History rhymes?

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If one lives long enough, one will realise that history has an unmistakable tendency to repeat itself. Occasionally, the roles are reversed, with the initial victims now taking on the role of the aggressor. At times, history also rhymes, featuring different players in somewhat altered contexts.

The latest thing that caught my eye is how the USA is raising such a hue and cry over the fentanyl problem that has hit the country. They are creating quite a scene on the international stage, squarely blaming the issue on China. The raw material, allegedly synthesised in China, has found its way into America through agents in Mexico and Canada. Recently, India was also called upon to assist, as it serves as a stopover for the merchandise, or perhaps some of its components are manufactured in India, the capital of pharmaceuticals.

The amusing thing is that it is primarily the USA that is so severely affected by the recreational use of fentanyl. Other Western countries are not as impacted. Interestingly, the potency of fentanyl has increased substantially over the years, leading to even accidental deaths of American paramedics attending to overdosed patients through mere inhalation or skin contact. The US (the West) is crying foul.

Interestingly, over two hundred years ago, such a fiasco dealt a significant blow to one of the two wealthiest nations in the world, China, which took over a hundred years to recover from the consequences.

The Western imperial powers believed they were providing a valuable service by introducing cannabis to China. The East India Company (EIC) viewed the business in which the Portuguese were engaged as notably profitable. The British were willing to spend excessive amounts on Chinese silk, porcelain (which they affectionately referred to as "china"), and tea. As a result, Britain was losing a considerable amount of silver to China, depleting the national coffers.

https://images.app.goo.gl/4LBwmSgZZa4yB9vZ7

Opium was widely available in India, and by the end of the 18th century, the country was under the control of the EIC. It began cultivating opium on an industrial scale. Many farmers were coerced, lacking choices or under compulsion, to grow this highly prized commodity destined for China. Numerous local traders and middlemen benefited from this arrangement. Even the Mughals became involved by cultivating opium in the fields they owned.

 

In China, the limited access imposed on foreigners confined their business dealings to Guangzhou (Canton), Xiamen (Amoy), and Zhoushan. From these ports, smuggled opium was transported to the mainland. Over time, this transformed the once-mighty Middle Kingdom into a land of addicts. At its peak, there were between 10 and 12 million addicts in China.

It culminated in two opium wars, treaties, territorial losses for China, legislation regulating the opium trade, the rights of foreigners to engage in trade, and the permission for Christian missionaries to traverse China. Subsequently, the Qing Dynasty fell. It took nearly a century, marked by numerous coups, upheavals, and shifts in political systems, for normalcy to be restored. That is how long it took for a generation to recover and for the nation to reclaim its dignity.

 

So, the last time a country fell into the clutches of addiction, what did the rest of the world do, and what did the opportunists within the country do? They reaped the benefits that arose from other people's miseries. Nobody truly helped; they simply asked, "What's it for me?"

British faux pas. Pinning poppy flowers at the Hong Kong handover ceremony
in 1997. Reminding the former owners of the real reason why they lost
 Hong Kong in the first place. Or is it their way of giving the middle finger?

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The reality of addiction

Requiem for a Dream (2000)
Director: Darren Aronofsky

The President of India, a rocket scientist and an overall good soul, once told his audience, "Dream is not that which you see while you sleep, but is that something that does not allow you to sleep." Don't jump about it; put it in action!

They also discuss the American dream, which states everyone has equal opportunity to achieve success and prosperity through hard work, determination, and initiative.

Yes, we can convince ourselves that we can do it. We should go for it, putting our minds and souls into it. However, the fact is that people win and people lose. Only some people are cut for it. A thin line exists between having the mojo to do it and not. One should recognise their shortcomings and jump on to Plan B, not forever flogging a dead horse.

Worse still, when one fails to pick up the telltale signs, one buries oneself deeper and deeper into a cesspool of self-defeating habits, hoping for a miracle to happen. When the going gets tough, one should know when it is time to get the tough going, when to retreat and live to fight another day. Failure to discern will spell disaster.

