Tuesday, September 29, 2009

Medical Technology-confusing even in 1955

Medicine has changed so dramatically since I graduated medical school in the 1980's, that it is hardly recognizable.

Certainly there has been an enormous growth in knowledge which is often beneficial, but has often led us down the wrong path.  For example, when advanced imaging techniques such as "CAT" scans and MRI's became available, we were able to see the inside of large numbers of patients but we didn't know what was really normal.  One thing we found in quite a few people was a small growth on their adrenal gland.  Many of these patients were subject to operations and it ultimately turned out that the growths were harmless.

This is one of the problems with undergoing medical tests.  You have to deal with the results.  Sometimes the results are incorrect, leading to further testing and treatments.  Sometimes the results are correct, different than normal, but still harmless.  An example of this would be the "bulging discs" seen on so many MRI's of the spines of patients with back pain.  It seems logical to assume cause and effect in a patient with back pain and a spine abnormality, yet it turns out that bulging discs are a common finding and usually not associated with pain.

We have certainly improved our treatment in many areas of medicine, but it has come at a price, both in cost and in quality of care.  Too many people can't be seen quickly.  Our attempt to provide care for everyone gas created problems.  We have lower level people doing higher level functions, and they simply can't do them as well.  This ranges from blood drawing to EKG's.  A controversial area is the autonomy given to caregivers that have less formal training than physicians, such as midwives, nurse anesthetists, and nurse practitioners.  The overload of patients has led us to treat by email or video, an idea which is hard to accept when one learned that the basis of quality treatment is a good history and physical exam, neither of which can be done electronically. 

Physicians had it good for a long time, and really didn't take care of the field.  Now there is conflict between physicians and the AMA, and a new voice has arisen at Sermo
Unfortunately Sermo does not have a section for non-physicians, although I think it would be a good idea.

This post was inspired by an item in the Journal of the American Medical Asociation (JAMA) from December 24, 1955 by G.W. Pickering M.D..  It reads as follows:

Machine Age Overtakes Medicine-
As year succeeds year, some new physical or chemical technic and some new and elaborate machine are applied to the study of disease; great claims are always made for the precision of the answers yielded by these technics and machines.  One of the greatest struggles that a practicing doctor has is to keep up-to-date with advances of this kind.  No sooner has he mastered one than another is upon him.  Moreover, the machines or technics are often so complex that he cannot understand them.  He has to take what they tell him on trust...There is a growing tendency for doctors to rely on the information given by such technics and machines in preference to the information which they gain themselves from the history and physical signs.  I am extremely doubtful if this is in the interests of good doctoring, and for three reasons.  First, the errors and limitations of these new technics are not at first appreciated...Second, a thorough clinical examination, which will be carried out only by doctors who appreciate its worth, is the best method of establishing that spirit of mutual understanding and good will which is the core of the doctor-patient relationship.  Finally, to rely on data, the nature of which one does not understand, is the first step in losing intellectual honesty.  The doctor is particularly vulnerable to a loss of this kind, since so much of therapeutics is based on suggestion.  And the loss naturally leaves him and his patient poorer.

I think there was a lot of wisdom and foresight in this 1955 article.  Technology has advanced medicine without doubt, but a good history and physical exam remain the basis of good care.  The explosion of medical technology has introduced many useless and expensive technologies as well as pure snake oil, in addition to the useful technology.  Marketing directly to patients has made it more difficult for physicians to practice good medicine and avoid the use of treatments that look wonderful on television but are not in the patient's interest. 

We have a lot of work to do, but I think that physicians still have the best interests of their patients in mind and are the only ones who can fix what has broken, even if we played a role in breaking it.

Sunday, September 27, 2009

Another customer gone

Consumerism is down and companies are trying harder to get your business.  Well, at least some of them are.

I'm amazed at some of the sales I see.  25% off plus free shipping.  As one would expect, prices fall  when people have less money to spend, but is it all about money?

As companies cut prices, they have to cut costs too.  Have you ever called a company, any company, to become their customer?  Almost immediately you will have a live person on the phone.  Call the same company now that you are already a customer and try to get live support.  You will probably wait on hold through a series of voice menus (listen carefully, because their voice menus have recently changed) and you may end up with a person in a half hour or so.

