In a consumer society there are inevitably two kinds of slaves: the prisoners of addiction and the prisoners of envy. ~ Ivan Illich, Tools for Conviviality (1973)

I am addicted to the twentieth century. ~ Martin Amis, Money (1984)

Two years ago the Conservative Canadian government launched a multi-million dollar National Anti-Drug Strategy, with its predictably punitive crackdown on illicit drugs, mandatory minimum sentences, hectoring propaganda, abstinence-based “treatment,” and police-heavy approach – in short, a classic drug-prohibition stance.

No one questions that drug addiction is a problem, but the Harper government’s dogmatic handling of this complex issue betrays its inability to get at the true roots of substance use and abuse. The resurgent puritanism in Ottawa angers Bruce Alexander, who has recently published a new book, The Globalisation of Addiction: A Study in Poverty of the Spirit (Oxford University Press).

Alexander, a psychologist and Professor Emeritus at Simon Fraser University, believes that addiction is not about sinners in need of salvation, but about the society they live in. “The conventional wisdom depicts addiction most fundamentally as an individual problem,” he writes. “Some individuals become addicted and others do not. An individual who becomes addicted must somehow be restored to normalcy.”

The government’s dogmatic thinking fails to recognize that a problem as terrifying as addiction has its roots in the kind of fragmentation that is inevitably produced by free-market economics. The solemn press conferences and media images of frowning officials in dark suits or uniforms simply repackage and reinforce the old idea that the reason we have people who aren’t behaving properly is drugs – that drugs have a magical quality of taking over human beings who would otherwise be normal smiling happy people shopping at Wal-Mart.

The Globalisation of Addiction presents a radical reappraisal of the nature of addiction, which science and sermons have failed to manage. There are no reliable methods to cure it, prevent it, or take the pain out of it. There is no durable consensus on what addiction is, what causes it, or what should be done about it. Meanwhile, it continues to increase around the world.

Addicts are people struggling to adapt to and deal with difficult psychological and social circumstances. Viewing addictions of all kinds as adaptive responses to dislocation seems odd at first, for we have been taught to view addiction superstitiously as some kind of malevolent entity taking over the soul. But understanding addiction not as “possession” but as an adaptation makes the phenomenon both more comprehensible and more familiar, and is ultimately a deeply sympathetic and humane perspective. It is also a hopeful one, offering a variety of options that can help addicted individuals find social integration and therefore happier lives.

Alexander argues that the failure to control addiction can be traced back to the conventional wisdom of the 19th and 20th centuries which focused too single-mindedly on the afflicted addict. Although addiction obviously manifests itself in individual cases, its prevalence differs dramatically among societies. For example, it can be quite rare in a society for centuries, and then become common when a traditional culture is destroyed or a highly developed civilization collapses. When addiction becomes commonplace in a society, people become enslaved not only to alcohol and drugs, but to a thousand other destructive pursuits: money, power, dysfunctional relationships, gambling, or computer games.

A social perspective on addiction does not deny individual differences in vulnerability to addiction, but it removes them from the foreground of attention, because social determinants are the more influential factor. This book shows that the social circumstances that spread addiction in a conquered people or a declining civilization are also built into today’s globalizing free-market society. Capitalism is magnificently productive, but it subjects people to irresistible pressures towards individualism and competition, tearing rich and poor alike from the close social and spiritual ties that normally constitute human life. Alexander calls this a “worldwide rendering of the social fabric.” People adapt to their alienation or dislocation by finding the best substitutes for a sustaining social and spiritual life that they can, and addiction serves this function all too well.

The most effective response to a growing addiction problem is a social and political one, rather than an individual one. Because addiction is an individual and social response to “dislocation” – especially severe social, economic, and cultural dislocation – the solution is “psychosocial integration.”

Alexander BK. The roots of addiction in free market society. Ottawa: Canadian Centre for Policy Alternatives; 2001. Available from: http://www.cfdp.ca/roots.pdf

Levine HG. Review of “The globalisation of addiction: a study in the poverty of the spirit” by Bruce K. Alexander. Harm Reduct J. 2009; 6: 12. Published online 2009 June 23. doi: 10.1186/1477-7517-6-12. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2717062/

Trying to decide on a database cancellation can be fraught with uncertainty.  Evidence-based criteria are important but often shoved out of the way by other considerations. The culling process is a little more sophisticated than resorting to eeny, meeny, miny, moe. Basing decisions on research is laudable, but in the end it’s dollars and a Hobbesian political deftness that count for more. It’s not a case of evidence-be-damned, but rather the Ellenbogengesellschaft – the sharp-elbowed social reality – of collection development.

Consider the following databases: AMED (Allied and Complementary Medicine Database), CINAHL, EMBASE, and Global Health. If you had to cancel one of them, which would it be? The latter might get the boot from some of us, but I’m guessing most health libraries would probably push AMED overboard first. We would justify this to ourselves with the comforting assumption that the combination of the other databases provides good enough coverage of complementary and alternative medicine. CINAHL, for example, is well known for its lavish attention to allied health; PubMed offers its petal-strewn Complementary Medicine subset to smooth the way for us; and so on. And isn’t it true that in the minds of many faculty and health professionals CAM is to real medicine what holy water is to healing? That, to me, is the key issue. Always present in the background of a library’s cancellation decision is one of the guiding principles of a public service, multa docet fames (hunger teaches us many things). Regardless of what the literature tells us, this question cannot be avoided: to which database’s disappearance would the most influential library patrons object least?

