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California Pastoral

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by Hubert H Bancroft 1832-1928

Book Review

As a clerk in his brother’s Ohio booksore, Bancroft went to San Francisco in 1852 to sell books. Over the years he  accumulated an extensive collection of his own books and historical documents, that became the basis for 39 volumes on Native races, the histories of Mexico, and Central America, and the American West. Critics assert that he employed many assistant authors whom he merely edited. Yet even if true, the result is a unique compendium, reflecting the breadth and depth of the Americas of those times. I have volume number 34 of 39, published in 1888 by the Library of Congress. It’s an unpretentious cloth bound item like like the first two volumes of this venerable set,  picured below. The 4 1/2 pound 808 page tome is in good condition, but the thick bond pages are brittle and yellowing.

Bancroft is a loquacious writer who provides extensive details, and erudite commentary laced with classical historic and literary references. It seems very likely he was competent in Spanish, and had a classical education in History and English. Sometimes the language, both in English and in obscure Spanish are difficult.  I found my browser helpful to interpret it! https://en.wikipedia.org/wiki/Hubert_Howe_Bancroft .

He begins with a long and rather didactic lecture on ‘comparative civilization’ between the West and what he likes to call savegery, a 56 page history  of Western civilization, followed by long expositive sections on the Spanish Colonial empire, and then more than twenty chapters on  ‘Lotus Land’, or the West Coast of North America, with a strong focus on both Californias starting with Baja CA as did the Spanish in general, and Mexico in particular.  He details the founding and development of the Missions, and the fatal habit of Spain in governing with a heavy hand, and taking but not really giving much excepting rules, restrictions,  and regulations in all of her American colonies, as far North as San Francisco. These ultimately led to rebellion and revolution, almost exactly the experience of the British in her colonies. He ends with chapters on the founding and development of San Francisco and Benicia. The whole book is ‘filthy rich’ in details, names, people, customs, and events.  He sees as the future of California to be gateway to the  Pacifc rim nations, and  the commercial and cultural giant of the Western USA.

I would be remiss to overlook Bancroft’s obvious racism. While understandable… because we all are condemned to live within the limits of our time… it is anachroinc  now, and irritating. He considers the white races, especially anglo-saxon derived, as far more ‘developed’ than all the rest.

Nonetheless, I reccomend it highly, even though it was as challenging a read for me, as it would likely be for most of us in this 21st century.  Although all the  Americas, North, Central, and South are the homeland I love and honor most, California has  always been the heartland, the land dearest to my heart, and the pole star of  my world; Bancroft’s weighty book, California  Pastoral, makes me more than ever, grateful to be American, and to be a Californano.

Muchas gracias, Don Hubert! 

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Being There

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A primary care physician,–or generalist by whatever name–can best prepare and accompany a patient in that transcendental experience that is dying and death; can Be There.
Family Medicine physicians, in particular, are ipso facto, concerned with the health of Family. Therefore, provided the patient agrees, the physician should encourage the participation of family and friends during death and dying whenever; the life-long advantage of Being There for death is highly significant for both survivors and physician.

The doctor who personally attended a dying patient was routine, 100 years ago. Perhaps that was in part because nothing else could be done; see the Luke Fildes painting of a doctor sitting resignedly at the bed of a patient:

The_Doctor_Luke_Fildes

While it may seem overly dramatic, the painting merits a closer look: The physician’s demeanor; the neglected cup and potion; the disarray; the child’s parents; the darkened humble room. This doc is not attending nobility, but a family that lives at the edge of life. The doctor can do little except Be There. Isn’t that precisely the nature of death, that physicians can offer nothing except comfort, advice and –- most important under the circumstances–our presence?

We seem to have forgotten–or become fearful of– just being there for family and friends of the dying patient. Maybe we are afraid of being found merely human; to have failed in our pretentions or hopes of scientific omnipotence. Because omnipotence implies guilt and deception when it becomes impotence. Yet the nature of life’s end is too critical a moment for a physician to give over that privelege to well meaning hospice teams, hospitals, nursing homes, or institutions.

Clearly, Being There for death is quintessential to medicine. It completes the circle of a life, and  defines what is human, and  what it is to be a physician.

Why should physicians abandon patients and families in their extremis? No one, I believe, can better be there at that time than the physician, especially if well known to the patient.