For many online retailers, it is almost impossible to find a contact phone number.  The price we pay for low prices is the inability to contact the seller if something goes wrong.  Sure enough, I checked on the Epocrates website and they have links for live chat or to email them.  No phone number that I could find.  For an interesting story about Amazon's contact number, see this link.

Companies must do research on how severely service can decline before customers flee, even if prices are low.  Of course if service is poor everywhere, then we shop based on price alone.  I would think that when one buys a household item like a washing machine, low price is the main factor and one will take the risk that service won't be required. 

If you buy something like internet service, or phone service, then you want a company that takes good care of it's customers.  It's worth a little extra money.  I suspect that when the economy turns around, it will be the companies that provide good customer service that do well.

I had an interesting experience recently.  I received an email from Epocrates, a company that provides information on medications and other medical information to portable devices like Palm Pilots and iPhones.  The email informed me that in appreciation of my being a loyal customer (since 2002) I was being given special notice that they will no longer be supporting Palm devices that go with Macintosh computers.  I wonder what they do for their non-loyal customers? 

Now, I don't want to be too hard on them.  There was a special offer for me by which I could receive an ipod touch and Epocrates software for $199.  This is actually a pretty good deal since an ipod touch costs about $180 and the software costs $159.  But the thing that bothers me is that they are abandoning a loyal customer, and the only way I can remain a loyal customer is to shell out $200 for a device I don't need.  They point out that the offer saves me almost $200, but I went to their website to find that the regular price, for non-loyal customers is $309, so I'm really saving $110.  It probably makes sense to you if you took marketing courses.

I wrote back a thoughtful email, explaining how it was disappointing that they would drop support for the Macintosh and expect their loyal customers to spend $200 to get something they already had-a working epocrates system.  I have an ipod and I don't need another one.  I love my Mac and I'm not going to buy a Windows computer.  My suggestion to them was that they treat their loyal customers to a free ipod touch with a paid renewal of their subscription to Epocrates.  That way they would maintain their customers and would be making a genuine good will gesture.  I know I would have been swayed.  I should also mention that I always thought Epocrates was a good product and I used it frequently.

I probably would have been swayed just to receive a real reply from a real person.  Instead I received a canned reply from "Gold Support" at Epocrates thanking me for my suggestion, and letting me know it had been forwarded to the Product Development Team for consideration.  Nobody signed his or her name at the end of the email from Gold Support.

I don't expect to hear from them again, but if I do I will post it here and eat my humble pie, but it seems to me that customer service, like so many things, is just words and not action.  "Gold Support".  "Loyal Customer".  It all means nothing.  Show me the money.

In the meantime, as it turns out, there is now competition for Epocrates.  Medscape Mobile is free.

Monday, September 21, 2009


From my childhood I remember the magic of fireflies.  I associate them with vague memories of warm damp summer nights when I was up past my bedtime.  They would flash like impossible beings that symbolized the magic of childhood.

The kids in the neighborhood would chase them with nets and jars, and sometimes our bare hands, for they were one of the few bugs that we were not afraid to touch.  They were good.  A few holes would be punched into the top of a jar and the poor bugs would become night-lights, shaken until they lit up or until we fell asleep.

There was always someone who would squash one and we would look in amazement at the continuing glow that outlived the fly itself.  This was a cruel act of childhood, like burning your friend's foot with a magnifying glass in the hot sun while he was busy trying to burn ants with his magnifier.

I live in the country now in a place where the nights are so dark that the milky way is brightly visible and the stars burst through the clear night sky vividly.  There are no kids in the neighborhood except for mine.  The woods are alive with sounds that could be crickets or deer, but are always wolves to my children.

One night I was out looking at the sky and I was surprised by the flash of a firefly.  I hadn't seen one for decades.  I felt the same excitement I had as a child, a response that I think is a part of the human genome.  I rushed to find the butterfly nets from where they had last been carelessly thrown, and a jar.

There were only a few fireflies out and I ran from one end of the yard to the other as I saw them appear, and then disappear, the flicker turning into just a dark bug, barely visible, flying higher out of reach into the night.  Finally I caught one and breathlessly placed it into a jar.  I proudly brought it upstairs to my sleeping daughter and woke her to see it. 

I think it was one of those moments for her that was hard to distinguish from reality.  One minute she was sound asleep, dreaming and the next she was looking at a bug that could produce light, a strange concept to accept, perhaps blending with that night's story about something equally fantastic.

