Quotulatiousness

February 25, 2015

Dealing with “dark tetrad” personalities

Filed under: Health — Tags: , — Nicholas @ 02:00

Bobby Stein linked to this column in Psychology Today from last summer, talking about how to deal with sadists, psychopaths, narcissists, and Machiavellians:

There are several personality types that are more likely to harm another than the average person would. Sadists possess an intrinsic motivation to inflict suffering on innocent others, even when this comes at a personal cost. This is because for sadistic personalities, cruelty is pleasurable, generally exciting, and can be sexually stimulating.

In a recent study, Buckels and colleagues examined examples of everyday sadism as part of what they refer to as the “Dark Tetrad,” sadism plus the original members of the “Dark Triad”—psychopathy, narcissism, and Machiavellianism. These personalities have some overlap and are characterized by callous manipulation, self-centeredness, disagreeableness, and exploitation. In their research, the team sought to determine whether everyday sadism could be captured in the laboratory, as well as whether measures of sadistic personality would predict these behaviors beyond already established measures of the Dark Triad. Among the findings were that sadistic personalities were the most likely members of the Dark Tetrad to select the task involving killing from an array of unpleasant tasks. Those sadists who killed more bugs derived greater pleasure from the act than those who killed fewer bugs.

In a second, related study, those high in sadism, psychopathy, and/or narcissism, as well as those low in empathy and perspective-taking, were willing to aggress against an innocent person when aggression was easy. Only sadists increased the intensity of their attack once they realized the person would not fight back, however. Furthermore, sadists, unlike the other “dark personalities,” were the only ones willing to expend additional time and energy (in this case, first completing a boring task) in order to have the opportunity to hurt an innocent person.

Previous research has found that although psychopaths have no qualms about hurting others, they are more likely to do so when it serves a specific purpose. Narcissists are less likely to aggress upon another unless their ego is threatened. Machiavellians will usually aggress upon others only if there are sufficient perceived benefits and the risk to themselves is acceptably low.

February 24, 2015

The bitter war between men and women

Filed under: Health, History, Religion — Tags: , , , , , — Nicholas @ 03:00

Sarah Hoyt recently reposted her rant (in her words) about the ongoing struggle between men and women:

I know this goes completely against everything you’ve ever heard and learned. History — and SF — is full of dreamers who are convinced that if women ruled the world it would all be beauty flowers and non aggression. (To these dreamers I say spend a week as a girl in an all-girl school. It will be a rude awakening.)

Dreamers of the Dan Brown stripe posit a peaceful female worship, with yet more beauty and flowers and non-aggression. They ignore the fact that 99% of the goddess-worshiping religions were scary. And don’t tell me that’s patriarchal slander — it’s not. The baby-killing of Astoreth worship has been documented extensively. (Of course, the Phoenicians were equal-opportunity baby killers.) The castrations of Cybele worship were also well documented. Now, I can hardly imagine a female divinity without imagining hormonal episodes requiring appeasement — but that’s because I’m a woman of a certain age, and that’s fodder for another altogether different discussion. Suffice it to say that the maiden and mother usually also had a crone persona who was … er… “not a nice person.”

Anyway — all this to say since I joined the MOB (Mothers Of Boys) the scales about such things as the inherent equality of men and women as far as their brain structure and basic behavior have fallen from my eyes. (Well, the scales that remained. My experience in school notwithstanding, I’d been TAUGHT that females were getting the short end of the stick and that’s a hard thing to overcome. Learned wisdom is so much more coherent than lived wisdom, after all.)

Again — indulge me — I’m going to make a lot of statements I can too back up, but which would take very, very, very long to document — so it will seem like I’m ranting mid air. Stay with it. If I feel up to it later, I’ll post some references.

Yes, women have been horribly oppressed throughout history including the rather disgusting Victorian period that most Americans seem to believe is how ALL of history went. I contend, though, that women were not oppressed by some international conspiracy of males — yes, I know what Women’s Studies professors say. I would however remind you we’re talking of a group of people — men — who a) have issues finding their own socks in the dresser they’ve used for ten years. b) Are so good at communicating as a group that they couldn’t coordinate their way out of a wet paper bag, or to quote my friend Kate, couldn’t organize a bonk in a brothel. (In most large organizations the “social/coordinating” function is performed by females at various levels.) c) That women being oppressed by a patriarchy so thorough it altered history and changed all records of peaceful female religion would require a conspiracy lasting thousands of years and involving almost every male on Earth. If you believe that, I have this bridge in NY that I would like to sell you. — Women were oppressed by their own bodies.

