Late in 2017 the nation’s top medical journal – Journal of the American Medical Association, JAMA – featured endorsement of an “innovative” plan by the U.S. Food and Drug Administration (FDA) for use of electronic cigarettes, “vaping”, to substitute for that of tobacco cigarettes as a form of medical harm reduction. The message was clear and came from one of the America’s most trusted and authoritative medical institutions: vaping is a much safer alternative to smoking. That message targeted, through mass media dissemination, a vulnerable and trusting public trapped in arguably this culture’s most costly and lethal compulsive substance use problem, the annual half-million deaths due to tobacco use eclipsing those related to alcohol, opioids, and other street drugs combined.
The message would also have been taken as authoritative by America’s medical professionals, who encounter smokers routinely in primary care and other settings and advise them on interventions to help stop smoking. Institutions including top medical journals, medical regulatory agencies, and media have powerful influence on American medical practice, their cultural fabrication of a new medical gold standard for treatment of chronic pain, for example, substituted for clinical and ethical judgment and responsibility and resulted in runaway, medically inappropriate dispensing of Schedule II opioids for the established non-medical condition of common chronic pain generating a lethal public opioid crisis. But that’s another story.
That JAMA-endorsed medical harm reduction flipped within months, predictably, to a child nicotine abuse and dependence problem, now widely recognized as another public health epidemic.
The public disinformation campaign worked, providing for booming sales and use of vape products. Worked, that is, apart from the worsening child nicotine dependence epidemic.
And apart from the emerging adult vaping illness epidemic.
But it’s not just advertising at work, when e-cigarette use is endorsed as an innovative harm reduction approach in the nation’s leading medical journal, and the same journal endorses a research report – disseminated to American medical practitioners – with claims that vaping is an effective method for stopping cigarette use, repeated in authoritative media outlets.
As reported in JAMA and published in another leading medical research journal, the New England Journal of Medicine (NEJM) the landmark study, a “seminal study” according to medical authorities, establishes that vaping of nicotine is effective for stopping use of tobacco by smoking, affirming vaping as a new medical gold standard for smoking cessation. It’s even more effective than nicotine replacement treatment (NRT), based on critical evaluation of the research study by medical professionals, leading authorities, and major mass media. (Coincidentally, NEJM is the top medical research journal that published another seminal study not long ago – the study establishing that Schedule II opioids were safe and effective to use for all pain, including chronic pain.)
It’s just that – the study in question establishing vaping as a new medical gold standard actually provides no evidence at all of benefit for smoking cessation from either NRT or e-cigarette use, instead points to no benefit. And it turns out that the demonstrably false, unvalidated claims of benefit (of about 10 percent and 20 percent cessation success rates for NRT and vaping, respectively), were based on errors in experimental design and interpretation of the most elementary and demonstrable types.
And now – to add to opioid, alcohol, and other substance use epidemics – a youth vaping epidemic with poor prognosis.
And public branding and media script for a treatment response?
That of course is being driven by the same American Medical-Media collaboration. The collaboration that distorted and fabricated evidence to create the increasingly lethal opioid crisis and the never-validated, harm-increasing medical fix that dispenses addictive, diverted opioids fueling and worsening the crisis.
Predictably, that branding identifies potential responses, “treatments”, for the non-medical condition of compulsive use of vaping as medical, provided by medical professionals, just as for the non-medical conditions of common chronic pain, substance use, depression, and other public health crises. That is, just as for other lethal public health crises that predictably worsen the more that indicated-against sham medical “treatments” are applied.
The vape crisis is no exception:
From the piece in STAT –
It’s hard to imagine most families sending their kids to a residential program to quit vaping. More common are the methods normally used for tobacco cessation: the nicotine patches, gums, or lozenges that smokers can use to wean themselves off the chemical. These medications are sold over the counter, but only to people 18 and over, so minors need a prescription.
“We’re basing whatever we do on what we know about cigarettes and it’s clearly a different product,” Levy said. Even for traditional smoking, she added, nicotine replacement generally works better for adults than for adolescents.
In the past few weeks, she’s seen some patients who were suddenly open to quitting who’d had no interest before, while others were still dead set against the idea of even being in her office at all. “I saw a patient on Wednesday who uses Juuls and dabs, so he’s vaping both nicotine and marijuana. He wasn’t really tuned into the lung disease piece of it,” she said. “Like so many kids I see, he was very ambivalent [about vaping] but that was being buried under, ‘My mother should stay out of my business.’”
That would be a STRUGGLE indeed. A futile, lethal struggle, doctors entirely lacking understanding or competence required to provide any type or level of treatments or supports for helping youth or anyone reduce and stop use of nicotine. Doctors are out of scope of competence to treat substance use problems, which are not medical conditions at all, instead compulsive behaviors driven by inner psychological distress, environmental stressors, and inaccurate beliefs.
Current, worsening lethal substance use epidemics were predictable, all along, from the unethical and fraudulent application of medical “treatments” with no evidence for expected effectiveness, applied to non-medical conditions.
It would be less tragic and deadly if it were only true that the never-validated, fraudulent medical “treatments” for non-medical conditions like compulsive substance use are ineffective, providing no benefit.
