Pairodocs' Podcasts

The Pairodocs has become a bit obsessed with MAiD lately. But in our defence, it has slid so far down the slippery slope that the insanity is laid more and more bare, for all (hopefully) to see.Cast your mind back 6 years, when COVID was not a cold, but a terrifying disease coming for us all. Like a meteor hurtling towards earth, death and destruction was on the way.Public health/the government/legacy media promoted ideas and rules that were somewhere between ridiculous and insane, but definitely evil: “lockdown” (prior to 2020 a word only used for prison riots or school shootings), masking rules (put it on when you stand up, but you can take it off if you sit down, or are eating—as logical as taking off your condom when you switch positions), and later “vaccine” mandates (we know there are no long term side effects even though it’s brand new!). To bring people on side, it was necessary to terrify them by exaggerating the threat of COVID. And it worked. This is not news to readers of this Substack. A terrified populace is a compliant one. Statistics (and our post-COVID voting record in Canada and other countries) shows that most of these measures are still thought of as reasonable and necessary, even in retrospect. I think (and last year’s “drought lockdown” in Nova Scotia proves my point) that the government remains very comfortable infringing our civil liberties, and the majority of the electorate will be on board with draconian measures again next time .Honest, open-eyed physicians noticed the disconnect between reality and the mainstream news early in the COVID saga. Far from overflowing with COVID victims, hospital wards and ER’s were emptier than at any other time during the 33 years since I started medical school. I recall thumbwrestling my colleague for the privilege of seeing the next patient in ER, because we had both been sitting for an hour with nothing to do. (I won).So, unable to terrify us with video of people gasping their last breaths on COVID wards or photos of young, healthy people who had dropped dead in the middle of the street, what was a poor government to do? It turns out that motivated parties can always find ways to lie with statistics.I’ve written about this before but statistically, deaths from conditions like cancer, dementia, and heart failure actually FELL after COVID arrived. How? Did COVID cure cancer?Not at all. Rather, what was happening was that we were re-defining “cause of death,” taking people from other statistical buckets and using them to fill the COVID bucket. It didn’t matter if “having” COVID (in some cases this meant just a positive test, not the disease) had shortened a life by a month, a week, a day, or not at all. A person right at the end of life, literally even someone on the palliative care ward (yes I saw this happen), who died after a positive COVID test had died “of” COVID. They were entered in the stats as such, stats which the obedient media and medical officer of health could then use to terrify us. The most egregious case I know of was a patient in their late 80’s. (My use of the indefinite, plural pronoun is to avoid identifying the person’s sex, not because they had pronouns in their bio.) They had severe, end-stage dementia and were at most a few weeks from end-of-life. Their quality of life was so poor that their family wanted no further treatment for any diseases. Because the patient’s brain was so damaged they couldn’t swallow reliably, and they aspirated food on a Wednesday. By the next day it was clear they had developed aspiration pneumonia. The family was informed and re-stated they wanted only comfort care. The patient became very unwell and stopped eating altogether.Because the patient had “respiratory symptoms”, the nurses (against my recommendation—they were “following protocol”) swabbed the patient for COVID every 48 hours. The test was negative on Friday, Sunday, and again Tuesday. Wednesday morning the patient died. Shortly after death, a report came back from the lab saying that the Tuesday swab had been “reprocessed” and was now positive for COVID. (I assume “reprocessed” meant re-running the test at a higher cycle threshold, which is more likely to give false positive results—read “The King’s Chessboard” to understand this issue). The death was reported as being from COVID, even though it doesn’t take any medical training to understand that the patient died of dementia and ultimately aspiration pneumonia. The patient at best died “with COVID” (or more likely with a positive COVID test), not “of COVID”.Even for those on death’s door with one foot in the grave and the other on a banana peel, if they happened to test positive for COVID at any point near their death, there was strong pressure and intellectual momentum to report this as a “COVID death”.Considering all of that, the great irony and contradiction of a recent new guideline from the College of Physicians and Surgeons of Ontario struck me full force when a colleague shared it.Unlike a COVID death, where the actual cause of death is to be ignored and COVID is to be substituted as cause of death—whether or not it was 11th hour, or contributory in any way, with MAiD we are being instructed to do the opposite: even though it is ABSOLUTELY the cause of death, we cannot list it as such.Keep in mind that MAiD is not palliative sedation, when we give a comatose patient gurgling and struggling for breath at the very end of life enough medication to be comfortable, even if it might hasten his death. MAiD can only legally be done to lucid, competent individuals—by definition, those who are not in their final throes.Achy knees, a