In my own experience Being There is eminently doable, even though that was decades ago, when house calls were still common. My practice included something called Home Rounds: regular visits, usually one afternoon each month to those who had difficulty getting to the office due to the limitations of chronic illness. The best features of those home calls were interpersonal, quiet, unspectacular, and shared humanity. The visits quite naturally led to the time when death visited as well. The downside of those home visits was that better diagnostic and treatment options were not in hand back then. Yet present day micro-technology can minimize that problem; how contradictory it is that as technology becomes ever more reasonable, available, effective, and mobile, its use outside institutions seems more limited.

There is no serious barrier to home visits, or to Being There today, even during the current medical politico-economic perfect storm. (see below) Medicare regulations, for example, have been modified to allow and encourage primary care physicians to discuss end of life decisions as part of a health assessment. It seems clear the same sort of hocus-pocus will be made available for younger people facing death. (see below.)

However, the physician who hopes to Be There should think about the process and plan for it –as we do with any other aspect of medicine. Perhaps the easiest part is already at hand; the material that is available from, for example, CMA, referenced here without further comment:
1) Advance Directives: see, for example:
https://www.cmanet.org/about/patient-resources/end-of-life-issues/
2) POLST. Be able to discuss Physician Orders for Life Sustaining Treatment https://www.cmanet.org/about/patient-resources/end-of-life-issues/physician-

The topic of dying is almost impossible to introduce quickly or easily. I suggest the physician make up a simple, easily understood one or two page letter to communicate with patients about the subject for people themselves to use. It is found below in a version for use by patients, but should be updated when things change; it can easily be revised by a physician or others to introduce the subject in discussion. a version is viewable on line at https://nwalmanac.wordpress.com/.

###########################

Thoughts on Death and Dying
When it becomes impossible to avoid death and dying, you may want to consider whom you want to Be There, even though no one is able to provide more than comfort. Consider setting down information that can make clear your preferences. The purpose is not to replace the physician, pastor, other counselor, or hospice; but to assist them, and you, and your loved ones in this universal life experience that is at least as significant as any other, including birth. You may want consider:

If Faith is a part of you life, reach out for it now. Hold fast to your faith.
Review your personal belief about death
Consider experiences that seem death-like:
Consider the condition we were in before birth;
Consider what you expect your own death will be like:

Will your death be:

  1. permanent or temporary;
  2. The beginning of life everlasting? Yes_____ No_____
  3. A temporary condition before rebirth? Yes_____ No_____
  4. A permanent state of rest, nothingness? Yes_____ No___
  5. Will you be aware or even conscious? Yes_____ No_____
  6. Will you- can you- feel pain after death? Yes_____ No_____
  7. Will you be rewarded or punished for your life? Yes_____ No____
  8. Do you want religious guidance to die? Yes_____ No_____
  9. If so, who will be with you?_________________________________________
  10. Will friends or family to be with you when you are dying? Yes_____ No_____ _
  11. If so, who will contact them?
  12. Name: ___________________________________________Phone_______________________
  13. Name: ___________________________________________Phone_______________________
  14. Name: ___________________________________________Phone_______________________
  15. Name: ___________________________________________Phone_______________________
  16. 7) Do you have an Advanced Directive? See, for example: https://www.cmanet.org/about/patient-resources/end-of-life-issues/
  17. 8) Consider POLST, Physician Orders for Life Sustaining Treatment so you can better say what to do when or if you can no longer make decisions: see
  18. https://www.cmanet.org/about/patient-resources/end-of-life-issues/physician-orders-for-life-sustaining-treatment

—You may want to take this completed form to your physician, friend, pastor or family.

—Speak up if your ideas change. That can happen!
—If you want your doctor to be with you when you die, ask that a copy be
placed –or scanned– into your record. Keep the original.

Date: ___________Signed:________________________________________________________

################
Note:
There is much written on the subject of death and dying. However it is often too detailed, tedious or theoretical to be practical. That is why you, yourself, are the best person to determine your ideas on death and dying. You may think about practicing detachment from the things of your life. The short list below is inspired by Chapter 3 of The Tibetan Book of the Dead by Robert Thurman 1944 Bantam.
1) Begin giving things away. Especially things you care about. Give thoughtfully, carefully.
2) Review your relationships, concentrating on what may make your relations and friends.
3) Let go of your own body concerns; take care of it but be relaxed about it.
4) Meditate; when you do, or when you write, you can best find your inner self.