Some justly claim their decisions to be reasoned and evidence-based. Others, if pressed, might have to admit that a decision can be biased, gratuitous, hasty, or obviously political. Journal and database cancellations are determined centrally in my world, and hence are mostly out of my hands. I like to think that the best reasons, and not just sharp elbows, are always brought forward before a subscription is dropped. Be that as it may, with respect to CAM resources, a Canadian study [1] has succeeded in undermining most of my notions about the quality and comprehensiveness of PubMed’s coverage of complementary and alternative medicine. I also see AMED in a new light.

AMED acclaimed
In a recently published article in Evidence-based complementary and alternative medicine, the authors’ objective was to compare a number of databases relevant to CAM. In all, they searched fifteen databases to identify CAM controlled clinical trials not also indexed in MEDLINE.

Their abstract sums things up adequately:

Not unexpectedly, in their conclusion the authors recommend a multi-database approach:

With budget restrictions looming, the University of Manitoba Libraries has just dumped AMED, which this study identifies as second only to CINAHL for controlled clinical trials coverage in complementary and alternative medicine. Who would have guessed that AMED would stand out in this subject area, considering how poorly it is rated in another recent study which has just been published in Physiotherapy [2]?

AMED def-amed
Researchers at the University of Sydney compared the comprehensiveness of indexing the reports of randomized controlled trials of physiotherapy interventions by eight bibliographic databases (AMED, CENTRAL [Cochrane], CINAHL, EMBASE, Hooked on Evidence, PEDro, PsycINFO and PubMed). The results in a nutshell? PEDro indexed 99% of the trial reports, CENTRAL indexed 98%, PubMed indexed 91%, EMBASE indexed 82%, CINAHL indexed 61%, Hooked on Evidence indexed 40%, AMED indexed 36% and PsycINFO indexed 17%.

Poor AMED comes a cropper here, outclassed as it is by a free resource like PEDro (a name almost as silly as Acubriefs, which sounds like the latest offering from Stanfield’s Ltd., Canada’s self-proclaimed, one-and-only “Underwear Company”). A library might feel quite justified in cancelling its subscription after reading about AMED’s poor coverage of physiotherapy research.

Given these contrasting evaluations of a database’s effectiveness, the question arises as to which evidence will have the most weight in the decision to cancel or retain? Our pair of studies illustrate how difficult it can be to play the database shuffle in making cancellation decisions. When budgets are tight and sacrifices must be made librarians are always ready to lend a hand, but attached to those hands should be sharp elbows.

References

1. Cogo E, Sampson M, Ajiferuke I, Manheimer E, Campbell K, Daniel R, Moher D. Searching for controlled trials of complementary and alternative medicine: a comparison of 15 databases. Evid Based Complement Alternat Med. 2009 May 25. PubMed PMID: 19468052. DOI 10.1093/ecam/nep038.

2. Moseley AM, Sherrington C, Elkins MR, Herbert RD, Maher CG. Indexing of randomised controlled trials of physiotherapy interventions: a comparison of AMED, CENTRAL, CINAHL, EMBASE, hooked on evidence, PEDro, PsycINFO and PubMed.Physiotherapy. 2009 Sep;95(3):151-6. Epub 2009 Apr 23. Review. PubMed PMID: 19635333.

Photo credit: CC licensed flickr photo by fabbio:  http://flickr.com/photos/fabiovenni/240530154/

On Friday my colleague Tania Gottschalk and I were looking forward to the pleasurable task of introducing a group of library staff to the new, improved PubMed. These are people we know well and work with every day. So they were in a tolerant mood as we began to stumble about the new PubMed interface, trying to point out the most important features and to differentiate the substantial from the merely cosmetic changes.

What we thought would be a breeze turned out very differently. After my experience in that lab I’m ready to put on my old T-shirt from the 90s, with the slogan “Smash Forehead on Keyboard to Continue.”

Preliminary philosophical reflections
Now, I’m an easy-going type, and the continental drift that has randomly rearranged PubMed’s major menu items is no big deal. Think of all the wrists around the planet getting more exercise as cursors are sent on expeditions to rediscover vital menus and links scattered across the vast white sea of the introductory PubMed page.

One could argue that the apparent complexity and randomness – I would not go so far as to say capriciousness – of the PubMed redesign must have emerged in a way that did not depend on finely-tuned details of the system: variable parameters appear to have changed spontaneously without affecting the underlying programming code, in a sort of self-organized criticality. In short, little is where it used to be, which wouldn’t necessarily be a bad thing if one had a sense of the fundamental rationale.

Why, for example, are the tutorials separated from the FAQs? Why are Clinical Queries and Single Citation Matcher called a “resource” in Advanced Search and a “tool” on the main page? Why have the ready-to-hand tabs been replaced with the scattered remnants of their algorithmic detonation?

Philosophers have argued for centuries on what constitutes the quiddity or “whatness” of a thing as opposed to its haecceity or “thisness.” Librarians, equally inclined to make much of a muchness, cannot help but quibble about a drop-down menu here or a radio button there, a menu before or a link after, this option or that feature. Nor can we stop ourselves from applying our hermeneutic of suspicion to the new PubMed.

But it is not my purpose in this post to vent on what I dislike about the changes to my favourite database. There is also a great deal that I like. Let me return to Friday’s lab session on the PubMed redesign. Brief and informal as it was, our little demo gone demonic gave rise to two apparent bugs in PubMed’s programming, something more substantial than its desultory interface tweaks.

