Category Archives: Health

Nicotine Gum for Depression and Anxiety

(This article was reprinted in the online magazine of the Institute for Ethics & Emerging Technologies, May 5, 2016.)

(Disclaimer – I’m not a medical doctor. For more info on these topics consult an M.D.)

I was thinking about a friend who quit smoking about 10 years ago with the help of nicotine gum. She eventually kicked the nicotine gum habit too, although she claimed that it was about as difficult to quit the gum as it was the cigarettes. She did notice that her ability to deal with anxiety was reduced after quitting the gum, and she also became more depressed. As a result, she has considered starting to chew gum again.

Her main arguments against chewing the gum are: 1) the cost of the gum; 2) the worry that will come with always having to make sure she has enough gum; 3) possible dental issues caused by the gum; and 4) the sense of failure she feels in not being able to live without this crutch. Moreover, there is no guarantee that the gum will minimize her anxiety or depression, although there is some reason to think it will.

The main argument for chewing the gum is the reduction in anxiety and depression. (There are good reasons to think nicotine can help.) The thing to remember about this benefit, if it occurs, is that it is substantial and multi-faceted. Not only would she feel better—because her anxiety and depression would be minimized at all times—but she would be able to participate in and better enjoy other things that would make her life go better, like social relationships and productive work. Moreover, this reduction in anxiety and depressive symptoms would have good consequences for her physical health. (This assumes there are no negative health risks from chewing small doses of nicotine. As best as I can determine, there are no health risks.) So nicotine gum might both minimize her negative symptoms and make it more likely that she participates in activities that help her symptoms. You don’t want to join a group or do productive work if you are anxious and depressed.

Now let’s consider her arguments against using the gum. If you can’t afford it, then you can’t buy the gum. In her case she can afford it, although the $60 or so a month is costly. The worry about having the gum readily available is a reasonable one, although it isn’t any different from worry about having any other kind of medicine with you. That is a small price to pay for a medicine that is effective. As for oral health, the evidence suggest it has no ill effects  at least as far as I can tell.

The fourth argument is particularly interesting, but I think ultimately fallacious. There are many “crutches” people use to get by including but not limited to: alcohol, tobacco, food, sex, religion, therapy and exercise. We also depend on things for our well-being like air, water, medicine, and more. If something helps you live better and doesn’t hurt anyone else, why not utilize the help? In fact, given that our behavior affects others, we may be morally obligated to do what’s necessary to help ourselves so as to be in a better position to help others. So if someone tells me they need to take some medicine or other drugs to physically or psychologically function, or they need to go the therapist or to church or for a long jog, I say … go for it. And those who say otherwise are probably motivated by their own guilt or perfectionism, or the desire to control other people.

To place this issue in a philosophical context consider that we are all thrown into this world without our consent. We must live in a world about which ultimately we know very little. We don’t know what to believe or what we should do. All we can do then, is do our best. The philosopher and psychologist William James, who was himself tormented by depression, expressed these sentiments beautifully:

We stand on a mountain pass in the midst of whirling snow and blinding mist, through which we get glimpses now and then of paths which may be deceptive. If we stand still we shall be frozen to death. If we take the wrong road we may be dashed to pieces. We do not certainly know whether there is any right one. What must we do? ‘Be strong, and of good courage.’ Act for the best, hope for the best, and take what comes. If death ends all, we cannot meet death better.

Marijuana for Anxiety

(This article was reprinted in the online magazine of Institute for Ethics & Emerging Technologies, March 13, 2015. )

A few days ago there was an interesting article in the New York Times, “The Feel-Good Gene,” by a professor of clinical psychiatry at Weill Cornell Medical College. The author wonders why some people are predisposed to anxiety which doesn’t have obvious environmental causes, and which is thus not helped by psychotherapy; while others are immune to such anxiety.

Not surprisingly, the answer is that “a genetic variation in the brain makes some people inherently less anxious, and more able to forget fearful and unpleasant experiences. This lucky genetic mutation produces higher levels of anandamide — the so-called bliss molecule and our own natural marijuana — in our brains.” Those who have this mutation are also “less likely to become addicted to marijuana and, possibly, other drugs — presumably because they don’t need the calming effects that marijuana provides.” Unfortunately only about 20% people have the mutation.

