by Michael

Gun Control is Being Able to Hit Your Target

January 13, 2013 in Politics

The introduction of more gun control laws will literally put American Citizens at a higher risk of gun crimes. It has been proven. Yet, POTUS would consider an executive order to push new gun legislation through despite the fact that statistically these types of laws do not reduce gun related crimes.

Just shy of half of all Americans will be a victim of a violent crime in their lifetime. More than 80% will be victim of an attempted violent crime and half will be victim of or the attempted victim more than once. (according to the U.S. Department of Justice)

Law makers will have you think that gun bans will reduce crime, yet in 1976, the Washington, D.C. City Council passed a law prohibiting residents from possessing handguns and requiring that all firearms in private homes be (1) kept unloaded and (2) rendered temporally inoperable via disassembly or installation of a trigger lock. The law went into effect on Sept. 24, 1976. The law was repealed by the United States Supreme Court on June 26, 2008 and rules as unconstitutional.

During the years in which the D.C. handgun ban and trigger lock law was in effect, the Washington, D.C. murder rate averaged 73% higher than it was at the outset of the law, while the U.S. murder rate averaged 11% lower.

I have argued in other forums against people who say that Obama is going to “take our guns”. The fact of the matter is that immediately proposed gun control legislation will likely be a ban on large capacity magazines, a ban on “assault rifles” (inaccurately referred to by many) and more strict requirements when purchasing a gun (e.g. Federal background check, background check requirement when purchasing from an individual). Pre-ban purchases will likely be grandfathered.

However, even though an introduction of these bans is not going to immediately take our guns, I believe it does pave an illegitimate path for more laws in the future. It is possible they may consider mandatory registration of all guns. With most government records available through a simple Freedom of Information Act request, gun owners across the nation could soon be a dot on a map that criminals and law abiding citizens will have access. Keep in mind that these dots also plot on the map the “safe from criminals” locations of homes without guns. Besides, anti-gun activists and other citizens do not have the right to know if I have a gun anymore than I have the right to know your religion beliefs.

According to The U.S. Centers for Disease Control and Prevention, Americans use guns to frighten away intruders who are breaking into their homes nearly 500,000 times per year. If criminals are given a map of gun owners’ homes, I predict that this number will go down while home invasions continue to rise.

35% of violent criminal (in Federal Cases) were carrying a gun when they committed their crime (according to the U.S. Department of Justice).

It is VERY important to know that a survey of male felons in 11 U.S. state prisons found:

• 34% had been “scared off, shot at, wounded, or captured by an armed victim”
• 40% had decided not to commit a crime because they “knew or believed that the victim was carrying a gun”
• 69% personally knew other criminals who had been “scared off, shot at, wounded, or captured by an armed victim”

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by Joe

The Second Presidential Debate: The ‘Act of Terror’ Argument

October 17, 2012 in Politics

In short, during one exchange in the debate, President Obama said he had called the attack an “act of terror.”  Governor Romney responded, “I want to make sure that we get that for the record because it took the president fourteen days before he called the attack in Benghazi an act of terror.”  To which the president replied, “Get the transcript.”  The moderator, Candy Crowley, then corrected the governor, saying that the president did indeed call it “an act of terror,” which instigated a round of chuckling from the town hall audience.

This brief exchange has spawned several heated debates across the Internet, most of which are littered with logical fallacies, misquotes, and other elements that foster the development of poor arguments.

If you’re interested in diving into the fray, here are a few points to consider along the way:

Start by reading the rose garden transcript yourself. Here is a reprint of the paragraph in question: “No acts of terror will ever shake the resolve of this great nation, alter that character, or eclipse the light of the values that we stand for. Today we mourn four more Americans who represent the very best of the United States of America. We will not waver in our commitment to see that justice is done for this terrible act. And make no mistake, justice will be done.”

Don’t take my word for it, double check.  I rewound the debate and found this, “The day after the attack, Governor, I stood in the rose garden and I told the American people and the world that we were going to find out exactly what happened, that this was an act of terror, and that we were going to hunt down…[etc].” And, to restate an earlier quote, Romney replied, “I want to make sure that we get that for the record because it took the president fourteen days before he called the attack in Benghazi an act of terror.”