Auto Suggest
Our first difficulty came to light with Auto Suggest. This feature, I would suggest, is not all that it should be. In our little training demo we were working with the search terms “low carbohydrate diet” and “carbohydrate restricted diet.” In our prep for the session, we noticed that after typing the former, PubMed auto-suggested the latter with “or.” What a handy way to show how PubMed could help the novice search aided by suggestions about alternative search terms. As luck would have it, when we had PubMed up on the big screen during our lab session, this happy combination failed. No “or” appeared after Tania typed the first phrase. Not even after multiple attempts.

Oh well, it gave us our first opportunity to use that time-honoured escape clause of the harried presenter: “Moving right along …” I have tried to repeat the same thing again today, but Auto Suggest seems to be working again.

Is this a real bug in the PubMed code, or could it have had something to do with the congested entrails of our proxy server? I’m not sure about this one. But when my turn came to discuss field searching in Advanced Search, a truly nasty surprise was waiting.

Advanced Search: Search by Author, Journal, Publication Date, and more
This function of Advanced Search looks like a great way to introduce casual users of PubMed to searching within fields. I wanted to compare a simple, across-the-board two-word search to looking for each of the terms in the title field only. I often use the latter method (using the [TI] delimiter in the command line) just to reconnoitre unfamiliar terrain, as a quick-and-dirty way to find some relevant articles. I had never tried this method before.

My chosen example was a search employing the two keywords “doctors” and “torture.” The basic, unadvanced search “doctors torture” yields 353 results and produces the following details log:

No surprises there. Before using any Advanced Search procedure I tried my standard method of adding the Title field tag to each term just to make sure that PubMed would produce some results. There were 70 hits with this search (the field tags prevent any mapping):

Then (as illustrated above) I attempted the same search using Search by Author, Journal, Publication Date, and more in Advanced Search. I selected the Title field for each of the first two search boxes. I made sure “All of these (AND)” is selected. I entered my two terms in their respective locations.

Result? Fail.

Error #1: PubMed ignores the first term, takes only the second term (in this case, “torture”), and puts into a search box with “[Title]” directly appended.

Error #2: In doing so, PubMed leaves Advanced Search and displays the orphan term in the search box on its main search page.

Error #3: Having reverted pointlessly to the main page, PubMed fails even to perform the search for the one term it has placed in the search box there, leaving the user marooned.

Error #4: For no obvious reason except perhaps Schadenfreude, PubMed adds a peculiar message below the search box: “If you are trying to search, please enter a term.”

A true bug?
Since Friday’s embarrassment, I have been able to reproduce this error consistently, using a variety of terms: “men” and “women,” “blood” and “pressure,” “aerobic” and “non-aerobic.”

I have employed various methods to ensure that other factors are not interfering, such as clearing the entire history, clearing any previous search terms, and even clearing my browser cache and restarting PubMed. Nothing will make this feature work with the Title field.

Here is another annoyance. If have performed a previous search and have not cleared everything out of the search box, searching Search by Author, etc. as above adds that orphaned second term to my existing search statement – without warning.

After my embarassing experience with advanced field searching, I felt like the guy in Hell who doesn’t know where to tell someone to go.

Other field searches work
As I investigated further into field searching in Advanced Search, I did not encounter the same errors ANDing together two Author names (e.g., Smith & Jones), or two terms as Text Word. Even as implausible a search as entering “English” and “French” into the Language fields causes the database to cough up 11,855 bilingual articles.

As far as I can determine, this PubMed bug is confined to the Title search.

Needless to say, there was much tittering around the lab as my colleague and I “moved right along” from that bit of pother. I’m curious to know if the PubMed people are aware of this bug, and if so, whether that is one of the causes of the seeming delay in transitioning to the redesigned interface. It will be interesting to see if others have endured the same sort of PubMed redesign tribulations.

Photo credit: cc licensed flickr photo by TaranRampersad: (flickr.com/photos/knowprose/101872870/)

An alert public health official in Winnipeg pointed out that my post on oral sex barriers failed to distinguish between dental dams and sex dams. I freely admit to having been vague on the distinction between the two, this not being an area of expertise for me. So I delved a little more deeply into what the web could offer. Because the primary literature is so focused on condoms (male or female), the web is often the only resort for the safer sex researcher. When you consider the popularity of oral sex in the general population and the clear documentation on disease transmission by means of oral-genital or oral-anal contact, it is surprising and distressing to see so little research.

Try a search in Scopus, for example, on “sex dams.” 15,000 journals and not a single mention. One fares a little better with the search term “dental dams,” until it becomes clear that all the serious research strictly involves their use in dental practice.

Differentiating the dams

In my defence I should say that the term “dental dam” is frequently used to refer to any patch of latex, polyurethane or polyethylene used for oral stimulation during sex. Many safer sex web pages use the phrase exclusively, without mentioning sex dams. It is not surprising that this leads to some terminological confusion. Yet there is a notable difference between the two types of dams, and I hope that the following will be a useful clarification.

A dental dam is a small latex patch, normally 5 or 6 inches square, used in dental procedures. A sex dam is a delicate latex sheet, usually 10 by 6 inches, specially designed for oral sex. It is larger and much thinner than a standard dental dam and frequently comes in various colours and flavours. Polyurethane sex dams are also available commercially, but again, don’t expect to find terminological exactitude or you may miss the Hot Dam Banana Flavored Polyurethane Dental Dam when you do a Google search.

