Episodes
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I was very honoured to speak with Dr. Kanji Nakatsu, a PhD in pharmacology and emeritus professor from Queen’s University, about the interesting and somewhat controversial subject of Vitamin D.
Is D a wonder drug? Or a fad? Should we be supplementing? If so, how much?
This discussion is a little technical, and perhaps not for everyone, but I hope many of you find it of interest.
This should be a scientific, not political, topic. But like everything that brushed up against COVID, it got gooey politics all over it. My hope is that we can return to objectivity and stay away from politically-fueled motivated reasoning regarding this and other nuanced topics. I think we have to be careful not to contract what I call FDS or “Fauci Derangement Syndrome”, where we start to automatically believe the opposite of everything he and The Experts™ said during the last few years - even though in most cases that will lead you to the right conclusion. Even a broken clock is right twice a day, so approaching each topic with a neutral view is the only way to return to real scientific thinking.
It remains a bit unclear to me if we can separate out whether Vitamin D is a risk FACTOR or a risk MARKER. I’m not sure if we have a definitive answer yet, but the bulk of the evidence seems to be that supplementing Vit D is at worst benign, and much more likely very good for your health.
Dr. Nakatsu is an impressive human - obviously brilliant, and at 78 years old about to bicycle across the country as you will hear. He is worth listening to very carefully. You can find info at his website https://areyougettingenough.info/ He is involved with the Canadian COVID Care Alliance (CCCA - which I gather is in the process of broadening its mandate and morphing into the Canadian Citizen’s Care Alliance).
Thanks to Dr. Nakatsu for an interesting discussion. You can find him here on Substack, or at the websites above.
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Urban wastelands
One of my friends described our hometown of Sydney’s downtown as looking more and more like a zombie apocalypse.
Those who are addicted to the point of homelessness tend to migrate to larger centres. A rural community won’t put up with Joe Smith, Mike and Maggie’s son, pitching a tent in the field where the kids play baseball, leaving dirty needles around, and passing out on the grass. Cities are big and anonymous and such behaviour is tolerated. More than tolerated, some would say it is implicitly encouraged by the presence of harm reduction programs that make a lifestyle of homeless addiction more sustainable, as well as selective non-enforcement of loitering, panhandling, and other bylaws.
A recent media article I came across referred to ‘safe’ injection sites as “controversial”. This is an understatement. Although harm reduction is preached as gospel truth, one who speaks with a representative sampling of doctors, nurses, or thinking citizens will find mainly dissenting opinions.
Although one can selectively comb the literature to find small studies where harm reduction programs tout their local successes, a look at the big picture suggests a different conclusion. Even though our downtowns are more and more being turned over to addicts, Experts™ tell us to reject the evidence of our own eyes and ears. Harm reduction is working great, we just need to do more of it. Do The Experts™ know something that we don’t?
I recently attended an online education session on a pilot project designed to bring “harm reduction” into the ER. The presenter suggested that we should be screening patients for addiction (requiring another piece of paperwork and a longer triage process), providing naloxone kits, starting “opiate replacement” and “safe supply” immediately, and prioritizing people with addictions ahead of other ER patients (sorry little old lady with the broken hip, I’ll be another 25 minutes…).
At the end of the session I asked if there was actual evidence that this program was helping. I pointed out that although we have invested far more in harm reduction in the last generation, there are more addicts and more overdose deaths, not fewer. ER funding is a zero-sum game: when we do more of one thing we do less of another; when we prioritize one person we de-prioritize others. The answer I got was that indeed, there was no actual evidence that this pilot project was helping, but that we “have to do something”. And that “we think it might be worse if we weren’t doing this”. One presenter suggested that if we could find “the denominator” - ie: the total number of addicts - then we would see that even though there are more addicts, and even though there are more overdose deaths, that a smaller PERCENTAGE of addicts are dying of overdose. Et voila, that would prove that harm reduction helps. It felt like a stretch, to say the least. A moving of the goalposts. (Or for you math-y folks, this is called P-Hacking.)
Data that contradicts visible reality should be treated skeptically
The below article in the Journal of the American Medical Association concludes that “safe supply” (the new golden boy of harm reduction programs) was associated with INCREASED harms - in this case opioid-related hospitalizations - in the area of British Columbia where it was implemented. This data seems trustworthy, given that it matches, rather than contradicts, real life evidence.
There is a joke about academics, who are prone to believing very ridiculous things if they appear in a journal: “one would have to be highly educated to believe such nonsense”. Much of the “evidence” for harm reduction falls into this category. The average joe/josephine who walks downtown, or reads the obituaries, knows that whatever The Experts™ are doing just ain’t working.
Most citizens do not set up tents on the sidewalk and use drugs in public
It’s great to want to help those with addiction issues. But at the same time, what does non-enforcement of loitering, littering, public intoxication, and other bylaws do to the ability of an average citizen to enjoy his city? To play with his kid in the park? To walk down a street without getting constantly panhandled? To not have his car broken into again and again? To not be randomly assaulted?
How is it that we can speak incessantly about the needs, wants, and rights of one group - those who abuse drugs - while at the same time completely ignoring the needs, wants, and rights of the great majority of society who do not?
Consider a law-abiding tax-paying citizen who has no criminal record. He wants to build a garage on his own property, which he owns and pays taxes on. First he needs a permit which requires a trip to city hall housing/zoning department. He has to pay a fee and spend time spent filling forms. The garage is finally built. The inspector comes and finds out that an ‘i’ was not dotted and a ‘t’ not crossed properly on the form. The citizen is forced to either pay a fine, or to have expensive modifications done on the garage to correct the error. (This is a real story, by the way). All this even though his garage affects no one else, and is on his own property. If he does not comply immediately he could end up charged higher fines or interest, and eventually if he did not pay he could be in contempt of court and face jail time. The police would eventually be called to enforce the bylaw. As the saying goes, “All laws are ultimately enforced at the end of a gun.”
Meanwhile, a few hundred metres away, a large group of addicts has taken over a park. Land that belongs to, and is maintained by, taxpaying citizens. They erect tents and more “permanent” shelters of various kinds on land where people used to walk their dogs and kids used to play. No building permits are demanded. No inspections are done. No police are involved. No attempt is made to remove them. No one is threatened with jail. There are no consequences.
We seemingly have chosen to enforce unreasonable laws on reasonable people, while at the same time not enforcing reasonable laws on unreasonable people.
Are “safe injection sites” creating “safety”, or a Zombie Apocalypse?
The first safe injection site in Canada opened in Vancouver around 20 years ago, and since then “harm reduction” has grown massively. It now includes the distribution of seemingly limitless clean needles, free tents, free drug paraphernalia (to crush and melt pills), naloxone kits (an injection drug that can be given to reverse the effects of an overdose) and most recently “safe supply”. In fact, more than 1 million dollars PER DAY was being spent in downtown Vancouver on these programs, even before “Safe Supply” (more properly called PSAD – Public Supply of Addictive Drugs) was added to the tally. We have put a lot of tax money into making homeless drug addiction a practically sustainable way of living.
Many harm reduction advocates lament NIMBYism (Not In My BackYard): that nobody wants to have a safe injection site in his neighbourhood. But there are logical reasons for this. These facilities are bug-lights for criminal behaviour.
Just several years ago, downtown Sydney Nova Scotia was safe. Like many downtowns in North America, suburban malls and online shopping had meant there were lots of empty shops, but it was safe. Male or female, one could stagger home from a bar at 2AM unmolested. Then we went all in on "harm reduction".
The local (taxpayer-funded) addiction help centre has become a focal point of loitering, public intoxication, scuffles and fights, littering, and even middle-of-the-day public sex acts (presumably prostitution-related). Piles of garbage are strewn around. My friend was propositioned by a prostitute while running on lunch break. Another friend saw a "fine gentleman'" receiving sexual services on the stoop of the senior's club just across the street from the help centre, in broad daylight. Panhandlers have become more aggressive and even threatening - a friend of mine now won't use the bank machine in the area after a bad experience.
Police do not enforce vagrancy or loitering laws. I suspect if they did, they would be pilloried for picking on addicts, who have been afforded coveted victim status in our current victim society.
Meanwhile (unless it changed in the last 5 minutes) overdose deaths in Sydney remain at an all-time high, violent crime has increased, and rates of addiction have not dropped. What harms have been reduced?
I drove by the centre last fall. As usual, there was much garbage and debris around. There was a mass of humanity milling about in various states of consciousness. Some passed out, several obviously severely intoxicated. Two were “up in each other’s grille” having a major verbal altercation. Ironically, in the midst of the mayhem, many were sporting brand new T-shirts that said in large letters: "HARM REDUCTION SAVES LIVES!".