The typical argument stemming from this generally has one or more common fallacies at its root—either straw man, red herring, equivocation, or any combination of the three.  Here’s an example:

One headline reads, “Candy Crowley gets it wrong: Obama never called Benghazi a ‘terror attack’ in Rose Garden speech.” You’ll remember that the straw man happens when distorting or misrepresenting a person’s position in order to make it easier to attack, and a red herring happens when the arguer sidetracks the audience with an irrelevant issue and then claims that the original issue has been effectively settled by the irrelevant diversion.  The author of the headline here distorts the term “act of terror” into the term “terror attack,” insinuates that Candy Crowley confirmed the president’s use of the distorted term (which she did not, she used the correct term “act of terror”), and attempts to settle the issue based on the fact that the president never called it a terror attack.

A point of interest: Many of the arguments I’ve seen this morning imply that the president was saying something different by his choice of words—that in the debate the president was claiming that during his rose garden address on September twelfth he had called the killings a terrorist attack against America.  The claim here is that even though in the debate he accurately represented his own verbiage, the president was trying to get away with insinuating that he had meant something stronger than what he had actually said.  The problem with that argument is that it leads us straight to another logical fallacy, Equivocation (using a key word or phrase in an argument in two [or more] different senses).  Considering that the president didn’t give any additional context, but rather restated his comment from the rose garden, makes it more difficult to read into his point.  Conservative supporters are claiming that the administration was focused on the idea that the killings were in response to the anti-Muslim YouTube video.  The video caused an Internet uproar, millions of people from around the world had seen it.  And, most importantly, when the attacks took place, association with the video became a rumor that went viral on the web.  A look at the rose garden transcript and a look at the original address by Secretary Clinton reveals that the administration was aware of the magnitude of the rumor, and regardless of the origin of the attacks, the administration had to comment and denounce the message of the video.  Note that Secretary Clinton stated that they did not yet know the origins of the attack.

An important question here asks what the value is in this argument.  Think about it.  Apply critical thinking skills. Stay sharp.

 

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by Joe

The Three Typical Responses To Statistical Information: Which Describes You?

October 16, 2012 in General

a. The Naïve- These are the suckers.  Unfortunately, this describes many people ingesting statistics.  Mostly trusting and honest, they expect that those presenting stats will be the same.  Without a true understanding of what statistics actually represent, the naïve are prone to buying into the numbers whole-heartedly and to mangling stats as they pass them along to others.

b. The Cynical- These are the shysters.  A small but important group in the world of statistics, the cynical don’t believe that the numbers tell the truth.  They understand that statistical data are malleable and doubt the validity of numbers used in proving facts.  As statisticians, the cynical will manipulate numbers to further whatever agenda it is that they are promoting, and they expect that their opponents are doing the same.

c. The Critical- While the cynical tend to reject stats, the critical attempt to differentiate between the good stats and the bad.  They realize the imperfection inherent in all stats, even good stats, but still understand that very valuable information can be obtained from good stats.  They understand the processes involved in creating statistics and ask deeper questions regarding who, how, and why when presented with numbers.

Strive to become a better critical thinker.  Recognize statistics for the value as informative tools, but remain aware of their limitations.  See good stats as potential for support, not as proof positive of your position.

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by Joe

The Numbers Don’t Lie… Or, Do They? Issues With Statistics

October 16, 2012 in General

How can you shore up your argument with indisputable facts that will cement your point and convince your opponents?  Simple, get the statistics that support your position and your done, right?

Unfortunately, it’s not that simple.  Let’s take a look at some common issues that affect the efficacy of statistical information.

a. Guessing- Inventing numerical representations in the absence of reliable data.  Stats founded on guesses have the tendency to take on lives of their own, in which someone mistakes the guess as fact, reports it as such, others accept it as such and further purport it; in some cases, widely known “facts” had their foundations laid by pure speculation.

b. Definitions- The definition of an issue can distort the norms in which the issue exists.  The author may make use of examples as mechanisms used as definitions, many times exaggerating the norms.  For example, death penalty proponents will often cite the most heinous and graphic crimes to shock their audience, making it appear as if these are the norms for death row inmates, when in reality the literature shows that the majority of death row inmates are there as a result of lesser crimes gone bad.

c. Measuring- A major issue in the concept of measuring is that certain types of data collection, for instance survey research, are prone to over-simplification.  Respondents are limited to the available choices listed on the survey, so if their “true” response exists outside of those offered on the survey, then the survey results can’t be considered completely accurate.

d. Sampling- With sampling, two key factors can be problematic:

1. The sample size; a researcher might survey 1,000 people to represent a population of 1,000,000… maybe only 100.  The smaller the sample, the less reliable the results. 

