Claudewell S. Thomas, MD, MPH, DLFAPA, is an established psychiatrist currently retired and living in Rancho Palos Verdes, California. He received his medical degree in 1956 at SUNY Downstate College of Medicine and specializes in social psychiatry, public health psychiatry, and forensic psychiatry. Dr. Thomas was board... more
In the midst of the failure of the 'repeal and replace' effort of the GOP, is the "America First" issue representative of nations first, healthcare protectionism versus globalism, and a multinational view of epidemic and pandemic overview and control?
This month's American Journal of Public Health devotes a multi-part section to the health-related consequences of the U.K's departure from the European Union (BREXIT). Somewhat unexpectedly, the most expectant of benefits from the "Britain First" sentiment and implementation are expected to suffer a premature death most dramatically. In the same journal is an analysis of health and voting sentiment in middle America,"Epidemic Despair" in the American Heartland, and suicide in rural eastern Maryland (mostly male and gun-effected). A persuasive picture emerges that health problems, though individually experienced, are best understood when viewed from a public health point of view. The loss of instant access to treatment data, drug reviews, siting access to a comprehensive library, etc., are exiting with Brexit. Access to much of this that is currently available through the US will be lost when and if the US gives up its EU affiliation (treaty).
The heartland "epidemic of despair" seems to be traveling on two legs: unemployment and addiction. Addictive drugs may provide temporary relief from depression and pain, but are needed in greater quantities as time passes and have less and less effect. With opioids, a certain percentage of the population will experience a paradoxical response called hyperalgesia (notice the 'an' is missing) with excruciating pain instead of relief as a neural pain complex is activated, as in fibromyalgia.
Methamphetamine and alcohol are the commonest and cheapest addictive substances, but ketamine, the codenones, inhalants, and nicotine are in the mix. These latter contribute to death via lung cancer, cirrhosis, nasopharyngeal tumors and death by miscalculation.The rural/urban difference in gun suicide in SE Maryland and male preponderance therein implies that a macho male image unsupported may be a deadly burden. Female suicide attempts (mostly without guns) may end up being interpreted as cries for help.
Do the the Brexit/Britain-First Britons share the same psychological vulnerability of America-First middle Americans or that of Eastern rural Maryland? Healthcare has been politicized, which seems unfortunate because of its national security and world preservation implications.
Physicians are being widely blamed for promoting opioid dependency through over-prescribing opioids. The over-prescribing involves both excessive usage and dosing that exceeds manufacturer recommendations. An example of which is the use of a dosage of OxyContin every 8 hours instead of every 12 hours. The problem is that, when introduced over twenty years ago, the drug was touted as minimally addictive and, as such, a substitute for more addictive drugs such as demerol or morphine. Therefore, when after a few hours of inadequate or spotty pain control, many MDs felt free to modify the order to every 8 hours, therefore opening the addictive door somewhat wider. I remember working as a drug representative while I was a third year medical student and being taken aback by the training session in which we were told that we were the "postgraduate instructors" of the practicing MDs. We objected and the phrase was withdrawn, but this posture may have contributed to physicians being schooled into carelessness.
Similar behavior on the part of prosthetic company reps is going on today in surgical suites. There is no question but that profit and the backing of a powerful family played a part in the popularity of the drug, which became a gateway to other cheaper narcotics. However, if 12% of the current problem can be attributed to physician-induced prescribing, that number pales in comparison to the number of addicts that use cheaper, street drugs at a lesser price and less trouble obtaining than the prescribed narcotics. Heroin, crack cocaine, and methamphetamine dominate as street drugs and shine a light on the decades of the 70s and 80s. The Caribbean connections (Curacao and Jamaica) are replaced by Colombia and Mexico with active money laundering by European and American banks. Then came the era of NAFTA and the cascade of trucked drugs from Mexico, although much originated elsewhere.
The erosion of values including self esteem, the elevation of transactional and momentary pleasure, exposure of leaders who have monetary motivation for behavior coupled with the ability of leadership to set styles, escapism from the pain of job unavailability, etc., are probably more responsible for numbers of addicts than anything else, but what do we do about a story that's yet to be told? Making the American picture more troublesome is the rest of the world experiencing much of the same and each and every country is in some kind of crisis. The risk of war under such circumstances rises either because it is a distraction or because cooperative, collaborative associations are suffering and the appeal of decisive often warlike rhetoric and action is increasing. For the last 50 years, the world has looked to America for example and guidance. In 2017, we are not in the position to supply either.