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Tactical Ninja - No cut for you today

Feb. 4th, 2014

11:21 am - No cut for you today

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So Philip Seymour Hoffman died, apparently of a heroin overdose.

"Yes yes we know, Tats. That's yesterday's news." I hear you say.

I just have a few things to say about it, in response to the various opinions I've been reading over the last day or so.

For a start, drugs are not evil. Good luck even defining exactly what a drug is, never mind ascribing human characteristics or value judgements to them. Heroin is not inherently evil either. People who use heroin are not evil. I think poor dead Philip is a case in point, eh?

Using drugs does not inevitably lead to addiction or death. In fact, depending on who you read (and believe me, I've read as many studies on this as I could find), between 85 and 97 percent of people who use illegal drugs* never have any problems. So let's not be saying he died from drug use. He died from an overdose of a drug that he had used many times without dying. He died, if you insist, from drug MISuse - he got the dosage wrong, took too much. Just like, you know, if you use a car it's not harmful. If you misuse one you can kill yourself and others. It's an important distinction in the field of drug study. I suggest you learn and use it.

Did you know that heroin-assisted maintenance programs are improving outcomes for even the most entrenched cases of heroin addiction in Europe nowadays? The programs aren't getting people off the drugs directly. What they are doing is allowing people to extract themselves from the 'junkie' lifestyle by removing the harms associated with the black market - dirty needles, impure heroin, dealing with the criminal underworld, paying exorbitant prices - by providing measured doses of pure heroin free of charge, under supervision. What they have found is that when people are no longer having to deal with all that crap, they can improve their lives to the point where many heroin addicts are functioning within normal society - holding down jobs, paying taxes, raising families. And often, when people are experiencing these trappings of 'success', they then choose to slowly reduce their dose and come off heroin. Not all, but it's telling that heroin maintenance has been significantly more successful over a number of outcomes than just about every other intervention available.

Why am I telling you this? Because I'm tired of hearing about how it was the drugs that did this, that or the other to a person. In the case of heroin, while it is addictive, does have high overdose potential, and is objectively one of the most harmful drugs, it still does not have the power to make a person do anything. Even people who have previously been considered hopelessly addicted are showing that given the ability to take control of other aspects of their lives, they can use heroin regularly and will not inevitably die or be criminals.

So if heroin is not the culprit, then what happened to Philip Seymour Hoffman? It says in the article I linked to above, that he is quoted as saying:

"I don't know, I was young, I drank too much, you know, so I stopped. It's not really complicated. I had no interest in drinking in moderation. And I still don't. Just because all that time's passed doesn't mean maybe it was just a phase.

"That's you know, that's who I am."


This was in reference to his previous stint with addiction, that time to alcohol. Those lines were spoken in 2011, when as far as the world knows, he was free from addictions. He said about himself that moderation was not in his nature. He was a pusher of boundaries. It seems to me that addiction maintenance was not likely to be an option for him - it was either completely clean/sober, or 'drinking too much'. It's not hard to see how this would translate to heroin use turning into misuse, followed by overdose. "How high can I get?" Especially with increasing tolerance levels**.

So maybe he should have just stayed away from drugs then. Well, he did say that himself, after a fashion. But it's ignorant to make blanket statements about the nature of drugs because the occasional boundary-pusher goes too far and dies.

Dan Osman was a boundary-pusher too.



Known mostly for his freeclimbing exploits, he died, ironically, while using a rope. It broke and he fell to his death.

I doubt there are many eulogies that mention how evil ropes are, or even how evil climbing is. Nobody will say he died from climbing. They will say he died in a fall. They might talk about the unwise decision to jump that day after exposure of his gear to the elements, or about how he was always a risk-taker. But they won't talk about climbing as if it has agency, and nobody has called for it to be banned because of what happened to Osman.

He was looking for the edge. He found it. End of story.

Why do we make different assertions about someone's death when it involves an illegal drug? People who do that, please stop and think about what you are doing.


* I am assuming here that in this context when people say 'drugs' what they actually mean is 'illegal drugs'.
** It's a recorded phenomenon that people who've been clean for a while are at higher risk of overdose if they start using again, because their tolerance has decreased and they then hit at the dose they stopped at, which is too high for their current state. Either scenario sounds possible.

