Quotulatiousness

January 21, 2014

Euthanasia on TV and in real life

Filed under: Health, Liberty, Media — Tags: , , , — Nicholas @ 12:10

It’s been many years since I watched an episode of Coronation Street, so I was a bit surprised to find that the show’s writers are “political”, at least on some issues:

Many a soap-opera storyline has created a news story in itself. So it was in the case of Hayley Cropper, a character on a British soap, Coronation Street. News of what happens to Hayley, in an episode to be shown tonight, created a furore when the press release for the story went out last Tuesday. The dilemma for the writers was how to kill off a character who had been a mainstay of the programme since 1998, when she was introduced as the first transsexual character. The answer, provided by producer Stuart Blackburn, was to have the character dying of pancreatic cancer, but finishing herself off with a cocktail of drugs in an on-screen suicide.

Julie Hesmondhalgh, the actor who plays Hayley, called for a discussion on legalising assisted suicide. She was backed by Sara Wootton, chief executive of Dignity in Dying, who praised the show’s ‘sensible and sensitive handling of assisted dying’. Lord Falconer, whose Assisted Dying Bill will be introduced in the House of Lords in the coming months, penned an article in the Sun. The Sun’s editorial called for a change in the law and the newspaper published the results of a poll indicating that 69 per cent of Britons support the legalisation of assisted suicide for the terminally ill.

[…]

It is difficult not to suspect – despite the even-handedness of the treatment of the issue (the character’s on-screen husband, Roy Cropper, opposes Hayley’s decision) – that the programme is part of the well-funded campaign to legalise assisted suicide. Stuart Blackburn had previously explored the same issue while at a rival soap, Emmerdale. (He perhaps risks becoming the Jack Kevorkian of the soap world.) Hesmondhalgh was forthright about her support for a change in the law in several interviews, and many journalists seem poised to call again for the legalisation of assisted suicide.

But it is entirely appropriate that a fictional plotline is used to promote legalising assisted suicide. The reason that so many people wish to have the ‘right to die’ is based on the morbid imagination of the ‘worried well’, traded on so effectively by right-to-die campaigners. ‘What if it happened to YOU…?’ is the plotline of Dignity in Dying and other organisations that campaign for legalised assisted suicide.

There are arguments on both sides of this issue (personally, I’m in favour of making it legal), but there are concerns that less-than-scrupulous family members might attempt to “hurry” an elderly or infirm parent or relative to a decision that wouldn’t really be voluntary.

It’s also an issue that came up this weekend, as one of my online acquaintances (we’d never met in person, but we both belonged to a special interest mailing list and had had several email discussions) committed suicide with his wife last week. Maarten and Irma apparently faced an unpleasant future in their declining years and mutually decided that their time had come. While euthanasia is legal in the Netherlands, it does not seem that Maarten and Irma followed the letter of the law in their case:

Euthanasia in the Netherlands is regulated by the “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” from 2002. It states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These criteria concern the patient’s request, the patient’s suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life. To demonstrate their compliance, the Act requires physicians to report euthanasia to a review committee.

The family is, understandably, not providing a lot of detail but said that they were found in bed, hand in hand and “together, peaceful and loving” but did not specify how they had died.

Becoming dependent on whomever or whatever, or seeing your partner slowly fading away, are situations we do not ever want to contemplate, therefore we have, in good health, clear of mind, together 150 years old, in our own bed, hand in hand, ended our lives.

At risk of sounding trite, I’m saddened that they chose to do this, but I respect their right to make that decision. It cannot have been an easy one. Rest in peace.

January 8, 2014

David Harsanyi on Colorado’s recent marijuana legalization

Filed under: Health, Law, Liberty, USA — Tags: , , — Nicholas @ 13:45

On the one hand, he’s delighted that something he advocated for years finally came to pass. On the other, well, he’s still also in favour of adults being allowed to make decisions on what they put into their bodies (and owning the consequences of their actions), so perhaps we only need the one hand after all.

As a Denver Post columnist from 2004-2011, I spent a considerable amount of time writing pieces advocating for the legalization of pot. So I was happy when the state became one of the first to decriminalize small amounts of “recreational” marijuana. I believe the War on Drugs is a tragically misplaced use of resources; an immoral venture that produces far more suffering than it alleviates. And on a philosophical level, I believe that adults should be permitted to ingest whatever they desire — including, but not limited to, trans-fats, tobacco, cough syrup, colossal-sized sodas, and so on — as long as they live with the consequences.