Sex dam benefits

The major factors that differentiate the dams are size, look and feel, taste and smell, thickness, and transparency. Sex products need to be “fun,” a basic requirement often forgotten by those whose main concern is to get the science right.

1. A good sex dam should be large enough to fit over the entire genital or anal area. Normal dental dams or cut-up condoms are really too small for cunnilingus and anilingus, however “approved” they may be as a barrier.
2. Some condoms have a powdery surface that is not suitable for oral contact, and dental dams are too rubbery and clinical. The tactile sensation involved in using a dam for pleasurable stimulation is important, for the giver as well as the receiver.
3. Sex dams are usually scented to hide the turn-off latex stench, and flavoured to please the tongue.
4. Sex dams are also very thin and delicate. They are designed to give pleasure. A good thing, since there is very little pleasure in trying to find and purchase them on the web or in shops. It goes without saying that a thick, podgy slab of latex has all the sex appeal of a placemat.
5. Finally, the transparency of a dam is an important motivator. We’re talking sex here, after all, not wrapping cutlets for the freezer. One of the reasons that plastic wrap is used at all is that it allows both sexual partners to see the erogenous terrain, as it were. This is a definite plus when it comes to sexual pleasure. A well-designed sex dam should have this characteristic of transparency or at least translucency.

Alternatives to dams

As I explained in my previous post, most of us who might benefit from them do not have easy access to good sex dams. That is why efforts have been made to suggest safe alternatives, even in the face of the overwhelming lack of good evidence as to their efficacy.

SexualityandU.ca, a Canadian safer sex website, has a good definition of the use of what it terms “dental dams” for oral sex, and it has the most reasonable advice I have been able to find for anyone thinking about using plastic wrap as an alternative barrier:

CDC would have done well simply to borrow this balanced and objective plain-language explanation for its revised pronouncement of last June on oral sex and HIV risk.

The SexInfoOnline website, maintained by students from the University of California, Santa Barbara, offers well-illustrated instructions on how to make an oral sex barrier using a standard condom. The final photograph shows revealingly just how small a cut-up condom actually is. Although somewhat chaotically organized, SexInfoOnline is an excellent resource. For example, I learned the meaning of “queefing,” a spicy new addition to my vocabulary.

Compare the cut-up condom photo to this illustration of a sex dam found at Sheer Glyde Dams, a U.S. commercial website that is known to ship product to Canada and Australia. The difference is considerable. A dental dam, the kind used by your dentist, is somewhat larger than a sliced condom, but not as large as the typical sex dam produced for sale at sex shops, on commercial websites, and very occasionally at pharmacies.

The best instructions I have seen for constructing an alternative dam from a condom or latex glove can be found at the website of Agence de la santé et des services sociaux de Montréal. The information is available in English and French accompanied by detailed colour photographs. With predictable Canadian reserve, the instructions, thorough as they are, do not show the practical application of these improvised barriers in situ.

Another good general resource on oral sex and HIV prevention is thebody.com.

Dams around the world: Lecktücher, digues dentaires, fazzoletti di lattice

In German the thick latex sheet used by dentists is called der Kofferdamm. For sex dams the Germans employ the more sexually suggestive word das Lecktuch (lick sheet), which for no apparent reason is in the neuter gender. The plural form is Lecktücher. One occasionally finds the more sedate term Latextuch, but it’s not as popular.

The French language is content to settle for a single term for the dental/sex dam. It is the (appropriately) feminine la digue dentaire. Digue is also the French word for dike.

The Italians use the term il fazzoletto di lattice (literally, latex hanky), whereas the Russians simply transliterate the technical German term: коффердам.

Be wary of Wikipedia entries

Wikipedia’s article on dental dams is adequate for a simple explanation of their use by dentists. But it is very disappointing for the sex researcher, devoting all of two sentences to the subject of their sexual use. You will have to go to the entry on cunnilingus to get more on the safer sex angle. As we have seen, there are far better sources on the web for this kind of information.

The German Wikipedia has a lengthier article, whose only reference, curiously, is to the Canadian site sexualityandU’s page on dams.

The French Wikipedia entry falls somewhere between the English and the German coverage. Its single reference is to a poorly illustrated, bare-bones instruction page on a French AIDS prevention website. Come on, francophone colleagues. Get snapping.

The Italian Wikipedia entry provides only very general information, like the French. But the Italian entry at least has a reference to a relatively decent PDF on lesbian health issues.

The Russian Wikipedia entry is all business, i.e., dentistry only. The sexual use of коффердам (a transliteration of the German term) is as far from view as Lenin in his tomb.

Plastic wrap around the world

It’s a relief to see that, despite the lack of adequate research support, there is general agreement in many countries that the clear, scritching, clingy stuff we use to keep old pizza slices in the fridge is not the best means of warding off a serious sexually transmitted infection.

In French the term for plastic wrap is film alimentaire. Browsing through various French websites I saw general consensus that le film alimentaire n’est pas du tout recommandé (because it’s porous).

The Italians concur: la plastica alimentare è un mezzo poco sicuro (plastic wrap is a less secure method).

German safer sex sites also consider die Haushaltsfolie (lit. “household foil”) as less than ideal, to be used nur im Notfall (only in a pinch).