weak heart, an early cancer—any condition can qualify a Canadian to apply for euthanasia, as long as he feels his suffering is “intolerable”— even if the condition might be compatible with years more of life (“Track 2 MAiD”). If we euthanize a 65 year old with mild COPD and arthritic knees, it takes no medical training to see that the cause of death is clearly “euthanasia”, not “achy knees and COPD”.In the same way that the Venezuelan government pressured doctors not to write “starvation” as a cause of death there, soon we will not be allowed to write “Euthanasia”, “Suicide” or even “MAiD” on a death certificate here in Canada. And so the statistics will lie to suit government purposes and agendas. Of course we’re not euthanizing thousands of people per year! Of course there weren’t thousands of people starving in Venezuela! Where did you right-wing conspiracy theorists ever get such a crazy, crazy idea!!? After all, just look at the statistics!The best we can hope for is that ethical physicians will not knuckle under, and will refuse to sign false death certificates. But given that the type of physicians who are involved in MAiD are not necessarily the most ethical (Ellen Wiebe, anyone?), I despair somewhat that this will be the case. So be prepared for future headlines like “MAiD deaths peaked in 2025 and are falling”. Worried about MAiD? Fuggedaboudit! Fudged statistics will provide convenient, constructed cover for a practice that cannot be defended ethically. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

The Pairodocs have been on a bit about euthanasia recently, but please indulge us. It’s a deep subject - literally life-and-death.Since my first piece on euthanasia (“MAiD”), and then again since Julie’s more recent piece about extending it to the mentally ill, several interesting issues have bubbled up through comments and discussion. I thought these were worth fleshing out.Did someone order MAiD service?What’s in a name? A lot. MAiD used to be a name for someone who cleans your house. And in the same way that a maid can sanitize your bathroom, the term “MAiD” sanitizes suicide. By coining such a clean and optimistic term, euthanasia proponents seized the linguistic high ground. But despite the obfuscatory name, “MAiD” actually means a person committing suicide (or being suicided). This was until very recently considered an extreme act. Perhaps the single most extreme act there is. At worst, suicide is a mortal sin that prevents that individual from being buried on hallowed ground and leaves his soul in purgatory. Now it’s just a medical procedure.Euthanasia is not assisted suicideThere is an important distinction between euthanasia and assisted suicide. These terms are often used interchangeably, but are in fact distinct. Euthanasia is passive on behalf of the party being euthanized (with the exception in humans of taking part in the decision to be put down). The hamster that was gasping and suffering was euthanized by a whack from my dad’s shovel before we buried it in our backyard. It wasn’t a case of assisted suicide. Assisted suicide is a human-specific way to end a life, as lesser life forms can’t ask to be killed. Jack Kevorkian never “killed” anyone, he just set it up so the patient could easily kill himself. With assisted suicide, the doctor or nurse might put in an IV and get the meds ready, or provide the pills in a cup by the bedside, but in the end the patient has to push the plunger or swallow the tablets. Assisted suicide, unlike euthanasia, is an active act.Far from being a distinction without a difference, assisted suicide is very different philosophically and practically from euthanasia. A very interesting natural experiment has been underway since California legalized assisted suicide at almost the same time that Canada legalized euthanasia. In California, the doctor puts the suicide meds out for you but you have to take them. In Canada, you just lie there and let the doctor perform a “medical procedure”.And what a difference it makes. Being euthanized in Canada is about 19 times more common than committing assisted suicide in California.The euthanasia slope is more slippery than assisted suicideIt’s hard to kill yourself. Atheists might recognize this difficulty as the strong evolutionary urge to live. The religious among us might see it more as a recognition that our life is a gift, and ending it by our own hand is a sin against God. Either way, I can’t tell you the number of people I’ve seen in the ER through the years who had stood on the edge of a cliff, stared down the barrel of a gun, tied a rope in a tree, or looked at the cup full of pills and then changed their mind. They deeply felt that suicide was the wrong choice. But when the patient is a passive recipient of “medical care” as with MAiD, this epiphany cannot happen. It’s easy for “MAiD recipients” to think of themselves as having a medical procedure, whereas it is more clear to the person who is required to swallow a lethal overdose – even if it was put on the nightstand by a doctor – that he is committing suicide.Your right to die is not the same as the state’s obligation to kill youAnother distinction that is important, and that was a source of controversy and misunderstanding amongst commenters on various forums, is the difference between arguing to have the “right to die” versus the need to have a program run by the state and funded by the taxpayer that approves, facilitates, and even performs the killing. There is actually a wide difference between these two arguments. The libertarian dream is freedom of choice, not state-administered and funded programs to control and