Throughout most of history women had no safe and effective means of stopping pregnancy. — please, spare me the “herbal” remedies. I grew up in a village that had little access to medicine. If there had been an effective means of preventing pregnancy we’d have known it. TRUST me. There are abortificients, but they endanger the mother as well. However, until the pill there was no safe contraceptive. The herbal contraceptive is a plot device dreamed up by fantasy writers. Also, btw, the People’s Republic of China TESTED all these methods (including swallowing live tadpoles at the full moon.) NONE of them worked. SERIOUSLY.

What this meant in practical fact is that most women were pregnant from menarche to menopause, if they were lucky to live that long. I’ve been pregnant. If you haven’t, take it from me it’s not a condition conducive to brilliant discourse or reasoned logic. On top of that, of course, women would suffer the evils of repeated child bearing with no rest. In effect this DID make women frail and not the intellectual equals of men. And it encouraged any male around to “oppress” them. I.e., when the majority of females around you need a minder, you’re going to assume ALL females need a minder. It’s human nature. Note that beyond suffrage, the greatest advance in women’s equality came from the pill. Not a coincidence, that.

However, the people who think that women were oppressed by an international historical cabal rule the establishment. Including the educational establishment. I find it hilarious that in their minds men/boys are so powerful that they must be kept back and are suspected of being criminals just because they have a penis. This is attributing to them god-like powers to rival what any Victorian housewife would believe.

Anyway — these people have decided all efforts must be made to equal male and female performance in school. Since, in practical fact, this is impossible because males and females develop at different paces and favor different areas, they’ve settled for hobbling the all-powerful males.

You see this everywhere from Saturday morning cartoons to kindergarten to all the grades beyond. In cartoons these days, the girls ALWAYS rescue the boys. (They do it while keeping impeccably groomed hair, too. Impressive, that.) And in school all the girls are assumed to be right and all the boys are assumed to be wrong.

February 22, 2015

Obamacare’s externalities

Filed under: Economics, Health, USA — Tags: , , , — Nicholas @ 03:00

Megan McArdle on just what externalities are and why we pay attention to them:

For those who might not know the term, “externality” is economist-speak, and it means about what it sounds like: an effect that your action has on others. An externality can be positive or negative, and obviously, we as a society would like to have as many as possible of the former and as few as possible of the latter. In other words, “Your right to swing your fist stops at the end of my nose.”

I’m a libertarian, and libertarians love talking about externalities. They give us a (relatively) clear way to define what are and are not legitimate scopes of public action. Whatever you’re doing in the privacy of your own bedroom with another consenting adult is really none of my business, even if I think you oughtn’t to be doing it. On the other hand, if you’re breeding rats and cockroaches in there, and they’re coming through the shared wall of our respective row houses, then I have the right to get the law involved.

Framing things as “externalities” is therefore a good way to get a libertarian, or someone who leans that way, on your side. And such frames have come up over and over in the debate over Obamacare, which has been variously justified by the cost to the state of emergency room care; the cost to society of free-riding young folks who don’t buy insurance until they get sick; the public health cost of people who don’t go to the doctor and get really, expensively sick; an unhealthy workforce that is less productive; and the cost to friends and relatives who have to chip in to cover uninsured medical expenses.

I didn’t find any of those arguments particularly convincing. The third can just be dispensed with on the grounds of accuracy: In general, preventive medicine does not save money. Oh, it may save money in the particular case of someone whose diabetes or cancer went long undiagnosed. The problem is, you can’t just look at the cost of sick folks who would have been a lot cheaper to treat if their conditions had been caught earlier. You also have to include the cost of all the healthy people you had to screen in order to catch that one case of disease. And with limited exceptions, the cost of screening the healthy generally outweighs the cost of treating the chronically ill. Now, you can certainly argue for preventive care on other grounds — for example, that it makes people healthier (though even then you have to add the cost of unnecessary medical procedures, such as biopsies following a false positive on a blood test, which is why we do not, say, give annual mammograms to every American woman). But it’s not generally a money saver, so this particular externality doesn’t exist.