Saran wrap is a wonderful invention. It’s irresistible for pranksters and goofballs too. The Urban Dictionary defines it thus:

Beneath the humour, however, is the sticky reality that plastic wrap is commonly being used for purposes for which it was never designed. In light of the significant concern about the risks of using plastic wrap for any kind of sexual encounter, it is inexcusable that science has not given it the kind of attention that has been lavished on condoms, gloves, masks and other barriers to infection. It is not stretching a point to assert once again that more research is urgently needed.

A note on kissing and STIs
My contact in public health also expressed concern that I had linked kissing with transmission of the human papillomavirus. I believe there is adequate support in the literature for this position [1,2]. In short, along with things like the common cold, mononucleosis, influenza and meningitis, kissing can also pass on some sexually transmitted infections: HPV, herpes simplex, and syphilis.

References

1. Slots J. Oral viral infections of adults. Periodontology 2000. 2009 Feb;49(1):60-86.

2. Kreimer AR. Oral sexual behaviors and the prevalence of oral human papillomavirus infection. J Infect Dis. 2009 May 1;199(9):1253-4.

Every year we make enough plastic film to shrink-wrap the state of Texas. ~ EcoSection.com. Tweeted 31 Mar 2009. http://twitter.com/ecosection

Two years ago, with tongue occasionally in cheek, I wrote a lengthy discussion about my efforts to find information on the effectiveness of plastic wrap (a.k.a. cling film, sandwich wrap, shrink wrap, Saran Wrap) as a safe barrier for oral sex. At that time I found this cautious admonition offered by the Centers for Disease Control and Prevention (HIV/AIDS among women who have sex with women, June 2006): “Plastic wrap may offer some protection from contact with body fluids during oral sex and thus may reduce the possibility of HIV transmission” [1].

Well, we can put our rolls of Saran wrap back in the kitchen drawer. It appears that the CDC is shrinking from even that heavily qualified recommendation. In a fact sheet released last June, Oral Sex and HIV Risk, the CDC emphasizes the risk of oral transmission of a number of diseases and continues to advocate the use of physical barriers such as condoms and dental dams. However, on the issue of plastic wrap the CDC has changed its tune:

Medical librarians have welcomed the announcement of the National Library of Medicine’s Pillbox as a useful addition to our arsenal of drug ID tools. Both e-CPS in Canada and Lexi-Comp Online, for example, have fine indentification modules for pharmaceuticals.

But where can we find photo collections of drugs not normally dispensed at the local pharmacy? Pharmacists and health providers are interested in all drugs that people are consuming. There should be reputable resources doing the same job for street drugs that compendia do for discreet drugs, i.e. any legitimate pharmaceuticals allowed to occupy clean dispensary shelves by bureaucrats and politicians. Aside from obvious sources like High Times and Hollywood films, what guides and directories are out there and how good are they?

A pharmacist colleague of mine alerted me to the Royal Canadian Mounted Police’s Drug Identification Chart, which describes itself as “a reference tool for identifying illicit drugs and their harmful effects.” This shoddy effort (supported by the Sûreté  du Québec, the Canadian Association of Chiefs of Police, and Health Canada, no less) is flagrant proof that there has never been a situation so dismal that Dudley Doright couldn’t make it worse.

As a directory of illicit drugs the whole thing is risibly inadequate. Clearly, dope comes in many forms, and it would be hard to catalogue them all visually; but this looks more like an elementary school project than a police web page. It’s rife with bad grammar and spelling, poor quality images, and clumsy design. Hashish, for example, comes in many colours and forms. From the RCMP photograph it’s impossible to get a sense of perspective on what is being depicted. Is it thick as a brick, or a size that can be more discreetly concealed in a cigarette pack? Is it possibly a piece of burnt toast, or a map of Oregon made out of Play-Doh? It’s hard to tell from the single tiny picture displayed.

It’s almost as if the Mounties were somehow embarrassed to include better photographs and more explicit detail, similar perhaps to the reluctance of Catholic catechisms to elucidate more fully the Seven Deadly Sins, whilst revelling in descriptions of the Seven Cardinal Virtues.

And why is it that the combined efforts of three police organizations and the Canadian government could not figure out the proper spelling of marijuana? The photograph of “marihuana” shows a greenish pile of something that resembles a green hedgehog. How is this supposed to help new recruits in the war against drugs? This website is supposed to be an official resource for police officers, but it has the distinct look and feel of something thrown together for appearance’s sake. Look at the treatment of Canada’s favourite illegal pastime (along with tax evasion and cigarette smuggling). What about showing an actual leaf from the marijuana plant, just for starters? Or a grow-op specimen? Last I heard, when raiding a drug den it’s rare to find weed spread in convenient piles all over the kitchen table. Is it not more usually found in pockets or backpacks in small plastic bags or rolled into joints? But in this official directory you would look in vain for such a photograph. It’s like explaining all the forms of tobacco use by showing large brown leaves hung to dry in a barn or a pinch of snuff.

Surely from their vast reserves of confiscated drugs and drug paraphernalia the Mounties could have done something better than this farrago. I could go on, and I’m certainly no expert. Canadian police forces need to consult someone with professional or street experience of these drugs and come up with a decent range of samples. How can a ten-year-old find a pusher any time and the cops can’t?

Not only are the RCMP’s photographs of dubious value, the text of the Drug Identification Chart needs to be revised, badly. Here is how LSD is categorized:

Perception-distorting (Substance that alters sensory perception. It causes changes in user’s mood, thoughts and consciousness)

The Chablis chilling in my fridge fits this description quite well.