Comments:

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From:fbhjr
Date:February 3rd, 2014 10:37 pm (UTC)
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You know this:
"I don't know, I was young, I drank too much, you know, so I stopped. It's not really complicated. I had no interest in drinking in moderation. And I still don't. Just because all that time's passed doesn't mean maybe it was just a phase."
is exactly why I don't drink.
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From:tatjna
Date:February 3rd, 2014 10:47 pm (UTC)
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Yeah. I think a lot of people have something like that with particular substances or activities. For me it's ice cream. I'm lucky, it's relatively harmless in that I'm unlikely to OD on it.

As a wonk, my mind immediately turns to the question of agency. Some people are unwilling or unable to make the decision not to touch their nemesis substance. The vast majority of other people will be fine with it (even heroin only has an addiction rate of 25% of regular users).

So, what interventions are a) effective and b) respectful of human rights in terms of someone's inability to use X in moderation? And I keep coming back to 'pretty much none'. So, what to do?

[edit] I'm increasingly of the view that folks should be allowed to make these decisions for themselves, and that the supposed support systems of society are what needs looking at in terms of how they are failing these people when there is a problem. But even if they were perfect, some people will still die of bad decision makin, and maybe we just need to accept that.

Edited at 2014-02-03 10:49 pm (UTC)
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From:springheel_jack
Date:February 3rd, 2014 11:33 pm (UTC)
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"The Edge... there is no honest way to explain it because the only people who really know where it is are the ones who have gone over."
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From:tatjna
Date:February 4th, 2014 12:36 am (UTC)
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Hahaha so true.
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From:richaarde
Date:February 4th, 2014 12:30 am (UTC)
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I really wish they had heroin maintenance programs here. Heroin is nasty stuff but at least you know that you're getting a consistent product from a maintenance program.

The worst part is that bloated government egos are the reason for not starting maintenance programs. It basically comes down to governments not wanting to change their ways because changing would force them to admit they were wrong. And governments are never, ever wrong.
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From:tatjna
Date:February 4th, 2014 12:35 am (UTC)
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There is this bizarre perception among policymakers and governments that providing heroin maintenance programs means condoning drug use - and they are afraid of being seen to condone drug use.

It's a bit of a worry when those who are responsible for a country's wellbeing will sacrifice that wellbeing for the sake of face-saving even when confronted with irrefutable evidence. Never mind that harm minimisation is a million miles from condoning..
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From:pombagira
Date:February 4th, 2014 12:45 am (UTC)
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maybe they should be made to watch that documentary on the rat park experiment where the the rats taken out of the cages and put into the rat park weened themselves of the drugs because they were happier..

actually maybe the policymakers should be required to keep up with uptodate research, rather than relying on the filters they were given when they first did their study.. ??

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From:tatjna
Date:February 4th, 2014 12:54 am (UTC)
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I think what happens is that the policymakers do get the evidence, but that somewhere between the summary of evidence and the signing off of policy, some politician gets the wind up about constituents who won't vote for them if they're seen to be lenient about drugs, and then some neoliberal puts a 'tough on crime' spoke in, and everyone forgets about evidence in the face of political pressure.

This is slowly changing, but it's taking the old guard literally dying off for it to happen.
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From:pombagira
Date:February 4th, 2014 01:02 am (UTC)
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true that..

i also think that there should be a time limit on how long you can be a politician in parliament for..

:)
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From:crazedturkey
Date:February 4th, 2014 01:04 am (UTC)
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Heroin management program's is interesting,

The prevailing thought process when I did addiction medicine (and it wasnt that long ago!) was that opiod substitution was a better idea I.e bupe/methadone, because heroin is too short acting - the fast onset/offset makes for easier addiction and harder management in terms of withdrawals. Whereas methadone and bupe are slow up and down. The problem with that though is of course you don't get the rush (unless you divert and inject hence the need for supervision because that's a fast way to get an abcess).

Edited at 2014-02-04 01:08 am (UTC)
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From:tatjna
Date:February 4th, 2014 01:20 am (UTC)
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I think (but am not certain) that there's recently been a shift in terms of understanding addiction from the point of view of the person experiencing it. So while methadone etc are convenient in terms of their slower redose compulsion, it's also harder to come off than heroin (being one of the few substances from which withdrawal can kill you). So if the endgoal is to help a person get off drugs altogether, methadone is not so helpful.

Also, heroin addicts tend to spend a very large proportion of their time seeking their next hit, and this often involves complex, dangerous and difficult tasks. So to go to a clinic twice a day for their dose is orders of magnitude simpler than finding it for themselves.