2. Those chosen to represent the population must accurately represent that population.  A survey of one hundred upper-middle income white families in a city whose residents are mostly poor minorities would not necessarily accurately represent the greater population of that city.

e. Mutant stats- These are stats that may have started out as reliable numbers, but have been twisted or distorted past the point of legitimacy.  Sometimes this is a product of deliberate distortion to add power to someone’s claim on an issue.

To safeguard yourself, be critical and don’t take stats at face value.  As with everything else promoted at Jopples, apply critical thinking skills, look beyond the surface, and ask the deeper questions.  Start by asking yourself if what you’re looking at makes common sense, then do the research and make an informed decision.  In the end, you will be more confident in the reliability of the information that you are sharing with the world.

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by Joe

Socrates On Democracy: It’s Better Than Tyranny But Not By Much

October 16, 2012 in Philosophy, Politics

There are three kinds of people in a democracy: the idlers, the wealthy, and those who work with their own hands. I refer to them in the present tense as it seems just as applicable today as it did twenty-four hundred years ago when Plato wrote it down. Today we might think of the separation as: the politicians, the rich, and those who do the work.
Socrates claims that the idlers are the managers of democratic government. This group makes a craft our of flattering the majority; they are the strong speakers who know what the majority wants to hear and they deliver with skill and charisma that gets them elected into positions of power and influence. According to Socrates, this group can be subdivided into Group A, the leaders that take action and give the speeches, and Group B the followers that promote the rhetoric while dismissing and disallowing the message of the opposition. One interesting example from contemporary circles might be to look at someone like Mitt Romney as a Group A member and Rush Limbaugh as a Group B.
The second group are the wealthy products of deteriorated oligarchy, if one is to follow the sliding scale example proposed by Socrates. In the oligarchy the wealthy are the power brokers of government; in the democracy they feed the idlers their wealth in order to purchase power. We see this today as well. While you or I might have quite a difficult time trying to get an audience with the President of the United States, billionaires and captains of industry can get that audience, some don’t even need an appointment.
Both of these groups, the idlers and the wealthy, are in the minority as most people belong to the third group. Socrates describes the working class as the most powerful group, yet as a group that rarely exercises its power. These are the common folk who are busy with the toils of living from day to day, rarely concerning themselves with money and politics beyond that which directly affects them at any given moment. This group seems to match up well with today’s American middle and working classes. This is the group that handles all of the production and labor, and very little of the wealth.
As we are several models away from Socrates’ ideal government, Socrates voices concern over how leaders are selected in a democracy. The free thinking open minded view of the democrat doesn’t leave room for inequality (even, as Socrates puts it, among unequals). As such, whoever can win over the majority opinion, regardless of qualification, background, or training, will be selected to manage the government. And Socrates points out that management of such a government is prone to failure regardless of management due to intrinsic holes in the concept of democracy itself.
One major flaw in the concept of true democracy stems from that which democracy praises above all else, personal freedom. The highest value is given to personal freedom, which ultimately must arrive at a point of anarchy as no man will be willing to give himself over to the rule of any master. Notice here that Socrates is talking about freedom in its most extreme state; in this sense there doesn’t seem to be much distinction between democracy and autonomy, as both seemingly imply complete self-rule without the encumbrances of others. Socrates points out that the only possible response to extreme freedom is extreme slavishness. This effect is due to the inevitable rallying around a hero/tyrant who will “save” the city from the oppressive hording wealthy class through a period of forced redistribution, at which point the wealthy will blame the idlers, who do nothing but talk and give orders and wear enamel veneers on their teeth. Revolution breeds and the masses rally around a strong central figure who will restore order at the cost of all that freedom the citizens had spent so generously.
Of course what’s important about all of this to Socrates is how this example of city governance can be transposed to represent the self-governance of individuals. The seemingly desirable qualities of freedom and equality take on a different light. Socrates tells us that the individual who rules himself as a democracy will ascribe equal value to all pleasures, both necessary and unnecessary, due to his core belief in equality. The fundamental flaw in this is that serving all desires will be looked at as good; therefore, people will not be motivated by the Good itself, nor will they be able to identify it as something in and of itself, but rather never get beyond their own opinions and will always fail to arrive at any substantial truths. If one cannot identify the Good, then one would have great difficulty in determining that which springs from the Good. As such, these people will be unable to determine Justice thereby supporting the bigger argument that the Republic presents.
At the end of the day, Plato has produced a work of remarkable insight that seems as relevant today as it ever was. While I might not agree with every point he makes, each point is still worthy of consideration. If nothing else, Plato provides a solid foundation to ground the argument from which argument can grow.

