NFL and Prescription Drugs

The NFL is being sued by 1,300 former players for the way it distributed prescription pain medicines so players can get back in the game. The former players claim that they were not informed of the side effects of potent pain killers such as Percodan, Percocet, Vicodin, and Toradol. Percodan, Percocet and Vicodin are all opioid painkillers and Toradol is a strong non-steroidal anti-inflammatory (NSAID) drug.

Many of the former NFL players involved in the lawsuit played during the 1980s and 1990s when practices for administering powerful painkillers, both opioids and NSAIDs, were cavalier. Today they are, in theory, more regulated. The players state that the “NFL medical staffs routinely violated federal and state laws in plying them with powerful narcotics to mask injuries on game days.” They also claim that medical staff was negligent by keeping important information on the players’ medical conditions from them, such as markers for kidney disease or broken bones.

At issue are 1) whether doctors and trainers violated the law by illegally administering prescription drugs, and 2) whether players were adequately informed of the side-effects of the drugs as well as informed of any medical issues that doctors found that might affect their decision.

Doctors Behaving Badly?

In an attempt to investigate whether illegal practices were going on, the DEA paid unannounced visits to several professional teams in November (2014) in which they questioned team doctors and trainers after the game. This investigation was to ensure that doctors were prescribing and distributing drugs appropriately, that they were handling controlled substances properly when crossing state lines, and that they had a license to practice in the state. Thus far, the DEA has not found evidence of illegal activities in their investigation.

However, an investigation from Vice Sports into how and where NFL doctors acquired such large amounts of prescription drugs, shows that, at least in the past, they were likely obtaining drugs illegitimately. From 2009 to 2010, several NFL teams, as well as other professional and college sports teams, acquired large amounts of opioids and NSAIDs from a company called SportPharm, an illegal drug distributor operating behind the legitimate company, RSF Pharmaceuticals. RSF Pharmaceuticals eventually shut down, and SportPharm was re-branded as a subsidiary of Champion Health Services, which is still in operation. Many teams would fill prescriptions in player’s names without the player knowing so that the actual quantities would fly under the radar.

Informed Consent

The second issue has to do with players’ rights, and whether they were adequately informed of what drugs they were given, their medical options given their current medical situation, and the long-term side effects.

Many of the players received opiate drugs without being told about their addictive nature, and were often told to take them for longer or in higher dosages than what is recommended by the FDA. Furthermore, many players were given prescription pain medicine without a doctor’s evaluation or monitoring. One former player reports that while playing for one team, an assistant trainer would pass out unlabeled manilla envelopes with pain medicine for any player that raised his hand and said he needed them. Another former player said that envelopes with prescription pain medicine would be waiting in the seats on the airplane for the players.

Player testimonies from the class action law suit website show that many players were given powerful pain medicine instead of being told that they needed rest and recovery or that the problem was actually much worse and required surgery. Several players said that NFL doctors knew of existing health issues, but did not inform the players. Two players’ testimonies state that NFL doctors knew that they had indicators of kidney problems but did not tell the players. Both former players now have renal failure.

Another former player, Rex Hadnot, said in a Washington Post interview that he was given Toradol pills and/or injections once-per-week for nine years. He was never told that Toradol should not be administered for more than five days due to risk of kidney damage, heart attack, and stroke.  He said that sometimes he would receive both a shot and a pill on the same day, a much higher dosage than the FDA recommends.

The Mountain Climber Problem

Part of the problem with discerning the ethics of safety for football players is exemplified in what H. Tristam Engelhardt calls “the mountain climber problem.” In general, climbing a mountain is more dangerous than not climbing a mountain, but we do not consider it unethical to allow a mountain climber to scale a mountain if he so desires. Similarly, playing sports is inherently more dangerous than not playing sports. Football players take on additional risks by choosing to play the sport. Therefore, what protections, if any, are football players owed?

