Medicine

What’s the matter with you, can’t we advocate infanticide without angry blowback?

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Francesca Minerva and Alberto Giubilini wrote a paper entitled After-birth abortion: why should the baby live?. They were subsequently shocked that their argument in favor of infanticide instead of putting up for adoption led to death threats.

There is something deeply wrong in the state of modern, academic philosophy and ethics. The first problem is in making the argument. The second is in being so isolated from society that the reaction to the article surprises them.

Update: The journal article has been moved and now resides behind a paywall.

Graphic Novels on Health Care and other items….

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-from SHOTS, NPR’s Health Care Blog:

Health care reform is no laughing matter, but MIT economist Jonathan Gruber’s new comic book on the subject aims to communicate some pretty complicated policy details in a way that, if not exactly side-splitting, is at least engaging.
 
In Health Care Reform: What It Is, Why It’s Necessary, How It Works, Gruber steps into the pages of a comic book to guide readers through many of the major elements of the law, including the individual mandate to buy insurance, the health insurance exchanges where people will be able to buy coverage starting in 2014 and how the law tackles controlling health care costs.

I draw your attention to another graphic novel: The 9/11 Report: A Graphic Adaptation.

While I was buying a copy of Persepolis from a real-life book store a few years ago, a young woman at the sales counter mentioned that there was a “great” graphic novel about North Korea that I might like. I’m not a graphic novel reader and I think Persepolis is it for me unless I decide to review the health care book, but it interested me that she seemed so enthusiastic about the topic of North Korea and graphic novels. I guess it makes sense given our “information overload” society. I don’t know. Why not look for clarity?

PS: Linking is not endorsement and all that.

PPS: What’s the “all that” about? Eh, I’ve been burning the candle at both ends for the past week or so and my blogging has been pretty terrible because of it. I linked the health care graphic novel because it amused me, not because I am simpatico with the message. I think you all knew that already….

Frontier Surgeon or Ferdinand and Hermann’s Excellent Frontier Adventure

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The practice of medicine in these United (and for the period 1861-1865, somewhat disunited) States was for most of the 19th century a pretty hit or miss proposition, both in practice and by training. That many sensible people possessed pretty extensive kits of medicines – the modern equivalents of which are administered as prescriptions or under the care of a licensed medical professional – might tend to indicate that the qualifications required to hang out a shingle and practice medicine were so sketchy as to be well within the grasp of any intelligent and well-read amateur, and that many a citizen was of the opinion that they couldn’t possibly do any worse with a D-I-Y approach. Such was the truly dreadful state of affairs generally when it came to medicine in most places and in all but the last quarter of the 19th century they may have been better off having a go on their own at that.

Most doctors trained as apprentices to a doctor with a current practice. There were some formal schools of medicine in the United States, but their output did not exactly dazzle with brilliance. Successful surgeons of the time possessed two basic skill sets; speed and a couple of strong assistants to hold the patient down, until he was done cutting and stitching. Most of the truly skilled doctors and surgeons had their training somewhere else – like Europe.

But in San Antonio, from 1850 on – there was a doctor-surgeon in practice, who ventured upon such daring medical remedies as to make him a legend. His patients traveled sometimes hundreds of miles to take advantage of his skill …

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“Watchful Waiting” vs. “Precautionary Principle”

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Watchful Waiting = Do nothing, even though it may be a good idea to do something, because it’s difficult to justify doing something when institutional third-party payers who evaluate everything in terms of population average costs and benefits rather than your cost and your benefit are making the decisions.

Precautionary Principle = Take extreme measures, even though it may be a good idea to do nothing, because it’s difficult to justify doing nothing when activists who evaluate everything in terms of hypothetical worst cases rather than probability weighted costs and benefits are making the decisions.

The question that always matters most is “Who decides?”. Answer it and you can usually predict what the answers to the other questions will be.

Do you believe?

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Do you believe in communism? In its most technical sense, communism is the idea that bureaucrats can reasonably control production and distribution to provide adequate supply and avoid shortages. At this point, most people say no, they don’t believe, and for good reason. The quest to find a sustainable government system of production that didn’t break down has consumed decades, untold lost production, and created a river of blood as the need for scapegoats of this system’s failure consumed millions of lives.

Do you believe that there is an exception for drug production communism? The US Government thinks there is. In the 1970s it established the current production quota system, a system that is currently in the middle of breaking down as shortages pile up. It is unabashedly communistic with the Attorney General in charge of both overall production numbers of Schedule I and II drugs and List 1 chemicals as well as assigning individual company quotas on a yearly basis.

As virtually anyone with a brain could predict, the system lasted for a while and is now breaking down amidst a growing number of shortages. About 1 in 5 medical practitioners knows of circumstances where these increased shortages have adversely affected patient outcomes. It is unlikely we are going to ever get an accurate body count of this drug communism. Nobody is going to want to open themselves up for liability if they are a private practitioner and no bureaucrat is going to want to turn over this rock because of its political implications.

Fortunately, over the next two years, these regulations are going to finally come under review. So as a practical matter we’re going to have an answer to my title question, do you believe?

Well, do you?