Archives for posts with tag: art

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.

National Institute on Drug Abuse[1]

 [This is Fred and I’m here with more bad news about heroin and the other opioids now destroying us, plus some cheerful speculation. Note the paragraph quoted above. Apparently in the 1990s we didn’t understand that opium and its relatives are highly addictive, even though it was obvious 200 years earlier. See our recent blog[2] on Thomas de Quincey’s Confessions of an English Opium Eater.[3] So I guess our great planners didn’t expect patients to start abusing opioids once those drugs became plentiful by prescription. And once more people became addicted certainly no one expected the criminal class to fill the increased demand with their own, informal products. Who would ever dream such a thing?

Also, we still don’t know if opioids actually treat pain when they are used in the long term. According to one recent study: “Evidence is insufficient to determine the effectiveness of long-term opioid therapy for improving chronic pain and function. Evidence supports a dose dependent risk for serious harms.”[4] Translation?  The long term benefits are unclear, but the dangers are obvious.

Not to worry, the National Institutes of Health [NIH], and their parent, the Department of Health and Human Services [HHS] have swung into action. Today society has a problem with opioid addiction and they will solve it by:

  1. Improving access to treatment and recovery services;
  2. Promoting use of overdose-reversing drugs;
  3. Strengthening our understanding of the epidemic through better public health surveillance;
  4. Providing support for cutting-edge research on pain and addiction; [and]
  5. Advancing better practices for pain management.[5]

So what could go wrong? Well, think about it. If we’re going to improve access to “treatment and recovery” services [Point 1], what does that mean? Do we have some magic cure that will wipe away addiction? I don’t think so. It’s very difficult to ween an addict from his [or her] opioid of choice. It was that way for Thomas de Quincey, and the situation hasn’t changed.  And if the weening process takes a long time, that sounds expensive. Taxpayers beware!

OK, but surely it would be a good thing to promote “overdose-reversing drugs.” [Point 2] Yes it would, because those drugs prevent death by overdose and it’s always good to do that. But overdose drugs don’t cure addiction, so we still have the problem of treating the survivors.

All right, then what about Point 3? NIH wants to know more about the size of the problem, how many addicts there are, and so forth. Again, who can quarrel with that? “Knowledge is power,” we’re told;[6] and why rent a rowboat for addicts if we really need a passenger liner? So yes, by all means study the problem, but not at the expense of making progress elsewhere. And by the way, the early returns are in. See Crappy News, the next section.

How about “cutting edge research” [Point 4]; is that a good idea? Practically always, say I. If our scientists research pain, perhaps they’ll develop new ways to treat sufferers without dosing them with addictive substances. That’s got to be a “better practice” [Point 5] than what we’ve been doing.

Then what about “cutting edge research” on addiction itself? Should we work on that as well? Yes, and we’ll discuss that later, under Vaccines.]

The Crappy News, or Why One Should Avoid the Drudge Report Early in the Morning

So the other day I was minding my own business, checking the Drudge Report, when I happened on a piece from Reuters that said: “More than third of [all] U.S. adults [were] prescribed opioids in 2015.[7] [Drudge is my substitute for a morning tabloid; feel free to pick a different service if you want; but definitely we all need something to read at breakfast.]

Ugh? Looking further I found the original data, or at least an abstract of it.[8] Officially the study is called the 2015 National Survey on Drug Use and Health [NSDUH]. So let’s sketch the findings. What else can you do with an Abstract?

