12/29/17

Protestants Without Sola Fide, Part 2

Some of the reported findings of the Pew Research Center’s “U.S. Protestants Are Not Defined by Reformation Era Controversies” have left more than one person scratching their heads. Surprisingly, only 27% of Protestants correctly said that Protestants alone traditionally teach that salvation comes through faith alone; 44% of Protestants said that both Catholics and Protestants hold this doctrinal belief. Confusingly, the survey also found that 24% of self-identified Protestants said they were not familiar with the term “Protestant.” What does it mean when 24% of Protestants aren’t familiar with the term “Protestants”?

In Part One of this article, I looked at the confusion with how Pew defined one of the fundamental doctrinal differences between Protestants and Catholics, sola fide: justification by faith alone. The Pew survey linked sola fide with salvation and not justification within the questionnaire when it said: “faith in God alone is needed to get into heaven.” This Pew definition was not the classic Protestant understanding of sola fide. Nevertheless, only 46% of self-identified Protestants said they thought “Faith in God is the only thing that gets people into heaven,” 52% said: “Both good deeds and faith in God are necessary to get into heaven”—a Roman Catholic sense of salvation.

The Pew study does seem to suggest that: “U.S. Protestants are not united about – and in some cases, are not even aware of – some of the controversies that were central to the historical schism between Protestantism and Catholicism.” Most American Protestants (57%) believe the two Christian traditions are more alike than different. And as noted above, 52% of Protestants believe that faith and works are necessary for salvation. This is a dramatic shift from the position of the Reformation.

In his article on justification in the New Dictionary of Theology, N.T. Wright said popular Protestantism has suppressed the distinction between justification and regeneration, while Roman Catholics have continued to be influenced by Augustine, “who saw it as God’s action in making people righteous, through pouring into their hearts love towards himself.” The emphasis on the change brought about by God’s action has continued into modern Roman Catholic theology, with the consequence that the reference of the word has been broadened significantly “to include far more than Paul (or the Reformers) intended.” So it seems worthwhile to review here the essential Protestant doctrines, noting where they are distinct from Roman Catholicism.

Writing for Themelios, Scott Mantesch said in “Is the Reformation Over?” that Protestant Christians often summarize their primary doctrinal commitments with the five “solas”: sola Scriptura, sola gratia, sola fide, solus Christus, and soli Deo Gloria. He noted that Calvin wrote the five solas should not be treated as discrete or independent doctrines. “They cohere with, inform, and require other important biblical truths.” For example, there is a theological inconsistency in affirming the doctrine of justification by faith alone, while remaining committed to the sacrament of penance. “Calvin recognized that whatever authority the Catholic Church ascribed to Scripture in theory, Rome undermined Scripture’s authority in practice by commanding the exclusive right of interpreting the biblical text.”

P. Chase Sears said in his article on “New Testament Theology” for the Lexham Bible Dictionary that the Reformers insisted that the church return to sola Scriptura—Scripture alone as the authoritative source for theology. They emphasized the grammatical-historical method of interpretation in order “to grasp the overall structure of the biblical understanding of God and his relations with mankind.” Martin Luther saw Jesus Christ as the heart of Scripture, but he wrestled with the problem of unity in diversity within Scripture. In order to resolve this difficulty, he distinguished between law and gospel, “with the doctrine of justification by faith as his hermeneutical key to piecing the entire Bible together.”

Mantesch said the following on how the Reformer’s understanding of the doctrine of justification by faith distinguished Protestant and Roman Catholic theology from each other:

For the Protestant reformers, justification was a first-order doctrinal concern. Not so with many contemporary Catholics. The most recent edition of the Catholic Catechism gives only brief attention to the doctrine of justification. Clearly, sacramental grace, not justification, occupies the central position in Catholic conceptions of salvation. American Cardinal Avery Dulles admits as much: “Justification is rarely discussed at length except in polemics against, or dialogue with, Protestants.” It is noteworthy that the official Catholic formulations of the doctrine of justification found in the “Catholic Catechism” and the “Joint Declaration” make no mention of the positive forensic character of justification—that sinners are acquitted before God on account of the imputed righteousness of Christ. Moreover, both of these documents describe justification as including divine pardon and the process of renewal of the inner person. The “Catholic Catechism,” for example, reaffirms the definition of justification formulated at Trent in 1547: “Justification is not only the remission of sins, but also the sanctification and renewal of the interior man.” [See Chapter VII of the Council of Trent]

Mantesch then asked how Protestants should respond when contemporary Roman Catholic churchmen affirm one or several of the solas. In the Joint Declaration of 1999 Roman Catholic officials approved “by grace alone” and “by faith alone.” Responding to his own question, he said we should be grateful that Catholics are willing to affirm these central biblical truths, while remaining cautious and realistic.

The Gospel Coalition now has a series of free online courses available, one of which is on The Five Solas. In “Remembering the Reformation by Reflecting on its Solas,” Stephen Wellum said: “The solas remind us about the God-centered nature of Christianity and how human beings, as important as we are as image-bearers, are completely dependent upon God’s sovereign initiative to create, reveal, rule, and redeem.” Each of the five solas is addressed and there is a wealth of information (written and video) on each doctrine.

Similarly, in his lecture on “Sola Fide: Lady Jane Grey & the Rediscovery of Justification by Faith,” Steve Nichols said: “Salvation from start to finish is the work of God for his glory.” The doctrine of justification reminds us that we don’t have to do anything for our salvation. Indeed, we cannot. “Christ has done it for us.” Nichols went on to suggest that Martin Luther used two words to describe the doctrine of justification: alien and immediate. By alien he meant justification is outside of us. “The doctrine of justification reminds us that it is nothing that we muster.” By immediate, Luther meant “without a mediator.” Where the medieval Catholic church saw salvation between Christ and sinful humanity mediated by the church and its sacraments, for Luther there was no mediator between humanity and Christ. The video for the Nichols lecture is under The Gospel Coalition material on Sola Fide. A link there will take you to Ligioner Ministries, where there are additional links to the lectures Dr. Nichols gave on the five solas.

In its attempt to assess differences between Protestants and Roman Catholics on one of the classic Reformation solas, The Pew Research Center study treated sola fide as a discrete and independent doctrine from the remaining four, something John Calvin said should not be done. Together the five solas, “cohere with, inform, and require other important biblical truths.” Additionally, by removing the term justification from its definition of sola fide and asking participants to choose whether “faith in God” or “good deeds and faith in God” were necessary for salvation, Pew effectively neutered what was a first-order doctrinal concern for Protestants—at the time of the Reformation and today.

Thomas Schreiner in his lecture on Sola Fide for the 2015 Theology Conference at Southern Baptist Theological Seminary, said it was right to say faith alone saves us “since imperfect works don’t pass muster to make us right with God.” Good works are necessary for eternal life, but they can’t be the basis for our right-standing with God since He demands perfection. “Good works are a fruit of faith and a result of the Spirit’s work.” As Shreiner and others have said: “We are justified by faith alone and yet our faith is never alone.” In conclusion, I think it’s worth repeating another statement Schreiner made in his lecture:

When we speak of justification by faith alone, we aren’t saying that our faith justifies us. We see here how the five solas are closely linked together, for righteousness is by faith alone because our righteousness is in Christ alone as the crucified and risen one. And if our righteousness is by faith alone and in Christ alone, then it is by grace alone since our works don’t constitute our righteousness. And our righteousness is also to the glory of God alone since he is the one who has accomplished our salvation. Justification by faith alone doesn’t call attention to our faith but to Christ as the redeemer, reconciler, and Savior. [As an aside in the video, Schreiner noted he didn’t mention sola Scriptura here. “But everything I said supported that.”]

12/26/17

Give MDMA a Chance?

In August of 2017 the FDA designated MDMA-assisted psychotherapy as a breakthrough treatment for PTSD. Bringing MDMA to market as a legal, legitimate therapeutic agent has been the goal of Rick Doblin, the Executive Director of MAPS (Multidisciplinary Association for Psychedelic Studies), since he founded the nonprofit in 1986. That was one year after the DEA classified MDMA, better known as the street drug ecstasy, as a Schedule I controlled substance. Doblin said: “For the first time ever, psychedelic-assisted psychotherapy will be evaluated in Phase 3 trials for possible prescription use, with MDMA-assisted psychotherapy for PTSD leading the way.”

The MAPS press release said the Phase 3 trials will assess the efficacy and safety of MDMA-assisted therapy in 200-300 participants with PTSD in the U.S., Canada and Israel. Two Phase III clinical trial studies will begin enrolling participants in the spring of 2018. Randomized participants will receive three day-long sessions of either MDMA or placebo in conjunction with psychotherapy over a 12-week treatment period. There will also be 12 associated 90-minute nondrug preparatory and integration sessions. Now that the FDA is onboard, Doblin said MAPS plans to start negotiations with the European Medicines Agency.

Speaking for MAPS, Amy Emerson, said the Phase 2 data was extremely promising. Out of 107 participants, 61% no longer qualified for PTSD after three sessions of MDMA-assisted psychotherapy two months after treatment. Then at the 12-month follow up, 68% no longer had PTSD. “All Phase 2 participants had chronic, treatment-resistant PTSD, and had suffered from PTSD for an average of 17.8 years.” The Phase 2 trials are being prepared for publication.