The rest of the arguments have some weight, but in the end, I don’t think they’re weighty enough. Let me explain.

February 21, 2015

Ace unloads on the media over their “coverage” of the Ebola outbreak

Filed under: Health, Media, Science, USA — Tags: , , — Nicholas @ 05:00

At Ace of Spades H.Q., Ace is underwhelmed by the Washington Post‘s belated acknowledgement that they aided and abetted the CDC in downplaying the seriousness of the Ebola outbreak last year:

Scientists: “There Was Almost a Rush to Assure the Public That We Knew A Lot More Than We Did” About Ebola; Experts Now Concede Ebola May Be Transmitted by Purely Airborne Route

Incidentally, the Washington Post, which is itself an Expert at Writing to whom you should bow and scrape, reported his words as “there was a rush to ensure the public,” which is not what he said, because it’s stupid. And if he did say it, you throw a “(sic)” after it to indicate the error is in the quoted material, not in your own writing.

[…]

I assume he is speaking here of a proper airborne transmission, and not the layman’s “airborne” transmission; either way, the experts who so ensuredly ensured us that there was no way to get ebola from the air were wrong.

Not just wrong. Arrogantly and loudly wrong.

See, the media is not particularly bright but they are Bossy and they like pretending they Love Science. So when they see an opportunity to Pretend to Be Scientists and Yell At Their Dumb Readers, they seize upon it, even if they don’t have any idea about what the fuck they are talking. (Note preposition smartly undangled, all expert-like.)

The media were always wrong on this, and the CDC was always deliberately deceptive. This new information about an actual airborne route of transmission is new (ish), but even before, the CDC was falsely suggesting that “no airborne transmission” meant that you could not catch ebola except by direct contact with an infected person or his fluids, like his blood and stool.

They sort of forgot that his “spit” and vapor in his breath counted as “liquids,” so you could in fact catch ebola by what the layman would call an airborne route. (Scientists do not call this path of transmission “airborne” transmission, but rather “spray” transmission or “droplet transmission.”)

The CDC deliberately lied to people, and the demented little Apple Polishers of the media rushed to scream at the rest of the class that you could not possibly get ebola by anything other than direct contact.

February 20, 2015

The not-so-binary nature of sex

Filed under: Health, Science — Tags: , , , , — Nicholas @ 02:00

In Nature, Claire Ainsworth explains why it’s becoming more difficult to discuss sex as a binary:

Sex can be much more complicated than it at first seems. According to the simple scenario, the presence or absence of a Y chromosome is what counts: with it, you are male, and without it, you are female. But doctors have long known that some people straddle the boundary — their sex chromosomes say one thing, but their gonads (ovaries or testes) or sexual anatomy say another. Parents of children with these kinds of conditions — known as intersex conditions, or differences or disorders of sex development (DSDs) — often face difficult decisions about whether to bring up their child as a boy or a girl. Some researchers now say that as many as 1 person in 100 has some form of DSD.

When genetics is taken into consideration, the boundary between the sexes becomes even blurrier. Scientists have identified many of the genes involved in the main forms of DSD, and have uncovered variations in these genes that have subtle effects on a person’s anatomical or physiological sex. What’s more, new technologies in DNA sequencing and cell biology are revealing that almost everyone is, to varying degrees, a patchwork of genetically distinct cells, some with a sex that might not match that of the rest of their body. Some studies even suggest that the sex of each cell drives its behaviour, through a complicated network of molecular interactions. “I think there’s much greater diversity within male or female, and there is certainly an area of overlap where some people can’t easily define themselves within the binary structure,” says John Achermann, who studies sex development and endocrinology at University College London’s Institute of Child Health.

These discoveries do not sit well in a world in which sex is still defined in binary terms. Few legal systems allow for any ambiguity in biological sex, and a person’s legal rights and social status can be heavily influenced by whether their birth certificate says male or female.

“The main problem with a strong dichotomy is that there are intermediate cases that push the limits and ask us to figure out exactly where the dividing line is between males and females,” says Arthur Arnold at the University of California, Los Angeles, who studies biological sex differences. “And that’s often a very difficult problem, because sex can be defined a number of ways.”

