Quotulatiousness

January 15, 2012

As you’d expect, healthcare costs are not evenly distributed

Filed under: Economics, Health, USA — Tags: , , , — Nicholas @ 12:20

Jordan Weissmann in The Atlantic:

When it comes to America’s spiraling health care costs, the country’s problems begin with the 5%. In 2008 and 2009, 5% of Americans were responsible for nearly half of the country’s medical spending.

Of course, health care has its own 1% crisis. In 2009, the top 1% of patients accounted for 21.8% of expenditures.

The figures are from a new study by the Department of Health and Human Services, which examined how different U.S. demographics contributed to medical costs. It looked at the $1.26 trillion spent by civilian, non-institutionalized Americans each year on health care.

The top 5% of spenders paid an annual average of $35,829 in doctors’ bills. By comparison, the bottom half paid an average $232 and made up about 3% of total costs.

January 14, 2012

Making the War on Drugs even more dangerous

Filed under: Cancon, Health, Law, Liberty — Tags: , , , , , — Nicholas @ 11:25

Colby Cosh points out that the recent spate of deaths from ecstasy overdoses in western Canada is at least as much a result of the way the so-called War on Drugs is being prosecuted:

In recent weeks, it seems, adulterated ecstasy (MDMA) has left Alberta and B.C. with a sizable heap of young corpses. A tragedy has thus come home to roost in the West: namely, the tragedy of policy that incentivizes adulteration of drugs that, if manufactured in the open and checked for purity, would kill hardly anybody. Pure MDMA has a larger “therapeutic index” — a wider safety margin for overdose — than alcohol. It would probably make a pretty reasonable substitute for alcohol in many settings if we were to sit down and rebuild a drug culture from scratch. But over the past ten years or so, both Liberal and Conservative governments have worked to increase penalties for and monitoring of the flow of “precursor chemicals” used in the manufacture of MDMA.

It has been their goal to make pure MDMA more difficult to manufacture; when precursors are seized it is hailed as a triumph. But illicit drug factories never do put out the follow-up press release announcing that they’re putting less MDMA in their “ecstasy” and replacing it with other party drugs that have much smaller safety margins, or with drugs that interact dangerously with MDMA. And when rave kids die as a result, the RCMP chooses not to pose imperiously alongside the body bags giving a big thumbs-up. They are eager to take credit only for the immediately visible results of their work.

[. . .]

The debate over “harm reduction” in Canada has, for the past year or so, revolved around the Insite clinic in East Vancouver. That debate has been fraught with as much confusion and misinformation as drug moralizers could possibly create, but the core message, I think, has gotten through to Canadians, and certainly to the gatekeepers of their media. The message is this: we have only meagre power to stop people from abusing heroin if they are determined to do that. We do have, however, significant ability to protect people from the problems of a poorly-titrated or actively adulterated supply of heroin. The morbidity and mortality burden from the actual addiction itself, compared to the burden resulting from the drug’s illegality, is both modest and intractable. Insite is basically designed to yield the benefits that allowing heroin to be issued by prescription would bring.

Canada is apparently too under-equipped with libertarians to see that the logic extends to ecstasy, which about a million adult Canadians have used at least once. Yet rave-scene users have already been implementing “harm reduction” philosophy on the dance floor for decades. They react as best they can to adulteration risks by sharing information about dealer reliability, and they mitigate the most important medical peril of MDMA — the possibility of hyperthermia, i.e., internal overheating — by making sure ravers have access to cool rooms and plenty of fluids.

No government of any ideological stripe has ever successfully kept intoxicants away from eager customers: not the US government in Prohibition, not the Soviet government (on-the-job drunkenness was endemic), not even modern day prison authorities (drugs are plentiful behind bars). The “War on Drugs” has — predictably — failed. The question should be how to minimize the harm to drug users and society at large, because drug prohibition is a massive failure.

January 12, 2012

New $10m X Prize for a “medical tricorder”

Filed under: Health, Science, Technology — Tags: , , , — Nicholas @ 10:51

Get your Vulcan ears out for the next X Prize:

The Qualcomm Tricorder X Prize has challenged researchers to build a tool capable of capturing “key health metrics and diagnosing a set of 15 diseases”.