The harm reduction advocates I know have never volunteered that one of these centres be located next door to their own lovely home in the suburbs. Instead they criticize others for not wanting it near their neighbourhood.
Where’s the proof?
Even harm reduction advocates will admit it’s not a panacaea, but more of a band-aid. But does it really do any good at all overall?
The original version of “the proof is in the pudding” was: “The proof of a pudding is in the eating”. But either way you phrase it, this adage is apropos to harm reduction. If these programs worked, they should work. We should see fewer overdoses. Fewer deaths. But instead, as we have spent more and more on “harm reduction” we have just the opposite happening. The same BC government that is still pushing forward hard with even MORE harm reduction just reported their 2023 stats and set a(nother) new record for drug overdose deaths at over 2500. Drug overdose is now by FAR the leading cause of death in younger age groups in Canada.
In response to this clear data trend, the main argument of “harm-reduction” proponents is that “it would be even worse if we weren’t doing all of this”. This is not scientific, but rather a statement of belief. And there are logical reasons that harm reduction may be (probably is, in my reading) making things worse.
But it’s probably worse than unhelpful
OK, I’ve pounded home my point that there is, to say it politely, a lack of evidence for efficacy of harm reduction programs. But let me take this one step further and suggest that there are several ways in which harm reduction could be making things worse.
There is a concept in behavioural science called “risk compensation” or eponymously “The Peltzman Effect”. Put a helmet on a kid before he rides his bicycle and he takes more chances. Enforce a facemask-wearing-rule in a hockey league and players aren’t as careful to keep their sticks down. A humourous corollary is this: the best safety device for cars would be a 6-inch spike mounted in the steering wheel pointing at the driver. Suddenly, everyone would drive much more carefully. To summarize risk compensation: the safer something feels, the more chances we take.
I’ll tell 2 real stories (with enough details changed to avoid identifying a patient unintentionally).
Many years ago, working in a big city ER, a young man I’ll call Zach came in late at night. He was in withdrawal from injection narcotic use. He wanted help to get clean. His friend had just died of an overdose the day before and it had hit him hard. They had been using together, and tried a little extra for a higher high. They passed out. Zach woke up, his friend never did. Zach told me he knew the same was in store for him if he didn’t get off drugs. I asked if he had a naloxone kit. Yes, he and his friend both had them. I then asked if he thought they would have used as high a dose if he hadn’t have had the kit. Zach thought for a minute and answered no. The presence of the kit made chasing a higher high seem “safe” to him. Does having these kits kill more people than it saves? We have distributed many thousands of naloxone kits, and yet more people are dying of overdoses. It is easy to point to the lives they save, but are there many deaths to which they have contributed by giving a false sense of security - deaths that we have no way of counting?
Another night in a big ER and another addict wanting to quit – I’ll call him Jimmy. Jimmy’s (latest) girlfriend had just kicked him out. He had nowhere else to go, being estranged from family (having stolen from his parents then grandparents). He had hit rock bottom. He was suicidal. Jimmy was young, good-looking, articulate, and clearly intelligent. I asked him how a guy like him ever got started in the first place? It’s easy to understand how people KEEP using, but what about the first time you pick up a needle and shove it into your own arm? I asked him wasn’t he worried about OD’ing? He explained that he was at a party, drinking with friends. He went out back to the garage where some of the guys were hanging out. A friend of his was experienced with injecting narcotics and encouraged him to try it. The friend allayed any fears about overdose. “What about catching diseases?” I asked. “I’m not stupid enough to use a dirty needle” Jimmy said. There was a large container of clean needles there, supplied by the local harm reduction clinic. I asked if he would have used had there not been fresh needles. He was adamant that no, he never would have used a dirty needle, and that in his several years of using he never had used anything but a fresh needle – all provided free of charge via “harm reduction”. Have we made it easier and “safer” for people to develop a drug habit in the first place? Would Jimmy ever have taken the first step onto the path that wrecked his life (to that point – I hope he recovered) had we not made that step seem “safe”?
At the same time these aspects of harm reduction have made drug use appear “safer”, the destigmatization movement is likely having an effect in lowering or removing one of the barriers to starting a drug habit by making use appear more normal or socially acceptable.
And finally, diversion of “Safe Supply” drugs is extremely concerning. This is the phenomenon where taxpayer-funded opiates are provided to addicts, with the assumption that they will replace opiates like fentanyl that the addict had been buying on the street. But just giving someone a less potent drug doesn’t automatically make them stop wanting the more potent one. Instead, it appears that many addicts take the free opiates and sell them, using the money to buy their drugs of choice.
Although advocates tend to downplay this issue, evidence suggests that it may be extremely common. (I highly recommend reading this well done article by Adam Zivo.) Basic economics dictates that increasing the supply of a product lowers the price. If a bunch of “free” opiates are suddenly given to addicts in a community, and those opiates are diverted and end up on the street thus increasing supply, this lowers the black market cost of these drugs. In some communities, a huge drop in the price of opiates has now made them a cheaper option than beer or marijuana for youth who want to get a buzz on before the Friday evening high school dance. Some believe this mass prescription of “Safe Supply” is creating a whole new generation of addicts, just as the mass prescription of Oxycontin and other opiates may have triggered round one of the opioid crisis.
Harm Reduction had noble intentions. But by making drug use appear safer, appear more normal and socially acceptable, and most recently by releasing a deluge of cheap opiates onto the streets of our communities, it is very likely part of the reason we see an ongoing increase in addictions, homelessness, and addiction-related deaths.
Time to change course?
We can’t “harm-reduce” our way out of the addiction crisis. But “harm-reduction” may be part of what has gotten us here in the first place. In a recent media piece lauding a “safe supply” physician who had received an award for his work, he unknowingly gave support to those of us who think it may not be helping. In the concluding paragraph he is quoted as saying “I’ve been doing this for 20 years and there’s more demand now than when I started... it’s worse”.
Einstein is credited with having said “The definition of insanity is doing the same thing over and over and expecting a different result”. Just as there are those who still advocate for communism by saying that we haven’t tried REAL communism yet, continuing to think that harm reduction will work if we just do more of it is, by this definition, insane.
If you’re interested in more…
To those of you who took the time to read or listen to the Is there Harm in Harm Reduction series, thank you. I’m happy to hear your thoughts, positive or negative, either by private message or here in the comments. Whether I’m totally wrong, totally right, or most likely a bit of both, this is an issue that needs a fulsome discussion and debate.
For a more positive view on the potential of addicts than you’ll get from Bonnie Henry, The Pairodocs recommends this recent Free Press article on the success of Hazard, Kentucky which is rebuilding out of the ashes of addiction and despair called Recovering Addicts Save an Opioid Town.
For a thoughtful and deep perspective on how Harm Reduction became “The Science”, I recommend my colleague Dr. Rick Gibson’s Substack “Wishful thinking about addictions”
If you want to hear me try my best to explain how the through-line runs from The Enlightenment through Freidrich Nietzsche, Carl Jung, and eventually to modern 12-step programs, have a listen to my conversation with David Gardener on his new Freedom Convo Podcast
And finally, for a hard-hitting critique of our current lenient, harm-reduction-only approach to addictions and homelessness, I recommend watching “Canada is Dying” by Aaron Gunn.
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Missing episodes?
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The watering down of language
When I was a medical resident in Kingston Ontario in the late 90’s, we would sometimes receive patients from the Rideau Regional Centre. This was a residential facility or “Institution” between Kingston and Ottawa that at its peak in the mid-50’s housed over 2500 mentally handicapped people.
Back then in the 90’s, the government was in the last stages of phasing out these larger centres in favour of “small options homes” and “community care” for the handicapped. Whether this is an improvement is a debate I won’t step into here, except to say “it’s complicated”.Some of these residents had been admitted to the centre when they were very young, and many were old by the time I cared for them. They would arrive with their original paper charts, some of which had admission data from the 1940’s, 50’s or 60’s. Admission notes included diagnoses such as “Low-Grade Idiot”, or “High-Grade Imbecile”. Back then, these were technical terms. “Idiot” meant someone with an IQ of 0-25, an “Imbecile” between 25 and 50, and a “moron” between 50 and 70.
As I don’t have to point out to you, these terms were co-opted from being technical and medical to being terms of insult and derision. Their use in medicine was abandoned. Numerous iterations have followed. “Retarded”, which etymologically means “slow” followed, but also became a term of derision. So then we used the word “slow”. “Mentally handicapped” followed. “Delayed” or “developmentally-delayed”. “Differently-abled”. Or now I have heard the term “Multiple Learning Disabilities” to describe someone who in 1950 would have been a “High-Grade Moron”.
