Someone who knows what they're talking about.
Thank you for articulating on this.
Must dash!
WHEN DID WE BECOME A SOCIETY THAT CAN LOOK AT A BEDBOUND HUMAN BEING AND FEEL ABSOLUTELY NOTHING?
I’ve been reading heartbreaking accounts on my timeline.
Husbands.
Wives.
Sons.
Daughters.
People who once worked, walked, competed in professional sports, participated in life, now confined to their beds after losing access to pain medication that helped them function.
Not lounging in bed.
LIVING IN BED!
Twenty-three hours a day.
Dependent on caregivers for food, bathing, sometimes even a bedpan.
And somehow, we’ve reached a point where that level of human suffering can be met with another shrug.
To every physician, nurse, policymaker, and healthy person reading this:
I challenge you to watch Unrest, the extraordinary 2017 documentary by Jennifer Brea.
It documents the devastating reality of myalgic encephalomyelitis (ME), commonly called ME/CFS.
Even the term “chronic fatigue syndrome” has been criticized for trivializing a profoundly disabling multisystem illness.
This isn’t being tired.
This is a disease that steals someone’s ability to tolerate light, sound, conversation, or even sitting upright.
The CDC estimates up to ONE IN FOUR people with ME/CFS become homebound or bedbound at some point.
And ME isn’t the only illness that can imprison someone in a bedroom.
Severe, inadequately treated chronic pain can devastate mobility, independence, and quality of life, too.
Now, about opioids.
We don’t wake up one morning and decide prescription opioids sound like a fun lifestyle choice.
Many of us have endured years of specialists, procedures, physical therapy, medications, failed treatments, and endless documentation before arriving at opioid therapy.
We understand the risks.
We live with the stigma.
We don’t want the medication.
We want the FUNCTION that effective pain relief can sometimes give us.
The ability to shower.
Prepare a meal.
Walk the dog.
Hug our children.
Participate in the world.
And yes, opioids aren’t appropriate or effective for everyone.
But when an established treatment demonstrably improves someone’s function, removing it without individualized consideration can have devastating consequences.
Even the CDC warns against abrupt discontinuation of long-term opioid therapy.
So tell me, Dr. Jane Doe:
When your patient becomes bedbound, when their entire world shrinks to the dimensions of a mattress, at what point does preserving your professional comfort become more important than investigating their suffering?
A BED IS SUPPOSED TO BE A PLACE OF REST.
NOT A LIFE SENTENCE!
Watch Unrest once. (I’ve watched it 4 times)
Sit with the discomfort.
Then imagine that the person on the screen is someone you love.
Compassion shouldn’t require personal tragedy.
And humanity should never be an optional part of healthcare.
The YouTube link to Unrest will be in the replies.
The short footage accompanying this post is from The Golden Girls, Season 5, Episode 2, “Sick and Tired, Part 2” (1989), featuring Bea Arthur as Dorothy Zbornak confronting the physician who dismissed her illness.
Think about that.
In 1989, a fictional television character was demanding the same dignity, compassion, and medical accountability that real patients are still fighting for in 2026.
Thirty-seven years later, Dorothy’s confrontation remains painfully relevant.
For countless patients who have been dismissed, disbelieved, or made to feel invisible, she gave voice to words we wish we’d been able to say ourselves.
Different decades.
Same dismissals.
Same suffering.
How many more years must patients beg to be believed before medicine finally listens?
'Seems as if' the system paperbacks(sic) can still fail while purporting to 'care'.
I wish I never had to take another opioid painkiller for the rest of my life.
There. I said it.
For two years, prescription opioids have given me something chronic illness took away:
a measure of quality of life.
The ability to walk, leave my house, drive somewhere, sit through a movie, or enjoy an ordinary afternoon without debilitating pain.
But there’s a side of prescription pain management that healthy people rarely understand.
The medication that gives me some freedom also makes me feel like a prisoner.
Every 28 days, my ability to function depends on a prescription being written, approved, stocked, and filled.
Every month, I live with the knowledge that a physician could retire, become afraid to prescribe, or abruptly stop treating me.
A pharmacy could refuse to fill my prescription.
A shortage could leave me without medication.
And because my body has developed physical dependence, losing access could mean withdrawal on top of the return of excruciating pain.
Imagine living with that uncertainty indefinitely.
Imagine wanting to fall in love again and wondering how to explain to someone that you need prescription oxycodone just to enjoy a walk in the park together.
Imagine being judged by family, friends, emergency physicians, and strangers for taking the very medication that allows you to participate in life.
Who would willingly choose this existence?
I didn’t ask for incurable, painful medical conditions.
I didn’t ask for treatment after treatment to fail. And I certainly didn’t dream of spending my life tethered to a controlled substance and a pain management contract.
