Is it addiction or dependency?

Addiction vs dependency5Dr. Michael J. O’Connell, Healthcare Consultant, New Hampshire commented that the distinction between addiction and dependency is constantly mangled by the press, lay people and even many professionals.  The difference between dependency and addiction is not withdrawal.  Withdrawal is a phenomenon common to both.

Addiction marks a transition into pathology; the chemical, activity or behavior to which one is dependent (oxycodone, heroin, alcohol, THC, sex, eating, extrovertism/introvertism) becomes harmful…physically, psychologically and/or functionally, to the individual.  Withdrawal or craving is not necessarily a pathology and therefore not necessarily an indication of addiction.

One would be hard pressed to declare a weekly snorter of heroin or cocaine an addict.  If a person dreams much about food, craves certain tastes or dishes, but lives a functional work and social life and is not obese, this can hardly be defined as an addict.  If another has elevated liver enzymes, presence of abdominal fat in an otherwise slender body, is thinking about drinking alcohol much of the day, has a couple DUIs, occasional blood in the stools, and yet persists in drinking alcohol, this is most likely an addict.

If a chronic back pain patient has had a laminectomy and then fusion, still requires pain meds but goes into intense withdrawal with sweating, shakes, diarrhea, and piloerection, when away on a trip forgetting meds at home, this is dependency, but unlikely addiction.

 

Automatons…

Automoton

The recent 350,000 subject study in the American Journal of Clinical Nutrition demonstrating consumption of saturated fats to be no more the cause of cardiovascular disease than consumption of polyunsaturated fats, is another blockbuster example of the rise and fall of yet another conventional wisdom.  For decades we have been fed garbage (pun intended) by media and by medical literature that the hydrogenation (saturation) of fatty acids (converts liquid fat to solid, as in margarine) is tantamount to chemical ‘perversion,’ and ingestion of such products is certain to result in premature death.  The recycling of age old ‘rock solid’ advice from physicians is in my opinion analogous to the frequent ‘turning’ of my backyard compost pile.  Depending on how deeply I drive my pitchfork, the more likely I am to find intact wine corks, jar labels, oak leaves and other paraphernalia from years ago.  Scientific literature, the term itself meant to be synonymous to ‘truth,’ is hardly that.  Facts are destroyed then reinvented in a truly bewildering and dangerous process.  When is the public going to raise its intelligence quotient to the level at which it realizes that scientific literature is often no better than my compost pile, occasionally far worse?

Now, this is not to criticize the mountains of ‘applied research’ that has led to astounding technological advances.  Information retrieval, data storage, communications, robotics…all have been made possible through science, and many if not most, make our lives much easier and productive.  However, when science is applied to the human body, not a machine, not a flask of chemicals in the lab, science does not exactly shine.  Medical science more often than not fails us.  It usually does not get it right the first time, or even the second, third or umpteenth time.  This does not reflect an evil underpinning to medical research, but rather the infinite complexity of humans, both the researcher and the researched.  The list of barely effective medications, medications that years later cause catastrophic health problems, or surgeries that do not cure but rather maim if not immediately after, but years down the road, is staggering.

Which brings me to my favorite subject, Obamacare.  One of the primary tap roots of ACA (Affordable Care Act) is EBM (evidence based medicine).  The presumption is that the medical literature will guide doctors and other worthy practitioners in their treatment of various human pathologies, for the noble purpose of applying the’ treatment at the right time’ (whatever that means).  This purpose has the effect of reducing providers of healthcare to automatons, who merely plug in patients’ complaints, physical findings and results of lab and radiological procedures and voila, up pops the right and timely treatment on the computer screen.

If only it all worked so smoothly.

Settlement Agreement – NH.gov…

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Dr. Michael J. O’Connell, Barrington, New Hampshire, noted that most residents of the Lakes Region of NH know, the town of Wolfeboro entered into a Settlement Agreement with the Justice Department over non compliance with the Americans with Disabilities Act (ADA) in 2010.  Many changes to the structure of sidewalks, wheelchair ramps, uneven pedestrian surfaces, parking spots, etc. had to be made within a specified period of time and at considerable taxpayer expense.

