Month / January 2016

by drcpatc

The advantage of being the stupidest one in the room.

CODE ALERT: U.S. Preventive Services Task Force says women should be “screened for depression” during and after pregnancy. Their answer, of course, is to “find the right medication.” And how many on the “Task Force” are on big pharma’s payroll? Follow the money on this one. Hormonal changes during and after pregnancy are NORMAL. Mood changes are NORMAL. Meditation helps. Prayer helps. Nutritional support helps. Love helps.

Recently on social media I came across this gem.

I’m not going to specifically cite the author here – she’s all over social media so you should be able to find it easily if you’re interested. I prefer to avoid signal-boosting such Froot Loopery any more than necessary to make a point.

As far as I’m concerned, the recommendation is long overdue. I have to say I’m disappointed they didn’t specifically recommend paternal screening as well. I don’t think there’s anyone in the medical profession who really takes ownership of care for fathers in the way our obstetricians look after mothers. All that’s aside from what I want to say here, though.

There is a lot to say about the current crop of science denying “purity cults.” These folk act as if there was no such thing as disease in the Neolithic, when everything was all organic and non-GMO and we didn’t have any of those terrible, terrible medicines and vaccines that are steady killing folks. I’m not going to say most of that stuff.

Here’s what I’m going to say: Science is going to win, over and over, because science is intentionally and stubbornly stupid.

Let me illustrate by contrast. Take a look at this slightly enhanced version of that quote:

CODE ALERT: U.S. Preventive Services Task Force says women should be “screened for depression” during and after pregnancy. Their only answer, of course, is to “find the right medication.” And how many on the “Task Force” are on big pharma’s payroll? Follow the money on this one. All hormonal changes during and after pregnancy are NORMAL. All Mood changes are NORMAL. Meditation always helps. Prayer always helps. Nutritional support always helps. Love always helps.

Yeah, she never really came out and said meditation always helps. She damn sure doesn’t use sometimes much, either. You see, she knows.

Back when I was applying to college, in between chucking authentic artisanal spears at the antibiotic-free, free-range cave bears wandering about at the time, I was introduced to my good friend Joe Bloggs.

Joe Bloggs, according to my SAT prep books, was a guy of approximately average intellect. Joe got easy questions right, middlin’ questions about half the time, and was usually wrong on the hard stuff. To his credit, Joe B. knows his own strengths.

Joe B.’s cognitive capacity was the key to a very meta test-taking strategy. First you looked at a question to figure out how hard it was. Then you asked yourself, “What would Joe Bloggs do?” On an easy question, no need to overthink; just write down the answer. On a hard one,  the most immediately appealing answer is probably wrong.

One thing Joe Bloggs had nailed down was this: always and never statements are usually false. Very few things are so simple as to be universally true – for heaven’s sake, even a second doesn’t always last a second. Among the universe of possibilities, always and never can only be true in exactly one circumstance, whereas sometimes can be true under several.

So, our not-too-bright-but-not-too-dumb friend Joe Bloggs might look at such statements and think, “Is there never such a thing as an abnormal mood change? Is there nothing that prayer, meditation, and food can’t help?”

What our boy Joe Bloggs lacks in straight-up horsepower, he makes up for in wisdom. To paraphrase another deeply wise man, Joe knows what he doesn’t know.

Some would make science out to be a monolithic entity that spouts unquestionable truths from on high, and only a small dedicated group can see through it. In fact, the way of science is rigorous, corrosive, unrelenting doubt.

Real, no-kidding scientific conclusions tend to look like this: Under these circumstances, when you do X, Y happens more often; however, it doesn’t always happen and we haven’t looked at some circumstances. So, to the best of our knowledge, X probably contributes to Y.

Science starts out from a position of ignorance about anything, thinks up several possible explanations, and then immediately starts obsessively tearing each one of them apart. Science is pretty much one giant Woody Allen monologue.

Knowing is a lot easier. It’s a lot more pleasant to be smart, to know better than other people.

Except when you’re smart, when you know; you stop looking. For example, you might not look at the actual guidelines since you just know that those @#$%ers are in the drug company’s pocket. If you did, you might find something like this:

They found evidence that cognitive behavioral therapy and other talk therapy are effective treatments and have little risk of harm for the woman or baby. The Task Force found that antidepressants can cause serious harm for a fetus, but the risk of this happening is small. Clinicians and pregnant or postpartum women are encouraged to work together to identify the best approach for treating depression that will meet the woman’s individual needs.

What? Clinicians acknowledging that scientific evidence shows there are both risks and benefits to medications? Pointing out non-pharmacologic treatment options? Encouraging rational discussion and individualized decision-making? It’s even more sinister than we thought! It’s not Big Pharma, it’s BIG PSYCHOTHERAPY!

No, that can’t be it. Must be reverse psychology. They’re trying to misdirect those sheeple into thinking they’re not up to what they’re up to. We could look for actual evidence of their conflicts of interest. Why bother, though? We’re the smart ones. We are the enlightened. We know.