###############

See also:
http://www.nytimes.com/2010/12/26/us/politics/26death.html?pagewanted=all&_r=2&
http://voiceofsandiego.org/2013/08/12/second-opinion-how-does-obamacare-address-end-of-life-care/
‘Note: End-of-life counseling to is a now usuallya billable physician service, giving families and doctors a clear route to make decisions about when to forgo treatment. The idea was at first worrisome because it might pressure families and incentivize doctors to pull the plug. But there is language in the regs that minimizes that chance. Generally “voluntary advance care planning” can be included by insurance covered annual wellness appointments. The planning can include creating an advance directive, a legal document that dictates how aggressively a patient can be treated once he or she loses the ability to make decisions.’

THREE DREAMS

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Cover of The Sandman, No 1 Neil Gayman, Jan 1989; art by Dave McKeen

I sleep 8 or 9 hours, but can resuscitate these three complicated early morning dreams:

  1. A tour group in a foreign land. I think it is London, a favorite place. I have a 2×2 plastic ticket in my hand; maybe it is for entry to a church, because museums are free there. Another tourist exchanges tickets with me. There is no conversation, but we go off together to rent a car; I will drive because I have driven right hand roads in South Africa. Connection with reality: After retirement I enjoyed several years as tour ship doc and leading tours to South America.
  2. A mountain trail. I don’t know who my compainions are but we are talking about a project providing elder-care, the subject of a book of mine about caregiving. I am retired, but still a licensed physician who can supervise caregivers and assist or intervene when appropriate. Connection with reality: a life long love of the trail, the river, the mountain top.
  3. ‘Mustering out‘ after two years with the US Navy I am wondering if I should re-enlist. Connection with reality: 1957 -59 as I completed the first year of a surgery residency, I was drafted into the US Navy and sent to the 32nd St. Naval Sation in San Diego. Part of my job was to read hundreds of 4×5 cm chest Xrays every week; advised to apply for a short course in radiology, I broke the basic rule in the military: Never Volunteer. Bingo: I was immediately reassigned to the USS Orca, AVP 49, a Seaplane tender in the Western Pacific (Fifth) Fleet. Yet in retrospect, that was fortunate. Seaplane Tenders, at the time, set up seadromes and provided fuel and support for seaplanes used for antisubmarine warefare. That inclued medical care for pilots. The Navy had decided aviators should command aircraft carriers: football field sized floating cities with several thousand residents, and good medical and surgical resources. Yet to bring a carrier as big as that past coastal shoals and rocks, or into a harbor is a complex task involving politics, regulations, and seamanship. Therefore aviator carrier captains must first become ship captains; the Orca was devoted to training them. A captain trainee took command for six months to learn the ropes (a fortuitous old sailing ship term; but it should have been ‘sheets’; sheets, however, generally was taught ashore!) The captain trainee needed to visit and become familiar with ports like those in Hawaii, Cebu, Guam and in Hong Kong. During each month-long visit to Hong Kong I, as a 25 year old physician with only 3 weeks introduction to the Navy, was responsible, among more traditional health matters, for medical liaison between US Naval vessels, and the Royal Naval Hospital, if a visiting ship couldn’t care for a crew member. While alcohol was a frequent shoreside fuel for US sailors, I held the only alcohol on board under lock, reserved for medicinal puposes, like a sailor who fell into the contaminated harbor. But for the Brits, fine alcohol in all forms, seemed to be a daily religious ritual. I enjoyed my work, was always treated tolerantly and leniently on the Orca; in port there was little for me to do except treat hangovers and venereal disease. At sea I did some minor surgery like the correction of a sailor’s prominent forward facing bat-like ears; read the Will and Ariel Durant’s huge 13 volumes of world history; played the guitar; and was allowed to bring aboard a motorized bicycle to drive around Okinawa while we are at White Beach. Best of all there was no live conflict with China over their intent to invade Formosa/Taiwan; that was one reason for the presence of the Fifth Fleet in the area. I feel priveleged to have been a physcian and officer in the Navy during a relatively uneventful time. Back in the real world a few years later I reflected: Should I have re-enlisted? But no. Half the time I would have been away from my young family. I had to become a physician for real,

Organizing and leading tours is the backgroud for the first dream. The Mountain trail conversaton and The Melba Notebooks. second edition, now in galley proofs and is background for the second dream. And Being a physician on a Seaplane tender 1957- 99 is the basis for the last.

