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.

Two Petitions Worth Signing

I have the somewhat tedium-inducing sense that the next four years of our lives will involve a lot of petitions–reading them, signing them, and enduring widespread derision for doing so.

Tedious it is, but don’t let that stop you. It’s doubtful (I know) that petitions serve any straightforwardly instrumental function: it’s not as though the Trump Administration will recoil in horror at the discovery that 20,000+ academics deplore his Executive Order on immigration, and that 272+ academics deplore the attitudes he’s expressed toward Mexico–and then decide to roll back his immigration policies. But those of us who oppose Trump and his policies feel the entirely healthy desire to do something to oppose his administration, and signing a petition is something–not much, but something. At the very least, it gives us something cheap and easy to do while we figure out what else to do. It serves an expressive function, which is not nothing, and offers solidarity to those adversely affected by the policies, which, though not much, is better than nothing. Continue reading

CFP: Eleventh Annual Conference, Felician Institute for Ethics and Public Affairs

Speaking of events I’m organizing, here’s one worth keeping in mind: the Eleventh Annual Conference of the Felician Institute for Ethics and Public Affairs, taking place on Saturday (9 am – 6 pm), April 22 on the Rutherford campus of Felician University (227 Montross Ave., Rutherford, New Jersey, 07070). Here’s the official CFP itself:

The Institute invites submissions on any topic in moral or political philosophy, broadly construed, not exceeding 25 minutes’ presentation time (approximately 3000 words). Please send submissions in format suitable for blind review to felicianethicsconference at gmail dot com by February 1, 2017. Acceptances will be announced by March 1, 2017.

Here’s last year’s program. Here’s 2015. You can look at the rest, going back to 2007, by going to the Institute’s web page, clicking the “Spring Conference” tab, and scrolling down a bit.  Continue reading

Haidt—The Righteous Mind, Chs. 7 & 8

In chapters 7 and 8, Haidt describes in detail his account of our innate “moral foundations”—a relatively small set of fundamental psychological mechanisms that underlie and produce our moral intuitions. In previous chapters, he has argued that moral judgment is driven primarily by moral intuition—that the intuitive dog wags the rational tail—and that our moral intuitions cover more areas of life than just harm and fairness. It is now time to get specific. Just what are these fundamental, innate sources of moral intuition, and how can we show that we really have them?

Continue reading

Haidt, The Righteous Mind, chs. 3 & 4

In chapters 3 & 4, Haidt elaborates his basic dual process model of the mind, which he represents metaphorically as a (rational, conscious, deliberative) rider on an (intuitive, unconscious, automatized) elephant. This sort of dual process theory is in a fair way to becoming orthodoxy in contemporary psychology. (Though it’s not there yet. See this symposium in Perspectives on Psychological Science, kicked off by this target article by Keith Stanovich and Jonathan St. B. T. Evans. The best single account of the dual process theory that I know of is Daniel Kahneman’s Thinking, Fast and Slow.) In Haidt’s version, emotions are emphasized in the elephant, and the rider is treated as subordinate and even subservient to the elephant. Thus, his view has more than a whiff of Platonic dualism about it, with the twist that the Platonic charioteer can’t control his team of horses. At best, the charioteer urges and remonstrates with the team. For the most part, the charioteer’s role is to persuade others that the team is going the right way, whatever the appearances may be.

This adversarial view of the relationship between elephant and rider doesn’t sit particularly well with me, much less the treatment of reason as mere post hoc rationalization. Continue reading

Morals and the Free Society: 11. Aristotelianism, Part 3—Conclusion

Here at last is the final chunk of the argument, in which all problems are resolved. To return to the tenth chunk, click here. The complete essay is posted here.


The social excellences that I have suggested can be derived by considering the effective functioning of a free society make a conventionally appealing set: respect for others’ rights, candor, probity, patience, nonlitigiousness, loyalty, and reliability. But it should not be thought that every widespread intuition—“prevailing ethical belief”—about social ethics is thereby confirmed, or even most of them. A couple of examples of prevailing ethical beliefs that are contradicted by the argument from the needs of a well-functioning free society will help make clear the sort of social ethics that is implied by this line of thought. Continue reading

Morals and the Free Society: 10. Aristotelianism, Part 2—Economic Analysis Can Reveal Natural, Social Human Functions

Here is the tenth chunk of the argument. To return to the ninth chunk, click here. To advance to the eleventh and final chunk, click here. The complete essay is posted here.


When it comes to the social arena—an important one for ethics, obviously—I suggest that insights from economics can provide guidance concerning human functioning. I have in mind especially North’s (1990) analysis, mentioned earlier, of economic functioning in terms of institutions and their effects on transactions costs. That analysis showed that economic growth and prosperity depend on social institutions that reduce so-called transactions costs; i.e., costs associated with trade. In general, any established practice that makes human interactions more predictable and transparent will tend to reduce transactions costs. Simple examples are the convention of driving on the right side of the road and a uniform system of weights and measures. In the latter case, think of the difficulty of putting together a trade of, say, a certain quantity of cloth in return for a certain quantity of corn, without a mutually understood, reliable means of assessing the quantity and quality of these goods. The trade might still be made, of course, but the gains to the parties will be reduced by the additional time and effort required to assess the goods.