But how do we know our capability if we do not know ourselves to the limit? How do we know our breaking point unless we are stretched to the limit? The telltale sign must be when pharmacological agents get involved. Where does the concoction of ayahuasca with active ingredients like DMT (Dimethyltryptamine) and MAOIs (Monoamine oxidase inhibitors) fit in? Ayahuasca is a potent hallucinogen used to open portals inaccessible to human minds to explore one's true potential. Many ultra-marathoners in the desert of Mexico consume it to push their bodies to the possible human limits. 

Some have labelled this movie as one of the most disturbing films ever produced. It is not so much of the gore factor at play here; it is much the depiction of hopelessness one experiences when one is trapped in an addiction.

Loneliness, depersonalisation and self-prescribing are the greatest bane of modern living. Human interaction is so superficial. 

A widow, Sara, lives alone in her apartment. Her young adult son, a drug addict, occasionally goes AWOL, only to sell off his mother's goods for a bit of cash and a quick fix. The mother's constant companion is a TV, and her fixation with a particular game show keeps her going. Her only other human contact is when her neighbours sunbathe along the walkway.

One day, Sara receives a call that she will be a guest in a game show. She and her friends are all so excited. Sara plans to appear in a dashing red dress that she appeared in during her prom. For that, she goes on a diet spree and later gets prescription drugs. Sara loses weight, albeit slowly. So, she increases her dosage on her own, causing hallucinations and insomnia. She is finally institutionalised. 

Sara's son, Harry, tries to make money by reselling heroin at an inflated cost. He and his girlfriend have big plans of starting a boutique. Things do not go as planned. Harry, his girlfriend and his business partner are all heroin addicts. They decided to test out the merchandise that they sell. Things go spiralling down from then on. Harry even pimps his girlfriend to make ends meet.

A compelling story on the reality of addiction. 

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All snuffed out?

Look at the literature on senile dementia. Invariably, the first thing to be mentioned about managing these patients is discontinuing statins. Funny. I remember a time not too long ago when statins were hailed as the greatest of human inventions, after sliced bread, of course. Some even advised starting statins prophylactically after turning 40. Besides its coronary vessel-sparing effects, statistics then proposed protection against fractures and reduced incidences of bowel cancers.

Something so good had suddenly gone over to Dark Side? If one loves long enough to be afflicted with dementia, wouldn't he also be having raised cholesterol, cardiac events and the gamut? Now comes the chicken and egg story. Did the statins precipitate loss of neural functions as the whole 3kg brain is nothing more than a lumpen of fat?

Why am I even not surprised that only after two years of decriminalising cannabis, basically to draw in tourist dollars, it has taken a 180-degree turn. The Thai authorities must have realised that it was all wrong. Now, they want to reserve marijuana for medicinal uses only, under prescription and supervision.

This thought has plagued me since childhood. At six, my father brought me to the race club. I remember getting all excited seeing all those majestic horses run. It must have left a strong impression on my young mind that I became excited when a prancing horse reel appeared on our home 16" black-and-white TV. That is when the fight started. My father must have had quite an earful—one for attending the turf club and, second, for bringing a six-year-old there.

Why is it so readily available for everyone if going to the races is wrong? In the same manner, my mother told me that it is wrong to smoke and indulge in intoxicants. But then, I saw both my grandfathers in a perpetual state of inebriety with beedis or other unfiltered cigarettes slipped between their fingers. Well, that is the schizophrenic world we live in, I soon realised.

If we look back at history, mankind has been yo-yo-ing between promoting and banning intoxicants, between party time and prohibition.

When sailors returned from the New World with leaves that could be smoked, people thought that that would be their new plaything. They thought it was fantastic. Then they realised it gave them nasty coughs. By then, it was too late. They were hooked. The natives back in the New World never had this issue as smoking was customary, not a leisurely activity.

When Europeans brought in the technique of distillation of alcohol from the Islamic Empires, the Europeans discovered drunkenness, bumps and cirrhosis. The Aztecs chewed coca leaves to give vitality. Europeans thought heroin was the panacea for all ailments from fibromyalgia to insomnia and alcohol addiction!