The willingness of MAPS to use the existing clinical trial process to scientifically validate the potential therapeutic benefits of MDMA is encouraging. Running the FDA gauntlet for drug approval, for better or worse, is the most effective process we currently have to prevent a return to the days of patent medicines, when anything and everything was promoted as “cures” and “treatments” to an unsuspecting public. Those were the days when cocaine was in tonics (Coca Cola); heroin was in cough suppressants and teething medication; and the typical heroin addict was a middle class woman in her forties.

At least one individual at John Hopkins has referred to the recent interest of MAPS and others into the therapeutic effects of psychedelic substances as a “psychedelic renaissance.” Writing for Massive, Benjamin Bell said: “Astounding preliminary research suggests psychedelics may yet revolutionize mental health care.” His historical gloss painted the history of the medical use of psychedelics as going from a potential revolution in psychotherapy during the 1950s to drug-addled lunacy by 1968. The culprits responsible for this change, according to Bell, were Timothy Leary and Richard Alport. “Although the pair began as respected researchers at Harvard, their firing coincided with their choice to promote hallucinogens in unique, and distinctly non-academic, ways.”

Unwittingly, when Harvard psychologist Timothy Leary signaled springtime for the “Summer of Love,” promoting LSD as a means to achieve cosmic connection, he also drew closed the curtain on academic research into a class of substances which held massive promise.

Richard Nixon labeled Leary as “The most dangerous man in America.” Alport went to India and a spiritual quest and changed his name to Ram Dass. In 1968, the US government outlawed all hallucinogens, universally restricting research on the substances. In the early 1980s, there was a brief time of psychotherapeutic research with MDMA. “But recreational use quickly captured the spotlight, and MDMA was classified as a Schedule 1 drug” in 1985. This was what motivated Rick Doblin to found MAPS.

According to The Washington Post, Doblin used LSD “as a rebellious, long-haired college freshman in the 1970s.” He believes it helped him see the world and himself in new ways. He wanted to become a therapist and use psychedelics to help others achieve similar insights, but he couldn’t because LSD was banned. When MDMA was criminalized, he realized psychedelics were too much on the fringe of culture to win public support. “The flaw of the early psychedelic movement was that they made it countercultural, a revolution. . . . Culture is dominant. Culture is always going to win.” He decided he had to bring psychedelics as therapeutic agents into the mainstream.

Doblin was admitted to the public policy PhD program at Harvard, shaved off his moustache, cut his hair and “learned to navigate the federal bureaucracy.” He laughed about how simple it was. “You put on a suit, and suddenly everyone thinks you’re fine.” Instead of fighting government officials, he sought to use science to win them over. So MAPS was born. And it was no accident the organization chose PTSD as its initial foray into its quest to end the government ban on psychedelics. Dobin said: “We wanted to help a population that would automatically win public sympathy. . . . No one’s going to argue against the need to help them.” He added that if you were going to design a drug to be used as an adjunct in psychotherapy to treat PTSD, “MDMA would be it.”

But his dream extends beyond just developing a treatment for PTSD. Rick Doblin dreams of a time when psychedelic treatment centers are in every city. People could go there for enhanced couples therapy, spiritual experiences and personal growth. “These drugs are a tool that can make people more compassionate, tolerant, more connected with other humans and the planet itself.” He thinks they can help address homelessness, war and even global warming. Needless to say, this kind of talk makes others nervous.

Despite its promise, there are risks. What’s sold on the street as “molly” is often not MDMA See “MDMA—Not!” for more on this topic. At high doses, it can cause the body to over heat. It can cause anxiety and increase stress. Chronic use can cause memory impairment. But there are additional concerns with MDMA not mentioned in The Washington Post.

The National Institute on Drug Abuse (NIDA) related the following in its article on MDMA (Ecstasy) Abuse. MDMA was said to affect the brain by increasing the activity of at least three neurotransmitters: serotonin, dopamine, and norepinephrine. “Like other amphetamines, MDMA enhances release of these neurotransmitters and/or blocks their reuptake,resulting in increased neurotransmitter levels within the synaptic cleft (the space between the neurons at a synapse).” Releasing large amounts of serotonin causes the brain to become depleted of this neurotransmitter, contributing to the negative psychological aftereffects some people experience for several days after taking MDMA.

Low serotonin is associated with poor memory and depressed mood, thus these findings are consistent with studies in humans that have shown that some people who use MDMA regularly experience confusion, depression, anxiety, paranoia, and impairment of memory and attention processes. In addition, studies have found that the extent of MDMA use in humans correlates with a decrease in serotonin metabolites and other markers of serotonin function and the degree of memory impairment. In addition, MDMA’s effects on norepinephrine contribute to the cognitive impairment, emotional excitation, and euphoria that accompanies MDMA use.

So despite the optimism of individuals like Rick Doblin and Benjamin Bell, there are clear dangers with a renaissance of psychedelic psychotherapeutics. Attributing objections and concerns to over fifty years “of drug prohibition and abstinence-only education,” as well as “a culture that has shaped the negative stigma of all psychedelics,” is disingenuous and dismissive of the legitimate concerns. Should there be further research into the potential for MDMA-assisted psychotherapy as a breakthrough treatment for PTSD? If all they are saying, is give MDA a chance, then absolutely. See the photo in Bell’s article of Timothy Leary singing, “Give Peace a Chance” with John Lennon and Yoko Ono.

But let’s not run ahead of the science to treat other emotional or psychiatric problems; or apply psychedelics to resolve the problems of world peace, homelessness and global warming just yet.

12/22/17

Taliban as an IED

The President of Afghanistan, Ashraf Ghani said that without drugs, the Afghan war would have been over. “The heroin is a very important driver of this war.” Former President of Afghanistan, Hamid Karzai, said the opium problem was the single greatest threat to the long-term security, development and effective governance of Afghanistan. “Either Afghanistan destroys opium or opium will destroy Afghanistan.” The New York Times reported Afghanistan has consistently produced approximately 85% of the world’s opium, despite more than $8 billion spent by the US to eradicate the trade.

Economic factors are driving opium problem in Afghanistan. The United Nations publishes a yearly Human Development Report that “focuses on how human development can be ensured for every one—now and in future.” It uses a summary measure referred to as the Human Development Index (HDI) which assess progress in three basic dimensions of human development: a long and health life (measured by life expectancy), access to learning and knowledge (measured by expected years of schooling), and a decent standard of living (measured by Gross National Income per capita). Afghanistan’s HDI value for 2015 was 0.479, placing it in the lower section for human development at 169 out of 188 countries and territories.

As one of the poorest countries in the world, its 31 million people have an average per capita income of just $800, with 80 percent of its rural population living in poverty. Only 23 percent of Afghans have access to safe drinking water, and only 6 percent to electricity.

Colonel John Glaze wrote the above quote in a report for the Strategic Studies Institute of the U.S. Army War College titled, “Opium and Afghanistan: Reassessing U.S. Counternarcotics Strategy.” Glaze went to note how the high turn on investment from opium poppy cultivation drove an agricultural shift from growing traditional crops, like wheat, corn, barley, rice, to growing opium poppy. “In recent years, many poor farmers have turned to opium poppy cultivation to make a living because of the relatively high rate of return on investment compared to traditional crops. Consequently, Afghanistan’s largest and fastest cash crop is opium.”

Cultivating opium poppy makes powerful economic sense to the impoverished farmers of Afghanistan. It is the easiest crop to grow and the most profitable. Even though the Karzai government made opium poppy cultivation and trafficking illegal in 2002, many farmers, driven by poverty, continue to cultivate opium poppy to provide for their families. Indeed, poverty is the primary reason given by Afghan farmers for choosing to cultivate opium poppy. With a farm gate price of approximately $125 per kilogram for dry opium, an Afghan farmer can make 17 times more profit growing opium poppy—$4,622 per hectare, compared to only $266 per hectare for wheat.Opium poppy is also drought resistant, easy to transport and store, and, unlike many crops, requires no refrigeration and does not spoil. With Afghanistan’s limited irrigation, electricity, roads, and other infrastructure, growing traditional crops can be extremely difficult. In many cases, farmers are simply unable to support their families growing traditional crops; and because most rural farmers are uneducated and illiterate, they have few economically viable alternatives to growing opium poppy.

Business Insider reported an Afghan farmer could be paid $163 for a kilo of raw opium, which looks like a black sap. When the raw opium is refined into heroin, it can be sold for $2,300 to $3,500 per kilo at regional markets. “In Europe it has a wholesale value of about $45,000.” In the past, most of the opium harvest was smuggled out of the country as raw opium and then refined in other countries. But now, officials estimate that half or more of Afghan opium is processed at some level within the country.

“Afghanistan’s economy has thus evolved to the point where it is now highly dependent on opium.” In 2006, revenue from opium cultivation was over $3 billion, more than 35% of the country’s total gross national product (GNP). Opium production has become Afghanistan’s top employer and the principle base of its economy. An estimated 10% of the population are involved in some way with opium cultivation. Yet less than 20% of the $3 billion in profits goes to the farmers that grow the opium.

