04/28/17

Psychiatric Huffing and Puffing

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For awhile now I’ve been aware of the ongoing dispute between mainline psychiatry and what is disparagingly referred to as the “anti-psychiatry” movement instead of the critical psychiatry movement.  Over time I have come to identify with the “anti-psychiatric” types. The term sets up a false dichotomy, implying you can only be “for” or “against” psychiatry. Critiques of psychiatric diagnosis or the use of psychiatric medications are regularly dismissed out-of-hand by mainline psychiatry. One of the ongoing dialogues of dispute occurs between the author and journalist Robert Whitaker and the eminent psychiatrist Ronald Pies.

Robert Whitaker is the author of three books that relentlessly drive their readers to question the narrative for mental illness and psychiatry verbalized by mainline psychiatrists like Ronald Pies. These books are: Mad in America, Anatomy of an Epidemic and Psychiatry Under the Influence.  His articles on the mentally ill and the drug industry have won several awards. A series he wrote for The Boston Globe was a finalist for the Pulitzer in 1998. Anatomy was the 2010 winner for best investigative journalism by Investigative Reporters and Editors, Inc. Mad in America is also the name of a nonprofit organization and webzine, madinamerica.com, whose mission is “to serve as a catalyst for rethinking psychiatric care in the United States (and abroad).”

Ronald Pies is a noted psychiatrist, a Clinical Professor of Psychiatry at Tufts University and SUNY Upstate Medical University, Syracuse NY. He is also Editor in Chief Emeritus of Psychiatric Times. A bit of a Renaissance man, he’s published poetry: The Heart Broken Open, a novel: The Director of the Minor Tragedies, nonfiction: Becoming a Mensch: Timeless Talmudic Ethics for Everyone, as well as psychiatry: Psychiatry on the Edge, Handbook of Essential Psychopharmacology and psychotherapy: The Judaic Foundations of Cognitive-Behavioral Therapy.  He has authored or coauthored several other books as well.

Whitaker and Mad in America authors have disagreed with Pies on several issues. For example, they disagreed on whether psychiatrists widely promoted the chemical imbalance theory (see “Psychiatry DID Promote the Chemical Imbalance Theory” and “My Response to Dr. Pies” on madinamerica.com); or whether the long-term use of antipsychotics is helpful (see “Dr. Pies and Dr. Frances Make a Compelling Case that Their Profession is Doing Great Harm on madinamerica.com).

Into this mix Pies has written three articles for Psychiatric Times: “Is There Really an ‘Epidemic’ of Psychiatric Illness in the US?,” “The Bogus ‘Epidemic’ of Mental Illness in the US” and “The Astonishing Non-Epidemic of Mental Illness.” He’s clearly playing off of Whitaker’s book: Anatomy of an Epidemic. In his third article, “The Astonishing Non-Epidemic of Mental Illness,” Pies said that the epidemic of mental illness narrative is (with a few qualifications) “mostly fear-mongering drivel.” It sells books and makes for good online chatter, but “The so-called epidemic of mental illness among adults in the US proves largely illusory.”

He did some rhetorical sleight-of-hand, stating that by pulling out the bottom card of the epidemic narrative, the entire house of cards of the anti-psychiatry movement would collapse. In order to do this, he first quoted what he said was the CDC definition of epidemic: “ . . . an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area . . .” Pies then said the CDC definition of epidemic applied to actual cases of disease; not to changing rates of diagnosis, which are subject to many socio-cultural variables. The distinction was critical,

Since psychiatry’s critics do not claim merely that there is more diagnosis of schizophrenia or major depression; rather, they claim there are actually more people sick with these illnesses, owing to misguided or harmful psychiatric treatment.

Remember that in psychiatric diagnosis, there are relatively few diagnoses that can be confirmed by medical tests. The vast majority of psychiatric disorders are assessed by a diagnostic process alone. If you demonstrate to a clinician that you meet the diagnostic criteria for a psychiatric disorder, you are treated as if you actually have the disorder. So Pies seems to be splitting hairs with his distinction between actual cases and diagnoses. And I don’t think he really hasn’t made as telling a point as he thought.

It would seem he is suggesting that psychiatric diagnostic rates for a disorder are overstated from the actual cases because of the influence of socio-cultural variables.  Yet how can you distinguish the actual cases from the false positives due to socio-culturally influenced diagnosis? The same diagnostic criteria are used. Is there an unstated assumption that diagnostic inflation is due to factors beyond psychiatry? Namely, that if a trained psychiatrist follows the structured clinical interview process, only actual cases of a psychiatric disorder will be identified?

Pies also said the “epidemic” claim was largely based on the increasing US rates of psychiatric disability over the past 50 years. Here he cited an article by Whitaker without mentioning Whitaker’s name. He dismissed the validity of using disability determinations, saying they cannot be used as “a legitimate index of disease incidence or prevalence.” He then shifts the focus to affirm there is a growing population of “persons with serious psychiatric illness who are not receiving adequate treatment.” Here he named two well-known psychiatrists who have written of their concerns with the “epidemic” of neglect with our most severely impaired citizens. But one of the persons he mentioned, Dr. Fuller Torrey, wrote The Invisible Plague about the rise of mental illness from 1750 to the present.

In the Introduction to The Invisible Plague Torrey described what he saw as “the epidemic of insanity.”  He said a major impediment to understanding the epidemic of insanity was that its onset occurred over so many years. Few people fully appreciated what was happening. “Those who did raise an alarm were largely ignored.” He said the suggestion today that we are living in the midst of an epidemic of insanity strikes most people as unbelievable.

Insanity is an invisible plague. There are no body counts with which one can compare the present with the past. In most countries, there are remarkably few statistics that can be used to assess insanity’s prevalence over time. Professional textbooks assume that insanity has always been present in approximately the same numbers as now.

Fuller Torrey is a believer in insanity as an epidemic of brain dysfunction. And he blames the likes of Michel Foucault, Thomas Szasz, Ronald Laing and others for emptying the insane asylums that have been “the mainstay for containing the epidemic for a century and a half,” without insuring these individuals received the treatment needed to control the symptoms of their illness.

When looking at the costs of this epidemic, Torrey said the combined costs in 1991 for the US were $110 billion. “And this included the single largest disease category for federal payments under the Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs.” So in quantifying the cost of the epidemic of insanity, Torrey used the same statistic to make his point that Whitaker did. Pies either didn’t realize this, or ignored it in his critique of Whitaker. I wonder if Pies sees what Torrey said as fear-mongering drivel or one of the few qualifications?

Pies dismissively cited two articles written by Marcia Angell for The New York Review of Books in 2011 (“The Epidemic of Mental Illness: Why?” and “The Illusions of Psychiatry”) in all three of his articles as an example of the promotion of the false narrative of “the raging epidemic of mental illness.” Her articles discussed three books and their implications for psychiatry: The Emperor’s New Drugs, Anatomy of an Epidemic, and Unhinged: The Trouble with Psychiatry. Angell’s review of Whitaker’s book drew it to the attention of a wide audience; so it seems this may be at least partly why Pies is dismissive of it.

However, read her articles. They will give you a thumbnail sketch of issues Pies goes to great lengths to deny and minimize. Then read the books she discusses. Remember that Marcia Angell is a Senior Lecturer at Harvard Medical School and was the first woman to serve as editor-in-chief of the New England Journal of Medicine. Don’t be dismissive of what she has to say; she has great credibility.

