Letters: Let's live with thanksgiving every day

IndyStar

We all need to be reminded of the tremendous importance of thanksgiving – not as a day, but as a way of life.

One person said it well, “Don't grumble because you don't have what you want . . . rather be exceedingly grateful you don't get what you deserve!” The Bible tells us that our lives are to “overflow with thanksgiving.” (Colossians 2:7) 

Some may think that they have nothing, or very little, to give thanks for. Writer Andre Dubus, who’d lost both his legs in an accident, asked readers to imagine that they’d only have in heaven what they’d thanked God for on earth. He asked if we’d ever thought to thank God for our hands and arms. Have we? If our right arms were a gadget we’d gotten for Christmas, we’d be ecstatic. 

Count your blessings. Don’t be like the farmer who said to his wife of 42 years: “Wife, you’ve been such a wonderful woman that there are times I can hardly keep from telling you.” I wonder if some of us are that way toward God?

“Always be thankful.” (Col. 3:15)

Pastor Timothy Morbitzer

North Manchester

Tax reform will spur economic growth

I read Frederick Emhardt’s anti-debt, anti-tax cut letter and I just wonder if he was hiding under a rock during the Obama years.

The debt doubled, spending was out of control and what do we have to show for it but crumbling infrastructure, a decimated military and weak economic growth.

Emhardt is correct to be concerned with the debt, which is the accumulated deficits plus interest owed.  But the tax cuts, if structured properly, would result in 3% economic growth and, if sustained over the long haul, coupled with restraint on discretionary spending, will result in balanced budgets and reduced debt.

Now is not the time to put the green eye-shades on.  When President Obama was handing out cash to his cronies was the time for that.

It is high time we had a pro-growth, flatter, fairer tax code.

John L. Sorg

Indianapolis

Tax bill will hurt those with student loan debt

This tax bill the GOP has constructed is going to greatly damage our lives. College students hold some.of the highest debt in this country and with the new tax bill they will not longer be allowed to deduct their student loans from their taxes.

I am a college graduate who relies on my student loan tax returns. This will endanger the lives of young people hoping to gain a higher education to better our country. 

The midterms are coming up. Is this really a wise thing for the Senate to pass when many seats are up for re-election? Also, sneaking in a health-care amendment is shady. How many Indiana voters rely on the Affordable Care Act and state-funded health care? Probably a lot more than you would care to admit. There is already an opioid addiction and HIV crisis in this state. A nuked health-care reform will make it worse. This bill will kill thousands and damage the economy and livelihoods of voters.

Amohlia Lewis

Warsaw

Science doesn't support use of "Bridge" medical device

On Nov. 15, Innovative Health Solutions (IHS) of Indiana announced FDA clearance for their device, the "Bridge" for treatment of opioid withdrawal. As reported in the Indianapolis Star on Nov. 17, this government endorsement will likely make the device eligible for insurance coverage. As a professional working in neuroscience, pharmacology and addiction psychiatry on the front lines of treatment, this announcement is troubling.

I am an enthusiastic supporter of Indiana’s growing biotech sector and developing evidence-based methods in the addiction treatment space. The problem here is that this device, which delivers electrical current to the ear lobe, at a cost of several hundred dollars per patient/per withdrawal episode, is not yet sufficiently supported by scientific evidence. It has been endorsed by the government with nowhere near the level of evidence normally required by the FDA to approve medications, and no evidence that it actually improves long-term recovery from opioid addiction.

Why is scientific evidence, that is so lacking here, so important, especially for addictions? Because in the absence of science, especially for illnesses that we are so desperate to treat in vulnerable populations, other forces will determine whether treatments are accepted and covered by insurance: marketing, business interests, ideology, hype and/or politics.

Marketing for the Bridge has directly targeted Indiana legislators and criminal justice officials, along with the efforts of local pharmaceutical company lobbyists and sales people representing another company called Alkermes. Alkermes has pursued a strategy of directly marketing its product for opioid addiction (Vivitrol) to legislators, judges and prosecutors, who have little medical or scientific expertise, but great political power. This has allowed Alkermes to gain market share and political support over other addiction treatment modalities that Alkermes competes with. Marketing of the Bridge to politicians and criminal justice officials is good for Alkermes because the Bridge, if it gains a reputation of being effective (real or imagined), would literally act as a ‘Bridge’ between the discontinuation of Alkermes’ competitor’s medications, to starting their own. Vivitrol is a solid evidence-based medication, but it is not the best or most efficacious for everyone, and the decision to put someone on it, and how this is done, should go by the evidence base and individualized treatment planning by a trained physician and addiction treatment team that will provide long-term care.