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by Joe

So, How Did All of this Reasoning Business Get Started in the First Place?

October 16, 2012 in Philosophy

I’m glad I asked.

In order to shed a bit of light on what we accept as the genesis of reasoning in Western thought we’ll have to take a trip back in time to take a peek at the philosophers who predated and influenced Socrates.  A study of the pre-Socratic philosophers, from Thales through Leucippus and Democritus, provides insight into three major intertwined innovations in thought which changed the way in which the universe is explored and understood.  Primary to the of the pre-Socratics is the concept of reasoned argument, that if one is to make a claim, then that claim needs to be supportable through proper reasoning.  Here, the rise of logical debate set a standard of justifying claims by backing them up with reasoned arguments.

Secondly, with reasoned argument came a rejection of a priori arguments that attempted to describe the nature of the universe.  Appeals to divine authority no longer sufficed to explain the nature of the universe.  Instead, the pre-Socratics stated that everything in the universe can be explained in natural terms from within itself; to discover what the universe is made of one need look no further than nature itself for the answer.  Here was the development of a natural philosophy.  This was a bold rejection of the Homeric descriptions of ancient Greek mythology which had attributed much to the gods and which tended to anthropomorphize nature and natural occurrences.

On this point, the earlier pre-Socratics, Thales through Parmenides, posited that there was some fundamental ingredient that operated as the most rudimentary building block for everything in the physical universe.  For Thales it was water, for Anaximander it was something indefinite yet real, for Anaximenes it was the dense mist he called aer.  How these things might be understood to fit together in order to make up the universe as we know could not be reasonably explained by religious dogma.  According to Readings in Ancient Greek Philosophy 3rd ed., edited by Marc S. Cohen, Xenophanes explained of those appealing to divine authority, “even if a person should in fact say what is absolutely the case, nevertheless he himself does not know, but belief is fashioned over all things” (23).  This led to the third innovation in thought by the pre-Socratics, that if there are, in fact, fundamental building blocks of some essential stuff in the universe, then there must be some definable laws that determine how that stuff is arranged and combined in order to create and sustain the universe as we know it.

The Pythagoreans posited that the laws were rooted in numerical ratios.  Heraclitus called the law of the cosmos logos, a single, independent law that “rules and guides the universe” (24).  Here, Heraclitus attempts to “bridge the gap between divine and human knowledge [...] by claiming that there was a link between the divine logos (the account of what there is) and the souls of human beings” (24).  This shows, among other things, that the pre-Socratics weren’t ready to completely give up on the idea of the divine, they simply realized that the divine was a topic that was beyond the capabilities of human reasoning to understand; therefore, it did little good to argue about it.  Also important to Heraclitus was the idea that things are defined by their opposites.  Thus, what is hot is only hot in relation to that which is colder and vice versa.  This sets up Parmenides’ theory that their must be a significant amount of void in the universe, as there is a significant amount of substance; and, according to the law of opposites substance can only be explained as substance if there also exists, not a lack of substance which is a negative, but a positive something that he explains as a void.  My example is to compare the notes in music to the rests.  It is through the combination of notes and rests, both as positive values, that rhythm is created; without the rests, there would be just one blob of sounds, each locked to the others.  Likewise, Parmenides argues that there could be no movement without void as everything in the universe would be but one solid mass.