For those without the lucky genetic variation, the author has found that marijuana is generally effective for anxiety, and the reasons for this are physiological.  It turns out that marijuana targets “the endocannabinoid system [which] is closely related to the brain’s own anandamide.” And when anandamide “binds to the cannabinoid receptor, it has a calming effect … We all have anandamide, but those who have won the lucky gene have more of it because they have less of an enzyme called FAAH, which deactivates anandamide. It is a mutation in the FAAH gene that leads to more of the bliss molecule anandamide bathing the brain.”

So the evidence strongly supports that the mutation doesn’t just correlate with less anxiety, it causes people to have less anxiety. The author’s moral conclusion is that “there is more to abstinence than grit and moral fiber: Having a double dose of a gene mutation gives you a big advantage in being able to “just say no.” Of course the author notes that “… these studies should not be taken to mean that biology calls all the shots … The environment plays a critical role and can sometimes even trump genetics.”

As for the use of marijuana to treat anxiety the author is skeptical.

The problem is that cannabis swamps and overpowers the brain’s cannabinoid system, and there is evidence that chronic use may not just relieve anxiety but interfere with learning and memory. What we really need is a drug that can boost anandamide — our bliss molecule — for those who are genetically disadvantaged.

Reflections – I have written recently about issues of freedom and responsibility regarding anxiety and depression. I think we should accept that many things are out of control, especially the past, while accepting that we have influence on the present and future. So I agree with the author’s claim that such diseases have a strong genetic influence.

As for marijuana, while I have never been a user myself, I disagree with the author’s conclusion. However, before I continue let me issue two disclaimers: (Disclaimer #1 – I am not a medical doctor. Disclaimer #2 – I do not advocate using marijuana if it is against state law.)

Alcohol, cigarettes,  tylenol, antidepressants, antipsychotics and benzodiazepines have more bad side-effects and are more dangerous than marijuana by  a considerable amount. This is a fact. So in a cost-benefit analysis between marijuana and persistent anxiety, or marijuana and these other drugs, marijuana win easily. Ask yourself this. Do you want cortisol coursing through your veins? Do you want the awful side-effects that accompany so many of the mainstream anxiety medications? Do you want to drink alcohol or smoke cigarettes? Do you want to experience life-effecting and possibly life-destroying anxiety? Or do you want to feel better with some possible minor cost?

I think the rational choice is clear. If marijuana is legal where you live, as it is today in Washington and Colorado, then there is little cost and much benefit in trying it for anxiety. (I include the legality constraint because people are still incarcerated for marijuana use, although that is patently unjust.) Yes what your psychiatrist and psychotherapist say is true; there is no demonstrable scientific evidence for marijuana helping with major anxiety. But this is because the government classifies marijuana and a Stage I drug, and it is thus not available for normal research.

And while I’m at it I think nicotine gum would be a better, safer alternative than most of the psychopharmaceutical  drugs currently in use.

Mark Bittman on the Purpose of Society

(This article was reprinted in the online magazine of the Institute for Ethics & Emerging Technologies, February 21, 2014)

New York Times food expert and op-ed columnist Mark Bittman wrote a recent piece, What Is the Purpose of Society? Obviously the title captured my interest. But what could an expert on healthy food have to say about the purpose of society? A lot it turns out.

Bittman begins,

The world of food and agriculture symbolizes most of what’s gone wrong in the United States. But because food is plentiful for most people, and the damage that conventional agriculture does isn’t readily evident to everyone, it’s important that we look deeper, beyond food, to the structure that underlies most decisions: the political economy.

Bittman argues that progressives don’t pressure the “Democrats to take strong stands on everything from environmental protection to gun control to income inequality …” Instead they accept that most politicians are indebted to monied interests. But the big problems of the country—income inequality, race relations, climate change, unhealthy food, immigration law, education—won’t be fixed by creating a nice business climate. So he offers a different vision.