There is one final point to be made with regard to Pies’ third article. In the conclusion, he references Thomas Kuhn’s idea of “paradigm,” saying it is misleading and unfair to suggest that psychiatry is laboring under a “failed paradigm.” This was, he said, because “there is no one paradigm the defines all of psychiatry or that dictates practice on the part of all psychiatrists.” But I wonder if he truly understood the implications to his comment. If you apply Kuhn’s notion of paradigm (“a paradigm is what members of a scientific community share”) with Pies’ application of the term to psychiatry, then you would have to conclude that psychiatry as it’s practiced, is NOT a science. Rather, it would either be what Kuhn called a “pseudoscience” or pre-scientific. He also seems to be oblivious to the possibility of an implicit paradigm generated in psychiatric practice with DSM diagnosis—that it classifies a real “illness” or “disease” of the brain.

I’m reminded of what Robert Whitaker pointed out in his review of Jeffrey Lieberman’s book Shrinks, “The Untold Story of Psychiatry.” Whitaker noted how speeches given by the presidents of the American Psychiatric Association at their annual meetings regularly sounded the same theme: “Psychiatrists are true heroes.” He said it struck him that Shrinks served as an institutional self-portrait of psychiatry. “What you hear in this book [Shrinks] is the story that the APA and its leaders have been telling to themselves for some time.” Similarly, it seems Pies is preaching to the psychiatric choir—a message that there really isn’t an epidemic increase in mental illness; the argument of the anti-psychiatry movement is just a house of cards. Yet it seems to me that house is still standing despite the huffing and puffing of Pies and others.

04/25/17

Pesticides, Fungi and Pot

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In 2015, two Colorado marijuana users sued the state’s largest marijuana grower, claiming it used a dangerous agricultural fungicide on its pot plants. The fungicide, Eagle 20, contains the chemical myclobutanil, which becomes poisonous when ignited. The allegations were that while Eagle 20 is approved for certain edible products, it is not approved for smokable products like marijuana and tobacco. The lawsuit said: “Persons who smoke cannabis that has been sprayed with Eagle 20 inhale … poisonous hydrogen cyanide.” The company, LivWell, maintained its plants are safe.

The two individuals alleged they were not aware of LivWell’s use of Eagle 20 on their cannabis when they bought it. Had they known, they would not have smoked LivWell’s cannabis. They were asking for a monetary reimbursement for their unused product and were also demanding that LivWell stop using the Eagle 20 fungicide on its cannabis. The plaintiff’s lawyer said that to his knowledge, this was the first product liability action filed against the legal marijuana industry. LivWell’s owner said: “Testing of our finished product by an independent, state-licensed lab approved by the City of Denver showed that our products are safe – as we have always maintained.”

In the end, the lawsuit was dismissed. The Denver judge who heard the case said the plaintiffs couldn’t sue because they were not actually harmed. They bought and then consumed the pot without any repercussions. The written opinion noted there were no allegations that the cannabis did not perform as it was supposed to; and both consumers smoked it without harm. LivWell’s owner said this had been a ploy intended to smear the company’s name. “The people behind this case do not want the commercial cannabis industry to succeed and will try anything to bring down the industry.”

Setting aside the rhetoric from the lawyers on both sides of the dismissed lawsuit and LivWell’s owner, the use of pesticides on marijuana is a growing concern for the industry. The marijuana website The Cannabist has an archived page on marijuana pesticides with fourteen articles published between December 4, 2015 and July 29, 2016. Their titles range from: “Check Your Stash: Are you consuming pesticide-peppered pot? Full recall list” to “State releases hundreds of recalled pot batches after they tested pesticide-free.”

Ricardo Baca and others, writing for The Cannabist, said Denver’s Department of Environmental Health has issued 26 recalls of marijuana and pot products since September of 2015. The Colorado Marijuana Enforcement Division has issued 26 recalls in the form of administrative holds between February and July of 2016. The recalls originated from an executive order issued by the governor of Colorado in November of 2015. Within the order, the governor said: “Until scientific assessment establishes which additional pesticides can be safely applied to marijuana, marijuana contaminated by an Off-Label Pesticide shall constitute a threat to the public safety.”

At the core of legal cannabis’ pesticide problem in Colorado is the state’s lack of a pesticide certification for marijuana testing labs. So while cannabis testing facilities are certified by the state’s health department to test for potency and contaminants, the Colorado Department of Public Health and Environment is still working with other agencies, labs and industry to develop proficiency standards and testing certification requirements for pesticide tests.

Reporting originally for The Denver Post, David Migoya and Ricardo Baca, noted how The Post revealed in its own testing that a number of marijuana-infused products contained high levels of pesticides that shouldn’t be used on cannabis. The Catch-22 is that there is no pesticide specifically approved for use with marijuana, because pesticide chemicals are regulated by the EPA. And since cannabis is illegal under federal law, there are no federal standards. “As a result, there have been no tests to show how pesticides used on marijuana could affect consumers or whether their use is safe.” Colorado state agriculture officials have allowed certain pesticides to be used on marijuana as long as it does not violate the restrictions of the product’s label.

Ron Kammerzell, a senior director in the Colorado Department of Revenue, which oversees the state Marijuana Enforcement Division (MED), said the state’s responsibility was to make sure the marijuana is safe for the consumer and not contaminated by pesticides. The top priority is to keep pesticide-contaminated products from getting to consumers. He added that pesticides were a challenging area fro testing, so they wanted to be sure they did it right. “Once we have mandatory testing for pesticides, that will be a game-changer in terms of making sure that we’re minimizing these types of contaminations.” Kammerzell hopes to have the state’s pesticide testing certification program implemented sometime in 2017.

Writing for Slate, Rachel Gross noted how cannabis vendors are pitching healthier, organic marijuana to their customers. “Like wine aficionados, certain weed smokers have always had a reputation for being connoisseurs.” The U.S. legal cannabis industry was projected to bring in almost $7 billion in 2016. The founder of Clean Green, a marijuana-certifying program, said: “These are sophisticated buyers, the same people who are buying organic food and organic coffee.” The industry is becoming more industrialized and corporate and the fear is that industrial pot is laced with pesticides.

Consider the gram of weed you can buy, right now, in the four states (Washington, Oregon, Colorado, and Alaska) and Washington, D.C., where recreational marijuana is legal (or the 24 states where it’s available for medical purposes). Before it was sealed in that baggie, it was a plant. That plant likely got sprayed with fungus-, insect-, and disease-killing chemicals. Before it was a plant, it was a seedling. That seedling may have sat in soil that had been fumigated with even more pesticides. And before that seedling got planted, the grow room that would one day be its home was probably bug-bombed and lined with pest strips, which are laced with chemicals that linger in enclosed spaces.

Thanks to the series of recalls, like those noted above in Colorado, consumers are becoming more aware of the pesticide issues in the marijuana industry. The Oregonian found abnormally high levels of pesticides in nearly half the products sold in state dispensaries. “Those pesticides included a common roach killer, half a dozen human carcinogens, and a fungicide [myclobutanil] that allegedly turned into hydrogen cyanide when heated.” The dose is the issue. Even a toxic substance like hydrogen cyanide could be harmless in a small enough dose. Oregon is working closely with the state of Washington and Colorado to coordinate which pesticides should be tested for in cannabis.

