Quotulatiousness

October 16, 2009

Friday links of possible interest

Filed under: Britain, Football, Health, Humour, Religion, Technology — Tags: , , , , , , — Nicholas @ 12:25

October 8, 2009

Not quite the solution they were looking for

Filed under: Health, Politics — Tags: , , — Nicholas @ 12:40

Jacob Sullum looks at a not-very impressive result in clinical testing:

A study reported this week in the Archives of General Psychiatry found that an experimental “cocaine vaccine” was mostly ineffective at reducing consumption of the drug. Less than two-fifths of the subjects injected with the vaccine, which is supposed to stimulate production of antibodies that bind to cocaine molecules and prevent them from reaching the brain, had enough of an immune system response to significantly reduce their cocaine use (as measured by urine tests). Even among those subjects, only half cut back on cocaine by 50 percent or more.

[. . .]

Vaccine boosters think the real money lies in an effective anti-nicotine treatment, which they believe would attract “inveterate smokers” who have repeatedly tried to quit with other methods. But as The New York Times notes (in the headline, no less), such a vaccine “does not keep users from wanting the drug.” If all goes well, their cravings are not diminished in the slightest; they just can no longer satisfy them. And that’s assuming the vaccine is fully effective (as opposed to maybe 10 percent effective, like the one in the study); if not, it could actually increase consumption by neutralizing a percentage of each dose. A partially effective nicotine vaccine could be hazardous to smokers’ health if it encouraged them to smoke more so as to achieve the effect to which they’re accustomed. In any case, it’s not clear how appealing the idea of biochemically taking the fun out of smoking will be; the success of such a product hinges on consumers looking for a way to frustrate themselves.

If you take the cynical view, it’s a perfect Puritan drug: take away the benefit without reducing the desire. That way, you see, the sinners would still get all the suffering they’re entitled to without any satisfaction at all. Hell on earth, just the way Puritans like it.

October 6, 2009

Another bulletin from the “Institute of Obvious Findings”

Filed under: Food, Health, Law, USA — Tags: , , — Nicholas @ 16:02

New York City has the most “progressive” laws on the books for labelling fast food menu items. The intent was to ensure that customers would be aware of the calorie and nutrition values of food before ordering, with the hope being that people would deny their tastebuds and order less fattening foods. A recent study found — to nobody’s surprise — that this hasn’t been working:

A study of New York City’s pioneering law on posting calories in restaurant chains suggests that when it comes to deciding what to order, people’s stomachs are more powerful than their brains.

The study, by several professors at New York University and Yale, tracked customers at four fast-food chains — McDonald’s, Wendy’s, Burger King and Kentucky Fried Chicken — in poor neighborhoods of New York City where there are high rates of obesity.

It found that about half the customers noticed the calorie counts, which were prominently posted on menu boards. About 28 percent of those who noticed them said the information had influenced their ordering, and 9 out of 10 of those said they had made healthier choices as a result.

But when the researchers checked receipts afterward, they found that people had, in fact, ordered slightly more calories than the typical customer had before the labeling law went into effect, in July 2008.

The laws were changed because paternalists in power thought that consumers were being gulled against their better instincts, and that merely pointing out the information in a hard-to-miss fashion would assist these poor, weak-willed eaters to trim back on calories and fat. It doesn’t work because people like eating food that’s calorie-rich and fattening. You’re not going to change that without instituting literal rationing: and don’t think they haven’t considered it.

October 1, 2009

Canada as prescription drug “parasite”

Filed under: Cancon, Economics, Health, USA — Tags: , — Nicholas @ 08:07

I guess the discussion on medical costs got boring without bringing international issues into play. Senator Bob Corker got into it with Liberal MP Carolyn Bennett:

An American legislator called Canada “parasitic” on Wednesday for siphoning U.S. dollars to Canada with low prescription drug prices while his country does “all the innovation.”

Canada benefits financially from America’s role as a world leader in medical advances, Republican Sen. Bob Corker charged in an exchange with a Liberal MP as she testified before a U.S. Senate committee.

“One of the things that has troubled me greatly about our system is the fact that we pay more for pharmaceuticals and devices than other countries, and yet it’s not really our country so much that’s the problem, it’s the parasitic relationship that Canada and France and other countries have towards us,” the Tennessee lawmaker told Carolyn Bennett.