  • In 2015 72,600 eligible civilian, noninstitutionalized adults were selected to participate in the study, and 51,200 completed the survey interview.
  • Based on these inputs, NSDUH estimated that, in 2015, 91.8 million (37.8%) of U.S. civilian, noninstitutionalized adults used prescription opioids.
  • 11.5 million people (4.7% of all adults) misused opioids; and 1.9 million (0.8%) had an opioid use disorder.
  • Among adults with a prescription, 12.5% reported they misused it; and of these, 16.7% reported a “prescription opioid use disorder.”
  • Most commonly people who misused opioids did so to relieve physical pain (63.4%). Does that sound familiar? Check out Thomas de Quincy’s story, referenced above.
  • Misuse and use disorders were most common with adults who were uninsured, unemployed, had low income, or had behavioral health problems.
  • Among adults who misused opioids, 59.9% reported using them without a prescription, and 40.8% obtained prescription opioids – for their most recent episode – for free from friends or relatives.[9]

So there you have it. Lots of doctors prescribe opioids; more than one-thired of U.S. adults had prescriptions in 2015; and some of those also used opioids without a prescription. Thank you, NSDUH, for that insight.

And some patients get violent if their doctors refuse to write prescriptions.[10] The states are upset; they argue over-prescription and the resulting addictions are impacting state resources;[11] and they’re beginning to sue the drug companies [and others] they think are responsible. Congress is alert, and will hold hearings on the matter.[12] Mexico is producing more and more opium to satisfy the demand growing in the U.S.[13] [Frankly, I didn’t know Mexico produced any opium; I thought most of the world’s supply came from our dependency, Afghanistan.] And, of course, our medical establishment is studying the problem that, one could argue[14], it created.

Vaccines

None of this is good, but is there sunlight behind the clouds? A month or so ago a friend[15] sent us an article about medicines that fight opioids and other addictive substances.[16] Apparently this has been researched since the 1970s, although without much recent success. Right now therapists have only three medications – methadone, buprenorphine, and naltrexone – to use to help the opioid addicted “get clean” and stay drug free. They work, but “not perfectly.”[17]

Current research is directed toward finding vaccines to directly counter opioid addiction. Most foreign substances are blocked from entering the brain by something called the blood-brain barrier. Opioids are an exception to that. They are very tiny molecules; can penetrate the barrier and enter the brain; and then do their damage unopposed. Opioids may lose their advantage – of small size – if they are attacked by antibodies “that bind to the drug molecules, creating complexes that are too large to cross into the brain.”[18] If the brain isn’t accessed, “there’s no high.”[19] And, one might add, there’s no corresponding brain damage to reinforce later addictive behaviors.

So the research is directed at triggering the human immune system to directly attack opioids. To (i) convert opioids to larger things that will not pass into the brain, or (ii) flush them out of the body before they reach the brain, or (iii) to do both. The Scripps Research Institute in La Jolla, CA, and the Walter Reed Army Institute of Research in Silver Spring, MD, have promising lines of study, and may have vaccines ready to begin human trials in the not too distant future. There are other candidates out there as well.

Conclusion

The situation with opioids is grim and looks worse every day, but perhaps there really is sunlight behind the clouds. The important thing for Congress to remember is that, when they’re throwing oodles of money at law enforcement to chase bad guys with drugs, they shouldn’t forget the scientists who, with funding and a bit of luck, may solve this problem for everybody.

Until the next one comes along, of course. Humans are weak, and our criminals are very ingenious. Didn’t you know?

 

[1] This is from the website of the National Institute on Drug Abuse, an organization within NIH. You can find it at https://www.drugabuse.gov/drugs-abuse/opioids/opioid-crisis . It was last updated in June of this year.

[2] That’s the blog of 07/16/2017, Opium Portrayed, at  https://opsrus.wordpress.com/2017/07/16/opium-portrayed/

[3] That’s Confessions of an English Opium Eater, Being an Extract from the Life of a Scholar. It’s currently in print from the Oxford University Press.  It was first published in 1821 in London Magazine, and was picked up in 1886 by George Routledge and Son. You can find the hard copy on Amazon. However, in keeping with blog policy, we found an alternate, free source for the text, this time in an eBook from Project Gutenberg.  Go to http://www.gutenberg.org/files/2040/2040-h/2040-h.htm .

[4] See Annals of Internal Medicine, The Effectiveness and Risks of Long-Term Opioid Therapy for Chronic Pain: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop (February 17, 2015) at Abstract, available at http://annals.org/aim/article/2089370/effectiveness-risks-long-term-opioid-therapy-chronic-pain-systematic-review .