The peak of “euphemizing” about mental handicaps hit a few decades ago. I remember listening to the news and hearing about the “Association for Community Living”. What was this new organization? Did they help seniors remain in their homes? Or provide affordable housing? A church organization? Were they a swinger’s group? No, this was the new name for the Association for the Mentally Retarded (it is VERY hard to find traces on the internet, as record of its existence now seems to be memory holed). The Association for Community Living supports mentally handicapped people, but there is no longer any trace of that apparent in their name. It has been euphemized to the point of being completely devoid of meaning.
This process has been called the “euphemism treadmill”.
Euphemizing can lead to normalizing
We have followed a similar process with the word “addict”. Many euphemisms have been used. “Drug abuser”, “substance abuser”, “person living with addiction” (as Lionel Shriver says, a description which makes it sound like they took in a roommate), a “person who abuses substances”. We seem to have somewhat settled on “a person with an SUD” (substance use disorder).
Recently the term “a person who uses substances” has come into common usage. The problem with that is that we all “use substances”. I drink coffee most mornings. I bet many of you have taken Advil for a headache. Some might have a drink of wine on Saturday evenings. Cheerios are a “substance”.
The term “a person who uses substances” does not differentiate the average person from someone who has emptied his wife’s bank account to supply his drug habit, wrecked his marriage, impoverished his family, and is living under a bridge. (Could living under a bridge be called “Community Living”?)
It’s not what you say, it’s what you do that matters
Our society tends to develop euphemisms for issues which are uncomfortable or difficult to discuss. But it seems to me that the term you use to describe someone is not nearly as important as the respect and compassion that you actually show that person.
I’ll never forget when one of those handicapped patients from the Rideau Regional centre died, watching 2 of his caregivers completely overcome with tears. The fact that his record indicated that he was officially a “moron” hadn’t stopped them from loving and caring for him over several decades. They wept for him as if he were a brother. On the other hand (if you’ll recall back in part 2), Bonnie Henry is very careful to use the term “people who use substances” instead of “addicts”. But then she says they have a “brain disease” and that they can never get better. Is that respectful? Is it compassionate? We can run on the euphemism treadmill but go nowhere.
When we water down a word, we lose something. There is still some stigma about being an “addict”. It is normal to be a “person who uses substances”. Perhaps this is why I meet lots of people who self-describe as “addicts” or “alcoholics”, many of whom haven’t used or touch a drop in decades, whereas I’ve yet to have met someone who describes himself, or is described by his family, as “a person who uses substances” who has kicked his addiction.
The first step to a cure is a proper diagnosis
We need straight talk. Many media reports muddy the issue of addiction and homelessness, referring to them as “intertwined”. It is suggested - or sometimes said directly - that some people become addicted because they are homeless. Yet in all my years in medicine I have never once met someone with this story. In 2024 nearly every homeless person in Canada is addicted, which suggests the arrow points in one direction, from addiction to homelessness, but not in the other.
If your brother, cousin, or friend called you some frigid winter evening and said that he was down on his luck and needed a place to stay for a while, how many people would tell him to go fly a kite? Not many. I sure wouldn’t. Now picture if you knew that person was addicted, injecting drugs regularly, stealing to support his habit, and had stolen or got in fights at the last few places where he stayed? Would that change your answer? Non-addicts rarely end up homeless, or if they do it’s not for long.
Getting stigma right, not getting rid of it
Julie and I sometimes joke that we need to start a “Restigmatization” movement to counterbalance the destigmatization movement. Why?
Shame is normal and necessary. There are whole books written on this subject. Shaming those who engage in personally and/or societally destructive behaviour is not only reasonable, it’s necessary. Shame helps hold societies together. We could probably steal our neighbour’s bicycle and sell it for money and get away with it, but that would be shameful. We could knock down a little old lady and take her purse, but that would be shameful. The vast majority of us don’t do these things, not because the police are watching us every minute (at least not yet), but because we would bring shame on ourselves and our families. We know certain actions are wrong - there is stigma attached to them. The only way to never feel shame is to not have a conscience.
As we destigmatize drug use, we can unintentional cross a line into normalizing and condoning it. We need to remember that it SHOULD be shameful to be an addict. It is bad for your family, for your community, and for you personally. If there is no stigma, there is less impetus to change.
What is the right amount of stigma? If there is too much stigma and shame, a person can feel beyond redemption, and give up on himself. An addict should not be made out to be hopeless or evil. But they are not just fine like they are.
It’s important to stigmatize the BEHAVIOUR and not the PERSON. An addict is not worthless or irredeemable or forever lost, despite what Bonnie Henry says. But the behaviour is destructive, costly, and socially irresponsible. Hate the sin, love the sinner.
We need to get stigma right, not eliminate it. You can love someone who drank and drove, or love someone who is doing time for grand larceny. But the DUI or their felony is not what you love about them. It’s not what you’re proud of them for. It’s the part that you hope they will change. So it’s not what you put on a t-shirt.
Compassion versus empathy - when does empathy become toxic?
Whole books have been written about “toxic empathy”. “Against Empathy” by Paul Bloom should be required reading for all parents, healthcare professionals, and teachers in my opinion. Toxic empathy is the kindness of heart that makes us want to give every kid a trophy. To let the screaming toddler eat the chocolate bar an hour before supper. To shut down free speech because someone’s feelings might be hurt. To avoid enforcing educational standards because someone might actually fail and feel bad.
Toxic empathy is destructive in many realms, including with drug use. We need to draw lines. We need to say that some things are not acceptable. We need to avoid allowing our natural empathetic instincts to push us over the line from helping to enabling.
American historian and thinker Christopher Lasch said:
“…the ideology of compassion, however agreeable to our ears, is one of the principle influences in its own right, on the subversion of civic life, which depends not so much on compassion as on mutual respect. A misplaced compassion degrades both the victims, who are reduced to objects of pity, and their would-be benefactors, who find it easier to pity their fellow citizens than to hold them up to impersonal standards, attainment of which would entitle them to respect.”
Is the key to success lowering standards?
A number of years ago there was much hand-wringing around physical activity (PA) guidelines. There was debate over what the minimum standards should be. There had been a sharp dropoff in PA over the preceding years, and rising obesity rates. The “solution”? Lower the standards. Experts™ said that having a high standard would mean too many people would fail to meet it, and thus would feel bad about themselves. We needed more “realistic” goals. So your tubby kid could now feel happy if he was active for an hour a day, rather than the previously recommended 90 minutes.
The joke “if at first you don’t succeed, lower your standards” feels like it has actually been applied to drug addiction through changes in language and the move from abstinence promotion to harm reduction.
The healthy solution when someone we care about is not meeting a standard is not to lower it, but to help that person achieve it. The way we talk about and treat addicts in 2024 is a great demonstration of “the soft bigotry of low expectations”.
It seems that in general in modern society, and specifically around the issue of addiction, we have a hard time remembering there is a difference between BLAME and RESPONSIBILITY. But clearly defining this difference is crucial if we want to help those addicted to drugs, but not enable them.
Addiction as a disease
Is addiction a “disease”? To be generous, perhaps in some senses. There are genetic and lifestyle risk factors. There are measurable differences in someone’s brain chemistry over time. We can treat certain symptoms with drugs. Addiction, like many diseases, causes morbidity and mortality.
But with just a bit of thought we see the problem with this model. Breast cancer is certainly what I would call a disease. Yes, a woman’s choices - smoking, obesity, poor diet, and lack of exercise all increase risk, as does genetic susceptibility, but breast cancer itself is not A CHOICE.
In all my years as a doctor, I have never seen a woman cure herself of breast cancer by waking up in the morning, looking in the mirror, and saying to herself “that’s it, I’m sick and tired of breast cancer and I’m just not going to have it anymore”. That just doesn’t happen. But I know MANY recovered addicts who have cured themselves of their addiction in exactly that way. They are in my family, they are my friends, they are my co-workers, I play hockey with them. They are people I admire. If addiction is a “lifelong disease” then why are there so many more ex-addicts than current addicts?
Speaking about addiction as a disease is infantilizing and disempowering. It suggests to an addict that he is a victim. That he is helpless. That he has no choice but to go on suffering.
Addiction is a BEHAVIOUR, not a disease. It’s a behaviour that is hard to change (by definition), but one that is possible to change. People can, and do, change their lives. They can and do wake up one morning and say “I’m done with this. Enough.”
The Experts™ look down on the addicted
Does the view that addicts are helpless victims - a view that is at the base of our harm reduction strategies - rob addicted people of their own human agency?
We have essentially given up on abstinence. Which in my mind is the same as giving up on addicts. Most recovered addicts I have met talk about having hit “rock bottom” before quitting their habit. By cushioning their “rock bottom” with harm reduction, it seems to me we are in all likelihood preventing abstinence. We are trying to fill the god-shaped hole in addicts hearts with clean needles and now with free supply of government-provided drugs.