This being a police directory, advice is given on detection of drug users. To this end, in an odd mix of nouns and adjectives, the LSD user is described as exhibiting the following symptoms:

Hilarity, hallucinations, excitable, wild-eyed, dilated pupils

Yes officer, I cannot tell a lie. My Labrador Retriever frequently chases imaginary squirrels.

For some more helpful information on recreational drugs, I recommend the following:

And remember what Abbey Hoffman said: Avoid all needle drugs – the only dope worth shooting is Richard Nixon.

Coughs and sneezes spread diseases. Trap the germs in your handkerchief.  ~  World War 2 health slogan

Charities and non-profits provide critical services to communities across Canada. What if they are not adequately prepared for an H1N1 outbreak? asks Marcel Lauzière, head of Imagine Canada, a national program to promote public and corporate giving, volunteering and support to the community.

In an opinion piece that appeared in a number of Canadian newspapers this week, including the Winnipeg Free Press, Lauzière attempts to bring to public attention the potential impact of the H1N1 pandemic on Canada’s charitable and non-profit organizations. From the blank looks and long pauses over the phone he says he has been experiencing when he starts talking about it, it is apparent that this issue is still languishing at lower levels in the nation’s health bureaucracies.

The focus of most official attention is on hospitals, schools, businesses, First Nations reserves, and vulnerable individuals like pregnant women. There is a lively and useful public debate about how prepared we are, and how prepared we should be, for a major outbreak. But charities and non-profits are too often not part of the discussion. Left out of the picture is the fact that charities and non-profit organizations deliver critical services to Canadians. If the H1N1 epidemic is severe, what will happen if charitable organizations lose up to a third of their staff and volunteers to illness?

What if food banks start closing? How will desperate families feed their kids? What if meals are no longer prepared and delivered to elderly people who can’t get out and who have no friends or relatives nearby to help them? What about Canadians needing dialysis or chemotherapy but who can’t get to the hospital because there are no volunteers to drive them? What about the thousands of children and their families who rely on local sports and recreation and arts and cultural organizations for their weekly activities? What if the homeless shelters shut their doors in the middle of winter?

As a third pillar of Canadian society alongside governments and business, charities and non-profit organizations are part of an intricate system of societal supports that significantly improve the quality of life in Canada. They are also a significant part of our economy. “The sector generates more than $87 billion annually, a contribution of almost seven per cent to Canada’s GDP. It employs more than 1.5 million Canadians (full-time equivalents)and mobilizes 12.5 million volunteers in Canada.”

Lauzière refers to the importance of “business continuity” during an outbreak and the plans that government and major corporations are putting in place. Everyone agrees that the economy must keep on working. That is precisely why we cannot forget charities and non-profits.

[They] are part of our economy too, as well as being major contributors to our quality of life… The demand many of them face is already greater given the impact of the recession and now they must prepare for the possibility of an H1N1 outbreak. What if they are not adequately prepared?

We will need them more than ever at a time of crisis. This is no time for blank looks. As a country, we need to figure out how we can help them be prepared for whatever this influenza season brings.

Lauzière’s argument is lucid and important, but he has put the focus largely on continuity of vital services to the disadvantaged. Yes, if H1N1 cripples charities the results could be, according to the Halifax Chronicle Herald’s melodramatic headline, “catastrophic.” But where are the plans to prevent H1N1 transmission among people these charities serve? This, it seems to me, is an issue that should be higher up the priority list of public health authorities. Toronto has a working document, the Toronto pandemic influenza plan: a planning guide for homeless and housing service providers [PDF]. Other Canadian agencies seem to be a little slow on the uptake.

Rather than focusing almost entirely on business continuity, it makes sense to intensify efforts to slow the spread of the virus among disadvantaged and equity seeking groups who make use of charitable services such as food banks and shelters. These are environments in which disease can spread quickly. Sleeping and eating in close quarters, the homeless are even more vulnerable to infection by H1N1, many of them already being immune compromised, poorly nourished, and suffering addiction and chronic illness.

While Marcel Lauzière’s plea for a plan to maintain services should not go unheard, it is also important that our public health authorities act now to slow the spread of H1N1 among the many vulnerable users of charitable services until the vaccine is ready. Or we may find down the road that we have adequately prepared service organizations with no one left to serve.

Advertising may be described as the science of arresting human intelligence long enough to get money from it.  ~  Stephen Leacock, Garden of Folly (1924) ‘The Perfect Salesman’

A recent systematic review in PLoS One demonstrates quite effectively something that shouldn’t surprise any intelligent high school student: pharmaceutical advertising in medical journals often provides “poor quality information.” This strikes me as the authors’ excessively polite way of saying that drug ads, even those that appear in authoritative periodicals widely read by physicians, are unregulated, manipulative, meretricious and mendacious. Selling the latest SSRI is not really different from shilling shampoo, with the difference, of course, that there is superior evidence of shampoo’s efficacy.

The article, buffed to a high scholarly polish with any hint of libellous language or ethical disdain well suppressed, warrants close reading. Here are some highlights:

Advertising in medical journals is one of the techniques used by pharmaceutical companies to promote their products to medical doctors. During the first four years of a new medicine on the market, pharmaceutical companies may gain approximately US $2.43 for each dollar spent on medical journal advertisements for a medicine. The return on investment has been reported to increase to more than US $4 after that period.

We found that pharmaceutical advertisements in medical journals usually provided brand and generic name and indication. Other essential information required for rational prescribing including contraindications, interactions, side effects, warnings and precautions were less commonly provided. The majority of references cited to support pharmaceutical claims were journal articles. However, less than two-third [sic] of the claims were supported [emphasis mine] by a systematic review or a meta-analysis (110/1375, 8%) and randomised control trial (455/1500, 30%).