The reality is different. Longstanding lethal substance use epidemics were driven and are worsened by not only outcomes of the sham “treatments” (like the runaway indicated-against medical provision of opioids of abuse fueling and worsening the opioid epidemic), but in more damaging and fundamental ways by predicted negative outcomes and what is represented each time a patient seeks help with a substance use problem from a medical professional.
Just as the evidence-free, medical/pharmaceutical industry constructed lie that common (centralized) chronic pain is a biomedical condition that could be medicated effectively has led to enormous harms in the form of the Opioid Crisis, longstanding worsening substance abuse epidemics are driven by diversion of healthcare resources to promised medical fixes for the entirely non-medical condition of compulsive substance use, with no bodies of evidence to support medical treatments, instead for longstanding evidence-based psychotherapies and psychosocial supports.
Every visit to a medical office or provider for a substance use problem causes harm by instilling and reinforcing false belief in a passive, ineffective medication, a pill for a complex, individualized inner reality of potent early experiences, psychological injury, distress, distorted beliefs and associated mood states – an individualized inner reality with only collaborative, extended work in psychotherapies as indicated treatments – disincentivizing patients engaged in a potentially lethal compulsive behavior (the symptom of that inner reality) away from engaging in the more intensive, active work of counseling and behavioral changes. Predicting continued distress, illness and harm.
Americans have been trained by deceptions over decades, provided drugs for which there is no evidence base (no body of adequately designed randomized controlled trials (RCTs) supporting effectiveness), deceived about the meanings of the outcomes research, assured of benefit by their medical providers to whom they entrust their wellness – professionals lacking the training, competence, and capacity to evaluate and think critically about research, research claims, and practices required to evaluate effectiveness of treatments and avoid harm.
The distorted, misused research and predictably harmful outcomes are documented, with links to primary research and other materials in multiple posts here at A Critical Discourse.
That false, ingrained, trained belief leading vulnerable Americans to access medical visits for those non-medical problems is associated with immeasurable public health costs and harms. The Opioid Crisis the most visible and attention-grabbing example. Costs including the enormous waste of public and private resources for biomedical “treatments” with no benefit, and no predicted benefit supported by research, for example: $ 90 billion annually for ineffective, inappropriate biomedical interventions for lower back pain.
More fundamentally and pervasively – because those beliefs drive emotional states and behavior, choices – the deceptions, wildly lucrative and beneficial to medical, pharmaceutical, and “harm-reduction” industries, are effective psychological barriers between trusting, vulnerable Americans and real, effective evidence-based treatments for those non-medical conditions.
It turns out that pattern of “relapse” (return to a pattern of problem substance use after quitting) is NOT explained or consistent with the required assumptions and features of the long-invalidated medical “hijacked brain” or disease model of addiction – the research clearly invalidates that. Instead, key predictors include belief by the user in that fictional model, belief that the user’s compulsive substance use is a medical disease. If I have a disease (a brain disease!) after all, that’s something out of my control, out of my understanding and ability to do something about.
Nothing to do for it but trust the medical experts for the only types of treatments that would be treatment for a disease, a medical condition – medical treatments.
Whatever my doctor recommends.
Instilling belief in a fictional medical condition explaining relapse is a deception critically important to validate and enrich entitlement systems like “addiction medicine” and “harm reduction” that divert public healthcare funds away from evidence-based treatments. As such it has been ingrained, trained into trusting, vulnerable Americans for decades, every single visit to a medical provider or office to address smoking or any other substance use problem further reinforcing the lethal deception that there is a pill or medical treatment, a passive easy fix, that can replace the work of therapy and change and serve as treatment for a compulsive behavior driven by inner emotional distress and distorted beliefs.
Another, complimentary factor strongly supported by extensive research as protective against relapse and required generally for change is self-efficacy, or sense of confidence in one’s own choices, abilities, and effectiveness to make the changes needed to resolve a problem or regain health and safety.
Self-efficacy is developed, reinforced, experienced and strengthened in a process of interaction with skilled therapists over which experiences that include active changes (not passive changes like taking a pill) are experienced as effecting positive changes in the patient’s life and resolution of problems.
That is, a key factor established by research as required to stop and protect against return to problem substance use requires work in therapy over time in order for patients to internalize, own, and self-affirm personal agency and effectiveness, control, in behavioral and other changes that protect against problem substance use.
Medical visits and the sham “treatments” are a barrier to self-efficacy, a barrier to the critical, patient-driven, active process of healing and wellness. That process is subverted when vulnerable patients are reinforced, by medical visits for a non-medical problem – in the false belief of a passive fix for substance use, a pill.
The trained belief in a non-existent condition “addiction” as a medical condition with medical treatments was predicted, all along, to generate illness, “treatment” failures, ultimately lethal epidemics.
Every medical visit for those overtly, demonstrably non-medical conditions causes harm, hijacks American brains, diverts trusting, vulnerable Americans from real treatments for those conditions, year by year, decade by decade, Americans sicker and sicker.
The evidence lies all around, and buried, on a national crime scene.