February 19, 2015

Epigenome: The symphony in your cells

Filed under: Health, Science — Tags: , , — Nicholas @ 05:00

Published on 18 Feb 2015

Almost every cell in your body has the same DNA sequence. So how come a heart cell is different from a brain cell? Cells use their DNA code in different ways, depending on their jobs. Just like orchestras can perform one piece of music in many different ways. A cell’s combined set of changes in gene expression is called its epigenome. This week Nature publishes a slew of new data on the epigenomic landscape in lots of different cells. Learn how epigenomics works in this video.

February 11, 2015

Everything the government has told about “healthy diets” is wrong

Filed under: Food, Government, Health, Science — Tags: , , — Nicholas @ 07:01

Well, maybe not everything, but a lot of government advice — which may well have been a major factor in the rise of obesity — was based on very little empirical evidence:

Whenever standard nutritional advice is overturned — as it has been this week by a study which effectively rubbished government guidelines limiting the intake of dietary fat — I am instantly reminded of a scene in the Woody Allen film Sleeper, first released when I was 10. I expect a lot of people my age are.

In the film Allen plays Miles, a cryogenically frozen health food store owner who is revived 200 years later. Two scientists are puzzling over his old-fashioned dietary requirements, unable to comprehend what passed for health food back in 1973. “You mean there was no deep fat?” says one. “No steak or cream pies, or hot fudge?”

“Those were thought to be unhealthy,” says the other scientist. “Precisely the opposite of what we now know to be true.”

This was meant to be a joke rather than a prediction, but it’s beginning to look as if we may not have to wait until 2173 to see it validated.

[…]

Of course the new study isn’t comprehensively refuting the association between high saturated fat intake and heart disease; it’s just pointing out that dietary guidelines first adopted in the mid-1970s were not, on reflection, based on any real evidence. In terms of what one should and shouldn’t be eating, I sometimes feel as if I’ve spent the past 30 years in a freezer.

February 9, 2015

Paradoxically, rising cancer deaths are a form of good news

Filed under: Britain, Health, Science — Tags: , , , , , — Nicholas @ 03:00

Last month, in his Times column, Matt Ridley explained why — until we discover a treatment for aging itself — rising cancer rates are a weird form of good news:

If we could prevent or cure all cancer, what would we die of? The new year has begun with a war of words over whether cancer is mostly bad luck, as suggested by a new study from Johns Hopkins School of Medicine, and over whether it’s a good way to die, compared with the alternatives, as suggested by Dr Richard Smith, a former editor of the BMJ.

It is certainly bad luck to be British and get cancer, relatively speaking. As The Sunday Times reported yesterday, survival rates after cancer diagnosis are lower here than in most developed and some developing countries, reflecting the National Health Service’s chronic problems with rationing treatment by delay. In Japan, survival rates for lung and liver cancer are three times higher than here.

Cancer is now the leading cause of death in Britain even though it is ever more survivable, with roughly half of people who contract it living long enough to die of something else. But what else? Often another cancer.

In the western world we’ve conquered most of the causes of premature death that used to kill our ancestors. War, smallpox, homicide, measles, scurvy, pneumonia, gangrene, tuberculosis, stroke, typhoid, heart disease and cholera are all much rarer, strike much later in life or are more survivable than they were fifty or a hundred years ago.

The mortality rate in men from coronary heart disease, for instance, has fallen by an amazing 80 per cent since 1968 — for all age groups. Mortality rates from stroke in both sexes have halved in 20 years. Cancer’s growing dominance of the mortality tables is not because it’s getting worse but because we are avoiding other causes of death and living longer.

It is worth remembering that some scientists and anti-pesticide campaigners in the 1960s were convinced that by now lifespans would be much shorter because of cancer caused by pesticides and other chemicals in the environment.

In the 1950s Wilhelm Hueper — a director of the US National Cancer Institute and mentor to Rachel Carson, the environmentalist author of Silent Spring — was so concerned that pesticides were causing cancer that he thought the theory that lung cancer was caused by smoking was a plot by the chemical industry to divert attention from its own culpability: “Cigarette smoking is not a major factor in the causation of lung cancer,” he insisted.