In the morning we released the fly together.  The next night I caught two.  I would have liked to have her catch them with me but they were out too late.  It became my nightly ritual, rewarded by the glow of excitement my daughter showed as she cupped the jar and took it into bed with her, the only bug I can think of that she would happily hold next to her. 

It remained a nightly ritual for about a week, at which point the fireflies stopped coming, and the wonder it all faded, as things do once kids accept them. 

Now, a year later she barely remembers them, but for me they were a moment of my childhood relived and shared.  A happy moment. 

Next year maybe she'll be up late enough to catch them with me.

Wednesday, September 16, 2009

The New Technology-Rudeness

We live in a world where the ability to communicate is easier than ever.  We have email, cellphones, faxes, texting, twitter, and more.  Along with the ease of communication has come some negative aspects such as spam and scams.  A negative side that is not often addressed is the loss of a personal human touch.  Many of our modes of communication do not involve face to face, or even voice to voice contact.  It wasn't that long ago that the only way to communicate was by mail or by talking to someone.  Of course there was also telegraph and telephone which were introduced in the mid to late 1800's.

The personal touch makes an enormous difference.  Try merging from three lanes to two while sitting there with your blinker on.  Nobody lets you in.  If you manage to make eye contact with another driver and give them a signal that you'd like to get in front of them, you will almost never be denied.  It's very hard to be rude to people that are real, not anonymous, or just a voice or electronic series of letters.

Dial a wrong number and the odds are you will be treated rudely or hung up on.  If someone actually takes the time to speak with you, figure out if you misdialed or have the wrong phone number, it's a day-making experience.

I recently had three experiences that, aside from being rude, were hurtful, and made me more cognizant of the negatives of our new technologies.

While on a recent vacation, I visited a park where my kids were playing with another woman's kids.  It turned out that she was a single mom, and we chatted for about an hour, ultimately agreeing that the next time I visited I would email her to arrange another play-date for our kids.  A few months later I emailed her to let her know that we were coming down and my kids would love to play with hers again.  No reply.  I tried again.  No reply.  I tried one more time (three strikes and you're out) explaining that I was not looking for a date, that I realized she may be involved with someone, but all I wanted was for our kids to play.  No reply. 

Maybe her email had changed, but I didn't get any returned emails.  I suspect that something in her life made her uncomfortable meeting socially with a single man and that rather than explain that to me, she simply ignored me, which was easier for her.  In fact, she can even put my email address on a list so that it won't even appear in her inbox.

I recently re-connected with an old girlfriend.  We shared a few long phone calls and many emails, all within a period of a couple of weeks (while her married boyfriend was out of town).  We even made plans to meet, although we live several hours apart.  Suddenly my emails received no reply.  My phone calls went unanswered.  Did she die?  Is she in a coma in a hospital somewhere?  Or did her boyfriend find out about me and get angry?  The first two are unlikely, the third is more likely.  I would understand it had she taken the time to consider my invested feelings and politely explain that we could not continue our friendship.  Sure, I might have argued for it and this would have made it more difficult for her.  So, the easy way was to ignore my calls and emails, eliminating the need to deal with an unpleasant situation, eliminating the need to admit that she was controlled by her married boyfriend.  I think we all know that the easy way is not often the right way, especially when human feelings are involved.

Once in a while I look through some personal ads.  A few months ago I came across one that sounded so right that I decided to answer it.  Her ad mentioned that she did not want to post her picture on the internet since we live in a small community (although I don't really see what's wrong with admitting that one is looking for a partner.  That's a natural thing to do and online dating is pretty mainstream, but I could understand her reluctance).  She did promise that "your picture gets mine".  Well, I sent her a nice email and enclosed several pictures of myself.  No reply.  I waited a few weeks and sent her an email reminding her that she had promised to send her picture.  No reply.  I'm sure that she decided I was not for her, or perhaps she was inundated with so many responses that she simply could not reply to them all.  Whatever the reason, she had made a promise and she had not kept it.  I had gone out on a limb, introducing myself to a stranger and including my pictures, so that I was no longer a stranger to her.  I consider it rude to not reciprocate when one has promised to.  The irony is that her ad mentioned that she was sensitive and kind, that she hated rude people, etc.  My feelings were hurt.

I'm not suggesting we treat spammers and scammers with courtesy.  Their intentions are bad and I don't include interactions with them as real human interactions.  They are like a bad side effect of an otherwise good medicine.