In Brave New World, Aldous Huxley suggests that a drugged populace does not question authority, but rather depends on it. From Valium to Prozac to Ritalin and Adderal, and now an implicit acceptance of opioid addiction as a life choice. Are we creating a dystopia?
Stay tuned for Part 4 of Is there Harm in Harm Reduction: Data, Dystopias, and Detrimental Effects
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Once again you have the option to listen or read. Either way, thanks for being here and I look forward to your comments and ideas.
The Solution to drug addiction is unlikely more drugs
Big Pharma was a Big Part of creating this crisis in the first place. At minimum it poured gasoline on a fire lit by the loss of religion, social and community connections. Yet of course Big Pharma has come up with "the solution", which is (surprise!) more drugs. Call me Mr. Suspicious-Pants, but I just don’t trust them. But, according to The Experts™, the best thing to do for narcotic addicts is to put them on Opioid Replacement Therapy (ORT) in Opioid Replacement Programs (ORP’s).
Methadone was the first drug used for ORT, and for many decades was the only show in town. Methadone is a once-a-day, slow-onset-slow-offset narcotic that does not give the “high” of other shorter-acting versions, and is thus felt to be less addictive. But like other narcotics, methadone still blunts emotion, saps energy, and likely causes increasing chronic pain over time through “receptor upregulation”. This phenomenon is known as narcotic-induced hyperalgesia.
As mentioned in part one, opioid replacement therapy is an odd name, as it implies that an addict’s problem is that he lacks opioids. But a few generations ago, the name made more sense. Those entering a methadone program would sign a contract. They agreed to stop using other drugs, and methadone replaced the drug they were giving up. Admission to the program, continued attendance, and continuing to receive methadone was contingent on adhering to the contract. If your urine spot-test was “dirty”, you were out. There were expectations and standards for those in the program. You weren’t free to use whatever drugs you wanted if you wanted to be in the program.
Freedom without responsibility = disaster
Circa 2012 I attended a large conference where a certified Harm Reduction Expert™ who ran a methadone clinic was asked what he did when a patient failed a spot test. His answer shocked me (and I should add - also those sitting around me). A dirty test was a failure of the program, not the individual, he explained. It was a sign that the dose was not high enough. If an addict was getting enough methadone, he wouldn’t be using other drugs in the first place. This was when it struck me that today’s ORP’s are not what I learned about in the 90’s, where contracts were strict, and tapering was de rigueur.
I’ve watched this idea that giving people drugs will somehow make them use less other drugs creep into medical practice. Circa 2021 I had an alcoholic patient come to ER in a very bad state. He had been to ER a couple of nights earlier and was given a prescription for a huge bottle of clonazepam. This is a benzodiazepine - a drug that some call “dehydrated booze”, which can be used to wean people off alcohol in inpatient settings. But because it’s effects overlap so much with alcohol, it is dangerous when used in combination. And that’s what this patient had done. Most of the bottle (enough for a big daily dose for a month or two) was already gone. The patient did survive. When I reviewed the previous notes, it was apparent that the patient hadn’t solicited the prescription. He hadn’t said anything about wanting to quit or taper. The physician thought that if the patient was taking clonazepam, he would drink less. Instead, he used both drugs, and nearly died.
As Dr. Julian Somers so eloquently talked about at FSIM 2023 (watch for an online Free Speech In Medcine event with him coming up soon), methadone programs used to be a PROGRAM with many facets - vocational training with a view to employment, counselling for mental health issues, reconnecting with family. The “active ingredients” were everything but the methadone. Now a methadone (or Suboxone) program is about getting a drug every day, and little or nothing else.
In a well written City Journal article , journalist Erica Sandberg describes her experience in San Francisco, posing as a drug addict who had just arrived from the midwest. Here is an excerpt:
In NS, as I’ll go into below, there are zero government-funded inpatient abstinence-based programs for narcotic abuse, and fewer inpatient options for alcoholics than in the past.
This time for SURE this is going to work
Recently methadone has mostly been replaced by Suboxone, which is a somewhat safer alternative that blocks opioid receptors in our brain and spinal cord, blunting withdrawal symptoms. And by happy coincidence it’s more expensive, generating a higher profit for Big Pharma. Experts™ explained to me that changing from methadone to Suboxone would cause overdose deaths to plummet. I think you can guess what has actually happened.
Although there is no doubt that both methadone and Suboxone can mitigate the cravings that withdrawal causes, they do nothing to address the root causes of addiction, and used alone they do nothing to help an individual move past addiction and into the sober, meaningful life that lies beyond.
The Abandonment of Abstinence as a North Star
Despite the failure of ORP’s, increasingly they are the only tool in the healthcare practitioner’s toolchest here in Canada (and elsewhere as I understand it).
Over the years, healthcare overlords have increasingly abandoned funding “abstinence-based” programs (ABP’s) - those that are focused on helping patients get off drugs rather than just replacing them with a (purportedly) less harmful alternative drug. Most ABP's also involve reintegrating into the community - be it through finding a job, having a sponsor in the community, reconnecting with family, finding a group home, a church, whatever. ABP’s are organized on the belief that sending a person directly back into the same environment and circumstances that stimulated him to be addicted in the first place will likely torpedo his chances of staying sober, even if we do give him methadone or Suboxone in an ORP.
Harm reduction including needle exchanges, supervised injection sites, shelters, ORP’s, and most recently “safe supply” - have replaced abstinence-based programs. These interventions are more left-brained and mechanistic, with no need to bring in all that controversial spirituality or (God forbid) religion which were the foundation of success in 12-Step programs. Governments appear to be “doing something” to fix addiction when they run harm reduction programs, while at the same time that the death toll increases.
These programs give hard data for proponents to use to argue that they are working. The number of needles you give out, or the number of people on methadone, the number of people “retained” in programs can easily be counted - very important for the bean counters that abound in our overly-bureaucratized healthcare system. But not everything that can be counted actually counts.
When travelling recently I picked up an old-fashioned local print newspaper. There was a front-page article announcing the fantastic successes and expansion of the local harm-reduction program. In the article, the director touted the number of patients on methadone and Suboxone, increased staffing at the centre, and the huge number of free needles they had given out in the prior year. More than the year before! Wow! The program was clearly a success!!
Not once in the article was there any mention of how many overdose deaths had occurred that year. I looked it up - it had increased greatly in that area. And not once was it mentioned how many (if any) of their clients had become abstinent, gotten off the street, or found jobs. Nowhere could I see evidence that this program had actually helped anyone in a meaningful way. And for anyone who walked around the city it was clear that the problems of homelessness and addiction had objectively worsened.
Thomas Sowell and others have talked about how government-funded programs, although often started with a noble goal in mind, quickly morph into entities that are mainly focused on their own survival, growth, and enrichment. Free needles and drug-free people are not the same target. Program directors and politicians patting themselves on the back for the former, while ignoring the latter as it worsens, is frustrating to watch, and a perfect demonstration of Goodhart’s Law.
Giving out drugs is lucrative
Doctors make BIG MONEY doling out daily doses of drugs such as methadone and Suboxone. This creates a perverse incentive where physicians want as many people on methadone and Suboxone as possible (cha-ching, cha-ching). I have had numerous addicts tell me that they asked to taper off their ORT, they have been directly told not to do so, because it would be “dangerous”.
I should mention that there are thousands of ex opioid addicts who strongly disagree with Dr. Henry’s view.
A doctor friend of mine took a methadone prescriber's course recently. Being logical, old-fashioned, and innocently naive to the new dogma in addiction medicine, she asked about tapering. The Expert™ running the program tut-tutted. You could never take an addict off methadone, she explained. "It would be like taking a diabetic off their insulin". She was told that addiction is a “lifelong disease” that can only be treated by "replacement" and “harm reduction”.
In many provinces, “addiction specialists” who run ORP’s are amongst the highest paid physicians. For instance, a CBC article from Newfoundland details how 2 of the highest 10 paid physicians in that province run methadone clinics. One bills 1.6 million dollars per year, the other “only” 1.2 million. This is many times more than a regular old family physician can manage to bill. It’s also far more than your neurosurgeon earns, and he trained for 8 extra years beyond med school and has to be prepared to get called in at 3AM to do a delicate emergency operation on your brain.
ABP’s are not a panacea, but they should be an option
Why were abstinence-based programs abandoned? Well, here’s my understanding. These programs are expensive. Many patients fail. Many relapse. Being sober is hard. Those who work in these programs are poorly paid for a difficult and emotionally taxing job. It’s much easier just to hand out ORT.
Currently if you are an addict in Nova Scotia and you want help, the only “help” I can get you is to refer you to start on ORP. And unlike something like cancer treatment or a referral to neurology, there is no wait to start on ORT.