What astounsds me most are the details of dreams. Where do they come from! I have never, to my memory, seen little plastic admission tickets like those in my dream today. I have never seriously considered a career as a US Navy doc, or thought of managing a team of elder-care givers. Or have I? I can’t say.

Wiki claims Dreams are the stuff of memory and myth. Dreaming is thinking. We examine our current issues. We come up with ideas; we gain a }clearer picture of ourselves  Consider:

1) Alice in Wonderland; getting lost in a dream state with connections and observations about real life.

2) Greece and the dream infused by Zeus, to persuade Agamemnon to attack Troy. Homer believed in the influence of dreams on life, as did many in those times.

3) The Hogwart hero is led astray by subconscious thoughts implanted by a villain. But “It does not do to dwell on dreams and forget to live.”

4) Wuthering Heightss. Caththerine accepts a marriage proposal from Edgar after a dream about going to heaven with him.

5) Orwell’s 1984... Dreams are beyond our control. The Thought Police can read them and know that ‘If you want to keep a secret, you must also hide it from yourself.’

6)  Midsummer Night’s Dream: Bottom: ‘I have had a dream, past the witt of man to say what / dream it was. Man is but an ass if he go about t’expound this dream.’ 

7) Scrooge ‘You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of underdone potato. There’s more of gravy than of grave about you, whatever you are!’.

 8) Freud: Dreams are wish fulfilment or an attempt by the sleeping mind to heal festering issues in our past.‘The virtuous man contents himself with dreaming that which the wicked man does in life.’

9) Niel Gaiman’s brilliant book, features dreams of transplanted American Gods … also he is very active and keeps a live blog, well worth looking at!

10) Franz Kafka: Metamorphosis “One morning, upon awakening from agitated dreams, Gregor Samsa found himself in his bed, transformed into a monstrous vermin.”… a cockroach.

11) Elias Howe’s nightmare: In a dream, a spear with a hole in one end allegedly inspired his concept of the sewing needle.

12) John Lennon: , #9 Dream. The chorus repeats the phrase ‘Ah! böwakawa poussé poussé’. He says it came to him in a dream. 

13) Salvador Dali referred to his painted dreams as  Persistence of Memory where meltiing clocks, are melting time.

 

Well. I don’t want to go on so long that an innocent reader has nightmares. Life is but a Dream, is it not? If so, hope to Dream On.

UNBELIEVABLE

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My daughter Amy called my attention to this series. It is based on a true story set forth in  The Marshall Project and a  ProPublica article,.“An Unbelievable Story of Rape,”  written by T. Christian Miller and Ken Armstrong. I sat down one evening, to watch the first episode but could not give it up until finising all eight. A timely theme, a complex story, sensitive acting, careful direction and film making, all came together, and held me capitive. Wiki capsulizes it approximately in this way:

GENRE DramaTrue Crime
PREMIERE 09/13/19
CREATOR Susannah GrantAyelet WaldmanMichael Chabon
PERFORMERS Toni ColletteMerritt WeverKaitlyn Dever
NETWORK Netflix

The story is roughly as follows: Marie, a young woman, is raped repeatedly at knifepoint by a masked assailant who threatens to kill her but leaves her bound and gagged. She escapes with difficulty and reports to authorities; so begins an long formal, exhaustive and detailed investigation, and so begins her post traumatic rape syndrome, that includes the resultant investigations. It begins with a protocol driven professional rape exam; an exhaustive interrogation follows where her story is carefully investigated, to clarify details, and evaluate its veracity.

By that time Marie has relived her rape over and over in the telling and retelling and the justification of her story. No one is obviously unkind, but most all seem unaware of Marie’s growing and increasingly desperate desire to escape the fact-finding process, while reliving her rape over and over again.

At last she becomes so exhauted, dysfunctional, and confused, that when asked if she might have, or possibly could have, imagined the rape, she recants. She denies it happened. Therefore, she is informed that she lied in her original account, which is a crime in itself; one that requires a full investigation, and possible prosecution, with a bail of $500. In short, she needs a lawyer, a monetary expense she cannot afford, on top of her emotional and physical wounds. The rape story therefore remains somewhat in doubt; and there is not a single bit of evidence at the scene, to confirm that it ever happened. The rapist, Marie claims, even forced her to shower afterwards.

Marie’s terrified and dyfunctional reactions increase; the rape itself, and this ongoing legalistic variation of rape aggravates her post rape stress syndrome during the following months. We follow here through those events.