provide those choices.You absolutely have the right to die. You can stop eating and drinking. You can jump off a cliff, shoot yourself in the head, hang yourself, or take pills. Even though I think it is a sin to commit suicide, I can’t stop you in the end even though as a physician - and a human being - I will certainly try to convince you not to. After 27 years in ER, one of “Milburn’s Laws” is “Patients who really want to kill themselves, kill themselves” despite our best efforts to prevent them from doing so. Despite (and some would argue perhaps because of) a proliferation of therapists and counsellors, self-esteem promotion, suicide prevention, “wellness” initiatives and more, suicide rates have increased.In practice, choosing euthanasia is about hopelessness and not the medical conditionA number of commenters supported euthanasia in people with terrible physical diseases, but felt that we cross a line when we offer it to depressed patients. But in my experience, people who choose to be euthanized always do so because of hopelessness, whether or not we call that hopelessness “mental illness”. The vast majority of those with cancer, dementia or sore joints want to live their lives out to the fullest. They want to spend time with family and friends, see more sunsets and sunrises, play music, write their life story for their grandkids, clean the junk out of their house, finalize their finances, and more. The ones who want the express checkout lane are the ones who feel they have nothing left to live for. It has been said that “He who has a why to live for can bear almost any how.” So although many commenters on our previous pieces see that euthanizing mentally ill patients has crossed a line, they don’t see that the distinction between hopelessness caused by mental illness and hopelessness caused by physical illness is actually artificial. In my experience, we are already euthanizing depressed people.And, if one agrees that the criteria for “being approved for MAiD” should be that one’s suffering is intolerable, how can we deny euthanasia to those suffering from mental illness, which in my experience causes suffering at least as severe as those with physical diseases.Furthermore, in a system where real care is routinely delayed or even unavailable, providing rapid access to suicide services seems doubly immoral. One of my patients with a neurodegenerative disorder faced an 18 month wait to be reassessed by a neurologist, but could talk to a MAiD assessor within 48 hours.There is no such thing as “necessary suffering” if one believes in suicideSeveral commenters said that they supported assisted suicide because it prevented “unnecessary suffering”. But “unnecessary” suffering is a tautology for people who believe in suicide. The Buddhists say it best. “Life is Suffering”. If one lives, one suffers. Life is a sexually transmitted disease with a 100% fatality rate. We all die. And we will all suffer before we do.If we believe in preventing unnecessary suffering, the solution to any physical or emotional pain is always clear. Girlfriend breaks up with you? Kill yourself. Wife sleeps around and then leaves you? Kill yourself. Your knees ache every morning for hours? Kill yourself. Every patient I’ve seen choose to be euthanized chose it because of hopelessness, not because of the disease. Well-adjusted people with good relationships, even when they have terrible cancers, ALS or other conditions that cause suffering, want to squeeze every drop out of this precious, short existence that they can.If you have a painful, progressive cancer but could live anot… Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

This is the podcast version of Julie’s recent Substack on the issue of euthanasia, or “MAiD”, and its pending extension to patients with mental diseases. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

A number of readers have asked for a podcast version of our Substacks, and I felt it was worth re-issuing this 2022 article as a podcast. It meshes, with some significant overlap, with Julie’s recent Substack on the same topic, and an upcoming (and likely our last, at least for a while) follow up by me to address some bones of contention.So if you like listening rather than reading, here you go. Remember that the written version contains useful links and a few spicy memes. Thanks for listening. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

I’m a slow thinker. It’s why I don’t do Twitter. It takes me a long time to come up with an opinion. I have to keep turning over an issue and looking at it from different angles. I read both sides of an argument. I often find some book on philosophy, poli sci or history that is relevant. And finally after all of that I (might) have an opinion on the subject.So it took me a while to write about the Canadian election, which happened 6 months ago. It was obviously time for a changeThere is a saying that government is like underwear. After a while it gets dirty and you have to change it. Over time the problems of the day rub off on the once fresh government until it accumulates a stink, and people eventually want something that smells better. The fact that the Liberal government under Trudeau the Younger was 10 years old in 2025 was a strong predictor that it was the Conservatives’ time for electoral success, even if the Libs had been doing a reasonable job.But by any measure, they weren’t. They gave us many reasons to give them the boot. The Libs massively violated civil liberties during COVID. They made it a human rights violation to refuse to call a man who says he is a woman a man. They filled high positions with geniuses