These reasons make heroin substitution a much better deal for the person being treated IMO, especially given that by the time a person is seeking treatment or a maintenance program, they aren't really after the hit any more, they're simply trying to avoid dopesickness.
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From:crazedturkey
Date:February 4th, 2014 02:17 am (UTC)
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Hmmmmm...it's interesting, but I think you'd have a very hard time convincing the medical establishment without a lot more research. We just hate, hate, hate fat acting opiods. (Although ironically in terms if metabolites heroins probably a cleaner drug than morphine).

I work frontline with a large drug seeking population, so I'm not unsympathetic nor inexperienced in the addiction medicine field. It's messy to say the least. I can see positives and negatives to this. (And, hey, if it keeps them out of my office threatening to punch/knife/murder me its all fir the good!)
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From:tatjna
Date:February 4th, 2014 02:20 am (UTC)
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Yeah, the medical establishment (and the political one) have been quite resistant to heroin maintenance. However, there's now a body of research from Switzerland that's coming up 20 years old, and since they held a referendum and instituted it within policy in 2008 it's been much more widely implemented. So the research is there, and it's slowly gaining traction in other countries - often against a great deal of resistance.

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From:crazedturkey
Date:February 4th, 2014 02:23 am (UTC)
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Oo thanks ill take a look at it.

Not that one GP fending off OxyContin seekers will make much of a difference but I'm interested nonetheless (not that it will ever gain traction here right now - ultra conservative govt at the mo - I'm lucky if ill still e getting a salary when I go back to work...)

Edited at 2014-02-04 02:25 am (UTC)
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From:tatjna
Date:February 4th, 2014 02:31 am (UTC)
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Yeah, it's the same here. It seems to me that a country's stance on provision of naloxone generally gives an indication of how they'll approach heroin maintenance. Having said that I've no clue how Australia deals with it. Here it's prescribed, but no longer has to be on a controlled drug form.

Personally I'd like to see it more freely available than just on prescription.
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From:crazedturkey
Date:February 4th, 2014 02:32 am (UTC)
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Controlled :p
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From:clashfan
Date:February 6th, 2014 09:24 pm (UTC)
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The Los Angeles Times is a fairly respected newspaper.

http://www.latimes.com/nation/la-na-heroin-antidote-20140206,0,1953564,full.story#axzz2sZvVwaBh
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From:jaylake
Date:February 5th, 2014 01:00 am (UTC)
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Somewhat laterally apropros of this, as someone who has undergone six resections in the past six years (colon, lung twice, liver three times), I have a developed a deep and abiding horror of opiates, to the point of refusing them for post-operative pain control after my last three surgeries. To the jaw-dropping amazement of some of my healthcare providers, I might add. Apparently choosing to cope with intense post-operative pain (even with toradol, etc.) over pathological constipation (including a bounceback hospital admission after my third resection) isn't usual. I really, really don't understand the appeal of opiates, because they mess me up far more than they help me, but that's just my idiosyncratic experience.

LSD, on the other hand, I took exactly once in 1984 or so. I liked it *so* much that I realized I'd better never touch it again, unless I wanted to spend my life living in a box under a bridge scrounging for hits. Doesn't matter now, I'm almost certainly dying sometime this year anyway, but I still won't go back to acid.

So, yeah, to each their own devilment. In my case, food addictions and behavioral pathologies which have given me a more-or-less textbook case of metabolic syndrome. That makes me the same shape as more than half the middle-aged men in America. Except for the scars, of course.
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From:tatjna
Date:February 5th, 2014 01:06 am (UTC)
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My Mum hated opiates too. They made her vomit constantly, which really didn't help with the pain after they'd pretty much cut her in half.

LSD is technically not addictive, because it has a very steep tolerance curve combined with a very low redose impulse. There have been no known cases of LSD addiction. However, I personally believe that it's possible to take it 'too often' without being addicted, and that that would in most cases not be a good thing for the taker. I respect the self-knowledge behind your choice.

I made a similar choice about cocaine in my 20s. I discovered 20 years later after a lot of experimentation with other things, that these days coke makes me go 'meh' to the point where I no longer avoid it for fear of addiction, but because I can't be bothered with it.
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From:jaylake
Date:February 5th, 2014 01:37 pm (UTC)
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LSD may not be addictive in a physiological sense, but I certainly recognized a powerful potential in myself for an emotional and psychological response that would have produced much the same effect on my life. Self-knowledge, or perhaps just self-preservation.