The Pluralists claim that there are many, rather than one, essential substances that set the foundation for the physical universe.  Yet Zeno elucidates the apparent contradiction in the Pluralists dialog.  If there are many essential things that make up the fundamental building blocks of the universe, then there are a limited number of those things, yet if there are more than one, then “there are always others between the things that are, and again others between those, and so the things that are are unlimited” (61).  The problem presented here is that the infinitely divisible rejects the idea of any rudimentary element from which all else is derived.  This brings us to the end of the pre-Socratics as it sets up the Atomists whose claim it is that somewhere at the bottom lies that which is indivisible.  It is from these fundamental “atoms” joining in concert with one another in particular combinations that give the foundation for the universe–not bad for a group getting by on thought alone.

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by Joe

It’s My Body, Isn’t It? Finding an Ethical Model for Pain Management that Works

October 16, 2012 in Health Care

Millions of Americans suffer from chronic pain.   A Gallup survey taken in 1999 reported that “pain is so common that about 9 in 10 Americans suffer from pain at least once a month, and data as of 2000 suggest that almost 1/3 of all Americans will experience severe chronic pain at some point in their lives” (Nathan 156).  Chronic pain sufferers whose best chance of relief often comes in the form of opioid pain medicines are often met with frustration when they turn to doctors for relief in the face of a system influenced by a society that discourages the use of narcotic analgesics.  Considering that “pain constitutes the most common reason why individuals seek health care” (Nathan 156) an ethical approach to pain management must be found that meets the needs of both patients and the medical community.  To meet those needs, a two-fold formula of narrative-based ethical theory implemented through a comprehensive clinical team approach should be adopted throughout the medical community.

An examination of the broad-based consequentialist and deontological theories will illuminate the need for an approach that has the flexibility to address individual needs of patients with chronic pain.  Looking at the narrative approach the focus will move from the patient’s own story, to the need for patient autonomy, to issues of physicians’ trust in patients’ self-presentation, and to issues of drug addiction.  The team approach to treatment will address issues of physician autonomy, overcoming patient manipulation, and the government’s role in providing an ideal environment for physicians to utilize their skills to the fullest of their abilities to deliver the best possible patient care.

The idea of positive rights to pain relief, while worthy of debate, are beyond the scope of this paper.  Also exempt from the discussion are issues regarding treatment of cancer pain and terminal illness as “improving palliative care [care for those whose conditions are incurable] for the dying, including relief of pain, has been a national policy priority for nearly a decade.  There is broad and deep agreement that pain management is a core medical and ethical duty for the dying patient” (Johnson 220), so the focus will be on illustrating an ethical model for the broader chronic pain community.

A problem facing the pain management community is that “we now have high quality evidence about what works in pain management, but patients still experience moderate to severe pain and the consequences of this can be long lasting and severe” (Seers 4).   Competing ethical views of approaches to pain management prevent physicians from “consistently meeting the challenge of optimal pain management for a variety of reasons, including lack of knowledge; the values and beliefs that affect our judgments; how we make decisions and use evidence about pain management; and a lack of prioritization of pain and its management both at an individual and institutional level” (Seers 4-5).  An individualized, flexible and comprehensive approach is needed to address the growing disparity between patient needs and treatment norms.

In formulating ethics in pain management, it is necessary to gain an understanding of the complexity inherit in tensions between conflicting patient needs and the needs of the physician, forcing the question as to “what other duties must be balanced against the duty to provide pain relief” (Sullivan 274).  The Kantian might argue that as long as the doctor adheres to the concept of the categorical imperative, of acting from a sense of duty, the doctors will always do the right thing.  But physicians often find themselves in a dilemma of conflicting obligations “due to the dual imperatives of the pain management movement and the prevention of prescription drug abuse” (Miller 54).  Extrinsic social factors weigh upon physician decision making and influence treatment approaches.  On one hand, “the ethical principle of beneficence mandates physicians to do good for their patients” (Lebovits 441).  Advocates of the pain management movement for chronic pain sufferers adhere to the principle that “when the primary disease/condition cannot be eliminated, the objective of medical intervention needs to focus on the relief of pain and suffering” (Nathan 155).  On the other hand, societal views and government policy on drug abuse create a duty to refrain from doling out narcotics without justification.  The trouble for the Kantian is that “because all duties are considered absolute, there is no guidance available for balancing conflicting obligations” (Sullivan 276).  When doctors are required by duty to do both x and y, but x and y conflict, there is no mechanism for reconciliation in the Kantian framework.