Meanwhile two women detectives, Rasmussen and Duvall, pick up the trail of the rapist and pursue it relentlessly. They are determined, astute, and persistent; they are very real, and very likeably human, often carrying on their difficult work with wity interaction or humor.

In time they discover a series of rapes elsewhere across the country, with the identical pattern of Marie’s rape assault. All these rapes are so carefully and skillfully carried out that there is not a shred of evidence left behind. The rapist is knowlegable somehow; he knows the territory, and may even be a professional or a policeman.

Indeed he is apoliceman, and finally, marshalling all their interrelated evidence, they find and arrest him. The case is so compelling that he goes to trial, and is convicted to 327 years in prison.

A happy ending follows, where Marie gradually recovers. She is a survivor, and furtheris relieved that her rapist is caught. The detecitves are recognized and lauded; the original investigator- inquisitor realizes his errors and apologizes briefly to Marie. While the ending is almost too neat, it is satisfying. I have no hesitancy in reccomending this series. It is informative, and timely. To those who underestimate or tend to dismiss the nature and persistent trauma of rape, Watch Out; you may learn something. To MeToo activists : This is your series.

However, I hope we all agree that any injustice should be condemned; that would include men who are accused of rape without evidence. The burden of proof should fall to the acuser in any case. That is the main reason rape should be immediately reported, even though to do so requires great courage.

Vaping.Inc.Gov

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The object of a psychoactive drug is the brain, and Vaping provides brain access very efficiently, and effectively. Even intravenous injection is delayed by dilution in liters of blood and by dispersion throughout the body, before any reaches the brain. The oral/ gastrointestinal route is even less efficient, taking a drug through the gut and liver even before reaching the bloostream.

Incredibly, in the USA, where we rant and cant about the safety and sanctity of children, we appear to stand aside while our youth are harvested for profit. I, like many citizens, am not opposed to profit, and am wary of government over reach. And yet, it seems insane for legislators to oversee remarketing of nicotine, and the new marketing of Vaping to children!

  1. Every TV media mention of Vaping, features glorious images of young people blissfully blowing beautiful billows of vape vapor.
  2. An on line search for “Where to Buy JUUL Near You” features two AMPMs within 1.7 miles of my home, and a TonicVape and Smoke Store at 2.5 miles.
  3. A simple search turns up this:

Local Results

4) A JUUL support page offers these flavors NOTE: ALL feature tobacco.

  • Virginia Tobacco (5% and 3% nicotine strength)
  • Mint (5% and 3% nicotine strength)
  • Mango (5% and 3% nicotine strength)
  • Creme (5% and 3% nicotine strength)
  • Fruit (5% and 3% nicotine strength)
  • Cucumber (5% and 3% nicotine strength)
  • Menthol (5% nicotine strength)
  • Classic Tobacco (5% nicotine strength)

How long does a JUULpod last?

“One JUULpod is intended to last about 200 puffs”

Can I open or refill my JUULpod?

To help ensure product quality, JUULpods are not designed for refills or re-use and should not be opened. ( Yeah, Right!

4) A simple search reveals an astounding array of Vape products like: Portable devices generally around $4 and less in bulk; nicotine laced refill and replacement options (Amazon, SMOtech, Eliquids, SaltNic etc.)

Many products seem useful for adulteration of vaping devices with Cannabis and other drugs.

Vaping Associated Lung Disease: VALD… There have been serious cases of pneumonic inflammation associated with vaping with six recent deaths.* The American Vaping Association is apparently not alarmed, and claims that vaping can help people quit smoking.

Maybe so. But the consequences of vaping long term are unknown. How can it be that goverment is not interested or very active in Vape grooming of children? Or VALD? Maybe that is understandable, considering how busy legislators are in between vacations. Yet it seems to me that physicians and Medical Societies concerned with the health of people, and considering that children are, or may become people, should make physicians more active in regard to vaping! To not do so is to be as vapid and shameful as government or commerce.

* https://www.bing.com/videos/search?q=deaths+associated+with+vaping&&view=detail&mid=C5F7EC9E63CD6686C8E1C5F7EC9E63CD6686C8E1&&FORM=VDRVRV

This item added Dec 12, 2019:

Death Toll From Vaping-Related Respiratory Illness Rises To 48, CDC Says

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Reuters  (12/5, Maddipatla, Joseph) reports the CDC reported another death from vaping-related respiratory illnesses bringing the total to 48. The agency says there have been 2,291 cases requiring hospitalization across the US as of Dec. 4.