It was the only recreational drug (legal or illegal) that I ever really responded to that way. Mostly I like my clear head and vivid imagination a whole lot more than I like my drug/alcohol-modified head. Like I said, to each their own.
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From:brynhilda
Date:February 4th, 2014 02:44 pm (UTC)
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Yes, we have heroin-assisted maintainance programs overhere in Germany. Mostly it's substitution via methadone. I do know some folks who went through it.
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From:tatjna
Date:February 4th, 2014 07:31 pm (UTC)
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Yep, here it's methadone and bupe. I've known a few people who've used it (heroin isn't really big here, I suspect because our society is relatively equal), and was kind of shocked to find one person who had quit heroin 10 years previously, still on the methadone because now she was addicted to that.

Doesn't really seem like the best option, eh?
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From:brynhilda
Date:February 9th, 2014 12:33 pm (UTC)
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Yeah, that's the problem...methadone is of course as addictive as heroine :(...still, it's great to offer it to people to keep them from the streets.
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From:danjite
Date:February 4th, 2014 05:28 pm (UTC)
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Dude had more than 50 baggies in his flat.

Junkies I have known (thanks to life in the music industry) wouldn't keep more then TWO around, as not having the stuff right there was part of not overdosing. Having five- much less fifty- in one place seems like willfully creating a condition so one can die.

Depression- like addiction- is an expression of mental illness. The two together can be a spectacularly bad combination, as was likely the case with PSH.

When I was young, depression was badly underdiagnosed, incorrectly treated, and too shameful to discuss. Same with addiction. Yes, things are still really bad with addiction treatment in much of the world, but I am glad to have seen the start of humane treatments for both during my lifetime.

Edited at 2014-02-04 06:19 pm (UTC)
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From:tatjna
Date:February 4th, 2014 06:29 pm (UTC)
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The addiction-as-a-disease model is definitely a step in the right direction from the previous view of addiction-as-a-personal-failing-that-deserves-punishment. However, it also fails to recognise the social factors that can greatly increase the chances of addiction - you know how problematic drug use tends to be a lot more common among marginalised groups? This implies not only that there's something happening socially in much of addiction, but also that in some cases, drug use can be a rational choice.

So while considering addiction as a product of mental illness is a more humane view, I'm not convinced it's accurate - and it can lead as much to removal of agency and violations of the rights of the addict ("We know what's best for you") as the previously-held model.

Julian Buchanan has more on this view if you're interested.

Having said that, my first thought on reading about PSH was "Needle in arm? Loads of heroin around? This is very convenient - was it set up to look like an accidental OD or what?"
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From:happyinmotion
Date:February 4th, 2014 07:04 pm (UTC)
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You know I'm not going to be all libertarian and say agency should have higher priority than every other factor.

Danny Osman didn't die because he was climbing, he fell, and then his safety rope broke. He died by taking deliberate and repeated falls onto a single rope with no back-up and no safety. That's not pushing boundaries. That's running at them full speed while juggling knives. That's pushing risk-taking to the point of willful idiocy. That's a character flaw, to say the least.

Heroin's pharmacological effects are a hideously good fit with that kind of character flaw. That results in people and behaviour that I don't want to be around.

And yes, the public health response needs to be an effective one, and yes, heroin user only equals junkie under some economic and social circumstances. But in the meantime, we can't regulate character so we have to regulate against some drugs. The biggest policy challenge I see is not simply getting over the "drugs are bad mmmkay" foolishness. It's normalising the use of some drugs while effectively controlling the use of others. And heroin is at the top of the list of others.
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From:tatjna
Date:February 4th, 2014 07:23 pm (UTC)
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1. So you're suggesting that there should have been a public health intervention to stop Dan Osman doing what he did?

2. Actually, depending on what evidence you look at, alcohol is at the top of the list of others. I know, we've had this discussion before and it depends on how you carve up the 'harms' group. If you're looking only at LD50 and addiction potential, heroin is above alcohol. But if you're looking at cost to the health system from long term use/misuse, it's the other way around. And I'm not saying that because more people use alcohol (and likely still woule even if heroin were legal), but because alcohol does more damage to a person's body than heroin.

3. The vast majority of harms associated with illegal drugs stem from the unintended consequences of their prohibition. This is especially true for the more addictive ones. So for a public health response, I'd be interested in seeing what 'effective control' looks like. Because to me, it looks like it falls somewhere between the current situation of prohibition, and complete legalisation (and thus control by profit-based interests). So the heroin maintenance programs seem to me to be a pretty good place to start with that effective control.

[edit] The US does not have supervised heroin maintenance programs, not even for rich people. So getting over the 'drugs are bad, mmk' attitude in order to allow for the effective control of the more harmful drugs seems pretty damn important to me.