On the other hand, if you want to get off drugs, there are currently no government-funded inpatient or residential programs. If you want one you’ll have to search around yourself for a handful of community-led residential ABP’s. The ones that I know are always begging and scraping to find enough money to keep the lights on. (If you want to donate, for just one example check out Talbot House in my home of Cape Breton.) There are some excellent and highly-regarded residential programs like Homewood, which you can access if you - or someone you know - has 10 or 20 large burning a hole in your pocket.
The spectre of withdrawal
This may seem like an aside, but I believe the exaggeration of the difficulty and danger of opiate withdrawal contributes to the move away from abstinence and is part of the push to go “all in” on harm reduction.
I highly recommend the book “Romancing Opiates” by Theodore Dalrymple (aka Dr. Anthony Daniels). (You can’t go wrong with any of Dr. Daniels’ books, by the way. I think he is perhaps the most brilliant writer of our age.) I’ll give you a Substack-length version of his book here.
Nowadays we talk about withdrawal from opioids as something cruel, inhumane, dangerous, and possibly deadly. We keep people on narcotics or ORP’s for long periods of time (sometimes for life), and if we taper at all we do it extremely slowly. Opiate addicts are given the impression that they can’t stop on their own, and in fact to do so would be dangerous. They get tied into potentially counter-productive ORP’s that are expensive for the taxpayer and coincidentally highly profitable for the physicians who run them, and Big Pharma. Movies like Trainspotting and other pop-culture depictions of opiate withdrawal helped make it the bogeyman it has become.
The problem is this story is wrong. Opiate withdrawal is no doubt very difficult - gooseflesh, chills, sweats, diarrhea, vomiting. I’ve seen it many times and it ain’t no picnic. But PURE opiate withdrawal is not medically dangerous (unlike withdrawal from other substances such as valium or other benzos, barbiturates, or alcohol). People withdrawing from opiates sometimes feel like they WANT to die, but they won’t.
When tens of thousands of heroin-addicted soldiers arrived home from Vietnam at the end of the war, the vast majority simply stopped using. They had things to do, and drug addiction had not been “destigmatized” in their families and communities. When Chairman Mao took over and announced that all opiate addicts would be summarily executed, the vast majority simply stopped using. They preferred to stay alive. When the Beatles/Rolling Stones/every famous musician from the 60’s wanted to kick heroin, they sweated and shat and cursed for a weekend (often in the comfort of the Betty Ford clinic) and then moved on with life.
I still meet many recovered addicts who did the “Cold Turkey” method. One memorable patient had lived in Ontario for years. He got a call that his mom had fallen ill, and he had to come home to Cape Breton tout suite. He bought a plane ticket for Monday. His mom didn’t know he had developed an addiction and he didn’t want her to find out. He needed to be ready to look after her. He paid a friend to lock him up in his basement for the weekend with the instructions to “bring food to the basement window out back but don’t let me out no matter what I say”. He flew home Monday morning a little weak and unwell, but having kicked his opioid habit. When I met him, he hadn’t used in the 12 years since then.
Withdrawal is a speed bump, not a brick wall
My (somewhat belaboured) point is that people CAN and do quit drugs when they really want to. When they are motivated. When they have something meaningful to move on to. Withdrawal is not cruel and unusual. It’s a necessary hurdle that an addicted person must jump over to become drug-free.
Is it better to just rip the band-aid off quickly?
There was a very interesting study done on smoking cessation in Britain several years ago. It compared those who tapered smoking - ie: cut down over time, with the goal of getting to zero smoking - with those who simply quit immediately and dealt with the withdrawal.
The result was surprising to some but fit with my experience with patients. Those who just quit were more successful by a significant margin. Why? Likely because those who slowly taper are actually in a mild withdrawal as long as they are tapering. They are cranky, irritable, and hungry, but are still smoking. They put up with this for many months, instead of the relatively short few weeks of the same (but debatably more intense) withdrawal after just quitting. The chronic withdrawal is so difficult to deal with that many just say “the heck with it” and go back to their original pack-per-day or whatever.
Rip the band-aid off quickly, or peel it slowly and painfully. It seems like the former works better, at least for smoking. I have to wonder - do we make it harder for people to become narcotic abstinent by slow drug tapers? Are we prolonging their agony in a vain attempt to avoid ultimately unavoidable withdrawal and discomfort?
You become who you hang around with
Slow tapers (or no tapers) and ongoing attachment to ORP’s may also unintentionally make it harder for a person wanting to achieve a sober lifestyle to do so. Having spoken with hundreds of patients over the years who have overcome addictions, there is one common refrain: stay away from other users.
If you quit smoking last week, don’t go to a party and hang around with your 3 friends who all smoke. If you quit alcohol, don’t head to a party with your friends who like to drink. If you want to stay off drugs, don’t hang around other people who are using.
Help centres and shelter projects - like those planned for cities like Halifax, Sydney, and Moncton here in the Maritimes of Canada - by nature warehouse addicts. Interestingly, surveys have shown that addicts themselves do not want this either, as they recognize that finding a supportive environment away from other drug users is best for them personally. Integration into non-drug-using environments, not enforced cohabitation and constant contact with other drug users, is what a person needs to be sober and regain a meaningful and healthy life.
Do harm reduction programs really help? Or do they enable users to continue their habit, thus increasing risks overall? Stay tuned for part 3 of “Is there Harm in Harm Reduction”.
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(I’m posting this as a podcast as some of you have mentioned you like having an audio version. But if you prefer the traditional written format, simply continue reading…)
Problems in Cottonland
I moved back home to Cape Breton in 2003. CB has long been a “depressed area”, Canada’s equivalent of Appalachia, which JD Vance wrote about so well in Hillbilly Elegy. We were a coal-mining area for many generations, and thus in decline ever since King Coal was gradually usurped by Big Oil.
Over several generations, including my cohort (‘87 high school grad), Cape Breton’s biggest export was young people. Those with get-up-and-go got-up-and-went, heading off to university or to pursue jobs or start businesses anywhere but CB. Many never came back. Or if they did it was only after they were incapable of work due to disability, addiction, or age. There was a reverse natural selection process that left behind a lot of older folks, seasonal workers, unemployed, underemployed, and those on welfare or public benefits of some sort. A recipe for social disaster, and a perfect set-up for addiction problems.
Although tourist literature paints Cape Breton as vibrant and friendly (which it always was, and still is, in many ways), a dark underbelly of social problems and drug abuse grew. Just ask any police officer who has worked in CB. Like Appalachia, we became an epicentre for addiction to prescription opiates, drugs like Oxycontin or “Hillbilly Heroin” and more recently Fentanyl. The impact of drug abuse in Cape Breton was well captured in the documentary “Cottonland”, which you can watch online here.
My own aunt was one of those who became an addict, aided and abetted by a notoriously “loose” prescribing family doctor. He was representative of a very credulous medical profession, only too glad to accept the “education” sponsored by companies like Purdue. and then to do the work of promoting Big Pharma “solutions” to issues like pain, anxiety, depression, and social dislocation. But that’s another Substack…
Blaming the massive problem of opioid addiction and deaths of despair on Big Pharma alone is facile, however. Addictive drugs, and those who want to sell them to us, have been around for centuries. It seems that societal changes have made us soft targets for false promises. Over the last few generations we have become emotionally fragile, listless, and easily manipulatable due to much deeper psycho-social-spiritual issues.
What is Addiction?
Our model of addiction has inexorably become more mechanistic and scientistic, as has our thinking about human life overall. In this modern view a human is a predictable machine, whose running is understood by understanding chemicals, electric signals, or the mechanisms of joints and muscles. If we can only do more research, we can completely predict (and therefore control) The Machine that is us.
Using this modern mental framework, the logical approach to addictions asks the question: "What is wrong with, or missing in, this person's brain that we can fix for him?". The term “Opioid Replacement Therapy” is now used to describe giving methadone or Suboxone to addicts - a term that suggests that what is wrong with them is they are lacking opioids. The same way we would prescribe thyroid medication for someone whose body doesn’t make it properly, or growth hormone for kids who are deficient. The term “Stimulant Replacement Therapy” has now crept in for people who crave stimulants, for which the withdrawal is much less problematic than with opiates.
As this new mechanistic model has taken hold of our thinking, we have abandoned a deeper spiritual-social-cultural model of addiction. In that model we ask the question: "What is missing in this person's life that doing drugs seems like the most logical choice?”
Rat Park
The Rat Park studies give us a wonderful insight into this issue. Many of our studies that “showed” that drugs are extremely addictive were done on isolated rats. Take a rat, put it alone in a cage with 2 water bottles. One has cocaine (or morphine, or valium, or something addictive) in the water. The other doesn’t. Most rats quickly become addicted and dependent, and will go into withdrawal if their drug is taken away.