This review noted that references used to support pharmaceutical claims were often of low quality. The inappropriate use of references in journal advertising suggests that the availability of references does not always guarantee the quality of claims.

Information on medicines is essential to help doctors ensure the optimal use of medicines. However, studies show that doctors who use journal advertisements as a source of information may prescribe less appropriately. In addition, reliance on journal advertising for information is associated with increased costs of prescribing. Even doctors who think that they obtain their knowledge from the scientific literature can be influenced by promotional sources without being aware of it. As information provided in journal advertising has the potential to change doctors’ prescribing behaviour, our review indicates that ongoing efforts including complaints and recommendations by researchers, health professionals and policy makers to improve the quality of advertisements in medical journals are crucial.

Governments may need to take more proactive action such as engaging independent experts to help in designing regulation for journal advertising where self regulatory codes are limited. In addition to that, effective regulatory system may complement pharmaceutical litigation to ensure accuracy and reliability of information in journal advertising.

Our review found that the low quality of journal advertising was a global issue. Poor quality advertising has been observed in developing countries and post-Soviet Russia where controls might be weak and limited as well as in developed countries which have stricter regulations.

Globally, pharmaceutical advertising in medical journals often provides poor quality information. The impact of this problem on doctors’ prescribing behaviour might be even greater in developing countries and post-Soviet Russia where access to industry-free medicine information is limited. The results from our review suggest the need for a global pro-active and effective regulatory system to ensure that information provided in medical journal advertising is supporting the quality use of medicines.

It is the most extraordinary thing, but I never read a patent medicine advertisement without being impelled to the conclusion that I am suffering from the particular disease therein dealt with in its most virulent form.  ~  Jerome K. Jerome, Three Men in a Boat (1889)

“When I see a bird that walks like a duck and swims like a duck and quacks like a duck, I call that bird a duck.”  ~ James Whitcomb Riley

We consume hundreds of toxic chemicals from the things we use day to day to keep ourselves sheltered, fed, clothed and healthy. So say authors Rick Smith and Bruce Lourie in their recent book Slow death by rubber duck: how the toxic chemistry of everyday life affects our health (Knopf Canada, 323 pages, $32). But they are hopeful that things can change for the better, noting a recent European ban on noxious flame-retardant chemicals in television sets, Canadian legislative changes to end toxic baby bottles, and a new U.S. law to restrict hormone-mimicking ingredients in the plastic of children’s toys.

Almost everything we use, recline on, sleep in, eat off, wash with, or rub into our skin is a source of pollution. “For most people belching smokestacks, sewer outfalls, and car exhaust are the first images that come to mind when the word ‘pollution’ is mentioned,” the authors observe. Pollution is still seen as “an external concern, something floating around in the air or in the nearest lake. Something that can still be avoided.” But research makes it clear that pollution is so pervasive “it has become a marinade in which we bathe every day.”

Pollution is actually inside us all. It’s seeped into our bodies. And in many cases, once in, it is impossible to get out.

Toxic chemicals are now found at low levels in countless appliances, in everything from personal care products and cooking pots and pans to electronics, furniture clothing, building materials, and children’s toys. They make their way into our bodies through our food, air, and water.

From the moment we get up from a good night’s sleep under wrinkle-resistant sheets (which are treated with the known carcinogen formaldehyde), to the moment we go to bed at night after a snack of microwave popcorn (the interior of the bag being coated with an indestructible chemical that builds up in our bodies), pollution surrounds us … It has been estimated that, by the time the average woman grabs her coffee, she has applied 126 different chemicals in 12 different products to her body.

The authors advise readers on which products to choose in order to avoid the ones that are most dangerously polluting. But these are only short-term solutions. “For the long-term fix,” they warn, “only improved government regulation and oversight of toxic chemicals is the answer. It’s critical that we address this problem, not only as consumers, but also as engaged citizens demanding better of their governments.”

Rick Smith, one of Canada’s leading environmentalists, is director of Environmental Defence, a non-profit organization known for its innovative work on environmental issues.

Bruce Lourie started one of Canada’s largest environmental consultancies. He works closely with governments, businesses, foundations, and non-profit organizations. He is president of the Richard Ivey Foundation, which supports environmental and other beneficial projects.

This is a modified version of a review by Roy LaBerge which appeared in the September 2009 issue of The CCPA Monitor.

These be the stops that hinder study quite
And train our intellects to vain delight.

Love’s Labour’s Lost, 1.1

Who has the time for research? Very few of us, unless it is somehow part of our work day. Our teaching faculty colleagues do not teach from 9 to 5, Monday to Friday, nor are they always required to be in their offices when not in front of a class, especially between June and August. But academic librarians, it seems, can never have their cake and eat it too. We are expected to be on the job, at the workplace, every day, summer included, unless we are on vacation or on ventilation. And, with some variations, from the midst of this perpetual motion machine we are also expected to produce viable, publishable, imperishable research.

At the University of Manitoba we librarians take our research obligations seriously. We enjoy academic status and are members of the University of Manitoba Faculty Association (UMFA). We have senior management who by and large recognize the value of research and support our pursuit of it. We now also have new language in our Collective Agreement that guarantees us academic freedom and twelve paid days a year to devote entirely to scholarly pursuits. During our last protracted contract negotiations, obtaining recognition from the University that, as part of our academic status, librarians needed time to do the research required of them was a hard-fought battle.