You know, that old chestnut.

Unrealistic? Maybe. But less so than allowing myself to believe human behavior can/should be endlessly nudged, cajoled and coerced by politicians.

So, naturally, I was curious to see how marijuana sales in Colorado would shake out. According to the Denver Post, there are nearly 40 stores in Colorado licensed to sell “recreational” pot. Medical marijuana has been legal for more than a decade. (And, having spent time covering medical pot “caregivers” — or, rather, barely coherent stoners selling cannabis to other barely coherent stoners, a majority of whom suffer from ailments that an Excedrin could probably alleviate — it will be a relief to see that ruse come to end. I’m not saying marijuana doesn’t possess medicinal uses. I’m saying that most medicinal users are frauds.)

Not surprisingly, pot stores can’t keep up with demand for a hit of recreational tetrahydrocannabinol. Outside of Denver shops, people are waiting for up to five hours to buy some well-taxed and “regulated” cannabis. The pot tourists have also arrived. All this, the Denver Post estimates, will translate into $40 million of additional tax revenue in 2014 — the real reason legalization in Colorado became a reality.

January 4, 2014

By DSM-5 standards, most of us are suffering from personality disorders

Filed under: Health — Tags: , , — Nicholas @ 10:55

From the last issue of the City Journal, Theodore Dalrymple‘s critique of the latest edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a rather wide-ranging diagnosis that applies to a huge number of people:

The overlap between straightforwardly pathological conditions (in Szasz’s sense) and those that result from social, psychological, or personal factors, or from bad moral choices, suggests that psychiatrists should show discretion in what they regard as genuine illness. The state of ignorance in which psychiatrists now practice, which will probably endure, ensures that they will often be wrong; but no one who has encountered, say, a manic in full flight is likely to doubt that he is in the presence of illness. But nor would it be easy, then, to see so-called factitious disorder, which consists of “falsification of physical or psychological signs and symptoms, or induction of injury or disease, associated with identified deception” in quite the same light: that is, to grant the same status to someone pretending to be ill as to someone genuinely ill.

Yet this is precisely what the DSM-5 does, establishing its authors’ lack of common sense, the quality that psychiatrists, perhaps more than any other kind of doctor, need. The manual’s lack of common sense would be amusing were it not destined to be taken with superstitious seriousness by psychiatrists around the world, as well as by insurers and lawyers.

The section of the volume devoted to personality disorders proves the point. Among the criteria for personality disorders in general are the following:

    A: An enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, in fields such as thought, emotion, interpersonal relations and impulse control . . .

    B: The enduring pattern is inflexible and pervasive across a broad range of personal and social situations.

    C: The enduring pattern leads to clinically significant distress or impairment in social, occupational or other important areas of functioning.

    D: The pattern is stable and of long duration.

The DSM-5 then informs us that more than one in seven people have such a lifelong disorder — adding up to 45 million Americans and even more Europeans. These astonishing numbers give the authors not a moment’s pause (any more than does the fact that their own prevalence rates suggest that the average American suffers from more than two psychiatric disorders in any one year). Several undesirable characteristics must be present in an individual for a diagnosis of personality disorder to apply. Considering those characteristics, and that such a significant portion of the Western population supposedly exhibits many of them, either a mass outbreak of human nastiness and inability to deal with everyday life must have occurred, or the whole business of diagnosis must be dubious or even ridiculous.

Here is a random list of some of the characteristics that, in the DSM-5, make up personality disorders of various kinds:

    Unjustified suspicions that others are harming, exploiting or deceiving.

    Persistently grudge-bearing.

    Detachment from social relations and limited expression of emotion.

    Behavior or appearance that is odd, eccentric or peculiar.

    Deceitfulness.

    Persistent irresponsibility.

    Indifference to risk to self or others.

    Irritability and aggressiveness.

    Lack of remorse.

    Recurrent suicidal behavior, gestures or threats, or self-mutilation.

    Inappropriately intense anger, frequent displays of temper.

    Rapidly shifting and shallow expressions of emotion.

    Use of physical appearance to draw attention to self.

    Self-dramatization, theatricality.

    Grandiosity.

    Requirement for excessive admiration.

    Sense of entitlement.

    Interpersonal exploitativeness.

    Lack of empathy.