In fact it turns out that pollution causes very little cancer and cigarettes cause a lot. But aside from smoking, most cancers are indeed bad luck. The Johns Hopkins researchers found that tissues that replicate their stem cells most run the highest risk of cancer: basal skin cells do ten trillion cell divisions in a lifetime and have a million times more cancer risk than pelvic bone cells which do about a million cell divisions. Random DNA copying mistakes during cell division are “the major contributors to cancer overall, often more important than either hereditary or external environmental factors”, say the US researchers.

(Emphasis mine.)

To sum it up, until or unless medical research finds a way to stop the bodily effects of aging, cancer becomes the most likely way for all of us to die. Cancer is a generic rather than a specific term — it’s what we use to describe the inevitable breakdown of the cellular division process that happens millions or even trillions of times over our lifetime. As Ridley puts it, “even if everybody lived in the healthiest possible way, we would still get a lot of cancer.” I’m not a scientist and I don’t even play one on TV, but I suspect that the solution to cancers of all kinds are to boost our immune systems to more quickly identify aberrant cells in our bodies before they start reproducing beyond the capability of the immune system to handle. The short- to medium-term solution to cancer may be to make us all a little bit cyborg…

February 7, 2015

Is there a relationship between physical illness and depression?

Filed under: Health, Science — Tags: , , , — Nicholas @ 02:00

Last month, Scott Alexander tried to show the evidence, pro and con, on whether we have detected a causal relationship between physical ailments and depression:

Start with From inflammation to sickness and depression [PDF], Dantzer et al (2008), who note that being sick makes you feel lousy [citation needed]. Drawing upon evolutionary psychology, they theorize this is an adaptive response to make sick people stay in bed (or cave, or wherever) so the body can focus all of its energy on healing. A lot of sickness behavior – being tired, not wanting to do anything, not eating, not wanting to hang around other people – seems kind of like mini-depression.

All of this stuff is regulated by chemicals called cytokines, which are released by immune cells that have noticed an injury or infection or something. They are often compared to a body-wide “red alert” sending the message “sickness detected, everyone to battle stations”. This response is closely linked to the idea of “inflammation”, the classic example of which is the locally infected area that has turned red and puffy. Most inflammatory cytokines handle the immune response directly, but a few of them – especially interleukin-1B and tumor necrosis factor alpha – cause this depression-like sickness behavior.

[…]

Here are some other suspicious facts about depression and inflammation:

– Exercise, good diet and sleep reduce inflammation; they also help depression.

– Stress increases inflammation and is a known trigger for depression.

– Rates of depression are increasing over time, with the condition seemingly very rare in pre-modern non-Westernized societies. This is commonly attributed to the atomization and hectic pace of modern life. But levels of inflammation are also increasing over time, probably because we have a terrible diet that disrupts the gut microbiota that are supposed to be symbioting with the immune system. Could this be another one of the things we think are social that turn out to be biological?

– SSRI antidepressants, like most medications, have about five zillion effects. One of the effects is to reduce the level of inflammatory cytokines in the body. Is it possible that this is why they work, and all of this stuff about serotonin receptors in the brain is a gigantic red herring?

– It’s always been a very curious piece of trivia that treating depression comorbid with heart disease significantly decreases your chances of dying from the heart disease. People just sort of nod their heads and say “You know, mind-body connection”. But inflammation is known to be implicated in cardiovascular disease. If treating depression is a form of lowering inflammation, this would make perfect sense.

– Rates of depression are much higher in sick people. Cancer patients are especially famous for this. No one gets too surprised here, because having cancer is hella depressing. But it’s always been interesting (to me at least) that as far as we can tell, antidepressants treat cancer-induced depression just as well as any other type. Are antidepressants just that good? Or is the link between cancer being sad and cancer causing depression only part of the story, with the other part being that the body’s immune response to cancer causes inflammatory cytokine release, which antidepressants can help manage?

– Along with cancer, depression is common in many other less immediately emotion-provoking illnesses like rheumatoid arthritis and diabetes. The common thread among these illnesses is inflammation.

– Inflammation changes the activity level of the enzyme indoleamine 2,3 dioxygenase. This enzyme produces kynurenines which interact with the NMDA receptor, a neurotransmitter receptor implicated in depression and various other psychiatric diseases (in case your first question upon learning about this pathway is the same as mine: yes, kynurenines got their name because they were first found in dog urine).

