Category Archives: drugs

C-Pap and Apnea

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A month of so ago, I went to see a sleep doctor for my snoring. I got a take-home breathing test that gave me the worst night’s sleep in recent memory. A few days later, I got a somber diagnosis: “You are a walking zombie.” Apparently, I hold my breath for ten seconds or more every minute and a half while sleeping. Normal is supposed to be every 4 to 10 minutes. But by this standard, more than half of all middle-aged men are sub-normal (how is this possible?). As a result of my breath-holding, the wrinkled, unsmiling DO claimed I’m brain-dead now and will soon be physically dead unless I change my ways. Without spending 3 minutes with me, the sleep expert told me that I need to lose weight, and that I need a C-Pap (continuous positive airway pressure) device as soon as possible. It’s supposed to help me lose that weight and get back the energy. With that he was gone. The office staff gave me the rest of the dope: I was prescribed  a “ResMed” brand C-Pap, supplied by a distributor right across the hall from the doctor (how convenient).

I picked up the C-Pap three months later. Though I was diagnosed as needing one “as soon as possible,” no one would release the device until they were sure it was covered by my insurance company. The device when I got it, was something of a horror. The first version I tried fit over the whole face and forces air into my mouth and nose simultaneously, supposedly making it easier to inhale, but harder to exhale. I found it more than a bit uncomfortable. The next version was nose only and marginally more comfortable. I found there was a major air-flow restriction when I breath in and a similar pressure penalty when I breathed out. And it’s loud. And, if you open your mouth, there is a wind blowing through. As for what happens if the pump fails or the poor goes out, I notice that there are the tiniest of air-holes to prevent me from suffocating, barely. A far better design would have given me a 0-psi flapper valve for breathing in, and a 1/10 psi flapper for breathing out. That would also reduce the pressure restriction I was feeling every time I took a deep breath. One of my first blog essays was about engineering design aesthetics; you want your designs to improve things under normal conditions and fail safe, not like here. Using this device while awake was anything but pleasant, and I found I still hold my breath, even while awake, about every 5 minutes.

Since I have a lab, and the ability to test these things, I checked the pressure of the delivered air, and found it was 3 cm of water, about 1/20 psi. The prescription was for 5 cm or water (1/14 psi). The machine registers this, but it is wrong. I used a very simple water manometer, a column of water, similar to the one I used to check the pressure drop in furnace air filters. Is 1/20 psi enough?How did he decide on 1/14 psi by the way? I’ve no idea. !/14 psi is about 1/200 atm. Is this enough to do anything? While the C-Pap should get me to breathe more, I guess, about half of all users stop after a few tries, and my guess is that they find it as uncomfortable as I have. There is no research evidence that treatment with it reduces stroke or heart attack, or extends life, or helps with weight loss. The assumption is that, if you force middle-aged men to hold their breath less, they will be healthier, but I’ve no clear logic or evidence to back the assumption. At best, anything you gain on the ease of breathing in, you lose on the difficulty of breathing out. The majority of middle-aged men are prescribed a C-Pap, if they go for a sleep study, and it’s virtually 100% for overweight men with an apple-shaped body.

I’d have asked my doctor about alternatives or for a second opinion but he was out the door too fast. Besides, I was afraid I’d get the same answer that Rodney Dangerfield got: “You want a second opinion? OK. You’re ugly, too.” Mr. Dangerfield was not a skinny comic, by the way, but he was funny, and I assume he’d have been prescribed a C-Pap (maybe he was). He died at 82, considerably older than Jim Fixx, “the running doctor,” Adelle Davis, the “eat right for health” doctor, Euell Gibbons “in search of the wild asparagus,” or Ethan Pritkin, the diet doctor. God seems to prefer fat comedians to diet experts; I expect that most-everyone does.

Benjamin Franklin and his apple-shaped body

Benjamin Franklin and his apple-shaped body; I don’t think of him as a zombie.

What really got my goat, besides my dislike of the C-Pap, is that I object to being called a walking zombie. True, I’m not as energetic as I used to be, but I manage to run a company, and to write research papers, and I get patents (this one was approved just today). And I write these blogs — I trust that any of you who’ve read this far find them amusing. Pretty good for a zombie — and I ran for water commissioner. People who use the C-Pap self-report that they have more energy, but self-reporting is poor evidence. A significant fraction of those people who start with the C-Pap, stop, and those people, presumably were not happy. Besides, a review of the internet suggests that a similarly large fraction of those who buy a “MyPillow.com” claim they have more energy. And I’ve seen the same claims from people who take a daily run, or who pray, or smoke medical marijuana (available for sleep apnea, but not from this fellow), or Mirtazapine (study results here), or  for electro-shock therapy, a device called “Inspire.” With so many different products providing the same self-reported results, I wonder if there isn’t something more fundamental going on. I’d wish the doc had spent a minute or two to speak to this, or to the alternatives.