More interestingly from the point of view of ethics, transactions costs are reduced when property rights are scrupulously observed, and more, when economic agents are candid about the characteristics of their goods and services and are forthcoming with economic information generally, when their honesty can be trusted implicitly, when they are forbearing of others’ faults and of perceived injuries, when they are not litigious, when they are faithful to long term agreements, when they are reliable. Observance of such principles, where it is widespread, is a sort of institution or set of institutions, the social mores. It seems that we can learn from economic analysis which social mores are most important for producing a prosperous society in which desire satisfaction is optimized for everyone through voluntary arrangements. This is an instance of the strategy I mentioned at the outset, and which we noticed in Hayek, of taking the superiority of the free society for granted and asking what moral principles are required to sustain it. The strategy is powerful, inasmuch as history demonstrates pretty clearly that free social arrangements promote human social functioning at its best. Where free social arrangements have prevailed, there wealth has grown—for all, but perhaps for the poorest most of all—personal dignity has been respected, and humanity has flourished. Moreover, arguably any alternative social arrangement must depend on the principle of coercion, which—theoretical reasons and historical evidence seem to show—is incapable of producing a prosperous society of flourishing individuals. To the degree that all this is true, we have good reason to think that effective social functioning depends on the social mores that create and promote a free society. And this would seem to be an application of the Aristotelian functional approach to discerning proper ethical principles for the social realm. Continue reading

Morals and the Free Society: 9. Aristotelianism, Part 1—Natural Human Functions Can Be Investigated Scientifically

Here is the ninth chunk of the argument. To return to the eighth chunk, click here. To advance to the tenth chunk, click here. The complete essay is posted here.


The basic tenets of a broadly Aristotelian approach to ethics are, I think, familiar. Therefore, I shall just provide a basic sketch of the sort of view I have in mind without dwelling overmuch on the details. The aim is to show how an Aristotelian ethics might resolve the difficulties that have been identified for any moral view that hopes to provide a moral vision for a free society. Those difficulties, to repeat, are: first, to provide a reason why agents operating within a free market should care about observing (a) the rules that create the free market (basically, individual rights to one’s own person and property) and ideally also (b) additional principles that reduce transactions costs, such as candor, loyalty, reliability, zeal for just punishment, and fair-mindedness; and second, to reconcile this reason to care about maintaining the free market with the sort of motives and behavior that are appropriate within the free market.

I take the fundamental claim of an Aristotelian ethics to be that the highest value for any organism is to be a good organism of its kind. Continue reading

Morals and the Free Society: 8. Ayn Rand

Here is the eighth chunk of the argument. To return to the seventh chunk, click here. To advance to the ninth chunk, click here. The complete essay is posted here.


Ayn Rand claimed that her system of ethics “is the moral base needed by…Capitalism” (1961, 33, all citation emphases original). Her moral defense of a free society can be stated very briefly as follows. Human beings must live by reason. Other animals may be able to get by on instinct, but the human animal cannot. This point is made particularly clear by considering economic activity since the industrial revolution. The exponential growth in quality of life by essentially every indicator—from life expectancy to population to nutrition to health to education to comfort and leisure opportunities to you-name-it—since the industrial revolution has been made possible not only by the application of scientific and technological knowledge but by innovation and entrepreneurship. These are the achievements of a rational animal and only a rational animal. But the achievements of advanced economies are only the most dramatic demonstration. In every aspect of life, at any level of civilization, we can and must employ reason to determine our interests, goals, and actions, if we want to be successful in the game of life.

Now, reason is a faculty of individuals. Continue reading

Morals and the Free Society: 6a. Addendum on Cultural Group Selection

Apropos of Hayek’s claim that the mores needed to sustain the extended order (namely, several property and personal responsibility) evolved by a process of cultural group selection, I want to add a note about the origin of the prosocial attitudes (or values, behaviors, etc) needed to support the operation of the free market. To return to part 6 (on Hayek), click here. To advance to the next chunk of the main argument, click here. The complete essay is posted here.


Bowles and Gintis, in A Cooperative Species: Human Reciprocity and Its Evolution (2011), provide a helpful chart of the different theories of how prosocial behavior might have evolved (page 53). The main division is between some form of genetic evolution and cultural evolution. Genetic evolutionary theories basically depend either on some sort of kin selection mechanism (organisms are benevolent toward family members because they share their genes) or on group selection (prosocial traits like honesty spread because groups of honest individuals out-compete groups of dishonest individuals). Cultural evolutionary theories generally depend on some sort of mechanism of reciprocity, either direct (tit-for-tat) or indirect (benefits of having a good reputation).

None of these provides a good explanation of how the sort of virtuous behavior that brings the free market into existence could have evolved, especially in large scale societies. Continue reading