I would give anything to wake up tomorrow without pain and never need another opioid.
But that’s not the reality I live in.
And physical dependence from taking medication as prescribed does not automatically mean addiction.
My ability to participate in the world is contingent upon the very medication that our healthcare system makes increasingly difficult for patients like me to access.
Read that again.
I’m grateful for the relief.
I’m exhausted by the uncertainty.
And I’m tired of being made to feel ashamed for needing treatment.
Chronic pain patients deserve dignity, continuity of care, and individualized treatment.
We deserve to live.
And we deserve to stop being treated like criminals for trying to do exactly that.
youtu.be/KdQjQJ_oOVA?si=e1BV… "in microbes, we trust"
Full Dagga Farmer piece to follow tomorrow I think.
"use in private only"
"Super Cheese was born in Cape Town"
flappers retweeted
In 2023 Heineken bought Distell in a deal valuing the business at about R40bn. By the end of that year it had already written down R10bn on its South African operation. Today it confirmed its SA wine business, home of Nederburg and JC Le Roux, is "under strategic review".
That's how exits often start. First a review, then a sale, then a quiet goodbye.
Their beer is growing, so South Africans are still buying. The problem is a country where excise keeps climbing, illicit alcohol already makes up 18% of what's sold, and doing business gets harder every year.
Nobody has said Heineken is leaving. But if it reduces its SA exposure, the jobs at risk are jobs SA cannot afford to lose. Heineken directly employs almost 5,000 people here, and the wine industry it anchors supports over 270,000 jobs, from farmworkers to bottlers. All this at a time when official unemployment is already 33.6%.
Government should be asking why one of the world's biggest brewers is reviewing its SA bets, not waiting for the announcement.
flappers retweeted
The '#WarOnDrugs' has failed…but at what?
As drug markets thrive, punitive #DrugPolicy helps justify the expansion of rights-curtailing police powers, surveillance & institutional arrangements that feed private profit.
We bring these conversations to #MozFest2026. Come say hi!
flappers retweeted
The irony of adulthood is something else.
I’m a grown man. A homeowner. A father. I pay the mortgage, the bills, the taxes. This is MY house.
Yet here I am, sitting at my kitchen table trimming cannabis, watching the clock because I have to make sure everything is cleaned up, put away, and the house doesn’t smell like weed before my kids get home.
Somewhere along the way, I went from being a teenager hiding weed from my parents to being a parent hiding weed from my teenagers.
Full circle.
The funniest part? I’m not even doing anything wrong. I’m a responsible adult, in my own home, doing something perfectly legal.
But apparently, no matter how old you get, there’s always somebody you’re worried about coming home and smelling weed.
🤣🌿
(off topic: I miss Maltabella) "John Ntsitsi Malatjie Wins Legacy Grower Award for Preserving Traditional Maize Farming"farmersmag.co.za/2026/10/joh… via @Farmers Mag
Exactly.
WHAT IF ONE OF THE BIGGEST MISTAKES IN MODERN PAIN MEDICINE IS CONFUSING FEWER PRESCRIPTIONS WITH BETTER PATIENT OUTCOMES?
Think about that for a moment.
👉A physician reduces a patient’s long-term opioid prescription.
👉An institution reports declining opioid utilization.
👉An insurer celebrates reduced exposure.
👉A healthcare system points to fewer prescriptions as evidence of responsible prescribing.
But here’s the question nobody should be allowed to skip:
WHAT HAPPENED TO THE PATIENT?
Did their pain improve?
Did their physical functioning improve?
Did they return to work?
Sleep better?
Regain independence?
Experience fewer hospitalizations?
Or did the prescription simply disappear while the suffering remained?
Because reducing a number on a spreadsheet is not the same thing as improving a human life.
And here’s where the conversation becomes uncomfortable.
Full agonist opioids carry serious risks.
Nobody should pretend otherwise.
But the existence of those risks does not establish that removing an effective medication from every long-term patient produces a better outcome.
• Some patients benefit.
• Some don’t.
• Some experience substantial harm, including addiction.
• Others experience meaningful improvements in function and quality of life through responsible, medically supervised use.
That complexity is precisely why individualized medicine exists.
Yet prescription reduction is measurable, reportable, and institutionally convenient.
A patient’s deteriorating quality of life is much easier to overlook.
So here’s my challenge to the healthcare establishment:
If you’re going to celebrate fewer opioid prescriptions, show us what happened to the people whose prescriptions were reduced or discontinued.
Show us their pain outcomes.
Show us their functional outcomes.
Show us their mental health outcomes.
Show us whether they actually became healthier.
And show us the patients who deteriorated, too.
Because a policy cannot be judged solely by the medication it removes.
It must also be judged by the consequences it leaves behind.