    Enviousness of others.

    Arrogance and haughtiness.

    Unwillingness to become involved with people.

    Sense of social ineptitude and inferiority.

    Avoidance of risk.

    Difficulty in expressing disagreement with others because of fear of disapproval, i.e., pusillanimity.

    Feeling of helplessness when alone.

    Preoccupation with details, rules, lists, order, organization or schedules.

    Excessive devotion to work.

    Over-conscientiousness or scrupulousness.

    Reluctance to delegate.

    Rigidity and stubbornness.

The diagnoses for most of the disorders require at least four of the undesirable characteristics to be present, predominant, and persistent. One is reminded of the King of Brobdingnag’s view of Gulliver’s countrymen: “I cannot but conclude the bulk of your natives to be the most pernicious race of little odious vermin that nature ever suffered to crawl upon the surface of the earth.” Lest anyone object that “only” one in seven people suffers from personality disorders, and that therefore the King of Brobdingnag’s opinion of Western humanity — that it suffers from the “worst effects that avarice, faction, hypocrisy, perfidiousness, cruelty, rage, madness, hatred, envy, lust, malice, and ambition, could produce” — is not relevant, one must add that, for the DSM-5, people with personality disorders are merely the most extreme exemplars of their type. And if only the extremes have four or more undesirable and frequently horrible dominating characteristics, many individuals must have one, two, or even three such characteristics. If the DSM-5 reflects the American Psychiatric Association’s views, then that organization clearly views humanity with Swiftian distaste. Yet its distaste is not that of a disappointed lover (and certainly not expressed with Swift’s genius) but is motivated, one suspects, by the hope of an endless supply of patients. For those with psychiatric disorders need psychiatrists.

December 23, 2013

Psychiatry does not seek “to colonise everyday life – rather, everyday life now invites colonisation by psychiatry”

Filed under: Health, Science — Tags: , , , — Nicholas @ 11:32

In Spiked, Sandy Starr reviews Gary Greenberg’s recently published The Book of Woe:

There is an inevitable contingency about diagnostic categories, particularly when it comes to psychiatry. Greenberg argues that for all the useful work that goes into constructing these categories, psychiatric diagnosis has a ‘self-validating nature…by which once you’ve created a diagnostic category, the fact that people fit into it becomes evidence that the disorder exists’. Greenberg reminds us that ‘while many diagnoses are made on clinical signs and symptoms rather than on lab tests or other external validators, only in psychiatry are all diagnoses made that way’.

It’s worth adding that this may be changing. As psychiatry seeks to predicate itself more and more upon genetics and neuroscience, there are expectations in some circles that biochemical diagnostic tests for psychiatric disorders will follow ineluctably. This prospect does not reassure me. Psychiatry is attempting the difficult feat of relocating its foundations without toppling its façade, and this involves elisions — several of which are discussed by Greenberg — that leave me feeling less persuaded of the profession’s credentials, not more.

[…]

That said, one can certainly appreciate the need for psychiatry to appear coherent and confident, given the far-reaching consequences of the DSM’s contents. Greenberg explains, for example, how the use of a single ‘and’ where an ‘or’ might have been used, in the definition of ‘paedophilia’ that made its way into the fourth edition, inadvertently made it far easier for US authorities to detain indefinitely (on psychiatric grounds) people who had been convicted of sexual offences against minors. In other words, a single use of the word ‘and’ in the DSM led to a complex domain of morality and law — the culpability (or otherwise) of people charged with sexual offences in various circumstances, and proportionate sentencing for their crimes — becoming subordinate to the considerations of psychiatry.

[…]

‘Once you start to think of your troubles as a disease, your idea of yourself, which is to say who you are, changes’, warns Greenberg. But while psychiatry gives a diagnostic imprimatur to our expectations of ourselves and of one another, psychiatry is not solely capable of bringing about a wholesale alteration of these expectations. To understand what else might account for a psychiatric turn in society, one needs to recognise that we live in a culture in which our adult capacities are constantly denigrated, in which victimhood has become one of the few widely recognised sources of authority, and in which we are constantly encouraged from all directions not only to put our problems on public display (rather than addressing them within the intimate confines of trusted friends, family or — in extremis — psychotherapists or even psychiatrists), but also to assume that our problems will most likely afflict us in perpetuity.