But Dr. Bruce Alexander of rat park fame (and mentor to FSIM 2023 speaker Dr. Julian Somers) recognized that rats are complicated, social animals. They need social contact. They need touch. They need companionship, structure, and purpose. Rats in a healthy social environment (the rat park) were FAR less likely to become addicted, even when given ready access to addictive substances.
Jordan Peterson has spoken eloquently about this issue (as he has with many others). Rather than asking “Why do some people become addicted”, the better question is “Why doesn’t everyone become addicted?”. Rather than focusing only on what goes WRONG in the lives of addicts, what is it about those who aren’t addicted that makes them different?
The answer seems to be that we are much less likely to become addicted if there is something to get up for in the morning. Why not drink that 3rd (or 8th or 12th) beer? Or smoke a few more joints? Or accept the offer to snort a few lines of coke? Because we have something better, something more important, to do with life. Because we have to be at work in the morning and our coworkers are counting on us. Or get up to drive our kid to hockey. To get that Substack written that has been burning in the back of our mind. Or drive our elderly mom to get groceries. We have things in our life that are more meaningful and fulfilling than being intoxicated, and being chronically intoxicated gets in the way of our doing them.
Johann Hari and other authors have said that the opposite of addiction is not sobriety. The opposite of addiction is connection.
Harm Reduction, at it’s base, approaches addiction (and the problems that stem from it) as medical problems, ones to be solved by experts and the collective, rather than individual spiritual problems. Some of us believe that this approach is destined to fail. In the next few Substacks, I’ll expand on why I think so.
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By now most people who are tuned in to these issues have heard lots about the recent Federal Court ruling that concluded that Trudeau’s invocation of the Emergencies Act (formerly the War Measures Act), which granted the government essentially unlimited powers to forcibly end the trucker rally in Ottawa, was unjustified.
This decision amounts to a hard beat-down of Trudeau and his minions who made this decision. And it is directly contradictory to the findings of an inquiry (perhaps not surprisingly headed by a court justice with close Liberal Party connections) that came to the opposite conclusion.
Many of us are wondering how could this decision be so in contrast to the findings of the inquiry. How was this conclusion reached? What does or might it mean to current legal actions? Does it open up the door to future legal actions? What are the odds that it will be overturned?
Aris Lavranos is both a practicing physician but also a lawyer, and was kind enough to walk us through this decision, and speak about what it might mean to those of us concerned about decreasing civil liberties and growing government power.
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I first heard of Dr. Ken Zucker back in 2015 when the story about his firing as the head of the CAMH (Centre for Addiction and Mental Health’s) gender dysphoria clinic first broke. The story struck me as strange. At that time he had 40 years of experience in the clinic. And as far as I could tell he was being accused of being “anti-trans”, one of the new heresies of the woke age. The clinic had existed for decades, and he had worked there forever, and been the head a good chunk of that time. They had a great reputation as leaders in the (until recently very small) field. What the heck had happened? Why would an anti-trans person volunteer to help gender dysphoric people for 40 years, many of whom did indeed go on to have surgery and hormone treatment?
As Dr. Zucker mentions, well-known journalist Jesse Singal did a very good bit of investigative journalism which was critical in proving a number of the accusations written about Dr. Zucker in an external-review (or was it a witch hunt, I’m not clear?) were factually untrue. Untrue enough to win him a large court settlement for wrongful dismissal.
And as an interesting aside, as I read more about the details of his case, I realized Dr. Zucker and I have a strange intermediary connection (which he alludes to at one point later in the podcast) - one of these “6 degrees of Kevin Bacon” things that gave me insider knowledge that had me even more suspicious of the odd criticisms about Dr. Z than I would have been anyway. FSIM conference attendees may hear more about this connection, depending on how loose-lipped I am feeling at the time.
Dr. Zucker didn’t leave the field after his firing. He continues to see patients and edit the journal “Archives of Sexual Behaviour”. In 2 years he will have 50 years of experience with gender dysphoria. I’m about 24 years into my medical career and am considered an OG. All I can say is hats off to him.
Very few clinicians have 50 year of experience in any field, let alone a highly specialized area like gender medicine. And most clinicians not in the field will only see an occasional gender dysphoric patient. So Dr. Zucker’s perspective is truly singular. Who else in the world is in a better position to make sense of the rapid, strange, and divisive changes that first seeped and then flooded into the field of gender medicine in the last 2 decades. Who could better help us sort out truth from fiction, ideas from ideology, wheat from chaff: a process that is critical. If we submit to the radical forces advocating for automatic and rapid affirmation, we will hurt many patients. If we become reactionary we risk throwing away years of essential acquired knowledge in the field. We can’t forget that those with gender dysphoria are human beings who are struggling and need help. How do we best do that? There’s a baby in the gender medicine bathwater that we should attend to as we try to pour out the dirt. And I think Dr. Zucker knows what that baby looks like.
Dr. Zucker was fired in 2015 not for thinking that gender transition is always wrong, but simply for thinking it is often not RIGHT for those with gender dysphoria. He is guilty of having a balanced view. This makes him unfit to head a gender clinic in the Age of Woke. But it makes him perfect to speak at Free Speech in Medicine.
Some of you listening will hear Dr. Zucker in person in Baddeck next week. You can still sign up for the conference at freespeechinmedicine.com. For those who don’t make it, remember to stay tuned for online events later this year and early next, one of which will be a replay of Dr. Zucker’s talk, with live online Q&A with him afterwards.
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Dr. Eric Payne is a paediatric neurologist. He has a degree in Public Health from Harvard, and worked at the Mayo Clinic for a number of years before returning to Canada to take a job in Alberta in 2020.
A healthy society sacrifices for and protects its children. I know of no grandparent who would not willingly lay down his or her life for a grandchild. But COVID policy took such choices out of the hands of individuals and collectivized them, outsourcing decisions to The Experts™. They decided that in order to protect the elderly and comorbid, children’s sports, school, graduation ceremonies, extracurricular activities, dating, and socialization in general had to be sacrificed. They justified coerced vaccinations for children and youth - who are at exceedingly low risk from COVID - with the idea that vaccinating youth would prevent spread to the elderly. We masked toddlers. We closed parks. You know the story.
Despite his experience, credentials, and obvious unshakable ethics, Dr. Payne was hauled onto the mat for daring to criticize vaccine mandates. As you’ll hear, his life changed a lot. But he has no regrets.
Eric is active with the Canadian Covid Care Alliance and continues to be a strong voice of reason pushing for sanity in the (for some) never-ending War on COVID. We are happy that he will be one of our speakers at FSIM 2023, coming up in a week in Baddeck.
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(note that in this podcast I read this intro in the audio version, so if you plan to listen, you can save the time and eyestrain)
The idea of “god-given freedoms” is at the basis of classical liberalism. These are often referred to as “negative rights”.
I touched on this issue briefly in a previous substack. Negative rights can be thought of as freedom FROM something. The right to be left alone - freedom from violence; the right to say what you want - freedom from censorship; the right to not have your things stolen - freedom from theft. Basically the right not to be interfered with. These require nothing from anyone else, other than that they leave you the heck alone.
On the other side of the rights divide is positive “rights”. And I use scare quotes to suggest that these are not clearly “rights”. I would actually call them privileges. These are things like the “right” to healthcare, the “right” to clean water, the “right” to welfare. If these are indeed “rights”, then it is mandatory that someone else provide you these things if you do not have them.
During this podcast, the next in our 2023 FSIM speaker’s series, James Manson - a lawyer who is working with Charter Advocates Canada to preserve civil rights - dives into this very complex issue with me.
What does the Canadian Charter of Rights and Freedoms say about positive rights? Where does the idea and the institutional support for positive rights come from?
In a society where we cannot avoid interaction, rights often conflict. I want to say what I think, but if you have the “right” not to be offended then my freedom of speech is impacted. If you have the “right” to do drugs and set up a tent in the park, my freedom to use the park is impacted. You want the “right” to play AC/DC at 120 decibels at 4AM, but I want the right to peacefully enjoy my property. I want my handicapped child in a regular classroom, but that child will require a disproportionate percentage of the teachers time and decrease the amount of time the teacher spends with the other kids. Who’s “rights” should prevail in these battles?
Human Rights Commissions (which fall in an odd grey zone outside the rules of the regular court system, with its normal checks and balances) have thrown a wrench into the gears of normal societal functioning in Canada. You would be hard pressed to find a person in Canada today who would say that unfair discrimination is wrong. But HRC’s have been given the power to decide how “discrimination” or “being treated fairly” are defined. Is it discrimination to fire a male teacher who likes wearing Z-cup prosthetic breasts to work? Is it discrimination to fire an alcoholic truck driver who crashes your truck? Is it discrimination for a comedian to make a joke about a handicapped person? Or for a bar-owner to remove a person without proper ID from his bar? In Canada it now is.
