Editorial Comment:  Medicine beyond pharmacotherapy

This week’s emphases are dominantly on social interventions:  season as an indicator for prevention, the parenting role and punishment, telemedicine (2 times), care for the caregiver (resident duty hours caps). 

In the article below addressing seasonal onset of drug misuse (Palamar J. et al.), the authors conclude that possibly more effort should be put into prevention methods prior to the onset of summer.  This may be so, although it begs the question of whether publicity-centered  interventions have value, seasonal or otherwise.  From the sidelines, having heard very many AA & NA testimonials regarding the onset of drug or alcohol use, the most frequently-named culprits have been boredom, drug availability, and peer induction.  There will be social scientists who argue that there are interventions that can anticipate use and which are effective, but that is not really contrary to my position.  If the triggers to use are year-round, regardless of the relative frequency within any one season, they warrant a year-round effort, with immunization by skill-building and positive peer affiliations.

So, my initial response on reading the article was dismissive. "Of course they use most during the summer," I exclaimed to my physician wife. "Why would we need a study to confirm what is so intuitive?" Her response, being accustomed to my exclamations, was to ask me whether intuition had ever failed me.   Mockery being the enemy of self-righteousness, and she being almost always correct, I was forced to recall another time I had been dismissive.  In the 1970s, Sen. William Proxmire made a reputation for assailing government spending projects, targeting particularly the National Science Foundation. One of the more infamous examples was his lambasting of a study which he called,  “…a study to figure out why children fall off tricycles” [ https://science.sciencemag.org/content/185/4151/597Science 1974 ]. He gave it his "Golden Fleece Award,” which seemed appropriate given that the obvious elements contributing to the phenomenon were: 1) gravity, 2) unstable platform (wheeled trike), 3) unstable operator (little kid).  What I didn't do until much later was to go back and look at the actual grant, which was more about the instability of all wheeled recreational vehicles and the risks for injury; objectives which few of us would criticize.  Tricycles were but one component of the study, one which the senator could seize upon for its seeming silliness, its…intuitiveness.  Yet it proved neither silly nor intuitive, and led in turn to inquiries that improved safety standards [N.B., tricycles prove to be the second most common cause of death in toy-related deaths for children under 15 years; and are most commonly associated with child swimming-pool drownings (https://www.scientificamerican.com/article/most-tricycle-deaths-happen-when-children-fall-into-swimming-pools/  )] .  By analogy, this report describes not merely a period of heightened onset of drug use but notes the specific drugs of misuse which are not subject to season; it is new information.   Assumptions and intuitions do not a complete picture of reality provide.

- W. Haning, MD, DFAPA, DFASAM