Edited at 2014-02-04 07:33 pm (UTC)
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From:happyinmotion
Date:February 4th, 2014 07:36 pm (UTC)
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1) Yes, because we know the result of not intervening. What kind of intervention and by whom is a separate question.
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From:happyinmotion
Date:February 4th, 2014 07:38 pm (UTC)
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2) Quite possibly.
3) Yes, but it doesn't then follow that the risks of legal use are negligible.
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From:tatjna
Date:February 4th, 2014 07:41 pm (UTC)
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3. Nobody has been implying that they are. I'm not sure where that idea comes from, but I end up saying this in every discussion we have about heroin and I don't understand where I'm coming across that way.
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From:happyinmotion
Date:February 4th, 2014 08:16 pm (UTC)
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Because we don't do politics on the basis of reasoned argument. We'd like to, but it's mostly carried out by deliberate mis-representation of opposing positions. So it isn't enough for a suggestion to be coherent, it must also be resistant to restatement as an idea that no one would support.

Hence the problem here, it's easy to rhetorically slide from "the problems with heroin are mostly because heroin is illegal" to "making heroin legal makes heroin not a problem".

That's not what you said, but it's easy for an opponent to make the audience think that is what you said.
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From:tatjna
Date:February 4th, 2014 08:20 pm (UTC)
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So you did it on purpose in order to make me consider my words more carefully to avoid allowing people who disagree with me to misrepresent my position?

I'm glad to hear that because I was starting to wonder.. although for future reference it's probably easier to just say "Hey, when you say this, some people could interpret it as this other thing. You might want to watch that."

And I still don't know what I said that could be construed that way. Call it a character flaw, but I think anyone with intelligence could see what I'm getting at. And yes, I know that not everyone's clever and those people are the ones whose opinion needs to change. But the audience for this blog probably don't fall into that camp,eh?
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From:tatjna
Date:February 4th, 2014 07:39 pm (UTC)
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Yeah, I'd definitely be curious to hear your thoughts on that, specifically:

1. Why it's important not to have let Osman die from his own stupidity.

2. What sort of intervention might be effective in such a situation.

3. What the implications of such interventions would be for others who operate at the extreme end of extreme sports. Like the guys who invented bungy jumping, or the freeclimbers.
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From:happyinmotion
Date:February 4th, 2014 08:21 pm (UTC)
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... Am now fed up of typing on phone keyboard, so... Laters
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From:tatjna
Date:February 4th, 2014 08:25 pm (UTC)
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Yeah, I was figuring in person, eh? Also, impressed with phone keyboard skills. Much accuracy, very spelling.
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From:happyinmotion
Date:February 5th, 2014 05:59 am (UTC)
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Ah yes keyboard...

K then:
1) Everyone is stupid sometimes, it's part of the human condition. I think we have a moral duty to reduce the personal risk from stupidity, even if we cannot eliminate it. Hence mandatory seat belt laws.

I'm fine with providing people with learning opportunities, where an individual's stupidity leads to pain for that individual and results in a chance to reassess behaviour. When behaviour leads to sudden death, there's not opportunity for learning. The same line of argument also justifies a prohibition on giving children high explosives.

2) Most interventions don't directly come from public health authorities, they come from family, friends, and community. Any public health policy that strengthens those networks might have resulted in a better outcome.

For the specific circumstances of a bunch of climbers in a national park, rangers act as the main (and sometimes only) point of contact with authority. Recognising that those rangers have multiple roles above and beyond conservation and resourcing them to carry out those roles would be the easiest first step. See also DoC staff in NZ wilderness and Housing NZ staff in urban areas.

3) You could argue this by asking "what's a socially acceptable death rate for innovation"? You could point at the death rate from the early days of aviation or space exploration or motor racing and say that we're too cautious now and that caution is holding back innovation. However, that's presuming that making innovative behaviour less risky will result in less innovation. I think that's precisely arse-backwards. Making innovative behaviour less risky increases the amount and degree of innovation.

An example: there was nothing preventing Osman from having a back-up safety line. Then he wouldn't have died when his first and only rope broke and then he could have spent another couple of decades exploring what is humanly possible. Instead, he was chasing danger, not innovation, and that's a quick way to an early grave.