On first read, it sounds as though the way things ought to be, right?  Americans with disabilities should have wheelchair access to all public facilities, and so called “handicap (HC) parking spots” associated with both public and private commercial buildings and enterprises.  On second view however, the ADA legislation and this particular settlement agreement sickens me and should you too.  It represents a blatant overreach of the federal government in yet another area of our lives.  A federal government that should be serving us by providing defense of the public and collecting taxes to pay for it, is now reaching ever more deeply into our pockets to fund yet more costly endeavors.

Trust me, I have plenty of compassion for the truly disabled, note the emphasis on the word ‘truly.’  Having had a very long career in medicine, it amazes me how frequently patients who do not even come close to the definition of ‘disabled,’ are granted all the perks of disability, from steady monthly income to Medicare health insurance.  Then to add insult to our injury, these same frauds are afforded all the same benefits of the broad and invasive ADA.  If most of the frauds could be weeded out of the system, the need for HC parking spots could reduced by 75%, or more.  Fact is, most HC spots are taken by “disabled” who are not wheelchair bound, and do not even require canes.  They are capable of walking unassisted, but no, the federal government dictates they should have prime access to stores, city hall, DMV, golf courses, zip lines, ski lodges, national hiking parks, and the list goes on.  When evidence based medicine (yes that concept embraced by our beloved President) would support that the best thing patients with chronic health problems can do is exercise and stay otherwise fit, we provide them the shortest possible distance from car to building.

The justice department needs to stop with these abominable settlement agreements, and start rendering……justice!  Investigate the disability system and stop investigating our towns and villages that are struggling under the burden of runaway federal bureaucracy!  For more information see:  http://www.ada.gov/wolfeboro_NH.htm

 

NH Meningitis Cases are NOT Confirmed

The media in New England continues to report erroneously on the steroid meningitis outbreak. NH does NOT have 11 confirmed cases of meningitis related to the tainted steroid product from NECC. The cases are “probable” not “confirmed.” Also, there are not 11 probable cases of meningitis, there are 8, and the other 3 are joint infections. No fungus has been cultured or seen under a microscope from fluids of any patients exposed to the presumably tainted steroid product.

Below is a cut and paste from the most current CDC definition of “cases.” Again, there are no confirmed cases of either meningitis or joint infection in NH. The misleading reporting is causing undue concern.

Dr. Michael J. O’Connell

October 24, 2012 6:30 PM EDT

Probable Case

A person who received a preservative-free methylprednisolone acetate (MPA) injection, with preservative-free MPA that definitely or likely came from one of the following three lots produced by the New England Compounding Center (NECC) [05212012@68, 06292012@26, 08102012@51], and subsequently developed any of the following:

  • Meningitis1 of unknown etiology following epidural or paraspinal injection2 after May 21, 2012;
  • Posterior circulation stroke without a cardioembolic source and without documentation of a normal cerebrospinal fluid (CSF) profile, following epidural or paraspinal injection2 after May 21, 2012;3
  • Osteomyelitis, abscess or other infection (e.g., soft tissue infection) of unknown etiology, in the spinal or paraspinal structures at or near the site of injection following epidural or paraspinal injection2 after May 21, 2012; or
  • Osteomyelitis or worsening inflammatory arthritis of a peripheral joint (e.g., knee, shoulder, or ankle) of unknown etiology diagnosed following joint injection after May 21, 2012.

1 Clinically diagnosed meningitis with one or more of the following symptoms: headache, fever, stiff neck, or photophobia, in addition to a CSF profile showing pleocytosis (>5 white blood cells, adjusting for presence of red blood cells by subtracting 1 white blood cell for every 500 red blood cells present) regardless of glucose or protein levels.

2 Paraspinal injections include, but are not limited to, spinal facet joint injection, sacroiliac joint injection, or spinal or paraspinal nerve root/ganglion block.

3 Patients in this category who do not have any documented CSF results should have a lumbar puncture performed if possible, using a different site than was used for the epidural injection when possible.

Confirmed Case

A probable case with evidence (by culture, histopathology, or molecular assay) of a fungal pathogen associated with the clinical syndrome outbreak in New Hampshire