There is a tension between restricting someone’s freedom and allowing them to put themselves in harm’s way. Typically, with the mountain climber problem, ethicists will say that it is unethical to allow additional harm to come to the person such that he or she could not accomplish the stated goal of climbing the mountain. For example, while mountain climbing is inherently dangerous, the climber should still use a harness and ropes. In the case of football players, while it is an inherently dangerous sport, one can enforce safety precautions to ensure that players are not injured in such a way that they cannot play the sport. This is the motivation behind stricter rules to prevent concussions, helmet design, and padding.

The difference between the mountain climber and the football player is that collisions are part of the sport. Pain is a given. The former players who are suing the NFL claim that their health was sacrificed in the name of sales. But, other players criticize the lawsuit as nothing more than a money grab on behalf of former players because they knew what they were risking by playing the sport.

Despite whatever motivations are behind the lawsuit or the NFL’s medical decisions, it is unethical to de-humanize athletes, even if they willingly chose to engage in de-humanizing activities. Let’s take a non-football example: If a woman choses to trade sex for money, she is willingly commodifying herself and ultimately engaging in a de-humanizing activity. While this may have been her free choice, it does not mean that if she goes to a doctor, the doctor is no longer ethically obligated to treat her with human dignity. In other words, even if she chooses to engage in activities that are de-humanizing, that does not mean it is okay for medical health professionals to treat her as less-than-human.

In the case of football players, even if they may choose short-term returns at the expense of long-term injury, they need to be given the opportunity to make an informed choice on the matter because, ultimately, they are the ones that have to live with the consequences.

In the latest issue of Salvo Magazine (Winter, 2014) I cover the larger issue of prescription pain medicine addiction, what opiate drugs actually do to the brain, and how one becomes addicted. The former NFL players’ claims about the over-prescribing of prescription painkillers may be part of a larger national problem that saw a peak in opiate drug prescriptions during the years that many of the former players were active in the NFL.

What Does Death Have to Do with Having a Happy Holidays?

Two Christmas stories that have stood the test of time are Charles Dickens’ A Christmas Carol and Frank Capra’s It’s a Wonderful Life. Both stories invite the main character to suppose he were dead. In A Christmas Carol, the ghost of Christmas future asks Scrooge to look at how people will talk about him once he has died. In It’s a Wonderful Life, George Bailey is taken to an alternative world in which he sees how things in his town would be different had he never lived.

Additionally, both main characters must look into the face of death, confronting their own mortality, before they are ready to see that their problems originate in their own hearts. In A Christmas Carol, before Scrooge faces his own death, he encounters Marley’s ghost who warns Scrooge that if he continues in this path, he will end up like Marley, chained to his idol.

In It’s a Wonderful Life, George sinks into such deep despair that he ends up standing on the edge of the bridge considering suicide, but instead rescues another jumper from the bridge. Incidentally, the other jumper was Clarence who, similar to Marley, was once alive but now is dead, and whose mission is to help George live a better life. Scrooge and George Bailey are vastly different characters, yet both are miserable because of the same seed of discontent growing within them, and both are cured through similar means.

Interestingly, what is different about George Bailey and Ebenezer Scrooge is telling. Scrooge is the lonely wealthy man who seeks to rob others of joy because he cannot feel it himself. George is the sympathetic family man who begrudges his tender-heartedness because it has left him poor and stagnant. Both the rich man and the poor man struggle with discontent, and both the rich man and the poor man believe that money is the key to their happiness.

Both men are plagued by the same disease, discontent. When a person is discontent in poverty, he does not see the mercies and blessings he has been given, but only his lack. Puritan writer, Thomas Watson, points out that a man who is discontent in this estate will think even bitter things taste sweet. We see this when George Bailey considers compromising his standards and partnering with Mr. Potter, the town tyrant.

When a person is discontent in wealth, he can never accumulate enough to satisfy his true needs. Scrooge hoarded his wealth as a kind of security. Marley warns that rather than a security it is a fetter. The discontented wealthy man can never acquire enough, and we see this in Scrooge’s bitterness. He left his loved ones to pursue wealth, but wealth proved to be a burden rather than a companion.

By the end of the story Scrooge and George Bailey are not in a different place than they were when they faced their supernatural reminders of their mortality. Yes, George got the lost money back, but his town didn’t change, his house still had the broken bannister, and he still had four children to feed.  Scrooge still lived in the same dark house and Bob Cratchit was still his employee. What changed was their state of mind. And that is the lesson. Contentment is a state of mind, not some perfect combination of annual income, a home’s square footage, stock investments, luxury car, or vacation experiences.