like Theresa “Gloryhole” Tam who made us an international laughing stock. They flooded the country with immigrants by increasing immigration rates 15-fold. They massively increased the debt and deficit and rubbed salt into that wound by doing things like paying friends of the party 750 times the original budget for the ArriveCan app. They were debatably the most scandal-ridden government in our history, with so many examples to pick from that Trudeau’s multiple blackface appearances don’t even make the top 10. Obviously there was no way they could win. Right?In the run-up to the election there was a lot of fighting over which poll was more accurate. Conservatives disbelieved polls that pointed Liberal, and vice versa. What was initially a clear lead for the Conservatives shrank and then disappeared under the influence of a clever Liberal campaign which tapped into the most central part of Canadian identity: anti-Americanism. When the Liberals won, many of my conservative friends were surprised and disappointed. I was not surprised. A long socialist slideWestern society’s slide towards socialism - including the 2025 Canadian election result - is a predictable outcome of a gradual but inexorable transformation of our collective vision of government’s role in society. Politics - and thus our choice of government - is downstream from culture.Historically, a centralized authority was seen as being a necessary evil, there to prevent your neighbour from killing you and/or stealing your stuff. Food, clothing, and shelter were your own problem.But over generations the Overton window through which we view government’s role has shifted inexorably leftward. As we expect more of government, it has grown to occupy a much larger place in our economy and our day-to-day lives, as I have previously written about:This shift in politics has developed as the belief in positive “rights” has become entrenched in our collective psyche. (You can flip back to another previous Substack for more on positive versus negative rights.) If we have a “right” to an always expanding wish list of services, then government must necessarily take more from productive citizens to provide these things to citizens who are less productive and responsible.A major leftward shiftA simple but controversial example. Is it the duty of the state (and therefore the taxpayer) to support a woman who gets pregnant and cannot support her baby? A hundred years ago, even the most extremely progressive politicians would not have thought so. Such a duty was thought to lie with the mother herself, the father, the families involved, and the local community and church. Benevolent societies might help, but were run by volunteers, and contributed to voluntarily. Generations ago, not even the most progressive politician would have suggested the government take on this moral and financial responsibility.In 2025, even the most “far-right” politician would not DARE suggest that such support is not the duty of the government. That is how much the Overton window has shifted.Similar changes have occurred in most realms - housing, education, addictions, healthcare, dental care, child care, and now school lunch programs. There are few areas where we do not now see the government as responsible for providing the needs (and sometimes the wants) of the populace.The mindset that one is responsible for taking care of himself - let alone his family or community - is less and less common, even amongst the more conservative demographic. “Free” stuff is not really free, but rather quite expensiveEven some of my conservative friends, after ~1/3 of their taxes went towards healthcare for several decades, were thankful that they “didn’t have to pay” for their healthcare when they finally access the system. Wow, what a bargain! Lucky!The word “free”, when used in place of “taxpayer-funded” is a politician’s trick. When Big Government runs a service, we pay a huge administrative premium on top of the price of the service. Someone must collect taxes. Someone must dole them back to organizations and individuals. Someone needs to be in charge of gender and racial equity. Someone must do an environmental impact assessment. Someone must manage the service delivery. And of course someone still has to actually perform the service. All the extra steps require bureaucrats and functionaries, who have well-paid positions with pensions and benefits. Would you rather pay someone to dig a hole for you, or pay a government administrator to arrange it for you? Does it become “free” if you pay taxes to have it dug?I’ll vote for you if you give me stuffAlthough politics has always attracted graft and corruption, I do think that we once expected our politicians to be wise. Perhaps I’m over-romanticizing the past (I certainly know that politics has always been dirty) but it seems that we have devolved into pure “pothole politics”: we simply vote for people who promise us the most stuff. “Stuff” paid for with productive citizens’ taxes.Voters who expect the government to give them free stuff vote for politicians who promise free stuff. And this means voting for politicians who are considered good “constituency men”. If you haven’t heard the term, here is an AI summary:My take on the term is less generous. To me, a constituency man is simply someone who people think will get them free stuff. In my former home in industrial Cape Breton - a hyper-unionized and hyper-entitled place with very high rates of “disability”, welfare, and seasonal EI - we constantly vote in good constituency men who will “do anything for ya”. Just as one example: Want support in insisting that your sore