When does being reasonably discriminating become unfair discrimination? In Canada, the answer is “when the HRC commissioner tells you it is”.
As James mentions, the provincial HRC’s are adjudicated by appointed - not elected or accountable - commissioners and generate regulations such as the Ontario’s HRC’s 38-page legalese policy document on gender discrimination. That’s just one of many documents, full of things that employers and others “should” do. Although not laws per se, an individual or business can be brought in front of a tribunal - a process that costs the defendant lawyers and time but is free for the complainant. If found in violation of the code that the HRC has set, a defendant can be fined. And, to put it mildly—as James mentions—HRC functionaries are not chosen from the centre or right of the political spectrum.
And if HRC’s were not enough to tilt the scale of positive versus negative rights, professional regulators, unions, the civil service, universities, health authorities, and other government-funded/empowered/regulated bodies all now undermine basic freedoms in their own ways. Want to get into medical school? Tell us how you plan to be “anti-racist.” You want to work in the civil service? Don’t argue with the diversity trainer. If you want to be in certain jobs, you have to agree to abandon your right to express your disagreement with approved political views.
This is a complex and thorny subject. What is the correct balance of positive versus negative rights? Whichever direction we head in, there is no utopia at the end of the road. But at this point in history, it’s clear to me that the scale is wildly tilting away from basic civil liberties.
Libertarianism may not be a destination that we all agree upon, but I would argue that at this point it is the right direction in which to point the nose of our cultural boat.
We look forward to hearing James flesh this out more at FSIM 2023, and I thank him for spending this time with me.
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Lisa Bildy is an important person in my life. Were it not for her and the Justice Centre for Constitutional Freedoms (please consider donating!), I’m not all that sure I’d still be practicing medicine.
The first time I ran into the guardrails of the increasingly narrow road of allowable free speech was in 2019. You can read some details here. We physicians pay for insurance to an organization called the CMPA (Canadian Medical Protective Association). For the substantial amount that we pay, we are supposed to receive legal representation in case of court cases or college complaints.
After a left wing activist group complained to the College of Physicians and Surgeons about a newspaper editorial I wrote, the CMPA medical advisor I spoke to ended up shouting at me when I suggested I wanted to push back rather than apologize. She frustratedly blurted out “we’re here to help you keep your license, not protect your free speech!”, and went on to suggest that unless I was willing to apologize, they couldn’t do much for me. The lawyer assigned to my case analogized my op-ed to “someone standing on a soap box in the park and denying the holocaust” and suggested that if I “showed contrition” I could probably keep my license. That was a very, very dark time for me.
I realized that I needed help from someone who “got it”.
Through a connection I got in touch with Bruce Pardy, who suggested the JCCF, who assigned Lisa to the case. She immediately made me feel understood, and that I wasn’t crazy for fighting back. And, long story short (or at least not longer) I’m still a doctor. Thanks Lisa.
Lisa has helped many people in many similar situations in the last few years. Now with her own firm, Libertas Law, she has helped important clients like Amy Hamm (one of our speakers this year!) and Richard Bilkszto, the Toronto teacher who sadly committed suicide before his case was complete.
It has been said that freedom of speech is our most basic and fundamental liberty, since even if all other rights are eroded, freedom of speech can help get them back. Once it disappears, we are truly in a dark place. Lisa is working hard to make sure that doesn’t happen here in Canada.
I so much appreciate her work, both personally and on a societal level, and we are so happy that she will be discussing medical colleges and free speech at FSIM 2023, coming up in 2 weeks in Baddeck, Nova Scotia.
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Did you know that Anthony Fauci’s wife is the chief bio-ethicist at the National Institute of Health in the USA? Does this strike you as a little odd? Knowing that, is it somehow less surprising that vaccine mandates are “ethical” according to Fauci and his minions?
Many of you who follow our Substack will already know what the Nuremberg Code is, it’s approximate history, and why it is foundational to medical ethics post-WW2. Twenty-six years ago, even the very “woke” New England Journal of Medicine thought that the Nuremberg Code was essential. Then COVID hit, and suddenly it wasn’t anymore.
But some people still thought it was. Aaron Kheriaty did. He thought it was important enough to lose his job over.
Dr. Kheriaty is an important figure in 2023.
Aaron is a litigant in the seminal Missouri v. Biden case (which, if you don’t already know about, you should familiarize yourself with here). It is currently wending its way towards the Supreme Court of the US. Many people think this will be the most important case to reach the SCOTUS in 50 years (and I agree).
In addition to this incredibly important endeavour, Aaron is a fellow of the Brownstone Institute, a consultant to a Washington-based medical ethics think tank, a practicing psychiatrist, a father to 5 boys and husband to a wonderful wife. He is also the author of a recent book entitled “The New Abnormal: the rise of the biomedical security state”. Not many people could manage so many important roles, but he manages to do so, and even found an hour to spend with me. I can’t thank him enough.
We are at a point in society where one has to have his vax QR code scanned in order to go to the gym, or might have his bank account locked for contributing to a protest. How the heck did we get here? As you’ll hear, Aaron has important insights into the societal trends that have led us to this point.
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FSIM is VERY honoured and blessed to have the well-known Dr. Gad Saad as our lead-off speaker for FSIM 2023 in Baddeck, Nova Scotia from the evening of October 27th to afternoon of Oct 29th.
Dr. Saad is fearless. He is not bully-able. He says what he thinks, without any virtue-signalling filter. He believes what he says, and says what he believes. As a bonus, he is hilarious and fun.
Over the last few years, Dr. Saad has become one of the most prominent, outspoken, and important voices fighting back at the forces which are encroaching on free speech and open debate in Canada and across the western world. In short, he is perfect for our conference.
Dr. Saad was invited to Dr. Jordan Peterson’s ARC initiative, which sadly overlaps with our conference. But due to other commitments he was unable to attend ARC. Their loss is our gain.
Thanks to Dr. Saad for speaking with me for this podcast, and thanks to him for agreeing to speak in Baddeck.
Julie and I highly recommend his popular books - The Parasitic Mind and the recently-released “The Saad Truth about Happiness”. You can pick them up on his website.
https://www.gadsaad.com/
For those of you who prefer video to audio, Dr. Saad has posted the audio version of this podcast on his YouTube channel.
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Amy Hamm is a nurse, but has training in journalism, and is an excellent writer. She has written for Quillette, the Post-Millennial, and elsewhere.
However, apparently clarity of thought and communication combined with a deep knowledge of subject matter is not an appreciated skill set in the 2020’s. Amy found this out when she dared to challenge the required thinking around the very difficult and contentious transgender issue.
Amy uses the word “TERF” in our discussion. For those of you who don’t know, this is a nouveau, derogatory term meaning “Trans Exclusionary Radical Feminist”. To translate into English, a TERF is someone who believes that there are differences between a man who undergoes a variety of treatments (or in some cases no treatments) and then calls himself a woman, versus someone who is born female.
I often think that if someone went into a coma in 2010 and then woke up in 2023 and saw that people had lost their jobs, been physically threatened, and censored by social media for saying statements like “men are not women”, I think they’d want to be put back into the coma. “Wake me up when things are sane again!”.
Amy is articulate, thoughtful, and brave. Her involvement with paying to install an “I (Heart) JK Rowling” billboard landed her in hot water, and a drawn-out and still-not-complete investigation by the BC nursing college overlords. Like Jordan Peterson and other medical professionals who have been persecuted for their views, the complaints against her have nothing to do with her nursing care or competency, and the complainants have no repercussions to worry about as they are anonymous.
As we discuss in the podcast, the vast majority of trans people, just like the vast majority of non-transgendered people, are not criminals. But we don’t need rules and laws for those of us who are harmless. We need them for the small percentage of the population who are sociopathic or psychopathic, and will use loopholes to take advantage of those who are vulnerable. Opening women’s sports, shelters, and prisons to anyone who identifies as a woman is potentially a buglight to these bad actors. How do we accommodate trans people while keeping this loophole closed? These are complex questions that need vigorous debate, not censorship and coercion.
Apologies in advance for the sound quality, but despite some challenges Amy and I had an interesting conversation about her situation, the state of the gender wars, and the importance of pursuing truth, damn the torpedoes. Thanks to her, and we look forward to hearing her (and her lawyer Lisa Bildy) speak at the FSIM conference Oct 27-29th in Baddeck, Nova Scotia. We hope to see you there.
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I remember a few years back when I first started hearing about “The Deep State”. It sounded very dark and conspiratorial. Of course, it was just the “fringe minority” who called it that, so any right-thinking person was supposed to dismiss it. But is it just a more negative name for “the administrative state” or “bureaucracy” or “the civil service”? Since Trudeau Jr. came to power in 2015, we have 40% more federal employees. A whole new department to collect and administer carbon taxes. A whole department to deal with Phoenix Payroll System issues. More regulation. More taxes. Higher debt.