Researchers at UC Davis recently announced a study that found medical marijuana contained “multiple bacterial and fungal pathogens that may cause serious and even fatal infections.” Smoking, vaping or inhaling aerosolized marijuana may pose a serious health risk to individuals, especially those with impaired immune systems. George Thompson, one of the study’s authors, noted where patients with impaired immune systems are routinely advised to avoid exposure to plants and certain raw foods because of the risk of infection. “But at the same time, they are increasingly turning to medical marijuana to help them with symptom control. Because microorganisms known to cause serious infections in immunocompromised patients were found to be common on marijuana, we strongly advise patients to avoid it.”

They publically voiced their concerns in a letter to the editor of the journal Clinical Microbiology and Infection. There is a copy of the letter here. The news media also picked up on the study. Claudia Black, writing for The Sacramento Bee, said the uneasy news comes as a majority of states have eased laws on medical and recreational marijuana, and a majority of U.S. doctors support the use of medical marijuana for symptoms such as pain, nausea and loss of appetite during chemotherapy and other treatments. George Thompson was quoted as saying it was a big oversight to not warn patients with compromised immune systems to avoid marijuana. “It’s basically dead vegetative material and always covered in fungi.”

The study gathered marijuana from 20 Northern California growers and dispensaries. The analysis of marijuana for the study was done by Steep Hill Labs, a cannabis testing company. “The analysis found numerous types of bacteria and fungi, including organic pathogens that can lead to a particularly deadly infection known as Mucor.” There is a misconception that if it is from a dispensary, the marijuana must be safe. But that’s not the case, according to Joseph Tuscano, another one of the researchers. “This is potentially a direct inoculation into the lungs of these contaminated organisms, especially if you use a bong or vaporization technique.” You can watch a CBS Sacramento news video on the study posted on YouTube here.

So it’s not just that the anti-pot people are out to sink the industry. Its customers are concerned about the presence of pesticides in their pot. Researchers are finding that some marijuana contains common bacteria and fungi that poses a danger to individuals with compromised immune systems. The marijuana industry is going through some serious growing pains. But the question begs to be asked, did the states that legalized recreational and medical marijuana run ahead of the regulatory and bureaucratic changes needed to support it?

04/21/17

An Evil Treasure

 

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In the third chapter of Indwelling Sin in Believers by John Owen, he moved on from describing how indwelling sin was a law to where it is located, what are its properties and how it operates.  First, Owen noted that everywhere in Scripture indwelling sin is said to have its “especial residence” in the heart. Citing Matthew 15:19, he listed how evil thoughts, murders, adulteries, fornications, thefts and other sinful actions proceed from the heart. There are many outward temptations that excite and stir up these evils, but they merely open the vessel and let out what was already laid up and stored there. “The root, rise, and spring of all these things is in the heart. Temptations and occasions put nothing into a man, but only draw out what was in him before.”

From the very beginning, God saw that every intention of the human heart was “only evil continually” (Genesis 6:5). In Luke 6:45, Jesus referred to the evil treasure of the heart, which Owen said was “the prevailing principle of moral actions” in humanity. Note how the beginning of the verse also points to “the good treasure of the heart,” referring to the grace received from our Savior. This good treasure will never be exhausted. The more we draw out of this treasure, the more it grows! And their indwelling sin decreases. However, the more we exert and manifest the fruit of our lusts, the more they are increased in us. “It feeds upon itself, swallows up its own poison, and grows thereby.”

The more men sin, the more are they inclined unto sin. It is from the deceitfulness of this law of sin, whereof we shall speak afterward at large, that men persuade themselves that by this or that particular sin they shall so satisfy their lusts as that they shall need to sin no more. Every sin increaseth the principle, and fortifieth the habit of sinning. It is an evil treasure that increaseth by doing evil. And where doth this treasure lie? It is in the heart; there it is laid up, there it is kept in safety. All the men in the world, all the angels in heaven, cannot dispossess a man of this treasure, it is so safely stored in the heart.

As an aside Owen commented how the heart in Scripture has various meanings. Sometimes it refers to the mind and understanding; sometimes to the will, sometimes the emotions (or affections); and sometimes to the whole soul. It typically refers to the whole soul and all its faculties, but not always. However all these faculties act together as one principle when doing good or evil.

This is the subject, the seat, the dwelling-place of this law of sin,—the heart; as it is the entire principle of moral operations, of doing good or evil, as out of it proceed good or evil. Here dwells our enemy; this is the fort, the citadel of this tyrant, where it maintains a rebellion against God all our days. Sometimes it hath more strength, and consequently more success; sometimes less of the one and of the other; but it is always in rebellion whilst we live.

The properties of the heart include that it is unsearchable, except by the Lord (Jeremiah 17:9-10). Can anyone know the perfect measure of their own light and darkness? “We fight with an enemy whose secret strength we cannot discover.” Often we think sin is quite ruined, but after awhile we find it was merely out of sight. It has places to hide in an unsearchable heart where we cannot enter. We might persuade ourselves that all is well, when sin is safely hidden in the hidden darkness of our mind, or the will’s indisposition, or the disorder and carnality of the emotions.

The best of our wisdom is but to watch its first appearances, to catch its first under-earth heavings and workings, and to set ourselves in opposition to them; for to follow it into the secret corners of the heart, that we cannot do.

Not only is the heart unsearchable, it is also deceitful. The deceit we see in the world around us is nothing in comparison to the deceit in our hearts towards ourselves. “Now, incomparable deceitfulness, added to unsearchableness, gives a great addition and increase of strength to the law of sin, upon the account of its seat and subject.” Owen wants us to be clear that he speaks here of the deceitfulness of the heart, and not of sin itself. And this deceitfulness of the heart has two advantages in harboring sin.

First, it abounds in contradictions, so there is not any constant rule by which it proceeds. “The frame of the heart is ready to contradict itself every moment.” Whenever you think you have everything under control, you quickly discover it is “quite otherwise.” So no one knows what to expect from it. This is because of sin working upon all the faculties of the heart. Sometimes the mind is subjected to God’s will, as are the emotions, and the will is ready for its duty. But if the emotions rebel or an obstinate will arises and prevails, everything is changed.

This, I say, makes the heart deceitful above all things: it agrees not at all in itself, is not constant to itself, hath no order that it is constant unto, is under no certain conduct that is stable; but, if I may so say, hath a rotation in itself, where ofttimes the feet lead and guide the whole.

Second, its deceit lies in the initial appearance of things. Sometimes our emotions are moved and “the whole heart appears in a fair frame; all promiseth to be well.” But in a little while, the whole frame is changed—the mind was not affected or turned; the emotions played their part at first, and then wandered off; and all the fair promises of the heart left with them. Add this deceitfulness to the previously mentioned unsearchableness, and we find that the difficulty of dealing with sin is exceedingly increased. Who can cope with a deceived and heart? Particularly since it employs all its deceits in the service of sin.

All the disorder that is in the heart, all its false promises and fair appearances, promote the interest and advantages of sin. Hence God cautions the people to look to it, lest their own hearts should entice and deceive them.