– Sometimes doctors treat diseases like hepatitis by injecting artificial cytokines to make the immune system realize the threat and ramp up into action. Cytokine administration treatments very commonly cause depression as a side effect. This depression can be treated with standard antidepressants.

– Also, it turns out we can just check and people with depression have more cytokines.

There’s also some evidence against the theory. People with depression have more cytokines, but it’s one of those wishy-washy “Well, if you get a large enough sample size, you’ll see a trend” style relationships, rather than “this one weird trick lets you infallibly produce depression”.

[…]

So in conclusion, I think the inflammatory hypothesis of depression is very likely part of the picture. Whether it’s the main part of the picture or just somewhere in the background remains to be seen, but for now it looks encouraging. Anti-inflammatory drugs do seem to treat depression, which is a point in the theory’s favor, but right now the only one that has strong evidence behind it has side effects that make it undesirable for most people. There’s a lot of room to hope that in the future researchers will learn more about exactly how this cytokine thing works and be able to design antidepressant drugs that target the appropriate cytokines directly. Until then, your best bets are the anti-inflammatory mainstays: good diet, good sleep, plenty of exercise, low stress levels, and all the other things we already know work.

February 6, 2015

QotD: Listerine

Filed under: Business, Health, Humour, Quotations — Tags: — Nicholas @ 01:00

The stuff had an unpalatable reputation — no one likes the taste of Listerine, which is why Listerine had to come up with Flavored Listerine. Perhaps people respected it because it did taste so horrid; you could well imagine it was killing germs by the millions, because it tasted like death in your mouth. If Listerine Toothpaste had been flavored with mint or Pepsin! or Iridium! or some other brand-new ingredient, surely they would have told you up front. Unmodified “Listerine” is a warning.

James Lileks, The Bleat, 2015-01-20.

January 25, 2015

Prescribing modern drugs for Richard III

Filed under: Britain, Health, History, Science — Tags: , , , — Nicholas @ 02:00

In Richard Lehman’s BMJ journal review, there was an amusing bit of interest to Ricardians:

King Richard III of England was 32 when he died at Bosworth and then famously suffered the indignity of being buried in a Leicester car park. I think I probably drew your attention to this account of his post-mortem examination when it appeared online last September. Had Richard III been spared avoidable mortality in the form of a bashed-in skull and a spear through his spine, he would probably have needed a walking frame by the age of 70. He was never in the best shape:

I, that am curtail’d of this faire Proportion,
Cheated of Feature by dissembling Nature,
Deform’d, unfinish’d, sent before my time
Into this breathing World, scarse halfe made up,
And that so lamely and unfashionable,
That dogges bark at me, as I halt by them.
(from The Tragedy of Richard the Third: with the Landing of Earle Richmond , and the Battell of Boʃworth Field by Wm Shakespeare c.1592, First Folio text 1623)

With his nasty scoliosis and his habit of moving around castles with smoky rooms and no hand rails on the stairs, Richard III would have needed an OT assessment and a dosset box containing all the drugs which are now compulsory for elderly people in the UK:

simvastatin 40mg to add 2 days to life and cause muscle aches
tramadol 50mg to fail to ease pain & cause dependency, falls, confusion
naproxen 500mg to cause GI bleeds and fluid retention
furosemide 20mg to reduce fluid retention due to naproxen
omeprazole 20mg to prevent GI bleeds, encourage C diff
senna 7.5mg to counter tramadol constipation
citalopram 20mg to cause serotonin syndrome with tramadol
trazodone 50mg for agitation due to serotonin, to worsen it & cause falls
gababentin MR 800mg to see if it will help pain
paracetamol 500mg because it hasn’t helped the pain
tamsulosin 400mcg for nocturia due to age and furosemide
lisinopril 5mg for “grade 2 CKD” due to furosemide & naproxen
Seretide inhaler for low FEV1 due to scoliosis
etc.

My kingdom for a bit of horse-sense.