When I started med school in ‘93, healthcare was “in crisis” but the newly elected John Savage liberals in Nova Scotia were set to fix things. They were succeeded by NDP who were going to fix things, then by liberals and conservatives who were going to fix things.
After 30 years in medicine, I can definitively say that no government, no matter what its political stripes, has “fixed” anything. Nurses and doctors and other staff make lots of money, but are less and less happy with their jobs. Patients get less service. Patients die and suffer from lack of care.
The only bright spot is for healthcare managers. We have way more of them and they seem to be better and better paid. When I have a problem with something, it is never clear who is empowered to make the decision required to fix it. There are so many layers that the buck stops nowhere. Fighting with management is like punching a cloud. The Nova Scotia Health Authority org/management flowchart is more complex than many of the ones that I learned about when studying nuclear physics in grad school.
From the point of view of managers and politicians, is this massive, useless, unwieldy, and expensive bureaucracy a feature or a bug? If you read Thomas Sowell (who at age 93 just published his 40th book and is still awesome and articulate), this has not happened by accident. The real purpose of a bureaucracy is not to solve problems but rather to protect their positions and proliferate. And their fecundity is incredible.
How did we manage to so quickly produce “consensus” on our approach to COVID - a brand new virus that we knew nothing about? Suddenly we all agreed on new public health measures: “Lockdown” - until 2020 a term used only in prisons. Universal mask mandates. A brand new “vaccine” that was immediately known to be “safe and effective”. An all-powerful administrative state that can shut down and censor any dissenting voices is required to create The Science™ in such a short time.
Aris has some deep insights into these issues, which he touches on in the podcast and will expand on in his talk at FSIM 2023. We hope you consider coming.
In our chat, I refer to my first experience of running into the guardrails of “professionalism” as defined in our modern age. Thanks to the JCCF I got through it.
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In the latest of our 2023 Free Speech in Medicine speaker interviews, I chat with Dr. Julian Somers, a clinical psychologist and researcher who trained with Dr. Bruce Alexander of Rat Park fame. (If you don’t know about Rat Park, you’ll want to take a minute to read about it).
Julian’s life experience and training led him to work in the field of addictions. He has become an expert and important voice in the field of drug policy.
I learned so much from Julian during this discussion (you’ll notice it’s longer than my typical podcast). He describes the “Janus face” of addiction - how addiction is about devotion to something if it’s positive, but slavery when it’s destructive. He elucidates he “active ingredients” of a successful addiction treatment program.
If we really care about people who are addicted, truly see them as having potential, and really want to help them, then what should we do? Certainly more than giving them drugs and needles, and then patting ourselves on the back for our altruism.
Dr. Somers is one of the most important voices in this field and, like many truth-tellers who refuse to bow down to political forces in the age of “cancel culture”, he has paid a price for his efforts. We are flattered and blessed that he will be speaking at the Free Speech in Medicine 2023 conference, and I look forward to hearing more from him there. We hope you consider joining us.
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Dr. Ben Turner has a true old-fashioned university degree from a traditional school where they teach how, not what, to think. He has a master’s in healthcare ethics. He is a surgeon. This CV makes him uniquely qualified to talk about British Columbia’s Bill 36, which has been passed and is now being implemented.
This bill should not only be of concern to British Columbians, but to all of us. It is a harbinger of what is to come for all of us in terms of more centralized control of healthcare. Should healthcare decisions be made between a patient and his doctor? Or should a government official micromanage these interactions from on high? Bill 36 is another step towards creating a system that enshrines the latter model.
In this podcast, Ben talks about the organization he recently assumed the headship of: CSSEM.org - the Canadian Society for Science and Ethics in Medicine, and also dissects Bill 36 for us. There were a few minor things he said that are reassuring, but mostly I came away even more concerned than before about the direction this is all heading.
This new medical world - one of proscribed, templated, mandatory treatments and decision-making protocols decided on and enforced from on high - is slowly replacing the traditional doctor-patient relationship. And IMO it will continue to do so unless we push back.
Thanks to Ben for taking the time to talk to me. And please remember to check out CSSEM.org
You can hear another great interview with Ben (done by FSIM alumnus Dr. York Hsaing) here.
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Rupa Subramanya is our first guest in this year’s “Speakers Series” featuring our invited speakers who will be there in person Oct 27-29th in Baddeck, Nova Scotia for the 2nd annual Free Speech in Medicine conference.
Rupa is a journalist for the Free Press, has been extensively published in papers such as Foreign Policy and The Wall Street Journal. You can follow her Podcast which she does through True North Canada.
In this podcast Rupa and I cover how the trucker rally drew her into journalism somewhat unintentionally, some of her thoughts on the euthanasia issue (which she has written about extensively), how it is that she avoids groupthink, some thoughts on COVID, and censorship of physicians.
These interviews will give you a little taste of each of our guests, and a teaser of what they plan to speak about. The conference is a great venue to meet our speakers as well as the other attendees over what promises to be an interesting and amazing weekend.
Check out FreeSpeechInMedicine.com for details and conference registration links. Space is limited so sign up soon.
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Dr. Roy Eappen is an endocrinologist who works in Quebec, who has been doing work with DoNoHarmMedicine.org - a group founded by Dr. Stanley Goldfarb that is pushing back against wokeness in medicine.
Roy has recently penned a VERY important editorial that appeared in the Wall Street Journal and generated a lot of useful discussion. As well, he recently manned a booth at the Endocrine Society’s annual meeting along with Chloe Cole, a prominent detransitioner. This booth drew endocrinologists’ attention to the lack of evidence, and potential risks, around the medical transitioning of minors.
Roy is a brave voice in a time where we sorely need more brave voices. I am proud to know him, and so happy he agreed to talk with me.
Remember that you can now find details on the event, a list of speakers, and registrationi for the 2023 Free Speech in Medicine conference at freespeechinmedicine.com. The issue of transgenderism is a focus for this year, with speakers like Dr. Ken Zucker, Amy Hamm, and an expert panel which will include them and Roy. Other topics include drug policy and “Safe Supply”, the state of journalism in Canada, free speech limits by professional organizations, and the importance of truth in medicine and society overall. We hope to see you there.
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I’ve interviewed Dr. Matt Strauss before. He is an ICU doctor, has journalism training, and is a very wise and widely read man. You may recall that he has been the MOH (Medical Officer of Health) for Haldimand-Norfolk in Ontario through a good chunk of the pandemic.
Matt’s “alt-right” views - crazy things like thinking kids should be in school, thinking that vaccine mandates and travel restrictions are unhelpful and unethical - have made him a target of the mainstream press. There was a concerted effort to have him removed.
After about 18 months in his position, Matt is stepping down. But rather than throw a party, Bruce Arthur (a sports-journalist-cum-COVID-commentator who has gone after Matt before) in the notoriously politically-biased Toronto Star couldn’t resist shooting some arrows at Matt on the way out the door. His piece was actually so egregious that he was forced to make corrections, and what you will now find has been toned down and corrected. The original article, before he was forced to edit it, is below.
In this podcast Matt talks about his decision to step down, his experience dealing with Mr. Arthur, and why he thinks his views were misrepresented.
You can read Matt describe this incident in his own piece in the National Post here.
(As an aside, thanks to Mr. Terry Kelly for providing us with our new intro and outro music. I’ve been a longtime fan and am very honoured that he gave us this.)
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You may already know the name of Dr. Richard Schabas from hearing him on the news or reading him in the newspaper from his many years as a prominent public health official, including 10 years as Chief Medical Officer of Health of Ontario. But you won’t have heard him for the last 3 years, as he was blacklisted for his heretical views on COVID. “All doctors agree that X is true” now means that “we don’t interview doctors who don’t agree that X is true”.
Looking back on the last 3 years, it’s obvious we got a lot wrong. A two week lockdown would flatten the curve. Masks mandates would stop the spread. Handwashing was the answer. Shutting down society wouldn’t cause any harm. After all, we were doing it for noble reasons.
Public Health consistently overpromised and underdelivered. They consistently exaggerated the risks of COVID, while dismissing risks of their interventions. They acted as though we needed to be treated like misbehaving children, and thus took total control of our lives, acting like tyrannical parents.
During our long discussion on COVID policy, Dr. Schabas and I make reference toThe Sydney Tar Ponds and The Trolley Problem.
I was so honoured that Dr. Schabas took the time to speak with me. His views are reasonable, logical, non-partisan, and therefore very refreshing in this polarized time. In my opinion, the last 3 years would have been a much better time with him at the helm.
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