loyalty to their country. Doctors and medical personnel take the Hippocratic oath, swearing to practice medicine honestly. So how are we to apply what Jesus says about oaths in the Sermon on the Mount?

Again you have heard that it was said to those of old, “You shall not swear falsely, but shall perform to the Lord what you have sworn.” But I say to you, Do not take an oath at all, either by heaven, for it is the throne of God, or by the earth, for it is his footstool, or by Jerusalem, for it is the city of the great King. And do not take an oath by your head, for you cannot make one hair white or black. Let what you say be simply “Yes” or “No”; anything more than this comes from evil. (Matthew 5:33-37)

In his commentary on the gospel of Matthew, Leon Morris noted this passage was peculiar to Matthew, who returned to the theme when He confronted the scribes and Pharisees in Matthew 23:16-22. “Clearly he [Jesus] was interested in the fact that people seemed very ready to swear oaths.” Oaths played a significant role in the life and culture of the Jews. The Mishnah, the first written record of the oral law, contains a complete treatise on oaths. In biblical and ancient times, oaths bound the person to his or her word.

According to the Lexham Bible Dictionary, oaths imposed a great sense of obligation on the individual; and breaking an oath was unthinkable. They were used to confirm the truthfulness of a person’s word, bind individuals in a contract, or confirm God’s intent to act according to His word. “Even rash oaths were binding and required confession of sin and sacrificial compensation if broken” (Leviticus 5:4-6). Yahweh served as the guarantor of a person’s oath, and here it had its greatest power. Breaking an oath was tantamount to breaking faith with Yahweh. Doing so took His name in vain (Exodus 20:7; Leviticus 19:12).

In this section of the Sermon on the Mount, Jesus was addressing how a series of quotations from Scripture should be understood. In Matthew 5:33, the Old Testament command to not break an oath (Leviticus 19:12; Numbers 30:2, etc) was paraphrased by Jesus. Then He said his followers should not swear an oath at all! However, sometimes it was necessary—Jesus himself responded when the high priest put him on oath (Matthew 26:63-64). So Jesus is not forbidding Christians from taking an oath, as some individuals apply the restriction today.

Rather, he is saying in the strongest terms possible that his followers must speak the truth. They should never adopt the sense that only when an oath is sworn do they need to be truthful.

The Jews held that unless the name of God was specifically mentioned the oath was not binding; there were lengthy discussions about when an oath is or is not binding, and people would sometimes swear by heaven or earth or a similar oath and later claim that they were not bound by that oath because God was not mentioned. Jesus rejects such casuistry.

This was why Jesus mentioned the forms of oaths used to sidestep telling the truth in Matthew 5:33-37. Remember the Mishnah had an entire treatise on oaths. Heaven, earth, Jerusalem, your head, were all somehow linked to God. You cannot escape the requirement to tell the truth by using these hair-splitting differences.  Keep your pledges without insisting that a certain form of words was necessary to make it binding.  Essentially Jesus is saying: “No oath is necessary for a truthful person.”

The conclusion of the matter is that it is never necessary for Christ’s people to swear an oath before they utter the truth. Their word should always be so reliable that nothing more than a statement is needed from them. God is in all of life, and every statement is made before him.

The importance of honesty in 12 Step Recovery is well known. Self-honesty begins with recognizing whether or not you are an alcoholic. In chapter 3, “More About Alcoholism,” it says A.A. doesn’t like to pronounce anyone as alcoholic. The suggestion is to try some controlled drinking—more than once. “It will not take long for you to decide, if you are honest with yourself about it.”

The manner of life demanded of the person who admits being an alcoholic is even qualified further as rigorous honesty.  In discussing what to do after making a personal inventory (the Fourth Step) in chapter 6, “Into Action,” of the Big Book it says: “We must be entirely honest with somebody if we expect to live long and happily in this world.”

As Bill Sees It, a collection of thoughts by Bill W. on the A.A. way of life, cites a 1966 letter he wrote. Bill said that only God can fully know what absolute honesty is. The best we can do is to strive for a better quality of honesty. Sometimes we have to place love ahead of indiscriminate ‘factual honesty.’ In the name of ‘perfect honesty’ we can cruelly and unnecessarily hurt others. “Always one must ask, ‘What is the best and most loving thing I can do?’”

