And it’s really only one word

A strange picture of a chicken to go along with how strange you feel about getting rid of your doctor

I’ve had my own journey with chronic unexplained illness, and in my medical career, I’ve helped thousands of others to find a path out of such a situation. I’ve never found the answer to these situations in a textbook. That shouldn’t be hared to believe, because if the answer to such problems were in textbooks, there wouldn’t be such problems. The thing about any chronic illness is that the answer isn’t obvious.

More and more today, the problems faced by physicians in our country are chronic illnesses. That’s a terrible mismatch as our system…

A porcupine never starts a fight — image courtesy of the LP of Minnesota

[NB — I was scheduled to speak at the Libertarian National Convention in Orlando ongoing now. I am attending remotely due to the increasing new cases of SARS-CoV-2 infection in that part of the country now. This is the speech I was going to give.]


We come together at a time of medical crisis in this country.

Am I talking about the epidemic virus? Am I talking about the epidemic of opioid overdoses? Am I talking about our endemic problem with racism?


The latest incarnation of crisis started with the virus, eclipsing the existing addiction crisis in the news…

Some thoughts on certainty

Nothing is certain. Things only look certain when their cloud of probabilities becomes narrow enough for us to ignore the rest. When we act to affect a certainty, what we are really doing is manipulating the cloud of probabilities around that idea.

This is true for medical diagnoses though we don’t like to think so. When a doctor tells us we have pneumonia and prescribes an antibiotic, we are hopeful that she is certain of the diagnosis as well as the causative organism and best treatment. In fact, that is rarely the case.

In a related way, when dealing with…

Why you’re hearing about this now

How it started

About two months ago, the world first learned that there was yet another cluster of respiratory viral illness in China. This is not an infrequent story, as traditionally the flu seasons start in Asia and travel east across the Pacific. What made this story unusual were two factors. The first was that the number of cases that presented in serious condition were larger than normal. The second was that we were quickly told that the cases centered on a wet market in Wuhan. What happened then was unusual as well.

Because Wuhan is the…

Have I got a deal for you (clipped at top and bottom)

So here’s the deal. I need to borrow a dollar. Just lend me a dollar. I don’t know when I can pay you back, but I’ll give it back to you one day. And no interest, okay? I’ll just pay you the dollar, even if it’s a few years before I get it to you. Deal?

Well, you probably would say yes. A dollar is such a small amount of money that you don’t mind parting with it. Even if I don’t offer security for the loan, pay you for the time I’ve…

With apologies to Goldratt for stealing his title

Derived from Yaron Schwinger’s photo on Wikimedia Commons

My wife and I are both in Medicine. Our careers have spanned a time when the field transitioned from being lead by physicians to being managed by business people. You might think that from our point of view that this would be enough to complain about, but, no. What is much worse is that when I’ve tried to help the business people get even more of what they want, they won’t listen.

My experience with non-medical managers is that they manage to a local optimum. It isn’t their fault. They are given…

Analysis of a study

Does this plant make your babies smaller? I don’t know.

This study was posted to an email group of Addiction Medicine doctors I’m in. It’s behind a paywall so a lot of my friends didn’t read it. The conclusions of the abstract confirmed their thoughts though. No need to read further, right?

Here’s the abstract so you can read what my friends read. You can skip to the conclusion at the bottom of the quote like most of them did if you want:

Objective: To compare birth and early developmental screening outcomes for infants with and without in utero cannabis exposures.

Study design: Observational cohort of…

At least I don’t think I have

The recent belligerence with Iran caused a US Congresswoman to comment on her PTSD. Others responded to this saying that only combat veterans should be able to speak of PTSD. It got me thinking about our ‘post-9/11' view of war and how it differs from the view I had in the Navy during the Cold War.

It’s been said that combat consists of long periods of boredom punctuated by moments of absolute terror. Interestingly, DOD doesn’t define the term. Perhaps that’s because DOD understands that combat can come in many forms.

For the…

Bringing about change in any field

The Mermaid by Howard Pyle

In a previous post I discussed difficulties with getting the addiction treatment industry to change. I’ll briefly summarize here. When you are considering changing there are only two choices, to change or not to. And in either case there are costs and benefits to the choice. So one could create a grid of 4 squares as we see below.

Even when we think everything is going great

Last week I wrote about the folly of the current default model of addiction treatment in America based on long-term residential rehab, often without medical intervention. Insurance companies have been increasingly reluctant to pay for such treatment in the last few years, and rehabs have responded to the decreased compensation with additional services such as in-house labs and pharmacies to deliver margin. The recent decades have been one of conflict between the rehabs and the insurance industry. I don’t like conflict, because it’s a waste of effort. …

Howard Wetsman MD

Addictionologist educating the world soon at Solves problems with TOC. Author of Questions and Answers on Addiction. Twitter: @addictiondocMD

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