Lies and Omissions of the “Opioid War” — Part 1

I’ll be writing a series of little posts here about various articles in the media regarding the war on opioids, as I find that the news media often doesn’t tell the full story, and seems to be following (or promoting) a morality play or political narrative, rather than actually presenting the problem as it is.

This article from The Economist I found curious mainly because writers such as this almost always maintain — without any real attempt at argument– – that prescription opioids don’t “work” for chronic pain. As a someone who suffers from chronic pain, I can assure you that nothing could be further from the truth.

Prior to having spinal fusion in 2013, I was on a long-acting prescription opioid. Because I still had some pain, I thought the medicine wasn’t working, so I went off of it, only to become essentially nonfunctional for six weeks. I was in so much pain that I lost my wallet, my keys, my Kindle, my smart phone, and even my car all within a span of six weeks.

It was then that I discovered that my spine was essentially crumbling, that I had no disk left at L5, and that L4 wasn’t looking too much better. I needed major surgery on my lumbar (lower) spine.

If we restrict access to pain medications, the result will be more people in pain, more nonfunctional, and more on disability. Back pain is the most common cause of disability in the entire world. Restrict access to pain medications in the way that so many advocates demand, and we’ll essentially be denying needed relief to millions of people in serious pain. That relief allowed me to work. Was opioid use ideal in my case? No, it wasn’t, but it kept me working, and it’s hard to discount the importance of a paycheck.

It’s already challenging enough to get these medications, even with a prescription. In fact, I’d have to see my doctor monthly to get the relevant prescriptions in New York State, where I live. The fact that these visits are both costly and medically unnecessary seems irrelevant to politicians content to sacrifice people like me to their newfound compassion for addicts.

We can do little for addicts who refuse assistance. Some of them will die. But by indiscriminately trying to control the availability of these medications both to addicts and to those who genuinely need them, we would deprive millions of people access to the medications they need to avoid having to live a life completely in thrall to physical pain. In weighing the costs and benefits of any policy concerning pain medications, it might help to imagine what it’s like to live a lifetime in serious pain–with painkillers, and without.

Sadiq al Azm on Edward Said: Correspondence

Apropos of our recent discussion on Edward Said’s Orientalism: having held onto this letter some eleven years–and given the deaths of both principals–I thought I’d post it for whatever historical interest it may or may not have.  Sadiq al Azm passed away this past December (December 11, 2016). Edward Said died on September 25, 2003.  The letter, from Al Azm to me about Said, more or less speaks for itself. Continue reading

Hell Makes the News

A few days ago I posted some contrasting literary conceptions of hell. Today hell makes the news. Evidently Bernie Sanders (yes, the Bernie Sanders) thinks that the traditional Christian belief that salvation requires faith in Jesus disqualifies a person from holding public office. Such, at any rate, seems to be the reasoning behind his inferring that Russell Vought, Trump’s nominee for deputy director of the Office of Budget and Management, “is really not someone who this country is supposed to be about” from Vought’s refusal to deny that Muslims — or any other non-Christians, and probably, by Vought’s lights, many people who think of themselves as Christians — will be going to hell if they do not come to faith in Christ. There’s some dispute about the legality of Sanders’ questioning, but it seems likely that Sanders can vote however he wants for whatever reason he wants and that simply questioning Vought about his religious beliefs does not amount to a religious test for office. Legality aside, though, Sanders’ reasoning and behavior here seem monumentally stupid; refusing to vote for someone for holding this traditional view seems wrong in principle, and it seems especially moronic strategically.

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Hell

Jean-Paul Sartre:

GARCIN: Will night never come?

INEZ: Never.

GARCIN: You will always see me?

INEZ: Always.

GARCIN: This bronze. Yes, now’s the moment; I’m looking at this thing on the mantelpiece, and I understand that I’m in hell. I tell you, everything’s been thought out beforehand. They knew I’d stand at the fireplace stroking this thing of bronze, with all those eyes intent on me. Devouring me. What? Only two of you? I thought there were more; many more. So this is hell. I’d never have believed it. You remember all we were told about the torture-chambers, the fire and brimstone, the “burning marl.” Old wives’ tales! There’s no need for red-hot pokers. Hell is — other people!

(No Exit (Huis Clos), 1944)

T.S. Eliot:

There was a door
And I could not open it. I could not touch the handle.
Why could I not walk out of my prison?

What is hell? Hell is oneself,
Hell is alone, the other figures in it
Merely projections. There is nothing to escape from
And nothing to Escape to. One is always alone.