It’s not so much the case that psychiatry now seeks to colonise everyday life — rather, everyday life now invites colonisation by psychiatry. In circumstances such as these, even the most well-meaning and scrupulous psychiatrist might struggle to parse the suffering and idiosyncrasy they encounter, so as to partition it sensibly into the pathological and the normal. Greenberg’s barbs against psychiatry may be well deserved, and are certainly grounded in tantalising insider detail and no small amount of wit. But they represent an incomplete picture of the dynamics he sets out to get to grips with, which lie outside the institution of psychiatry as much as they lie within.

December 21, 2013

Overzealous regulators create nationwide Sriracha shortage

Filed under: Bureaucracy, Business, Food, Government, Health, USA — Tags: , — Nicholas @ 11:56

Baylen Linnekin on the latest attempt to be safer-than-safe in food regulation:

Sriracha rooster sauceLast week California health regulators ordered the makers of Sriracha hot sauce to suspend operations for 30 days. The 30-day hold comes despite the fact the product has been on the market for more than three decades and that “no recall has been ordered and no pathogenic bacteria have been found[.]”

So what’s the issue?

The problem, reports the Pasadena Star News, is that Sriracha is a raw food.

“Because Sriracha is not cooked, only mashed and blended, Huy Fong needs to make sure its bottles won’t harbor dangerous bacteria,” writes the Star News.

Aren’t three decades of sales sufficient proof of that fact?

“The regulations outlining this process have been in existence for years,” writes California health department official Anita Gore, in a statement she sent to L.A. Weekly, “but the modified production requirements were established for the firm this year.”

In other words, the state changed the rules of the game.

I’m starting to think that Megan McArdle is a bit jaundiced about Obamacare

Filed under: Government, Health, USA — Tags: , , — Nicholas @ 11:27

Otherwise, how can you account for running a column titled like this?

Obamacare Initiates Self-Destruction Sequence

On Wednesday, Politico’s Carrie Budoff Brown reported that the administration was saying fewer than 500,000 people had actually lost insurance due to Obamacare-induced cancellations. This struck me as a strange leak: Half a million is a lot less than many people (including me) have been estimating, but it is still not a small number, and the administration has tended to sit on negative information until the last possible moment.

Yesterday, we had a more official announcement from the administration: Anyone who has had their policies cancelled will be exempt from the individual mandate next year. The administration is also allowing those people to buy catastrophic plans, even if they’re over 30.

What to make of these two statements? On the one hand, the administration is trying to minimize the number of people who have been affected by cancellations, and on the other hand, it is unveiling a fix to the problem of cancellations. And these are not minor changes.

[…]

The White House is focused on winning the news cycle, day by day, not the kind of detached technocratic policymaking that they, and the law’s other supporters, hoped this law would embody. Does your fix create problems later, cause costs to spiral or people to drop out of the insurance market, or lead to political pressure to expand the fixes in ways that critically undermine the law? Well, that’s preferable to sudden death right now.

However incoherent these fixes may seem, they send two messages, loud and clear. The first is that although liberal pundits may think that the law is a done deal, impossible to repeal, the administration does not believe that. The willingness to take large risks with the program’s stability indicates that the administration thinks it has a huge amount to lose — that the White House is in a battle for the program’s very existence, not a few marginal House and Senate seats.

And the second is that enrollment probably isn’t what the administration was hoping. I don’t know that we’ll start Jan. 1 with fewer people insured than we had a year ago, but this certainly shouldn’t make us optimistic. It’s not like people who lost their insurance due to Obamacare, and now can’t afford to replace their policy, are going to be happy that they’re exempted from the mandate; they’re still going to be pretty mad. This is at best, damage control. Which suggests that the administration is expecting a fair amount of damage.

December 2, 2013

The FDA and 23andMe

Filed under: Bureaucracy, Business, Health, USA — Tags: , , — Nicholas @ 11:24

Kyle Smith on the FDA’s sudden interest in shutting down private DNA testing company 23andMe:

… the FDA has the power to regulate medical devices, which is the pretext it is using to stop 23andMe. Ordering it to stop selling its personal genome service, the FDA declared that the tube “is a device within the meaning of section 201(h) of the FD&C Act, 21 U.S.C. 321(h), because it is intended for use in the diagnosis of disease or other conditions or in the cure, mitigation, treatment or prevention of disease, or is intended to affect the structure or function of the body.’

