Unhealthful News 39 - Whatever is not said is not thought

Today's New York Times had a series of articles and a video about the Insite drug harm reduction operation in Vancouver (it is a safe injection site, one of the few that exist).  The article was positive and accurate, and I recommend it though there is more thorough information elsewhere.  It did have the problem of implying that the use of drugs is entirely a matter of being caught in a trap that the user only wants to get out of, though that is certainly true for many who depend on Insite.  It also had a bit of a tone of "here is an exotic foreign oddity that you probably have never even imagined", which I suppose might be accurate for many readers, but there is something disturbing about it anyway.

What is interesting about the article for purposes of this series is not just that it was a fairly accurate and balanced story about a politicized issue, but how it contrasts with this NYT story from two days ago about the problems of pharmacies suffering armed robberies by people seeking prescription narcotics like OxyContin.  There was nothing wrong with that story as a simple "this is a crime pattern happening in the country" report.  But since it talked a lot about the use of the drugs, it cries out to be judged on its reporting about health issues, and there it is badly wanting.

The story discusses various bank-like measures merchants have used to reduce their risk and police have used to catch the robbers (safes, barriers, stocking limitations, tracking chips).  What was completely absent from the conversation is that maybe a harm reduction solution could be found by changing the fact, stated in the story, that "people are so desperate to get what they keep behind those counters."

The story refers to "abuse" of prescription painkillers as if that is a self-evidently defined construct.  But "abuse" of drugs is a social construct that simply means "putting them into your own body in a way that has not been explicitly approved by those in power (government, medical guideline creators, etc.)".  For the case of pain killers, someone relieving their own pain without permission of the authorities is an abuser – and maybe desperate enough to pay black market prices or even commit a crime if they cannot afford those. 

So what is the most obvious way to reduce the risks faced by pharmacy workers?  End the artificially-created shortage of these drugs that makes them so valuable.  If we did that, the pharmacies will be no more worth robbing than the sandwich shop next door – well, maybe a bit more worthwhile in the U.S. where we often have to pay a fortune even for medicine without street value ("give me the cash and refill my asthma medicine and no one gets hurt").

Anyway, society might decide it is a bad idea to solve the problem by making it easy to obtain drugs that treat serious pain, though it is appalling that people have to endure pointless pain that could be treated.  There are arguments about dependency (the article implies that this is the only reason there is a black market), recreational use (some people think that is bad), and loss of functionality.  Whatever someone might think about these, increasing availability should certainly be part of the policy discussion.  Thus, concern about robberies should be put in context as one additional argument in favor of a policy change that already has support.

But the article offered no hint about that.  There was not only no suggestion that individual freedom or harm reduction policies be considered, but not even an acknowledgment that the current restrictions are not simply the necessary state of the world.  By not mentioning this, the author effectively prevented all but a handful of readers from even thinking about it.  Anyone involved in group management knows that setting the agenda for a meeting dramatically increases the chance of getting your preferred outcome.  Being able to control a narrative has even greater effects.  I am not sure how often a reporter writing about health policy in this way has a personal agenda, how often she is just duped into the worldview of the government officials who are major sources, and how often she is just writing the easy story, but it is quite common for the story to implicitly eliminate any view that departs dramatically from the status quo. 

So health policy questions like "how can we do a better job of making people stop X?" (where X = smoking, being overweight, using OxyContin, watching so much television, etc.) are discussed, and perhaps news reporters occasionally get bold enough to ask "are the policies really helping?" or maybe even "are they worth the cost?"  This conveniently takes off the table questions like "is it appropriate for government to being doing this?", let alone "is it really best for there to be less X?" 

And this is not just a matter of libertarian issues like drugs.  Health policy reports about mammography focus on how to get women to get more rather than the real possibility that some of the current recommendations cause more harm than good (e.g., a not-high-risk 40-year-old might well be more likely to have cancer caused by a mammogram than detected by it).  Analyses of food policy seem to overlook the possibility that "none" is even healthier than "less" for many products (soda, most meat and dairy foods, corn oil). 

It is not the job of health news reporters to support substantial departures from the status quo, but they should not support the status quo either, especially by hiding the other options.  The reader needs to realize that the health policy news will leave most readers unaware that there even are arguments or options that depart substantially from current policies.


[On an unrelated topic:  For those of you who do not read the tobacco harm reduction blog but have an interest in the subject, I just posted a call for submissions there.  We are looking for original material for the Tobacco Harm Reduction 2011 yearbook and Harm Reduction Journal, as well as suggestions for material to reprint in the yearbook.]