Dr. William Cooke with Laura Ungar
Canary in the Coal Mine: A Forgotten Rural Community, a Hidden Epidemic, and a Lone Doctor Battling for the Life, Health, and Soul of the People
Carol Stream, Ill.: Tyndale House Publishers, 2021
Along America’s two seaboards, provided law and order remains intact, the cities are glittering economically. But as one moves inland, the economic desperation caused by the American elite’s policy of deindustrialization increases. This is particularly evident in Indiana.
Madison Grant called Indiana
. . . a typical American State, owes nothing worth mentioning to the original French population. In early days it must be considered little more than an extension of Kentucky. Virginia had set aside a large tract for rewarding the men of George Rogers Clark’s expedition and those who were the original land agents for the territory. But all along the border a frontier population drifted there across the Ohio River. As late as 1850 there were twice as many Southern people in Indiana as there were from the Middle States and New England put together. A good share of those were from Kentucky, which means that they or their parents were previously from Virginia or North Carolina. That Indiana was in sympathy a Northern State bears testimony to the fact that these migrants had little in common except original racial stock with the older slave-holding population. The Ulster Scots were the largest element, although there were also many Quakers from North and South Carolina . . .
Indiana is a Northern state with a Southern population. Austin, Indiana is a town that exemplifies this heritage. One of the town’s founders, William Harrod, was the first white child born in Louisville, Kentucky. Harrod’s descendants helped to create a canning company, today called Morgan Foods, where many people from Kentucky came to work. Austin is only a single tank of gas from Hazard, Kentucky, and the town got the nickname “Little Hazard” because so many workers came from there.
Austin’s only physician is Dr. William Cooke. He is an Indianan whose family came from the Appalachians to settle on the Ohio River’s north bank. Dr. Cooke feels he was called by Divine Providence to be a physician after a spiritual revelation he had in church, which was followed shortly thereafter by a health scare of his own. His first experiences as a doctor in Austin was naïvely fending off a hustle from a local hooker and treating a man who had been shot in the neck by his wife with a BB gun. Dr. Cooke was thus the only practicing physician in the town when the opioid crisis overtook Austin.
The opioid crisis started in the mid-1990s, just as the neoliberal trade schemes began to sink their talons of poverty and loss into America’s Rust Belt. The first problem was that the medical community added pain to its list of vital signs. Any pain needed to be treated. At the same time, the FDA approved OxyContin as a painkiller.
OxyContin is a drug manufactured by Perdue Pharma, a company owned by the Jewish Sackler Family. OxyContin was said not to be addictive and it was liberally prescribed across America. Perdue Pharma’s sales literature falsely emphasized that the drug was not addictive.
Dr. Cooke argues that part of the reason a harmful substance such as OxyContin was given mass distribution is that rural medical practices have a difficult time making ends meet. A single-doctor clinic has to abide by all the regulations of any other clinic in a large city, yet has far fewer paying patients. Thus, there is a temptation to distribute opioids to clients. A doctor running such a “pill mill” can see 15 patients an hour. A pill common in Austin, Indiana is Opana.
Dr. Cooke refused to allow his clinic to become a pill mill. Consequently, his practice was not a financial bonanza. The work put a big strain on his marriage and he divorced in 2008. Around the same time, the economy collapsed, and both Dr. Cooke and Austin came under more financial strain then before.
Heath in the Deindustrialized Zone
The medical situation in Austin is illustrative of the medical support situation in the broader rural and deindustrialized parts of the United States. Dr. Cooke cured a patient who had had a tumor in his mouth for several years. The reason the patient had waited for so long for treatment is that he didn’t have a car to get to a hospital. Dr. Cooke’s practice in Austin was the first there had been in the town since the 1970s.
This pattern continued. Dr. Cooke found that cervical cancer — which can easily be treated if caught early — metastasized undetected because few women were able to undergo a pap smear.
There were also diseases communicated by sharing or reusing needles. Prescription opioid pills are manufactured to release their painkilling effects slowly so that pain is reduced without being accompanied by a high. But users can simply crush the pills or bake them in an oven in order to make them potent for recreational use. Once the pill is in an injectable form, anyone can use a syringe to inject its active ingredients directly into one’s bloodstream.
An opium high is potent and enjoyable, but terribly addictive. Withdrawal symptoms are painful and unpleasant, and eventually the user will do anything possible to avoid that pain. Likewise, syringes are difficult to get, so addicts reuse and share them. As a result, bacteria gets into the blood, as well as Hepatitis C and HIV.
Cooke discovered that there was an HIV and Hepatitis C epidemic in Austin. Entire families were sharing needles. When he began addressing the issue publically, he was faced with a local backlash. The townspeople were afraid they would get HIV if they went to his clinic, while those infected were afraid their condition would be exposed. There were also those who regularly paid local female addicts for sex, and they feared exposure from them.