Therefore it is not for nothing that the Lord says in Jeremiah 17:9 that “the heart is deceitful above all things and desperately sick.” So consider these things. First, never think that your work in contending against sin is at an end. It hides within the unsearchable places of our heart. So when we think we have thoroughly won, there is some reserve of sin remaining that we missed. Second, since our heart is changeable and deceitful, we should be perpetually watchful against it. Against an adversary that deals in deceit and treachery, only perpetual watchfulness will give you security. Third and finally, commit the whole matter to Him who can search and know your heart (Jeremiah 17:10). For there is no treacherous corner in your heart that He cannot search to its uttermost.

A digital copy of Owen’s work, Indwelling Sin in Believers, is available here.

04/18/17

Porn is a Public Health Hazard

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In a strange but true way, there was a study published in the Journal of Sex Research that found a correlation between some measures of religiosity and Google searchers for the term “porn.” In states with higher percentages of Evangelical Protestants, theists and biblical literalists—as well as states with higher church attendance rates—predict higher frequencies of searching for “porn.” Higher percentages of religiously unaffiliated persons in a state are related to lower frequencies of searching for porn. “Our findings support theories that more salient, traditional religious influences in a state may influence residents-whether religious or not-toward more covert sexual experiences.”

The above discussed study, “Unbuckling the Bible Belt: A State-Level Analysis of Religious Factors and Google Searches for Porn,” raised some questions when I saw graphics from the study on Twitter. Here is the link to the Twitter post. The linked study abstract and graphic on Twitter may be somewhat deceiving, as they plot and discuss searches done for the actual word “porn,” which could be done for a variety of reasons besides just wanting to view pornography. Yet the concern over the adverse social and spiritual effects of viewing pornography is a very real concern among a wider audience than just Evangelicals, theists and biblical literalists.

The state of Utah passed a resolution in March of 2016 declaring that pornography was a “public health hazard.” The resolution recognizes pornography leads to a broad spectrum of individual and public health concerns. It pointed to how young children are increasingly exposed to pornography, with the average age of exposure now 11 to 12 years of age. This early exposure leads to a multitude of personal and social problems, including: adolescents engaging in risky sexual behavior; an increase of sexual behavior at a younger age; depicting women and children as sex objects and rape and abuse as if they were harmless.

Writing for the Evangelical website The Gospel Coalition in May of 2016, Joe Carter described how pornography is increasingly being seen as a public health problem. Studies from the late 1960s to the mid-1980s concluded pornography had “no marked social effect.” But that was before the Internet. Since the late 1980s, there has been a wealth of social science research demonstrating the negative effect of porn on individuals, families, children and communities. Carter linked two meta-analyses that found sexual aggression among males and females was associated with the consumption of porn; and an overall positive association between pornography and attitudes supporting violence against women.

In “The Science of Pornography Addiction,” Gary Wilson described the effects of watching porn on the brain. He said that 25% of all Internet searches are for porn. It is the fourth most common reason people give for going online. In many ways, it acts like a drug. With prolonged exposure, it will lead to tolerance, loss of control and the compulsive desire to seek it out despite negative consequences. And there is “withdrawal” when it goes away. “The issue is that continued exposure can cause long term or even life-long neuroplastic change in the brain.”

There is a release of dopamine in our brains as a reward whenever we accomplish something, including sexual activity. “It alters and forms the brain cells to motivate certain actions. It rewires your brain.” The more time you spend doing a certain action, like viewing porn, the more dopamine is released—which then reinforces the behavior. As you begin to imagine the images away from the computer or while having sex, they become reinforced as well. “It’s a feedback loop that becomes harder to escape.”

The good news is this can be reversed or extinguished. Wilson said the brain is often described as “the use it or lose it system.” Like with muscles, the neural connections you use become stronger and want to be activated, while the ones you ignore become weakened. So the same neuroplastic system used to acquire these habits can be used to acquire healthier ones.

In another article on pornography and the brain, Joe Carter recommended “The Science of Pornography Addiction” video. He also summarized the thoughts of William Struther, an associated professor of psychology at Wheaton College. Commenting on the dopamine process described above, Struther said: “Pornography thus enslaves the viewer to an image, hijacking the biological response intended to bond a man to his wife and therefore inevitably loosening that bond.” Overstimulation of the reward circuitry, as when repeatedly viewing pornography, creates desensitization. “When dopamine receptors drop after too much stimulation, the brain doesn’t respond as much, and we feel less reward from pleasure.”

The psychological, behavioral, and emotional habits that form our sexual character will be based on the decisions we make. . . Whenever the sequence of arousal and response is activated, it forms a neurological memory that will influence future processing and response to sexual cues. As this pathway becomes activated and traveled, it becomes a preferred route—a mental journey—that is regularly trod. The consequences of this are far-reaching.

Internet porn is unique in a number of ways. First is its extreme novelty. Second, unlike food or drugs, there is almost no physical limit to its consumption. Third, a user can easily escalate to more novel “partners” and unusual genres. Fourth, unlike food or drugs, the brain’s natural aversion system is not activated. Like with drugs, the age users start using porn is a crucial factor. “A teen’s brain is at its peak of dopamine production and neuroplasticity, making it highly vulnerable to addiction and rewiring.”

A nonprofit organization called Fight the New Drug is trying to raise awareness on the harmful effects of porn and get this information to a wider audience. They use science, facts and personal accounts to bring the issue out in the open and get people talking about it. The organization’s website said not only are we the first generation to face the issue of pornography at this intensity and scale, “we’re also the first generation with a scientific fact-based understanding of the harm pornography can do.”

Then there is Elizabeth Smart. On June 5, 2002 when she was 14, Elizabeth was awakened by a strange male voice saying that he had a knife to her neck. She was told to get up without making a sound and come with him or he would kill her family. She remained a captive by this man and his wife for nine months, where she was repeatedly raped by the man. Sometimes he brought her hardcore porn, which he looked at and forced her to look at. Then he acted out with her what they had seen. Here is a short video of Elizabeth telling her story.

Looking at pornography wasn’t enough for him. Having sex with his wife after he looked at pornography, it wasn’t enough for him. Then it led to him finally going out and kidnapping me. He just always wanted more.  I can’t say that he would not have gone out and kidnapped me if he had not looked at pornography. All I know is that pornography made my living hell worse.

The morning following her rescue, her mother gave her a piece of advice that changed her life. She told Elizabeth the best punishment she could give to the people that did those things to her was to be happy. Elizabeth went on to become an advocate for abuse prevention and an advocate against pornography. She married in 2012 and gave birth to a daughter in February of 2015.

P.S. Elizabeth Smart lived in Utah when she was abducted.

04/14/17

An Opioid Shell Game

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Heroin sales and overdoses get a significant mount of attention, but we need to also remember that since 2002, the number of deaths related to controlled prescription drugs (CPD) have outpaced those for cocaine and heroin COMBINED. And the number of individuals who report current use of CPDs is more than those reporting use of cocaine, heroin, methamphetamine, MDMD and PCP (phencyclidine) combined. Each day, 129 individuals die from a drug overdose in the U.S. And yes, five of the seven most prescribed CPDs are opioids. The other two are amphetamine (i.e., Adderall) and methylphenidate (i.e., Ritalin and Concerta).