But we need the human touch and I'm afraid we are learning to do without it.  Without it we become depressed.  We become uncivilized.  We become unkind.  It's like the odd experience of visiting New York City where one is surrounded by people, almost none of whom will look you in the eye or greet you.  It would be nice if we remembered that there are human beings with lives on the other end of our computer/cellphone/fax and the rules of human interaction are still appropriate.  People need people.

Saturday, September 12, 2009

Fishing in Florida

My true love is the ocean.  Away from it, I feel empty.  I spent many happy years in Florida, most of the time as a boat-owner.  I remember the first boat I bought, a 24 foot Grady-White.  I was tied up at the dock, working in the small cuddy cabin and I began to feel seasick.  I was shocked.  I had just bought a new boat and I was seasick at the dock!  Eventually I learned that it's just not a good idea to be in a closed-in, small cabin, in a rocking boat, even at the dock.  I moved up to a 27 foot Grady-White several years later and enjoyed trips to the Bahamas where the water was clear and the fishing was great.  My pleasure in boating changed from a strong desire to catch fish to a desire to have my friends catch fish.  I seldom grabbed a rod that had a fish on it, preferring to watch others have that fun.  The process of keeping the boat in good shape, rigging baits, reading the water, and enjoying the life of the ocean were all I needed.  I'm nowhere near salt water now, but I have my memories and pictures that help.  This is a story I wrote long ago, actually before I was married, and reminds me of the fun I had fishing with my friends.  I actually still have the gold hook on which this story is based, but I don't wear it.  I also have a silver hook necklace which is less prone to snagging things, and I wear it often.  The worst is when I'm in the shower and my hook gets caught in one of those plastic scrubby things.  Almost impossible to get out!  Here's the story:

I blame the whole thing on my wife because she's the one who told me to exchange the tuna pendant I had bought to wear around my neck.  She reminded me that it is bad luck to wear any fish that you have not caught yet. When I bought a belt with embroidered wahoos on it, it subsequently took six years to catch my first wahoo, and that was only after I had burned the cursed belt in a secret, private ceremony.  So I returned the tuna to get a fish I had actually caught, only they didn't have any grouper pendants.  Eventually,  I left the jewelry store happily sporting a gold fishhook around my neck.
The hook had a tendency to get caught on things like my wife's cashmere sweater one time when I gave her a hug,  but I adapted to it and kept it out of trouble most of the time.
Last summer we were camping in the Florida Keys and decided to spend the morning snorkelling on one of the shallow reefs.  We brought a box of glass minnows to feed the fish.  My wife and I were in the water snorkelling with our friend Deb while Deb's husband Jim stayed on the boat.  We were surrounded by yellowtails and grunts eagerly gulping at the cloud of glass minnows we had dished out.  Suddenly one of the yellowtails ate the hook around my neck and was hooked solidly.  Although I was surprised, I had the presence of mind to note that he looked like a keeper and I started swimming to the boat.  I was about ten feet from the boat when the barracuda hit.  I only saw a blurry silver streak and felt a tug on my neck.  I looked down to see a quivering, blood trailing, yellowtail head dangling from my gold hook.  I gasped, inhaling a mouthful of sea water and swam to the boat as fast as I could while looking over my shoulder for the return of the barracuda and trying to remove the remains of the yellowtail from the gold hook around my neck.
I shot out of the water and climbed up the ladder,  sputtering.  Jim looked at me with the bloody fish head dangling from my neck and I recall that he backed up a few steps with a strange look on his face.  As I gathered composure I explained to him what had happened.  We called Deb and my wife back to the boat and baited one of our spinning rods with the yellowtail head. The cuda took the bait and we were hooked up.  After a nice battle we released the four footer after warning it never to scare a human so badly again.  I traded in the gold fishhook and had a nice barracuda pendant made which I now wear proudly and safely.

Friday, September 11, 2009

A sad story

I find myself awake early, walking around the too-big house, thinking about the mistakes I made the day before and knowing I will likely repeat them again today.  But it is a brief time of piece before the overwhelming anxiety of the day, of life, kicks in.  It's amazing how hard three little things can be.  Brush teeth, eat breakfast, get dressed.  To do that for two kids and get them each to their respective schools on time is harder than it sounds and sometimes leaves me feeling worn out before my day even really begins.

