Monday, October 31, 2016

Rangoli 2016

USPS Diwali Stamp

The US Postal Service issued a Diwali stamp, a sheet of which looks like this:

Sunday, October 30, 2016

Americans on Opioids

This paper from 2012 uses data from 2008 to study the Geographic Variation in Opioid Prescribing in the U.S.

Some excerpts (refer to the original paper for full details):
.....Geographic variation in prevalence of prescribed opioids is large, greater than variation observed for other healthcare services. Counties having the highest prescribing rates for opioids were disproportionately located in Appalachia and in Southern and Western states. The number of available physicians was by far the strongest predictor of amounts prescribed, but only one-third of county variation is explained by the combination of all measured factors......
Wide geographic variation that does not reflect differences in the prevalence of injuries, surgeries, or conditions requiring analgesics raises questions about opioid prescribing practices. Low prescription rates may indicate under-treatment, while high rates may indicate overprescribing and insufficient attention to risks of misuse.....
...Regression analysis was conducted to identify the correlates of prescribing prevalence at the county level....

Saturday, October 29, 2016

Chief Arvol to President Obama

From here:

Chief Arvol Looking Horse to Obama: Keep Your Word

Mitakuye (my relative),

I greet you with our traditional greeting,

Mitakuye Oyasin – all things are related!

As Keeper of our Sacred C’anupa (Pipe) Bundle of the Lakota/Dakota/Nakota Nation, I address you from our original governance of our people, Woope – Creator’s Law. I am not a member of leadership under any political government, I stand in position as the center of our people, the voice of our traditional government, and so this communication is nation to nation, as indicated by our treaties. Additionally, we have over 300 flags of indigenous nations including other countries supporting our stand, because they are suffering as well.

In our honor ways, when we leave this Unc’i Maka – Grandmother Earth, the only thing we truly own is our word. When you met with our people on your campaign trail in Sioux Falls, South Dakota, you stated that you are a lawyer and understand treaty documents. You told us that you realized our treaties were violated and you would address these violations against our people if you became President. This was your Word. You then took a photo of us together at that time and then I found out you used my photo for your campaign brochure, even without asking me. I accepted you as a man of his word and ignored people asking me if I gave you permission, because I thought you understood Woope - in keeping one’s Word.

Yesterday, October 27, 2016, our Elders stood with their sacred items, including their sacred C’anupa pleading for sanity in a state of distress, and were arrested. Once we stand with our sacred filled C’anupa, we make a commitment to the Creator that we cannot break. We stand under the Freedom of Religion Act of 1978 with our Pipe of Peace and the Treaty of 1851. Our protectors had no lethal weapons, but we were met with an army of lethal weapons. In the middle of our water protectors we found a DAPL worker (infiltrator placed to discredit) who had lethal weapons, stating he was ordered to lay a pipeline, and he would shoot anyone to do just that… when asked if he was planning to shoot women and children. Yet media states he was one of our people, his credentials in his truck were from DAPL when the BIA police arrested him.

You are ignoring our pleas to use your time as President to move us toward sustainable development as fast as possible, because of our Mother Earth – our Grandmother Earth, is sick and has a fever. We as people that want to do Creator’s work to create these changes and are stuck with using oil, because it is all you have allowed to invest in to transport this country.

It is time you stop this desecration of our sacred sites, which have been indicated by our Traditional Cultural Tracker, Tim Mentz. He has been ignored by DAPL, who now have police and National Guard’s protection as they continue to desecrate our sacred places.

I would like to include a statement from our Traditional Elders Council:

We are a part of Creation; thus, if we break the Laws of Creation, we destroy ourselves
We, the Original Caretakers of Mother Earth, have no choice but to follow and uphold the Original Instructions, which sustains the continuity of Life. We recognize our umbilical connection to Mother Earth and understand that she is the source of life, not a resource to be exploited. We speak on behalf of all Creation today, to communicate an urgent message that man has gone too far, placing us in the state of survival. Not heeding warnings from both Nature and the People of the Earth keeps us on the path of self-destruction. These self-destructive activities and development continue to cause the deterioration and destruction of sacred places and sacred waters that are vital for Life.
We respect and honor our spiritual relationship with the lifeblood of Mother Earth. One does not sell or contaminate their mother’s blood. These capitalistic actions must stop and we must recover our sacred relationship with the Spirit of Water

In a Sacred Hoop of Life, where there is no ending and no beginning!