back really means you are disabled? No problem! I can’t tell you how many times I have seen this done by “good constituency men”. A colleague’s patient who was later caught building decks under-the-table while collecting compensation for a back too sore to work at the local call centre got a very supportive letter from his MLA when fighting for compensation payments. The politician helped get his constituent free stuff, guaranteeing that vote next election, as well as more votes from family and friends of the happily disabled man who knew the constituency man was someone they could count on.One of Cape Breton’s most prominent/notorious politicians - Dave Dingwall - was famous for stating that he was “entitled to his entitlements” even though it was clear he was pork-barrelling. Despite this he is still beloved, and prominent in our comm… Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

I was honoured that Dr. JD Haltigan agreed to speak with us for the Free Speech in Medicine Podcast. Julie (the X/Twitter-literate half of the Pairodocs) loves his tweets so much that she feels that they “are sharing the same brain”. He is fearless in following the evidence on psychopathology in modern society, and speaking about what it says, even when it leads to politically incorrect places.As you’ll hear, Dr. Haltigan is a developmental psychologist with an interest in psychopathology and how it develops. Why do more and more people identify as mentally unwell in modern society? What is the role of feminism and safety culture in this trend? Dr. Haltigan has some great insights into these questions.If you don’t yet, you should follow his work. He writes here on Substack. You can find his work at jdhaltigan.com, and follow him on X/Twitter @jdhaltigan.I hope you enjoy the conversation as much as I did. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

When I started family practice in ‘99 I held flu shot clinics for several years for patients in the rural community of Lansdowne, Ontario, where I worked. I was taught that “Flu Shots Save Lives”. The government advertised them to my patients. Demand was high. The pay was good.Over the years I became more skeptical about vaccines, including flu shots. What does the science say? We learned during COVID that public health messaging is often very disconnected from facts and reality.When I wanted to know the truth behind flu shots, the first person I thought of was Dr. David Zitner. A retired family doctor and expert in medical data science, David is also the Senior Healthcare Policy Fellow at the MacDonald-Laurier institute. Even better, through his work with CURAC (the College and University Retirees Association of Canada) he has specifically dug into the question: should we be promoting flu shots. I’m glad he described himself as a gadfly, so I didn’t have to! But he’s just the kind of gadfly that we love at Free Speech in Medicine.We cover many topics, and some may fly by fast for non-medical listeners. Some links of great interest:* Christine Stabel Benn’s TED talk on vaccines was controversial and thought-provoking, and for more detail her discussion with Dr. Jay Bhattacharya is worth the time.* the CURAC paper on flu shots is directly apropos* TheNNT.com is a website well worth bookmarking. “Number Needed to Treat” is essentially the odds that a drug will help you if you take it (typically calculated for a 5-year period). eg: if the NNT is 100, there is a 1 in 100 chance the drug will help you.* For those of you too young to have grown up with friends with phocomelia, you can read about the thalidomide debacle here. It was a disaster that should have made the medical profession more careful and humble.* The Cochrane Collaboration (the same organization that has steadfastly refused to let the strong political winds blow away their conclusion that masking does not prevent respiratory virus transmission) also has concluded that flu shots make little difference.* As Dr. Zitner mentions, some research suggests that we may be trading short-term benefit for long term harm with repeated flu shots.* Dr. Danuta Skowronski’s work that suggests that those who had been vaccinated in previous flu years were more at risk for contracting H1N1 back in 08-09 is interesting, and scientifically important.* Dr. Zitner mentions a court case in which the NS Court of Appeal did not think much of Dr. Strang’s “expertise”. Assertions backed by qualifications are not “evidence” or “The Science”.To summarize, we don’t know that “Flu Shots Save Lives!” Are certain patients (old and frail, on chemo, those affected by lung disease) more likely to see benefit than harm? Are certain patients (younger, healthier, fewer comorbidities) more likely to see harm than benefit? Before vaccinating everyone willy-nilly, we should know the answers.Given that flu shots are of dubious benefit, it seems likely that the large amounts of government money going towards producing, buying, distributing, and administering these shots every year would do more good somewhere else in the healthcare system. (Or, God forbid, simply reducing government expenditure). I have come to the conclusion that whatever the nitty-gritty detail on what subgroup might benefit, I resent my tax dollars going to promoting an intervention of unproven benefit. And until someone from public health answers Dr. Zitner’s request to provide the proof behind the “Flu Shots Save Lives!” claim, I’ll be skipping mine. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