It needs to be light enough for would-be Dr McCoys to carry — a maximum weight of 5lb (2.2kg).

The prize was launched at the Consumer Electronics Show in Las Vegas.

[. . .]

The award organisers hope the huge prize may inspire a present-day engineer to figure out the sci-fi gadget’s secret, and “make 23rd Century science fiction a 21st Century medical reality”.

“I’m probably the first guy who’s here in Vegas who would be happy to lose $10m,” said X Prize Foundation chairman Peter Diamandis.

While the tricorder is obviously the stuff of science fiction, other X Prizes have become science fact.

In 2004, the Ansari X Prize for a privately funded reusable spacecraft was awarded to the team behind SpaceShipOne.

Update, 3 February: I’d forgotten about ESR’s post from a while back that — in many ways — we already have tricorders:

But in an entertaining inversion, one device of the future actually works on smartphones now. Because I thought it would be funny, I searched for “tricorder” in the Android market. For those of you who have been living in a hole since 1965, a tricorder is a fictional gadget from the Star Trek universe, an all-purpose sensor package carried by planetary survey parties. I expected a geek joke, a fancy mock-up with mildly impressive visuals and no actual function. I was utterly gobsmacked to discover instead that I had an arguably real tricorder in my hand.

Consider. My Nexus One includes a GPS, an accelerometer, a microphone, and a magnetometer. That is, sensors for location, magnetic field, gravitational fields, and acoustic energy. Hook a bit of visualization and spectral analysis to these sensors, and bugger me with a chainsaw if you don’t have a tricorder. A quad- or quintcorder, actually.

And these sensors are already completely stock on smartphones because sensor electronics is like any other kind; amortized over a large enough production run, their incremental cost approaches epsilon because most of their content is actually design information (cue the shade of Bucky Fuller talking about ephemeralization). Which in turn points at the fundamental reason the smartphone is Eater-of-Gadgets; because, as the tricorder app deftly illustrates, the sum of a computer and a bunch of sensors costing epsilon is so synergistically powerful that it can emulate not just real single-purpose gadgets but gadgets that previously existed only as science fiction!

January 11, 2012

Computers as doctors

Filed under: Health, Technology — Tags: , — Nicholas @ 12:02

An interesting post from Alex Tabarrok at Marginal Revolution:

In 2004 I wrote In Praise of Impersonal Medicine arguing:

    I have nothing against my physician but I would prefer to be diagnosed by a computer. A typical physician spends most of the day playing twenty questions. Where does it hurt? Do you have a cough? How high is the patient’s blood pressure? But an expert system can play twenty questions better than most people. An expert system can use the best knowledge in the field, it can stay current with the journals, and it never forgets.

and in 2006 I noted:

    The practice of modern medicine is surprisingly primitive … My credit card company knows far more about my shopping history than my physician knows about my medical history.

I now believe that we are on the cusp of major changes to medicine. The thousand dollar genome sequence is less than a year away, Ford has just developed a car seat that can monitor your health, many people are already using wrist monitors to measure heart and sleep patterns. All of this data will soon be combined with massive databases to offer predictive and prescriptive health diagnosis.

But my favourite part of the posting was this comment from Joseph Huntington:

Stay clear of Doctors. I am a lifelong physician. Cardiologist, Head Surgeon, UCLA for 17 years. Medicine today is riskier than any casino. I left the zoo when it became a Federal Collection Center for data that will likely be used in population selection. If you’re a model or athlete, you have nothing to fear. If you’re sub-average, or over age 35 … just sleep well, drink water, walk, breathe deeply, eat mostly fresh things, laugh, love, work honorably and again, stay away from guys like me.

An unlikely source of healthcare innovation: Singapore

Filed under: Asia, Economics, Health — Tags: , — Nicholas @ 00:10

In a post from a few years ago, Bryan Caplan sings the praises of the very different approach to public healthcare practiced in Singapore:

In The Undercover Economist, Tim Harford highly praised the health care policies of Singapore. But it wasn’t until I read the section on health care in Ghesquiere’s Singapore’s Success that I realized how amazing the official numbers are. If the following is true, all the comparisons showing that the U.S. greatly outspends Europe without getting better health are beside the point, because Singapore makes Europe look like the U.S.:

    The Singapore government spent only 1.3 percent of GDP on healthcare in 2002, whereas the combined public and private expenditure on healthcare amounted to a low 4.3 percent of GDP. By contrast, the United States spent 14.6 percent of its GDP on healthcare that year, up from 7 percent in 1970… Yet, indicators such as infant mortality rates or years of average healthy life expectancy are slightly more favorable in Singapore than in the United States… It is true that such indicators are also related to the overall living environment and not only to healthcare spending. Nonetheless, international experts rank Singapore’s healthcare system among the most successful in the world in terms of cost-effectiveness and community health results.