This information was taken from a yearly statistical summary published by the DEA called the National Drug Threat Assessment (NDTA). The 2016 NDTA Summary covers a wide range of data and classes of drugs. There’s even information on the various drug cartels operating in the U.S. This article will focus on CPDs.

The first figure (Figure 26) gives a comparison of the drug poisoning deaths for prescription drugs, cocaine and heroin from 2007 to 2014. Then Figure 29 shows the top five CPDs distributed nationwide in the BILLIONS of dosage units. Far and away from all the other CPDs, hydrocodone and oxycodone are the most prescribed drugs in the U.S. Both of these figures were taken from the 2016 NDTA Summary.

Not surprisingly, the number of admissions to publically funded treatment facilities for non-heroin opiate/synthetic abuse was 24% higher in 2013 than in 2008. The number of admissions has declined since 2011, but that has been offset by an increase in heroin use between 2011 and 2013.

Recently there has been an increase in the abuse of stimulant medications, specifically amphetamine. Between 2006 and 2011 the nonmedical use of Adderall increased by 67%.  Emergency department visits related to Adderall almost tripled between 2005 and 2010. Misuse of ADHD medications as a class resulted in a 76% increase in poison control interventions from 2005 to 2010.

Young adults 18-25 years old represent the majority of the increase in Emergency Department visits, despite children comprising the largest subset of ADHD diagnoses. Many high school and college age students display limited knowledge of either the side effects or the addictive nature of Adderall. This coincides with the popular reputation of the drug on college campuses as a study-aid to improve concentration, and not something harmful or addictive. This contributes to the increased rate of non-medical use among adults.

Looking at concerns with prescription drug use and misuse from another perspective, a report by Quest Diagnostics suggested many Americans are misusing their prescription drugs. In their 2016 Prescription Drug Monitoring Report, Quest Diagnostics found that 54% of patient specimens showed signs of prescription drug misuse. For the purposes of their analysis, a consistent result was when a patient was taking a prescribed drug appropriately. An inconsistent result meant the patient was either not taking their prescribed drug, was taking drugs in addition to those that were prescribed, or was taking drugs that hadn’t been prescribed to them. These three combined causes of “inconsistent test results” indicated potential drug misuse in the Quest report.

About 45% of the inconsistent specimens showed evidence of patients taking drugs in addition to what was prescribed to them, “suggesting the potential for dangerous drug combinations in a sizeable number of patients.” This 2015 finding was considerably higher than other years. STAT News quoted Quest’s medical affairs director as saying, ““The discovery that a growing percentage of people are combining drugs without their physician’s knowledge is deeply troubling, given the dangers.” Of particular concern is the combination of opioids and sedatives, which can lead to respiratory depression, coma and death. The following graphic was taken from the Quest Diagnostics report.

Quest also examined the drug groups associated with the highest number of inconsistencies, by age groups. Unfortunately, given their composite sense of “inconsistent test results,” it is not clear what caused the top inconsistent drug classes. For example, we can speculate that in the under age 10 category, the top two drug inconsistent classes (amphetamine and methylphenidate) were likely due to no drug found, meaning those children were prescribed, but not taking their ADHD medications. The same can be said for the various places that “marijuana metabolite” appeared. However, the inconsistent classes for benzodiazepines, opiates and oxycodone are not distinguished by cause. So while benzodiazepines are noted as the top inconsistent drug class for every age group over 25, it is not clear if that meant they were taken in addition to what was prescribed or not.

One exception to this was with heroin and benzodiazepines. Quest found 1.56% of their tests were positive for heroin. Among adults who tested positive for heroin, 28.6% were also positive for benzodiazepines. Among those who combined these two drugs, 92.3% of the benzodiazepines were not prescribed.

The Fix, an addiction and recovery website, enlisted Peter Grinspoon, the author of Free Refills: A Doctor Confronts His Addiction, to look at the study. Dr. Grinspoon observed that Quest Diagnostics is in the business of doing urine drug testing, so they are interested in promoting drug testing. He went on to say:

Drug tests simply aren’t that accurate. They’re subject to human and lab error, and are rife with both false positives and false negatives. Savvy drug users can outsmart these tests. Any drug testing needs to be interpreted in the context of who is using the drug and why they are using it.

It is true that Quest Diagnostics makes money by increasing the amount of urine testing it does; that it is interested in promoting and highlighting drug-testing. But this was the fifth Prescription Drug Monitoring Report done by Quest. Additionally, Quest provides testing services to about half of all physicians and hospitals in the U.S. So the claim in the report, that it is “well positioned to identify trends in prescription drug monitoring and misuse” is legitimate.

Further, Dr. Grinspoon’s comments on the inaccuracy of urine testing seem overstated. Yes, there are false positives and negatives; and labs can make mistakes. But he gave the impression these errors happen so often that drug testing was a questionable, unreliable procedure. The FDA, among other sources, considers laboratory testing of urine samples to be the most reliable way to confirm drugs of abuse.

He also seems to assume the testing in the Quest report included drug users given urines as part of their treatment within drug treatment programs, which is not the case. Quest specifically stated that drug rehabilitation clinics and addiction specialists were excluded from the analysis “given the higher rates of testing and potentially higher rates of inconsistency.” There is no reason for a drug user to want to outsmart a urine test done in conjunction with their ongoing medical treatment that I can imagine.

The bottom line is that I think the Quest Prescription Drug Monitoring Report still provides helpful and valuable information on the dangerous practice of combining prescription medications. But prescription drug misuse is just one third of a kind if opioid shell game. Along with heroin and fentanyl, it keeps us trying to guess where the next opioid crisis will be.

04/11/17

Love Your Enemies

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Some people mistakenly think that the proverbial saying, “God helps those who help themselves” is some where in the Bible. Well it’s not. Actually, it came from one of Aesop’s fables, Hercules and the Waggoneer. A waggoneer driving a heavily loaded wagon became stuck in a muddy road. The more the horses pulled, the deeper the wheels sank in the mud. So he prayed to Hercules for help, who then replied that the wagoneer should get up off his knees and put his shoulder to the wheel. The moral of the fable was: “The gods help them that help themselves.”

In a similar way, Jesus corrected in Matthew 5:43-48 what had become a misapplication of the commandment to love your neighbor in Leviticus 19:18. In preceding passages of the Sermon on the Mount, Jesus introduced teachings from Scripture with the phrase that begins 5:43: “You have heard it said” (Matthew 5:21, 5:27, 5:33, 5:38). But here “what was said” was not from Scripture. Instead of the command to Love your neighbor as yourself,” it seems that what was being taught was “Love your neighbor and hate your enemy.” Nowhere in the Old Testament does it say, “Hate your enemy.”

There were passages that called for the destruction of Israel’s enemies (Deuteronomy 7:2) or counseled to keep your distance from non-Israelites (Exodus 34:12). Yet you were to feed your enemy (Proverbs 25:21-22) and help them when they were in need (Exodus 23:4-5). The Old Testament teaching on how you were to treat your enemies was complex, according to Leon Morris. In his commentary on Matthew, he said:

All this means that those who summed up Old Testament teaching as calling for love for neighbors and hatred for enemies were oversimplifying. The call for hatred is certainly the kind of addition to the command that many have put into practice.

Again, instead of lowering the bar to the common social standard he quoted in 5:43, Jesus said his followers were to love their enemies and pray for them!

