Sunday, October 09, 2016

Americans on Amphetamines

 How the first amphetamine epidemic came about (emphasis added):

From 2008:
America’s First Amphetamine Epidemic 1929–1971
Am J Public Health. 2008 June; 98(6): 974–985.
The first amphetamine epidemic was iatrogenic, created by the pharmaceutical industry and (mostly) well-meaning prescribers. The current amphetamine resurgence began through a combination of recreational drug fashion cycles and increased illicit supply since the late 1980s. On the basis of treatment admissions data, methamphetamine abuse doubled in the United States from 1983 to 1988, doubled again between 1988 and 1992, and then quintupled from 1992 to 2002. According to usage surveys, during 2004, some 3 million Americans consumed amphetamine-type stimulants of all kinds nonmedically, twice the number of a decade earlier. As noted, 250000 to 350000 of them were addicted. Thus, in terms of absolute numbers, the current epidemic has now reached approximately the same extent and severity as that of the original epidemic at its peak in 1970, when there were roughly 3.8 million past-year nonmedical amphetamine users, about 320 000 of whom were addicted. (Of course, the national population then was about 200 million compared with 300 million today, meaning that in relative terms today’s epidemic is only two thirds as extensive.)

Another striking similarity between present and past epidemics relates to the role of pharmaceutical amphetamines. Although illicitly manufactured methamphetamine launched the current epidemic, in step with rising amphetamine abuse in recent years, the United States has seen a surge in the legal supply and use of amphetamine-type attention deficit medications, such as Ritalin (methylphenidate) and Adderall (amphetamine). American physicians, much more than those in other countries, apparently are again finding it difficult to resist prescribing stimulants that patients and parents consider necessary, or at least helpful, in their struggle with everyday duties. According to DEA production data, since 1995, medical consumption of these drugs has more than quintupled, and in 2005, for the first time exceeded amphetamine consumption for medical use at the epidemic’s original peak: 2.5 billion 10-mg amphetamine base units in 1969 vs 2.6 billion comparable units in 2005. Thus, just as the absolute prevalence of amphetamine abuse and dependency have now reached levels matching the original epidemic’s peak, so has the supply of medical amphetamines.
(Of course, the national population then was about 200 million compared with 300 million today, meaning that in relative terms today’s epidemic is only two thirds as extensive.)
and (emphasis added)

Besides iatrogenic dependence and diversion to nonmedical users, there is another way that widespread prescription of amphetamine-type stimulants can contribute to an amphetamine epidemic. When a drug is treated not only as a legal medicine but as a virtually harmless one, it is difficult to make a convincing case that the same drug is terribly harmful if used nonmedically. This is what happened in the 1960s and is presumably happening today. Thus, to end their rampant abuse, amphetamines had to be made strictly controlled substances and their prescription sharply curtailed. Today, amphetamines are widely accepted as safe even for small children, and this return of medical normalization inevitably undermines public health efforts to limit amphetamine abuse. We have not yet reached the point where up to 90% of the amphetamines sold on the street are products of US pharmaceutical firms, as the federal narcotics chief reluctantly admitted before Congress in 1970. But with half the nation’s nonmedical users evidently consuming pharmaceutical amphetamines only, the comments made by Senator Thomas Dodd in those hearings echo strongly today. America’s drug problems were no accidental development, Dodd observed; the pharmaceutical industry’s “multihundred million dollar advertising budgets, frequently the most costly ingredient in the price of a pill, have pill by pill, led, coaxed and seduced post–World War II generations into the ‘freaked out’ drug culture” plaguing the nation. Any effort to deal harshly with methamphetamine users today in the name of epidemic control, without touching medical stimulant production and prescription, is as impossible practically as in 1970—and given historical experience, even more hypocritical.
We have seen a similar opioid epidemic created in a similar way; and opioids are a gateway to heroin. 

Obviously, criminalization is not a solution, but medical normalization, removal of tight regulations, and making it socially acceptable (e.g., the way alcohol is) is not going to help either.  It is not clear to me why society cannot find getting intoxicated/getting high as socially unacceptable as body odor or even perspiration.

Saturday, October 08, 2016

Not learning from history: legalization of drugs

History doesn't provide any comfort about the legalization of drugs. Per Alan Schwarz in ADHD Nation: Children, Doctors, Big Pharma and the Making of an American Epidemic, in the 1960s:

Dexedrine had become perhaps the most widely abused drug in the United States—more than hippies' marijuana, more than Timothy Leary's LSD, more than the heroin that would soon kill Jimi Hendrix and Janis Joplin. In the 1960s, doctors prescribed amphetamines so willingly—for weight loss, depression, all but hangnails—that an estimated four billion tablets were dispensed by American pharmacies per year, or enough for every man, woman and child in the United States to have twenty apiece.

The United States military handed out Dexedrine so freely that an estimated 7 percent of its Vietnam forces became abusers and addicts. About eight hundred thousand Americans were dependent on amphetamines, about three hundred thousand of them flat-out addicted—and many of them average housewives. These addicts weren't the young beatniks and hippies so reviled by the establishment; they were, in many cases, the establishment itself.

There was talk in about banning amphetamines in the United States altogether, its medical uses be damned. Instead the federal Controlled Substances Act placed unprecedented restrictions on the handling of addictive pharmaceuticals like Dexedrine and Ritalin. Prescribers were now required to maintain a special government license, fill out much more paperwork, and prescribe no more than a thirty-day supply at a time. Drug companies could not produce such medications in quantities higher than the government deemed clinically necessary.

It was the ultimate buzzkill. US production of amphetamine plummeted an astonishing 90 percent in only a few years. Stimulants could no longer be handed out as mere pick-me-ups for tired professionals, but only for narcolepsy or short-term weight loss. And for a children's malady just now hitting America's living rooms: minimal brain dysfunction.