How does Singapore do it? Singapore is no libertarian health care paradise, but it does self-consciously try to maintain good incentives by narrowly tailoring its departures from laissez-faire:

    The price mechanism and keen attention to incentives facing individuals are relied upon to discourage excessive consumption and to keep waste and costs in check by requiring co-payment by users.

    […]

    The state recovers 20-100 percent of its public healthcare outlay through user fees. A patient in a government hospital who chooses the open ward is subsidized by the government at 80 percent. Better-off patients choose more comfortable wards with lower or no government subsidy, in a self-administered means test.

I’ve heard a lot of smart people warn that co-payments are penny-wise but pound-foolish, because people cut back on high-benefit preventive care. Unless someone is willing to dispute Singapore’s budgetary and health data, it looks like we’ve got strong counter-evidence to this view: Either Singaporeans don’t skimp on preventive care when you raise the price, or preventive care isn’t all it’s cracked up to be.

January 10, 2012

Parents (absolving themselves from any responsibility) want Ottawa to solve child obesity problem

Filed under: Cancon, Government, Health, Media — Tags: , , — Nicholas @ 10:27

Parents who fear to let their children go outside want the federal government to magically fix the problem the parents have created:

The majority of parents believe they play a major role in whether their children are overweight, but many also want the government to build more recreation centres.

[. . .]

The survey done by Ipsos Reid talked to 1,200 people, and most feel obesity is the leading health issue facing children today — more so than drugs, smoking and alcohol.

The survey found that 61 per cent of Canadians don’t think Ottawa is doing enough, and 70 per cent strongly support government initiatives that would educate children on healthy choices.

If you don’t let your children go outside unattended (hence the desire for “recreation centres”, where the little snowflakes will be supervised at all times), they won’t get as much exercise. Without exercise, on a typical modern diet, they’ll gain weight. Having gained weight, they’ll be even less likely to voluntarily exercise. Rinse and repeat for 18 years.

December 29, 2011

Girls from single-parent homes “more resilient” at school than boys

Filed under: Britain, Education, Health, USA — Tags: , — Nicholas @ 10:55

An article in the Guardian summarizes a recent study’s findings:

Girls appear to be more resilient than boys in preventing problems at home from affecting their behaviour in school, according to a study which aims to explain the educational achievement gap between the genders.

The tendency for girls to perform better in the later years of school has become increasingly pronounced in the UK in the past two decades. In 2011 the percentage point gap between the proportion of girls gaining A* or A grades in GCSE subjects and that for boys hit a record 6.7, up from just 1.5 percentage points in 1989.

Educational researchers have sought to explain the difference through a variety of factors connected to both physiology and environment, including theorising that boys are inherently more resistant to a formal educational system.

But the new study, based on detailed data from 20,000 US children over a decade, found no particular evidence of school-based factors being significant. Instead, it discovered that boys raised outside a traditional two-parent family were more likely to display behavioural and self-control problems in school and were suspended more often. The data ended when the children were about 14, but suspensions are seen as a strong indicator of subsequent poorer educational performance.

This finding, if validated by other studies, implies that the gender gap will continue to widen as more children are being raised in single-parent households now than ever before. Girls’ increasing share of university entrance will continue to grow — although the system will still likely consider girls and young women “more vulnerable” and in need of more systemic support.

December 27, 2011

Retirement age will have to rise: The Economist

Filed under: Economics, Government, Health — Tags: , , , — Nicholas @ 10:38

In a development that should surprise nobody at all, governments around the world are slowly, reluctantly, grudgingly starting to make changes to their state pension systems:

Put aside the cruise brochures and let the garden retain that natural look for a few more years. Demography and declining investment returns are conspiring to keep you at your desk far longer than you ever expected.