It would seem that 23andMe could simply put the words, “not intended for us in the diagnosis, cure, mitigation, treatment or prevention of disease” on its website and satisfy the FDA, but we all know that the motto of today’s federales is “We make it up as we go along.” The FDA seems determined to conduct a lengthy war with 23andMe.

[…]

Using the same reasoning, the FDA might as well shut down WebMd.com because people might type their symptoms into the site, and the response might affect whether or not they choose to go to a doctor. Any computer or iPhone thereby becomes a “medical device” that people can use for the “diagnosis, cure, mitigation, treatment or prevention of disease.”

Come to think of it, that thermometer you use to check your temperature is pretty dangerous too — it might give you either a false positive or a false negative — but why stop there? You exercise to mitigate or prevent disease, don’t you? Maybe the FDA should take your running shoes and your yoga pants away.

November 29, 2013

We’re from the FDA, we’re here to help you

Filed under: Bureaucracy, Government, Health, Science — Tags: , , , — Nicholas @ 09:19

Nick Gillespie on the mindnumbingly awful exercise of FDA regulatory power in shutting down personal DNA testing company 23andMe:

Personal genetic tests are safe, innovative, and the future of medicine. So why is the most transparent administration ever shutting down a cheap and popular service? Because it can.

In its infinite wisdom, the Food and Drug Administration (FDA) has forbidden the personal genetic testing service 23andMe from soliciting new customers, claiming the company hasn’t proven the validity of its product.

The real reason? Because when it comes to learning about your own goddamn genes, the FDA doesn’t think you can handle the truth. That means the FDA is now officially worse than Oedipus’s parents, Dr. Zaius, and the god of Genesis combined, telling us that there are things that us mere mortals just shouldn’t be allowed to know.

23andMe allows you to get rudimentary information about your genetic makeup, including where your ancestors came from and DNA markers for over 240 different hereditary diseases and conditions (not all of them bad, by the way). Think of it as the H&M version of the haute couture genetic mark-up that Angelina Jolie had done prior to having the proactive mastectomy that she revealed this year.

[…]

Peter Huber of the Manhattan Institute, a conservative think tank, has an important new book out called The Cure in the Code: How 20th Century Law is Undermining 21st Century Medicine. Huber writes that whatever sense current drug-approval procedures once might have had, their day is done. Not only does the incredible amount of time and money — 12 years and $350 million at a minimum — slow down innovation, it’s based on the clearly wrong idea that all humans are the same and will respond the same way to the same drugs.

Given what we already know about small but hugely important variations in individual body chemistry, the FDA’s whole mental map needs to be redrawn. “The search for one-dimensional, very simple correlations — one drug, one clinical effect in all patients — is horrendously obsolete,” Huber told me in a recent interview. And the FDA’s latest action needs to be understood in that context — it’s just one more way in which a government which now not only says we must buy insurance but plans whose contours are dictated by bureaucrats who arbitrarily decide what is best for all of us.

November 28, 2013

Colby Cosh on Obamacare’s international ripples

Filed under: Cancon, Government, Health, USA — Tags: , , — Nicholas @ 11:12

You’ll have guessed from the tone of my Obamacare links and comments that I didn’t think it was a good idea from the start and it’s been a great example of how not to implement a major government initiative. That said, it’s a sure bet that Obamacare will have influence on other countries as they consider their own health programs. Colby Cosh is surprised that the scandal-addled Canadian media hasn’t been paying more attention to the Obamacare train wreck as the wheels fall off in all directions:

Obamacare isn’t going to make major systemic change in either direction look more appetizing to Canadians. That’s an important Canadian angle right there. Not long ago it looked as though national pharmacare was likely to become an election issue here, quarterbacked by the NDP and perhaps the Liberals, too. The concept has plenty of support among economists and other health policy experts—the same class of kindly boffins that, in the U.S., lined up almost unanimously behind the Affordable Care Act.

For better or worse, nationalizing prescription-drug insurance seems likely to be a much tougher sell here in the immediate future. Any large, complex health care experiment will be. The more wise heads support it, the easier it will be for supporters of the status quo to shout, “Unintended consequences! Ivory-tower tomfoolery!” Indeed, political strategists may already be saying it to themselves.

