Hoffman and the Hype about “Killer Heroin”

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Phillip-Seymour-HoffmanWithin hours of the death of Philip Seymour Hoffman, rumors spread that this magnificent actor had been taken from us by “killer heroin”. The threat of a batch of impurity-laced, unusually potent heroin is a staple of opioid overdose news coverage and popular debate. But it’s usually hype.

Hoffman’s tragic overdose was absolutely the norm: He died from a combination of drugs, not from impure or unusually strong heroin. The benzodiazepines may have been particularly lethal in that they, like alcohol, seem able to lower acute tolerance for opioids, thereby turning a user’s standard dose into an “overdose”.

Two people who will be totally unsurprised by Hoffman’s toxicological test results are addiction researchers Shane Darke and Michael Farrell:

If there’s one thing we can quite clearly say about heroin deaths, it’s that impurities are rarely, if ever, found or are relevant to the death. Those that are found are typically innocuous substances, such as sucrose.

Data on overdose deaths from legally-manufactured prescription opioids are the other reason to doubt the killer heroin hype that so regularly grips the media. Prescription painkllers are consistently pure and of knowable dose, yet they kill 5 times as many Americans a year as does heroin.

Can President Obama Save Uganda’s Oppressed Gays and Lesbians?

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Chatham House has an illuminating and disturbing report on the domestic and regional politics of Uganda’s anti-LGBT oppression. Bottom line: pressure from the West to stop the nation’s brutal anti-homosexuality bill — which mandates a life sentence for gays and lesbians – might only foster bigoted actions in the short run.  Equality for LGBT people is regarded by many Uganda elites as “colonialist decadence.” Now, that’s decadence I can believe in!

But what to do? At this point, the administration’s best option is to order the US Embassy in Kampala to start processing LGBT Ugandans for humanitarian parole. According to United States Citizenship and Immigration Services, humanitarian parole can ”bring someone who is otherwise inadmissible into the United States for a temporary period of time due to a compelling emergency.” USCIS may grant parole temporarily “to anyone applying for admission into the United States based on urgent humanitarian reasons or if there is a significant public benefit for a period of time that corresponds with the length of the emergency or humanitarian situation.” Humanitarian parole does not bring with it immigration status, although it is very rare for parolees to return their country of origin.

Of course, there is one obvious threshold question: how would the Embassy determine whether someone is actually threatened?  The best first approximation would be to consult with NGOs inside Uganda who serve the population.  (Full disclosure and kvell: I’m proud to be working with the American Jewish World Service, which has close ties with many NGOs in Uganda that do this work, and which has developed a major campaign around LGBT and women’s rights.).

This would obviously be an imperfect way of identifying people at risk of incarceration, but in many ways, this is a feature, not a bug.  Two decades ago, Larry Lessig wrote an important article on “The Regulation of Social Meaning.” The law, Lessig, can at times change not only what is prohibited or allowed, but the meaning of actions. For example, before anti-discrimination laws, lunch counters that wanted business from African-Americans would be pressured into segregating from the local Conservative Citizens Council.  But after the Civil Rights Act, the owner of the lunch counter — who did not need to be a saint, but rather just someone out for a buck — could respond to such pressure by saying, “Oh yeah? And are you going to pay my legal bills when I’m sued?” The meaning of an integrated lunch counter changed after the passage of the Civil Rights Act.

Back to Uganda.  It would be salutary to see thousands of Ugandans claiming to be LGBT if they thought it would get them into the United States.  The very ambiguity of who is LGBT and who is not could do some work in reducing anti-LGBT sentiment in the country.  We might call it a Spartacus moment:

And oh yes — allowing humanitarian parole in these circumstances could save hundreds, perhaps thousands of lives.  Note to the President: No Congressional authorization necessary.

Sunday Afternoon Word Quiz: Fun with Spaghetti

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Here’s a silly word game to help you while away your Sunday afternoon. Below are ten clues, each of which suggests a one word answer. To make the game easier, here is a hint: Every answer can be spelled using the letters in SPAGHETTI.