Canadian provinces have a financial lever that is a direct result of the single-payer model: if you want to sell your drug in Canada, you have to sell to the government monopoly for each province. The market is small, and there are only a limited number of buyers, so the best price you can get for your product will end up being the price all of the geographical monopolies are willing to pay . . . or you don’t sell into that market at all. Under the circumstances, it’s rational for the companies to sell at close to cost: the bulk of their costs are already sunk in the R&D effort and the regulatory effort to get the drug on to the domestic market.

That doesn’t make the charge any more palatable, but there’s some justice to making it.

September 30, 2009

A different approach to healthcare reform

Filed under: Government, Health, Politics — Tags: , — Nicholas @ 09:03

“John Galt” has a different suggestion for fixing what ails the American healthcare field:

We have some real problems: Bizarre incentives that have led to runaway costs. Rescission. An employer stranglehold over workers’ healthcare. Overuse in the form of care prescribed to protect doctors from lawyers, rather than protecting patients from illness. Arbitrary requirements to carry coverage for other people’s expensive risks.

The truth is that every one of those issues could be addressed — right now, and in a bipartisan fashion — without a single-payer system, a mandate, or any other form of “universal healthcare.” It wouldn’t even take a single massive “reform” bill — just a few simple bills, mostly repealing existing regulation.

But the left has settled on universal healthcare. The “public option.” No other reform is acceptable. No other reform will be permitted. Nothing can actually be fixed if it will lower the number of people who might benefit from a universal system, or if it will reduce national dissatisfaction with market-based care.

It’s quite true that there’s already massive government involvement in the health market, and that a lot of that consists of regulations that have dubious health benefits, but measurable detriments to patients, doctors, and hospitals.

The intersection of the War on Drugs with the government’s role in healthcare, for example, has led to a number of doctors being imprisoned for “inappropriate” prescriptions of painkillers to patients with chronic pain issues. It has also led to a huge number of doctors being afraid to prescribe what their patients actually need, for fear of being charged and convicted of “drug trafficking”. Many patients now suffer prolonged pain because they can’t get an adequate dose of painkillers and can’t find doctors to prescribe them.

All this, in pursuit of getting tough on illicit use of prescription medicine. Government at its finest.

September 28, 2009

Random links of possible interest

Filed under: Health, Law, USA — Tags: , , , , , — Nicholas @ 07:38
  • More on the ongoing ammunition shortage in the US, as manufacturers are still unable to produce enough to satisfy demand.
  • Police at G20 take trophy photo including arrested protester handcuffed and kneeling in front of the group. H/T to Radley Balko.
  • Voyeurs rejoice! What sounds like a report from the Journal of Spike TV reveals that a mere 10 minutes of ogling well-endowed women provides as much benefit to men as 30 minutes in the gym, as far as heart disease, high blood pressure and stress are concerned. H/T to Ghost of a Flea.
  • New Zealand bans in-vehicle GPS navigation systems . . . but only if they’re running on a mobile phone. Non-phone based systems apparently don’t distract you with directions the way phone-based ones do. Or something.
  • Detroit Lions fans love the Washington Redskins.

September 23, 2009

A few random links

Filed under: Cancon, Health, Randomness — Tags: , — Nicholas @ 17:12
  • Nick Packwood on a reason to be proud of Canada: “Canada’s entire delegation is set to walk out of the United Nations General Assembly chamber when Persian tyrant, Twelver whack job and Holocaust denier/enthusiast Mahmoud Ahmadinejad takes the podium.”
  • Talking down to irresponsible American adults. “Secretary Chu said he didn’t think that the public would throw the same political temper tantrum over climate legislation has has happened with the healthcare debate.”
  • “You Can Have Either Sex or Immortality”
  • Pimp my . . . bed?
    “After years of catering to women, manufacturers are setting their sights on men. The new macho mattresses they’re introducing have “muscle-recovery properties” and cooling technology, on the theory that men are more likely to feel too hot in bed. The bed frames feature built-in TVs, iPod docking stations, wine coolers, safes and other guy-friendly gadgetry.”