American commentators are already starting to wonder if Obamacare’s difficult start and increasingly troubled prospects may end up as a victory for small-government conservatism. The problems for the program do not end with the calamitous state of the federal insurance-exchange website, or even with the nasty surprises handed to the self-employed and freelancers in the “individual market” who were falsely promised: “If you like your plan you can keep your plan.” Some Obamacare buyers are finding themselves shut out from their preferred doctors and hospitals; employers are junking non-compliant health plans; and many in the middle class who liked the Obamacare concept are facing sticker shock.

[…]

The redistributive aspects of Obamacare were undersold, and possible pitfalls obviously not foreseen. The neoliberal Democrat Walter Russell Mead put it neatly the other day: “President Obama may be the Democrat who ends up convincing millions of American millennials that Ronald Reagan was right, and that the progressive administrative state is neither honest nor competent enough to solve the problems of the American people.” If that is the case, the effects cannot be confined to the U.S.

November 27, 2013

OMG! There are scary-sounding chemicals in your Thanksgiving Dinner!

Filed under: Environment, Food, Health, Media — Tags: , , — Nicholas @ 09:23

Our American friends are about to celebrate their (weirdly late) Thanksgiving this week, so junk science food scares are also making another annual appearance. Angela Logomasini explains why you can safely ignore most of the advice you may receive about food safety this Thanksgiving:

Toxic chemicals lurk in the “typical” Thanksgiving meal, warns a green activist website. Eat organic, avoid canned food, and you might be okay, according to their advice. Fortunately, there’s no need to buy this line. In fact, the trace levels of man-made chemicals found in these foods warrant no concern and are no different from trace chemicals that appear in food naturally.

The American Council on Science and Health (ACSH) illustrates this reality best with their Holiday Dinner Menu, which outlines all the “toxic” chemicals found naturally in food. The point is, at such low levels, both the man-made and naturally occurring chemicals pose little risk. This year the ACSH puts the issue in perspective explaining:

    Toxicologists have confirmed that food naturally contains a myriad of chemicals traditionally thought of as “poisons.” Potatoes contain solanine, arsenic, and chaconine. Lima beans contain hydrogen cyanide, a classic suicide substance. Carrots contain carototoxin, a nerve poison. And nutmeg, black pepper, and carrots all contain the hallucinogenic compound myristicin. Moreover, all chemicals, whether natural or synthetic, are potential toxicants at high doses but are perfectly safe when consumed in low doses.”

Typically, these kinds of food safety scares depend on using unfamiliar scientific names of various chemicals, knowing that most peoples’ memories of high school science have long since faded away. Anything “safe” has an ordinary name, while anything “toxic” goes by a tongue-twisting science-y name that conceals far more than it reveals to non-scientists. Remember how many times the dangers of dihydrogen monoxide (DHMO) have been used to whip up support for petitions to ban the stuff (see the Material Safety Data Sheet (pdf) for it). Dihydrogen monoxide is a science-y way of describing a molecule with two hydrogen atoms and one oxygen atom … it’s another name for water, but it sounds so much more ominous that way, doesn’t it?

November 24, 2013

A life reconstructed

Filed under: Health, Science — Tags: , , , — Nicholas @ 12:28

In the New York Times, Mary Lou Jepson talks about the near-total loss and recovery of her life:

In my early 30s, for a few months, I altered my body chemistry and hormones so that I was closer to a man in his early 20s. I was blown away by how dramatically my thoughts changed. I was angry almost all the time, thought about sex constantly, and assumed I was the smartest person in the entire world. Over the years I had met guys rather like this.

I was not experimenting with hormone levels out of idle curiosity or in some kind of quirky science experiment. I was on hormone treatments because I’d had a tumor removed along with part of my pituitary gland, which makes key hormones the body needs to function.

[…]

In my experience it can be difficult to find a doctor to help a patient do this. I believe it is only partly because of the shortage of endocrinologists, doctors who specialize in the hormonal systems. Some doctors seemed not to believe that every hormone mattered. How many other patients like me have failed to find their ideal balance of medications?

There is evidence that careful tuning of these hormones can lead to dramatic personal and professional outcomes. Doctors and patients should consider replacement of every known hormone that is missing. New neurochemicals are identified by researchers every few years and should be studied as possible additions to the mix.

And access to these medications should not be hindered. As it stands today, some of the hormones I need daily to stay alive and to thrive can be, and frequently have been, blocked at the whim or neglect of a doctor’s office, insurance company or pharmacy. And still, 18 years after my surgery and despite great advances in endocrinal science, I need to fight to get them.