The consequentialist would say that the “best overall result is determined from an impersonal perspective that gives equal weight to the interests of each affected party” (Sullivan 275).  The problem here is that utilitarianism would allow patients to drug themselves into oblivion.  From a patient’s perspective, “if someone were to truly prefer an opioid regimen that produced a lifelong stupor rather than some minimal discomfort from walking, utilitarianism would support such a choice” (Sullivan 275).  The consequentialist view from a physician’s perspective would allow that “obtaining pain relief in easily treated individuals would be favored over obtaining pain relief in less easily treated individuals” (Sullivan 275) as that would promote the best interest of the physician.  If a utilitarian agrees with the notion that drug abuse is harmful to individuals and/or society, given that “the National Institute on Drug Abuse (NIDA), a division of the National Institutes of Health, reports that an estimated 4 million people—almost 2% of the population aged 12 and older are currently using prescription drugs, including pain relievers, sedatives, and tranquilizers, nonmedically” (Miller 56) the utilitarian must acknowledge the need for regulating physicians’ abilities to prescribe these drugs.  But Lebovits asks, “what is the harm if treating chronic pain adequately means that opioids may get into bad hands—if the overall good is that patients will suffer less and be more productive members of society, have better relationships with their spouses, and be better parents to their children” (441)?

The Kantian and the consequentialist ethical theories are too broad-based to effectively apply to pain management, for “where utilitarianism seems to fail by making everything negotiable, in the pure Kantian system nothing is negotiable” (Sullivan 276).  Instead, the complexity involved in making pain management decisions calls for flexibility in understanding and accepting individual circumstances to allow for tailoring appropriate approaches to each patient.

A two-fold approach is called for, one part theoretical and one part empirical.  The theoretical approach must be rooted in the unique narrative brought by each patient “because it is very difficult to determine whether and how much someone is suffering without being aware of the story that accompanies their experience” (Sullivan 276).  A narrative-based ethical theory “is the opposite of the principle-based or top-down model.  Here the story of the individual case becomes of core importance, of paramount understanding” (Sullivan 275).  Differences in condition, severity, pain tolerance, genetics, psychological state, upbringing, and cultural background all affect the patient’s level of comfort, response to pain, and response to treatment.  The only way to begin developing a program that works is to understand the narrative that addresses how all of these issues are affecting the patient.

The concept of applying a narrative-based ethical approach immediately brings up two questions:  can it be done, and can patients receiving narcotics be trusted?  (A third question, should it be done, is a valid question, but it goes beyond the scope of this paper.)  In attempting to treat a patient suffering from chronic pain the physician finds that “the complexity of pain management decision-making is compounded by the subjective nature of pain, the necessary communication between patient and clinician to understand and treat the pain problem, and the dependent relationship promoted by the healthcare system” (Seers 5).  In order for the narrative process to work the patient must have autonomy and “autonomy requires two essential conditions: 1) liberty, or independence from a controlling influence; and 2) agency, or a capacity for intentional action” (Sullivan 277).  Enabling patients to retain and utilize their agency means that “patients need to be educated about the risks and benefits associated with pain treatment.  They need to be cognizant of the trusting relationship that must exist between themselves and their physician in order for their pain to be adequately treated” (Nathan 160).  Difficulty in maintaining patient autonomy arises with the introduction of pain and the desire of the patient to be rid of his/her own suffering as “pain, for example, may push patients to a point where they are no longer able to carefully weigh the risks and benefits of surgery” (Sullivan 277).  Adding to the difficulty is the fact that “medications such as opioids or benzodiazepines that induce physiologic dependence hold special risks for erosion of patient autonomy.  In these situations, respect for patient choice must be combined with awareness of the compromise of patient autonomy by unrelieved pain and by dependence-inducing medications” (Sullivan 275).  Since autonomy requires freedom from controlling influence, addiction to pain killers can create “patients who are unable to make choices that avoid harm” (Richeimer 396).  But addiction is often overstated and misunderstood.

The Cleveland Clinic defines addiction as “characterized by loss of control, cravings, and adverse consequences resulting from use of a substance” (Webpage).  The Cleveland Clinic makes a distinction between “physical dependence [and] tolerance.  In cases of physical dependence, there are withdrawal symptoms if a person suddenly stops using a substance.  Tolerance occurs when the initial dose of a substance loses its effectiveness over time” (Webpage).  Chronic pain patients who take narcotic pain medication as prescribed will develop tolerance and physical dependence over time, by that does not, by definition, constitute addiction.  Contrary to popular belief, “the risks of addiction to opioids in chronic pain patients is low” (Lebovits 441).  But that fact doesn’t eliminate distrust.