I was very honoured to speak with Dr. Kanji Nakatsu, a PhD in pharmacology and emeritus professor from Queen’s University, about the interesting and somewhat controversial subject of Vitamin D.Is D a wonder drug? Or a fad? Should we be supplementing? If so, how much?This discussion is a little technical, and perhaps not for everyone, but I hope many of you find it of interest.This should be a scientific, not political, topic. But like everything that brushed up against COVID, it got gooey politics all over it. My hope is that we can return to objectivity and stay away from politically-fueled motivated reasoning regarding this and other nuanced topics. I think we have to be careful not to contract what I call FDS or “Fauci Derangement Syndrome”, where we start to automatically believe the opposite of everything he and The Experts™ said during the last few years - even though in most cases that will lead you to the right conclusion. Even a broken clock is right twice a day, so approaching each topic with a neutral view is the only way to return to real scientific thinking.It remains a bit unclear to me if we can separate out whether Vitamin D is a risk FACTOR or a risk MARKER. I’m not sure if we have a definitive answer yet, but the bulk of the evidence seems to be that supplementing Vit D is at worst benign, and much more likely very good for your health.Dr. Nakatsu is an impressive human - obviously brilliant, and at 78 years old about to bicycle across the country as you will hear. He is worth listening to very carefully. You can find info at his website https://areyougettingenough.info/ He is involved with the Canadian COVID Care Alliance (CCCA - which I gather is in the process of broadening its mandate and morphing into the Canadian Citizen’s Care Alliance).Thanks to Dr. Nakatsu for an interesting discussion. You can find him here on Substack, or at the websites above. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

Urban wastelandsOne of my friends described our hometown of Sydney’s downtown as looking more and more like a zombie apocalypse. Those who are addicted to the point of homelessness tend to migrate to larger centres. A rural community won’t put up with Joe Smith, Mike and Maggie’s son, pitching a tent in the field where the kids play baseball, leaving dirty needles around, and passing out on the grass. Cities are big and anonymous and such behaviour is tolerated. More than tolerated, some would say it is implicitly encouraged by the presence of harm reduction programs that make a lifestyle of homeless addiction more sustainable, as well as selective non-enforcement of loitering, panhandling, and other bylaws.A recent media article I came across referred to ‘safe’ injection sites as “controversial”. This is an understatement. Although harm reduction is preached as gospel truth, one who speaks with a representative sampling of doctors, nurses, or thinking citizens will find mainly dissenting opinions.Although one can selectively comb the literature to find small studies where harm reduction programs tout their local successes, a look at the big picture suggests a different conclusion. Even though our downtowns are more and more being turned over to addicts, Experts™ tell us to reject the evidence of our own eyes and ears. Harm reduction is working great, we just need to do more of it. Do The Experts™ know something that we don’t?I recently attended an online education session on a pilot project designed to bring “harm reduction” into the ER. The presenter suggested that we should be screening patients for addiction (requiring another piece of paperwork and a longer triage process), providing naloxone kits, starting “opiate replacement” and “safe supply” immediately, and prioritizing people with addictions ahead of other ER patients (sorry little old lady with the broken hip, I’ll be another 25 minutes…). At the end of the session I asked if there was actual evidence that this program was helping. I pointed out that although we have invested far more in harm reduction in the last generation, there are more addicts and more overdose deaths, not fewer. ER funding is a zero-sum game: when we do more of one thing we do less of another; when we prioritize one person we de-prioritize others. The answer I got was that indeed, there was no actual evidence that this pilot project was helping, but that we “have to do something”. And that “we think it might be worse if we weren’t doing this”. One presenter suggested that if we could find “the denominator” - ie: the total number of addicts - then we would see that even though there are more addicts, and even though there are more overdose deaths, that a smaller PERCENTAGE of addicts are dying of overdose. Et voila, that would prove that harm reduction helps. It felt like a stretch, to say the least. A moving of the goalposts. (Or for you math-y folks, this is called P-Hacking.)Data that contradicts visible reality should be treated skepticallyThe below article in the Journal of the American Medical Association concludes that “safe supply” (the new golden boy of harm reduction programs) was associated with INCREASED harms - in this case opioid-related hospitalizations - in the area of British Columbia where it was implemented. This data seems trustworthy, given that it matches, rather than contradicts, real life evidence.There is a joke about academics, who are prone to believing very ridiculous things if they appear in a journal: “one would have to be highly educated to believe such nonsense”. Much of the “evidence” for harm reduction falls into this category. The average joe/josephine who walks downtown, or reads the obituaries, knows that whatever The Experts™ are doing just ain’t working.Most citizens do not set up tents on the sidewalk and use drugs in