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F. Cole, M.B.A., M.D.

Medical Instructor, University of Central Florida College of Medicine

In this field, those who either withhold or distort information in order to support the current social policy run the risk that potential users will detect this falsification and then will tend to disbelieve all other reports of the potential harmfulness of use (Kaplan 1970; Zinberg & Robertson 1972). Conversely, those presenting the information that not all drug use is misuse, thus contravening formal social policy, run the equally grave risk that their work will be interpreted and publicized as condoning use. It is a frightening dilemma for a researcher, particularly for one who cannot believe that the truth will set one free in some mystical, philosophical way. Of course, neither can one believe that hiding facts, hiding the truth, will make everything come out all right. And when the research concerns powerful intoxicating substances, abstract principles about truth and objectivity are not all that is involved: human lives are at stake. The growing popularity of the drug was evident, no fatalities from its use had been reported, and there was a need for more precise information about its effects in order to differentiate myth from fact. For example, at that time police officers and doctors believed that marihuana dilated the pupils, and this misconception had to be cleared up because it was affecting both arrests and medical treatment. But when it came to studying drugs like heroin, whose physical properties, unlike those of marihuana, can cause disastrous effects if control is not maintained, the ethical problem grew more serious. Moreover, the effort to inform the professional community and also the public (by way of the media, to which anything in the drug area is good copy) that heroin use is not inevitably addicting and destructive involved the risk of removing that barrier of fear that might have deterred someone from using. However important knowledge may be, research cannot be countenanced if subjects are not protected from the harm that may be caused by it, either directly or by withholding information as, for example, in the case of the unfortunate U. Public Health Service research on syphilis, which withheld a treatment long after it had been proved effective (Hershey & Miller 1976). Nevertheless, even my preliminary investigations of heroin and other opiate use confirmed what had been found in every other investigation of drug use: that the reality was far more complex than the simple pharmacological presentation given in medical schools. Certainly, heroin is a powerfully addicting drug with great potential for harm, but some users managed to take it in a controlled way, and even those who did get into trouble displayed patterns of response very different from those of the stereotypical junkie. In addition, other investigators, such as Leon Hunt and Peter Bourne, were beginning to report similar phenomena (Abt Associates 1975; Bourne, Hunt & Vogt 1975; Hunt & Chambers 1976). Once it became clear that these phenomena were extensive and significant, it was also clear that any attempt to remove such behavior patterns from the scientific purview because they were morally reprehensible or socially disapproved would reduce the credibility of all scientific enterprise. Further, it was possible that these heroin users, in the process of controlling their use, had developed a system of control that could be an extremely valuable basis for designing new approaches to the treatment of addiction (Zinberg, Harding & Winkeller 1981; Zinberg, Harding & Apsler 1978; Zinberg et al. That such research has a, potentially positive application and is not for information alone does not, however, figure in the principle of what makes work scientifically acceptable. But the way in which the work is received and treated, particularly by the media, can raise grave problems. Though researchers may be as accurate and careful in their statements as possible, they cannot control what others say or do with the information. Yet in the present climate of emotionalism about drug research, they would be naive indeed if they did not realize that certain findings are susceptible to distortion by the press. Unfortunately, several researchers have called press conferences before publication in order to herald their findings (New York Times 4 February 1974 and 9 April 1974), and they have not been unwilling to venture into far-reaching speculations that go well beyond the published data. Researchers must also do their best to avoid causing those who would not otherwise use drugs to do so. One way to shift attention away from the preoccupation with illicit use is to emphasize the potentially positive application of the work. Even here, however, the researcher who discusses his work as a therapeutic aid can run into another brand of sensationalism and misrepresentation. The difficulty of defining and maintaining objectivity and the ethical problems associated with carrying out certain research and imparting its results are not confined to research on illicit drugs. Few investigators today, when individuals are faced with an overwhelming number of choices, are able to preserve the image of the disinterested scientist actuated solely by dedication to the purity of science. At its most extreme, I have heard scientists say that they would consider not disclosing risks which in their view are insignificant, but which might alarm the public if taken out of context. They illustrate dramatically how concern for minimizing public reaction can overwhelm scientific candor. First, it arrogates to the scientists the final say over which risks are important enough to merit public discussion. More important, it leads to the suppression of information that may be critical to developing new knowledge about risks or even to developing ways of avoiding those risks. Who is willing today to assume the responsibility for limiting our scientific knowledge