(The Cocktail Party, 1949)

Opinio copiae inter maximas causas inopiae est: on mistranslating Mill’s Latin quotations

As you might have guessed, I’ve been reading through some of J.S. Mill’s major works lately. Mill had an unusually intensive classical education that enabled him to read Greek and Latin as a young man with a fluency that few people today manage in a lifetime. In 19th century England, however, a basic working knowledge of Latin was still part of virtually every ordinary educated person’s repertoire. Accordingly, Mill, like many other authors, sometimes used Latin phrases and quotations in his works without translating or citing them, expecting that his readers would understand the Latin, if not recognize the source. For better or worse, ordinary educated readers today do not have basic Latin as a matter of course, and so more recent editions of older works tend to add helpful footnotes when Latin shows up. Such footnotes can only be helpful, however, when they get the Latin right. Usually they do. Occasionally, however, they do not.

I’ve recently discovered that there is a widespread tendency to get the Latin wrong in one passage of Mill’s On the Subjection of Women. This passage comes in the first chapter, in the midst of an argument that men are not in a position to suppose that they understand even the particular women they know, let alone women’s “true nature,” if there be such a thing. Given the conditions of enforced dependence and servility that women live under, men cannot infer that the attitudes and behaviors of most women in society reflect women’s “true nature” rather than the peculiar dispositions that their position in society has encouraged them to have, and men cannot even presume to know the minds of their own wives so well as they might come to know the minds of other men with whom they interact on a basis of equality. This will be so, he says, “as long as social institutions do not admit the same free development of originality in women which is possible to men. When that time comes, and not before, we shall see, and not merely hear, as much as it is necessary to know of the nature of women, and the adaptation of other things to it.” He then continues, and here we get the Latin in question: “I have dwelt so much on the difficulties which at present obstruct any real knowledge by men of the true nature of women, because in this as in so many other things ‘opinio copiae inter maximas causas inopiae est’; and there is little chance of reasonable thinking on the matter, while people flatter themselves that they perfectly understand a subject of which most men know absolutely nothing, and of which it is at present impossible that any man, or all taken together, should have knowledge which can qualify them to lay down the law to women as to what is, or is not, their vocation.”

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A Tale of Two Citizens (and Two Citizenries)

Donald J. Trump on the recent terrorist attack in Britain:

@realDonaldTrump  

  1. Do you notice we are not having a gun debate right now? That’s because they used knives and a truck!

  2. At least 7 dead and 48 wounded in terror attack and Mayor of London says there is “no reason to be alarmed!”

  3. We must stop being politically correct and get down to the business of security for our people. If we don’t get smart it will only get worse

  4. Whatever the United States can do to help out in London and the U. K., we will be there – WE ARE WITH YOU. GOD BLESS!

  5. We need to be smart, vigilant and tough. We need the courts to give us back our rights. We need the Travel Ban as an extra level of safety!

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Mill on Public Education (and its alternatives)

Comments on my previous post reporting Mill’s comments on the American Civil War led to some discussion of education. I’ve been teaching for ten years, and so I’ve given a good amount of thought to education, but much of that thought has been about the peculiarities of the subjects I teach: classical languages, literature, and philosophy, with a bit of writing and rhetoric thrown in. I’ve thought less, though still quite a bit, about broader questions in education. Probably the most politically divisive issue in education concerns public education: should we have it, what is it for, how should it be done, and how should we regard various alternatives to it? As often, mainstream political opinion seems to split into two rival camps, neither of which strikes me as satisfying. Though people disagree about details, there’s a discernible trend: progressives tend to be fans of public education and want to increase its funding massively, conservatives tend to be severe critics of public education and prefer some sort of alternative. Rather, many and perhaps most people don’t have strong views about this topic, but when someone does, the severe critics tend to be conservative and the fierce supporters tend to be progressives. As usual, I do not have a firm, settled view on these matters. But insofar as I have any views on the matter, they tend somewhat in the conservative direction in one respect and in the progressive direction in another: we ought to have a much greater variety of schools to choose from, with much greater local autonomy on the part of the schools (the ‘conservative’ part), and we ought to have a lot more funding of a far more equitable sort (the ‘progressive’ part).

I don’t find anything odd about this combination, but it seems to be an unpopular one. Support for ‘school choice’ in general and for charter schools in particular tends to be seen as a right-wing view, while support for vastly increasing public spending on education tends to be seen as a left-wing view. Of course, there’s a reason for this: conservatives hate taxes, while the mantra of ‘school choice’ stands not only for an increase in the diversity and autonomy of schools, but for efforts to have taxpayers fund fully private and religious schools. Debates about charter schools are also complicated by differences among charter schools and the kind of oversight to which they’re subjected in different states; while the best charter schools are non-profit organizations that seek to admit students from a variety of socio-economic backgrounds, some prominent charter schools are in reality for-profit businesses that effectively price out lower-income families through fees and related expenses. So, as so often, the issues here are complex, but our political discourse tends to reduce them to two bad package deals. On the level of general principle, though, I wonder just what is wrong with John Stuart Mill’s take in On Liberty (I promise that the Mill posts will stop soon!):