publicIt’s great to want to help those with addiction issues. But at the same time, what does non-enforcement of loitering, littering, public intoxication, and other bylaws do to the ability of an average citizen to enjoy his city? To play with his kid in the park? To walk down a street without getting constantly panhandled? To not have his car broken into again and again? To not be randomly assaulted?How is it that we can speak incessantly about the needs, wants, and rights of one group - those who abuse drugs - while at the same time completely ignoring the needs, wants, and rights of the great majority of society who do not?Consider a law-abiding tax-paying citizen who has no criminal record. He wants to build a garage on his own property, which he owns and pays taxes on. First he needs a permit which requires a trip to city hall housing/zoning department. He has to pay a fee and spend time spent filling forms. The garage is finally built. The inspector comes and finds out that an ‘i’ was not dotted and a ‘t’ not crossed properly on the form. The citizen is forced to either pay a fine, or to have expensive modifications done on the garage to correct the error. (This is a real story, by the way). All this even though his garage affects no one else, and is on his own property. If he does not comply immediately he could end up charged higher fines or interest, and eventually if he did not pay he could be in contempt of court and face jail time. The police would eventually be called to enforce the bylaw. As the saying goes, “All laws are ultimately enforced at the end of a gun.”Meanwhile, a few hundred metres away, a large group of addicts has taken over a park. Land that belongs to, and is maintained by, taxpaying citizens. They erect tents and more “permanent” shelters of various kinds on land where people used to walk their dogs and kids used to play. No building permits are demanded. No inspections are done. No police are involved. No attempt is made to remove them. No one is threatened with jail. There are no consequences.We seemingly have chosen to enforce unreasonable laws on reasonable people, while at the same time not enforcing reasonable laws on unreasonable people.Are “safe injection sites” creating “safety”, or a Zombie Apocalypse?The first safe injection site in Canada opened in Vancouver around 20 years ago, and since then “harm reduction” has grown massively. It now includes the distribution of seemingly limitless clean needles, free tents, free drug paraphernalia (to crush and melt pills), naloxone kits (an injection drug that can be given to reverse the effects of an overdose) and most recently “safe supply”. In fact, more than 1 million dollars PER DAY was being spent in downtown Vancouver on these programs, even before “Safe Supply” (more properly called PSAD – Public Supply of Addictive Drugs) was added to the tally. We have put a lot of tax money into making homeless drug addiction a practically sustainable way of living.Many harm reduction advocates lament NIMBYism (Not In My BackYard): that nobody wants to have a safe injection site in his neighbourhood. But there are logical reasons for this. These facilities are bug-lights for criminal behaviour. Just several years ago, downtown Sydney Nova Scotia was safe. Like many downtowns in North America, suburban malls and online shopping had meant there were lots of empty shops, but it was safe. Male or female, one could stagger home from a bar at 2AM unmolested. Then we went all in on "harm reduction". The local (taxpayer-funded) addiction help centre has become a focal point of loitering, public intoxication, scuffles and fights, l… Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe

The watering down of languageWhen I was a medical resident in Kingston Ontario in the late 90’s, we would sometimes receive patients from the Rideau Regional Centre. This was a residential facility or “Institution” between Kingston and Ottawa that at its peak in the mid-50’s housed over 2500 mentally handicapped people. Back then in the 90’s, the government was in the last stages of phasing out these larger centres in favour of “small options homes” and “community care” for the handicapped. Whether this is an improvement is a debate I won’t step into here, except to say “it’s complicated”.Some of these residents had been admitted to the centre when they were very young, and many were old by the time I cared for them. They would arrive with their original paper charts, some of which had admission data from the 1940’s, 50’s or 60’s. Admission notes included diagnoses such as “Low-Grade Idiot”, or “High-Grade Imbecile”. Back then, these were technical terms. “Idiot” meant someone with an IQ of 0-25, an “Imbecile” between 25 and 50, and a “moron” between 50 and 70.As I don’t have to point out to you, these terms were co-opted from being technical and medical to being terms of insult and derision. Their use in medicine was abandoned. Numerous iterations have followed. “Retarded”, which etymologically means “slow” followed, but also became a term of derision. So then we used the word “slow”. “Mentally handicapped” followed. “Delayed” or “developmentally-delayed”. “Differently-abled”. Or now I have heard the term “Multiple Learning Disabilities” to describe someone who in 1950 would have been a “High-Grade Moron”.The peak of “euphemizing” about mental handicaps hit a few decades ago. I remember listening to the news and hearing about the “Association for Community Living”. What was this new organization? Did they help seniors remain in their homes? Or provide affordable housing? A church organization? Were they a swinger’s