Cooke put his head down and weathered the storm. Eventually he worked through a variety of organizations dedicated to fighting HIV/AIDS and came to the attention of Governor Mike Pence. After being granted a meeting with Pence and the Indiana legislature, Cooke argued for a needle exchange program. Addicts could turn in their used needles and exchange them for new, sterile ones.
Needle exchanges are controversial. For one thing, state-sponsored drug rehabilitation centers can become an ad hoc black market for narcotics trafficking, and needle exchanges themselves are in effect a subsidy for furthering drug use. Yet, needle exchange programs are often the first step in an addict’s journey to recovery. Additionally, diseases such as HIV and Hepatitis C can spread to people who are not engaged in drug use, so a case can be made that needle exchanges are moral. Governor Pence declared the situation a health emergency and authorized exchanges with a 30-day window.
Soon, several agencies descended upon Austin to aid Cooke in his efforts to help the town. Cooke describes the various frictions between the agencies in his book. It’s worthwhile to read this part of it to get a sense of how to manage factions in a time of crisis. One bit of advice that stood out is that he hired a person to attend meetings at one of the agencies. This attendance allowed him to continue to work on treating patients while keeping the problems with the other agencies manageable.
Today, Austin has started to turn things around. Those with HIV are treated at a higher rate than nationally, and many victims have reduced their viral load so that they are in remission and can even marry and have children. HIV is no longer the death sentence it was in the 1980s and ‘90s.
Structural Problems — and Solutions?
Indiana is a part of America that shouldn’t be poor. It has rich farmland, a mostly white population, and a history of industry and invention. It is a victim of the hostile elite that presently rules America, however.
The illicit second constitution that is the 1964 Civil Rights Act designates people in a nearly all-white area such as Indiana as enemies of the state. Underemployment, an opiate epidemic, and deindustrialization therefore don’t even register as social issues. This legal structure allows neoliberal politicians to enter into trade agreements that damage white areas of the United States.
Striking down the 1964 Civil Rights Act will go a long way toward making indifference to America’s deindustrialized white areas untenable for politicians. Ending immigration will also bring up the wages of laborers in Indiana. Additionally, small towns and rural counties need to connect with as many federal programs as possible to get support. Cooke mentions that when he started his practice, no local officials had done the required paperwork to obtain federal assistance for medical clinics.
Economics isn’t everything, but there is something satisfying about a job well done and the paycheck that comes with it. And while it seems that the modern economy has bypassed places like Austin, Indiana, the telecommuting revolution has changed the equation. It is entirely possible for a person to relocate to a small town with a lower cost of living and still earn large wages. A telecommuter making Washington, DC-level wages can thus inject a great deal of capital into such a small town.
On the individual level, one needs to guard his sobriety. Sobriety is a brittle thing, and it is very easy to reach for the bottle to take the edge off. But substance abuse damages one’s family life and can causes the user to do stupid and careless things. It creates a terrible cycle of abuse, too. Cooke shows that many people fall into the trap of drug use because their parents were users, and consequently were often physically abusive. Traumatic childhoods rarely produce well-functioning adults. Cooke shows a number of ways to recover from such childhood traumas besides drug use.
Dealing with the opioid crisis requires a broad array of strategies, from prison to sympathetic counseling and needle exchanges. Probably the most critical one is to develop a community where a person can feel valued. Many soldiers used opiates during the Vietnam War but quit when they returned to the US because they’d rotated back to a functioning community and got on with their lives. Raising awareness of the danger of opioids is likewise important, as well as making them hard to get. Since opiates are out there and Americans live in a dangerous world with many enemies, opiates should be taken out of American communities and moved into places like Saudi Arabia and China. The poison exists and won’t go away, but it can be moved away from us.
Dr. Cooke’s book clearly shows that spiritual efforts combined with a connection to one’s heritage can be a powerful thing. Every Rust Belt or economically challenged small town needs such a man, but you don’t need to wait for one to arrive. You can work to become such a person.
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 Lieutenant Colonel Archibald Roberts, a prominent Rightist of the early 1960s, warned of globalist-inspired plans to win friends in far-away places by deindustrializing America. He wrote in The Anatomy of a Revolution, “[In] 1964, President Lyndon B. Johnson revealed that emerging nations are to be industrialized under UNCTAD. Small and medium-size business owners destroyed by such a relocation of production and labor skills will, he said, be compensated by such loans from the United Nations International Monetary Fund, which theoretically will enable ruined American businessmen to enter new fields of endeavor — leaving the market open to tariff-free imports from UNCTAD industrialized nations.” (p. 20)
 Madison Grant, The Conquest of a Continent (York, S. C.: Liberty Bell Publications), p.167.
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