As for weight loss, statistical analysis of lifespan suggests that there is a health advantage to being medium weight: not obese, but not skinny. I present some of this evidence here, along with evidence that extra weight helps ward off Alzheimer’s. For all I know this protection is caused by holding your breath every few minutes. It helps to do light exercise, but not necessary for mental health. In terms of mental health, the evidence suggests that weight loss is worse than nothing.

Jared Gray, author of the Alien movies, was diagnosed with apnea, so he designed his own sleep-mask.

Jared Gray, author of the Alien movies, was diagnosed with apnea, so he designed his own sleep-mask.

Benjamin Franklin was over-weight and apple-shaped, and no zombie, The same is true of John Adams, Otto Von Bismarck, and Alfred Hitchcock. All lived long, productive lives. Hitchcock was sort of morbid, it will be admitted, but I would not want him otherwise. Ed McMahon, Johnny Carson’s side-kick, apologized to America for being overweight and smoking, bu the outlived Johnny Carson by nine years, dying at 89. Henry Kissinger is still alive and writing at 95. He was always fatter than any of the people he served. He almost certainly had sleep apnea, back in the day, and still has more on the ball, in my opinion, than most of the talking-head on TV. The claim that overweight, middle-aged men are all zombies without a breath assisting machine doesn’t make no sense to me. But then, I’m not a sleep doctor. (Do sleep doctors get commissions? Why did he choose, this supplier or this brand device? With so little care about patients, I wonder who runs the doctor’s office.)

I looked up my doctor on this list provided by the American Board of Sleep Medicine. I found my doctor was not certified in sleep medicine. I suppose certified doctors would prescribe something similar  but was disappointed that you don’t need sleep certification to operate as a sleep specialist. In terms of masks, I figure, if you’ve got to wear something, you might as well wear something cool. Author Jared Gray, shown above (not the author of the Alien) was diagnosed with Apnea 6 months ago and made his own C-Pap mask to make it look like the alien was attacking him. Very cool for an ex-zombie, but I’m waiting to see a burst of creative energy.

What do we zombies want? Brains.

When do we want them? Brains.

What do vegetarian zombies want? Grains.

Robert Buxbaum, March 15, 2019. In case real zombies should attack, here’s what to do.  An odd legal/insurance issue: in order to get the device, I had to sign that, if I didn’t use it for 20 days in the first month of 4 hours per night, and thus if the insurance did not pay, I would be stuck with the full fee. I signed. This might cost me $1000 though normally in US law, companies can only charge a reasonable restock fee, but it can’t be unreasonable, like the full  price. I also had to sign that I would go back to the same, quick-take doctor, but again there has to be limits. We’ll see how the machine pans out, but one difference I see already: unlike my pillow.com, there is no money back guarantee with the C-Pap treatment.

Sex differences in addiction.

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Men become addicted and so do women, but the view in popular movies and songs present some clear differences. Addicted men are presented as drunks or stoners. By contrast, the popular picture of an addicted woman is a middle-aged housewife who takes “mother’s little helper“: anti-depressant and pain pills, “mother’s little helper of the classic Rolling Stones song. Male addicts are presented to take their drugs in the company of friends while female addicts are pictured taking their pills in private. A question I have: is there any evidence to back these popular perceptions.

All addiction may not be bad. Though Churchill was addicted to drink, he imagined it as a virtue not a vice.

Not all who are addicted consider their addiction a liability. Though Churchill was addicted to drink, starting the day with a tumbler of whiskey, he imagined it as a virtue. One would be hard-pressed to prove otherwise.

As it happens, if you look at the statistics in a certain way, they do bear out the popular perceptions. About three times as many men as women are in treatment for alcohol or pot, voluntary or court-mandated. Meanwhile, as a percentage of the addicted, women are nearly twice as likely as men to claim pills as their primary addiction. Percentage data is plotted below. The problem with the percentage graph is that it ignores the fact that twice as many men as women are in treatment: 1,233,000 men vs 609,000 women, as of 2011. Multiply the total numbers by the percentages and you find that there are more men than women with primary addiction to pills, or to cocaine, heroin, or meth-amphetamines. For any drug you mention, the real sex-difference is that more men are addicts.

It could be argues that rehab attendance is a bad measure of addiction, but I would argue that this is the best measure, not only are the numbers are more accurate, rehab is an indication that the addict feels that his or her addiction is a problem. It is a mistake, I think, to include people who feel their addiction is not ruining their lives with people who do not, e.g. Churchill. Any person who believes he or she is benefiting, and who has managed to avoid running afoul of the police, it could be argued, does not have a serious problem. Friends and employers may disagree in terms of diagnosis, but in terms of statistics, other measures like self-reporting come to the same conclusion: if it’s a stupid addiction, more men do it than women. Men self-report that they smoke more, binge-drink more, and use drugs more. Men also commit suicide more and end up in jail more.

Main addiction of men and women. percent based on rehab records, 2011. From the TEDS Report 4/3/14. Twice as many men as women go to rehab.