Onipiktec’a (that we shall live).
Nac’a (Chief) Arvol Looking Horse, 19th Generation Keeper of the Sacred White Buffalo Calf Pipe Bundle.


Thursday, October 27, 2016

Two paths through the woods

Ross Douthat, conservative columnist for the New York Times, October 2016, about American conservative intellectuals (don't laugh at the oxymoron) who have lost their way:

History does not stand still; crises do not last forever. Eventually a path for conservative intellectuals will open.

But for now we find ourselves in a dark wood, with the straight way lost.
Mahatma Gandhi, conservative Hindu, September 1929:
"The Shastras have taught us both our ideal dharma and our practical dharma....

"However, we do not seek solutions to [such] problems by regarding them as matters of absolute dharma. Relative dharma does not proceed on a straight path like a railway track. It has, on the contrary, to make its way through a dense forest where there is not even a sense of direction. Hence in this case, even one step is sufficient. Many circumstances have to be considered before the second step is taken and, if the first step is towards the north, the second may have to be taken towards the east. In this manner, although the path may appear crooked, since it is the only one which is correct, it can also be regarded as the straight one. Nature does not imitate geometry. Although natural forms are very beautiful, they do not fit in with geometrical patterns."
 Commentary:  The real world is complicated.  Gandhi acknowledges this, finds it natural.  American conservatives like Douthat do not.

Sunday, October 09, 2016

Americans on Amphetamines

 How the first amphetamine epidemic came about (emphasis added):

From 2008:
America’s First Amphetamine Epidemic 1929–1971
Am J Public Health. 2008 June; 98(6): 974–985.
The first amphetamine epidemic was iatrogenic, created by the pharmaceutical industry and (mostly) well-meaning prescribers. The current amphetamine resurgence began through a combination of recreational drug fashion cycles and increased illicit supply since the late 1980s. On the basis of treatment admissions data, methamphetamine abuse doubled in the United States from 1983 to 1988, doubled again between 1988 and 1992, and then quintupled from 1992 to 2002. According to usage surveys, during 2004, some 3 million Americans consumed amphetamine-type stimulants of all kinds nonmedically, twice the number of a decade earlier. As noted, 250000 to 350000 of them were addicted. Thus, in terms of absolute numbers, the current epidemic has now reached approximately the same extent and severity as that of the original epidemic at its peak in 1970, when there were roughly 3.8 million past-year nonmedical amphetamine users, about 320 000 of whom were addicted. (Of course, the national population then was about 200 million compared with 300 million today, meaning that in relative terms today’s epidemic is only two thirds as extensive.)

Another striking similarity between present and past epidemics relates to the role of pharmaceutical amphetamines. Although illicitly manufactured methamphetamine launched the current epidemic, in step with rising amphetamine abuse in recent years, the United States has seen a surge in the legal supply and use of amphetamine-type attention deficit medications, such as Ritalin (methylphenidate) and Adderall (amphetamine). American physicians, much more than those in other countries, apparently are again finding it difficult to resist prescribing stimulants that patients and parents consider necessary, or at least helpful, in their struggle with everyday duties. According to DEA production data, since 1995, medical consumption of these drugs has more than quintupled, and in 2005, for the first time exceeded amphetamine consumption for medical use at the epidemic’s original peak: 2.5 billion 10-mg amphetamine base units in 1969 vs 2.6 billion comparable units in 2005. Thus, just as the absolute prevalence of amphetamine abuse and dependency have now reached levels matching the original epidemic’s peak, so has the supply of medical amphetamines.
(Of course, the national population then was about 200 million compared with 300 million today, meaning that in relative terms today’s epidemic is only two thirds as extensive.)
and (emphasis added)