Put 5 minutes on the clock and see how well you can do. Answers and scoring after the jump.

1. “Crazy” card game
2. Meanness
3. Rose has the most
4. Consumes
5. Slang for being drunk
6. Lacunae
7. Kind of Infection
8. One is Black, one is Yellow, one is Red and one is White
9. Touts and servers love them
10. __________ cannot wither her, nor custom stale her infinite variety.

Continue Reading…

The Paradox of Acceptance and Psychological Change

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Lindsay Holmes has penned a widely-circulated piece on what not to say to people with anxiety disorders. Many people respond to the chronically anxious with phrases like “Calm down”, “Why can’t you relax?” or “Just do it”. As she and I discussed, these well-intended responses often make people feel they have to fight to defend their anxiety to others, which makes their emotional state worse rather than better:

“Obviously if they could overcome this they would because it would be more pleasant,” Humphreys says. “No one chooses to have anxiety. Using [these phrases] makes them feel defensive and unsupported.”

In couple counselling sessions and in life more generally I have countless times listened to one person express a negative emotion and then another well-meaning person respond by tell them effectively that no, they don’t actually have (or should not have) the negative emotion they just revealed. I am sure I have done the same thing, and left suffering people feeling rejected as a result.

The humanistic psychologist Carl Rogers described a paradox of acceptance and psychological change that I often saw validated in my experience as mental health professional. Simply put, the moment people feel accepted in their misery is often the moment they begin to change. “Letting go” of anxiety, sadness, hurt, anger, grief and the like is not easy when someone tries to actively take it from us. Perverse as it sounds, we hang on to our dysphoria more rather than less when someone tries to argue us out of it. Yet when painful emotions are recognized and accepted, letting them go voluntarily suddenly seems possible.

If someone you love is suffering emotionally and you want it to stop, ordering them to change is likely only to generate mutual frustration. But being with them non-judgmentally in their suffering strangely enough can sometimes be the doorway to exiting it together.

Weekend Film Recommendation: La Haine

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C’est l’histoire d’un homme qui tombe d’un immeuble de cinquante étages. Le mec, au fur et à mesure de sa chute se répète sans cesse pour se rassurer : jusqu’ici tout va bien, jusqu’ici tout va bien, jusqu’ici tout va bien.

Mais l’important c’est pas la chute, c’est l’atterrissage.

This week’s film recommendation is often considered one of the finest that independent French cinema has to offer: Mathieu Kassovitz’s La Haine (1995). It’s the story of a man who falls fifty storeys down a high-rise. While falling, he reassures himself by repeating the same words: so far everything’s ok, so far everything’s ok, so far, everything’s ok. But the important thing isn’t the fall. It’s the landing.

Screen shot 2014-02-28 at 02.18.40The backdrop to the film is a riot that has thrown Paris into tumult, and a young man named Abdel into a coma from a violent altercation with the police. While we never meet Abdel, his story is told for us over the course of a single day by his three friends who live in the Parisian banlieues. Vinz is a Jew with an impetuous streak, played by a young pre-Hollywood Vincent Cassel; Saïd is an Arab with a flair for comedy, and is played by Saïd Taghmaoui, also before his own successful – albeit less illustrious – career kicked off; and Hub, played by Hubert Koundé, is a taciturn black former owner of a boxing gym that was burned down during the riots. During the confusion of the riots, Vinz has picked up a gun left by a policeman and resolves to use it to exact revenge on the cops in the event that Abdel dies.

The three characters drift listlessly through the Parisian landscape, searching for something to do. They have no jobs, no aspirations, and no social network beyond one another. Even the neighborhood they come from is a barren wasteland an hour away from downtown central Paris. They feel disconnected, and they don’t seem to care about it. Instead, they try desperately to eke out some excitement from their day, whether by finding a rooftop party worth attending, or by crashing an art gallery reception, or by embroiling themselves in conflict with either the local skinheads or the cops. But the film doesn’t so much glide from scene to scene as it scrapes your nerves back and forth across broken glass. While you know the characters are trying to achieve little more than ‘getting by’, you also know that l’important c’est pas la chute, c’est l’atterrissage.

