June 20th, 2016

Happy Summer Solstice!

For those who love the sun best, I hope the day is cloudless so you can enjoy it to the fullest.

For the rest of us, it's all downhill for the next 6 months -- in a good way!

BostonGlobe article about response to opioid limitations

http://www.bostonglobe.com/metro/2016/06/18/the-other-side-america-war-opioids/i9YYLR0bGWFdP9z1T1pwjI/story.html

As I expect nearly every reader knows, public interest in opioid abuse/overuse/overdose/death has been quite high in recent months/years. This is probably mostly because the number of people dying as a result of opioid overdose has gotten to be on a level with things like automobile related deaths. There has been a push -- at the state level, at various agency levels, etc. -- to get doctors to prescribe fewer opioids for shorter periods of time. There is a community of patients suffering from chronic pain and the doctors who serve them which has objected to this additional regulatory pressure. The article examines the problem.

"Dr. Julia H. Lindenberg, a primary care doctor at Beth Israel Deaconess Medical Center in Boston. ... But when Lindenberg’s practice stepped up urine testing, the doctors found that a few longstanding patients, who had been considered at low risk for abuse, in fact were misusing drugs. Some had cocaine or other drugs in their urine, and some were not taking the prescribed opioids, suggesting they were selling the pills."

Contrast Lindenberg's story with this primary care doctor's:

"Baratz said he, like most other primary care doctors, has long experience managing patients who take opioids for chronic pain. These people, he said, have no part in the addiction crisis. He monitors them closely and stops prescribing at the first hint of abuse."

I sort of wish the Globe had asked Baratz if his practice was also doing regular urine testing on chronic pain patients who had long-standing opioid prescriptions.

The article concludes with people making dire predictions that people unable to get legal pain meds will switch to illegal ones (indeed, some will -- that's exactly why we're trying to reduce opioid prescriptions. They have such a tendency to result in people becoming addicted and turning to illegal opioids for cost and convenience reasons) and people with chronic pain will commit suicide.

I predict we will be seeing more articles like this over the coming months. I hope more of them include details about which people being quoted are doing urine testing and which ones are not. That's a helpful detail, that lets us know who is actually committed to best practice ... and who is committed to status quo ante. Anyone committed to status quo ante who is worried about an increase in suicide has perhaps not taken seriously the increase in deaths due to opioid overdose over the last few years.

Also, if you are thinking along the lines of, those poor people, don't just take their pain medication away, I would point you at this:

https://en.wikipedia.org/wiki/Opioid-induced_hyperalgesia

In at least a few cases -- as Lindenberg pointed out -- taking away the pain medication actually helped with the pain.

_Work_, Louisa May Alcott (unfinished)

I'm not going to finish this. I read through Actress last night, and stupidly continued through Governess and Companion today, but Companion has done me in. As near as I can tell, no one noticed the heavy handed eugenics in this book, cause google finds me no indication that anyone has written it up.

_Work_ is an episodic novel about a young woman whose parents died when she was young and she was raised by a maternal uncle and his wife on their farm (at least, I think it was a farm). She goes off to make her way in the world, because Reasons. She tries a bunch of gigs; each chapter is one gig start to finish, with a lot of moralizing and Christie excelling and being cheerful and so forth. But in Companion, I met my match. I refuse to continue.

The invalid doesn't have TB or something infectious. Nope, she has insanity or madness, generally unspecified, which is believed to be hereditary in her father's family, which has the money. When the daughter is told she shouldn't marry and have kids because it is hereditary, she falls into a decline (actually spend a bunch of time in a room designed to keep herself from killing herself before graduating to more normal rooms where she hangs out with Christie -- if normal extends to the most amazing conservatory I've run into in 19th century fiction). She feels better hanging out with Christie hearing about Christie's various adventures, but younger sister has her coming out and someone is about to make an offer so Bella is about to be told and blah blah blah. Here is Christie's response to Helen's explanation (a lot of this is kept secret from Christie for a while). "The bitter grief, the solemn fervor of her words, both touched and awed Christie too much for speech. Helen had passed beyond the bounds of ceremony, fear, or shame: her hard lot, her dark experience, set her apart, and gave her the right to utter the bare truth. To her heart's core Christie felt that warning; and for the first time saw what many never see or wilfully deny, -- the awful responsibility that lies on every man and woman's soul forbidding them to entail upon the innocent the burden of their own infirmities, the curse that surely follows their own sins."

Sounds like eugenics to me, but whatever it is, it is def the author using Christie as a mouthpiece for People (Who Might Be) Subject to Mental Health Issues Such As Severe Depression and Suicidal Ideation/Attempts Should Not Have Kids. Period. End.

Yuck.

Good bye, _Work_. Apparently, the only books by Alcott I'm ever gonna love are _Eight Cousins_ and _Rose in Bloom_ which, honestly, are pretty deeply problematic but at least don't obviously suffer from this particular problem.

This was the library adult book group selection for Mayberry, NH (<-- not its real name) for the month of May. However, the May meeting was canceled for a variety of reasons and we will be discussing both _Gulp_ and _Work_ today. Which should make for an interesting combination.