Physicians prescribing narcotics must be continually aware of the possibilities of manipulation by the patient “because treatment of pain with opioids, unlike most other professionally sanctioned medical treatments, is subject to a heightened level of scrutiny from outside agents, some of which have the power to levy significant legal or professional sanctions” (Miller 57).  As a result, “trust in patients in this context can be hard to achieve and easily fractured” (Miller 57).  Here, the major argument against the narrative approach is that “doctors are continually faced with patients whose clinical presentation appears to be influenced by other motivations:  seeking disability income, drugs, a work excuse, a jail excuse, or to gain attention” (Richeimer 396).  As a result, “doctors are now likely to refuse to give opioids.  Many doctors also refuse to deal with disability issues.  It is almost as if the default position has become one of distrust” (Richeimer 396).  Yet, Richeimer’s implications fail to address the fact that “a patient who legitimately experiences chronic pain does not assure honesty or reliability in the control of prescribed medications.  In the same respect, a patient with a criminal history or history of addiction is not prevented from the emergence of painful conditions” (Nathan 159).  The solution to these issues comes from the empirical side of this two-fold approach.

The narrative approach implemented through a comprehensive approach utilizing a team of physicians and clinicians moves to solve both the problems of patient deception and the danger of sanctions faced by physicians.  For patient honesty “the use of multiple team providers, physicians, and nonphysicians would help detect deception.  In particular, the employment of a psychologist who is trained in behavioral assessment as part of the interdisciplinary team” (Lebovits 441) would help to address patient needs even if the patient was suffering from addiction in addition to pain.  As it stands today, “an addicted patient in chronic pain presents physicians with two of the conditions with which medical education in the US least prepares them to cope” (Miller 59).  As such, the best chances for success lie within the clinicians’ abilities to work with one another and know each others’ abilities and limitations; “for health professionals to collaborate in meeting patients’ needs, they must understand each other’s role and expertise.  This understanding is the foundation for valuing and respecting others’ contributions to the management of complex problems, particularly for people with persistent pain” (Seers 5).  This comprehensive approach gives the patient the best chance of success by combining the efforts of specialists in various fields such as internal medicine, anesthesiology, psychology, and family practice.  The approach also gives the team of clinicians greater indemnity, enabling them to focus more on treating the patient and less on extrinsic influences like Drug Enforcement Administration investigation and social biases that tend to be pervasive in decisions made by individual physicians treating chronic pain patients.

The physicians need autonomy as well in order to function to the fullest of their abilities.  Government is slowly giving doctors the protections they need to freely treat patients.  State “legislatures, withCaliforniain the lead, have enacted statutes to protect physicians from inappropriate disciplinary action; to encourage effective treatment of patients in pain; and to ensure that physicians receive appropriate training” (Johnson 220).  While the patients and their stories may be unique, standards can still be applied to the prescribing of narcotic medications. To this, “twenty-two states have adopted all or part of the Federation of State Medical Boards (FSMB) ‘Model Guidelines for the Use of Controlled Substances for the Treatment of Pain’” (Miller 55).  Doctors are given enough flexibility within those standards to accommodate for reasonable parameters in pain assessment.  “These guidelines, published in 1998, are meant to provide protection to physicians who prescribe opioids for pain, by encouraging clear and consistent standards and by educating the regulatory and physician communities on treatment with controlled substances” (Miller 55).  The fine-tuning and further adoption of these guidelines by the nation’s medical communities can put the decision making back into the doctor’s office and out of the administrator’s office.

At the end of the day the most important aspect of the narrative approach is forging of a strong physician-patient relationship because, “at the most fundamental level, in a good physician-patient relationship, the physician typically trusts the patient as a moral agent” (Miller 53).  Acting in a trusting physician-patient relationship within the parameters of flexible but consistent standards, with a team of clinicians all focused on the best interests of the patient gives the patient the best chance of success, which, after all, is the point of medicine.