When William of Orange wanted to balance his trade with France, he thought the most novel way to do that was for the British to brew their own gin. This led to the Gin Craze and a generation of abandoned children because their mothers were too high to let their babies suckle. To offset this, a gin tax was instituted by the mid-18th century.

People have short memories. By the mid-19th century, in the Victorian Era, it was hip again to be seen in gin palaces. This was compounded by the fact that gin and beer were cleaner than drinking water, as the sanitation system was non-existent in London. The Thames was an open sewage stream. The flamboyant drinking palaces fizzled out under the weight of drunkards and their disorderly behaviour.

Gin Craze in London

Opium was an exotic Eastern product that made its way into Europe. It became a status symbol to be indulging in a bit of weed every now and then. It was customary for artists, writers, poets and even Sherlock Holmes to be on snuff. In their stately duties in the Empire, the British East India Company was actively growing them in India to balance their trade with China. They also flooded the Chinese market with cheap opium and turned the Chinese population into opium addicts, which they successfully did. Their misdeeds finally caught up with them to bite them at their posteriors.

So, it is a cycle. People will hail intoxicants, and then the ill effects will manifest. People will suppress them, only to forget all about them later. Rinse and repeat. We are just caught in the eternal cycle like a dog chasing its tail. For the record, one theory postulates that the inhabitants vanished without a trace because they were all addicted to soma.

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A nation addicted?

Dopesick (Miniseries; 2021)

Disney plus.

The medical fraternity has an uphill task. Too often than not, they have not lived up to their promise. The public cannot be blamed if they get the impression that this noblest profession has been infiltrated with financial gains, deviating far from what Hippocrates and ancient healers had in their minds. Medical professionals are looked upon as conniving smooth talkers who are just out there to cheat their clients blind through incomprehensible jargon and careful wordplay.

In the 1950s, thalidomide was hailed as the next best thing for pregnancy-related nausea and vomiting. Advertisers were out on a limb trying to sell it as a safe drug until the American courts banned its production after being linked to causing babies to be born with defective limbs (phocomelia). Then joining in the fervour in wanting to vaccinate the nation against poliomyelitis, the medical-industrial giants went on a crusade to produce a polio vaccine. Cutter Laboratories in California inadvertently had live active viruses in its vaccine instead of the live attenuated ones. Consequently, 120,000 children were injected with the Cutter vaccine, resulting in 40,000 recipients getting iatrogenic 'polio-like illness', 55 having permanent paralysis and 5 deaths.

From the Framingham studies to WHI studies, people have been painted with the same narrative by the medical business industries. Backed with scientific statistics, media presence, legal backing, bottomless financial wells and the medical professionals at their beck and call, Big Pharma can sell ice to the Eskimos. A Tamil proverb says, 'at the mention of money, even a corpse would open its mouth in awe'. In modern life, everyone and everything has a price. There is nothing like a bit of palm greasing would do.

Ad for thalidomide

Doctors often try to keep up with the latest advances in medical sciences via peer-reviewed articles and carefully conducted research. When research is tainted with grant money obtained by the drugmakers and vested interest is involved, one cannot get unbiased findings. The doctors are caught in the centre. They are in the unenviable position of bridging between the patients, who trust their good doctors and the vulture businessmen. The patients like to think that their doctors would put the patients' interest foremost, not the manufacturers', whose main appeal is showing profitability to their shareholders.

Doctors often try to keep up with the latest advances in medical sciences via peer-reviewed articles and carefully conducted research. When research is tainted with grant money obtained by the drugmakers and vested interest is involved, one cannot get unbiased findings. The doctors are caught in the centre. They are in the unenviable position of bridging between the patients, who trust their good doctors and the vulture businessmen. The patients like to think that their doctors would put the patients' interest foremost, not the manufacturers', whose main appeal is showing profitability to their shareholders.

In a world that constantly values material things over altruistic causes, it is easy for one to fall into the trap of materialism and have his soul sold to the devil. After all, they start their professional careers as debtors and spend their whole professional life trying to pay them off. Do they not deserve a little comfort in life after slogging their whole life through? 