Articles 17 and 20 of the UMFA Collective Agreement, not to mention our own promotion guidelines, more than adequately define both research and the purpose of the working time entitlement for librarians (in particular 17.A.2.5; and see also the Research, Scholarly and Other Creative Works section, 20.B.1.2.2, of the Promotion article). But lately there has been talk amongst my colleagues of establishing “guidelines” to determine the suitability or otherwise of someone’s research and whether a request for time away from other duties to pursue research should be granted.

My generous nature interprets this development as arising from good intentions, but I have to ask: why establish a set of guidelines separate from what has already been well defined in the contract, as well as in a detailed document on guidelines and criteria for the promotion of librarians through the ranks? As I see it, the subject of a librarian’s research is a matter of professional judgement in an atmosphere of academic freedom and collegiality. Our Collective Agreement wisely includes its own warning that librarians’ academic work must be undertaken responsibly: “Academic freedom carries with it the responsibility to use that freedom in a manner consistent with the scholarly obligation to base research, teaching and the collection, dissemination and structure of knowledge in a search for truth.” (17.A.1) Must we form yet another committee to encode and encapsulate what “responsibly” means?

Here is the controversial addition to our contract that seems to stick in some people’s craw. As I mentioned, Article 17 (Academic Librarians) was revised in 2007 to include language on so-called “research days”:

Academic librarians holding probationary and continuing appointments are entitled to twelve (12) working days on full salary in each academic year for research and scholarly activities relating to library science or an academic subject within their expertise, subject to notifying the department head of their proposed work and arranging a mutually agreeable schedule.  (17.A.2.5)

Article 20 on Promotion defines the nature of librarians’ research, scholarly work and other creative activities:

Factors that may be considered include:  the publication of books, monographs, and contributions to edited books; papers in both refereed and nonrefereed journals; papers delivered at professional meetings; participation in panels; both supported and nonsupported unpublished research including current work in progress; editorial and refereeing duties; creative works and performances; and scholarship as evidenced by the candidate’s advanced study and research in library and information science and/or a subject specialization, his/her depth and breadth of knowledge and general contributions to the research of the University. (20.B.1.2.2)

Here, in clear and unequivocal language, the UMFA Collective Agreement spells out what is considered research by librarians and carves out a bit of unencumbered space in which such research can be performed. Some have complained that the twelve days are no more than “automatic days off.” To argue so, I would reply, is misguided in the same way that it would be foolish to maintain that sick days should not be provided because they might, heaven forfend, actually be taken. Should the remote possibility that one of us might abuse a provision of the Collective Agreement be used as a pretext to reshape or subvert what is already appropriately defined in that document? Life is too short for us to start composing intricate commentaries on reasonably comprehensible contractual language. I think what Calvin Trillin once said is appropriate: if law school is so hard to get through, how come there are so many lawyers?

It might be argued that establishing more rigorous guidelines for librarians’ research activities would provide clarity and  improve equity across the library system. My response is that the existing contractual provisions for librarians’ research are entirely sufficient for this purpose. If all librarians read, understand and abide by it, the Collective Agreement itself is the best assurance of equity and should be the primary authority on this issue. It is only when the Collective Agreement specifically calls for the creation of guidelines that we are obligated to go beyond its provisions, as is the case with hiring and promotion at this university.

It is the responsibility of an academic library to foster librarians’ research and to organize the work of the academic staff in such a manner as to accommodate time away from other duties for that purpose. This is in the spirit of the Collective Agreement. If a manager disagrees with a librarian about his or her request for time to pursue research, that is an academic matter which should be resolved between the two of them. If no resolution is possible at that level, there are agreed-upon steps that individual can take. Under the terms of the UMFA Collective Agreement, extended postponement or denial of research time could lead to a grievance. Moreover, any attempt further to enumerate and codify what should or should not be the nature of a librarian’s research – beyond the very detailed provisions already cited above – could be interpreted as an infringement upon his or her academic freedom.

It is unfortunate that we have become accustomed to use the term “research days” – which, by the way, is not to be found in the Collective Agreement – as a convenient but demeaning moniker for what that document calls “twelve working days on full salary in each academic year for research and scholarly activities relating to library science or an academic subject within [a librarian's] expertise.” (17.A.2.5) The entry of this term into common usage has contributed to a general perception that Article 17’s provision for time given over to research is somehow an add-on, accessory or perquisite, when in fact research is an essential component of our work. This is precisely the attitude that our hard-won provision for research time was meant to dispel.

As I see it – and I speak solely from my Canadian experience – some academic libraries have not yet developed or have not fully developed a culture of research. That goal can only be achieved by creating work environments and job expectations that are not so demanding as to discourage librarians from considering research and creative scholarly contributions, or from thinking that such pursuits could be an integral part of their “regular” working day. A strong faculty association and a Collective Agreement with guts are two other important factors in furthering librarians’ participation in academic research.

I have often heard from librarians at this and other universities that they are too busy just coping with their job even to contemplate doing research. That is why I think it vital to focus on fostering research rather than devising methods to contain or curtail it. It is part of moving away from what I call the “No” school of librarianship, the kind of passive-aggressive impasse where – I speak figuratively – it is illegal to make liquor privately or water publicly. If any more guidelines are to be written for us librarians, let them elaborate on how we can open up the taps of creativity, improve our working conditions, provide better service, and be more rounded scholars and professionals.