The degree of association between our controlled subjects and opiate addicts varied. Some subjects had none because they bought through an intermediary; most of the others had contact only in the process of buying, but a few interacted with addicts in a variety of ways. I: As you see it, when you were using it, did you identify yourself as an occasional user, a chipper, as- When I worked in the organization and when I worked in the program, things like that kept that one foot out, kept me from jumping in the fire with both feet. But I was fortunate enough to keep one foot outside of it, so that I could observe, and see what danger could fall upon me if the other foot were dragged in. This fear of crossing the line and becoming an addict or, more exactly, a junkie-because it was the life style as much as the actual physiological addiction that was terrifying-had to be dealt with. Subjects went to great lengths to deny their fear and to establish external controls. The experiment he carried out would be labeled counterphobic in ordinary psychiatric parlance. And I got to learning about the nature of withdrawal, what it was that these guys were actually kicking, and what the nature of the habit was, whether it was a physiological process or whether it was psychological. A couple of them looked downright scary; they looked like they were going through hell. But in the course of talking to them about their experiences, I became convinced that they were addicted to the rituals and the life style much more than to the substance. Shortly after that time I bought a whole lot of heroin and did it daily for ten days. Those occasional users who were in close contact with addicts invariably had experiences that indicated how real the horrors of addiction could be. Since almost half of our subjects had had a brush with addiction before they settled into a long-term controlled using pattern, they knew what they had to fear: R: Yeah, he would shoot up more than I would. And I also had pains, so I was sure it was something we ate or something like that. The fear of being like a junkie, that is, accepting addiction and an addictive life-style, was very real to those who had had extensive contact with addicts. The fear of becoming an addict or a junkie or of being arrested was bad enough, but there were even worse concerns. Most of our subjects observed social sanctions that were really safety precautions to minimize the risks of an overdose and of infection. And I felt anyway that cough syrup and Doridens produced about the same effects that heroin did. R: It was really weird because I never had anything like that happen before, and then all of a sudden every vein in my whole arm just swelled up and turned red, and I could just see it climbing right up my arm, and I did it in this arm, and it was only from here to here. And I just kept boosting it, because it was to late at that point to do anything about it anyway, so I figured I might as well just enjoy it while it was there. Fortunately, in order to understand the social-psychological relationship of each of these to personality (set) and to social setting, only a minimum of knowledge about their pharmacology is needed. Marihuana the common hemp plant, cannabis sativa, used for millennia to produce paper and rope, is the source of marihuana. The flowering tops, particularly from the female plant, produce an aromatic, sticky resin that contains the intoxicating properties. When the flowering tops themselves are gathered, the term marihuana is applied; when the resin alone is collected, the term hashish is applied. Interestingly enough, in contrast to most drugs, marihuana, in usual doses, cannot be classified pharmacologically as either a stimulant or a depressant, In heavier doses, it is more likely to act as a psychological depressant, even a sedative, but causes few of the physiologically depressing actions of such drugs as alcohol, barbiturates, benzodiazepines, and opiates, thus accounting for the low toxicity of cannabis. Although the action of marihuana is sometimes called psychedelic, the cannabis group is not chemically related to the psychedelics. In fact, there are over zoo chemical constituents in the natural plant, some of which potentiate or inhibit the action of a particular plant strain, giving different strains not only different strengths but also individual qualities of response. In contrast to many drugs, cannabis is not water soluble but is soluble in fat, which explains the fact that it is retained in body fat for some days after use. It takes place in a wide variety of settings and circumstances, such as before going to a movie, during a party, while watching television, or during a walk in the woods.

Southerners in general felt little guilt about slavery and defended it vehemently. In some seaboard areas, slavery by 1850 was well over 200 years old; it was an integral part of the basic economy of the region. Although the 1860 census showed that there were nearly four million slaves out of a total population of 12. Twelve percent owned 20 or more slaves, the number defined as turning a farmer into a planter. Three-quarters of Southern white families, including the "poor whites," those on the lowest rung of Southern society, owned no slaves. They feared that, if freed, blacks would compete with them economically and challenge their higher social status. Southern whites defended slavery not simply on the basis of economic necessity but out of a visceral dedication to white supremacy. As they fought the weight of Northern opinion, political leaders of the South, the professional classes, and most of the clergy now no longer apologized for slavery but championed it. Southern publicists insisted, for example, that the relationship between capital and labor was more humane under the slavery system than under the wage system of the North. Before 1830 the old patriarchal system of plantation government, with its personal supervision of the slaves by their owners or masters, was still characteristic. In such circumstances, slavery could become a system of brutality and coercion in which beatings and the breakup of families through the sale of individuals were commonplace. In the end, however, the most trenchant criticism of slavery was not the behavior of individual masters and overseers. They sought territorial expansion because the wastefulness of cultivating a single crop, cotton, rapidly exhausted the soil, increasing the need for new fertile lands. Moreover, new territory would establish a basis for additional slave states to offset the admission of new free states. Antislavery Northerners saw in the Southern view a conspiracy for proslavery aggrandizement. An earlier antislavery movement, an offshoot of the American Revolution, had won its last victory in 1808 when Congress abolished the slave trade with Africa. Thereafter, opposition came largely from the Quakers, who kept up a mild but ineffectual protest. Meanwhile, the cotton gin and westward expansion into the Mississippi delta region created an increasing demand for slaves. The abolitionist movement that emerged in the early 1830s was combative, uncompromising, and insistent upon an immediate end to slavery. This approach found a leader in William Lloyd Garrison, a young man from Massachusetts, who combined the heroism of a martyr with the crusading zeal of a demagogue. On January 1, 1831, Garrison produced the first issue of his newspaper, the Liberator, which bore the announcement: "I shall strenuously contend for the immediate enfranchisement of our slave population. He sought to hold up to public gaze the most repulsive aspects of slavery and to castigate slave holders as torturers and traffickers in human life. He recognized no rights of the masters, acknowledged no compromise, tolerated no delay. Garrison was joined by another powerful voice, that of Frederick Douglass, an escaped slave who galvanized Northern audiences. Theodore Dwight Weld and many other abolitionists crusaded against slavery in the states of the old Northwest Territory with evangelical zeal. One activity of the movement involved helping slaves escape to safe refuges in the North or over the border into Canada. The "Underground Railroad," an elaborate network of secret routes, was firmly established in the 1830s in all parts of the North. In Ohio alone, from 1830 to 1860, as many as 40,000 fugitive slaves were helped to freedom.