January 24, 2015

Problems besetting the British health system

Filed under: Britain, Bureaucracy, Health — Tags: , , — Nicholas @ 04:00

At Samizdata, Natalie Solent shares a post written by “ARC” discussing why the National Health Service seems to be under such pressure lately:

1) Flow-though is crucial to A&E: you must get people out the back-end of the process to maintain your rate of input to the front-end. However ever-increasing regulations mean a patient without family cannot be released until a boat-load of checks have been done. This is clogging up the back end. It may be preventing the release of a few who had better not be sent home yet (not much and not often, is the general suspicion) but it is definitely delaying hugely processing the release of all others who could be. All this admin takes time and effort — delaying release and also using up time of staff in non-health work — and costs money.

This effect needs to be understood in the context of the 15-years-older story of the destruction of many non-NHS nursing homes by galloping regulation. These homes were mostly owned and operated by senior ex-NHS nurses and provided low-grade post-operative care. The NHS relied on them as half-way houses to get patients out of NHS hospitals when they no longer needed intensive care but were not yet recovered enough to go home. These nurses did not want to spend time form-filling instead of caring for patients, and for each home there was always one of the 1000+ rules that was particularly hard for that given home to meet without vast expense or complication. So they died one by one. The ‘waiting times have increased’ story of Tony Blair’s early-2000 years — “If the NHS were a patient, she’d be on the critical list” — was caused by this and the resultant bed-blocking more than any other one cause.

The problem with waving the regulatory wand to “solve” a problem like this is that it tends to create perverse incentives so that the artificial target can be achieved — like this post from a couple of years back where the regulators dictated a maximum time a patient could be kept waiting for admission to A&E. The reaction of the people running the system was to change the definition of “admission” so that now patients’ timers don’t start running until they’re unloaded from the ambulance … so the end result is people are spending more time in the back of ambulances waiting outside the hospital until there’s an open slot. This meets the artificial target, but creates a worse situation because patients are still waiting as long (or longer), but now they’re also tying up ambulances from attending other emergency situations.

Back to ARC’s list of NHS problems:

2) The new 111 service is sending many more patients to A&E.

2.1) The service’s advice is very risk averse. The people who set up the process were afraid of the consequences of the statistical 1-in-a-million time when anything other than mega-risk-averse advice would see some consequence that would become a major news story blaming them.

2.2) Thanks to the post-1997 reforms, GPs work less hours on-call but the doctors are not just slacking off and doing nothing. The huge growth in regulation means they are in effect putting in as many hours as before, but on form-filling and admin to provide all the info the NHS and other government demand, to ensure they tick every box, etc. The out-of-hours on-call time they used to have is now swallowed by this work. So they are not in fact working less; it is the balance of what they are working on that has changed: less on healthcare, more on admin. Thus 111 must send people to A&E, not an on-call GP (and, of course, fewer on-call GPs mean more people phone 111).

From context, I assume the 111 service is a telephone health advisory service like Telehealth Ontario.

January 21, 2015

“Sir, please put the Sriracha down. Now!”

Filed under: Cancon, Food, Health, USA — Tags: — Nicholas @ 04:00

Megan McArdle worries that the otherwise welcome introduction of spice to the awesomely bland North American diet of yesteryear may have gone just a tad too far:

It has come to my attention that some of you are becoming unable to eat good food unless it is spiced to within an inch of its life.

I’ve been noticing this for a while. It started with friends who put hot sauce on everything, even on dishes that were perfectly good without hot sauce. With dinner party hosts who proudly declared that the secret to good cooking was just to douse something in Cajun spices until you noticed the powder forming drifts on the side of the pan. With people who reported that an Asian restaurant was “good” because it had left their taste buds numb for hours.

Then, during the holiday season, I saw a Slate food writer declare that American apple pie is not as good as French apple pie because it is “bland and goopy,” and I began to suspect that something had gone seriously wrong with our food culture. When I saw an article on restaurant chefs who are daring to bring back prime rib, I became sure of it.

I’m as excited as anyone about the majestic spread of foreign food throughout our nation’s urban downtowns, its strip malls and cookbook aisles, its fruited plains and amber waves of grain. I can’t think of a national cuisine I don’t like, and that includes foods that will sear the taste buds off a water buffalo’s tongue at 20 feet.

I love me some spices … but I also like the idea of not feeling my tongue in pain for hours after I’ve finished eating my meal.