Hispanic = American

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Hispanic is a term often used to designate race. But it is a race that does not exist except in political terms where it refers to people who speak, or whose forebears once spoke, Spanish or an indigenous language; whose name may sound like it is of Spanish or indegenous origin; who may – or may not– speak Spanish, or be brown skinned.

Hispanic is best understood as an equivalent of ‘American’, except that there is no modern nation of Hispania.* Neither Hispanic or American name any particular race.

There is no Hispanic race and there is no American race. Both refer to diverse but culturally inter-connected peoples. Regrettably, in the USA Hispanic has sometimes been used prejudicially, though that concept is now outmoded. Most everywhere, to be bilingual in English and Spanish is becoming a distinct asset.

There is no rational reason, therefore, to use Hispanic as a meaningful term now, because the entire Western Hemisphere is essentially American, and is also Hispanic, one people, scattered over many nations, sharing the same indigenous, Polynesian, Asian, European, and African heritage, and generally, the same values.

We share the same three modern languages: English, Spanish, and Portuguese. All three are linguistic cousins, so that one is an introduction to the rest, and even to other Indo European languages .**

Be ‘Woke’ to being American in the real world. Be Woke to America in its true physical, hemisperical, and inclusive sense.

*The term Hispanic includes people of Spain ( Hispania); Once, like England, France, and Portugal, Spain was a great colonial power; the Spanish ruled most of the New World– the Americas, first from Lima, Peru, and later from Mexico. Now the three colonial languages, English, Spanish, and Portuguese/Brazilian, are the modern languages of America.

** English and Spanish are beautiful bastard languages inseminated and enriched by centuries of invasions. (See The Mother Tongue, by Lancelot Hogben; he’s British, with that name, with French and English roots, what else!: https://en.wikipedia.org/wiki/Lancelot_Hogben Hogben suggests that the English, were ruled by invaders for so many centuries at a time, that English became a universal key to all IndoEuropean languages. Likewise, Spanish was enriched by many invasive languages, including Arabic, and therefore is also key to Indo-Eropean languages. In fact, today the combination of English, Spanish and Portuguese permit easy communication with most of the Western World; 1.750 Million of the world’s people speak one these three languages. (Mandarin claims 1.2 billion speakers. ) https://www.listsworld.com/top-10-languages-most-spoken-worldwide/

The Opiate Beast: Res Ipsa Loquitor

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From 1999 to 2017, almost 400,000 people in the US died by using or misusing prescription and illicit opioids. The graph below (https://www.cdc.gov/drugoverdose/epidemic/index.htm holds a black line indicating numbers of deaths related to “natural, commonly prescribed, and illicitly manufactured opioids”; deaths increased very rapidly beginning in 2013; by 1917 these black line opioid related deaths are roughly equal to the combined total opiate deaths from all other causes. That impacts me personally because the fentanyl deaths include a grandson of mine.

Yet obviously opiate users contribute to their own demise; who knows why self loathing or self destructive behavior is attractive or rewarding. Making opiates illegal has not paid off. We seem unaware that social rules are far more effective than laws, as the War Against Drugs, or our own Prohibition experience suggests. Healthy behavior cannot be imposed; but self destructive behavior could become socially scorned, like smoking has recently; everyone used to smoke in movies 50 years ago; (I always chuckle when I see a driver chastely holding a lighted cigarette out the window!) Today attractive young women snort cocaine in many movies or TV shows.

Years ago I was in Nepal on an assignment for Peace Corps. Drugs of all sorts were available, and some volunteers enjoyed pot, but were avoided by locals who saw that as the offensive and base behavior of undesirables.

Recently I took a job with a drug investigational research operation. It quickly became clear that protocols for ‘research’ were devised and intended to justify new drug applications before the Federal Drug Agency. They were artfully crafted and brilliantly concieved, but biased.

The corporation that hired me was hugely profitable to the owner. I, as a critically important MD employee meritied special consideration, though the pay was modest. My first shock was being sent to ‘symposiums’ that were informational sessions for investigators. At a typical one in Florida the benefits were lush digs, sumptuous meals, and proffered sexual favors. I found myself, one evening, after a long day and a dinner with dance band, in an elevator with an attractive young woman who had been at my table. She explained that she had no place to stay the night. That required some fast action by me. I abruptly stepped out of the elevator as the door was closing as if not realizing the floor that was not mine, and so deserted my would be roomate. Whoah! A new drug application to FDA requires a lot of talent and work of different sorts!