Screen shot 2014-02-28 at 02.21.05The metaphor of the film, of the man falling fifty storeys, reappears frequently. It isn’t entirely clear until the ending – and even then, interpretations can still vary – whether the falling ‘man’ represents the three protagonists or French society. For my money, it represents Vinz, whose pride inexorably leads him into trouble, but watch the film and let me know your thoughts in the comments.

While the decision to use black and white was probably driven by budgetary constraints, Kassovitz does some great work with the camera, and the washed out colors in fact add to the effect of the prevailing sterility of the environment. The dialogue is outstanding, and even in translation La Haine captures the syncopation and lyricism of lower class urban French patois. The characters are all – even the cops – presented both sympathetically and unsympathetically, thanks to the superb acting on all fronts. A standout scene in particular is ‘The Grunwalski Monologue,’ about… well, no one really knows what it’s about, but I’ve embedded it below in the hopes of getting you hooked.

Debating the Value of Blog Comment Sections

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Austin Frakt of The Incidental Economist group blog recently discussed TIE’s decision to close off comments with Anna Maria Tremonti of CBC Radio One (full program here). One of the good points made in the discussion is that the costs and benefits of comment sections vary by blog. If you are running a big news website in the world’s most polite country and have staff hired to moderate your blog, even thousands of comments are manageable and valuable. In contrast, if you are operating an academically-oriented blog that has no paid staff like TIE, the comment section may feel like more work than its aggregate value justifies.

I miss reading the insightful commenters who used to be able to respond to my blog posts, but on balance am very happy with my decision to close off comments on most of my posts. The result has been that I have more time to engage on Twitter with knowledgeable people. I also have time to look at emailed comments from readers, and thus far at least have been able to respond to every one that was civil and substantive. Last but not least, I like knowing that in blogging I am no longer providing a platform for the subset of people who comment out of hatred, ignorance or intellectual dishonesty. That’s a lot of upside for one click on the WordPress template.

My suspicion is that in the long run, Twitter and whatever technologies succeeds it will supplant most blog comment sections as fora for interactions between bloggers and readers. In the meantime I can understand and respect why some bloggers choose to maintain them, and others do not: The variables in the cost-benefit analysis are qualitatively different from site to site and from person to person.

Zionism, Colonialism, and the Toxic Conversation On Israel

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The New Republic’s John Judis is the latest recipient of over-the-top right-wing attacks on any who would question Israeli policy.  Judis’ book, Genesis: Truman, American Jews, and the Origins of the Arab/Israel Conflict has been attacked as part of a “new worldwide effort to question the legitimacy of Israel” (Ronald Radosh in the Jerusalem Post) and the work of a “faux Elder of Zion” (Rick Richman in Commentary) who “deploys the bigotry of yesteryear” (Jordan Chandler Hirsch in the Wall Street Journal) and insists that Arab massacres against Jews are “justified” (Hirsch and Radosh).

I haven’t read Judis’ book yet, and I can tell that these sentiments are nonsense. Judis is a fair-minded writer; it beggars belief that he would justify Arab massacres against Jews.  More sober reviewers such as Jonathan Kirsch in the Jewish Journal and Gershom Gorenberg in The American Prospect have a lot of trenchant criticisms of it, but they are intelligent enough not to have a conniption fits about policy disagreements and nowhere mention the sorts of absurdities that Judis is accused of.