Traditionally, processing of Afghan’s opium into heroin has taken place outside of Afghanistan; however, in an effort to reap more profits internally, Afghan drug kingpins have stepped up heroin processing within their borders. Heroin processing labs have proliferated in Afghanistan since the late 1990s, particularly in the unstable southern region, further complicating stabilization efforts. With the reemergence of the Taliban and the virtual absence of the rule of law in the countryside, opium production and heroin processing have dramatically increased, especially in the southern province of Helmand. In 2006, opium production in the province increased over 162 percent and now accounts for 42 percent of Afghan’s total opium output. According to the UNODC, the opium situation in the southern provinces is “out of control.”

The refining labs are simple, nondescript huts or caves containing maybe two dozen empty barrels for mixing, sacks or jugs of precursor chemicals, piles of firewood, and a press machine. They also have a generator, a water pump and a long hose to draw water from a nearby well. Afghan police and American Special Forces repeatedly ran into them all over Afghanistan in 2017. “Officials and diplomats are increasingly worried that the labs’ proliferation is one of the most troubling turns yet in the long struggle to end the Taliban insurgency.” Afghanistan’s deputy interior minister in charge of the counternarcotics police estimated his forces destroyed more than 100 of the estimated 400 to 500 labs in the country last year. However, “They can build a lab like this in one day.”

The NYT noted the Taliban has long profited by taxing and providing security for producers and smugglers. “But increasingly, the insurgents are directly getting into every stage of the drug business themselves, rivaling some of the major cartels in the region — and in some places becoming indistinguishable from them.” Refining makes the drug easier to smuggle and dramatically increases the profits for the Taliban. Officials estimate that up to 60% of the Taliban’s income now comes from the drug trade.

In country drug seizures suggest more opium is being processed within Afghanistan. Previously, the amount of opium seized would be five times or more than that of morphine and heroin. “In 2015, for example, about 30,000 kilograms, or 66,000 pounds, of opium was seized, compared with a little over 5,000 kilograms, or 11,000 pounds, of heroin and morphine combined.” But so far in 2107, the seizure numbers have reversed. The amount of heroin and morphine seized is double that of raw opium.

And there seems to be a direct relationship between recent Taliban gains territorially and the drug trade. The Southern Afghan provinces of Helmond, Uruzgan and Kandahar are where much of the country’s opium-poppy production occurred in 2016. They are also in the midst of the country’s provinces with the highest security risks. A senior Afghan official said: “If an illiterate local Taliban commander in Helmand makes a million dollars a month now, what does he gain in time of peace?” See the map below originating with the United Nations Department of Safety and Security.

The Taliban seem to be in the midst of changing from a fundamentalist Sunni political movement into a drug cartel. Their mixture of ideology, power and greed has led to a situation in Afghanistan that can be likened to a political and cultural IED. Afghanistan’s deputy interior minister in charge of the counternarcotics police said the Taliban used the growing insecurity over the past two years to establish more refining labs and move them closer to the opium fields. The Afghan deputy minister of counternarcotics said: “We have to merge these two things together — the counterterrorism and the counternarcotics. It has to go hand in hand, because if you destroy one, it is going to destroy the other.”

For more on the Taliban and the drug trade, see “Opium and the Taliban.”

12/19/17

Protestants Without Sola Fide, Part 1

Five hundred years ago, Martin Luther is credited with sparking the Protestant Reformation when he nailed his 95 Theses to the door of All Saints Church in Wittenberg. Classically, there were two fundamental ideas that drove Luther: sola fide, meaning that justification is dependent upon faith alone; and sola scriptura, that Scripture is the only ultimate authority for Christian belief and practice. There were other concerns over religious practices such as the sale of indulgences, but sola fide and sola scriptura “became the rallying cry for many Protestant reformers.” Yet a recent Pew Research study suggested less than half of U.S. Protestants (46%) affirmed a belief in either doctrine, and only 30% affirmed a belief in both; another 36% did not believe in either sola fide or sola scriptura. This raises the question, are modern Protestants no longer Protestant?

A Pew study, “U.S. Protestants Are Not Defined by Reformation-Era Controversies,” found that half of American Protestants (52%) thought that both good deeds and faith in God were needed to get to heaven. The same percentage (52%) also agreed that in addition to the Bible, Christians needed guidance from church teachings and traditions. While Protestants are almost evenly split on sola fide and sola scriptura, U.S. Catholics are mostly aligned with the teachings of the Catholic Church, which affirms both of these declarations. Eighty-one percent believe both good deeds and faith in God are needed to get into heaven and 75% agree that in addition to the Bible, Christians need guidance from church teachings and traditions. “Overall, two-thirds of Catholics take the traditional positions of the church on both of these issues.”

Among Protestant subgroups, two-thirds (67%) of white evangelicals say salvation comes by faith alone, with 33% saying that both faith and good works are needed. White evangelicals also had the highest percentage of believers in both sola fide and sola scriptura (44%). See the following chart from the Pew Research Center report.

Above sola fide was said to mean: “justification is dependent upon faith alone.” This doctrine reaches back to Martin Luther and his understanding of Galatians 3:28, “For we hold that one is justified by faith apart from works of the law.” Luther’s theological insight here was the heart of his personal spiritual change and his theology that followed. In The Encyclopedia of Christianity, Notger Slenczka added the following:

This exclusion of works as a ground of justification does not mean the isolating of faith but singles out justifying faith because it receives the righteousness of Christ that is given by grace alone. The formula thus has the implication of solus Christus (Christ alone) and sola gratia (grace alone).

But here is where it gets a bit tricky theologically. The Pew study said sola fide was: “faith in God alone is needed to get into heaven,” but getting into heaven is related to salvation. The statement alone is true as far as it goes (“For by grace you have saved through faith”, Ephesians 2:8), but the problem is where Pew equated it with the Reformation principle of sola fide. In doing so, Pew confounded what has historically been a crucial theological distinction between the Protestant and Catholic understanding of the doctrine of justification by faith. In the Lexham Bible Dictionary, Michael Bird gave the following explanation of differences between Catholics and Protestants on justification by faith:

The primary debate between Protestants and Catholics is whether justification is a forensic declaration based on the imputation of Jesus’ righteousness to believers [Protestants], or based on the infusion of righteousness into the believer through the sacraments, enabling them to do works of charity by which they might be justified [Catholics]. . . . While fresh new ecumenical ground has been broken, thus far no consensus has been reached. The Catholic Catechism remains firmly committed to the teachings of the Council of Trent, which remains a barrier to any consensus emerging.

The Council of Trent stated in Chapter VII about justification: “[It] is not only a remission of sins but also the sanctification and renewal of the inward man through the voluntary reception of the grace and gifts whereby an unjust man becomes just and from being an enemy becomes a friend, that he may be an heir according to hope of life everlasting.”

In Reformed Dogmatics, Geerhardus Vos added the following aboiut the Roman Catholic understanding of justification:

The Roman Catholic church makes a distinction between a first and a second justification. The first consists in the infusion of habitual grace, by which original sin is suppressed and expelled. The formal cause of the second justification is to be sought in good works that man himself performs. This is a confusion of sanctification and justification, and makes the fruits of the former meritorious. As justification becomes sanctification, so sanctification again becomes justification in the hands of Rome—naturally, a legalistic justification.

With regard to second justification, Roman Catholicism said in the Council of Trent: “If anyone says that the justice received is not preserved and also not increased before God through good works, but that those works are merely the fruits and signs of justification obtained, but not the cause of its increase, let him be anathema.” What Roman Catholicism condemned here is the clear Protestant understanding of sola fide, justification by faith alone.

My systematic theology is not sharp enough to have picked out that problem with the Pew survey on my own. I read an article by Joe Carter for The Gospel Coalition, “New Survey Finds Majority of Protestants Are (Maybe) Not Protestant,” that brought the Pew study and how it framed sola fide to my attention. He updated his original article on the Pew survey, as he himself had missed the Pew Research Center’s “mistake.” He explained how he originally read the Pew description as referring to justification, which a theologically minded Protestant who associates sola fide and justification by faith, would do. Here is an example of what Pew said that was confusing: “For example, nearly half of U.S. Protestants today (46%) say faith alone is needed to attain salvation (a belief held by Protestant reformers in the 16th century, known in Latin as sola fide).”

As Carter pointed out, belief in sola fide was determined by how Christian respondents answered the following question in the Pew survey: “Which statement comes closer to your view, even if neither is exactly right?” Their choices were: 1) “Both good deeds and faith in God are necessary to get into heaven” and 2) “Faith in God is the only thing that gets people into heaven.” Similarly, sola scriptura was determined by how they responded to this question: “Which statement comes closer to your view, even if neither is exactly right?” Their choices were: 1) The bible provides all the religious guidance Christians need” and 2) In addition to the Bible, Christians also need religious guidance from church teachings and traditions.” See the “Survey Questionnaire” attached to the Pew Research Center article on the survey.