September 10, 2009

More than you probably wanted to know about gender

Filed under: Health — Tags: , , — Nicholas @ 12:31

By way of John Scalzi’s Delicious bookmarks page, a thoughtful explanation of what people mean by ‘gender’ and why it is different from ‘sex’:

I have been asked at various times what people mean by “gender” and why it is different from “sex’. Also I’ve been asked to explain the multitudinous types of “trans” people, and why they often seen to be at each other’s throats. Hopefully I can traverse the various minefields involved without offending too many people, but sadly there are so many different perspectives out there that I’m bound to offend someone. My apologies in advance.

So, gender, what is it? Many people still think that gender and sex are the same thing. People, animals, even objects in many languages, are either male or female, one or the other, a very simple binary choice. Sadly life is never that simple. I’d like you to consider four different ways in which things are viewed as masculine or feminine.

Biological sex

That’s easy, isn’t it? People have one sort of dangly bits or the other. You either have XX chromosomes or XY chromosomes. You either produce sperm or eggs. Simple.

Well, no. Biology is a fickle thing. Many people are born with ambiguous biology. I don’t just mean genuine hermaphrodites, though such people do exist. All sorts of things can happen to us in the womb, and thereafter, that make our gender difficult to determine by physical tests. These conditions are known as “intersex”, and there are an enormous number of different ones. The Intersex Society of North America has a fairly comprehensive list of them together with data on how common they are. It is reasonably certain that as many as 1 in 1000 people have an ambiguous biological sex in one way or another, and as people get old and parts of their body wear out that can increase significantly.

September 8, 2009

John Snow and the start of modern epidemiology

Filed under: Britain, Health — Tags: , , — Nicholas @ 08:52

Another “on this date” entry for you: in 1854, John Snow persuaded the local authorities in a London borough to remove the handle from a water pump at the centre of a cholera outbreak. The move was successful, and the death rate dropped immediately. Randy Alfred has the story:

BroadSt_cholera_map

Physician John Snow convinces a London local council to remove the handle from a pump in Soho. A deadly cholera epidemic in the neighborhood comes to an end immediately, though perhaps serendipitously. Snow maps the outbreak to prove his point . . . and launches modern epidemiology.

The Soho neighborhood was not then filled with galleries, clubs, restaurants and other fine urban diversions. Some of it was an unsanitary slum where centuries-old cesspits sat chockablock with the wells that provided drinking water to a crowded populace.

Asiatic cholera had stricken Britain in successive waves since 1831. Snow, an obstetrician who pioneered the use of anesthesia in Britain, published On the Mode of Communication of Cholera in 1849. His hypothesis (and supporting data) held that the scourge was caused by sewage pollution in drinking water and “always commences with disturbances of the functions of the alimentary canal.”

September 2, 2009

NHS better than Canadian health system, says Jeremy Clarkson

Filed under: Bureaucracy, Cancon, Health — Tags: , — Nicholas @ 00:03

It’s always surprising to find a British author willing to call their massive National Health Service (NHS) “a monster that we can barely afford”, but that’s exactly what Jeremy Clarkson says in his latest Times column. But that’s merely an aside. The venom in this article is reserved for Canadian healthcare, specifically in Quebec:

Some say America should follow Canada’s lead, where private care is effectively banned. But having experienced their procedures while on holiday in Quebec, I really don’t think that’s a good idea at all.

[. . .]

Now, we are all used to a bit of a wait at the hospital. God knows, I’ve spent enough time in accident and emergency at Oxford’s John Radcliffe over the years, sitting with my sobbing children in a room full of people with swords in their eyes and their feet on back to front. But nothing can prepare you for the yawning chasm of time that passes in Canada before the healthcare system actually does any healthcare.

[. . .]

After a couple of hours, I asked the receptionist how long it might be before a doctor came. In a Wal-Mart, it’s quite quaint to be served by a fat, gum-chewing teenager who claims not to understand what you’re saying, but in a hospital it’s annoying. Resisting the temptation to explain that the Marquis de Montcalm lost and that it’s time to get over it, I went back to the boy’s cubicle

[. . .]

And they also had the cash to employ an army of people to slam the door in your face if you poked your head into the inner sanctum to ask how much longer the wait might be. Sixteen hours is apparently the norm. Unless you want a scan. Then it’s 22 months.