If the recent pandemic taught us anything, it at least re-emphasised the fact that there are two sides to the story. What is accepted as the gold standard does not stay such for long. It gets 'oxidised' and loses its sparkle for new metal to emerge. First, the scientists posited that lockdown was necessary to curb transmission to avoid strain on the medical services. They promised that vaccination would help to hasten herd immunity. Then the scientific community suggested that a second dose was necessary to maintain immunity. The basic consensus about herd immunity suddenly took a re-definition. The classical dictum dictated that it is not the individual immune status that mattered but the whole community. If formerly 80% immunity was considered sufficient to ward off illness from the community, the 21st century warranted each individual to be mandated to have the vaccine, carry a vaccine passport and denied individual liberty if he decided that the whole exercise was bunkum.

Cutter polio vaccine

If all that was not enough, somebody decreed a third booster dose and maybe a fourth dose for the most vulnerable in society. The literature search for this topic becomes more perplexing. For every point substantiating a particular subject matter, there would be many opposing points depending on the type of media the issue is discussed or who is sponsoring the journal.

Almost like an afterthought, everything is off - no lockdown, no mask, no travel restrictions, no vaccine passport. I guess the financial gains from a lab-made virus have run thin.

Pain has always been thought a form of body self-defence. Injury to a specific area of the body triggers chemical substances within the vicinity to restrict the part's movements to curb further damage. Pain has always been accepted as a normal body response to trauma or inflammation. Ancient societies had even linked a virtue to this body response. Penance has been carried out to appease the divine forces. Life miseries have been assumed to be a test of faith, and the Lord's suffering on the Cross has its special meanings in Christianity.

However, to modern society, pain is a meaningless annoyance that they can do without. Perhaps, the comforts of life have turned mankind into fragile mimosa pudicas. In the 1990s, alleviating pain was the pharmaceutical industry's primary concern. The problem with oral pain medication is that the most effective of the pain reliefs are the habit-forming addictive narcotic analgesics. Purdue Pharma somehow convinced everybody, including the FDA, that their slow-release narcotic formulation, Oxycontin, is unique in minimising addiction. Addiction was determined to be less than 1% through dubious inpatient studies!

FDA and soon the medical fraternity bought the Purdue Pharma story wholesome. Doctors followed the sciences, and the scientists' recommendations were good enough. Pretty soon, doctors become more and more liberal with their prescription of Oxycontin for their patients' even the mildest of pain.

In an effort to treat pain adequately, the American Pain Society, in 1996, classified pain as a vital sign to monitor (after pulse rate, blood pressure, respiration, temperature). They even have a visual assessment chart to quantify pain to administer adequate analgesics. Interestingly, pain is very subjective, and patients tend to overscore the pain they feel, making doctors overprescribe. Purdue was not complaining. The demand more Oxycontin increased. The previously unmentioned subject of tolerance to Oxycontin came to light. Pretty soon, America saw a spate of drug-related violence. Many states with mining industries, including the Appalachian region, saw a phenomenal increase in break-ins into pharmacies. Drug addicts even started snorting Oxycontin. It piqued the interest of a particular DEA officer and a few lawyers in the AG office of the State of Virginia.

This miniseries is a dramatisation of one of the events that started the fall of the domino in the trust of the medical institution. It tells its narration with the journey of a dedicated small-town doctor who is duped by the drug company to widely prescribe and use the drug for himself. He spirals down the bottomless pit of drug addiction. He almost kills a patient and loses his medical licence. 

Part of the story involves a young Appalachian girl in the same town who was prescribed Oxycontin for a mining injury. Another part tells the moral dilemma of a drug sales representative for selling drugs with questionable benefits. Then there is the question of family dynamics within the board of Purdue Pharma.

This type of misinformation is not exclusive to the medical profession. What would a client think when his case gets dragged till it reaches the Court of Appeal and wins? Is there a hidden agenda for the lawyers to prolong his representation for more lucrative remunerations? Despite all the contributions from philanthropic members of the congregation, why is it that houses of worship are perennially short of cash and demand contributions?

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