From time to time, a case study: Heroin

From time to time, a case study

Racism, Labor Conflict, and Drugs

CBC focus on the topic, with coverage of 1st Nation vulnerabilities and alcohol.

http://one.npr.org/i/537762064:537762066

If nothing else, listen to Carl Hart segment at 17:20 - 20:00.

Read up on it to get the chemistry right as you think about cocaine powder HCl and crack-cocaine

Skips over the difference between nasal insufflation and inhaling fumes into lungs ("smoking"?).

Also see book by Helmer & Vietorisz, 1974, an early introduction to racism and labor conflict described in the podcast.

https://libcom.org/history/drug-use-labour-market-class-conflict-john-helmer-thomas-vietorisz

Eric download

Recent news story pertinent to  this topic:

Former NFL Player Sues Jeff Sessions Over ‘Unconstitutional’ Marijuana Laws

http://www.huffingtonpost.com/entry/marvin-washington-jeff-sessions-marijuana-lawsuit_us_597746f6e4b0a8a40e825949?section=us_politics

Shaffer Library of Drug Policy

The online library is pretty impressive.

Library link

"The Facts about Drug Abuse"

Concluding paragraph of the report:

"Recognizing that deeply felt attitudes and established policies reflect fears and judgments that will yield slowly, if ever, to facts and conditions described in the council's publications, we recommend that serious consideration be given to the use of individual state or local option as a means of attempting solutions appropriate in one place but not in others. Local option could encourage greater flexibility and ingenuity rather than reliance upon an unrealistic, rigid homogeneity in national drug policy. We need to respond to the diversity of people who use and misuse drugs, base all our policies on a consistent set of principles seeking to discourage misuse, and keep our seemingly innate drug-using behavior within reasonable limits through means which do not themselves cause more harm than they prevent."

Drug Abuse Council final report, 1980.

Cross-sectional Schmosh-sectional. What is the issue?

I have stopped accepting "cross-sectional design" as a weakness in descriptions of study limitations.

This is like saying a US sample in 2017 is a limitation because it is not a sampling of the totality of human experience.

My most recent critique says this:

They confess cross-sectional design as weakness, but that actually is not right. 

The cross-sectional design is not the impediment to inference.

The impediment is failure to assess/know temporal sequencing of construct values.

The work might have been constructed with cross-sectional design, to sort out the temporal sequences, thereby avoiding sample attrition, measurement reactivity, and other biases that plague prospective and longitudinal studies.

Framed in this way, the problem is not one of cross-sectionality in design.

Rather, it is failure to sort out temporal sequences.

True, you can sort out temporal sequences more readily in a longitudinal design, but suppose you don't assess temporal sequencing.

All you know is that X converted from a value of 0 to a value of 1, during the same interval within which Y converted to a value of 0 to a value of 1. You have done a longitudinal study, but you haven't kept track of whether X changed from 0 to 1 before Y changed from 0 to 1.

 Clearly, the limitation is not the cross-sectional nature of the design.

Rather, it is failure to keep track of and to manage the temporal sequencing.

Does this distinction matter?

Textbook learning teaches you to think of the cross-sectional design as always inferior to the longitudinal design.

Experience teaches you that the cross-section, per se, is not necessarily a weakness.

Bittersweet symphony

What Cookies and Meth Have in Common?

Interesting question. The implicated assumption here is that cookies and meth do have something in common. Do they? Is the engagement of the brain reward system after intake what they have in common, or the other way around-- stress-induced changes to the reward system alters the risk for both eating and drug problems? Food is for survival. Meth is not. Meth interacts with dopamine transporters directly; cookies don't. (Cookie Monster's sad face)

Is stress and high accessibility the deadly combination for obesity and drug problems? Don't we need a 3*3 factorial design to test it out? I'd bet my money on accessibility. 

Thoughts are welcome!

Keith Connors, Ph.D., R.I.P., July 5, 2017

Excerpt from interesting BMJ linked obituary co-written by Allen Frances and by Connors, with primary focus on ADHD:

"Keith believed that the overdiagnosis and overmedication of millions of children resulted from aggressive marketing by pharmaceutical companies, careless doctoring, worried parents, and schoolroom chaos."

BMJ link: http://www.bmj.com/content/358/bmj.j2253

Describes his early work with Leon Eisenberg, then at the Hop.

In the 1980s it was interesting to watch and learn how Connors was focused on careful standardization of clinician examination protocols, with diagnostic cross-examination and workup, and to contrast the standardized questionnaire approach advocated by Tom Achenbach (with no cross-examination involved during assessment).

Interesting BBC news article on gender issues pertinent in research

Link to article