At about 1.30am a doctor arrived. Boy, he was a piece of work. He couldn’t have been more rude if I’d been General Wolfe. He removed the bandages like they were the packaging on a disposable razor, looked at the wound, which was horrific, and said to my friend: “Is it cash or credit card?”

August 24, 2009

Infant mortality rates in the US

Filed under: Health, USA — Tags: — Nicholas @ 07:54

Steve Chapman looks at one of the bigger question marks in the debate over health care in the United States: why such a high infant mortality rate?

The American medical system has the latest technology, the greatest variety of new drugs, and unparalleled resources. But anyone who thinks we’re getting something great for our dollars inevitably encounters a two-word rebuke: infant mortality.

The United States is the richest nation on Earth, but it comes in 29th in the world in survival rates among babies. This mediocre ranking is supposed to make an irrefutable case for health care reform. If we cared enough to insure everyone, we are told, we would soon rise to the health standards of other modern nations. It’s just a matter of getting over our weird resistance to a bigger government role in medical care.

[. . .]

No one denies the problem. Our infant mortality rate is double that of Japan or Sweden. But we live different lives, on average, than people in those places. We suffer more obesity (about 10 times as much as the Japanese), and we have more births to teenagers (seven times more than the Swedes). Nearly 40 percent of American babies are born to unwed mothers.

Factors like these are linked to low birth weight in babies, which is a dangerous thing. In a 2007 study for the National Bureau of Economic Research, economists June O’Neill and Dave O’Neill noted that “a multitude of behaviors unrelated to the health care system such as substance abuse, smoking and obesity” are connected “to the low birth weight and preterm births that underlie the infant death syndrome.”

August 22, 2009

Right wing nutbars, observed

Filed under: Health, History, Liberty, USA — Tags: , , , — Nicholas @ 08:23

P.J. O’Rourke tries to save readers the effort of reading the Washington Post coverage of recent town hall protests:

So there was Rick Perlstein calling everyone to the right of Nikita Khrushchev a candidate for the state psychiatric ward with Alec MacGillis playing his KGB Bozo sidekick, firing blanks and honking his “End-of-life care eats up a huge slice of spending” airhorn. Then, to add idiocy to insult, the Post sent Robin Givhan to observe the Americans who are taking exception to various expansions of government powers and prerogatives and to make fun of their clothes.

Givhan writes a column called “On Culture,” and this is what passes for culture at the Post: “Of the hundreds of thousands of style guides currently for sale on Amazon, not one . . . was prescient enough to outline the appropriate attire for those public occasions when good citizens decided to behave like raving lunatics and turn lawmakers into punching bags.” Meeting with Givhan’s scorn were “T-shirts, baseball caps, promotional polo shirts and sundresses with bra straps sliding down their arm.”

I’ve never seen Robin Givhan. For all I know she dolls herself up like Jackie O. But I have seen other employees of the Washington Post and — with the exception of the elegant and, I dare say, cultured, Roxanne Roberts — they look as if they got dressed in the unlit confines of a Planet Aid clothing-donation bin.

Perlstein, for all the highness of his dudgeon, doesn’t catch the nuts saying anything very nutty. The closest he gets to a lunatic quote is from a “libertarian” wearing a holstered pistol who declares that the “tree of liberty must be refreshed from time to time by the blood of tyrants and patriots.” And those are the words of lefty icon Thomas Jefferson. I myself could point out the absurdity of protestors’ concerns about government euthanasia committees. Federal bureaucracy has never moved fast enough to get to the ill and elderly before natural causes do. And what’s with those “birthers”? Why their obsession with a nonentity like Obama? How about John Adams with his Alien and Sedition Acts choke-hold on the First Amendment? Or Jefferson? He could tell his Monica Lewinsky, “I own you,” and he wasn’t kidding. Or John Quincy Adams, pulling the original Blagojevich, buying the presidency from Henry Clay? Or that backwoods Bolshevik Andrew Jackson? Or William Henry Harrison, too dumb to come in out of the rain? Not one of these scallywags was born in the United States of America — look it up.