George Bailey and Ebenezer Scrooge may not be characters in our time and place, but their lesson applies now as it did then. Ours is a culture that thrives on us never having enough. There are noble things that we should not be content to endure, like children dying from leukemia, or grandparents whose mind has been ravaged by Alzheimer’s, or diseases that destroy the body and injuries that result in loss of function.

However, wanting to rid the world of innocent suffering is not the kind of discontent that haunted George Bailey or Ebenezer Scrooge and it is not the kind of discontent that is endemic in our own time. Ours is a discontent that says “You deserve the best.” It is a discontent that comes from a sense of entitlement and a lack of thankfulness.

Many people blame our cultural sense of discontent on commercials that tell us that you will be happier driving a particular car or technology industries selling newer and better products before the warranty is out on your old one or magazines with air-brushed models sporting impossibly perfect bodies. But George Bailey and Ebenezer Scrooge didn’t have Cadillacs, iPhone 6s, or Photoshop. These industries are not the problem; they just make a profit from it. The problem is as old as human nature. We are dissatisfied with what we have and instead of addressing the root of our dissatisfaction, we would rather strive for more and more like Scrooge, or sink into despair like George Bailey. Their lesson strikes a chord with us because we are like them, and perhaps, like them, our focus on our lack robs us of our joy in what we have.

Creepy Critters in Our Gut

What is the microbiome?

The microbiome is the bacteria that reside within and on our bodies. Often these bacteria do more than just hang out with us. Some bacteria fight off disease, while some cause disease. Others will help us digest foods or reject bad food. For this post, I am going to focus on the gut biome, the bacteria that live in our large and small intestines, because the gut has made for some interesting headlines lately. The “microbiome” refers to all of the bacteria on the body.

The small intestines have a plethora of bacteria that act symbiotically with us to help us digest and process foods. Scientists have been studying the gut biome for many years, but it is only recently that it has garnered public attention. There have been several theories lately that have suggested the gut biome is responsible for everything from food allergies to autoimmune diseases to autism. Furthermore, new diet fads, fecal transplants, and probiotic supplements have emerged as a result of the gut biome hype, many of which are untested or whose claims are unsubstantiated. As is the case with pop-science trends, the microbiome is becoming the poster child for pseudo-scientific claims and grandiose promises.

What does the research show?

Let’s start with some facts because the gut biome does affect our health and well-being. The National Institute of Health is currently working on the Human Microbiome Project. This project seeks to identify and characterize the bacteria (and fungi) that are associated with the human body. Similar to the Human Genome Project, the original plan was to characterize the microbiome of healthy individuals and then to compare it to unhealthy individuals in hopes of understanding the role the microbiome plays in disease. However, those goals may need to be adjusted.

The Human Microbiome studies have revealed two things: 1) no two human microbiomes are alike, and 2) the microbiome is dynamic. Because each person has a unique microbiome, there is not a gold-standard, “healthy” microbiome by which to compare “diseased” microbiomes. Also, because the gut biome changes with diet and environment, it is difficult to determine a particular signature for a person. It’s composition is just too dynamic.

Additionally, the microbiome’s composition (the types of bacteria that make up the biome) are different at different times depending on the individual’s diet and environment. This is especially true with the gut biome. There are hundreds of different species of bacteria that could potentially live in our digestive system, and those species may be in different abundances at different times. Furthermore, sometimes studying two different parts of the same sample will show different results. This is a classic sampling problem. Imagine that you wanted to find the amount of lead in soil in a field. You could collect soil from the top of the ground, which might give you a different lead concentration than if you took soil that was one foot underground or you might get different results if you took samples that were 100 feet away from each other.  The gut biome has a similar problem. Apparently, the biome composition is different depending on where in the digestive tract you retrieve the bacteria (e.g., from a fecal sample or from the small intestines).