Shouldn’t adequate shelter, clothing, food and health care be universal? Isn’t everyone owed a society that works toward guaranteeing the well-being of its citizens? Shouldn’t we prioritize avoiding self-destruction?

These are the questions we should be asking ourselves, not how do we create a better business environment. Consider what this implies about the purpose of people, to say nothing about the meaning of life. The business of America should not be business, but well-being.

No philosopher can read this and not be reminded of Aristotle’s assessment of governments. They are good to the extent they provide the conditions in which all their citizens can live well. But does America today do this or even try to? As Bittman says:

For example, is contemporary American agriculture a system for nourishing people and providing a livelihood for farmers? Or is it one for denuding the nation’s topsoil while poisoning land, water, workers and consumers and enriching corporations? Our collective actions would indicate that our principles favor the latter; that has to change … For example, if we had a national agreement that food is not just a commodity, a way to make money, but instead a way to nourish people and the planet and a means to safeguard our future, we could begin to reconfigure the system for that purpose.

Bittman understands that there will be unintended consequences that follow from tinkering with complex political and economic systems,

But without an agreement on goals, without statements of purpose, we are going to continue to see changes that are not in the interest of the majority. Increasingly, it’s corporations and not governments that are determining how the world works. As unrepresentative as government might seem right now, there is at least a chance of improving it, whereas corporations will always act in their own interests.

Bittman challenges us to rethink political philosophy and political economy, whose goal should be to create a society in which everyone can flourish. A society so much different from America today.

The big ideas and strategies for how we should manage society and thrive with the planet are not a set of rules handed down from on high. To develop them for now and the future is a major challenge, and we — progressives and our allies — have to work harder at it. No one is going to figure it out for us.

Dying from Infections

Last night PBS “Frontline” aired a wonderful documentary entitled: “Hunting the Nightmare Bacteria.” It investigated the rise of deadly drug-resistant bacteria. As the world health organization has recently reported we may be heading for a post-antibiotic world where common infections will again kill.

Almost all of us are aware that a large part of the problem is that most antibiotics are fed to livestock. Everyone knows that we shouldn’t engage in that practice, but the agricultural and pharmaceutical lobbies are just too powerful to defeat on this issue. The clients of those lobbies–private citizens and corporations–are interested in profit not public health.

Perhaps lesser known is that few drug companies are developing new antibiotics. The reason is that it is less profitable to develop antibiotics which are taken occasionally, as opposed to drugs that are taken regularly for conditions like blood pressure, cholesterol, hair loss, or erectile dysfunction. This is a classic example of how the market does not always serve an individual’s best interests. It may give us erections and hair, but we might have to have an infected leg amputated.

How real is the problem? The CDC claims:

Each year in the United States, at least 2 million people become infected with bacteria that are resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections. Many more people die from other conditions that were complicated by an antibiotic-resistant infection.

Only government research supported by tax dollars is likely to solve such large problems. The purpose of good government is to act in the interest of the common good. This is their raison d’être. Private corporations by comparison answer to their shareholders–profit is their only concern. While tobacco killed millions over decades, the tobacco industry actively covered up the problem–tobacco was a profitable product. But government slowly exposed the problem by placing constraints on the sale of tobacco and publicizing it as a public health hazard. After decades of polluting the air, earth, and water, only the creation of the EPA stemmed the tide, successfully enacting measures to clean up the environment. As global climate change proceeds unabated, fossil fuels companies and their allies again lie and deceive. And why not? It is profitable to burn fossil fuels. Only governmental power is likely to stop the ruination our fragile climate.

From an economic standpoint even larger steps probably need to be taken–including the creation of a new economic system. Politically what is needed is cooperation between countries, or granting an intergovernmental bodies like the IPCC or UN the coercive power to make individuals comply with international law, or a full-fledge global government. Many problems we confront today–including antibiotic resistance–cross international borders.

So thanks PBS for an informative documentary. It wasn’t profitable to investigate this for a small audience, and without adequate public funds you are forced to beg, but last night you performed a great public service. By the way. PBS stands for “the public broadcasting system.”

Note – A few days after this post the NY Times published this op-ed.