Nonetheless, I was fascinated by the details of drug trial protocols. Several were very interesting and absorbing. Yet some were third stage trials of new opiate formulations. Trials require people–.subjects who had been recruited through advertizing– for testing of a new drug up for FDA review. In this case the drug was described as a ‘non addicting’ (opiate) pain medication. Participants were required to be already using opiate pain meds for their problems. They would be provided free opiates in the dose they usually needed or a slightly increased dose if required by the study. They would not only benefit humanity by participating for several months, but be provided with the opiates, and paid while they completed the study.

One day I was asked to evaluate and examine a new applicant. He was an 18 year old who had a remote very minor back strain many months prior. He was still using large doses of opiates. After completing the exam I felt an obligation to ask him if he really had thought about the risks of long term opiate use. But he was not at all interested in the question. Additionally, he mentioned my comment to his ‘handler’. Handlers are very capable people, who work hard with several subjects for a given project; they are expected to supervise the subjects and encourage adherence to, and completion of the protocol. Where opiates are concerned, that was, arguably, a multiway partnership between handler, opiate user, the physican businessperson, and the drug manufacturer. Everyone wins. Every subject required some investment by the research company, but brought a very substantial bounty to the physican owner, and a benefit to the handler involved. My comment to the new subject, had he changed his mind, jeapordized several dozen thousands of dollars of net income to the business.The next day I was, of course, terminated.

I have nothing against money. In fact I like it a lot, the more the better. Still, money is the fount of many illegal activities, even those that grow within the womb of the law. Money is the mother’s milk not only of politics but of the opiate industries. The ultimate goal of drug producers seems to be to sell drugs by grooming the public and prescription writing Physicians. While physicians often swear by the Oath of Hippocretes, and aspire to follow the adage primum non nocerum— do no harm we can be bought off by a drug industry that is very adept at the procedure.

For many years huge quantities of opiates have been made and promoted by drug makers and distributors and by physician dealers. Very tiny pharmacies have sold millions of opiate tabs yearly, far more than their whole state could use. This sort of thing has been well known for years, but continues. Certainly by now legislators, drug companies, distributors, and many physicians know the facts. But the government has been unable or unwilling to interfere effectively even though much could be done quickly and simply.Here are a only few suggestions among many:

  1. Confine pharmacies to reasonable numbers based on local population.
  2. Prevent physicians from selling and distrubuting opiates from their own offices.
  3. Require a new hand written physician prescription for a refill of an opiate.
  4. Limit prescritptions to 30 opiate tablets unless a ‘triplicate’ style prescritption is used. (Triplicates are outmoded but useful in this respect. They are bothersome!)
  5. Require Drug distributors, at their own expense, to provide pharmacies with 4 mg Narcan Nasal spray to be available without prescription to anyone with valid identification.
  6. Require Drug distributors to provide all county health departments with 100 Narcan 4 mg Nasal Spray sets at no cost to the health department. It could be used for distribution to high schools, individuals, homeless shelters, and even college health services.
  7. Permit drug distributors to buy low cost Narcan Nasal Spray offshore.
  8. Prohibit direct to consumer advertizing of drugs. ( So far as I know only US and New Zeland allow it. Besides, it would make TV ads less offensive)
  9. Prohibit Drug “Detailing” of physicians (food, samples, camraderie and literature provided by attractive salespersons.)
  10. Require that Continuing Medical Education (CME) to be funded by physician attendees, rather than as now, subsidized heavily by Drug companies who also apparently buy the speakers.
  11. Prohibit all drug company funding of medical research and CME because that subverts, co-opts, and brainwashes physicians and administrators.
  12. Create a national patrimony for medical research using drug company opiate abuse fines or heavy taxes. CDC could be an ideal administrator.

No doubt these are contentious suggestions; they would, in the unlikely event they are ever seriously considered beyond these pages, cause outrage and loud objections. Nonetheless, I believe they are worth considering. Res Ipsa Loquitor, I think, means The Beast Speaks For Itself; despite that being a legal term, it may be that our lawyers can allow me to use it here. After all, legislators are mostly lawyers and all lawyers are mostly legislators.