With these caveats, scientists have still observed some trends. For one, an individual’s gut biome changes after taking antibiotics. This makes sense because antibiotics are meant to kill bacteria. What is unclear is how long the changes persist and how this affects a person’s health.

Scientists also know that the gut biome plays a role in aiding digestion of certain hard-to-digest foods, such as carbohydrates. Furthermore, they have found differences between the gut biomes of obese people and non-obese people and between people with digestive diseases, such as Crohn’s disease. However, whether the different gut biome is the cause or is the result is unclear.

Healthy skepticism

There are several other correlations between the microbiome and physiological effects.  The difficulty is whether these are merely correlations or causation. William Hanage has an excellent article in Nature, “Microbiology: Microbiome Science Needs a Healthy Dose of Skepticism” in which he discusses five key questions to help discern the truth from the hype:

  1. Can experiments detect differences that matter?
  2. Does the study show causation or just correlation?
  3. What is the mechanism?
  4. How much do experiments really reflect reality?
  5. Could anything else explain the results?

Many studies show that the gut biome is very responsive to diet and environment, which means the differences we see in people with a certain disease (or condition) may be the gut responding to the disease rather than causing it.

The gut biome is a new area of research that may shed some light on digestive disorders and the effects of antibiotics on the body. However, Hanage cautions us to not fall into the same kind of non-discretionary, cure-all thinking that we’ve seen in other new areas of science such as the Human Genome Project, stem cell research, genetic engineering, or nanotechnology. He also remind us not to blame the microbiome for all of our ills: “In pre-scientific times when something happened that people did not understand, they blamed it on spirits. We must resist the urge to transform our microbial passengers into modern-day phantoms.”

Is It Cheating or Discrimination?

Dutee Chand (Manjunath Kiran/AFP/Getty Images)

Sprinter Dutee Chand has been banned from competing in track-and-field because her body produces abnormally high levels of testosterone as reported in The New York Times. Chand is India’s 100-meter, under 18 champion and was an Olympic hopeful, but after an official or a competitor at the Asian Junior Athletics Championships in June requested that Chand be tested for hyperandrogenism, she was pulled from the sport. Chand had won two gold medals at the event.

It was found that Chand has a condition which causes her body to produce more testosterone than what is considered the normal range for women. Chand’s case is not unique. Recent studies have shown that hyperandrogenism may be overrepresented among female athletes compared to the general population. Four female athletes were pulled from the 2012 London Olympics and taken to France for testing. All of them, like Chand, came from rural regions of developing countries. The London athletes were told to undergo surgery if they wanted to compete. The International Association of Athletics Federations (I.A.A.F.) deemed that Chand cannot compete unless she takes hormone suppressing drugs or has surgery. Chand is contesting this stating that she should not have to change her body.

From a bioethics standpoint, there are several issues that are cause for concern regarding Chand’s case: 1) It is one thing to ban performance enhancers. It is another to require performance “diminishers” to change someone’s natural abilities. 2) Elite athletes are, by definition, not within the range of normal. Why are some genetic abnormalities allowed, but others are not? 3) What is the purpose of sport if it is not to celebrate God-given abilities coupled with training and hard work?

Chand has always considered herself a female and for all intents and purposes is female, but her body produces more testosterone than most females do. Her diagnosis of hyperandrogenism does not necessarily mean that she had an additional Y chromosome, as in Klinefelter syndrome, or a segment of a Y chromosome attached to one of her X chromosomes, as in De la Chappelle syndrome. It just means that her body produces significantly more testosterone. Furthermore, while synthetic testosterone, often taken for doping, confers an unnatural athletic advantage, the science on how naturally produced testosterone caused by hyperandrogenism and some of these other syndromes is still unknown. David Epstein, in his book The Sports Gene, cites Spanish hurdler Maria Jose Martinez-Patino as an example of this. She had De la Chappelle syndrome so her body was producing male levels of testosterone. However, she developed fully female because her body also had androgen insensitivity, which means her body does not respond to testosterone. Hormones, like testosterone, are chemical signals, and in people with androgen insensitivity, their body does not seem to read the signal. Her success as a hurdler, Epstein argues, is likely due to something else.