In an August 1961 article for the AA Grapevine,  “This Matter of Honesty,” Bill W. observed how the problem of honesty touched nearly every aspect of our lives. While his intended audience was other A.A. members, I think what he said applies to everyone. After commenting on the extremes of self-deception and reckless truth-telling, he noted there were countless situations in life where nothing less than utter honest will do, “no matter how sorely we may be tempted by the fear and pride that would reduce us to half-truths or inexcusable denials.” He concluded the article with:

How truth makes us free is something that we AAs can well understand. It cut the shackles that once bound us to alcohol. It continues to release us from conflicts and miseries beyond reckoning; it banishes fear and isolation. The unity of our Fellowship, the love we cherish for each other, the esteem in which the world holds us–all of these are products of such integrity, as under God, we have been privileged to achieve. May we therefore quicken our search for still more genuine honor, and deepen its practice in all our affairs.

This is part of a series of reflections dedicated to the memory of Audrey Conn, whose questions reminded me of my intention to look at the various ways the Sermon on the Mount applies to Alcoholics Anonymous and recovery. If you’re interested in more, look under the category link “Sermon on the Mount.”

03/7/17

Between a Rock and a Hard Place

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Terry Lynch is an Irish physician and psychotherapist who challenged the commonly held view that psychiatric disorders are legitimate brain disorders. He did so in a brief video that had an interesting take on the issue. He showed where two of the organizations affiliated with the U.S. National Institute of Health (NIH) apparently have different opinions about whether several psychiatric disorders should be considered to be brain disorders.

In his video, “It’s official: Psychiatric diagnoses are NOT known brain disorders,” Lynch gave a screen capture from the “Brain Basics” educational resources page of the National Institute of Mental Health (NIMH). He highlighted the opening statement there, which says: “Welcome. Brain Basics provides information on how the brain works, how mental illnesses are disorders of the brain, and ongoing research that helps us better understand and treat disorders.”  Further down the page is the following: “Through research, we know that mental disorders are brain disorders.” These disorders were said to include depression, anxiety disorders, bipolar disorder, attention deficit hyperactivity disorder (ADHD) and many others.

He also called attention to a second NIH Institute, the National Institute of Neurological Disorders and Stroke (NINDS). The official mission statement of NINDS is “to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.” On the NINDS homepage is search engine where you can search by disorder. Lynch proceeded to show that depression, bipolar and schizophrenia were not listed in the NINDS database as neurological disorders. ADHD does appear in the NINDS, database but was not mentioned by Lynch in his video. You can replicate what I’ve said here be searching the “Brain Basics” page on NIMH and the NINDS database here.

One response to the differences Lynch found would be to say that NINDS attends to neurological disease, while NIMH addresses a different kind of brain dysfunction, namely mental or psychiatric disorders. But that response doesn’t resolve the dilemma. Because the next question becomes what is the difference between neurological disease and mental/psychiatric disorder? Attempting to articulate the difference may have placed psychiatry in a sort of catch-22 situation.

Lynch addressed this dilemma in an essay he wrote, “Psychiatry: Between a Rock and a Hard Place.” His opening statement there was that contrary to their repeated claims of doing so, “psychiatrists do not treat known organic illnesses.” They do not treat known organic brain disorders, which are under the care of neurology and neurosurgery. He said emotional and psychological distress typically comes under the care of counseling or psychology. So where, then, does psychiatry fit in?

Psychiatry is caught between a rock and a hard place—somewhere between the medical specialties treating known brain diseases (neurology and neurosurgery) and the talk therapies of counseling and psychology. Psychiatrists, according to Lynch, invented terms such as “mental illness” or “mental disorder,” and made themselves the experts who would diagnose and treat said illness/disorder. “They have fed the public with unsubstantiated ideas about neurotransmitters, chemical imbalances and brain disorders, ideas which the public have generally believed wholeheartedly.”

The challenge for psychiatry has been to carve out its own distinct identity. Claims that depression and other psychiatric diagnoses are biological illnesses are crucial to psychiatry’s identity and its unmerited position at the top of the mental health pyramid. These assertions separate psychiatry from the talk therapies and ensure that psychiatry has first claim to these “diseases” and the people they diagnose as having them.

He said psychiatry wants to be more closely aligned with the respected medical standing of neurology than to psychology or counseling. But it has to be seen as distinct from neurology to maintain a separate identity. “Specializing in ‘mental illnesses’ and ‘mental disorders’ provides the needed distinction.” Towards that end, Lynch said psychiatry has convinced the general public (and perhaps themselves) that psychiatric disorders are biological illnesses. In the process, they have side stepped “the fact that there is no reliable corroborative scientific evidence for this.”