That said, Judis’ attempt to defend himself gets him into trouble, and does lead me to wonder whether this book is the masterpiece that some are hailing. In particular, I noticed this paragraph in Judis’ response to his critics:

Theodor Herzl, Chaim Weizmann and the British Zionists who helped draft the Balfour Declaration did not aspire to create an empire like that of the British or French, but to be junior partners of the Western imperialist powers. Herzl, who admired Cecil Rhodes, described the Jewish state as “a part of a wall of defense for Europe in Asia, an outpost of civilization against barbarism.” The Zionist movement established “colonies” and aspired to create a Jewish state in a territory where, at the beginning of the Zionist movement, Arabs made up 95 percent of the population. American Zionists compared the Zionists in Palestine with American colonial settlers. At the time, colonialism and imperialism were not dirty words they way they are now. So yes, I think much of the Zionist movement—with the exception of Ahad Ha’am and his followers—saw themselves engaged in a mission that could be described as settler colonialism.

Now, I realize that these replies cannot go on too long, and that thus nuance gets lost, but if this response accurately and completely reflects Judis’ views and the message of the book, then that represents a real problem. Whatever Herzl might have thought, the man died in 1904 (13 years before the Balfour Declaration), and the British Zionists who helped draft the Balfour Declaration were nowhere near the core of the Zionist movement that actually created the state in the 1930’s and 1940’s.  David Ben-Gurion and the rest of the Yishuv institutions and leadership had no interest in being junior partners of western imperialism: they loved working with Orde Wingate in the late 1930’s, but basically detested the British and other imperial powers. “We must assist the British in the war as if there were no White Paper and we must resist the White Paper as if there were no war,” said Ben-Gurion. That is not someone who wishes to be the junior partner of imperialism. Indeed, the Mapai leadership was shocked when Israel was not invited to the Bandung Conference in 1956 and Israel’s government leaped at any chance to establish strong relationships with African governments as soon as they were independent.  (The much-ballyhooed Israel-South Africa relationship really did not get going until 1976, after the rest of Africa cut off ties with Israel following the Yom Kippur War).

Thus, “colonialism” represents a deeply flawed view of the Zionist project.  “Colonialism” assumes a metropole to which one is loyal.  The Zionists who actually built the state had little for any metropole and saw themselves as a nationalist movement.  Gershon Shafir, one of the best scholars out there working on this, makes an absolutely crucial distinction between “colonialism”, which Zionism was not, and “colonization,” which it clearly was.  Any time  a group of people moves from one part of the world to another, in one sense it is “colonization.” But to see Zionism as a “colonialist” movement is at best imprecise and misleading.

None of this excuses the hysteria against Judis in the right wing press. But Judis isn’t doing himself any favors in his response — and very possibly, he won’t be doing it in his book, either.

Why the Announcement of Edward Snowden’s Nobel Prize Nomination Increased My Admiration for my Fellow Professors

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Two Norwegian politicians recently made news by issuing a press release announcing that they have nominated National Security Administration leaker Edward Snowden for a Nobel Peace Prize. Even though it violates the prize committee’s request to keep nominations private, similar press announcements are common each Nobel Peace Prize awards cycle (Literature nominations have also been disclosed over the years, though less frequently). The public announcement of Snowden’s nomination pleased some people and infuriated others. My main reaction was to feel increased respect for my professorial colleagues at Stanford and other schools of medicine.

Most people are unaware that many people are allowed to submit Nobel Prize nominations. For the Nobel Prize in Medicine or Physiology, full professors of medicine all over Scandanavia are always allowed to nominate, and this group is supplemented by academics of similar rank at a rotating list of other medical schools around the world. All full professors at Stanford Medical School and some other leading schools will therefore been asked at some point to serve as nominators.

To the press and the average person, being a “Nobel Prize nominee” is a magnificent, rare honor conveying credibility forever after. Any nominator who wants to boost someone’s profile can therefore do so by nominating them and then telling the press. As a result, the Nobel Prize nomination process is an opportunity both to celebrate achievement and to create mischief.

A nominator could nominate a completely deserving colleague at his/her medical school (which is ethical) and then inform their press office (which is not), thereby bringing some easy positive publicity to their university. A professor could also reveal to the press that s/he has nominated a powerful person in the hopes of currying favor (“I forgot that Francis Collins was the head of NIH when I nominated him for his extraordinary achievements, but yes, now that you mention it, I do have some grant proposals under review there…”).