Minimal brain dysfunction is simply the old name for Attention Deficity Hyperactivity Disorder (ADHD). The author says it is a real malady, but where about only 5% of children are actually affected by ADHD, about 15% are diagnosed with ADHD, leading to a massive over-prescription of drugs. Why?  There are simply too many perverse incentives in the system.

I expect there is a similar story behind opioids and their widespread abuse today; and in a few years, I expect the states busy legalizing pot, whether for medical purposes only or more comprehensively, will have similar findings.

FYI: alcohol use is a leading cause of death in the USA and in the world; but in the USA the deaths due to alcohol are parceled up among many different buckets to disguise that fact.  While Daniel J. Levitin's very timely book A Field Guide to Lies: Critical Thinking in the Information Age does not mention this example, it does mention the template of this lie. Levitin calls it "specious subdividing".
Suppose you work for a manufacturer of air purifies, and you're on a campaign to prove respiratory disease is the leading cause of death in the United States, overwhelming other causes like heart disease and cancer. 
 But respiratory disease is only the third leading cause of death, and doesn't make for an impressive ad campaign.  So subdivide heart disease into categories like rheumatic heart disease, hypertensive heart disease, acute myocardial infarction, and so on, and likewise with the various cancers.
By failing to amalgamate, and creating these fine subdivisions, you've done it! Chronic lower respiratory disease becomes the number one killer.  You've just earned yourself a bonus.

Thursday, October 06, 2016

Hurricane Matthew

The forecasts are highly uncertain, but since they look highly unusual (from to my eye, here they are.  This hurricane could possibly go around in a complete circle and hit Florida twice.

Thursday, September 29, 2016

PCA, Neighbor-joining

This is from the 2016 Reich paper:

 The pink dots at the top of the PCA diagram are "West Eurasia".  The green dots down the side are "South Asia".  The blue dots further below are East Asia/C.A.S., clustered along with the dots for Amerindians.

The PCA diagram would lead you to believe that the green and pink are more closely related than the green and blue.   But the first two principal eigenvectors account for only 7.8% and 4.0% of the variance.   The remaining 88% of the variance is in dimensions not shown in the diagram.  It is a very high dimensional space, and perhaps the normal intuitions of distance do not apply, and that is why we see the counter-intuitive result that the group of green dots is closer connected to each other by neighbor-joining rather than some green dots being put close to some pink dots, and other green dots being put close to some blue dots.  The spread of green dots along PC2 does not preclude them from being closer to each other than to any other pink dot (the Tajik being the exception). Likewise the wide spread of the blue dots along PC2 does not preclude them from joining in one group; and finally, the green and blue join together before the green joins with the pink. 

The PCA in the 2009 Reich paper does not present how much of the variance is captured in their first two principal eigenvectors, as far as I can tell.

Tuesday, September 27, 2016

ANI, ASI, etc.

CIP wrote in the comments to the previous post about the 2016 Reich paper:
This is in accord with the conventional view that Europeans and Asians probably separated after leaving Africa in the Middle East. East Asians then separated from South Asians in India and Amerindians and related groups separated from East Asians much later.
Guest wrote in the comments about the 2009 Reich paper:
One, the ‘Ancestral North Indians’ (ANI), is genetically close to Middle Easterners, Central Asians, and Europeans, whereas the other, the ‘Ancestral South Indians’ (ASI), is as distinct from ANI and East Asians as they are from each other. By introducing methods that can estimate ancestry without accurate ancestral populations, we show that ANI ancestry ranges from 39–71% in most Indian groups, and is higher in traditionally upper caste and Indo-European speakers. Groups with only ASI ancestry may no longer exist in mainland India. However, the indigenous Andaman Islanders are unique in being ASI-related groups without ANI ancestry.
Guest wrote this in another comment:
You are confusing the ANI and Indians who currently live in the North. All Indians studied in the Reich paper (except Andamese) are mixtures of ANI and ASI, and consequently more related to each other than to outside groups like West Eurasians. The two papers are quite consistent, and David Reich is an author on both papers.

My response:

Sunday, September 25, 2016

New indications on the peopling of India

The NYT reports:
In the journal Nature, three separate teams of geneticists survey DNA collected from cultures around the globe, many for the first time, and conclude that all non-Africans today trace their ancestry to a single population emerging from Africa between 50,000 and 80,000 years ago.
The three teams are led by Eske Willersley of the University of Copenhagen (A genomic history of aboriginal Australia), David Reich of Harvard University (The Simons Genetic Diversity Project: 300 genomes from 142 diverse populations), and Mait Metspalu of the Estonian Biocentre (Genomic analyses inform on migration events during the peopling of Eurasia).

Unfortunately all the articles are behind a paywall, and a visit to the nearby university library is not in the plan for now.  The article with the most to do about anything Indian is the Reich article.

Some observations follow.

Thursday, September 22, 2016

Towards a sustainable economy

It should be fairly obvious that fisheries and timber industries cannot grow indefinitely.  They have a natural limit which is the renewal rate of the underling resources.  

It may be somewhat less obvious, but manufacturing on the planet as a whole also similarly has a natural limit.  About the only thing you can do here is replace lower value manufactures with higher value ones.  But the planet's ecosystem can sustain only so much manufacturing.   One could have manufacturing in space, and thus keep growing.   But that won't generate a lot of employment for humans on earth.

The obsession with manufacturing jobs is misplaced. Services - what humans do for each other - however are sustainable, can employ any number of people.  If the human touch is of value, then these can only be assisted but not replaced by artificial intelligence and robots.   The question then is - how to make human services more valuable?