15 Comments

A broad misunderstanding about suicide in our society is that it’s a rational/well considered choice. I think talking about deaths of despair, it adds to this idea that suicide “makes sense” for the people who are dying by it. In reality most suicides are about a temporary spiraling and considered for about 15 min to hour before taking action. They’re more about the environment than anything in terms of the outcome (survival versus death). The key determinant is whether you have a gun handy during your momentary crisis or not.

Expand full comment
author

That's a great point about suicide -- I think it's pretty brazen to group suicide, alcohol, and opioid ODs all under the same category. These things just don't go together the way they think they do. Only with a very reductive and simplified understanding of these phenomena can they all said to be alike.

Expand full comment

Additionally: some portion of suicidality is a rapid onset of a neurotransmittor issue that has nothing to do with a person's intentions or life factors. Plus, the more we learn about epigenetics, the more it appears that things like early childhood abuse are related to risk at a biological level, versus an individual level.

Expand full comment

America’s drug and health care system is deregulated? Tell that to the chronic pain patients who can’t find a pain management practice or get any medication due to CDC “guidelines,” and state medical boards that can ruin a physician for prescribing “too much.”

Expand full comment
author

In the 2000s it sure was

Expand full comment

Not really. Obamacare was just a sop to the insurance industry. Pill mills existed and Purdue pharmaceuticals sneaked oxy past the regulators but the health care system was not a free market. Far from it in fact. Hospital price fixing and collusion have been going on forever.

Expand full comment
author

Price fixing, collusion, pill mills, Purdue's corporate crimes -- isn't all this symptomatic of a deregulated health care system?

Expand full comment

No it’s symptomatic of a corrupt one. With deregulation you would have competition among hospitals, lower drug prices and reasonable rates for doctors visits. Even Mexico has these things.

Expand full comment

Oh.

I see.

If things are really deregulated everyone will fairly compete to get the best thing and groups will never create cartels because that's just a symptom of regulation.

That's some strong kool aid you got there....don't eat the worm. 😉

Expand full comment

I think we can agree that there’s bad and good regulations. Good ones make health care easier and cheaper. Bad ones increase the profit of hospitals, drug companies and insurance companies and don’t benefit the people.

Expand full comment

hospital price fixing goes on with the blessing of the regulatory bodies in contravention of the law. Try again.

Expand full comment

It's a relative term.

Compared to most wealthy nations our system can be said to be deregulated and your experience shows why that's the case.

Where I live I had no trouble getting into a pain clinic, and CDC "guidelines" aren't laws, no one has to follow them.

There's no national standards.

Instead you just have to deal with whatever is happening locally or whatever is the mood of the person you happen to get.

Threats to providers that come from local politicians, pressure groups, DEA or local drug enforcement isn't regulation. None of those people should be involved in medicine at all, but they have power.

So even though it feels like "regulation" to you, it's actually the opposite.

It's chaos.

Expand full comment

Come on man. Legal Threats from the DEA and guidelines that can end careers are regulations, however chaotic the end result. I know the pill mills in Florida and other states were not heavily regulated but they were shut down after the addiction issues became known. I wish that was the biggest thing we had to worry about! I agree that the health care system is messed up but not just from lack of regulations.

Expand full comment