Main addiction of men and women. percent based on rehab records, 2011. From the TEDS Report on substance abuse. 4/3/14. The most significant sex difference, as I see it: twice as many men as women go to rehab.

In terms of age of prescription drug use, the graph below shows a difference between men and women. There is a slight tendency for women to persist with prescription drugs, but that may reflect the tendency for men to move on to some other stupid behavior.

While more female than male addicts consider opioids their main addiction, since there are twice as many male addicts as female, it comes out that the number using opioids is about the same. Interestingly, a greater fraction of men seem capable of switching out from opioids -- likely to some other addiction.

While more female than male addicts consider opioids their main addiction, since there are twice as many male addicts as female, it comes out that the number using opioids is about the same. A greater fraction of men switch out from opioids, perhaps to another addiction. Source: ibid.

A few cheerful bits of news are in order. One is that smoking, the most deadly of the addictions, is on the decline. It seems like vaping is a contributor to this, and much safer. Similarly, with illicit drug addictions, while use is on the upswing, and while an amazingly large share of Americans have used such drugs — see graph below from Statista — only a small fraction remain users into middle age. Most seem to quit on their own — they even seem to quit heroin when it ceases to serve a purpose. At present, only 60,000/year total die of overdose out of some 120,000,000 who’ve used illicit drugs. Ringo Starr’s song, “I don’t smoke it no more“may be cited, especially when paired with his “Oh my my” song about quitting through dance. If you want to quit and dance doesn’t work for you, I’d suggest AA or NA. To quote Ringo: “You can do it if you try.”

Number of people in the US using different drugs as of 2016. The vast majority have not used in the last year.

Number of people in the US who have used different illegal drugs as of 2016. It’s about 1/3 of America. The vast majority from every category have quit, and are not using. 89% of heroin uses have quit. You can too. Statista.

As for why men more than women do drugs, all I can say is that they do all sorts of stupid things. They fight in wars more often, they go over Niagara Falls in barrels more often, and they start new businesses more often. Sometimes it works for them; usually not. Here is a more detailed article with the same semi-conclusion: men are stupid, risk takers. I suspect that’s their language of love.

Robert Buxbaum, June 11, 2018

Elvis Presley and the opioid epidemic

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For those who suspect that the medical profession may bear some responsibility for the opioid epidemic, I present a prescription written for Elvis Presley, August 1977. Like many middle age folks, he suffered from back pain and stress. And like most folks, he trusted the medical professionals to “do no harm” prescribing nothing with serious side effects. Clearly he was wrong.

Elis prescription, August 1977. Opioid city.

Elis prescription, August 1977. Opioid city.

The above prescription is a disaster, but you may think this is just an aberration. A crank doctor who hooked (literally) a celebrity patient, but not as aberrant as one might think. I worked for a pharmacist in the 1970s, and the vast majority of prescriptions we saw were for these sort of mood altering drugs. The pharmacist I worked for refused to service many of these customers, and even phoned the doctor to yell at him for one particular egregious case: a shivering skinny kid with a prescription for diet pills, but my employer was the aberration. All those prescriptions would be filled by someone, and a great number of people walked about in a haze because of it.

The popular Stones song, Mother’s Little Helper, would not have been so popular if it were not true to life. One might ask why it was true to life, as doctors might have prescribed less addicting drugs. I believe the reason is that doctors listened to advertising then, and now. They might have suggested marijuana for pain or depression — there was good evidence it worked — but there were no colorful brochures with smiling actors. The only positive advertising was for opioids, speed, and Valium and that was what was prescribed then and still today.

One of the most common drugs prescribed to kids these days is speed, marketed as “Ritalin.” It prevents daydreaming and motor-mouth behaviors; see my essay is ADHD a real disease?. I’m not saying that ADD kids aren’t annoying, or that folks don’t have back ached, but the current drugs are worse than marijuana as best I can tell. It would be nice to get non-high-inducing pot extract sold in pharmacies, in my opinion, and not in specialty stores (I trust pharmacists). AS things now stand the users have medical prescription cards, but the black sellers end up in jail..

Robert Buxbaum, January 25, 2018. Please excuse the rant. I ran for sewer commissioner, 2016, And as a side issue, I’d like to reduce the harsh “minimum” penalties for crimes of possession with intent to sell, while opening up sale to normal, druggist channels.

Penicillin, cheese allergy, and stomach cancer

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penecillin molecule

The penicillin molecule is a product of the penicillin mold

Many people believe they are allergic to penicillin — it’s the most common perceived drug allergy — but several studies have shown that most folks who think they are allergic are not. Perhaps they once were, but when people who thought they were allergic were tested, virtually none showed allergic reaction. In a test of 146, presumably allergic patients at McMaster University, only two had their penicillin allergy confirmed; 98.6% of the patients tested negative. A similar study at the Mayo Clinic tested 384 pre-surgical patients with a history of penicillin allergy; 94% tested negative. They were given clearance to receive penicillin antibiotics before, during, and after surgery. Read a summary here.