January 10, 2015

Living with diphallia

Filed under: Health, Randomness — Tags: , — Nicholas @ 04:00

BBC Newsbeat on the plight of a poor American boy who lives a secret life due to his rare diphallia condition:

A man with two penises has been speaking to Newsbeat about living with the condition.

Known only as Triple D, the 25-year-old from the east coast of America claims to have had 1,000 sexual partners.

He suffers from diphallia which is a rare condition where a male is born with two penises.

According to a report by the BMJ — the global healthcare knowledge provider — one-in-five million males in the world are born this way.

[…]

Triple D describes himself as “very much bisexual” and has been in polyamorous relationships — sexual or romantic relationships that are not exclusive to one person.

He says his longest relationship was with a couple.

Everyday things like buying underwear are an issue — so he tells Newsbeat he doesn’t wear any.

Both penises are fully functioning. “I can urinate and ejaculate through both at the same time,” he explains.

“Entering into the porn industry has crossed my mind. I knew people who worked in the sex industry and some of them knew what I had, some had heard what I had.

“Nobody had seen it. I remember thinking about it but I don’t want to become a novelty. My dignity is priceless.”

Newsbeat has seen photographs which support Triple D’s claims but cannot independently verify his identity.

The four kinds of healthcare spending

Filed under: Bureaucracy, Business, Economics, Government, Health, USA — Tags: , , , — Nicholas @ 03:00

Megan McArdle explains why healthcare costs more than you think it should:

Milton Friedman famously divided spending into four kinds, which P.J. O’Rourke once summarized as follows:

  1. You spend your money on yourself. You’re motivated to get the thing you want most at the best price. This is the way middle-aged men haggle with Porsche dealers.
  2. You spend your money on other people. You still want a bargain, but you’re less interested in pleasing the recipient of your largesse. This is why children get underwear at Christmas.
  3. You spend other people’s money on yourself. You get what you want but price no longer matters. The second wives who ride around with the middle-aged men in the Porsches do this kind of spending at Neiman Marcus.
  4. You spend other people’s money on other people. And in this case, who gives a [damn]?

Most health-care spending in the U.S. falls into category three. In theory, the people who are funding our expenses — the proverbial middle-aged men in Porsches, except that they’re actually insurance executives and government bureaucrats — have every incentive to step in, cut up the charge cards, and substitute a gift-wrapped box of Hanes briefs with the comfort-soft waistband. In practice, legislators frequently intervene to stop them from exercising much cost-control. The managed care revolution of the 1990s died when patients complained to their representatives, and the representatives ran down to their offices to pass laws making it very hard to deny coverage for anything anyone wanted. Medicare cost-controls, such as the famed Sustainable Growth Rate, fell prey to similar maneuvers. The only system that exhibits sustained cost control is Medicaid, because poor people don’t vote, or exit the system for better insurance.

The result is a system where everyone complains that we spend much too much on health care — and the very same people get indignant if anyone suggests that they, personally, should maybe spend a little bit less. Everyone wants to go to heaven — but nobody wants to die.

Unfortunately, this is what cost-control actually looks like, which is to say, like people not being able to spend as much on health care. Oh, to be sure, we could achieve this end differently — instead of asking patients to pay a modest share of their own costs (the article suggests that this amount is less than 10 percent, in the case of Harvard professors) — we could simply set a schedule of covered treatment, and deny patients access to off-schedule treatments, or even better, not even tell them that those treatments exist. But people don’t like that solution either, which is why medical dramas are filled with rants about insurers who won’t cover procedures, and the law books are filled with regulations that sharply curtail the ability of insurers to ration care. And the third option, refusing to pay top-dollar for care, would be a bit tricky for Harvard to implement, given that they run exactly the sort of high-cost research facilities that help drive health-care costs skyward. Nor do I really think that the angry professors would be mollified by being given a cheap insurance package that wouldn’t let them go see the top-flight specialists their elite status now entitles them to access.

Instead, they persist in our mass delusion: that there is some magic pot of money in the health-care system, which can be painlessly tapped to provide universal coverage without dislocating any of the generous arrangements that insured people currently enjoy. Just as there are no leprechauns, there is no free money at the end of the rainbow; there are patients demanding services, and health-care workers making comfortable livings, who have built their financial lives around the expectation that those incomes will continue. Until we shed this delusion, you can expect a lot of ranting and raving about the hard truths of the real world.

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