You have heard that it was said, “You shall love your neighbor and hate your enemy.” But I say to you, Love your enemies and pray for those who persecute you, so that you may be sons of your Father who is in heaven. For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust. For if you love those who love you, what reward do you have? Do not even the tax collectors do the same? And if you greet only your brothers, what more are you doing than others? Do not even the Gentiles do the same? You therefore must be perfect, as your heavenly Father is perfect. (Matthew 5:43-48)

Jesus named two groups who were widely seen as enemies by the ordinary Jew—tax collectors and Gentiles (non-Jews). Don’t they take care of their own; don’t they love one another? So if you love only those who love you; if you only greet others like you (your brothers), how are you different from the tax collectors and the Gentiles?

While tax collectors are never popular in any culture (think of the Internal Revenue Service in the U.S.), in first-century Palestine they were particularly unpopular. Not only would they collect taxes for the Romans, they would also be sure to get some extra for themselves. Leon Morris commented, “In the eyes of Jesus’ audience there were no more wicked people than tax collectors as a class.” That’s the point of the encounter Jesus had with Zacchaeus, who was a tax collector (Luke 19:1-10).  They were the last ones you would expect to show love to others. The implied question is shouldn’t your love for others be greater?

The verse about greeting your brother is deeper in meaning than most people realize. When first-century Jews greeted one another, they would say “Peace,” which was in fact like saying a prayer; something like this: “May the peace of the Lord be upon you.” In our culture we say “good-bye” without remembering we are actually saying a shortened form of: “God by with you.” So making a sincere greeting meant you expressed goodwill and welcome to your brother. Shouldn’t your wishes and greetings to others be more sincere than the Gentiles?

The final command in verse 48, “to be perfect, as your heavenly Father is perfect” seems to set an unreachable standard—be as perfect as God the Father.  But that’s not what it means. The sense of the Greek word for “perfect” here pertains to you being fully developed in a moral sense. Look, your Father in heaven lets the sun rise and the rain fall upon both the evil and the good; the just and the unjust. Shouldn’t you do the same? The command to love your neighbor as yourself includes loving your enemies.  Isn’t that the same message as in the parable of the Good Samaritan?

There is an interesting grammatical structure in verse 5:45b called a chiasm, named after the Greek letter chi, which looks like an “X.” The verse reads: “For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust.” The crossing/chiasm is between the “evil” and “unjust” as well as the “good” and the “just.” The crossing pattern is accomplished by taking the first pair of contrasting words, evil and good, and then reversing the position in the second pair of contrasting words: just and unjust. So the chiasm looks like this:

The chiastic structure helps to reinforce the point of the passage. It gives a visual warning to the followers of Jesus: they are not to follow the contrasting advice of loving their neighbor and hating their enemy. Rather, just as their heavenly Father sends sun upon the evil and the good, and rain upon both the just and the unjust, they are to love and not hate their enemies. This action of God’s is known as the principle of common grace, where the good things of the world like sun and rain fall equally upon the evil and the good; the just and the unjust. God does not withhold the gifts of rain and sunshine from people who are evil or unjust. So followers of Christ should withhold love from their enemies.

In an active addiction, addicts and alcoholics make a lot of enemies. The hostility in these relationships can be either a one-way or a two-way street. You resent one another in mutual hostility. But you resent what someone did—or they resent what you did—in one-way hostility. The remedy for this in recovery is stated in Matthew 5:44: love and pray for your enemies. In order to do so, you have to let go of your resentment.

When discussing the Fourth Step in the “How It Works” chapter of Alcoholics Anonymous, Bill W. said: “Resentment is the ‘number one’ offender It destroys more alcoholics than anything else.” It leads to various forms of spiritual disease—“a life which includes deep resentment leads only to futility and unhappiness.” If the alcoholic is to live, they have to be free of anger. Realize that the people who wronged you were perhaps spiritually sick as well. “We asked God to help us show them the same tolerance, pity, and patience that we would cheerfully grant a sick friend.”

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.”

04/7/17

Souless Psychiatry

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A psychiatric resident at Stanford University School of Medicine wrote an essay on the crisis with psychiatry that appeared in a Scientific American blog. The author said the field was in decline as fewer medical students sought to specialize in psychiatry. He stated psychiatry was looked down upon by nearly every segment of society; and patients avoided treatment because of the stigma related to the field. His solution was to change the name of the field—call it something else.

The crisis, in his view, stems largely from a misunderstanding of what psychiatry is. He said it was “the medical field where doctors incorporate neuroscience and medical research to treat patients with diagnosable mental disorders.” But his friends seem to think he interprets dreams and administers Rorschach tests. Administering Rorschach tests and interpreting dreams are activities associated with psychoanalytic practice that dominated psychiatry up until the 1970s. While “mental health” has made great strides raising awareness (i.e., May is now National Mental Health Awareness Month), “psychiatry has been left behind as its anachronistic forebear.” So he asked, “Would renaming the field help?”

The word psychiatry evokes thoughts of dated medical practices, like Freudian analysis and ice-pick lobotomies. Its sordid history turns away patients, providers, and the public from the progress of mental health care today.

He acknowledged where relabeling could be seen as a Band-Aid. A mere name change ignores the root causes of the problem, which from his perspective is the stigma attached to psychiatry and mental illness. However, citing studies of name changes within the U.S. and other countries, he suggested these language shifts helped psychiatry sound more reputable. He imagined most people would rather have a mental health disorder than a psychiatric disorder, “even if it were the same thing.”

“Mental Health Care” would be a simpler name for the field instead of psychiatry. Psychiatrists would then become “mental health physicians.” Medical centers could create departments of mental health, combining specialties such as internal medicine, psychiatry, psychology and social work. “By uniting these fractured disciplines under one roof, clinicians could provide more comprehensive care to patients without the stigma associated with aging terminology.” Mental health units were said by the author to be far less frightening than psychiatric wards.

In conclusion, he noted how the term psychiatry meant: “healing of the psyche,” drawn from the Greek goddess of the soul—Psyche. “It’s a romantic notion, but we don’t treat patients’ souls. We treat diagnosable diseases of the brain. Perhaps it’s time to rename the field.”

In reading this essay, I was reminded of what psychiatrist Jeffrey Lieberman wrote in his book, Shrinks about psychiatry. He commented that in the 1970s, “the majority of psychiatric institutions were clouded by ideology and dubious science,” mired in a pseudomedical Freudian landscape. But now in the twenty-first century, psychiatry offered scientific, humane and effective treatments. “Psychiatry is finally taking its rightful place in the medical community after a long sojourn in the scientific wilderness.” You can read about the fallacies of “Freudian analysis and ice pick lobotomies” in Shrinks, but you won’t hear the complete and unvarnished truth about psychiatry.

Robert Whitaker astutely commented that Shrinks is more of a story of how psychiatry sees itself as an institution, than it is an accurate history of psychiatry. And I see the same approach here. I wonder if the Stanford psychiatric resident who wrote “Maybe We Should Call Psychiatry Something Else” is simply rehashing the received view of psychiatric history.

If you want a truly unvarnished look at psychiatry, read Whitaker: Mad in America, Anatomy of an Epidemic, and Psychiatry Under the Influence. You can read more about Lieberman and Shrinks on this website. Do a search for “Lieberman.”