08

Orange showing three different strains of the penicillin mold; some of these are toxic.

This is very good news. Penicillin is a low-cost, low side-effect antibiotic, effective against many diseases including salmonella, botulism, gonorrhea, and scarlet fever. The penicillin molecule is a common product of nature, produced by a variety of molds, e.g. on the orange at right, and in cheese. It is thus something people have been exposed to, whether they realize it or not.

Penicillin allergy is a deadly danger for the few who really are allergic, and it’s worthwhile to find out if that means you. The good news: that penicillin is found in common cheeses suggests, to me, a simple test for penicillin allergy. Anyone who suspects penicillin allergy and does not have a general dairy allergy can try eating appropriate cheese: brie, blue, camembert, or Stilton. That is any of the cheeses made with penicillin molds. If you don’t break out in a rash or suffer stomach cramps, you’re very likely not allergic to penicillin.

There is some difference between cheeses, so if you have problems with Roquefort, but not brie or camembert, there’s still a good chance you’re not allergic to penicillin. Brie and camembert have a white fuzzy mold coat of Penicillium camemberti. This mold exudes penicillin — not in enough quantity to cure gonorrhea, but enough to give taste and avoid spoilage, and enough to test for allergy. Danish blue and Roquefort, shown below, have a different look and a sharper flavor . They’re made with blue-green, Penicillium roqueforti. This mold produces penicillin, but also a small amount of neurotoxin, roquefortine C. It’s not enough to harm most people, but it could cause an allergic reaction to folks who are not allergic to penicillin. Don’t eat a moldy orange, by the way; some forms of the mold produce a lot of neurotoxin.

For people who are not allergic, a thought I had is that one could, perhaps treat heartburn or ulcers with cheese; perhaps even cancer? H-Pylori, the bacteria associated with heartburn, is effectively treated by amoxicillin, a penicillin variant. If a penicillin variant kills the bacteria, it seems plausible that penicillin cheese might too. And since amoxicillin, is found to reduce the risk of gastric cancer, it’s reasonable to expect that penicillin or penicillin cheese might be cancer-protective. To my knowledge, this has never been studied, but it seems worth considering. The other, standard treatment for heartburn, pantoprazole / Protonix, is known to cause osteoporosis, and increase the risk of cancer, and it doesn’t taste as good as cheese.

A culture of Penicillium roqueforti. Most people are not allergic to it.

The blue in blue cheese is Penicillium roqueforti. Most people are not allergic.

Penicillin was discovered by Alexander Fleming, who noticed that a single spore of the mold killed the bacteria near it on a Petrie dish. He tried to produce significant quantities of the drug from the mold with limited success, but was able to halt disease in patients, and was able to interest others who had more skill in large-scale fungus growing. Kids looking for a good science fair project, might consider penicillin growing, penicillin allergy, treatment of stomach ailments using cheese, or anything else related to the drug. Three Swedish journals declared that penicillin was the most important discovery of the last 1000 years. It would be cool if the dilute form, the one available in your supermarket, could be shown to treat heartburn and/or cancer. Another drug you could study is Lysozyme, a chemical found in tears, in saliva, and in human milk (but not in cow milk). Alexander Fleming found that tears killed bacteria, as did penicillin. Lysozyme, the active ingredient, is currently used to treat animals, but not humans.

Robert Buxbaum, November 9, 2017. Since starting work on this essay I’ve been eating blue cheese. It tastes good and seems to cure heartburn. As a personal note: my first science fair project (4th grade) involved growing molds on moistened bread. For an incubator, I used the underside of our home radiator. The location kept my mom from finding the experiment and throwing it out.

Arrested for decriminalized possession

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The arrest rate for marijuana is hardly down despite widespread decriminalization, but use is up. decriminalization, but use is up. A rate that exceeds that for all violent crime.

Despite years of marijuana decriminalization, arrest rates for marijuana are up from 20-25 years ago, and hardly down from last year. Why?

There are a couple of troubling patterns in US drug arrests. For one, though marijuana has been decriminalized in much of the USA, marijuana arrest rates are hardly down from five years ago, and higher than 20-30 years ago — see graph at right. Besides that, it’s still mostly black-people and Latinos arrested. And the crime is, 4/5 the of the time, drug possession, not sale.

At the same time that violent crime rates are falling, marijuana possession arrests are rising (see graph below). Currently, according to FBI statistics,  more people are arrested for marijuana possession than for all violent crime combined. You’d expect it would not be this way, and a question I’d like to explore is why. But first, let’s look at more data. I note that part of an explanation is that marijuana use is up (18% in 2015 vs 12% in 1990). This still doesn’t explain the racial imbalance but it could explain the general rise. Marijuana isn’t quite legal, and if use is up, you’d expect arrests to be up. But even here, something is fishy: use rates are the same as in 1980, 35+ years ago in the midst of the “war on drugs,” but arrest rates have more than doubled since. Why? Take New York City as an example, 17,762 people were arrested for low-level marijuana possession in 2016 (smoking in public or possession of 25 gm to 2 oz). The low-level arrest rate is twice the national average in this Democratic-bastion city, where the drug was decriminalized years ago. Arrest rates in NYC went up an additional 10% in 2016, with black people arrested at 11 times the rate of white people. How could this be?

