Medicine

“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?

Preserve Yourself With Preservatives

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Noting the passage of the creator of the Doritos chip who recently died at the ripe old age of 97, Glenn Reynolds quips, “I think the preservatives in junk food keep you young.”

Actually, there is reason to suspect that he might be right.

One of the most common preservatives is butylated hydroxyanisole also know has BHA or E320 in food labeling. BHA keeps foods from growing rancid by preventing the oxidation of fats by oxygen free radicals.

Say, what do you call a substances that controls oxygen free radicals? It’s right on the tip of my tongue…

… Oh, right, an anti-oxidant! You know, those things every other organic food product is advertised as having.

Benzoic acid, probably most commonly seen as Sodium Benzoate (E211) is another common bugaboo. In fact, its probably the poster child preservative being one whose name most people will recognize.

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Putting Alternative Energy and Government Workers First… Before Medical Care for the Poor

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California faces intense budget challenges. The budget gap is approximately $10 billion, and instead of “fixing” them, their budget has optimistic assumptions such as extra revenue due to an improving economy and many other sleight-of-hand items. The California executive and legislative branches are all solidly in the hands of Democrats, who control the agenda but must at least negotiate with the Republicans on the topic of tax increases (because a super-majority is needed to raise taxes).

I wrote here about how the State of California has a super-aggressive (and expensive) plan to move to “alternative energy” even though the cost / unit is much higher than traditional forms of energy, especially when transmission is taken into account.

In contrast with other states where the government is attempting to make their union workforce pay more for insurance and pensions, the completely captured Democratic officials don’t even attempt to reduce compensation, benefits or pensions.

Thus how does California intend to balance their budget, when they 1) won’t reduce government union worker pay or benefits 2) won’t back off their alternative energy zealotry?
By reducing medical care to the poorest citizens in their state. This article in today’s Chicago Tribune is titled “Health Law Model State Eyes Drastic Surgery” describes the situation in California’s medicare system which covers 6 million children and poorer residents.

California spends less per beneficiary than any state. It is now seeking waivers from the federal government to impose copays of $5 for office visits and prescriptions, $50 for emergency room visits and $100 for hospital stays.. (they) would drop reimbursement for a standard physician visit to less than $12.

It actually is a bit worse than that. The co-pays would have to be collected by the doctors, and if they can’t collect the money, then their reimbursement will fall further.

And what would the likely impact be of these cuts? Per the article:

Many doctors have already closed their doors to Medicaid patients. Other providers are following suit.

It is telling that the Democratic-controlled executive and legislative branches have decided that protecting the salaries and benefits of their union workers has a higher priority than providing basic medical care for the poorest residents in their state. They also believe that an incremental (and insignificant) move towards alternative power, which costs billions, rises above the needs of the poor for medicine.

This is analogous to the teachers’ unions that put their needs and benefits ahead of the children, who suffer through some of the worst schools in the country here in Chicago.

I can only imagine the smug outpouring of punditry that would occur if the Republicans abandoned a core principle to the same degree that the Democrats in California are abandoning the poor in this instance. Like this article in the Chicago Tribune and LA Times, the fact that the Democrats are abandoning the poor and instead focusing on their own direct needs isn’t even mentioned, since it apparently isn’t a fact that they believe their readers need to know. The situation is presented as a sad part of the budget sideshow rather than as a calculating prioritization decision made on the part of California’s Democrats, which it actually is.

Cross posted at LITGM

Quote of the Day: John Robb

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Global transition points like this are so rare, it’s a great time to be alive.

John Robb

Right on. Yes. Yes.

More of this type of thinking, please.

If I could live at any time in history it would be now.

(If you are not a regular reader of Mr. Robb’s Global Guerrillas, get that way.)

(Also check out Mr. Robb’s way cool new Wiki MiiU, which is all about resilience. I eagerly await his book on resilient communities.)

(Here is an xcellent John Robb talk about open source ventures, but full disclosure, a lot of it sailed over my head.)

(And if you have not read his book, Brave New War: The Next Stage of Terrorism and the End of Globalization, go get it.)

Friends, please let me know in the comments, on a scale of 1 to 5, strongly disagree to strongly agree, how you respond to this quote. Put me down as a 5, obviously enough.