[5] See n. 1.

[6] See Knowles, Oxford Dictionary of Quotations (6th Ed., 2004) at Proverbs, p. 624, n. 45.

[7] It’s at Reuters Health News, Seaman, More than a third of U.S. adults prescribed opioids in 2015 (July 31, 2017), available at http://www.reuters.com/article/us-health-opioids-prescriptions-idUSKBN1AG2K6 .

[8] The Abstract appears as Prescription Opioid Use, Misuse, and Use Disorders in U.S. Adults: 2015 National Survey on Drug Use and Health (August 1, 2017). You have to pay for a copy if you want to read the underlying article. I don’t know why that’s the case, since the study apparently was funded by our government. Anyway, the abstract is available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4782928/pdf/nihms753305.pdf .

[9] These findings are paraphrased or directly quoted from the Abstract.

[10] See, e.g., Fox 5, Hundreds mourn doctor slain after denying opioids to patient (August 2, 2017)), available at http://www.fox5ny.com/news/271464646-story .

[11] See Reuters, Raymond, State attorneys general probe opioid drug companies (June 15, 2017) available at http://www.reuters.com/article/us-usa-opioids-idUSKBN1962JJ

[12] See Clair McCaskill speaking to the DNC on July 28, 2016, available at https://www.bing.com/search?q=hthtps%3A%2F%2Fwww.yahoo.com%2Fnews%2Fu-senator-launches-probe-five-top-opioid-drugmakers-165514279 finance.html&form=EDGEAR&qs=PF&cvid=59500fa1e8204d0a8a8906e8292f9679&cc=US&setlang=en-US&elv=AXXfrEiqqD9r3GuelwApuloTP6wVwkOjONBqpuAMtOReD2p9Vv8km70BwEANJJDGrbYQZQruLL%21jduPgTqpAT%212GMOjDF0L2w7LKJr4QVFIa

[13] See RT, US offers to help fund Mexico’s heroin eradication efforts – report (22 April 2017) available at https://www.rt.com/usa/385656-mexico-fund-heroin-reuters/

[14] In fact, there doesn’t really seem to be an argument about this. See n. 1 and the quote that accompanies it.

[15] That’s Dave Feagles. Many thanks, Dave!

[16] See Science News, Gaidos, Vaccines could counter addictive opioids, Vol. 190, No. 1, p. 22 et seq. (July 9, 2016), While we have this article in our library, we don’t have a web  address for it, so we’re citing to the hard copy magazine.

[17] Id. We’re citing to the print version of the article, but don’t have the printed pages before us. We estimate that this information appears around p. 23.

[18] Id. at around p. 24.

[19] Id.

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I am Goya

Of the bare field, by the enemy’s beak gouged

Till the craters of my eyes gape,

I am grief,

I am the tongue

Of war, the embers of cities

On the snows of the year 1941

I am hunger

Andrei Vaznesensky[1]

 [Phil, I was in the DC area last week, and stopped by to see our friend Rosemary Covey.[2] She has a brilliant, and as usual disturbing, new line of work; it’s topical, a “sign of the times,” you might say; and one piece in particular left me gob smacked. So much so, I might add, that I remembered an idea we had a while ago, but later discarded: i.e., to nominate annually some work of art that best exemplifies some of the worst characteristics of the human race.  

I know you think that’s too negative; that we should focus instead on the positive things in life; but I disagree. If you want flowers and ponies, or visions of the afterlife, go to the church of your choice.  Artists who spotlight the evil out there do us a valuable service. I’m thinking of a series of prints called Los desastres de la guerra[3] that Francisco Goya[4] produced in the early 19th Century. I understand they’re well thought of, even today. Certainly the Russian poet Andrei Vaznesensky knew about them. So one shouldn’t kill [or ignore] messengers simply because they bring unpleasant news.

I know we’re supposed to look for consensus before branching out, and art criticism definitely is new to our blog; so please run my idea by the others. If you [and they] agree the project is worth doing, then please do it. With a little research I’m sure the team will find a way to say something sensible. For my part, it’s hot and I’m heading to the beach. Ta, ta! See you in August!