The term “psychiatry” was originally coined by Johann Reil—a German physician—in 1808. And it does literally mean the medical treatment of the soul. Another German physician, Johann Heinroth was the first person to hold a chair of psychiatry. He also staked out working with the mentally ill as medical territory. Since there was little or no knowledge within the medical tradition to equip doctors to deal with mental disturbances, he proposed the creation of a new branch of medicine—psychiatry.

In his 1818 Textbook of Mental Disturbances, Heinroth said: “Since we are speaking of medical art and science, we should think that nobody but a doctor should have a right to make mental disturbance the object of his studies and treatment.” In The Myth of Psychotherapy, Thomas Szasz said of this time:

The birth of psychiatry occurs when the study of the human soul is transferred from religion to medicine, when the “cure of souls” becomes the “treatment of mental diseases,” and, most importantly, when the repression of the heretic-madman ceases to be within the jurisdiction of the priest and becomes the province of the psychiatrist.

There have been some radical shifts in how psychiatrists function since the early 1800s. Initially they were administrators of large institutions for the insane. Under Freud’s influence, psychiatrists began to consult with individuals living in society rather than working solely with those within institutions. Then in 1909, Freud was invited to give a series of lectures on psychoanalysis by Stanley Hall, the president of Clark University.

The cover photo for “Maybe We Should Call Psychiatry Something Else” shows seven men from the time of that conference, but only identified Sigmund Freud and Carl Jung. At the time, Jung was still friendly with Freud. The photo credit said the others were “pioneers in psychiatry,” but that is not entirely accurate. The photo shows Sigmund Freud and Carl Jung on either side of Stanley Hall in the front row. In the back row from left to right are Abraham Brill, Ernest Jones and Sandor Ferenczi.

Stanley Hall was a well-known American psychologist in addition to the then president of Clark University. He had an interest in Freud’s psychoanalytic theories and invited him to be part of a “galaxy of intellectual talent” to celebrate the twentieth anniversary of the founding of Clark University. Jung and Ferenczi were invited as the leading European disciples of Freud. Ernest Jones, another protégé of Freud, was then in Toronto Canada, building a private psychoanalytic practice and teaching at the University of Toronto. Jones would later become a biographer of Freud. Brill was the first psychoanalyst to practice in the U.S. and the first translator of Freud into English. In 1911 he founded the New York Psychoanalytic Society.

So these individuals are better seen as pioneers of Freudian psychoanalytic practice —the approach dismissed by the author of  “Maybe We Should Call Psychiatry Something Else” as a dated medical practice, which he placed alongside ice pick lobotomies.

By the 1940s, psychoanalytic theory had not only taken over American psychiatry, it had become part of our cultural psyche. Alfred Hitchcock’s 1945 film, Spellbound is an example of how influential psychoanalytic thinking was. The opening credits of the film announce that it wanted to highlight the virtues of psychoanalysis in banishing mental illness and restoring reason. Look for the Freud look-a-like character as Ingrid Bergman’s psychoanalyst and mentor.

Psychoanalytic thought dominated the field until the 1970s when the birth of biological psychiatry was ushered in by Robert Spitzer and his reformulation of psychiatric diagnosis. After Spitzer was appointed to do the revisions for the 3rd edition of the DSM in 1974, he was able to appoint whomever he wanted to the committees. He made himself the chair of all 25 committees and appointed individuals who he referred to as the “young mavericks” psychiatry. In other words, they weren’t interested in Freudian analysis. Spitzer said: “The feeling was that the same techniques that were useful in medicine, which is you describe something, you do laboratory studies; that those same kind of studies were appropriate for psychiatry.” Except it didn’t happen because in the 1970s, there just wasn’t a lot of psychiatric research. So the decisions of the committees were based on the expertise of the committee members.

David Chaffer was part of the process back then. He said committee members would gather together into a small room. Spitzer would sit with a mid 1970s “portable” computer and raise a provocative question. “And people would shout out their opinions from all sides of the room. And whoever shouted loudest tended to be heard. My own impression was … it was more like a tobacco auction than a sort of conference.” So much for using the same techniques as those used in medicine. Listen to the NPR story, “The Man Behind Psychiatry’s Diagnostic Manual” for the above information on Spitzer and the DSM.

But the real driving force behind the revisions made by Spitzer and others was because a “psychopharmacological revolution” couldn’t begin with the diagnostic process that existed before Spitzer and the DSM-III. Allen Frances, the chair of the next revision, the DSM-IV, acknowledged as much in his comments before the American College of Neuropsychopharmacology in 2000. Frances said the DSM-III was an innovative system that focused on descriptive diagnosis and provided explicit diagnostic criteria. “In many ways this aided, and was aided by, the knowledge derived from psychopharmacology. . . . The diagnostic system and psychopharmacology will continue to mature with one another.”

The psychopharmacological revolution required that there be a method of more systematic and reliable psychiatric diagnosis. This provided the major impetus for the development of the structured assessments and the research diagnostic criteria that were the immediate forerunners of DSM-III. In turn, the availability of well-defined psychiatric diagnoses stimulated the development of specific treatments and increasingly sophisticated psychopharmacological studies.

In the Foreword to his book, The Anatomy of an Epidemic, Robert Whitaker explained how he first wandered into the “minefield” of psychiatry by writing in the mid 1990s about research practices such as rapidly tapering schizophrenic patients off of their antipsychotic medications and then giving them a drug to exacerbate their symptoms. This “research” was done in the name of studying the biology of psychosis. Jeffery Lieberman took part in some of those studies, using methylphenidate (Ritalin, Concerta) to deliberately provoke psychotic symptoms in schizophrenic patients. Read “Psychiatry, Diagnose Thyself! Part 2” for more information on Whitaker’s articles and Lieberman. Incidentally, the series of articles Whitaker co-wrote for the Boston Globe was a finalist for the Pulitzer Prize for Public Service. Whitaker said in the Foreword to Anatomy of an Epidemic:

I began this long intellectual journey as a believer in the conventional wisdom. I believed that psychiatric researchers were discovering drugs that helped “balance” brain chemistry. These medications were like “insulin for diabetes.” I believed that to be true because that is what I had been told by psychiatrists while writing for newspapers. But then I tumbled upon the Harvard study and the WHO findings, and that set me off on an intellectual quest that ultimately grew into this book, The Anatomy of an Epidemic.

Maybe there is a stigma against psychiatry for more than just the past use of ice pick lobotomies or insulin comas or ice baths or the electroshock treatment shown in One Flew Over the Cuckoo’s Nest. But simply changing the name of what we now call psychiatry will not change the opposition against a medical specialty that no longer treats patients’ souls. And perhaps that is really why the field is in decline.

04/4/17

CBD and the DEA

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As 2016 drew to a close, the DEA announced its decision to classify cannabis extracts separately under the federal government’s Schedule I category. As Victoria Kim reported for The Fix, the ruling sent ripples of panic through the marijuana industry, playing on fears of what is ahead as our country grew closer to a Donald Trump presidency. While the DEA sees the change as marking a clear distinction between cannabis and it extracts, the marijuana industry sees it as saying that those who sell CBD oil are in violation of federal law. However, according to the DEA, the decision was made to more closely align U.S. policy with the United Nations, which already treats cannabis and its extracts separately.