Epstein spoke with two endocrinologists who believe that androgen insensitivity is likely overrepresented in both sports and modeling. Even though their bodies do not respond to testosterone, they do seem to exhibit certain physical features. In women with high testosterone but androgen insensitivity, their arms and legs tend to be longer than the average female, and they tend to be a couple of inches taller than average female height. Because they do not respond to testosterone, they are feminine, but this added height and limb length can be an athletic advantage in certain sports.

Epstein interviewed Jeff Brown, an endocrinologist who works with top athletes in the U.S., several of whom are Olympic gold medalists. Dr. Brown reports that several of his female athletes have partial 21-hydroxylase deficiency, which is genetically passed down from the parents, and can cause an overproduction of testosterone. Women with low-level 21-hydroxylase deficiency develop normal ovaries and uterus, but their bodies produce more testosterone. How that testosterone is read by the body is still unclear. As a note, men can have 21-hydroxylase deficiency, but its effects are less dramatic.

Interestingly Dr. Brown points out that the endocrine system of elite athletes, in general, differs noticeably from those of most adults. He points out that there are many things about the bodies of elite athletes that are different from most people. This brings up the second issue with Chand’s case. By definition, elite athletes are rare. Once we start talking about the upper echelons of athletic performance, it is often the rare combination of genetics, work ethic, and opportunity that allows an athlete to become elite.

Consider the example of arm span in the NBA. It is a given that a six-foot male is considered “short” in the NBA. In general, most NBA players are taller than average. But being over six-feet tall is not as rare as having an arm span that is longer than height. This rare trait is overrepresented in the NBA. Normal adults have an arm span that is roughly equivalent to their height. In the NBA, most players have an arm span that is significantly longer than their height. For example, Kevin Durant is 6’9” but has a reported wingspan of 7’4”. LeBron James is 6’7.25” with a wingspan of 7’0.25”. Michael Jordan is 6’6” with a reported wingspan of 6’11.5” (Statistics are from NBA.com and wikiepedia.org). Longer arm span means that these athletes actually have a taller effective height.

Pertinent to the topic, NBA players are not asked to do something about their arm span in order to compete in the Olympics or play competitive, professional basketball. One possible exception is Baylor University’s Isaiah Austin. His basketball career was cut short when pre-draft testing found that he had Marfan syndrome, deeming him ineligible to play basketball competitively. One of the symptoms of Marfan syndrome is tallness and an elongation of arms and fingers due to weak connective tissues in the joints. It also gave Austin a longer wingspan than height, likely giving him an advantage on the court. However, the difference between Austin’s case and Chand’s is that the effects of Marfan syndrome are well-known. Marfan syndrome can endanger an athlete because it affects the heart, eyes, circulatory system, and the skeletal structure. Austin was told that he had an enlarged heart and extreme physical exertion could kill him. Chand’s condition does not pose a known health risk.

The NBA is only one example. Genetic aberrations are seen in many other sports, yet these people are not asked to undergo chemical or surgical alterations to conform to certain notions of “normal.” Indeed, in the case of using performance enhancing drugs, which are illegal, the point is to synthetically procure what one was not given naturally. The point is to become “like” someone who is rare so that you can win.

Finally, Chand’s case brings up a larger philosophical question of the purpose of sport. Pierre Coubertin, who was instrumental in re-inventing the modern Olympic movement, considered athletic training part of the cultivation of virtues. He takes a post-Enlightenment, humanist perspective that stems from the pre-modern Judeo-Christian idea that all people are of equal moral worth, although not all are of equal capability. For Coubertin, the point was not winning-at-all-costs, but becoming a better person through discipline, integrity, self-control, hard work, and perseverance. However, given equal training and opportunity, if one athlete has bad knees and the other does not, then the one with better knees will prevail. Coubertin’s perspective would have little to say about an athlete like Chand. Presumably, the emphasis would be on whether she was cultivating a virtuous character.

