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10 Controversial Medical Questions Answered by Dr. Dalrymple

Where do you stand on these challenging ethical and scientific debates?

by
Theodore Dalrymple

Bio

March 15, 2014 - 8:00 am
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From September 2013:

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8. Is drug addiction really just like any other illness?

Who can imagine an organization called Arthritics Anonymous whose members  stand up and say “My name is Bill, and I’m an arthritic”?

Sometimes a single phrase is enough to expose a tissue of lies, and such a phrase was used in a recent editorial in The Lancet titled “The lethal burden of drug overdose.” It praised the Obama administration’s drug policy for recognizing “the futility of a punitive approach, addressing drug addiction, instead, as any other chronic illness.”  The canary in the coal mine here is “any other chronic illness.”

The punitive approach may or may not be futile. It certainly works in Singapore, if by working we mean a consequent low rate of drug use; but Singapore is a small city state with very few points of entry that can hardly be a model for larger polities. It also seems to work in Sweden, which had the most punitive approach in Europe and the lowest drug use; but the latter may also be for reasons other than the punishment of drug takers. In most countries (unlike Sweden) consumption is not illegal, only possession. That is why there were often a number of patients in my hospital who had swallowed large quantities of heroin or cocaine when arrest by the police seemed imminent or inevitable. Once the drug was safely in their bodies (that is to say, safely in the legal, not the medical, sense), they could not be accused of any drug offense. Therefore, the “punitive approach” has not been tried with determination or consistency in the vast majority of countries; like Christianity according to G. K. Chesterton, it has not been tried and found wanting, it has been found difficult and left untried.

But the tissue of lies is implicit in the phrase “as any other chronic illness.” Addiction is not a chronic illness in the sense that, say, rheumatoid arthritis is a chronic illness. If it were, Mao Tse-Tung’s policy of threatening to shoot addicts who did not give up drugs would not have worked; but it did. Nor would thousands of American servicemen returning from Vietnam where they had addicted themselves to heroin simply have stopped when they returned home; but they did. Nor can one easily imagine an organization called Arthritics Anonymous whose members attend weekly meetings and stand up and say, “My name is Bill, and I’m an arthritic.”
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Some people (but not presumably The Lancet) might say that it hardly matters what you call addiction. But calling it an illness means that it either is or should be susceptible of medical treatment. And one of the most commonly used medical “treatments” of heroin addiction is a substitute drug called methadone. According to The Lancet, though, 414 people died of methadone overdose in Great Britain in 2012, while 579 died of heroin and morphine overdose. Since fewer than 40 percent of heroin and morphine addicts are ‘”treated” with methadone, treatment probably results in more death than it prevents, at least from overdose. Moreover, some of the people it kills are the children of addicts.

The United States, with five times the population of Great Britain, has nearly fifteen times the number of drug-related deaths (38,329 in 2010). This, however, is not because illicit drug use is much greater than in Britain. It is because doctors in America are prescribing dangerous opioid drugs in huge quantities to large numbers of patients who mostly do not benefit from them. More people now die in the United States of overdoses of opioid drugs obtained legally than are murdered. It is not true, then, that all the harm of opioid misuse arises from its illegality.

Recently I asked a group of otherwise well-informed Americans whether they had heard of the opioid scandal. They had not.

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images courtesy shutterstock / Evdokimov Maxim / Julia Reschke / Peter Bernik

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All Comments   (9)
All Comments   (9)
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More than half of these questions would simply go away if everyone (or their family or close friends as needed) paid for their own health care. For the remainder - perhaps excerpting parental responsibility for an obese child - it is sufficient for everyone to have their own opinion and act accordingly.
27 weeks ago
27 weeks ago Link To Comment
There's so much PC BS on most topics that it's startling to hear or read TS, "true speak." Thanks, Doc.
27 weeks ago
27 weeks ago Link To Comment
RE: Obesity & RE:Healthy Diet. I know 17 people with Hypo-Throidism, & most continue to gain weight eating healthy low cal diets with lots of aerobic exercise. I doubt most overweight people have this, but some do have a medical reason for obesity, likely a small minority. Those who simply choose a poor diet likely fall into one of these categories...1) I will eat what I want (needs immediate & constant gratification). 2) Too uninformed (or ill informed) to make intelligent choices. 3) Too poor to buy healthy food (the price, per calorie, of junk food has dropped, while the cost of real food has skyrocketed). If most people would eliminate all processed foods made with white flour & white sugar, & replace that with a MUCH SMALLER amount of whole grains than the food pyramid recommends & eat mostly lean sources of protein + lots of organic produce, they would naturally loose weight. For weight loss to be permanent, you have to make permanent changes!! "Let thy food be medicine & let thy medicine be food"...Hippocrates
27 weeks ago
27 weeks ago Link To Comment
Here in NV our absurd Medical Marijuana laws require a patient to break the law BEFORE they can comply with it. First, you have to break the law & illegally obtain the seeds. Then you apply for a Medical Marijuana card ($50.00), then pay another $50.00 for an "Illegal Contraband Tax Stamp", (no I'm NOT making that up). Then you have to "grow your own". Once "your crop comes in"...you FINALLY have your medicine. As a patient who laid in bed CRYING AND SCREAMING IN AGONIZING PAIN FOR MONTHS ON END, because pain pills don't work on me, NOT opiates & NOT NSAIDS, I can tell you that "witch hunt" leveled against Medical Marijuana is merely "cover" to TORTURE cancer patients like me. I choose not to break the law, because there's no telling when/who the Fed. Gov't. will turn on next & my Hubby is a legal immigrant, here on a Green Card from Canada...so I SUFFERED!! The freely available (by RX) dangerous, highly addictive, toxic narcotics & their horrific side-effects they "experimented on me with" are what we should be worried about...NOT a plant that grows out of the ground!!
27 weeks ago
27 weeks ago Link To Comment
With the understanding that people should be free to obtain help for obesity, addiction, and all health issues at any age, but cannot demand that others pay for this treatment (Charity given by others is ok and encouraged), my take is as follows. Let the debate begin.

1. Obesity is neither a disease nor a moral failing
2. Alcoholics should not be denied available medical care
3. Psychiatric illnesses merit treatment as much as physical illnesses
4. Doctors sometimes are guilty of giving pain killers to addicts who con them
5. Elderly should not be denied available medical care
6. Marijuana can be a medicine, with side effects
7. Nutrition is important to health
8. Drug addiction is not like non-addiction illnesses but addicts should be treated
9. Obese children are not victims of child abuse
10. Parents should vaccinate their children
27 weeks ago
27 weeks ago Link To Comment
Interesting that the author chose only one vaccine to discuss pros and cons.
27 weeks ago
27 weeks ago Link To Comment
He must be in on the CONSPIRACY!!!!!!!
27 weeks ago
27 weeks ago Link To Comment
A government funded psychiatrist on an NHS pension in on 'the conspiracy'? No. Not possible.
27 weeks ago
27 weeks ago Link To Comment
Thank you, Doctor, for this thoughtful and objective article. These are two qualities that in tandem are virtuous but rarely encountered today.
27 weeks ago
27 weeks ago Link To Comment
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