4) Depends upon how well those interventions are designed. A dumb "everyone doing anything dangerous must wear all the safety gear forever" isn't going to help. Something along the lines of "anyone jumping out of a plane must have two parachutes" makes jumping safe enough that enough people are keen to do tandem jumps that parachutists can make a living out of jumping out of planes. This results in more people jumping out of planes.
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From:tatjna
Date:February 5th, 2014 08:15 pm (UTC)
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1. So you're arguing for safety standards to be set for use of risky technologies/methods to protect people from stupid moments. I've no beef with that, although I'd ask if Dan Osman types would adhere to such standards given that he wasn't the only person doing static bungy at the time, he's just the only one that died.

2. I agree also that policy that strengthens community networks has a better chance of working for everyone, and I'm all for resourcing such policy. This makes a lot of sense to me.

3. You could argue that, but it isn't what I was asking. To be more clear, what I was asking was, how do interventions aimed at the folks who take stupid risks affect the majority of people also engaging in risky behaviour, who don't take those risks and thus don't die.

I used extreme sports because we were talking about Dan Osman, and bungy because that's how he died (sort of). I could have just as easily said heliboarding or those folks in the wingsuits, or any one of a number of activities that make me to NO WAY ARE YOU EVER GETTING ME DOING THAT. These people are doing these things, right now, and probably some are dying while the vast majority don't.

So rather than ask what's a socially acceptable death rate from innovation, I'm interested in how imposing a globaly policy on risky activities will affect those who aren't chasing danger, but simply seeking thrills, by doing the same activity.

Ie, how do you legislate against wilful stupidity? Safety standards seem like a good option, but as mentioned above, Osman could have used a safety and he didn't. How does one police that kind of behaviour?

To me, that's the crux of the matter. Getting back to drugs, it's the same thing. Most people use them with no problems. Some people are stupid, others deliberately push the boundaries. I've known people who've taken up to 10 tabs of LSD to see how far they could push it. What sort of safety standards could be set around that? And more so with herion, a much more risky drug to use - especially given the current marginalisation of drug use as a behaviour which forces people outside the very networks that are most effective at helping them?

So yes to safety standards and yes to resourcing the strengthening of community networks.

Along these lines, I'm a huge fan of DanceSafe, and also KB's paddock relief. I do wonder how such a thing could be implemented to deal with more chronic risk taking rather than the acute situations that those guys deal with - again I think the stigma around drugs sets up a citizen vs authorities dynamic that most people who are taking risks are likely to avoid.

And there will always be the Osmans of this world, who jumped despite years of being encouraged by friends and family to behave more safely, and did it unsafely against all recommendations. These people exist, and part of me thinks that if they want to die that badly, there's not much the rest of us can practically do.
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From:Will Marshall
Date:February 5th, 2014 04:07 am (UTC)
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I'd also be interested in:

4. What the implications of such interventions might be for those who operate at the non-extreme end of extreme sports?
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From:helianthas
Date:February 4th, 2014 06:30 pm (UTC)
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And if that's the case, I'll put my 2 cents in and say that I really wish more celebrities would talk openly about suicidality before actually dying either intentionally or unintentionally. I believe a real open discourse led by some people in the public eye could be so helpful.
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From:wildilocks
Date:February 8th, 2014 08:12 am (UTC)
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When you take the word "drug" out of the equation, I think it simply boils down to the fact that in our society in general, we purportedly admire and reward restraint, control of the self, mastery over desire or indulgence. This is a common thread in most major religions and philosophies. Mastery over the self instead of giving in to our base urges. So with that framework I do understand the mindset of "drugs are bad, mmmkay" and that those who choose to let their desires rule them are "getting what they deserve" when it all goes wrong. However, thanks to the new God, money, I personally feel that we live in such a dysfunctional society now that it is something of a rational choice to want to escape it (hence notably higher drug use in lower socio economic strata).

I do believe self-restraint is something to be celebrated. It is one of the few things that can give us all genuine satisfaction, no matter where you sit in terms of wealth. But it is hard. Maybe harder than it ever has been in history. Human desire for mind-state alteration is universal, but we have lost the community, the ceremony, the structure and the attribution of meaning to it, thanks I think largely to the rampant run of the Century of the Self (see Adam Curtis' excellent documentary). Of course, we have in some circumstances been able to create new rituals (and this is why Burns are the only festivals I think I *really* enjoy now, though the Self still dominates there is at least some structure, some community and some ritual and this doesn't require drugs to appreciate and be fulfilled by) but because we are more Self - focused (and also -aware, thanks to Science), we can't (in general Western society at least) easily make ritual as integral in our lives as it used to be.

"That's you know, that's who I am."

Is chasing the edge, the all-or-nothing response to desire, a valid response to a lack of meaningful community, ritual and purpose in life, in a society obsessed with the Self?
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