For some, sport is about showing off technological prowess, which is often tied to a sense of nationalism when played on a global stage. Oftentimes, this view does not see using performance enhancers as a problem because it is considered part of training with the best technology possible. The competition is not just between individual athletes, but between countries. The question isn’t which athlete won the gold, but how many gold medals did a particular country receive. The accumulated successes reflect back on the country’s resources, politics, training, and technological capabilities. From this perspective, it is in the competing countries’ interest to make sure that the competitors are homogenous. This would mean that an athlete like Chand would be excluded because she does not fall within the “norm” and therefore provides one country with an unfair advantage over another.

Finally, another perspective is that sport is about admiring individual differences and God-given abilities. From this perspective, demanding that an athlete chemically or surgically “normalize” herself would constitute cheating because she would be altering herself from how she was born in a way that is meant to change her athletic performance. Incidentally, using performance enhancing drugs would also be unethical for the same reasons, but rather than attempting to normalize the athlete, those that use PEDs are intentionally trying to make themselves above the norm. This perspective would include Chand in world-class competition. Whether she should compete with men or women is another debate, perhaps one that calls into question some notions of gender segregation in sports.

Sports is an age-old social sphere that, in many ways, reflects something about our cultural values. Chand’s body is not within the “norm,” but most elite-level, world-class athletes are not, in one way or another, within the norm either. It is unfortunate that rather than celebrating her distinctive qualities and abilities as a sprinter, she is treated as less-than-adequate for physical qualities that are not under her control. Furthermore, one has to wonder why Chand’s particular physical qualities are considered something to be “fixed” rather than a gift to be celebrated.

Are We Bored Yet? The Apple Watch and New Technologies

One of the plights of modernity and postmodernity is hyperboredom. This is not the kind of boredom that comes out of having nothing to do, but the kind of boredom that comes out of having too many options and no way to distinguish which one is better than the other. We are jolted out of this boredom when we encounter disruptive technologies. These are technologies that fundamentally change a particular market and have an impact on our culture.

According to Ian Bogost, Apple is a company that is as much in the business of shaking us out of our routine with disruptive technologies as it is in the business of manufacturing them. This may explain why people flock to Apple’s announcements (either virtually, or in person) with a big-tent revival fervor in hopes of seeing what groundbreaking new technology Apple has in store for us. For a brief moment, the hyperbordom is replaced with anticipation and excitement over the possibility that the multitude of options will become passé to be replaced by that one technology that supersedes all of them.

Take, for example, Steve Jobs’ announcement in January, 2007 of this little gadget called the iPhone. He knew the implications of this device and where it stood in the grand scheme of things: (Quoted from “How Apple Introduced the iPhone” in The Atlantic):

This is a day I’ve been looking forward to for two-and-a-half years. Every once in a while, a revolutionary product comes around that changes everything and Apple has been—well, first of all, one is very fortunate if you get to work on just one of these in your career—Apple has been very fortunate. It’s been able to introduce a few of these into the world. In 1984, we introduced the Macintosh. It didn’t just change Apple. It changed the whole computer industry. In 2001, we introduced the first iPod. It didn’t just change the way we all listen to music, it changed the entire music industry. Well, today, we’re introducing three revolutionary products of this class. The first one is a widescreen iPod with touch controls. The second is a revolutionary mobile phone. And the third is a breakthrough Internet communications device. An iPod, a phone, and an Internet communicator. These are not three separate devices. This is one device. And we are calling it iPhone. Today Apple is going to reinvent the phone.(emphasis added)

Since then, every time Apple unveils a new iPhone, people flock to stores in anxious anticipation, some of them going so far as to sleep outside the Apple store’s doors in hopes of being the first to get the latest and best that Apple has to offer. And, it does not seem to be slowing down. Sales for the iPhone 6 and 6 Plus broke last year’s record, selling ten million phones last weekend, an opening weekend that was strategically timed to ensure that there will be visions of iPhones dancing in everyone’s head by December.

So with such excitement and Apple’s track record of disruptive technology, what happened with the Apple Watch?* Apple had not released a new device in four years. This was to be the next device after the death of Steve Jobs that shows Apple is still changing markets. However, rather than the fanfare of groundbreaking technology, the Apple Watch was met with mixed reactions..