The race discrepancy of arrests persists across the US. Though black citizens use drugs only 15% or so more often than whites, and make up only 13% of the US population, they are arrested for drugs about three times as often and incarcerated about 4 times as often. It’s mostly for marijuana possession too, and the discrepancy varies very strongly by location In Louisiana, Illinois, and New York City arrests are particularly weighted to people of color. When New York City police precinct captains were asked about this, they explained that their instructions come from above. It’s a curious answer, I’d say, reflecting perhaps their dislike of the mayor.

Drug arrests are mostly for possession, not sale, and the spread is rising.

Drug arrests are mostly for possession, not sale and the spread is rising. More than half the time, it’s marijuana.

One of the race-affecting instructions is that the police are instructed to patrol black neighborhoods, but not the student unions of majority-white colleges like NYU. They’re mandated to stop and search junky cars but not nice ones, and to search people who have outstanding parking tickets, but not generally. They even get raises that depend on the number of tickets given, a practice that does not lead to a pattern of looking the other way — one many New Yorkers would prefer. Another issue: in many states, including New York, the police can keep money or cars, if they can claim that the asset was purchased with drug money or used in the drug trade. This leads to a practice where the city budget benefits when the police arrest persons they don’t expect will be convicted. It’s a practice called civil asset forfeiture, one lampooned, on Last Week Tonight, but jealously guarded. Since it is near impossible to prove that the money or car was not used in any way illegally, once they arrest someone, the police can expect to keep his or her money or cars indefinitely. The annoyance of lawyers perhaps encourages the arrest of people who do not seem to have them — people of color. New York mayor deBlassio justifies his arrests as a way to protect the neighborhoods, as his version of former mayor, Guilliani’s broken window approach. Maybe. But I think the profit motive is at least as relevant.

drug arrests hit black folks a lot more than white

Drug arrests hit black folks a lot more than white.

I note that strict justice tends to land hardest on the poor and defenseless. I also note that many important people have used marijuana without it damaging their lives in any obvious way. Both Jeb! Bush and Bill Clinton claimed to have smoked it; as did Barak Obama, Al Gore, and the Beatles. My bottom line: while marijuana decriminalization is worthwhile, it must go along with the repeal of civil asset forfeiture laws, and other means that make arrests into profit centers – or so it appears to me. Otherwise we’ll keep on flushing lives down the drain for no good reason.

Robert Buxbaum, March 6, 2017. I’ve previously blogged about the structure of criminal sentencing, coming to conclude that the least strict sentence that does the job is to be preferred. I also ran for water commissioner in 2016.

The boon of e-cigarettes

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E-cigarette use is rising fast among US smokers, and have passed traditional cigarette smoking among US High Schoolers, according to a recent CDC survey. Among the advantages: e-cigarettes are less regulated and cheaper than regular cigarettes. The vapors smell better. The smoke is supposed to be 95% less unhealthy. And the vape (e-cigarette “smoke”) doesn’t stain teeth like regular cigarettes. Not everyone is thrilled to see a safer cigarette alternative, though. A 2014 Harvard Study, The E-cigarette Quandary, points out that 95% less dangerous is not the same as 100%, that kids might come to smoke who might not otherwise, and that one could still get unwelcome, second-hand nicotine from exhaled vape. To correct these issues, some 200 regulation and prohibition bills have been introduced in 40 states in the past year alone. Among these, prohibitions on selling to minors, prohibitions on vaping where smoking is prohibited, and a National Park Service prohibition on e-cigarette use anywhere in a national park. 

Inside an e-cigarette

Inside an e-cigarette

My sense is that, for some people, those who already smoke, a 95% less dangerous alternative has got to be a boon, unless (as seems unlikely) people come to smoke twenty times more e-cigarettes than regular. To the contrary, It appears that e-cigarettes seem to help smokers quit tobacco, even with no help from a smoking cessation service. And over time, e-smokers tend to reduce the amount of nicotine in the juice, in that way reducing the toxic burden of the e-cigarette too. This is an option that is not possible with traditional, combustion cigarettes.

The claim that e-cigarettes are 95% less harmful than combustion cigarettes is based on a comparison between the concentrations of poisonous vapors inhaled, as measured for a study published in the journal, Addiction. Sorry to say, you have to pay to read the whole article, but you can read the abstract for free, or read a blog post by the lead author, Dr. Konstantinos Farsalinos. A British study supports this too, as described in a more-recent report by Public Health England. While it is not 100% clear that a 95% reduction in harmful vapor means that e-cigarettes are 95% less dangerous, that would seem to be the conclusion on a puff-per-puff basis, assuming no change in the formulation of e-cigarette “juice”, and only if the smokers don’t end up smoking vastly more.