Oh, and I’m emailing you the image that caught my attention. Rosemary says we can use it in the blog. I’m interpreting that as, “for one blog post only.” G. Sallust[5]]

Well, our illustrious founder has struck again. He’s come up with a project, delegated the work, and left town. Normally I don’t agree when he does things like that but he asked nicely this time and the picture he nominated is, well, extraordinary. Perhaps “arresting” is the better term. Anyway, I’ve never seen anything quite like it. Just looking at it warps most of my ideas about what art should do; it’s brutal, graphic [of course it’s graphic; it’s a picture], and detailed, but not overly so. Much more detail and it would be pornographic, at least to someone of a certain mindset. This picture says its piece about the human condition, but stays on the right side of mental illness. Thank God for that. Now if our media would just do the same.

What picture am I talking about? We have a very good image of it, provided by the artist, that we’re posting separately, but at the same time as this commentary. The title of that post is The 2017 EZ2 Picture of the Year. As of now the picture itself doesn’t seem to have a name.

Let’s start with an admission. Unlike G. Sallust, I like “pretty” pictures. I’m in good company there; for centuries intelligent people treated art as something that lasts forever, at least in theory. “All passes,” said Henry Dobson. “Art alone [e]nduring stays to us, [t]he best outlasts the Throne …”[6] Or, more simply put: “Art is long and life is short.”[7] Of course that doesn’t apply to art materials. Ask any conservator what she [or he] has to do to keep things looking fresh in the museum.

Pretty pictures can be a refuge for the weary. Gustav Flaubert, a French author most of us read in college, thought art was something “to conjure away the burden and bitterness” of life.[8] Oscar Wilde, the English writer, agreed. He said: “It is through Art … and through Art only, that we can shield ourselves from the sordid perils of actual existence.”[9] That man could certainly turn a phrase, couldn’t he? And finally Saul Bellow, a modern novelist I like, put it best. “Art has something to do with the achievement of stillness in the midst of chaos. A stillness which characterizes prayer … in the midst of destruction.”[10]

I like it: To meditate or pray by looking at art. For sure you would need quality pictures for that. But that’s not the only view out there. Marshall McLuhan, for example, said that advertising was the greatest art form of the last century.[11] Fancy you or I meditating over some advert in Rolling Stone! If your significant other caught you staring at something like that, she [or he] might think you were up to nothing good! Then there’s our President, Donald Trump, who back in the 1980s said that deals and deal-making are his art form.[12] I’m not mentioning this simply to be facetious. My point is that there’s a whole range of opinions about art and how or why we make it.

We first met Rosemary Covey back in the early 1980s, when she had a very small studio in the old Torpedo Factory Art Center. By “old” I mean the building that existed before the renovation; the one that was far larger and, I think, full of asbestos. Anyway in those days she specialized in wood engraving, a wood cut technique that involved gouging fine lines in super-hard wood blocks. Those she would ink and print from by hand; and “by hand” I mean by laying paper on the inked block, then rubbing the paper with a wood spoon until the ink transferred. The whole process was laborious and accident-prone.

Eventually she went to a professional to print the larger things, but that was laborious as well, because she’s a perfectionist. So she moved on, bought a hand press, and did most of the print work herself.  Since then she’s worked with a variety of techniques, and today specializes in a kind of collage that utilizes her own images, rather than found objects, and painstakingly assembles, modifies and adapts them into a wholly different thing. The final products can be quite beautiful, or brutal, depending on her intent. But always they involve an enormous amount of effort and each, in my view, is its own thing. These originals are not reproductions although from time to time she has reproductions made from them.

So what did Rosemary Covey make with the Picture of the Year? Not a pretty one, that’s for sure. But there’s a view out there that art is anything you do to create order out of the chaos that surrounds. “Art is the imposing of a pattern on experience, and our aesthetic enjoyment is recognition of the pattern.”[13] I think that’s close to the truth of her enterprise and this work.  She’s showing us an underlying reality of today’s world, and this time it’s bad.[14] Nobody should kill the helpless. That seems obvious, I guess, but judging from the headlines it’s not so to a lot of people. Hopefully they’re not all psychopaths and some can be made to listen.