Carter went on to indicate he thought there was a priming bias in how the survey questions here were worded, meaning “the types of questions that are asked tend to prime a respondent to assume later questions are of the same type.” This led him to conclude that respondents were set up to look for a distinction between what Protestants and Catholics believe. His own mistake was evidence of that. “ I was primed to follow Pew’s reasoning even though when I wrote this article I was explicitly on the lookout for the effects of priming on the survey results.”

He concluded that it was impossible to know based on these results how many people are “pseudo-Protestants” and how many (like him) were reading too much into the survey questions. “The conclusion I draw is that some people were reading the question as I did as being about justification, while many others were seeing it as merely about salvation.” Given this confusion, it might be helpful to have a more comprehensive discussion of sola fide.

In his article for Themelios, “Is the Reformation Over?” Scott Mantesch noted how John Calvin believed the doctrine of justification held an essential place in the Christian gospel. He also believed it was one of the most significant issues separating Protestants and Catholics, saying it was “the first and keenest subject of controversy between us.” While Calvin emphasized that justification must be distinguished from regeneration or sanctification, he still insisted that justifying faith necessarily resulted in spiritual renewal and growth in godliness. While it is faith alone that justifies, “yet the faith which justifies is not alone.” Calvin said:

As God justifies us freely by imputing the obedience of Christ to us, so we are rendered capable of this great blessing only by faith alone. As the Son of God expiated our sins by the sacrifice of his death, and by appeasing his Father’s wrath, acquired the gift of adoption for us, and now presents us with his righteousness, so it is only by faith we put him on, and become partakers of his blessings.

Not only is justification by faith doctrinally important, it is pastorally vital. In order to illustrate this point, Thomas Schreiner, who, wrote Faith Alone: The Doctrine of Justification, asked when we stand before God on Judgment Day, what will we plead before him? “Will we plead our own righteousness and goodness?” The doctrine is not a matter of indifference.

Thomas Schreiner is a New Testament professor at Southern Baptist Theological Seminary. At a 2015 Theology Conference on The Five Solas, he read a paper summarizing his book. All the papers presented at the conference can be found here, in an edition of The Southern Baptist Journal of Theology. There is also a link to a video of Schreiner’s presentation under The Gospel Coalition’s page on The Five Solas.

He said the shorthand phrase of sola fide, meaning justification by faith alone, “summarizes in short form the theology that has been hammered out exegetically, historically, and theologically.” An untutored individual may think this means that good works are not necessary or important. But when most advocates say that justification is by faith alone, they quickly add that such faith is never alone. “Hence, when they affirmed that justification was by faith alone, they were ruling out the notion that our works were a basis of justification. So, the slogan justification by faith alone is useful as long as it is rightly understood.”

When we speak of justification by faith alone, we aren’t saying that our faith justifies us. We see here how the five solas are closely linked together, for righteousness is by faith alone because our righteousness is in Christ alone as the crucified and risen one. And if our righteousness is by faith alone and in Christ alone, then it is by grace alone since our works don’t constitute our righteousness. And our righteousness is also to the glory of God alone since he is the one who has accomplished our salvation. Justification by faith alone doesn’t call attention to our faith but to Christ as the redeemer, reconciler, and Savior. [As an aside in the video, Schreiner noted he didn’t mention sola Scriptura. “But everything I said supported that.”]

Schreiner observed that Roman Catholics believe that justification comes in part from our adherence to the moral law. They will point out that the Scriptures only address whether justification is by faith alone once in James 2:24 in the negative: “You see that a person is justified by works and not by faith alone.” But Schreiner argued that in James 2:14-26, James is rejecting a saying faith, a faith where works are absent. “It is this kind of faith that doesn’t save, for it is a faith marked by intellectual assent only.” When James says faith without works doesn’t save, he is thinking of a “dead” faith (2:17, 26), a useless or idle faith (2:20).

But genuine faith, a faith that embraces all that God is for us in Jesus Christ, saves, and such a faith inevitably produces works. But this accords what we mean when we speak of sola fide. We are justified by faith alone and yet our faith is never alone.

The problem may have been that Pew researchers believed (in all likelihood correctly) that the typical person taking the survey would not have previously heard of, or understood, the differences between the Catholic and Protestant views of sola fide, the doctrine of justification by faith alone. So they redefined sola fide as described above, and chose to not use the term “sola fide” in the questionnaire. Apparently Pew thought the phrase: “Which statement comes closer to your view, even if neither is exactly right,” was enough to guide those individuals who did understand the classic sense of sola fide to their redefinition. Given Joe Carter’s confusion and that of others (See the endnote “correction” for Sarah Eekhoff Zylstra’s article on the same Pew survey in Christianity Today), it was not.

If Carter and other Protestants could misread or confuse the Pew “mistake” with sola fide, doesn’t that add further validity to the point of the Pew article? Namely, there may be a significant number of American Protestants who are Protestant in name, but not necessarily Protestant in theology. What then does it mean to be “Protestant” in theology, and how does that differ from Roman Catholicism? We’ll examine these questions in Part 2 of this article.

12/15/17

Head of a Snake

As a result of a Washington Post and “60 Minutes” investigation, Representative Tom Marino withdrew his name from consideration for the position of “drug czar,” Director of National Drug Policy. As the investigation showed, Marino had been the primary force behind what became the “Ensuring Patient Access and Effective Drug Enforcement Act of 2016.” Marino spent several years trying to get the legislation through Congress, and was finally successful when Senator Orin Hatch negotiated a final version of the bill with the DEA. What wasn’t readily apparent by the title of the bill—and sunk Marino’s chances of approval as the new drug czar—was that instead of ensuring effective drug enforcement, it hobbled the DEA’s ability to go after the drug companies suspected of enabling the widespread distribution of prescription pain medication.

The law was the crowning achievement of a multifaceted campaign by the drug industry to weaken aggressive DEA enforcement efforts against drug distribution companies that were supplying corrupt doctors and pharmacists who peddled narcotics to the black market. The industry worked behind the scenes with lobbyists and key members of Congress, pouring more than a million dollars into their election campaigns.

The DEA had opposed the legislation for years, but was finally outmaneuvered by the nation’s major drug distributors and a few members of Congress. The new law made it effectively impossible for the DEA to stop suspicious narcotic shipments from the companies. Despite being fined, some drug distributors had repeatedly ignored warnings from the DEA to shut down suspicious sales. “Overall, the drug industry spent $102 million lobbying Congress on the bill and other legislation between 2014 and 2016, according to lobbying reports.” Through various political action committees, the drug industry contributed over $1.5 million dollars to the 23 lawmakers who sponsored or co-sponsored four versions of the bill. Marino received $100,000; Hatch $177,000. See the following chart from the Washington Post article.

The drug industry, the manufacturers, wholesalers, distributors and chain drugstores, have an influence over Congress that has never been seen before,” said Joseph T. Rannazzisi, who ran the DEA’s division responsible for regulating the drug industry and led a decade-long campaign of aggressive enforcement until he was forced out of the agency in 2015. “I mean, to get Congress to pass a bill to protect their interests in the height of an opioid epidemic just shows me how much influence they have.

Besides the sponsors and co-sponsors, few lawmakers knew what the impact of the bill would really be. Apparently, the same was true for the White House as President Obama signed it into law without any comment. “It sailed through congress and was passed by unanimous consent, a parliamentary procedure reserved for bills considered to be noncontroversial.” Michael Botticelli, who was the drug czar at the time, said neither the DEA nor the Justice Department objected to the bill at the time, which removed a major obstacle to the president’s approval. All this suggests there was some serious behinds-the-scene maneuvering going on. “Neither the DEA nor the Justice Department informed OMB about the policy change in the bill.”

The DEA’s top official at the time, Chuck Rosenberg, declined repeated requests for interviews by the Washington Post and “60 Minutes”; as did Loretta Lynch, then the attorney general and Tom Marino. A spokesperson for former President Obama referred reporters to Botticelli’s statement. Additionally, the DEA and Justice Department repeatedly denied or delayed over a dozen requests filed by the Washington Post and “60 Minutes” under the Freedom of Information Act for public records that could give additional information on what happened. “Some of those requests have been pending for nearly 18 months.”

Another key player in the “Ensuring Patient Access and Effective Drug Enforcement Act of 2016” was a former associate chief counsel for the DEA, D. Lindon Barber. While working for the DEA, he helped design and implement the early phases of the agency’s enforcement campaign against drug companies that were failing to report suspicious orders of opioids. Barber was also one of dozens of DEA officials recruited by the drug industry over the past decade. He brought first hand knowledge of the DEA’s strategy and how it could be countered when he went over to the drug industry in 2011. According to an internal Department of Justice email, Barber has a central role in crafting early versions of the legislation. “’He wrote the Marino bill,’ the official wrote in 2014.”

With a few words, the new law changed four decades of DEA practice. Previously, the DEA could freeze drug shipments that posed an “imminent danger” to the community, giving the agency broad authority. Now, the DEA must demonstrate that a company’s actions represent “a substantial likelihood of an immediate threat,” a much higher bar. “There’s no way that we could meet that burden, the determination that those drugs are going to be an immediate threat, because immediate, by definition, means right now,” Rannazzisi said.Today, Rannazzisi is a consultant for a team of lawyers suing the opioid industry. Separately, 41 state attorneys general have banded together to investigate the industry. Hundreds of counties, cities and towns also are suing.“This is an industry that’s out of control. If they don’t follow the law in drug supply, and diversion occurs, people die. That’s just it, people die,” he said. “And what they’re saying is, ‘The heck with your compliance. We’ll just get the law changed.’”