Have e-cigarettes caused the decrease of regular smoking, or is it a threat to the decrease in regular smoking?

E-cigarette use among US High School students, 2014. The rise in e-cigarette use parallels a decrease regular smoking; perhaps it’s the cause of the decrease. From “The E-cigarette Quandary.”

For the reasons above, I gave an e-cigarette device to an employee who smokes. So far, it seems he likes it, and I’m happy that he doesn’t have to go outside to smoke. It also seems to have saved him some money and his teeth look a bit whiter as best I can tell. Interestingly, he claims he has less of a desire for regular cigarettes, too matching observations among high school use, and among the population in general. My first impression, the e-cigarette seems to be a boon, a good thing, for him at least.

Despite the sense that e-cigarettes are a boon, that sense is rooted in cæteris paribus, the assumption at all else remains static. Without regulations, I expect some nasty developments — in the content of e-cigarette juice, in the operation of the cigarette, and in the product marketing. Nicotine is a drug, cigarette makers are clever, and there is money to be had. I see regulation being needed over the acceptable composition of the juice, over the operating temperatures and flows of the cigarettes, and over sales and advertising to minors. With these put into place, I see no need for further prohibitions on e-cigarettes in the work-places or the national parks — or so it appears to me today.

Dr. Robert E. Buxbaum, November 8, 2015.

Marijuana, paranoia, and creativity

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Many studies have shown that marijuana use and paranoid schizophrenia go together, the effect getting stronger with longer-term and heavy use. There also seems to be a relation between marijuana (pot) and creativity. The Beetles and Stones; Dylan, DuChaps, and Obama: creative musicians painters, poets and politicians, smoked pot. Thus, we can ask what causes what: do crazy, creative folks smoke pot, or does pot-smoking cause normal folks to become crazy and creative, or is there some other relationship. Dope dealers would like you to believe that pot-smoking will make you a creative, sane genius, but this is clearly false advertising. If you were not a great artist, poet, or musician before, you are unlikely to be one after a few puffs of weed.

The Freak Brothers, by Gilbert Shelton. While these boys were not improved by dope, It would be a shame to put the artist in prison for any length of time.

The Freak Brothers, by Gilbert Shelton. What’s the relationship?

When things go together, we apply inductive reasoning. There are four possibilities: A causes B (pot makes you crazy and/or creative), B causes A (crazy folks smoke pot, perhaps as self medication), A and B are caused by a third thing C (in this case, poverty culture, or some genetic mutation). Finally, it’s possible there’s no real relationship but a failure to use statistics right. If we looked at how many golf tournaments were won by people with W last names (Woods, Wilson, Watson) we might be fooled to think it’s a causal relationship. Key science tidbit: correlation does not imply causation.

The most likely option, I suspect is that some of all of the above is going on here: There is an Oxford University study that THC, the main active ingredient in pot, causes some, temporary paranoia, and another study suggests that pot smoking and paranoid insanity may be caused by the same genetics. To this mix I’d like to add another semi-random causative: that heavy metals and other toxins that are sometimes found in marijuana are the main cause of the paranoia — while being harmful to creativity.

marijuana -paranoia

Pot cultivation is easy — that’s why it’s called weed– and cultivation is often illegal, even in countries with large pot use, like Jamaica. As a result, I suspect pot is grown preferentially in places contaminated with heavy metal toxins like vanadium, cadmium, mercury, and lead. No one wants to grow something illegal on their own, good crop-land. Instead it will be grown on toxic brownfields where no one goes. Heavy metals are known to absorb in plants, and are known to have negative psychoactive properties. Inhalation of mercury is known to make you paranoid: mad as a hatter. Thus, while the pot itself may not drive you nuts, it’s possible that heavy metals and other toxins in the pot-soil may. The creativity would have to come from some other source, and would be diminished by smoking bad weed.

I suspect that creativity is largely an in-born, genetic trait that can be improved marginally by education, but I also find that creative people are necessarily people who try new things, go off the beaten path. This, I suspect, is what leads them to pot and other “drug experiments.” You can’t be creative and walk the same, standard path as everyone else. I’d expect, therefore, that in high use countries, like Jamaica, creative success is preferentially found in the few, anti-establishment folks who eschew it.

Robert E. (landslide) Buxbaum, September 4, 2014. The words pot, marijuana, dope, and weed all mean the same but appear in different cultural contexts. To add to the confusion, Jamaicans refer to pot as ganja or skiff, and their version of paranoid schizophrenia is called “ganja psychosis”. I’m not anti-pot, but favor government regulation— perhaps along the lines of beer regulation, or perhaps the stricter regulation of Valium. My most recent essay was on the tension-balance between personal freedom and government control. I was recently elected in Oak Park’s 3rd voting district. My slogan: “A Chicken in every pot, not pot in every chicken”. I won by one vote. For those who are convinced they’ve become really deep, creative types without having to create anything, let me suggest the following cartoon about talent. Also, if pot made you smart, Jamaica would be floating in Einsteins.