More darkly, any professor of medicine who is a nominator could announce to the press that s/he has nominated Andrew Wakefield for a Nobel Prize in Medicine, thereby helping him to persuade more people to forgo vaccinating their children for mumps, measles and rubella. Likewise, a venal medical school professor could accept a financial inducement to announce the Nobel Prize nomination of someone hawking some ineffective food supplement or quack medical procedure.

Yet to my knowledge, no professor of medicine has ever done anything like this. Each year hundreds of them around the world submit their nominations and stay closemouthed about them. In an age of so much disclosure of virtually everything in the media and online, that speaks well of the standards of academic medicine and the character of the people in it.

“Ten commandments”? Ain’t no such thing in the Bible.

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I’m no longer the note-taker for the Hirshleifer-Rosett  Faculty Tanakh Study Group, so I haven’t been reporting on its activities in this space, but it continues to flourish; we’re now reading Exodus, and today we hit Chapter 20, the Ten Commandments.

Or, as it turns out, not.

It’s news to me, as no doubt to most of you, but that phrase does not occur in the Biblical text. In Exodus 32:28, when the original pair of tablets is replaced, the new tablets are referred to as containing “the words (דִּבְרֵי, divarai) of the covenant, the ten words (עֲשֶׂרֶת הַדְּבָרִים , asheret ha-devarim).” (For reasons utterly obscure to me, the later tradition uses debrot, the feminine plural, rather than the masculine plural devarim.)

There’s no ambiguity here. “Commandment”  (מִצְוָה, mitzvah) is a key-term in the text, and in Jewish tradition. Its root is the word for “command,” or perhaps it would be better rendered as “instruction” or “guidance.”  A mitzvah is that which one is commanded or instructed or guided to do; the Talmudic rabbis counted 613 of them in the Torah.

Devar, by contrast, means “word” or “statement” or “speech”: thus the Greek “Decalogue.”  In particular, what the Jewish tradition has always counted as the first of the asheret devarim - “I am HaShem your God, who has brought you out of the land of Egypt, out of the house of bondage” – is not a command, but a statement of fact. It serves as the first of ten clauses making explicit the covenant to which the Children of Israel had already assented (Ex. 19:8).

I’m not sure when or how the mistranslation happened. But once again we see the great wisdom of the founders of Harvard College (as a Congregationalist seminary) in requiring entering students to know Hebrew.

Update Commenter Raghav Krishnapriyan corrects my Hebrew. (Only in America!):

(1) עֲשֶׂרֶת should be transliterated /aseret/. The dot on the upper-left of the shin turns it into a sin. 
(2) Dibrot (not debrot – under most circumstances, you can’t have two consecutive shvas at the beginning of a word) isn’t a feminine plural: it’s the plural of a different word, diber (דיבר), meaning “utterance.” While dibrot looks like it should be feminine, it’s actually part of a class of masculine nouns that have feminine-sounding plurals. You can find a list of other such words here.
(3) דִּבְרֵי should be transliterated /divrei/ or something similar, since that’s a shva under the vet. It’s simply devarim in the construct state (smikhut).

 

 

What makes torture OK?

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The Nation and the Guardian both carry stalwart defenses of the Bolivarian Revolution in Venezuela against Yanqui imperialism and its counterrevolutionary allies in the streets of Caracas.  Curiously, neither account picks up on this sentence from an AP story:

Maduro said Friday that San Cristobal Mayor Daniel Ceballos, a member of the same party as Lopez, would soon join the jailed opposition leader behind bars for fomenting violence. “It’s a matter of time until we have him in the same cold cell,” Maduro said.

The “cold cell” refers to the use of hypothermia as torture. I seem to recall that when the cold cell was being used on the orders of Donald Rumsfeld and Dick Cheney, progressives – including writers for The Nation and the Guardian – tended to be rather critical of the practice. I wonder what might make this circumstance different enough to allow support for a regime whose leader openly boasts about torturing his opponents?