Sadly, the limitations placed upon the DEA by the “Ensuring Patient Access and Effective Drug Enforcement Act of 2016” were reported by the LA Times soon after the law was passed in 2016, but no consequences occurred until the Washington Post and “60 Minutes” investigation led to Marino withdrawing his name for the position of drug czar. The LA Times noted how the law was backed by some of the same wholesalers, manufacturers and pharmacy chains targeted by the DEA for not doing enough to monitor and restrict the overflow of pills. The stalled legislation also moved through Congress after the resignation of Joseph Rannazzisi from the DEA in October of 2015. He left, in part, because of his view that the bill was “misguided and would worsen the epidemic.” He said: “They are taking the word of industry rather than the government’s expert in diversion control.”

In 2012 the DEA took action against a major national wholesaler of pharmaceuticals and medical products, Cardinal Health, Inc. Data had shown enough pain medication was supplied to two CVS pharmacies in Sanford FLA for every person in the small city to have 59 doses. The DEA accused Cardinal and CVS of failing to maintain “effective controls” against diversion. “Cardinal was banned from shipping prescription drugs from a Florida facility for two years and CVS paid a $22-million settlement.” Note that CVS lobbying expenditures above were $32.5 million, second only to PHRMA, a trade group representing companies in the pharmaceutical industry.

The above are only the most notable and recent actions of the venomous pharmaceutical lobby. The Milwaukee Journal Sentinel published a two-part article on how drug makers work behind the scenes fighting against measures aimed at fighting the tide of prescription painkillers flooding our nation. Part 1 said there is a state level strategy where “hundreds of lobbyists and millions of dollars in campaign contributions” are used to weaken or kill measures aimed at turning back the opioid epidemic. The Associated Press and the Center for Public Integrity found they often use funded advocacy groups to fight limits of drugs such as OxyContin, Vicodin and fentanyl.

Between 2006 and 2015, drug makers spent more than $880 million nationwide on lobbying and campaign contributions — more than 200 times what those advocating for stricter policies spent. For comparison, it’s also more than eight times what the formidable gun lobby recorded for advancing its agenda through similar activities during that same period.

There have been hundreds of opioid-related bills introduced at the state level over the past few years. The few groups fighting for tighter prescription restrictions are primarily grass roots organizations formed by family and friends of individuals killed by opioids. “Together, they spent about $4 million nationwide at the state and federal level on political contributions and lobbying from 2006 through 2015 and employed an average of eight state lobbyists each year.” Compared to estimated lobbying of drug companies, they are being outspent 220 to one.

Part 2 of the Journal Sentinel article highlighted the efforts of a little-known group called the Pain Care Forum. The organization has worked at both the national and state level to communicate the message of the vital role played by painkillers in the lives of millions of Americans. The Pain Care Forum is a loose coalition of drug-makers, trade groups and nonprofits supported by industry funding. A 2012 Pain Care Forum “Meetings Schedule” listed about 64 participating organizations, a mix of medical organizations, advocacy groups and pharmaceutical companies. Among the pharmaceutical companies were: Abbott Laboratories, Allergan, Eli Lily & Company, Endo Pharmaceuticals, Johnson & Johnson, Merck, Purdue Pharma LP, and Teva.

From 2006 through 2015, participants in the Pain Care Forum spent more than $740 million lobbying in the nation’s capital and in all 50 statehouses on an array of issues, including opioid-related measures, according to an analysis of lobbying filings by the Center for Public Integrity and the AP.The same organizations reinforced their influence with more than $140 million doled out to political campaigns, including more than $75 million alone to federal candidates, political action committees and parties.

Purdue’s Washington lobbyist co-founded the Pain Care Forum and coordinates the group’s meetings. The Pain Care Forum doesn’t have an online presence or a physical address, yet it hosts high-ranking officials from the White House, the FDA and other agencies at its monthly gatherings. While Forum members maintain it does not take policy positions, the AP and Center for Public Integrity have shown where the group’s participants worked together “to push and draft federal legislation, blunt regulations and influence decisions around opioids.” A major talking point is the false assumption of a conflict between reducing our dependence on opioids and improving care for patients with pain. “It’s an artificial conflict, but there are lots of vested interests behind it.”

Tom Marino will not be the new “drug czar,” and hopefully the media attention recently received by “Ensuring Patient Access and Effective Drug Enforcement Act of 2016” will result in Congress restoring the enforcement power to the DEA that the legislation removed. But since some legislators have been seduced by pharmaceutical money and influence, Congress may not have the collective will to resist the lobbying influence of Pharma companies. Therein lies the problem: how can you cut off the head of a snake if you depend on the snakes?

12/12/17

Greed with OxyContin is NOT Good

The health insurer Cigna announced that effective January 1, 2018, it will no longer cover OxyContin as a preferred medication. The company is in the process of notifying customers with current OxyContin prescriptions and their doctors of the upcoming change. Individuals who have begun using OxyContin for hospice care or cancer treatments will continue to be covered through 2018. If a doctor believes the use of OxyContin is medically necessary, Cigna will consider approving coverage. Needless to say, Purdue Pharmacy, the manufacturer of OxyContin, disagrees with the Cigna decision.

Cigna will offer an oxycodone equivalent medication with abuse deterrent properties, Xtampza ER with Collegium Pharmaceuticals. Collegium signed a “value-based contract” with Cigna, which will hold the company financially accountable if average daily dosage strengths of Xtampza ER prescribed for Cigna customers exceed a specific threshold. If the threshold is exceeded, Collegium will reduce the cost of the medication. “Linking financial terms to dosage metrics may encourage more education to prevent overprescribing.”

The Fix reported a Purdue spokesperson said there were few differences between OxyContin and Xtampza ER. “Unfortunately, Cigna’s decision limits the tools prescribers can use to help address the opioid crisis as both products are formulated with properties designed to deter abuse.” Cigna responded by saying the point is to change prescription practices. “The insurer hopes that doctors will begin to prescribe drugs like Xtampza ER ‘in lesser quantities and for lesser amounts of time.’”

Cigna’s decision comes in the midst of increasing pressure on Purdue Pharmacy for their aggressive, and at times illegal marketing practices of OxyContin. The pharmaceutical company came under scrutiny partly because of a series of investigative reports by the LA Times that noted a series of issues. The issues including how Purdue Pharma knew pain relief with OxyContin did not last the 12 hours as it claimed; but the company continued to insist the drug did last, in part, to protect its revenue. When doctors complained about the duration, Purdue instructed them to prescribe stronger, not more frequent doses. “OxyContin’s market dominance and premium price hinge on its 12-hour duration.” Purdue allegedly knew of this issue for more than twenty years.

For years, Purdue Pharma lied to federal regulators and the public about the addictiveness of OxyContin and countless patients got hooked on this deadly painkiller. We need to know if Purdue once again lied about the longevity of OxyContin’s pain-relieving properties and hold Purdue accountable.

Additionally, Purdue knew OxyContin was being overprescribed and illegally trafficked, but in many cases, did nothing about it. With one such operation, Lake Medical, Purdue did not stop supplying OxyContin and did not tell authorities what it knew for several years until the clinic was out of business and its leader indicted. By that time, 1.1 million pills has been put on the street.

A Los Angeles Times investigation found that, for more than a decade, Purdue collected extensive evidence suggesting illegal trafficking of OxyContin and, in many cases, did not share it with law enforcement or cut off the flow of pills. A former Purdue executive, who monitored pharmacies for criminal activity, acknowledged that even when the company had evidence pharmacies were colluding with drug dealers, it did not stop supplying distributors selling to those stores.

In 2015 Kentucky received $24 million from Purdue to settle the state’s 2007 against the company over their allegedly illegal promotion of OxyContin. As is usual in cases where pharmaceutical companies settle outside of court, they requested the records gathered in the court case be sealed and destroyed. In this case, there were 17 million pages of documents, including a deposition of Dr. Richard Sackler, the former president of Purdue Pharma and a member of the family who owns the privately held company. As part of the agreement, the Kentucky attorney general destroyed its copies of the documents provided by Purdue. However, copies of several key documents, including the Sackett deposition, filed under seal at the Pike County court, were not destroyed.

STAT News learned of the existence of these documents and filed a motion in March of 2016 to unseal the documents. In May of 2016 a Kentucky judge ordered that the documents be unsealed by June 12^th. The judge said he would stay the release of the records if there was an appeal filed before then. As of June of 2017, the documents were still not released. Purdue appealed the ruling to the Kentucky Court of appeals and although the appeals court said it expected to rule on the matter by the end of August, there was still no announcement by the middle of October.