For over a century, psychiatry has reassured the public that both the necessary understanding and more effective solutions lie just around the corner. “Bear with us, we are almost there,” psychiatry’s catchphrase for the past 100 years and more, buys them more time, every time.

Lynch thought psychiatry would confront a nightmare of their own making if it ever connected brain abnormalities to psychiatric diagnoses. If structural or functional brain abnormalities were ever found to be associated with psychiatric diagnoses, care of those individuals would likely be transferred away from psychiatry to neurology—“a specialty that deals with known brain abnormalities.” He said precedent within medicine would dictate that responsibility for those patients would be transferred to neurology or some other relevant specialty.

Given this, Lynch thinks the best position for psychiatry is to stay exactly where it is. As long as there are no reliable biological abnormalities identified, there is no threat to their position. By claiming that mental disorders are rooted in biology, psychiatry has set itself apart from talk therapies. “As long as no biological abnormalities are reliably identified, there is no threat that their bread and butter will be removed from them to other medical specialties.” Maintaining the myth that biological solutions are imminent, satisfies the public and preserves it’s position.

“If biology isn’t seen as central to the experiences and behaviours that have become repackaged as so-called “mental illnesses,” what special expertise can mainstream psychiatrists claim to possess?” So when psychiatrists defend their pronouncements on depression or any other psychiatric label, they are not just defending a diagnosis. “They are defending themselves, their ideology, their modus operandi and ultimately, their status and role in society as the perceived prime experts in mental health.”

Lynch is not alone in his views of psychiatry and diagnosis. There are clear echoes of the thought of Thomas Szasz in what he says. Peter Breggin, Joanna Moncrieff, Robert Whitaker, Peter Gøtzsche, David Healey, Sami Timimi and others would agree with parts, if not all, of what he asserts. Here, for example, is a blog article by Chuck Ruby for the International Society for Ethical Psychology & Psychiatry (ISEPP), “Blue Illness.” Reflecting on an article that affirmed depression was a mental illness, Ruby noted that for decades, attempts have been made to demonstrate the brain-pathology basis of depression.

Despite the billions of public dollars invested in this research, no such evidence of brain pathology has been discovered. The only thing this research has shown is that our experiences and behaviors are mirrored by changes in the brain. This is something we already knew. Yet, instead of giving up the search and redirecting those monies to more worthy research of real diseases, the mental health industry repeats the worn out pronouncement that discovery is just around the corner! Ironically, if such a discovery came, wouldn’t depression then fall within the medical specialty of neurology, the real medical specialty that studies real brain illnesses?

In the concluding paragraphs of their book, Psychiatry Under the Influence, Robert Whitaker and Lisa Cosgrove wrote that from a scientific standpoint, psychiatry is facing a legitimacy crisis. “The chemical imbalance theory is collapsing now in the public domain.” The former director of the NIMH, Thomas Insel, has written of how second generation psychiatric drug are no better than the first, “which belies any claim that psychiatry is progressing in its somatic treatment of psychiatric disease.”

The disease model paradigm embraced by psychiatry in 1980 has clearly failed, which presents society with a challenge: what should we do next?

Terry Lynch is right. Psychiatry is between a rock and a hard place. But save your sympathy for the patients who are there with it.

03/3/17

Shatter and Psychosis

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Dr. Kiri Simms is an emergency psychiatrist in Victoria, British Columbia. Two years ago she saw her first patient with marijuana-induced psychosis. The person was very young and very disconnected from reality. “She was very, very ill.” Shatter, a butane hash oil product, was the only drug she used. In the past, most people did not become psychotic with marijuana use alone, Dr. Simms said. “That has changed with these butane hash oil products.”

Dr. Simms said she’s seeing an increased severity and intensity of symptoms with some people at her emergency department (ED). In the past year, she estimated she’s treated ten people who had used shatter and whose problems were severe enough to require a stay in psychiatric intensive care or on one of their inpatient wards. People are often surprised they experienced psychotic symptoms from using marijuana products, she said.

It used to be that people did not become psychotic from marijuana use alone. Infrequently, individuals with a family history of schizophrenia might have a psychotic experience after smoking marijuana, but not any more. It’s not like the old days, where symptoms would pass in a few hours or days. Now Dr. Simms said they are seeing people who sometimes take weeks and occasionally months for their psychotic symptoms to clear.

