Disease, Ignorance, and Cruelty
This is a story about disease, ignorance, and cruelty. To make it interesting, we'll make you the protagonist.
The year is 1665, and you live in London. You're trying to stay away from people because plague is sweeping through the country. More than a quarter of the people you know have already died. In spite of your efforts, you wake up one morning feeling weak. Your body hurts. It's hard to move. You know immediately what's wrong, or fear you do, and you know there's no hope. You don't know anyone who has survived though you've heard a few rumors that there are such people. You're eventually able to get up to void your bladder and notice large swollen masses in your groin. You throw up, and the effort has worn you out. You crawl back in bed, and later that day, you die. What did you die of?
I am confident in saying that you died of disease. In this case the disease was bubonic plague, a very virulent illness caused by a bacteria called Yersinia pestis.
Now the year is 2000 and you live alone in Arizona about 2 hours from the nearest town. You're out in your garden digging and you coincidentally find the skeletal remains of an gopher. You think nothing of it. A few days later you wake up feeling weak and feverish. You think it must be the flu because your body hurts and you have a terrible headache. You get out of bed and when you get to the bathroom, you throw up, confirming for yourself that it's the flu. You have a lot of survival gear in the house because you live far away from help. This includes antibiotics like doxycycline, but you know that they don't help the flu, so you just go back to bed. You try to stay hydrated but it doesn't work out. By the time you start considering this might be more than the flu you can't get out of bed. After falling into unconsciousness later that day, you die. What did you die of?
I'd say you died of ignorance; you died of a lack of information. You didn't know plague bacteria can live in the ground. You didn't know it could be found in your area. You didn't know you had plague. You didn't know you had the cure 20 feet away. You died not knowing that you died of ignorance.
Now the year is 2016 and you aren't living alone. You're a microbiologist living in a group of other scientists in Arizona. You go out one day and dig in your garden and discover the recently dead body of a rat. You tell your friends about it when you get back, and one of them mentions that he hopes the animal didn't die of plague. Everyone laughs. 4 days later you wake up feeling weak and feverish. You have a terrible headache and throw up when you try to walk to the bathroom. You call your friends for help. They know what's wrong. You have plague. They aren't particularly worried because they have plenty of doxycycline. They know they can take care of you with impunity. They give you water to keep you hydrated, and you ask to start a course of doxycycline. One of your roommates comes back to tell you that they voted and decided that since you were stupid enough to touch the corpse of a dead animal you brought this on yourself, and you need to learn a lesson. So they'll keep you hydrated and give you a good chance of survival, but no doxycycline for you. In spite of the hydration, you weaken and die. What did you die of in this ridiculous, impossible-to-imagine scenario?
You died of cruelty. You died of the deliberate decision to not give you a treatment that is known to work. Plague didn't kill you; your friends’ cruelty did.
Like every story, mine has a moral. The moral of this story is that in every case, a pathologist would list Yersina pestis infection as the cause of death, but that pathologist would be wrong. Yes, Yersina infection was the problem in each case, but in two of the cases the solution was at hand. In the first case there was no solution; the problem killed you. In the second, you died because you didn't know what the problem was and didn't know you had the solution to the problem. In the third case, the problem was known and the solution readily available, but a cruel conscious decision not to use it was what killed you.
Why am I telling you this far fetched tale of a group of people deliberately keeping treatment from an ill person just because he became ill from what they saw as a mistake? What a silly story! Who would do something like that? All of us. We as a country. We as a society. We have all done it and are doing it today, not with plague, but with addiction.
I want to make this as clear as I can. I'm going to put it in bold letters. In case you missed the internet revolution, that means I'm screaming. NO ONE NEED DIE OF ADDICTION EVER AGAIN. Not unless we use ignorance and cruelty. Without ignorance of the biological illness of addiction, we can recognize it when we see it. And without cruelty we can use the treatments we have, treatments that work. Can we cure it, the way we can cure the plague? No, but that's not necessary to keep people from dying. All that is necessary is that we use the treatments we have and keep them alive long enough to die of something else. I'll repeat, NO ONE NEED DIE OF ADDICTION EVER AGAIN.
If you don't believe me, I can guarantee you are missing some information about the disease. It's not always easy to get accurate information through a societal barrier cast by cruelty. It might be the person dying that lacks the information. It might be the doctor who's treating him. It might be you. The only one you can do anything about is you. There are plenty of places for you to learn more. Read any blog post here that you find searching for neurobiology of addiction, watch my YouTube channel, or get my book. Or get somebody else's book, I don't care. Learn all you can and then start spreading the word, because no one need die of addiction ever again. And you can be part of making that a reality.
copyright Howard C Wetsman MD 2018
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