August 21, 2009

QotD: Heroin as a treatment for addiction

Filed under: Health, Quotations — Tags: , , — Nicholas @ 11:53

Stripped of the medicalese, what the researchers found is that if you give heroin addicts heroin, they will keep coming back for more. They will also be less likely to buy heroin on the street or commit crimes to support their habit. These findings, similar to the results of European studies, are not exactly surprising. The puzzling thing is that we’re asked to pretend that heroin is a “treatment” for heroin addiction. “Study Backs Heroin to Treat Addiction,” says the headline over a New York Times story that begins, “The safest and most effective treatment for hard-core heroin addicts who fail to control their habit using methadone or other treatments may be their drug of choice, in prescription form.”

What the study actually shows is that the problems associated with heroin addiction are largely caused by prohibition, which creates a black market in which prices are artificially high, quality is unreliable, and obtaining the drug means risking arrest and associating with possibly violent criminals. The drug laws also encourage injection by making heroin much more expensive that it would otherwise be and foster unsanitary, disease-spreading injection practices by treating syringes and needles as illegal drug paraphernalia. When you take these dangers out of the equation, regular use of heroin is safe enough that it can qualify as a “treatment” dispensed by men in white coats. That rather startling fact should cause people to question not just current addiction treatment practices but the morality of trying to save people from themselves by making their lives miserable.

Jacob Sullum, “This Just In: Heroin Addicts Like Heroin”, Hit and Run, 2009-08-21

August 15, 2009

The high cost of coping with Celiac Disease

Filed under: Health — Tags: — Nicholas @ 12:33

An article in the New York Times discusses something near and not-particularly-dear to our hearts — Celiac Disease:

Seven years after receiving his diagnosis, Mr. Oram, who is married and has one daughter, is symptom-free, but the cost of staying that way is high. That’s because the treatment for celiac does not come in the form of a pill that will be reimbursed or subsidized by an insurer. The treatment is to avoid eating products containing gluten. And gluten-free versions of products like bread, pizza and crackers are nearly three times as expensive as regular products, according to a study conducted by the Celiac Disease Center at Columbia University.

Unfortunately for celiac patients, the extra cost of a special diet is not reimbursed by health care plans. Nor do most policies pay for trips to a dietitian to receive nutritional guidance.

In Britain, by contrast, patients found to have celiac disease are prescribed gluten-free products. In Italy, sufferers are given a stipend to spend on gluten-free food.

Some doctors blame drug makers, in part, for the lack of awareness and the lack of support. “The drug makers have not been interested in celiac because, until very recently, there have been no medications to treat it,” said Dr. Peter Green, director of the Celiac Disease Center at Columbia University. “And since drug makers are responsible for so much of the education that doctors receive, the medical community is largely unaware of the disease.”

Elizabeth has suffered from gluten intolerance for most of her life, so we’re very aware of the difficulty (and added cost) of finding food that doesn’t contain wheat gluten. Wheat is a very cheap way of adding bulk and body to foods that traditionally do not contain it . . . it’s distressing the number of times we’ve discovered that a packaged food that used to be gluten-free has been “improved” . . . and the extent of the improvement has been to add wheat in place of more expensive non-gluten ingredients.

QotD: The biggest risk in moving to a single-payer system

Filed under: Health, Quotations — Tags: , , — Nicholas @ 11:05

My objection is primarily, as I’ve said numerous times, that the government will destroy innovation. It will do this by deciding what constitutes an acceptable standard of care, and refusing to fund treatment above that. It will also start controlling prices.

Now, at this point in the discussion, some interlocutor starts chanting what I’ve come to think of as “the mantra”: othercountriesspendlessandhavelongerlifespans. Then they ask me how I can ignore the overwhelming evidence that national health care is superior to our terrible system. Now, what’s odd about this is that all of those countries do precisely what I am concerned about: slap price controls on the inputs, particularly pharmaceuticals. Their overwhelming evidence indicates that I am 100% correct that a government run system in the US will destroy the last really profitable market for drugs and medical technology, and thereby cause the rate of medical innovation to slow to a crawl.

[. . .]

The things that make markets innovate — profit potential — have been mostly squeezed out of the system. The things that hasten market discover — prices — have also been increasingly relegated to central authority. Having something like that in the United States would produce exactly the outcome I’m worried about. So if Matt is right, and this is where the slippery slope ends up, my nightmare will have been realized.

Megan McArdle, “What Does It Mean To Have a Private Health Care System?”, Asymmetrical Information, 2009-08-13

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