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Mill on the American Civil War

In nearly four decades of life as an American, I’ve heard a whole lot of conflicting things about the Civil War. Probably the most contentious point is about what slavery had to do with it. My own elementary education made clear that the principal issue in the war was slavery, but that this issue was mixed up with more general disputes about states’ rights and federal authority. That same education made it clear that the North fought the war primarily in order to end slavery, but also to “preserve the Union.” It was only in early adulthood that I learned that this is apparently not how the Civil War is presented to many young Americans and that there is a lot of disagreement about it. Evidently many, maybe most, kids are taught that the war was primarily about states’ rights and that slavery was a secondary issue. People — including historians who actually have some claim to know what they’re talking about — disagree about exactly what combination of factors motivated the North to fight. But a fair number of people I’ve encountered, mainly people without any historical credentials but a few with some, have barked at me about how the Civil War wasn’t really about slavery at all, but was entirely about economics; slaves mattered for that reason, but for that reason only.

I’m not about to enter into this dispute. I do, however, find it worth noting what J.S. Mill — yep, him again — thought about the war and his report of English opinion about it. No doubt historical causation is complicated, but it is interesting that, to an outside observer at least, this war was very definitely about slavery, and immensely important.

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Orientalism, Racism, and Islam: Edward Said Between Race and Doctrine

David Riesbeck’s recent post on essentialism reminds me that I have a paper on a loosely related topic that I’ve been meaning (for eight years!) to revise and submit somewhere. As I’m teaching Edward Said’s Orientalism in the fall, I figured I’d make the time to revisit the book and the topic, and finally revise the paper. So here it is, in the interests of feedback from PoT readers, and potentially, for purposes of comparison and contrast with David’s post. Originally presented at the California Roundtable on Philosophy & Race, Hampshire College, October 2, 2009.


Orientalism, Racism, and Islam:
Edward Said Between Race and Doctrine

  1. Introduction

Edward Said’s Orientalism has gotten relatively little attention from philosophers in the Anglo-American analytic tradition. Arguably, though, the book has been at least as influential in contemporary political thought as has the work of say, Rawls, Nozick, or Dworkin, and has probably been more influential across the breadth of the humanities than the combined efforts of the sum total of analytic normative theorists. Widely regarded outside of philosophy as the foundational text of postcolonial studies, and as the touchstone of a progressive conception of comparative politics and area studies, Orientalism is also a pioneering contribution to race theory. Where English-speaking race theorists had, prior to Orientalism, devoted the bulk of their attention to anti-black racism and anti-Semitism, Said was one of the first academic writers to draw sustained attention to Western conceptions of the Arab/Muslim Oriental.  As one early reviewer concisely summarized the book, “Professor Said uses [his] privileged vantage to observe the West observing the Arabs, and he does not like what he finds.”

In what way is Orientalism a contribution to race theory? The question leads to a bit of a conundrum. On the one hand, it is hard to deny that there is some such contribution. On the other hand, the contribution in question turns out to be surprisingly difficult to specify with any precision. I want to suggest that the conundrum arises from a systematic equivocation that runs throughout Said’s treatment of Orientalism—namely, his persistent conflation of claims about the essence of Oriental racial identity with claims about the essence of Islamic religious doctrine. Contrary to Said, a critique of the first sort of claim, however cogent and insightful, is not easily (or at all) transferable to claims of the second sort. The failure to distinguish race from doctrine undermines what is valuable about his account and abets serious confusion.

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An Essential Question

Like most terms in philosophy, ‘essentialism’ gets used in a variety of different ways in a variety of different contexts. In its most general use, though, essentialism is the view that some things have essences. What is an essence? Accounts differ, but roughly at least we can say that an essence is a set of properties that a thing must have so long as it is the thing that it is and that it cannot lose without ceasing to be the thing that it is. Not all properties that a thing has are essential, because some of them are properties that a thing can gain or lose without ceasing to be the thing that it is; these are so-called accidental properties. Philosophers argue about whether this is the right way to understand essences and essential properties. Some, for instance, follow Aristotle in distinguishing further between necessary properties and essential properties: a property is necessary if it is one that a thing must have to be the thing that it is and that it cannot lose without ceasing to be the thing that it is, but a property is essential only if it is both necessary and fundamental, explaining why the thing has the other necessary properties it has, but not itself explained in terms of some other property. I’m not much interested here in the distinction between necessary and essential properties. What interests me is that there are plenty of philosophers who want to reject essentialism altogether. They don’t just want to say that for some categories, such as ‘human’ or ‘American’ or ‘fun,’ there is no set of properties that everything falling within that category must have and cannot lose without ceasing to belong to that category. Instead, they want to deny that there are any essential properties at all. I find this puzzling. Here’s why.

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