The above discussion was in an interview she did with Greg Craigie the host of the CBC radio program, On the Island. You can read excerpts or follow a link to hear the full interview here. Craigie followed the Simms interview with one he did with Rebecca Jessemen, the senior policy advisor for the Canadian Centre of Substance Abuse. She said they were really concerned with minimizing the risk of harm with youth, as marijuana legalization moves closer in Canada. “That includes key messages such as delaying initiation of use, reducing frequency of use, and reducing the quantity of use… Part of that is quantity in terms of concentration too.”

Not surprisingly, the interview and web story prompted several mostly negative Facebook comments rejecting a link between shatter and psychosis. Accusations were made of this being false news, that CBC was spreading anti-cannabis propaganda, etc. You can read an article about Craigie’s interview with Rebecca Jessemen here. But this is not fake news. There is a clear, known association of marijuana use and psychotic episodes. And with higher THC content in a marijuana product, the risk of a psychotic episode increases.

Do people react differently to the same dose of THC? Does cannabidiol (CBD) reduce the psychotic effects of THC? There was an experiment done at the Institute of Psychiatry at King College, London that looked at the relationship of the effects of the two main cannabinoids in cannabis, THC and CBD. You can watch a video of a reporter participating in the experiment here.

She was given pure THC and a mixture of THC and CBD. On the THC and CBD mixture, the reporter said she seemed flippant; on pure THC, she just didn’t care. The mixture of THC and CBD left her with the giggles: “No matter how hard I tried to take the experiment seriously, it all seems hilarious.”

With pure THC, she was suspicious, introverted; “weird.” Every question seemed to have a double meaning. She felt morbid. “It’s like a panic attack.” “It’s horrible. It’s like being at a funeral . . . Worse . . . It’s just so depressing. You want to top [kill] yourself.”

The researchers used the Positive and Negative Syndrome Scale (PNASS), a standard test to measure changes in psychotic symptoms. On the PNASS sub scale used, changes above four was clinically significant; changes that would be associated with schizophrenic psychosis. She scored fourteen. The effects on the reporter were temporary and would not be long lasting. But the video clearly shows how higher concentrations of THC can induce temporary psychotic symptoms in normal individuals.

In a NPR interview, Dr. Nora Volkow, the director of the National Institute for Drug Abuse (NIDA) said while no one would question that marijuana can trigger temporary symptoms of psychosis in some people, it is not clear whether cannabis alone can trigger schizophrenia. “You can have a psychotic episode from the use of marijuana without it turning into schizophrenia. . . . It’s very distressing, but you’ll get out of it.” While drugs like marijuana and methamphetamine can lead to experiencing symptoms like paranoia and disorganized thinking, that’s very different from schizophrenia.

Dr. Volkow suggested the studies show that people with schizophrenia tend to smoke pot. People with an emerging schizophrenic disorder maybe “trying to self-medicate because they just don’t feel right.” Volkow believes if someone has a vulnerability to schizophrenia smoking it could trigger a psychotic episode. Without the predisposition, “you can smoke all the marijuana you want and it will make no difference.” Volkow did acknowledge the dramatic increase in people showing up in the emergency department with a temporary psychotic episode could be related to “a much more potent marijuana.”

But not everyone has the same opinion; that there is a clear distinction between schizophrenia and marijuana-induced psychosis. Sir Robin Murray, a psychiatrist at King’s College in London said 20 years ago he would tell patients that cannabis was safe. “It’s only after you see all the patients that go psychotic that you realize—it’s not safe.”

Krista Lisdahl, a clinical neuropsychologist, said that if marijuana is causing schizophrenia, this happens during an individual’s early years of development. There hasn’t been an increase in the number of people with schizophrenia; the number still hovers around 1%. However, studies do show that the earlier someone starts using marijuana, the more likely they will develop a psychiatric disorder in general.

A report by DAWN (Drug Abuse Warning Network) found that ED visits due to marijuana increased by 52% between 2004 and 2011. This was lower than the increase in ED visits for anti-anxiety and insomnia medications (124%), narcotic pain relievers (153%), antipsychotics (71%), and stimulants like ADHD medications (292%).  Nevertheless, Sir Robin Murray said the data strengthens the case of an association between cannabis and the risk for schizophrenia. A study in The Lancet which he published suggested marijuana with around 15% THC could increase the risk of schizophrenia 5 times. “We think about 5 percent of people will go psychotic instead of 1 percent.”