I also try to comb my daughter's hair each morning so she doesn't look scruffy.  It used to be a painful process but I have a new solution!  I bought a special "ion infused" brush and a bottle of infusium 23 leave-in conditions.  To quote Junie B, first grader (a book series by Barbara Park), Wowie Wow Wow!  This may sound obvious to some, but as a baldie, I felt this was a remarkable discovery!

I've always loved writing and wished I had chosen it as a true path, rather than something to do when I feel sad.  Oddly, my recent efforts at writing were inspired by a television show I watched about a once productive writer.  For some reason it made me want to try writing seriously, to get my style back.  Maybe it was the royalty check he received, allowing him to go out and buy a brand new Porsche, but  best of all was that he really didn't want the Porsche.

I would buy mental health, an ability to enjoy what I have now instead of missing it once it's gone.  Of course this can't be purchased.  We fill the voids in our lives with things that can be appreciated now, new ipods, computers, bicycles, and other items that bring us temporary pleasure and eventually go unnoticed.  It's easy to see how one can become a shop-a-holic, as shopping brings an immediate gratification to a life that may not have much deep pleasure.  Deep, long-lasting pleasure is hard to find.  We work hard and are sometimes successful, but happiness may still remain elusive.  I know I've been there and still had a hard time being happy.  The best feelings I've had are when I make someone else feel better.  Making up a nice story for my children, helping a stranger lift something heavy.  I suppose that our political leaders feel that way, as do our judges, doctors, and others whose job it is to help others.  Somehow it becomes badly diluted.  Helping others on a small scale is easy.  Helping others within the societal machine, as a service, fails too often.  Laws that had good intentions become twisted like a bad LSD hallucination.

A man starts a bonfire for his children, a happy occasion and a nice thing to do.  He may not have been the most careful person, or perhaps he was unlucky, but the fire burns his house that night and kills the very same children for whom he built the bonfire.  The same kids who delighted in roasting marshmallows on that fire.  How do you want your marshmallow, brown or burnt? 

An accident, and a horrible one.  I build bonfires.  On my honeymoon, my wife and I almost burnt the house down and we are both smart people.  It was not due to bad intention but to bad judgment and lack of knowledge.  How do you pay for that?  You repair the damage and learn from the experience.  How do you pay when lives are lost?  Nothing brings back the lives.

The man was arrested, had a trial, and was put to death for murder.  Before he was killed, evidence came forth that he truly was a kind, loving and loved father, that the fire was enjoyed, that it was all a terrible accident.  Why was killing him justified?  New evidence was not allowed as due process had been provided.  He's dead.  His children are still dead.  He is a villain despite whatever he really may have been.

Somehow justice has become distorted in our country.  There is a lot of power in the hands of law enforcement.  Jails are clogged, court systems are clogged, judges are rushed.  Even wise judges don't have time to spend on cases that are the most important things to ever happen in someone's life.  Crime is not stopping.

Sunday, September 6, 2009

Labor Day

Taking a break for the holiday.  Will resume posts on Tuesdayl

Wednesday, September 2, 2009


I promised the occasional fiction piece.  Although I seldom write poetry, I did write this one.  I would be curious if anyone has any comments on it, likes or dislikes, and what you think it's about.  I ask because I sometimes write too sparsely so that the meaning is obscure, but in poetry I like that.

acrid tendrils of gasoline smell clear the thickness in my head that I've had so long.
flames keep the coyotes at bay, finally, conspiring in newscaster voices.
I can't tell if this feels good because it's too

Why I blog

I have always enjoyed writing and that's why I decided to start a blog.  I haven't written much since college and I thought this would allow me to sharpen my skills again.  It was very easy to start the blog.  I had expected to have to learn about the complex process of creating a website, but it took me about two minutes using Google's blogspot.  I'm sure there are many other options available, each with their own advantages and disadvantages, but I am not able to comment on that.

I eagerly began writing again, enjoying the feeling when a good sentence was created.  I hope to write essays about things I know about that I think would interest the public.  My ultimate goal is to refine my writing to the point that I can begin submitting pieces to magazines and perhaps write a novel.

I searched for websites about how to make a blog successful.  Some things were obvious:  write regularly, choose topics that are of interest, but others were less expected.  There is a whole language that was new to me.  There are various rating scales for blogs based upon how many visits they get and how many people click through to links on the blog site.  Once again it boils down to money.  Apparently there's gold in them thar hills and people are after it.  A successful blog can generate money.  How much, I don't know.