Writing for Leafly, Bruce Barcott described the DEA announcement as an attempt “to criminalize the status of cannabidiol (CBD).” Hundreds of thousands of people around the country who rely on CBD products will be forced find CBD on the black market, according to the CEO of Women Grow. She said the rule “has the potential to inflict substantial harm to a legitimate industry that has been operating legally worldwide for over a decade.”  The executive director of the Cannabis Business Alliance said it creates “unfair barriers for companies with cannabidiol in their products.”

Cloaked in the guise of a bureaucratic technicality, DEA Administrator Chuck Rosenberg made an aggressive bid to wrap CBD into the Controlled Substances Act as a federally illegal Schedule I drug.

In an article he wrote for Leafly on the day of the DEA announcement, Barcott noted where the acting administrator for the DEA said the new code would allow the DEA to track quantities of marijuana extract separately from marijuana. The changes bring U.S. regulations into compliance with international drug-control treaties and present no major change in the law. “Rather it serves to clarify and reinforce the DEA’s position on all cannabis extracts, including CBD oil.” All marijuana extracts will continue to be treated as Schedule I controlled substances.

So what is the uproar if the DEA is merely bringing U.S. regulations in line with international regulations—if marijuana extracts were already Schedule I controlled substances? Barcott said the new rule clarifies the DEA’s position after the 2014 farm bill allowed certain states to grow hemp and blocked federal law enforcement from interfering with state agencies, hemp growers and agricultural research. Hemp-derived CBD oil is available nationwide on web sites and through mail order services. “Those operations survive on the assumption that cannabidiol products below the legal threshold for THC percentage in hemp (0.3 percent or less) are technically legal.” Barcott suggested the rule now says you can grow hemp, but if you try to extract CBD oil from it, the DEA considers that a federal crime.

First, hemp-based CBD products do not have the therapeutic benefits they claim to have. Writing for High Times, Mike Adams noted in his 2014 article, “The Difference Between Hemp Oil and High-CBD Strains,” that while CBD was still illegal in most of the U.S., its rise as “the rock star of the medical marijuana industry” provided the opportunity for some hemp businesses to “market a variation of knockoff CBD treatments that they claim have the same healing power as popular strains such as Charlotte’s Web.” These so-called “knockoff CBD treatments,” while technically similar to medical marijuana strains with CBD, “do not provide the same health benefits as high-CBD cannabis strains.”

However, after patients began submitting complaints about some of these products, including “Real Scientific Hemp Oil,” claiming they were making them sick, a research firm dedicated to cannabidiol education – called Project CBD – launched a full-blown investigation into the matter. After six months, the organization emerged with a 30-page report entitled “Hemp Oil Hustlers: A Project CBD Special Report on Medical Marijuana Inc., HempMeds and Kannaway,” which began as a curious look into an umbrella penny stock company, but transformed into a dissection of the hemp oil industry and its sometimes shady business practices.

Project CBD published a report in 2014 that investigated hemp oil products. The introduction of the report said that Project CBD did not believe that industrial hemp was an optimal source of CBD. On page 13 of the report is a quote from a press release of the Hemp Industries Association. The quote clearly indicates its position:

 It is important for America farmers and processors of hemp to understand that most CBD in products mislabeled as ‘hemp oil’ is a co-product of large-scale hemp stalk and fiber processing facilities in Europe where the fiber is the primary material produced at a large scale. CBD is not a product or component of hemp seeds, and labeling to that effect is misleading and motivated by the desire to take advantage of the legal grey area under federal law. Hemp seed oil does not contain any significant quantity of CBD.

So the hue-and-cry about the DEA’s clarification means that the loophole opened by the 2014 farm bill for hemp CBD products has been closed. Retailers selling “knockoff CBD treatments” of questionable medicinal value will now have to stop selling these products or face possible federal prosecution. This is a good thing. But what about the new 7350 drug code proposed by the DEA?

In the Federal Register, vol. 81, no. 240, under “Why a New Code Number is Needed,” it was noted that U.N. conventions on international drug control treated cannabis extracts differently from marijuana and THC. So creating a new drug code for marijuana extracts would allow for more appropriate accounting of these materials consistent with existing treaty provisions. The existing schedules contained in DEA regulations include marijuana as a Schedule I drug (drug code 7360). This listing includes “any material, compound, mixture, or preparation, which contains any quantity of the substance, or which contains any of its salts, isomers, and salts of isomers that are possible within the specific chemical designation.”

Until now, the DEA has used the 7360 drug code for all marijuana extracts. The proposed rule change recommends that a new drug code, 7350, should be used for marijuana extracts. Marijuana extracts “will continue to be treated as Schedule I controlled substances.” In other words, they were always Schedule I substances.

The Single Convention on Narcotic Drugs and 1971 Convention on Psychotropic Substances are international treaties that provide for the international control of marijuana. The schedules under the Single Convention prohibit the production and supply of specific drugs as well as drugs with similar effects—except for drugs under license for specific purposes, such as medical treatment and research. Many of the provisions of the Controlled Substances Act (CSA) under which the DEA operates were drafted to comply with these Conventions. Both the CSA and the Single Convention list drugs in four schedules, but their classification schemes mean different things. For one, drugs can be in more than one schedule under the Single Convention.

In the Single Convention, the most stringent controls are in Schedule IV; and all Schedule IV drugs are also listed in Schedule I. So placing a drug into both Schedule I and Schedule IV “imposes the most stringent controls under the Single Convention.” Cannabis or marijuana falls into three listings within the Single Convention. Cannabis is the flowering or fruiting tops of the cannabis plant (with the resin not extracted). Cannabis resin is the separated resin, crude or purified, obtained from the cannabis plant. Then there are the extracts and tinctures of cannabis.

The Single Convention placed “cannabis” and “cannabis resin” under both Schedule I and IV of the Convention, the most stringent level of control under the Convention. While “cannabis resin” is extracted from “cannabis,” the Single Convention specifically controls “extracts” separately. Extracts of cannabis are controlled only under Schedule I of the Convention, which is a lower level of control than “cannabis resin.”

Cannabis resin and cannabis (marijuana) will continue under the drug code for marijuana (drug code 7360). The DEA changes will distinguish cannabis extracts from cannabis resin, by defining “marijuana extract” to exclude material referenced as “cannabis resin” under the Single Convention. The new code number created by the DEA is as follows:

Marihuana Extract—7350 ‘‘Meaning an extract containing one or more cannabinoids that has been derived from any plant of the genus Cannabis, other than the separated resin (whether crude or purified) obtained from the plant.’’

Not only does this distinction bring U.S., CSA regulations in line with the Single Convention, it creates a category for medicinal cannabis extracts to be scheduled differently from the recreational cannabis products that fall within the “7360” drug code. Cannabis resin products such as shatter, wax, honey, budder and others will remain classified as 7360—along with the flowering or fruiting tops of the cannabis plant that are rolled into joints or smoked in pipes. But cannabis or marijuana extracts, coded with the 7350 drug code, could be reclassified into a lower CSA Schedule. As the science of CBD research demonstrates the medicinal efficacy of CBD more clearly and consistently, this could be done without rescheduling cannabis bud and flower or cannabis resin. No wonder companies selling marijuana and hemp-based CBD products don’t like the new DEA ruling.

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.