In his article “Future Ennui” Ian Bogost says that the problem is not the technology itself, but the burden that comes with it. We have become bored of the constant barrage of groundbreaking technologies. He compares it to Google’s innovations,

Unlike its competitor Google, with its eyeglass wearables and delivery drones and autonomous cars, Apple’s products are reasonable and expected—prosaic even, despite their refined design. Google’s future is truly science fictional, whereas Apple’s is mostly foreseeable. You can imagine wearing Apple Watch, in no small part because you remember thinking that you could imagine carrying Apple’s iPhone—and then you did, and now you always do.

Bogost may be giving Google too much of a pass, though. The Google Glass has sparked some controversy among those paranoid of being filmed by its wearers.

Perhaps the difference between Google’s innovations and Apple’s innovations can be compared to the difference between reading Isaac Asimov and Margaret Atwood. Asimov writes about robots and artificial intelligence, and even explores some of the ways that this technology can go awry, but Asimov’s stories do not come with a sense of prophetic inevitability that Atwood’s do. Atwood writes speculative fiction, not science fiction (See Atwood’s book In Other Worlds). Atwood’s stories, like her recent Madd Adam trilogy, are disconcerting because they are a little too plausible. Rather than something that may be fifty years from now, her books describe a near-future in which technologies that are already in place are ratcheted up. Similarly, while people will likely not drive automatic cars in the next ten years, it is much more likely that they will be wearing technology that is collecting data on all of their bodily process, purchases, and locations in the next two years.

While the fervor over the iPhone 6 hit record levels, perhaps the mixed response to the Apple Watch signifies that we are tempering our enthusiasm over internet-in-our-pocket technologies. Clive Thompson, quoted in an in an opinion piece in the New York Times, says that our attitudes toward technology follows a predictable pattern, “We are so intoxicated by it, and then there’s a fairly predictable curve of us recognizing as a society that this is untenable, and we’re acting like freaks.”

Thompson is an optimistic writer on technology who believes that there are many benefits to the kind of community interactions that are possible with the internet. Rather than focusing on the doom-and-gloom of the here-and-now, Thompson takes a broader, historical perspective, reminding us, in an interview with The New Yorker that we have been through this before,

We have a long track record of adapting to the challenges of new technologies and new media, and of figuring out self-control…More recently, we tamed our addition [sic] to talking incessantly on mobile phones. People forget this, but when mobile phones came along, in the nineties, people were so captivated by the idea that you could talk to someone else—anywhere—on the sidewalk, on a mountaintop—that they answered them every single time they rang. It took ten years, and a ton of quite useful scrutiny—and mockery of our own poor behavior—to pull back.

Indeed, studies on cell phone addiction and parents neglecting their children and state laws addressing car accident deaths because people cannot pull away from their cell phones are all indications that we are becoming keenly aware that we might be acting like “freaks.”

While disruptive technologies may also disrupt our postmodern malaise, there does come a point when we become weary of the constant announcements of the next-big-tech. Bogost’s article is compelling because he touches on this very notion. Once there are too many next-big-tech options available, the hyperboredom of modernity and postmodernity sets in.

*The marketing team at Apple wisely opted not to go with “iWatch.”

Cell Phone Addiction, Texting Anxiety, and Email Bankruptcy

A new study in the Journal of Behavioral Addictions by Roberts, et al looks at the incidence of cell phone addiction among college-age males and females. The study also looked at what types of programs or behaviors had a positive correlation to addiction. As it turns out, some people do seem to be addicted to their cell phone, but perhaps the more accurate statement is that people are addicted to Facebook, Twitter, Instagram, and Pinterest.

Incidentally, I am writing this as I am sitting at a Starbucks, the enabler, par excellence, of socially acceptable addictions. Both men and women are sitting on their cell phones doing something with their thumbs. If any of these people were to leave home without their cell phones, would they suffer from withdrawal? That’s one of several questions from the study. Another is whether you find yourself using your cell phone more and more.