The President of the Kentucky state Senate planned to file a motion to support the efforts by STAT to unseal the documents, saying that shielding the records from public view was “inappropriate.” He acknowledged his request to intervene could be unsuccessful, and it seems that it was. He thought the documents could help evaluate whether the $24 million payment from Purdue was a good settlement for Kentucky. “Two prior attorneys general valued the case at between $100 million and $1 billion.” Senate President Robert Stivers was concerned the state settled for “pennies on the dollar.”

Purdue was already pivoting to go overseas with its marketing strategy by 2011. With the growing concern over the opioid crisis in the U.S. and the awareness of the role OxyContin played in it, prescriptions fell by almost 40% since 2010, meaning billions in lost revenue for Purdue. Again, the LA Times documented this market expansion by Purdue in a December 2016 article, “OxyContin Goes Global.” Using a network of international companies owned by the Sackler family, Purdue Pharma is moving rapidly into Latin America, Asia, the Middle East, Africa and other regions. “In this global drive, the companies known as Mundipharma, are using some of the same controversial marketing practices that made OxyContin a pharmaceutical blockbuster in the U.S.”

In 2011, operations were started in China, Russia, Turkey, Hong Kong and South Africa. 2013 saw activity in Indonesia, Vietnam, Thailand and Taiwan. Dubai, Brazil, Columbia and Spain came on board in 2014. Lebanon and Portugal opened operations in 2015; Argentina in 2016. Chile, Ecuador, Peru, Uruguay and Venezuela plan to launch operations in the near future. There is an interactive map on “OxyContin Goes Global” that graphically illustrates this expansion.

In Brazil, China and elsewhere, the companies are running training seminars where doctors are urged to overcome “opiophobia” and prescribe painkillers. They are sponsoring public awareness campaigns that encourage people to seek medical treatment for chronic pain. They are even offering patient discounts to make prescription opioids more affordable.

Like the initial marketing of OxyContin in the U. S., some Mundipharma representatives and promotional material minimize the risks that patients will become addicted to opioid medications. While U.S. public health officials were warning of the growing pain killer threat in 2015, a Mundipharma executive in Seoul South Korea was saying doctors there worry too much about addiction: “Many studies have shown that it’s almost impossible for those with chronic or severe pain to become addicted to narcotics, as long as the drug is used for pain relief.” The opioid problem in the U.S. is said to be largely due to recreational abuse of the drugs.

“That is exactly the same thing they were teaching U.S. physicians when they launched OxyContin in this country,” said Sharon Walsh, an addiction expert who advises the FDA on risks from pain medications.

Mundipharma uses consultants (referred to as thought leaders in the U.S.), as did Purdue and other pharma companies, to overcome this opiophobia among doctors reluctant to prescribe narcotics. Top company officials have said their success in new markets depends on defeating this mind-set.

In Spain, Mundipharma used a series of actors, musicians and models in a campaign against chronic pain. “Ebélate contra el dolor (Rebel against the pain).” The ads did not recommend a specific medication, but urged viewers to seek out a healthcare professional (call your doctor?). “The campaign is part of a strategy to redefine back pain, joint aches and other common conditions as a distinct malady — chronic pain — that doctors and patients should take seriously.” Mundipharma sales were up seven-fold since 2007.

Around the world, Mundipharma companies cite statistics suggesting there is a great unmet need for their products. Opening an office in Mexico in 2014, Mundipharma officials declared that 28 million citizens were suffering from chronic pain. In Brazil, the company cited a figure of 80 million. In Colombia last year, a company news release said 47% of the population — about 22 million people — were afflicted by ‘this silent epidemic.’”

Meanwhile, back in the US, the lawsuits against Purdue Pharma just keep on coming. In May of 2017 the NYT reported Purdue and three current and former executives pleaded guilty in federal court to criminal charges “that they misled regulators, doctors and patients” about the drug’s addiction risk and potential for abuse. In order to resolve criminal and civil charges stemming from the drug’s “misbranding,” Purdue agreed to pay $600 million, one of the largest amount ever paid by a drug company in such cases. Three executives, including its president and its top lawyer pleaded guilty as individuals to misbranding, which is a criminal violation. “They agreed to pay a total of $34.5 million in fines.”

Purdue Pharma acknowledged in the court proceeding today that “with the intent to defraud or mislead,” it marketed and promoted OxyContin as a drug that was less addictive, less subject to abuse and less likely to cause other narcotic side effects than other pain medications.

Reuters reported that New Hampshire announced in the beginning of August of 2017 that it was suing Purdue for engaging in deceptive marketing practices. The lawsuit followed similar cases against Purdue and other pharmaceutical companies by Oklahoma, Mississippi, Ohio and Missouri and several cities and counties in California, Illinois, Ohio, Oregon, Tennessee and New York.

A week later, South Carolina filed suit against Purdue Pharma, according to Reuters. Again the company is accused of unfair and deceptive marketing of opioid painkillers. South Carolina had been part of a 2007 settlement when Purdue and three executives pleaded guilty to federal charges of misbranding OxyContin. In the August 2017 lawsuit, “South Carolina claimed that since the 2007 settlement, Purdue has continued to engage in misleading opioid marketing practices rather than reforming them to conform with the law.”

In the 1987 movie Wall Street, Michael Douglas as Gordon Gekko famously said, “Greed, for lack of a better word, is good.” He went on to claim that greed captured the essence of the evolutionary spirit. “In all of its forms; greed for life, for money, for love, knowledge has marked the upward surge of mankind.” At the end of his speech, he was applauded. The greed of Purdue Pharma and the Sackett family, which privately owns Purdue Pharma and OxyContin, is not good. Their unrestrained greed has contributed to the current opioid epidemic in the U.S., despite the denials of the company. And now they want to export the same drug and marketing strategy to the world.

12/8/17

Room for Differences on Creation

Tim Keller stepped down as the Senior Pastor for Redeemer Presbyterian Church in New York City in July of 2017. Redeemer also split into multiple congregations, “actualizing our long-stated plan of shifting from being a single large church with multiple congregations to becoming a family of smaller churches.” Keller said his new role would be as a teacher and trainer for the next generation of leaders and pastors within the Redeemer family of churches. “The gospel is a living force, always sending and giving—and as I am sent in a new way now, so is every member of Redeemer, to love and serve this great city.” And yet he has been smeared as having such a low view of Scripture and creation, “that he goes out of his way to promote the false doctrine of theistic evolution.”

The above is the stated opinion of E.S. Williams in “Keller’s false gospel” on The New Calvinists website. Williams has also written a book titled The New Calvinists, which critiques Keller and others. Williams claims in the subtitle of his book these pastors are changing the gospel. In another article on The New Calvinists bashing Keller (there are several), “Keller’s theistic evolution,” Williams distorts Keller’s position by saying he believes the Bible must be made to conform to the ‘truth’ of science. “Keller does this by asserting [in The Reason for God] that the first chapter of Genesis is a poem.” He is certainly not the only critical source of Keller on his understanding of Genesis one and whether theistic evolution can be affirmed by those with a high view of Scripture.

Ken Ham, the founder of Answers in Genesis (AiG), has also been critical Tim Keller. He said: “It is so sad to see a great Bible teacher like Tim Keller promote belief in evolution to the church.” Ham contends Keller and others have misunderstood what he and Answers in Genesis are saying in relation to the loss of biblical authority. According to Ham, this is the result of “contributing to undermining the authority of the Word of God by accommodating man’s ideas of evolution or millions of years into Genesis.” He believes there has been “an increasing generational loss of Biblical authority because so many in the church have opened the door to compromise beginning in Genesis.”

Within a document, “Where Do We Draw the Line?,” AiG said it is made up of “Christians who unite to defend the authority of the Bible in today’s secular culture.” That is what they say they are about—“the authority of the Bible, often in Genesis.” An example of how the issue of Biblical authority is understood by AiG has to do with the age of the earth.

For example, the secular world has been teaching that the earth is billions of years old. The Bible, based on genealogies recorded throughout the Scriptures and the context of the Hebrew word yom (day) in Genesis 1, reveal that the earth is thousands of years old. So, this question becomes a biblical authority issue. Is one going to trust a perfect God who created all things (Genesis 1:1), has always been there (Revelation 22:13), knows all things (Colossians 2:1–3), and cannot lie (Hebrews 6:18), or trust imperfect and fallible humankind who was not there and speculates on the past?

In the original AiG article, you can see links that elaborate their understanding of “genealogies,” the “context” of the Hebrew word yom (day), and whether the earth is “thousands of years old.” There is also a chart that lists “a sampling of biblical authority topics” such as the age of the earth, evolution and whether or not Noah’s flood was global or local as issues of biblical authority. AiG said the Bible does not teach the earth is millions of years old; that man was specially created from dust and the woman from the man. An evolutionary worldview says humanity came from an ape-like ancestor. And Genesis 6-8 affirms the Flood was global, covering the highest mountain by over 15 cubits. “Those appealing to a local Flood trust secular authorities who say that the rock layers are evidence of millions of years instead of mostly Noah’s Flood sediment.”