Other related issues that are beyond the scope of this paper, but are none-the-less worthy of consideration include: the requirement of patients trusting their doctors and the ethical implications of mutual trust between actors of unequal power and authority (the doctor being the authority and the patient retaining autonomy in a quasi-paternalistic relationship), the effects of requiring physicians to act in the capacity of law enforcement in detecting and preventing drug abuse, criminal prosecution of physicians for drug trafficking and the effects of those cases on the medical community’s approach to pain management, and the over-arching question of whether or not society has the right to regulate how people medicate themselves in the first place.

Works Cited

ClevelandClinic. “Pain Medicines: Understanding Addiction.” 1995-2009. 27 Apr. 2009 <http://my.clevelandclinic.org/disorders/chronic_pain/hic_pain_medications_understanding_addiction.aspx>

Johnson, Sandra H. “Commentary: Sandra H. Johnson, JD, LLM.” Pain Medicine 5.2 (June 2004): 219-221. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH.  27 Apr. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=13355879&site=ehost-live>.

Lebovits, Allen. “Physicians Being Deceived: Whose Responsibility?.” Pain Medicine 8.5 (July 2007): 441-441. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH.  27 Apr. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=25905230&site=ehost-live>.

Miller, Jessica. “The Other Side of Trust in Health Care: Prescribing Drugs with the Potential for Abuse.” Bioethics 21.1 (Jan. 2007): 51-60. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH.   27 Apr. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=23414138&site=ehost-live>.

Nathan, Jonathan I. “Chronic Pain Treatment: A High Moral Imperative with Offsetting Personal Risks for the Physician—A Medical Student’s Perspective.” Pain Practice 9.2 (Mar. 2009): 155-163. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH. 27 Apr. 2009.  <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=36606225&site=ehost-live>.

Richeimer, Steven H. and Lisa Victor. “Response to Commentaries.” Pain Medicine 6.5 (Oct. 2005): 396-396. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH.  27 Apr. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=18589960&site=ehost-live>.

Seers, Kate, Judy Watt-watson, and Tracey Bucknall. “Challenges of pain management for the 21st century.” Journal of Advanced Nursing July 2006: 4+. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH.  27 Apr. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=21023432&site=ehost-live>.

Sullivan, Mark. “Ethical Principles in Pain Management.” Pain Medicine 1.3 (Sep. 2000): 274-279. Academic Search Complete. EBSCO.KentStateUniversityTrumbull Library,Warren,OH.  27 Apr. 2009 <http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=5511991&site=ehost-live>.

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by Joe

A Look at a Negative Political Ad Against Obama

October 15, 2012 in Politics

Here’s an ad that a friend was sharing on Facebook. It offered a picture of Barack Obama sporting a smug smile and a smaller portrait of an old Obama campaign poster over a caption reading “Hope is Fading.”
Here is the ad’s text:

“Obama thinks taxing billionaires will pay for his reckless spending. Obama is nothing more than an idiot in need of basic math skills.
Number of Billionaires in the United States: 403
Average Annual Income of US Billionaire: $106 Million
Tax Revenue if All Income Taxes at 70%: $30 Billion
Obama’s 2011 Budget Deficit: $1.27 Trillion
Percentage of Deficit Paid by Billionaire Tax: 2%”

I enjoy well reasoned discourse and debate on the candidates and issues. Posts like the one above try to convince in lieu of well reasoned argument. Let’s break it down and see how it holds up:

1.”Obama thinks taxing billionaires will pay for his reckless spending.” This is an excellent example of a Straw Man fallacy (distorting or misrepresenting a person’s position in order to make it easier to attack). After four years in the Senate and four years in the presidency, it’s a fair bet that Obama does not think that taxing billionaires will balance the budget.

2. “Obama is nothing more than an idiot in need of basic math skills.” Here we have a good example of an Ad Hominem (Attacking a person’s character rather than his or her argument or claim). You can call it personal attack, name calling, etc. However, at the end of the day claims like this result in dialog that resembles this: “Yer ig’nert!” “Nuh uh, yer ig’nert!” “Nuhhh uhhh, yerrr ig’nert!” And, so on.

3. We also have a bit of a Red Herring in the math argument. Note that if you accept the premise that statement one distorts Obama’s position, then the table at the bottom gets revealed as an irrelevant issue that sidetracks the reader and then claims to settle the argument that Obama needs math skills based on the irrelevant diversion of the billionaire math.

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