In my experience, the most so-called problem solving in this world is just solution-jumping. This is true in business, government policy, personal relationships, sports, personal health. We grease the squeaky wheel. We tamper with systems. We mask symptoms. We throw money at it. We temporarily relieve pain. Solution-jumping is insidious. Not only does it fail to get to the root of a problem, but solution-jumping consumes resources and attention, and creates problems all of its own. Dr. Marc Siegel of the NYU Langston Medical Center warns in the Wall Street Journal op-ed piece that opioids shouldn’t be a doctor’s first resort. It provides an illustration of my point above.
The article warns, “Four out of five heroin users started with prescription painkillers.” Being careful with statistics, we should note a few things. First, this does not mean that 80% of people who use opioids will progress to heroin. Second, it tell us only that of the heroin users questioned, four of five had started with opioids, but nothing else about this population. Unstratified data is seldom useful data. Third, it does not mean that opioids were the cause of the heroin addiction. People become drug addicts not simply by exposure to drugs, but due to a variety of biological, psychological, social and economic reasons. It is important to note these things because compelling but context-free data can cause us to jump from “heroin addiction is a problem” to solutions such as “let’s crack down on prescription opioid abuse”. We think we see cause-and-effect patterns in data, and a voice whispers, “jump”.
Dr. Siegel calls for more responsibility from doctors, citing the fact that half of the opioids in the USA are prescribed by primary care physicians, whose pain training is minimal. “Too many of us jump too quickly” to drugs that “merely mask the symptoms instead of addressing the underlying causes.” Why would doctors jump to a solution? Perhaps, Dr. Siegel writes, because “doctors may be too rushed or self-serving” to explore non-harmful pain relief options such as weight loss, proper posture, heat, or muscle relaxants. A pill is quick and effective in the short-term, while behavior change and long-term root cause correction is hard. When then the only tool you have (time for) is a prescription pad, all pain remedies look opioid.
The favored method to combat drug abuse in the USA has been a “war” on illegal supply. This 30-year solution-jump has mostly yielded unintended consequences. Dr. Siegel writes that “a better long-term strategy is to keep people from getting hooked in the first place.” Yes, that is a a better long-term strategy for almost any problem. So why don’t we keep people from getting hooked?
While it is unlikely that doctors, patients, pharmaceutical manufacturers or insurance companies want to get people hooked on drugs, unless they are all driven by the same incentives, drug addiction can be the result. A doctor’s incentive may be to get to the next patient. A patient’s motive may be immediate pain relief to get back to work. A pharmaceutical company executive maybe highly motivated to sell profitable pain pills. An insurance company executive wants to avoid paying for expensive procedures that address root causes. A politician may work hard to allow whichever behaviors lobbyists pay him to. While none of these parties wants the patient get hooked, that is sometimes the result of their combined neglect. All parties agree that better patient health is the goal. Their incentives drive behaviors counter to this.
Participants in the scenario above are solving different, individual problems. They are not fully aligned towards solving one common problem, that of the patient. Getting to root cause would require them to each cross into the other’s domain, and example their own incentives. As a result, none do. Four separate parties jumping to their own solutions. The massive social problem called opioid addiction is the unintended consequence.
Effective problem solving must always be a blend of short-term containment and long-term root cause countermeasure. In medical terms containment is triage, stopping the bleeding, pain relief, stabilizing the patient, while root cause countermeasure involves some combination of interventions such as physiotherapy, surgery, changes to diet and exercise, or medication. The same is true for any type of problem solving. Begin by preventing the problem from getting worse, creating freedom from debilitating pain and discomfort. Protect the customer. Then, doctor and patient identify possible root causes of the condition, agreeing on a set of countermeasures which may be proven cures as well as experiments.
In a sad irony, the branding of diamorphine as “heroin” is a case in point of solution-jumping. In 1895 the pharmaceutical company Bayer advertised heroin as a “non-addictive morphine substitute”. What they expected would heroically solve the problem of addiction to recreational morphine had unintended consequences.