Withdrawal is one of several indicators of addiction. Roberts, et al use the standard definition of addiction to identify whether college co-eds are addicts. They look for the presence of salience, euphoria, tolerance, withdrawal symptoms, conflict, and relapse, as well as the incidence of continued use despite negative consequences. They found that many people have a cell phone addiction that is comparable to a behavior addiction, like compulsive shopping or compulsive gambling. (This is different from a substance addiction, which can involve not only neurological changes due to the formation of a habit, but also neurological effects that are a result of how the substance interacts with the body). In an effort to determine how and why a cell phone addiction forms, they focused on identifying the “tipping point” in which the cell phone goes from being a tool that people like to use, to becoming a need.

When exactly this tipping point occurs is difficult to identify. Incidence of phone addiction seems to correlate with the prevalence of Smart Phones, which means the underlying issue is what the phone is being used for. Furthermore, many of the students they surveyed consider their cell phone an integral part of their identity, meaning that the cell phone is viewed as something more than a tool or business or diversion. According to Kent Dunnington in his book Addiction and Virtue in which he looks at addiction from the perspective of Aristotle and Aquinas, addiction has an orienting nature to it that provides a semblance of identity and order (priorities) in a disordered, fragmented world. As the authors of the study point out, “Cell phones have become inextricably woven into our daily lives – an almost invisible driver of modern life.”

The study determined that men and women, who are addicted to their cell phones, use the cell phone slightly differently. Activities that positively correlate to cell phone addiction in men were number of emails sent, reading books, Facebook, Instagram, Twitter, number of phone calls, and number of texts. Activities that positively correlate to cell phone addiction in women were Pinterest, Instagram, Amazon, Facebook, number of calls made, and number of texts and emails. Women spent significantly more time on their phones compared to men (10 hours per day versus 8 hours per day), but had the same number of calls, texts, and emails as men. Women spent more time on Facebook, but Facebook was a stronger predictor of addiction in men.

The authors contend that the addiction has to do with being socially connected. Gaming, for example, was not strongly correlated with cell phone addiction, while social media was. Furthermore, mental health issues as a result of cell phone use indicate that social connection is much more important to people than entertainment. Consider two issues that have arisen since Smart phones became popular: Text bubble anxiety and email inbox overload.

Ben Crair has a thought-provoking piece in the New Republic on the concept of “text bubble anxiety” or the sense of tension someone has when they know that another person is typing a message but the message has not been sent. The longer someone takes to type, indicated by ellipses on iPhones or “Bob is typing…” in Google Chat, the more anxious the other person becomes because the longer someone types, the more we tend to assume it is something bad. In reality, the other person may have been interrupted by another phone call or had to re-type the message for some other reason. When the person finally does send the text, and it happens to have trivial content, then we tend to be disappointed. This roller coaster ride of assumptions takes an emotional toll. Jessica Bennett, in an op-ed in the New York Times, confesses that her therapist recommended turning off the typing awareness indicator because it was causing her mental distress.

Another mental health issue is due to an overwhelming email inbox. Some people become so burdened by a burgeoning inbox that they must declare what Sherry Turkel, sociologist at MIT, calls “email bankruptcy.” Similar to financial bankruptcy, email bankruptcy is when your inbox becomes so full of unread or unaddressed emails, that it has become too unwieldy. This can cause some people additional stress and anxiety. One solution is to archive all emails, clear their inbox, and send a message to contacts saying that if they want to continue to do business with you to send a new email.

When it comes to addiction, the behavior is really a symptom of a deeper problem. This study indicates that cell phone addiction is really an addiction to mediated socializing. Dunnington says that addictive behavior, which is based on something more than mere sensory pleasure, can tell us what human beings most deeply desire. While addictions, like addictions to social networking, may begin as diversions to deal with boredom, they morph from diversions to addictions because they provide a sense of purpose or, in this case, a sense of community that is lacking in our modern individualistic culture.

Sherry Turkel says that it is important for people in our culture to demarcate sacred spaces where one will not engage in internet mediated socializing because people need to interact with one another in a more substantive way. She also says that people need to learn the practice of privacy and solitude, or put another way, people need to set personal boundaries and to cultivate an ability to be alone without being lonely.

While this study certainly has its limitations (e.g., the test subjects were college students), it is telling that the activities that have a positive correlation to cell phone addiction are not gaming or entertainment, but social networking.