Every forum I found about blogging was essentially about how to make money with one's blog.  This is not necessarily a bad thing, but it would be like searching how to catch fish only to find websites about how to win fishing tournaments.  I was more interested in taking my kids fishing, if you get the analogy.

Some blog forums allow you to post your blog's website on your forum messages, but only after you've achieved a certain status on the forum.  This usually means that you have posted a certain number of messages on the forum.  The result is numerous mindless posts that are intended simply to increase one's message count, such as "Nice post, bro", or "I totally agree, dude".

One forum had a post with a list of hints at how to make your blog successful.  Since I had been reading a lot about this very subject, I recognized the article as an almost exact duplicate of an article I had read on another site.  A couple of people mentioned this fact but their comments were ignored.  I posted a comment, my first on this website, stating that the article was plagiarism and the person who posted it should be removed from the forum.  As yet I have received no replies.  I did get my first post though.  Only 59 to go before I can put my blog's website on my postings.

Meanwhile I am enjoying writing again.  I have to admit that I periodically search for my blog on google, hoping that one day it will pop up in the results, or that I will receive comments from strangers on my blog's posts.  Even comments from friends would be nice.  I can't say that it wouldn't be nice to make money from my blog either, but that is not what it is all about, at least for me.

Tuesday, September 1, 2009

An Unfairly Treated Patient

I saw a patient who had injured his neck while reaching for something.  An MRI showed severe disease in his cervical (neck) spine which could account for his symptoms and he was referred to a surgeon.  The surgeon felt he was a good candidate for surgery and I planned to manage him with pain medications and injections until his surgery, as he was in quite a bit of pain.

He was a patient who I liked.  He was pleasant and his style was friendly and easy to be with.

As per our routine, when starting a patient on narcotic pain medications, I ordered a urine drug screen to make sure he was not taking illegal drugs, or already on pain medications and just doctor shopping. 

Much to my surprise, a week later I received the results of his urine test and it was positive for the drug Ecstasy.  At our next appointment I asked the patient about this and he adamantly denied ever taking Ecstasy.  This is one of those difficult situations in medicine when a patient may be lying, or may have an addiction problem, yet still has a legitimate disease that is appropriate to treat with pain medications.  I refilled his pain medication and obtained another urine specimen.  I asked him point blank what I would see in the results.  He told me that there would be no illegal drugs.

Yet again, a week later I received the results and they were positive for Ecstasy.  The patient's next appointment was with the surgeon who was quite disturbed by these results.  He suggested that the patient get his addiction treated before having surgery.  The patient became indignant, angry, and perhaps hostile, and was asked not to return to our hospital.  I never saw him again.

Months later a bulletin arrived from the pathology lab, informing us that they had been having many false positives for Ecstasy in urine specimens.  In other words, they were finding urine specimens that tested positive for Ecstasy even though the patient had not taken Ecstasy.

I thought about my patient and wondered what had become of him.  It seemed to me that if I were a patient in severe pain who was told that surgery would help me, and then was told that I was a drug addict based on a urine sample that had a false result, I would also be angry and hostile, especially if I was told that surgery was to be cancelled until my "addiction" was treated.

I felt sad and hoped he had received the care he needed elsewhere.

In the field of Pain Medicine one encounters many patients with addiction.  Addiction is a disease and not a character flaw.  The treatment is not well defined and not readily available, and usually not paid for by insurance.  This is an example of how "mental illness" is treated differently than other illnesses, even though mental illnesses are legitimate illnesses that involve the brain.

There was a time that multiple sclerosis was felt to be a disease of crazy people.  Fibromyalgia, ADD, and others are finally being recognized as real diseases.  In medicine we have a hard time accepting disease that we cannot either quantify, or successfully treat.  Insurance companies don't like to pay for things that they don't have good evidence for a successful mode of treatment, or for diseases that are controversial.

Addiction is a disease that takes a significant toll in lives and deserves to be treated aggressively.  The twelve step approach is a caring approach, but unfortunately has a poor success rate and certainly does not address the pathology but just the behavior.  It has been shown that there is true physical pathology in addiction.

I hope that we, as a society, are willing to spend the money needed to fund research and treatment for the disease of addiction, and to remove the stigma of the disease, just as the stigma of depression has essentially been eliminated.