But is this really Art?[15] Yes. “Fine art is that in which the hand, the head and the heart of man [or woman] go together.”[16] She’s done that with this work. And by the way, she ought to think about naming it. Francisco Goya has already taken No se paede mirar[17], but something more contemporary along that line might do.

There, that’s enough from me. Award confirmed.

 

[1] See ODQ at Andrei Vaznesensky, p.817, n. 1. He was a Russian poet, quite popular here in the 1960s. For more information check out the Wikipedia entry at https://en.wikipedia.org/wiki/Andrei_Voznesensky . I don’t believe he was an art critic, but he did seem to know the artist Goya’s work pretty well. Goya’s famous for a lot of things, one of them being a series of prints on war. See note 3.

[2] She has a web site at http://www.rosemaryfeitcovey.com/ . There’s also an out-of-date write up on Wikipedia at https://en.wikipedia.org/wiki/Rosemary_Feit_Covey . Go to the website.

[3]The Disasters of War”.

[4] That’s Francisco José de Goya y Lucientes, who is not to be confused with the food company. There’s a pretty good write-up about him in Wikipedia, at https://en.wikipedia.org/wiki/Francisco_Goya .

[5] G. Sallust is our distinguished founder.

[6] See ODQ at Henry Austin Dobson, p.278, n 15. The full quote is: “All passes. Art alone, Enduring stays to us, The Best outlasts the Throne, The Coins, Tiberius.” Actually I don’t really think of Roman coins as works of art but, on the other hand, I don’t collect them. Dobson lived in the 19th and early 20th Centuries. You can read the essentials about him at Wikipediahttps://en.wikipedia.org/wiki/Henry_Austin_Dobson .

[7] See ODQ at Proverbs, p. 614, n. 32.

[8] See ODQ at Gustav Flaubert, p. 325, n. 16. The full quote is: “Human life is a sad show, undoubtedly; ugly, heavy and complex. Art has no other end, for people of feeling, than to conjure away the burden and bitterness.” It’s a translation, of course. Everybody knows about Flaubert but if you don’t, check out the Encyclopedia Britannica at https://www.britannica.com/biography/Gustave-Flaubert .

[9] See ODQ at Oscar Wilde, p. 835, n. 28, and p. 836.

[10] See ODQ at Saul Bellow, p. 66, n. 2. Most of Saul Bellow’s major works remain in print courtesy of the Library of America.

[11] See ODQ at Marshall McLuhan, p. 503, n. 17. The actual quote is: “Advertising is the greatest art form of the twentieth century.” Everybody in my generation knows about him, but probably no one else. If you’re interested check out his official site at https://www.marshallmcluhan.com/films/ .

[12] That’s from the 1988 book, Art of the Deal. You can also find the relevant quote in the ODQ at Donald Trump, p. 801, n. 16. “Deals are my art form. Other people paint beautifully or write wonderful poetry, I like making deals, preferably big deals. That’s how I get my kicks.”

[13] That’s from Alfred North Whitehead, a philosopher of the early 20th Century. See ODQ at Alfred North Whitehead, p. 892, n. 14. If you want to know more about Whitehead the philosopher, start with the Stanford Encyclopedia of Philosophy, at https://plato.stanford.edu/entries/whitehead/

[14] “Art does not reproduce the visible; rather it makes visible.” See ODQ at Paul Klee, p. 407, n. 16.He was an artist.

[15] “The Devil whoops, as he whooped of old: It’s clever, but is it Art?” See ODQ at Rudyard Kipling, p. 453, n.19.

[16] See ODQ at John Ruskin, p. 660, n.3.

[17] That’s “one cannot look at this.” See ODQ at Francisco jose’ de Goya y Lucientes, p. 357, n. 15.