Our findings show the importance of raising public awareness of the risk associated with use of high-potency cannabis, especially when such varieties of cannabis are becoming more available. The worldwide trend of liberalisation of the legal constraints on the use of cannabis further emphasises the urgent need to develop public education to inform young people about the risks of high-potency cannabis.

A 2014 article in Frontiers in Psychiatry, Gone to Pot,” reviewed the emerging evidence of a connection between cannabis and psychosis/psychotic disorders, including schizophrenia. The review was comprehensive and suggested cannabis may be a component in the emergence of psychosis. But the precise nature of these associations remains unclear. However, the relationship has been evident since the mid 1800s. One of the earliest studies of marijuana and psychosis was done by the French psychiatrist Jacques-Joseph Moreau, and reported in his 1845 book, Hashish and Mental Illness. Moreau said hashish (cannabis resin) could precipitate:

 … acute psychotic reactions, generally lasting but a few hours, but occasionally as long as a week; the reaction seemed dose-related and its main features included paranoid ideation, illusions, hallucinations, delusions, depersonalization, confusion, restlessness, and excitement. There can be delirium, disorientation, and marked clouding of consciousness.

Consistent with the YouTube video of the Kings College experiment linked above, cannabis extract and THC alone have been shown to produce a range of transient symptoms similar to the positive symptoms of schizophrenia: “suspiciousness, paranoid and grandiose delusions, conceptual disorganization, fragmented thinking, and perceptual alterations. Additionally, cannabis and THC also result in depersonalization, derealization, alterations in sensory perception, and feelings of unreality.” A double-blind, randomized, placebo-controlled study by D’Souza et al. found that THC produced transient positive psychotic symptoms. A similar study replicated these findings in healthy individuals with a lower THC dose than D’Souza et al.

Several studies suggest a “window of opportunity” hypothesis, meaning there is a critical period during early adolescence “where the brain is particularly susceptible to the psychosis-inducing effects of cannabis.” The premise suggests cannabis may affect the brain during a critical period of development and maturation. Cannabis could disrupt one or more of these maturation processes.

By disrupting the endocannabinoid system and interfering with neurodevelopmental processes, exogenous [from outside of an organism] cannabinoids may provide a biologically plausible mechanism by which exposure to cannabinoids during adolescence may increase the risk for the development of schizophrenia.

While there has been a notable increase in the rates of cannabis use over the past four decades, there has not been an increase in the prevalence of schizophrenia. The authors admit these results are difficult to explain in the context of their review showing how “the relationship between cannabinoids and psychosis fulfills many but not all of the traditional criteria for causality.” One possible explanation is that schizophrenia rates are lagging behind increased rates of cannabis consumption. In other words, we need to look for a future increase of schizophrenia rates with a cannabis connection.

Given the evidence presented above, it is likely that cannabis is an important component cause in the development of psychotic disorders. This causal role is apparantly magnified when cannabis exposure occurs at an earlier age, in greater quantities, and over a longer time-course. Further, as was discussed in this review, specific populations (i.e., those with a genetic vulnerability or a history of childhood abuse) may be particularly susceptible to the causal effects of cannabis. In conclusion the authors said:

Acute exposure to both natural and synthetic cannabinoids can produce a full range of transient symptoms, cognitive deficits, and psychophysiological abnormalities that bear a striking resemblance to some of the features of schizophrenia. Also clear is that, in individuals with an established psychotic disorder, cannabinoids can exacerbate symptoms, trigger relapse, and have negative consequences on the course of the illness. Finally, exposure to cannabinoids in adolescence confers a higher risk for psychosis outcomes in later life and the risk is dose-related. However, it should be remembered that the majority of individuals who consume cannabis do not experience any kind of psychosis.

So the On the Island interview with Dr. Simms was not an example of fake news or anti-marijuana fear mongering. While the dangers of cannabis use don’t approach those portrayed in the classic cult film Reefer Madness, there is growing evidence of a risk of psychotic symptoms with higher levels of THC in marijuana products like shatter. And there is an increased risk of psychosis later in life for a subgroup of adolescents who use marijuana. The evidence is not conclusive at this time, but can we afford to just wait-and-see if wide spread recreational marijuana use conclusively causes the adverse effects discussed above before taking regulatory action?