Syndromes

• Nausea and vomiting
• Chest tightness
• Endometrial ablation
• Benzodiazepines or antihistamines for nighttime relief
• Increased and more severe infections due to damaged immune system
• Chest pain
• The surgeon will make a cut inside your mouth along the lower gum. This gives the surgeon access to the chin bone.
• Infection

Lewis Mumford contends that the car turned the suburban housewife into a full-time chauffeur. Certainly the transformations of the wheel as expediter of tasks, and architect of ever-new human relations, is far from finished, but its shaping power is waning in the electric age of information, and that fact makes us much more aware of its characteristic form as now tending toward the archaic. There is a moment of translation or "abstraction" needed to separate the reciprocating movement of hand from the free movement of wheel. Some might object that log-rolling is closer to the spindle operation of the hands than to the rotary movement of feet, and need never have got translated into the technology of wheel. Under stress, it is more natural to fragment our own bodily form, and to let part of it go into another material, than it is to transfer any of the motions of external objects into another material. To extend our bodily postures and motions into new materials, by way of amplification, is a constant drive for more power. Most of our bodily stresses are interpreted as needs for extending storage and mobility functions, such as occur, also, in speech, money, and writing. All manner of utensils are a yielding to this bodily stress by means of extensions of the body. The need for storage and portability can readily be noted in vases, jars, and "slow matches" (stored fire). Perhaps the main feature of all tools and machines -economy of gesture -is the immediate expression of any physical pressure which impels us to outer or to extend ourselves, whether in words or in wheels. One of the most advanced and complicated uses of the wheel occurs in the movie camera and in the movie projector. It is significant that this most subtle and complex grouping of wheels should have been invented in order to win a bet that all four feet of a running horse were sometimes off the ground simultaneously. This bet was made between the pioneer photographer Edward Muybridge and horse-owner Leland Stanford, in 1889. The movie camera and the projector were evolved from the idea of reconstructing mechanically the movement of feet. The wheel, that began as extended feet, took a great evolutionary step into the movie theater. By an enormous speed-up of assembly-line segments, the movie camera rolls up the real world on a spool, to be unrolled and translated later onto the screen. That the movie recreates organic process and movement by pushing the mechanical principle to the point of reversal is a pattern that appears in all human extensions, whatever, as they reach a peak of performance. The road disappears into the plane at take-off, and the plane becomes a missile, a self-contained transportation system. At this point the wheel is reabsorbed into the form of bird or fish that the plane becomes as it takes to the air. Skin-divers need no path or road, and claim that their motion is like that of bird flight; their feet cease to exist as the progressive, sequential movement that is the origin of rotary action of the wheel. It was the tandem alignment of wheels that created the velocipede and then the bicycle, for with the acceleration of wheel by linkage to the visual principle of mobile lineality, the wheel acquired a new degree of intensity. The bicycle lifted the wheel onto the plane of aerodynamic balance, and not too indirectly created the airplane. It was no accident that the Wright brothers were bicycle mechanics, or that early airplanes seemed in some ways like bicycles. The transformations of technology gave the character of organic evolution because all technologies are extensions of our physical being. Samuel Butler raised great admiration in Bernard Shaw by his insight that the evolutionary process had been fantastically accelerated by transference to the machine mode. Butler, himself, had at least indicated that machines were given vicarious powers of reproduction by their subsequent impact upon the very bodies that had brought them into being by extension. Response to the increased power and speed of our own extended bodies is one which engenders new extensions. Every technology creates new stresses and needs in the human beings who have engendered it. The new need and the new technological response are born of our embrace of the already existing technology a ceaseless process. Those familiar with the novels and plays of Samuel Beckett need not be reminded of the rich clowning he engenders by means of the bicycle. It is for him the prime symbol of the Cartesian mind in its acrobatic relation of mind and body in precarious imbalance. This plight goes with a lineal progression that mimics the very form of purposeful and resourceful independence of action.