Criminal Punishment Theory

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I’ve often wondered about the theory of criminal punishment. How long should sentences be? For which crimes and external circumstances should people be let off, for which should there be alternative punishments, like civic work, or a fine instead of jail time. I’ve a few ideas, but here are some thought cases:

Someone steals an expensive handbag from a clothing store. What should the punishment be for (a) a ghetto black with no job, (b) a middle-class, college sophomore (c) a famous actress? Should it be the same for all? Is jail the best punishment — it costs money, and doesn’t help the criminal or the store. If jail, how long is appropriate? Should the length of stay correspond to the cost of the bag? If the punishment is money or civic service, how should the fine vary with the wealth of the thief, or if the person is a repeat offender? Many countries have corporal punishment — why or why not?

My sense is that sentences should be shorter for less-expensive items, and longer for more expensive. My sense is that a fine or civic service is appropriate for most first offenses, and while jail seems necessary for serious crimes, if only to keep criminals off the streets, the sentences should be reasonably short and include rehabilitation. I suspect that long sentences don’t help the criminal or society. I suspect that victimless crimes, e.g. prostitution or drug sales should have very short sentences or non-jail punishments, and I’m not quite sure what to do if the thief reforms in prison or appears to.

The US leads Russia, China, South Africa, and all of Europe in terms of percent of population is prison.

The US leads Russia, China, Cuba, India, and all of Europe in terms of percent of population in prison. It’s caused byvery long sentences, a product of fixed minimums. Strangely, our crime rate is low. Chart from the international business times.

Regarding prostitution perhaps it should be policed by the clergy, that’s why they get tax breaks. And why is sex between consenting adults punished as prostitution if money changes hands but not otherwise, or if the only pay is dinner? Why should the professional offender (the prostitute) pay more than the casual (the john). Why is drug use punished more than alcohol. Many drug and alcohol users live happy productive lives. To the extent that these crimes should be punished, it seems to me that fines, community service, or corporal punishment might be appropriate — I can not see prison healing a moral failing or reforming a victimless criminal.

And then there is rape. As a crime, the definition of rape has a long slippery slope, but the punishment does not. It isn’t quite clear where consensual become criminal, but the punishment is strict and undivided. We treat some cases as extreme crimes and others are let completely free. We have cases where the sex-criminal man or woman marries his or her underage partner, but is still guilty of statutory rape, and is then listed forever as a sex-criminal.

Children under 21 can not drink alcohol in the US, but they can in many other countries, and in some countries even older people can not drink at all. Is Saudi Arabia a very productive country; is Germany falling apart because of young drinkers? It seems not, so why is 21 the drinking age when you can choose to marry or join the army at 18. Soldiers are allowed to drink earlier than non-soldiers, but young marrieds are not afforded the same benefit. I don’t see why. The punishment for underage drinking varies too, as does the punishment for underage driving.

The Bible has some enlightened ideas on punishment, prescribing the use of fines of double or four or five times the value going to the victim (the thief pays 4 times for a stolen sheep, 5 times for a stolen cow, for example), but in other cases, it’s positively draconian prescribing death for homosexuality, violating the sabbath or for taking God’s name in vain. A seducer has to marry his seducee, but can not divorce her (assuming she agrees) but what if it’s an unhappy marriage? There is no room for judicial leniency in the bible, but there is in traditional applications; I’m not sure that’s not an improvement.

Robert E. Buxbaum, May 30, 2014. I’ve been wondering about the theory of appropriate punishment for at least 35 years. Are we protecting society, extracting vengeance, helping the criminal or doing some vague combination. My sense is we’re just bumbling blindly, and sorry to say, I have no answers.

Buddhists, Hindus and dentists joke

At the dentists’ office, Buddhist and Hindu monks don’t need anesthesia to have their teeth worked on. They transcend dental medication.

It’s funny because it’s a 3 word pun, and because there is something magical about the ability of people to conquer pain through meditation.

Focussed meditation can keep you from worry and other pain.

Focused meditation can keep you from worry and some physical pain. As for thugs, that’s more controversial. It’s possible that laughter, or looking at a spot will do as much. Gahan Wilson

The types of meditation, as I understand it, are two which are four. The two are focused and non-focused. focused meditation is supposed to allow you to conquer pain, both physical and spiritual. You concentrate on your breathing, or some other rhythmic action and thought; and whenever you realize that your mind is wandering you bring it back. A popular version is called square breathing: you breath in, hold, breath out, hold, etc. In time there is a sense of calm with the world. In theory, you can transcend dental medication, but I use the normal western practice of Novocaine plus gas. Meditation practitioners claim that directed meditation can also protect you from villains and bring peace in the world; I suspect that’s true, but also suspect that humor, or staring at a spot will do as much. I suspect that Dr Seuss has done wonders for peace in the world.