Me, I’ve had most pretense at knowledge beaten out of me. I’ve got some evidence to go by in what I do. Despite the fact that so much has been discovered, I’m still deep in the weeds a lot of the time. There are plenty of medicines that improve the chance somebody will get better, they all have side effects, and they will fail lots of people. The same can be said for all other therapies.

Most of what I’ve got now is some hard-won humility, persistence, and a sharp sense of what I don’t know.

I would rather tell somebody, “I don’t really know what to do, but I can think of some things we can try. Let’s think about which one is worth a shot” than blow smoke. Of course, I got no books to sell.

I’m Joe Bloggs, MD.

Still, I think I’m smarter than some.

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by drcpatc

Teetering.

“I’m kind of scared of it, yaknow’msayin? Like, I’m gonna lose my edge.”

He’s talking about stopping heroin. He’s a lifelong dealer, so that has to change, too. There’s a crude but clear slogan in the Fellowships around here: “A monkey can’t sell bananas.”

“Doing what I do, you know, you make enemies. For all I know, I relax, I forget to look behind me one day, and something from 15 years ago comes up. That’s it for me.”

He’s still wearing a hospital gown but it’s backward, showing his chest. He sprawls with the affected don’t-give-a-damn manner common to the street guys, but there’s a restlessness.

He should go to a residential program after he leaves but he doesn’t talk about it. It’s his first time getting help, and he doesn’t know anything about recovery. Instead, he talks the three cardinal just haftas. Just hafta be strong, just hafta remember how bad it was, just hafta get a job and keep busy. 

Me, I translate strong to mean walk blindly into temptation and expect not to give in. Memory fades too, scary fast.

The other things he talks about are his girlfriend, and moving to the county. Getting a house to themselves, after getting a warehouse job.

Half the time he talks about these things he’s not looking at me. Then he sounds like  he’s making up a story and listening if it sounds right, or maybe trying to convince himself.

He reminds me of this soldier who left Afghanistan and landed in a bottle. The two of them look nothing alike, but the soldier talked about marrying his girlfriend and getting a job in the same way; like it was some place he had only read about. I remember thinking, “So that’s what the thousand yard stare looks like.”

The man in front of me has taken some bullets, too. There are still some left in him. I reckon he’s dealt a few as well, but I don’t inquire after that. Best to wait until he’s willing to tell the truth, rather than having him lie and then have to stick to it.

One minute he talks about how the drug life kept him sharp, and strong. He’s afraid if he’s not hustling, if he drops his guard, something – seen or unseen – is going to get him. It’s a belief rooted in a kind of backward Darwinism. If you’re still alive, you must be the fittest. So what kept you alive must be working.

The next minute he talks about how the drug kept him numb, and mean. How he’s chasing a high that barely even happens any longer.

“I lie to my family. I hurt people, you know. I break laws all over, and then the law takes my freedom. I’m tired of all that.”

He’s never held a real job for longer than a month. I’d lay solid money he’s never written a check or had a bank account. Never had to swallow his temper when a boss talks down to him.

Early on, the dealers have a similar problem to the prostitutes – access to large amounts of cash fast. They have records, records that include things like “with intent to” or “with a firearm,” so bad jobs are hard to get and good ones might as well be on the moon. Unlike the prostitutes they make victims and nobody thinks they are victims. They get locked up for long times for doing very, very bad things.  Drugs make the money, then drugs take the money. The meat grinder keeps turning and young men’s corpses pile up.

He’s right about old times coming back. You can quit the life but it may not quit you. Somebody he burned might be waiting outside his mother’s or sister’s or girlfriend’s house one day.

With all that: Here he is, though. I’ve met a lot of men in his line of work. Some take pride in what they’ve become, slyly bragging about what they think they’ve gotten away with; or just doing their best to impress me with their brutality and callousness before talking about how they’re tired of it.

This fellow, he’s not in that spot. There’s real remorse there, mixed in with a fear. Fear, I think, of peace. Having it but not belonging in it, or finding out it’s just a story he’s been sold. Having heard his history, I can’t say I would trust it, either.

A question everybody faces, but magnified twenty fold for him: What do you pick, what you know or what you want? Hope or fear?

I like the ambivalent ones. The ones who want to stop but are afraid of everything that could go wrong, who still remember the good things about the drug life.

They are the ones for whom a thumb on the scale could tip it. They’re the ones you can help.

I say, “Sounds like there was a lot you liked about that life.”

He looks at me, just a little surprised. I’m supposed to be lecturing him. I won’t.

“Yeah,” he says. “I know it’s crazy, but there was.”

“So when it comes down to it, how are you going to keep yourself from doing what you want?”

“I’m not even thinking about that now.”

“You will, and you are.”

He doesn’t say anything. That’s good.

“You’re going to have to deal with a lot of things you have never dealt with. That’s going to be rough.”

“Yeah.”

“You think you’re going to do that by yourself?”

He looks at me, the tiredness and sadness looking out of place in that sprawl.

“No.”

It’s on.