Additional examples of topics on biblical authority in the chart include the Trinity and racism. The article went on the say: “Basically, AiG is involved when any issue impacts the authority of Scripture—especially when human claims run counter to what God teaches.” What seems clear is that AiG’s position is that any Christian seeking to affirm the authority of Scripture necessarily has to acknowledge an understanding of Genesis that aligns with its own position. AiG believes the age of the earth is in the neighborhood of thousands, not millions, of years; that there was a global flood covering the highest existing mountains of the time of Noah; and that humans were specially created out of dust. Tim Keller and other Christians who allow for or teach any views that do not agree with this understanding of Genesis are therefore undermining the authority of the word of God.

The weight given to these positions is seen clearly in the AiG Statement of Faith, last updated on August 10, 2015. In order to preserve the function and integrity of the ministry “in its mission to proclaim the absolute truth and authority of Scripture,” employees and volunteers should abide and agree to the AiG Statement of Faith. Board members for the AiG ministry must hold to the following six tenets:

Scripture teaches a recent origin for man and the whole creation, spanning approximately 4,000 years from creation to Christ.
The days in Genesis do not correspond to geologic ages, but are six [6] consecutive twenty-four [24] hour days of creation.
The Noachian Flood was a significant geological event and much (but not all) fossiliferous sediment originated at that time.
The gap theory has no basis in Scripture.
The view, commonly used to evade the implications or the authority of biblical teaching, that knowledge and/or truth may be divided into secular and religious, is rejected.
The view, commonly used to evade the implications or the authority of biblical teaching, that knowledge and/or truth may be divided into secular and religious, is rejected.

While Ham and AiG does not go as far as E.S. Williams in claiming Keller and others are promoting a false gospel, Ham and AiG do seem to believe that if Keller and others disagree with the AiG understanding of Genesis on creation, the age of the earth, and whether the Noachian Flood was local or global, they have a low view of Scripture. A recent origin for humans and creation (approximately 4,000 years from creation to Christ), six 24 hour days for creation, and a global, Noachian Flood are non-negotiable beliefs about creation, according to AiG.

The Gospel Coalition (TGC), an evangelical ministry founded by Tim Keller and Don Carson, posted a video discussion between Tim Keller, Ligon Duncan and Russell Moore on what is necessary to be believed; what are the non-negotiable beliefs about creation. Both Duncan and Moore are council members for TGC.

Keller led off the dialogue on the essentials of what has to be believed about the Bible when talking to nonbelievers. Keller said the relationship of God to the creation—the Creator/creation distinction—should be stressed. He said nonbelievers may want to talk about creation as a religion versus science battle, but he suggested to not go there. “The relationship of creation to evolution isn’t the heart.” There are at least four, five or six orthodox Christian views of evolution, according to Keller. “But let’s not go there at first.”

Duncan said he’d want to tell the skeptical, intelligent unbeliever that Christianity and science are not in conflict. Protestant Christianity laid the philosophical foundation for the rise of science.

Within the church, Duncan thought the essentials or boundaries of what we have to agree on in order to recognize each other as orthodox are: creation ex nihilo, the goodness of creation and the special creation of Adam and Eve. By creation ex nihilo, Duncan meant there is a Creator-creature distinction—God was the Cause of everything else. Adam and Eve have to be acknowledged as the fountainhead of humanity to support the federal headship of Adam to have the Adam-Christ parallel for the gospel.

Keller said he would want to talk first about the first two points, the Creator-creature distinction and the goodness of creation, with a nonbeliever. With a Christian, he said he would discuss Adam and Eve, saying there are a lot of different understandings about how old the earth is, what the days are in Genesis 1, and to what degree evolution was a part of how God created things. “But where I would stop is, with Adam and Eve.” Keller said there had to be an actual Adam and Eve, otherwise he doesn’t understand how the Pauline view of salvation in Romans 5 works.

He acknowledged that the consensus, even among Christian scientists, is that all human beings were not genetically related to a human couple. It had to be a little group of people somewhere in sub-Saharan Africa. “But when I read the text … it sure looks like it’s saying that God created Adam and Eve. And he didn’t just adopt … a human-like being and put in the image of God.” Keller said the text said he created them out of the dust of the ground. He thought he had to let his reading of the text correct his understanding of the sciences.

Science is a way of telling me truth. And the Scripture is a way of telling me truth. But if they are clashing, even though I know the science might show me I’m reading the Scripture wrong, and that has happened in the past, where the science came in and said “Are you really … does the Bible really teach that the sun revolves around the earth? So it’s possible for the science to make you ask, “Did you read the text right?” But if you go back and read the text and you come to your conclusion, that as far as you can say before God “I’m trying my best to read this as I think what the Scripture says.” Right now it says to me, … and everyone came from Adam and Eve and they were special creations. And so even though I don’t have an answer to my science friends, that’s where I stand.

I don’t think Tim Keller compromised biblical authority in what he said; nor did he preach a false gospel. I do see him saying belief in the authority of the Bible has room for differences on how to interpret Genesis 1 and whether the age of the earth is 6,000 years. It may even have room for some form of evolution. AiG and E.S. Williams vehemently deny this possibility. AiG has linked a denial of evolution, a localized flood, and an age for the earth and creation around 6,000 years with the Trinity and racism as key issues of biblical authority. So it doesn’t seem they would stand with Keller or any other Christian—which includes me—who won’t affirm their understanding of Genesis. For more articles on creation in the Bible, see the link “Genesis & Creation.”

12/5/17

Pick Your Poison: Diabetes and Psych Meds

The American Diabetes Association said 30.3 million Americans, 9.4% of the population, had diabetes in 2015. There are 1.5 million news cases of diabetes diagnosed each year. It is the 7^th leading cause of death in the U.S. with 79,535 death certificates in 2015 listing it as the underlying cause of death. A total of 252,806 death certificates listed diabetes as an underlying or contributing cause of death. If the number of deaths from diabetes were equal to 252,806, it would be the third leading cause of death in the US, according to the CDC … and psych meds increase the risk for diabetes.

SSRIs have been associated with an increased risk of diabetes, as Yoon et al. noted in “Antidepressant Use and Diabetes Mellitus.” The researchers ruled out depression itself as a potential confounding variable in the relationship between antidepressants and diabetes. Their findings suggested that antidepressant drug treatment and not the depression increased the risk of diabetes mellitus (DM). “Given the widespread use of antidepressants, the implications of the increased risk are serious.”

The authors noted that while there is disagreement as to the reason for the association between antidepressant use and DM risk, some studies “propose that antidepressants may bio-pharmacologically affect glucose homeostasis and insulin sensitivity.” In “Use of Antidepressants Linked to Diabetes,” Peter Simons of Mad in America noted a study that has supported that hypothesis. A study led by Raymond Noordam and published in The Journal of Clinical Psychiatry, found the use of SSRIs in nondiabetic participants was associated with lower insulin secretion and an increased risk of insulin dependence in type 2 diabetes in older adults.

It is biologically plausible that SSRIs decrease insulin secretion and that this might, therefore, be a mechanism underlying the previously observed association between SSRIs and increased risk of type 2 diabetes. Consequently, type 2 diabetes patients treated with SSRIs might also have a higher risk to develop insulin dependence, a condition associated with an increased risk of mortality.

The researchers also found that participants already diagnosed with diabetes who were taking antidepressants were twice as likely to start insulin treatment than those who did not take antidepressants. They said: “our data might suggest that progression of type 2 diabetes during the use of SSRIs is accelerated.” Simons commented how the higher mortality rate for individuals who require insulin treatments made this “a particularly alarming finding.”

This new study provides additional convincing evidence that although SSRIs are commonly believed to have fewer risks of adverse effects than TCAs, they still carry significant risk. This appears to be particularly relevant when it comes to patients with diabetes. Whenever antidepressant medication is considered, patients and prescribers should carefully weigh the potential risks and benefits.

There was an updated meta-analysis published in PLos One, “The Risk of New-Onset Diabetes in Antidepressant Users.” Their meta-analysis found an increased risk factor of 1.27 between exposure to antidepressants and new-onset diabetes. When they restricted the analyses to higher quality studies, the relative risk was higher. The researchers noted their findings were in line with two previous meta-analyses that reported “a 1.5-fold increase of diabetes among AD [antidepressant] users.” In an interview with Endocrinology Advisor, the lead investigator of the study extrapolated that given a 13% prevalence rate of antidepressant use in the US, a 1.3-fold increase in diabetes risk would translate to over 1 million cases of diabetes that could be due to concurrent antidepressant use.

Pharmacy Times reported in “Atypical Antipsychotic-Induced Type 2 Diabetes” that patients with schizophrenia were at an increased risk of developing metabolic disorders like type-2 diabetes mellitus (T2DM). Schizophrenic patients had a number of risk factors for T2DM, including family history, increased body mass index (weight gain), a sedentary lifestyle and the use of atypical antipsychotics. There have been several proposed mechanisms for the association of diabetes and atypical antipsychotics, one being the weight gain associated with the medications.

A 2006 study by Alvarez-Jiménez et al. found that 78.8% of patients taking atypical antipsychotics experienced a weight gains greater than 7%, the cut off for clinically meaningful weight gain in the study. In 2004 the FDA required a warning be placed in the medication guides of all atypical antipsychotics warning of the increased risk of hyperglycemia and diabetes.