The second major version of mediation is non-focused; it can bring enlightenment if you use it right. You repeat a mantra slowly and let your mind wander along some general paths. The classic incantatory mantra is OM, and the classic paths include: what am I doing with my life, imagine a stick with one end, what is the sound of a hand clapping. The enlightenment that is supposed to arise is supposed to promote non-violence, charity, and a sense of oneness with the all. In general, I’ve found that letting one’s mind wander is a great way to solve difficult problems and to help one decide whether certain situations are worth being involved with. To the extent I’ve used a mantra, it’s versions of “radiator not leaking, mind leaking,” or “computer solution not unstable, mind unstable.” In the calm of realizing there is a solution, I’ve generally been able to find a solution.

Enlightenment can be as simple as realizing that you're there already or that you shouldn't manage a country that's unlike you and dislikes you.

Enlightenment can be as simple as realizing that you’re there already.

As for the other 2 types of meditation, it depends. To some, it involves rocking to the sound of the one hand clapping (or not). To some, it’s realizing you’re there already, or that you really don’t want to get involved in an Asian war to defend and manage a country that’s completely unlike yours, and that dislikes yours as well, or that it’s OK to use Novocaine and gas when you have your teeth worked on. That’s what they are there for.

Robert E. Buxbaum, May 24, 2014. Some wisdom from the Jewish mystics: Wherever you go, there you are, as for your baggage, who knows? Tea, with the first sip joy, with the second, satisfaction, with the third, Danish.

Stoner’s prison and the crack mayor

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With the release of a video of Rob Ford, the Mayor of Toronto, smoking crack while in office, and the admission that at least two US presidents smoked pot, as did the Beatles, Stones, and most of Hollywood, it seems worthwhile to consider the costs and benefits of our war on drugs, especially pot. Drugs are typically bad for productivity and usually bad for health. Thus, it seems worthwhile to regulate it, but most countries do not punish drug sale or use nearly as harshly as we do in the US.

The Freak Brothers by Gilbert Shelton. Clearly these boys were not improved by drugs, but perhaps we could do better than incarcerating them, and their fans, for years, or life.

The Freak Brothers by Gilbert Shelton. Clearly these boys were not improved by drugs, but perhaps we could do better than incarcerating them, and their fans, for years, or life.

While US penalties vary state by state, most states have high minimum penalties that a judge can not go below. In Michigan, where I live, medical marijuana is legalized, but all supply is still illegal. Marijuana cultivation, even for personal medical use, is a felony carrying a minimum punishment of 4 years in state prison and a $20,000 fine. For cultivation of more than 20 plants the minimum sentence is 7 years in prison and $500,000; and cultivating 200 or more plants results in 15 years plus a $10,000,000 fine. These are first-time, minimum sentences where the judge can not consider mitigating circumstances, like a prescription, for a drug that was accepted for use in the US in the 70s, is legal in Holland, legalized in Colorado, and is near-legal in Belgium. While many pot smokers were not served by the herb, many went on to be productive, e.g. our current president and the Beatles.

In Michigan, the mandatory minimums get worse if you are a repeat offender, especially a 3 time offender. Possession of hard drugs; and sales or cultivation of marijuana makes you a felon; a gun found on a felon adds 2 years and another felony. With three felonies you go to prison for life, effectively, so there is little difference between the sentence of a repeat violent mugger and a kid selling $10 rocks of crack in Detroit. America has more people in prison than Russia, China, or almost every industrialized nation, per capita, and the main cause is long minimum sentences.

In 2011, Michigan spent an average of $2,343 per month per prisoner, or $28,116/year: somewhat over 1.3 billion dollars per year in total. To this add the destruction of the criminal’s family, and the loss of whatever value he/she might have added to society. Reducing sentences by 10 or 20% would go a long way towards paying off Detroit’s bankruptcy, and would put a lot of useful people back into the work-force where they might do some good for themselves and the state. 60.8% of drug arrestees were employed before they were arrested for drugs, with an average income of $1050/month. That’s a lot of roofers, electricians, carpenters, and musicians — useful people. As best we can tell, the long sentences don’t help, but lead to higher rates of recidivism and increased violent behavior. If you spend years in jail, you are likely to become more violent, rather than less. Some 75% of drug convicts have no prior record of violent crime, so why does a first-time offense have to be a felony. If we need minimums, couldn’t it be 6 months and a $1000 fine, or only apply if there is violence.

Couldn’t we allow judges more leeway in sentencing, especially for drugs? Recall that Michiganders thought they’d legalized marijuana for medical use, and that even hard-drugs were legal not that long ago. There was a time when Coca-Cola contained cocaine and when Pope Leo was a regular drinker of cocaine laced wine. If the two presidents smoked pot, and the Mayor of Toronto could do a decent job after cocaine, why should we incarcerate them for life? Let’s balance strict justice with mercy; so the fabric of society is not strained to breaking.

Robert Buxbaum, Jan 16, 2014. Here are some other thoughts on Detroit and crime.