We’re god. We might as well get good at it.

Dorothy_0011b God-Satan Desk SignsI was listening to a radiolab episode about efforts to restore ecosystems in the Galapagos islands and was struck by this line at 34:26.

We’re god. We might as well get good at it. And, we’re going to have to create these ecosystems based on our best science.

I’d wager that the speaker believes he’s just following the science in an empirical, rational and value-free manner.

I believe strongly in the value of research and evaluation. I believe in seeking truth. I believe in continuous learning.

BUT, I’m skeptical of people who insist the evidence says we should do X, OR they are only following the evidence, OR they are relying on value-neutral rational thought.

The truth is that these arguments conceal (probably unintentionally) their operational assumptions and values. It ends up making their writing and thinking less transparent.

They probably have some truth, maybe some important truths, but be skeptical of anyone who speaks or writes as though they have THE truth, whether it’s  delivered by god or science.

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e-cigarette manufacturers lobbying their way out of regulation


Vox reports on the lack of regulation for e-cigarettes:

Electronic cigarette companies are quietly winning the war on regulation by successfully lobbying state legislatures to exclude them from tobacco control laws.

Public health officials and smoke-free advocates say industry-sponsored bills have the veneer of public health—with provisions about banning sales to minors—but avoid the more stringent rules other tobacco products must abide by.

“These are Trojan Horse bills that look good but leave gaping holes in public health regulations,” said Vince Willmore of Tobacco Free Kids. “They result in different penalties and enforcement from regular tobacco products, they exempt e-cigarettes from being included in smoke-free air laws, and some exempt manufacturers from state taxes as well.

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There is no blame; there is only love


This week’s throwback Sunday is an essay from the mother of a young woman who is addicted to heroin.


From NPR’s “This I Believe” series an essay from a mother of a young woman who has struggled with heroin addiction. After years of blaming herself and others, she now believes that there is no blame. Below is an excerpt, but follow the link and her the entire essay in her own voice.

You don’t expect your child to grow up to be a heroin addict. From the moment of her birth, you have hopes and dreams about the future, but they never include heroin addiction. That couldn’t happen to your child, because addiction is the result of a bad environment, bad parenting. There is most definitely someone or something to blame.

That’s what I used to believe. But after failed rehab and long periods of separation from my heroin-addicted daughter, after years of holding my breath, waiting for another relapse, I now believe there is no blame.

I don’t know why or how my daughter became addicted to heroin; I do know that it doesn’t really matter. Life goes on, and Katie is still my daughter.

Katie and I meet for breakfast on Friday mornings now. We drink coffee and talk. I don’t try to heal her. I just love her. Sometimes there is pain and sorrow, but there is no blame. I believe there is only love.

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Five Engagements That Will Define the Future of Health

Alan Weil, the Editor-in-Chief of Health Affairs recently gave a talk on health care reform and “The 5 Engagements.” The first two engagements are engaging the whole patient and engaging social supports.

The video below covers those engagements. (The whole talk can be viewed here.) A couple of interesting discussion points include:

  • one’s zip code being as important as your genetics in determining health, and
  • the failure of the health care system to engage natural social supports and instead create artificial supports.

Broadcast live streaming video on Ustream

The similarities between this and Bill White’s model of Recovery Management are striking. It just goes to show that specialty addiction care has a lot to teach the rest of medicine, and we’ll have a lot to learn from watching their successes and failures.


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Above criticism

AA-Groups-ClevelandBill White on varieties of secular AA experiences.

The ongoing evolution of A.A.’s story — its history — suggests that the fellowship will meet this challenge by finding ways to adapt to both religious renewal movements and cultural trends toward secularization without losing its essential character.

But “suggest” is all that history can do. The fundamental question for the future of Alcoholics Anonymous — which necessarily includes the present — is whether its Tradition that having “a desire to stop drinking” remains “the only requirement for A.A. membership” OR if membership becomes reserved exclusively for those who adhere to a verbatim interpretation of the Twelve Steps as they were written in 1939.

In short, will A.A. be able to find ways to embrace more “varieties” – or not?

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No change in teen pot use after medical marijuana passage?

From the Washington Post:


The chart above shows the trend in teen marijuana use, as measured by state Youth Risky Behavior Surveys, in Alaska, Arizona, Colorado, Delaware, Maine, Mississippi, Montana, Nevada, New Mexico and Vermont. The x-axis is standardized to track the three-year periods before and after each state passed its medical marijuana law. The lines are essentially flat.

I asked study co-author Daniel Rees if there were any significant changes within individual states. He told me that “no single state stood out — the effect of massing a medical marijuana law on youth consumption appears to be zero across the board.” These results are consistent with earlier research showing little change in youth pot consumption in Los Angeles after marijuana dispensaries opened there.

I’ll be interested to see what kind of responses this study gets.

It will also be interesting to see the effect of legalization in Colorado and Washington on pot consumption.

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Sentences to ponder

wpid-wp-1406109969456.jpeg“For harm reductionists, addiction is sometimes viewed as a learning disorder. This semantic construction seems to hold out the possibility of learning to drink or use drugs moderately after using them addictively. The fact that some non-alcoholics drink too much and ought to cut back, just as some recreational drug users need to ease up, is certainly a public health issue—but one that is distinct in almost every way from the issue of biochemical addiction. By concentrating on the fuzziest part of the spectrum, where problem drinking merges into alcoholism, we’ve introduced fuzzy thinking with regard to at least some of the existing addiction research base. And that doesn’t help anybody find common ground.” –Dirk Hanson

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