Disputes between organizations on whether prescriptions, test results or proper forms were transmitted or not. Communication breakdowns. A Kafka-esque nightmare of constantly needing another approval. It can take weeks to be notified of a rejection.

H/T to Tim O’Reilly for the link:

November 21, 2013

“The food police have a gargantuan appetite for ordering other people around”

Filed under: Bureaucracy, Business, Food, Health, USA — Tags: , — Nicholas @ 10:32

In Reason, A. Barton Hinkle explains why the Food and Drug Administration’s latest regulatory move may cost more than a billion dollars, require millions of hours of work … and provide no measurable benefits whatsoever:

In comments shortly after the menu labeling rules were proposed, the Center for Science in the Public Interest — they are the folks forever hectoring the public about the dangers of Chinese food, Italian food, movie theater popcorn, etc. — insisted that “if a restaurant has both an inside and drive-thru menu board, both must list calories.” And: “The calories should be at least as large and prominent as the name or price of the item.” And: “Calories should be posted for each size beverage available.” And: “The color, font size, font type, contrasting background, and other characteristics should all be comparable to the name and price of the item.”

What’s more: “Deli items or prepared foods that are dished up into standard containers should have signs posted next to each item with calorie counts for each container size available. For example, potato salad that is typically dished up into half-pint, pint and quart containers should list calories for one half-pint of potato salad, one pint of potato salad and a quart of potato salad.”

Rules such as these, the CSPI says, should apply not just to restaurants and supermarket delis but also to “salad bars, buffet lines, cafeteria lines, and self-serve, fountain soft drinks.” Moreover, “Calories must be posted for each pizza topping, sandwich component, omelet selection, sundae topping, or salad ingredient or dressing.”

The object of such Byzantine busybody-ness is plain enough: to “nudge” (former Obama regulatory czar Cass Sunstein’s favorite word) people to ingest fewer calories.

Just one small problem: It doesn’t work.

“Restaurant menu labels don’t work, study shows,” reported Today back in July: “No matter how much calorie information is on the menu list, people still choose the food they like, not what’s supposed to be healthier, researchers from Carnegie Mellon reported Thursday. … ‘Putting calorie labels on menus really has little or no effect on people’s ordering behavior at all,’ says Julie Downs, lead author of the new study published Thursday in the American Journal of Public Health.”

November 15, 2013

Misunderstanding the purpose of health insurance

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

One of the big problems facing everyone in the US is the cost of healthcare: it’s expensive and getting more so. Obamacare is supposed to be an attempt to lower the overall cost of healthcare, but by approaching it from the “insurance” angle, it’s likely to make the situation worse rather than better. The Anti-Gnostic reposted an extended comment from Steve Sailer’s blog explaining why misunderstanding the purpose of insurance is a big problem:

1) Most people lose money on insurance, because most of the time insurance doesn’t pay out more than it takes in.

2) Thus, a “good” policy is a catastrophic-coverage-only, high-deductible policy, where most payments are out of pocket. This is a policy that protects you against the downside risk, but where you lose a lot less on average.

3) This is because the purpose of insurance is to protect yourself from *catastrophe*, not to make routine purchases.

4) For example, if you went to Best Buy and whipped out your home insurance card to get a new flat screen TV, everyone would look at you as a crazy man. “Don’t you know that home insurance is only for fires and floods, and not for routine purchases?”

5) And so it should be with health insurance, because you’ll actually — *provably* — pay less with a high deductible plan for all but catastrophic conditions.

6) Indeed, the most innovative and technologically advanced areas of medicine are ambulatory areas in which people feel that markets are “ok”. These are paradoxically the most trivial areas: lasik, plastic surgery, dermatology, dentistry, even veterinary medicine.

7) Why are these areas so advanced? Because people pay cash money, because they choose based on quality, and because they are *able* to choose — i.e. they aren’t being wheeled up to the hospital in a gurney in a no choice scenario.

8) Moreover, with every technology ever, from cars to cell phones to air travel to computers, things that start out expensive become cheaper when enough people demand them. With medicine it seems to bite more that money means differences in care. But at the end of the day doctors, patients, nurses, drugs, ambulances…all that stuff means real resources, and a refusal to do explicit computations just results in massive waste as costs are shunted to a place where no one looks at them.

