RESUMEN
The target of my discussion is intuitions lay people have about justice in the context of drug policy-intuitions that take on a more or less moral-desert-based shape. I argue that even if we think desert is the right measure of how we ought to treat people, we ought still be in favour of Harm Reduction measures for people who use drugs. Harm Reduction measures are controversial with members of the public, and much of the opposition seems to come from something like an appeal to a desert conception of justice-the notion that a just state of affairs is one in which everybody gets what they deserve, no more, no less. A recent study, for example, found that 'moral outrage' predicts a preference for prevalence reduction (criminal sanction, etc.) over Harm Reduction. The thinking seems to be that, since drug use is wrong, letting people who use drugs suffer and/or die as a consequence of their use is just. Aiding their health and safety, while perhaps compassionate, is unjust. I argue that there is a bad desert fit between using drugs and suffering avoidable harm even if using drugs is morally wrong. Many of the possible harms of drug use are socially/policy driven, and much problematic drug use is context dependent, not cleanly attributable to the decisions of the person who uses drugs. This means that even if drug use is wrong, people who use drugs deserve Harm Reduction policies, at minimum.
Asunto(s)
Reducción del Daño , Principios Morales , Trastornos Relacionados con Sustancias/epidemiología , Humanos , Política PúblicaRESUMEN
BACKGROUND: New gastric bands have been available for the past 3 years in the United States: Lap-Band AP (LBAP), Realize Band (RB), and Realize Band C (RBC). No RBC data have been previously published. The objective of the present study was to report our experience with 3 newer gastric bands in an experienced, private, U.S. bariatric surgery center. METHODS: Data were prospectively collected and retrospectively reviewed. The characteristics evaluated include age, body mass index (BMI), gender, percentage of excess weight loss, band fill volumes, and complications. RESULTS: From April 2007 through February 2010, 633 patients (mean age 42.3 ± 10.3 years) underwent laparoscopic band placement. The LBAP was placed in 384 patients (78% women, BMI 45.4 ± 6.9 kg/m(2)), the RB in 167 patients (84% women, BMI 46.4 ± 7.9), and the RBC in 82 patients (76% women, BMI 46.1 ± 8.2). The corresponding mean 1-year percentage of excess weight loss was 44.4% ± 19%, 38.9% ± 16.2%, and 32.1% ± 16.1% (LBAP versus RB and RBC, P <.05), with a 91%, 90%, and 83% follow-up rate. The 2-year percentage of excess weight loss for the LBAP and RB patients was 52.5 ± 21.2 and 43.3 ± 21.3 (P <.05), respectively, with a 76% and 67% follow-up rate. The corresponding mean band volumes at 1 year were 4.6, 7.6, and 10.2 mL, with 2%, 12%, and 38% of the bands filled more than the manufacturer's maximal volume capacity recommendation. The postoperative complications included slippages and erosions in .5% and .5% of the LBAP, .6% and 1.8% of the RB, and 1.2% and 0% of the RBC patients, respectively. CONCLUSION: Of the new bands available in the United States, the LBAP provided significantly better weight loss in our private practice setting. The RBC patients had the least weight loss, with a high band-fill volume needed to achieve effective restriction.
Asunto(s)
Gastroplastia/instrumentación , Obesidad Mórbida/cirugía , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Laparoscopía , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estados Unidos , Pérdida de Peso , Adulto JovenRESUMEN
BACKGROUND: Severe obesity is associated with type 2 diabetes and hypertension. Improvement in these comorbidities after surgically-induced weight loss has been documented, and laparoscopic adjustable gastric banding (LAGB) is an effective weight loss operation. METHODS: Of 840 patients who underwent Lap-Band, data are available in 402 out of 413 patients whose surgery took place at >/= 1 year ago. Preoperative and follow-up data were studied retrospectively to examine the effect of Lap-Band-induced weight loss on diabetes and hypertension. RESULTS: Of 413 patients with at least 1 year postoperative follow-up, 53 (12.8%) were taking medications for type 2 diabetes preoperatively and 189 (45.7%) were on antihypertensive medications. 66% (n=35) of diabetic patients were also hypertensive. Resolution of diabetes was observed in 66% at 1-year and 80% at 2-year follow-up. HbA1c dropped from 7.25% (5.6-11.0, n=53) preoperatively to 5.58% (5.0-6.2, n=15) at 2 years after surgery. Hypertension resolved in 59.8% and 74% at 1 and 2 years, respectively. Percent excess weight loss (%EWL) was lower for diabetic patients than for our cohort population (39.2% vs 41.2% at 1 year, 46.7% vs 54.2% at 18 months, and 52.6% vs 63.3% at 2 years, respectively). Patients in whom diabetes was improved but not resolved had lower %EWL than did those whose diabetes went into remission (27.0% at 1 year and 26.5% at 2 years). Patients with the shortest duration of diabetes (<5 years) and better weight loss after surgery achieved higher resolution rates. CONCLUSIONS: Dramatic improvement in - and frequent resolution of - diabetes and hypertension have been observed as a result of weight loss after Lap-Band surgery.