group? No, this was the new name for the Association for the Mentally Retarded (it is VERY hard to find traces on the internet, as record of its existence now seems to be memory holed). The Association for Community Living supports mentally handicapped people, but there is no longer any trace of that apparent in their name. It has been euphemized to the point of being completely devoid of meaning.This process has been called the “euphemism treadmill”.Euphemizing can lead to normalizingWe have followed a similar process with the word “addict”. Many euphemisms have been used. “Drug abuser”, “substance abuser”, “person living with addiction” (as Lionel Shriver says, a description which makes it sound like they took in a roommate), a “person who abuses substances”. We seem to have somewhat settled on “a person with an SUD” (substance use disorder).Recently the term “a person who uses substances” has come into common usage. The problem with that is that we all “use substances”. I drink coffee most mornings. I bet many of you have taken Advil for a headache. Some might have a drink of wine on Saturday evenings. Cheerios are a “substance”.The term “a person who uses substances” does not differentiate the average person from someone who has emptied his wife’s bank account to supply his drug habit, wrecked his marriage, impoverished his family, and is living under a bridge. (Could living under a bridge be called “Community Living”?)It’s not what you say, it’s what you do that mattersOur society tends to develop euphemisms for issues which are uncomfortable or difficult to discuss. But it seems to me that the term you use to describe someone is not nearly as important as the respect and compassion that you actually show that person. I’ll never forget when one of those handicapped patients from the Rideau Regional centre died, watching 2 of his caregivers completely overcome with tears. The fact that his record indicated that he was officially a “moron” hadn’t stopped them from loving and caring for him over several decades. They wept for him as if he were a brother. On the other hand (if you’ll recall back in part 2), Bonnie Henry is very careful to use the term “people who use substances” instead of “addicts”. But then she says they have a “brain disease” and that they can never get better. Is that respectful? Is it compassionate? We can run on the euphemism treadmill but go nowhere.When we water down a word, we lose something. There is still some stigma about being an “addict”. It is normal to be a “person who uses substances”. Perhaps this is why I meet lots of people who self-describe as “addicts” or “alcoholics”, many of whom haven’t used or touch a drop in decades, whereas I’ve yet to have met someone who describes himself, or is described by his family, as “a person who uses substances” who has kicked his addiction.The first step to a cure is a proper diagnosisWe need straight talk. Many media reports muddy the issue of addiction and homelessness, referring to them as “intertwined”. It is suggested - or sometimes said directly - that some people become addicted because they are homeless. Yet in all my years in medicine I have never once met someone with this story. In 2024 nearly every homeless person in Canada is addicted, which suggests the arrow points in one direction, from addiction to homelessness, but not in the other.If your brother, cousin, or friend called you some frigid winter evening and said that he was down on his luck and needed a place to stay for a while, how many people would tell him to go fly a kite? Not many. I sure wouldn’t. Now picture if you knew that person was addicted, injecting drugs regularly, stealing to support his habit, and had stolen or got in fights at the last few places where he stayed? Would that change your answer? Non-addicts rarely end up homeless, or if they do it’s not for long.Getting stigma right, not getting rid of itJulie and I sometimes joke that we need to start a “Restigmatization” movement to counterbalance the destigmatization movement. Why?Shame is normal and necessary. There are whole books written on this subject. Shaming those who engage in personally and/or societally destructive behaviour is not only reasonable, it’s necessary. Shame helps hold societies together. We could probably steal our neighbour’s bicycle and sell it for money and get away with it, but that would be shameful. We could knock down a little old lady and take her purse, but that would be shameful. The vast majority of us don’t do these things, not because the police are watching us every minute (at least not yet), but because we would bring shame on ourselves and our families. We know certain actions are wrong - there is stigma attached to them. The only way to never feel shame is to not have a conscience.As we destigmatize drug use, we can unintentional cross a line into normalizing and condoning it. We need to remember that it SHOULD be shameful to be an addict. It is bad for your family, for your community, and for you personally. If there is no stigma, there is less impetus to change.What is the right amount of stigma? If there is too much stigma and shame, a person can feel beyond redemption, and give up on himself. An addict should not be made out to be hopeless or evil. But they are not just fine like they are.It’s important to stigmatize the BEHAVIOUR and not the PERSON. An addict is not worthless or irredeemable or forever lost, despite what Bonnie Henry says. But the behaviour is destructive, costly, and socially irresponsible. Hate the sin, love the sinner. Get full access to Pairodocs’ Collection of Heresy at pairodocs.substack.com/subscribe