This painful truth is no longer news in the rich world, and many governments have started to deal with the ageing problem. They have announced increases in the official retirement age that attempt to hold down the costs of state pensions while encouraging workers to stay in their jobs or get on their bikes and look for new ones.

Unfortunately, the boldest plans look inadequate. Older people are going to have to stay economically active longer than governments currently envisage; and that is going to require not just governments, but also employers and workers, to behave differently.

December 14, 2011

Reason.TV: Weed wars

Filed under: Government, Health, Law, Liberty, USA — Tags: , , , , — Nicholas @ 17:05

December 8, 2011

Health advocates argue in advance of the data in new cancer study

Filed under: Britain, Health, Media — Tags: , , , , — Nicholas @ 08:36

Rob Lyons on the latest cancer study, which makes unsubstantiated claims about the “lifestyle” causes of cancer:

The essential idea we are being sold here is that medical experts know that certain behaviours — like smoking, drinking alcohol, eating read meat and not eating enough fruit and vegetables — increase your risk of developing cancer by a certain percentage. So, all we need to do is work out how many people would have got cancer if no one did any of those things, take that number away from the number of people who do get cancer, and the remainder is how many people that ‘unhealthy living’ is killing. Simple, right?

According to the report, If you do all the ‘right’ things — if you are a cigarette-dodging, skinny teetotaller who avoids all red meat, barely goes out in the sun (except, perhaps, to take the prescribed 30-minute sessions of exercise five times per week), gets lashings of fibre, cuts down on salt, avoids infectious diseases and ionising radiation, and so on — then you can cut your cancer risk by over 40 per cent. On that basis, you may avoid cancer but die of boredom instead.

More specifically, even in this report there’s a huge gulf between the widely acknowledged risk of smoking — which is estimated here to cause 19.4 per cent of all cancers — and other risk factors. Smoking accounts for nearly half the lifestyle risk of 43 per cent claimed in the report. The next biggest factors suggested are overweight and obesity (5.5 per cent), lack of fruit and veg (4.7 per cent), alcohol (4.0 per cent), occupation (3.7 per cent) and sunlight (3.5 per cent). No other single factor, according to the report, is responsible for more than three per cent of cancers. Some oft-quoted examples like salt (0.5 per cent) and physical exercise (one per cent) have little effect at all. Even avoiding red meat altogether would only avoid 2.5 per cent of cancers, says the report.

November 30, 2011

Reason.tv: California vs. The Feds on medical marijuana

Filed under: Government, Health, Liberty, USA — Tags: , , , — Nicholas @ 09:32

November 25, 2011

“[Fill-in-the-blank] is now a clear and present danger”

Filed under: Environment, Health, Media, Science — Tags: , , , , — Nicholas @ 12:07

Andrew Orlowski explains how we keep falling for junk science through media exposure:

Firstly. An obscure researcher or scientist will make a dramatic claim.

The media picks up on this, and a reporter is assigned to the story. The reporter will have no scientific background — but looks to the state and the bureaucracy to do something. Anything.

The hapless minister is then hauled on to explain the inaction. He will be intelligent — he is likely to have a PPE from Oxford, like the presenter — but no specialist knowledge. He, too, trusts the scientists.

A pledge is then made to increase funding for the scientist who makes the claim.

A pledge is also made to act — by introducing legislation or other regulations. Perhaps a task force or committee will also be involved:


Illustrations: Andy Davies

The bandwagon is now rolling.

November 18, 2011

EU panel spends three years to determine that water cannot be sold as a remedy for dehydration

Filed under: Bureaucracy, Europe, Health — Tags: , — Nicholas @ 08:53

Ah, Brussels! What would we do without you and your panels of experts on quiet news days?

Brussels prompted a flood of abuse this week by apparently banning bottled water vendors from promoting their products as a counter to dehydration.

The European Food Standards Agency was asked to consider its “opinion on the scientific substantiation of a health claim related to water and reduced risk of development of dehydration and of concomitant decrease of performance”.

The request for clarification was submitted by two German professors in 2008, in a bid to determine what health claims could be slapped on bottled water. A panel deliberated on the issue for three years, before the adjudication was delivered back in February, in time to hit the UK’s Euro-sceptical media yesterday.