If the prescription count goes down but the patient’s suffering goes up, what exactly are we celebrating?
Chronic pain patients are not statistical inconveniences.
We are human beings.
And we deserve something far more meaningful than a healthcare system congratulating itself for prescribing less.
WE DESERVE PROOF THAT OUR LIVES ARE GETTING BETTER.
flappers retweeted
Good morning! ☕️
Apparently, I haven’t pounded this information into enough dense skulls yet. Figuratively speaking, of course. 😂
I’ve addressed this subject repeatedly but apparently, repetition is the mother of learning.
So here we go again, different wording, same medical reality.
PHYSICAL DEPENDENCE IS NOT ADDICTION.
Should I say it louder for the people in the back? 📢
CHRONIC PAIN MYTH:
“If you need a higher dose of a full opioid agonist, you’re becoming addicted.”
FACT:
Tolerance is not addiction.
Physical dependence is not addiction. And neither, establishes opioid use disorder.
Full opioid agonists, including oxycodone, morphine, and hydromorphone, activate mu-opioid receptors to provide analgesia.
Over time, the body can develop physiological adaptations.
Tolerance MAY develop, meaning a previously effective dose provides less relief.
Physical dependence means the body has adapted to a medication and MAY experience withdrawal if it’s abruptly discontinued.
Neither indicates addiction.
Many patients remain stable on the same dose for years.
Others require adjustments.
Those decisions should be based on individual clinical circumstances, functional improvement, benefits, and risks, not assumptions about someone’s character.
Opioid use disorder involves a problematic pattern of use, not simply taking prescribed medication daily.
And yes, higher opioid doses carry greater risks.
That deserves careful medical consideration, not automatic condemnation.
A prescription is not a confession.
Tolerance is not a character flaw.
Physical dependence is not proof of addiction.
If we’re going to have serious conversations about opioid prescribing, the absolute minimum we can do is understand the terminology.
Because when we confuse these concepts, real patients suffer the consequences.
Chronic pain patients deserve individualized care, medical accuracy, and dignity.
And if I have to explain this another 47 times, apparently I’ll be back tomorrow morning. ☕️😂
flappers retweeted
🔥 Every so often, someone wanders into a conversation about chronic pain and confidently demonstrates just how little they understand about it.
One of my personal favorites?
“People take painkillers for too long because they’re ignoring the root cause of their pain.”
Oh, really?
And what happens when the root cause is PERMANENT?
What happens when the damage is irreversible?
When surgery isn’t an option?
When every available treatment has been exhausted?
When the disease is progressive, incurable, or simply beyond what modern medicine can fix?
Here’s a concept that shouldn’t require a medical degree to understand:
NOT ALL PAIN CAN BE CURED.
Chronic pain patients aren’t necessarily ignoring the root cause.
Many of us know EXACTLY what’s causing our pain.
We have the MRIs, diagnoses, surgical histories, specialists, and years of failed treatments to prove it.
Pain management isn’t always about fixing what’s broken.
Sometimes it’s about helping someone LIVE with what cannot be fixed.
Are opioids without risks? Of course not.
But neither is leaving severe, debilitating pain untreated.
Long-term medication use doesn’t automatically mean someone is abusing it, avoiding treatment, or making their condition worse.
Symptom management IS legitimate medical treatment.
The next time you’re tempted to lecture a chronic pain patient about finding the “root cause,” consider the possibility that they’ve spent YEARS searching for answers you’ve spent five seconds assuming they overlooked.
Your lack of understanding doesn’t invalidate someone else’s medical reality.
And frankly, some of us are getting pretty damn tired of having to explain that.
flappers retweeted
On Oct 5, I gave a plenary to the Addiction Health Services Research meeting: a room of researchers who study opioids, pain and addiction. Some of the analyses used to justify forced dose reductions came from our community. I’m part of that community.
Researchers didn’t write the policies. But our choices made those policies easy: which variable we treat as the cause, which results we emphasize, which puzzling findings we leave unexplained. Those are ethical choices, not just technical ones.
If you live with pain and had your opioids cut against your will, this talk is partly about you. I’ll post it in 9 short clips, one a day, in this thread.
Full talk: youtu.be/svU90FHZ-Q0
Essay: stefankerteszmd.substack.com…
Views my own, not the VA’s.
flappers retweeted
This is one of the biggest geopolitical mysteries of the year: why did China just save the world economy?
Because, make no mistake, it absolutely did. Analysts are pretty much unanimous on this: had China not dramatically - and I mean dramatically - reduced its oil imports this year, the price of crude oil would have gone through the roof and dragged the global economy down with it.
For proof, read how Javier Blas from Bloomberg - widely recognized as one of the world’s top energy analysts - explains what China did to Jake Sullivan and Jon Finer on their podcast “The Long Game” (thelonggame.substack.com/p/t…).