Besides iatrogenic dependence and diversion to nonmedical users, there is another way that widespread prescription of amphetamine-type stimulants can contribute to an amphetamine epidemic. When a drug is treated not only as a legal medicine but as a virtually harmless one, it is difficult to make a convincing case that the same drug is terribly harmful if used nonmedically. This is what happened in the 1960s and is presumably happening today. Thus, to end their rampant abuse, amphetamines had to be made strictly controlled substances and their prescription sharply curtailed. Today, amphetamines are widely accepted as safe even for small children, and this return of medical normalization inevitably undermines public health efforts to limit amphetamine abuse. We have not yet reached the point where up to 90% of the amphetamines sold on the street are products of US pharmaceutical firms, as the federal narcotics chief reluctantly admitted before Congress in 1970. But with half the nation’s nonmedical users evidently consuming pharmaceutical amphetamines only, the comments made by Senator Thomas Dodd in those hearings echo strongly today. America’s drug problems were no accidental development, Dodd observed; the pharmaceutical industry’s “multihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have pill by pill, led, coaxed and seduced post–World War II generations into the ‘freaked out’ drug culture” plaguing the nation. Any effort to deal harshly with methamphetamine users today in the name of epidemic control, without touching medical stimulant production and prescription, is as impossible practically as in 1970—and given historical experience, even more hypocritical.
We have seen a similar opioid epidemic created in a similar way; and opioids are a gateway to heroin. 

Obviously, criminalization is not a solution, but medical normalization, removal of tight regulations, and making it socially acceptable (e.g., the way alcohol is) is not going to help either.  It is not clear to me why society cannot find getting intoxicated/getting high as socially unacceptable as body odor or even perspiration.

Saturday, October 08, 2016

Not learning from history: legalization of drugs

History doesn't provide any comfort about the legalization of drugs. Per Alan Schwarz in ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic, in the 1960s:

Dexedrine had become perhaps the most widely abused drug in the United States—more than hippies' marijuana, more than Timothy Leary's LSD, more than the heroin that would soon kill Jimi Hendrix and Janis Joplin. In the 1960s, doctors prescribed amphetamines so willingly—for weight loss, depression, all but hangnails—that an estimated four billion tablets were dispensed by American pharmacies per year, or enough for every man, woman and child in the United States to have twenty apiece.

The United States military handed out Dexedrine so freely that an estimated 7 percent of its Vietnam forces became abusers and addicts. About eight hundred thousand Americans were dependent on amphetamines, about three hundred thousand of them flat-out addicted—and many of them average housewives. These addicts weren't the young beatniks and hippies so reviled by the establishment; they were, in many cases, the establishment itself.

There was talk in about banning amphetamines in the United States altogether, its medical uses be damned. Instead the federal Controlled Substances Act placed unprecedented restrictions on the handling of addictive pharmaceuticals like Dexedrine and Ritalin. Prescribers were now required to maintain a special government license, fill out much more paperwork, and prescribe no more than a thirty-day supply at a time. Drug companies could not produce such medications in quantities higher than the government deemed clinically necessary.

It was the ultimate buzzkill. US production of amphetamine plummeted an astonishing 90 percent in only a few years. Stimulants could no longer be handed out as mere pick-me-ups for tired professionals, but only for narcolepsy or short-term weight loss. And for a children's malady just now hitting America's living rooms: minimal brain dysfunction.

Minimal brain dysfunction is simply the old name for Attention Deficity Hyperactivity Disorder (ADHD). The author says it is a real malady, but where about only 5% of children are actually affected by ADHD, about 15% are diagnosed with ADHD, leading to a massive over-prescription of drugs. Why?  There are simply too many perverse incentives in the system.

I expect there is a similar story behind opioids and their widespread abuse today; and in a few years, I expect the states busy legalizing pot, whether for medical purposes only or more comprehensively, will have similar findings.

FYI: alcohol use is a leading cause of death in the USA and in the world; but in the USA the deaths due to alcohol are parceled up among many different buckets to disguise that fact.  While Daniel J. Levitin's very timely book A Field Guide to Lies: Critical Thinking in the Information Age does not mention this example, it does mention the template of this lie. Levitin calls it "specious subdividing".
Suppose you work for a manufacturer of air purifies, and you're on a campaign to prove respiratory disease is the leading cause of death in the United States, overwhelming other causes like heart disease and cancer. 
 But respiratory disease is only the third leading cause of death, and doesn't make for an impressive ad campaign.  So subdivide heart disease into categories like rheumatic heart disease, hypertensive heart disease, acute myocardial infarction, and so on, and likewise with the various cancers.
By failing to amalgamate, and creating these fine subdivisions, you've done it! Chronic lower respiratory disease becomes the number one killer.  You've just earned yourself a bonus.

Thursday, October 06, 2016

Hurricane Matthew

The forecasts are highly uncertain, but since they look highly unusual (from to my eye, here they are.  This hurricane could possibly go around in a complete circle and hit Florida twice.