Patients with schizophrenia are at increased risk of developing metabolic disorders like type 2 diabetes. This is due to a number of factors, including the treatment of schizophrenia with atypical antipsychotics. There are several potential mechanisms behind antipsychotic-induced diabetes, including the weight gain associated with these medications, the effects on pancreatic receptors and/or glucose transporters, or some other cause not yet discovered. Most likely, it is a combination of these effects. Of the atypical antipsychotics, clozapine [Clozaril] and olanzapine [Zyprexa] are associated with the highest incidence of metabolic dysfunction, whereas ziprasidone [Geodon] and aripiprazole [Abilify] are considered to be the least risky.

In “Antipsychotic-Induced Diabetes Mellitus” published in U.S. Pharmacist, Chhim et al. reported there are several metabolic consequences with antipsychotic use, including weight gain, hyperglycemia (abnormally high blood glucose) and dyslipidemia (an abnormal amount of triglycerides, cholesterol and/or fat phospholipids in the blood). The association of type 2 diabetes mellitus (T2DM) and antipsychotic use is supported by retrospective epidemiologic studies as well as post-marketing assessment. Data indicate the prevalence of diabetes and obesity is 1.5 to 2 times higher in people diagnosed with schizophrenia or affective disorders than the general population.

The authors noted that diabetes was reaching epidemic proportions worldwide, and the contributions of medications to the development of hyperglycemia and other metabolic problems was getting more attention. “Pharmacists are in a unique position to counsel and encourage appropriate self-monitoring in patients receiving certain drugs, such as antipsychotics, that can contribute to the development of weight gain, hyperglycemia, and dyslipidemia.” They can encourage patients to report adverse events to other health care providers and seek therapeutic substitutions, counseling, and/or treatment for the adverse events.

Another resource addressing these concerns, one that was cited in “Antipsychotic-Induced Diabetes Mellitus,” is the “Consensus Development Conference on Antipsychotic Drugs and Obesity and Diabetes.” This is a joint consensus statement from the American Diabetes Association, the American Psychiatric Association, the American Association of Clinical Endocrinologists, and the North American Association for the Study of Obesity to help reduce the risk of developing diabetes, cardiovascular disease, and other complications of diabetes.

There was a large longitudinal study done in Denmark by Rajkumar et al. that found in addition to the high risk for diabetes conferred by schizophrenia on individuals, “the risk is further increased by both first-generation and second-generation antipsychotics.” Reporting on the study for Mad in America, Bernalyn Ruiz said the authors said the prevalence of diabetes was 4 to 5 times greater in people diagnosed with schizophrenia. “After adjusting for potential confounders, the risk was elevated threefold compared to those without a schizophrenia diagnosis.” No differences were seen between first-generation and atypical antipsychotics.

This large nationwide study confirmed endogenous risk for diabetes among individuals diagnosed with schizophrenia, with risks increasing significantly when antipsychotics are prescribed.

The bottom line is that in addition to their other adverse effects, there is credible scientific evidence that antidepressants and antipsychotics increase the risk of diabetes among individuals taking them. So when you’re advised to use one of these classes of psychiatric medications, it’s a bit like being asked to pick your poison.

12/1/17

Snorting Chocolate

You probably won’t see any of this product in your kids Trick or Treat stash, but keep a lookout for a tin of Coco Loko in their rooms just in case. Yes, you read that correctly. Coco Loko is snortable chocolate powder. Marketed by Legal Lean, the Florida-based company founded by Nick Anderson, Coco Loko is the first product of its kind in the US. Similar products have been available in Europe for several years. After ordering and trying one, Anderson decided to create his own “raw cacao snuff.” So he invested $10,000 with an Orlando-based supplement company and created Coco Loko.

The Washington Post quoted Anderson as saying the effect is “almost like an energy-drink feeling, like you’re euphoric but also motivated to get things done.” He said he uses his product as an alternative to drinking and at music festivals and in “those types of social situations when you feel anxious.” Rolling Stone reported that Coco Loko promised a “30-minute buzz,” that would lift moods, reduce anxiety and give you a surge of energy. “Legal Lean claims Coco Loko will cause a rush of endorphins and serotonin, boost energy, and bring about a sense of calm. But the company hasn’t provided concrete research to back up those claims.”

However, the company website now refers to its product as “Coco Snuff” and the overt claims noted in Rolling Stone and other media write ups just after its release and attributed to Legal Lean are now not directly attributed to Coco Loko/Coco Snuff. Legal Lean makes no such claims anymore about Coco Snuff. You learn about endorphins, that a serotonin rush produces “an elevated mood and a state similar to the feeling of ecstasy [not the drug ecstasy]. This is the feeling that will make the music sound better and overall happiness.” Gee, isn’t that why the drug ecstasy was used at raves?

Raw cacao is said to give you a steady rush of euphoric energy that helps party goers “Dance the nigh away without a crash.” Then it claims raw cacao can give you a “calm focus,” reducing the chatter in your brain. “It is also known to help with anxiety and to reduce stress.”

The revisions to product description are likely the result of action taken by Senator Chuck Schumer where he called on the FDA to formally launch an investigation into “Coco Loko.” He said the product was a “brazen example of ‘narcotic marketing.’” He said it was like cocaine on training wheels. Schumer, The Washington Post and others (like The Fix) have reported it contains caffeine, guarana and taurine, which are ingredients commonly found in energy drinks. You won’t find that information on their website.

This suspect product has no clear health value. It is falsely held up to be chocolate, when it is a powerful stimulant. And they market it like a drug – and they tell users to take it like a drug, by snorting it. It is crystal clear that the FDA needs to wake up and launch a formal investigation into so-called Coco Loko before too many of our young people are damaged by it. ‘Coco Loko’ isn’t even pure chocolate at all. Instead, it is chock full of concentrated energy drink ingredients masked and marketed under the innocence of natural and safe chocolate candy. Parents and doctors don’t want kids snorting anything at all, especially not dangerous stimulants proven to wreak havoc on the bodies and brains of young kids and teens. That’s why the FDA must formally investigate this dangerous ‘party goer’ fad before it hurts our kids, not after.

The Washington Post reported in July of 2017 the FDA had not decided on how or whether to regulate the product. An FDA spokesperson said: “In reaching that decision, FDA will need to evaluate the product labeling, marketing information, and/or any other information pertaining to the product’s intended use.” Thus the changes in product effects on the website. The company is trying to keep under the FDA’s radar A representative for the DEA said he was not aware of any agency concerns with chocolate inhalants. According to reports mentioned by Schumer, the Legal Lean said the effects were “equal to about two energy drinks.”

Anderson said he didn’t consult any medical professionals when he created Coco Loko, “nor have scientists tested the snortable snuff before it was released to the public,” according to Rolling Stone. A company spokesperson said they used research data on the market in Europe. “There are no health issues … everyone seems fine. . . . It says not to do more than half the container, I think everything is self-explanatory, there are warning labels on it and I don’t think I would be responsible.”

There have been previous concerns raised about the health effects of energy drinks containing the ingredients reported to be in Coco Loko— caffeine, taurine and guarana. There can be increased blood pressure or heart palpitations. Those effects could be magnified when someone inhales these stimulants. The director for the John Hopkins Sinus Center said as yet, there is no data reported on health consequences, but he did have a few concerns.

First, it’s not clear how much of each ingredient would be absorbed into the nasal mucus membranes. And, well, putting solid material into your nose — you could imagine it getting stuck in there, or the chocolate mixing with your mucus to create a paste that could block your sinuses.

Another sinus specialist, Dr. Jordan Josephson, said you could expect more pulmonary problems like asthma or bronchitis. Blocked sinuses could lead to snoring and even sleep apnea, which in some cases could be fatal. There are multiple social media and online reports of trying snortable chocolate products like Coco Loko.

Hopefully, this product will go the way of Palcohol, a powered alcohol product that Senator Schumer took on in 2015. As with Coco Loko, his concern was it would be marketed to teens. One of the voiced concerns then was that powered alcohol could be snorted. According to The Hill, the manufacturer of Palcohol fought back by saying: “Listen, people can snort black pepper … so do we ban it? No, just because a few goofballs use a product irresponsibly doesn’t mean you ban it.” The company reported that although its product was approved on March 10, 2015 for legal sale in the US, it would not be manufacturing Palcohol. Rather, it would be “auctioning off the secret formula and manufacturing process.” Let’s hope Coco Loko ends up with a similar fate. For more on Palcohol, see: “Hype Over Powered Alcohol” or “Down For The Count?”

P.S. On December 11, 2017 the FDA took action against Legal Lean for its marketing and distribution of two of its products, Coco Loco and Legal Lean Syrup. “The warning letter explains how the claims made in the promotional materials for Legal Lean Syrup and Coco Loko demonstrate that the products are intended to be used as alternatives to illicit street drugs and that the products, as labeled and marketed, may pose safety concerns.” The FDA warning letter stated that Coco Loko was labeled as a food and marketed as a dietary supplement on the company website. However, since it is intended for intranasal administration, it is not a food or dietary supplement. “Failure to correct violations may result in FDA enforcement action, including seizure or injunction, without further notice.”

Faith Seeking Understanding

Charles Sigler, D.Phil.

Monthly Archives: December 2017