At the Independent Institute blog, John Graham points out that — in the few places that government allows free markets to operate — prices tend to drop over time even while services or features improve:

It has taken a long time, but the price of hearing aids is in the process of falling dramatically. How has this happened? Technological innovation, of course, but there is more. There’s no shortage of technological innovation in U.S. health care. However, because third-party payers, that is, health insurers and governments, determine prices, there is no mechanism for customers to signal value to providers.

This is not the case for hearing aids: Although some states have mandated insurance coverage for hearing aids, this is usually limited to disabled children. The big market for hearing aids is seniors, and Medicare does not cover hearing aids.

This is another case of a phenomenon observed elsewhere by Devon Herrick of the National Center for Policy Analysis [PDF]: Where patients pay directly for medical care, prices fall like they do in every other market.

Seniors who want highly personalized service from an audiologist in his own practice can get it, and they will pay for it. Those who want to order online can save money by doing that. Those who want to get their old hearing aids repaired can make that choice. And the most adventurous seniors, who don’t mind running an earpiece into an iPhone, can get a functional hearing aid almost for free.

We are on the verge of enjoying universal access to hearing aids — but only because the government restrained itself from interfering, and let the market operate.

November 2, 2013

Jogging – the exercise of the devil

Filed under: Health, Humour — Tags: — Nicholas @ 11:59

Scott Feschuk loves jogging. Well, he loves some things about jogging: pretty much everything about it except the actual “jogging” part:

I took up jogging recently because I had begun to lose sight of certain things in life, such as my genitals. Year upon year of sports viewing — abetted by halftime nachos, intermission chili dogs and anytime beers—had taken a physical toll. I’m not saying I was out of shape, but I still remember my first run in the springtime: the sweat, the laboured breathing, the searing chest pain. And that was just from climbing onto the treadmill.

Several months later, I am a changed man! Sure, I’m pretty much the same weight and I don’t look any better. And sure, I still consider the stairs to be the Devil’s method of ascent. (Folks, there’s a reason God invented the elevator, the escalator and waiting patiently until the object you want eventually comes downstairs of its own accord.)

[…]

Getting injured. Early this fall, I strained my hip and couldn’t run for a couple weeks. This turned out to be an ideal scenario because I could still self-identify as a jogger without having to, you know, jog. I’d wake up and think, “Yep, I’d be out there crushing a 10K run right now if I hadn’t hurt myself being SO SUPER ATHLETIC. Hmm, perhaps my recovery will be hastened by multiple Eggos!” By the way, there’s no quicker way to get in tight with runners than to ask them about their injuries. Runners love talking about injuries. YES, OLD MAN, PLEASE CONTINUE YOUR MESMERIZING TALE OF THE GREAT HAMSTRING PULL OF 1993.

The sense of satisfaction. I like knowing that I play a positive role out there: Other out-of-shape people see me and instantly feel better about themselves. They think, “Sure, my knees are shot and I’m running a 13-minute mile, but at least I’m not getting repeatedly concussed by my own man boobs like THAT guy.”

November 1, 2013

The Obamacare moment of clarity

Filed under: Government, Health, USA — Tags: , , , — Nicholas @ 07:49

In the Washington Post, Charles Krauthammer on the moment of understanding:

Every disaster has its moment of clarity. Physicist Richard Feynman dunks an O-ring into ice water and everyone understands instantly why the shuttle Challenger exploded. This week, the Obamacare O-ring froze for all the world to see: Hundreds of thousands of cancellation letters went out to people who had been assured a dozen times by the president that “If you like your health-care plan, you’ll be able to keep your health-care plan. Period.”

The cancellations lay bare three pillars of Obamacare: (a) mendacity, (b) paternalism and (c) subterfuge.

(a) Those letters are irrefutable evidence that President Obama’s repeated you-keep-your-coverage claim was false. Why were they sent out? Because Obamacare renders illegal (with exceedingly narrow “grandfathered” exceptions) the continuation of any insurance plan deemed by Washington regulators not to meet their arbitrary standards for adequacy. Example: No maternity care? You are terminated.

So a law designed to cover the uninsured is now throwing far more people off their insurance than it can possibly be signing up on the nonfunctioning insurance exchanges. Indeed, most of the 19 million people with individual insurance will have to find new and likely more expensive coverage. And that doesn’t even include the additional millions who are sure to lose their employer-provided coverage. That’s a lot of people. That’s a pretty big lie.

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