November 12, 2011

QotD: The uses of junk science

Filed under: Environment, Health, Media, Quotations — Tags: — Nicholas @ 00:05

The Sierra Club campaign against coal is motivated by a desire to reduce CO2 emissions to prevent global warming. But since global warming skepticism and global warming fatigue are widespread, the club has opted for a junk science approach to reach its goals. The club tells people that their babies will die, or at least get asthma, if coal plants continue to operate. Although the cause of asthma is not known, it is suspected that it is related to the high levels of cleanliness in advanced countries that denies children and their immune systems exposure to the dirt and filth found in primitive places. This is known as the hygiene hypothesis. The incidence of asthma is about 50 times higher in developed countries compared to rural Africa. For all the Sierra Club knows, coal plants may prevent asthma. Given the hygiene hypothesis, that seems plausible.

With junk science, it is easy to scare people. There are many things that are bad for us that are present at low levels in the environment — for example, mercury, lead, radiation, or tobacco smoke. The junk science approach to trace toxins is to claim that if a high level of the bad thing would cause X people to get sick, then a level 10,000 times smaller must cause 1/10,000 as many people to get sick. Given 300 million people in the country, this math can give you thousands of people getting sick from low levels of mercury, lead, radiation, or secondhand tobacco smoke. This approach is known as the linear no threshold hypothesis.

The Sierra Club and its ally, the Environmental Protection Agency, lean on the small emissions of mercury from burning coal to work up a calculation of deaths from coal. They minimize the fact that much of the mercury falling on the U.S. comes from China, volcanoes, or even from burning dead bodies with mercury-based fillings in their teeth. Mercury pollution becomes an excuse to get rid of coal. Arguing the science behind such claims often degenerates into a paper chase about statistics and what studies are good or bad. From the bureaucratic point of view, the linear no threshold hypothesis is wonderful because it means that problems are never solved and there is always a need for more bureaucratic activity.

Norman Rogers, “Sierra Club at the Metropolitan Club”, American Thinker, 2011-11-11

November 3, 2011

A “fat tax” would not improve anyone’s health or the healthcare sector

Filed under: Government, Health, Liberty, Media — Tags: , , , — Nicholas @ 09:10

Politicians and “food celebrities” in many western countries are calling for a tax on obesity, either on the foods that “make people fat” or on obese people themselves. Other than being incredibly regressive (poor people in the west tend to be fatter than well-off people), such a tax would do nothing to address the problem it is supposed to solve:

The regular calls for a fat tax — whether on the ‘wrong’ foods or on fat people themselves — are symptomatic of two regressive trends in society. The first is the view that experts know best, that these latter-day sages can come to an impartial view based on The Science, then guide government about the appropriate policy action. The new, evidence-based policy usually involves some kind of manipulation of our individual behaviour from gentle ‘nudges’ and increasing taxes through to criminalisation, as in the case of the smoking ban.

But this is not evidence-based policy, but policy-based evidence, with preconceived ideas being pushed through in the name of science at a time when those at the top of society have lost the ability to convince the electorate on the basis of a moral or political argument. This style of policymaking rarely solves social problems, but it does distort both politics and science.

The second worrying trend is the sheer intolerance towards obese people. Being very overweight has always attracted a certain amount of moral opprobrium. But Hatton’s outlook reflects a sea-change. Once, the NHS reflected a progressive outlook that disease was a misfortune that could strike any of us at any time and that the best thing to do was to share that burden across society. Now it’s every man and woman for themselves. In the worldview of Hatton and Coren, some morally weak individuals are costing them money and must be punished.

Ironically, this flows from a left-wing view of disease as having social causes. In the late Seventies, left-wingers correctly saw that some ill-health was the result of poverty, poor housing, polluted air, and so on rather than infection or bad luck. Unfortunately, this has morphed into the idea that disease is caused by individual behaviour — and so health professionals have taken to camping out in our private lives, demanding we stop smoking, drinking and eating the wrong things. Every naughty little pleasure must now be sacrificed to the god of longevity. If we don’t play ball, this intolerance suggests we should lose our right to treatment.

The disease of intolerance is likely to have a far more detrimental effect on society than obesity ever could.

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