As Blas puts it, China went “from 11, 12 million barrels a day to less than 6 million barrels a day” of seaborne crude imports, and that “freed a lot of oil for other countries, particularly in Asia.” India, Japan, Korea and Southeast Asia “could buy the barrels that China was not buying.”
To be clear, China wasn’t the only factor - surging US exports and the IEA’s emergency release helped too - but it was by far the biggest: JPMorgan reckons China accounted for about 74% of the fall in global crude trade (fortune.com/2026/06/10/oil-p…).
So it's no exaggeration to say that it is China, first and foremost, that saved the world economy this year.
If you remember the early days of the Iran war, none of this is what was predicted. In fact some US think tankers, such as the (always horrendous) Zineb Riboua from the Hudson Institute, were even cheering the war as being “all about China… the opening act in the larger contest against China,” the moment the US would crack “the central pillar of a regional order that Beijing has assembled” (thefp.com/p/the-iran-strike-…).
Seven months on, what actually happened is that not only did China come out of the war unscathed economically, and strengthened strategically, it also ended up shielding the world economy, America’s included, from the fallout of the very war that was supposed to be its undoing.
Breaking news: if you do something that’s supposed to be a “blow” to someone else - some sort of 3D chess move to gain the upper hand - and they end up having to rescue you from the fallout, maybe it wasn’t such a brilliant strategic move after all.
So how did China pull it off? And, more intriguingly, why did it choose to rescue countries, including the US, from a war that Washington’s own hawks were openly selling as a strike against China itself?
And why do this when it effectively dampened Iran's leverage considerably, even though they're supposed to be China's "ally" (which, as we'll see, is false)?
This is the topic of my latest article. I went very deep researching all the Chinese sources I could find on this, looking at the exact legal mechanisms, and at what officials, oil refiners and state media actually said.
The answer turns out to be far stranger than I expected: no-one in Beijing actually ever ordered an import cut. China, effectively, seems to have saved the world economy incidentally, as a by-product of its own domestic policy to protect Chinese consumers.
Which is the real story here: China has become so large and so important it can just rescue the world economy as a mere side effect.
In fact what I discovered, hilariously, is that the Chinese were just as surprised as anyone else: it’s only weeks after Western media started crediting China with saving the world economy that Chinese media picked up the story. And even then, CCTV’s first take in July (chinanews.com.cn/gj/2026/07-…) presented it as something 外媒称 (wàiméi chēng, “foreign media claim”) 🤣
Almost like a giant suddenly waking up to its own powers. Because, that's the thing: intentions fade, consequences stay. Intentional or not, as Igor Sechin, the head of Rosneft, Russia’s largest oil company, put it (reuters.com/business/aerospa…), the consequence is that it's now China, not OPEC, who calls the shots on global energy markets.
The valve of global oil pricing is now in Shandong, not in Zhongdong anymore (Zhongdong, 中东, is the Middle East in Chinese).
Full article here, with how China’s 20-year strategic nightmare, the “Malacca dilemma”, has now effectively become its leverage over the rest of the world: arnaudbertrand.substack.com/…
flappers retweeted
For 60 years the blue tits of Britain broke into the milk on your doorstep, and all they ever took was the cream.
It was first seen in Swaythling, near Southampton, in 1921. A blue tit landed on a bottle, pecked through the cap and drank. By the 1950s every tit in the country seemed to know the trick. Housewives put out saucers, stones and upturned cups. The birds learned to follow the milk float down the street and be waiting at the next step.
You will remember the bottle. Silver foil on top, and beneath it 2 inches of thick yellow cream that had risen overnight, with the white milk underneath. The first one down in the morning got it on the porridge.
That cream was the whole point of the burglary. A bird cannot digest milk. It has no means of handling the sugar in it. Cream is nearly all fat, with very little sugar, so the tits drank down to the line and stopped.
A wild animal weighing 11 grams, with every bird table and berry bush in the street to choose from, worked out how to open a sealed container to get at butterfat.
Then the habit died, in about 10 years. Nobody trapped them or changed the caps. The milk changed. It was homogenised so the cream no longer rose, then skimmed so it was hardly there, then moved to a plastic jug in a supermarket.
The blue tits inspected the red top, found nothing in it worth stealing, and went back to the hedge.
They were the last creatures in Britain to judge a pint of milk on what was actually in it.
Revolution Day returns on 7 November 2026 fieldsofgreenforall.org.za/r…
L'est we forget.
"Revolution Day returns on Saturday, 7 November 2026, under the banner Honouring Fallen Heroes, inviting Cannabis .... and members of the wider community to take part."
This guy's consistently passionate about Africa, & he has something to say.
youtu.be/IvLWnNROFCU
#investment #facts #sovereignity #heritage