Earlier this year in Indiana, the Johnson County/Greenwood court started a pilot program that gave prisoners a choice between punishment as usual, or treatment with the Bridge leading directly, and exclusively to Vivitrol (but not other evidence-based treatments). Understand what this means: In 2017, Indiana prisoners, who are being criminalized by the government in connection to having a brain illness called addiction, have essentially been coerced (even if subtly and with the best intentions) by the government into agreeing to a unscientifically proven treatment that electrically shocks their ears, that then leads directly to just one specific treatment provided by a company that is directly lobbying and marketing to politicians and the criminal justice system. Given the high degree of ethical oversight that prisoners are normally protected by as participants in legitimate medical research in the U.S., it is hard to understand how this situation is ethical or legal.

Now with federal endorsement for the Bridge, the legality or ethics of this scenario will appear moot, and there will be even less motivation for the company, the government, the treatment community, or the public to question the device, and to rigorously scientifically test it or parameterize its efficacy.

So is this the process we really want to develop and approve new treatments? From corporate marketing to politicians and judges, to uncontrolled experimentation on prisoners, to FDA approval, all with no science needed? At least we can hope that a little shock to the ear would cause no harm, right?

Well, at several hundred dollars per treatment for a chronic disease where patients may have to undergo many treatments (having opioid addiction can cause dozens of episodes of withdrawal), the cost could get quite high. This is disturbing when right now, so many other treatments, and standards of care for addiction that actually are solidly evidence-based, are still not adequately covered by insurance, or even actively blocked by insurance. Notably, in the Nov. 15 press release announcing the FDA endorsement, IHA suggests the device is relevant not only opioid withdrawal, but post-acute withdrawal symptoms (PAWS). This is significant because PAWS is a controversial diagnostic entity, of uncertain validity that is not officially recognized as a psychiatric or medical diagnosis, or well characterized scientifically. Moreover, the company’s FDA announcement states: “the device helps take away the fear of withdrawal and leads to a much higher success rate”. Unfortunately, these claims, however much I wish they are true, are not established or supported by scientific evidence.

I hope the public and health professionals who are interested in decisively treating the opioid epidemic might see the parallels here with what started this nightmare 20 years ago: Heavy pharmaceutical company lobbying to politicians and doctors; lack of interest or attention to science or scientific proof; unsupported claims about efficacy; exaggeration, over-generalization and marketing of uncertain diagnostic constructs to create market share; identification of good treatment with products rather that comprehensive care or well-trained professional expertise; focus on addiction as a criminal rather than a biomedical problem; focus on quick fixes, etc. In medicine, science is our only defense against the dark arts of quackery, medical greed and exploitation of the sick. For the sake of patients, I do hope the Bridge works. But for me to use it in regular practice, don’t show me a sales job, or the enthusiasm of lobbyists, politicians or prosecutors; just give me the solid science.

R. Andrew Chambers, MD

Addiction Psychiatrist

Indianapolis

Banded tuition helps students

Most people have heard of a baker’s dozen: buy 12 and get an extra one free. Fewer people may be aware that many Indiana colleges offer an even better bargain called banded tuition.

Banded tuition allows students to take up to 18 credits per semester for the same price they would pay for taking 12 credits. That results in big savings for Hoosier families since students must complete at least 15 credits each semester (30 per year) to graduate on time and an extra year of college can cost them more than $50,000 in added tuition and delayed earnings.

While not all students are able to attend college full time, those who can stand to benefit from taking at least 15 credits per semester. Data show that students who take 15 or more credits per semester earn higher grades, complete college at higher rates and are less likely to end up with debt but no degree.

About one-third of Indiana college students already are enrolled in 12 to 14 credits per semester. Taking just one more class each semester would put thousands more Hoosier students on track to graduate on time with a more affordable degree. That’s why the Indiana Commission for Higher Education has encouraged all of the state’s colleges to adopt banded tuition as a student success strategy.

Some Indiana colleges, including Ball State University, Indiana State University, Indiana University Bloomington and Purdue University West Lafayette have offered banded tuition for years, and more campuses have been moving in that direction recently. IU’s seven regional campuses adopted banded tuition last year and Purdue announced that its two other campuses will transition to banded tuition next year.

We are encouraged that more Indiana campuses are embracing banded tuition and hopeful that this student-friendly practice will become the statewide standard. At a time when higher education has never been more important to our students and our state, we must do everything we can to remove financial barriers to college completion.

Teresa Lubbers

Indiana Commissioner for Higher Education